Friday, September 23, 2016

STANDING TALL – How I (with considerable help) Conquered Chronic Back Pain

This post is about my recent spine surgery (posterior lumbar 3-4 decompression and fusion) at the Mayo Clinic—aided by guided self-hypnosis—and my miraculous recovery to date.

One Man's Wonder is about seeing and celebrating small wonders. Still, once in a great while, I’m inspired by what seems a really, really big wonder. One of them has just happened to—and in—me. But as I’ve pondered how best to write about it, I realize that even this great miracle was, after all, simply a confluence of many small ones.

        Turning away from that battering-ram 
        impact was tantamount to cowardice.

At the exclusive private school I attended from sixth to twelfth grade, American-style football was mandatory. That’s right, unless one had a very good excuse, every boy in the junior-high grades had to play full-contact football.

I didn’t love the sport, but I continued playing it through high school simply because most of my friends did. Indeed, it was a way to belong and in some ways a welcome personal challenge. But most of all I suppose it was simply a right of passage.

My high school coach was a little bulldog of a man, a rough-around-the-edges ex-Marine who I suspect was hired by the school’s well-meaning leadership to counter the softening effects of our otherwise mollycoddled lives.

PHOTO: ImageSourceInternational

To prove to Coach Rasmussen that we weren’t “chicken” or, still worse, what he called a bunch of “snot-nosed pantywaists sipping parfaits by the country club pool,” we were expected to block and tackle ferociously, always leading with our heads. Turning away from that battering-ram impact was tantamount to cowardice.

This and, to be fair, some genetic factors—was the beginning of the end for my poor spine.

         This was the spine of a crippled person.

Flash forward to April, 2015. It was then, after decades of increasingly limiting back problems—stiffness, pain, crippling muscle spasms—that whatever was amiss in my spine started sending intense pain signals to my left hip and groin.

It had been coming on gradually over several years, but now I could no longer walk or even stand for more than a few minutes. So I finally decided I had to do something about it.

When I first saw the MRIs, I thought they must have gotten them switched with someone else's. This spine curved where it shouldn't—side to side—and didn't curve where it should—the normal front-and-back curve of the "small of the back" was now stovepipe straight. Some of these vertebrae didn't even sit squarely one atop the next, as if someone had attempted to pull one out of the stack, Jenga-wise.

No, this was the spine of a crippled person.

While confirming that it was indeed my spine, Dr. W, the first orthopedist I saw, wasn’t quite sure what to make of it. He insisting we do something about my back pain, even though I kept reminding him that the worst of my pain was coming from my hip and groin.

As if to prove me wrong, he sent me off to several weeks of physical therapy. It did not help. (Even so, I did learn from this orthopedist that all of these futile attempts to avoid surgery were hoops I'd have to jump through anyway in order for my health insurance to ultimately pay for it.)

There happens to be a real Chinese acupuncturist right upstairs from my office/studio, so I figured it couldn’t hurt to try that. Based on my brother’s recent success with acupuncture, I really thought it would work. The guy even sent electrical currents through the needles into my muscles and nerves. But, alas, after several weeks of treatments with no effect on my symptoms, I called it quits, feeling guilty that I’d let my very earnest, optimistic practitioner down.

So back to the orthopedist I went, and this time he suggested an epidural, the injection of cortisone directly into my spine right where he seemed to think my pain was originating. A week or so later, when I told him I’d gotten no relief from my hip pain, he looked shocked. “Hip pain!” he exclaimed. “An epidural can’t do anything for hip pain; we did that for your back pain.”

Goodbye orthopedist number one.

My second-opinion orthopedist, Dr. X, was younger, better looking…and a far better listener. He took one look at my images and pointed right to the problem: spinal stenosis; the nerve passageway through which my spinal nerve bundle * passes (at lumbar vertebrae three and four) had closed in, compressing the nerves that lead to my left hip and groin. Thus the “referred” pain I was feeling there; this made total sense.

I suppose I should have jumped at the chance to have Dr. X do the surgery he recommended to fix this. But I figured I still only had a .500 record with my medical opinions; not quite high enough for a winning season. So, since what is arguably the country’s finest medical center, the world-renowned Mayo Clinic in Rochester, Minnesota, is just 80 miles south of my home—and, as luck would have it, they are in my HMO’s network—I decided to get a third opinion.

      Like some desperate little starlet trying to 

      break into pictures, I took what I could get.

Note to anyone considering getting an appointment at the Mayo Clinic: Do not, as I foolishly did, try to simply book it through the “Make An Appointment” link on Mayo’s web site. Get your primary physician to refer you!

I don’t know what had possessed me—I suppose it was part of my effort to own my own cure—but I ended up spending several hours on the phone with Mayo’s gatekeepers. We even got down to such minutiae as an awkward little fall I’d taken while water-skiing the previous summer, and since then an occasional popping or snapping sensation in my left knee when I walk—completely unrelated to my longstanding back problems and hip pain.


Though polite enough, the triage interviewers were far from encouraging. In fact, when I commented to one on how long the call was running, she replied, “Well, we want to make very sure that we have all the information we can get before denying a patient an appointment.” In disbelief I repeated her words back to her. She was quite apologetic…but it wasn’t the last time I’d hear words to that effect.

At least a week later, just as I’d all but given up on Mayo, I got a call. Turns out the orthopedic team had put their heads together to discuss my case. And they’d decided that Dr. Y would see me…about my knee.

Like some desperate little starlet trying to break into pictures, I took what I could get, figuring that once I was in I could re-direct them to my real problem.

As luck would have it, though, a few days later I got the call I’d been hoping for in the first place. Apparently, they’d taken another look at my plea, and Dr. Z, a lumbar spine surgeon, agreed to see me. Voilá, orthopedist number three.

        He’d open up the hole in my vertebra 
        which had closed in around the nerve 
        bundle and was causing my hip pain.

I suppose there's a good reason why the Mayo Clinic spends so much time on triage. Thousands of people from all over the world want to go there. But once I was in—I knew because I was given my “Mayo number,” which from then on I carried around with me like a badge of honor—everything changed. I felt like I’d just been accepted into some exclusive, high-priced club.

Mayo is indeed an amazing, historic, bustling international community. One can see it just walking around the campus. The whole place just reeks of excellence. A sea of patients—folks obviously of many cultures and walks of life—hobble or are wheeled around, indoors and out. Medical and support staff, appearing nearly as international themselves, hustle around efficiently.

A large, colorful, fluid installation by famed glass artist Dale Chihuly and music from a live pianist reduce the huge Gonda Building lobby to a congenial, human scale. (By the way, the rest of the Mayo's art collection, which adorns nearly every public space in every building, is nothing short of magnificent.)

PHOTO: Wikimedia Commons

Dr. Z—actually Dr. Brett A. Freedman—collected and reviewed all the diagnostic reports and images I’d amassed to date and then scheduled me for two days of back-to-back diagnostic and information-gathering appointments in Rochester. Then I met with him and heard his evaluation and proposal.

He confirmed orthopedist number two’s diagnosis of spinal stenosis and recommended a posterior lumbar 3-4 decompression and fusion. In other words, he’d open up the hole in my vertebra which had closed in around the nerve bundle and was causing my hip pain. Then, to stabilize the site, he’d take a bone graft from my right hip, grind it up, mix it with some “cadaver bone” and use that amalgam to fill the space between vertebrae three and four.

Finally, he’d install four two-and-a-half-inch-long screws to hold the whole new bone assembly in place and let the fusion solidify.

      My mental and spiritual leap of faith 
      just took on a sobering financial dimension.

Meanwhile, I’d been doing my best to ensure that, whatever I ended up doing, my insurance would cover it. After a half dozen phone calls to Mayo and Health Partners (HP), my HMO, I found myself in buck-passing’s proverbial revolving door. HP insisted I get written prior authorization for the surgery from Mayo. Mayo, citing the fact that Medicare, not HP, would be the primary payer, refused. And both informed me that Medicare won’t even talk to them, much less me, about whether they’ll cover anything.

The breakthrough came when, at my insistence, Mayo finally conceded that, if I demanded it, they’d have to provide the prior authorization. I did; they did; and at least Health Partners was happy.

I never did hear word one from Medicare, but a week later I got a letter from HP approving coverage—with the notable caveat: “Health Partners will pay if and only if Medicare pays.” My mental and spiritual leap of faith just took on a sobering financial dimension. **

        It said I could expect to suffer at least 
        two weeks of the worst pain I’ve ever felt.

Dr. Freedman was, on the one hand, brutally honest about the possible down side of the proposed surgery. The first thing that stood out for me on his information sheet was that only two of three patients could expect at least a 50 percent reduction of their symptoms. Hm-m-m, not exactly the kind of odds I’d risk more than a few bucks on in Vegas.

Secondly, it said there is no cure for general back pain. Even though my referred hip pain might be reduced or even eliminated, chances are I’d continue to experience some degree of back discomfort.

Finally, it said that, following surgery, I could expect to suffer at least two weeks of the worst pain I’ve ever felt. Are you kidding me? Why would he even say this? Wishing not to rile someone who might soon hold my life in his hands, I decided he must have had a good reason.


On the other hand, Dr. Freedman’s obvious enthusiasm about my case was quite encouraging. His carefully worded suggestion was that, because of my positive attitude and generally good physical condition, I would be an excellent candidate for the surgery. I took this to mean that my odds might be a good deal better than those noted in the official “party line.”

So, considering those self-enhanced odds—countered by any number of articles out there in cyberspace relating horror stories from various spine surgeries—I had a weighty decision to make: either I keep living with about a five-minute window for any kind of standing or walking activity, or I go for it, with the prospect of at least moderate relief and a somewhat more active, adventurous lifestyle for the ten to twenty years I hope to have left.

I decided the benefits far outweighed the risks, and scheduled the procedure for August 16.

In the intervening weeks I did my homework. I added to the considerable research I’d already done on my condition and various treatments; I looked for still more alternatives to surgery; I checked out Dr. Freedman’s credentials and experience; and I began to prepare myself physically and mentally for the operation and the likely months-long recovery.

     I pictured my skin, muscle and bone...
     wise enough to know the difference between 
     violation and benevolent intervention.

A friend and long-time office neighbor is a psychologist and world-renowned expert on something called alert hypnosis. When I told him of my plans, he loaned me a CD program called Smooth Surgery, Rapid Recovery: A Systematic Approach, by a respected colleague of his, Dr. Carol Ginandes, a health psychologist affiliated with Boston’s McLean Hospital and Harvard University.

What a sweet gesture, I thought. But really, I’m going to hypnotize myself to affect the outcome of my spine surgery? Ri-i-ight. In the introduction, Dr. Ginandes’s voice reminded me of that old Saturday Night Live skit involving two women with comically understated voices conducting a local public radio lifestyle talk show. I chuckled out loud…but I was not deterred.

In fact, I found myself anxious to get back to the program and listen to the next part, “Pre-op 1.” And, as I continued opening myself up to the experience, I soon started really buying into the calming reassurances and positive imagery Dr. Ginandes was breathing into my head. Before long, I felt them all but tangibly relaxing my body and nudging aside any fears creeping into my mind.

PHOTO: Pixabay

       I asked God not just for Dr. Freedman’s 
       skill and alertness, but for his creativity.

First, she suggested I create a kind of on-demand happy place, a focus which, along with awareness of my breathing, would serve as an instant mental and spiritual refuge whenever I needed it. All I had to do was give myself a simple physical cue—in my case, just touching together the tips of my right thumb and index finger.

Once I’d retreated to my little haven, I allowed Dr. G.’s soothing voice to lead me through a kind of virtual tour of my surgery and my intentions for my body’s response to it. I pictured my skin, muscle and bone yielding easily to the intrusion, wise enough to know the difference between violation and benevolent intervention.

I allowed every twist and knot of my apprehension to be undone by the knowing hand of faith—in my surgeon, in his O.R. team, in the Mayo Clinic, in the power of loving support from my family and friends...and in myself.

I also prayed—actually, for a pantheist like me, not all that different a process from the self-hypnosis. Only later would I realize how apropos it was that I asked God not just for Dr. Freedman’s skill and alertness, but for his creativity.


Even as my inner resolve and confidence solidified, I still experienced some anxiety about the operation. After all, it was still risky, with a chance that, after a whole lot of pain and immobility, I’d see no improvement—or even a setback—in my symptoms.

A couple of my friends and relatives still had their doubts. In their efforts to help me and, understandably, to address their own fears, they’d come across some studies, articles and anecdotal information that suggested certain types of back surgery have proven ineffective, short-lived or even counter-productive for patients. I suppose it was an indication of my own lingering doubts that I took these well-meaning gestures, at least at first, as betrayals.

Working through those feelings, I did end up addressing my loved ones’ concerns and reading the articles. I found, to my great relief, that none of them applied to my situation, nor to the specific type of surgery I’d be undergoing.

Once I’d cleared this hurdle, though, what little was left of my open-mindedness needed to close. This was going to take pure commitment and faith. So I adopted a kind of tunnel vision, tuning out any further doubts and focusing exclusively on the positive imagery instilled by my hypnosis sessions.

              I wondered with a little smile

              if I'd been abducted by aliens.

The day of my surgery finally came. Sally and I walked from our Rochester hotel to St. Mary’s Hospital—I wanted one last chance to experience the pain that had been gaining on me these past few years…and to say goodbye to it forever.

Pre-op preparations seemed to go smoothly. I was in a good place—certain of my decision, confident of success and, okay, still a little nervous. At about noon they wheeled me into the operating room, which was so full of masked characters, high-tech monitoring equipment and out-of-this-world batteries of lights that I couldn't help wondering with a little smile if I’d been abducted by aliens.

I asked the engaging anesthesiologist if I could see Dr. Freedman before I got knocked out. (I’ve decided I like to make eye contact with surgeons just before they cut me open.) He said yes and sent word to have someone let him know. We waited nearly fifteen minutes for Dr. F. to show up, but show up he did, and within seconds I, confidently, was off to oblivion.

Next thing I knew, fuzzy yet familiar images began to materialize. Sally and my brother, Dan, were there, and went with me down what seemed a long tunnel to my hospital room. It was awfully quiet;  they told me it was 9:30 PM. Wow, I thought, I’d gone into prep. at about noon! That must have been one long surgery!

Of course, one never quite knows what to think of one’s pain level right after surgery. You’re still under the dwindling effects of the heavy sedation, and from there you transition seamlessly to the oxycodon, which still doesn’t let you really know how you feel.

But almost immediately, I thought of my left hip and groin, and, at least for now, I didn’t think I felt any pain at all in that area. As for the rest of me, I definitely knew I’d had major surgery; the three incisions in my lower back hurt enough to make me very grateful indeed for the oxycodon and super-tylenol.

   What he had found of my spine turned out 
   to be even more of a mess than he’d expected.

Next morning, Dr. Freedman came to check up on me. He apologized profusely for having been a bit late to the surgery suite—unexpected complications with another patient, apparently. And he apologized for the length of my surgery, which ended taking nearly seven hours.

What he had found of my spine turned out to be even more of a mess than he’d expected from my images. He explained the process, which involved a few additional, spur-of-the-moment fixes. (This was where I was glad I’d prayed for not just his skill, but his creativity.)

He told me he’d accomplished what he’d set out to do…and then some, and then pulled out the two x-rays taken after he was done. There was my still-rickety spine—not exactly that of the mediocre athlete I once was—but with L-3 and 4 looking better aligned and with metal rods and four huge screws holding them together.

So I had my surgeon’s account of the operation’s immediate success, but still no logical way of knowing how my recovery would go, especially whether or not the actual fusion would “take.” Intuitively, though, I already felt quite certain that, based on my mental and spiritual preparation, I would recover, in my hypnotist Dr. Ginandes’s words, “quickly and well.”

This hunch turned out to be a good one indeed. On day one, instead of trying a few tentative steps in my room, I was walking around the whole recovery ward. On day two, instead of trying out the three steps up the P.T. department’s simulated staircase, I was taking full flights up the real staircase. Instead of five days in the hospital, I went home on day three.

Back at home, instead of weaning myself off of the powerful oxycodon over several weeks, I was off of it after one. At the same time, instead of the expected limitation to short walks for several weeks, I was going a mile or more around the neighborhood. And by the end of week two I was driving.

After three weeks, I returned to Rochester for my first post-op visit with Dr. Freedman. It was all I could do not to throw my arms around the man and embrace him. He asked a few questions, watched me walk around the room on my toes and then on my heels, and pronounced that I was recovering beautifully.

Not only was the hip and groin pain I’d been enduring for years completely gone, but the ongoing back pain Dr. Freedman had cautioned me I might have to live with was also all but gone.

It’s been a little over a month now since my surgery. I continue to walk every day—sometimes several times a day. I’m finding it easier by the day to do the things that had so harshly reminded me, at first, what my back had been through—like getting in and out of my car. I’m sleeping much better. And I’m just about ready to put away my grabber, that fabulous device that allows you to pick stuff up off the floor without bending over.

        Now that I’ve emerged from that long, 
        dark tunnel, it feels like I’ve been reborn.

I have gone through a life-changing experience. It has been coming on for many, many years—in fact, since that very first head-on tackle goaded by Coach Rasmussen. And now that I’ve emerged from that long, dark tunnel, it feels like I’ve been reborn. I no longer take for granted those death-by-a-thousand-cuts hurts my genes, a ton of abuse and lots of time have inflicted on my back.


Instead, I celebrate each and every step I take. I think about the thousands of people out there who suffer the same symptoms I did, and feel a deep sense of gratitude for having found a way out of their grip. I want those poor folks to know that, at least from this wonder-man’s point of view, there is hope.

If you’re one of them, or know someone who is—or if you’re just curious about this type of back surgery or the surgery-prep. hypnosis program I used—I’d welcome your questions and comments either here or by email: Please put the word “fusion” in the subject line of your email.

* The human spinal cord ends between the first and second lumbar vertebrae, below which its continuation is referred to as the nerve bundle or cauda equina.

** Exactly one month after my surgery I received my statement from the Mayo Clinic. Other than the births of my children, it seemed the finest gift I’ve ever received. Total charges: $106,830.53. Insurance claims paid: $106,815.53. Balance due from patient (my co-pay): $15. I feel just a bit guilty that my abhorrence at the excesses of this country’s out-of-whack health care system just got bought off so easily.

Thursday, September 15, 2016


(Many thanks to my friend Jane Stephenson for the inspiration to write this post.)

As I ponder this pod of horse chestnut conkers encountered on my walk the other day, I’m struck first by the beauty—the contrast between leather-tough, spiny casing, velvety lining and waxy-smooth seeds*; the way the seeds nestle into their cozy little compartments; the pod’s elegant seams allowing it to unzip into perfect thirds.

And then there are those colors—toasty amber, fresh-lemon yellow and my favorite, that gorgeous shade of deep, reddish brown—a color so distinctive that, whether gracing a horse, a garment, a car or anything else, it can be called nothing but chestnut.

       One or two might first catch the eye 
       of someone who’s made room in his day 
        for delight.

Even more fascinating is the process by which these handsome little quads have gestated, grown and finally prepared to propagate. How similar it is to mammalian reproduction. For it too involves ovaries, eggs, sperm and then this pod—though not called a uterus, it acts just like one.

First it stretches to accommodate the new life growing within. Then, when some chemical signal tells it it is time, a combination of the seeds’ growth and their receptacle’s contraction pops them out.

As with all life, the world will have its way with them. Most will be eaten by squirrels, bats or insects. One or two might first catch the eye of someone who’s made room in his day for delight.

And a very few, exactly as allocated in Nature’s accounting of such things, will be carried and buried or just settle into soil, where they will start the whole miraculous cycle all over again.  

* The poisonous, nut-like fruit of the horse chestnut tree is, at least botanically, not considered a nut, but a seed. The pods most often contain from one to three seeds each. The one I picked up, with four seeds, is quite a rare find.

PHOTO: Wikipedia