Back Issues (Part 1)
In which I question a surgeon's judgment
The agony had finally gotten to me. I was head down on the dining room table, weeping uncontrollably. I’m done. I can’t take this anymore.
The pain in the lower right side of my back and leg has been intensifying for at least six months. It’s been a simmering cauldron of distress, an unwelcome companion that’s haunted me day and night. When it flares up—as it does several times a day—it’s like a thick dagger stabbing into the soft tissue around my hip and spine. The suddenness paralyzes me. I have to fight the urge to collapse and fold up into myself. I almost blacked out a couple of times in recent weeks.
I’ve progressed from thinking I’m sure this is nothing to realizing I’ve been reduced to a barely functional state. Presently, I’m unable to stand or walk for more than five minutes at a time. I’m finding it nearly impossible to find a position that allows me to sleep more than two hours at a stretch. I can’t concentrate. I’m irritable. I’m stuck in a living nightmare.
I saw Dr. H, my orthopedic surgeon, about a month ago. He ordered the obligatory x-rays, which showed that the laminectomy I had four years ago is still “good” and that nothing else looked particularly amiss with the bone structure of my spine. Of course, soft tissues like muscles, discs, tendons, and nerves don’t show up on X-rays.
Three weeks later, I squeezed into an MRI tube with my arms pressed tightly against my sides for twenty minutes of claustrophobic hell. After examining the MRI imaging, the surgeon told me I have a charming cocktail (my words) of issues in the L4-5 region and a cyst on one of my disks.
“I recommend you schedule a consultation with the anesthesia department for two injections, one for the pain and the other to drain the fluid from the cyst.”
“Okay, but just so you know, I had a cortisone injection before the laminectomy in 2020 and it did absolutely nothing for the pain.”
“I understand. But that doesn’t mean the medication won’t help this time. It’s a different part of your spine.”
“If it doesn’t work, what recourse do I have?”
“Well, surgery would be an option, except…”
“Except?”
“This surgery would be a spinal fusion, which we do using minimally invasive techniques. You’d have to be within a certain BMI range in order to meet the requirements for the surgery.”
Translation: You’re too fat for surgery. Which means I’ll have to suffer this intolerable pain the rest of my life if these injections aren’t effective? That can’t be right.
I wasn’t about to argue the point with this doctor during our brief telehealth call. He’s a hotshot in his field, someone who has had great success helping celebrities and sports figures at a major hospital here in Chicago. So who am I to challenge his opinion?
After the call, I could feel the heat of ire rise in my torso. What the absolute fuck? This surgeon hadn’t exhibited any anti-fat bias previously, but it was difficult for me to accept his judgment at face value. Also, it was his PA who had refused to honor my request to desist from the tedious and dismissive “diet and exercise” lecture when I asked her to stop. Doctors are human; all humans harbor prejudices.
First things first: I needed some data. Is it a fact that minimally invasive spinal fusion surgery is impossible to perform due to a person’s size? What does the research say? Driven by fear and anger, I dialed up Google Scholar and went to work.
I’ve had back pain since I was 12. And unlike what my surgeon at the time told me, it didn’t get better with lower back surgery when I was 13. It made it worse down the line. Anyway, It is SO HARD to find smart docs who think outside of the fat-phobic & all the other phobic boxes and actually take the time to figure out what would really work for each person. Holistic medicine and exercise helps but there’s so much you can do when you are in excruciating and/or chronic pain. I hope you are able to find your medical team & protocols to help fix the root cause and not just get pseudo bandaids.
I have grade 3 spondylolisthesis at L4/L5, where I also have spina bifida occulta and transitional vertebra (several of my vertebra didn’t form right in utero)… took many years for diagnoses and then was shuffled around between PT and fat-shamers for years. Finally a few years ago I met a doctor who specializes in congenital defects like mine and he said he could fix it surgically (it would be a lot of hardware to fuse the spine), but they’d have to go through the abdomen, which requires the help of a thoracic surgeon. None of the thoracic surgeons in the county (a huge metro area) will work on a patient with a bmi over 28 or some shit. He said he’s willing to do the surgery but he needs help and won’t get it.
He says my leg pain and paralysis could be alleviated but I’d definitely have pain from the fusion. Then he says the surgery would need revisions every 1-2 years for the rest of my life, due to my age (40s) and the nature of the damage. I’d be trading in one lifetime pain for another, if I could get the surgeries.
So even if I can lose enough weight to allow me the surgery (unlikely), science says I’ll regain that weight (with interest), so I could theoretically get the initial surgery and then I would be ineligible for revisions because my body did what science predicted it would do?
He had no suggestions except for swallowing some balloon device that would fill my stomach and prevent me from eating. I said it was bold to assume my size is due to overeating without asking about my eating habits and ended the visit.
I use a wheelchair when I need to walk or stand more than 5 minutes. I don’t mind the wheels, but it does make life less convenient. But I gained a lot of independence when I got my chair.
The worst part is knowing that someday things will worsen to the point where I will not be able to urinate or move my bowels on my own, and that will be a medical emergency, when they’ll be forced to take surgical action. Since they’re not willing to act when it’s not an emergency, and now I live in a rural medically-underserved area, I suspect this is how I’m going to die.