Injury Update–Final Surgeon Weighs In, EMG Preliminary Results

Well, Monday morning I went to see the final surgeon for his opinion on whether or not I need surgery for my extruded/herniated C6/7 disc. This surgeon is Dr. John Lettice, who comes highly recommended by HealthGrades, Dr. Armen, and the CEO of the company I work for.
Dr. Lettice was very calm and patient and first took a full history of my issue. He then did some of the standard physical exams that the other doctors have done, along with a few than no one had done. In the end, he said I have no signs that he can see of cord compression, and while my left arm/side may be smaller and weaker than my right, I am still plenty physically strong and shouldn’t be debilitated by this at all. That, combined with the fact that I am improving at a reasonable pace, leads him to advise that I hold off on the surgery for a little while and let the natural healing process continue. His advice was that as long as I do not have a relapse or worsening of my condition, that I should give things another two months or so and then get another MRI to check how the reabsorption of the extruded disc material is progressing.
This was awesome news, and exactly mirrored my thoughts on things to this point, but he then added some details that concern me. First, he suggested that I be very careful with any heavy lifting, specifically anything involving the valsalva maneuver. This, unfortunately, means dropping the one heavy lift I have been able to reliably do to this point: The squat. He also said that pretty much anything that irritates my nerve or causes a ‘pinching’ feeling I should unanimously avoid for a bit. This takes out Pendlay rows and (as of this week) Kroc rows with my left arm. If I follow this, I’ll end up with what resembles a straight-up bro routine, doing benches 5 days a week (following Rip’s rehab), a bunch of arm work one to two days a week, and calf work another two days.
Now, I’ve been squatting more or less straight through since about 2 weeks post injury, and at this point, I’ve squatted through some serious pain. However, the concern is that increasing spinal canal pressure with the valsalva maneuver will cause more disc material to be extruded and cause a relapse. Similarly, the additional pressure exerted by the weight of the bar across my shoulders may cause more material to get extruded. Still, I’m not pleased about this directive one bit.
However, his argument is that if I go through surgery, I will be forced to lay off lifting for some period, perhaps up to 6 months, so this is potentially significantly better. And I have to admit, I’m in this for the long haul, so it really makes no sense to really risk damage when I am so close to being able to push hard again. So, for the time being, I will drop squatting. I’m going to start with a two week period and see how I feel. After that, I’ll make a determination about the next two weeks, and so forth.
So, I made that decision yesterday, and skipped squatting (heavy day) today. Then, this afternoon, I went to South Valley Neurology and met with Dr. Zepure Kouyoumdjian, otherwise known as “Dr. K” for my EMG.
The idea behind getting an EMG is to figure out for myself how damaged the nerve/motor units in my left side are. At the very least, this gives me another baseline to track against in order to judge improvement. If you’ve never had an EMG, let me be the first to tell you, the experience isn’t particularly pleasant. Basically, the Dr. takes a roughly 18g, 3” long probe and sinks it into your muscles, wiggles it around a bit, and then has you contract the muscle. Those of you who have injected intramuscularly before probably know that pretty close to the last thing you want to willingly do with a needle in a muscle is contract it. Anyhow, it’s not super painful by any means (I’ve had injections that hurt way worse), but not a great way to spend the afternoon, and I imagine some soreness will be felt.
In any event, the results from the EMG are that I do still have some active muscle damage going on. Whether that is from the damaged nerve, or from the months of disuse is hard to say,  but it bears watching. Despite that, Dr. K still thinks the prudent course is to continue conservative treatment for two months and reevaluate at that time. That means I officially have a tie, with two docs (Neurosurgeon, Orthopedic surgeon) telling me to operate now, and two (Neurologist, Orthopedic surgeon) telling me to give it some more time and ease off of the heavy lifting. I’ve always felt that I should not go forward with surgery unless I am sure it’s the correct course, and the more docs I talk to, the less sure I am, so for now, conservative care it is.
While on conservative care, I’m going back to eating at maintenance so I can maybe hold on to a little leg mass. Besides, it’s looking like I’m going to drop another couple of pounds and hit my longtime goal of 205 this week, which means it’s about time to start adding muscle again. So, after all of this, it does look like there’s light at the end of the tunnel. Hopefully, the next time I post about this injury, I’ll know what the source of that light is.

  1. #1 by RasmusF on June 14, 2012 - 12:58 pm

    Congrats on the good news!

  2. #2 by Brian Hill on June 14, 2012 - 1:40 pm

    Thanks man 🙂

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