Friday, November 2, 2012

Surgery likely...and how dwindling FMLA determines when I can have it

Today I went to the surgeon to discuss where I am in terms of relief and place on the timeline of recovery from the situation with my spine.

This doctor is in the orthopedic department, not the same medical professional who is handling my epidural steroid injections (ESI), that's a good thing. I want to keep these practitioners and their philosophies separate. The latter doctor is an anesthesiologist who specializes in non-surgical treatments for spinal problems and pain, in this case mine's a bad herniation at L5-S1. After my second ESI, the doctor was cautiously optimistic given that my MRI showed my herniation was bad. He said if I had signficant relief by mid-November I could get shot #3. If that third shot doesn't get me to 90% back to normal, that I need to think about surgery.

This was not much different than the conclusion that the surgeon came to today after I told him about my level of relief (acute pain down quite a bit) and reviewed what has transpired, but I:
  • still limp, dragging my left leg, which is weak;
  • have pretty annoying dull tailbone pain, which he said makes sense based on what the steroid shot has accomplished so far in terms of pain reduction at L5-S1. This is painful particularly after driving;
  • have an inability to sit comfortably for very long (I have a desk job) without getting really stiff and in pain. I've been toughing it out.

Now all of this is still an improvement over the screaming, disabling pain that kept me housebound and unable to drive -- I have returned to work, and I am able to walk and do grocery shopping without needing to rest after only a short time (as pain escalated). It's just not where I'd like to be long term. This is what is going on in my back:

So we agreed to wait and reassess after shot 3, which is in 2 weeks. After that, I will wait a couple of months to see if I have meaningful lasting relief, or just more of the same. If it's the latter, then I'll work on scheduling surgery. I cannot take any rheumatoid arthritis medications within 2 weeks of surgery.

The procedure that I would need is called a discectomy.
The surgical treatment of a herniated disc is to remove the fragment of spinal disc that is causing the pressure on the nerve. This procedure is called a discectomy. The traditional surgery is called an open discectomy. An open discectomy is a procedure where the surgeon uses a small incision and looks at the actual herniated disc in order to remove the disc and relieve the pressure on the nerve.
A discectomy is performed under general anesthesia. The procedure takes about an hour, depending on the extent of the disc herniation, the size of the patient, and other factors. A discectomy is done with the patient lying face down, and the back pointing upwards.
In order to remove the fragment of herniated disc, your surgeon will make an incision over the center of your back. The incision is usually about 3 centimeters in length. Your surgeon then carefully dissects the muscles away from the bone of your spine. Using special instruments, your surgeon removes a small amount of bone and ligament from the back of the spine. This part of the procedure is called a laminotomy.
He said recovery takes about 2-4 weeks. 

How my job -- and health insurance benefit -- determines when I have surgery.

I've burned through most of my paid time off between this mess and my rheumatoid arthritis. What complicates matters is I've also burned through most of my Family Medical Leave Act leave. I have roughly 2.5 weeks left of that -- after that, I would have to take unpaid personal leave from my job, which would mean that:

1) they could refill my position (your job is not held), and
2) I would be responsible for covering the whole nut for health insurance -- around $650/month.

No matter that next year will mark my 20th year working (really hard and often long hours and performing well) for my employer; I'm basically expendable because of a disability. Speaking of disability -- I already spoke with HR, and I am not "sick" enough for long enough continuous periods of time to qualify for the university's disability policy and federal disability isn't an option (that requires you to be completely out of work for at least a year). I'm in a job/health limbo that many Americans face every day. And it's worrisome and stressful to feel like you're positioned under a personal economic and health guillotine.

What's kind of sad is that management and people in my unit have been nothing but supportive and accommodating; the problem here is the general legal quandry and institutional policies that deal with serious and chronic illnesses in this country. Most people don't want to think about this unpleasant subject until they are faced with the ramifications head on.

So what do I do?

I have no choice but to continue working to build up enough FMLA hours and paid time off to allow me to take the unpaid leave for surgery and hope I don't have any complications that cause me to exhaust it. It will take several months to accrue this, and in the meantime there's no guarantee that the relief from the ESI will last that long. The surgeon also mentioned today -- and this complicates my timeline as well -- that I shouldn't put off a decision about surgery for too long if shot #3 is not effective enough. The longer I wait, the more difficult the journey and risk will be.

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