I wrote this story shortly after returning home from Surgery in 2003.
For over 20 years I had suffered from increasing back pain, given up almost all the physical activities I love and was loosing hope. Then one day on the news, a story mentioned disc replacement, some studies were underway! Excited by this news I rushed to my computer to search the Internet for more information. I discovered that indeed an FDA study was underway on something called ProDisc. After further research, I contacted a clinic where they were participating in this trial. To my horror, they expected me to submit to a random study where I could end up with a fusion. Please understand, just days ago, prior to all my research on disc replacement, I was begging my doctors for a fusion. Now, I knew, that fusion was an obsolete and unacceptable option. I pushed on, and learned that another trial, on The SB Charite III, was not random. My spirits soared as I worked with a clinic in LA to get into the SB III trial. After months of calls and emails with the staff there, I gradually discovered that this would likely cost me over $60K. Depressed and dismayed I almost resigned myself to waiting a few years for the FDA trial to be completed and my insurance company and doctors to approve this for me. At some point in my research I had in fact stumbled onto a Swiss firm who offered to arrange for the surgery there for $40K, I had dismissed this when I discovered the trial in LA and thought it would be less. Now with a new mission I set out to get more information on disc replacement in Europe. Searching the Internet for long hours and sending many unanswered emails finally paid off, when Malte Petersen responded with request to review my images and then a quote of 25K Euros for the disc replacement, and their credentials looked remarkable. So, I made my decision, after 9 months of research and correspondence, I was off to Germany!
Originally I was going to go alone, but at the last minute my Dad insisted he join me. Our liaison, offered to let him stay in the room with me, so it was settled and off to Germany we went. We flew out of San Francisco to Amsterdam, had a short adventure there during our layover, and then caught a short hop to the Bremen Airport. When we arrived in Bremen I was met us at the airport and he took us to the hospital, we were in a private room and the hospital was out in the countryside, quite peaceful. The area is wonderful and there is a hotel and pub across the street. If your family members would feel more comfortable they could get a room there and walk over to see you. If you go for dinner, the food is great, ask for the English menu. In fact remember to ask wherever you go in Germany.
As it turns out, this Stenum Hospital is a participating hospital in Germanys Universal health care system and specializes in orthopedics. They do mostly hip and knee replacement, as well as spine fusions, and for over 10 years have been a leader in the development of the disc replacement procedure. Medical treatment of humans must consider the unexpected, here all this is included: postoperative complications, i.e. infections, thrombosis are taken care of by them - as part of the package deal. Patients are under their care for 1-2 preoperative days +/- 5 postoperative days with daily physiotherapy and daily rounds by Dr Zechel, plus, a 7 day out-patient stay at a Bremen Hotel. Dr Zechel and Dr Ritter-Lang have done 312 monosegment disc replacement and 78 bisegmental disc replacement using the SB Charite III disc replacement. Dr Ritter-Lang was trained and specialized in the spine department of the University Hospital Charite in Berlin - the hospital that developed the SB Charite I-III, together with LINK, the company that invented the implant. The level of care and detail given to each aspect of this procedure is astounding. The extreme care taken to avoid risk of damage to organs, nerves and arteries on the approach path, in addition to the careful and precise placement of the implant was impressive. The disc replacement team included Dr. Zechel, Dr Ritter-Lang and their team, in addition to a representative from Link, the implant manufacturer. I felt that no better team could be assembled anywhere in the world to insure my procedure went well. And it did!
I seriously doubt that any US doctors will ever get to this level, even after hundreds of surgeries, not to mention the hassles you will likely go through getting your doctor and insurance company to agree to do a disc replacement, before you are forced to suffer for years.
Our room had a wonderful view of the grounds, all the comforts of home, a phone with calling card available, although CNN was the only english channel on the TV. Very nice for a hospital! The next day they did x-rays, an EEG, blood work, etc..and we sat down with the doctor to discuss the procedure. They really take the time to answer any questions you have and make sure you understand what is going to happen.
I awoke in the ICU, their version of a recovery room,
soon after surgery and was told all had gone well.
There was no pain to speak of, due to a nice morphine drip,
although I had a true sense that my disc pain was gone.
After a few hours the doctors asked me if I wanted to try and stand,
shocked and in a morphine stupor, I declined.
Some time later they informed me I needed to urinate, after unsuccessful efforts on my part they resigned to do a catheter. Looking back I would highly recommend taking their offer to stand, and walk to the toilet!
Anyway, 12 short hours later I was back in my room and feeling fine. They switched me over to a pump which I could control for the morphine and I quickly realized that the nausea and hot flashes I was feeling were a direct result of the morphine, a fact that seems obvious now, but when you are 12 hours post-op and on morphine these things are not so clear. I decided to only use the pump when the pain got bad, it never did. Now less than 18 hours post-op, I decided to take their offer and stand up. No problem! I walked with a walker at first, then asked why it was needed. They commented that I was on morphine and could get dizzy. When I told them I had not used it for several hours they were first shocked, then happy to let me walk unassisted. I took advantage of this breakthrough to walk to the toilet, and was quite happy to relive myself without the help of a catheter. From then on I was up every 4 hours walking around and morphine free, as well as mostly pain free. The only real pain was from the incision and some post catheter burning.
Over the next 3 days I walked more and more and had some physical therapy. I was really feeling fine, except for the annoying stitches, which dropped below my waist line and prevented me from wearing pants, or anything with a waist band. Several times Dad and I snuck out of the hospital to have a meal and a beer across the street at the pub. These events were met with great concern from the nurses upon our return, and we were soon refered to as the American tourists down the hall. On day 3 post-op I was done with being in a hospital, although my private room where my father and I enjoyed all the comforts of home was wonderful, it was still a hospital. We were released the next morning and moved to the Bremen Marriott.
I must make an important point here, not all recoveries are this fast! Your recovery will depend on factors like, age, how long you have been in pain, how much nerve and ligament damage is present, etc. Many have had similuar experiences, but I would not consider mine typical. You leave Stenum when you and the doctor agree you are ready. Most patients are getting up, spending most of the day up and about, by day 2-3, many are not.
The Vacation...week 2 of recovery!
We proceeded to shop and walk around Bremen like the true tourists we were, and by day 6 my father was having trouble keeping up with me. Bremen Germany is a wonderful city, with all the charm of San Francisco, a long history, and the Becks plant! The first day we walked across the bridge into town and shopped, checked out the market square and the historic buildings, I think we covered a mile or two.
The next day we ventured a little farther, to the waterfront and around the town. Set aside a day to explore the Schnoor shops, Lunch at John Benton is good, great place to people watch. If you cross the bridge (coming from the Park Hotel) and turn right (left after the Pigs coming from the Hilton) just before the pigs, you'll see, you will come to a cafe called Stecker, the only place in Germany we found eggs and bacon, great pastries!
I did have some soreness in my back as the muscles and facets adjusted to their new status, I was now 3/4 inch taller.
Castles and more!
On day 7 we set out on a driving tour of Germany, yeah, me driving. What a trip, many of Germany's castles are now hotels, we drove the autobahn in our Mercedes, stayed in castles, wondered through cute villages, all the way to the Alps and back in 5 days, a bit aggressive but it was divine.
This link will get you to the castle web site, http://www.german-castles.biz/
Landsberg was my favorite, the dining room is to die for.
Driving did cause more soreness after a couple of hours, so we stopped often and I soaked in a hot tub each night. (Please note, I now believe that driving, and certainly soaking in a tub, after just 7 days was a mistake and is not recommended)
Day 14 post-op, I was on a plane for home, no pain other than a little muscle soreness from all the travel activity.
One important point I must clarify is that when I left for Germany I was a slim and fit 46 year old, still working full time and although not athletic did exercise regularly. I also prepared for this ordeal by dropping more weight and working out with a focus on the leg and abdominal muscles which would be so important post-op. I probably represent close to the best case possible for quick recovery. Any factors like excessive weight or lack of muscle strength will lengthen your recover time. It is also important to consider getting this done early on to avoid complications and even disqualification for the procedure. Factors like age, nerve damage, prior surgeries, and severe progression of the degeneration can be contra-indications and prevent you from getting an implant. Don't wait!
After a long and successful ordeal I find myself, for the most part, pain free. I still get sore with activity, and have an annoying pulling feeling down to my toes, although the doctors assure this will pass with time. I am so glad that I persisted in my pursuit of disc replacement. So glad that I didn't fork over the $60K to some US doctor who had only done a handful of these procedures. As it turned out, since I was released in only 4 days my bill was adjusted and the whole thing cost less than $22K (and this became the price for later Americans who followed, your welcome! now 23K Euro, inflation!).
I feel very confidant that I got the best care available in the world, and that most Americans have no idea this level of expertise exists outside the US, or that it is available to them. I will do everything I can to prevent the thousands of unnecessary disc fusions done on innocent Americans each year and to educate back pain sufferers on this breakthrough. Whether they go to Germany, to receive the quality care I got, or work through the insurance process to take their chances with the US doctors, this will change how degenerated disc disease is treated forever.