OPERATION CERVICAL FUSION.

This is a SPECIAL PURPOSE REPORT for someone, who knows someone, who may benefit from the information contained herein.  THIS REPORT may also be of benefit to those suffering from balance / feeling / nervous / neurological disorders.  Readers are welcome, and encouraged to leave comments.

NEURO KIT

OPERATION CERVICAL FUSION – REPORT. 

The planning for this operation started in early November 2014, after an appointment with an Orthopaedic Surgeon at Randfontein Robertson Hospital (A Dr. Piet Botha) declared that he could fix my worn out knees any day, but would not, until I took steps to improve my balance.  Dr. Botha’s logic was unarguable when he said “it is no good giving you new knees, if you are going to fall over and break them.”  After a very quick examination, and an exercise in Common Sense, both myself and Dr. Botha agreed my balance problem resided in my cerebellum or down a bit in the cervical vertebrae.  This is because the numbness in my hands and feet are symmetrical left to right.  If the numbness symptoms were caused by pinched or damaged nerves emanating from my spine, it would be very unlikely that the symptoms would be symmetrical left to right.  Of course this would have to be verified by a high powered neurologist.  I had previously met low powered neurologists that had difficulty in grasping the above logic.  The high powered neurologist was to be one Dr. John Fleming at Millpark Hospital.  OK so far.  Interestingly, Dr. Botha’s consultation fee was R.550, 00.

NOTE: The partial numbness in my feet prevented my feet from properly feeling the ground I walked on – thus causing the occasional stumble, and loss of balance.  The sudden effort of catching my balance would put undue strain on my knees.

The first difficulty was that Dr. Fleming, apart from being a neurologist was also a WBA administrator / arbitrator, and was currently in New Zealand making decisions on a vacant boxing title.  He also intended to do some sight-seeing in and around Sydney.  OK, so this was an unanticipated delay, but I made an appointment, and shifted my research focus from knee replacements to possible neurosurgery procedures.  I managed to find quite a few ex-neurosurgery patients, and also a few ex-knee joint patients.  Most of them were more than happy with the results of their surgery, but very few could explain the details of their operations.  They did what they were told, and it all seemed to pan out in the end.  Some of these happy ex-patients had heard stories of patients that were not so happy with their results.  I would need to dig deeper.  The internet gave up a lot of information, but not a lot of important (to my mind) details.

The 1st of December 2014 rolled along, and with it my appointment with Dr. Fleming.  For a consultation fee of R.1 100, 00 he showed himself to be an experienced logical professional.  One drawback when Dr. Fleming found out my home town was Sydney, is that he wanted to discuss his recent sight-seeing trip to Sydney and the Blue Mountains west of Sydney, and Brumby’s wild horses around Canberra.

I was able to satisfy his curiosity on all counts and we could get down to the business of neurology and the state of Millpark’s carpark.  As my numbness manifested it’s self in my hands and feet he would start his “electronic nerve tracking test” (my term).  I think it is commonly referred to as an ECT.  A tiny current is supposed to follow a nerve line until it hits some kind of resistance, and therewith locate the damaged / faulty / pinched nerve.  The ECT cost was to be included in Dr. Fleming’s consultation fee.    These tests carried out from my extremities proved to be inconclusive.  Alright, Dr. so we cannot prove a negative, and say because the problem is not there it must be here (in my neck).  Correct !!  No choice now but to negotiate some MRI imagery.  Is there a MRI machine in the hospital ??  Yes Jim, they have got one or more down stairs in Radiology.  Can you organize it for me ??  Yes.  How much will it cost ??  7 to 8 thousand Rands. Fuck, OK let’s start.

I should add at this stage, that the set-up at Sunninghill Hospital wanted R.1 550, 00 for the neurologist fee, plus R.3 500, 00 for the “electronic nerve tracking test”.  Everything about that hospital smells of rip-off, even the coffee shop.  It is a terrible place.  I had paid the R.1 550, 00, but could very quickly see nothing worthwhile would come out of it.  The (ha ha) neurologist there (one Jody Pearl) actually refused to hand over the results of a blood test she ordered, unless I came back for the “electronic nerve tracking test”.  However with the aid of another young female doctor, I managed to hack it out of her computer – bye bye Sunninghill.

Still at Millpark, downstairs now with the owners of the MRI machines (Milpark Radiology Incorporated) – Yes sir, the imagery for your MRI scan of the cervical spine  will cost R.13 500, 00.  Really, but I am a private patient and pensioner, and prepared to go elsewhere to save a couple of hundred bucks, how about R.5 500, 00?  Er, OK let me look again, how about R.7 500, 00.  No, still too much – how about R.6 000, 00?  I pay you right now, and I want the complete results in my hand within 2 hours from now.  The deal was struck.  The Radiology man shouted to some of his staff, they all snapped to attention, and led me to a vacant MRI machine.  This was all very new to me, while I knew the principal of MRI, and the computer images it can produce, I did not know it takes 40 minutes of laying stock still on my back in one of the noisiest confines I have known.  You have to wear ear plugs and ear muffs, and it is still unpleasantly loud.  To amuse myself, I decided to try and count the time by means of breaths.  I remembered last time I timed my breaths, it was a little under 18 breaths per minute – so 18 x 40 = 720 respirations.  I was a bit slow to start, and it was slightly under 18, so 700 respirations should get me out of here.  At 698 the doors opened – phew.

Anyway, about two hours later Millpark Radiologists found me in the coffee shop, and handed me the CD and written report.

I rushed it back up to Dr. Fleming’s rooms where we slapped it into his computer, and almost instantly the problem was obvious.  There was a squashed cushion between C4 & C5 bulging backwards, and beginning to restrict the spinal cord.

007BA2B0
MRI IMAGE – CERVICAL SPINE.

Pretty obvious Huh ??  But it is mainly the sheath being distorted, and the cord to a much lesser degree.  At this point Doc Fleming was noticeably hesitant.  He does not pretend to be a surgeon, and I can see that he can NOT see any kind of external manipulation being possible.  Does the hospital have a resident neurosurgeon?  Yes, there is a Dr. Zorio upstairs, I will run it by him for an early appreciation of the possibilities, and if it is positive make an appointment for you.

MRI REPORT P.1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MRI REPORT P.2

 

 

Well according to Dr. Fleming, the Millpark neurosurgeon was not easy to track down. A “Squeeze You In” appointment was made, but not until 18th February.  Quite a way into the future, but OK, I still had some research to do.   After a week or two I had studied this whole thing to death, at least as far as a layman can – I am behind schedule, and needed some early action.  So back to Dr. Piet Botha at Randfontein.  I told him the story, and asked if there is not a neurosurgeon at Randfontein I could consult with urgently – Yes, we use and recommend a Dr. Fourie at Krugersdorp Private, here is his number.  I was able to secure an appointment (Proper consultation, not a squeeze in) 28th January 2015.  The receptionist, Ane Olivier said it would be R.900, 00, but only cash, we do not have a card facility.  Well that is OK by me, I liked the sound of the whole set up at Dr. Fourie.  It is hard to work out how these surgeons arrive at their fees.  They all seem to have more accountants than any other staff.  Now I would take the appointment at Krugersdorp, and get as much information as I can, including costs, and keep the appointment with Dr. Zorio at Millpark as a second opinion and quotation

Dr. Fourie’s set-up appeared very business-like, so was Dr. Fourie’s approach.  It was a simple neurological examination followed by a study of the MRI images.  The prognosis: Surgery – no surprise.  3 – 4 days in hospital.  Stitches out in 2 weeks.  Neck Brace for 6 weeks. 35% chance of full success.  35% chance it stays the same, and a 30 percent chance it gets worse.  After a bit more thought Dr. Fourie said it is probably a bit better than that.  This sounded like pretty good odds to me, so can we proceed with a full quotation and time line?   Yes we can, my girls will take care of it.  And so they did!

Hospital deposit – includes prosthesis –                                 R.60 000, 00

Surgeon – work only –                                                              R.23 668, 00

Prosthesis – built into hospital quote –                                    R.16 212, 00 zero.

Anaesthetist – Estimate only –                                                 R.  4 500, 00

Note: Hospital insists on full deposit, but will refund any left over.

Errors and omissions:

  1. Hospital only counted ward bed / days – should have included 1 – 1, 5 high care / ICU ward bed / days.
  2. X-Rays were not mentioned anywhere – turned out to be R.1 240, 00.
  3. Physiotherapists were not mentioned anywhere, nor should they be. They tried to impose themselves in a very secretive way – Ronel Venter’s group.  I am not sure what they were up to. They did nothing worthy of payment.  Without sending an account or mentioning an amount they went behind my back to get money from my hospital’s left over account.   The hospital refused.
  4. Neck Brace. Mentioned verbally, but not by name.  The salesman – calls himself “Medical Orthotist Prosthetist” his spelling.  Promised me a substantial discount at bed-side, then threw a spare liner on the bed, and billed me for both at full price of R.1 027, 20 with all the arrogance and authority he could muster. He will receive the discounted price on the brace (R.407, 99), and I will return the un-ordered spare part.  His name is Steve Green.  The Neck Brace is poor quality, and has many irritating qualities.  If forewarned, any patient could do much better.
  5. After me providing my height and weight the very charming and professional anaesthetist, Anina van der Westhuizen gave me a firm quote of R.2 000, 00.
  6. Blood tests ??

Dr. Zorio’s consultation came along at Millpark.  I should mention that Millpark’s carpark is a real mess, it fills up very quickly, and only one car can get in when one comes out.  There is 300 – 400 meters of narrow road leading to the car park, once you are in this road all you can do is wait.  Of course with the motorcycle there is no problem, you can park 20 meters from the entrance.  All of Dr. Zorio’s morning patients arrived about 14h00.  My appointment was at about 15h00.  I was there until 19h00.   However I did get a good consultation.  A proper neuro examination.  A good discussion on the MRI images.  The prognosis is very much the same as Dr. Fourie, except Dr. Zorio will use an imported cage – hollow plastic spacer between the vertebrae and filled with some cement like stuff called PEEK?  Made with crushed up seashells I am led to believe.  Whereas Dr. Fourie fills the entire gap with donor bone which eventually fuses the two vertebrae rigidly.  Dr. Zorio predicts 100% recovery with the proviso there are no other nerve problems we do not know about.  He also warns of the amount of human energy needed to heal the procedure’s wound – As he puts it, if your body uses 1 cup of energy per day normally, your body will use half of that cup, just healing the wound.  Dr. Zorio’s published first visit consultation fee is R.1 800, 00.  However R.1 600, 00 cash was acceptable, and included a complete quotation and time line.  Combining the two estimates – 80% full recovery, 15% stays the same, 5% gets worse.  Not bad.  OK, can we go ahead with the quotation and timeline??  Yes.  Please take this note to Esther, to get to work on it.  Esther, the hard working receptionist could not read the note, and we had to call out the Dr. to explain, but then Esther got to work.

The next day Esther started phoning through the various costs.  This is fine Esther, but to put it on a more business-like footing, perhaps you could e-mail me these quotes / estimates.  I was getting a little wary of unwritten estimates.  Anyway, to my surprise Esther replied she does not have e-mail, and was only trying to get me the information quickly.  Well bless her heart.  I told her, that Dr. Fleming down stairs has e-mail and a scanner (I had seen it there), and I am sure he would not mind scanning it through to me.  I received the written quotes a few days later from another office in Millpark.  They looked like this:

1.Surgeon                                                                   R.33 636, 00

2. Anaesthetist                                                          R.25 000, 00

3. Hospital                                                                 R.56 500, 00

4. Prosthesis (Not included anywhere else)            R.27 702, 00

5. Dr. Zorio asked for 10 day notice.

Obviously this is well over the odds, and at this stage I had no idea of the possible extras / omissions, and that Millpark Carpark was a major consideration.  Although I had no reason to doubt the level of professional surgery, but these prices appeared too high to negotiate down to compare with Krugersdorp, and I could not negotiate with the carpark.   Although Esther was being helpful, I do not think she was entirely in my corner.  I asked Esther to ask her prosthesis supplier to send me pictures and information on this so called cage that was to be installed in my neck.  The Supplier, one Greg Hegland (Cape Town) declined to do this, not helping my cause at all.  By now Esther was on the phone every second day offering me near dates that Doctor could do my procedure.

A bit about these Prosthesis devices:

The Prosthesis quotation for Krugersdorp came from a lady named Zelda Louw, with a Krugersdorp address.  Up until now I suspect she is a rep of some description for Elite Surgical, who are based in Pretoria West.  On request, she sent me a picture of the plate and screws that Dr. Fourie intended to use, but nothing more.  From Zelda’s documents I eventually got a website and e-mail address for Elite Surgical.  I then struck up an e-mail / telephone friendship with one John O’Toole, MD of Elite Surgical.

John pegged my level of knowledge (about zero) immediately and set about explaining to me in layman’s terms, exactly how it all worked.  Along with strength tests, manufacturing machinery, tolerances, research etc.  Stuff that I did understand, and more pictures.  John’s company also makes a variety of knee joints.  Out of this came some unexpected, and unasked for praise for Dr. Fourie, who had been using his products for many years, and Dr. Piet Botha at Randfontein.  Even though Dr. Botha does not use his products.  In fact John congratulated me on my choice of Surgeons, he said I could not have done better.   Things were looking up.  Although I have the MRI images, and a picture of the plate, I could not form a clear idea of how it went together.  I phoned Zelda Louw to ask if she could actually show me some of these plates and screws, and explain their fitting.  We arranged to meet at Dr. Fourie’s rooms (as a meeting place) for the demonstration.  At the due time – no Zelda – I phoned her.  She does not think she knows enough to show me what I want, and has arranged with Dr. Fourie to do the explaining.  I had suspected that Zelda was out of her depth, but she could have told me of the change of plan.  Anyway, better than plan A, is plan B.  Dr. Fourie asked what I want to know.  I think he was quite surprised when I asked H.T.F. does it all fit together?  I was actually worried about going into the theatre with one small plate and four little screws – what if it does not fit?  It took Doctor a couple of seconds to realize this dude knows nothing, but when he did realize, he rushed off to get his skeleton and large tray of plates, screws and bits and pieces.  It was this tray of plates and screws that answered my questions.  Anyway we still went through the whole procedure, and I expressed myself 100% satisfied.  Thank you doctor.

This particular product is called ROTO LOCK, and refers to the way the screws are locked in place to prevent them from backing out.

With regard to Zelda Louw – I am not sure what role she plays in Elite Surgical.  Although the hospital took her quote on board without question??

Roto-Loc brochure

 

Now dealing with Dr. Zorio’s cage and PEEK method (anterior).

https://www.youtube.com/watch?v=ziQImZJvNSw    Is the best example I could find,  Elite Surgical’s plate, and Dr. Fourie’s donor bone seems to do the same thing.

Most of the value in these things is in the tools needed to put them in place.  In fact in the theatre and ready to go, I asked Dr. Fourie if he had sharpened all his tools, he replied “no, I have got new ones”.

At about this time Ane Olivier came through with a firm quote from Anina van der Westhuizen of R. 2 000, 00 for the anaesthetic work, my mind was made up, I would go with Krugersdorp.  I called Ane for the soonest date for my procedure – I could have Tuesday 03rd of March or Thursday 05th of march.  I was now super keen and settled on the sooner rather than the later date.  Finances would be tight, I would have to sell a motorcycle in Australia, and call in a few depts around Johannesburg, and get the money in the bank (A just in time financial economy).  I phoned Mrs. Paddy Blom at Krugersdorp hospital to ask if a deposit of R.50 000, 00 would secure my booking for 03rd March, and I said nothing about the balance of R,10 000, 00, I would make a plan.  I then phoned Dr, Fourie’s office and offered R.20 000, 00 to confirm my booking for the 3rd.  All OK.  I remembered to ask Ane about the Neck Brace – where will that come from ??  Oh, that will be a separate supplier. OK, so far Ane had been shooting straight, but this would turn out to be a real aggravation.

I regretfully informed Esther at Millpark of my decision.  I think she was disappointed, but understood my circumstances.

With everything taken care of (I thought) not much more to do, except to think about what one needs while in hospital, I had not been in a hospital for at least 50 years, and even at that, I do not remember when or what for.  Oh well, common sense will prevail.  I thought of a tooth brush, Henrietta thought of spare nickers and some filter water from home.  Oh yes, then phone, credit card and pen and paper – that should do it.  I would dress for my arrival, and then have clothes for my departure.

At 04h00 on the 3rd my alarm sounded.  We staggered around for a while, and set off for Krugersdorp in time to arrive there at 06h00.  We were careful to show Henrietta the land marks so she could find her way home. At this hour there was not much going on, and plenty of parking, just opposite the hospital on Burger St.  I was pretty shaky on my feet so Henrietta took charge.  I checked my phone – damn – that motorcycle money from Australia had not yet landed in my bank account, this is going to be interesting.  I had promised to pay the balance on admission – I asked Henrietta to slow things down a bit, but a good story was a better option.  As I did not know the system, I decided to say nothing until asked, then tell the truth –“Money has not arrived”.  Mr. Morris, please come to this cubicle to sign a few papers so we can get you up to the ward.  Thank you Mr. Morris, all done, I will just file these papers and get someone to take you to the ward.  Just as the reception lady sat down again with my envelope, I heard my phone beep, beep, Aah Ha, there it is.  Now Mr. Morris it looks like you still owe us R.10 000, 00.  Yes Miss, you are quite correct – here is my card.  Whew!!.

I was shown a nice corner bed in the High Care ward, with Henrietta in tow.  Reality had now arrived, and I thought I was pretty cool about the whole thing.  Henrietta packed my tooth brush and spare nickers in the bedside cupboard, and we decided she would take everything else with her for safe keeping.  I was then hooked up to a monitor, and along came the first surprise.  Blood pressure 206 mmHg (systolic) over 160 mmHg (diastolic), I had never seen or heard of such high readings, and I said so to who ever would listen.  I made such a fuss, that another monitor was connected, I was given a pill and the readings dropped a little.  Pulse rate was OK in the 70s.  It never occurred to me that maybe I am not as cool as I thought I was.  I never thought blood pressure was indicative of much, but this was excessively high.  There was now a queue of people lined up to see me – The lab girl wanting blood, the x-ray girl (with mobile x-ray machine) wanting to see my lungs.  Then the bottom feeders, the physiotherapist wanting to tell me a lot of stuff I already knew, and the ha ha Medical Orthotist Prosthetist was there to demonstrate the neck brace (incase I did not understand the workings of velcro).  These bottom feeders were to be a source of trouble later in the game.  The x-ray girl then announced to the ward that I have got the biggest lungs she has ever seen, and everyone, including me rushed to her mobile machine to see the lungs in question.  I asked if perhaps she could show us her lungs by way of  comparison, but she declined. Well eventually all the fuss died down, I was given a surgical gown to put on, and was wheeled off to the theatre, crashing violently into every, and I mean every, corner along the way.  I still thought I was pretty cool about the whole thing, but  wondered seriously about the high blood pressure.

I soon arrived alongside the operating table clutching my MRI CD, and there was the charming Anina van der Westhuizen (anesthetist), soon after to appear was the not quite so charming Dr. Fourie (my favourite neurosurgeon), who said “give me that shit” referring to the MRI CD.  I handed it over without delay – Time in the theatre is expensive and charged for by the minute.  Dr. Anina went to work on me, and the last thing I remember thinking was that maybe I should have emptied my bladder before this procedure.

The next thing I knew is that I was shouted at aggressively to wake up, and was on my wheelie bed headed somewhere (I guess my spot in the High Care ward) the bed again crashing into every corner along the way.  I noticed later that most of the beds (not all) had horizontal wheels mounted on each corner at mattress height.  But my drivers were cutting the corners, and hitting the side of the bed.  You need to make sure your arms and legs are not protruding.  I was fully aware of where I was and what had happened to me, and begin tests immediately.  Other ex-patients had told me they had regained full feeling the minute they had woken up.  This was not the case with me.  First of all my feet were still partially numb to each other – same as pre-op.  My hands were still fuzzy to each other – feels like all surfaces are dusty – Same as pre-op.  I tried the finger to nose, finger to ear, finger to finger tests, all missing by at least 150 mm.  I was pretty disappointed.  Eventually I landed in my corner spot at High Care ward, and was ceremoniously attached to the monitors.  Drip in left hand, blood pressure on right bicep, ECG receptors all over upper body, temperature sensor between my legs,  Oxygen feed in both nostrils, blood oxygen analyzer taken from finger or toe, I think, and respiration rate taken from somewhere?  The blood pressure monitor was set to take a reading every hour.  I managed to absorb all this and then conk out.  Henrietta came a bit later, and I managed to tell her I was comfortable.  She said she was going, and was taking all my stuff – cards, ID, phone, watch etc. but leaving filtered water from Home.  Henrietta was clever enough to phone the ward later and leave a message that she was safely home, and loved me – that was a welcome message.

The High Care Ward: Was certainly one of the noisiest places I have spent a night.  No attempt at peace and quiet was made.  Conversations were carried out at full street volume.  Mop buckets were dropped from table height.  Wooden broom handles falling onto tiled floors, and an ultra exceptionally loud telephone.  The monitors beeping all the time, but extra loud when they malfunctioned or became disconnected.  My blood pressure sleeve pumping itself up every hour was enough to wake me if nothing else did, and the moaning and crying of other patients.  I remember the noise in an American ward once, described as the “murmur of nurses”.  Very different here.

One woman two beds away found the sudden sharp noises like the dropped mop bucket or broom handle, and a multitude of other sharp noises, very painful.  She would cry out in sheer agony the instant one of these noisey events took place.  The attending nurses, male and female, would rush to her bed to see and ask what was the problem.  It was strange to me that they did not associate the noise with the agony.  I now started to take an interest in my own monitor:  On several occasions I noticed my blood pressure was 120 over 80.  Pretty much normal, I wondered again about yesterday morning’s high readings.  I came to the conclusion, I was just not as cool as I thought I was.  Anyway it is a normal body reaction, if you are nervous about something, whether you know it or not – Preparing for the fight or flight decision syndrome.  The next thing was so many ex-patients had told me how painful this procedure would be, and how difficult talking would be.  Right, well I have not tried talking yet, but there is certainly no pain – why would that be?  After a short ponder – I must be on a pain killer drug of some kind – looking about I spotted another small bottle attached to my drip line.   “NURSE” – Yes Mr. Morris.  Am I on some kind of pain killer mutti?  (good I can talk, sort of).  Yes Mr. Morris, morphine.  How much?  You are on 1 to 3.  What does that mean?  It is the settings on the drip controller.  OK, well I have no pain at all, can you set it onto minimum – less than 1?  Yes Mr. Morris, I can do that.  I assumed this was CCs per hour.  I also concluded the black male nurse did not know what the numbers meant, only that they were numbers.  I now turned my attention to my monitor, all looking good as far as I could tell, except one largish black number that wandered between 88 and 96, what could that be?  “NURSE” – Yes Mr. Morris.  What is the big black number now standing at 94?  Oh sir, that is blood oxygen level.  OK, but 94 what?  Well sir, it is 94, 95, 96, 97.  Yes, but 94 what? Apples? Pressure? Breaths? Beats? Bedpans?   No, but it sometimes goes down to 93, 92, 91, 90, 89, 88.  I did not want to put words in his mouth, but is it percentage?  Ah, yes Mr. Morris, it is percentage.  Well, my blood cannot be 94% oxygen, so I suspect it is the percentage of blood / oxygen saturation.  But I did not ask.  I will experiment.  I took 25 big deep breaths, and the reading went up to 97, and touched 98 for an instant.  I waited a bit and then took 25 of the slowest, shallowest breaths I could, and sure enough, down to 87.  Good I am satisfied with that.  Now for some more physical self inspection.  I brought both knees up as high as I can, and both knees fell together – strange.  But I noticed the usual little nerve bite down the outside of my right leg was absent – that was a relief.

Just the heels of my palms felt slightly un-numb – good start.   I thought the top of my feet had a little more feeling – hard to be sure, but certainly no fireworks.  The finger to nose test was still missing by more than 100 mm.  This is an interesting test.  From lying flat on your back, with eyes closed, bring your forefinger up to touch your nose exactly.  When you get close, you will (unless your nerves are operating perfectly) notice a sort of no-mans-land space of zero perception between finger and nose.  The size of this space is inversely proportional to the good working order of your nervous system (my opinion).  My bladder still seems empty, and yet I am not a bit thirsty.  A tension stiffness has developed in my neck and upper back, but I suspect this is nervous tension, and unrelated to my procedure.  This is usually fixed by natural sleep.  I could not eat my supper the night before.  This did not go un-noticed, and I was given a blood / sugar litmus test during the night – it came back at 5,4.

The night wore on.  The noisy chatter, the moans of agony, the loud telephone schrill, the dropping of things, and the forever beeping of monitors, mine included.  I must have become disconnected at least 6 times through the night.  Sometimes it was noticed, sometimes not.  Then a new noise – the telephone shouting at the caller in a loud aggressive voice “THE NUMBER YOU CALLED IS AN UNAUTHORIZED CALL, PLEASE HANG UP.  At least 4 times.  And 4 screams from the lady 2 beds away.  Staff trying for free calls I guess.

Eventually the crack of dawn appeared in my east facing window.  A couple of hours later my breakfast arrived, I could only eat the porridge.  My monitor looked in order.  I felt a slight twinge in my bladder – this would be more than 24 hours.  I decided to call for a bed bottle.  I could stand up alongside of the bed without disconnecting anything, and yes my bladder was very full, and it took a while – something different there.  Back into bed, I asked the nurse to check all monitor sensors / connectors and set about more tests to check procedure results.  1. I could not feel my own pulse, it had been that way for months.  2. The heels of my hands now felt unusually smooth – good.  3. I rubbed my heels on the top of my feet, this felt a bit more like normal.  I pulled up my knees, and they flopped all over the place.  Finger to nose test, now consistently missing, but within 100 to 125mm.  Lower throat was tender to the swallow, even the porridge, and drinking water.

I know there had been some breathing tubes in my throat during the procedure.   At some point around mid morning the nurse asked if I would like to go to the bathroom?  Yes please!  I was disconnected and helped to the bathroom with toothbrush in hand.  After the teeth, I had a big spit and bought up a single blob of green phlegm slightly smaller than golf ball size.  This was the biggest such blob I have ever seen – anywhere.  Anything remotely similar had not come from my throat for more than a decade or maybe two – very strange.  But it was a relief, and my voice improved slightly, and swallowing water was much easier.  But what had caused it??.

Late morning Dr. Fourie visited.  I reported on the receding numbness in my hands and feet, he said any overnight improvement was a real good sign.  I asked about the incredibly high blood pressures from yesterday, he reviewed my chart, and said it was not that high, and he confirmed my diagnosis that I was not as cool as I thought I was.  Now, what about the blob of phlegm? – no explanation, and not concerned.  Ok, well Doc did it all go as per expected from your side?  Yes Jim 100% – here are the X-rays of the finished job.  And can I go someplace quiet??  I will get you out of here and into the wards immediately.   Good.

MORRIS-JAMES H--MR- 1943-09-20- CR (X-RAY CERVICAL SPINE PORTABLE) from 2015-03-03 S1 I0

 

 

 

 

MORRIS-JAMES H--MR- 1943-09-20- CR (X-RAY CERVICAL SPINE PORTABLE) from 2015-03-03 S2 I0

 

 

 

 

MORRIS-JAMES H--MR- 1943-09-20- CR (CERVICAL SPINE) from 2015-04-22 S0 I0

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Not good pictures.  The white spots are metal pivot points on my neck brace.  The plate can be seen above – slight list to port.

Well as soon as Dr. Fourie said “Get him to the ward”, High Care staff had me in a wheelchair in no time, but after he walked out of the ward, things went back to dead slow.  I sat in the wheelchair for quite a while, and when we were ready to go, I had to remind my driver about my stuff – documents, toiletries & personal oxygen filter etc, and still my MRI CD was lost in the war.  Now with everything on my lap we were ready – I asked if I could drive?  Yes, OK, I will walk behind.  Off we went.  Same floor, other end of the hospital.  Not so hard to drive these things, but glad I do not have to.  Ruimsig Ward, bed G3.  Absolute peace and quiet compared to High Care.  Well not much to do except sleep and breath oxygen.  It crossed my mind that the water filtered oxygen could be causing the phlegm build up in my throat.

The next big annoyance was a young lady standing alongside saying she was a physiotherapist implying she was sent by doctor (she was charming enough), – but she did not say exactly which doctor.  I was a little suspicious.  She asked if I would like to walk with her.  Well I did feel like taking a stroll to test my balance, so I agreed.  She held my arm in such a way that if I stumbled she would certainly not be able to catch me, and I wanted to test my balance, so I needed to be completely independent.  When we walked about 10 meters, she suggested we walk down the stairs it was clear then she had no concept of my circumstances – my doctor certainly knew my circumstances.   When I refused the stairs, she asked if I was dizzy.  I decided then to inform her of my circumstances, and that I did not want or need a physiotherapist.  She left gracefully.  There was to be a third try by Ronel Venter, Physiotherapists the following morning to impose themselves on me in an underhanded, and not quite honest manner, but this time I saw the badge on our lady’s shirt as she introduced herself, and briefly ran through the reasons why I did not need or want any physiotherapy.  She became aggressive and threatening, as she stomped off.

The day after my discharge Ronel Venter, physiotherapists phoned me to ask what email address they could send my account to.  I replied that I think that would be a waste of time as I did not receive any service worthy of payment, and outlined my reasons. The lady said she would take it up with management.  I said but you have already taken it up with me.  Ronel Venter Physiotherapists later went behind my back to try and get money from the hospital refund.  The hospital declined.  I prepared the below document immediately.

PHYSIOTHERAPY. 

Preamble:

I am seeking knee surgery.  My orthopaedic surgeon demands I fix my balance prior to knee surgery – hence the Anterior Cervical Fusion procedure at Krugersdorp Hospital on 3rd March 2015.

I have been preparing for this operation since October 2014, and have had numerous interviews / consultations with 3 physiotherapists, 2 neurologists and 2 neurosurgeons during that period.  I have visited a multitude of libraries and websites to this end.  I have also studied and practiced the before and after exercises associated with this procedure.  I was as fit as I could be at the time of procedure.

Your first therapist (3rd) appeared un-beckoned.  While very charming, proceeded to read of to me a list of dos & don’ts which I have read at least a dozen times myself.  When she told me to sleep with a neck pillow under my neck so my head will not hang down, I began to lose interest, but when she told me how the surgeon will scrape of bone matter from my own vertebrae to replace my removed disc, I stopped listening altogether.  I think she realized this, and left.

Your second therapist (4th), while not so charming, appeared (like a ghost) alongside my bed, and implied doctor had sent her?  She wanted to take me for a walk.  As I felt like a walk, I obliged.  She held my arm in such a way, that if I fell, she would certainly not be able to save me.   When I declined to walk down the hospital stairs she asked if I was dizzy.  This led me to believe she had no understanding of my circumstances.  So I told her – as outlined in the preamble above – .  I concluded by saying I do not want a physiotherapist at this point in time.  She left gracefully.

Your third therapist (on the 5th) also appeared abruptly alongside my bed, but this time I recognised her shirt badge first, and explained my circumstances as why I did not need her services.  She responded by implying that my 4 months study was nothing compared to her 22 years experience.  She stomped off mumbling something about reporting my refusal, and make a note to cover herself.

All in all I am not pleased by the way your company acts, and the level of service offered.

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Well back to the ward.  All going well I would say.  Some blood taken, Blood Pressure taken a couple of times, and I am still breathing oxygen, and have coughed up a few more blobs of green phlegm, but much smaller than the first lot.

Doctor Fourie came, looked at my chart, not much to discuss.  Do you want to go home on Friday??  What about tomorrow??  No answer!!  Henrietta came, and I asked her to help shower me – she agreed.  Then how about this, I removed my neck brace and walked straight into the shower, forgetting all about my surgical wound and the instructions I received about not getting it wet.  Henrietta was horrified, and so was I, mainly for my stupidity.  Oh well sister will have to redress it.   Doctor came back and said I can go tomorrow.  Great Doctor, will you take care of the paperwork? – done!!  Henrietta will bring her son Raffaele tomorrow to help get me out of here.  Mike and Nan van Nie Kerk came to visit in the evening for my entertainment – thanks Mike & Nan.

Well tomorrow came along as it always does.  By early afternoon Henrietta and Raffaele had arrived and I was ready to go.  A miniscule of paperwork to do and I was out of there, but pretty shaky.  Raffaele fetched the car, and we headed for Fourways.  The back of my neck and shoulders was pretty knotted up, but I knew natural sleep (as opposed to induced sleep) would fix it.  The other minor problem that still persisted was my inability to swallow my last mouthful of a meal.  The last mouthful would push the second last mouthful down, but I had to cough up the last one and spit it out.  This persisted for a little more than a week.  I did get a comfortable long night’s sleep.

Day 4. At home.  I can now definitely feel my own pulse every time without fail.  Finger to nose test now consistently under 100mm.  Calves / shins becoming normal – regaining normal feeling slowly from knees down.  Note: these gains remain symmetrical left to right.  The lady from Ronel Venter phoned today for address to send account – story above.  Pretty lazy day, but the Physiotherapy lady had aroused my suspicions – was there something rotten in the Krugersdorp hospital?  I slept in the afternoon and again most of the night.

Day 7.  Vast improvement – neck fully relaxed.  Can feel my own pulse 100%.  Finger to nose test still under 100mm, but certainly not bang-on.  Toes and balls of my feet still stubbornly numb.  Then, as I half expected, the invoice from my friendly Medical Orthotist Prosthetist (MOP) arrived asking for the full amount.  Forgetting all about the promised substantial discount.  Steve also thought that by throwing the spare liner on my bed as he walked out, constituted a sale.  The below email correspondence below outlines the squabble.  Reads from bottom up.

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Please find payment slip attached.  R.407, 00

I will be returning your ICD-10:M48.02 (SPARE LINER), unfitted and in good order.

I have ignored your disapproval.

Best regards

Jim Morris.  082 553 8552.

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From: Steve Green [mailto:steve@greenortho.co.za]

Sent: 10 March 2015 01:09 PM

To: ‘Jim Morris’

Subject: RE: ACCOUNT STEVE GREEN ORTHOTIST – NECK BRACE.

Dear Mr Morris,

Attached please find your account which has been discounted to our private rates.  Your account was

Charged at normal allowable medical rates. We apologise for the misunderstanding.

The brace that was fitted onto you, was requested by your Neurosurgeon, Dr. C. Fourie.

If you have a problem with this, kindly please take it up with Dr. C. Fourie. We only supply

and fit whatever the Doctor requests. We will forward the email to Dr. Fourie for his records as you are so unhappy with the brace.

We treat all our patients needs and requests professionally and with utmost respect at all times and totally disapprove of your remarks and the way you handled this.

Thank you

Kind regards,

Steve Green

Medical Orthotist Prosthetist

Cell no. 0768799079

Tel no.  011-6604717

Email:  steve@greenortho.co.za

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From: Jim Morris [mailto:morris@iafrica.com]

Sent: 10 March 2015 11:29 AM

To: ‘Steve Green’

Subject: RE: ACCOUNT STEVE GREEN ORTHOTIST – NECK BRACE.

Wow Steve, good day to you too.

What happened to the Pensioners / Private Patient discount you promised me in the hospital ???

You must know that is hard to imagine a more unsuitable material from which to fabricate a prosthesis device to be placed in the vicinity of living human skin for any length of time, never mind 6 weeks.  You could look inside any motorcycle helmet for some more advanced ideas.  They can be worn months on end without any adverse effects.

Your prices are crazy high.  Second hand neck braces of various descriptions are available in Cash Converters for R.50, 00 to R.150, 00 in good condition.  Some with soft removable / washable helmet type pads.  I suspect you have attempted to take advantage of my circumstances.

Best regards

Jim Morris.  082 553 8552.

————————————————————————————————————-

From: Steve Green [mailto:steve@greenortho.co.za]

Sent: 05 March 2015 11:56 AM

To: morris@iafrica.com

Subject: ACCOUNT STEVE GREEN ORTHOTIST – NECK BRACE.

Good day

Attached herewith , please find your account outstanding for payment

For the neck brace fitted onto you in the hospital.

Banking details are on the attached account.

Please use your account number 6507 as a deposit reference number.

Thank you.  (THIS WAS FOR R.1 027, 00)  

Kind regards,

Lucy Luff

Accounts Dept

011-660 3038

Email: steve@greenortho.co.za

STEVE GREEN MEDICAL ORTHOTIST PROSTHETIST

——————————————————————————————————————–

From: Steve Green [mailto:steve@greenortho.co.za]

Sent: 05 March 2015 11:52 AM

To: STEVE@GREENORTHO.CO.ZA

Subject:

This email has been checked for viruses by Avast antivirus software.

www.avast.com

————————————————————————————————————

Steve thought it appropriate to phone me a couple of days later to swear at me, and call me a miserable old man.  I only listened, and hung-up when he ran out of breath.

Day 10.  Heels of hands pretty much clear.  Started exercises today.  Hand pressure on head from 8 directions, 40 seconds each way, and slow head roll with-in the brace.

Krugersdorp Hospital sent my final account showing a fair sized credit refund, and asked if they have permission to pay Ronel Venter physiotherapists out of the balance.  I phoned the hospital accounts and said definitely not.  Hospital agreed, and confirmed that Ronel Venter had approached the hospital for some of my funds (sneaky lot).  A few days later I received my full refund, so all is good.

Day 15.  Stitches out (Actually metal clips).  Very little fuss – wound healing perfectly.  Still completely numb inside 100mm radius around big toes.  Finger to nose test now at 50 to 75mm.

Day 18.  Can carry a full cup of coffee without spilling it.  Can march pretty well, with Halt, Left turn, Right turn, About turn – with what I would call “Clumsy success”.

Day 19. Regression.  Feet gone numb again, but hands good.

Day 21. Recovery progress back on track.  Big toes and surrounding area still holding out.  Finger to nose test now consistently under 25mm.  Still sleeping 2 to 3 hours more than was my norm prior to this procedure. There is no pain anywhere.  Swallowing is almost back to normal.  I did not take any of the pain mutti given to me on discharge from the hospital – no need.  This consisted of some syrup called “Stilpane”, and Disprin.  I did taste the Stilpane, and it brought back an ancient memory of a headache.

Day 25.  Confirmed doctor’s final inspection and brace off date of Wednesday 22nd April.  This will be 7 weeks after fusion.  It seems that Dr. Fourie has revised his fusion steading time to minimum 6 weeks (say 7) for necks, and minimum steading period for backs 8 weeks (say 9).  Well that is OK with me.  In the meantime progress continues.  SEE CONCLUSION.

List of questions for Doctor at end of fusion period.

  1. Did I wet my pants in theatre? – NO.
  2. There has been no pain at all – How come ? Morphine drip?  I asked for it to be reduced to 1cc / hour, comment.  –  ALL IN ORDER.
  3. Idid not take the stilpane or disprin. Stilpane jogged an ancient memory of headache.  Comment?  –  NO PROBLEMO.
  4. Am I now shorter or taller?? –  TALLER +/- 3mm.
  5. What about internal stitched? –  YES, DISSOLVING TYPE, GONE NOW.
  6. What affect on bowels, bladder and testicles??? I have different sensation, not good, not bad.  But maybe more control.  Comment??  –  TO BE EXPECTED, BETTER NERVE SIGNAL.
  7. Can I now ride my mountain bike? My motorcycle?  Stand on my head?  Do backward and forward rolls?  –  YES, YES, YES, YES & YES.
  8.  Would you like a full “no punches pulled” report from me ? –  YES PLEASE.  OK I WILL EMAIL IT TO YOU.
  9. Can you do a report to Piet Botha (orthopaedic surgeon), and John Fleming (neurologist) ?? –  YES, IF YOU WANT, BUT I THINK THEY WILL BELIEVE YOU OR PHONE ME.
  10. Can I get tax invoices from you – (I paid via beneficiary transfer)?? – YES, NO PROBLEMO.
  11. How common is my problem? E. exactly the same or otherwise?  And how caused?  –  PRETTY COMMON, I CUT MY TEETH ON THIS PROCEDURE.
  12. What about next cushion down – relieved or not?? – NO, BUT IT IS NOT UNDER CONSTRAINT AT PRESENT.

Blood work:  Blood taken pretty often along the way by charming AMPATH  “Blood Takers”, and nothing wrong with the pathology, except that: – Within the first week I get a SMS asking for an e-mail address to which they can send the account.  I responded immediately with my address, and asking that AMPATH be sure to include their banking details (I wanted to pay by beneficiary), and the actual lab results.  A few days later the account arrived with banking details, but no lab results.  I wanted to point out that the lab results had been overlooked, but the account came from a “noreply” e-mail address.  I read this as “just pay the account, do not query it”.  But to be fair I did later find an accounts queries address slightly obscure in the documentation.  I sent a reminder to this address.  Another account arrives, but still no lab results.  I sent another email reminder plus SMS reminder, and still another bare account arrives.  Then, on 8th April (now 5 weeks later), Jessica from AMPATH phones to say I can collect the lab results from Doctor.  Why not send it to me??  Against policy.  How can that be justified??  I do not know.   But later, Jessica phones again to say it is because of confidentiality.  But that does not gel – we have phoned, emailed and SMSed, she must know it is me, and if not what does it matter.  I then queried the “noreply” mail box, another source of annoyance.   Then funnily enough it comes out that Jessica is phoning from Sunning Hill.  She says I can collect the lab results there.  Uggh!!   Logically illogical.

Wednesday 22nd April.  (D. Day).  Henrietta drives me for the last time (we both hope) to Krugersdorp Hospital.  The charming Ane Olivier (my favourite Secretary) is standing by with instructions for the Radiologist in hand – no horsing around with this girl.  Second floor she says, they are expecting you.  Great, but I want to take a minute to ceremonially thank you, and hand over a gift showing my thanks for the way you organized my stay in your hospital last month, and smoothed out all the little niggles along the way.  I noticed Ane started licking her chops when she peeked in the bag and saw the bottle of champagne and box of chocolates.  I should mention the lifts are a bit fickle in this hospital, but maintenance is underway.

In short time we were at radiology, and as Ane predicted they were all standing to attention awaiting our arrival – even the accounts lady who smilingly informed me that I had not paid one of their previous accounts – a small one I had infact overlooked.  But as I had already made them a beneficiary to my account, I was whisked away by Natalie to the dreaded radiation machines with all due haste, and to the surprise and comment of the dozen or more waiting patients.  When I came back with my envelope of x-rays and CD, I explained to the waiting patients that I was their favourite patient, so everything was OK.

Henrietta was feeling peckish, so we stopped at the coffee shop for a snack, and a quick look at the x-rays.  We soon realized we needed Dr. Fourie to interpret for us, so Henrietta gobbled her snack, and we set off to the consulting rooms where Ane would take charge again.

While waiting for Doctor I asked Ane if she could bring pressure to bear on Ampath pathologists for my bloodwork results, as mentioned earlier.  Ane immediately picked up her telephone and swung into action – problem solved!!

Doctor says, the current rate of improvement will continue up to six months, and then perhaps continued improvement up to 12 months, albeit at a slower rate.  This was bloody good news, and I am confident that will be the case.

I am a super happy camper.  All the scheming, planning and juggling has come to fruition.  Put to the test – driving home was a real pleasure, my hands and feet went exactly where they should, and I could look left and right past 90 degrees with ease.  Tomorrow Suzie will be fired up, and I will check my motorcycle skills.   I will also shoot the neck brace.

MORRIS-JAMES H--MR- 1943-09-20- CR (CERVICAL SPINE) from 2015-04-22 S0 I0 (2)

 

 

 

 

 

 

 

 

Front view. Showing plate.  The previous radiology report said it was perfectly and squarely placed.  Obviously this was not strictly true. The fusion of “Donor Bone” is not clearly visible on this image.

MORRIS-JAMES H--MR- 1943-09-20- CR (CERVICAL SPINE) from 2015-04-22 S0 I0

 

 

 

 

 

 

 

 

 

Side view:  With head held back – chin up high.

The “Donor Bone” fusion is the slightly darker area between the screws with a race course type curve to the back.  There is also a lighter whitish cross marking the centre of the “Donor Bone” fusion.  Hence my slight gain in height.  Doctor says this is now the strongest part of my cervical spine.

NOTE: The spinal cord is not visible at all on x-rays.

Image (1) (3)

Image (2) (3)

Image (3) (3)

Conclusion:

I have never placed much importance in Blood Pressure – unless it is really excessively high or low, and immediately life threatening.  It goes up and down according to your subconscious nervous inner warnings to prepare you to make the decision to fight or flight.

Similarly with cholesterol in the blood.  It is something being happily pumped around with your blood – so what.  Again, I suppose it can be excessively, stupidly high.  And if it is stupidly low, then I do not know.  I guess whatever it does, it would not be able to do it very well.

Day 35. Improvement to feet has come to a standstill.  There were some slightly non-symmetrical L to R changes, but not improvement.  I got despondent at this point.

Day 42. Continued very slight improvement in feet, but not symmetrical.  Still numb 100mm radius around big toe.  This area is holding out on me.

Day 45 /46.  All sorts of sensations in the toes area of my feet.  This is an amazing feeling, and I cannot help thinking that my Cervical Spinal Cord is sorting itself out.  It is like a full blown battle with bullets, spears, flame throwers, Tasers and swords firing off in all directions, and when the battle is over, and the dust settles, you find you are still alive and gained some ground – not bad at all.

Day 49.  Just small parts of my big toes still holding out – wow!!  Nearly there.

Day 51.  Motorcycle test ride.  Absolutely 100% perfect.  No sense of any imbalance.

My intention now is to do some serious fitness / strength training for a month or so.  It should be mentioned that I have experienced an immediate gain in strength due to properly working nerves.  It reminds me of the 9th stanza of Rudyard Kipling’s “If”.  I had not understood this before.

NOTE:  I have developed a neurological instrument kit for private home use.  Anyone may feel free to duplicate same and make use of it.

NEURO KIT

NEUROLOGICAL INSTRUMENT KIT.

You will find these instruments very useful in diagnosing neurological disorders.

——- RIDE HARD, SHOOT STRAIGHT, AND SPEAK THE TRUTH ——

Jim Morris.  002782 553 8552.

morris@iafrica.com

One thought on “OPERATION CERVICAL FUSION.”

  1. Jimmy, now I know why I always have the urge to answer you back. Made very interesting reading but bloody glad I was no where near all those nice people who looked after you, cause I would have helped “throttle you” be grateful the grumpy old man is feeling a lot better❤️

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