review MRI with Dr. Nelson and talk fusion

Met with Dr. Nelson to discuss fusion surgery and my latest MRI. The images were much clearer than previous MRIs, and it was easy to see how chewed up and "painful looking" my L5/S1 disc space was. As Nelson said, it is bad and something clearly needs to be done at that level. The L4/L5 level is not as bad, but the facet joints don't look good -- which would be a contraindication for ADR. Also implicating the facets as culprit is the fact that I get more pain leaning back, a movement which loads the facet joints. Finally, I am developing some bone spurs at L3/L4, but otherwise that level looks OK.

We talked about how many levels to fuse. We've been over this before. One level has best chance of satisfaction, two levels is (exponentially?) worse, three is pretty much unsatisfactory, from his experience. Then we got into the discussion about doing one or two, concluding that it was better to shoot all our guns (do a two-level) instead of wondering what would have happened if we had done more. He said that it would probably never be "perfect" that we would hope for a 60-70% improvement. I think I would be happy with that.

Hospital: 3 nights in Scripps Memoral La Jolla, which he said was a very nice facility.

Recovery time: Full recovery at 9 months. Driving in about 2 weeks. Wearing a brace for around 2 weeks, more as a reminder to really take it easy than actually bracing anything. Plan to return to work in about 2 months. Could do 1 month if absolutely necessary. Probably 3 months off to return to a construction job. Hospital would provide a riser for the toilet seat. Cooler ice pack device provided or prescribed.

Physical Therapy: walking. He does not recommend anything else. Walk as tolerated.

Pain meds: Percocet for 2 weeks, some vicodin, hopefully off all medication within a month. Wow!!!

Scheduling. He said pick a week, 2-3 weeks out, and we could probably do it. I mentioned that I was looking for a new apartment so I could recover from surgery in peace and quiet. Side note: Am I just trying to procrastinate and postpone what will undoubtedly be a painful experience? Yes, but I truthfully can't imagine trying to recover from major surgery while lying in an apartment with airplanes flying overhead and inconsiderate neighbors making noise.

Diet. Drop the booze. Try to cut down on the vicodin beforehand as that will help me to get off the pain meds afterwards. Drink milk: big glass twice a day, or calcium supplements.

I asked him about his qualifications, and he talked briefly about his education and residency before referring me to his website.