Thailand

Microdiscectomy

This post doesn’t really follow the trend of my others. But it does cover, in some detail, a recent fairly major event in my life. My first surgery.

In October 2012 I started to feel some pain in my left leg when sitting. Nothing major, just a fairly dull ache that got worse the longer I sat. This stayed fairly constant until mid-November, now it was quickly changing from a dull ache to a shooting pain in about ten minutes of sitting. Soon I was only able to lay down or stand comfortably, sitting became far to painful.

At this point I decided it would be a good idea to seek medical assistance. So Mos and I headed off to our favourite clinic in Chiang Mai, the highly recommended Health Care Medical Clinic. Earlier in the year I had had some stiffness in my neck which had caused my last visit to the clinic. And because of this the assumption was made that I might be suffering from muscle stiffness, this time in my hamstring. So I was injected with a dose of muscle relaxant and given a four-day course of pills to keep me relaxed.

During the my check-up at the clinic, they mentioned that a few things were not right. If this was purely a tight hamstring some of my symptoms didn’t quite fit. So they suggested that if there was no improvement after my four-day course of pills, that I should visit a physiotherapist at the local hospital. My doctor recommended Khun Took at Rajavej Hospital.

Over the next four days I tried to remain active, take the pills as and when ordered and to make sure I didn’t do anything that could pull or twist my hamstring. But, it didn’t get better, in fact, it got worse. By the end of the four days I was now barely able to walk for more than five minutes and had to spend most of my day in bed. We booked the next available appointment with Khun Took, thankfully it was only a few hours after we phoned.

After a very painful scooter ride I arrived at Rajavej Hospital, headed up to the physiotherapy department and introduced myself to Khun Took. She immediately set to work, strapping me up to machines that stretch my leg, straighten my pelvis and heat my muscles. I also had intensive and very painful massages (which although they hurt, felt like they were doing something good). She also used ultrasound to ease the pain. Once my session was over I felt better. Not Olympic fit, but able to walk without a limp, which was a big step.

I continued on a fairly intensive seven-day course of physiotherapy, but on the sixth day, the results nose-dived. Previously I had ridden my scooter, with Mos, to and from the hospital. It’s ten minute ride. The journey to the hospital was always painful but nothing I couldn’t handle with some codeine and a stiff upper lip. The ride home was always less painful. On the sixth day however, the pain was greater even after the first few meters. By the time we reached halfway I realised that I was going to have to stop the bike. Thankfully I managed to pull over, put the bike on its stand and loosen my helmet before I blacked out draped over a nearby gate. I was only out for about twenty seconds. I limped around in circles trying to get some blood back to my head and pain out of my leg. We got back on the scooter, this time with Mos riding so I could keep my legs straight at the side of the bike, which seemed to help the pain.

On arrival to the hospital I informed Khun Took of the drama that was my commute to the hospital. She said that because of that, paired with the fact I was making nowhere near as much progress as she had hoped, I should see an orthopedic surgeon. Within ten minutes a member of staff was there to whisk me down to the orthopedic section where I chatted to one of the hospitals surgeons. Over the next hour I had an X-Ray and a very large dose of morphine. From this moment on, I would be on a constant stream of the of highest strength painkillers available. All of which barely dented the pain I was now in. The doctor also booked me in for an MRI scan, but that would have to take place at a neighboring hospital due to a malfunction at Rajavej. But to my surprise they managed to fit me in that afternoon.

The following day, with MRI results in hand we went back to see the surgeon. He said immediately that the X-Ray showed to bone damage. So that was a big relief. He was concerned that maybe I had fractured a part of my pelvis. We then handed over the MRI scan and even Mos and I, with no medical training could tell there was a problem. He pinned up the scans on the light-box on his wall and started to circle various parts of it with a red marker. We all know that red markers mean bad things. He went on to explain that one of my discs had ruptured and in spectacular fashion. The cause of my sever leg pain was now apparent, the material that had ruptured from my disc had pushed against and now become wedges against my sciatic nerve. Causing what is commonly know as sciatica.  Well known as one of the most severe pains going. Pregnant women can sometimes get a mild sciatica from the pressure from the womb, this is however less painful due to the direction at which the pressure is being applied, as the surgeon explained.

So as I lay on his examination bed, fully dosed on morphine and a cocktail of other über-strength, but ultimately useless painkillers. Shaking and sweating with pain. He continued to describe in great detail just how painful sciatica is. But then he paused. And made a very careful and very deliberate red circle on a different area of the scan. Then, to himself he muttered ‘Oh, that’s interesting’. He looked at me and then back at the scan. Then he peeled the scan from the light-box and showed it to me. The material from my ruptured disc was not only crushing my sciatic nerve. It was also putting pressure on my spinal column. The surgeon went on to explain that I would need surgery to remove the ruptured material from my back, this would cure the sciatica and remove the possibility of the material causing permanent damage to my spinal column. And he didn’t need to detail what exactly ‘permanent damage to my spinal column’ meant.’ We all know that at best wheelchairs would be involved. We went on to discuss what the surgical options where, quite simply, there are two. I could have a Discectomy or a Microdiscectomy. They are both ultimately the same procedure, however the ‘micro’ option is a form of what most people call keyhole surgery. Whereas the regular Discectomy involves a far larger incision and a much longer recovery time.

Both procedures have the same objective. Cut a whole in your back, where on your back depends on where your damaged disc is. They will move your sciatic nerve, guard your spinal column and then the surgeon will pull, scrape, cut and burn the excess material away from your disc. That’s it. A fairly simple procedure in a potentially dangerous area.

From my fairly extensive research on the internet, many people seem to think that they have had the micro option but they have in fact had the regular option. The scar from Microdiscectomy surgery is between 2-3cm in length. And is almost always glued, not stitched or stapled. My scar for example is smaller than a ten pence piece.

The orthopedic surgeon at Rajavej Hospital went on to say that they do not have the specialists or equipment to perform the Microdiscectomy, but could perform the regular surgery with four days notice. He advised however that I have surgery as soon as possible. And that the best option would be to travel to Bangkok to see one of the major hospitals.

Mos and I immediately thought of Bumrungrad International Hospital. We had been there previously during a visit to Bangkok about a year previously. Mos had come down with a kidney infection and they treated her like royalty. Superb service, excellent facilities and one of the best rated hospitals in the whole of Asia. We didn’t even need to discuss it. That night Mos called Bumrungrad and explained the situation. We knew that I would need to travel to Bangkok by sleeper train, as this was the only option that meant I could lay down. So the following day we boarded the sleeper train in Chiang Mai, I swallowed a handful of multi-coloured, prescription-only painkillers and we set off.

I managed to sleep for a few hours. I’m pretty sure it was pure exhaustion rather than lack of pain. But as we pulled into Bangkok I was very happy to see an ambulance team from Bumrungrad who had been sent to collect me from the station. Unfortunately they had not been allowed to bring the stretcher onto the platform so the two taller guys held me on either side as we slowly hobbled to the station exit and the waiting ambulance. The driver helped Mos with our bags.

It was a short trip to the hospital, and as soon as we arrived I was whisked up to the twelfth floor, which is the Spinal Center. Although we had arrive four hours early, my surgeon came to meet me within two hours. He looked over my MRI scan, poked and prodded me, and then told me that I must be in a lot of pain. Surgeons seem to like to point that out here.

My surgery team would be led by Dr. Surapong Anuraklekha, who was brilliant. He could see that I was fairly nervous and in a lot of pain. So he described the surgery to me and asked me when I wanted to have it. I was expecting to have to wait maybe a week, or two. I had heard of people in the UK on the NHS waiting list having to wait up to three years! But not here. By this point it was 13:30, and we had scheduled my surgery for 17:00. Which was brilliant, as soon my pain would be gone! But also because it meant I didn’t have enough time to get worried.

I was taken to my room, which was far more like a luxury apartment than hospital room. The nurses positioned my fully electric robotic bed into an ‘s’ shape, which was amazingly comfortable. Then, just as I was still sinking into the bed, two nurses came in, introduced themselves very politely and then proceeded to strip me naked. Before I had a chance to buy them a drink I was in a hospital gown with a morphine drip in my left hand. Mos arrived after completing some of my paperwork and we talked for a few minutes before I fell asleep. Again, out of exhaustion rather than lack of pain. The next thing I knew my surgeon was waking me up, it was 16:00 and time for me to move into the special room for people about to have an operation. I’m sure it has a more catchy title, but I don’t know it. Mos walked alongside my bed as I was wheeled to this new room. And she said good luck and ‘I love you’ at the door, quite tearfully. I’m not sure if I replied. I was in a different world, a world of morphine on tap.

I stayed in that room for what seemed like ten minutes before a nurse said that I need to go to the toilet before my operation. So she helped me hobble over to the toilet and thanks to the many grab handles and safety rails I managed to do the rest on my own. Minutes after getting back on my bed I was met by my surgeon, this time dressed in surgical scrubs and looking far more like a surgeon than a doctor. He and his team wheeled me out and into the operating theater. The pulled my bed up next to another bed which had a large triangular object in the middle which it quickly became apparent I was to be placed over, naked and arse in the air.  Before I have the chance to take a second glance the anesthetist introduced herself through her protective gear. Placed a plastic mask over my mouth and nose and told me to count out-loud from ten to zero. The last number I remember was six.

I woke up in the same pre-operating room as I was in previously. A nurse was monitoring my oxygen levels, and as I woke up she removed my oxygen mask and told me to breathe slowly and deeply. I managed for a few breaths, looked at my oxygen monitor which was dropping from 99 down to 98 and then 97, but then fell back asleep. She re-applied the oxygen mask and we tried again. On about the fourth time I managed to stay awake, I looked at my oxygen monitor and proudly, and I think quite loudly, declared ‘I did it I’m at 99’. The nurses laughed got me ready to leave. As I was wheeled out of that room The first person I saw was Mos. Leaning against the wall and looking tired. Apparently I’d been in there for nearly six hours. The operation took just under two hours, the rest was preparation and waking up. I was very happy to see her and squeezed her hand as tightly as I could, which I imagine was very weakly. The nurses used a spinal board to move me from the transport bed to the bed in my room. They reset the bed and arranged my blankets, I think I managed to stay awake for about an hour before falling asleep.

Every hour the nurses would sneak into the room like medical ninjas to measure my blood pressure, temperature and my various bags of liquid drugs that were being fed drip by drip into my hand. Mos was fast asleep on the sofa, I imagine this time, she was sleeping thanks to exhaustion.

In the morning, just after I’d been served breakfast, my surgeon appeared. This time looking like a very smart doctor, not a surgeon. He told me that everything had gone very well, and despite taking slightly longer than expected, the operation had gone perfectly to plan. Then he handed me a small plastic pot. This pot contained a pale transparent liquid, and in it was white lumps of hard and soft tissue. This was what he had removed from my spine only last night! Mildly disgusting but completely fascinating. He also gave me a DVD video of the procedure. Which I had asked for previously when I found out that the keyhole procedure was done using a remote camera.

Then, after I had played with my ruptured disc in the plastic pot, he asked me to stand up. Now, for three months I had not been able to walk without pain, and for the last two I hadn’t been able to stand up straight. For the last two weeks I had been completely unable to walk without people helping/carrying me. So to ask me to stand up only hours after surgery seemed a bit much. But I shuffled out of bed and a nurse helped me to my feet. Aside from the slight tightness and soreness from the incision, I felt no pain. None. Not even an ache. My left leg was slightly numb, but my surgeon explained that this was normal. My sciatic nerve was simply readjusting to not being crushed. All of the pain had gone. I no longer had to drag myself off the bed, onto the floor and to the toilet. I could walk! No more sleepless nights. No more painkillers and morphine drips. No more blacking out through pain and exhaustion. I felt completely normal.

I opted to stay in hospital that night, just to make sure everything was as it should be. I thought that surgery on my spine deserves that extra bit of caution. After all… it is my spine!

The following morning we headed back to Chiang Mai, again on the sleeper train. I slept like a baby. I enjoyed a week of bed rest mixed with regular exercise, light walks, mostly between 5-10 minutes. After a week I was feeling great. Fairly week, but that’s to be expected after being stuck in bed for months prior to my operation. We headed back to Bangkok for a checkup, my surgeon was very happy with my progress. And signed me off as able to continue normal activities from March. In the meantime I should continue with light duties. Which meant not sitting on the floor, at all. Not sitting on chairs for longer than twenty minutes at a time and not lifting more than five kilograms.

I had my surgery on the 25th January 2013. It’s been twenty days now and I am improving everyday. Most people wouldn’t even be able to notice that I am still in recovery. I am living a perfectly normal life. And I’m still on ‘light-duty’.

Here is a picture of my scar. Taken today, 20 days after surgery. For people not familiar with Thai currency, that coin is the same size as a ten pence piece. For you Americans, the coin is about an inch in diameter.

Scar

Thailand

Absence

So, this is my first update in what feels like years. The lack of writing has been caused to a number of factors. I’ll try to cover as many of them as I can, and can remember now. One of the main reasons for me to start writing this blog was to have a detailed journal of what I’ve done, the adventures I’ve had and the trouble I’ve caused. Hopefully this update will fill the gaps that are missing.

MacBook Pro

There’s only one logical place to start in this update, at the beginning. It happened a couple of days after my last update. My MacBook Pro laptop melted. I know that sounds like an exaggeration, but it’s not. I’ve had this MacBook since starting my last job in London. It was a company laptop, which was already four years old when I was given it. Whilst at the company it had been used for high demand editing, audio work, rendering and all sorts of other recording and mixing tasks. When I left the company, they gave me the laptop. By this point, in terms of video and audio work this laptop was very out of date and underpowered. This was highlighted by the battery failing shortly before I left. I don’t want to sound ungrateful, it was a great gift, but at that point the laptop was well past its prime.

Almost immediately after leaving the company, in March 2012 I packed my bags and headed back to, what at that point was my second home, the island of Koh Tao, Thailand. It was a few weeks before my wedding. At this point I hadn’t even started this blog. As you can imagine my mind was elsewhere. I had a whole new family to get to know. I had a paradise island to live on, and my friends around me.

Since entering the heat and humidity of South East Asia with me, the MacBook Pro hasn’t been under an average temperature of 30⁰C. Well apart from a few nights in air-conditioned hotel rooms in Malaysia during business/visa trips. As with all technology, the cooler you can keep it the better it performs. And as you probably already know, laptops have internal cooling fans to pull air through the machine and keep it cool. Which is great if your laptop it heating up to 60⁰C+. A steady stream of cool British air would pull that temperature back down to a more stable 30⁰C. However, when the laptop is in the humid heat of Thailand, rather than the cool British countryside, the air it pulls in is already warm.

One night, I left the laptop on overnight, it was downloading some television shows from the UK. By the time I woke up, the MacBook had failed. I rushed it to the local repair shop, then to a registered Apple repair shop. The diagnosis was grim. The logic board had overheated, with a last recorded temperature of 97⁰C. The logic board is the brain of a MacBook. So I was now left with a choice. I could replace the logic board at a cost of nearly £400, or I could let my brain-dead machine die in peace (in a cupboard under the stairs). I chose the latter.

Luckily, I had another laptop, a tiny Samsung NC10 netbook. I’d given it to Mos when I was using the MacBook. Although the NC10 is great for putting in a backpack and walking around town, or some quick web browsing, it’s a less than ideal machine for writing. The keyboard requires microscopic precision to hit the right keys. That, or the fingers of a five-year-old. I quickly came to the conclusion that I’d need to buy a new computer.

Damian

Shortly after I lost my MacBook to the heat of Thailand I got an email. It was from a friend of mine from university, Damian. We lived together in halls of residence then again later in a private rented house in our middle year. But more notably, we started a company together. The company was set up to produce corporate videos, with the aim of moving into television production once we built up enough cash to fund the transition. Damian and I started the company with two other friends of ours. The company was very successful and started to make profit after just two months of trading. We invested in cameras, new offices, staff and all of the other expenses you would expect of a growing media business.

Damian and I had taken a year off from our studies to run the company, and decided to take a temporary step back from the company the following year to complete our final projects and assessments. Whilst completing my final projects I decided to make my ‘step back’ a more permanent move and left the company entirely. I left for a variety of reasons, I wasn’t happy with making corporate videos, but I was more concerned about the lack of ambition and professionalism from the other two, that we had started the company with. So I left, and Damian and I gradually lost contact as I moved to London and he stayed with the company in Staffordshire.

Damian’s email said that he was coming to Thailand. No reason, no explanation. I put him in contact with my travel agent friend ‘Bangkok Dave’. Damian has a reputation for jumping on the first mode of transport that he sees. So I knew Dave would get him to Chiang Mai, where I live, safely.

Damian’s arrival in Chiang Mai would provide the second obstacle to my writing. We had a huge amount of catching up to do, and beers to drink. And I still hadn’t got a new computer.

We visited all of the tourist spots, drank in all of my favourite places and ate in all of my favourite restaurants, cafe’s and eateries. I also managed to get him addicted to the ham & cheese toasties that they sell in 7 Eleven. Sorry.

One morning we decided to ride our scooters up Doi Suthep (a mountain) and shoot a time-lapse video of the sunrise. We made plenty of sandwiches and headed off. The video was great, but the real memory of the trip was just relaxing on the side of a mountain, watching the sunrise, with a good friend and my wife.

Our most memorable trip with Damian was our drive from Chiang Mai to Pai. Which has one of the most winding and stomach churning roads I’ve ever driven on. We took the truck. Halfway through the drive we discovered that the tyres where backwards. As you may or may not know, car tyres are designed to turn in one direction only. It’s designed like this to push water from under the tyre to the side. Driving on backwards tyres pulls water under the tyre resulting in a very unstable drive in wet conditions. And we found this out on a mountain road, a few hundred meters above the canyon floor on a patch of road with only a few rocks to mark the edge. We span nearly 180 degrees.  But thankfully the road was fairly empty and I managed to keep the truck on the good side of the marker rocks. Don’t worry mum, we only drove another hundred kilometres or so on these tyres…

Once we got to Pai we met up with our friend who owned a bungalow resort on the mountain. We feasted on barbecued… well… everything. We drank whiskey, beers, shots, the lot. We then headed off into Pai to a karaoke rock bar. That was fun. And the next morning we all headed home. And yes we got the tyres swapped over before driving back!

The BBQ in Pai

On the drive back, on the very top of the mountain, the truck ran out of brake fluid. It was a spectacular place to break down. Luckily the local army base was able to top us up before we headed down the mountain. Something I’d always rather do with brakes.

Damian’s next stop was Australia, where he would meet his girlfriend Georgia and go travelling around outback in a campervan. So we said our goodbyes and we sent Damian back to Bangkok on the train. Bangkok has him now.

Bangkok has him now.

Bueng Kan

Almost as soon as he’d left, Mos and I packed up the truck and headed off on the 20 hour drive to our farm in Bueng Kan. So that accounts for yet another day of no blogging. And once there, I am put to work by the family. Chasing chickens, fixing trucks, feeding dogs, rescuing motorbikes from rice fields and other general Thai farm work. And as you may have guessed, there is no WiFi connection on the farm.

Our farm is also only a few hundred meters from the Thai-Laos border. It’s a geographical border in the form of the Mekong River, which runs from central China, all the way through south-east Asia and finally into the sea in Vietnam. It is home to many legends and religious tales. And as a result is very important to the locals that live along it. Here is Mos, my brother-in-law (Foamy) and Mos’ Mum (my mother-in-law) enjoying a some lunch overlooking the Mekong.

Lunch on the Mekong

The purpose f this trip to the farm was to hand over the new truck. So after showing them the ropes and handing over the paperwork we made our way back to Chiang Mai via public transport. Which means a five-hour aircon bus from Bueng Kan to Udon Thani, followed by an overnight bus to Chiang Mai. We opted for the more expensive ‘VIP Extra’ bus. Which includes wide seats that nearly fully recline, waitress served snacks and drinks, aircon, and you also gets blankets and pillows. The one thing you can’t upgrade is the endless and tight-turning mountain roads that will ensure you can’t sleep. Good fun though.

 Harry & Charlene

Once back in Chiang Mai, just as we’d managed to grab five minutes to relax, Harry and Charlene arrived. Harry is my younger sister, she works in PR, but we mustn’t judge her on that alone. The last time I’d seen her was at my wedding which she had flown over from London for. And we all know how hard it is to get PR folk to travel without the promise of pens, mugs, lanyards and other soon-to-be-binned freebies. Charlene is Harry’s housemate in Clapham. Charlene also works in PR, but in a different field.

Mos and I decided to make a sign to welcome them to Chiang Mai when we picked them up from the airport.

Harry & Charlene

Once they had touched down, collected their bags and laughed at our sign we gave them another surprise. We took them home on the backs of our scooters. Thai Style. They looked horrified.

We got home safely, and for the next week they kept me suitably busy and as a result, offline. We had a great time, I’m fairly sure they did too. One of my favourite memories was eating on Huay Ting Tao lake, literally. We love it there.

Huay Ting Tao

Mum & John

Soon after Harry and Charlene left, less than 48 hours after, Mum and John arrived. We repeated most of the activities that we’d done with Damian, Harry and Charlene. But we also did some new ones that even Mos and I hadn’t done. We went to the Elephant Nature Park (Mos’ first time), we flew to Mae Hong Song in a tiny twelve-seat plane, took a longtail boat to visit the Karen hilltribe (longnecks). Mum and John also accompanied us on another trip to our farm in Bueng Kan, that was awesome! We had a great month. It went far too quickly. And I hope to write about it, and all of the other events in far greater detail at some point. But the purpose of this post is to detail the reasons that I’ve not blogged in so long.

Hospital
Two days ago, I took Mos to the hospital, she’d suddenly come down with something and it quickly became clear that she needed medical help. I’ve been by her side since she was admitted and I don’t plan on leaving anytime soon.

Thankfully the issue is not too serious. Something to do with a virus and low blood pressure. But solved by a few days rest in the hospital on a variety of drips. And during this time I’ve managed to catch up on my blog. I nipped out and bought a new laptop just after Damian had left. But I had hardly used it. Mos is now fully recovered and at home. And I am back on schedule with my blog.