The Irony:

It takes one to know one.. right.

The shoemakers children run barefoot… of course

A physical therapist (specializing in working with surfers) with a significant back injury..-argh.

What started as a work injury grew into a nag, which grew into a pain, which ultimately has grown into a moderate level of chronic pain, debilitation, and limited ability to surf.

The whole situation has kind of sucked. Holy shit it has really sucked, but I’ve learned so much from the experience and I think I better share the story… because I know there are people, surfers, humans that are still seeking answers, swallowing fist fulls of Advil to just be able to try and get in the water, never mind sleep or walk.

 

A Shitty Situation

On December 2nd, whilst working at my ‘day job’ in the local skilled nursing facility, I was transferring a patient with another nurse to a shower chair, when the patient lost bowel and bladder continence, covering the floor with excrement. Unfortunately for me, midway through transferring this end-of-life stage man from the edge of the bed to the wheelchair, I slipped in the mess. In efforts to make sure that this 6’4 man didn’t end up on the ground, my back basically took one for the team. Shitty situation, eh’?

Five months after the fact, I had not really gotten any measurable medical care as the bulk of it has been denied by the work comp insurance. I have been to deposition to state my case, but the company I work for chooses not to settle things. They had left me hanging, no medical care, no options, not able to really work at my full capacity, and surfing.. what was that..? The cornerstones in my life such as surfing and growing my private practice seemed nearly a distant memory at this time. Nagging depression has been creeping in. My marriage has been rocky. My confidence in my ability to earn a living totally diminished 

Not Surfing and Not Living

So what’s one to do..? Rot? Cry? Wallow? No thanks, had enough of that. Having spent some time traveling in Central America in my past, I had some other ideas. I took matters into my own hands, and armed with MRIs and XRays, and some uncertainly, I boarded a plane headed for Panama City, Panama to get some medical care.

I had found 2 neurocirgones via word of mouth through social media connections with friends that I trusted (note not online thanks to the censorship our internet has now it can be very difficult to ‘Google’ the doctors you may want to try and see).  I set up 2 consultations with 2 different doctors from 2 different hospitals, just to triangulate and see what each one would say. Each doctor spent about an hour with me, discussed and reviewed every imaging study, reviewed my old operative report, and took time to explain to me why my symptoms were the way they were, and where the corresponding pathology was showing up on the imaging studies.

Each doctor also carefully and smugly suggested that the prior laminotomy and discectomy that had been performed on my spine in 2014 was likely a ‘botched’ job, leaving much of the debris and disc remnants from the initial injury in place. Awesome. No wonder my previous doctor had shoed me out the door as fast as humanly possible when I was still having some symptoms in my legs 4 months post-operatively. If I recall correctly, his exact words were ‘your disc failed, not me’.  Ballsy doctor to say these words to me when he himself had mentioned ‘I can’t quite seem to find your MRI’ minutes before putting me under sedation. Awesome patient care. Simply amazing.


Vamos a Panama

So after arriving Panama, having spent now $150.00 total for two 1-hour consultations with spine specialists, $483.00 for the flight, and $600.00 for the week in an airbnb in the city I was finally starting to see some progress and get some answers. Keep in mind, that even if I was able to find a doctor willing to do the injections in the states who wasn’t ‘put out’ by the fact that it would have been cash pay but in a work comp situation, I would have paid upwards of 6k for the injections alone, never mind the initial $350.00 consultation fee to see the doc of about 10 minutes prior to the appointment.

The injections that I sought would at least buy me some time and pain management, but ultimately, I have a bigger fish to fry that an injection is likely not going to fix anything other than taking the edge off the pain. Each of the exiting nerve roots on either side of my L4/5 vertebrae are nearly totally occluded by hypertrophic/ arthritic bone formation as well as a nasty recurrent disc herniation. So essentially, even if a pain injection helps, the nerves are in a compromised position. What’s worse, lumbar extension, the position that we must be in when paddling a surfboard, is the position that most severely compromises these exiting nerve roots.

What are the options? Fuse my spine? Surgically excise the facet joints and their hypertrophic bone growth? Ugh. I may prefer to slit my wrists. I have had hopes about stem cell treatment, but not 100 percent convinced. Stem Cell therapy can be done in the US, but think at a much more subdued, regulated level that isn’t necessarily as therapeutic as it could be. And after stopping by the world renowned Stem Cell Institute inside the Ibica Financial Center, I am anxiously awaiting an appointment still 2 weeks later.

In the interim of deciding if Stem Cell treatment will be a good fit, I had to do something to manage my symptoms. After 5+ months of waking up with excruciating pain in my spine every morning, I was starting to wither, dwindle and feel complete sadness. I was made to feel like a fraud or a fake because my injury happened at work, and Workmans compensation is not in the business of caring for patients, they are in the business of insurance.

Treatment

Within a few days of my stay in Panama, I was able to consult with an AMAZING doctor, Dr. Nelson Sopalda at his office location in San Fernando hospital. I opted to move forwards with lumbar facet, nerve and disc injections. After a thorough consultation, it was decided that there had been a significant change to my historical disc bulge, likely due to the accident at work. Doctor Sopalda took the time to explain that I may be able to get by with another discectomy and possibly avoid the spinal fusion until later on in life. Good news.

And so bravely, I checked into Hospital Nacional last week for the procedure. I gritted my teeth a bit in attempts to avoid having to be fully sedated.  Advocating for myself to the nurses when I was a little bit doped up was possibly one of the more challenging aspects of the procedure, but overall, everything went well.


Do you take much for pain? My doctor asked.

Try not to if I can help it. I responded

Okay, good good.. .you know we have a hard time with patients from the States sometimes because they have been told to take so much pain medicine. My doctor mentioned.

I was discharged from the facility after receiving about 8 injections in my spine. The grand total at the cash register: $1340.00 (and if you want to get really specific, the total grand total for the whole trip coming in at $2573.00). And while that may be a high price to pay out of pocket, being treated like a human, having a clear plan and understanding of my condition, and finally feeling better is pretty much priceless. Saving $3427.00 to feel better was really just a bonus.

Relief

Two days after the procedure I had another 1-hour follow up consultation with my doctor where we reviewed the effect of the injections, future risks and things to keep an eye out for, and devised a plan to try and push for surgical management of the recurrent disc herniation I experienced during my work injury.

Yesterday I woke up without pain. It was amazing. I was practically dancing. I have been walking and reintroducing a lot of the back stabilization exercises that I wasn’t able to do prior to the injections due to the pain I was experiencing every time I tried to do my physical therapy exercises. My hope and goal is that I will spend the next month strengthening, progressing, and hopefully getting back into the ocean/water slowly. Paddling could be a great exercise to strengthen the multifidi muscles in my spine.

As for my work comp case that is still pending in outer space.. who knows if they will ever come back with an approval for this same care that I just had. Who knows how long they will leave me to ‘wait it out’ in pain. I am grateful that I have had the means to be able to take care of my health and get the care that I needed. I am grateful for my insight into the medical industry which allows me to see ‘both sides’ of the coin of a work comp injury. It is absolutely no wonder that people get so discouraged and depressed, addicted to pain medication and feel disenfranchised when going through a work injury.

Afterwords

Statistically 80% of Americans suffer from back pain at some point in their lives, and next to hand injuries, a low back injury is the second most common work-related injury. Losing the ability to do your job, provide for your family and have a daily sense of freedom without pain is enough. Being painted as a fraud when you legitimately sustained a work injury is humiliating. Losing the ability to surf is one thing, but losing your identity due to a process like this, something completely else.

The experience has helped me to shift my views on how I will continue with my practice Surfer’s Edge Physical Therapy. I will be relocating most of the year to Playa Veano and Pedasi Panama and offering comprehensive wellness retreats for surfers and others.  I will be slowing down, limiting my lifting and movement of bed ridden patients. I will operate more holistically by offering a peaceful and calm environment that allows my clients to have some mental clarity. I have expanded on my practice by taking life coaching classes to help with progressing my clients mindset by removing blocks. I intend to refer business to Panamanian doctors for those of my clients who are looking for an alternative. 

This journey has just begun, but please reach out if you are interested in hopping off the hamster, spending a week in warm weather and warm water, with the guidance of a physical therapist/ ex-pat who just so happens to know a thing or two about recovering from an injury and getting back to surf.