Max Omni / Omnimax / Xaminmo

Just a Mad Scientist and Midnight Shadow

Today's PT
Josh 2004 Happy
I was little more sore yesterday and today in the nerve area, so no twisting PT today.

Instead, so much sweating! Squat sled, one-legged kickbacks, medicine ball crunches, Physio ball hip bridges, front planks (8x10s) and side planks (more like lifts with very little hold because SO WEAK). Feel good, and it was nice to sweat. I like having an appointment since it keeps me from putting it off for days, weeks, or forever.

OH, and there is just a tiny bit of a stitch that is fused with the skin, and it's been bugging me. I was able to pluck most of that off (not out, it's literally just stuck to it). Incision is good. No adhesions, and mashing any direction has very little discomfort.

Still weaker on the left side by probably 50%, but I'm confident that it will be 100% by next year, since everything "works".
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Still so excited!
Josh 2004 Happy
I'm still really excited about Star Trek Axanar​. The story is pre-Kirk, and is referenced in Trek canon. It's the first non-UPN/CBS Trek production I've seen that felt and looked like real, full-quality Trek to me.

They're building the sets and render farms now. Shooting should be in October. Release should be 2Q/3Q 2016. It's a really professional project -- you can see their short movie Prelude to Axanar on YouTube for an example of their quality.

Also, this group has a solid history of delivering on time. It's never too late to donate. You know, there will always be extra expenses, etc. Donations get you the BluRay, script, etc. There are also posters of the Aries class battleship schematics, etc you can buy from the donor store.

Spine updates
Josh 2004 Happy
90% of my numbness is gone. When sitting weird, I get some on the other side, but it goes away when I straighten up.

Still some low grade pinch on the left, but not enough to take tylenol.

Some strength back on the left, more than PT has done (mostly core, not leg). It's noticeable, but does not affect my daily activities. It would affect travel, and biking.

No discomfort for normal moving. I lean more, but still are cautious about how far, and not carrying heavy things.

Dr follow up in 2 more weeks.

Spine ponderings
Josh 2004 Happy
I think my back stuff had been progressing for longer than I thought. I know I'd have a stiff back from time to time, but more often in the last tear.

But when walking today, how my foot kind of drops and clops, I think that had been going on for a while too, and I'd just dismissed it as having sat too long, or whatever.

Anyway, yesterday was a little tougher, and today is a little easier than any other day. 2 steps forward, 1 back. I like the 2 step forward days.

I found two movements that are weaker on the left. Lifting my foot/toes, and lifting my leg to the side. Everything else is matching well. Even the piriformis pain is an illusion. I have the same flex and strength in hammies and glutes.

Also, making a right turn while driving is painful. Basically it pinches right and expands left. I can compensate by shifting my hips the opposite way.

Spine follow up dr visit
Josh 2004 Happy
13 day followup with surgeon. All is great. Bandage and surgical tape removed. Solid healing there. Progression of neuromuscular recovery is great. No need to wear brace anymore. Listen to my body as for activity levels. Got Rx for PT, and followup in 1 month.

Tech details:
* confirmed bilateral laminotomy vs laminectomy
* ligamentum flavum removed at L4/5 but is non-structural.
* Disc is not sealed, and no device installed. Will scar over in a few months. (Disc was rinsed out, so nothing loose in there to extrude unless I am really stupid.)

Things I rediscovered that are interesting
Josh 2004 Happy
Things I rediscovered that are interesting:
1) When you burn a gram of glycogen from your muscles, you also lose 2-4 grams of water that was part of the glycogen matrix. Also, Glycogen is almost exactly the same as starch in plants. Pectin and amylopectin - trees of glucose molecules, bound together.

2) While a gram of fat contains 9 kcalories, it's a gram of pure fat. Animal fat is about 13-15% water (including humans). So that's why the math of 3500 kcalories in a pound of body fat comes out to 7.7 kcal per gram.

3) STIR MRI sequences are really interesting. They use an inverse field for the 180 degree plane, leading to nice, high contrast issues (T1 and T2 echo contrasts are additive). Since the signal passes through null before swinging positive, they can add a delay corresponding to the type of tissue they want to be invisible (aka 160-180ms to make fat invisible). This helps the clarity. On the flip side, there is a little more noise, and some of the T2 weighted details get clobbered (ie, disc jelly, and other watery things). Also, the higher energy in the 180 pulse causes increased tissue heating. (I felt this during my STIR sequence as 10-15 degrees of warming on my forearms.)

4) It seems that the most detail on a spinal MRI is found in the T2 weighted images. This means a longer delay for picking up the echoes. This means some of the brighter echoes have already passed, allowing the visualization of lower-signal tissues. The drawback is lower contrast, since some of the faster echo signals have decayed substantially. This is the only image type that shows the disc jelly that has extruded past the bulged disc edge. The jelly shows as very dark, almost black, because it has very high water content.

Whiling away time...
Josh 2004 Happy
I have a lot of spare time, where about all I can do is read on my phone. I have a little bit of computer time, but it's really not convenient or comfortable. I try to save it for things I cannot do on the phone screen.

Much of what I've been doing is more review on medical studies, etc. There's a whole lot of science backed info on the mechanics of this, and statistics of progression, etc.

1) There are very few patches to the annular tear that actually have a clinical benefit. There is one that's a mesh, and one that's a Gel, that actually have some long-term benefit. I want to find out if any were used.

2) Healing of the fissure takes 3-4 months. The key is to stay mobile to prevent pain, but to be cautious and not re-herniate.

3) Statistically speaking, a quarter of people with a wide fissure will re-herniate.

4) The disc will never be "back to normal". Even accounting for the loss of nucleus pulpus, age wears on discs. The REAL wear factor is compressive loads. Discs only handle X amount of axial loading, and their layers begin failing. The collagen fibers break, and never go back to as good as before.

5) there's actually a ligament between the disc and the spinal canal. A rupture like this not only tears through the disc, but through that ligament. IE, really high loads.

So, this means my long term prognosis is really based on how much load I put on the disc, and really, all of my discs. During healing, twisting and bending is restricted. Aside from that, I think my days of heavy lifting are over. ALSO, I absolutely must lose more weight. I always have an "I don't wanna" mentality. Whatever. I need to suck it up and take care of the, lest I be crippled for too many years at the end of my life.

That's my challenge. To stay motivated, to stay hopeful, and make no excuses. The injury itself has given me a kickstart - I'm back down to my 2014 weight. I'm starting back on calorie tracking as well. I need to stick with a lot of crunchy veggies. I'm probably going to be eating a lot of grilled chicken salads and grilled veggies, forever. Permanently. Real portions. Let's say I got an 8oz steak? Well, that's fine, but that's 2-3 servings of meat. etc.etc

Surgery wound looks good
Josh 2004 Happy
We changed my Silverlon dressing today. Really not as bad as it could have been. No inflammation. Shaved areas are itchy. There are little 1cm strips of strapping tape (steri-strips) across the incision, which is about 1.5-2" long. They are still holding fast. There are a couple of suture threads taped down on the edges. Sutures should start coming loose in a couple days.

It FEELS like a little extrudate is still in there, or in there again. It was a broad based extrusion, so it's entirely likely that is the case. It's definitely manageable, and normal healing should be able to take care of it. It's just annoying.

I think I will post photos in a few mins at the bottom of

Updated my work peeps
Josh 2004 Happy
Tired and back is weak, but already starting to back off pain pills very slowly.

Leg pain is very minor if any. I do not feel it, but I'm on a lot of pain meds.

About 10% of toe numbness left, and about 80% leg strength back.

Low back is angry, but lying in bed is okay. Getting up, I have about 6 mins to make it up and back down before the nausea wins (ie, huge pain physiologically, but pain meds turn it into a strong pressure). That will need to abate before much work, which I guess is around 10 days.

Have Dr and PT checkups tomorrow before discharge, but all the gross stuff looks great. Probably out of here around lunch time.

Back to sleep I go!

Tired after surgery
Josh 2004 Happy
Everything went well. Dr. Guyer will have photos for me tomorrow. Olympic sized fragments. No complications. 1.75 hrs in surgery and no mechanical complications.

Leg/butt pain is gone. Faint numbness in the big toe, but that was the first distal part, so will be last to fully resolve.

Some ache in my hips from lying in them for days, but not bad.

Phlegm from breathing tube. Some irritation from cough/clear, and also from throwing up while under.

Back muscles are very tight (rightly so) and some pain there. If I am still, pain is 2-4. Coughing is 4-5. Have a morphine button, and should use it more than I am. It's climbing a bit, so I am trying to keep up with the pump.

My apnea is troubling me for the first time in a while. Fall asleep and my O2 goes down to 85. Then it beeps at me, and I wale. So sleepy!

Had a big meal at 5pm and am still stuffed: Cod, wilted spinach, blanched tomatoes, pilaf, juice.

Definitely tired, what with only 3H sleep (pain last night) and surgery.

Jenn and Erica have headed home for the night. I feel really loved and content. Thanks to all for the thoughts, light and prayers.

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