Coccygectomy July 15, 2010

Doreen - stoeps5@sympatico.ca

Posted 2010-07-25

Hello, my name is Doreen and I am now 9 days post-op. Here is my story...

In January, 2006, I injured my tailbone at work by accidentally missing the seat of my chair, and landing heavily on the metal armrest instead. I immediately felt a very sharp pain, which felt like a shock throughout my body, almost like when you hit your elbow "funny bone" I continued to sit, though, but as the day progressed the pain became much worse, and it was really difficult to drive home as I had to sit on one butt cheek. The pain continued to worsen, and became a generalized burning pain. I could only stand, although this still hurt, or perch on the edge of my seat. Rolling over in bed was terrible. I started to do some research, and by reading through the info on the t-bones web-site, I figured I had probably broken my coccyx. I went to see my doctor a few days later, and as there is not much to be done for a broken tailbone, other than wait for healing, we decided not to do x-rays, and she just prescribed pain meds and I proceeded to wait for healing to take place. For about six weeks after the injury, I would sit very gingerly, find a good position, and try not to move. But if I did move, I could feel a popping sensation in my butt, almost like a knuckle cracking. After about six weeks, this sensation was gone, and the acute pain was gone, but I still became uncomfortable sitting longer than about 20 minutes. I went back to my doctor after about six months, and we decided to do x-rays and MRI to determine why I still had pain. Both reports came back normal. Exactly one year after the injury, when I still had discomfort, I decided to see a chiropractor. I had never been to one before, but I was desperate, and I figured they deal with backs, and this was related to my back. Before beginning treatment, the chiropractor wanted to see the actual x-ray and MRI films, not just the report. And she was able to show me the source of my ongoing pain, the bottom piece of my tailbone was positioned posteriorly! I just cried when she showed me, I was beginning to think I was nuts! I started treatment with her, but she was pretty much just treating the secondary symptoms such as general back pain from sitting wrong, as the original injury was too long ago to be able to fix that.

Thereafter, I began my battles with the "knowledgeable, respectable medical community", whose opinions people at workman's comp. are looking for. One "helpful" doctor, after a complete and thorough physical that did not include looking at the x-rays I had with me, just the report, told me that the pain was "in my head". She prescribed heavy-duty anti-inflammatory pain medication, and physiotherapy, and cortisone injections. I did the pain meds for two days, then stopped because of terrible side effects. I also saw a physiotherapist, but they were at a loss as to what they could do for me, not much more than teaching me core-strengthening exercises. I went back to the radiologist at the hospital to challenge him about the incomplete x-ray report, even went as far as reporting him to the College of Physicians and Surgeons, who did not think he had done anything wrong. I called several orthopedic surgeons in my area, they were either not accepting new patients, or they did not deal with this type of situation. I found a spinal clinic at one of the hospitals in Toronto, and thought they might be able to help, but reading through their website, for them the spine ends at the lumbar region.

I found a surgeon at the hospital at which I am a nurse, and although he is an orthopedic surgeon, he had no interest in seeing the x-rays I had with me, he was just going by the report he had (which said the coccyx was normal). Despite this, though, he felt he knew enough about my situation to suggest conservative treatments such as pain meds, physiotherapy which this time included laser treatments, and cortisone injections. I asked him about doing the injections with x-ray guidance, he said that was not necessary. I left his office again deflated, and thinking that no-one is taking this seriously. I did do the laser therapy, though, with no real change in the situation. (as I understand this is a soft-tissue treatment, and my issue was related to the bone). I continued to live with the discomfort, and fortunately my pain was not constant. It began after a time of sitting, and as soon as I changed position or got up, the pain was gone too. Shortly thereafter, as I was reading through the personal experiences on this website, I read Shelley's story, who had had her surgery done by another doctor at the same hospital as I work at, who I knew quite well, but hadn't been my first choice mainly because I thought he was close to retirement. What struck me in her story was that he wanted to see her x-rays! I was able to get a consult with him (Dr. R. Carbin [as of 2012, Dr Carbin is no longer carrying out surgery]) quite quickly, and when I commented on the fact that he wanted to see actual x-rays, he said it was the old orthopedic surgeon in him. He agreed that the appearance of my tailbone was unusual, and could be the cause of the pain I was experiencing. He did not want to progress straight to surgery, though, and suggested a cortisone injection. I agreed to let him do this, since he was the only one who had bothered to look at the x-rays. The injection really hurt, and although I didn't think it was very effective, looking back I do think I had some partial relief for about six months, when I went back for another one. Early this year, when the second injection had worn off, I experienced a crisis in my back, which started in the tailbone, and moved into the SI joints, and caused ongoing back spasms for about a month, finally improved with naprosyn and flexeril. At this point I knew I had to do something, so I called for a F/U with the surgeon. We discussed my options, basically continue as I have been, try another cortisone injection, or have surgery. I made the decision to have surgery, and was able to get a date fairly quickly. Then I began to fret and worry, and think about the what-ifs. (as a nurse, I know too much about what can go wrong, as well as my co-workers and my chiropractor were finding it unbelievable that I was considering such a drastic treatment.)

My surgery was on July 15, at 12:30. One stupid thought that kept going through my head was the fact that my co-workers would be seeing me in such an undignified position on the OR table. Who cares!?! I was recovering by 1:15, and admitted for the overnight stay at 3:00. I was lying on my back this whole time, and well-medicated. Unlike Shelley, (in Shelley's story, she was awake for the surgery, I chose to be asleep). I didn't have supper that day, was feeling nauseated, but I was drinking. I was able to get up to the bathroom on my own, and although it was difficult to start peeing, it appeared that all the nerves were intact in that department. I took morphine every couple of hours through the night, and by morning started to take percocet in preparation for going home. I was fairly comfortable, only rolling over in bed and getting in and out of bed was uncomfortable. I walked out of the hospital with minimal difficulty, supported by my husband. On the way home I laid on the back seat, on my side. Getting out of the car was a little more difficult than getting in. I spent a fair amount of time that day lying down, but also standing. I ate a normal supper, and did the dishes after. I went for a short walk that evening. In the following days I was able to decrease the pain meds to tylenol Xstrength, or ibuprofen 400mg, with a tylenol #3 one or two times/24 hours. I chose not to use the percocet, as it made me feel too dizzy and sleepy. I was able to resume most of my standing activities, including cooking, dusting, hanging the laundry, and mopping the floors within the first week post-op. I could sit for short periods perched on the edge of a chair. I avoided getting into a car until the appointment with the surgeon 1 week after surgery.

I apologize for the length of this story, but I wanted to make sure I included most of the important details. I had my follow-up app't with the surgeon July 23, and he said he had never seen anything like it(my tailbone), and he had called all the nurses in the OR over to have a look. He called it a mal-union of a fracture, basically the tip broke off, floated around for awhile, and reattached in the wrong position. It was more than 90 degrees out of it's normal position. He said I had been sitting on a point all these years! (which I knew, of course). He also felt that I had been patient with this for far too long. I said I had tried to get help, but all the doctors I saw did not look at the x-rays, just relied on the incomplete x-ray report. He acknowledged that that is a problem, and why he always looks at the x-rays himself.

I would encourage everyone who is convinced that something is wrong, to keep searching for a competent HCP that can find what it is. Even though it is difficult to be optimistic each time you leave another office with no answers, don't give up. As I kept telling myself, this is my body, and I have had it for 50 years, and I know when something is not right with it. I really worried about the surgery, and how awful it would be, and I was very fortunate that it wasn't too bad. Not much pain, and very rapidly back to activities as tolerated, except sitting, of course. I am avoiding driving as long as I can, and will be off work for about 1 month. Some other details about me are that I am 50 yrs. old, 5'10" (177cm), and weigh about 150lbs. I am fairly active, but by no means a fitness freak, I hate exercise! To prepare for the surgery I took some of the helpful tips from this website, including getting a raised toilet seat, and buying some dresses and loose fitting pants to wear afterwards. I started stool softeners a couple of days in advance, as well as probiotics since I knew I would be getting antibiotics. I also take much more Vit.D than the RDA (which is 400iu, I take about 3,000iu), as well as calcium/magnesium supplements, to ensure quick healing. My incision is mid-line, about 6cm. long. It has dissolving stitches, and some external tape-like stitches (steri-strips). The surgeon told me yesterday I could start showering/bathing. (sponge-baths up until now)

I hope that my story is helpful to others out there who are considering surgery. I am so thankful for all the information I got from this website, which gave me the ability to challenge what some of the HCPs were telling me. I would be happy to answer any questions.

Doreen

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