What a pain in my Back – Surgery in Costa Rica

Written by Michael Simons on . Posted in Costa Rica Living, Costa Rica Medical Care, Newsletters

Tank Tops Flip Flops Newsletter edition no. 68

Surgery in Costa Rica

“Life is not a journey to the grave with the intention of arriving safely in a pretty and preserved body, but rather to skid in broadside, thoroughly used up, totally worn out, and loudly proclaiming, ‘Wow… what a ride!!!!!” Can I get a Tequila Sunrise please?

Costa Rica FAQ's

The first time you jump out of a perfectly good airplane, it is a very daunting task. Anyone who tells you they were not scared is a liar. When that door slides open, and you see the ground from 13,000 feet, your breathing becomes challenged, your mind goes blank. As you plummet toward earth at a terminal velocity speed of 124 mph, your blood flowing, your heart pounding, all other issues in your life seem to melt away; the only concern you have is whether or not your parachute will actually open. After what seems like the longest minute of your life, the canopy deploys above you, as you come to a screeching halt, and you can actually enjoy the scenery as you gently float to earth. The second my feet touched the ground, the first words out of my mouth were “Let’s do it again!”

Back Surgery Costa Rica

As you become more proficient at this sport, you can obtain speeds of almost 200 mph, barreling along like a NASCAR racer.  They say that the trauma to your body for each successful flight is similar to a small car accident, as the deceleration of the parachute opening, creates 3 to 4g pressure on your spine, as you slam on the brakes down to 15 mph. The most dangerous part of the entire ride is when you finally touch down, as one small mistake can face plant you into the dirt. In my life, I experienced 86 small collisions like this over a period of a few years, and a couple real fender benders as well.

“I will pay you $50” someone once said to me, “if you jump off that glacier.” I will do it for free, I replied, if you take my picture for me. As my best friend Brad always says, “We were extreme skiers back when they just called us stupid.” Now these guys are famous and even have their own Olympics, the X Games.  The second time I ever went skiing, my buddies told me “you don’t need a lesson, come with us; we will teach you.” They proceeded to lead me to the top of the most difficult run at Vail, a Double Black Diamond, only for professionals and experts. “Good luck” they hollered as they left me to fend for myself. Boy, friends are great, aren’t they?  Of course I figured it out, as I am here to tell you about it, and that just led me to push myself further and faster, every time we went. As expected, the more intense you ski, the harder you crash, and I can honestly say I had a few dozen “yard sales” over the course of my life, coming face to face with a tree one time.

extreme skiing

When I was in my 20s, I fulfilled my adrenaline addiction, by racing boats, sometimes to the tune of over 90 mph. At those speeds, you are not actually touching the water, but rather 6 to 18 inches above the chop, with just the propeller below the surface driving the hull. The force is unimaginable, as you hammer up and down in your seat, holding on to the steering wheel for dear life. One mistake and its game over, but the rush is beyond description. Sometimes, after an especially long weekend, it might take me an hour or so just to straighten out and stand up tall, as your lower back is compressed like a waffle in the iron.

speed boating

I have white water rafted some of the toughest rivers God has created, bungee jumped off incredibly high bridges and rode most of the fastest and more violent roller coasters man has ever built. I have horseback rode, jet skied, snow mobile and 4 wheeled drives; zip line, rappelling, and motor cross, even crashing a bike once; knocking myself out for an hour. Everything I ever did or played, I had little regard for my safety or my body, whether it was football or tennis, and when it was baseball, I played it like Pete Rose; and don’t forget, I was a rock n roller too; try jumping off a 10 foot speaker riser every single night.

I fell out of trees, slipped off of roofs, upended my bicycle doing wheelies; skate boarded and roller blade, played ice hockey on a frozen lake and jumped from the top of cliffs; you name it; if it was stupid or dangerous, I did it.

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So when Dr. Huertas asked me if I could think of any one particular event that might have caused my visit to his office, I just smiled; “Nope. Nothing comes to mind Doc. I have lived a very calm and tranquil life; Church on Sundays; that’s it.”

If I am a camel, then this was my straw; as I actually got a herniated disc washing my dogs. It was 7 years ago, and I had just gotten back from the beach. I was in the process of taking one of my fur children off the chain, and putting it on another, when they each decided to pull in opposite directions. “POP” I heard, like a gun shot went off, and I fell to the ground, screaming, as it felt like a hot metal poker was stuck into my lower back. The agony was unlike anything I had ever experienced, and trust me when I tell you; I have a very high tolerance for pain. I immediately called my client Bill, who had become a very good friend. He was one of my very first sales as a real estate agent in Costa Rica 12 years ago, and has returned every year since. He brought the first MRI machine to Pura Vida land, and is the owner of one of the top spinal clinics in the United States of America. He is Mr. Back Doctor.

“There is only one person you want to see Michael. He is the best surgeon in Latin America, and he works at CIMA hospital in San Jose. His name is Dr. Eduardo Huertas.”

After a long consultation, I have to say I was very impressed. He told me that the last thing we wanted to perform was surgery, and that with proper physical therapy, stretching and exercise, I could stay out of the operating room for at least a few more years. But he was also very honest with me, telling me that it was almost a guarantee that I would be back.  “You are probably not going to do all the things you are supposed to do” he told me, “and you are way too active to heal this on your own.”  He went on to tell me that I most likely wasn’t going to do Yoga every single day for an hour, nor swim in the pool for another. I would probably not rest and relax and take some time off, stretch every morning before rushing out the door, nor avoid activities that put compression on my back: Like bouncing up and down in my pickup truck 8 hours a day, selling condos and land, or flying around in airplanes to sporting events and concerts (how did he know me so well?). Your discs act like shock absorbers in a car, and they look very much like a scallop. They are what cushion the vertebrae so that they don’t slam into each other, causing damage to the nerve. After all this time, my disc is actually completely destroyed, and the vertebrae are grinding into each other, inflicting a constant chronic pain that has finally gotten me to the end of my rope. After years of eating Ibuprofen like they were skittles, wearing ice packs under my belt as part of my daily attire and smelling more like Ben Gay than Ralph Lauren, I finally threw in the towel; Back to CIMA I went.

Michael Simons Spine 2

So when I walked into his office last month, he knew the time had come. “You made it two years longer than I thought you would” he commented, and he went on to explain the procedure he was going to perform. It is called an XLIF (Extreme Lateral Interbody Fusion) with a Minimally Invasive Spinal Surgery (MISS). This means they will enter from the side of my body, not from my back. The problem with surgery in the old days is that they had to cut the muscles in your lower back to get to the designated area. This is what causes so much pain and discomfort afterwards, as the scar tissues keeps healing and tearing, over and over, and many times limits movement for the rest of an individual’s life. They will actually go in between the muscles for this event, not cutting or tearing them, to get to the lifeless disc. They will remove the injured pad and replace it with titanium NuVasive® implants, using neuromonitoring instruments and technology, to insure that none of my nerves are damaged or injured during the operation. When he showed me the equipment, I was completely blown away. It is like something out of Star Trek, with cameras and sensors, monitors and alarms. It is truly STATE OF THE ART. The entire ordeal will only be a couple of hours long, and I will be allowed to go home the next afternoon. He also told me that I would be walking the same day as the surgery, and that I would never feel better in my life.  

I chuckled when people found out about my plans and asked if I was going back to North America to get it done. The last place on this planet I want to have an operation is in the United States of America, no disrespect to my medical friends out there. But all I hear about, on 60 Minutes or 20/20 every week are the problems with understaffed emergency rooms and over worked Doctors. It seems someone is always contracting some virus or staph infection, or filing some mal practice law suit, because the wrong kidney or lung was removed. NO THANKS.  Costa Rica medical care is some of the best in the world, and thousands of people fly here every year for all kinds of procedures. From knee replacements to Lasik, cosmetic surgery to dental work; and the costs are substantially less than back home, but for this operation, I didn’t have to pay a cent nor a Costa Rica Colon.

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You see as a Permanent Resident of Costa Rica, I am entitled to FREE health care under the CAJA system. Also, because I no longer live in the law suit capital of the world, the USA, I can qualify for top of the line, private medical insurance through companies like Lloyds of London for a fraction of what Blue Cross Blue Shield of Florida used to cost me. I pay less for my annual policy than I did for 2 months of coverage back in Boca Raton. I submitted my claim, and within a matter of a few days, the entire procedure was approved, and I don’t have to fork over one single penny out of pocket. Tell me again, why would I want to go back? Never; this is home now.

I arrived at CIMA hospital at 5 am the day of my event, and they whisked me into the Pre-Op room where they had my strip down naked and put on one of those horribly embarrassing gowns, that you have to somehow figure out how to tie behind your back. The first nurse came over to see me, with her check list in her hand.

Did you eat in the last 12 hours? NO

Any allergies to medicines? NO

Pre existing family conditions? NO

Do you have a cold? NO

Are you taking any prescription medicines? NO

Do you smoke? NO

Do you take or use drugs? NO

Do you drink?

Hmmmmmm. Now, this one stumped me? I obviously can’t lie and tell them I don’t drink, but I surely can’t tell them the truth either. Can you imagine what this innocent young girl would have thought if it said “oh yeah, I drink like a fish. Bloody Mary’s for breakfast; Beers for lunch; Happy Hour cocktails; Sunset Mojitos; and then we get really serious over dinner; nothing like a good bottle of Merlot and then some Gran Marnier with dessert.” So I did what everyone does and answered TWO. A couple Pilsens a day, I told her, just to wind down. She wrote it on her pad, smiled and pulled the curtain shut on my bed. The funny thing about these hospital screens is no matter how hard the nurses try, they never completely close. There is always 3 to 6 inches left open, just enough, so that anyone walking by (and there are dozens of people) can peek in and check you out. EVERY SINGLE PERSON that walked past my bed took a look. You really start to get a little self-conscious wondering if the word has been passed around: the blonde haired dude in bed 8 has his junk hanging out LOL.

A few minutes later, another nice young lady came to see me. She took my vitals; temperature, blood pressure, heart rate; and then proceeded to prick my arm and insert a tube into my vein, and hooked me up to an IV. This is just an antibiotic and a little something to calm you down and help you to relax. Yummy I thought; finally some of the good stuff. She then asked me the same series of questions, and I answered, ending with “just a couple beers at the end of a hard day’s work.” This reminded me of high school and a Defensive Driving Class I had to take one time to get out of a ticket. The State Trooper teaching it, told us all, that every drunk driver, when asked by a police officer “Have you been drinking tonight?” always answers the same thing; TWO, right before they fall out of the car and vomit on the cop’s shoe.

About 15 more minutes went by, and the head nurse came to see me. She informed me she would be with me the entire time during surgery, and that everything was going to go fine. I love how they constantly reassure you that you aren’t going to die that day. She checked my vitals again, and then, believe it or not, asked me the same damn 8 questions. I wanted to say something snappy like “why don’t you check out the last 2 clip boards and save us all a little time.”  But I had nothing else to do anyway, laying there half naked, and she was so nice, I didn’t have the heart. “Yup; I definitely drink.” I told her. “I mean, come on, I don’t want to sound like a lush, but I live in Guanacaste at the beach. Every day is a party and life is great.” The other two nurses heard that and started to smile. “Let’s go for margaritas” I said, and the room became a lot livelier. Obviously the drugs were starting to kick in and I was feeling pretty good.

My next visitor was my anesthesiologist, a very gentle man, who asked me if I would like to talk in English or Spanish. By the way, almost every single person at the hospital spoke English, from the administrators, to the MRI and X-ray technicians. Every nurse, orderly or physical therapist that I met during my 24 hours, was EXTRA warm and kind. They were some of the nicest, most caring people I have ever met in my life, and they went above and beyond the call of duty to make me feel at ease.  It was the best hospital experience I have ever had in my life. TRULY FIRST CLASS.

cima hospital

I told the man, that since he was going to be pumping me full of narcotics and basically sending me into a coma, I would prefer if we spoke in English, just to make me feel a little less anxious. He went on to explain exactly what he was going to do, how he would watch over me, and all the safety precautions they had in place. He then, you guessed it, went through the same series of questions.

NO NO NO NO NO NO and NO. When he got to the $64,000 question all three nurses, literally in harmony answered for me; “of course he drinks. He lives in Guanacaste!!!!!! Fiestas!! Topes!! Rodeos!! Pura Vida!!!!!!” and we all burst out laughing. God I LOVE COSTA RICA, everyone parties!!!

My last visitor before surgery was Dr. Huertas himself. When he came into my tent, I think I blurted something out like “YES I DRINK, OK? It’s the only thing that has kept me from being a serial killer all these years, wiping out the stupid people that I meet.” The drugs were really rocking now, and he just chuckled and sat down beside me. All serious though, this is one fantastic Neurosurgeon. When I told him that I had 8 dogs, he told me he had 12. It turns out he is only 4 days younger than me, and has had 3 of these implants put in him, by our mutual friend Dr. Bill. He even performed this surgery on his wife, and she was running around like nothing happened a couple weeks after it was over. That blew me away. I remember my old girlfriend once yelled at me because I couldn’t properly zip up the back of her dress; she wouldn’t even let me trim her bangs for fear I might chop off her ear, let alone carving up her spine. Their marriage is the true definition of a TRUSTING relationship. He told me he had done hundreds of these and never had a single issue. “I don’t want to tell you Mike, how easy it is, because it is back surgery; but really, this is a piece of cake.” Unbelievable huh? Think about it. He is going to enter my side, just below my ribs. Go in and around half a dozen vital organs, and between who knows how many muscles; pull out a disc the size of a quarter and replace it with a titanium version, a metal plate and two screws. All while looking through a camera and microscope millimeters from my nerves and my spinal cord; one mistake and I could be paralyzed for life. Yeah; just a walk in the park; I have a hard time hanging a picture or doing a jig saw puzzle for God’s sake; I cut my finger opening a milk carton, and bump my head getting into my truck. I was definitely not put on this earth to be a surgeon.

At 6:55 AM I was wheeled into an operating room that looked something like a space ship. All of the crew was there, and they we so friendly and reassuring. The anesthesiologist approached me with something in his hand, grabbed my IV tube and said “This will just make you feel…………………….”






The next thing I know I am being wheeled out of Post-OP on a gurney and into my private room. It is about 3 PM and I am surrounded by about half a dozen nurses. Again, I cannot begin to tell you how caring and attentive everyone was. They brought me some Apple Juice, made sure I was comfortable and left me to relax. Shortly thereafter, Dr. Huertas arrived glowing like a light. “It was a huge success! Everything went perfect, not a single problem. The whole ordeal was 2.5 hours, and you were an excellent patient. But man do you have some tough bones! I had to really work to get those screws in there.” I knew I was always hard headed, but I guess I am hard boned too!!! He explained that when they started this expedition, my spine had a 26 degree scoliosis curve from the radicular entrapment (the damage done by the herniated disc) and now my alignment was less than 1%. In other words, my spine was almost perfectly straight. He also told me that he used one of the largest discs that they make, so I guess I am about a half an inch taller than when I woke up that morning.

Michael Simons Spine

“No rest for the wicked” he said, and I was on my feet. Two of the most adorable Physical Therapists arrived and we went for a small walk. Now remember, it has only been 7 hours since someone was playing can opener on my spine, and here I am trucking around the hospital floor and doing pretty well, if I say so myself. Of course, at that exact moment, the singular sexiest nurse you have ever seen came by to visit me. Ticas are famous for their amazing looks, hottest women on the planet, but this one was right out of a Victoria Secret Runway show. Here I am with my ass hanging out, looking like a zombie from a horror movie, dopey and drugged out of my mind, lips crusted from dry mouth, hair going every which way, eyes glazed like a donut and I am walking like a duck needing two people to hold me up; Just my luck huh? I look like a real catch!

Truthfully, I had almost no pain that first night and checked out of the hospital the next day around noon. I spent the next evening at a condo in the city, and it was a completely different experience. I felt like I got hit by a train, every single bone in my body hurt. Every time I moved an inch, it felt like an electric shock jolting through my eyes, and it was a very long and painful night. It was then that I realized how important that little black bag was, that was hanging around my neck back at the hospital; can you say “Morphine drip.” But by morning, I was truly feeling like a new man, and we drove back to Guanacaste that day. Dr. Huertas had given me specific instructions for my recovery, and I was determined to obey. “Walk as much as you possibly can” he said, don’t sit around. “When you aren’t walking, I want you resting and relaxing.” He gave me a special diet designed by a nutritionist that included lots of fruit and an Anti-Inflammatory menu, and urged me to just take it easy for a couple of weeks.”  So here I am, floating in my pool on a raft, drinking smoothies, soaking up the sun, watching hockey and cranking rock n roll. If I would have known Physical Therapy and Rehab was going to be this much fun, I would have done this sucker years ago. I can honestly say that after a few days, I am almost completely pain free. I can move around and walk, and other than some minor stiffness and aches, I feel closer to 100% than ever before. I haven’t felt this good in 20 years.

our commitment at cima san jose people

Anyway, I have to go take my dogs for a walk and then back to my raft. After all; Doctors orders. This will be the first time in my life that I actually do exactly as I am told. Pura Vida.

Take care, hope to see you soon.


P.S. I do want to share something with you that touched me deeply. I read an inspiring book this week, while recovering, called FEARLESS. Written by Eric Blehm, it is about an amazing individual named Adam Brown. This is not your normal book about a Navy Seal and their ultimate sacrifice for our freedoms, but a story of a man of extremes, whose courage and determination are unlike anything you have ever heard. I enjoy reading about extraordinary people like Chief Brown, because it puts in to perspective how recovering from a small back surgery is nothing compared to the obstacles that he had to overcome to persevere.  I encourage you all to buy this book and read it. It will make a huge impact on your life, I promise.

I want to thank all the nurses and staff at CIMA hospital in Escazu Costa Rica, for their unwavering commitment to my recovery and especially to Dr. Huertas and his team for doing such an outstanding job. You are true professionals.  Most importantly, I want to thank my special friend Flory, who was my private nurse through my entire recovery. Thanks for putting up with my grumpiness, you are the best!!!!

My next sport: Base Jumping. Stay tuned.

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