While Joffrey Lupul may not be a top level player according to KHL standards, he’s a top badass according to Quiet Room standards. He didn’t meet their criteria for national or Olympic experience, isn’t a Stanley Cup winner, hasn’t won anything at the NHL awards banquet (seriously, THAT qualifies you to play in the KHL?), and couldn’t even make it based on number of games played having missed most of 2009-10 and a healthy chunk of 2010-11 with a back injury.
The back injury is exactly the reason Joffrey Lupul is Tougher Than You ™. What began as back spasms toward the end of 2009-10 Ducks’ training camp evolved into pain and numbness in his right leg, loss of power, and eventually injections in attempts to calm the symptoms. Lupul missed several games at the end of November, and after consulting specialists and having an MRI it became clear that the problem – a herniated disc in his back – wasn’t going to solve itself.
Okay, so what’s a disc and how do you herniate it?
Your spine is a column of little round bones (the vertebrae) that are stacked on top of one another. They’re separated by discs, which are tough rings of cartilage with a soft center. Their job is to allow the spine to be mobile, to cushion the vertebrae (banging two bones together is a bad idea), and to hurt like a bitch when they get out of whack. Disc injuries happen because of injuries, aging, or because you did something dumb – generally consisting of lifting something too heavy, or lifting something not too heavy in a spectacularly stupid way.
Usually you’ll start out with a bulging disc. The stiff outer cartilage pokes out from between the vertebrae and presses on the spine itself or the spinal nerves (the big nerves that run from the spine out to the rest of the body). A leg will go numb or hurt like crap pretty quickly once a big lump of cartilage decides to sit on its nerve supply. A bulge can progress to a herniation, where the disc self-destructs, and the stiff outer cartilage completely gives up and barfs out its softer jelly-like insides. While a little pressure from a bulge is bad, a lot of pressure from a herniation is excruciating. Most people can get their cruddy disc under control with steroids, physical therapy, and not being stupid when they lift things. A few unlucky souls will find themselves in need of a surgical fix. Joffrey Lupul was one of those unlucky souls.
December 17, 2009 – Lupul undergoes a microdiscectomy
A microdiscectomy is a fancy bit of surgical wizardry usually done by a neurosurgeon (reminder: they train approximately forever to do what they do). They make a tiny incision in the back, tunnel down through the muscle, and using microsurgical techniques (we’re talking fancy microscopes, people) they’ll remove a tiny piece of bone to access the bits of the disc that are pressing on nerves. They snip out the offending disc chunks, leaving the remainder of the disc in place. This relieves pressure and generally solves the leg pain or numbness that led the patient to the OR in the first place. Because the surgery is so minimally invasive compared to the traditional “open it up and hack out all the bad bits” approach, and doesn’t require taking out a big chunk of the vertebrae to access the area of interest, generally you’re up and walking in a day or two, starting physical therapy in a week or two, and back to full activity in six to eight weeks.
Early January, 2010 – More surgery? More surgery.
A few weeks post-op Lupul’s back was still hurting. While that’s to be expected with the old hack-and-slash approach, microdiscectomy patients usually have almost immediate symptom relief. When a follow-up MRI showed that there was still disc debris in the area of the original procedure, a second surgery was performed to clean it out. What should have been the end of Lupul’s back issues turned out to be the beginning of months of IV antibiotics, misery, and what many thought would be the end of his career.
February, 2010 – the first of the heinous infections
Blood infections are really bad. Bone infections are basically horrible. Lupul dabbled in both of them. He developed a bone infection (osteomyelitis) at the surgical site. Vertebral osteomyelitis (you can call it osteo if you want to sound extra cool and all medical-fancy) is generally diagnosed with a combination of imaging, needle biopsy (seriously) and blood cultures, because if your bone is infected, generally your blood is too (that’s called bacteremia, and it’s also the pits). Cultures will allow you to identify the offending bacteria (in his case Staphylococcus aureus, well known to be a complete asshole) and pick the most effective antibiotics. The problem with osteo is it’s IN THE FRIGGING BONE, so you have to treat it with very strong antibiotics for a very long time. In Lupul’s case, it meant two months of IV antibiotics. How do you get IV antibiotics at home? Through a PICC line (peripherally inserted central catheter), which is a nice way of saying a great big gigantic IV that goes in your arm and ends somewhere near your heart and stays in for a really long time. Sound awful? It is. It’s not painful once it’s in, but it doesn’t feel great going in (it’s BIG), and then you’ve got a hose hanging out of your arm for a few months.
You learn to inject your own antibiotics, and you do so once, twice, maybe three times a day for six to eight weeks. And in the meantime you lie in bed because it hurts too much to move.
Spring/Summer 2010 – Lupul feels pretty okay (but not really)
After the antibiotics, everyone thought that once again the back issues were over. People thought Lupul was on track to start the 2010-2011 season. He was working out and doing therapy, but he was also still in pain. In late July things went from tolerably bad to completely terrible. More bloodwork, and more bad news. He had a high white blood cell count, a sign of infection. And of course it was the same butthead infection, back again for another round of IV antibiotics and to shut down any hopes of starting the season. Two more months of IV antibiotics, lying in bed, and hurting. Losing weight, not training, not skating, and thinking that was it for his NHL career.
Early September 2010 – The long, slow road back
In late September Lupul pissed off the higher-ups in Anaheim when he tweeted that he’d been cleared to skate. He was actually cleared to start working out, but by November he really was skating, and feeling good. On December 5, 2010, almost a full year later, Lupul was back in the NHL.
Recap – Sick as snot, surgery, surgery, antibiotics, antibiotics. BADASS.
As if recovering from an infection in his spine (HIS SPINE!!!1!!!) weren’t enough, Lupul recovered, went back to playing NHL hockey, and got better at it. He rehabbed with the Syracuse Crunch for all of three games before he returned to Anaheim. After only two months back he was traded to the Maple Leafs, still taking prophylactic antibiotics to prevent recurrence of the infection. Plenty of Toronto fans questioned the decision to take a chance on someone who hadn’t played for a year, and whose health was still up in the air. Doubts disappeared in a hurry with a 2011-2012 season nobody expected – 26th in the league in points, assistant captain at the all-star game, and handling a hostile crowd in Ottawa like it was a spine full of staph aureus. Better, actually.
Joffrey Lupul: Official badass, officially tougher than you.