Well, Screw That!

[Pcpete]

Get that fixed ASAP. I procrastinated with mine and it cost me a good share of my strength in my legs. I have a really good surgical team and physical terrorists, and am a repeat offender. My misspent youth is catching up with me, and yes, getting old is a bit#h.

 

[menzies]

Get that fixed ASAP. I procrastinated with mine and it cost me a good share of my strength in my legs. I have a really good surgical team and physical terrorists, and am a repeat offender. My misspent youth is catching up with me, and yes, getting old is a bit#h.

Pete, that was my concern. I was worried that with nerve damage I would lose muscle. But that what the EMT was for. They found no nerve loss at all. So we decided to go with the injection rather than an op for now.

If there had been signs of nerve damage then the operation may have been in the conversation.

 

[Kit_L]

But to your point, I did stop doing the P.S. stretches - so maybe I need to start those up again.

Please try the ones I linked to; they were developed at the Australian National University over almost 30 years, and were tested and re-tested on a huge, and moving sample (almost 25,000 people in all). If this is part of your problem, one or more of those exercises may help.

 

[BVL]

For what it's worth, I graduated from C.M.C.C. in 1970. Just the last month I attended to 4 x 50 yrs old people with sciatic pain with or with out back pain, 3 of the four with relief (not cure) in less than 4 visits = why not try your Chiropractor first? After all that is his/her training and practice for how ever many years they have practised. By all means make sure they take an x-ray, explain satisfactorily what and why they doing what they do...if not, get second opinion from another recommended Chiropractor. Then simply follow instructions to completion. Those that don't, generally get a less satisfactory result as with any other professional advice.
Confusion with other professions? Only when one says he does what the other does! Don't expect to get the best in Acupuncture from a white guy unless he/she speaks fluent mandarin, cantonese, japonese or perhaps malaysian.!
As to surgery (on which I am no expert), an interview with a surgeon in the new Zealand listener magazine with an orthopaedic surgeon who stated that he now did 12 surgeries per year instead of 12 a week, and spends the rest of his time talking people out of operations = gives the lie of the land. Yes, mandatory for a corda equina syndrome where you loose control of bowel or bladder and leg muscle function,
but perhaps risky for the rest.
As to disc protrusions, they are often found on MRI in asymtomatic patients (about 40% of the time) so what conclusions are to be drawn from that?
In closing, " look after what you've got, lest you wind up putting up with what you get!" Applies to all sorts of stuff including your car, your boat and your Spine....
Just my 10 cents/dime for what it's worth.
I will shortly be joined in my practice by a young practitioner whose 6 aunties and uncles as well as her father and grandfather are all Australian Drs of Chiropractic. The grandfather (an ex radiologist) took over my Canadian rooms with wife and 5 kids in tow. I might now have more time to go boating (I hope)....

 

[jimfrens]

BTDT with L4-L5 in 1999. First occurrence, got over it with PT / exercise. Second occurrence, that didn't work anymore. Bulging disc doesn't go away. A good ortho surgeon nipped off the bulge, left the rest of the disc which is somewhat collapsed but still there. The last 24 hours before the surgery, all I could do was lie on my stomach. Since the surgery, no issues. I do have to be careful how I lift things, no twisting at all.

 

[jimfrens]

p.s. I went to Chiropractor before going to ortho doctor. Chiro took some xrays and said "I can't help you, I'll make an appointment for you at the ortho doctor".

 

[BruceK]

Had the injection Friday 2/7.
.....The patient tolerated the procedure well and there were no apparent complications. After appropriate observation, the
patient was dismissed in good condition under their own power.

Good news,for you and the medico. As you explained re choice of procedure, correlating physical findings with radiology is important.
Been a while since I`m been in the daily thick of spinal injury case compensation litigation, but I recall the value of anti-inflammatory treatment, including steroid injection. In fact I had 2 of those myself,(without an image intensifier).
If some body part, nerve etc, is impinged upon I think it responds by becoming inflamed, then it gets impinged all the more,a snowball effect. So reducing inflammation is doubly helpful.
I hope the procedure brings you good relief.

 

[moparharn]

Some thoughts.

Why seek input here? I never felt quite as alone as I did in some of my “episodes”. The pain shuts down your body and your mind to the point where judgement becomes impaired. The drugs you take to help the pain also can also shut down your mind and impair your thinking. Sometimes talking to people can be very helpful in getting through these sorts of situations. Listen to people who care about you, but act on the supervision of a doctor. My preference is a neurosurgeon.

All back injuries heal themselves. The question is with what level of nerve damage.

The focal block is more of a diagnostic tool than an analgesic. For me, nothing works like a medrol dose pack. If you are not already on it you should inquire. Steroids are a powerful anti inflammatory. Nectar of the gods.

I still take 1-2 norco pills per week. Know yourself well before you use them.

Every day is one step closer to the end of this problem. Odds are, you will see it again.

 

[C5F]

I've had numerous problems with my back since 81'. Had a fusion and then a Laminectomy in 15' but No Joy. I now get injections in the top and bottom regions of my spine about every three months... a hassle (down for a day) but it works. If I'm going on a trip that requires walking, sitting on an airplane, etc I request a steroid pack (6,5,4,3,2,1). You cannot take these packs very often (probably once a year). This pack is really the answer for your trip and will help you out for approx. 3-4 months (everyone reacts differently). Hope this helps as I know your pain.

 

[Monk36]

Are taking a cruise to SA?
We are on March 15 sailing oh Seabourn Quest
Thought it would be a really small world if you are on the same cruise starting in Bueno’s Aires

 

[menzies]

Nope. Flying to Rio for Carnival. Then to the Amazon via Lima for four days, then to Machu Picchu, and Galapagos.

 

[BruceK]

Nope. Flying to Rio for Carnival. Then to the Amazon via Lima for four days, then to Machu Picchu, and Galapagos.

That`s a tad "courageous" in your condition, but it`s just envy, I`d like to see Carnivale.Pre arranged I guess, and you`re unlikely to be in coach on where there is something better. Hopefully the injection kicks in and you get to fully enjoy the trip.

 

[menzies]

That`s a tad "courageous" in your condition, but it`s just envy, I`d like to see Carnivale.Pre arranged I guess, and you`re unlikely to be in coach on where there is something better. Hopefully the injection kicks in and you get to fully enjoy the trip.

Yep, booked in September. I don't think I am bad enough to cancel. Plus you are correct. We are in Delta One, so can assume a position that does not hurt!

Feeling a bit better today, nearly sitting up at the dinner table. Hopefully by the two week mark on Friday I am dancing the Samba with the scantily clad ladies!

Plus we have a walking tour of the Rocinha Favela booked for Saturday - so I need to be able to run like hell if needs be!

 

[Insequent]

Be careful in Rio. Its a dangerous place. Always be with a local if possible, and heed their advice on what to wear, and avoid carrying any valuables. No phone if possible. One credit card, a few banknotes, that's it. No flashy watches or other jewelry. One of my staff guys was mugged strolling around a lake on a Sunday afternoon with his girlfriend, even having lived there for some time. He said its quite unpleasant to have a handgun shoved into your ribs.

Carnival is all about the extended get-together with friends. There is only so much samba-school parade-watching that you can do. I was at Carnival, at Copa Cabana, back in the late '90's for about 4 days. Enjoyable enough, but very much 'ticked that box' experience. The rest of your trip sounds fabulous.

I think you will be fine - the steroids give fairly slow but continuous improvement and you've got enough time to be in good shape for it all.

 

[menzies]

I told my Snr. Director who managed my LatAm team that I was going. His comments below!

* * *

If you don't mind me asking: are you going to Rio with a group or on your on? I'm asking as a Brazilian native -- and because personal safety is a serious matter in Rio. This is one reason I haven't been there in many years (also true for many of my Brazilian friends). In any event, please exercise caution and situational awareness at all times. Let me know if you'd like some more specific suggestions.

* * *
Indeed, my neck hair did go way up when I read about your plans for visiting a Favela (BTW: the latest and politically correct name is "community" -- nothing has changed, but many people believe that by calling it a different name those who live there will be better off).

If your city tour already includes sights such as Corcovado (Christ the Redeemer), Pao de Açucar (Sugar Loaf) and the Botanical Gardens, I don't think there's much left to add to the list.

In case you'd like to try one of Rio's famous and authentic bars (a.k.a. "barzinhos") I recommend JOBI, ASTOR, BRACARENSE or BELMONTE. If you're feeling particularly adventurous, ask your hotel Concierge for a trusted driver to take you to ARCOS DA LAPA. This is a busy night-scene with restaurants and bars located under the city's old aqueduct (ARCOS means Arches, while LAPA is the section of the city where they were built). You'll find a long, colorful, open-air stairwell connecting multiple bars, restaurants, night-clubs, etc.

One final note: when you go to Copacabana beach try to stay in front of your hotel. Most beach-front hotels have a security detail specialized in safekeeping their respective guests while these enjoy the beach in front of the property. If you decide to move right or left it will most likely translate into forfeiting that extra (and valuable) layer of protection.

Wishing you a safe and enjoyable trip!

 

[Insequent]

Sounds like CopaCabana has deteriorated a bit. We felt safe enough even if alone, although we were mostly a group of several guys. By the time I was visiting on a regular basis the beach gangs, who would simply start at one end and then strip all valuable from anyone and everyone who were on the beach at the time, were a thing of the past. Now more likely solo/pairs of guys with handguns, who can be fast and not draw much attention to themselves or what they are doing.

Regional/rural Brazil is a delight - but sounds like you are not doing that. The vast majority of Brazilians are friendly and helpful. Stay safe, be careful and enjoy.

 

[menzies]

An update on this.

First on the back issue.

They had injected the steroid into the L5-S1 in February as that is where they believed the left leg referral pain was being generated.

We went off to South America a few days later and the injection didn't help. I managed through it on the flights as I could stretch out, Also on the transfer and tour vehicles as I got a seat on the right with left leg outstretched on the aisles. Had some pain during the trip but it didn't detract much from the experience. The issue certainly wasn't resolved.

So when we got back I went and saw the surgeon at Mayo. He looked at the images and said he thought they injected in the wrong place. My other bulge was between L4 - L5. While he said the worst stenosis there was on the right side and I wasn't having pain on the right side he can see why they went elsewhere. However he felt that the the heavy stenosis was pushing everything left and squeezing the left nerve. He recommended another epidural at L4-L5. So we scheduled it.

The afternoon before my second procedure at the end of March they closed down all procedures because of COVID-19.

They opened back up last week and I was rescheduled for today. the doctor came into the cubicle and said that he had spoken to my surgeon and recommended a change in what the surgeon had written up. Instead of going in from the top he recommended going in laterally as the stenosis was pretty tight and he felt he could get a better result. OK said I.

Long story short, it was awful. He numbed me up. Told the nurse to prepare a six inch 22 gauge needle. And in he went. For any of you who had had this you can understand by the time he injected the numbing fluid and was in I was sweating on the table and trying not to bite my tongue.

He asked the nurse to move the X-Ray machine he was using a number of times and didn't sound happy. Then he withdrew the needle and I heard the dreaded words.

"Look we need to go in again and get a better position. Since we are here there is no sense in not getting it absolutely right."

F!

And so we did it all over again. I was a pretty miserable pup when I met my wife in the waiting room afterwards. She asked to look at the injection point band aids when we got home and declared, "he wasn't even close the first time!" I asked her to take a pic so I could see where he was! Pic below (I actually don't think he was that far off)

Anyway, feeling really good this evening. It could be the numbing not worn off yet - but hope springs eternal!

* * * *

Now to the comments above about Rio, we had a great time, but one incident spoiled it somewhat.

We were walking into the Sambadome for the parade when a small gang of kids rushed my wife, ripped off a necklace and one earring. I managed to quickly turn her into me and call for the police. They were there within seconds and grabbed a couple of the kids. Necklace and one earring long gone. Unfortunately we hadn't noticed until a couple of minutes later that they had also knocked off her glasses. This pretty much spoiled a lot of the parade for her, and us.

We actually felt MUCH safer when doing the walking tour of Rio's largest Favela.

Overall it was a good visit there apart from that, and the places we visited afterwards soon erased the bad memory. The Amazon and Galapagos were great.

 

[BruceK]

Your experience reminds me of the time we called Professor Nikolai Bogduk, consultant physician with an interest in musculo skeletal research at Newcastle University. My client was using morphine for neck pain, the insurer said he was drug addict with no pain, we said he was allocated 15 doses a month but never used all of them,only what he needed, and his pain was real.
So, using an image intensifier, Bogduk injected local anesthetic into a tiny neck joint he thought the pain source, using a fine needle. The pain vanished, the neck became completely free in movement, but only for the expected lifespan of the anesthetic, whereupon pain and restricted movement returned. Joint pain source identified and confirmed. Case won.

Bogduk referred very unkindly to others who injected a freezing solution into joints using a needle he compared to a thick six inch nail to perform a similar test.Sounds similar what you endured,twice. Your procedure is of course different, to deliver more product to a larger space.

The approach sounds like trial and hope. I hope it works this time. The stenosis sounds severe, and to my uneducated mind,to be mechanically causing the nerve embarrassment.

 

[Potomac boater]

Could you repost your mri images?

 

[menzies]

Your experience reminds me of the time we called Professor Nikolai Bogduk, consultant physician with an interest in musculo skeletal research at Newcastle University. My client was using morphine for neck pain, the insurer said he was drug addict with no pain, we said he was allocated 15 doses a month but never used all of them,only what he needed, and his pain was real.
So Bogduk injected local anesthetic into a tiny neck joint he thought the pain source, using a fine needle. The pain vanished, the neck became completely free in movement, but only for the expected lifespan of the anesthetic, whereupon pain and restricted movement returned. Joint pain source identified and confirmed. Case won.

Bogduk referred very unkindly to others who injected a freezing solution into joints using a needle he compared to a thick six inch nail to perform a similar test.Sounds similar what you endured,twice. Your procedure is of course different, to deliver more product to a larger space.

The approach sounds like trial and hope. I hope it works this time. The stenosis sounds severe, and to my uneducated mind,to be mechanically causing the nerve embarrassment.

Well I wouldn't say trial and hope exactly.

This afternoon I googled six inch 22 gauge needle and it is a pretty standard needle. Plus it was a steroid rather that a freezing fluid.

The aim is to give the nerve some relief while the body tries to heal the bulge itself.

The self-healing is the critical thing here. It seems it is quite common for the bulge to retract. Often the fluid sack dries somewhat and it reduces the bulge. This can mean quite a long time before any surgery needs to be done - a decade or more. So long as I don't do anything dumb - quite the limitation on a boat!

The surgeon is very conservative and wants to try all this before even considering surgery.

 

[menzies]

Could you repost your mri images?

Yes, I'll have a look in a while. I can show the whole spine shots showing bulge, the issue is with the cross sections showing stenosis, it's hard to ID which vertebrae. At Mayo their cross section imaging numbers each section, on my portal they do not.

I know you posted previously that you thought my bulge pic was the L4-L5, but don't forget that was me trying to pick the image at home, not what they were evaluating.

 

[Potomac boater]

The aorta branches to the iliac arteries at L4/5 most of the time . On an axial image you can tell where where that is. Look in front of the vertebrae and see where one big round structure branches in Two.

 

[menzies]

I looked last night. I have 250 images in total, but apart from the full spinal pics it's hard to see where exactly I am in the cross sectionals. I can't download a full set at once only individually!
I'll look at the area you mentioned later and see what I can see.

 

[moparharn]

Glad you are home safe and sound as the trip was more than a little risky in your condition. I am not a doctor, but please allow me to make a few comments (some I have likely already made)

1. Nearly all back injuries heal themselves. The question is with what level of nerve function?

2. The focal block you received is common and so is the experience. I rather stupidly rejected pain medicine for my second one because the first one was not bad enough that I did not think I could not get through the second. I got through the first because I received pain medicine! As you know they go in, look at the imaging, go in further, look at the imaging, go in further still, etc etc. I also looked at the needle on the tray and was shocked at how big it was (I am big as well). The front end of the injection in lydicaine so they can numb on their way in after they freeze the surface.

3. The purpose of the focal block is more diagnostic than therapeutic.The relief it gives you can sometimes offer enough time for the patient to self resolve. Usually this is now how it goes down. Because you have already had a good deal of time pass since the injury I doubt this is going to "fix" you. The fact that you got instant relief is very important as it tells the doctor exactly where the surgery is needed (where the impingement is). In 7-20 days I would guess you will begin sliding back to where you were. DO NOT use this relief as an opportunity to exercise or manipulate your spine in any way. You might get lucky and the disc could resect on its own. It also may not be a disc but rather a foraminal narrowing. You could also makes things worse. Remember, any loss of bowel or bladder function means you go directly into surgery in 5-7 hours or the issue could become permanent. Timing may vary, but IMMEDIATE action is needed.

4. I am a little surprised at the lack of precision going in in both your diagnosis and the need to re-enter for the block. Spinal work is still an inexact science, but I am still a little surprised. Mayo? Stuff happens, but I would still do some further background on the personalities involved. I am sure they are stellar, but excellence varies amongst the excellent.

5. It sounds like you have multiple issues, but only one causing the current pain. A conservative approach would be to only address the area of your last focal block. However, as long as they are going in, and as long as the disc does not need removal, you might end up with 2 or 3 level laminectomy to head off future issues. This judgment is where your doctor really earns his keep. Sometimes the diagnostician is not, and should not be the surgeon.

6. While you are not in pain, now might be a good time to share your experience and studies with another highly recommended neurosurgeon and try to see if consensus can be had. When they ask "what did Dr. So and So recommend, tell them " I am here for your expert opinion".

7. My surgeries were in 2004 and 2013, both three level laminectomies. Stenosis is a fun time, and it can be both in the central canal and foramina. Radicular pain wrapping around the front of your thigh is often foraminal. My issue is a bad combination of osteo arthritis and genealogy. My grandfather and father both had bad backs, and bad stenosis. My father and I have had the exact same joint replacements in the exact same order. Mine were sooner because I am 4 inches taller and forty pounds heavier and I played contact sports. Do not underestimate genetics and look into your families past for any potential clues.

I wish you the very best results. Tame your frustration and expectations. This is a challenge that will require both, along with some philosophical resolve. Bill

Disclaimer: This is one idiots opinion and nothing more.

 

[Al]

I've had back pain for too many years to count. And I fear I'm getting closer to surgery on my L4-5 with a torn disc. Been going to a pain doc (anesthesiologist specializing in pain management) for 15+ years for steroid shots and nerve ablations which work for a few months. Last summer I tried CBD ointment and it has worked better than other topical ointments. I also use a TENS unit when the pain gets bad enough. As they say "I feel your pain".

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Regards,
Al

 

[Choices]

My dad was scared of back surgery, and self medicated with a bottle of Bacardi and the couch, every day.

Finally after a month agreed to surgery.

Surgeon was 30, looked 14, did about five a day, and told my dad he was the best, knew it, and he would also know the minute medication wore off.

When my dad woke he said all pain was gone, and he was walking thirty minutes latter.

Everyone is different.

 

[menzies]

So I had the injection into L5/S1 and no relief.

Had a subsequent injection into L4/L5 and no relief.

Met with the surgeon today and talked for an extensive time on all of the options. Seems there is a minor issue L3/L4 as well but that is a ways out.

Without going over all of the conversation we are going with a fusion on L4/L5. Scheduled for July 23rd.

Understand the pressure a fusion puts on other local vertebrae, but he feels that a laparotomy will be a short term solution given the stenosis.

We did discuss doing both the L4/L5 and L5/S1 but he feels my issue is driven by the former. By focusing on one it will be minimally invasive, if we aim for both it will be open surgery.

I opted for the awake surgery. Epidural and no general anesthesia. Which will help with recovery.

Also enrolled in a study comparing awake versus general.

Going for the COVID test on the 21st and if clear will go under the knife on the 23rd.

12 weeks before I can cruise again. Around first of October. All calendars are based on cruising!

Tally ho old chaps!

 

[Insequent]

Damn!

Disappointing that the injection did not do the trick. Mine worked a miracle on L5/S1.

Good luck for later in the month and the recovery.

 

[bligh]

A bulging disc can not be medically treated through surgery.

Is that so?

 

[BruceK]

So I had the injection into L5/S1 and no relief.

Had a subsequent injection into L4/L5 and no relief.

Met with the surgeon today and talked for an extensive time on all of the options. Seems there is a minor issue L3/L4 as well but that is a ways out.

Without going over all of the conversation we are going with a fusion on L4/L5. Scheduled for July 23rd.

Understand the pressure a fusion puts on other local vertebrae, but he feels that a laparotomy will be a short term solution given the stenosis.

We did discuss doing both the L4/L5 and L5/S1 but he feels my issue is driven by the former. By focusing on one it will be minimally invasive, if we aim for both it will be open surgery.

I opted for the awake surgery. Epidural and no general anesthesia. Which will help with recovery...

You tried the conservative moves,hope the fusion is a cure. Doing it awake is interesting,won`t you hear the trusty De Walt drilling pilot holes for the screws. I didn`t understand the laparotomy option.