Thursday, June 30, 2011

UPDATE ON BACK:

Background

In November 2009, I started experiencing pain in the middle of my right buttock. It would start really late in the day, and I would just go to bed at that point and wake up fine the next morning. Over the next few weeks, the pain would start earlier in the evening until it would happen at work. I would take an over-the-counter (OTC) pain reliever and feel some relief.

In December 2009 and January 2010, the pain began to curl down the back of my right thigh and my toes started tingling. Laying down, walking around, and taking an OTC would give me some relief. So would going to sleep. In January, I woke up and I was already in pain, and that is what prompted me to see my primary care physician (PCP).

My PCP said that I had the symptoms of sciatica and prescribed me neural medicine and a non-narcotic pain medicine. They didn't really help, so after a few weeks, he prescribed me some ibuprofen and submitted an authorization for me to get an x-ray and physical therapy. As some of you know, the physical therapy authorization did not go through. I had my x-ray in February 2010, but it did not show anything significant (you can't see nerves on an x-ray).

The ibuprofen helped, but if I would forget to take it, I was in a lot of pain. I went back to my PCP, and he decided to send me to an orthopedic specialist. The specialist also diagnosed my pain as sciatica and submitted an authorization for me to get physical therapy. I was finally approved and started in April.

For two months, physical therapy was nice but it didn't help. I still felt pain. The physical therapist said I needed more diagnostics, and the ortho specialist submitted an authorization for me to see a spinal specialist, a neurosurgeon.

After my visit to the spinal doc in early June, I got the authorization to get an MRI in mid-June. I got the results a little more than a week ago.

MRI Results

One centimeter posterior, central right-sided herniated disc at L5-S1 with nerve root impingement and spinal stenosis, which means that my disc is popping out pretty far, and my spinal cord and nerve roots are being compressed.


Spinal Specialist Recommendation

I had my appointment with the spinal specialist yesterday evening. He said essentially what I had been thinking since I found out I have a herniated disc. He said my weight loss and physical therapy might have been effective if I had a small to medium herniation (3 mm to 7 mm), but that the size of my herniation at 10 mm is severe, and there are not a lot of options available to me. His recommendation for me is to have surgery, but that it's not at an emergency level at the moment.

We spent the next half hour going over my MRI results, with him patiently explaining the different views and angles. In the images, I could see about have of the cavity meant for my spinal column was being taken up by my disc mass/fluid. He also talked about my nerves in very clear analogies. For example, he said that my left nerve root exited my spinal column in what could be called a four-lane highway. On the right side, it had been reduced to a dirt road.

We discussed another symptom that concerned him more than anything. Two weekends ago, while I was taking my boys to see Karate Kid, I was wearing high heels. When I was almost half way to the theater, my right ankle started turning out. It didn't hurt, but I couldn't walk well. It felt so uncomfortable, I stopped and bought some sandals. He tested me, and I have reduced reflexes in my right ankle, and I couldn't balance on my right root. If that gets worse, I will need emergency surgery.

We talked about my options.

Chiropractor

I asked him if going to a chiropractor would be an option. He said no quite emphatically. My nerve channel is so narrow, a chiropractic adjustment could cut it off completely. I was concerned that he just wanted me to have surgery, and he said that even if I don't have surgery, that I should not risk cutting off the nerve completely because I could lose all function in my leg. Not something I really wanted to hear, but it was his professional appraisal after all.

Epidural

He says I could get an epidural steroid injection for the pain, but with reservations because it might not work due to the size of my herniation. Apparently, the shot would only delay the inevitable.

Surgery

He said that my best option for a complete recovery would be surgery. I asked him how long the recovery time would be, and he said that I would probably have to take a month off of work.

Outcome

After discussing the options with the spinal specialist, I said that I needed to figure out how I could take a month off of work and figure out my finances. I have to pay 30% of my hospital costs out of pocket. That's a lot of cash. So his staff submitted an an authorization for me to receive the injection so I can at least have some relief from the pain while I figure out what I'm going to do.

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