AN update

[steve55]

Thanks DS . I went to my neuro today. When I showed him where it hurts, he said I was pointing to t4!! But it could be referred pain from a disc above. He said if by chance fusion was necessary at any part of the t spine, they do not do discotemy and allograft or autograft. He said they simply do rod and screws posteriorly from the back. WOW! I asked him if I had a bulging disc or tear causing the pain, how would a fusion without discotemy solve my problem. He just said I'm getting too far ahead of myself and let's wait on the MRI . I personally believe that the discs are causing the pain and I cant see how anything short if a discotemy will do. Heck, I never heard of a fusion without discotemy. I'll have to definitely get a 2nd opinion on that. He also says they dont do discograms to help confirm which disc is the painful one. I guess he is one of those docs who don't trust those tests.

I wish it was higher up. If a 2nd opinion suggests a fusion with discotemy, I think they have to collapse a lung and go through the rib cage area. Sounds hard core.

[Maria]

Don't get ahead of yourself. Get the diagnostics done and then perhaps get several opinions. That makes the most sense to me.

[cp7959]

Steve,

Any update on that MRI?

[steve55]

Hi all. Yes! To my amazement, the MRI is for the most part clean!! Though, that's just based on reading the written report. Havent met with the neurologist yet. I dont see how it was so clean given that Ive had occasional slight burning in my hands and arms, and also have experienced the old below the waist nerve tenderness (but very slight, but noticeable)

The only thing that was found wrong was as follows below. Everything else was normal so I didnt retype the good parts.

Findings : There is mild disc space narrowing and anterior marginal endplate vertebral spurring from T4 through T 10.

Impression: Mild multi level mid thoracoc Spondylosis, but no disc displacement, and no canal foraminal stenosis.


Upon looking at my films, I do see very thin Thoracic discs, and yes, the T4 disc looks the thinnest and the darkest.

However, I have good news to share . About 8-10 days ago, I switched from neurontin (which seemed to of stopped working) to Lyrica. And within 2 days of being on lyrica I was pain free!! I went from pain levels of 5-6, and having to take pain meds almost every night to a occasional pain level 1-2 on a few nights a week and mostly no more pain meds . Ive taken meds for pain only once , maybe twice in the last 12 days. I thought Id wait a week to be sure it wasnt just a temporary natural reprieve. But having 9-10 days 90% pain free, I know it has to be the lyrica. I was pain free within 2 days of starting lyrica. And I dont have that deep tender sore spot over T4 anymore either. If lyrica was just blocking the nerve pain, I would have thought Id still have that sore spot over T4, but its also gone.

Lyrica kicked my pain's butt! Total KO. Amazing. Hope it stays that way, Mark asked me to do a seperate post about my Lyrica experience so if you see it posted again here, thats why I did it. I pray this isnt just a temporary relief. We'll see

[steve55]

Well, soon after I praised Lyrica so much, it suddenly stopped working. One thing Ive learned with spine issues is to not get too overconfident for very long. For example, as soon as I emailed Dr B and Dr Sullivan how well I was doing last summer, I soon crashed again. It's like some kind of jinx for me. Anyways, Ive read that the body isnt supposed to develop a tolerance to these antivonvuslants type drugs : ( Gosh. I cant imagine what happened then. My pain is so bad before and after the lyrica, its hard to believe it was a just a coincidental pain free stretch. I may get back on lyrica again to see if I get the same result as Ive been off of it for several weeks now since it stopped working. But my doc wants me on Cymbolta next. I guess the Lyrica experiment will have to wait.

UPDATE- so, my CT and MRI cervical and Thoracic show nothing wrong other than thinning thoracic discs. I had a long talk with the pain mgt doc (I believe he is one of the best here in Dallas, TBI uses him and he is in many magazine "Top docs" lists in peer to peer reviews. He is seasoned and I trust him). The pain mgt doc agrees with the Neuro. My films are clean. I told him that since my pain is at T4, what if I have "Internal Disc disruption"? (A condition where the disc has tears and Ive read often isn't picked up on MRI and CT's). He seems to think the MRI would have picked that up if that was the case. But what I read online since then says otherwise. So I need to ask him about that again. I found studies whose results said the following :

1. On magnetic resonance imaging 21 of the 48 discs appeared normal.
However, on discography, only 10 were judged as normal.
Both studies supported the concept that discographically provoked
concordant pain is seen in symptomatic degenerative discs studied, but
that in asymptomatic individuals, very little pain typically is observed
even in morphologically abnormal discs.

2. Thoracic discography may demonstrate disc pathology not seen on
magnetic resonance imaging. In addition, subtle, yet potentially
painful disruptions in disc morphology can be missed by MRI in its
current state.

I know there is a huge controversy about discograms. My neuro doesnt believe in them but TBI and Dr Bertagnoli seem to. Ive read Mark's extensive reply to Aaron's post about the controversy surrounding discographies. My pain mgt doc as experienced as he is, made a comment he hasn't done a thoracic discography before which surprised me. But he would consider it if we run into dead ends in the diagnostic process. The internet research seems to indicate they are extremely rarely done. But how else will the docs know if you have a "internal disc disruption" or torn discs leaking fluid hence causing all the pain?? MRI's wont necessarily catch them right? DO I have that right?? If this is right, how else can you be sure whether you have tears in the thoracic then? If I do have tears missed by the MRI, then doing a thoracic discotemy would fix me just as the cervical discetomy resolved my pain. What makes that more convincing is that my current symptoms are mostly the same as before my cervical discotemy minus the radicular arm and hand pain.

Anyways, I am scheduled for facet joint injections at C3 and T1 next Tuesday. Based on his diagnostic experience, he feels my pain is "referred". He thinks the T4 pain is originating from one of the adjacent level discs or facets next to my 3 level fusion.

So, I guess I'm in the same boat as Mark. Clean films but still tons of pain. I guess it leaves docs guessing as to the cause. I wish my films showed where the problem was so at least we know what to do.(sigh)

As it is now, I'm not eating much (losing weight), Ive been missing work because I cant get out of bed due to the sheer exhaustion of pain. I usually get up at 10:30AM but the last few days Ive just layed in bed till 2pm, just cant get up due to the physical exhaustion and toll. Yes, the pain meds help, but they arent a cure all and I cant see myself taking vicodin 4-5 times a day. I'm thinking that's just too much for the liver. So once again, Im back to being somewhat terrified as to what the future holds. The thoughts of Social security disability start popping in my head again. (Ughh)

[Maria]

A stronger longer lasting pain medication like Methadone or one of the other pain meds in a catagory such as this? Vicodin wouldn't even work for a toothache on me. I realize pain meds aren't a cure and I can understand not wanting to "go there" re pain meds yet if something stronger/longer lasting would allow you to be upright and mobile that's better for your overall functioning than lying in bed because of pain (which I did for weeks to months and over a long number of years when my back would go out and long before I started pain medication).

Sorry if you've stated you cannot take pain meds for any reason or have already tried a number of them w/o much help. I realize this post goes back a way. Starting the Cymbalta is probably a good idea. Hope you get some relief again and sorry to hear you crashed on the Lyrica after some really good relief. Whatta pain!

[dshobbies]

Steve,

When I read you sometimes don't get out of bed until 2- it brought back memories of a place and a life I hated. And I knew from where my pain originated. My heart breaks for you.

It does sound like your pm is more receptive than others as to both listening to you and trying to find the source of your pain which should/could/would ultimately lead to the 'cure'.

Until then, know you are in my thoughts, hopes and wishes.

Dale