runner's surgery blog, L4/5, 2008

[runner]

I hope you can get answers and resolution to your current situation with your legs, feet, the numbness and tingling issues. I would say if your gut is telling you it's time to go back to the doctor with your questions, then do it. Whether it's normal or not, you need answers and reassurance, if nothing else. Peace of mind is golden. I totally am on the same page as you when it comes to the frustration of not being in shape, nor getting to be as athletic as I am used to being. It's just a very hard place to be. I try to focus on the good, the positives, keep my "can do" attitude in check, but it doesn't mean it's easy. My one daughter-in-law and I were at lunch one day, and she was remarking on how my son was telling her how active and athletic I used to be, and it occurred to me, that both my daughter-in-laws have only known me since the bicycle accident, along with my chronic pain, and all my limitations. It made me sad and kind of depressed. But, then it later motivated me. I will not stay stuck in this place. I have to get a strong back to hold my future grand-daughter. Period. Every day is a new day. New hope. New beginnings. Chances. I will hold these same thoughts for you, as you seek answers and hope to move forward with your healing process.
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CindyLou
bicycle accident 6/19/01
2 compression fractures sustained, T12, L1;
vertibroplasty @ above levels, 9/15/01
4/06 right hip labral tear repair
4/07 Lumbar ProDisc replacement by Dr. Bertagnoli, 3 levels; L3-6
7/2/08 ALIF and Laminectomy of L6-S1
7/30/08 Removed bone cement that leaked thru onto S1 nerve root.
8/7/08 Diagnosed with pulmonary embolism, double pneumonia, collapsed left lung, pleurisy, pleural effusion. Hospitalized 1 wk.
Wear bone growth stimulator 2 hrs per day.

[runner]

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Thanks Cindy.

Yeah, looking at me now, you couldn't tell that I was a really fast runner in 2006 and part of 2007.
That motivates me, the wanting to get in shape and feel good again.
When are the grandchildren coming??
Having a goal is important.
Had a good workout in PT today, was finally sweating. The muscle stimmulator helps block the back pain signals.
I wore it for all the exercises. 15 minutes on the elyptical trainer today.
The first thing my PT asked me was when my doc appointment was. Haven't called yet i told him.
I am waiting to see if my legs will return to normal feelings. Today is a little better than yesterday, so i will see.
Tomorrow is another day.

[runner]

Runner,

Am curious. What is a muscle stimulator? Who prescribed it, or does it not need a prescription? I start with my regular physical therapist next week. I did the warm water therapy at a different place in downtown Minneapolis, that my doctor wanted me to try. I had 5 sessions. Only one of them was with an actual certified physical therapist. The other times I had an "assistant." She was super busy. Never seemed to pay attention to my form on the exercises. Would just walk away to tend to other business, and then come back to tell me what to do next. All in all, a lousy experience. My regular physical therapist who has been with me thru a number of years of my surgeries, watches every step, every move I make. Corrects me. Gives me alternative ways to do things, if something hurts too much. She is also a certified Pilates instructor and fitness instructor. I can't wait to get back to her and get busy with the real business of p.t., some electrical stim. for my muscle spasms, and tens unit, which I don't even know what that is.

I did my own treadmill walk last night, and could only do 20 minutes as my back just continues to tighten up. Very frustrating. Certainly not burning the calories like I would want to. I am still on 4 percocet a day, and know that I should get off it. I hate still being on it. I'm going to ask my doc at next scheduled appt., which is Monday, 10/27, if we should just work up a tapering off program and see where my body is.

Now on to something way more uplifting. My first grandchild is due March 11th. I am over the moon! I just want my back to get better so I can hold my grandbaby. You are right. That is my goal and motivation right now. Yes, I want a feel good back for my quality of life, but a future grandchild just takes it to a whole new level, if you get my drift.

Have sat here way too long. Time to move and stretch.

Hang in there, and keep me posted on how you are coming along.
__________________
CindyLou
bicycle accident 6/19/01
2 compression fractures sustained, T12, L1;
vertibroplasty @ above levels, 9/15/01
4/06 right hip labral tear repair
4/07 Lumbar ProDisc replacement by Dr. Bertagnoli, 3 levels; L3-6
7/2/08 ALIF and Laminectomy of L6-S1
7/30/08 Removed bone cement that leaked thru onto S1 nerve root.
8/7/08 Diagnosed with pulmonary embolism, double pneumonia, collapsed left lung, pleurisy, pleural effusion. Hospitalized 1 wk.
Wear bone growth stimulator 2 hrs per day.

[runner]

Cindy,

A muscle stimulator is like a mobile TENs unit. You have pads on the front (stomach) and back and there are little shocks that block pain signals. Seems to block back pain but not sciatica.
I used one in PT so I could get through the exercises. Before, my PT wouldn't let me do some more aggessive exercises because I was getting back pain. So now I can turn that little sucker up and block the signals.
The goal here is to get my muscles in better shape, loose weight with more activity and in turn get a more stabilized back with the stronger muscles.

I spoke to the medical device company yesterday and my insurance does cover 80 percent of the cost (well, at least they cover this) but we are responsible for 20 percent which works out to something like 24 dollars per month. I have to rent the device but then can buy it after a year. The rep said the insurance co wouldn't pay for it if it was bought outright.
I reserve the right to return the device and stop payments at any time.
So that is okay.

Just more money out the door. Facing these huge medical bills is sad. We have already paid off a lot on co-pays and PT. I still haven't found out what we owe the hospital after we applied for financial assistance. Will probably know soon. We have a cat, Sunny, and she won't eat. We spent money at vet couple weeks ago trying to find out what was wrong. No conclusive answer and they wanted to admit her but we cannot afford it. It was diffiuclt telling my girls that there is nothing we can do and she is going to die. I am thinking of calling my insurance company and and telling her what my insurance company has put us through. I want them to feel as bad as we feel.

Wrong forum....back to back pain. Yes, it will give me peace of mind to find out what is going on. I was doing really good, just normal healing and then this. I thought my feet were a little less numb yesterday and then at night, I was feeling the sciatica as I was laying on the couch. This drives me crazy because there is not one consistent symptom, the numbness is here and there and then sometimes there is burning feeling and the sharp pins and needles and it is not like a muscle injury where you can point to one area and say that hurts.

The muscle stimmulator needs a prescription. My PT sent a prescription to my doc and my doc signed it and then it was sent off to the company.

My PT watches me like a hawk too. Making sure about keeping a pelvic tilt, doing exercises correctly and so on. I really believe PT helps, especially with the tight muscles.

I have a question, after ADR, can nerve compession only be seen with a spinal myleogram? Last time my doc said MRI would have artifact, which I already knew, but did not mention myleogram.

Cindy, you have some time before grandchild arrives and they usually weigh under 10 pounds so hopefully you will be able to lift him/her and eventually be able to lift more. I didn't even ask what lifting restriction I have currently. I don't usually lift more than 10-20 pounds and try not to lift at all.

Congrats on starting PT.

I agree with you about the drugs. I am off the pain meds, except for over-the-counter, and would like to get off this Gabapentin but can't right now. I asked to get back on it because I couldn't stand the sciatica. I hate the swelling from the Gabapentin.

Got to go get an Times now to get thrid part of insurance story. Keep up the good work. 20 minutes on a treadmill is more than zero. I feel like you, maybe, I breathe harder than I should and my resting pulse rate is far from what I had a while ago. Just been through the ringer and trying to recover my cardiovascular condition.


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[runner]

re: mylogram

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Hi,
I had a CT mylogram about 4-5 months after my ADR surgery because of some serious back pain. The Dr. was able to find the cause but the procedure set my nerves off and I needed to take a medrol pack (cortisone) after that to settle things down. You know that since the second decompression surgery I have some serious sciatica and tingling in both legs plus sacral back pain through the roof at times. My Dr.'s. PA just ordered an MRI with contrast to look at the area. The articles I have read on failed back surgery and arachnoiditis talks about nerve scarring and clumping caused by too many procedures. Of course this info just scares me to death so BE CAREFUL is really what I wanted to say. MRI's are not invasive and they can still see a lot of the area. I do not know much about facet problems and am going to look that up also. I do more bending than I should and since I had that lower L5-S1 done I am concerned about over-bending that area. I hope that you continue to heal but also try not to overdo the exercise in case that is causing your sciatica.
Phylly
__________________
Cervical fusion C4-C6 2002
Fall on tailbone April 2005
Discogram positive at L4-S1 2007
Prodisc ADR surgery L4-L5-S1 November 2007 Dr. Delamarter
Decompression surgery L4-S1 for left sided sciatica July 2008
Continued back pain, looking at possible fusion
Removal of Prodiscs and L4-S1 fusion February 2009

[runner]

Thanks Phylly for the info. And thanks tconner94 for the tip.

Phylly, I probably react like you do to the procedures. With the epidurals, I got more inflammation at first and then it calmed down. They didn't help that much and then the facet joint injections were worse and definitely didn't help at all. I hurt for days after each of those and then the discogram, pushed everything off the charts.

I know that too many procedures are not good for the body. I could probably live with sciatica but I'm taking 1500 mg of Gabapentin daily and still feeling the sciatica. Exercise does increase the symptoms but then they go back to kind of a baseline. I know my nerves are already inflamed, exercise or not. And I don't believe the answer is to exercise less (although when this started, I reduced my walks to a distance of one mile). Exercise helps strengthen my back and core muscles which in turn helps stabilize the spine.

I have had these symptoms for 7 weeks now and they are not really abating. Although they might change and move around. Because of my health care background, I know that certain nerves are getting compressed. It is really obvious. I went to my podiatrist, who is like the best podiatrist around and I have been going to him since I was in college running, and told him my current symptoms. He poked around and found a spot near my ankle which is really tender on my right foot. The nerve goes right there and then wraps under my heel. So i got a cortisone shot there and the plantar fascia symptoms calmed down for a few days. I had plantar fascitis before and since I have had bad back pain,the pain from it has just been nerve-related. So instead of the normal plantar fascitis, my heel hurts when i am sitting and not when standing. I had the same symptoms before my surgery and a little bit afterwards. At that time, we figured it was not the normal plantar fascitis when my symptoms increased when i wasn't doing any exercise.

Maybe too technical.

I get conflicting opinions about what procedure can actually show the nerves after ADR. I was told MRI with contrast will still have artifact in it from the disc. I also saw where a CT with contrast might work. I am jumping the gun, but if I do get an earlier appointment with my doc I want to be informed. I know he told me that an MRI would have too much artifact to show anything.
You know my doc and believe me, he is very conservative. I don't think he would do a test if he thought it would cause a lot of harm.

I always go with the conservative docs because I believe in conservative treatment. Too many times, I have seen things go wrong with an overzealous doc. I picked my doctor, who has not done as many ADRs as others, because of his skill and I trust him. I could have made an appt with a more well-known ADR doc, but I don't care if they have done 500 ADRs. I once made the mistake of having arthroscopic surgery with a top orthopedic knee doc and I regreted that. Because that doc, did not take as good care of me as maybe a less well-known doc would. And I worked for this doc, but this was before I went into the health field and could sniff out the really good docs.

I just want some answers because I am really not getting any better and i want to know why.

A lot of times, I don't show pain too well. Meaning, I hide it well and so if I don't complain loudly, no one listens to me. That is the way I am. I have always felt I have a high pain threshold and when I was running track in college and afterwards, I got used to hiding pain. This happened in the hospital right after my back surgery. I got up with PT and we are walking the hallway with the walker and he says, "You must not be in much pain, is your level 5-6?" And I laughed, and said, "More like 9 out of 10." I was really hurting and he couldn't tell.

So this is what is happening now; I really need to yell a little louder.

So last time I see my doc, he says I can go up on the Gabapentin because I was taking a "low" dose of 900 mg a day but he warns me about dizziness and I told him I haven't gotten dizzy from Gabapentin but he says I could. So I slowly went up on the Gabapentin to the current dose. I could go up to one more tab, but I honestly don't think I could remember to take a pill six times a day. LOL. Doesn't make me dizzy, just makes me want to eat and makes me sleepy.

Currently, I am real pissed off because I feel a whole lot better except for the right-sided back pain and the sciatica stuff. I feel like I didn't go through this surgery ordeal to have this happen now.

Phylly, yes, you could have done more harm having the decompression surgery, but it is a done deal and you cannot really beat yourself up about it. Pain and numbness are not normal physiological reactions; they are the body's way of telling you that something is wrong. You need to find out what is wrong so you can get better. MRIs are a piece of cake. The only way they are harmful is if there is metal around. Please keep me informed on how it goes. One thing I found out from all the back research I did, the back is incrediblly complicated and we need to tread lightly when we are fooling with it.

Hang in there.

[runner]

10-24-2008, 02:28 PM
tconner94

MRI vs. CT
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I will try to offer a little info on your questions about imaging studies after ADR. MRI artifact at the level of surgery will prevent that level from being evaluated. If IV MRI contrast is given, it won't help visualization of the surgical level. MRI with contrast can be used to assess for nerve root irritation/inflammation away from the hardware, and it can be used to check for complications of the surgery such as infection. Also, the other levels can be assessed with MRI either without or with IV contrast.

I used the term "IV contrast" deliberately. CT of the lumbar spine is usually done without IV contrast. The ADR will cause a different type of artifact on the CT that will also affect the evaluation, but it is easier to compensate for this when viewing the CT. However, CT is not that good at evaluating disks, nerve roots, etc. I believe that you are referring to CT myelography. That procedure involves a lumbar puncture (spinal tap) where 10-20 cc's of contrast are injected directly into the spinal canal. A few regular X-rays are usually taken, and then a CT is done soon after to evaluate nerve roots, spinal narrowing, etc.

In general, it is difficult to predict in advance which test may help. MRI with IV contrast is quicker and safer, but it may or may not help. CT myelography may help, but it's more involved, a little riskier, and there's still a chance it won't show the ADR level due to artifacts from the metal.

Hope this helps.
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L5-S1 rupture 11/04, left leg pain for 2 wks.
Regular exercise/pain-free until 2007
L5-S1 degen. disease w/constant pain since 6/07
PT, ESI, SI jt injections, 3-level nerve root inj. x 2
L5-S1 Charite Jan. 19th, no back pain so far