Help - new back patient - and lost

Jakea222 · #1 (**permalink**) 10-27-2008, 09:41 PM

Hi all - I am Guy Anderson. I am a professional chef. If you don't know - it really is not the food network. Lots of hard on your feet - lugging pulling and lifting. So I pulled my back a few years ago - and a tordol shot or 2 helped and I guess I worked it out.

So 3 weeks ago - major pain lower right side and it did not get better. MRI was ordered by my Internal Med Doc (wife is a Nurse Practitioner and shields me too much)

Report says - L3 L4 L5 minimal disc bulge without spinal stenosis.
Grade 1 Anterolthesis of L5 S1 likely degenerative s- this would probably affect the L5 nerve roots.

So guys - what can I expect here??? I am in a panic state in the fact that this could end my passion for being a chef or will the physical therapy and taking it easier on the "work" stuff maybe pull me around to normal or workable --- Please do not sugar coat your answer I really need to prepare myself for the road ahead --- I am sure you all will be helpful in this new segment of my life.... Chef Guy

mmglobal · #2 (**permalink**) 10-27-2008, 10:16 PM

Jake... welcome to the forum.

I'm Mark Mintzer and I'm the founder of this forum. I've been involved in the online spine patient community since mid-2000.

Hopefully, this will all blow over. If you have not been having back problems and are 3 weeks into this, conservative treatment (or even doing nothing) still offers great promise. If your spine is the problem and it's already too compromised to avoid surgery, there are many good options out there (depending on what you are a candidate for.)

The first multi-level disc replacement patient I ever met was a professional chef from San Diego... excellent results.

Grade 1 instability indicates < 25% slip. I went to the North American Spine Society meeting earlier this month and saw a presentation about successful treatment of this condition with bracing instead of surgery.

I know how physically demanding your profession is. I hope you can continue (especially if that is your passion.)

All the best,

Mark

Jakea222 · #3 (**permalink**) 10-28-2008, 12:49 AM

I am very concerned about what I have read about the "above" stuff and the pain that people are living with. I have a very high threshold of pain - but some of the posts and things I have seen in the last few days on the web have literally made me cry for the people that are writing them. I just hope I can get out of the weeds and rest my brain a little with information from people that are living this.

dshobbies · #4 (**permalink**) 10-28-2008, 03:52 AM

Hi Guy,

Welcome to the forum and glad you found us. The first thing you need to do is breathe and calm down. Worst case scenario is some type of surgery and you don't appear even close to that. Ultimately, if you do need that, it's here for you but you are so jumping the gun.

The horror stories you've read are from people, like me, who tried conventional therapies and surgeries and there was nothing left. The advent of new procedures opened up a whole new world to spine sufferers and many of us got our lives back. I don't know your circumstances but if rest doesn't minimize your pain, you might want to look into a consultation with a neuro or ortho surgeon who specialize in the spine. Mark may be able to recommend a doctor in your area or ask your wife. I'm sure your internist is a fine doctor and getting an MRI is the first step but now that you know there is indeed a problem, you want someone who deals in those problems on a daily basis. Even then, we often recommend more than one opinion but you don't even have any prognosis yet.

So for you, take it easy. No twisting and bend from the knees. Reaching for things is a no-no. Brace yourself when sneezing or coughing. If necessary, minimize standing and sitting times. A zero gravity position takes the pressure off your tailbone. Let common sense rule your world. Make an appointment with a specialist. I'm not sugar coating but you're panicking without cause. I'm not blaming you, just telling you that things aren't necessarily as bad as they seem.

Please don't hesitate to let us be your sounding board. We all know about the pain and panic but sometimes worrying is nothing more than a waste of time.

Good luck to you and I hope it all turns out well, Dale

Jakea222 · #5 (**permalink**) 10-28-2008, 02:45 PM

ok - so I meet with a physical therapist today - the back doc. tomorrow. thanks

Jakea222 · #6 (**permalink**) 11-10-2008, 09:53 PM

OK - so PT is on going BUT now I am to a stage where they are saying epideral injections are the next step in about 2 weeks. Can you tell me if these are like a limbar puncture as far as pain? Everyone kind of avoids the answer when I ask including my own wife - the PT says they are a good thing for therapy because it allows the physical part to go on without the pain. Anyone had a good experience with this procedure and how long was the pain deceased after the procedure....I have changed pain meds and walking with a cane now...so just trying to picture the steps ahead....thanks all. CHef

dshobbies · #7 (**permalink**) 11-11-2008, 01:28 AM

I had the these injections under mild sedation and didn't feel a thing. It was a series of 3 injections over 3 weeks. I had very little relief and only for one additional week but knew it was a longshot going into it. Maybe you'll do better.

Be careful if they do provide pain relief for you. Your spine will still be unstable and PT and care will still be a priority.

Good luck, Dale

fireyangel76 · #8 (**permalink**) 11-11-2008, 04:54 AM

I had 4 ESI's in the L5-S1 without any sedation. It did hurt for a minute or so, but compared to the pain I was already in it was like a bee sting. They never worked for me but I think I was too far gone.

I know quite a few people helped by epidural injections and never need anything more. In fact most of them don't understand why they did not work for me.

Good luck I hope you get relief!

Jim M2 · #9 (**permalink**) 11-11-2008, 06:52 AM

Chef Guy,
The only painful part for me was when they injected local anesthesia. This gave me a few fleeting bee stings like Firey mentions. Once numbed up it's just an uncomfortable and somewhat creepy feeling when the actual ESI is given. It's far from being a big deal. Especially, as Firey mentions, when compared to our normal pain levels. Good luck, I hope it helps.

Maria · #10 (**permalink**) 11-11-2008, 07:59 AM

I've been getting lumbar ESIs for the last 7 years and they are extremely helpful to me w/pain relief. I will state that the first one is the worst one I ever had and not because it hurt at the time of the procedure as I believe I had some level of anesthesia but rather because it seems that with the first one there's more discomfort at least for myself it lasted a full 3 days feeling like a the beginning of a flare up with increased pain in the area that normally hurt (or like my back was going out all over again).

That was the only time it ever really hurt for more than a day after the procedure itself altho usually one is advised that there can be increased pain for up to 7-10 days but that's not been my experience and over the last few years I just relatively low to no pain afterwards or only some discomfort but I still rest that day with ice packs to the area intermittantly.

I do hope you will get good relief and that this will be a limited experience with pain/back probs and you can be back doing what you love~

Eastex · #11 (**permalink**) 11-11-2008, 06:01 PM

Guy,
I have only had two done and I didn't feel any relief. My first one didn't bother me, but it was weird. I had never been in a hospital for anything, so I was a little nervous. I was surprised how I was in and out of the procedure room. The wait before and after was the part I didn't like. They had me in a wheel chair on my way to the entrance to meet the best wife in the world with the car. (She has put up with me and this pain for a long time, and I need to be extra nice!) While they were wheeling me along, It felt like my legs were moving back and forth like I was walking. It was a strange feeling. On my second one, I felt more pressure and it was a bit more discomforting. My back hurt more for a few days and then it was back to the normal pain. My mother had an injection a few weeks ago and it helped her a lot. She has to have surgery, but it did relieve the pain. I am not to far ahead of you in the battle of back pains. Good luck to you and secret recipes are always welcome!

mmglobal · #12 (**permalink**) 11-11-2008, 07:05 PM

Guy, in the early days of my ordeal, I had 8 epidural injections. Most helped, a few had no impact and one set me off (made me much worse) for about a week.

It sounds like you are relatively new to spine problems and are in the stage where you are trying to avoid surgery. Epidurals stand a good chance of cooling down the inflammation and allowing you to heal quicker. The don't work for everyone, but IMHO, the risks are relatively low. That is why such a high percentage of lumbar patients get epidurals, even though a relatively small percentage of us get long term relief.

The ESI's were helpful to me when I was still the the avoiding surgery phase. They saved several vacations, as my pain management doc would fit me in if I was having problems just before a trip was planned.

Good luck,

Mark

Jakea222 · #13 (**permalink**) 11-13-2008, 03:22 AM

thanks for the great responses. in quite a bit of pain now and really walking parking lots etc with a cane. the kitchen work is very hard and i take pain killers before each shift and sometimes in the middle especially tonight where I had quite a few reservations. I am doing PT on my off days and doing the same stuff at home with lots of ice packs.

I really appreciate all of you and value your life experiences a lot...guy

mmglobal · #14 (**permalink**) 11-13-2008, 04:18 PM

If the 'first two' were zero relief... will there be more? I've always wondered what motivates the doctor to do a third ESI.

Are you getting ANY improvement? Are you still working?

Mark

Maria · #15 (**permalink**) 11-13-2008, 06:32 PM

Someone that is ethical about the ESI helping you would probably not offer it the 3rd time if the 1st and 2nd don't help. Some PMs would go ahead and do the series of 3 because it's their bread and butter so to speak and a series of 3 have already been authorized however that makes me think twice about the person doing the procedure.

Always with the use of fluroscopy(sp) BTW.

Thankfully ESIs help me. Particularly the transforaminal approach. I've been told when I'm getting L4 and/or L5S1 area done and that's what's helpful to me. L3 even with annular tear seems to be useless. Caudal approach seems OK for L5S1 area but it doesn't last that long with me or help as much.

Jakea222 · #16 (**permalink**) 11-16-2008, 04:18 AM

I have my "work" done on Tuesday....I am not too worried as the pain has reached the crying in the kitchen level (if you didn't know I am a chef) so I have been a little grouchy but everyone loves me....the one server that I really like, saw me for the first time today with my cane and started laughing and the rest of the crew were gonna GET HIM - but he said I remind him of the tv show HOUSE md --- I laughed and then called him and moron and popped my pill! The exec Chef said the new nickname is House for me....they are all supportive and I am still giving 110% - but without moving shipments around! Oh well - we should find the humor in the terrible situation somehow - my friends just had to show me - morons! Ha

Maria · #17 (**permalink**) 11-16-2008, 09:51 PM

Dear Chef House
If after the ESI you do get relief and as much as I do please refrain from the from throwing your cane at the *morons* and your pills in customers salads.

But most of all don't OVERDO/heavy lifting/moving/reaching/pushing, etc! It's something I do nearly every time I have great relief from the injection and then I'm miffed at myself while I have to spend a bit more time lying down when I could be active just not crazed!

You'll see, if it helps you like it helps me, you'll know what I mean and you'll be House no more (possibly/I hope so)!

Jakea222 · #18 (**permalink**) 11-22-2008, 08:19 PM

Ok I won't hit anyone Maria and since you say so I will PLAY NICE with everyone. It has been eye opening as I struggle to find my fine line of what I can and can't do....I got in the floor to fix the tv componenet and got literally stuck! THe Epideral thing - insurance required a consult with the doc first - so I have another 3 weeks to wit for this so called finger crossing pain relief. Not looking for Thanksgiving in the kitchen to be a fun thing but I have a great crew and I will and have started things already so I am not pushing the food at the last minute.

I would like to say to my American friends Happy Thanksgiving and to my other friends in the world happy shopping for the holiday gifts....Chef Guy

Maria · #19 (**permalink**) 11-23-2008, 04:08 PM

Guy,
You have to work Thanksgiving? Ouch!!!!! I sure hope that it goes well and of course am wishing you a Happy and Healthy (and as painfree as possible) Thanksgiving! This goes for everyone~

Sorry to hear you have to go thru the bother of seeing someone else before you can get anything else done or attempted relief wise~ good luck with the next visit tho

Jakea222 · #20 (**permalink**) 11-26-2008, 03:06 AM

I think that has been the hard thing for me to accept...I changed careers to be a chef and now this back thing is really preventing me from it - so I just have to get my brain around it --- 3 more weeks until shots so we will see - I did get a new electric shock machine thing - so that is nice with my ice packs...Maria you have a nice holiday too - I have 17 turkeys and all of the trimming almost ready for the day and at 5pm I will be home with family and shocking and icing! - Chef G

Gil Denis · #21 (**permalink**) 11-26-2008, 04:55 AM

Hi chef

I am new to this site! Had several injections and they worked for a while. the last ones i had were hard and no help. Do what ever it takes to relive pain.
pain is my friend I just wish he was nicer. Have a happy turkey day and do not work to hard take several breaks.

Good day Gil

johnb · #22 (**permalink**) 11-26-2008, 08:26 AM

Early on I too did injections and got good relief. Some clinicians tell you they want to do 3 injections. The clinician I had would do 1 and see how I felt, then it was my decision if I wanted to schedule another one with a limit of 3 per year. Since good relief was obtained with the first one but didn't find the procedure too unpleasant (also the Dr. administering them was quite attractive

, I decided to do an 2nd one and got a bit more relief out it but decided not to do a 3rd one. Compared to surgery, the risks are minimal but not zero. You will sign a consent form which lists the potential complications. If you are curious about risks, you can google "epidural steriod injection risks" and get more info.

Some clinics want you to do 3 injections no matter what. IMHO, this to maximize revenue as this service is a fat money maker for the clinics. Remember that you are the patient and you are the one assuming the risks. We patients should not have to assume extra risks if we have already recieved a desired benefit just so they can fatten their pockets.

John

Maria · #23 (**permalink**) 11-26-2008, 05:28 PM

what John states re revenue. What I like about my PM is he never pushes for anything and in fact I see him every 3 months or so for scripts and whenever I think I need an ESI I have to speak with my Primary Treating doctor first (OSS) and he orders the ESI and then the PM orders it and then it goes to WC for denial or authorization (what a freaking process at this point).

My PM is nice looking too ~ I call him SurfDoc as he just that kind of SoCal kind of near mid 40's guy who has a harley, used to surf, and is just laid back and pretty dead on with his aim re the ESI's.

For me the benefits have outweighed the risks and relief from pain has been quite welcome.

racergaldar · #24 (**permalink**) 11-29-2008, 02:39 AM

I've had 11 epidural injections and with conscience sedation it was a piece of cake. You're awake, but you don't remember. When I had an EMG, it was excrutiating, so if I can easily tolerate the injections.......

Before you go, make sure they provide sedation. I've heard others didn't have it; so if the dr. doesn't provide it, go to someone else.

johnb · #25 (**permalink**) 11-29-2008, 04:08 AM

That's funny that you mention the sedation. The lady who did the majority of mine didn't use sedation and I didn't know it was an option. 6 weeks into my dynesys surgery was when the bilateral nerve pain/burning and weakness started and I elected to see if an injection might calm things down. Due to the hardware, my PM said it would have to be done caudally so I'm glad sedation was an option. I'm glad I wasn't awake for that.

When I was young (4 to 5), I had a blood disorder, lymphoblastic leukemia, which required a lot of needle sticking so I guess I just became used to needles on a weekly basis. Various professionals over the years always remarked on how calm I've been with various procedures. In fact, the fellow that gave me the discogram remarked that I had the highest pain tolerance that he'd ever seen. I'm not sure about that but my mom did refuse pain medication at the hospital when she fractured her ankle (the nurses thought she was crazy) so it could be a family thing. The discogram occured after my IDET so perhaps it did seal some things up. I need to get my full medical record to look at it for myself. Point being is that my L5/S1 was not concordant for pain and it looks sick on the MRI for sure. L4/L5 was somewhat concordant but not awful so who knows really, I can only speculate. Can a disc be sick looking and not be painful? It most certainly can.

The blood disorder went into remission on its on and my pediatrician just said it was a one of those things that some would call a miracle.

John

Jakea222 · #26 (**permalink**) 12-02-2008, 12:45 AM

I have another question - While I wait another 12 days for my injections I have been pretty hard core in doing Physical Therapy. I go to a place and then I do it at home on my own -- I have 2 PTs and the younger chick (sorry just a term ladies) she is real good about -especially after a hard day on the line to ease me out of the severe pain I am in - the other is in my opinion too gentle -

So here is my question - is PT a good thng - what I mean by that if you are trying to strengthen the muscles but they tell you not to do things that hurt - well I hurt all of the time....see my problem. As a former "guy that worked out and had a washboard stomach and some cut BEFORE I GOT MARRIED AND BECAME A CHEF" ha that was a little humor. I used to work out to burn and have thet muscle soreness....so how do you build it without burning it OR not creating pain while doing it ----- boy I just read it and it spins around but has a question....tell me your opinions....Chef G

johnb · #27 (**permalink**) 12-02-2008, 02:52 AM

I'm a believer in PT. However, it took me awhile to find a good one. Additionally, I think some just have a special talent for it like a certain intuition or something. My PT used a technique called strain counterstrain. He always wanted to view an MRI abstract if available. PT's cannot diagnose but he knew more about what was cuasing my pain than any MD I saw at that time. I was 24, diagnosed with disc disease at L4 to S1 with some bulging, some annular tears but still with good disc height at both levels. I had no nerve related symtoms at the time. My pelvis would get out of alignment which caused pain. He'd press on different muscles and I'd give feedback on which ones were painful when palpitated. Then he'd put my body in a position where there was no tension on that muscle and put pressure on that muscle for 1.5 minutes. This did something to release that muscle that was pulling my pelvis. The muscles that were in this state were described by him to be in a state of dysfuntion and needed to be reset. Once these muscles were reset, he'd instruct me on stabalization exercises that go from level 1, 2, and so on. Before meeting him, I was very scared due to persistant pain at such a young age with surgeons telling me not to have surgery. He helped me out tremendously. Out of the 6 PT's or so that I've worked with, he was the only one that helped me. God bless Tim McMahon.

So it really depends on your particular issues I suppose. It makes sense to have a strong core to support your spine. If your muslces aren't doing their jobs, your spine is going to be under more strain.

John

mmglobal · #28 (**permalink**) 12-02-2008, 03:32 AM

I've always had bad luck with PT. It always seemed to set me off.

I think it's important for some. Most people are going to return to a fitness level and activity level based on who they are and what their recovery is like. Getting early return to gentle range of motion is important and some people really need to be retrained in how they stand, lift, etc...

Many of us suffer from alignment problems and muscle spasms that can be improved quickly by a good PT (or aggravated by an overly agressive one.)

Let is know how it goes...

Mark

Maria · #29 (**permalink**) 12-02-2008, 06:26 PM

I've had only one really good PT work with me post my failed discectomy in '92and he utilized many of the techniques of Osteopathic doctors with myofascial release and of course strain/counterstrain however it was his ability to really feel where the problem was and deal with it at a very precise level. I've not ever had anyone that skilled work with me in that way.

I was fortunate to see this PT for a year and over that year plus utilizing ESIs and pain meds I really made progress in terms of pain relief and mobility. Now that was going from complete bedrest and only up to BR and kitchen to able to walk on beach again, have some fun, and be more social.

Oh well, just wanted to chime in on PT. With regard to my knee surgery I had very good success with the PT's that worked with me.

Jakea222 · #30 (**permalink**) 12-13-2008, 01:52 AM

well - pt has been good and bad and has made me feel good some days and terrible others. I go for injections Monday - keep your fingers crossed for me - Chef g

Jakea222 · #31 (**permalink**) 12-24-2008, 01:04 AM

Hey guys - well I had the injections last Monday and I have to say post 6 days I can see a difference - they did inject the stuff around where the L5 is pushing on the nerve and while I am not feeling the radiant pain down my leg and "butt" sorry but that is where it is! It is now just a sharp pain at L5 and it does kind of radiate around the front but it is tollerable! SO it has helped a great deal but as a chef and the holidays it is a little tough still I am holding back still from doing the real tough stuff,,,,working on banquet stuff and partys etc and will go back to therapy after the first of the year....doing PT at home with my siberian cats and still popping pills but living ---thanks for the support and I will be posting from time to time.

I am happy to share any of my experience with anyone that wants my spin....Oh they did knock me out instead of a local - someone told me that it was only a local so it was nice not to know what was happening...let me know if you need any assistance ---

mmglobal · #32 (**permalink**) 12-24-2008, 01:35 AM

Jake... great news about getting some relief from the injection. Some docs schedule them as a series... 2 or 3 indections, maybe 10 days - 3 weeks apart. I've never understood why they'll do a 3rd injection in a patient with no relief from the first 2, but I do believe that getting another injection while you are still experiencing relief from the previous injection increases the chance of getting long term relief. If you are one of the lucky folks that gets good relief... if you got some relief from the first one, you may get even more by doing a series. (Kind of like hitting a fire with second hose before the first one runs out - as opposed to letting it run out and letting the fire build up again before restarting the water.)

Have a great holiday!

All the best,

Mark