L4-L5 DDD, cannot sit, burning feet

[james]

Hi Everyone!

I am 47, computer programmer. My bad back is because of sitting long hours behind computer. I have lost lots of job opportunities, my PhD after 4 years of study, as well as my wife because of back pain, in the past years.

I was diagnosed with annular disk tear and DDD at L4/L5 in 2006. I had mild back pain and buttock pain at that time, when sitting.

My doctor referred me to physical therapist and the PT managed to destroy my back. After therapy, I was in bed for the next 6 months, because of pain. I had also tingling in my legs and numbness in my feet .

After recovery I was not able to sit even a minute. When I sit I have burning and tingling on the back side of my both legs, from my back to my knees. I gave up sitting and tried to do my daily work standing or laying down on my stomach (this was a bad decision).

Right now I have mild back and left buttock pain and extreme burning sensation on my feet sole when standing or walking. Any movement is also painful.

Dr. Howard Tung in San Diego, wanted to fuse my disc, which I refused.

I do back exercise , including Plank, Cat-Camel and Medex machine to strengthen my back muscles. They don't alleviate the pain, but I am hoping exercise prevents herniation of other discs and preventing the L4/L5 to become worse.

In my current job, I have some freedom. I can lay down in my office, behind close door, or sometimes work from home, while I am in bed. My employer does not know much about this. I pretend I am okay.

I am very limited and haven't been further than 5 miles vicinity of my home for the past few years. I drive short distances to work/grocery. It is very painful, but I have no other choice. If I need to see a doctor, I hire someone to drive me.

I have difficult sleeping at night, because all sleeping positions are painful. I put pillows around myself and sleep in 45 degree position; between sleeping on my side and sleeping on my back.

Sleeping and sitting problems aside, my biggest problem is burning sensation on the bottom of my feet.


New development: Today I developed a new buttock pain, which I did not have before.

[newhere]

Originally Posted by james

Hi Everyone!

I am 47, computer programmer. My bad back is because of sitting long hours behind computer. I have lost lots of job opportunities, my PhD after 4 years of study, as well as my wife because of back pain, in the past years.

I was diagnosed with annular disk tear and DDD at L4/L5 in 2006. I had mild back pain and buttock pain at that time, when sitting.

My doctor referred me to physical therapist and the PT managed to destroy my back. After therapy, I was in bed for the next 6 months, because of pain. I had also tingling in my legs and numbness in my feet .

After recovery I was not able to sit even a minute. When I sit I have burning and tingling on the back side of my both legs, from my back to my knees. I gave up sitting and tried to do my daily work standing or laying down on my stomach (this was a bad decision).

Right now I have mild back and left buttock pain and extreme burning sensation on my feet sole when standing or walking. Any movement is also painful.

Dr. Howard Tung in San Diego, wanted to fuse my disc, which I refused.

I do back exercise , including Plank, Cat-Camel and Medex machine to strengthen my back muscles. They don't alleviate the pain, but I am hoping exercise prevents herniation of other discs and preventing the L4/L5 to become worse.

In my current job, I have some freedom. I can lay down in my office, behind close door, or sometimes work from home, while I am in bed. My employer does not know much about this. I pretend I am okay.

I am very limited and haven't been further than 5 miles vicinity of my home for the past few years. I drive short distances to work/grocery. It is very painful, but I have no other choice. If I need to see a doctor, I hire someone to drive me.

I have difficult sleeping at night, because all sleeping positions are painful. I put pillows around myself and sleep in 45 degree position; between sleeping on my side and sleeping on my back.

Sleeping and sitting problems aside, my biggest problem is burning sensation on the bottom of my feet.


New development: Today I developed a new buttock pain, which I did not have before.

i dont have buttock pain...but i have so strong pain in low back...caused by annular tear..
i will go to selective endoscopic discectomy with thermal annuloplasty,suposed to heal annular tear and shrink the disc...

[Hooch]

Gday, I went the fusion and disc replacement 5-6 months ago, on how I am now I should've done it 3 and a half years ago. Very tough recovery tho... lost awareness of pelvic positioning due to pain etc.. being switched on re physio is important.

I was at the point where mentally I couldn't go on in that state anymore and wasn't going to work. I don't know what would have happened to me.

I know you don't need me to tell you how debilitating your condition is, to my mind when I was like that it was quite clearly time for surgery and just hope like hell things improve.

About physio, you need to look at transverse abdominus, pelvic floor, multifidus activation, gluteal dominance over hamstrings.. there is a good book by Jemmet called Spinal Stabilization. It's the basis for pilates. At least that way you can rehab without breaking yourself down.

If you're considering surgery you've probably got a good chance of a good outcome, considering how bad you are and one level blown. Not exactly a risk taken lightly tho.

[Maria]

If you live in the SD area and want a good consultation try Dr.Frank Coufal (he's a Neurosurgeon). At the time I saw him for a 2nd surgical opinion (WC) re 2 level ADR he didn't perform lumbar ADRs, rather fusions altho he went along with 2 level ADR recommendation.

I'd also recommend talking to Mark here (mmglobal) GPN Artificial Disc Replacement ADR

He accompanied me to see Dr.Delamarter, Dr.Regan, and Dr.Coufal. Definately worth talking to Mark.

[dshobbies]

James,

You have suffered for too long. There is help out there but you need to understand where your pain is coming from, what procedures might help, and the pros and cons for each. Only when you have full knowledge of all these things can you make an informed decision. But I will tell you that living like this is a waste of your time, your life.

You are not experiencing anything unique. Too many of us have walked in your shoes.

The first thing is for a consultation, actually second and third opinions too, with a top surgeon. You didn't mention where you live but perhaps someone can make a recommendation. We also don't know your insurance, financial status if your insurance won't cover and ADR surgery - not that this is your only option. So far, it seems you've only seen one doctor who recommends fusion, which I think you rightfully declined. You also said PT didn't work which might indicate that surgery is your only option. But you still need guidence.

All this is assuming you are willing to have a surgery. Some are not and would rather live with the pain regardless of the disability.

And as Maria, a good starting place is with Mark. He has helped so many of us.

Please tell us more about your circumstances and perhaps we can make some recommendations.

Good luck, Dale

[Maria]

I had put this on the other surgical thread that was Jamie's so wanted to put it here~ re understanding that you have doubts, concerns and so forth plus then seeing surgeons who state that the MRI doesn't show anything.

There are other diagnostic tests that might reveal the pain generator(s) so it is important that if your life is that limited to get to the root of the problem as best able because as you're lying there resting your spine to protect it from further pain/harm the rest of your body is suffering the consequences of inactivity.

That might not seem like much right now but years of this adds up w muscle mass loss, osteopenia/osteoporosis possibly and other consequences of inactivity.

Here are my recommendations:
Call Mark to see if he can help you find someone in your area to see.
Consider Pain Management to see if being on some type of medication can enable you to be more mobile in the interim.
Keep an open mind with regard to the process of trying to find out what's going on and what might possibly be done about it. You always have the last say about surgery so even if you find out you can have it doesn't mean you have to have it.

As stated we've walked in your shoes hence getting to where we each have individually today. Good luck and thanks for taking the time to post and tell us about yourself/your pain.

[james]

Thanks for your attention!

I live in San Diego. My MRI shows disc tear, degenerated disc and slightly degenerated facet joint.

I was unlucky w.r.t to the doctor and the physical therapist, I met at the start of my problem. No one told me what to do and how to treat my problem.

At the start of my back pain, doctors basically told me "you do not need surgery now, go and come back when we can operate you!".

By the time I realize what to do and how one should treat back pain, it was too late. Now I am here with pain and disability.

The last doctor I met (Ramin Bagheri, San Diego), basically said he is interested in patients that he can operate on, if I don't want to be operated on, better not to waste his time!

I have had epidural injections and take pain medication, but they don't help much other than making me sleepy. I also feel disconnected to my environment, when I take them.

I will have my 4th MRI soon.

My back is extremely fragile. Any sudden or harsh movement puts me into pain, which lasts for months. Recently, I have started using ice pack.

[Maria]

Come back when we are ready to have surgery... and how do we know that? I'm sorry but Dr."I'm too busy" should be getting paid for a consultation/opinion whether or not you are going to have surgery however I know how busy surgeons can be (worked with Neurosurgeons for a number of years back in the late 70's and early 80's) my strategy was to seek opinions with the idea in mind that if findings so indicated I would definately consider having surgery. I never stated to anyone that I didn't want any surgery. I mean we have to at least let the person we're consulting give his or her opinion so I go to the appt. with my "I want to know what's wrong face and see what you say."

Ok so you've tried meds. Have you had an injection of Toradol 60mg IM for muscle spasms? You can request this and see if it helps. It's often offered in Urgent Care or ER for muscle spasms. While I don't think all of your problem is muscle spasms at least in part it could be such as when disc material leaks out on nerve and then you go into muscle spasms as protective mode. I'm only suggesting this for very temporary relief and/or to break a cycle up. Worth a try.

Re SD area again I recommend Dr.Frank Coufal, Neurosurgeon for a consultation. He's in La Jolla. If you can see him with Mark going along that'd be even better. I think Dr. Coufal just gives you straight up what is going on and what some possibilities are surgically if one is a candidate for any surgery that might help. I also think he'd listen to whatever you have to say. Nice fellow and on the younger side (like in his 40s I think). Very thorough and doesn't have that "God" like complex that I have seen in many neurosurgeons of his calibur.

My PM is in SD at well as Scripps Mercy (Dr.Kevin Toliver). I have been seeing him for 7 years now and really like him.

I had that feeling of instability or fragile-ness for a long long time and that's when I mostly was in bed or lying down as I thought it was helpful and actually I just couldn't tolerate much else so I do understand what you're saying.

[james]

I will schedule an appointment with Dr.Frank Coufal. One more Dr. wont hurt.

I will also contact Mark.

I have united health care insurance. I am not sure if it covers back surgery/fusion/ADR.

[Maria]

James,
I'd call Mark first (I'm sorry if I'm coming across bossy/don't mean to) and talk w/him. Get his opinion on Dr.Coufal as a consultation. Re insurance covering surgery .. hopefully they'll cover your consult. Often it's how the doctor/surgeon presents the information as to what is done/not done and how persistant they are on your behalf. There are other considerations as well though at this point like you say "one more consultation won't hurt" so go for the information mainly (from someone willing to take the time).

I read you had a trainer on another thread~ I used to work out with some physical rehab docs and they helped me a great deal w/my work out regimes altho this is before I started having cervial probs (or when just limited to lumbar spine). Maybe if you were seeing a kinesiologist or physiatriat you could get insurance to pay though I've not heard about trainers being paid by insurance. Good idea though. Probably cheaper than sending someone to PT (for insurance co that is). Not cheap indeed I'm aware as I have friends that are trainers. Good that you're doing that for your bod.

[mmglobal]

I've not read the whole thread... 11:30pm in Bogen and I just got back to the room. This is the end of my trip and I'll be heading home tomorrow (Friday)... I'll be available on Monday. I'm posting because UHC is one of the companies who is coming around on ADR. A couple of weeks ago at SAS in Las Vegas, Dr. Coufal told me he'd received a letter from UHC stating that they'll be paying for cervical ADR. I think that means one level. I don't know their status on lumbar ADR.

All the best,

Mark

[james]

What really pisses me off is that few years back, when the back pain started, NO BODY, NO DOCTOR told me about abs and core exercises. They just told me take this pill and come back when you need a surgery.

Am I suppose to discover all remedies for back pain?

that's why I think our medical system sucks.

[james]

Originally Posted by Hooch

Gday, I went the fusion and disc replacement 5-6 months ago, on how I am now I should've done it 3 and a half years ago. Very tough recovery tho... lost awareness of pelvic positioning due to pain etc.. being switched on re physio is important.

I was at the point where mentally I couldn't go on in that state anymore and wasn't going to work. I don't know what would have happened to me.

I know you don't need me to tell you how debilitating your condition is, to my mind when I was like that it was quite clearly time for surgery and just hope like hell things improve.

About physio, you need to look at transverse abdominus, pelvic floor, multifidus activation, gluteal dominance over hamstrings.. there is a good book by Jemmet called Spinal Stabilization. It's the basis for pilates. At least that way you can rehab without breaking yourself down.

If you're considering surgery you've probably got a good chance of a good outcome, considering how bad you are and one level blown. Not exactly a risk taken lightly tho.

Thanks. Got the book. I try to go through it with my trainer.

[james]

took the 3rd MRI with contrast on Saturday. I have one from 2007, one from 2009 and one from 2011. I am going to schedule app. with Dr. Coufal.

[james]

Got my MRI results. L4-L5 stenosis and small facet joint degeneration. I guess they meant DDD.

I probably want to go for epidural.

Does anybody now about this:

AccuraScope™ Procedure for Back Pain Relief


Thanks.

[james]

Originally Posted by Maria

James,
I'd call Mark first (I'm sorry if I'm coming across bossy/don't mean to) and talk w/him. Get his opinion on Dr.Coufal as a consultation. Re insurance covering surgery .. hopefully they'll cover your consult. Often it's how the doctor/surgeon presents the information as to what is done/not done and how persistant they are on your behalf. There are other considerations as well though at this point like you say "one more consultation won't hurt" so go for the information mainly (from someone willing to take the time).

I read you had a trainer on another thread~ I used to work out with some physical rehab docs and they helped me a great deal w/my work out regimes altho this is before I started having cervial probs (or when just limited to lumbar spine). Maybe if you were seeing a kinesiologist or physiatriat you could get insurance to pay though I've not heard about trainers being paid by insurance. Good idea though. Probably cheaper than sending someone to PT (for insurance co that is). Not cheap indeed I'm aware as I have friends that are trainers. Good that you're doing that for your bod.

What is kinesiologist? I haven't heard of that before. My insurance doesn't pay for physical therapy anymore.