Newbie here - L4-L5 problems
 

Hi all! I am new to the forum and would very much like to know if anyone has had similar MRI reports on their lower lumbar, and what their doctors/medical professionals advised them.
MRI reads:
Grade I degenerative subluxation at L4-5 with bulge, annular tear, prominent facet arthropathy. Mass effect on the right lateral recess nerve root w/crowding of the left. Stress injury of the pedicle & pars region of L5.

Next Tuesday I go to a pain clinic for a 2nd opinion on surgery. Any and all replies much appreciated!!

I should have asked in my previous post.....does my MRI sound really bad to ya'll?
I know that it feels really, reeeally bad. Back hurts, right leg hurts all the way to the foot, muscle spasms in both legs are constant, right leg goes numb driving, both knees ache something awful in the backs of them.

Orthopedic surgeon rated it an 8 in severity, but he advised a laminectomy so fast that I was a bit leery of him.

Hi ~ I'm glad you're getting another opinion -- you might even want to get one more, perhaps from a Neurosurgeon this time.

Do NOT jump into surgery -- surgery should be a last resort, after all conservative methods have been tried UNLESS you're in danger of permanent nerve damage or the spinal cord is being impinged. You're never the same after surgery and surgery does NOT often relieve the pain. Many times you end up with the same pain or worse after surgery. :eek:

Best of luck - let us know what the pain doc says. Take care & God bless. Hugs, lee

Hi seahorse
 

So sorry you are going through back issues. There are alot of us on here who have both had surgery, and gone the non-surgial root. Don't rush into surgery, and for sure get a neruo surgeon opinion. It never hurts to get others opinions, and I would do that first. Also look up all words in your MRI report, so you will understand better just what your MRI says. Most MRI's do sound very scarry. If you understand the exact terms, when you do go for another exam, you will understand what they are telling you better. If you have nerve inpingement pressing on the nerve column that for example is reason for a surgery. I had nerve involvement compressing the nerves in my neck and had two spinal fusions. I would never tell someone to go ahead with surgery without all the opinions you need to satisfy your understand ing of the problem. If you understand all the issues, your decision making will be alot easier. Others here may chime in, with a more complete understanding about what your MRI states. I hope the best results happen for you. ginnie

Second Opinion
 

I had L4-5 fusion 5 years ago, along with a laminectomy. Still have a lot of pain; but major nerve compression would have made things much worse. The surgery was necessary in my case. Since the spinal cord was being compressed, did need to have laminia removed in that area as well.

I am currently under the care of a Pain Specialist; but not sure that would be the doctor to see for a second opinion since their primary job is to relieve pain. Too often, the Pain Specialist will start treating the pain/epidurals, etc.

I certainly would see an orthaepaedic surgeon and/or neurologist/neurosurgeon for 2nd/3rd opinion. They would be the best to give an opinion regarding your issues and the course of treatment.

ger715, thanks for sharing. Sorry you are still under pain mgmt. after all these years! The pain clinic here is staffed by neurosurgeons and ortho doctors as well. I will be seeing a dr. not a pain mgmt. specialist for the second opinion. They are all affiliated with the hospital next door to clinic so if surgery is called for it will be performed - or at least that is what I've been told. I am financially unable to argue much.

You said that you had a laminectomy...that was done prior to your fusion for L4/5? Was it a "minimally" invasive laminectomy or the traditional? I did speak with a neurosurgeon's office, one who is highly thought of in the area (also big $$), and was told that she does not do the minimally invasive procedures (like the 1st ortho wants to do on me) because the outcome to that is not as good as traditional.

ger715, you also spoke of nerve compression. My MRI states "mass effect on nerve root". Bumping around to different medical sites, I gather that compression and mass effect are interchangeable. Do you know that to be true?

As far as any epi's, I am not sure if I could ever go that route. I had a set of 3 cervical years ago, and I had a debilitating headache for 24 hours afterward -felt like my head was going to literally explode. Completely drained on the 3rd from the pain the day before. I have since found out that I am allergic to cortisone medications. Do they still perform lumbar epi's if that is the case?

Sorry for all the questions!!.....just nervous, can't sleep, & these constant nerve spasms are maddening!!!!!!!!!!

Hi Seahorse
 

It is OK to see a pain specialist for another opinion, In fact it was my pain specialist who "discovered" just what was happening to me when he did a Katamine infussion with the xray guide. He could see what was wrong and he ordered the new MRI as he could not control my pain. It was his referal to my new neuro surgeon. I wish you all the best while you go for your evaluations. ginnie

Ginnie, thank you so much for your well wishes and for sharing your experience! Happy it worked out well for you and that you had good care.
Tuesday just can't get here soon enough!

hi seahorse
 

I do care. All this stuff to do with the back issues are hard to deal with. I will be thinking of you when you go for your next appt. on tuesday. Go armed with as much information as you can gather. I sooooo hope that there can be a good resolution for you. I hope this weekend you can have peace in your life as you wait for your appt. Let me know how it goes. ginnie

Laminectomy/L4-5
 

My spinal fusion and laminectomy were performed at the same time. The surgeon said he had never seen such a "red angry nerve". Not sure the nerve root and my compression from the vertebrae crushing the nerve is the same. The surgeon did not realize how badly compressed the nerve until he was performing the surgery. Not sure, but things might have been much worse had I not had the surgery.

A couple of years before my surgery, I had also been to a doctor for my arthritis on my wrist and told him about my spine/leg/groin pain. He referred me to one of the doctors on their staff. They also have ortho/pain, etc. associated with their clinic as well. She did an MRI which showed spinal stenosis and degenerative disc disease and a problem with L4-5 but don't remember exactly whatelse was mentioned. She was a pain specialist. Did steroid injections and recommended physical therapy, which I did. (I get migraines from the steroids as well - inform you doctors of your problem.)

Eventually, the pain was almost unbearable. I tried to get an appointment with the ortho/spine specialist on staff; but he could see me for a couple of months. Pleaded; but still could not get in any sooner.

Because of this, I went to Rush Medical Center and had the fusion/laminectomy there. A couple of years later, did get to see the original doctor I had wanted in the first place. Both he and the surgeon felt further surgery would not help me as there were other problems as well so I should expect to have some continued pain.

Along with my spinal issues, did develope Pheiphereal Neuropathy. The burning feet, ankles, and leg pain is almost as bad as the spine pain. I am dealing with a few issues. Therefore, was given a name (someone else than from their clinic) of a Pain Specialist who I have been under his care for close to 3 years.

My only concern in your case is that they do not send you to one of their pain specialist first. Your second opinion should be from their spine/ortho. Like I mentioned, the clinic I first went to had a complete line of all these doctors as well. Just be sure your appointment is with a neuro or ortho/spine doctor.

Hope all turns out to be the best road for you to take. In the meantime, try to relax and have an enjoyable Christmas.
Ger

Re: re-state a different way seahorse
 

Ger, was right. The opinion from the neurologist, or neurosurgeon should indeed be on top of the list. I was mearly stating that it is OK to go to a pain specialist for another opinion in addition to the nerurologist. Maybe outside that particular facility. I had been in with a PCP for the six years, never realizing I had deterioated, and he didn't question it. I went to the pain specialist as "I Knew" I was getting worse, and had been told before all that could be done was corrected. I didn't think there was any hope of more surgery to help me. I would have sought out a neuro surgeon first had I thought there could be help. So this pain doc. did indeed rescue me, and sent me in the right direction. He gave me Katamine infusions while I waited for the surgery. This did not cause me any problems or pain, not even at injection site. The other epis were terrible. ginnie:hug:

Thanks for all comments.
May be Peace with you this Christmas and with all who have sought out this forum, for whatever reason. May your burdens be lessened!

Well ya'll, today wasn't a day I'd like to repeat.
I arrived at the Pain Clinic in all my unmedicated glory to show what was going on. After the 45 minute drive, I couldn't stand still, sit still, lean still due to the pain. I had no idea that the left lower lumbar hurt as bad as it does until today. Silly me, I thought the right side was the worst!
Here I bow to you more seasoned posters...I thought that I would be meeting with an ortho or neurosurgeon....wrong. I met with a pain specialty anesthesiologist, albeit a very kind, thorough, thoughtful fellow. He agreed with the diagnosis of the first ortho I saw, said he thought surgery will be the answer, said he did not think epidurals will be beneficial, but wants to try one epidural to see if it will buy us some time to find a facility and neurosurgeon who is willing to do the work on someone w/o insurance. He said that the choices of surgery will be a laminectomy & disectomy, or a fusion, but since he is not a surgeon he could not say which. I felt comfortable with him. I agreed to the epidural, scheduled for 1/9. Oh, also continuance of the percocet and upped the gabapentin from 800mg/daily to 1600mg/daily.
I took the 1st painkiller of the day at 3pm and was glad, so glad to take it! Glad today is over as well.

Hi seahorse
 

I am glad the pain specialist was kind to you. Percocet is a good medication and I am relieved for you, that he gave you this medication. I hope it is helping you with the pain. Indeed, the pain specialist was the person in my life who got me in touch with the best neruosurgeon around my neck of the woods. It is not much fun to present yourself in pain like that. I have cried to my doctors before, without shame, I couldn't help it. I so hope that a resolution, and this surgery works for you. I have no regrets with going through mine. Even when my first surgery failed, this second time brought a good relief from the pain. I will be thinking of you seahorse. Let us know how it goes. ginnie

I see others posting great MRI results in laymen's terms. Would anyone be willing to do that for me please? MRI statements are in the first post of this thread. Thanks much!

Update...Although the ortho and the pain specialist have predicted that an epidural will probably not be beneficial in my case, the PS is going to perform one this Monday, prior to my scheduled consultation with the neurosurgeon later this month. Regarding the epidural, I am not as hesitant about the needle in my spine (I've had them in my cervical spine years ago) as I am about being put under conscious sedation with Versed. Anybody have anything good to say about this chemical and your experience with it?

Re: on versed
 

This medication I have had used on me three times for proceedures/surgery/. I had no ill effects from it. The med. works quickly and you recover quickly. I did not experience any nausea when waking up. From what my Doctor said it is very safe to use. I also had a regular shot of it, before a local on my ankle. The doctor said I chatted the whole time, and I don't remember that! ginnie

Been there
 

I had a L3-L5 laminectomy and it did the trick. Back pain is history but the peripheral Neuropathy remains.

Been there
 

Hey Newbie;
I had a L3-L5 laminectomy and that took care of 35 years of back pain but left my legs still in pain. I have burning on my left and numbness on my right. Because of damaged as well as dead nerve cells I will never be pain free. So I will tell you something invaluable: You need to take maximum amounts of your medications. Half measures avail you nothing. Check with your Physician of course but Medications for neuropathy other than narcotics are of little use. But we do not want to take narcotics so there is Lyrica. Forget neurontin unless you take in conjunction with Lyrica. Just a little friendly advice.:):):):)

RX Horatio, thanks for the info on Lyrica. The 1st Dr. I saw - the ortho surgeon - put me on Gabapentin (Neurotin) so the 2nd dr. (the PS) continued with gabapentin but doubled the daily dosage, which controls the nerve spasms- somewhat. I personally do not want to increase medication UNLESS I HAVE to...start with minimum because an increase may be absolutely necessary in the future. From what I've read, gabapetin is not a scheduled drug but Lyrica is. The PS or neursurgeon may change the gabapetin to Lyrica or something else anyway, because I am getting swelling in my hands and that can be a side effect of gabapetin. Glad your laminectomy was beneficial to you! - and thanks for your input! I too am concerned about pemanent nerve damage in my buttocks, legs, feet, as I have had the spasms, which increase in number and intensity on a weekly basis, for so long and the dr.'s appointments are always at least weeks apart.

MRI reads:
Grade I degenerative subluxation at L4-5 with bulge, annular tear, prominent facet arthropathy. Mass effect on the right lateral recess nerve root w/crowding of the left. Stress injury of the pedicle & pars region of L5.

Can anyone please translate this MRI to laymen's? Thank you so much!

Hi Seahorse,

I agree with this for the same reason and another - that we should always take the least amount of anything required to acheive the desired results. Dosages are usually determined/recommended by the pharmaceutical companies based on averages derived from their studies/trials. Doctors tend to follow these guidelines unless they have experience/reason not to. But this also means "one-size-fits-all" medicine, and since we're all different, those guidelines are going to be too much for some and too little for others (which is my main argument for titrating from lower to higher).

The deal with gabapentin & Lyrica, as I understand it, is this: Gabapentin is an older medication now out of patent (generic). It is often used as a firstline treatment for PN and other neuropathic pain because it sometimes works (despite side effects), and because it is generic, it's cheap.

Lyrica is similar to gabapentin in several ways (some say an improvement on or improved form of - I'm not a chemist/pharmacologist), and ostensibly has (generally) less/fewer side effects, but it is still under patent, therefore more expensive. Some insurance companies/policies will approve Lyrica right off, some will approve it only after gabapentin is tried (and sufficient reason shown for prescribing Lyrica instead) and some will just flat out refuse it.

I have no bias/preference between the two - whatever works - but if cost is an issue, I think I'd give gabapentin a try.

I'm not sure (now) when Lyrica's patent is due to expire; one site says late next year ('13)
http://epilepsy.emedtv.com/lyrica/generic-lyrica.html
while another says '17 - '18
http://www.uspto.gov/patents/resources/terms/156.jsp
(2 patents near bottom of page)

I found this on the FDA's classification of Lyrica as a controlled substance.
http://www.mmm-online.com/setback-fo...article/22504/
This is the first I've heard of this, so I think it's worth pursuing further (factchecking on both patents and this controlled substance issue).

Google: lyrica patent expiration
Google: lyrica controlled substance

Doc

Dr. Smith - I've seen great MRI's turned into laymen's terms from you and others. Would you mind deciphering mine as well? please

Grade I degenerative subluxation at L4-5 with bulge, annular tear, prominent facet arthropathy. Mass effect on the right lateral recess nerve root w/crowding of the left. Stress injury of the pedicle & pars region of L5.

Monday from.....well ya'll know from where.
Got to the pain clinic, nurse got the i.v. needle she was putting in my hand hung up in her latex glove somehow (I didn't see as I was talking to the dr.), pulled it out of my hand youch!!, bled like crazy, popped up the size of a walnut, which she put pressure on, aaaarrrggh the pain! Errrr, shall we say not a good start? Wrapped my hand in ice. Put another iv in my arm - success this time! Due to lots of drug reactions/allergies, doc decided to use fentanyl at 1/2 dosage as anesthesia and 1/2 dosage of epidural steroid. Klonopin script written up to counter my usual reaction to steroids. Injected right lower lumbar. Went smoothly. Couldn't put any weight on my right foot going up steps when I got home, tho hours later the right side felt much better, but made me sooo much more aware of how badly the left side feels. As I've whined before, both PS and previous OS said that they did not think epidurals would do any good in this case anyway, but at least when I see the neurosurgeon in a couple of weeks he will see that I've already tried this. Permanent nerve damage a concern for the pain specialist doc, and for me as well. Said to take it easy for a few days, and just do things as I feel I can, nevermind what I WANT to do (see I'm one those hyper, irritatingly busy sorts - if I'm awake I'm in motion). I will call the neurosurgeon's office daily between now and my scheduled appointment to see if they can pop me into any cancellation spots they may have. Time goes by so fast UNLESS one is in pain doesn't it?!

Umm... your lower back is really messed up and hurts like cuss?

Seriously, I'm flattered, but I think it must have been someone else, and there are several people here who are much more knowledgable/experienced than me (I?); I'll have to look most of those terms up myself, but I'll take a stab at it and defer to others' corrections/different interpretations.

I think you know what degenerative means; it's deteriorating, and will continue to get progressively worse over time. This progression may be the natural result of aging; very slow (taking years to decades), and some natural healing may occur in the interim as the body tries to protect itself.

From: http://www.spine-health.com/conditio...ndylolisthesis
From: http://www.arachnoiditis.info/conten...listhesis.html
I would think that traumatic injury would be an exception to the above.

Paraphrased from: http://en.wikipedia.org/wiki/Subluxation
Subluxation implies the presence of an incomplete or partial dislocation of (in this case) a joint. A spinal subluxation is relatively rare, but can sometimes impinge on spinal nerve roots, causing symptoms in the areas served by those roots. In the spine, such a displacement may be caused by a fracture, spondylolisthesis or severe osteoarthritis.

From: http://www.mdguidelines.com/spondylolisthesis
Since we're talking about the joint between L4-L5, the bulge and annular tear are in the disk. A bulge is just that.
From: http://www.laserspineinstitute.com/b...ular_tear/def/
*(I have this type of annular tear at L5-S1)

The facet joints are the joints of the spinal column - between the vertebrae. Facet arthropathy essentially means arthritis of the facet joints. I believe prominent in this context means severe (subject to correction).

I'll need some help (or much more time) on the rest of it. Your doctor should be able to decipher and explain all this. Be firm and perseverent until you get satisfactory answers.

HTH,

Doc

Dr. Smith - perhaps I just thought you had interpreted others' mri's, but you seem to always make well-informed posts well worth reading. My issue with my own mri is that I pretty much understand what each sentence means but as a whole and taken all together, I'm a little lost (but not in space :)). I wish I knew which of the issues were caused by natural aging and which were caused by hitting the kitchen floor from a standing position with one foot in the air at 6 feet, AND what it all means as a WHOLE.
See, I was bragging about how strong and healthy my legs felt after power walking every day for 3 years, said I'd like to take up kickboxing or hiking (note to self - never, ever brag). My significant tormentor said that I could never kickbox because I couldn't get my leg up high enough, I said I could, he said let's see, when I showed him that I could, he caught my heel for just a second and I hit the tile floor on my upper butt. Might have been funny if we were both 6 years old. Regardless, shortly after that is when I began having pain - and I have never ever had any problem with my lower back before.

Thanks though, for your informative post! Great explanations! Does yours hurt like a "cuss" too?

D'oh! :Doh: What a cuss cavity! (Your "tormentor")

I think a lot of orthopedists and neurologist would have a difficult time with that, but I really don't know. If you're asking in contemplation of litigation, I don't blame you and I wish I could help more. That would definitely require the opinions of several qualified physicians. An attorney could/would help you find them, because this also sounds like a good candidate for a contingency case (meaning it wouldn't cost you unless you won).

Yes, I'm in pretty much constant pain, and couchbound more than I'd ever want to be, but I do get out - good days and bad days.

Doc

Hi seahorse
 

I too am still thinking about you. I hope you get some resolution to both the pain issues and insurance. Doc is super good with the information and research. We all wish there was a way to figure out exactly what happened to you. Soemtimes it does take the opinions of many doctors to get the Whole picture. I wish you all the best seahorse. You are in my prayers. ginnie

I hear you
 

I had an L4-L5 lami nectomy and my back is fine now. I had all your problems. Cleaning out that area with surgery finally worked for me. Screw Pain Management.
Good Luck

pain
 

Hi seahorse, sorry the shots hurt. Hope the coming appt. with neurologist answers all the questions you have, and can resolve the issue. ginnie

Yes, "cuss cavity" is a graceful way of stating the adjective I have in mind for him at this point. No contemplation of litigation, that would be much like cutting off my nose to spite my face, as I do have to live here for the time being. Every evening (prior to hitting the kitchen floor) I'm walking my big boy (the one pictured in my avatar) while ole "cuss cavity" is bending his elbow repeatedly. Mismatch is an understatement, and I take the blame for that - BUT not for falling in the blipping floor. In summary, the straw that broke the camel's back......... Fodder for an entirely different forum.
Now I just want my back well - and lose the daily stressor.

Miss Ginnie - you write the sweetest posts!

I took my dog for a much needed walk yesterday, walked for an hour at a good clip....probably should have gone a little easier. I noticed that I had a better push off with my right foot and ankle (side that got the epi), but also noticed now and then what felt like a squeezing at the bottom of my spine. Puppy dog sure was happy to get a walk tho! He's only 4 so he has loads of energy, but was born with hip dysplasia so he can't run, needs to be walked and if I don't walk him, he won't get walked. Sounds like we have a home for the disabled here doesn't it? :)

Today, no walk. Rained most of the day anyway. Nerve pain running down back of leg behind knee is back. Nerve spasms picking back up. Ah well, they did say they didn't think the epi would do any good anyway. It is what it is.

Yes, she does.

Sounds like sciatica. I envy you the long walk ....but not the sciatica. :o

Doc

RE:You are welcome
 

I am happy to help. Be careful as Lyrica side effects including swelling of hands legs and feet are not uncommon but believe it or not but it beats the alternative. I live with the swelling since that relieves the burning. I know that sounds weird but it is absolutely true.

See you around:

goodmorning searhorse
 

I am glad you got the walk in. sometimes just being outside in the fresh air makes a difference. I sure hope you get some good information from you next physician report. I know you will go armed with information. Sorry you hurt. I know it is miserable. Nobody deals well with pain. I had a tooth pulled a few days ago, and I am still miserable, I look like a chipmonk with my cheek. It too will pass, and I will be back to my normal self. I get impatient, and crabby over pain sometimes. I come back here for a dose of realility, and it puts my own pain into the background. Take care of yourself, and you know I will be waiting to hear from you, and so will doc, and others. I am glad you are with us, while you go through this medical trauma. ginnie

Horatio - thanks for the info, & yes, I do understand your logic, but for now I have to stick with the Gabapentin due to cost. It also controls the nerve spasms to the point that they are tolerable.

Miss Ginnie - again thank you for your kind post. Hope your dental swelling resolves soon. Chipmunks are cute tho! :)
Can totally relate to impatience and crabbiness. Unless it's raining, I've had long walks every single day for 3 years regardless of temperature, and not doing those, not feeling like doing those makes me an impatient crabby witch. Plus the health benefits, lower b/p, etc. was an added incentive to the pure enjoyment. For the past few months, I've been taking a pain pill, waiting 30 minutes, gritting my teeth and doing it anyway. I will continue doing that every day that I possibly can. What really gets me down, is the realization that is sinking in, that my back will never ever be the same as it was a year ago. :(

Just finished reading candlegirl's thread, recovery from spinal fusion advice. Very sobering posts. Am in total agreement with surgery being an individual's choice and only that individual. Having 2 doctors tell me that surgery is the only option, I do not expect anything encouraging from the neurosurgeon's appt. this upcoming Friday. It's what, after 1am now, I took the prescribed gabapentin for spasms 2 hours ago and spasms are so busy and numerous in my legs and feet there's no chance of falling asleep.

Somebody help here please...what's the best way to describe these nerve spasms to someone who doesn't have a clue? The best way I can is......imagine a bundle of hot wires that are unbundled, of different lengths, with different electrical capacities, all firing differently, ALL THE TIME. Not the best description. Can someone think of a more apt description so I can help someone who's asked understand?

Surgery petrifies me, but this is no way to live either. Can't carry groceries, pick up a gallon of milk due to pressure in the spine, vacuuming I do otherwise it won't get done and then I pay for it later, don't even carry my everyday purse due to weight, can't pick up a 6 pack of cokes, driving causes such pain I don't even want to get in the car, can't bloody function without drugs. Symptoms just get worse by the week, and living day to day in a chemical haze is the pits. If all conservative measures have been tried (they have for me) with no improvement or promise (or even hope) of improvement, then hold the door to the operating room open...... Personally, I'd rather take a chance on improving the situation than live in the situation as is.

hello Seahorse
 

I just wanted you to know I am thinking about you. I really hope that pain flair, goes down. I also read about the other post with a negative resolution to spinal surgery. I sure do know about being scared that way. I had heard storyies each direction. Surgery as you already know is the last resort. I just want to re affirm, that if this has to happen to you, for you to regain some quality of life it is worth the risk. I had a failed first fusion, followed my a re-do and C3-7. My results have not been perfect, but I am so much better. There can be good results from surgery. I did not go willingly to surgery either. A lot of crying and panick. I just want you to know that not every surgry turns out bad, that some do work, even after a first failure.
I really hope that you can have some good quality of life no matter what you choose to do. Have a good day Seahorse. I am off to one of my doctors as usual...humph! ginnie

Re: defination of spasms
 

The spasms that I had, left me in so much pain, I was flat on back and trembling and shaking head to foot. I couldn't control the pain or the shaking. There is no way to describe it. I really wish that nobody had to go through this kind of agony. I pray that none of you do. I pray for resolution to all these back pain issues that leave us helpless. It is horrible to go through and horrible for a caretaker to witness. I pray each day for all of us. ginnie

I believe we're all in agreement on that point. Sometimes opinions vary between neurosurgeons and orthopedic surgeons; it couldn't hurt to have opinions from both sides of that. Some here have said neurosurgeons are the better choice/option. If all are in agreement there, we can all only hope for the best.

It's not difficult to understand the strong pro/con feelings on these issues. The pros wish their successes for everyone; the cons wouldn't wish their predicaments on their worst enemies, and only want to prevent someone from suffering similar plight.

Informed decision, made... hopefully, NOT out of pain, fear, and/or desperation. We're all here for each other no matter what.

Doc

Hi Dr. Smith
 

Don't you just wish people didn't have to make these kinds of terrible choices? The issues each way, surgery or no surgery is so difficult for a person to make. It is heartbreaking to hear of others struggle with back pain.
I hope your pain is less today too. I go to the pain specialist in a little while. I got in trouble again, and have to have a joint replaced in my foot. I don't want to do this at all, but the pain is such I am not walking very well. I really don't want to wind up in a wheel chair for this, so I am at that debating point once again. I will see today what my pain specialist thinks about my situation. Take care, ginnie