New member needs advise
 

Hello

I am a 33yr old male of average height/weight and for the past 2 years have had recurring back and right buttock pain which usually subsided on it's own within a week to 2 weeks but my last episode has lasted 2 months now and is different then the rest in that for the first month and a half the pain was only
in my lower back and right buttock but about 2 weeks ago the pain seemed to lessen in my back and moved from my buttock down to the bend of my leg which in the past week has again moved from the bend of my knee down to my right calf and I do have some slight numbness in my right foot but for the most part it does not really bother me.

Anyway about a month ago I left my job because of the pain and a week ago I had my first MRI which showed I had a herniated disc on L5/S1 and was told I should go see a neuro but after shelling out over $2000.00 on the MRI (I don't have insurance) I cannot afford to go to the neuro so I found this forum while search the net for some advise and so here are my questions.


1.) Is the pain moving down from my buttock to my knee area and finally to my calf a normal thing ?

2.) If so does that mean it's getting worse or better ?

(I must say I can tolerate the pain in my leg better then I could when it was in my buttocks and I only take tylenol PM at nite to help me sleep and I don't take anything during the day on most days but I have been taking it easy for the past month or so)

3.) I would really like to go back to work but I am concerned because my job entails that I sit at a desk and my shifts are 10 hours long. I can get up and walk around every hour or so and I have the normal 30 min lunch break so I guess my question here is what can I do to during my off hours and during my breaks to keep my condition from getting worse or is it to soon to consider going back to work ?


Finally I just wanted to say thank you to everyone that does take the time to read this message and offers me some advise I do appreciate it tremendously.

Cheers,
Mike

Hi Mike

I dont have info on your condition but I did want to welcome you to NeuroTalk

I am sure others with more knowledge on spinal matters will be along soon to offer insight

Cheri

Mike,

Without citing the city where you live, would you mind sharing which state? There are several areas that offer low to no cost health care; some, base services on ability to pay (sliding scale) and others, some services are free.

Do you have a copy of the MRI report/the radiologist's notations?

If so, please post the section under Findings or Impressions.

It could be sciatica, nerve compression or radiculopathy, but, only a medical professional would be able to determine that for sure.

The answer to your #1 Q.: No, it's not normal.

The answer to your #1 Q. may also answer your #2 Q.: Is pain "normal"? No. It's an indication that something isn't "normal."

You might want to do some reading at ChiroGeek's site, i.e.:

http://www.chirogeek.com/000_Sciatica_General_Infor.htm

I don't mind sharing my location. I live in Tennessee and I have already tried to apply for Tenncare (our states medicare system) but was denied and I went to the only free medical clinic in the city and the Dr. there was to say the least a joke. I went to him on 4 different occasions in the past 5 months and he told me there was nothing wrong with my back and to just do some stretching and I would be fine of course he was wrong and now my back is worse then it was when I first went to see him.

As far as the MRI report goes I was never given one however someone from the hospital I had the MRI done at called me on Monday to tell me that I did have an herniated disc on L5/S1 and I was given a cd when I had the MRI done which has images of all my scans and on them they do show herniation at that disc. Here is a sample of one of my scans

----------------------

http://img264.imageshack.us/img264/2498/mri1wg5.jpg

----------------------


I don't know if that helps answer any of my questions or not or if you can tell me if that is a mild herniation or a sever herniation just by looking at the image because I certainly don't have a clue.


Anyway my other question still does stand which is if I would be ok going back to work or not considering I sit in a chair for so long everyday and what can / should I do to minimize my chances of making this worse (like exercises or stretching or anything that I can do to keep things from getting worse but still having a somewhat normal life)


Thanks again in advance for your replies they really are appreciated.

Mike

Hello Mike!
 

First off Greetings from Alaska!

I visit your state a lot. I know that at the University of Memphis you could possibly talk to someone in the Human Performance Laboratories...if you are near Memphis that is. They could look at the pics and talk to you about your question regarding work.

You have one plus - a cd picture of your injury. If I were you and that free clinic were my only option I would show him a copy of the MRI. What I see from your picture is a L4-L5 herniation - (need a closer pic) but looks like your L5-S1 diminished space too -but cannot tell.

If you want to learn more about herniations - go to http://www.chirogeek.com/001_Tutorial_Birth_of_HNP.htm
This website helped me in learning about my back issues.

First off I am not a doctor but I would like to try to answer some of your questions -

1.) Is the pain moving down from my buttock to my knee area and finally to my calf a normal thing ? No - this sounds like you have a pinched nerve at the L5-S1 area of your back....called Sciatica.

2.) If so does that mean it's getting worse or better ? From what you described - and your pain levels combined with inability to work sounds like it is getting worse. There are stretches and heat/ice therapies that can help alleviate the pain - but you need to get this looked at. Sciatica from herniations is very very painful. I understand how you are feeling.

(I must say I can tolerate the pain in my leg better then I could when it was in my buttocks and I only take tylenol PM at nite to help me sleep and I don't take anything during the day on most days but I have been taking it easy for the past month or so) Taking it easy is the one of the right things to do along with keeping well hydrated, eating right and moving your legs if you can get physical therapy that would be helpful as well as chiropractic care. Tylenol PM would not cut it for me - I am on an NSAID, Muscle Relaxant, and a mild opiod.

3.) I would really like to go back to work but I am concerned because my job entails that I sit at a desk and my shifts are 10 hours long. I can get up and walk around every hour or so and I have the normal 30 min lunch break so I guess my question here is what can I do to during my off hours and during my breaks to keep my condition from getting worse or is it to soon to consider going back to work ?
Before you do anything else - appeal the decision by Tenncare - and go to Social Security as well. You really need to get to a doctor that would listen to your symptoms, look at the mri, and give you the right diagnosis.
If you decide to go back to work there are a number of strategies you can use to help with the pain. First request a orthopedic chair, 2nd have plenty of ice packs in the communal refridgerator and use religiously, 3rd during your breaks find someplace to lie down flat on your back and stretch it out and put your legs up on a chair, 4th get up and walk around frequently, 5th have a pillow to stabilize your back while sitting, and 6th have plenty of fluids - to keep joints and body hydrated. I know of some collegues that use the 8 hour heating pads that you can buy but those get quite expensive - and others that use aspercreme.

Good luck to you - and welcome

Kim

Thanks alot for your reply and I don't live near memphis so thats not really an option although I do live about 20 minutes away from the University of Tennessee, Knoxville campus so I might try calling them but I am not really sure what I need to say to the receptionist or what department to even ask for but guess I will find out when I call.

As for the free medical clinic goes I can no longer go there since you have to be working in order to go so as long as I stay out of work I can't go there either.

It's interesting you say it's the L4/L5 disc that is herniated and the guy from the hospital said it was L5/S1 herniation so which one is it or is it both. As far as pain goes I am not really suffering very much at all for what I expected with a disc herniation although I am in pain I have never felt that pins and needles thing most people talk about the the leg pain just feels like a bad cramp most of the time which is why I don't take anything other then a tylenol PM at nite I also don't have alot of numbness in my foot which is another thing I read alot about. I know I am one of the lucky ones when it comes to that or I have not had it long enough for it to get to that point, either way I don't have the same feeling most people seem to describe when they have a herniated disc.

I would also like to thank you for the advise about work. I have a heating pad that is built into a belt that I wear sometimes it doesn't seem to do alot but it does help a small amount. As far as ice goes I have tried it and it does nothing for me but make my back cold and sting so don't know bout that one.

The finding a place to lay down I think I can do on my lunch break in my car and like I said I take 5 minute breaks every hour and go outside to walk around so I could do some mild stretching at that time.

As for the water I have that covered I drink it like a fish (about 100 ounces a day) so I think I am pretty well hydrated. Eating hmmm thats a hard one because I barely eat anything these days because I have really bad stomach problems but I do eat healthy when I eat.

Finally I have a massaging back pillow that I bought about 2 months ago when I first started having the pain and use it most of the time so again I have that covered.

I will try to call the university in the morning to see what they might be albe to do for me other then that I think I am pretty ready to go back to work and even if I can't get the university to look at my charts I can at least go back to the free medical clinic once I have my job and show that Dr my scans and then he will not have a reason to not send me to a specialist.

I have rambled on enough it's time to take action and hopefully everything will work out in the end. I don't expect a miracle or anything I just want to be able to work and support myself like the majority of the rest of the world does thanks for the advise and allowing me to vent you all have been great.

Cheers,
Mike

physical therapy...
 

Welcome Mike. I am also new here, but have already found a wealth of knowledge from other members.

I am 34 and have been dealing with a pretty large extruded disc at L4-5 along with a smaller herniation at the L5-S1. I have been taking a non-surgical route for almost 2 years now.

I am by no means a doctor, but i would highly suggest physical therapy. I think you could really benefit from PT!

HOW did you add that image into your message?

i have also wanted to see other peoples MRI's. I have spent hours on the internet looking for images of other people with similar MRI's -
it is just kind of fascinating to seen that we are not alone. it is so hard for people to understand that you have pain when they can't see it externally. kind of like if they don't see blood or bandages, it is hard for people to understand your pain.

That is what i like about this place thus far. Most people are sensitive and understanding because they also deal with pain...
if you would like to see my "ouchies"- click on the thumbnail...
; )

Attachment 1345

Again,
Welcome!
Theresa

Mike - the University of Memphis program I wrote about is as far as I know only in Memphis. They have studied back injuries extensively and I have spoken to staff there before regarding my back.

You could research the University of Tennessee near you and see if they have a comparable program.

Yes you are right - I looked at your MRI again and recounted your bones, it is the L5-S1 and the Sacrum has limited space. But like I said I am not a doctor. Regarding my MRI I relied on the report as presented by the radiologist. Funny that you did not get one with your films. According to my doctors what can floor me - it may not floor you - everyone is a individual - but know your symptoms.

Good luck in your endevors -

Sounds like you are doing everything right

Mike,

Here is some information on Sciatica:

http://www.spine-health.com/topics/c.../sciaex01.html

http://spinetalk.conforums.com/index.cgi?board=Sciatica

Also you might want to read about spinal stenosis...

http://spinetalk.conforums.com/index.cgi?board=Stenosis

Spinal stenosis symptoms, diagnosis and treatment
Lumbar spinal stenosis

http://www.spine-health.com/topics/c...is/sten01.html


The term “stenosis” comes from Greek and means a “choking”. In lumbar spinal stenosis, the spinal nerve roots in the lower back are compressed, or choked, and this can produce symptoms of pain, tingling, weakness or numbness that radiates from the low back and into the buttocks and legs, especially with activity. Spinal stenosis in the neck can be far more dangerous by compressing the spinal cord itself and possibly leading to major body weakness or even paralysis. This is virtually impossible in the lumbar spine, however, as the spinal cord is not present in the lumbar spine.

In rare cases, lumbar spinal stenosis can go no further than to produce severe persistent disabling pain and even weakness in the legs. Most cases, however, have pain that radiates into the leg(s) with walking, and that pain will be relieved with sitting. This is called claudication which can also be caused by circulatory problems to the legs, as discussed later in this article.

Spinal stenosis is related to degeneration in the spine and usually will become significant in the 5th decade of life and extend throughout every subsequent age group. Most patients first visit their doctor with symptoms of spinal stenosis at about age 60 or so. Patients need only seek treatment for lumbar spinal stenosis if they no longer wish to live with significant activity limitations, such as leg pain and/or difficulty with walking.

Spinal stenosis can occur in a variety of ways in the spine. Approximately 75% of cases of spinal stenosis occur in the low back (lumbar spine), which is called

Practical point
Patients need only seek treatment for lumbar spinal stenosis if they no longer wish to live with leg pain that significantly limits their activities, such as difficulty with walking. lumbar spinal stenosis, and most will affect the sciatic nerve which runs along the back of the leg. When this happens, it is commonly called sciatica.

What is spinal stenosis?
The vertebral column in the spine and sacrum (at the bottom of the spine) is like a stack of blocks that serve to support the structures of the body. Each of these bony structures has additional bony attachments that serve to help stabilize the spine and to protect the spinal cord or nerves passing downward from the brain to organs, muscles and sensory structures of the body. Each vertebral body and its attachments and the disc between the adjacent vertebrae are known as a spinal segment. The entire length of the spinal column has a large central canal or passage through which the spinal cord descends, and holes to each side of the canal to allow emergence of spinal nerves at each level. The spinal cord stops at the upper part of the low back, and below that the tiny contained nerve rootlets descend loosely splayed out - like a horse’s tail – and are protectively enclosed in a long sack. All central nerve structures are protected further by membranes, with a tough outer membrane called the dura (tough) mater (mother).

Major types of stenosis include:

Foraminal stenosis. As the nerve root is about to leave the canal through a side hole (lateral foramen), a bone spur (osteophyte) that has already developed from a degenerating disc can press on that nerve root. This type of stenosis is also called lateral spinal stenosis. This is by far the most common form of spinal stenosis. 72% of cases of foraminal stenosis occur at the lowest lumbar level, trapping the emerging nerve root (which comprises a major part of the sciatic nerve).

Central stenosis. A choking of the central canal, called central spinal stenosis in the lumbar (low back) area can compress the sack containing the horse’s tail (cauda equina, or cauda equine) bundle of loose nerve filaments. Central spinal stenosis is more common at the second from the lowest lumbar spinal level and higher and is largely caused by a bulging of the disc margin plus a major overgrowth or redundancy of a ligament (ligamentum flavum) which is there to help protect the dura. This overgrowth is caused by segmental instability usually from a degenerating disc between adjacent vertebrae. The ligament arises from under the flat laminas of the vertebrae and the inside part of the facet joints (stabilizing joints located on each side at the back of the spine segments).

Far lateral stenosis. After the nerve has left the spinal canal it can also be compressed beyond the foramen byeither a bony spur protrusion or a bulging or herniated disc. When this happens, it is called far lateral stenosis.


These differences in anatomy may result in similar symptoms, which is why all forms of stenosis are typically referred to as simply ‘spinal stenosis’. However, if surgery is to be performed, the differences are very important in guiding the surgeon. That is, the bad spot(s) must be exactly known in advance to guide the approach for its proper treatment or removal.

Mike,

If you can/do go back to work, it is as AK Kid/Kim stated: ergonomics is crucial.

What I learned in PT is to roll up a towel and place it between a chair (even ones sold as being "ergonomic," which my office chairs have always been touted as by the sellers) and where the spine would naturally curve or arch; it adds the right type of support/positioning for posture to the lumbar spine.

As well, if you can stand - something I can barely do without support these days - stand against a wall for 10 mins or so a few times a day with your shoulders touching a wall and with your feet against the baseboard, without arching your spine, which should be having a touch point with the wall.

That's the "proper" alignment, but, again, that's also a lot easier for people without spinal conditions. But, if one can retain such posture, and make it a conscientious effort initially, it's supposed to become something that's a "staple" of living and done without thought after a time. In other words, it should get easier. If it doesn't go smoothly, though, don't beat up on yourself; I heard it from a PT whom was in great shape and minus spinal disease or conditions.

From what I've learned, over some years, after my spinal disease was dx'd (following a fall down a flight of stairs when my limbs were numb), lumbar surgery does not pan out with nearly the same "success" rate on fusion as does cervical spine fusion. I'm not saying that to scare you. Not at all. But, it may also be one of the reasons why so many insurance companies also "push" at least 12-weeks conservative approach toward treatment prior to even considering an authorization on invasive surgical proceedures.

Without insurance, I also would not rule out a teaching hospital, particularly if there is one within "reach."

This is an example of why I asked what state you're from:

http://neurotalk.psychcentral.com/sh...67&postcount=4

I am just so sorry you've been in so much pain. I also know how it feels to have the worry of no insurance looming; I recently went through a job transition and went through so much negotiating just to seal things to assure I had the insurance I preferred.


Treesgirl, I feel terrible about saying "welcome" since I know that you are also in pain, yet... I'm glad that you have found a place where you will also receive support and info.

Mike was able to include his image by linking from a photo image hosting site/server and using a hyperlink direct to the image.

again- PT
 

Mike, I have to agree with all the advice listed here...
I cannot tell you enough how difficult it can be finding the correct treatment, especially with no insurance.

Again, just to reiterate what most everyone here has already said, try conservative methods of treatment before rushing into anything invasive. (it doesn't sound like that is something you would do in your financial situation anyway)

But agree, the more you read and learn about what is going on wiht your spine, the more power you have in treatment options.

Before you attempt any exercises or stretches, etc... I have to really suggest even if you can afford just one session with a PT- explain to them your situation - most good PT's will do a thorough exam on your first session and they can give you the correct exercises to fit your specific problems.

From personal experience - i have to warn against just doing any old exercises you find on the web, etc... even if they say they are to treat sciatica, etc... Please see a professional PT for at least one session...
and let them give you suggestions and a written list of exercises that you can take home.

The image you provided above is only a slice of your spine... there could be other things going in that we can't see from just that one image.

Good luck and keep us posted!

P.S. i totally feel for you about the lack of insurance, i have been self employed for a long time and haven't had insurance in over 8 years. it can be tough, but keep your chin up - and please find a qualified PT and spend the 60-100$ for an initial consult and explain to them that you can only have that one session. call around... remember MOST people that are PT's etc... choose their career because it was something they like- and they WANT to help people. (oddly- i don't find the same amount of compassion from surgeons or those that make a ton of $$$$) but i won't get into my personal opinions about greedy surgeons here.
; )

Theresa

Mike- I redid your MRI scan and brightened it up-

http://i137.photobucket.com/albums/q...84/mri1wg5.jpg

It's a really solid suggestion you shared, treesgirl :).

I read a lot, and, still, before I'd attempt something on my "own," I would also run it past a doc or do my best to do a "meet and greet" with someone such as a PT. I'd make sure, too, the PT, has reports and films on-hand, too.

Pain degree
 

Hi LikeMike,
I think I need to join this forum, and am starting with your problems.
I'm going through the process of finding out what is wrong with me too.
I have a good clue as I fell full force on my tail bone a number of years ago and have always had problems with my back, hips, neck.... A few years ago I started having problems with a shoulder so bad I couldn't get more then 2 hours of sleep. Sleeping pills and aspirin didn't cut it. The doctor gave me a muscle relaxant which helped till the pain got worse.
The reason I'm answering your post is that, 1. I have similar doctor problems and yesterday the doctor said my current problems are stress. I have almost all the symptoms for either syringomyelia or something similar.
2. and most important, my pain is so bad since I slipped on the ice about 6 weeks ago, I'm also now on 800 mg of Ibuprofen 3 x/ day along with the other pain meds etc.
The doctor is probably not believing you because you are not in need of enough pain medication.
I hate taking so much medication, but the pain is so bad, I'll go crazy if I don't. AND, not calming the pain down causes it to get worse.
The doctor also told me I might have herniation, but she doesnt really believe it. She really thinks I just need anti-depressants.
They all treated me the same when my shoulder was so bad. Finally I pushed enough to get an MRI. I had calcium deposits in it. Once I FINALLY got the surgery I was in such bad pain, I was ready to cut my arm and shoulder off.
I also was so bad, the doctor extracted enough calcium to make a nice size cookie. That's what he said.:winky: not me. He said I had an advanced case, and now I pay for it by continuing to have trouble with that shoulder along with my back etc.
I'm not trying to belittle your problem, just telling you what I KNOW about some (many) doctors tendencies.
Some people are able to withstand more pain too. Don't wait, please get the help you need.
I'm here for support while the doctor tries to say I'm stressed or depressed or both. The x-ray even shows the previous damage to my back, a few disk compressions, a schmorl's node and comparing an x-ray from 5 years ago, some curvature beginning. But only a chiropractor would compare those.
I'm on medi-cal, sort of thankfully.
I have the prescription for the MRI finally and now I have to fight with my own feelings of being able to deal with it if the MRI doesn't show anything.
You definitely should read the information about herniated disks. I never realized a herniation could be a really bad thing!
Don't underplay your pain, and realize that you could have some numbness that keeps you from feeling all the pain. And...find a different doctor.

my aching back
 

Hello,

I am hoping someone can give me some advice on my back / leg pain.

A few years ago, I suffered some sort of infection that weakened my immune system. I picked up "whatever it was" up in the mountains of Puerto Rico - I have suffered several repeated infections and was told that my immune system had weakened. I even came down with a staph infection from swimming in the warm ocean waters in Florida during the summer months.....and was hospitalized for a week. For the past year, I have had no trouble with the infections, but my back/right leg/foot pain is terrible. I read somewhere that back pain could come from having autoimmune problems - has anyone heard of this? Anyway, I had a recent MRI from a chiropractor that wants to put me on the DRX9000 machine -

my MRI results were:

1. L5-S1 small central disc protrusion/herniation confined to the epidural fat, which does not impinge upon the neural structures nor result in significant central canal or foraminal stenosis.

2. L4-L5 minimal disc bulge

3. T3-T4 tiny right paracentral disc protrusion/herniation, without cord impingement, central canal or neural foraminal stenosis.

4. T5-T6 and T8-T9 minimal disc bulges

I cannot sit for very long at all without my right buttocks and right leg hurting pretty bad - burning and constant ache down my right leg. If I walk even just a little bit outside of the house - my right leg kills me and I start to limp - my low back is sore and also between my shoulder blades always has big knots in them.........I take BC powder for the pain - which does not help much - and that upsets my stomach - also Excedrin Back and Body...............I have an appt Monday with a general doctor to give me a referral to see a neurosurgeon - if he thinks that is what I should do - I am scared that the DXR 9000 machine is a scam - the chrio told me it would cost about 5K.........and you have to have a referral to see the Neurosurgeon......nothing seems to help, except doing nothing and I can't live this way........I'm grumpy and in pain all of the time.......so far, no one has told me I needed surgery...............and I don't really want surgery, I just want to stop hurting so much and be able to do the things that I used to do again - I'm only 40.

Hi NJS, welcome to the forum. When you get your MRI done come back and let us know about the syringo.

I have syringo in my cervical area from an auto accident. It really is a painful condition and many times it takes a combination of things to get relief. This can be anti-depressants, pain pills, muscle relaxers and anti-seizure medication. I was reluctant to take anti depressants for a long time but after researching them I found that many are prescribed for nerve pain as well as some anti seizure medication. Plus who wouldn't get depressed being in pain 24/7.

There is another website called ASAP.org that you can check out. There are many fellow sufferers there that can answer your questions if it turns out you do have a syrinx.

Welcome to the group...Sue

Mike,

I believe that Chirogeek does consultations for a small fee. You send him all the records and she reads the reports and provides insight.

I know someone else listed the site.

Good luck.

Hello again everyone I apologize for taking so long to reply to this topic but until now I did not really have much news to report but that has since change. I have now been lucky enough to be able to see a physical therapist (PT) and he looked at my pictures and did a small exam to find out what the strength of my legs were and felt good that I still have almost all of my normal strength / function in my legs and he set me up with a exercise routine.to maintain a "neutral spine" position.

He also said if I felt like I could go back to work then I should try it and said I should try to alternate standing and sitting throughout the day and I need to do something called the "fowlers position" where I lay on my back with my knees bent and feet touching the ground for 10 - 15 mins a day.

He told me to do the exersices 3x a day and the fowlers position once a day during my lunchbreak and in 2 weeks he wants to see me again so he can give me some more advanced exercises and check on my progress.

He did say that he is confident that I will eventually need surgery and even though he would not give me any hard numbers of a successful percentage rate for the surgery he did fell it would improve my situation quite abit. I did tell him that from what I have read that most of the time surgery doesn't help and he replied to that by saying thats because most people don't follow the post surgery exercises they need to follow in order for the back to stay healthy but I didn't really buy that excuse so I kind of have mixed feelings about this guy even though he did seem genuine and very knowledgeable on the subject.

Anyway thats where things stand now. I still haven't heard back from my old employer yet and I submitted my rehire application a month ago now and called them numerous times so I am going to have to search for alternate employment it seems which is a shame because I really did like that job but I like eating and having a home more so it's time to hit the pavement so to speak and thanks again for all the replies and advise I will keep you posted if any developments arise.

Cheers,
Mike