The roller coaster

I went in to see my surgeon the morning after I had the very strong, sharp pains and muscle spasms.  I was kind of walking like an 80 year old, being very deliberate in all of my movements.  He took one look at me and said, "You look like you're walking very carefully."  I explained what had happened and he said that it was most likely scar tissue ripping free and that while it could be very painful, it actually was not a bad thing as things just freed up.  He gave me some oral steroids and muscle relaxers and said to call back in a week if it was still giving me problems and I would need to get another MRI.  I felt pretty relieved, most likely no big deal.

Over the next week, I experienced more bouts of sharp pains and some hip and leg pain that would come and go.  I just took it easy, and didn't really do much.  At times, it actually felt better than it had in a long time to sit, but then would be bad at other times.  The muscle relaxers turned me into a space cadet and it was very hard to keep my thoughts straight enough to work.  After a week, I developed a pain in my heel, although I had done nothing to my foot.  I was getting worried, and I decided I had better call my doctor again.  He said we needed to get an MRI to see what was going on, since if it was scar tissue, I should have been feeling better by now.

So I got in for my 3rd MRI, this time at Abbott.  I got in for a quick 5min discussion in the hallway the day after the MRI as he was completely booked, but agreed to overbook me into his schedule.  He said it looked like I had re-herniated a small disc fragment. 

He guessed that it was from doing pullups (although he had not only cleared me to do them before when I asked him, but had said they would help to take the load off my disc).  He guessed that this might have torn the disc apart a bit and let the fragment out.  He said he didn't have a lot of patients that did pullups and would probably tell his other patients to wait to do them in the future.  In any case, he said the fragment should reabsorb into the body in a couple of weeks.  But the fact that I reherniated meant that I still had a hole in the back of my disc which was not healed.  This was what was really bad.  After 4 months of sticking to a plan and being careful and doing absolutely everything my doctors and physical therapists has told me, my disc had not healed like it should have.  I don't blame the surgeon for telling me that pullups were ok and then having him suspect that they tore the disc apart.  The tear in my disc was quite large (which they didn't know until they opened me up for surgery), and combined with the fact that my disc just didn't want to heal no matter what I did, I was pretty convinced it was just a matter of time before something like this happened.  There was really nothing I could have done, but it still was like a punch in the gut.

Over the next couple days, the pain in my heel intensified to the point where it was hard to walk.  I understood this to be due to the disc fragment pressing on the part of the nerve that ran to my foot.  A few days later, I woke up and my heel felt fine, but I started to experience intense back, hip, and calf pain.  This pain got steadily worse and worse until it was at a level worse than my pre-surgery pain.  I'm guessing that the disc fragment had moved to a different spot and was causing this new pain.  I would experience some variability in my pain as it would sometimes feel much better for an hour and then come back.  I attribute this to the fragment possibly moving around.  One day, the pain was so bad, I had to take my first day off of work due to the pain because I couldn't concentrate well enough.  I was feeling pretty crappy and despondent.  Just when I thought I would be able to start getting back to a normal life, I'm now worse than ever.  This seems to be a never ending ordeal.

I had another dr. appt. with my surgeon and by this time, I was in extreme pain and was unable to walk without limping.  He suspected that perhaps the herniation had gotten worse and ordered yet another MRI. 
I had been doing a lot more research on disc replacement since the pain had been intensifying and I was becoming more and more convinced that my disc just would never heal properly.  It never healed on its own when I had the small disc tear, it never healed on its own after I herniated it, and now after surgery, it had also refused to heal properly.  I printed our a binder full of information about the disc I was looking at and the doctors in Europe who use it and brought it with my to my appt. and gave it to my surgeon.  He was familiar with the particular disc and said it looked like the best one out there today.  Unfortunately, since it is not approved by the FDA yet (despite being used successfully in Europe for some time) it is not available in the US.  He said that it could be an option, and that he would work with me and treat me when I came back if that is what I chose to do.  He had concerns that there was a possibility that the disc fragment would need to be removed surgically first before doing the disc replacement due to the location of the fragment which would make it impossible to get to when disc replacement, but we would need to get the MRI and see.

So off I went the next day to get my 2nd MRI in the last 12 days (this was on June 14th), my 4th MRI since my whole back ordeal started.  The surgeon called the next day and said, that it didn't look like the herniation had gotten any bigger, but that it hadn't changed much either. 

He suggested I get an Epidural Steroid Injection to help with the pain and buy myself some relief until we decided what needed to happen.  This would make 5 injections since the start of my back ordeal.

So on Friday, I had a friend generously drive me out to the special procedures clinic in Plymouth.  I had been in a lot of pain and the car ride out, combined with the long wait in the waiting room had driven my pain level up to an excruciating level.  They took my BP and it was 160/87 and my hands were shaking.  I rated my pain as a 9/10 and the nurse looked at me and said, "I'm just going to put down 10/10."  I limped into the procedure room and they did the injection, in which they also injected an anesthetic in addition to the steroid.  Luckily, this had an immediate effect and I felt a lot of relief.  They took me back out and my BP had dropped back down to close to normal and I could walk without limping.  The anesthetic they inject provides a lot of instant relief, but usually wears off overnight.  The steroid they inject helps to reduce the irritation and inflammation of the nerves and can take a few days to a week to take full effect and can last anywhere from a week to several months.  My past experience has varied quite a bit.

So the night of my injection, they instructed me to try and do normal, non-strenuous activities to see if the anesthetic helped.  They use this as a way to confirm if the pain is coming from the place they think it is.  If the pain goes away, they know that the pain was coming from the place where they injected.  If not, it must be from somewhere else.  It is often hard to localize the exact source of pain in back patients due to the numerous structure that can have problems that all cause similar pain.

I felt much better that night and was able to go out for dinner with some friends and walk to a couple of places in their neighborhood.  I think I sat for 2.5 to 3 hours with only some minimal discomfort/tiredness which was nice.  But I knew it would not be as good in the morning once the anesthetic wore off.
Sure enough, the next morning, the pain was worse, although not as intense as before the injection.  It can take a few days for the full effect of the steroid to kick in.

This brings us up to the current day.  My pain is a bit duller and not as sharp as before the injection, but it is still there.  I know this is just temporary as the injection will eventually wear off and I'll be back to where I was.  I have an appt. with my surgeon on Thursday to discuss next steps and I'm going to push for a more aggressive approach.  It is now nearly a month after I re-herniated my disc and more and more time goes by as I'm in pain and this isn't getting better.  I know a disc replacement will most likely mean several more months of planning, a risky surgery, and recovery but I just want to get back to being better and start on the path to that goal as soon as possible.