The start of treatment

So after doing some research online, I was pretty sure I had a herniated disc, so I looked around for back clinics and found the Institute for Low Back and Neck Care (ILBNC) across the street from Abbott Northwestern Hospital in south Minneapolis which is located not too far from where I live.  So I made an appointment and was examined by the doctor who had me try a number of things like the straight leg raise, which was quite painful, and trying to bend forward which was also difficult.  He said it looked like a herniated disc and gave me some medication for pain (tramadol) and neurontin which is supposed to help nerve pain and ordered an MRI to confirm the diagnosis.  So I went and got an MRI and sure enough, there was a decent size disc herniation pushing on the nerves going down my leg which is what was causing so much pain.  You can see it circled in red below.

If you are interested in more info on herniated discs and what they are, you can look here:  http://en.wikipedia.org/wiki/Spinal_disc_herniation.  After my follow up appointment, the Dr. recommended an epidural steroid injection or ESI (more commonly known as a cortisone shot, but they actually use a different, more powerful steroid).  These are supposed to reduce the swelling and irritation of the sciatic nerves and help to reduce pain.  A week after that I was to start physical therapy and I was told that 90% of people will recover from a herniated disc on their own within about 6 weeks.

So I went a week later to get my first ESI.  I had to drive to their special procedures clinic which was about 40 mins away from my house.  They have you lay face down on a large table, give you some numbing medication at the injection site and then use a fluoroscope (like a live action x-ray) to help guide the needle to the correct location and then injected some anesthetic and the steroid.  You can't wear pants with metal so I wore my pajama pants which they pull down so your butt is hanging out in the breeze while they do the injection.  It is tricky to get these injections in the proper locations because you can't see the soft tissues in the fluoroscope, only the bones, and if they are not in the right place along the nerve root (which you can't see in the fluoroscope), they don't do much good.  So they are kind of hit or miss, even for very experienced doctors.  I thought it would be funny to put a temporary smiley face tattoo on my butt the next time, but then thought I wouldn't want the doctor chuckling while trying to guide the needle to the exact correct location close to my spinal cord.  For me, the first one helped a little bit for the first week or so, but didn't help much after that.  They say their effects can last up to 3 months, but it varies from person to person.  The actual procedure took about 10mins and they bill your insurance company around $1400 (luckily with my insurance, I didn't have to pay that much out of pocket).

A week after the injection, I started physical therapy which consisted of a few simple stretches like laying on my stomach and propping myself up on my elbows with the idea that this would squish the gel-like nucleus material in my disc back forward, relieving some of the pressure on the nerves and giving the outer fibrous annulus a chance to heal itself.  I went twice a week, and while the physical therapist was nice and talked very knowledgeably about the subject, we seemed to do very little in our sessions.  He would give me a few pieces of paper with stretches on them and have me do one or two and would then have me lay on my back with my legs on an exercise ball while he pulled on my legs.  The idea with this was to stretch the disc and create a kind of vacuum effect to help pull the disc away from the nerves.  Very often our sessions would last less than 20mins.  Along the way there were a couple of setbacks after moving to a new stretch that I wasn't quite ready for, and the second time I tried traction which uses a machine that secures your upper body while it pulls on your legs to stretch the spine after which I had a lot of pain.  So after 4 weeks of not any significant improvement, I went back to the doctor who suggested a second injection.  I requested to try another physical therapist that had been recommended to me by a family member who was a personal friend and the Dr. agreed and wrote up another order.

So off I went to get a second injection, which this time seemed to give me some more relief than the first.  A week later, I started physical therapy at the new location.  This physical therapist had a very different approach.  Since the herniation had occurred, I had a lot of increasing muscle tightness and was told that the body will stop sending signals to some of the muscles controlled by the compressed nerve, and over time, the muscles kind of lock up and fascial adhesions can form along the nerves which causes pain which compounds the pain of the compressed nerve.  The goal of this physical therapist was to use a very deep and painful form of massage to break up the adhesions and reshape the muscles and tissues affected to loosen them up.  Over the next 6 weeks, the combination of the injection and the new physical therapy had me feeling some improvement and I was hopeful that things were getting better.  Unfortunately, this physical therapist was not "in network" for my insurance so I was basically paying out of pocket until my large deductible was met, it wasn't cheap at $100 per session and I had ten of them (and still didn't meet my out of network deductible).

Feeling a bit better, I decided to stop taking the neurontin and experienced horrible withdrawl symptoms even though, I weened myself off over the course of two weeks.  Apparently, this is a pretty rare reaction to this medication, but I found a few others online who had similar experiences.  I had massive anxiety attacks, rapid heart rate, and a number of completely sleepless nights.  It was horrible, much worse than the back pain I had been taking it for.  Had I known, I never would have started taking it.  Also, after coming off this medication, my sleep patterns (which I had always kind of had some issues with) became extremely disrupted to the point where it would take me a minimum of 2-3 hours each night to fall asleep, and I often would get less than 4 hours of sleep per night.  This persisted for several months and I ultimately had to get treatment from a sleep specialist to get me back on track.  Needless to say, it was a bit tough.

Unfortunately, a few weeks after completing the second round of the physical therapy, the pain started to return.  I'm not sure if it was the injection wearing off, or stopping the physical therapy or a combination of both.  Soon, I was back to my previous levels of pain and feeling let down that I was not actually getting better like I thought I was.  Not wanting to throw even more money away on physical therapy that wasn't giving me lasting results and not wanting to have to get surgery, I went back and got yet another injection to try and buy some more time for my body to heal.  It was now about 6 months after the herniation occurred.

This injection did not last very long, and maybe gave me a month of limited relief.  I was still unable to bend forward, or sit in a chair for more than 45 minutes without a lot of pain.  I still had pain in my lower back, hip, calf, and would get a cold feeling in my foot if I sat too long.  The realization of living with chronic pain was setting in after so long.  It was past the point of just toughing it out, it really starts to affect your whole outlook and gave me a new appreciation for what others with chronic pain face.  Everyday, you wake up and immediately start coping.  There were days of complete hopelessness and despair, feeling like it would never go away.  It is strange because from the outside, you look healthy to the outside world, but I felt like I had a row of flaming thumb tacks stuck in a line down my butt.  You wonder if people think you're faking it, or are just thinking, "awww it can't be that bad" but in reality it was much worse than they thought.  I often say that on the bad days, I would wake up and start the day completely drained, as if I had just finished the most hellish day of work, and then I would often have to go face an actual hellish day of work on top of it.  The closest thing I can compare the nerve pain to is if you have every gotten a cavity filled at the dentist and they touch the nerve and you get that sharp, intense pain.  Depending on how I would move, the herniation would press on the nerve and give me intense shocks of pain along with the persistent pain caused by the inflammation of the irritated nerves.

After another 3 months, my pain had increased again and I got my 4th epidural steroid injection basically out of desperation.  It lasted maybe a month and I started to realize that this was not going to go away.  I started to look at surgical options such as a disc replacement or a micro-discectomy in which they cut a hole in the disc to remove the protruding disc material to relieve the pressure on the nerve.  I started doing research on surgeons and picked one from ILBNC that had a lot of experience with both procedures.  Unfortunately, it was now late November, and it would take over a month to get an appointment with him.  More on my journey with surgery later.