Well, I survived my IDET procedure yesterday. There were some unexpected glitches, but all things considered I am doing well. Having experienced minimal discomfort during my epidural injections and discogram, I wasn't expecting that the IDET would be any worse and I guess my doctor wasn't either because he really failed to provide adequate pain relief. When he was threading the catheter through the right side of the disc, it got hung up on a tear and the pain was excruiating. They had to literally hold me down on the table while I screamed and yelled some appropriate expletives. This seemed to last for an eternity but was probably more like 10 minutes. The pain shot down my leg but the doctor reassured me that they hadn't hit a nerve and that the pain was because my disc was extremely sensitive. Then they had to remove the catheter and start again. When they finally pumped enough fentynl in me, I was OK. Because my disc is now so narrow (lost 50% of its height), he couldn't get the catheter all the way around the disc. So he had to enter from the left side and the right side and get that as far around as he could on each side. Fortunately, the grade V annular tear was on the left side. The actual heating part of the procedure was fine. I just felt a similar kind of pressure as I usually feel. After the procedure was over - it might have taken them close to an hour -I insisted on getting some stronger pain meds then I was used to. This proved to be a smart move since my pain was really ramped up the rest of the day.
I managed to have a good night's sleep and woke up feeling OK. Am still taking more pain meds then usual as I do not want to let the pain ramp up again, but I feel pretty good considering. My doctor's office really dropped the ball by not telling me I should get fitted for my corsett before my surgery. I just assumed they would give it to me upon discharge, but they said I had to go to a medical supply company and buy one. That's just the thing you want to hear after recovering from a fairly traumatic event. Anyway, I got one today and am using it when not lounging about. The doctor said not to use it when sleeping at all since if you wear it > 12 hours a day your paraspinal muscles will weaken.
I have read all kinds of reports on this bulletin board about what people are doing in the aftermath of IDET. My doctor told me absolutely no sitting for longer than 10 minutes for the first 2 months. No bending or twisting either and of course wearing the corsett unless showering or reclining. Another doctor I saw said that he doesn't want patients sitting during the first 3 months. I am definitely going to religiously follow the rules to give myself the best chance for recovery. Am looking forward to doing some walking tomorrow, but will start slow.
Tennisnut--Congratulations on being on the other side of that procedure! I hope it's all up ramp from here--keep us informed; your insights and experiences will be valuable to a lot of people. What you said about the corset probably already has been!
Hi Tnut - first my prayers and best wishes are with you for a good recovery...
I'm an athlete (tennis, surfing, more...) and I've been diagnosed with DDD (no herniations/bulges: MRI). I've done the run around to lots of doc's for ok to poor advice, had pelvic surgery to tighten my stomach muscles and now believe my symptomology more consistent with DDD than with some arcane pelvic malady. So, guru(s), I've got a couple of questions for you...
When you say you "didn't listen to your body..." - what do you mean? Do you think you could have done something that would have forestalled the symptoms that ended up debilitating you?
I'm trying to determine to what degree I should back off my life (eg. not playing singles anymore, and doubles for only 1 1/2 hr per wk) - can do MacKenzie exercises, swim, use an elliptical machine, lift weights (light). But I do have weird, diffuse leg discomfort (no weakness), difficultly getting out of a crouch, some back pain and I get up from my chair religiously each hour. I'm not taking any meds (not that they don't make me feel better, tho'). I know - you can say "... well, ask your doc..." but the doc's don't seem to know much. One guy will say "play tennis. Run. Work through it" - stay active philosophy. I'm doing pilates, watching my posture, strecthing - I've a kitchen sink full of little excercises that I do everyday. Yet - I'm in this for the long haul. If I have to back off my life for 5 yrs (or forever) to end run spinal surgery, well, that's what I want to do. You've all 'been there, done that' - is less more when it comes to DDD?
Tennis: The IDET procedure... Did you undergo, buying time for the "... last bit of hydrated portion of disc (nucleus)..." to leak out? The procedure itself adds no stability or improvement to the spinal structure -correct?
Thank you, in advance, for any guidance. And I'd like to take a moment to thank other board members, as well. Tomorrow, Successstory, Telzy, standingman and the many others - thank you for all the posts I've meticulously picked through...
And to for all those others with soberingly terrible stories of back pain - my humble prayers are with you.
You are asking some good questions and I'll give you the benefit of my experience and knowledge. If you have only DDD and no herniation, then I believe that doctors would tell you that there is no danger to you continuing to play sports and that you will not do damage to your disc. In fact, I believe they would encourage you to exercise as much as you desire since it only improves your overall health and well-being. It is true, however, that having DDD means your disc is weaker and is more vulnerable to herniation than is a healthy disc. In fact, I've read that healthy discs rarely if ever herniate unless the herniation was caused by a traumatic event (e.g., car accident). Because of this vulnerability, I would make sure that you undergo a rigorous core strengthening program under the guidance of a physical therapist (as opposed to a trainer). Having a super strong core can help you prevent injuries as you know.
When I first started experiencing back pain, I would stop playing tennis for a week or so and the pain would subside. Then I would start again and it would come back. Finally, after a few months, the pain never subsided even after I stopped playing. I suppose there are many possible scenarios as to what happened. Perhaps my annular tear was smaller at first and responded to rest. I may have actually worsened the tear through continuing to stress my back with some aggressive tennis playing (it's hard for me to play any other way). Would the tear have healed if I had stopped playing right away and never played again for months? It's possible but now I think unlikely. My disc is so badly degenerated now that I would imagine that its healing capacity is grossly compromised.
Regarding the waiting it out issue, I did wait it out over a year. When the doctor saw me at 9 months post-injury, he was hopeful that my problem might resolve in a few months. But when he saw no improvement at 1 year and no response to the epidural injections, he said I had only a 1 in 100 chance of improvement with just waiting. I wholeheartedly believe this to be the case. I have a grade V annular tear which are very painful and difficult to heal even in a healthy disc.
I'm sorry to hear that you ended up having what may very well be an unnecessary surgery. I too saw a lot of doctors. Some of them didn't think the IDET would help, but all thought it was worth a chance and that major surgery was my only other option. My hope is not that IDET will provide an instant cure, but that it will allow me to engage in a rigorous physical therapy program to build up my core strength that this will greatly help. I was unable to continue in PT because even very gentle approaches triggered a flare-up. You are correct in that the IDET itself does nothing to strengthen the spine-you need to do that work yourself. It is possible that the procedure contracts the collagen in the disc and stiffens it, but probably the most significant benefit it that it can kill the nerves growing in the outer 1/3 of the annulus. There is a lot of evidence that these are major pain generators.
I assume that you've have some of the major interventions: epidural injections, etc. If not, I would think that these could be both diagnostic and therapeutic. I have to end this note for the moment as am called to dinner. Will add some more thoughts tomorrow.
--tennisnut
Quote:
Originally Posted by waves2ya
Hi Tnut - first my prayers and best wishes are with you for a good recovery...
I'm an athlete (tennis, surfing, more...) and I've been diagnosed with DDD (no herniations/bulges: MRI). I've done the run around to lots of doc's for ok to poor advice, had pelvic surgery to tighten my stomach muscles and now believe my symptomology more consistent with DDD than with some arcane pelvic malady. So, guru(s), I've got a couple of questions for you...
When you say you "didn't listen to your body..." - what do you mean? Do you think you could have done something that would have forestalled the symptoms that ended up debilitating you?
I'm trying to determine to what degree I should back off my life (eg. not playing singles anymore, and doubles for only 1 1/2 hr per wk) - can do MacKenzie exercises, swim, use an elliptical machine, lift weights (light). But I do have weird, diffuse leg discomfort (no weakness), difficultly getting out of a crouch, some back pain and I get up from my chair religiously each hour. I'm not taking any meds (not that they don't make me feel better, tho'). I know - you can say "... well, ask your doc..." but the doc's don't seem to know much. One guy will say "play tennis. Run. Work through it" - stay active philosophy. I'm doing pilates, watching my posture, strecthing - I've a kitchen sink full of little excercises that I do everyday. Yet - I'm in this for the long haul. If I have to back off my life for 5 yrs (or forever) to end run spinal surgery, well, that's what I want to do. You've all 'been there, done that' - is less more when it comes to DDD?
Tennis: The IDET procedure... Did you undergo, buying time for the "... last bit of hydrated portion of disc (nucleus)..." to leak out? The procedure itself adds no stability or improvement to the spinal structure -correct?
Thank you, in advance, for any guidance. And I'* like to take a moment to thank other board members, as well. Tomorrow, Successstory, Telzy, standingman and the many others - thank you for all the posts I've meticulously picked through...
And to for all those others with soberingly terrible stories of back pain - my humble prayers are with you.
You've had an MRI...and it didn't show any 'obvious' bulges/tears. The reason I say obvious is that you could have a small tear in the back which would not necessarily show up on an MRI. I have a small bulge which did show...but, the tear did not. That is what is causing my pain as dx'* by Discogram.
I am not suggesting that you run and ask for this test. But, it is something to keep in mind.
Tennisnut's suggestion of core strengthening is a very, very good idea. I am waiting for surgery to be scheduled, and in the meantime, have requested the strengthening program in the hopes that it will make my recovery quicker. Nothing wrong w/ having good abs, right?
My tear has not healed itself and it's been over 3 yrs of pain for me. Every disc/every person is different.
As for healthy discs herniating? I'll have to say that I have read that you can sneeze and herniate a disc. Many people are asymptomatic w/ herniated discs. The popular thought on this is that an asymptomatic person would not have an MRI. I will try to find the study on that if you'* like. Not that it really applies here. You believe you already have DDD. Most people will end up w/ degeneration of discs as we age. Like everything else in our bodies, the discs dry out, lose height. Part of natural aging process. Genetics can also play a part in it. I come from a family of early degenerators! Lucky me.
The most important thing to remember is - Trust your own instincts. If you feel that there is more going on? There probably is. This pain is not in your mind...and don't let anyone tell you it is. You are doing the right thing in educating yourself 'in the trenches'. I have found more info here than any doc I visited in the first 2 yrs of this injury. It has given me my voice. What I mean by that....I am confident in the questions I ask now. And I think the doctor's appreciate my active participation in my treatment. And I will not have tx that I don't feel is appropriate for me, my lifestyle.
Standingman, Mokita, and Waves - Thanks for the kind notes of good wishes . These sweet gestures really do boost the spirits. Thought I'* give an update of my recovery. I was pleasantly surprised to find that my post-procedure flare-up had subsided by Thurs. (3 days after the procedure). I'm back on my usual dose of vicodin now. I've read various accounts of how long the flare-up lasts: some say a few days, others a few weeks, or possibly a month. In any case, I feel pretty good and have been out walking daily. I imagine that next week I'll be able to return to my pre-procedure routine of walking 3 miles a day and hope to lengthen that in the coming weeks. Walking has always been an activity that feels good for the first 30 minutes and then gets increasing uncomfortable. I generally have to push myself to go another 30 minutes.
I would not be surprised if my pain significantly decreases in the next few weeks because of wearing the brace and having my movements so restricted. It will be nice to get off of pain killers if possible. Even if I do find that I have little or no pain during the next few months, the real test will be when the brace comes off and I start PT. So I'm hopeful, but know that no real conclusions can be reached until I start moving about like normal.
The restrictions of the post-IDET recovery are not much different from those that I was experiencing due to chronic pain. I hardly ever sat before the procedure and almost never traveled. The only exercise I could do was to walk. Really the only difference now is that I can't do the chores that I was doing before. But getting help with these for a few months is no big deal. I have found that I can do some light cooking as long as I have all the pots and pans on the counter ahead of time and ask for help to put something in the oven.
One helpful tool in my recovery has been this "grabber" device (costs $20). It is an aluminum rod with some pinchers on the end. You squeeze a trigger to close the pinchers to grab an item up to 3 feet away. It is invaluable for grabbing stuff on the floor or in cupboards. Not really great with heavy items, but still a great little item since I can't bend.
One unfortunate consequence of lying down a lot is that my body actually ends up aching and feeling sore all over at the end of the day. It's funny that I experienced the exact same thing when I was recovering from knee surgery several years ago. I don't think there is anything to do done about this, but I find that the occasional massage is a great relief.
I do feel a bit "stir crazy" already even though, as I said, I didn't do all that much before the procedure. It does help that I can continue to work and have some jobs lined up. At least my mind is active during the day and the income relieves some of the financial stress. I have been working while lying down for the past 6 months. I have a stand on wheels that holds my laptop and adjusts to whatever height and angle I want. This is a great device. The laptop is connected via a wireless network to my printer and DSL. Happy to share the details of this arrangement with any interested persons.
I have to fight my insurance company's refusal to cover my IDET. Went ahead and had the procedure done and am working on the appeal. Will let everyone know how it goes and happy to share doctors letters if the appeal ends up successful. I was able to negotiate with the hospital to offer me the same managed care write-off that they normally offer the insurance company (about 35%). So my hospital fees will end up being $10,000 less 35%, so roughly $7,000. The doctors fees are to be about $3,000. I am also negotiating with them for this same discount.
Hi Tennisnut--It sounds like your recovery is coming along very well. I'm impressed that you are already moving as well as you describe and that the pain is that manageable. Also glad you can keep working to that extent as well.
I _would_ be interested to get more particulars on the gidget that you use to work with your laptop while lying down. As my name implies, I do most of my work standing at the computer, but that definitely "gets old" and the knees and hips are complaining in new ways. I've tried working reclined with a laptop and a tray, but never get the angles right without getting my neck unhappy. Last thing any of us need is yet more spinal unhappiness. So please do let me know the name of the device and/or relevant company. Very glad to hear about it.
In the meantime, continuing force be with you. Your description of pre-op life sounds very, very familiar!
Here is the info on this piece of equipment. I did a good deal of research trying to find the best fit for my needs and ended up finding this guy in Ohio who makes these things in his garage. It sounds a little iffy, but I spoke with him a good deal before I made the purchase and his return policy was good so I took a chance. He really is a guy who has very good motives and wants satisfied customers. The thing (I have no idea what to call it) is well made and true to its description. Go to [url removed] to check out the line of products. I have the ST-03 model. It may seem pricey, but it is far less then anything else I could find. I've used it while on the couch or in bed. I think I might get a comfortable recliner chair eventually and use that. I still think sitting is easier because I can sort through all my papers with greater ease, but I have a feeling that I will continue this methods of working for a long time to come. I type on the laptop keyboard but use an optical mouse instead of the laptop touch pad. Let me know how your investigator goes.
--tennisnut
Quote:
Originally Posted by standingman
Hi Tennisnut--It sounds like your recovery is coming along very well. I'm impressed that you are already moving as well as you describe and that the pain is that manageable. Also glad you can keep working to that extent as well.
I _would_ be interested to get more particulars on the gidget that you use to work with your laptop while lying down. As my name implies, I do most of my work standing at the computer, but that definitely "gets old" and the knees and hips are complaining in new ways. I've tried working reclined with a laptop and a tray, but never get the angles right without getting my neck unhappy. Last thing any of us need is yet more spinal unhappiness. So please do let me know the name of the device and/or relevant company. Very glad to hear about it.
In the meantime, continuing force be with you. Your description of pre-op life sounds very, very familiar!
Standingman
Last edited by moderator2; 11-22-2003 at 07:48 PM.
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Tennisnut--Many thanks for the info you provided. I have already looked over some of the models and think the one you suggested would fit my needs very well. Again I appreciate it.
It's amazing what's out there. I recently came across a half-sit/half-stand chair that may also be of good use.
... In fact, I believe they would encourage you to exercise as much as you desire since it only improves your overall health and well-being. It is true, however, that having DDD means your disc is weaker and is more vulnerable to herniation than is a healthy disc. In fact, I've read that healthy discs rarely if ever herniate unless the herniation was caused by a traumatic event (e.g., car accident).... Because of this vulnerability, I would make sure that you undergo a rigorous core strengthening program under the guidance of a physical therapist (as opposed to a trainer).... I'm sorry to hear that you ended up having what may very well be an unnecessary surgery....
I assume that you've have some of the major interventions: epidural injections, etc. If not, I would think that these could be both diagnostic and therapeutic.... --tennisnut
Tennis - I feel for you in that corset. You've gutted out 4 of 5 sets on a hot sunny day against a baseliner; you'll gut this one out too for what you have to gain.
I am a tennis player as well. Sounds like we'd have a hell of a match as I'm pretty aggressive - so much so that the cutting on my legs lead to an instability in my pelvis/pubis. The medical term is Athletic Pubalgia, avulsion tears in the rectus abdominus off the pubis. Theory was that instability in my pubis and adductors was giving my great pain in my back and stomach (forget about tennis; could play but could not recover. No sleep for days...). Surgery was a bi-lateral reduction of the adductor + pelvic floor repair. Yuck. Anyhow - through this passage I had every test in the book (looking for RA, MS, etc.) and my MRI was unremarkable except for "... severe DDD L5-S1...". Now, at the time, my surgeon said that the films were consistent with an athlete of my caliber and age (43); he said his back was in about the same shape. And after what I know now - his contention is totally plausible. Prior to surgery I couldn't do any rec ab type core strengthening work - burned my stomach/pubis too much. Made me nauseous. Now I'm a core strengthening expert (pilates: mat & reformer). However, my back is comprised...I think you get to a place where you begin to know more than any of your paid consultants (unless you are a Rockefeller). I think between the tears/instability of my pubis, the DDD disk in my back and a sacroiliac instability (not diagnosed but by my gut) - I have ongoing back pain.
My recovery from AP surgery incomplete - no hadn't seen a neuro through this - I've an app'y with Brian Hainline at the USTA in Forest Hills. Chief Med there, he's a neuro/pain mgmt specialist as well and can prolly tell me if I'm ever going to play tennis again. No, no epidural or prolo - no injections of any kind. Not even chiro (more cause I'm too nervous to try 'em). Not going to a discogram, either, because, frankly that procedure is really invasive.
I'm in that lost place we all know so well. I do all my little core exercises, get the workouts in I can - bought an inversion chair and invert 2x's a day - and pray. I can sit. But at night my legs are tired/uncomfortable and I've developed an anxiety around this; once the pain seeps in my mind runs and *boom* I'm up all night. Calf fatigue (but neuro exam is fine) upper thigh muscle burn (very slight)... This missive has been too long but my intro (by the old usenet rules) is overdue, so you all now know my story. No car accident. No trauma. Best of health. And struck down. Don't think I'm some kind of Sally, here, either. Have had my knee rebuilt (RL ACL Recon) and right shoulder. My .sig? Surfer, as well. I've dropped in on waves that would make you pale... (makes me, now that I know something about the vagaries of the spine). This, however, has been a markedly different passage...
In an effort to contribute (and per the subject header) I'd like to leave readers who are trying to work around back pain with some literature ideas (can apply to your recovery, as well).
Rick Jemmett's "Spinal Stabilization"
McGill's "Low Back Disorders"
Ungaro's "Pilates: Bodies In Motion"
"Pilates on the Ball"
McKenzie's Back/Neck bks
Davies "The Trigger Point Therapy Workbook"
Egoscue's "Pain Free: Stopping Chronic Pain"
Brourman's "Walk Yourself Well"
Jacobs "Say Goodnight to Insomnia"
Sarno's book is evil; blaming people in pain for diffuse trauma in their lives is a real pig in a poke.
I often think about this jewel found digging here:
Quote:
Originally Posted by Telzey
... The bad decision I made was to have surgery just because I couldn't do all the fun things I used to do, couldn't be as physically active as I used to be. If I stopped doing all those things, my pain was negligible. Given that, I think I was a really poor candidate for surgery. I really made a mistake. I ended up worse. I ended up disabled, when I wasn't before.
I'm trying, Tel. God must know I'm trying. But, like the header says - I'm open to ideas...
It was great hearing more about your story. We really share some things in common and I'll say a bit more about how my thinking has progressed during my personal ordeal. First, I should say that I would not have done anything invasive about my back just to be able to enjoy sports again. It would have been terribly sad to give up what is such a strong part of my identity and enjoyment, but I would have grieved the loss and focused on doing "nonimpact" activites like cycling (recumbent probably), cross-country skiing, etc. Unfortunately, my condition deteriorated to the point that the quality of my life was significantly impaired. I could not sit for longer than 15-20 minutes at a time and for no more than a total of an hour a day. If I wasn't able to work from home while reclining, I would be unemployed. The only exercise I can do that does not trigger a major flare-up is walking. To be sure, this is a much less bleak picture than that of many on this board. I certainly appreciate that and it gives me strength to see how others are coping with even greater adversity. But, for me, I felt that it was worth the risk to try to improve my quality of life. Will I play tennis again? My doctor seems to think so. We'll just have to wait and see. Right now, I'd be so excited to be able to do any type of exercise and work up a sweat. Like you, I've had some sports-related injuries (ACL/meniscus tear & torn elbow cartilage-both due to tennis) and had successful arthroscopic surgeries. I just took my back health for granted, having never had a hint of a problem before. But, as we know, the back is so complex and baffling to even the experts. Right now my plan is to see where I can get in recovery from IDET over the next 2 years. If it hasn't significantly help me, then I will look into artificial disc replacement. Scary as hell, to be sure, but may come to be my best option for a better life. But that's way down the road. I am not at all worried that IDET will permanently change my disc leaving no hope for...what? A natural cure for my grossly compromised and severly painful disc with a full thickness tear? Some new miracle treatment that will repair my disc to normal (yeah, right)? I just don't see it. I did worry about the possibility that I would get worse from the procedure, but the risks seemed rather low. Any intervention is always a calculated risk.
I agree with you that there is no purpose to having a discogram unless you are about to undergo surgery. It certainly does sound worthwhile to get a full work-up from a neuro/pain expert given the weakness and fatigue in your lower exremities. I never had any of these symptoms. Clearly, you've found a top expert to see. At Forest Hills, no less. My back pain started on a vacation to NYC to see the 2002 US Open. Sadly, I was unable to go this year but try to make it a regular trip. Frankly, I wouldn't see a chiro either. Just my particular bias and stories from several people in medical office waiting rooms who were there because a chirco fractured their disc (yikes). When you say "severe DDD", what does that mean in terms of disc height loss and hydration? It certainly seems possible that your back pain may settle down some after you fully recover from your pelvic surgery. For some people, pain from DDD comes and goes. I actually think that my pain is due to the full tickness annular tear rather than my DDD (though of course they are related-I wouldn't have the tear without the DDD). Unfortunately, there is no evidence that IDET can heal a full-thickness tear. Simple as that. So I have to hope that the rest of the benefits will be enough to break the cycle of inflammatory pain.
What is an inversion chair? Could this be making you worse? Please remind me-how long since your pelvic surgery? Is it mainly the pain or the worry that keeps you awake? Ask your neuro/pain mgmt specialist about neurontin. It has deifnitely helped me and they frequently prescribe it for nerve pain. The difficulty with sleeping is so common. I have always been a stomach sleeper though this position seems to make my back worse. It's really hard to change, but I've been trying. I usually have my worse pain at night and have to take painkillers right before bed. At least then I can sleep and wake up relatively refreshed and ready to face the world. You may be anti-medication, but pain killers are a necessity for me. You are probably worrying too much about your leg discomfort. You do need to trust that your doctors have ruled out the causes of this that are life-threatening or potentially catestrophic.
Here's something that I would like to get clarity about regarding DDD. First off, although everybody's discs do degenerate over time, there is a difference in both how a person with DDD has their discs degenerate. It is not a normal process (physiologically speaking). I have read that usually a disc will lose its hydration and, thus, harden by about age 50. So this is why it is rare for someone older than 50 to suffer a herniation. But the changes to the annulus and endplates that people with DDD have are not part of the normal degenerative process. Now many people with DDD will not have any pain while others may have significant pain. Usually, it is a manageable problem especially at one level. But there are always exceptions. I think in your case it may be difficult to know how much the DDD is affecting your back until you've healed from your other surgery. It is unlikely to be a source of your leg pain/discomfort.
Please continue to keep us updated about how you are doing and what you are learning. I will definitely do the same.
--tennisnut
Quote:
Originally Posted by waves2ya
Tennis - I feel for you in that corset. You've gutted out 4 of 5 sets on a hot sunny day against a baseliner; you'll gut this one out too for what you have to gain.
I am a tennis player as well. Sounds like we'd have a hell of a match as I'm pretty aggressive - so much so that the cutting on my legs lead to an instability in my pelvis/pubis. The medical term is Athletic Pubalgia, avulsion tears in the rectus abdominus off the pubis. Theory was that instability in my pubis and adductors was giving my great pain in my back and stomach (forget about tennis; could play but could not recover. No sleep for days...). Surgery was a bi-lateral reduction of the adductor + pelvic floor repair. Yuck. Anyhow - through this passage I had every test in the book (looking for RA, MS, etc.) and my MRI was unremarkable except for "... severe DDD L5-S1...". Now, at the time, my surgeon said that the films were consistent with an athlete of my caliber and age (43); he said his back was in about the same shape. And after what I know now - his contention is totally plausible. Prior to surgery I couldn't do any rec ab type core strengthening work - burned my stomach/pubis too much. Made me nauseous. Now I'm a core strengthening expert (pilates: mat & reformer). However, my back is comprised...I think you get to a place where you begin to know more than any of your paid consultants (unless you are a Rockefeller). I think between the tears/instability of my pubis, the DDD disk in my back and a sacroiliac instability (not diagnosed but by my gut) - I have ongoing back pain.
My recovery from AP surgery incomplete - no hadn't seen a neuro through this - I've an app'y with Brian Hainline at the USTA in Forest Hills. Chief Med there, he's a neuro/pain mgmt specialist as well and can prolly tell me if I'm ever going to play tennis again. No, no epidural or prolo - no injections of any kind. Not even chiro (more cause I'm too nervous to try 'em). Not going to a discogram, either, because, frankly that procedure is really invasive.
I'm in that lost place we all know so well. I do all my little core exercises, get the workouts in I can - bought an inversion chair and invert 2x's a day - and pray. I can sit. But at night my legs are tired/uncomfortable and I've developed an anxiety around this; once the pain seeps in my mind runs and *boom* I'm up all night. Calf fatigue (but neuro exam is fine) upper thigh muscle burn (very slight)... This missive has been too long but my intro (by the old usenet rules) is overdue, so you all now know my story. No car accident. No trauma. Best of health. And struck down. Don't think I'm some kind of Sally, here, either. Have had my knee rebuilt (RL ACL Recon) and right shoulder. My .sig? Surfer, as well. I've dropped in on waves that would make you pale... (makes me, now that I know something about the vagaries of the spine). This, however, has been a markedly different passage...
In an effort to contribute (and per the subject header) I'd like to leave readers who are trying to work around back pain with some literature ideas (can apply to your recovery, as well).
Rick Jemmett's "Spinal Stabilization"
McGill's "Low Back Disorders"
Ungaro's "Pilates: Bodies In Motion"
"Pilates on the Ball"
McKenzie's Back/Neck bks
Davies "The Trigger Point Therapy Workbook"
Egoscue's "Pain Free: Stopping Chronic Pain"
Brourman's "Walk Yourself Well"
Jacobs "Say Goodnight to Insomnia"
Sarno's book is evil; blaming people in pain for diffuse trauma in their lives is a real pig in a poke.
I often think about this jewel found digging here:
I'm trying, Tel. God must know I'm trying. But, like the header says - I'm open to ideas...
Brother - I've picked thru your posts, too. I think you've made the right
choice w/ IDET based on available modalities. We are on the precipice of a miracle in the form of ADR, but, as I wrote in a prior post, I'm not seeing enough objective evidence on the procedure yet. Besides, you do as little as you have too - first...
Quote:
Originally Posted by tennisnut
Please remind me-how long since your pelvic surgery?
I had the pelvic floor repair procedure late April of this year. Surgeon is world renowned for this type of disorder (William Meyers: Chief of Surgery at Hanemann in Phila). Basically everyone said if he believed my instabilities were due to AP, and suggested surgery, that I'd better seriously consider. I pulled the trigger. And I am definitely stronger and more stable in the compartment as a result. So I'm just about 7 mo's. post surgery. My local Dr. believes all of this sacro/lumbar discomfort is due to the reconstruction. "You have a brand new pelvis. Your back's not happy about it..." But he thinks the neuro checkup with a guy like Hainline can't hurt. At a minimum, I want this pro, who's prolly seen thousands of back films, take a look at mine and give me his read. Thought about ordering up a new set of pix's but my sports doc said "what, have you been in a car accident. MRI from Feb '03 will do
fine...". This whole back business is so full of conflicting advice - one
guys says that significant trauma is required to alter the spine. Another
says a sneeze will do it.
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When you say "severe DDD", what does that mean in terms
of disc height loss and hydration?
Here - it's a Rorschach - is my MRI report. We both know the statistical evidence associated with MRI's and the general population...:
Impression: Disc degeneration at L5 S1. There is no evidence of disc
herniation or stenosis.
Comments: There is severe loss of disc height and mild disc bulging at L5 S1. There is no associated disc herniation. There is no associated
foraminal or central canal stenosis. The remaining lumbar disc levels are
normal. There is some disc degeneration in the lower thoracic spine with desiccation disc material. Spinal canal is normal in diameter. There is no focal disc hernaition. There are no vertebral compression deformities.
Btw, my back pro's here were non-plus about the MRI. They basically agreed w/ my pelvic doc - consistent with an athlete of my caliber and activity level.
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Here's something that I would like to get clarity about regarding DDD...
I couldn't agree more... As common as this is, there must be a reason the medical community calls this a 'disease'. It's one hell of a precise cast of characters to get basic terminology wrong. Concerning DDD and symtomology - there was a thread here a while ago about DDD symptoms. It was like everything under the back sun. I get uncomfortable in a chair after awhile. But it's nothing like what you have reiterated. I'm sure you and StandingMan have much in common (btw - SM - would like to hear your etymology one of these days).
An inversion chair (mine is Total Motion's Back Machine) is a gentle traction device. You hang upside down for very short periods of time. I've only had mine a week. McKenzie, yoga, stretching (and chiro, etc) all activate the spine - this is another light modality and I've yet to find a story arguing against it (have found quite a few, tho', saying it's useless).
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Is it mainly the pain or the worry that keeps you awake?... You are probably worrying too much about your leg discomfort. You do need to trust that your doctors have ruled out the causes of this that are life-threatening or potentially catestrophic.
That's a nail, and it's head may be close to home. I know I was hard on Sarno in my book round-up and I will grant him this (and why I read his book) - there is a psychosomatic component to this/these maladies. Pain begets pain. Really. That's why breaking the cycle of pain is so important because it becomes a learned response to stimuli so quickly (numerous documentation). What keeps me up is a diffuse lower lumbar discomfort. It's not, however, acute pain. I am seeing the USTA neuro specifically because I'm afraid of going out, hitting a few balls, and ending up debilitated. One of the greatest losses I've had through this passage is that I can no longer trust when to just push through a physical challenge. I did that once - and ended up having to have pelvic surgery. That nagging 'is there something there' or 'where's physically too far' line has just gotten so hard for me to see. My pelvic doc has been an advocate of pushing through pain (back, pelvis - he doesn't care. But it ain't his body). If the neuro concurs, then I'm putting my head down and gutting it out. After all I've been through, seeing a neuro doesn't seem too gratuitous...
Tell ya what he says...
(btw - was trading notes with another post surgical AP sufferer and told him something I'll leave with you. Everytime I have major surgery I *almost* do something really stupid. Do less. Do nothing. Take it easy; you'll get there...)
Tennispeople! Just a quick word; I've "oversat" myself today, and even standing not entirely comfortable. Waves--did you mean "aetiology" by "etymology"? The latter, of course, reflects my problems with sitting. My story is somewhere between tennisnut's and telzey's. If I stay in the box, I don't have too many problems. The box allows my everyday work (teaching), but not a lot of other things--travel, etc.--which was also a big part of both work and other things.
Re: the inversion table, one contraindication (to use fancy medical term) would be if you tend toward high eye pressure, as I do. Anything that puts you upside down is not good in that respect.
Waves--I also agree that there is a lot of ambiguity in all these diagnostic categories. Of course, some of us fit one or another very well, and have the tests to prove it! If it all fits together, and there is a specific treatment for that specific circumstance, it's great. But things are often more complicated......
It's now been just over 2 weeks since I had IDET on L5-S1. The good news is that my pain continues to stay at about where it was before the procedure. So I don't feel like dancing but I'm not in agony. I'm walking every day for 45 minutes and then I get tired so I stop. Hoping that I can build up to more exercise but am listening to my body. One surprising thing is that I find myself very fatgiued even though I am sleeping a lot (9 hours) at night. Perhaps my body just knows it has been traumatized and is telling me to just rest. Sometimes I think that what is so tiring is having to think about every little movement both before you do it and while you're doing it. I am finding that it is very important to continue to ice my back at least 4 times a day, if not more. This really keeps the pain in check. I have been worried about a mysterious new symptom and thinking (hoping) that this is transient in nature. I started to have an ache down my right leg and numbness in my right foot. Very strange as have never had any leg discomfort during this whole lower back ordeal. It was freaking me out yesterday, but today seems to be noticably improved today. I have been getting used to my corset and it now seems to be less uncomfortable.
These are some of the longest days and weeks I have ever experienced. Time is crawling by...that's all for now .
Congratulations on your (hopefully) successful IDET. You are right about the ice. It is your friend. It is mine too. I still ice to this day and I am working on 2 years post-IDET. If you ever feel you have over done it...ice. It will literally take away the burn (you just might even hear your skin/back go "ssssss" when you apply the ice pack...hehe).
The dull ache you feel may very well be some of the burned tissue rubbing on the sciatic nerve. I take it you don't feel this pain after icing? Pelvic tilts may help to keep the scar tissue from forming around the sciatic nerve. But you must do them correctly. Walking 45 min. a day....WOW. I couldn't do that until I was after my 2nd week. And even then....it was too much. Had to cut down to 10 min. at a time and work my way back up. Make sure you take a nap after your walks and ice your back (even if it doesn't feel like it needs it). The activity aggravates the IDET and walking up stairs or up hills will make the aggravation even worse. So be careful. Did your DR say to walk that long so quickly? I think it's fabulous you are able to do this. Good for you.
The reason you are sleeping so long? Your body has only ONE time each day when it repairs itself. ALL other times it is busy trying to deal with the barrage of life coming at it every second of your waking moment. The air you breath must be filtered, the air that hits your skin must be cleansed, the things you touch, the things you eat and on and on and on. When you sleep, you are doing nothing...you are static. This allows your body to concentrate on broken issues. Whether it be a cold or healing from an operation...sleep is when this is done. This is one of the reasons why us spineys cannot get better "faster". We are in so much pain that we cannot sleep, thus....we also cannot heal. It really is a whizzer....but it is the truth. Be glad you are sleeping a lot. Your body IS telling you it needs it. It has gone through a traumatic thing...being burned. Think of your skin when it is burned and apply that memory/knowledge to your disk. Treat it carefully....if this doesn't work, fusion is the only other option. Unless you want to fly to Europe for an ADR.
It sounds like you are doing all good things. Just remember to be patient. Eat lots of fruits and vegies and always always think of your back first. Good luck to you.
As is so often true, Successtory said the wise things!!! So I'll just say, I've been thinking of you and will continue to. Thanks for the report. We're pulling for you (but only in a gentle, helpful way!!) Enjoy that healing sleep!
Sounds like you're doing what you're supposed to....and are healing as you should be. I'd have to agree w/ your thinking on the 9 hrs of sleep. Your body is surely telling you what it needs and, more importantly, you're listening. This will be the reason you succeed above all others, IMO.
I'm glad the leg thing has calmed a bit for you, but if it comes back, I would consider mentioning it if, for no other reason, than to calm your fears about it. It could very well be just from surgery or your disc readjusting or something else that will eventually just disappear.
Good luck and keep up the good work! It's good to hear the corset isn't bothering you so much now. It looks as if I may be getting fitted for one for post-nucleoplasty.
These are some of the longest days and weeks I have ever experienced. Time is crawling by...--tennisnut
Mr. T - adding my voice to the chorus of well wishers for you at the 'back board'. I think of you often and even keep you in my little prayers...
Go easy. It's great that you are sleeping so much; as an athlete I am capable of discounting a fair share of pain and discomfort - it's only when I stopped sleeping I realized I had careened into a bad place. Sleep is rich, delicious and oh so nutritive. Drink deep!
Had my neuro app'y; confirmed DDD at L5-S1 and, as part of presentation but to a lesser degree, T12-L1. But no complications (radiologically, end plate changes - etc.). Sounds a little like your case; doc says I'm on my way to an 'autofuse' at L5-S1 and, for me (thank you genetics) it's normal. I'm to meet a PT who is a myofascial sacro-cranial specialist, back off tennis but otherwise keep up my workouts to tolerance, and keep doing the milieu of things I've got going to keep DDD symptoms/complications at bay.
And Mr. Man - right you are; meant etiology and it's prolly a story you've laid out in one of your threads. Confounds me how so many people have DDD, how so many go on to back surgery yet so little is out there in the way of support groups and stories. You'd think 400,000 Americans a year having fusion would rank up there with all the copy of heart disease or cancer.
If the body is an ocean, the spine is it's Mariana Trench and we - disinclined explorers...
Waves - I should tell you that it's Ms. Tennisnut or, professionally, Dr. Tennisnut (Ph.d. not M.D.). I think I may have thrown you off track with all my talk about aggressive tennis play . There's nothin' sweeter than a 5'6" woman blowing an ace by a big fella. Gotta luv it. We are still kindred spirits, I think, though different genders. I so appreciate the healing thoughts. I am thrilled to hear about your neuro appt. This is great news. You must be relieved. Did the doctor give you any time frame on how long to the natural fusion? My primary care doc also referred my to a myofascial massage person, but I never went. Others on this board have said good things about this type of technique.
Success - Thanks so much for the words of wisdom. I was quite shocked by the almost total lack of patient education provided by my doctor re. the IDET. They mailed me this one-page summary that told me nothing I didn't already know about the procedure and failed to give me any practical advice whatsoever. No mention that I should get fitted for a corset beforehand, no instruction about how to best get up from lying on the couch or bed so as not to strain the disc. I am really disgusted with them on many levels by now. Wishing like hell I had stuck with Dr. Saal for my procedure but decided to go with the guy who was on my insurance plan (even though the insurer has denied coverage).
When I met with Dr. Saal before my IDET, he gave me much better guidance on the dos and don'ts. I asked him if I could do some upper body toning with little tiny hand weights and he said, "No. I find that people who start doing that kind of thing get too revved up." He said that I should walk (on flat ground) as much as I can tolerate. He also stated that the discs experience no greater mechanical load when a person is walking then when they are lying down. It's hard to believe, but I did some research and found out he was right. Because he and my other doctor told me no PT before 2 months, I assumed they meant no ab exercises including pelvic tilts. I was tempted to do some the other day, just to give the transverse abs some action, but held off. Since my annulus tear is right at the midline, I worry that even such a small movement and pressure may be contraindicated. But I have started doing some gentle hamstring stretches using a belt since I can't bend at the waist. I was shocked by how tight these muscles have become in 3 short weeks. Hopefully, this will help with the leg discomfort, which is back again.
StandingMan - Hoping you are recovered from your flare-up. It seems so rediculous that we can be in so much pain from sitting. For me, the ramping up of symptoms doesn't start until several hours after I have made the critical error of overtaxing my now delicate system. Then it can take up to a week to settle down. What a price to pay. Sometimes I just said, "what the hell. I want to go out to dinner just once," and payed for a week. I just stopped doing these things altogether in the end.
I am so very grateful that all of you kind people are out there. When I start to lose my sense of humor, I'll just read a few posts and start to smile again. I hear a nap calling me, so I'll sign off for now.
Post-IDET Report 
Post-IDET Report: 6 days later 
It is mine too. I still ice to this day and I am working on 2 years post-IDET. If you ever feel you have over done it...ice. It will literally take away the burn (you just might even hear your skin/back go "ssssss" when you apply the ice pack...hehe). 
