I have a herniated disk at L4/L5 and sciatica. I have been fighting it for 8 months now with PT, epidurals and Mobic. Still having sciatic pain, and I have to be very careful. When I mentioned I had epidurals and they helped, several people here suggested that I get a second opinion (not from another ortho), and that epidurals were not the way to go. Someone suggested I see a neurosurgeon. I know a neuro here in town very well, but I am wondering-what could a neurosurgeon do for me, other than surgery? What is anyone else's experience? I'm trying to gather info right now.
As far as I know, neuro's don't always want/need to do surgery! But they certainly can help you with your sciatica!! It's certainly worth a shot, what do you got to lose right??
Injections, especially cortisone aren't good for you either!! My drs told me that cortisone should be outlawed, and that you should only have a few in your lifetime as it eats away your bones etc.!! There are other kinds too, but I'm not sure what they are!! I've had Kenalog injected in my hips and Botox in the lumbar area, but none helped!
It's amazing how much we have to go through, in our attempt at pain relief!! Good luck to you, and take care!!
A person should have no more than 3 cortizone shots in one area in a one year period.
A person should have as few as possible because it can, not always, but can destroy tissue and muscle, never bone.
It should never be used where there is a tendon or ligament under stress as it will aid that ligament or tendon to snap or tear.
This hysteria over cortizone is unfounded, and probably caused by idiot doctors who didn't give a hoot and didn't use it properly. Used judiciously and by someone who knows how, it can be a very effective tool in the fight against pain.
My PM (Pain Management Specialist) who happens to be an Anathesiologist, knows all there is to know about corticosteroids and what they do to a person's body. It's his job. He still injects me every year like clockwork for my left leg nerve root, which was damaged when my disc herniated. So don't buy into this never ever, ever, ever, use it routine.
It's a tool. Not something to be dependant upon for the rest of your life. But it can be very helpful in pinpointing what your issue is. And USED CORRECTLY, be perfectly safe.
I have done some looking at cortisone, spoken with my doctors (both of whom are top in their fields-orthopaedics and anesthesiology), and decided the same-that cortisone, used judiciously, is OK. These are the two doctors that all the physicians in town go to for their back pain-I had to fight to get in to see them, so I have a lot of confidence in their abilities.
It's also the lesser of 2 evils-permanent nerve damage from swelling, or side effects from cortisone. Yes, I believe cortisone might cause problems, but guess what? A herniated disk pressing on my sciatic nerve long enough will, withoput a doubt, damage my sciatic nerve-that is a 100% certainty.
I have no doubt that the cortisone frenzy is WAY overblown.
Sorry-I had to vent. I was a little tired of lectures about epidurals.
Interestingly, both doctors told me (separately) to only have back surgery as an absolute last resort, and that they would only have it if they were completely debilitated.
I believe that all medications will have some form of ill-effect long term, and was only repeating what drs have told me! I think all meds need to be handled "correctly" or else, but cortizone's no cure for your nerve problems, therefore you're still looking at nerve damage! The sole purpose of the injections is to relieve the nerve pain, not cure it!! It's not going to stop the nerve from being pinched by the herniated disc!
One thing I do know for sure, is that you'll always get different stories or ideas on all this medical stuff LOL!! Afterall, if there weren't any disagreements in the world altogether, it would be one peaceful place to be, wouldn't you say? LOL!!
Out2Lunch-I am not lashing out at you, so please don't take it that way. Last week I posted something, saying what treatment I was receiving, and I had 3 or 4 people jump all over it, saying that I was hurting myself with cortisone epidurals, the doctors who do them should be sanctioned, etc., etc. I really think that's off-base, and it misses the point. I do believe epidurals (like any treatment), if misused, can cause problems.
Also, I want to clarify one thing you said. My understanding of an epidural is as follows-the cortisone causes the nerve to relax (and reduce swelling?). This can help the healing process by reducing pressure. So it does have some theraputic benefit.
Without an epidural, I am left taking pain meds, which can be addictive.
Back surgery will mean a lifetime relationship with your surgeon-no one can deny that.
I think maybe, you misunderstand what corticosteroid does. It is, in effect, an anti-inflamitory, and also acts as a pain releaver. When the sciatic nerve is being pressed upon by inflamed tissue, a shot of this in the right spot can help dramatically in releaving the pain, simply by reducing the inflamation that is pressing the inflamed tissue on the nerve. The goal is to get the nerve free of anything that is going to damage it and cause scarring, and steroid shots can do that faster than anything else. Unless your wipped right into surgery to do it.
I'm all for Steroid shots, but only by doctors who know what they are doing. Not by ones (and yes, I've had this sort too...) who poke around and put some here, and some there, and maybe a bit over here.... I ended up getting up while he was still holding the needle and saying "don't ever touch me again or I'll sue you into the next century." I got dressed and left, and went and found a doctor who knows what he is doing and not trying to make money off of innumerable shots to workman's comp patients or people who don't know any better. This one guy had them going into and out of his shot room like they were on a conveyor belt. This is the kind of doctor that is causing the problems with corticosteroid shots. *bad name*
Just make sure whoever is doing it is a licensed Anathesiologist, and knows what he/she is doing. Ask them how many times have they done this? How much have they studied about the controversy of Corticosteriods. What is their opinion? When do they condone using it? When do the refuse to use it? And any and all other questions you can think of.
I know that my nerve was permenantly damaged when I herniated my disc. I have to have these shots done once a year now, probably forever. However, I am able to be mobile. Without it I'm in the emergency room begging for morphine.
EDIT: can't type today for beans lol
Last edited by Stormygale; 08-10-2004 at 03:39 PM.
I was trying to say the exact same thing you said (but not as eloquently). I meant to say that cortisone reduces the swelling, which stops the pressure, calms the nerve, and gives it room to heal (or not scar).
I would never let just any doctor give me cortisone-I gather it's effective, but tricky, stuff. My anesthesiologist works exclusively with orthopods, and my orthopod is generally known in Mobile, Alabama (where I live) as the back specialist. He had to review my case before he would agree to see me-he's that busy because he's that good. So I think I am getting first rate care, yet I am still hurting. That's what is so frustrating.
I can sure understand your pain. Somedays I want to jump off the bridge. I don't know how, but I manage to live through them. It seems to be weather related, in that I hurt worse before a storm is coming or a front of some sort. Maybe it's just my imagination, who knows. I have lucked out and just met my new Primary Care phyisician. She is wonderful.
She's taking me off the oxycontin and putting me on some drug that you only take once a day. I guess it controls the pain better as you have less ups and downs as medication wears off. Hey, I'll try anything at this point. hehe.
Just remember wmcgowin, that I'm here for you. I know what your going through and how much it hurts. I've been doing this for 4 years now.
I think that you have to pick the lesser of two evils with back pain, or any inflammation. You can take the fast route, cortizone, or the slow route, taking anti-inflammtory drugs. If the nerve is being pressed on, or pinched, to the point that there is going to be significant damage to a nerve such as losing bladder function, then the doctor needs to get the inflammation down immediately. If the area is inflammed and you can stand to go the route with over the counter drugs or even prescription anti-inflammatory drugs, then I think that is the way to go.
Sure, doctors are going to offer you the needle. It is quick and easy and they do it all of the time. Insurance pays for it. It is an accepted practice.
There are a lot of things in the world that are accepted and not accepted. Take smoking for example. It is not against the law, it kills people, but people don't pay attention to the health risks. Same with shots. Everyone needs to stay informed, research it and then make up their own minds. After reading the Burton Report I would say that there is a group of people out there, including doctors, who don't accept the shots as safe. In fact, I have read that the manufactureres themselves are not calling them safe for the procedures that they are being used for. There has been a lot of bait and switch behind the scenes on what is going on with the shots.
Be happy that people are ready to share what they know about the shots. Just think, years ago when there was no internet information was passed over the back fence. I am happy to be alive in a time when information can be shared so widely.
A lot of doctors live in their own little worlds. They have been giving these shots for years. It is what they do. They listen to the pharmacuetical sales people rave about them. They are too busy to read about them. Some doctors are stuck in time. Some are too busy. Some just don't care. Some say, "if it ain't broke, why fix it?" These are doctors who scare me. Times move along. Ways of doing things improve. I can see where they are coming from, though. They have a patient in their office, the patient is in pain, and the patient wants relief. They have access to the cortizone shots. They offer them as part of the insurance plan. When they are done and you still have pain down now or down the line, they can state that they have documented it that they gave you a shot. This allows them to justify other methods of pain relief to the insurance company.
Cortizone takes away the inflammation. It is like when you get a sliver in your hand. It becomes inflammed. Once the sliver is gone, you start to heal. If the sliver is still there, the pain will continue. Cortizone takes that inflammation away for awhile, if at all. Meantime, it causes damage. Ice doesn't cause damage if used properly for inflammation.
There is no proper way to use cortizone. One shot, two shots, three? At what point does the damage start? If you knew that something would cause damage, just like smoking, would you do it anyway? The only difference here is, you have a doctor, someone in a position of trust, telling you that it is okay.
Remember back when babies were being born with fins instead of arms because science, and then in turn doctors said that it was okay and that there was benefit from the medications that evenually caused this to happen?
As we have moved along in time, some doctors, doctors who choose to educate themselves and not become drones of the insurance company rules, have decided to tell the truth, cortizone shots are not good for anyone. We are just now seeing the damage that they have caused. There are people on these boards who will attest to it. There are people on message boards all over the net who will attest to it.
Not all doctors are correct. Not all medicine is good. Everyone has to do their own homework on what ever they are having done to them by doctors and then make thier own decisions. Ultimately, it is the person whose body that is being worked on that must live with whatever decision is made, be it right or wrong.
There are some well informed, good hearted people on this net who have tried to educate, though thoughtful posts, the dangers of these shots. That is all that they can do, offer advice. The material is there for anyone to read.
It would be interesting to take a poll ten years from now, just how many people who got the shots received permanant relief and/or damage.
I have a herniated disk at L4/L5 and sciatica. I have been fighting it for 8 months now with PT, epidurals and Mobic. Still having sciatic pain, and I have to be very careful. When I mentioned I had epidurals and they helped, several people here suggested that I get a second opinion (not from another ortho), and that epidurals were not the way to go. Someone suggested I see a neurosurgeon. I know a neuro here in town very well, but I am wondering-what could a neurosurgeon do for me, other than surgery? What is anyone else's experience? I'm trying to gather info right now.[/QUOTE]
hello, wmcgowin: i'm just curious as to whether you've considered a microdiscectomy or not. you ask what can a neurosurgeon do for you other than surgery, but have you written off the idea of surgery completely? it is, of course, a last resort -- and only you can judge the quality of your life without it. i can tell you that i fought the idea of surgery completely -- NO WAY, i said! -- but my life deteriorated into one of totally nonfunctioning sciatic agony, despite meds and attempts at PT. (PT did help immensely after the microdiscectomy.)
i wonder, why not go see this neurosurgeon that you know well and get evaluated? if he isn't knife-happy and you can trust him, you can learn if you're a good candidate for the microdiscectomy and then at least consider it. i am so glad i went ahead and did it. the pressure is truly off my sciatic nerve now; it isn't damaged; and i have my life back. i have to be more careful now, and i have some very minor back pain to manage at times, but for me the microsurgery was the answer. why not at least find out if it might possibly be for you?
in any case, best of luck to you.
and moonlight, i agree, great post by you!
That seems awfully cynical-that most doctors are on the take, so to speak, and that they are puppets of the big bad insurance companies. Don't get me wrong-I don't think that Blue Cross/Blue Shield is my buddy and is looking out for me. I'm a lawyer, and I see all the bad things insurance companies do all day-some doctors too, for that matter. But I know my doctors very well (on a personal level). They are good, conscientious physicians who look out for a patient's best interest, and I am skeptical that they would shoot me full of a steroid just to make a buck, knowing that it is a bad treatment, or simply looking the other way.
Actually, Moonlight, I agree with you whole-heartedly.
Ultimately it's you that is going to have to live with the decisions you make and the procedures that you have done to you. It's your research and the information you find that will shape your choices. I, too, thank the heavens above for the internet. It has been a godsend. (And not just because it allows me to beta-test gaming software. )
You make an excellent point about Doctors being run by insurance companies and drug companies. "Come on... prescribe X number of this drug and we'll give you a trip to Aruba." I have friends who are doctors, and it does happen. It really does. It's called a "perk." It makes me sick. Everytime I'm sitting in the waiting room and see the "suit" come in carrying his bags full of samples, I know it's the drug rep and he's at the doctors to bring the newest and best of whatever his company is trying to push.
Here is a good example, look at Gabapentin aka Neurontin. Gabapentin was made and passed through the FDA testing procedure by Pfizer as a drug for Seizures. The drug reps were then told by Pfizer to tell the doctors to use it for everything from nerve pain to insomnia. (I take it for nerve pain relief myself.) There is a class action Lawsuit now against the maker of Gabepentin for doing this. They have no idea how it would react with medications other then those normally prescribed for people with seizures, and here they are pushing it to people with back issues, and heart attack patients, and who knows who else. The new miracle drug has arrived! I don't know how many people they killed with drug reactions, but it was quite a few. I know that when I take it while on Oxycontin it knocks my socks off. It's like a great sleeping pill only it leaves me very groggy the next day.
Are some doctors run by the drug companies? You bet. But they can only use the information they are given by the Representative. This was a clear case of of a major drug company crossing the line. They think they own us and they do.
And jeeze, don't get me started on the insurance companies and what they will allow and not allow your doctor to do for you. My surgeon had to go head to head with my insurance just so I could get on Vioxx. They didn't want me on it because it's too expensive, and they didn't want to take the hit when it came to my drug coverage. *bad word to the insurance company.* But, I'm on Vioxx.
Anyway, you make very legitimate points in your post Moonlight.
At some point one has to figure out what is causing the pain. Steroids are used to reduce inflammation and relieve pain while you do PT and figure out the cause. I've had them, but wouldn't do any more. At some point you need to figure out how to heal... to just continue using steroids over a long period of time will most likely be counter productive. Until you get a fix to the cause (And belive me I know that is easier said than done) the inflammation will just continue after the steroids wear off. The danger of steroids is long term for the most part - weakening of the tendons and ligmaments and weakening of the immune system. No drug is natural to the body, and their use is to help you until your body can heal. So I am neither against or for them, but you really need to know what you are up against. You're body has pain for a reason - something is wrong! duh! But what? Once you figure that out you will be on your way to recovery. Makes sense in all disease. The tricky part is you can't always figure it out and living with the potential of steriod damage may be easier than living with the pain. I read alot about how great everyones doctor is, but the bottom line is until your doctor figures out how to help your body heal it just doesn't matter.