My husband lost his job last year and we no longer have health insurance. We go to a free clinic where everything is rushed and so we get the feeling we don't have enough time to ask questions. The doctor did send me for an MRI after I kept complaining to him about having had backaches for a few years now, and he had also tried me on several different kinds of pills with no luck. I had the MRI done and here's what the report says:
FINDINGS:There is no vertebral compression or malalignment. The bone marrow signal intensity is normal. There is moderately severe disc degeneration and disc space narrowing at L5-S1 with mild degenerative bone marrow signal changes. There is a large central and left paracentral focal disc protrusion at L5-S1 measuring about 1.4 cm at its base and 5 mm in depth. It impinges on the thecal sac in the left. It also probably impinges on the left S1 nerve root. There is mild disc degeneration at the other levels with no disc space narrowing and no focal disc protrusion.
IMPRESSION: DISC DEGENERATION AND DISC SPACE NARROWING AT L5-S1.
LARGE CENTRAL/LEFT PARACENTRAL FOCAL DISC EXTRUSION AT L5-S1.
My doctor says I'm too young to consider surgery (geez, I'm 51, which I don't call young). We wouldn't be able to afford it anyway. He doesn't want to put me on any narcotics. I didn't push the issue fearing he'd think I'm some drug addict. He has me on neurontin right now which helps slightly but I still have a lot of discomfort. He tried me on prednisone, tylenol with codeine, and ultram, none of which helped at all. I just get the feeling that I have to live with this pain the rest of my life. He doesn't seem to have an answer, and even when we did have insurance my doctor didn't order an MRI so I'm even wondering if a doctor you pay money to would do anything. I wouldn't go anyway because of lack of money. My regular doctor had me get regular x-rays done, which apparently can't show the real problem. After I had that done he said there were no findings, that it looked normal, so I was thinking that I was a hypochondriac or something.
This is really so depressing. I have other health problems and now this hit me like a bomb. I have trouble crawling out of bed in the morning, trouble bending over even to turn on the water faucet to take a shower, and so many other things. I have to watch the way I walk because if I take too big of a step a pain flies into my back (temporarily but it's bad enough to startle me). Most days I feel like any wrong move and my back will go out. I have to be very careful sitting down and getting back up. I love gardening but have to sit down now to do anything. I can no longer pick up a laundry basket full of clothes because of the pain, so my husband has been helping me with a lot of things around the house. It's nice that he does that, but I wish that I wouldn't have pain and could do it myself.
I just don't know what to do. My life has become a living hell and lots of days I wish it would end.
I've got the same type of problem you do with a disc fragment at L5-S1 and am having surgery next week to take it out. My fragment measures 7 mm. My surgeon said the "normal disc fragment" they see is between 3 to 4 mm. So your's (as well as mine) would definitely be considered large.
I had the same problem with another disc fragment 7 years ago at L4-L5 and after surgery it was an immediate relief of pain...even with the surgery pain!
It's a one hour proceedure with a 2 inch incision....they just go in and remove the fragment, clean up a little in the nerves and close you back up. Overnight hospitalization and you're home.
How about your bladder? Is your urination o'kay. After the first fragment removal, I noticed I urinated a lot better....hadn't realized that my bladder was being affected by that fragment. This time around, I'm having bladder spasms in addition to back pain so I hope to eliminate the bladder spasms with this surgery.
A disc fragment becomes a foreign object in your body and so in addition to pressing on the nerve roots, it irritates them due to the "foreign object" natural response in your body.
The first surgery was a piece of cake and was well worth it. I expect the same result for this surgery.
Thank you so much for your reply! I guess you would probably know as much as anyone the pain I'm having. I can't imagine it getting much worse and me being able to put up with it. I'm very discouraged since we don't have insurance. I wouldn't be able to afford to have back surgery and if that's the solution to my problem, I'm thinking I might have to live to ever-increasing pain the rest of my life. I don't see an answer unless by some fluke of luck my husband would get insurance some year. Since we aren't real young (I'm 51 and he's 55), I don't know if that will ever happen or not since employers aren't real keen on hiring older people, not around here anyway. At this point with as much pain as I have and after reading what you said, I'd be more inclined to have surgery (if I could) than I was before. For some reason the doctor said at the free clinic that "we'd" want to avoid surgery at my age (I still can't imagine why he thinks I'm too young??!!). I said to my husband that the doc must want me to suffer until I'm 70 or 80 and I might get to have a back with little pain for a very short time before I croak. Sheesh. I have an orthopedic consult with another doctor next month, which I don't know what will come of that since I don't see that I can do much anyway because of our finances.
Are you taking any pain pills right now? I assume that you have pain in your back. I probably might as well not even take anything because I don't even know if the Neurontin is helping at all, and all those other ones didn't do anything either. It's very discouraging. I've been waiting for almost half a year to get this appointment with the orthopedic doctor for next week. I don't see why it takes so long to get in.
Could you explain to me just what L5-S1 means? I don't know what the letters and numbers mean when referring to a back problem. I wish I could feel like I could ask the doctor I've seen a few times for this, but it's always so rushed in there.
So are you saying that they usually operate on a person whose disc fragment is only 3-4" instead of waiting until it gets bigger? I wonder if those people are already in enough pain that they think they have to have surgery then. I wonder how they'd feel if they'd be you or me? :O Here I thought maybe I was being a big baby feeling like crying sometimes but when after reading my MRI report and reading what you said about my fragment being large, I know there actually is a problem.
Even if I would someday be able to have this fragment removed, could it grow back? I guess there's always a chance of getting another one anywhere, isn't there? I know that you said you had another fragment 7 years ago. Oh, to feel an immediate relief of pain would be so wonderful! I've had back problems for quite awhile but it wasn't until the past few years that I've noticed this particular pain, only it wasn't so bad then. Have you ever felt like jumping off a bridge to end your pain?
What causes these back problems? I thought it was probably because I'm getting older, but I read about people much younger than me having back problems. Did you have any kind of a trauma to your back at all that would have caused any back problems?
I had pain running down my one leg a few months ago and then down the other leg. I was like that for a month or so. I had trouble walking because of it hurting so bad. The doctor said I probably had a herniated disc. Does my report indicate that? I don't understand all of these terms and maybe something on the report means the same thing as a herniated disc.
I wish I'd have mentioned to my doctor that I also get shoulder blade pain a lot but I don't think I did. Even though I have it a lot, my lower back pain is so bad that I just forgot to mention that other pain. I hope the MRI checked my entire back and not just the lower part in case something would be wrong somewhere else. I'm sure they wouldn't send me for another MRI if the first one wasn't set up to check my entire back.
What is disc degeneration and space narrowing? I think that at least one of these means that my discs are becoming closer because of losing the cushioning between them. Is that right? Is there anything that can be done about that or not?
Ya know, it's funny that you should mention my bladder! I'm amazed that my back problem and that could be related! The doctor didn't ask me about that. I don't have any bladder spasms like you do. I urinate frequently but when I do it's not a lot, but yet I can feel shortly after that that I have to go again, especially close to bedtime. When I saw a urologist a few years ago because of this problem he widened my tubes because that works for some people, but it didn't work for me. I've been saying to doctors that I feel that there's something blocking my urine flow or doing something to keep it from coming out because I get the feeling that I have more in there than what will come out. When I went to the urologist for the very first time, I visited the restroom in that building right before I walked into his office and I was seen within five minutes. He put a catheter in me and got a lot out of me. Now, you would think that there would have hardly been any since I had just gone to the restroom, so I was amazed that there was that much! Maybe I shouldn't do it but I strain sometimes when I'm trying to urinate because I feel like there's more in there. I manage to get a little more out, not much. Like my back problem, this other problem is very frustrating. I'm so glad that you mentioned that.
I don't have to pay for the orthopedic appointment, however the arrangement is made between them and the free clinic. I want an honest, non-biased answer to my questions, so I'm not going in there saying right away that I can't afford an operation. I want to see if that's actually what the doctor would recommend or not without hearing that from me. I don't want it to sway him in one direction or the other. I guess I will have to tell the doctor sometime during the appointment that I wouldn't be able to get the surgery if that's what is recommended, but then I don't know what would happen from there. I have no idea what these surgeries cost and don't know if the hospital and doctor would be willing to take monthly payments but with what we'd be able to pay them, I can imagine with medical costs not being cheap, it would probably take us eons to pay it off. I don't know if there's any special program that the hospital would have to cover the costs (or partially cover) of a surgery. It sure would be nice. If only the doctor I used to see had looked into my back problems further rather than me having an x-ray done in his office and then saying nothing was wrong with my back. I have had depression and with having to deal with the back pain, I've become even more depressed despite being on an anti-depressant. I wish I had an answer. I just don't think I will be able to put up with this much longer. Thank you for your replies. I hope you have as much success with your surgery this time as you did before.
Hi Cathy. I'm so sorry you are in this kind of pain and aren't seeing anyone who will give you something to relieve it. Do you have any options for seeing anyone else at that clinic?
The statement that you are too young for surgery is ridiculous. In the first place, people a whole lot younger are having surgery when it's needed, and in the second place, he's not a spine specialist.
I'll try to explain what L5-S1 means, tho I'm not the best at putting this into words. Your lumbar spine is made up of vertabrae with discs in between. You have cervical discs (the neck) thoracic discs (middle of the back) and lumbar discs (lower back) The L5 disc is the lowest disc in the lumbar region. After that comes the sacrum which includes S1...that's the highest part of the sacrum. So, your L5 disc is herniated, or ruptured, and that is causing the nerve at that level to be pinched. That same nerve runs through the S1. There are charts on the internet called dermatome charts that will show you the layout of the spine.
Once a disc has ruptured, it will not go back into it's proper space...it doesn't "grow", but it can rupture more and affect another area. Disc degeneration simply means that the disc is drying out, losing some of its fluid, therefore it looks smaller on the MRI. It's normal with aging and starts much earlier than your age, so it's perfectly natural. The problem is that it will continue to dry out and sometimes that causes problems. By the way, the words herniated and ruptured are used interchangeably.
You mentioned other health problems.....I wonder if there is a possibility that you could get Social Security Disability? Have you worked outside the home in the last several years? If not, you may qualify for SSI, depending on your husbands income. Again, depending on income, you may qualify for help to pay for your medications simply by calling the companies who make the meds you take and ask for patient assistance programs.
I am somewhat concerned about your bladder problem....you do need to have that checked out by the back specialist. Be sure to tell him what you told us about not being able to empty your bladder. IF that problem gets worse and you can't empty at all, or you lose control of your bladder or bowels, you need to go to an Emergency Room.
Is there a teaching hospital near you? Sometimes they will take a pt on a "sliding scale" or even do surgery for free to give interns the training they need. You would need to talk to a patient advocate if surgery is recommeded. Also, the specialist you see might have other recommendations.
Cathy, I sure hope some of this information is helpful. I do understand the pain you are having as the first 4 surgeries I had were on the L5-S1. Please come back and let us know how you are doing; just stay in touch and vent if you need to because that's what we are all here for....to support each other.
I'm so glad that you and others are here for me. It means so much to me to be able to talk about this to understanding people who know what I'm going through. I can say that I haven't been so upset about a problem in a long time. The pain alone is enough to make me feel like crying every day. Then there's the fact that I've been waiting since July to get in to see this doctor and feeling like that pain has increased since just then. I also think of other people who can get medical help when we can't and they deserve it less than we do. I could write a whole post just on that, but I'll drop that subject. It upsets me that my doctor didn't look into this further about two years ago when I mentioned to him again about my back hurting. Back then if an MRI had been done and surgery recommended, we had insurance and I would have done it. Now I kind of feel like my hands are tied. I really hope that my thoughts are just me being pessimistic because of how I feel and that things aren't as doom and gloom as I'm thinking.
Nope, this doctor is the only doctor at the free clinic. He's a retired doctor who is spending 3-4 days a week seeing patients who can't afford to go to another doctor. I am grateful that we have this option. At least he ordered the MRI, whereas that wasn't done before. After I see the orthopedic doctor next week, I'll report back here and tell how things went. I might be either really depressed or optimistic, depending on the outcome of the appointment.
Huh, well here the doctor had me believing that surgery is put off until people are older than what I am. I wonder why he said what he did then?! After he said that, I know that I told him that I wanted to avoid surgery anyway. I guess it's just that I've always had a fear of operations to begin with, and then there's the idea that I have that there might be a chance that I'll never walk again. Yeah, I'm good at thinking of worst case scenarios, aren't I!
Thank you so much for explaining what L5-S1 means and also the other back terms. So are both the herniation and the fragment (of bone?) causing my pain? Is the fragment causing the hernation? So do you agree with the previous poster that what needs to be done is remove that fragment? Is there anything else you think they will do? When they do MRI's, do they do one of the whole back and therefore if I do also have a problem in my shoulder blade area that would also show on the MRI? I suppose I should mention to the orthopedic doctor that I also have pain in my shoulder blades. Is the shoulder blade area part of the area from L5-S1? If it is, then I'm hoping that whatever they do to get rid of the pain in my lower back will also get rid of my shoulder blade pain.
I wonder if a lot of people suffer from back problems then and need to be operated on? I've heard of spinal fusions. Is that something totally different from what I'd need to have done (assuming that he recommends having the fragment removed)? Reading more carefully what you said, it sounds like there is nothing that can be done about my discs becoming herniated. So a person naturally loses more and more of that disc spacing between the vertebrae until the vertebrae might eventually be rubbing together? What's done in that case? I know, maybe I shouldn't worry about that until later, but since I know now that it's happening to me, it crossed my mind that that's a possibility. I'll definitely look up those dermatome charts on the internet. Thanks for mentioning them.
Here's where I'm at as far as social security disability. Although I worked temp jobs in the last several years, I don't have enough points to qualify for regular disability. I think I did have enough points about ten years ago when I was still working regularly but quit because of problems that were going on and didn't work from about 1998 until 2203. Yeah, I know a long time and a long story and I won't go into it simply because it's too complicated and long. To make a long story short, I wish I had taken a psychiatrist up on his offer to write a letter to put me on disability because at the time I probably would have had enough points to qualify, but I turned him down, thinking that I would get my act together someday.
Fast forward ahead to now and I still have the same anxiety, panic, and distractibility issues in a job setting but now since I have only dabbled in working and don't have the points, I have one other option, which is SSI. I've looked into that but I think my husband probably makes just a little bit too much for me to qualify for it. I know that he was only about $100 over the cutoff amount that the county assistance office says you can't go over to qualify for assistance. We're just barely eeking along. He just took out a small pension that he had coming from a company that he worked at until shortly before they went out of business and that's how we'll pay for our heating oil bills this year, which will probably amount to about $2000 or so. That money was supposed to be saved for retirement, but we need the money so we don't freeze. It's obvious we aren't going to get help from any agency.
Oh, I'm sorry but I forgot to mention that thank goodness we do qualify for those prescription assistance programs. If we wouldn't, I don't think we'd be able to take our meds. I'm on an anti-depressant, an anti-anxiety, something for acid reflux, 2 asthma inhalers (a maintenance and a rescue), a nose spray (allergies) and also a pill for allergies, and the neurontin for my back which doesn't seem to be helping. I wonder if anything at all would help in my case. I don't know when a medication can help for certain back problems and when they can't. Maybe the neurontin would help for certain back problems but maybe not my particular one. Of course, the doctor put me on it after he read the MRI report. He acted like he was at a loss of what to try me on.
I will mention my bladder problem to the back specialist. So do you think that it does have something to do with my back problem then? I know you're not an expert and I'm just asking your opinion. My husband and daughter have been making comments to me for a few years already about my being in the bathroom so long and I tell them why. I never even dreamed that the back problem and the bladder problem could be related.
No, there isn't a teaching hospital near us. Besides, call me chicken, but even if there were, I'm not so sure I'd be comfortable with having an intern operating on my back.
Do you think they would be trained enough? Would you do that? I was just wondering if I'm too cautious.
Yes, your information was very helpful and thank you very much again. I can imagine that you would understand my pain since you had surgeries that were in that same area of the back. When they do those surgeries, do they just work in one area or do they have to move around within that area of your back?
My appointment is the middle of this coming week and I hope it goes well. My hubby has volunteered to go with me to kind of step in on my behalf because he knows how emotional I get about things and he, as well as I, am afraid that I will neglect to ask some things and get all of the information that I need to know. Thanks for any further help you can give me if you have the time, or if anyone else wants to jump in and post your opinions and experiences, I'm all ears. It's great to have friends who understand.
Also, is there anything that can be done to prevent things like herniated discs and fragments from happening? Does taking calcium supplements have any effect at all?
Another thing I'm concerned about is that I hope the doctor doesn't just look at me being overweight and send me home telling me to lose weight and not even consider anything else. THAT would upset me! Even when I was thinner I had back problems. I wish I could be thinner but I'm an overeater and every time I lose weight I gain it back plus some.