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Old 04-12-2012, 11:16 AM   #1
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my L5 struggle.

I have been working in the tree care industry for 20 years. the majority of the work requires significant strain on my lower back, and sure enough I went down at the end of February of this year. I had instant intense pain from my tailbone to my feet, and was unable to stand or walk. I saw my doctor, who put me on prednisone and percocet. he also got me in with an mri the next day, which showed a small herniation in L5 (central) with protrusion into both nerve roots. He and I were both encouraged with the "small" description of the herniation, and he recommended rest and continued steroidal treatment. While i was able to stand, i couldn't bend over, and often got "stuck" in a bent postion in incredible amounts of shooting pain from the waist down. I was also noticing numbness throughout both legs, feet, buttocks, and groin. I was also experiencing numbness in my penis during sex which scared the hell out of my wife and I. I immediately returned to my dr, who referred me to a neurologist, a spine pain management dr, and another mri for my upper back, just in case.

I had a EMG done to test for nerve damage, and it showed none which is a tremendous relief, and the mri revealed no damage to my upper back. I visited the spinal treatment center and had an epidural injection in my lumbar area. This proved to be a futile attempt, as the pain has remained the same. With a pregnant wife on the way, and bills mounting (and with the assurance from my doctors that by working, i wouldn't do more damage) I twice have attempted to return to work taking on a much lighter load than i normally do. both attempts ended with incredible pain and numbness in the same areas, usually halfway through the day, and increasing to intolerable when i get into bed.
I am at a crossroads in my life, as I am 35 years old and the tree company is my family's. I had no plans to change my career and i make a reasonable living. I'm running out of options, but i have not attempted physical therapy only because i'm convinced that the incredible repeated strain on my lower back resulting from everyday work will cancel out any strengthening of my core and surrounding muscles.
What surprises me is the feeling of guilt that i feel regarding the mri results. I can't shake this feeling that i should be able to bear the brunt of a "small" herniation. I feel helpless not working, so i'm going to do a "day on, day off" routine to allow the swelling to go down for a day after work. My wife wants me to see a specialist to weigh my options. I feel that i'm hurtling towards surgery, and i'm ok with that as long as i can return to work sooner than later, i'm just unsure if that's the next course of action or not, but i'm in this 8 week limbo of pain, helplessness and worry. I'm still trying to stay positive for my wife, daughter and upcoming baby

 
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Old 04-12-2012, 11:46 AM   #2
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Re: my L5 struggle.

Welcome to the board. Unfortunately you have a dilemma since even with surgery to easy the pain, it is unlikely that you could return to a physically taxing job without reinjuring your spine. I don't know precisely what labor your job entails, but if it requires lifting, bending at the waist or driving around in a truck all day, I would predict the odds are good that it will be difficult to resume work "good as you were when you where 16."

The two surgical options for you would be a discectomy or a spinal fusion. Each has its own inherent problems...with discectomy, you run the risk of reherniated the disc. With fusion, they would remove the disc and substitute a spacer and probably screws and rods to supplement the natural healing. This causes complete lack of movement in this spinal segment, which puts additional stress and pressure on the discs on either side, which must now pick up the slack. Often this causes these discs to break down faster than usual, resulting in more surgery down the road.

If you just have the discectomy, if you return to your former lifestyle that caused the problem to begin with, chances are the disc will rupture again. After this happens more than twice, most doctors will not repeat a discectomy as the segment becomes too unstable, so you end up with a fusion.

It would be worth your while to go through a course of strengthening with a PT who specializes in spine issues just to see if there is a way where you could work through these problems..and so you have left no stones unturned when you either decide to have surgery or seek some other resolution to your problems.

Also just from a practical point, most insurance carriers will not pay for surgery unless the person has tried less invasive treatment modalities first, such as medication, physical therapy and injections (ESIs).

Would it be possible to move into a more supervisory position in your family company?

 
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Old 04-12-2012, 12:14 PM   #3
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Re: my L5 struggle.

thank you so much for your advice and input. unfortunately, my job requires bending at the waist and lifting for the majority of tasks and i would be unable to change positions at this time. i'm curious if this type of herniation usually results in such discomfort and pain. i have realized that the types of movement required in my job result in swelling and pressure on the nerve roots, but again, with the smaller size of the herniation, i'm taken aback at the amount of discomfort it's produced. As far as insurance covering surgery, the only attempt at nonsurgical treatment i haven't tried is PT. i am planning on visiting a PT office today, but i'm not optimistic about the possible results combined with work related activities. What concerns me furthermore is pain management in the evenings after work. 10 mg of oxycodone, advil, ice, and stretching has done absolutely nothing to ease the pain. Should i be inquiring about other medication that might alleviate the pain?

 
Old 04-12-2012, 11:46 PM   #4
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Re: my L5 struggle.

Hi there -- keep in mind that small herniations can cause devastating pain, while massive herniations can cause little problems or even go unnoticed. Since you are eight weeks into this battle -- which is still early, a lot of the pain you are feeling may be due to the inflammatory processes related to the herniation itself. It would be worthwhile to ask your doctor about another epidural, a short course of oral steroids, prescription NSAIDs, and muscle relaxants, to try to alleviate your pain. Most medications are merely masking the damage, so be careful not to overdo anything.

Physical therapy may not cure your condition, but it will make your back stronger and help to prevent further injury. For example, as teteri mentioned, if you go forward with a fusion, the other discs will bear more force than they had previously. A good core and proper posture training will help those adjacent discs. Your physical therapist may also be able to give you suggestions as to how to accomplish some of the demands of your job while minimizing the impact on your back.

I have found in recovering from injuries/surgeries that shortening my hours is helpful. I have returned to work at 4 hours per day, 3 days per week, then slowly increased my hours and days per week over a two-month period. I don't know whether you have this flexibility.

Congratulations on the upcoming addition to your family!

 
Old 04-13-2012, 05:52 AM   #5
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Re: my L5 struggle.

The size of the herniation has no bearing on the amount of pain it can cause. It all depends on whether a spinal nerve is being irritated or compressed. You do not mention having seen a spine specialist. Considering that your livelihood depends on being able to use your spine, I really would emphasize that you need to consult with a spine specialist. This will be either an orthopedic spine surgeon (not a general orthopedic doc) or a neurosurgeon who limit their practice to the neck and back.

The reason for doing this is that there may be some other, more subtle issue going on that has not been picked up by others. This happened to me and I wasted over a year being treated for something that turned out to be just a peripheral issue to my main problem.

You need to be very watchful of symptoms that effect the bowel or bladder, such as incontinence, or a sudden weakening of a muscle, such as drop foot. These are signs of cauda equina syndrome, which is one of the few truly emergency situations concerning the spine. If this should develop you need to seek medical attention immediately. Ignoring this sudden onset of those type of symptoms can result in permanent damage to the nerves.

Depending on the extent of your nerve compression, you may need to have surgery to decompress those nerves as, generally speaking, the longer a nerve is left in a compressed state, the greater the chance for permanent damage.

Currently, as you describe your situation, you are in a vicious cycle. I'm not quite sure why you were told that you can't make your disc bulge worse. That doesn't make sense to this layman! We all have been told that any kind of activity that involves bending or twisting at the waist, pushing, pulling and lifting are not good for the discs. If you are trying to get a herniated disc to heal, you cannot keep repeating the same activity that caused the initial problem. It would be a bit like picking the scab off a wound while at the same time trying to get it to close completely. It is counterproductive.

Also, with one segment of the spine injured, the muscles and soft tissue automatically try to guard the injured area. This can result in muscle imbalances etc. which can pull the spine out of structural alignment, which can result in additional wear and tear to the discs, vertebrae and facet joints.

To be sure you are being given the most accurate information about your condition, I would suggest a visit to an orthopedic spine surgeon or neurosurgeon who specializes in the spine. Those are the two specialties that have the additional education and training in the back and neck, and have the training and experience to spot issues that other doctors may overlook or miss completely.

 
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