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Old 12-29-2012, 07:53 AM   #1
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Unhappy Wrong procedure done... ESI vs. Nerve Block

I went in to have my epidural done on 12/27. After reviewing my films, the Neuroradiologist explained the ESI won't work for me; the Neurosurgeon should have ordered a nerve block instead (No guarantees it would work). He was doubtful the medicine would reach the smashed nerve at L5-S1. He said he would send a report to the Neurosurgeon to let him know. I went through with the epidural anyway, and am in more pain than before. I've noticed increased motor weakness, and more stabs. The Neuroradiologist told me not to give up hope. I know my back is in bad shape, but why is it every Dr that reads my films doesn't seem to be optimistic? They all have the same tone in their voice when they talk to me. I feel like I'm spinning my wheels with all these conservative treatments, and am NOT improving at all. I'm scheduled for follow up with the Neurosurgeon 1/15, and am to the point of telling him I want to move forward with the lumbar fusion. I know this is a drastic decision, but at least I will know things are moving forward. I am FRUSTRATED!! I have a 2nd opinion scheduled the end of January with an Ortho. I am fearful I will have to start over with him?

Any thoughts or advice would be appreciated.

Christie

Last edited by lubear2003; 12-29-2012 at 07:57 AM. Reason: typos

 
Old 12-29-2012, 08:23 AM   #2
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Re: Wrong procedure done ... ESI vs. Nerve Block

I can understand your frustration. I have been thru 7 or so spine surgeries. That includes 5 major surgeries and then 2 more which was for the implanting and removing of a spinal cord stimulator. I am now moving forward with having an Intrathecal Pain Pump implanted on 1/11/13 to control the pain. It is a combination of morphine and another medication.

Every doctor I seem to see all they say is how complicated my case is. I am also at the point that some doctors wont even talk to me or see me once they hear my background. They figure they can't do anything for me.

One thing dont rush into surgery. There are risks invovled especially spine surgery. Before you make that decisioin, I agree you should get a 2nd opinion. I usually try to find the top qualifed doctors on my plan. By that I meant those doctors that are specifically trained in spine related issues but those that are also affiliated with Major Teaching Hospitals. Once your case gets complicated you need to find the best of the best as to doctors.

I usually try to see what they look like on paper meaning where did they go to school, where did they do their residency etc.

Good luck and let us know how you make out.

 
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Old 12-29-2012, 10:38 AM   #3
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Re: Wrong procedure done ... ESI vs. Nerve Block

I reread through your MRI results and I am a little surprised that the neurosurgeon only seems interested in investigating L5-S1 as the pain generator. Obviously I am not a doctor, and obviously I haven't even had the advantage of seeing the MRI, but I won't let that stop me from commenting anyway....

There are a number of things wrong at both L4-L5 and to a lesser extent, L3-L4 that as a patient I would want examined before thinking about having a one level fusion to treat L5-S1. There is little point in having a one level fusion, only to discover six months down the road that the adjoining level is causing just as much pain.

I have a question regarding your ESI appointment yesterday. Did the doctor suggest you should have a nerve block at one of the levels other than L5-S1? (like L4-L5)? It would depend on the placement of the ESI, but there would be little difference between a diagnostic nerve block and an ESI, so I don't understand what the doctor was telling you.

When you go to see the orthopedic spine surgeon, you can take the notes from the doctor that did the ESI or you can just tell him you had it and what the effect was....He won't make you "repeat" the ESI unless he feels there is value in having a second one.

Now is NOT the time to become impatient with the whole process. Having a spine fusion is a life-changing event and it is not something to rush into without careful deliberation and after getting several opinions. You have put up with the pain all this time. You can wait a few more weeks or months to be sure you are seeing the very best spine surgeon that is available to you and to be certain that the right procedure has been selected for your problems.

 
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Old 12-31-2012, 04:37 AM   #4
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Re: Wrong procedure done ... ESI vs. Nerve Block

[QUOTE=teteri66;5110125]I reread through your MRI results and I am a little surprised that the neurosurgeon only seems interested in investigating L5-S1 as the pain generator. Obviously I am not a doctor, and obviously I haven't even had the advantage of seeing the MRI, but I won't let that stop me from commenting anyway....

There are a number of things wrong at both L4-L5 and to a lesser extent, L3-L4 that as a patient I would want examined before thinking about having a one level fusion to treat L5-S1. There is little point in having a one level fusion, only to discover six months down the road that the adjoining level is causing just as much pain.

I have a question regarding your ESI appointment yesterday. Did the doctor suggest you should have a nerve block at one of the levels other than L5-S1? (like L4-L5)? It would depend on the placement of the ESI, but there would be little difference between a diagnostic nerve block and an ESI, so I don't understand what the doctor was telling you.

When you go to see the orthopedic spine surgeon, you can take the notes from the doctor that did the ESI or you can just tell him you had it and what the effect was....He won't make you "repeat" the ESI unless he feels there is value in having a second one.

Now is NOT the time to become impatient with the whole process. Having a spine fusion is a life-changing event and it is not something to rush into without careful deliberation and after getting several opinions. You have put up with the pain all this time. You can wait a few more weeks or months to be sure you are seeing the very best spine surgeon that is available to you and to be certain that the right procedure has been selected for your problems.[/QUOTE]

Thank you for your feedback. You are always so helpful. I'm not quite sure why the neurosurgeon doesn't seem to be as equally concerned with the L4-L5 level, as this area is causing equal pain as L5-S1. I will address this question when I see him for follow up on 1/15. The neuroradiologist didn't specify which levels he was injecting at the appointment. He mentioned it as he was reviewing my report, but I'm still unsure. He seemed confused as to why the neurosurgeon ordered the ESI rather than a nerve block. I didn't know there was little difference between the two procedures. If it's for diagnostic purposes, the nerve issues have already been diagnosed, and acknowledged, so now I'm really confused. It is now day 5 post injection and I feel no relief from it. I will make sure to pose that question when I see the Dr. This is my first time dealing with this situation, and am learning as I go. Your input always helps me.
Thank you,
Christie

 
Old 12-31-2012, 05:12 AM   #5
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Re: Wrong procedure done ... ESI vs. Nerve Block

[QUOTE=pebblebeach3;5110095]I can understand your frustration. I have been thru 7 or so spine surgeries. That includes 5 major surgeries and then 2 more which was for the implanting and removing of a spinal cord stimulator. I am now moving forward with having an Intrathecal Pain Pump implanted on 1/11/13 to control the pain. It is a combination of morphine and another medication.

Every doctor I seem to see all they say is how complicated my case is. I am also at the point that some doctors wont even talk to me or see me once they hear my background. They figure they can't do anything for me.

One thing dont rush into surgery. There are risks invovled especially spine surgery. Before you make that decisioin, I agree you should get a 2nd opinion. I usually try to find the top qualifed doctors on my plan. By that I meant those doctors that are specifically trained in spine related issues but those that are also affiliated with Major Teaching Hospitals. Once your case gets complicated you need to find the best of the best as to doctors.

I usually try to see what they look like on paper meaning where did they go to school, where did they do their residency etc.

Good luck and let us know how you make out.[/QUOTE]

Thank you Pebble. My Dr asked me at one point if I was open to seeing a Specialist at Stanford in Palo Alto. I was concerned about the 1.5 hr trip back/forth,but now I think it's something I need to do. I hope all goes well with your pump.
Sincerely,
Christie

Last edited by lubear2003; 12-31-2012 at 05:51 AM. Reason: typo

 
Old 12-31-2012, 06:21 AM   #6
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Re: Wrong procedure done ... ESI vs. Nerve Block

[B] I'm not quite sure why the neurosurgeon doesn't seem to be as equally concerned with the L4-L5 level, as this area is causing equal pain as L5-S1.[/B]

I would contend that it is difficult to know exactly where the pain is coming from. That's why it concerns me that the ns is focusing only on L5-S1. Without being privy to any further information, if L4-L5 isn't a significant issue now, it will be shortly after you are fused at L5-S1.

The difference between an ESI and a nerve block is twofold. The placement of the actual injection can be more precise with a nerve block and its main purpose is in knocking out the nerve for a short period of time. By this I mean an anesthetic is delivered to a specific nerve. The numbing effect is for a specific duration, after which it wears off. The way it works is that the patient is told to go about his/her normal activities, especially those activities that specifically cause the pain (rather than going home and resting as with an ESI). If the correct nerve is injected, the person can do these activities without pain. As the anesthetic wears off, the pain gradually returns.

If the "wrong" nerve is injected, it will make no difference in pain when the person goes through those activities...he/she will be in typical pain. Sometimes a steroid will be included in the injection so there will be some therapeutic benefit to it, but this is not the primary purpose of the injection.

With a nerve block, the person is requested to keep a journal to record how long the pain relief lasts, and to record when the pain started to return and what activity was being done when this happened.

If you get another opinion, you might want to consult with a fellowship-trained orthopedic spine surgeon. Sometimes there will be a difference in the way a problem is approached and is interesting for a comparison.

 
Old 12-31-2012, 06:51 AM   #7
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Re: Wrong procedure done ... ESI vs. Nerve Block

[QUOTE=teteri66;5110724][B] I'm not quite sure why the neurosurgeon doesn't seem to be as equally concerned with the L4-L5 level, as this area is causing equal pain as L5-S1.[/B]

I would contend that it is difficult to know exactly where the pain is coming from. That's why it concerns me that the ns is focusing only on L5-S1. Without being privy to any further information, if L4-L5 isn't a significant issue now, it will be shortly after you are fused at L5-S1.

The difference between an ESI and a nerve block is twofold. The placement of the actual injection can be more precise with a nerve block and its main purpose is in knocking out the nerve for a short period of time. By this I mean an anesthetic is delivered to a specific nerve. The numbing effect is for a specific duration, after which it wears off. The way it works is that the patient is told to go about his/her normal activities, especially those activities that specifically cause the pain (rather than going home and resting as with an ESI). If the correct nerve is injected, the person can do these activities without pain. As the anesthetic wears off, the pain gradually returns.

If the "wrong" nerve is injected, it will make no difference in pain when the person goes through those activities...he/she will be in typical pain. Sometimes a steroid will be included in the injection so there will be some therapeutic benefit to it, but this is not the primary purpose of the injection.

With a nerve block, the person is requested to keep a journal to record how long the pain relief lasts, and to record when the pain started to return and what activity was being done when this happened.

If you get another opinion, you might want to consult with a fellowship-trained orthopedic spine surgeon. Sometimes there will be a difference in the way a problem is approached and is interesting for a comparison.[/QUOTE]

Thank you again for your input. Sometimes I feel i'm the only one dealing with this I am really starting to see the importance of getting another opinion. My Dr. asked me early on if I was open to going to Stanford, but I didn't want to make the 1.5 hour trip unless as a last resort...well, it's last resort time! I'll have him go ahead with the referral, because it simply needs to be done!
Sincerely,
Christie

 
Old 12-31-2012, 12:04 PM   #8
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Re: Wrong procedure done... ESI vs. Nerve Block

Sometimes it is helpful to get an evaluation at a place like Stanford or another university teaching hospital even if you decide not to use them for your surgery...if that is what is needed. It helps the education process and may help clarify what type of a situation you would feel most comfortable in. This is of course, if there is a well-trained, experienced spine surgeon in your area. Sometimes it is necessary to go further away to find the best doctor.

For me it was a matter of confirming in my own mind that my local surgeon was every bit as good as the doctors I went to with the "bigger reputations." Also, I knew myself well enough to know that I needed someone in the same city that I could see often and quickly if need be, who would take my questions and would return phone calls, and I didn't want to be working with a physician's assistant or resident or even a fellow who would do all the work and see the doctor just for the surgery itself.

I think I saw eight surgeons before my first surgery, which was a fusion. This was over about a two year period. It was worth it to me as I ended up with the surgeon that was perfect for my needs.

 
Old 12-31-2012, 05:17 PM   #9
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Re: Wrong procedure done... ESI vs. Nerve Block

If you feel the surgery is needed don't put it off. If two professionals think it is the way to go, its more likely to be so.

If I thought surgery would solve my problem, I'd be there right now. Good Luck and God Bless

 
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Old 01-03-2013, 07:02 PM   #10
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Re: Wrong procedure done... ESI vs. Nerve Block

[FONT="Verdana"][COLOR="Purple"]Lubear, you have been given good advice.

One thing that I would stress that in situations like yours, it is better to err on the side of caution than to rush into surgery. I am fused from T9-sacrum and live with constant pain and will for the rest of my life.

In my opinion, waiting to see a specialist is first. Then going through with whatever type of treatment he suggests is next. As both my PM doctor and my spine surgeon say, surgery is an option, but it should be the last option. Once you have had surgery, you have committed your self and your back in an invasive procedure that may or may not cure your issue. You may find that it cures one thing only to have something else flare up with no hope of a quick cure.

Go to see the specialist and listen to what he says. Patience is a virtue..hard tho it may be. Keep your chin up and keep smiling...and keep us posted.
[/COLOR][/FONT]

 
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