Bulging disc and sciatica

[Ered_Lithui]

I hope you get some relief soon, daisylubob! Your pain pattern sounds exactly like mine. The day my foot went numb was the day I knew I wouldn't put off surgery any more. After all you've tried, I imagine the neurosurgeon will probably recommend surgery too. If you have any questions or concerns about it, feel free to PM me.

I'm still waiting for some progress. It seems as though my pain has changed and become a bit duller, but I have to lie down every few hours or suffer the consequences. When I don't, the pain is the same as the worst days pre-surgery (and this is while taking strong painkillers; when I'm late with the neurontin, the pain is severe). Sitting or bending over a table for any length of time make it worse. I'm getting another MRI next week before my 6-week follow-up because it doesn't seem to be getting better. It's really frustrating. I'd hoped to be active by now, but all I'm allowed to do is walk and do a few tailored PT exercises.

But PT is frustrating as well; each week I get asked the same questions and given the same instructions. I understand the need for a new PT to review my symptoms the first time, but once they have it in their notes I wish they wouldn't go (without first consulting notes), "So which leg is it in, and where in the leg?" It's not as though the answer ever changes. Equally tiresome: focusing on the back pain and forgetting entirely that the leg is an issue. The latest PT even had me do an extension stretch before remembering my diagnosis and going, "Oops! You're not supposed to be moving like that yet so soon after surgery."

Which isn't to say the surgery was a mistake, just that the verdict is still out. (And thanks, klesko -- I look forward to being able and allowed to be active, too!)

[KnottedYet]

There was an interesting study done a few years ago where the researchers gathered a bunch of folks who had NO back pain or leg symptoms, and ran 'em through an MRI. http://www.nejm.org/doi/full/10.1056...99407143310201

25% of them had disc bulges so honkin' gigantic that they were instant candidates for surgery.

But they had no symptoms.

EVERY single day I have patients with classic disc symptoms, yet their MRI show no evil bulges at all, just minor stuff that raises no red flags. I treat them like a disc problem, and their symptoms go away.

It is possible for distribution pattern of symptoms to be more accurate diagnostically for symptom-generator level than MRI.

[KnottedYet]

I had a patient with history of severe back and leg pain and loss of motor function of the leg. Patient had a multi-level fusion and I think also multi-level laminectomies. At 5 weeks post-surgery the patient was pain-free and had returned to commuting by bike to work.

There is hope, hang in there!

(Ered, what post-surgery protocol does your surgeon have you using? The protocol is chosen by the surgeon, not by the PT, cuz the surgeon knows exactly what he did in there and how he wants you rehabbed. The various protocols have exercises and goals and precautions clearly spelled out for every week, so I'm kind of surprised that your PTs seem to be a bit at cross-purposes. Ask them to give you a photocopy of the entire 3-month protocol. It's nice to be able to see all the exercises and goals and the progression at once, rather than just one week at a time as they dole it out. It also lets you over-see the new PT you get who may not be familiar with you. I'm sorry you are frustrated that they ask the same dang questions about your pain every time, but we have to do that to monitor progress and changes. It drives my patients nuts, too!)

[jessmarimba]

I can't speak for Ered, but my surgeon doesn't seem to care what I do. He can't ever remember if I've even started PT yet and last time just told me I could do anything "reasonable" that I wanted. I hope hers is a little more involved!

[Ered_Lithui]

Wow! Your patient's surgery sounds horrifically involved. I'm amazed he recovered so fast! It gives me hope. I appreciate your professional insight.

I've read the same about MRIs showing bulges that produce no symptoms. My MRI did coincide exactly with my symptoms, though. (There were two other asymptomatic bulges as well.) There was also severe stenosis at the same location, which may explain why PT didn't help before surgery. The surgeon went in and carved out a fair amount of bone, in addition to removing the bulge.

As far as I gather, the main concern right now is that another bit of disc may have come out right after the surgery was completed. (He warned me beforehand that the latter was possible, though in his 1,000+ surgeries it has only happened about 2% of the time.)

what post-surgery protocol does your surgeon have you using? The protocol is chosen by the surgeon, not by the PT, cuz the surgeon knows exactly what he did in there and how he wants you rehabbed.

I will ask for more details; the PTs work for the hospital in accordance with the surgeon's directions.

I'm sorry you are frustrated that they ask the same dang questions about your pain every time, but we have to do that to monitor progress and changes. It drives my patients nuts, too!)

I get the need to monitor, but the nature of the questions ("And have you ever had any leg pain?") makes it clear that they don't remember (understandable) but also haven't bothered to even glance at notes from the last session. Urr.

[KnottedYet]

I get the need to monitor, but the nature of the questions ("And have you ever had any leg pain?") makes it clear that they don't remember (understandable) but also haven't bothered to even glance at notes from the last session. Urr.

Whoa, now that just sucks! You have my permission to slap 'em upside the head. Tell 'em it's therapeutic...

[malkin]

I went nuts when they'd ask every day if I'd had any bowel or bladder incontinence---I wanted to scream--DON'T YOU THINK I WOULD HAVE MENTIONED IT???!!!!