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My Diary Page #2 02-06-04: The surgery is OFF! I just can't seem to bring myself to do it, for things are changing again. My lower back pain is now completely gone, and has been for some time now. I've went back to doing my core exercises again: Tummy-ups, Back extensions on the gym ball only, and Lat pull downs. I also do the supine knee chest stretch. I've also been off all percocet for quite some time now. I've been attending a 2 1/2 hour class at our local college once per week. That 2 1/2 hour sit is a killer, although I'm doing it. I can always relieve the foot and leg burning/numbing pain with about a 30 to 60 minute recliner rest. The other reason I cancelled is that I'm a little concerned by the fact my S1 root pain, has now spread to L5, and even a little L4. This is new over the last few months and has been worsening. I'm hoping its IDD but based on my past EMG that was positive for L4, L5, and S1 radiculopathy, and the tiny central herniation at L4/5, I'm concerned that the L4 disc my becoming symptomatic again - which if true, would decrease the chances of a successful L5 discectomy. I'm going to consult with Dr. Yeung of Arizona. He the one who does that SED discectomy which included a visual trip into the 'innards' of the disc (removing and hiding fragments) and finishing the procedure with a strategically placed IDET. 01-26-04: The surgery is back on again! I just feel like it's now or never and I'm willing to take the gamble, in hopes of increasing my ability to sit, and rid myself of this foot, leg, and thigh pain. 01-25-04: Well, I've recovered completely from that 'shitty' week, which stretched into two weeks, and am off all drugs and back to working full time, although I need that 30 to 60 minute 'decompression time' between the morning and afternoon shift. Mentally I just can't handle any more flare-ups! I've decided to try something new. For the first time in my treatment regime I've decided to DO NOTHING! Only work (which is physical enough - treating 15 to 20 patients a day) and rest. At my seminar this week-end, Dr. Slosberg drilled into me the importance of keeping the core strong. Maybe in February I'll pull out the gym ball and try one month of core stabilization training again - but this time at a more 'human' level. My stomach is still bothering me and has now flared-up again - probably from that four days straight on percocet. Stomach doc thinks its IBS, only the stomach version of this syndrome. What a miserable 14 months this has been. And finally I must announce that once again, for the third time now, i've cancelled my surgery' that was scheduled for 02/03/04. One more thing I must note: It seems that I've developed much more L5 and L4 dermatomal pain. Although its only a bother, it is this fact that caused me to cancel the surgery - again. I'm just convinced that removing that disc fragments on the S1 root will not take away all my problems. I've almost made to the magic 18 month mark so I guess I'll try and stick it out. 01-09-04 : The now shitty week has ended with a 10 hour day with no 'recliner time'. Last Friday I was feeling so good that I was off on a 80 minute trainer ride, and then a core exercise workout. Today my pain is the worse its been in some time. My sciatica has calmed down from earlier in the week but a but a brand new pain woke me up at 6:00 am; which is rare for me for I usually sleep well and pain free. Surprisingly the sharp stabbing pain is in my right L5/S1 region (my back pain is almost always left sided and occasionally over the sacrum. This stabbing pain, is very strange in that it only briefly attacks about every few minutes or so and lasts about 1 to 5 seconds long. It must be discogenic for the ice and therapy I had today didn't touch it. It will be a Soma and Percocet weekend for me. I'm greatly looking forward to trying the discectomy, but somehow I've got a feeling (since I once has L4, L5, and S1 radiculopathy) that its not going to take all of this pain away. Lets hope I'm wrong. Interestingly I had a new patient this morning who was in for a simple strain/strain of his ankle. What was interesting was what he told me as I was inquiring about his past history: Over ten years ago, he herniated a disc and was told that he needed surgery but there was only a 50/50 chance of the surgery working. He decided to 'wait it out' and DID finally recover after 3 years! That's right 3 years!!! This just about concurs with many of the long term outcome studies that I've read, some of which are posted on the research page. 01-07-04: Crummy week for me - I over did it last weekend (two 80 minute bike workouts back to back) and now Mr. Sciatica is back and so is my appointment with the "bright lights". I guess it all comes down to this; if I admit my disability (which may lessen somewhat over the next year), limit my physical activity (really basically just cut it out completely), I should do just fine with life. Unfortunately, I'm not ready to accept this disability and must try everything there is to try in order to get more of my life back. I'm also still somewhat limited in my work, i.e., I can't treat some of my 'bigger' patients who like the myofascial release done hard! I'm still not sure what got me this time. It was either the 80 minutes, which included three sets of 5minute 'low ME intervals (at only 140 watts [I used to this workout for 3X45 minute blocks at about 240 watts!) or the 2X15 sets of '1/2 good mornings with only body weight! How sad! This was the first time I've had this much sciatica in about 4 months! Damn!! I do have neurological loss in my left foot that has not gotten better. All the intraosseous muscle of the foot are shot. When I walk on the treadmill I can feel my forefoot collapse - very strange. My calf power is good, it's the small muscle of the foots that are screwed. 01-01-2004: A very good three weeks. I've been on the bike four to five times per week in the last three weeks and slowly increasing my power and distance. The theme of December was a shift from leg pain as my major complaint to lower back pain. I would put it at 60% lower back pain and 40% leg and foot pain, which is always a cold-buring type pain, if that makes sense I think I may be out of the woods. I'm increasing my wattage a little this weekend so we shall see how the back likes that. I'm also increasing my good morning to 3 sets of 10 or maybe more. My rehab routine has been: knee to chest stretch, crunches (2 or 3 by 15)(back flat), girly push-ups (2or 3 by 15) and good mornings against the bathroom counter (about 45 degree worth). These have been very dangerous for me in the past but I know I MUST get some strength back in my erectors or I'm domed to a non-athletic life. 12-12-03 : Well, maybe "enough wasn't enough"! I'm seem to have made a tremendous turn around, and had just finished my fourth 'bike workout' within a full 11 hour work-day. I'm breaking 'activity records' again and have had a record week at work and on my bike (even though 30 minutes is not much of a work-out compared to the 5 and 6 hour training rides I used to go on - but its a start!). What a 'roller-coaster ride' this whole adventure has been. I'm not out of the woods yet, for I know that this good week may be followed by another depressing week of pain and percocet (which I've been completely off of now for 9 days now). I thought I would share an e-mail of my current condition I wrote to a fellow 'limbo-dweller' or 'on the fence friend'. Hi Kyle, I didn't want to answer you right away but after today I feel pretty confident in saying that not only have I climbed back up the fence, but I think that just maybe I climbed off it all together. My doc wanted my to push it, but not by walking and ordered me back on my bike - on a trainer. So I've been slowing building up, every other day, on my road bike (which is really a terrible position of flexion but a good work-out for my weak back muscles). Today I had my fourth ride: I working treating 10 patients in the AM (3 hours), sped home and warmed up on the treadmill (5 minutes) then pounded out 30minutes on my road bike (still in my scrubs) at a pretty fast pace. I'm actually sweating now for the first time in about 11 months! Then, no time to rest or recline today, back to work for another 10 patients (2 1/2 hours mostly standing), then home and made dinner, then finally to my 'healing chair' (recliner) to decompress. I've got a little sunburn pain in my heal and lateral foot, and a tiny bit in my lateral calf but not near enough to even think about taking a Percocet (which I've been off of for 8 days now). It's really hard for me to justify having surgery now for it seems like the 'sands' of the healing hour-glass are flowing in the correct direction again, for this whole week has been a record or activity! I'm still scheduled for a micro-d in mid January and I'm not canceling just yet (maybe I'm scaring myself into recovery?) but things are looking better again. Two steps forward, one step back. Thanks for your concern, selfish or not! LOL I wish you the best of luck with those ESI's! It sounds like the 'hour-glass of healing' is still spilling sand in the right direction for you as well. Doug G. 12-04-03 : Neurosurgical exam #2: I've decided that 'enough is enough and have decided that its time for microdiscectomy'. I saw my neurosurgeon, Dr. XX this afternoon. We reviewed my latest MRI and he agreed that the herniation had slightly worsened, become more focal and definitely "had" the left S1 root. (Here it is) He said it was my call, for I still had good strength and was NOT physiologically being forced into the surgery - YET, and that I was indeed a very close call between surgery and continued conservative care. He was however, very confident that removing the fragment at the L5 disc level, that was undoubtedly hiding within my contain herniation, would give me good relief of my lower extremity symptoms, which is about 70% of my problem. He warned me that based on my athletic back ground - years of punishing my discs - that it would be doubtful that I'd be 100% better. I already knew this but given the fact I have a 42 Oswestry Score, I feel its worth a shot. I still have an issue with the L4 disc which has seemed to have developed a tiny herniation as well but one step at a time. My decision was based on two facts: 1) I'm becoming too dependent on Percocet for the control of my pains and 2) I'm still unable to do even the simplest of floor exercise without flaring-up. Carragee's recent research paper has also giving me the confidence that surgery can and does work for this f* cking disc condition, even in small contained herniations. I'm NOT going down (to disability land and drugs) without a hell of a fight! This is the next step and frankly I'm a little pissed that I have waited so long! So, as Joanne my 'Spiny friend' has stated, I'm going to be seeing the "bright lights" very soon! Plan: Microdiscectomy at L5. Dr. XX uses the exact same procedure as Carragee of Stanford uses, so I'm in great hands! Wish me LUCK!!!! 11-28-03 : I've flared myself up on purpose - just to prove a point: I need surgery. I just finally recovered from a three week flare-up from over hiking. The hills got me again. Here's what I did yesterday just to prove to myself how unstable I am. After a huge Thanksgiving Feast I came home and did three simple floor exercises: 1) Knee to chest stretch, 2) supine pelvic tilts while contracting TA and Pelvic floor, 3) supine heal drags (out and back) 1X8 each leg. Then I did step-ups on the second stair - 10 time each leg. Which in 20 minutes my lateral leg and foot were burning pretty bad. To complete the flare-up I fell asleep on my left side (which is a big no-no) and today I'm hurting. Not my lower back this time - pure sciatica in the S1 dermatome. I'll probably need some percocet tonight. I see the Neurosurgeon (XX) Wednesday. I'm ready to take the plunge! Even though this 'most excellent' 2003 research paper I'm reading is scaring me to death of surgery - I've got to do something. 11-23-03 :This has been the worst week for me in a long time. Four Percocet and I was grounded all weekend. Last night I had the worst sciatica I've had in probably 6 months! Not a good sign. This flare-up all started from walking those damn hills. I only walked about 5 hours worth 2 weeks ago but still haven't recovered from that flare-up. I want that L5 disc cut out but I'm concerned that I'm getting some L4 disc symptomatology now. I would hate to suffer through a microdiscectomy only to learn that I really needed a fusion! Ahh , what to do. I'm getting another ESI on Wednesday. I'm going for the translaminar approach, which worked much better last time and can be done without fluoroscopy. I'm afraid I'm going to need a discogram done next. Its a hard decision. I know that the L5 disc and the left S1 root are the main problem and probably will just try the less invasive procedure first but I keep thinking - will this ruin my chances for a ADR is I have to go this route? As our favorite doc says (Dr. Whitworth) "many things to ponder". 11-20-03 : The theme of the last two weeks has been lower back pain. I increased my walks to 1 hour four times a week and I've include two small 1/4 mile hills. I've flare-up and am having trouble working again. Very frustrating. I'm going to try and get in for my third intralaminar ESI this week. 11-07-03 : I've had one of the best weeks ever. I worked a 10 hour day Monday, 14 hour day on Wednesday, 11 hour day on Thursday and a 8 hour day today (Friday). No flare-ups! and only a 1 to 2 leg pain level (on scale of 0 - 10). Now if I can just get some strength in this back I'll be home free! I might try some easy stationary bike soon!! 10-29-03 : Neurosurgical evaluation #1: with Dr. XX Neurosurgeon . Dr. XX is one of the best microdiscectomy doctors in the bay area. I run into him quite often in the Workman Compensation work arena here in the bay area, where he is often used as an AME evaluator. In his technique, he uses a small drill to drill a hole in the lamina without removing it. He does all of his work through this hole. This technique is suppose to cut down on the post surgical scar tissue formation. My current complaints are: great trouble with lifting, repetitive bending, prolonged sitting, and of course, my inability to do any form of exercise - including my beloved road bike, golf, running etc. Today's Exam Findings: 2cm loss of left calf thickness, moderate weakness of the left ankle evertors , and mild weakness of the gastrocnemeus (calf muscle). My left achilles reflex has returned from the dead and is now normal! The kemp's test did not produce back pain but made my lateral foot go numb. All other ortho tests were normal. Sensory exam showed a loss of sensation in the left lateral foot. Recommendations: He told me that if it wasn't for the fact that I have had the best week I've ever had, he would have recommended a microdiscectomy. ( which greatly surprised me for he is known for being super conservative) He thinks that I may have finally turned the corner. He wants me to give it 3 or 4 more months and to try three more translaminar ESI's. He thinks with a little luck - I might make it out of the woods yet. He also wants me to try some stationary bike at the gym and some very basic leg exercise. No stomach or back extension (which have always flared me up) exercises. IDET & Nucleoplasty: As for the IDET, he said the same thing my long time neurosurgeon friend had told me back in the spring. IDET will turn the disc into "mush" and force you into a fusion. The Jury is still out on the Nucleoplasty but why take a chance with damaging the integrity of the disc? He went on to tell me the story of a patient he had recently performed a fusion on (from the anterior approach). This was a patient who had had an IDET 1 1/2 years prior. Her disc had collapsed and she was forced into a fusion. The IDET did initially give her 6 months of relief, then a relapse. When he began to remove the disc, he was stunned to find that the disc had literally turned to a mushy - cat food like substance! Another IDET story from hell: Last year he had a patient that was a candidate for the IDET. She was a marathon runner. She tried the IDET and developed severe foot drop! She was devastated although he reported that some of the power has returned. She will never run again and is now worse then me and headed for fusion. He has also wrote about some local studies on IDET in an AME report on one of my patients. In one study IDET seemed to help and in the other it didn't help. I may post this later. Final Comments: I told the doctor that I was worried about having a discectomy, for the research (especially the work done by Stanford's head of Neurosurgery - Eugene Carragee) currently indicates that my small 3 mm contained herniation do absolutely terrible with microdiscectomy. He told me that its the central contained herniations that cause the problem, NOT the ones in the lateral recess or beyond. He then stated that Microdiscectomy is designed to eliminate sciatica and "is not very effective for relieving axial (center) lower back pain." He said I would most likely do very well since 95% of my pain is in my left foot, calf, and butt. My axial MRI and CT clearly show compression the S1 root; which perfectly matches with my positive neurological examination. You can see my CT and MRI on the "My MRI EMG CT" page. 10-25-03 : I made it through another week of work despite a severe flare-up from Dr. Viking! My new approach to treatment is something I've not yet tried. DO NOTHING! All I'm going to do is try and work my 30 hours per week and rest. No more therapy. It seems everything I've tried, has ended in flare-ups. I'M SICK OF FLARE-UPS!!! I probably get enough exercise from treating my patients anyway! 10-18-03 : Its been one year now since my initial injury. I have complete a standard Roland-Morris-Questionnaire 24 today (here). I still have quite a disability and have only been able to just start the simplest of exercises with Tore. The stretching does give me good temporary relief. I hope the next 6 months will at least get me back on my bike - in a recreational manner. The natural history of this chemical radiculopathy seems to indicate that more that 1/3 of the patients with moderate to severe sciatica still have mild to moderate leg symptoms, work dysfunction, and limitations to leisure activity. I'm certain in this unlucky 1/3. I'm scheduled to see a top neurosurgeon in Los Gatos at the end of the month. I know what he's going to say (no surgery - live with it) but I'm willing to listen to his recommendations. 10-06-03 : I continue to improve month by month and am now working a full day treating patients. Its not easy for I am still suffering mostly that tooth ache sciatica but its not acute and hasn't been for quite some time. I have started a new form of treatment. I have thrown my broke body into the hands of a fellow Chiropractor and fellow X-Hammer thrower. Dr. Tore G. of Viking Performance - Los Gatos California - has begun a merciless campaign of stretching the sh *t out of my lower extremities and back. I've survived two weeks and now am looking forward to the 50 minute stretching period. This will be a big week for tomorrow we begin to add spinal strengthening exercise. I have to date not been able to tolerate any strengthening without suffering flare-ups. Medication wise I'm still needing two or three percocet per week. The neurontin that Dr. S YY MD gave me helped a lot but destroyed my already chronically upset stomach after a week. So now I'm back on the Percocet PRN and some good old fashion alcohol twice per week, (three glasses of red wine). 8-06-03 : The one week has dragged into four week but I've finally completed it as well as read many of the related research articles. My back and leg are improving, but the improvement is very slow. My sitting tolerance is now about 4 - 8 hours with occasional standing breaks. I've also started a very easy swimming program 3 - 4 times per week and some home traction. (I continue to get a few treatments per week at my clinic with Cox flexion/distraction methodology.) The biggest improvement has been my ability to stay out of the 'recliner' for most of the day. I'm usually good for 4 - 6 hour in the AM, and another 3 -4 hours in the PM. I still need a little recliner break during the day but recliner time is decreasing. As for my bike, forget it. I still am very unstable and will flare-up with even the simplest extension exercises or biking. 7-03-03 : I've just spent one week reading and studding Dr. Nicola Bogduk's latest medical text entitled "The Biomechanics of Back Pain" I've redone all of my educational pages incorporating the last information into them. (Lost notes between 04-07-03 and 07-03-03: Its on a crashed IBM hard drive) April 07, 2003 ( 7.0 LBP LT. LEG PAIN ) FLARE-UP AGAIN & EPIDURAL #2 Slept Okay in the new, very soft bed. I almost went back to Lydia 's room at 2:00 AM , I had that weird feeling and woke up on my left side which is a no no. Just a little stiff this morning with almost a pain in my left foot. Lot of walking yesterday. No lower back pain during my 40 minute 'mandatory' up. I'm in my healing chair getting ready for a big day. I was right, some how it flared-up again? Not sure but suspect the sleeping the wrong way. I had a miserable 'four patients' The sitting is just killing me! Standing gave me surprising relief today. I had bad lower back pain when I arrived at Dr. ZZ's office. I had to walk about 30 minutes then recline to break the cycle. I saw Dr. William ZZ this evening. A great and very knowledgeable guy. Here's the plan: 1) ESI (translaminar to get at that S1 root more - since the TFESI at L5 and L4 didn't help much) and double facet block (L5 and L4 on the left) (HE BASICALLY WHIPPED OUT A NEEDLE AND DID IT - TO MY SURPRISE AND RELIEF). 2) Ware a good strong - fitted brace and 3) in a few days begin extension exercise. He has a very modern gym. If these injections fail - Nucleoplasty kind of technique - al la ZZ style. ( trust him) He does not use the same tip as the others. He uses something different. He said the flimsy IDET tip is " at the Mersey of the contours of the disc. He said there is some very promising new stuff in the experimental stage. Nucleoplasty. Results: I have gotten instant pain relief. NO pain (other than some pressure and warmness in my leg) at all right now any where. I dove home in traffic sitting with no pain at all. It felt great. I got it at 5:30 PM . I can take Vicodin one per day / MAX four per day with Soma - 1 per day, no more than 4 per day. He said this race season is OVER. Another 6 months is needed. He also said I was 'wrong' to push through the pain and he does not want me to do this. He was also puzzled by the positive EMG? He also said that the MRI had worsened between January and March. He did not think the disc worsened when I stood. Its 9:00 PM and the huge epidural hole looks very swollen! It looks like I've got some pain headed my way. 10:20PM Had some ice cream and took a powerful Vicodin 10/750. I can't take the Orphenadrine (Precaution for arrhythmias and tachycardia). I'm still feeling good except for the spinal stiffness. Lots of superficial swelling at epidural site. No problem at facet site. Monday, March 24, 2003 (LBP: 7.0 ! Leg pain about 2) 50 mg Vioxx plus on Vicodine before bed. Worse day I've had since this thing began! Not off to a good start. I woke up with INCREASED LBP & LT FOOT CAUSALGIA. I'm not sure but getting suspicious of that mattress. I made my self walk around (put away the dishes ect.) Now I'm back in my chair. I took a Vioxx at 9:00 am. (probably should take two a day for three days.) First half of the day not good. ( LBP 6.0 ) The reason for the poor rating is because I'm getting 'twings' of acute pain in the lower back (the usual spot) The leg, although some numbness, is not the problem today. I took one section of ice and just got back from a 20 min stroll by the reservoir. Was getting occasional twinge of 'scary' type acute pain. My lower back is really pissed! I'm trying to sit and stand today to get a pump. I call both Dr. YY and Dr. PP. I think its time for an appointment with the Dr. PP who is the inventor of the IDET procedure. I call Dr. Aptekar. Nice guy. He recommends that I get another shot right away. And maybe even one more after that. If that does not work it's the IDET or/and "remove the disc". He wants me to go on Vioxx 50mg (two pills per day) for five days (told me not to worry about my heart, it's only for older people. ) He also said that if was almost pain free - after the Epidural - then go for another one. Just need to get over the hump. Dr. YY called me this evening. He said to go for another shot. He usually gives a series of three shots, one every two weeks! I'm considering it. He also said that he was waving his co-pay fee for me. Very nice guy. About 10:00 PM I was just miserable! The 'healing recliner chair' was even aggravating my low back. I tried to lye on the hard floor, finally I just got in my old bed room chair - which has no giving at all, and the pain went away. Probably the 50mg of Vioxx is also kicking in. I also to a vicodine! Wow did that put me out. My stomach is starting to act up so I hope this doesn't worsen things. ACCESSMENT OF INJURY: I fucked up last Tuesday by way over doing it on my walk and exercise. I finished it off on Saturday by 'prolonged sitting' five hours. I'm a little worried by the fact that the leg pain is now back again. The shot has probably wore off.
02/23/03 : FLARE-UP! (6.0 leg, 2.0 back) (Activity 1.5) (400 mg Celebrex) 11:00 AM : I slept great with no problems. When I started moving around this AM that butt - deep - muscle - cramping has worsened? Definitely an ACUTE aggravation of something!!! And Now my Calf has started that 'crampy feeling. I guess I've over did it yesterday??? Something is wrong down there. Valsalva's is still negative and strength feels fine. I'm getting EXTREMELY frustrated! Now I've got a "TOOTH ACHE" like pain down the Sciatic nerve III. Its very faint but its there! Fuck, Shit, Fuck, Shit. What the fuck is going on!!!!! This is totally new. The lower back feel fine. Also not too much burning or numbness. I guess I better not walk at all today. (I'm still on 400mg of Celebrex). 12:00AM : I was a pure couch potato today. Very little lower back pain at all today. But a lot of shit going on in that left leg. Also twitching quite a bit. 02/22/03 : ( 3.0 and decreasing - almost all problem is leg)(Activity: 5) Slept good, no lower back pain but still leg numbness three. The damage of the shot is undone but STILL, not a huge relief of any symptoms in my leg. Typed four reports in the black chair and I need to get up. Some LBP with sitting. I need to go out for lunch and walk a little. Have noticed a little butt cramping/pain which is new. 12:00 AM : Pretty good day. That little butt cramping went away. Took a 30 + minute flat walk on the bike trail, slow and easy. Limp disappeared. Was able to sit and type more four more reports around 10:00 . Felt better than in the AM. Much less numbness and burning. I hope I can improve tomorrow this much! 02/21/03 : (4.0 rating and decreasing) (Mostly leg burning/numbness) AM: Slept okay no lower back pain to speak of. The left leg is just burning/numb like crazy. No leg pain thank god. Went to work, no real lower back pain but my leg is numb with burning. My lateral/posterior heal is a Very, Very, Numb! 3:00 PM : FINALLY I can declare some relief of leg burning and the low back is doing much better. " Its like somebody flicked a switch!" I'm resting up for a Chevy's dinner. I bet I'll be doing better by Monday. Left Heal still very numb. No LBP. Definitely feeling a little better to night. Went out had a few Margarita's; over 2 hours of sitting. Heal still very numb. I hope I didn't over do it. 02/20/03 : EPIDURAL DAY#1 : (Leg 5.5 Increasing, LB 2.0) Great night of sleep. Had one Margarita at the office dinner. Up at 6:00 AM and off to see Dr. YY at the Forest Surgical Center. Less pain today but I was unable to sit in those uncomfortable chairs while awaiting my turn to get 'stuck'. Quite a bit of leg burning today in the usual spots. No leg pain only the burning but the lower back is still there from the last flare-up. They prepped my with an IV (no ideas why this was needed) and gave me a power shot of "happy medicine" and I was bombed! Could not remember a lot of detail but it was over fast! I think Dr. YY told me to start spinal stabilization exercise in three days, then the bike in one week! I was dizzy and silly after the procedure UNTIL about half way home I started to get 'Car Sick' bad. I turned white with cold sweaty hands. It passed after about 5 minutes (although Lydia , who had to drive me home, said I was sick for "half the way" home.) I crashed on the couch for a good hour nap and felt/ feel much better. Just a little groggy. BP was very low (109/68). Its 1:00 PM and I've still got the burning in the leg although its no longer a burning pain, its more of a numbness. Just sitting around today so not much chance to really test it. 12:00 AM : Leg is really Burning/numb, even a few twinges on L4 dermatome. I hope I did the right thing! Also feel swollen in feet and hands. (maybe from peporoni pasta dish). I'm wondering If S1 could have been done via a caudal or intralaminar? 02/19/03 FLARE-UP (LBP) (PAIN: 5.0 decreasing fast:) Celebrex 400/day again TOILET STRETCHING GOT ME!!!! Shit this low back if unpredictable! This is the first lower back pain I've really had in a long time. This day is not off to a good start. I had a reasonable good day yesterday. I worked on computers, being careful NOT to lift anything heavy. Then just sat in my chair and did 'Photoshop'. I took a shower at 11:30 and decided to increase my stretching from one set to two quick 'toilet - bent knee - back stretches.' I jumped in bed to watch King Pin. After about 30-40 minutes LBP (regular spot) started. It would NOT quit so I had to Ice my back for 25 minutes starting at 12:50 AM . The pain stopped and I slept OK with no pain. Little LBP already with strong leg numbness but NOTHING like the big flare-up which caused my first experience with leg pain! 02/13/03 'DELAYED BAD FLARE-UP' ( PAIN: 6.75 - LEG & BUTT) START 400MG CELEBREX Well I really over did things from all the walking and cleaning on 2-11-03 . Last night the leg burning increased to THROBBING AND PAIN! THIS IS THE FIRST TIME I'VE HAD ACTUAL LEG PAIN. It truly disturbed my sleeping. I called Aptekar to get some CELEBREX. By the PM the Celebrex did decrease the leg pain quite a bit. 02/11/03 Pain Level 2.0 Wt. 164 (walking + cleaning) FLARE-UP - DELAYED RX I had decided to cancel the epidural for I WAS feeling pretty good. All doctors agreed. Dr. Tan stated that the ESI would NOT speed recovery only take away the leg pain. Epidurals are made to reduce leg pain and only work a little bit on the LBP. Probably over did it today . Walks for three days in a row. Today I went to the lake and walked the dog. Probably 60min + then I went to clean the dog pen well ¾ of the pen. I had to ice it afterwards because of moderate pain. Over did it - again. Felt better after ice and laying in the recliner. I spoke with Dr. YY: who was surprised that my EMG was positive. He warned not to hurt it again and that he doubted that it was chemical irritation. Next step is CAT w/ Myelogram (but he warned this was a very serious test and would leave me with a headache.) Well this kind of freaked me out especially since I was feeling pretty good today. Dr. Solomon: Murray felt that chemicals could indeed cause the positive EMG but he also felt that is could be a 'traction injury' to the lumbosacral plexus, especially since I confessed Dr. Dave was the one who started the sciatica which his overly aggressive coxing of my back. He told me to call Dr. Sozani: Dr. Sozani reassured me that it would heal but agreed with Dr. Tan about NOT reinjuring this again. Said no racing for at least 3 months and maybe even 6 months. 02-07-03: Pain rating 2.5 VAS ( EMG/NCV) The fucking sciatica continues in the left lower limb as well as the lower back pain. I had my first consultation with Dr. YY, he feels that the a left L5 and L4 transforaminal ESI (under fluoroscopy) will help a lot with the leg pain. On examination I had no positive orthopedic signs or tests. Neuro seemed okay, maybe a little hypo on left patellar (which is no big deal according to Solomon: Hyper reflexia is big trouble). Dr. YY wants me to walk as much as I can and keep the 'core' strong. I'll probably be off the bike three months more! EMG Exam: Had my first EMG/NCV test with Dr. Soozani DO. What a surprise that was! The test was POSITIVE for radiculopathy at L4 and L5! (He didn't have time to do the errector's for S1, but I supect it would have been positive as well. ) Constant fibrillation in the vastus medius and worse in the gluteus medius. This indicates nerve irritation at the "root" level at L4 and Worse at L5. (S1 also I'm assuming.) He stuck that needle into the two muscles and I could hear and see the activity. NCV test was normal. (Incidental finding: right Superfiscial peroneal neuropathy! Some of the sensory nerve fiber had been killed from over training on my bike [which didn't surprise me, for the top of my right foot had been numb for months]). How can I have Radiculopathy at L4 and L5 with only mild orthopedic finds, no neurological findings, no severe S1 compression and no L4 or L5 root compression? It doesn't make sense!! 12-31-03: SCIATICA! For the first time EVER, I've developed (in addition to this fucking lower back pain) a moderately strong burning pain down my left posterolateral lower extremity; all the way into the lateral foot and heal. FUCK, it's sciatica. I'm not sure what caused it: two days ago, I was on my bike calibrating a new trainer that required me to generate over 500 lbs of force (per SRM), which hurt my back. Today, Dr. Dave put me on the flexion/distraction table and tractioned the shit out of me (probably way too hard) and within 30 minutes, I had signs of left lower limb pain! Fuck! I'm off to Monterey for four days with the wife; hopefully, this will pass with some rest. Top | My Diary Page 1 | Home |