Feet and back connected? What next?

[Barbara Grigg]

Questions first, background follows:
How do I keep from further damaging myself (L4-5 ruptured disc), particularly since it's hard to avoid lying down? Should I see a neurosurgeon in anticipation of needing eventual surgery? Would he give me better parameters by which to gauge my behavior?
Background:
A year ago both feet/calfs began hurting in bed, early morning. I'd get up and hardly be able to stand, but would work it out during an active day. 5/98 an orthopedic dr. diagnosed me w/interdigital neuritis, gave me orthoses, calf stretches and a month off my feet from work. Feet pain subsided, but as I returned to work in 7/98 my R buttock and R calf began hurting. I tried to work out these kinks til 9/98, when I fell along my left side, full body length, on a sidewalk. My R buttock began to cramp and R/calf/ankle/foot started tingling. The worst problem: no position (pillow or not) lying down is comfortable for long. A second orthopedic dr. at the same practice gave me a choice: MRI/back dr. or physical therapy. I chose PT and had two 3-week cycles. The PTist found a short L leg and gave me a 5mm heel lift, which helped pain when walking. He focused on my SI joint rather than L5, based on my responses and symptoms. My progress stopped, and the doctor sent me for a nerve conduction test which showed "irritated nerve root at the L5 position." Based on this he sent me for an MRI and forwarded me to the back dr. at that practice. The back dr. told me I had a ruptured disk at L4/L5 but wouldn't explain what that meant. He said "don't do stuff that hurts" but said he "couldn't tell me" what would help or hurt my healing, and that odds are 5 years out I'd be the same whether or not I had surgery now. I DON'T WANT TO FURTHER DAMAGE MYSELF. I was too stunned to ask to see the MRI, so I can only guess my rupture is minimal, if that is possible. I get on my feet to relieve my back/buttock, and my feet begin to hurt; I sit or lie to relieve my feet, and the buttock starts hurting. How do I keep from further damaging myself, particularly since it's hard to avoid lying down? Should I see a neurosurgeon in anticipation of needing eventual surgery? Would he give me more parameters by which to gauge my behavior? Thanks for your help.

[CCF Neuro[P] MD, RPS]

Dear Barabara Grigg:

Sorry to hear about your herniated disc.  Usually, the last resort is surgery.  Read the many posting on this site concerning back surgery.  I think that you need to see a physician that will talk with you and explain the options to you.  A good physical exam (neurological) should be performed.  I would agree that physical therapy should be involved and maybe a rehab specialist.  I am also not sure what the physician meant by "irritated" nerve?   If you have signs of a radiculopathy or neuropathy, that should be a firm finding on EMG or else these processes are not significant.  If there isn't the former by EMG than the nerve might be inflammed from the herniation.  However, your problems are a full year and half in duration.  Get a second opinion from a neurologist and then begin a rehab program with both the neurologist and rehab team involved.

Sincerely,

CCF Neuro MD

[charleen]

I am a 3 time sufferer of L5 nerve root compression from my L4/L5 disc rupture and re-ruptures.  I have had 3 operations, however do not gauge my ordeal as being the only answer.  It is always wise to delay surgery as long as possible if not forever.  In your case, however, I would suggest that you get another opinion.  By the sounds of it your pain and discomfort have gone on quite awhile.  If you were to have progressive symptoms such as loss of bowel and bladder, numbness that progresses making it so you can't even feel anything being touched on your affected calf and foot, or making it so unbearable that you could not function, then probably immediate surgery would be the answer.(as it was in my case)  Maybe because this has progressed over a long period of time, the doctors are hoping you might heal. (disc can heal or dry up not causing any further problems if given time) Surgery is not always the answer, and surgery can cause more problems in the end.  On another note, if you wait too long you may have permanent nerve damage that cannot be rectifited by surgery.(I don't know if this is the case with the doctor that told you surgery could not help you, but maybe it is)  Just thoughts to ponder....but in your case I would suggest a second if not a third opinion.

Good luck.....the doctors here have wonderful expert advise.

[CCF Neuro[P] MD, RPS]

thanks for the comment.

CCF Neuro MD

[Barbara Grigg]

Discovered neurologists here want referral for appt., so I already had backup appt. with osteopath in "pain clinic." He confirmed what I'd guessed from viewing my MRI: L4/L5 disc blew mostly forward (praise God) where there's not much to hurt. Smaller portion is protruding into fluid around spinal column; he said he saw no fragmentation. His first suggestion was epidural antiinflammatory. I didn't like the sound of that, so he suggested PT w/McKenzie techniques. I'm sort of thinking "if it's not too broke, let it fix itself in time," like the first orthopedic surgeon said. My guess is the disc nicks the cord when I get in certain positions, causing symptoms. If I maintain good lordosis, even lying down, I have minimal or no symptoms. I'm inclined to think: baby myself (mostly no bending, lifting, etc.) and forget invasive stuff unless symptoms worsen. Term "ruptured disc" scared me at first. But it looks to me like it's done its worst damage already, wherein I was blessed by the positioning. Both doctors imply disc remains will likely dissolve away with time. Given the above, is my "wait and watch" approach reasonable?

[CCF Neuro[P] MD, RPS]

Dear Barabara Grigg:

No, the data indicate that team rehab is better than medication alone, PT alone, and no treatment.

CCF Neuro MD

[marilyn]

I've had 2 back operations.  One 20 years ago in my lower back, and one 6 years ago in my cervical spine.  I wouldn't hesitate to have them done again if necessary.  I CAREFULLY checked out the doctors and each time (I was living in 2 different areas) I used a neurosurgeon.  I am thankful for wonderful medical help I had, and my life is very productive.  Good luck in your decision.

[CCF Neuro[P] MD, RPS]

Dear Marilyn:

Thanks for your comments.

CCF Neuro MD

[Barbara Grigg]

In past month I've experienced new symptom: tingling daily but intermittently underneath right shoulder blade. This causes me to suspect another disc problem, higher. I've contacted a local neurosurgeon's office who took my particulars and faxed them to the surgeon, who said he'd take a look at my EMG report and MRI films to see if he can help me. Am awaiting receipt of orthopedic documents to deliver to neurosurgeon's office. Also have had a couple episodes of waking up in my recliner (where I sleep) with little and ring fingers of both hands numb; I'm hoping that's from sleep positions, but this hasn't happened throughout my life. Am taking 25 mg daily of Vioxx, as Naproxen interefered with my beta blocker. I understand the Vioxx won't mask symptoms (causing further damage), but will reduce inflammation, which would help healing. Any further advice will be appreciated.

[CCF Neuro[P] MD, RPS]

Dear Barabara Griggs:

It does sound like a lower cervical spine or brachial plexus problem.  I hope that the EMG showed you the possible etiology.  Together with the MRI, and the neurological exam, things should be well underway to a diagnosis and treatment.

Sincerely,

CCF Neuro MD

[Barbara Grigg]

POSSIBLE HAPPY ENDING: While awaiting PT insurance authorization and call back from neurosurgeon, I happened into a "Relax the Back" store. Picked up book on McKenzie technique, as that's what osteopath had prescribed for next round of PT. HOWEVER...the real fix is turning out to be a zero-gravity recliner. I began sleeping in that with an air pillow in the small of my back. Immediately I could sleep through the night; it got me off my back. I've been overnighting in the chair for a month and doing a bit of the McKenzie exercises. I credit the chair with allowing my body to relax long enough to begin healing. I now am 90% symptom free. I haven't attempted to sleep in a bed again, figure I'll give the chair a few months. The PTherapist says "great," but we want me to heal flexible, not calloused, so he's having me bend the other direction some. If this continues I won't be needing more advanced medical services. Miraculous, simple, amazing? Seems so easy a fix, I'm curious why I had to stumble upon it myself. Appears to be turning out the dismissive orth dr. was right, brusque bedside manner aside. Here's hoping this is all you'll hear from me...

[CCF Neuro[P] MD, RPS]

Dear Barbara Grigg:

Great news.

CCF Neuro MD