Re: back pain and herniated disc

Posted By Karen S. Hardman on February 10, 1998 at 23:18:51:

In Reply to: Re: back pain and herniated disc posted by CCF Neurosurgery MD on February 08, 1998 at 12:13:50:








please help me to find the answers to what I should do next. I really don't know where to turn for help now.
I fell at work in 1989 and injured my neck, left wrist, arm, shoulder, left hip and back . I had several surgeries to the left hand and elbow to try to reverse numbness with no relief. When the numbness began to spread to the right arm i insisted on seeing another dr.
A hand specialist sent me to a neurologist (Hooshmand of Vero Beach)
and within one hour he had determined that the problem stemmed from my neck. Thermography and MRI proved this and he was able after extensive testing and treatment to diagnose Reflex Sympathetic Dystrophy. Three years later I was declared permanently  and totally disabled by workers comp. i reached a lump sum settlement with them which includes medical
care for the rest of my life for the injuries sustained.
In 1992 my husband and I moved to NC and in 1995 we started a snack shop restaurant on weekends at the local flea market . By June of July of '96 I was unable to help with the work there due to increasing pain in my lower back, feet and legs. I was having to travel to FL every three months for nerve blocks and treatment for the pain which only got worse. In Dec of '97 I went back to Vero and begged my  doctors partner there (Hashmi) for help as I could no longer function to help my husband at home or at work. We have a fourteen year-old son at home, also.After extensive tests and Examination, both drs sent me to have MRI's done on the Thoracic, Lumbar, and Cervical spine. They found an abnormal bone density in the T-8 vertebrae and the following:
(1) At C3-C4, C4-C5, and C5-C6 there are combinations of bulging annuli and small posterior osteophytes almost obliterating or obliterating the anterior subarachnoid space. There is a bulging annulus at C2-C3. There is a narrow AP diameter of the spinal canal.
(2) LUMBAR- Mild rotary scoliosis with the convexity to the left side. Posterior protrusion of the L5-S1 intervertebral disc. Diminuition of the normal signal intensity within the nucleus pulposus of the L5-S1 intervertebral disc disc space. Posterior displacement of the anterior epidural fat at L5-S1 and a bulging annulus at L5-S1
(3) Posterior protrusions of the T5-T6, T6-T7, and T7-T8 intervertebral discs. At T7-T8 there is a right  paramedian disc herniation which is impinging on the right side of the subarachnoid space and on the T8 nerve root. bulging annuli at T5-T6 and T6-T7. There is an abnormal bone density on the T8 vertebrae.(this shows up as a small roundish white circle
on the T8 vertebrae.)
After rexamination and retesting, they conferred and doubled my pain meds and muscle relaxers and told me that I needed surgery at once to relieve the pressure on the spinal cord as I was starting to develop bowel and bladder signs. They reiterated that I would  eventually be paralized from the waist down  if the surgery was not done.  They warned me not to travel more then was absolutely necessary and to be very careful not to be jarred or bumped in the meantime. They tried everything possible to make the arrangements for me to have the surgery, but Workers Comp refused to authorize it until we could prove this was all from the original injury. Since it would be March before we could get a hearing and I am not entitled to get aid in Fl on any other basis , my husband travel to Fl, padded me into the car and drove me home to NC. We contacted Vocational Rehabilitation who agreed to pay for treatment or surgery so I would be able to go back to work at our restaurant.Iwas sent to Emory Clinic in Atlanta to a Neurosurgeon. I was given reams of questionaires on the details of the  workers comp ins co . The  neurosurgeon came in and dfter watching me walk and cheching my reflexes he said that he didn't know where the pain was coming from, the Thoracic disk couldn't cause low back pain like this, and there couldn't be any danger of paralysis. He said that the neurologists don't do surgery and all this was probably from the rsd .He suggested "pain management"(?) and told me there was nothing he could do for me.
Now I am back to square one, still in pain that gets worse all the time and no idea where to turn next. I'm having more and more trouble going to the bathroom (constipation and urine retention and incontinence). My legs are starting to shake and get weaker when I try to stand . A friend told me that if the damage has gone too far the doctors won't admit it and will simply tell me to go away, i'm okay, because they will be afraid to try to help.I can't bear this pain like this. My husband is having to care for me, our son, the house and the restaurant by himself, and desperately needs my help.I tried applying for Social Security Disability to help with our income or at least to get medicare to help get medical assistance and was told I'm "not disabled enough" I guess they are waiting for the funeral. Vocational rehab still will pay for the medical bills but i don't know where to go now. Can someone please help me? Ican only go to somewhere in NC or to Emory in Atlanta .
I would deeply appreciate any advise anyone can give. Thank you very much, Karen Hardman



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Dear Ms. Hardman:
It sounds like you've had a very tough time lately:
Given the complexity of your case and without having had the opportunity to see and examine you, it would be difficult to answer all your questions appropriately.  The description you give for the MRI does not indicate (again without having the advantage of seeing it) a major problem in tne thoracic and lumbar areas. The cervical area from the description you give is a little more troublesome (but again it is very hard for me to judge). It is true that neurologists do not perform surgery and that the final decision to operate rests in the hands of a surgeon. However, I am troubled by the fact that you have bowel and bladder symptoms and typically this is a problem that is localized to the spinal cord. This may or may not necessarily be a surgical problem.
I suggest that you seek a second opinion from a neurosurgeon in your area. If you are seeking help at an academic institution, then I suggest that you contact a neurosurgeon specializing in spine disorders at either UNC or Duke.  If you have any other questions please write back.
I wish you all the best!



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Dear Dr. I spoke with my Neurologists office this AM and left a message. Dr. Hashmi called me right back and when I told him what the neurosurgeon at Emory had said he was VERY upset. He explained again that the pain was not the primary concernand that surgery might or might not relieve it at all. Their concern wa swith the symptoms and results of the examination they had given me: 1. extreme hyperreflexivity  2. that when the bottom of my feet are stroked that the toes turn up instead of down,(why this is important, I don't understand) 3. the increase in problems with bowel and bladder function. 4. decrease in sensitivity in areas below the herniated disk in the thoracic.  
He stated he would consult with Dr Hooshmand (the two have been my primary physicians for eight years and treat my rsd. ) and would contact the Dr at Emory and try to find out why the Dr would reach such a dismissive  diagnosis when the problem is obvious on the MRI films. So now I am ,Again, back to wondering where to go from here. Who is right and who is wrong? all I know is that I don't necessarily want surgery, but I certainly don't want to risk being paralized, and the pain is becoming unbearable.I do not wish to remain a burden on my family. The things I am able to contribute to our homelife are decreasing by the day, it seems. I am forty-four, educated and capable of many things . I am a licensed pilot, studied nursing and lacked peds and ob of having my RN.Up to the onset of the RSD, I have always been strong and able to do anything from sewing beautiful clothes, to building on to our house, including the plumbing and electrical, raising livestock, caring for my own garden, canning, winemaking, car repair, etc. Now I am unable to do more then sit, lie down and walk a few feet, and am in constant agony. I cannot live this way. Thank you for your response, and I can only hope that the Drs can find an answer for me. Thank you again, Karen Hardman