Oh what a wonderful and divine creation is the spine! But also what havoc it creates on many of our lives.
***I have lived with chronic low back pain for most of my life. It first came as a adolescent, got worse in my 20s and then became a backburner issue for nearly 30 years.***
It hurt, but it didn’t dominate my life. There were times that I had to take some kind of medication or be careful not to cause further injury, but it did not interfere a lot in what I wanted to do. I was a tough, stoic guy and such things were only for the weak! Boy, would I learn a lesson over time.
***In the middle of 2009, shortly after I had my first heart stent and before the bout with transverse myelitis in the fall, I complained to my primary care physician about back pain.***
I told him that this pain was different. It seemed to be in my entire spine, from my neck down to the last vertebrae of the lumbar region. Since it was too close to the time that I had the stent put in, he ordered a CT scan instead of a MRI. I think at that time, he was thinking about some sort of a metastasis as a result of my now Stage IV melanoma. The results came back and they seemed to only show spondylosis and osteoarthritis. His take on it was that it was the effect of getting older. There were some signs of disk compression, especially in the lumbar region but pretty much the entire spine was involved in some kind of arthritis including a couple of bone spurs. So, my approach was to grin and bear it. Of course, only a couple of months later he would diagnose left drop foot and not much later I was hospitalized with my first encounter with myelitis.
***Then in the Spring of 2010, I began to experience severe cervical pain. I went to my doctor again who prescribed some muscle relaxants and pain pills. A week later, I was back complaining of little to no relief.***
The doctor gave me an injection and a prescription for a physical therapy evaluation and treatment. At first, the treatment helped but the therapist sent me back to my doctor because he suspected a herniated disk. The pain was now radiating down my right arm and I could not hold my head up and absolutely could not turn my neck without excruciating pain. I did not find any medication to really be helpful at all.
***I was referred to a neurosurgeon and had a series of MRIs taken of my entire spine. These images showed the arthritis and degenerative disk disease but also showed some compression in the thoracic region as well as herniated disks in my cervical spine and in my lumbar spine.***
The worst of the problems appeared to be at C6/C7 where there was very likely nerve impingement that would explain the pain in my neck and the pain radiating down my right arm. He suggested conservative treatment including home traction and continuing physical therapy. While somewhat better, the pain would not go away.
***I was next sent to the anesthesiologists at the hospital for an epidural steroid injection to try to find relief.***
An epidural steroid injection is a common procedure to treat spinal nerve irritation that is caused by tissues next to the nerve pressing against it. The beginning of the nerve (nerve root) is most often irritated by an inflamed intervertebral disc, or disc contents, directly touching the spinal nerve. An epidural steroid injection involves bathing an inflamed nerve root in steroids (potent anti-inflammation medicine) in order to decrease the irritation of the nerve root that is causing pain. The epidural steroid injection procedure is quick and simple and many people are surprised when it is all over. As always, the brain plays tricks on us driving up our levels of anxiety to expect far more than what is real.
The spinal cord rests in the spinal canal. The nerve roots branch out from the spinal cord at each level of a spinal vertebra. The cord is protected by cerebrospinal fluid (CSF), which serves as a shock absorber for the cord. The CSF is held in place by a membrane with several layers, one of which is called the “dura”, from the Greek for tough (i.e. “durable”). The Greek word “epi” means “outside of.” So, the epidural space is outside of this tough membrane.
During an epidural steroid injection, a needle and syringe are used to enter the epidural space and deposit small amounts of long-lasting steroids around the inflamed spinal nerve. A fluoroscope (a viewing instrument using X-rays) is used to visualize the local anatomy during the injection. The epidural steroid injection specifically targets the inflamed area, thereby minimizing exposure of the rest of the body to the steroids.
***There are all sorts of side effects possible and I’ll let your doctor go over those with you if you end up having this procedure. And, of course, we remember the meningitis breakout that was associated with a compounding pharmacy providing contaminated steroids to various pain clinics around the country. I had no side effects and no infection and actually recovered from the procedure quite easily.***
I was scheduled for three injections to be done about two weeks apart. After the first injection, there was relief but still pain. After the second injection, no pain and great relief. While my neck was and still remains very stiff from the arthritis, I was feeling great. Eventually, the relief would go away. For some people, the relief may only last for a few months and then more injections are needed or a more invasive treatment such as surgery. I would have many other health adventures that again would put spinal pain on the back burner.
***Now we are in mid-2010. I still have drop foot and walk with a cane. I have some balance problems but have compensated well. I have pain but it s very tolerable. There is no cancer on my scans. All in all, I am feeling pretty good.***
There was one note of sadness that I and my family dealt with at this time. My older daughter and first child, her husband and (at the time) my ONLY grandchild were moving to Belfast, Northern Ireland leaving June 30th. I was very sad about that and it was one of those great stressors that we feel in our lives and must cope with to survive. Luckily Skype has allowed us to make video calls and we have been able to visit relatively frequently since the move.
In July 2010, I am still working full time and, since I feel so good, I decided to take a vacation with my wife and younger daughter (the baby of the family). We visited Kentucky bourbon country, saw many distilleries, ate great food, saw the Stephen Foster musical and visited Churchill Downs. Also ate at a Big Boy restaurant in Louisville – my kids used to love the “Big Boy” out front when Shoney’s was linked to this chain. We all remember this time as one of great fun.
***This vacation was the best time together that we had had since the whole cancer thing had started. And, it was good therapy for the loss we felt with my older daughter’s move.***
I continued to use traction and a little medication to deal with flare-ups in my neck but would very soon find even more health problems to take my attention. In August 2010, I would be diagnosed with very severe chronic obstructive sleep apnea and almost immediately thereafter have a bout with pneumonia. So, I must use a CPAP every night. I might write about that in a future blog post.
And even more adventures were on the way. Until next time – stay focused on the happy things in life! Don’t let your brain get you down.
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