Where to next? (Medical practitioner question)

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ValleyForge
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Re: Where to next? (Medical practitioner question)

Postby ValleyForge » Sun Nov 19, 2017 10:54 am

Sorry to hear you were stuffed around RX. It is a text- book disc prolapse and I wonder if it was only quite junior people pondering over you.

As for following advice, I would lean toward trusting a Neurosurgeon rather than a Sports Medicine practitioner. After all I can vouch that the Sports Med practitioner would likely not be able to point out your herniated disc on the scan let alone having ever seen one or operated on one. There are hard and fast reasons to operate on these, but you are absolutely correct in describing the problems: if one disc is stuffed, then they likely all are. Any surgery increases the load on the surrounding discs.
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RhapsodyX
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Re: Where to next? (Medical practitioner question)

Postby RhapsodyX » Sun Nov 19, 2017 5:40 pm

ValleyForge wrote:Sorry to hear you were stuffed around RX. It is a text- book disc prolapse and I wonder if it was only quite junior people pondering over you.

As for following advice, I would lean toward trusting a Neurosurgeon rather than a Sports Medicine practitioner. After all I can vouch that the Sports Med practitioner would likely not be able to point out your herniated disc on the scan let alone having ever seen one or operated on one. There are hard and fast reasons to operate on these, but you are absolutely correct in describing the problems: if one disc is stuffed, then they likely all are. Any surgery increases the load on the surrounding discs.


I saw the sports med guy *after* the actual diagnosis, I was after "care & feeding" instructions as I didn't get much out of the hospital or the GP's. He's well regarded, and I wish I'd seen him first instead of playing the waiting game with the local sports medicine people I tried to get in to see (the joys of the waiting list). All three doctors who examined me and the chiro (who is one of the "good ones" from word-of-mouth) were all thrown by the lack of any back pain.

And yes, hanging out to see the neuro - but in the mean time (on the advice of the sports medicine specialist) I've started hitting the pool for water-walking, and on the days I get to exercise the pain is greatly reduced. Except for the pain from the blister on my toe from the sideways efforts - this walking stuff is not something I'm used to, and I'm sure it's against "The Rules".

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ValleyForge
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Re: Where to next? (Medical practitioner question)

Postby ValleyForge » Sun Nov 19, 2017 6:02 pm

RhapsodyX wrote:All three doctors who examined me and the chiro (who is one of the "good ones" from word-of-mouth) were all thrown by the lack of any back pain.


Yup. A disc prolapse frequently gives no pain in the back. Pressure in your thigh and the symptoms in the car are classical.
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CKinnard
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Re: Where to next? (Medical practitioner question)

Postby CKinnard » Sun Nov 19, 2017 9:17 pm

ValleyForge wrote:Sorry to hear you were stuffed around RX. It is a text- book disc prolapse and I wonder if it was only quite junior people pondering over you.

As for following advice, I would lean toward trusting a neurosurgeon rather than a sports medicine practitioner. After all I can vouch that the Sports Med practitioner would likely not be able to point out your herniated disc on the scan let alone having ever seen one or operated on one. There are hard and fast reasons to operate on these, but you are absolutely correct in describing the problems: if one disc is stuffed, then they likely all are. Any surgery increases the load on the surrounding discs.


There's good and bad among all med specialties....though I've only worked with one sports med who never surprised me on the downside.
Though I also agree 'generally' spinal surgery is better dealt with by neurosurgeons than orthopods.

As for textbook disc prolapses, they are invariably unilateral in pathology and presentation, or at least much worse uni.
The complex bilateral and progressive nature of VA's reports here are textbook central stenosis, such as lower Lx spondylolisthesis, though you can't rule out the less frequent synovial cyst, epidural abscess, or space occupying mass!

vosadrian
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Re: Where to next? (Medical practitioner question)

Postby vosadrian » Mon Nov 20, 2017 11:17 am

All the best with your Neuro appointment RhapsodyX. It sounds like your issue is more acute than mine. Mine has kind of built up over a few years. There have been a few acute episodes where something knocks me over and then recovers about 50% until I can live with it, and then just hangs around.

I am pretty sure my issue is also L45 and L5S1. I know I have some facet arthritis worst at L45 and the L4 slipping forward on L5 a little. Because there is no glaringly obvious severe nerve compression, the first Neuro I saw basically said I function OK, so there is nothing he would do. I have seen another, and he thinks my issues are at L45 level. We will try injections etc. Hopefully they will help to determine if that is the cause, but I suspect the damage to me is beyond fixing itself so I will end up under the knife at some point.

My current list of symptoms is:

* Lower back pain that is constant with flare ups, but never goes away.
* Super tight hamstrings with radiating pain down left leg if I stretch that hamstring
* Constant left buttock pain that seems related to the left sciatic radiating pain
* Both ankles sore
* Bottom of both feet numb.
* Numb Coccyx/sacrum.

Despite all this I can actually still ride a bike pretty well (though it does flare symptoms) and I am pretty fit, and it is hard to get doctors to take you seriously when you tell them you ride 150k a week. Most of the physical tests I do pretty well at... but it concerns me when I have long term numbness that is clearly nerve related and I know that nerves don't heal well once they are damaged for a long time. I will probably never fully recover, but I hope I can stop progress and reduce some/most of the symptoms.

I will say I am pretty unimpressed in general by the Australian medical practitioner model. Even if you are willing to pay good money and not claim medical benefits, it is hard to get the right scans and referrals to the right people. Instead I bounce between different people costing myself and medicare a fortune while wasting time and making my issues worse. Lots of specialists have there bread and butter that they are very good at but if you don't fall in the box they can treat with their eyes closed, they just refer you on the next specialist.
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RhapsodyX
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Re: Where to next? (Medical practitioner question)

Postby RhapsodyX » Mon Nov 20, 2017 8:42 pm

Cortisone into the spine this morning, just the one involuntary jump during positioning of the needle.

I've booked a physio for Thursday, with the intention of getting specific exercises I can do in the pool until I see the neuro. The commuter/training cross bike (more aggressive position than the carbon race bike!) is now the commuter fat-tyre bike with the shortest & most angled stem I had and the saddle more forwards... but I'm not riding it until I have a better understand of "safe/unsafe". I need to be able to commute (only 19km round trip) because it costs more to park near work than it does to swim every day. Or, the cost of a med appointment per week. And luckily, I already have access to the work gym - I don't think I'd pass the medical at the moment.

vosadrian
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Re: Where to next? (Medical practitioner question)

Postby vosadrian » Tue Nov 21, 2017 10:23 am

I hope the cortisone helps you. Even better if it can fix things up to satisfactory level permanently. I think if you are willing to put the rehab effort in, the cortisone can fix you up good enough to enable the rehab which may give a permanent solution.

In my case, I have done lots of rehab which has not helped, but admittedly most of the rehab has been focused on things other than my back. I suspect my problem may not be manageable with conservative means, but I hope otherwise. I can put the effort in if someone can tell me the right things to do.
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RhapsodyX
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Re: Where to next? (Medical practitioner question)

Postby RhapsodyX » Fri Nov 24, 2017 9:41 am

Well, the cortisone/anesthetic wore off within 24 hours, and has left me with even more "fun" symptoms (tingling where it was just numb before). But I've since found out it can take up to a week before full effects are felt and as it was at an imaging facility rather than neurosurgeon, vosadrian has suggested that it was probably a conservative amount of steroids.

So, anyway... I saw the physio yesterday, and I got the impression that "if I were a horse"... he would put me down. First up, I'm going to be blunt : I have aspergers, now happily known as Autism Spectrum Disorder, and one of the "cute" aspects is that the neurological differences include poor motor function (stability, walking etc.). So, while the physio was surprised at the lack of anything like core stability, the inactivity of pelvic floor and stabilisation muscles, the under-developed musculature in my core/back and incorrect timing for glutes/hamstring firing... it wasn't a huge surprise for me.

He's been very up-front in that I'm completely out of the ball-park when it comes to back injuries, a genuine outlier. I have some very basic exercises to start with, which are all for proprioception of musculature. I'm going to be having a long (and expensive) relationship with this guy... and it's still 12 days until my first neurosurgery consultation. :|

RhapsodyX
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Re: Where to next? (Medical practitioner question)

Postby RhapsodyX » Wed Dec 06, 2017 8:04 pm

Saw the neurosurgeon today, in his opinion L4/L5 are already fused (a previous back injury has killed the disc a long time ago) and was the likely cause of L5/S1 herniating. And in his opinion I have the best chance of regaining leg function if I have surgery earlier rather than later, as the longer you leave it the longer it takes to return - assuming it isn't permanent damage. And it's not nucleus material compressing the nerve, it's the blown-out disc - and that could take two years to resolve. So I could delay surgery, see if the pain subsides and if I get the leg muscles back... or have the surgery, fix the pain and speed up whatever recovery is possible. So it's spinal surgery on the 18'th.

The 40+ minute car trip today to see the neuro required three hours of lying down to turn the pain off. I'm kind of over this.

vosadrian
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Re: Where to next? (Medical practitioner question)

Postby vosadrian » Thu Dec 07, 2017 2:12 pm

RhapsodyX wrote:Saw the neurosurgeon today, in his opinion L4/L5 are already fused (a previous back injury has killed the disc a long time ago) and was the likely cause of L5/S1 herniating. And in his opinion I have the best chance of regaining leg function if I have surgery earlier rather than later, as the longer you leave it the longer it takes to return - assuming it isn't permanent damage. And it's not nucleus material compressing the nerve, it's the blown-out disc - and that could take two years to resolve. So I could delay surgery, see if the pain subsides and if I get the leg muscles back... or have the surgery, fix the pain and speed up whatever recovery is possible. So it's spinal surgery on the 18'th.

The 40+ minute car trip today to see the neuro required three hours of lying down to turn the pain off. I'm kind of over this.


All the best for the surgery! Sounds like you have an interesting condition with the natural fusing. How do they diagnose that? Imaging or physical testing?

I just had some injections yesterday, so hoping they help. I guess have a few days to wait out before they may have positive effect.
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RhapsodyX
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Re: Where to next? (Medical practitioner question)

Postby RhapsodyX » Sat Dec 09, 2017 11:07 am

vosadrian wrote:All the best for the surgery! Sounds like you have an interesting condition with the natural fusing. How do they diagnose that? Imaging or physical testing?

From the MRI scan. No idea how they can tell, it's all shadowy images to me!

The car trip has put me back weeks in terms of pain. And the physio told me I could have a go at riding the bike... instant foot tingling if I go near the saddle. :(

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CKinnard
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Re: Where to next? (Medical practitioner question)

Postby CKinnard » Sat Dec 16, 2017 1:21 pm

Fused vertebrae are determined by MR or CT.
Below, L5S1 are beginning to fuse, after the disc has disintegrated.
The ligher color of the L5 and S1 endplates are called Modic changes, and indicate fatty infiltration which is an advanced degenerative bony change.
Note also S1 vertebra has a transverse fracture.

This patient is in their 50s, and has had 35 years of chronic pain after multiple LS insults in their teens.
At least a dozen GPs, specialists, and chiropractors had told him the pain was psychosomatic when younger.
It's obvious the L51 disc was damaged decades earlier, though MR imaging wasn't available when he was young.

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RhapsodyX
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Re: Where to next? (Medical practitioner question)

Postby RhapsodyX » Sat Dec 16, 2017 6:05 pm

Type II Modic Changes were mentioned in my report. There's three types, according to the linked page. Type II is the common one.

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