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!

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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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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.

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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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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. :|

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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.

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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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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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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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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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Re: Where to next? (Medical practitioner question)

Postby vosadrian » Mon Dec 18, 2017 2:15 pm

A bit of an update from me.

The injections helped a bit. Not enough to have me thinking I feel great. Enough for me to notice that there are more good days and less bad days. Mostly improved pain in the back... not much change to radiated pain down legs. Took at least a week to feel any benefit, and I have to think it through to determine the benefits... certainly not the golden arrow I hoped for.

I have seen more people, including a neurosurgeon who specialised in Peripheral Nerve Tumors. He ordered another MRI and after seeing him this morning. I most likely have a small Schwanoma (benign nerve sheath tumor) on my Sciatic nerve right under the piriformis muscle near where the nerve comes out of the pelvis. It explains most of the symptoms I have on that leg. Given the symptoms, next step is excision of the tumor. It all kind of makes sense. Many professionals have treated me for piriformis syndrome as I had symptoms consistent with that, but I never made progress through treatment. Surgery does not sound too bad, but will probably have me taking it easy for a month or so. I will delay it to end of summer riding season since there is no urgency.

Still a fair bit of unexplained stuff going on for me, but I'll keep chipping away and hopefully this takes a chunk away.

Cheers,

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

Postby RhapsodyX » Tue Dec 19, 2017 5:50 am

I'm lying in a hospital bed, pain free for the first time in months. I can highly recommend it. Still numb on the left, still no calf strength, but that's another journey.

Adrian - I assume they were cortisone shots? That an improvement has occurred would have to mean it's something in that area.

edit : ok, "relatively" no calf strength, and I'm on heaps of pain killers... but at this stage it feels pretty damned good compared to where it was.

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Re: Where to next? (Medical practitioner question)

Postby vosadrian » Tue Dec 19, 2017 10:22 am

Yeah, cortisone for me.

I would give anything for a pain break!! Hopefully when the drugs wear off you feel the same way. Great to hear things are looking positive for you!!

My condition is less severe than yours. I am still riding and actually riding pretty well. I mostly just have to manage back pain on the bike, but that is OK until about 1.5 hours in. Looking forward to enjoying a summer of cycling and then going under the knife.
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Re: Where to next? (Medical practitioner question)

Postby CKinnard » Tue Dec 19, 2017 12:31 pm

vosadrian wrote:Yeah, cortisone for me.

I would give anything for a pain break!! Hopefully when the drugs wear off you feel the same way. Great to hear things are looking positive for you!!

My condition is less severe than yours. I am still riding and actually riding pretty well. I mostly just have to manage back pain on the bike, but that is OK until about 1.5 hours in. Looking forward to enjoying a summer of cycling and then going under the knife.


Something I didn't cover in our emails.

- you said you had rested a lot after the injections. that may have eased pain on its own over a week. cortisone injections for the back usually have a local anesthetic added, like bipuvacaine, and you get immediate relief, if the right area has been injected...and the anti-inflamm properties of cortisone shut down inflammatory mediated pain within 24 hours.

- local low lumbar pain has no chance of originating from the schwannoma under the piriformis.

And your most recent neurosurgeon opined the following:
- that your low back looks ok and does not explain your 'symptoms'.
- that the facet joint problems explain the low back pain (despite facet jt blocks giving less than 20% relief.)
- he said your schwannoma shows no evidence of growing, and yet your symptoms are progressing.

This guy's summary is at odds with
- the neuropathological changes that occur in degenerating discs.
- that bilateral neuro symptoms in the lower limbs are most commonly caused by central stenosis, that is often not shown when lying supine on a MR table.
- that the facet jt blocks don't back his primary explanation for low back pain.

I'd fail the last surgeon for his systems analysis rigour.

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Re: Where to next? (Medical practitioner question)

Postby vosadrian » Tue Dec 19, 2017 1:55 pm

CKinnard wrote:
vosadrian wrote:Yeah, cortisone for me.

I would give anything for a pain break!! Hopefully when the drugs wear off you feel the same way. Great to hear things are looking positive for you!!

My condition is less severe than yours. I am still riding and actually riding pretty well. I mostly just have to manage back pain on the bike, but that is OK until about 1.5 hours in. Looking forward to enjoying a summer of cycling and then going under the knife.


Something I didn't cover in our emails.

- you said you had rested a lot after the injections. that may have eased pain on its own over a week. cortisone injections for the back usually have a local anesthetic added, like bipuvacaine, and you get immediate relief, if the right area has been injected...and the anti-inflamm properties of cortisone shut down inflammatory mediated pain within 24 hours.

- local low lumbar pain has no chance of originating from the schwannoma under the piriformis.

And your most recent neurosurgeon opined the following:
- that your low back looks ok and does not explain your 'symptoms'.
- that the facet joint problems explain the low back pain (despite facet jt blocks giving less than 20% relief.)
- he said your schwannoma shows no evidence of growing, and yet your symptoms are progressing.

This guy's summary is at odds with
- the neuropathological changes that occur in degenerating discs.
- that bilateral neuro symptoms in the lower limbs are most commonly caused by central stenosis, that is often not shown when lying supine on a MR table.
- that the facet jt blocks don't back his primary explanation for low back pain.

I'd fail the last surgeon for his systems analysis rigour.


I did rest after the injections. Nobody suggested that I should, but I just thought it would be a good idea. I have rested more in the past
(months of low activity) with less effect, but it is totally possible that the injections did nothing and the rest/physio I am doing had more effect. Either way I am feeling better on the bike and have more good days so happy with that. Diagnostically the injections achieved little IMHO.

I totally agree the Schwannoma cannot DIRECTLY effect the lower back pain. I am not sure if it could have indirect effect. For instance I know tight hamstrings can cause low back pain. I have very tight hamstrings that I am unable to stretch as it aggravates the left leg referred pain symptoms. Is it possible tight hamstring could cause my back pain.... probably possible but maybe not likely? I can think of a few indirect ways that a neural issue on one leg could effect low back pain, but all are a long grasp.

The latest neurosurgeon was selected because of his expertise in peripheral nerve tumors. The previous neurosurgeon referred me on as he did not consider himself the best person for that job. The new guy was only commenting on the findings on the Sciatic nerve. He had a look at the lumbar MRI because he was looking for other things that could cause the same symptoms in trying to determine if the mass on the nerve is likely to be causing symptoms. He could not find anything in the lumbar MRI. He explained my lumbar MRI the best anyone ever has showing me the nerve paths in the epidural space. I was very thankful for that. He ordered a new MRI of the sciatic nerve with contrast which confirmed initial suspicions. From imaging it seems very likely I have a Schwannoma. It could also be a neuro-fibroma, but not as likely. He never made any comments on the growth rate. We have two images only 6 weeks apart, so we do not know if it is growing. All we know is that symptoms started about mid 14 and the current size is quite small. So it seems likely it is growing very slowly if at all.

So in summary, I have symptoms of which some could be explained by the Schwannoma. There are no findings to indicate anything else could be causing symptoms (but there could be something not in current findings). In this situation, the next logical step is to get rid of the abnormal pathology and hopefully that improves symptoms. The latest Neurosurgeon was never asked to do anything with my spine. He is just treating the Schwannoma. He readily said it did not explain the back pain, but it could explain left leg symptoms and it is something that should not be there. He never said it, but I think he probably thinks there is something central going on with me, but in the absence of evidence, he is just doing what I was referred to him for.

I think you have made some assumption reading between the lines about the latest surgeon. He was not selected because the prior surgeon was not telling me what I wanted to hear. I was referred to him for a particular task by the last neurosurgeon, and he is going about that task. The last neurosurgeon thought it best to deal with the sciatic lesion before progressing with any spinal treatments. I suspect he is taking a "lets see what happens" approach in that maybe he thinks the path with the spine will be clearer if we can resolve any peripheral based symptoms that may be muddying the water. I actually found the latest neurosurgeon to be quite good so far. He was happy to answer my flurry of probably annoying questions and seemed to display the best knowledge of interpreting the MRI. He explained things very clearly, and I can't see any evidence of poor advice or interpretation of known data.
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Re: Where to next? (Medical practitioner question)

Postby CKinnard » Tue Dec 19, 2017 2:48 pm

You said in your next to last email there was no evidence the schwannoma is growing. Progressing symptoms are evidence in a clinical investigation.

He may have been asked to consult on the schwannoma, but that innately requires excluding other causes of your symptoms. Didn't he say without symptoms surgery was not justified?
Not weighting all causes for symptoms appropriately results in the extended history of not getting pain relief you've had following treatment for piriformis syndrome, gall bladder pathology, and inguinal hernia!

So the next step is to get your gluts transected and disrupt the sciatic epineurium to get the schwannoma out. And I take it this has to happen before the previous surgeon considers surgery on your Lx spine.

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Re: Where to next? (Medical practitioner question)

Postby vosadrian » Tue Dec 19, 2017 3:54 pm

There is no evidence it is growing. We know it is about 8mm now. We know symptoms (that may or may not be caused by it) started about 3.5 years ago. We don't know how big it was when symptoms started. It would be great to know that, but our only way forward on that is to wait 6-12 months and do a progress MRI. I'm not keen on that.

He did say that reasons for surgery are growth and/or symptoms. He indicated that symptoms were more concerning in terms of nerve damage than growth by itself.

You are correct about the treatment path. First neurosurgeon (well 2nd actually including the useless first one from a while back) wants the tumor treated before he would progress with spinal treatments. Second is just doing the tumor. He has done investigation of lumbar spine imaging and is satisfied that the tumor is causing symptoms and that it needs to go. I wish I could get a thorough investigation of lumbar spine including MRI with lumbar spine loaded vertically, but that does not seem to be available in Australia. I think you are right about Australia being behind in treatment protocols for this kind of thing, but I don't have the luxury of travelling elsewhere for this.

He says that if it is a Schwannoma, the neural part or surgery is relatively simple as it attaches to the nerve at two points that can be released with tumor encapsulated with minimal risk of nerve damage. Neurofibroma is worse to remove but unlikely. He gets a hip surgeon to do the work getting to it and putting it back together and says it is fairly low invasive with a small incision through the glute in line with muscle fibres that will repair quickly.

My personal thoughts are that as an athletic person, anything on the sciatic nerve that can tether the sliding of the sciatic nerve at that point is going to be a problem going forward (along with a small risk of malignancy), so I'd prefer to get rid of it. I suspect it has been there some time, and it just took me to hit a threshold in my cycling activity and development where it started to aggravate the nerve, and there seems to be no going back short of stopping activity long term (which may not help anyway).

Also, he did check the RHS Sciatic nerve for any issue but could see none. I have symptoms that are similar left and right and some that are quite different. Mostly the left is worse than right except for some numbness in sole of foot that is worse on right and has been intermittent for many years (well before this recent mess) until becoming more permanent recently. Left is very recent and seems to be a progression of the general back of left leg radiating symptoms.
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Re: Where to next? (Medical practitioner question)

Postby CKinnard » Thu Dec 21, 2017 10:32 am

I have no desire in endlessly arguing the point or attacking the motives of the neurosurgeons, but my money remains on the tumor not being a major cause of your symptoms. If it can be excised simply, then it is less likely to be mechanically compromising nerve function. And asymptomatic growths on nerves are very common.

I think you have had good advice from the second to last neurosurgeon, who I think I recall acknowledges you have enough going on in the lumbar spine to cause most of your symptoms. And I acknowledge his wisdom in referring you to have the tumor looked at.

The last neurosurgeon has given you good guidance on treatment of the tumor, but I think he has misrepresented the likely contribution from the lumbar spine.

I might sound like I am being a smart alec, but I've seen way too much surgery that came with the promise to stop pain, and it didn't. The most common is total hip replacements being offered to relieve buttock pain; when it was an easy matter to discriminate hip and lumbar spine origin of the pain. Most surgeons these days don't do comprehensive subjective or physical assessments, so are not proficient in discriminating pain origins. They are usually working off imaging and nerve conduction tests only.

Anyway, sounds like your symptoms are slightly improved still. I'd encourage you to keep experimenting with rest and exercise to strengthen your core, and use that standing desk more so. It's not common these days, but for acute back I recommend wearing a lumbopelvic brace that stabilizes the lower back during the day. Three to four days of this is often enough to reduce irritation of the lumbar spine and nerves; and is therefore good in differential diagnosis. These things can be hot and uncomfortable though.

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Re: Where to next? (Medical practitioner question)

Postby vosadrian » Thu Dec 21, 2017 12:13 pm

Yeah, I am not arguing the point... just explaining the reasoning as I understand it. Unfortunately the system we use in Australia leaves the patient at the mercy of the Dr and they have their ways that are not always the best for the patient. I am doing my best to navigate this system.

I agree with most of your conclusions. But I do think I have some symptoms from this tumor. I have been seeking treatment for Piriformis Syndrome for years. This tumor is a form of that but cannot be conservatively treated which fits with my history. I think that regardless of the central issue, the tumor would need treatment at some point. It is the thing that is clearly diagnosed and has a clear treatment path. There is nothing clear on a central issue and the treatment for that is invasive and there is no going back. Fixing the clear things first may provide better visibility on the central issue... who knows? If only I could find someone with authority to do central treatments I need who could provide a thorough analysis not necessarily by the Australian book!!

I have found a fair bit of literature on tumors with similarity to mine. Mostly the stories are very much the same as mine.... lots of treatment for other conditions over several years. Some had Pirifomris muscle release surgery and Spinal surgery with no rectification of symptoms and then eventually they found the tumor and treated that and had resolution of symptoms. Most were years of conservative treatment but again full resolution with removal of the tumor. All these cases symptoms were unilateral but included issues from back pain to posterior leg (thight, calf, ankle, sole of foot). I don't expect full resolution of my bilateral symptoms, but resolution of some unilateral would be a good start.

Have an ebay cheap lumbar brace, that I used a couple of days and found no help and uncomfortable. I might have to give it a go over several weeks. I did not find it felt that supportive... might be a poor product or poor use of it.
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Re: Where to next? (Medical practitioner question)

Postby CKinnard » Thu Dec 21, 2017 1:38 pm

re back braces, you want something with semi rigid stays i.e.
https://whiteleyallcare.com.au/product_ ... de=AOB4830
whiteley are a good supplier ime, though don't think they do retail...they could refer to a nearby though.

and I'd recommend you keep it on whether sitting standing walking, so essentially from breakfast to sleep time....3-4 days should be enough to help reduce irritation of lumbar tissues.

re symptoms stirred by the sciatic lesion (I am still not convinced it is a tumor), yes I agree you might get local pain with repetitive movements such as on the bike, but would not expect these symptoms to be constant. However, I think it is less probable it is the main source of your neuro symptoms in left lower limb, especially considering the last neurosurgeon said it can easily be excised from the nerve.

1.
One test I'd do to test the sciatic nerve's neuromechanical sensitivity is a sustained left leg raise for up to 5 minutes (done in supine with a rolled hand towel or very small pillow placed under the lumbar spine to stabilize it and the pelvis). This will stretch the nerve while supporting the lower lumbar vertebrae and discs. This will favor reproducing symptoms from the tractioned peripheral sciatic nerve, rather than the nerve roots within the spinal canal or IVF.

2.
A second test is to sustain a piriformis stretch for up to 5 minutes, with lower back supported as above.
This may depress the piriformis into the tractioned sciatic nerve, and thereby enhance local agitation.
http://www.sportsinjuryclinic.net/image ... formis.jpg
use your left elbow to push the left knee away from your head. and bring your right knee as high up as you can.

RhapsodyX
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Joined: Thu Oct 03, 2013 7:59 pm

Re: Where to next? (Medical practitioner question)

Postby RhapsodyX » Tue Dec 26, 2017 3:33 am

vosadrian wrote:Yeah, cortisone for me.

I would give anything for a pain break!! Hopefully when the drugs wear off you feel the same way. Great to hear things are looking positive for you!!

My condition is less severe than yours. I am still riding and actually riding pretty well. I mostly just have to manage back pain on the bike, but that is OK until about 1.5 hours in. Looking forward to enjoying a summer of cycling and then going under the knife.


Day 7 post surgery, numbness in the leg is pretty much gone, a very slight recovery in posterior muscles such that I can walk "normally" at really slow speeds as the calf can raise the heel. I only get nerve pain when "stuff happens" - I sneezed yesterday, and that was pretty unpleasant! I'm reading all of the stuff I can lay my hands on re. Segmental stability exercises and post-herniation exercise/recovery research. It's pretty confronting to see (from the studies) how many people injure their backs, have surgery and are sent off into normal life without addressing the causes of injury. On the flip side... Physio's aren't cheap, and most people aren't interested in investigating their health problems. I have a "Chattanooga Stabilizer" on order, yet another step in DIY. And my next physio appointment is already booked (Feb).

And day three of opiates withdrawal - I wasn't told to taper the meds (I guess I was supposed to just keep taking them for no reason?), so after six weeks on pain relief I'm having mild withdrawal symptoms. Meh... "coupla days" and I should be over it.

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warthog1
Posts: 6950
Joined: Wed Jul 25, 2012 4:40 pm

Re: Where to next? (Medical practitioner question)

Postby warthog1 » Tue Dec 26, 2017 5:47 pm

RhapsodyX wrote:
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. :(


Late to this. I had a microdiscectomy in 2001 for a herniated L5/S1 by Peter Oatey in Adelaide. Instant relief from similar symptoms you were describing.
No issues since, if I don't run.
I don't run.
All good on the bike.

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