Where to next? (Medical practitioner question)

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

Postby CKinnard » Wed Dec 27, 2017 5:06 pm

warthog1 wrote: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.


yep. I am pro surgery. Australia is way too conservative in offering disc surgery, and many people are left with debilitating chronic pain for decades.
In the US, the spinal surgery rate is way above ours, as is innovation and outcome.

warthog1
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Re: Where to next? (Medical practitioner question)

Postby warthog1 » Wed Dec 27, 2017 7:53 pm

CKinnard wrote:
yep. I am pro surgery. Australia is way too conservative in offering disc surgery, and many people are left with debilitating chronic pain for decades.
In the US, the spinal surgery rate is way above ours, as is innovation and outcome.


I was very lucky. A GP who got a CT organised immediately and a consult with Mr Oatey as soon as she had the results.
His advice was that surgery was the definitive treatment. No real alternative in his opinion.
I'm glad I followed it :)

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

Postby RhapsodyX » Thu Dec 28, 2017 7:26 pm

warthog1 wrote: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.


That's O.K. - running's against "the rules" anyway. ;)

Still no progress on the loss of strength, there was improvement over the first three or four days, and now it's staying the same. I'm hoping to be allowed to swim after next week, no hydrotherapy/physio stuff, just simple slow pool laps. The lack of exercise is killing me. My average resting heart rate is now up to 55! And if my leg doesn't come back... I might as well get started on being a swimmer.

warthog1
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Re: Where to next? (Medical practitioner question)

Postby warthog1 » Thu Dec 28, 2017 11:35 pm

RhapsodyX wrote:
That's O.K. - running's against "the rules" anyway. ;)

Still no progress on the loss of strength, there was improvement over the first three or four days, and now it's staying the same. I'm hoping to be allowed to swim after next week, no hydrotherapy/physio stuff, just simple slow pool laps. The lack of exercise is killing me. My average resting heart rate is now up to 55! And if my leg doesn't come back... I might as well get started on being a swimmer.


Hope it comes good for you.
An early 50s bloke I cycle with has just had L5/S1 disc surgery.
It took a while, but he is back on the bike and going well. :)

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

Postby RhapsodyX » Sun Dec 31, 2017 8:50 pm

Subjectively, I though I had some improvement, but objectively I had measured peak forefoot force the day I was turned away from the hospital, and almost two weeks after surgery it's still the same at 60kg and drops rapidly to 45kg when the fast-twitch gives up. So, more serious than a simple nerve compression block, now it's the wait to see if any function comes back over the next 4 months. Reading the lit... it's not looking promising.

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

Postby vosadrian » Mon Jan 08, 2018 10:57 am

RhapsodyX 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.


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.


Any updates Rhapsody? I am trying to firm up a date for my surgery (excision of nerve tumor). In the meantime was clocking up 300k/week over Christmas and feeling OK on the bike. Fitness is pretty good. It is sitting at a desk at work that is the biggest problem for me. Doing more standing these days which is a little better.
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RhapsodyX
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Re: Where to next? (Medical practitioner question)

Postby RhapsodyX » Wed Jan 10, 2018 12:11 pm

Not much to add, sadly. Over the opiate withdrawal, but still getting occasional sciatic twinges/tingles and the nerve damage to the calf hasn't recovered. My ability to walk is pretty much an endurance question - I'm only good until the remaining muscles get tired. I have a walking stick if I need to travel faster than "gentle stroll", ie. avoiding the human game of "frogger" when crossing roads. But (in general) I don't have pain. But when I *do* get pain, it's in the glute, which wasn't the case before.

Three weeks until I have the check-up and can start physio. In the meantime, my wife is eyeing off the bike collection.

And back at work as of yesterday, where I have my sit/stand desk. I've also also splurged on an "Upright Go", i'm working on my posture at every opportunity now. And I'm reading Stuart McGill's "Lower Back disorders, 3'rd edition", which gives good reason as to why you *shouldn't* sit at work. I've asked my physio what he thinks of "The McGill" way, we'll see...

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

Postby vosadrian » Thu Jan 11, 2018 11:32 am

Thanks for the update. I wish you the best with the recovery. It sounds like you are expecting some permanent nerve damage and may need to do physio to enable you to strengthen other areas to compensate for the damages areas?
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RhapsodyX
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Re: Where to next? (Medical practitioner question)

Postby RhapsodyX » Thu Jan 11, 2018 1:35 pm

vosadrian wrote:Thanks for the update. I wish you the best with the recovery. It sounds like you are expecting some permanent nerve damage and may need to do physio to enable you to strengthen other areas to compensate for the damages areas?


I'm expecting permanent nerve damage to the leg, and boy has it screwed up my ability to walk... but mainly I have my spine stability issue to work on. And what they don't tell you *before* surgery is that cutting through the multifidus muscle to reach the vertebrae results in a loss of muscle strength for the segment of ~ 30%, which reduces the segmental stability. With work, you get get it back to where it was *before* surgery, but often not much better than that. Long term (12 months), I'm hoping to be either fully-functional or (at worst) just missing the calf function.

Anyway... given I've got no room for error in the future with my spine, I really need to get my "stuff" together to ensure I've got a chance of still being able to walk in 30 years. If I live that long... 49 today. Happy Birthday, not quite. Then again, it isn't cancer.

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

Postby Baalzamon » Thu Jan 11, 2018 1:47 pm

RhapsodyX wrote:Three weeks until I have the check-up and can start physio. In the meantime, my wife is eyeing off the bike collection.


Not too good news. I'm going to shoot you a pm
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cyclotaur
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Re: Where to next? (Medical practitioner question)

Postby cyclotaur » Thu Jan 11, 2018 2:32 pm

ValleyForge wrote:
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.

Ditto for me 14 months ago.

Crazy left leg pain, worse driving to chiro (he's good for my back generally but didn't spot this) no relief after 2 days so off to physio. I had immediately linked leg pain to my back, but it took a few further physio treatments before she referred me for an MRI which revealed the disc bulge (not prolapse) - At this stage I was hobbling/limping as RX described and had numb patches down the leg and on the foot.

From the MRI the radiologist/surgeon/whatever recommended the MRI-guided cortisone ....which I had about 2-3 weeks after the first symptoms with no real guarantees, but measured confidence from all that it would help. It did, and my back recovered well with treatment and exercise over ensuing months.

However, the left leg was withered and very weak and I had tinglings and numb spots coming and going for another few months. I've been told that even after the pressure on the nerves (the pressure affected both the motor and the sensory nerves) is released the damage to the whole system can take 6-18 months to completely resolve, assuming it does.

I regained good motor nerve function over a few months though initially I could not pull my left leg over the top of the pedal stroke. This persisted for probably another 2-3 months, and still occasionally I feel a little hesitation there...

The sensory nerve was having fun for months and I still feel 'patches' on my shin and twitches in various left leg muscles from time to time. It has taken 14 months of exercise/riding for my left leg to get anywhere near the right leg in strength, but thankfully I've had no further major back issues.

Despite all this I actually rode up Mt Buffalo in the 2017 AAC200 about 10 weeks after first symptoms, basically quite carefully and slowly on one leg and spending many stretches out of the saddle to keep momentum/cadence up and help re-train the left leg on a long climb. Of course I pulled out at Bright and did not complete the 200, but it was a confidence booster.

Since this whole unfortunate episode I've lost some more weight (-5kgs), done some cycling specific functional strength work and, in the last few months, completed some solid 'big' rides. I'm probably in better nick now than any time in the last 25 years and hoping to complete the AAC200 in a few weeks. I still have a regular chiro session and have 4-6 weekly massages from my (new)physio. They both know I am an informed client/patient and have modest endurance cycling goals. I talk to each about the other's treatments and info. It works pretty well for me.
Here's my blog - A bit of fun :)
"Riding not racing...."

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

Postby RhapsodyX » Thu Jan 11, 2018 4:42 pm

cyclotaur wrote:
ValleyForge wrote:
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.

Ditto for me 14 months ago.

Crazy left leg pain, worse driving to chiro (he's good for my back generally but didn't spot this) no relief after 2 days so off to physio. I had immediately linked leg pain to my back, but it took a few further physio treatments before she referred me for an MRI which revealed the disc bulge (not prolapse) - At this stage I was hobbling/limping as RX described and had numb patches down the leg and on the foot. ...


Yep - I was told by the sports medicine doctor that I had months to have the compressed nerve sorted, but he was wrong. For gradual compression, it's not so bad and often resolves within weeks. For sudden compression, you can either have (a) fairly quick recovery as per gradual compression or (b) sheath and/or nerve fibre damage. If it's the myelin sheaths - up to four months for the sheaths to re-grow. If it's the nerve fibres - it dies and is re-absorbed below the break and then regrows slowly And the general consensus is about 12 inches of recovery before the muscle starts turning to scar tissue, and being tall that's only mid-thigh for me. There's ~ 1000 - 4000 motor muscle fibres to the triceps surae (calf), I've lost more than half - so I expect I'll be looking at having to have an "AFO" - ankle/foot orthotic brace. But, first, I need to get my spine stabilised.

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

Postby vosadrian » Thu Feb 01, 2018 11:26 am

Any progress RhapsodyX?

I have surgery for excision of Sciatic nerve sheath tumour at end of this month. Two surgeons involved
(Neuro and Ortho) and both think it will likely fix some of my symptoms (unilateral) but not all (I have bilateral). It will then be 6 weeks recovery so given the timing, I will probably just return to riding next Spring.

My logic in this is that some symptoms are likely to be caused by this tumour, and there is no known conservative treatment for that. So the only way to get rid of these symptoms is with surgery. Otherwise those symptoms will just continue even if the cause of other symptoms is found and fixed. So I will ride out the recovery and then see what is left to fix afterwards. Then I guess I will be back to searching for someone to fix the other stuff in 6 months time!
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RhapsodyX
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Re: Where to next? (Medical practitioner question)

Postby RhapsodyX » Fri Feb 02, 2018 10:04 am

Still alive - but now with regular low-back pain and occasional symptoms when I stand for too long or drive too far (tingles, occasional sciatic pain from simple things like blowing my nose), and some of these (tingles) have been in the back of the other leg. I've had the follow-up with the neuro, and he didn't have anything useful to add. In context to MRI scans... given they don't show what's happening through the course of the day (ie. disc hydration levels or instability of the vertebrae), I take all of the "facts" with a fair bit of skepticism. Example : MRI report said I have a bone spur on the left, but the neuro looked at the MRI scans and said it was on the right side!

Physio starting next week, and I'm expecting that I'll be setting the agenda - muscle recruitment patterns & core endurance, and we'll see where that takes me. I have no requirements beyond "pain free" (as much as possible) and "functional", after that it would be nice to be able to commute via bike and stay fit... but I'm not holding my breath. My "stretch goal" would be to return to a competitive level in time trialing, but I'm very aware that the damage to the disc will take years to heal. If it does.

Regarding bilateral symptoms... it really could be something as simple as inflammation causing compression of the nerves, and given I've had to relearn simple things like posture and how to sit & stand, there's a lot of changes to be made in day-to-day living that could reduce "triggers" and have positive impacts on pain. For me - staying in motion makes a big difference, going back to work and having periods of time of not moving has been a backwards step. My "stability pad" and regular movement (my Garmin watch reminds me) help, but it's certainly not ideal.

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

Postby RhapsodyX » Fri Feb 02, 2018 6:36 pm

Update : Rode both the commuter & the race bike this afternoon for 2km / 6m each. Despite struggling to walk, the calf can hold the foot for riding, I pushed it to 410 W / low cadence, and all was still good. But - baby steps.

warthog1
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Re: Where to next? (Medical practitioner question)

Postby warthog1 » Sat Feb 03, 2018 7:36 pm

RhapsodyX wrote:Update : Rode both the commuter & the race bike this afternoon for 2km / 6m each. Despite struggling to walk, the calf can hold the foot for riding, I pushed it to 410 W / low cadence, and all was still good. But - baby steps.


Good to hear.
I hope it continues and that you can stay positive. :thumbsup:

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

Postby vosadrian » Mon Feb 05, 2018 9:29 am

That is great news about riding!

I hope the physio is helpful for you. I'm with you.... pain free is king. Everyday life with constant pain wears you down. I can live without riding at a high level... but not sure I can live with the pain long term.
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RhapsodyX
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Re: Where to next? (Medical practitioner question)

Postby RhapsodyX » Tue Feb 06, 2018 1:08 pm

Saw the physio yesterday, he's not impressed I rode bikes on the road. Anyway.... more pool work, less walking, more individual muscle exercises. The last has been the hardest, my left glute isn't responding consistently the way the right glute does. Must be in my head.

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

Postby RhapsodyX » Sun Feb 18, 2018 6:36 am

Not dead. Still getting tingling in the left leg, occasionally in the right when I've been standing too long, and the low back is still super fragile & weak, especially if I'm getting in and out of a car (usually a Saturday). I'm still getting sciatica in the left leg if I lie on my left/right side in bed and don't get the pelvis/spine "just right". But I appear to have trained my muscle activation sufficiently that "stumbles" aren't a cause of concern.

For recovery I'm doing extensive pool work in the mornings to train the core stabilisers (try this - walk forwards/backwards in the pool, swinging the legs our wide at pace to force you off balance!). The physio is intending to start on building muscle endurance in about another three weeks.

I'm also back doing some limited riding. According to HR & PM, I've lost about 30 - 50% power vs HR, my max HR is up by 15 bpm. The good news is that L/R power is almost the same as pre-surgery (47/53 vs 48/52) at outputs up to FTP. The hard part with riding is keeping my abdominals braced - old dog, new tricks etc.

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

Postby vosadrian » Tue Feb 20, 2018 9:18 am

Hey Rhapsody,

That sounds mostly positive. Reading between the lines, it seems nerve symptoms are decreasing? Good luck with the Physio!!
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RhapsodyX
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Re: Where to next? (Medical practitioner question)

Postby RhapsodyX » Tue Feb 20, 2018 1:13 pm

Yes and no, I've just had a couple of days of tingly-left-foot, and the sciatica has dropped to a a low-level and stayed there. What I am better at is bracing the abdominals when rolling over in my sleep, or at least waking sufficiently to "get it right". Cycling is more hit-and-miss, bumps can trigger sciatica and the lower back doesn't like certain positions. But it's certainly better than it was.

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

Postby vosadrian » Sun Mar 04, 2018 3:04 pm

My surgery is done. I have a sore buttocks with a 4-5 inch incision. About 5 days into recovery now. They removed a 1cm thing that looks to be a Schwanoma of the sciatic nerve. It was right under the piriformis which may explain why I have been chasing piriformis syndrome the last few years. I have not felt the radiating pain down the leg since surgery, but I have mostly been laying on a couch which would not aggravate it anyway. Time will tell how/if this benefits me.

So now onto recovery. I was very cycling fit when the surgery was done... riding at the highest level I have in several years (not sure if that aids recovery). The surgery was to basically go through my glute max by separating the muscle fibres to get to the piriformis, and work underneath it to remove the Schwanoma and then patch it back up. Doctors say 6 weeks of recovery, but it very much seems like they are just saying a standard answer they have for any surgery. I am happy to stick to that if that provides the best outcome, but I am just wondering if I can do any rehab work on that Glute that received the most disruption to get it working better in the long run... maybe some glute strengthening and stretching after a couple weeks or something? Also I want to keep the sciatic nerve mobile (avoid adhering to scar tissue), so maybe some neural gliding?

Cheers,

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

Postby foo on patrol » Sun Mar 04, 2018 4:45 pm

Good to read that it is finally sorted, Vosadrian but don't get over zealous with gettin back on the bike to early. :wink:

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

Postby CKinnard » Sun Mar 04, 2018 8:22 pm

Adrian, early rehab days after this surgery is definitely best meted out by the surgeon or his side kick physio. Internet advice is inappropriate! Protocol would be influenced by how deep into the nerve the surgeon cut and whether he applied artificial material or transplanted fatty tissue to facilitate the nerve wound site. If you didn't get clear guidance, the best option is to phone the surgeon's office for clarification or wait patiently until your follow up appt. Do you have any paraesthesiae or motor changes in that lower limb?

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

Postby vosadrian » Mon Mar 05, 2018 12:08 pm

Thanks guys... I am hoping this is the start of some change for me. As I sit here I am still suffering general back and pelvic pain... but I have not experienced the radiating pain down the left leg... but as stated previously I have not tested it yet... very much resting since surgery so far with just a couple kms walk a day. My hope is that this issue has thrown my body out of balance and if I can achieve balance again the other pains may settle... but who knows? The rest from cycling is not a big deal for me. I have not ridden the last few winters in attempts to rest my issues. I am happy to do the same this year. I just want to arrive at September with my body in the best possible state to start riding again. From experience from last season, I know I can get form back pretty quick.

I believe the surgery was fairly straight forward. The type of tumour it was is the easiest to remove apparently with two small attachment points that are removed in a few seconds. I don't believe there was any complications and I am 100% motor with no deficiency. I had a couple of momentary paraesthesiae niggles in the first couple of days, but nothing since. I believe the nerve part of the surgery is quite good in terms of recovery. I believe the bigger recovery issue is the glutes. I don't believe the fibres were cut... just separated. The Drs have given me little in terms of recovery advice other than to not do anything strenuous for 6 weeks. The PT at the hospital came to see me, but had no guidance from the Dr and given the unusual surgery was hesitant to recommend anything. I am happy to do nothing for 6 weeks as advice was given, but something inside of me says I could benefit from some gradual building of strength in the glutes after a couple weeks initial rest. Not sure where to find some PT advice on rehab from a fairly rare procedure.
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