Sunday, October 28, 2012

Relief...spinal injection #2 is working...for now.

Last Tuesday (10/23) I went for my second epidural steroid injection for my herniated disc went much better than the first one-- that was an excruciating nightmare). This procedure the needle was positioned to better address the continuing pain in my left leg - it was a L5-S1 transforaminal ESI, L side, for those interested in Googling). It was injected in 2 places. It hurt a lot, but this time it didn't induce blood-curdling screaming or cursing in the operating room.

The good news

The good news is that within a day I was feeling a LOT better. Over the weekend I was able to walk through the grocery store to do our normal shopping, something I couldn't complete because of the pain. The  pain has been replaced by a general feeling of stiffness in my back, but it's not pain.

The bad news

The numbness from the nerve damage that travels down the left side of my leg, along with the weakness (it doesn't respond to the knee-tap reflex) and complete numbness of my left foot remains. The anesthesiologist who performed the procedure said this may not go away with the shot or surgery. It's more than annoying; it's more like neuropathy, which I already have from diabetes, but now it's my whole left foot.

Am I cured?

No. How long the relief will last is uncertain - there are no guarantees, no sure timelines. The defect in the spine remains. The conventional wisdom:
Although this procedure may give excellent pain relief, it will not fix the source of the “pinched nerve”. However, by reducing the inflammation of the nerve and with the help of some exercises provided by your orthopedist or physical therapist, you should have months to years of freedom from pain. And although you may have to return for a repeat series of Epidural Steroid Injections in future years, many people prefer this treatment than having surgery to repair the defect.
The only way to confirm whether the herniation retracted (this occurs some of the time, but based on my MRI the doctor said mine looked pretty severe) is to have another MRI. I also have a third ESI slated a couple of weeks from now.  When I left after the second one, the doctor had me make an appointment for another procedure. The agreement is that if I achieve about 80% effectiveness from my POV, we should try the third one.

The fun stuff - why shot #2 wasn't as painful

You won't believe this. Well, the answer was kind of funny in a black humor kind of way. Prior to going into the OR, the doc asked if I wanted Valium (to calm me). I said no, I'm not nervous, and besides don't you want me to be lucid while you're working on me. And, I noted, as long as you're ok with me screaming or cursing while you work.

The student anesthesiologist went a little gray as we both laughed (the doc laughed and said "no" -- my guess a lot of patients come unglued).

So a few minutes later I'm face down on the table in the OR, gripping the handles in anticipation of being tortured again. I told the nurse about my cursing and screaming and to get ready for it; she said that was fine,  "just don't bite me." Apparently some patient actually did this in response to a painful procedure.

And yes, the initial injection of lidocaine to numb the area for the real pain to come with the insertion of the catheter/needle hurt (more a quick sting and burn). Then the doctor guides the needle into the area of the spine where the steroid is to be delivered. This is where the excruciating pain occurred last time, escalating as the med was delivered into the affected area.

This time it was somewhat nausea inducing as he hit an area that he said he had to maneuver to avoid blood vessels. He had to remove the needle and reposition. All this is happening at a moderate pain level, no screaming or cursing.

Then he said "OK, I'm going to start putting in the medication now." I grimace and then I feel some pressure and mild pain for about 10 seconds. He then said "I'm half-way through. Do you need to rest?"

I'm completely taken aback because it took 10 minutes and four passes of push the plunger/screaming and cursing/take a breather to get it done last time. "Halfway through? Go ahead." Five seconds later he was done.

I was like WTF? That was it? I'm still face down on the table, and I said "How come this was so much less painful." His reply?

"Because I did it this time."

"Huh?" I said.

"Last time "Dr. So and So" did it."

Ah, yes, the joys of a teaching institution.

The trainee who was in the room last time was the one who actually did the procedure, with the doctor supervising. Jesus Christ -- of course since I was face down on the table both times, I didn't realize the other guy was doing the procedure -- I was the guinea pig.

I guess my discussion about screaming and cursing in the exam room this time made the doctor decide or take pity on me (or perhaps this other trainee was scared) and did it himself this time around.

What's next?

It's now almost a week since the shot and I have some odd residual problems -- cramping in my left leg (calf) along with random small spasms going from my rear end down my left leg and foot. There's no correlation to activity; it happens when I'm moving and when at rest. It's not painful, just annoying, but I'll need to monitor it. It's more of that "electrical storm" type of activity. My uneducated guess is the herniation is still aggravating the nerve in some way and the steroids are just masking any accompanying pain.

Since I am also having tailbone pain and spine pain higher (around the base of my neck), it would be good to get a look at this to see if my rheumatoid arthritis is causing additional deterioration.  I see the surgeon on Friday to discuss what has transpired so far with the ESI and what my surgical options may be.

Some people prefer the ESIs to put off or avoid surgery; I'm more inclined to fix the problem rather than keep dosing myself with steroids.

During this period of relief I have to remind myself that I'm not cured -- that too much strain, twisting or lifting things may make the herniation worse. But for now, it's nice not to be in acute pain.

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