new onset weakness after back surgery

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skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 3043
   Posted 9/16/2017 1:03 PM (GMT -6)   
Hi all,

Without going into all the details (it's a long & complicated story), I've had 3 back surgeries in the last 3 months.

The surgeries were:
1) L5-S1 microdiscectomy (left) at the beginning of June
2) L5-S1 exploratory/microdiscectomy (left) at the beginning of July
3) L5-S1 microdiscectomy (right) & L4-L5 facetectomy & foramenotomy (left) at the beginning of September

Prior to surgery, my symptoms were: severe pain in both legs (L>R) extending into the foot, and weakness in my left foot (partial foot drop). I also had significant functional limitations (particularly with the left leg) due to both pain and weakness.

Since my last surgery, 15 days ago, my left leg pain and function have slowly started to improve (the weakness is unchanged). However, my right leg pain has been much worse -- to the point where I required 5 days of hospitalization for pain control after surgery, and continue to have to take ER pain meds 3x/day, plus IR meds for breakthrough pain up to every 2 hrs -- and has remained mostly unchanged since waking up from anesthesia.

I was told not to worry about the pain, as it is just from inflammation -- we essentially traded nerve root compression by disc/bone for nerve root compression by inflammation -- and that because of the number of times that my back had been opened recently/the extent of the inflammation, it could be up to 8 - 10 weeks before I start to notice any significant improvement in my symptoms.

I won't deny that it sucks to be in so much pain, and to be even worse off now on one leg than I was before I went in to surgery. However, I'd been doing pretty well at not worrying about it, and staying optimistic Actually, even though I feel worse physically after this surgery, I had been feeling significantly better mentally/emotionally, knowing that everything was finally fixed. Then, three days ago, I tripped on my right foot when I was out walking. I didn't fall, so I didn't think much of it. But as the day went on, I noticed that I was having a harder and harder time pushing off on my right foot as I walked. By the evening, I was barely able to lift my heel off the ground. And when I tried to stand on my toes, I couldn't...

I must admit, I'm a little freaked out by this. My left foot has been weak since the start of things. But I have NEVER had weakness in my right foot before! The only thing that I can think of is that like the pain, this new onset weakness is also from the inflammation, as I haven't done anything to warrant reherniation. However, I was under the impression that it took significantly more nerve root compression to cause weakness vs. just pain. And nothing has changed that the inflammation should have increased by that much (pain is the same as it was before the weakness started, activity level has been the same, etc).

Thankfully I had an appointment to see the PA to get my sutures out the day after this started, and so I had him also look at my foot at that time. He is perplexed as well (said that this is highly abnormal). He offered to put me on steroids, in case the weakness is related to the inflammation. However, I turned him down, as I know that the neurosurgeon does not want me taking any more steroids, as they had to put me on massive doses of dexamethasone after this last surgery, & he's already afraid that I might not heal or might develop an infection due to the steroids plus the fact that my back has been opened 3x now in a relatively short timespan... So the PA just told me not to worry about it for now, but if it hasn't resolved by Monday, to call him, and they'll investigate it further.

I guess I was just wondering if anyone else has ever heard of or experienced something like this before. And if so, did it go away on it's own (as would/should be the case if this is just due to inflammation), or if it was the start of more serious problems?

Any words of wisdom, advice, or even just support would be appreciated! Thanks!

Skeye

PS - Sorry about the length of this. I did not realize how much I wrote until I saw the post after it was submitted...

Post Edited (skeye) : 9/25/2017 6:12:27 PM (GMT-6)


White Beard
Forum Moderator


Date Joined Feb 2009
Total Posts : 3667
   Posted 9/17/2017 11:11 AM (GMT -6)   
My Gosh skeye you have really been through the mill with this haven't you!!! skeye have you tried going to a different surgeon? ( some other neurosurgeon or some one???) for a second or third opinion about all this going on since your surgery???? Just a thought ............ you have been through so much........... I am just kind of wondering if a complete discectomy and fusion might not be a viable alternative to get this all this stuff back in order? Just some of my thoughts about it???) You know I really hate to see you going through all this!! Especially with everything else you've went through! Plus trying to obtain your dream of becoming a Veterinarian! I do hope you can get this all resolved and get back to finishing school and fulfilling your dream!

Please keep us informed on how this works out for you! I continue to keep you in my Prayers!

Wishing and hoping the best for you!

White Beard
Moderator Chronic Pain
USAF retired in Sept.1991. I went back to school and became a licensed RN in 1994, I worked on Oncology and Med Surg, Disabled in late 1999, was approved SSD in early 2002! Diagnosed with: DDD and Multiple herniated Disks; Foraminotomy L3/4/5 Jan 2013; Posterior Articular Joint fusion Nov 2010; C5/6 ACDF Sep 2009; C6/7 ACDF 1985; Implanted pain Pump Jun 2014.

(Seashell)
Veteran Member


Date Joined Dec 2012
Total Posts : 664
   Posted 9/17/2017 11:34 AM (GMT -6)   
Skye:
You have had 3 surgeries in the span of 3 months. Each surgery is an invasive trauma.

I would encourage you to give your body sufficient time to heal and refine its point of homeostasis. I would not explore additional surgery unless you have clear evidence of a neurogenic bowel or bladder - for the simple fact that any surgery is in itself traumatic and taxing to the body.

"Failed back syndrome" implies sensory or motor nerve pathways that have been traumatized by repeated surgical intervention. It can be a miserable state of being for anyone so afflicted.

Give your body time to heal before considering an added surgical intervention. The body has tremendous abilities to heal. Your new foot weakness may be a reflection of cumulative surgical stress and inflammation and swelling as opposed to a new and acute nerve root pathology.
Karen
Pituitary failure, wide-spread endocrine dysfunction
Addison's disease
Mixed connective tissue disorder
Extensive intestinal perforation with sepsis, permanent ileostomy
Avascular necrosis of both hips and jaw
Receiving Palliative Care (care and comfort)

skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 3043
   Posted 9/17/2017 6:16 PM (GMT -6)   
White Beard,

Thanks for the well wishes! Hope you and Pumpkin are doing well!

Yes, it's certainly ended up being a LOT more than I bargained for when I first agreed to surgery... No, I have not sought out another neurosurgeon/gone for a second opinion, as I really like my current NS/have not felt that I needed to. Believe it or not, the NS I'm seeing is actually really conservative when it comes to surgery. And despite all that I have been through, none of it was the neurosurgeon's fault/due to anything that was done wrong in surgery.

Things initially were great after the first surgery (90% reduction in pain and weakness on the left, and 30 - 50% reduction in pain on the right), and I could not have been happier. But then everything went to hell 9 days after surgery, when I coughed, and all of my pre-op pain and weakness returned, plus some... We're still not entirely sure what happened. We thought that I had reherniated (hence the second surgery), and I had to some degree (plus they found a few other abnormalities within the original surgical site that were contributing to nerve root compression), but fixing that did not help. It took a lot more investigating, but it turns out that the return of the pain and weakness on the left was actually due the development of lateral recess stenosis at the level above (which I did not have at the time of the first surgery), which was entrapping the L5 nerve root. We still can't explain it, as stenosis should not be able to develop that acutely, but we know from successive imaging studies that it did! The only thing that the NS can think of is that I had some kind of massive inflammatory insult at that level sometime after the first surgery, and that is what lead to the rapid degenerative changes in the bone/facet joint... But it doesn't make much sense to either of us.

As for a fusion, we've actually been trying our very best to avoid doing that, given that I am only 29. But it may become necessary at some point (especially now that I do have some instability at L5-S1). I know that the NS is worried, given that I've already reherniated (small, but clinically significant fragments) twice at that level. But we are trying to compromise my spine as little as possible, hence just opting to just do repeat microdiscectomies. But were I to need more surgery, and especially a fusion, I probably would seek out a second opinion first.

It's definitely frustrating having had to be out of school for longer than planned. The goal is to get back by January (at this point, I cannot go back sooner, even if I were ready, due to rules about maintaining full-time status). Being out for so long has already created some problems for me. The most frustrating of all being that I am most likely going to have to retake my national licensing board exam (despite having passed it in April), as the state through which I applied has a rule that invalidates your boards score if you have not graduated within 10 mo of taking the exam -- and right now, it is looking like I won't graduate until the end of April 2018 (i.e. 12 months after I took my boards...). I will try to appeal when I get a little closer to going back. But I kind of doubt that the state will make an exception for me, even though I have a very valid excuse, and will not be going over the deadline by much...

Skeye

skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 3043
   Posted 9/17/2017 7:08 PM (GMT -6)   
Hi Karen,

I'm so glad to see you posting again! I hope you recovered from your surgery, and are feeling better (as good as you can feel, anyway).

I appreciate your input. Yes, you are right, it is a LOT of trauma within a short time span! And I know that it is going to take a significant amount of time for my body to heal (which is why we are not worried that I am still very painful, etc). While we (me, the neurosurgeon, and my PM) all agree that the previous surgeries were necessary, there is definitely no way that I (or the neurosurgeon) would rush in to any more surgery at this point. I just find this new onset weakness quite perplexing (not to mention frustrating). But then again, my body never does seem to follow the rules...

Have you ever seen acute onset weakness post-op like this, from inflammation, as a PT? That is really the only thing that I can think of that this could be from, as I haven't "done" anything that should result in new pathology (although I reherniated previously while also following all of my post-op instructions to a T, so I suppose it is possible, though my gut feeling tells me that that is not the cause this time). The weakness does correspond to the S1 nerve root, which is the nerve root that was just worked on/freed up on that side, so inflammation of that nerve root makes sense to me. However, I thought that it took much more pressure on the nerve root to cause weakness rather than just pain, and the amount of inflammation in my back just doesn't seem to have increased that much. If anything, things actually look visibly better, externally, as the swelling and the seroma around the incision have both come down some over the last few days.

The only other thing that I can think of is that maybe this is related to my CRPS. I do have allodynia & probably hyperesthesia, as well, in my right leg since the surgery. Both are signs of CRPS. But I think that in this case, they are more related to the development of central sensitization, than anything else.

I go for my ketamine infusions M/T/W this week, so it will be interesting to see what happens with both the pain & the weakness... I also asked my PM doc if he could add magnesium to my infusions this time to see if that helps with the neuropathic pain in my legs, too. So I think he is going to do that for me (as long as he remembered to order it).

Skeye

(Seashell)
Veteran Member


Date Joined Dec 2012
Total Posts : 664
   Posted 9/17/2017 9:54 PM (GMT -6)   
Skeye:
Yes, I was going to comment on the possible correlation of your background with CRPS and your onset of foot weakness, but thought it prudent to hold back and offer a few considerations at a time for you to digest and contemplate.

I have severe HPA axis (hypothalamus-pituitary-adrenal axis) dysfunction. I have come to appreciate how my altered HPA axis interferes with almost every health condition that I grapple with. Dysfunction of my HPA axis infiltrates every aspect of how I experience life in my body. I have come to the conclusion that my body experience is vastly different than what "normal" people experience.

I developed RSD (now called CRPS) after a salvage 3 rd knee surgery to repair a torn ACL in my knee. I have often wondered if my HPA axis duafinction confributed to the RSD. My intrinsic sense is yes, it did.

Be generous to yourself in giving yourself time and space to heal.

Remember that medicine knows what it knows. There is a lot that medicine does not know nor understand.

This is particularly true of the neurological system and endocrine system. There are any number of chemical messengers and peptides and regulatory feedback loops that remain to be identified and understood.

As regards your question as to whether I have seen in my years of clinical practice anything similar to what you are experiencing (onset of new weakness post surgery where imaging scans are essentially normal) . . . Yes, I have.

Recovery is rarely a smooth upward course. It is not uncommon for people to make upward progress for 5-7 days, only to encounter a regressive during week 2-3 - forward 1 step and backward 2 steps. Inflammation is an expected part of the body's healing processes. But the busy can respond with an excessive of inflammatory response - which can be the source of a backward regression in an otherwise progressing recovery. Inflammation brings a host of chemical biomarkers and immune cells that may be acting on you in a type of auto-immune response. A heightened body-on-body response could account for the onset of new weakness.

CT and MRI imaging have inherent limitations. You could have delicate and immature scar tissue that is tethering on the arachnoid covering of the lower spine or tethering to the S 1 nerve sheath.

A short trial of dexamethasone or prednisolone could provide some detective understanding. I understand your hesitancy to go back on corticosteroids. But a short burst dosing could provide diagnostic information. If your new symptoms begin to subside, you could begin to identify an auto-immune response as causative.

So, there are my two possible quesstimations: 1. Post-operative inflammation, bringing a large influx of T cells and immune cells, causing an auto-immune body-on-body reaction of the sensory/motor nerve roots; 2. Early, non-mature scar tissue that is tethering to the nerve sheaths and causing decompensation of sensory/motor transmission due to sustained and constricting pressure.

You are clear in your thinking and analysis of your own situation. I am a firm believer that people best know their own bodies and that the keys to arriving at an accurate diagnosis are within our own narrative of how we experience our body in health and illness.

I am genuinely sorry for all that you are going through - with your lumbar spine, with completing your veterinary program. But I sense in you a resiliency that will see you through to the other side and better days ahead.

With time, this experience will most likely shape you as a veterinarian. It will instill in you a natural empathy that will transcend the pets that owners entrust to your care. You are apt to become a talented and gifted veterinarian, your personal health challenges altering the perceptual lens through which you see owners and their pets and how you interact with them.

I would keep faith and hope that your newly emerging symptomatology will dissipate with additional time for healing and recovery. Three microdiscectomy surgeries within the span of three months is an extraorinary stress on your whole body.

Add in your history of CRPS and it is fair to say that your recovery will be of its own timing - not to be compared to the norm or average.

Have faith that your body will be able to heal itself from here forward. Be allowing generously of rest, lying supine to unweighted the spine. Add in gentle walking to rebuild strength.

Know that you have a lot of friends in this forum that are rooting for your recovery and sending you healing energy and blessings. And Molly, my little tea-cup Maltese, sends you caring wet nose kisses and tail wags. Where would we be if not for our FurBuddies? Mm

Crossing my fingers and toes that you have a good surgical outcome?
Karen
Pituitary failure, wide-spread endocrine dysfunction
Addison's disease
Mixed connective tissue disorder
Extensive intestinal perforation with sepsis, permanent ileostomy
Avascular necrosis of both hips and jaw
Receiving Palliative Care (care and comfort)

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 14992
   Posted 9/18/2017 3:54 PM (GMT -6)   
Skeye, I am sorry to read about your turn of events. To be honest, I know there are success stories out there for the micro disc.. with that being said I have seen many failures. When the surgeons talk to the patient about it not being as invasive as an open surgery it sounds great. I think microdisc. is one of those that the patient must have certain criteria to have a good outcome. But, if they have some pretty significant findings going in, they just do not work. I wasn't all that surprised the first one didn't work with you.

Pretty much at this point time & a lot of healing is your best friend. I hope you have the time needed to heal because of school issues.

Take care.
Susie
Moderator in Chronic Pain & Psoriasis Forums

skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 3043
   Posted 9/19/2017 5:43 AM (GMT -6)   
Karen,

Sorry if this is a kinda all over the place -- in the car on my way to my infusions & I'm already a bit drugged from the pre-infusion lorazepam plus my pain meds... Thanks for the advice, ideas, and support! I really appreciate it!

Interesting that you bring up the possibility of an autoimmune component. I never would have thought about that as being the cause of the weakness, but I do have several other autoimmune diseases (CRPS being one of the ones that is suspected to be autoimmune) & autoimmune things like to group together... Actually I was kind of wondering about something like that going on at L4-L5, where I acutely developed lateral recesses stenosis due to a suspected massive inflammatory insult to the bone/joints at that level...

You are right, CT's and MRI's are far from perfect. The lateral recess stenosis, even, was not visible on my CT scan (although It did show that the facet joints were hypertrophied at that level). We initially though the nerve root compression was due to my herniated disc at that level. But when they actually got in there, the disc was fine (bulging, yes, but not impinging on any nerve roots), and only then did they discover that the nerve root compression was due to the lateral recess stenosis.

I'm glad that you have seen cases like this as a PT before, that makes me feel a little better. The one step forward, two steps back thing I totally get, and I'm sure it is going to be more or less like that for the next few months (and probably especially once I'm cleared to start doing PT).

I had my PM doc look at my foot yesterday before I got started with my Infusion. I thought that he was going to be really upset about it, but he actually didn't seemed too concerned, and he also though that it is most likely from inflammation. He basically told me to be careful, but not to worry too much about it right now. So that made me feel better.

I did not call the PA yesterday, as instructed. In part because even once I've finished the infusions, I'm still usually pretty out of it for the rest of the day. But mainly because there isn't anything they could do about it. I see the NS again in a week, so I'll just wait till I see him. Then at that time he can decide whether or not he thinks it would be safe or worthwhile to try a short course of steroids (doubt it though, as he was pretty adamant about "no more steroids" after I finished tapering off the dexamethasone that they had had me on in the hospital. Buy until then, I'm continuing to keep positive!

And you're right everything that I have gone thought will make me a better vet in the end (I always learn something from each one of my medical leaves/health problems). And like you, I don't know where I'd be without my dogs! They have been my biggest support system & my best friends throughout this all (and every other major medical issue I have/have had). My older male golden, in particular is so in tune to me. He's been with me since the very beginning of most of my health problems & He almost never leaves my side, especially when I am sick. My dogs truly are my best friends (and soul mates)!! Saying that I'd be lost without them is a total understatement...

Thank again for your words of support, etc, it is much appreciated! It's nice not to feel alone in this. My love to you and Molly!!!

Skeye

skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 3043
   Posted 9/19/2017 5:56 AM (GMT -6)   
Hi Susie,

Thanks for the well wishes!

You're right, time is definitely my best friend right now. I won't be going back to school until at least January. I think that should be enough time, as long as everything goes as planned. I'm not allowed to start PT for another month (just gentle walking for now). But once I can start PT & get some of my strength back, I should be good to go. I know the neurosurgeon won't clear me to go back until I'm ready, though. But either way, I will still have to be careful when I do go back. NS wants me to continue to wear the brace while working, etc, just to give me some extra support/keep me concientious about my back, my posture, lifting correctly, etc.

Skeye

straydog
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Date Joined Feb 2003
Total Posts : 14992
   Posted 9/19/2017 7:11 AM (GMT -6)   
Skeye, a very good friend of mine had a 3 level lumbar fusion the end of March. Keep in mind she is 69yrs old. Her dr put her in water therapy for 6 weeks.she said the water therapy was fantastic. After that she did regular PT. Her neuro does this with all of his patients. She has done fabulous & was traveling at 4 month mark. She is what I call the poster child of a 3 level fusion.

This may be something you may want to discuss with your dr. She gained a lot of strength back in the water & reaped huge benefits from both.

Take care.
Susie
Moderator in Chronic Pain & Psoriasis Forums

skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 3043
   Posted 9/19/2017 6:49 PM (GMT -6)   
Hi Susie,

Wow! That's great! Water therapy was something that I was actually already planning on doing! My NS usually lets me start walking in the pool once my incision has healed completely (usually around the 3 wks mark -- so I'm hoping I get the green light to do that when I see him again next week). And then once I'm cleared to do regular PT (probably around 6 - 8 wks post-op), I plan on going to a place that has an aqua-PT program, and so I'll probably do a combination of land and pool based therapy. I've done the pool therapy before for other surgeries (shoulders, knee), and it's especially great in the beginning for regaining strength and ROM. Having been restricted from bending, twisting, or lifting for about 4 mo now, I'm sure I'm going to need a lot of help regaining ROM of my back, once I'm cleared to do so. I'm definitely looking forward to starting PT. I'm so sick of being stuck in the house/not being able to do anything other than going for short, flat walks.

Oh, and one piece of good news: my PM doc added magnesium to my ketamine infusion today (the magnesium helps potentiate the effects of the ketamine) & remarkably, the weakness in both feet is already showing signs of improvement!! I'm very excited. I will be getting the magnesium in my infusion again tomorrow, but that is supposed to be my last day. However, I'm going to talk to my doc tomorrow about extending my infusions for the rest of the week, or coming back again next week so we can try to get as much improvement out of the infusions as possible. So far, pain-wise, there hasn't been much difference (maybe some improvement in the allodynia, but that is all),
at least not in the R leg, which is currently most painful, but the pain is less concerning than the weakness, anyway (or so my doctors always tell me)...

Skeye

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 14992
   Posted 9/20/2017 10:12 AM (GMT -6)   
Skeye, I do hope the infusion goes well today. At this point any improvement, regardless how small, is a win win for you in my book.

Yes, my friend was very worried about such a big surgery at her age. Her neuro had already prepared her for a possible 4 level fusion. He told her the decision would be made once he saw what things looked like on the inside. Had that happened her back would have been like a broom stick. She obviously limitations, but has done excellent. She tells everyone getting in the heated pool was the key to her having a great recovery. She firmly believes that she would have struggled had she just went straight to land PT. I saw this extensively when I worked, clients having fusions & many did not do well going to PT, & we have seen here over the years. She has been very busy traveling by car to the coast over the summer fishing with her sisters (before Irma) & then the long trip to Mt. Rushmore.

I am hoping this will be a huge help for you too.
Susie
Moderator in Chronic Pain & Psoriasis Forums

skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 3043
   Posted 9/20/2017 4:47 PM (GMT -6)   
That's fantastic! I can't imagine a one-level fusion, let alone 3 or 4!! That's awesome that she is doing so well! I hope that pool PT is able to get me back on my feet, too. The weakness in both feet continues to improve some with the infusions, so my PM doc and I are both very happy. We're not really sure what it is from (the addition of the magnesium vs the culmulative effect of the ketamine over several days), but it doesn't really matter. We are extending the infusions through the rest of the week to try and maximize their benefit, but already, I'm able to walk a little better! Now if it would just help with the pain, too, I'd be golden! But it seems like that is probably not going to happen at this point. Frustrating, since I'm so painful on the right (was hoping it would at least take the edge off & allow me to back down some on my pain meds & finally get some sleep...) but at least the weakness is improving -- that is more important/a bigger deal!

skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 3043
   Posted 9/23/2017 6:45 PM (GMT -6)   
Update: Yesterday I finished my 5 days of infusions, and I couldn't be more thrilled with the results.

The weakness in my left foot has improved by 90%, and my foot is almost normal now. This was a huge surprise, as the infusions have never helped the weakness in my left foot before. I think the main difference is that I no longer have any physical compression of the nerve roots, whereas nerve root compression was present at the time of all the previous infusions. However, I think the addition of the magnesium (which was new this infusion) was also helpful.

The weakness in my right foot is still present, but it has also improved by 50 - 60%.

With the improvement in the weakness, I'm walking much better. I'm still having trouble pushing off with my right foot, due to the remaining weakness, but the left foot is almost normal. After 9 mo of weakness, I had gotten so used to my left foot being weak, that I almost forgot what normal felt like! It's amazing!

My PM doc is thrilled with the improvement in the weakness, so I can only imagine how happy the NS will be when I see him again this week.

The improvement in my pain, however, is not as significant as the weakness. The allodynia in my right leg is about 95% improved, which is fantastic, but the baseline pain in that leg is only maybe 10 - 20% improved at best, depending on position. The improvement in the left leg is a little better, but the pain in that leg was less to begin with, and that leg was already starting to improve on it's own. I was hoping for a bit more pain relief -- especially in the right leg -- so that I could start tapering off some of the opioids. But I'll take any improvement I can get. I realize that this is going to be a long process (and that at only 3 wks out from the last surgery, I'm still just in the very beginning stages of healing), and I can't expect everything to just miraculously get better overnight. But that doesn't mean that I can't hope for that to happen! ;-)

But, that being said, overall, I am really very pleased with the results of the infusions. I hope that the improvements in the weakness, especially, hold, but at least now I know that things can get better. And the added hope that that brings me is a powerful thing. I still have a long road ahead of me, but I have an even stronger feeling now, that in the end, I'm going to have a good result from this last surgery, and that I am finally back on the road to recovery!

Skeye

Post Edited (skeye) : 9/26/2017 12:57:15 PM (GMT-6)


(Seashell)
Veteran Member


Date Joined Dec 2012
Total Posts : 664
   Posted 9/24/2017 7:38 PM (GMT -6)   
Skeye:
That's Good News all around regarding your familiar the ketamine infusions with the new addition of magnesium.

Magnesium, as I am sure you are aware with your veterinary schooling, acts as a calming agent on the central nervous system. Magnesium lowers the threshold of central/thalamic sensory sensitivity. It also acts to enhance skeletal muscle contractility. Your reduction in pain and improved muscle function of the foot may both be benefitting from the added magnesium.

Magnesium is currently a popular over-the-counter supplement owing to its calming effects in an ever more hurried and stressed life. "Natural Calm" (by Vitality Holistics) is a reputable magnesium supplement, available on Amazon.

More than anything, I would garner an opinion that your back needs -more than anything - rest. Rest, good nutrition, and time.

Susie's suggestion of water therapy is wise. A warm therapy pool can do wonders to support healing after surgery. The buoyancy of the water relieves stress to the back and joints. The water offers a natural resistance by which to strengthen core musculature. The warmth of the water eases muscular tension and trigger points. I hope that you can find access to a warm therapy pool a few times a week. The benefits gained are well worth the hassle of getting into the pool.

You'll be glad to know that my little tea-cup Maltese, Molly, is doing well. The Chron's flares are being controlled on 2 mg of prednisone + an antibiotic to keep bacterial overgrowth at bay. I am fortunate to have the services of an internal medicine veterinarian for Molly as well as a holistic practitioner who provides her with acupuncture and massage. This afternoon was a beautiful Fall day in Portland, so I took Molly to the campus of Reed College where she was fully engaged in looking for squirrels. Molly's passion for squirrels remains high. It was heartwarming to see Molly running across the grounds of the campus.

Continued best wishes,
Karen
Pituitary failure, wide-spread endocrine dysfunction
Addison's disease
Mixed connective tissue disorder
Extensive intestinal perforation with sepsis, permanent ileostomy
Avascular necrosis of both hips and jaw
Receiving Palliative Care (care and comfort)

Post Edited ((Seashell)) : 9/24/2017 7:41:02 PM (GMT-6)


skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 3043
   Posted 9/25/2017 4:30 PM (GMT -6)   
So, unfortunately, the effects of the infusions do not seem to be holding. I was up all night last night because of severe pain in both legs (and it has been no better all day). And when I got up this morning, I found that the weakness in both feet had also completely returned. So far, the only thing that is still better is the allodynia in my right leg, and even that is a little worse today.

I don't know what is going on. I talked to my PM & he said that the ketamine should not have caused improvement in the weakness if it was due to inflammation. So why the weakness improved & now has worsened again, I don't know (he's not sure that the magnesium has anything to do with it either). I still feel like all this is related to inflammation, but nothing makes sense anymore. I don't know, maybe there has been some kind of CRPS-like changes to the nerves & that is the cause of the weakness/why they initially responded to the ketamine? But even though I have some symptoms of CRPS in my legs, I am missing other key symptoms, so CRPS, itself, doesn't quite fit. But given my history, it wouldn't be entirely surprising to me if the nerves aren't exactly normal, either, even if it is not specifically CRPS...

I will talk to the neurosurgeon about all this when I see him tomorrow, but I doubt that he'll have any answer either, or any solution, other than just time/waiting and seeing what is going to happen. I know that time is my best friend right now, but it's just super frustrating to have improved so much, and then take that all away again (and to not know why)... But there is nothing else I can do, so I guess I just need to trust that my body is going to heal itself in time, whatever is going on...

Skeye

Post Edited (skeye) : 9/26/2017 1:03:40 PM (GMT-6)


skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 3043
   Posted 9/26/2017 12:53 PM (GMT -6)   
So last night I was feeling really discouraged and confused (as you can probably tell from my post) with the return of the weakness. But I feel a lot better after seeing the neurosurgeon again today. The neurosurgeon can't explain what happened with the weakness, but like me, feels that the weakness is due to inflammation, and that it will improve in time. Though he does think that I also have some kind of abnormality in regards to my nerves, and that that is a contributing factor to my pain. Whether it is related to my CRPS or something metabolic (I do have a history of unexplained, significant vitamin B12 deficiency), he isn't sure, but I agree with him 100% that something about my nerves isn't exactly normal, either.

So we are going to continue to give it time. Plus, both my pain management doc and the neurosurgeon advised me to start taking more vitamins to help fight the inflammation & support nerve function. And I will be starting formalized pool PT for stretching and strengthening next week. However, I am still prohibited from bending or twisting for another 3 wks.

Skeye

PS - After doing more research, I am now pretty sure that the transient improvement in my weakness was due to the anti-inflammatory action of the magnesium (it inhibits inflammatory cytokines). It's a shame that oral magnesium does not have the same effect.

Post Edited (skeye) : 9/29/2017 9:00:45 PM (GMT-6)

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