Disc herniation after lumbar epidural?/treatment suggestions?

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skeye
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Date Joined Mar 2008
Total Posts : 3068
   Posted 2/25/2017 1:19 PM (GMT -7)   
Thanks, White Beard. If I had to have surgery, it would be done up here, as insurance will only cover 100% (minus whatever copay I have) if it is done locally, and we can't afford to have it done elsewhere. I doubt the neurosurgeon will recommend surgery right away, though. It's only been (almost) 4 wks, and although that feels like an eternity in my present state, I got the impression from my other doctors that they like to wait at least 8 wks, if not longer, before they decide whether or not someone is surgical.

And then comes the issue of when could I have it done? I'm out of town for several weeks, and then I go back to the classroom for 2 mo beginning at the end of March. And I can't miss those 2 months, or I'd have to wait an entire year to make up those classes (they are only offered those two months, and they are mandatory). Not to mention I have my national board exam and a big presentation to give in April. So it probably couldn't happen until the end of May, anyway.

I'm trying not to think about surgery too much, as I'm still hoping that I'll get better on my own. And I've yet to try an epidural, etc. But I must admit, I do have a bad feeling about this. With my track record, I wouldn't be surprised at all if I do end up requiring surgery. I suppose it wouldn't be the worst thing (especially if it fixes me!), but I can't say that I'm looking forward to that possibility either. Anyways, we'll see what the neurosurgeon says next week...

Skeye

White Beard
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Date Joined Feb 2009
Total Posts : 3673
   Posted 2/25/2017 11:03 PM (GMT -7)   
Well skeye keep us posted on how your doing and what the surgeon says. The weakness and lack of reflexes is a major concern although it can sometimes be only temporary, but as you know it is still not a good sign! I sure hope everything works out well for You!

Your in my Prayers!

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.

skeye
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Date Joined Mar 2008
Total Posts : 3068
   Posted 3/1/2017 2:05 PM (GMT -7)   
Saw the neurosurgeon & he said that I need surgery. Apparently the herniation is HUGE and he thinks that it is extremely unlikely that it will resolve on it's own. He said that I can try an epidural, but given the extent of the herniation, he thinks that it either won't help, or won't help enough, and either way I'm going to have to have surgery. Not exactly the news I was expecting or hoping to hear. I thought that he'd say "you may need surgery, but try an epidural, and give it another month or two." But I guess I'm beyond that.

I'm still planning on trying an epidural, and have an appointment to see/discuss it with my PM in 2 weeks. I also made an appointment for a second opinion with another neurosurgeon back home in 3 weeks.

Regardless, I really don't see how I could possibly have the surgery done before June. I just have too much really important stuff coming up in the next 2-3 mo that I can't miss, or it would set me back a year. If I absolutely had to, I suppose I could. But already having had to take 2 plus years off, and being so close to done, I much rather wait and only take a few months off, than a whole other year. Ugh, it is going to be a very rough few months, though. I guess I'm going to have to give it some serious thought as to what is worse/see how things go...

Trying to stay positive still, but it is hard.

Skeye

White Beard
Forum Moderator


Date Joined Feb 2009
Total Posts : 3673
   Posted 3/1/2017 11:40 PM (GMT -7)   
skeye I'm really sorry for this bad news. Definitely get a second opinion, the question I have for you is, Do you think you can make it through the rest of your classes and be able to do the tasks necessary and required of you to complete them? Also and (I would consider this one of the most important considerations), if you put off having the Surgery, how will this affect your weakness and loss of Reflexes? Will it continue to get Worse? Or possibly become permanent? After all the delays and everything you've been through, I understand your desire to finally get your schooling completed with being so close to finishing! But your health is far more important! So please don't do anything that would sacrifice that!!

Just make sure you look at all the pros and cons of what ever decision you make, and consider the possible results of what ever action you decide on. It wouldn't do you any good putting off the surgery to complete your education now if by doing so causes you more physical damage that could possibly prevent you from working in your chosen profession!

skeye I continue to keep you in my prayers!

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 : 679
   Posted 3/2/2017 8:42 AM (GMT -7)   
Skeye:
I will chime in . . . you may disagree or agree with me . . .

I had instance of a desiccated disc at two levels, L3-4 and L4-5. As a physical therapist working with spinal cord and head injury patients, the physical demands on my low back were impressive. I am a petite 5'2" and 85 pounds and was this weight during my years of practice. I practiced sound body mechanics in conducting my patient care. "Small but mighty" was the nickname given to me by co-workers.

I had pretty severe sciatica, as you can image. I also had markedly diminished quadriceps and plantar reflexes. My anal sphincter reflexes were intact and I had no symptoms of hypotonic bladder. Based on intact sphincter reflexes, I postponed my surgery in order to take two rounds of epidural injections and McKenzie-based physical therapy (focusing on extension positions/manuevers to influence disc material in an posterior protrusion anteriorly).

In my own case, it was worth the wait. I went into surgery less acutely inflamed than if I had proceeded with surgery at the initial finding. I was also able to get care from the neurosurgeon that I was most confident with, rather than having to settle for a more immediately available neurosurgeon with less skilled experience. The skill of the surgeon does matter. As a physical therapist myself, I had witnessed too many less than ideal outcomes from less than ideal surgeons. I knew the neurosurgeon that I wanted to treat me . . . to have his care, I had to wait 3 weeks.

I had a microdisectomy and opted not to have the fusion (which was recommended). It was the right choice for me. Over the years since, my lumbar spine has fused itself at both levels. I have no residual deficits.

The Learning: The skill and competence of the neurosurgeon you choose will likely play a role in the overall success of your procedure. Take adequate time upfront to identify the best neurosurgeon for you.

Unless you have bowel and bladder sphincter compromise, you have the availability of time in making your choice. If you have bowel and bladder dysfunction, then you are in immediate risk and need for prompt surgical decompression. If you have demonstrative neurological deficit of your anterior tibialis musculature or gastrocsoleus, then you are in need for prompt surgical decompression (drop foot and/or inability to perform a toe raise). If your quadriceps and planter reflexes are present but diminished, you have time to make a thoughtful choice.

Rushed surgical choices should be avoided when ever possible.

My two cents plus change. You know your body better than anyone. Listen to your inner voice. Listen to what your body is telling you. If we are quiet and listen to what our body is telling us, most of the time our body is correct in what it is communicating.

You have my support in whatever you decide and my sincere best wishes for a full recovery and a career as a veterinarian.

My little Maltese, Molly, is 5 weeks into recurrent GI bleeds with pancreatitis. She is not doing well, unfortunately. It is so very hard. This little dog is my soul mate. We are one.
- 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 : 3068
   Posted 3/12/2017 12:33 PM (GMT -7)   
Thanks for the input, advice, and support, Karen and White Beard. I definitely appreciate it! I apologize for it taking so long for me to reply, but I was away for much of the last week.

I don't think that I'm currently in any immediate risk if I delay the surgery. I do have weakness and loss/reduction of reflexes, but I don't have a foot drop, or any bladder or bowel dysfunction, etc. It's just not going to be fun pain/comfort wise to wait. But I'm hanging in there. So unless things change, I'm still planning on waiting/trying to get through the next few months, and then having the surgery sometime around June, after I've finished my current coursework, boards, etc.

I'm supposed to see my PM on Tuesday to talk about trying an epidural/other options to help get me by until surgery, but I'm not actually sure if that is going to happen or not, seeing as we have a massive Nor'Easter on the way, with predictions of up to 20" of snow and blizzard conditions on Tuesday. I usually love snow, and especially big storms, but this time I'm hoping that it won't be too bad. If they/I have to reschedule, I don't know if there will be enough time to both reschedule the appointment and do the epidural, etc before I have to be back at school in another 2 wks. I know I could have the neurosurgeon at school do the epidural if I have to, but I much rather have my PM do it. Not to mention that logistically, it would be much easier to do it now, when I am home and have family members who could help drive me, etc.

I see the other neurosurgeon here for a second opinion the following week. I wasn't super crazy about the NS that I saw at school a couple weeks ago (personality wise, anyway), but according to my PT he has a good reputation -- or at least is very experienced. But I already have a lot more confidence in the NS that I am seeing next week, as not only has he performed surgery on another family member with good results, but my mom (a PT) and my dad (an MD) have also seen a lot of favorable outcomes from his surgeries, and out of all the NS's in the area, he is the one that they prefer to refer to. I'm hoping that if he also says surgery is necessary (which I'm fully expecting), that I can do the surgery with him. But in the end it is all going to come down to insurance coverage (i.e. whether or not Medicaid will pick up the rest of what my school insurance does not pay if I were to have to surgery done out of area), which is unfortunate, but is the reality of things.

Skeye

PS - Karen, I'm sorry to hear about Molly and I hope that she is doing okay! Pancreatitis can certainly be difficult to manage. :-(

(Seashell)
Veteran Member


Date Joined Dec 2012
Total Posts : 679
   Posted 3/12/2017 3:10 PM (GMT -7)   
Skeye:
It is GOOD to hear from you. I had been thinking of you and was concerned by the lack of a post or update from you. This forum genuinely cares about you.

I am glad to hear that your disc protrusion is at last stable/status quo. We'll take that as a win. I am glad to hear that you have no bowel or bladder sphincter involvement. We'll take that as a win.

In looking at the situation with your lumbar spine, veterinary school program, medical insurance provide through your status as a student, and the logistics of being away from home while at school without family support/assistance - you have a lot of balls up in the air simultaneously that you are trying to keep afloat. This is no easy task.

I think you are wise to have a consult with the NS in your home town. You then have two neurosurgeon opinions to weigh and two neurosurgeon personalities and skill sets to ponder.

I can appreciate your decision being impacted by the benefits of your insurance plan through your school and student status. Going outside of one's insurance network without explicit coverage can be financially restricting for most people. The costs of specific medical procedures and associated ancillary costs are out of reach for most people on a private pay basis. Be grateful that you have medical insurance.

You sound stronger in the voice of your writing and less overcome by the enormity of the disco protrusion and what it's. I hope this means that the pain level that you are experience has lessened, giving you less emotional burden and fatigue. It is hard to be optimistic and to think clearly when one is in unrelating pain.

Thank You for your expression of well-wishes for my little tea-cup Maltese, Molly. The pat 6 weeks have been a trying experience for her. The pancreatitis and GI inflammation and GI bleeds have eased but continue to wax and wane. She has two good days followed by one less than good day. Her spirit to live remains strong although her body is frail. I do have a good internal medicine veterinarian following her care - and what a difference that makes. But truth be known, I will never be ready to loose this little dog. We really are one. It has been a remarkable 14 years together and I cherish any additional time together with her.

I am glad that you have been able to have time at home with your mother and father. We are never too old for parental love.

Continued best wishes that everything your are working toward - your veterinary school graduation and licensure and successful resolution of your lumbar disc - comes to be true for you. You certainly are giving great personal effort.
- 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 : 3068
   Posted 3/22/2017 1:54 PM (GMT -7)   
Saw the second neurosurgeon yesterday, and I liked him MUCH better than the first guy. This NS actually really took the time to go through my history, scans, and do a good PE -- as compared to the other NS who spent only 2 minutes with me (and felt extremely rushed the whole time), and didn't even examine me at all (although his PA did before he came in the room).

This NS wants me to try an epidural first. He said that I very likely may still end up needing surgery, but that he doesn't want to rush into it. I do have a slight foot drop and moderate weakness in my left leg, but because it hasn't continued to progress, he said that we still have time. He is concerned though, that in addition to the marked bilateral nerve root compression from the herniation at L5/S1, that I also have a free-floating fragment of disc material within the spinal canal, because I can barely lift either leg without getting severe pain down my left leg. Apparently CT is not ideal for seeing fragments in the canal, but he is going to have his neuro-radiologist re-read my scans anyway, because he wasn't happy with the radiology report (I must admit, I wasn't either -- it was one of the most poorly written reports I've ever seen).

The hardest thing to hear from the new NS, though, was that either way (whether I end up needing surgery or not), he didn't think that I'd be able to have a career in large animal, because I'd probably just re-herniate, and could end up destroying my spine. It wasn't entirely unexpected, but was pretty devastating all the same. I pretty much spent all day yesterday crying. But today I'm trying to think more positively. I've already overcome a ton with all my health problems, and I haven't given up yet. And I'm so close to reaching my goals, so I'm not about to let this stop me now. It may end up being that I do have to re-think my career plans, but no one can predict the future, so for right now, I'm not going to let it get me down.

I was really hoping that the ketamine infusions that I had last week would help with my back/leg pain like they do for my CRPS, but they did not. I got some relief during the infusions, but once the ketamine was stopped, the relief did not last. If anything, my back/spinal pain (presumptively due to muscle tension/guarding) has gotten a lot worse over the last two weeks, to the point where sitting is now getting really painful, too, which sucks.

Anyways, for now I have an appointment scheduled with my PM for the epidural on Friday. We'll see what happens. Given my luck, I won't be surprised at all if I still need surgery. But hopefully the epidural will at least buy me a few months, so that I can get through the rest of classes and boards, and be in a better place for surgery. And hopefully if I do need surgery, I can work things out with my insurance so that I can have it done with the second neurosurgeon, as I trust him a lot more than the first guy!

Skeye


PS: Karen -- I'm glad to hear that Molly is still holding her own. I know what you mean about you and her being as one. I feel the same way about both my dogs, but especially one in particular. I don't know what I'll do if and when anything ever happens to him. He is my soulmate, and there is no way that I would have made it this far in life without him.

Post Edited (skeye) : 3/22/2017 2:58:05 PM (GMT-6)


straydog
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Date Joined Feb 2003
Total Posts : 15294
   Posted 3/22/2017 3:37 PM (GMT -7)   
Skeye, very glad to read that you obtained the 2nd opinion. This is an example why we urge folks to get a 2nd or even a 3rd opinion when surgery may be on their horizon.

I like the way he wants to try an eppie & have the films re-read. I am guessing when you mentioned the CT it was done when you had the mylo. Just like drs, not all radiologists are created equal. At least he told you up front & spent time with you explaining all of the options. The little bit of foot drop is not too cool though. When is your return appt with him?

If it all comes down to having surgery I would not throw the towel in on not being a practicing vet. You can always work with small animals. I have had 3 large golden retrievers each over 100 lbs & no one ever attempted to lift them alone. So, perhaps this can be in your future.

Keep us posted on how this all plays out. Take care.
Susie
Moderator in Chronic Pain & Psoriasis Forums

White Beard
Forum Moderator


Date Joined Feb 2009
Total Posts : 3673
   Posted 3/22/2017 4:38 PM (GMT -7)   
Hi skeye sorry for your bad news, when I had my first fusion at C6/7 in 1985 my disc was so badly herniated that I had several free floating fragments in my spinal canal that the neurosurgeon had to fish out. Being it was in the cervical spine it was considered an emergency, and they did the surgery right away. That is right away after they found the problem, it took the military over three months to find the problem though! Anyway this is nothing to mess around with! I was told by one of my neurosurgeons that they like to have the epidural done not only to help relieve the pain but it is also used as a diagnostic tool for the surgeon, and allot of them require having them done before they will do the surgery.

skeye, were you planning to go into large animal veterinarian practice? As Susie mentioned would going into small animal practice be so bad? Or maybe even small exotic animals or something like that? I know that when you get thrown a curve ball like that, especially one that threatens your life goals, it is a very very bitter pill to swallow. I've been there, when I had to go on disability which ended an all to short nursing career for me. But although this might sound cliché there is allot of truth in the saying ""when life throws you lemons, you just make lemonade out of it!!"" You have been through so, much skeye, and you will make it through this too! You're a survivor! It is natural to cry, but it is what you do after the crying that makes the difference!

We're all here for you! and I will continue to keep you in my prayers!

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.

Post Edited (White Beard) : 3/22/2017 6:55:10 PM (GMT-6)


skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 3068
   Posted 3/29/2017 3:59 PM (GMT -7)   
Susie -- Yes, the CT was done immediately following the myelogram. My follow-up with the second NS isn't until the end of May, as I can't get home before then. But I am supposed to call him in another 2 1/2 weeks (3 weeks after my epidural) to give him an update.

White Beard -- Yes, I was planing on doing either large animal ambulatory, or more likely, mixed practice (both large and small animal). Having to just go into small animal certainly wouldn't be the end of the world, as I enjoy small animal, too. But I really LOVE the large animal work. I don't think I would be a very good exotics vet, though. Birds, especially, are my weak spot.


Had the epidurals done on Friday. My PM did 2 transforaminal epidural steroid injections at L4 and L5. I was moderately worse for the first 24 hours, but now I'm back to "normal." Haven't noticed any kind of improvement yet, but they told me they could take up to a week to work, so we'll see. Fingers crossed. I'm supposed to talk to my PM again next Friday (2 weeks after the injections). He told me when I had the injections done that if they don't help or don't help much, then he'd want to repeat them. And if a second injection didn't work, then he'd stop and we'd have to think about other options (surgery, etc). He also mentioned the possibility of a percutaneous discectomy (as opposed to a micodiscectomy), which is done through a needle/cannula with the patient awake. I don't know if I am a candidate, though. But I guess I'll worry about that if/when we get to that point.

Skeye

White Beard
Forum Moderator


Date Joined Feb 2009
Total Posts : 3673
   Posted 3/29/2017 9:44 PM (GMT -7)   
Hi skeye thanks for the update date. I sure hope you get at least some relief from those injections. I know this all has been really difficult for you, you have been through so much and yet still trying to get through Vet school!!. Just want you to know your in my thoughts and prayers, and I have all my fingers and toes crossed that everything works out well 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.

skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 3068
   Posted 3/30/2017 5:38 AM (GMT -7)   
Thanks, White Beard!

(Seashell)
Veteran Member


Date Joined Dec 2012
Total Posts : 679
   Posted 3/30/2017 9:03 AM (GMT -7)   
Skeye:
Sometimes you just have to relinquish faith and trust to God/Higher Power and hope for the best.

If small animal veterinary practice becomes your pathway, perhaps it is meant to be in the larger cosmos.

I always aspired to be an orthopedic surgeon. But it became clear that I was too petite in body frame to pursue orthopedic medicine. I chartered a new course as a physical therapist and found my true calling and God-given talents. It was an intrinsically rewarding profession.

Having been consumed of recent in the care of my little Maltese and involved with several veterinarians and internal medicine veterinarians, I have to believe that you would be a veterinarian that I would choose for my little girl.

Be well,
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)
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