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Author Topic: Siatic nerve pain  (Read 2587 times)

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Offline doctorb

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Re: Siatic nerve pain
« Reply #20 on: June 01, 2018, 07:04:32 PM »
There's been a lot of posts about MRI's.  I'd like to throw in a few thoughts....

MRI is a wonderful modality to demonstrate hard and soft tissue findings within the spine, but is not some sort of full-proof perfect vision into your back that will 100% tell you:  1) What exactly is the reason for your pain and 2) What you have to do, including surgery, to relieve that pain.  When MRI first came out, it became almost like a religion.  We started operating on the MRI and not the patient.  Any detected abnormality seemed to become an indication for surgery.  There are all kinds of abnormalities within our aging spines, and the MRI will probably overstate many of them.  MRI's are often over-read, meaning the radiologist can over interprets what he/she sees.  The radiologist's reading is then sent to your doctor, who, unless he/she is a spine specialist, does not have the expertise to interpret the images themselves, and therefore accepts the radiologist's interpretation without question.

Look, MRI has demonstrated many exact problems within many patient's spines.  But those of us who are aging have abnormalities at multiple levels of our spines, and have multiple locations where nerves can appear compressed.  What is THE MOST IMPORTANT FACTOR is having a physician who takes the time to do a detailed physical/neurological examination to determine where in your back, which nerve root or roots, your irritation arises.  If, after an adequate trial of rest, PT, and maybe injections, your symptoms continue to be unbearable, you may be a candidate for surgery.  But that surgery should only occur when the MRI demonstrates an abnormality that accurately coincides with the findings on your physical exam.  If the MRI does not correlate with those findings, despite continuation of the patient's pain, surgery is very unlikely to help and should probably be avoided.

So the MRI is not a miracle truth detector.  It's a diagnostic tool that is part of the assessment of spine pain.  It does not always provide all the answers.  It is not an instant roadmap of your problem and your next step.  And it can be over interpreted leading to unnecessary and or unsuccessful surgery.  But when used wisely by good physicians, it is an invaluable test for better understanding of a complex problem.

As always, if you have been told that you are a candidate for spine surgery, I strongly suggest that you receive an unbiased second opinion before undergoing the knife.
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Offline Runningalucas

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Re: Siatic nerve pain
« Reply #21 on: June 01, 2018, 09:53:34 PM »
I just made the MRI rounds for my lower spine, and hips; also had a leg length test.  My overall opinion, I've always done holistic type stuff instead of the MD, and so far, I'm kinda glad.  Due to scoliosis, degenerated L4, and L5, they sent me into a consult I wasn't ready for; spinal fusion.  

Having L4, and L5 fused, fine, but oh, with scoliosis, at least according to the surgeon, it would mean a complete fusion all the way up into the thoracic region.  It really sounded like rods, or even any fusion should be used as a means of last resort, simply to be able to walk.  I skirted around it, and for the most part got the answer that after surgery, my spine would be perma-light duty. 

For now, and I've not seen it listed in this thread, and maybe someone will tell me it's horrible, but I'm thinking that I'm going to go with the Regenexx stem cell therapy for those 2 discs.  From what I saw online, it works fairly good, and is long lasting.  I asked the surgeon about the stem cells, and they simply had no comment; it's just another form of treatment in their eyes I guess, and separate from their discipline. 

Everything in the AMA seems very compartmentalized, and somewhat like an sales model using a lot of upseliing. 

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Re: Siatic nerve pain
« Reply #22 on: June 01, 2018, 10:22:32 PM »
I would be in interested to hear more about this stem cell technique you mention.  I do believe the MRI is a good tool to help in determining what is wrong.  I destroyed my L4,L5, and the discs in addition to some issues in the neck region, have done the PT, Chrio, injections, surgery, holistic, you name it.  The back is pretty decent these days, compared to when I could not walk that is, but I do have numbness in my feet and arms / hands, and have lost a lot of strength in certain muscle groups.  It's pretty embarrassing when the therapist tells you to resist the force of her hand against your leg, which she is barely touching and you tell her you are resisting it. 

Your observation about the compartmentalization of medicine is spot on.  
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Offline Runningalucas

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Re: Siatic nerve pain
« Reply #23 on: June 01, 2018, 10:33:17 PM »
I would be in interested to hear more about this stem cell technique you mention.  I do believe the MRI is a good tool to help in determining what is wrong.  I destroyed my L4,L5, and the discs in addition to some issues in the neck region, have done the PT, Chrio, injections, surgery, holistic, you name it.  The back is pretty decent these days, compared to when I could not walk that is, but I do have numbness in my feet and arms / hands, and have lost a lot of strength in certain muscle groups.  It's pretty embarrassing when the therapist tells you to resist the force of her hand against your leg, which she is barely touching and you tell her you are resisting it.

Your observation about the compartmentalization of medicine is spot on.  
LOL, been there on the 'I am resisting'...   I'm trying to schedule the stem cells in July.  From what I've read, and been told, you go in, they draw blood for plasma, then they also numb out a hip, and draw the stemcells from the hip.  They process the blood, into a platelet rich formula along with mixing in the stem cells harvested from the hip; then inject.  
https://www.regenexx.com/regenexx-procedures-family/the-regenexx-procedure-explained/

Offline tree-farmer

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Re: Siatic nerve pain
« Reply #24 on: June 02, 2018, 07:14:56 AM »
After half dozen adjustments by chiropractor back is much improved. Seems that sitting aggrivates  it more than anything. My job requires sitting at CAD station, but I have been making a point of getting up every hour or so and walking through shop plus  walking or working outdoors after work to keep pain at bay. 
Wearing a back support  when doing lifting jobs seems to help some too.
A little Irish whisky and Motrin also helps take the edge of the pain as well.

Goal is just to stay functional for as long as possible without more extreme measures.
Old doesn't bother me, its the ugly that's a real bummer.

Offline doctorb

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Re: Siatic nerve pain
« Reply #25 on: June 02, 2018, 08:27:46 PM »
Yes.  Medicine is compartmentalized.  There are those physicians and patients that believe in a treatment, those that want to believe, and those that don't believe.  This is very true for stem cell treatments.

These stem cell therapies have become very widespread throughout many areas of medicine.  The theory is simple...put some non-differentiated cells into an area of inflammation or injury, and they will "regenerate" or modify themselves to solve the problem.  Fix things.  Repair arthritis.  Cure tendonitis.  etc.  Easy peasy Lemon squeezy.  Not so fast, my friends.

As a doc, I am one who is based in science.  I am hopeful that science can demonstrate that these immature cells have the ability, once injected, to sense what is wrong and repair it.  However, real science has yet to back up this hopeful blueprint.  There are studies of improvement in neural function in non-human experiments, but long term clinical studies have yet to show any real improvement.  Yet we inject this stuff everywhere in the body, and do it multiple times (a friend of mine had 6 injections over 15 months for his patellar tendonitis.  He eventually got better, and swears by the treatment.  Would've probably resolved in that amount of time with no treatment.)

Now, the people doing the injections, they are gung ho!  And the risk of a problem from an injection of your own blood products is incredibly low.  So with very low risk, and the alternative treatments being much more costly and invasive, why not give stem cell therapy a try.  Makes sense.  Just doesn't yet have the scientific backing to say it truly works.  

So get in line for your injections, but don't have your head in the clouds.  It's not yet the miracle they want you to believe it is.  Someday.....
My father once said, "This is my son who wanted to grow up and become a doctor.  So far, he's only become a doctor."

Offline alan gage

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Re: Siatic nerve pain
« Reply #26 on: July 20, 2018, 04:50:51 PM »
Thanks for your insights doctorb. Nice to hear it from a doctor's perspective.

My 5 weeks of physical therapy are done. Improvement in some areas and backsliding in others. Most of the nerve pain down my legs is gone but still some, especially in the early morning. Still lots of hip pain and SI joint pain. Very stiff trying to bend at waist and poor mobility. Can walk ok but nothing faster. I'd say maybe 30% improvement overall after physical therapy. Don't know how much to contribute to physical therapy and how much just because it's been another 5 weeks. Seems to be making slow but steady progress no matter what I do.

Went back to the doctor and he ordered an MRI. Results were some bulging in the L4/L5 and L5/S1. Doctor is 2 hours away from me so I haven't talked to him directly yet, this was just through some sort of secretary that called to schedule things. We'd talked about a cortisone injection ahead of time and he still thinks that's the next best step so I go back out there Wednesday for that and a little chat.

Sounds like I shouldn't expect the shot to be a cure-all but hoping it will provide some pain relief and that by the time it wears off things will be feeling much better. I'm guessing if nothing else it would make a good diagnostic tool to determine if that's really where my trouble stems from.

Assuming this eventually gets better on its own it sure makes me worry about the future and this happening again. Going on 8 months now. Slowing me down a lot this summer. My idea of fun is taking 30+ day solo canoe trips into remote areas of Canada. Can't imagine having this happen in the middle of one of those. Certainly no trips this year.

Alan
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Offline alan gage

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Re: Siatic nerve pain
« Reply #27 on: July 26, 2018, 12:19:23 PM »
Got my shots yesterday. Left and right side. Not a big deal. Feeling some improvement already but not pain free. They said I could expect the quick acting pain reliever to wear off in a day and up to 5 days for the steroids to really kick in.

Alan
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Offline Ed_K

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Re: Siatic nerve pain
« Reply #28 on: July 27, 2018, 07:47:28 AM »
 The steroids should work. I have had incidents where I've damaged the L4-L5 disk and demanded the steroids  and they work for me each time. they stop the swelling of the disk I think.
Ed K

Offline alan gage

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Re: Siatic nerve pain
« Reply #29 on: August 03, 2018, 05:18:37 PM »
A few days after the steroid injections I felt very good. So good that I decided to redo my girlfriend's deck so she could get her house sold. Worked hard on it all weekend. Tried to work smart. Didn't lift anything very heavy and lifted properly. Didn't really feel any pain while doing the work and went to bed Sunday night feeling tired out but otherwise fine. Woke up Monday and could barely walk. Haven't had this much pain since it was at its worst in February/March but it feels a little different. More of a single sharp pain in the buttock rather than multiple hip/back/buttock/leg with radiating nerve pain as well. Been taking it easy and stretching. A little better now on Friday. Mornings are bad news. By the afternoon I feel better, especially if I keep moving. Sitting and then standing is the worst.

It's a wonder we do these things to ourselves.

Alan
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Re: Siatic nerve pain
« Reply #30 on: August 03, 2018, 10:31:14 PM »
It's very hard to sit still when you finially have relief after so much time hurting, but you need to. The shots eventually become less and less effective. Let your body heal. 
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Offline Runningalucas

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Re: Siatic nerve pain
« Reply #31 on: August 04, 2018, 12:32:40 PM »
I got my Platelet enriched Plasma last Thursday morning(week and 2 days).  I basically tried to take it easy for a few days, and did okay doing that; as I was trying to let the platelets do whatever they do.  I've read a lot of different things on how it's necessary to take it easy after the platelet injections,  and the doc said no heavy lifting for a couple weeks.  I guess the cells are fragile until healing begins??? Any ways, LOL, forget the fragile...

By Monday, I was fabricating almost all day long.  I noted no fatigue, and was able to stand up, crouch down, stand up, crouch down, stand up, crouch down, most of the day.  Before the procedure, I'd be lucky to get in around an hour of such work before needing to stop.  It was actually a little intimidating, as I ended up waiting for the big blow out to strike, and the longer it went without, the more I thought, 'uh oh' was going to come.... you know, stuck somewhere, and it goes so bad you can't move.

Since then, the last few days have been spent on the backhoe clearing brush, and stumps.... I didn't think of it as being hard on my back, till I saw the gopro footage that I was taking of doing the work; I was getting thrown around fairly good, I guess you just don't notice all that much....  Anyhow though, the back is still doing fairly good; by now, I would've needed around a week off to let the glass in my back settle down, but so far, I'm just 'this side' of the 'glass'.

I guess time will tell, supposedly it just keeps getting better, but with as hard on my back as I am, we'll see...  If it does, WOW.


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