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Looks like forced to make a choice...

jsirabellajjsirabella Posts: 311
Just as a preface I have three docs that I trust the most and have settled on these three to make decisions about my health with ofcourse my own opinion and some advice from you good folks here.

Well anyway I last left off that I will be going for my third epidural on Thursday which will be a caudal as opposed to the transformal based upon the advice from the doctor at the HSS. Well I went to my spinal orthopedist at Mt. Sinai here in NYC. He was the doctor initially saying hips, hips, hips. We later ruled it out.

Well anyway I went to see him today and told him about the IDET or Targeted Disc Decompression that the other doctor recommended and he immediately told me do not even think about it. This procedure is not done any longer and has been found that people who have a placebo have the same chance of healing. I than told him about the epidural which he is fine with. I than told him that the doctor said if the epidural does not work that I should do a discogram. He than said you only do a discogram as a prelude to surgery and should not be done otherwise as it is not a lightly taken procedure and can make your symptoms worse.

He said I am a conservative doctor and since you are getting stronger but your discomfort level is stuck to do the epidural. If the epidural makes all the discomfort go away than cancel the MRI. If the symptoms persist than lets do an MRI since you have not had once since July.

I explained than basically what you are saying doc is either surgery or no surgery. Than he verbally slapped me in the face with "this may be it for you john, this may be the best you will feel unless you feel it is making your life terrible". I am a big boy and can take a punch but that one was a load. If your herniation is still too small than that is it and you can just keep going the epidural route.

Honestly each of the three docs is kind of the three voices in my head which is really funny. I was hoping the docs could ass clarity but instead they are all expressing a different voice I already have. One has a procedure, One says been too long so do the procedure, one says do not try as things can get worse.

LOL...I have to laugh.

Honestly lately I continue to get stronger and be able to so much more in the weight room and walking is not much of an issue. But still plenty of issues like driving and sitting for longer periods are tough. Last two months ham strings continue to get tight and so do calves and sometime feet. The last couple of days actually finally feeling some pain in lower back but not in legs, calves or feet. The thing keeps changing. I pretty much stopped all meds except for some natural stuff and the occasional 1 advil.

I just deal with the rest with ice and heat and wondering when is too much ice/heat. I have now added lower body/back exercises like back extensions and leg curls and such. Maybe that is making it a bit more sore now. It is not that I do not have the strength it is just the discomfort it will generate. I can walk but if I put too much incline or use eliptical on more than a 3 difficulty I will get some discomfort.

Well lets see what the epidural does but I have a feeling I will have to make a choice soon...I will than do the MRI even if the epidural works so I can see any changes. This will give me more info to make a decision.

I just not sure if I could live with this is it.




  • As the recent doctor said, surgery could make it worse.

    First of all, until you are healed you probably should not be walking on any incline. It puts additional stress on the disc. Two years after my fusion, I always have pain if I walk on an incline, and I doubt it is going to magically improve.

    I'm surprised that a doctor at HSS would be doing a surgery that is out of date....But I can tell you, from my visits to various spinal surgeons, that they all have their prejudices when it comes to "procedures." I know mine would never do the IDET. I had surgery last Jan -- a lami-foraminotomy at L5-S1 after a fusion at L4-5 the preceeding Jan.performed by a different surgeon. The first surgeon who did the fusion told me he never does "that procedure" any more and kind of rolled his eyes. He said that it doesn't work with any lasting results...and sure enough, he was right. I was great for about a month!

    I guess you get the caudal and wait a month and then re-evaluated your situation. In the meantime, I hope you lay off everything and give your back a rest while allowing the caudal to work. You may just be pushing too hard too soon and not giving the disc a chance to really heal up. I feel like we've had this conversation before....

    I know it is frustrating. That's why some people get only one opinion!! Sometimes choices are tough.

  • Thanks for the advice.

    The doctor at Mt. Sinai explained the procedure is not "approved". He seemed very upset by the mention of it.

    I have found walking on any incline is a no no. The weight lifting though seems to generate very little discomfort and actually gets me through the day. I gave up on all elptical machines for a couple weeks now and cycling has been out of the question for months now. I have been following all the doctors recommended exercises since the beginning.

    I will give the caudal epidural a chance to do its work. I will ask the doctor exactly what type of PT if any he would like me to do in the weeks following the epidural.

    Let me ask you one question though as I thought about it. Is the pain traveling close to the back and away from the legs a good thing or bad thing? My pain never seemed to be in my lower back.


  • If you read the work of Robin MacKenzie, who is a well-known physical therapist from New Zealand, his exercises for sciatic pain are designed to get the pain to move out from the legs, up into the back.

    But they also say that the chance of surgery being successful is better if the pain is in the leg rather than in the back. If it is only in the back, it is more difficult to diagnose accurately.

    If the pain is in the leg it usually means that there is nerve compression. If you can get the pain to move up out of the leg, and stay that way, it usually indicates that the nerve now has enough room to function normally. Given even more time, the disc should heal up entirely and stop hurting.

    I think I told you my husband was able to avoid surgery this way...that was about 17 years ago and he was able to resume running again. He did give up playing ice hockey as skating really killed his back...but otherwise, his life has been very normal. He does his "back exercises faithfully every day. I tease him saying we could hear a tornado headed our way and if he hadn't done his exercises yet for the day, he'd be on the floor doing them as the roof blows off the house.

    I, on the other hand, the one with little discipline, am the one who ended up with fusion.
  • I think the surgery is approved by the FDA and can be performed in the US. It may be considered experimental by other surgeons since there is not a wide body of data to back it up yet. And, in the meantime, other newer procedures are passing it by. That is the case with endoscopic surgery, too.

    So much of this depends on the preferences, and the training of the specialists. You have been to some of the top programs, at least by reputation.

    If you wait a couple weeks, you can talk with DNice. She is having a microD at a hospital in an adjoining state that wouldn't be too far away from you. She searched for and wide for a surgeon and is very pleased, so far, with this guy.
  • I found a great photo to help you understand a caudal.


    Look for sacral hiatus. The doctor will thread a very thin catheter through that sacral canal and will work it up to the area where he wants the steroid to go -- I forget if you are L4-5 or L5-S1. When he gets it near the right location, he will inject the medicine and it will bathe the area in steroids.

    I thought this was a really great drawing, so wanted to share it with you.
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