I am a 63 yo man that has been having what I believe is sciatica pain. I need some advice because I can't seem to get any from my HMO.
I have had 3 episodes that have been increasing in severity.
I had a total hip replacement in 2004.
First episode was in February of this year and happened when I was asleep. At that time I thought it was a leg cramp, even though the pain was in the front of my rt lower leg not in the back where a leg cramp would be. Hey I was asleep, and didn't associate it with anything until July.
The second episode happened at the end of may and came on suddenly while sliding off of a chair that was of greater height than a normal chair. This pain was excruciating and was mostly in my hip that had the replacement surgery and I instantly thought that I had dislocated my hip because my leg would not bear any weight and I went to my hands and knees immediately. I couldn't walk and the pain was the worst that I have ever experienced. After the initial pain explosion I felt pain in my entire rt leg and foot with the most pain being in my hip and shin. I sat in my recliner which helped the pain but I needed narcotic pain meds to go to sleep. This pain started to subside in a couple of days after doing nothing but sitting in my recliner and after 7-10 days it was gone. If you wonder why I didn't seek treatment this was Memorial day weekend and my HMO clinic would probably have been too busy plus I didn't think that I could safely drive. By Monday I could walk with moderate pain so I simply toughed it out for a few more days.
The third episode was July 3 ( maybe I should avoid holiday weekends ) and happened, er well, ok it happened on the toilet for heavens sake. This episode was very much the same as #2 in pain severity but the duration is now through seven weeks. The initial severe pain lasted almost 2 weeks and on many days I had to use a walker to get around. The pain was very bad unless I was in my recliner. I couldn't stand without pain even while standing only on my left leg. I needed narcotic meds for 2 weeks to sleep at night since there was nothing that I could do while lying down to help the pain at all. Now at 7 weeks I have occasional pain while walking but it is very slight. The biggest problem now is that my foot is still numb which affects my balance while walking and stairs are difficult because of the numbness. The numbness was only noticed after about 2 weeks when the pain started to lessen somewhat.
Treatment. On 6/6 I went to see my GP however since I have an HMO he is a PA not an MD. At that time I believed that all of this was a problem with my hip implant. He xrayed my hip and said that was OK and gave me a referral to the orthopedic department. He also gave me a pain script. On 7/8 I had an appointment with the orthopedic department. Because I have an HMO this appointment was with a PA not an MD. He looked at the xray, and had me lie on the exam table while moving my legs. He said that my hip was fine and referred me to the neurosurgery dept. On 7/10 I received a call from the neurosurgery scheduler and was told the first appointment was 9/1. I said "but I can't walk" so he said that I could get an appointment with a clinic that was 45 miles away on 8/14. I filed a grievance and received an apology call from someone who got me an appointment at a closer department on 8/4. Because I have an HMO this appointment was with an ALPN not an MD. The ALPN ordered an MRI for 8/11. She wrote me a script for some prednisone which helped quite a bit, and started making the numbness get better. The ALPN also noticed a significant atrophy in my right leg. The circumference of my calf is 3/4 of an inch less than my other leg and at the thigh it is more than 1 inch less.
Here is the result of my MRI. I need to know what this means to me going forward since after 7 weeks I have not been able to see an MD and no one has called me about the MRI results.
" Lumbar spine alignment is normal. No acute osseous abnormality.
The conus is normal in position and terminates at L1-2. Infrarenal
abdominal aortic aneurysm noted measuring 3.5 cm in maximum
transverse dimension, not significantly changed.
Based on sagittal sequences, there are 5 lumbar vertebra.
L2-L3: No disc herniation. No thecal sac or neural foraminal
L3-L4: Minimal disc bulge. Mild facet joint hypertrophy. No thecal
sac or neural foraminal narrowing.
L4-L5: Minimal disc bulge and mild facet joint hypertrophy. No
thecal sac or neural foraminal narrowing.
L5-S1: Minimal disc bulge and mild facet joint and ligamentum flavum
hypertrophy. Central canal and left foramen are patent. Right
foraminal disc extrusion projecting superiorly and compressing the
right L5 nerve within the foramen, series 4, image 13. The disc
extrusion measures 10 x 6 x 8 mm, transverse, AP, CC dimension.
1. Right foraminal disc extrusion at the L5-S1 level compressing the
right L5 nerve within the foramen.
2. Infrarenal AAA again noted, not significantly changed.
The results of this study have been annotated as abnormal in EPIC,
the patient's electronic medical record. "
So does someone had any ideas on what my prospects are. Yes I am in the process of getting my medical records to an organization that employs actual Doctors but for now....
No on one the Spine-Health patient forums is medically qualified to provide any advice or
or recommendations on any diagnostic test. However, the following key words can always be applied.
MILD Treated with conservative measures such as Physical Therapy and mild medications. Many times these situations can be cleared up and the condition can be resolved.
MODERATE Some more treatments may be needed, ie Spinal Injections, Ultra sound and stronger medications. Always a possibility of more aggressive treatment if the conservative measures don't help
SEVERE Need for stronger medications. The requirement for surgery may be necessary
-- Ron DiLauro, Spine-Health System Moderator