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How aggressive should I be? And should I consider surgery?

Background--my back pain started over a decade ago when I hurt my lower back pulling weeds. I think that weakened it, but I didn't have very many episodes again until 2013, when I hurt my back so bad (no discernable reason) that I could not walk more than a few feet. At the time, I did all the usual--PT, saw a neurosurgeon who reviewed my MRI and then laughed at me when I suggested surgery because I had no pain down my leg. Understandably. I knew nothing about back pain then. I did have a bulging disk. It took probably 6 weeks to get back to normal activities.

Then, three years ago, I was working in a position where I had to do a lot of lifting. Not super heavy, nothing over 35 pounds or so, but I began having leg pains. At first I thought I had pulled something in my leg, but an urgent care doctor said it was sciatica and ordered another MRI, more PT, and restricted my lifting.  When it started to get better, my PCP said she thought it "would be fine" if I continued to lift on a daily basis, even though the MRI showed bulging disks at L4-L5 and L5-S1. I didn't believe her and got a different position without the lifting.

Since then, I've had probably 3-4 incidents of back/leg pain per year. I was just living with it, basically, and whenever I had a flare-up I'd take a day or two off work and down some pain pills. I've also had about 4 steroid shots in my back in the last year and a half to bump down the leg pain, and it's always worked pretty well before.

Fast forward to early June of this year (2018, almost 6 weeks ago). I was getting ready to buy a house, and moved some stuff around in the garage. The next day I had the usual flare-up--bad enough that it hurt to get out of bed, but it started to fade a little after a few days and I was up and around again. I was slowly recovering, and also realizing I couldn't lift anything, which would make it hard to move. Then, 2 weeks ago, I was just standing at the sink doing dishes when I felt my butt cheek tightening up more and more the longer I stood there. I decided to go lie down, and every time I got up took more steps it would start to hurt even worse. Finally, that evening, I got up to go to the bathroom, and it was so excrutiating on the way back to bed (felt like someone shoved an ice pick straight up my butt cheek and into my spinal chord). I screamed and dropped to the ground, and had to crawl back to bed. I called my cousin, crawled to the front door, and he took me to the ER. They did very little--just gave me a morphine shot in my hip so I could walk again.

When I got home I laid in bed for two days, only getting up to go to the bathroom. Then it started to recover again, and the pain moved down into my leg. I followed up with my PCP, who sent me to PT but refused to take an MRI, saying it would have to be "new" symptoms or if I was getting ready for surgery. She said to return if I had "worsening" symptoms. 

Over the last weekend, the symptoms did worsen. My leg pain got so bad that I couldn't sleep at night, even with pain pills, ibuprofen, muscle relaxers, aspirin, gabapentin. But I knew I had a steroid shot coming last Tuesday, so I stuck it out until then. I got the steroid shot, and the first couple of days, the pain was about half. But now it's back up again, three days after the shot, almost as bad as it was last weekend, and I'm waking up from the pain. Oh, and my right two toes on my right foot are numb. In the past week, I've also had 3 chiropractic visits and one PT session, where she told me if I didn't show improvement in 3 weeks she would let my doctor know.

When I talked to a friend, he told me he had the exact same thing happen, and he went right in, got an MRI, and had surgery, got out the same day. and a week later was up and walking around again, good as new.

That really made me mad, because my physician won't even give me an MRI. Should I be pushy about it? 

Also, I understand the philosophy of waiting it out with PT because "after a year, the results are the same." But here's what I don't get. If it's a choice between "wait it out" with PT for 3 weeks more of suffering, or have the surgery and be up and around a week later, why wouldn't I have the surgery (talking about a discectomy here, not a fusion)? I've read so many stories on here, about people who were so proud that they made it without the surgery, but it's now a year or two later and they're walking with a cane and can't lift more than 10-12 pounds. If the results are the same with surgery, only faster, why should I "tough it out"? Also the numbness in my toes concerns me, and I'm afraid this is just going to keep happening over and over again.

I'm perfectly willing to continue with the PT to build up my core, either way. But work is starting again in a few weeks (I work at a school, off for the summer, thank goodness), and I'm afraid I won't be able to go back to work with the pain I'm in now. 

Sorry this was so long. This was my first time on here, so I had to get my whole story out, lol. Thanks for any input!



  • dilaurodilauro ConnecticutPosts: 13,419

    I would seek second or third opinions. Its not the correct thing to do is insist on a MRI or any diagnostic tests.  The way insurance works today, its not the doctor that has to approve these tests, its the insurance company.   So, the doctor has to feel there are enough clinical reasons for them to write up the justification to the insurance companies.   They are tough and refuse so many tests.

    The one thing that I would be concerned about is the leg pain.  Having a bulging disc or two may be uncomfortable, but many times through conservative treatments they can heal.  But when the pain is going down your leg, like sciatica pain, there would be a disc that is impinging a nerve root.   But it seems so far, that your MRI's, nor you current condition back this up.

    But when it comes to nerve pain and damage you dont want to wait.  The longer a nerve is being compromised the larger the chances of it not completely healing.

    I would take all your current medical records along with the MRI images and reports and find another spinal specialist.  Sometimes , a second pair of eyes can see things the first do not.

    One  last thing, avoid chiropractors, especially since you already known you ave disc problems and suggest nerve problems.   Some manipulations can cause great more damage than good

    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences 
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