Sciatic Nerve Problems

[ThaiPauly]

I had the test results of my MRI Scan today and once again the Doctors at the reputable? Chaing Mai Ram Hospital have changed their diagnosis and say that it is NOT a sciatic nerve problem but is AGAIN a degenerative bone problem. This is what the result read word for word:

"the study shows that there is mild posterior bulging of L4-5 disc with flattening of the thecal sec anteriorly. Posterior bulging of L5-S1 disc is also seen with decreased T2W signal suggestive of degenerarive change, but no pressure effect on thecal sac is noted. Thickening of ligamentum flavum on L3-4 and L4-5 level are seen with slight narrowing of spinal canal. Bilateral neutral foramina are roomy and no nerve roots compression is seen. Bone structures are intact and no change of bone marrow signals is evident"

Does the above make any sense to anyone?

The Doctor treating me for this is telling me that this is an incurable condition but with regular accupuncture,excersise and generally not over-exerting myself the pain will be releived to some extent.. Quarterzone injections can be substituted for Accupuncture.

Obviously this result is a BIG dissapointment as he is saying that there is not much he can do about it. I am only 50 years old and I cant imagine a life whereby I just cant be my old self.

I have kept the MRI scan I am wondering if it is worth getting a second opinion because the Doctor says the results speak for themselves.

Any feedback to this would certainly be appreciated.

Many thanks for your time and assistance in these difficult times for me.

TP

[buadhai]

Where, exactly, do you experience pain?

I would suggest the same course of treatment I gave in the previous thread. If you have back pain (as opposed to butt or leg pain) associated with the degenerative disease then start out with an OTC pain reliever like aspirin or ibuprofin. If your stomach is sensitive to either of these, then try acetomeniphin (Tylenol is one brand name) instead.

Regarding the report: doesn't the sciatic nerve leave the spinal column at L4-5? L5 is the last vertebrae before your sacrum.

I would avoid getting hooked on Cortisone injections. Most physicians won't do it often enough to keep the pain at a consistent low level. If the acupuncture works for you, go for it.

[taxexile]

i dont have the anatomical knowledge to understand the results , but a good anatomy textbook (greys , or is it grays , anatomy) or a suitable website should be able to identify all the named landmarks on the vertebra and give you a clearer picture of the physical changes occuring in the affected vertebra.

if you havent done so already , then check some of the orthopaedic websites and look for your symptoms and all the differential diagnoses , search for some health forums concerned with sciatica and vertebral conditions ,

what is the name of this degenerative bone condition?

most importantly though , i would certainly get a second and third opinion before accepting a diagnosis , maybe someone can recommend a good orthopaedic specialist in bangkok.

good luck.

[waldwolf]

Without knowing your whole medical history no-one can accurately determine what/where/why you have this problem. Possibly you had prior injuries in your younger years, such as in sports, or maybe it just part of the aging process. We all age differently.

First, you definately should seek a second opinion. IMO "a bulging of the disk at L4-5" and the doctors statement "it is NOT a sciatic nerve problem", raise many questions.

There are a number of degenerative bone diseases, such as Spinal Stenosis, which is a narrowing of the spaces between vertebrae, wherein disks seperating the vertebrae are compressed (flattened) and pushed into the spinal canal.

If you have pain radiating down either, or even both legs, most likely there is or was some sciatic nerve involvement in the past.

While the body produces natural cortisone, drugs of the same name used for human injections are artifical and fall in the chemical group called steroids. While not identical to the infamous anabolic steroids used by some athletes, they can, if not used properly, weaken tendons and soften cartilage. Continious use is not recommended.

Physical theropy, such as traction and exersise may offer some relief, however in the end you need an very experienced professional who can properly diagnois your condition.

Good luck and keep us posted.

cheers

[austen]

And just to add another plug for accupuncture, I was also diagnosed with disc herniation-induced sciatica a while back and really do stress the benefits of accupuncture. It's something you have to commit to, but you can work up to having treatments fairly intermittently, depending on your pain (yours, admittedly, sounds much greater than mine).

McCormick Hospital was never my favorite by any means in CM, but they have a fantastic accupuncture therapist there that I can't recommend highly enough--cost is very affordable (actually, mine was covered under Thai Social Security as it was a referral from a GP) and she's excellent at explaining things in terms of Western science (she's actually an anesthesiologist at McCormick as well, which I'd say is a plus)...lots of Westerners go there and Thais alike, for minor aches and pains to a few elderly regulars who claim accupuncture has gotten them out of their wheelchairs (their claim, not mine). Anyway, just a recommendation from personal experience. Have to say that after moving to BKK, I miss having her there!

Best of luck...

[griffer]

since my operation i have become friendly with the surgeon who performed on me...if u would like a second professional opinion contact me and i will put you in touch with him.

[ThaiPauly]

Thanks everyone for taking the time to reply.

The pain I experiebce is in my butt and down my leg, the Doctor has diagnosed that I have Myopascial Pain and the diagnosis is Fibromyalgia.

I have had 2 sessions of Accupuncture so far and certainly on day one and the morning of day 2 there was a marked improvement with the pain returning intensley on Tuesday afternoon at its normal level, even though I had been swimming and done excersises recommended.

Anyway if anyone has heard of this condition I am eager to hear your thoughts.

Many Thanks again

TP

[ronz28]

Back Problems

Do you sit on a wallet in your back pocket all day long? Try moving it to your front pocket. Is your belt or waist band or your slacks a little tight? Do you fall asleep in a chair. What might you be doing to cause a little too much unequal pressure on your back? Have you tried a 3 inch memory foam mattress topper on your hard bed? I have had such severe back pain and pain on down to my foot in the past I was unable to sleep but am totally out of pain now by taking a muscle relaxant for two weeks and at the same time correcting those aforementioned problems. Hope this helps...

[chuchok]

I would get another opinion TP. I could be totally wrong, but it is very easy to give you these diagnosis ,unless they can show you the exact trigger points of the pain and exactly what causes it in laymans terms.

Here is a couple of web sites that might help.

Myofascial

Diadnosis of fibromyalgia

[ProThaiExpat]

There may have been a strarting thread I missed. Anyway, back pain in modern man is one of the most difficult problems to diagnose and treat. So your up against it and anything that relieves the pain, short of surgical intervention should be tried.

I read your MRI carefully and it appears to be about normal for a man of your age. Orthopedists often characterize backs on x-ray and MRI as young, middle aged or old backs. It is in that context that I refer to your back as normal for your age. Your back starts to age after puberty and it is literally downhill after that, the degree of degeneration varying with each individual.

I have read many MRI reports and yours reads without significant clinical pathology. Your doctors advice, based on the MRI results, are sound in my view.

Your symptoms of radiating pain over the buttock and down the back of the leg is classic sciatica. This dermatone pattern identifies the nerve root involved, the one between L5 and S1. Your MRI does not suggest the nerve root is being compromised by impingement from bulging or heniated disc material at that level, so the doctor reading the MRI correctly rules out disc involvement (differential diagnosis) and looks to the most likely other cause of nerve impingement, muscles.

You mention doing exercises, if in fact they are Williams flexion exercises then your are heading in the right direction. If a six weeks course of physical therapy hasn't helped, then medication for pain and muscle relaxants should be tried. Sometimes, subluxations are present and chiropractic helps, if the course of treatment is limited. Accupucture is reported to me helpful in some cases and should be tried.

The bad news is that the L5-S1 disc space is the space most often involved in degenerative disc disease and low back pain as it is the joint that takes the greatest stress and force torsion in the back. Many people never free themselves from this kind of pain regardless of what doctors they have seen or what treatment they have received, including surgery.

PM me if you have specific questions regarding anything documented in your MRI. Each finding, while not clinically significant pathologically, does say that your back is not in bad shape physiologically, despite your pain.

In other words, your MRI does not identify a likely cause of your back pain clinically, far from satisfying, but good news when compared to a MRI that yells herniated disc and immediate surgery.

Palliative treatment of your back is what your doctor is really saying. That is, try anything not invasive, hope for the best and if your lucky, you will stumble on something that relieves your pain without medicating for the rest of your years. Rarely a day has gone by since I was your age that I haven't taken a couple of Tylenol for releif of musclar-skeletal discomfort. Hasn't slowed me down.

Generally, medical advice for a back reported through MRI as yours, is physical therapy, Williams flexion exercises, posture control and a lot of walking. Sitting and laying down incorrectly is definitely bad for your back.

Sleeping on your back may be troublesome, depending on the degree of your lumbar lordosis. Side sleeping with both knees drawn up in the foetal position is best with a pillow bettwen your knees.

The thickening of your ligametum flavum may be suggestive of muscle impingement on your sciatic nerve, depending on degree and position.

Keeping your back muscles limber, stretched,active and strong is the best for you. The stronger your longitudenals are, the more support they are giving to your spine and relieving it of its weight burden.

Keep at it, you are your best doctor since your the only one in your skin and know the details of your pain and what relieves it.

A second opinion is a waste of money, but in Thailand it is inexpensive, so why not. The MRI is diagnostic in and of itself and unless you seek advice from a Ortho or Neuro who is willing and expert enough to read your MRI films himself and ignore the current report, he will be operating from the same fact base and the likelyhood of his opinion differing markedly is extremely remote.

I would keep a diary of your pain, when it comes on, how long it lasts, what aggravates it and what relieves it, so you have an accurate chart of your pain for the doctors to review in hopes of reaching a "symptom" related diagnosis.

Much good luck, there is a chance you will find relief of your pain but prognosticating what will work based on your MRI is problematic. There are many cases of spontaneous remission of pain in chronic cases, but I don't have enough information regarding your duration of pain to even say your back is chronic.

Your choice of words "back to my old self" are prothetic as you are now your "old" self, your youth and "young back" are gone and playing the cards dealt to you, rather than praying for a "new deal" is what will make the rest of your life worth living. I am confident, from having read many of your posts on other subjects, that you have it in you to keep trying until you reach an accomodation with your back, one with which you can live with. Perhaps, not a fantacy trip of what you used to do with it, but a "stand off " with its present condition.

Edited May 11, 2005 by ProThaiExpat

[ZZZ]

ThaiPauly,

I'm about your age and had the same (similar) problem. It was a bad pain one side of the lower back down one leg. The pain was worse if lying down or sitting and not to bad if walking but still bad enough to constantly be on my mind.

About a week ago I decided to do something about it and now it's just about gone, at least I don't even think about it for most of the time.

What I've done is (parts of it have been mentioned by others):

1. Three times per day I do some exercises, about 5min each time. Make sure to take it easy, do not over do it. Do all the exercises slowly and avoid twisting your back when changing positions.

AA. Lie down on your stomach and lift opposing leg and arm, repeat with the other leg and arm, repeat 50-100 times. This feels good, strengthens muscles and straitens your back.

BB. Do a push up but leave your lower body on the floor arching your back backwards. Hold the position as long as you are comfortable, repeat a few times.

CC. Lie down on your back, pull up your knees towards your chest and hold them down with your arms, this could be a bit painful to start with. Then rock gently backwards and forwards 25-50 times, then sideways 25-50 times.

DD. Stand up and lean against a wall with the feet about 30cm away from the wall. Slide down the wall with a straight back until the angle at the knees is about 90 deg. Hold the position as long as you can, hurts like ###### in the legs when not used to it.

EE. Stand up with you feet about 30cm apart, slowly turn your upper body left to right with the arms swinging loosely with the body, about 50 times. Don’t over do the twisting.

2. Be very conscious about how you move during the day. Try to avoid twisting your waist, use your legs or your head if you have to turn around. This is especially important if carrying anything. It’s good to turn your waist in a controlled exercise like above but otherwise it’s very easy to turn to quick and this could cause you pain for the rest of the day. After a while this will become second nature but try to think about how you move for the first few days.

3. When sitting down always use a lower back support and be conscious about how you sit. Head above shoulders, shoulders above hip and straight back. This goes for watching TV as well, make sure you have the right posture in the couch use pillows to support the lower back.

4. This point may be the most important as it involves one third of your day. My pain was worst when I got out of bed, during the day it usually got a bit better. Try to sleep on your back. I know this could be difficult, I used to sleep on my side or stomach. To make it easier put a pillow under your knees, this will give you a better angle of your lower back and it will also stop you from turning around in bed. After starting to sleep like this I have no problems in the morning and I sleep a lot better.

I’m not a doctor and can not guarantee anything but the 4 steps above have just about cleared my back pain in less than a week. Hope it works for you.

[udonguy]

i get this too - a side effect of DDD (Degenerative Disc Disease) which we all have to a degree or another - a sign of aging I'm afraid (I take arcoxia)