Fun with big long needles

After a year, five months, and 11 days, my spine doc finally talked me into an epidural steroid injection. Well, two of them, actually.

I’d had one before, in my neck, in October 2006.  That one didn’t go so well.  While it did significantly help my shoulder pain in the long run, I had intense pain at the injection site for about 3 weeks.  Vicodin did nothing and they finally put me on Lyrica, a central nervous system depressant.  So, while that was all very exciting, it didn’t make me really enthusiastic to have another epidural.

Finally, though, this back pain wore me down.  I saw my spine doc last week and we went through everything I’ve already tried in the past year and a half, in addition to the things I haven’t tried (a very short list).  As I’ve mentioned before , my spine doc is big on injections, and once more he tried to convince me that just because I’d had one bad experience didn’t mean it would happen again….and, besides, the procedure for the lumbar spine is different than that for the cervical spine.  And double besides, even if the injection did hurt, I’d have a sore back and wouldn’t be able to skate or ride my motorcycle….and the whole reason I was at his office was because I had a sore back and wasn’t able to skate or ride my motorcycle.  OK, touché.

As with the cervical spine epidural, Peter trotted me over to Menlo Park Surgical Hospital, where I was fitted with a lovely surgical gown, booties, and hair net.   John the nurse hooked me up with a saline drip IV and took preliminary vitals.

Peter and I loitered about for quite some time as my spine doc was running a little late with his previous injection patient.  At one point, he and the nurse came in to slow down my saline bag since I was going through it too fast given the delay.  “We wouldn’t want to give you CHF over an epidural!”, they laughed, and then immediately learned why one shouldn’t make jokes like that to someone with health anxiety.  It took about 20 minutes, but Peter eventually talked me down off the ledge and things returned to relative normalcy.

The procedure itself was pretty similar to my last epidural.  I laid face down on a padded table with a head rest (“Just like a massage table! Only, uh, with no massage,” said the nurse). They prepped my back, attached a blood pressure monitor/pulse oximeter/EKG sensors, made sure I was OK with George Michael playing on the CD player, positioned the flouroscope, and got to work.

Once again, the most painful part was the local anesthetic injection.  That burns like you wouldn’t believe.  I said bad words.

Positioning the needles took the longest amount of time but was relatively painless.  There were a few moments of intense dull pain — kind of like a really bad, really deep huge muscle knot — but otherwise uneventful.

Here’s a side view from the flouroscope.  The horizontal lines are the needles; the squares they point at are the L4 (top) and L5 (bottom) vertebrae. The disc in between these two vertebrae is the one that ruptured.

Once the needles are in place, they take a bazillion photos with the flouroscope and then inject contrast dye.  This shows the doc where the medication will actually go, to make sure it’s all going to the right place.  He said this part might hurt; I didn’t feel anything at all on the first injection site, but the second one was a bit painful.  It hurt at exactly the same spot that my back has been hurting, which the doc said was a very good sign because that meant the medication would go right to where the pain was.

Here’s a back-to-front view — the black blotches coming off the needles are the contrast dye.

After that, they inject the medication, which was painless.  There was no awful crunching-cartilege sound this time…in fact, everything was coming in from the side inside of directly at my spine, so it was a lot more comfortable.

And that was pretty much that — they cleaned off my back, unhooked the sensors and IVs, rolled me onto a gurney, and off to the recovery room with me.

The nurse gave me apple juice and graham crackers, which was awesome since I hadn’t eaten in 18 hours, and rechecked all my vital signs.  My left leg was cold and tingly for about 10 minutes, and it was a little weak to stand on for my first few steps, but otherwise everything was good. After about 20 minutes, the nurse and Peter helped me get dressed and we were on our way.

And here’s the aftermath — two bandaids! :D I’m posting it since most people don’t really know where the L4 and L5 vertebrae are on the body.  The L5 is the bottom-most lumbar vertebra; below it are the five sacral vertebrae that are fused together to form the sacrum.

I’ve been staring at these kinds of diagrams for 17 months, but here’s some reference:

The injections today went into the epidural space that surrounds the spinal cord.

About an hour after the procedure, my back stiffened up and I was in quite a lot of pain.  Not anything worse than the worst of my injury flare ups, but enough that it was very difficult to walk and I was getting strange looks from people at the pizza place we stopped at.  Once I got home, iced my back, popped ibuprofen, and got into my zero-gravity chair, things calmed down.

Other than some anxiety last night, I’m doing pretty well. I slept well last night and am very sore today but nothing horrible.  I have a slightly elevated heart rate (100-120bpm), which the doc said is a normal reaction to the steroid and should resolve within a day or so.  I’m to take it very easy throughout the weekend — thank goodness for streaming Netflix and my recliner — and gradually increase activity next week.  I can see Melinda for physical therapy on Thursday if I’m up to it.  I see my spine doc for a check up in two weeks, and we’ll see where we go from there!

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5 Responses to Fun with big long needles

  1. Keith says:

    Hope all goes well!

  2. corey says:

    Craziness. I didn’t realize we had such similar issues. I’ve got the exact same disk ruptured! I did it when I Wasserstein sixteen, immediately lost a lot of gymnastics ability, but was basically okay for years barring the couple days or week of severe pain every month or two.

    then pregnancy. then back-labor (where the infant’s) body part of head pushes on that same disk during labor and birth in really horrible ways (especially w/ previous injury!). Then the carrying, changing, and wrestling increasingly squirmy, heavy and strong little girl who will throw her full weight at the full length of my arm in a dead-drop from the shoulder with increasing regularity and momentum.

    Chris has been trying to get me to go in for years, but as a body worker who deals with a lot of fallout from bad surgeries, etc. I was not eager…and oh
    Yes, i too have Anxiety. Joy. I finally caved when I realized that instead of two days in a month of distinction/pain, I was now lucky to get two days in a month without it, and often had a week or more essentially crippled. yeah… No ju-Mitzi, circus stuff, climbing, can-can, etc. As another physical person I found that it only compounded the mommy identity crisis with the useless body one.

    So… St. Mary’s Spine Center, up here, supposed to be one of the best in the country. The osteopath there got me a lovely MRI/X-ray combo wherein I got to see that my disk was not just ruptured, but instead of making a little cavity space for the spinal cord, was actually making an arrow-shape pointing into it- so nice shooting nerve pain up back, down legs, etc. Bletch.

    BUT… He gave me many options without pushing any. The one I’m holding out for before going “bionic” as he puts it with an artificial disk (not fused, still moveable) is in trials. I was a perfect candidate for it, but the test for eligibility is like what you just went through, only injecting into the disk and increasing and decreasing the fluid levels with no pain mess to determine the level of pain I’m in pre-treatment… And then I could just end up in the control and wouldn’t be able to try other treatment until the study was over… So not so much.

    But I am going to wait for it, and i’m first in line- it will be only there for a while. Basically it is this: for years they’ve been doing injection of saline in to the disk (reinflate the tire as it were) but it only works until the leaking brings it back to where it was. This treatment includes fiber tissue from your body to essentially patch the
    tire as well as inflate it. It sounds promising and unlike all the other surgical methods it wouldn’t be an irreversible change. You probably know the success rate of back surgeries tends towered 50/50 at the moment.

    Anyway, in the meantime I’m doing the stretching I know to do, and getting acupuncture, which seems to be helping. Nothing can actually heal the disk, but anything that decompressed the spine, relaxes the surrounding muscles and gets more blood flow is your friend. I recently discovered the joys of the fanny-pack heat thing. It’s got all-natural clay stuff inside, moist heat, straps around your waist and microwaves for heat and freezes for cold. It’s awesome. Otherwise I’d never leve the hot water bottle/heating pad. On muscle relaxants when i need them (most of the time) and ibprophen. It only takes the edge off when it’s really bad but at least it’s not getting into the crazy drugs with nasty side effects (lyrica eek!). I can take vocoder if I need to when it’s that bad. The muscle relaxants are important because relaxing the muscles there helps decompress everything and slow down the reactive stuff (one set of muscles tensing up from mtgs others going in a chain reaction around your body). The acupuncture really helps with the blood flow among other things. Disk tissue is like tendon tissue- it doesn’t get much blood, and blood helps you heal. To that end heat is better than cold, and thing like tiger balm and traumel are good. Ditto with whatever walking, non-stress movements you can do. This is what my osteopath at the spine center suggested. I just wasn’t sure anymore because everything hurt, but yes, walking and gentle movement stuff is good. Here’s the other thing he told me: don’t sit. As much as possible, just don’t. Stand, lie down, but don’t sit. It puts the most pressure on that part of the back. The other thing he showed me was that I need to lie down neutrally. For most people this means with the knees up, feet planted. Whatever makes your spine go flat on the floor (or side-lie to sleep, which I already do). In my case because of gymnastics my spine is only flat when my knees are over my chest. Ah well. He also said to crouch or lunge in place of sitting on the ground (or seza), but as much as possible, just never sit.

    I hope that helps, and i can point you to my doctor if you’re curious. I’ve encountered to many people who have doctors with a favorite treatment (usually surgery) which they do whenever possible. This guy was looking at it holistically and in terms of me as ann individual (unique problems as mom, as gymnast/martial artist). He gave me a lot of options and explained them carefully and made suggestions which he explained, but pushed nothing.

    Here’s hoping we can both get a bit better. I also love my acupuncturist (never did it before this). Things seem better since following the Dr.s advice on movement etc. And getting acupuncture.

  3. corey says:

    Also ack for the spellcheck weirdness. Did that post on iPad, computer currently hosed.

  4. Keith says:

    +1 to camper trailers!

  5. pennswoodsed says:

    And some of the other things Corey said . Ruptured disc and riding ,skating ? Wow are you tough ! Respect and awe from this corner .

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