Question
I am 24 years old, when I was 16 I gave birth to my son (2002) and ever
since had had very minor spurts of back pain which I called back spasm. I
never got it looked at. In 2005 at 11 weeks pregnant I was walking at a
90 degree angle because I was in pain all coming from my back;
regrettably I had an abortion and I was not in pain anymore. In 2008 I
went through some light physical therapy after my doctor neglected my
concerns of bulging discs after stress from working as CNA. in April of
2009 I got confirmation by new doctor who did MRI and XRAY my l-4 and
l-5 discs are bulging; I received an ephidheral injection that relieved the
pain for 5-6 months, I moved and so started the shots with another
anesthesiologist but they have not been working. After the last one of a
three shot series I went to the er for excruciating pain 2days later. I have
sciatica affecting the left side. My left foot tingled from time to time. I
decided to go to the er because no matter which way I turned or tried to
turn I was in a lot of pain so much so that I stayed in one spot for an
entire day only being able to shift my arms or legs to certain degrees. At
the ER I was given a shot of dilaudid in my right leg and a valum when
nurse came in she I told her that the valum was working enough but I was
still in pain on my left side. She came in with another dose and gave me
the shot in left thigh this time. Shortly after I was able to get up and I went
to the restroom and back, I was discharged fast and on my way out the
door my foot went numb like it was falling asleep. The lady ignored my
concerns and I went back to the ER the next day as I was no longer able
to walk the numbness and pain grew up and into my hip.  The ER sent me
home the doctor I saw there wasn't listening to me when I said I couldn't
walk. It was as if he thought I were lying. The numbness is now from my
waist down and my feet feel like concrete blocks being hauled around. I
can not walk still with falling and adding pain to my thighs and calves. At
one point there was a fire burning pain radiating down the back of my
legs, much worse than the sciatica I have been trying to treat. The ER visit
was Friday, October 28th. I am on a medrol dose pak but I don't think it is
working. I also was prescribed flexaril which I have been taking too, I am
on gabbapenten, which hasn't been helping dilaudid pill form: Which I
have not taken, and ibuprofen 800 which I have not taken as much either.
My concerns here are with my legs of course I am terrified I will never
walk again. I have not gotten any answers from anyone. What can I do.


Answer
Dear Alicia,

This is a potentially very serious problem, and your concerns about walking again might be legitimate.

There is a condition called cauda equina syndrome in which the compressive forces upon the lower, ending part of the spinal canal become so intense as to shut off nerve function to the lower extremity (are you loosing bladder or bowel control?). The good news is that most lumbar disc and nerve problems begin to heal up and the critical/severe stage resolves itself into your old chronic nagging problem, usually within weeks to months. Many lumbar disc problems never require surgery... but some do, and some are emergency surgeries.

Your emergency room physicians are going to basically evaluate you to determine that you are medically stable (not going to die), then hop you up on heavy pain medications with the hope that you will go home, that the pain will subside, and you will begin to heal. The medications that you are taking do not heal you, no matter how many that you take, and no matter which ones. The disc problems that you describe have a tendency to progress with time and repetitive injury.

Lumbar disc problems are different for everybody, and they can range from mild to severe. The problem is that all of them can cause significant pain. The good news, as stated earlier, is that few require surgery. I have had many patients in my office with MRI-confirmed disc injuries and bulges. We treat them very well, helping them to learn proper lifting techniques. We also teach exercises, we do decompression traction, and we perform appropriate chiropractic manipulation or adjustments. Once they are at maximum medical improvement, we see them once per month for adjustments and tell them to continue their exercises for the rest of their lives. The smart ones do what I say... the others suffer relapses.

This is what I would do if I were you:
1) You need a neurologist MD to do another examination, and likely order another MRI. Disc problems can advance. A neurologist would determine the current state of your lumbar discs and determine if you are a case that needs immediate surgical intervention or if you should continue on the pain meds.
2) If your neurologist determines that you do not need surgery, you will have to allow yourself time to heal. Please remember, however, that you need to monitor yourself closely. If you are not healing with rest and medication, you go back to the neurologist for follow-up and re-evaluation again... and again... if needed.
3) Once this horrible episode subsides, either through medication, rest, injection, or surgery, you need to find a chiropractor in your area that can assist you with true recovery and rehabilitation. A good chiro will teach exercises and will take his/her time to evaluate you, diagnose you, and perform appropriate adjusting techniques, taking into consideration your history.  If you find one that ignores your history and immediately starts just talking about bones out of place and adjustments... without referencing your disc issues, you should likely find another. Ask around, find one that others that you know trust.

The most critical thing, however, is to get you through this crisis. Get to a neurologist NOW. Don't risk the potential of long term nerve damages. The ER will likely not direct you to one... insurance cost containment strategies pretty much dictate that you are drugged for pain and muscle spasms and sent home. You will have to find a specialist on your own.

Alicia, good luck with this. I know that it is causing you a horrible amount of pain, and I understand your worry about long term problems. Find a Neurologist and put your mind at ease. Make sure that they get you in quickly. Tell them how your legs are loosing strength. If they stall you, ask them if you are at risk for permanent nerve and muscle damage. Make them make time for you ASAP, or find one that will.

I hope that this helps you!