QuestionQUESTION: Dear Dr Dolan,
I am a 39 years old and in March was diagnosed with small herniations at L3-L4, L4-L5 and L5-S1 with impingement on the nerve. I was in agony with lower back pain and left leg pain. I also had funky things going on like circulation issues,mottling of my upper legs,different skin sensations and my middle toe on my right foot hurt more than my back at one time. It was enflamed and very painful. Eventually it turned kind blue and then went away. I was then diagnosed with Chronic Regional pain Syndrome and was sent to see a pain specialist. I then started Lyrica and steroids and had many injections and nerve blocks. Nothing was helping me and I was getting worse. I started to have foot drop and severe leg pain. I finally had surgery eleven and half weeks after the injury(You should know I did not have a traumatic injury or anything). They removed a large fragment that was lodged in the canal right up against the nerve, that was never seen in the two MRI's I had prior to surgery. Needless to say my surgeon was shocked at what he found. I am now eleven weeks post-op and I am having severe leg pain once again down the back of my leg into my foot and it is worse than before. I am getting the runaround now with my neurosurgeon but he did order another MRI and I was told that he didn't really see too much other than normal post-op swelling. I got the report from the radiologist and it says that I have scar tissue from the epidural injection at the nerve root along with mild bulging at L4_L5 and still the small herniations above. My neurosurgeon said the radiologist overread the MRI and he doesn't see any of that. Frustrated because I am in so much pain I had a friend's father who is a radiologist also read the images and he consulted with a specialist for neuro radiology and they did agree with my neurosurgeon but he also said there is another fragment,confirmed by both. How can everyone have such different opinions and what do I do now? I am currently taking Lyrica 100mgx3 and Vicadin 7.5 x3. I am frustrated and in so much pain. Please help.
ANSWER: Hello Jennifer,
I am very sorry to hear of your situation.
To have your problems and pain at any time in life is not fair, and worse since you are so young.
Let me set up some background: I am a Doctor of Chiropractic, so my education, license and experience will give me a certain perspective, a certain bias. Be aware that ANYONE you talk to has their own perspective, and that translates to having a bias, possibly even having an agenda. Any website, fellow patient, or doctor of any discipline will have a prejudice.
That said, even as a Chiropractic Doctor---- I will not disagree with your decision to have had surgery; especially since they found a fragment floating around or captured,,,, there really is no other way to treat a disc fragment.
Some other background information: Many people have herniated discs, bulging discs (and I do not know what a 'slipped disc' is), deteriorating discs, etc. Different people react differently to the different diagnoses, different test results. You may have a herniated disc (HNP= herniated nucleus pulposis) and have NO pain- you may run marathons!, while I may have a herniated disc and barely get out of bed. What is the difference?- it is not "pain tolerance"--- different bodies react differently. One person may have a large spinal canal which allows a disc herniation to exist,,, and it does not press upon/ irritate/ 'pinch' any of the nerves. One person may have a small spinal canal-- snd there is no 'extra' room to play with- and therefore even a 'small' disc herniation can cause symptoms. Each person is bioCHEMICALLY different- and the chemical component of inflammation, of pain is highly variable person to person.
As a Doctor of Chiropractic, with regards to spinal imaging, I feel very comfortable and competent. However- all of my Xrays, CT, MR examinations are reviewed by a radiologist (whether a Chiropractic Radiologist or Medical Radiologist). I do lots of different stuff in my office--- the radiologist ONLY reads films all day; I would defer to the radiologist opinion when reading imaging.
Chiropractic does have different specialties- similar to medicine. Just as a Medical Doctor can have an additional credential in orthopedics, neurology, sports injuries, or radiology- so do Chiropractic Doctors - see: http://www.acatoday.org/pdf/ApprovedChiropracticSpecialtyPrograms.pdf
A Radiologist I would recommend that you allow to view your films, teaches at medical schools, authors radiology texts- would be Dr. Terry Yochum - see: http://www.rmcrc.com/INFORMATION%20SHEET.pdf
Dr. Yochum is a Doctor of Chiropractic with a Radiology specialty. Perhaps he could review your films.
MRIs, Xrays, CT scans, blood tests, etc, etc, etc-- all of these tests are important, but just as important is YOUR function and how YOU feel. In My Staten Island Chiropractic office I utilize information handout sheets- perhaps this will be of help to you:
Disk Herniation
Low Back Pain can be caused by many different things.
Big, BAD, catastrophic things like a tumor or a cancer can cause low back pain (only a proper exam by a licensed doctor, like your Doctor of Chiropractic, or your family Doctor of Medicine, can evaluate your signs and symptoms, and perhaps refer for testing).
Big, bad things like a Herniated Disc, sciatica, possible fracture or dislocation can cause LBP (again, best evaluated by your DC or MD, and perhaps referral).
Bad things, like - Sprains, Strains, contusion, or Vertebral Subluxation Complex (all very efficiently diagnosed and treated by your Doctor Of Chiropractic.
Sometimes LBP is caused by a Herniated disc: Herniated disk is actually a quite common condition.
However, the course of the condition is highly variable. Some patients with a herniated disk literally cannot walk, yet other patients with similar MRI findings may be able to run marathons or lift heavy weights. Some people suffer for only a few days with pain and symptoms, some people suffer for months.
Although the course is highly variable, there are certain steps that are always helpful to follow: Ice the area when painful- 10/ 15minutes on, 30/ 45 minutes off; avoid certain postures and movements; bend the knees when coughing or sneezing; bend the knees when lifting anything; do not extend legs straight out when sitting, laying down, lifting, or driving. Avoiding certain movements and postures will prevent aggravation of the condition. Practicing good postures and movement patterns will help the condition heal and be less painful. Disk Herniation is often caused by, or often concurrent with the Vertebral Subluxation Complex.
Vertebral Subluxation Complex (a.k.a. 憇ubluxation?
The vertebral subluxation complex is the underlying cause of many healthcare problems.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
Subluxation is a serious condition identified by its five parts:
Spinal Kinesiopathology:
This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.
Neuropathophysiology:
Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.
Myopathology:
Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.
Histopathology:
A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.
Pathophysiology:
The VSC contributes to OsteoArthritic degeneration. Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position. When subluxated, joints are in a stressed, vulnerable, compromised condition. Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.
Vertebral Subluxation cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone. Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction- - - a manipulation, best performed with the chiropractic adjustment.
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PAIN
Pain is a 憆ed light on the dashboard?
Pain is your body telling you that something is wrong.
That RED LIGHT on the dashboard of your car-
-- do you ignore it until the car breaks down,
or do you get it checked and correct the problem?
Pain,
pain in your body-
-- do you ignore it until your body breaks down,
or do you get it checked and correct the problem?
Pain,
do you cover up the pain by taking a painkiller?
Take a painkiller,
mask the pain,
and allow a problem to progress in your body?
NOTICE ON PAIN RELIEVERS:
Label changes ORDERED by FDA; the FDA announced proposed label changes for OTC over-the-counter pain relievers to include the potential for stomach bleeding and liver damage (FDA news 206- 207; 12-9-06) ;
The American Heart Association issued a scientific statement recommending medical doctors change the way they prescribe OTC pain relievers from a first choice to an alternate of recommending non-pharmacologic treatment (AHA statement 2-26-07).
NSAID Acceleration of ARTHRITIS; an important side effect of Aspirin and other NSAIDS is that it will inhibit cartilage repair and accelerate cartilage destruction ( Journal of Rheumatology, 1982; 9: 3- 5 ). Many times people take NSAIDS for the pain of Arthritis, not realizing these drugs may make the underlying condition worse. These medications cover up the pain, and cause the problem to worsen.
Pain can often be the result of the Vertebral Subluxation Complex.
Vertebral Subluxation ( 慥SC?, 憇ubluxation? )
Vertebral Subluxation is actually a quite common condition. Doctors of Chiropractic look for pathological conditions which may require referral to other specialties, and also look for 慡ubluxation? Other disciplines look for pathology, but overlook the importance of alignment and movement in the spine which affects our nervous system (the master control system- ALL health disciplines learn this). VSC- 慡ubluxation??can be the cause of many symptoms and conditions.
Only a Doctor of Chiropractic will evaluate and treat for VSC, as well as other pathology.
The course of VSC is highly variable. Some patients with VSC literally cannot walk, yet other patients with similar test findings may be able to run marathons or lift heavy weights. Some patients immediately develop symptoms related to the VSC, some patients take years to develop symptoms. Some people suffer for only a few days with pain and symptoms, some people suffer for months. Some people recover in days, some take months or years, depending upon severity of the condition.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position. When subluxated, joints are in a stressed, vulnerable, compromised condition. Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.
Vertebral Subluxation cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone. Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction- - - a manipulation, best performed with the chiropractic adjustment.
Dr. Victor E. Dolan, Doctor of Chiropractic; Diplomat, American Chiropractic Board of Sport Physicians; Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST Chief of Chiropractic in a Hospital in New York State (DHSI); As Seen in PREVENTION Magazine
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".......there is another fragment,confirmed by both......."- there is another fragment?- Then it is very likely that you will need another surgery; please consult with a neurosurgeon on this point.
Scar tissue?- very common with any invasive procedure. Appropriate rest, followed by appropriate motion, movement, rehabilitation is needed to minimize adhesion formation.
You may want to try a regimen of conservative chiropractic care, perhaps it could be helpful and prevent further surgery,,,,,,, but given another free fragment... surgery is probably in your future.
I would recommend contacting Dr. Yochum for a radiology review of your films (see above), I do believe he provides such a service. If not him, then some other radiologist who specializes in spine.
AFTER review of the films by Dr. Yochum, depending upon his findings, perhaps a trial of chiropractic care.
And, after all of that, perhaps surgery is just plain necessary in your case.
"........How can everyone have such different opinions and what do I do now?......."; as you can see with the MRI pictures--- different people look at the pictures and see different things. That is why YOUR function, how YOU feel is more important then any test results.
I hope the above discussion helps you. Besides information I have given you at least one action (Dr. Yochum, or other chiropractic radiologist) to take.
If you need further,,, do not hesitate to REcontact me here at
AllExperts.
http://www.allexperts.com/ep/965-100794/Chiropractors/Victor-Dolan-DC-DACBSP.htm
Wishing you Good Luck, Good Health,
your Internet Chiropractic Staten Island Expert,
Dr. Victor Dolan, DC DACBSP
http://drvictordolan.chiroweb.com - - -- - Email NewsLetter
---------- FOLLOW-UP ----------
QUESTION: Do you have any input as far as the RSD/CRPS?
AnswerHello Jennifer,
Thank you for your followup question. I return from a short break, and find you in my Email!
RSD/CRPS , as you know is a tricky, difficult, complicated diagnosis to treat. I do not believe anyone has the definitive cause or treatment.
I have treated RSD/CRPS in my office; sometimes people respond favorably, sometimes they do not.
What is the difference???- I do not know.
Again, I recommend that the imaging be re-reviewed by Chiropractic Radiologist Terry Yochum (see above). IF chiropractic is indicated, I would begin a conservative course of chiropractic, with an additional emphasis on nutritional supplementation.
Again, some information I handout in my Staten Island Chiropractic office- this time with nutritional advice:
揚inched Nerve?
( Also Known As- neuritis, neuralgia, brachial-neuritis, sciatica )
損inched nerve??is only ?a diagnosis, WHAT is causing the 憄inch?
Your Doctor of Chiropractic will examine and evaluate you to make sure you are not showing signs of neurological damage or disease, tumors, cancers, severe pathology, perhaps a Herniated Disc, or a Vertebral Subluxation Complex.
Sometimes we can wake up with a 憄inched nerve? or a muscle spasm.... sometimes a slip, trip, fall, heavy lift, or even a motor vehicle accident can cause a 憄inched nerve? Very often - the true c a u s e of the pinched nerve, painor numbness in the: neck and/ or shoulder and/ or arm and/ or hand; pain in the back and/ or buttock/ hip/ leg/ knee/ foot - is a misalignment, a 慿ink?in the neck or back - more properly termed a Vertebral Subluxation.
Vertebral Subluxation Complex (a.k.a. 憇ubluxation?
The vertebral subluxation complex is the underlying cause of many healthcare problems.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
This is a serious condition identified by its five parts:
Spinal Kinesiopathology:
This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.
Neuropathophysiology:
Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.
Myopathology:
Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.
Histopathology:
A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.
Pathophysiology:
The VSC contributes to OsteoArthritic degeneration. Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.
Automobile accidents, improper lifting, improper posture, alcohol, emotional stress, chemical imbalances, and long periods of sitting can cause the Vertebral Subluxation Complex.
Vertebral Subluxation cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone. Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction- - - a manipulation, best performed with the chiropractic adjustment. For good health-
Treat the Cause, not just the Symptoms.
揚inched Nerve? ( Also Known As- neuritis, neuralgia, brachial-neuritis, sciatica )
損inched nerve??is only ?a diagnosis, WHAT is causing the 憄inch? ?That 損inch?has to be taken care of FIRST!
As the 損inch??the MECHANICAL component of the problem, the CAUSE of the problem is being taken care of through Chiropractic treatment, perhaps additional help would speed your return to health:
Nerve Health Support:
-----B complex containing thiamine, folic acid, B-12 and niacin is highly suggested for nerve support. High dose
B-vitamins should only be taken at the advice of a licensed healthcare professional.
-----B-6 is lower in patients with neuropathy. Vitamin B-6 reduces the glycosylation that can cause nerve damage. Amounts greater than 200mg/day can cause neuropathy symptoms.
-----Calcium and magnesium are important for nerve conduction and as muscle relaxants.
-----A multi-vitamin/mineral supplement is suggested for comprehensive support.
-----Essential fatty acids are necessary for nerve health. Essential fatty acids include omega-3 fatty acids (fish and flax oil) and omega-6 fatty acids (black currant seed oil, borage oil and evening primrose oil).
-----Proteolytic enzymes may be beneficial in neuritis for the inflammation.
-----Lecithin aids in nerve support.
-----Natural herbal remedies including passion flower, valerian, chamomile, scullcap and white willow bark may be helpful.
-----Eat a healthy diet. Avoid foods that stimulate the nervous system such as caffeine, chocolate, refined sugars, soda pop and cigarettes.
-----Drink plenty of filtered water.
-----Chiropractic care is imperative to remove nerve irritation.
Joint Support:
-----Glucosamine sulfate helps strengthen joint integrity. Glucosamine is effective in relieving joint pain associated with osteoarthritis. Glucosamine's pain-relieving effects may be due to its cartilage-rebuilding properties. These disease-modifying effects are not seen with simple analgesics and are of particular benefit.
-----MSM is known for its pain-relieving properties in such conditions as fibromyalgia, osteoarthritis, bursitis, tendonitis, back pain and muscle soreness. Not many clinical trials have been done using MSM, but clinical observations support the theory that MSM is beneficial in pain managment.
-----White willow is an antiinflammatory and analgesic agent. White willow was used as far back as the Middle Ages to reduce pain and fevers. The salicylates found in the white willow bark are responsible for the anti-inflammatory and anti-fever effects. Acetylsalicylic acid, otherwise known as aspirin, is chemically similar to the salicylates.
-----Boswellia and turmeric (curcumin) are potent antiinflammatory herbs. Curcumin may have similar action to aspirin.
Dr. Victor E. Dolan, Doctor of Chiropractic; Diplomat, American Chiropractic Board of Sport Physicians; Diplomat, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST Chief of Chiropractic in a Hospital in New York State (DHSI); As Seen in PREVENTION Magazine
I wish I could be more help on the RSD/CRPS, but this is the best I have at this time.
I wish you good luck, Let me know what the radiology review reveals.
Dr. Vic Dolan, DC
Email newsletter: . . . . . http://drvictordolan.chiroweb.com
