Well, three not one...

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Ysabel Kid
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Well, three not one...

Post by Ysabel Kid »

Well, this explains it.

My back has been acting up for months. Workers Comp, in their usual efficiency (I'm being sarcastic), took 7 weeks to approve my last injection. Lo and behold, it didn't really help - probably because it took so long. So I asked for a new MRI to get an idea of whether another injection will help, or we need to move on to more aggressive action (which would be my third back surgery). Met with my doctor this morning and, WC failed to send him the imaging and results. :evil: But he was able to get them sent while I waited and the good news is that it does explain why my pain levels have gone up so much. The bad news is that I now have three herniated discs (L5/S1 - the original, plus L4/L5 and L3/L4).

Doctor recommended that I try another injection doing two of them at once (L5/S1 and L4/L5; the L3/L4 is not herniated as much and probably not the cause of the pain). Now I just wait for WC to approve the next injections.

But I am still on the right side of the dirt and better off than a lot of people. Faith is the key!
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Re: Well, three not one...

Post by AJMD429 »

.
My Medical tool chest, that I tell my patients I have has five drawers in it.

The top drawer is prayer and meditation, and I am the first to admit I am not an expert there, and will defer to their preferred practitioner, but I also tell them that it is a very important medical tool drawer, because it helps almost every medical problem.

The second drawer I made very medical, for my own ego, so it’s surgery. You can’t get much more medical than surgery. Cut out a bad part, repair it if you can, replace it, if possible, or whatever. It’s an awesome tool, but it only works for certain things. What makes an awesome is that when it does work and actually fixes the problem instead of just treating the symptoms. As a family physician about the only tool I use in this drawer is when I take off skin cancers, but it’s very rewarding because typically it’s a 100% fix for the problem.

The third drawer as one I use the most often. That’s medication. Medication is usually effective at controlling symptoms, occasionally actually fixes the problem, is usually safe and often affordable. The biggest challenge is getting the right medication to the right part of the body without harming the wrong part of the body in the meantime. Sometimes the art involves pharmacokinetics, and sometimes the assistance of a surgeon and a needle to get the medication to the right place.

The fourth drawer is diet. Kind of like the first drawer, it affects almost everything, at least indirectly. Humans have a remarkable ability to tolerate lots of different fuels as long as we provide the needed trace elements and vitamins and minerals, but definitely what we intake has an affect on many medical conditions. I put it next to “medication” because supplements are sort of “concentrated food in a pill” and basically a way to get something into somebody that they probably wouldn’t be able to or want to eat. They may balk at taking six or eight omega-3 supplement capsules per day, but they would usually rather do that than eat several cans of sardines a day.

The fifth drawer is therapy. Now someone divide that between mental and physical therapy, but I don’t think there is that much difference. Both involve finding some thing that needs strengthened and strengthening it, whether it’s a muscle group or a coping skill, and both involve finding some thing that’s too rigid, and stretching it, whether it’s a ligament, or an obsessive thought process.

So keep in mind whatever a medical condition is, it’s worth looking at the potential of all five doors to provide some help. Musculoskeletal stuff can occasionally will be completely fixed with surgery, which is awesome and also can usually have pretty good symptom relief from medication if the doctor is willing to be creative and help the patient figure out the best regimen, but therapy is definitely important, and often can slowly fix things because it strengthens muscle groups and can realign parts and improve body mechanics to take stress off of vulnerable places. Practitioners of therapy include physical therapists (usually who the surgeons will refer to) chiropractics, osteopaths, craniosacral massage, and so on. The fullest spectrum of care is typically the chiropractics or osteopathic physicians. The other therapists can definitely help if they are experienced and given free rein by the physician. You can quickly run out of surgical options, and there are only so many classes of medications to try, but I think you could try a different therapeutic modality every week for the rest of your life and probably not run out of stuff to try that might still help.

Also, don’t forget the importance of good nutrition, including supplements at proper doses, like coenzyme Q and vitamin D and turmeric. Plenty of good protein. Good intake of walnut, olive, avocado, and fish oils. Glucosamine and chondroitin.

Finally, make sure that your free testosterone level is somewhere between half of the upper limit of the reference range, and the upper limit of the reference range. Anything below half the upper limit is often insufficient for an adult male, even though it will be “within the reference range.” You need to measure (not ‘calculate’) free testosterone, and not total. Also make sure the estrogen level is well below the upper level of normal. It seems like about half of the upper limit of normal is where most guys feel and function their best. The reason is because both hormones affect muscle mass, bone health, and overall energy and vigor. Doctors and patients often don’t think about those hormones unless there are bedroom issues, and often that’s the last thing to fail. There is also a lot of intriguing information out about progesterone in men and the potential it may have to reduce the risk of prostate cancer. It makes sense, because the uterus and the prostate are analogous organs embryologically, and share much of the same response to pharmacologic agents and hormones. Cialis helps both relax which explains why it helps BPH as well as menstrual cramps, and we see clear evidence that progesterone reduces a woman’s risk for uterine cancer. That’s kind of an aside, but when I have a guy who’s getting ready to have orthopedic surgery, or just needs to make sure his muscle mass stays healthy, which reduces his risk of diabetes and heart disease, that often makes us need to address testosterone levels.

The problem is that a lot of the stuff is sort of orphaned, because the surgeons are experts at the surgery, the therapists are experts at the therapy, but when it comes to the medical stuff, most of the specialists kind of only do one thing, and most of the primary care docs that should be filling in the gaps are too busy trying to see 40 patients today so they can get a bonus, and there’s no way they’re going to take the time to read the medical literature.
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Grizz
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Re: Well, three not one...

Post by Grizz »

two gold stars Doc, well done!
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Grizz
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Re: Well, three not one...

Post by Grizz »

Prayers UP for the Kid. back pain is rotten. hope the docs get good input in their prayer time.
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Re: Well, three not one...

Post by gamekeeper »

Grizz wrote: Tue Mar 21, 2023 9:30 pm Prayers UP for the Kid. back pain is rotten. hope the docs get good input in their prayer time.
Sorry to hear that your back is still giving you grief, prayers up Jay.
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Re: Well, three not one...

Post by 2ndovc »

Sorry Jay, that sucks!
I've seen what chronic back pain has done to my wife. She's gone the injection route, etc. without much relief.
a friend of hers invited her to a yoga class a few years ago and the improvement has been remarkable. She still has days when she's hurting, especially after over doing it in the yard, but they are few and far between.
It's great for me too, I never knew yoga could be such a spectator's sport! :D

Hope you find some relief soon!

jb 8)
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Re: Well, three not one...

Post by Bill in Oregon »

Jay, after four fusions, L2 through S1 and many injections over the years, I finally had one S1-S2, right side, that made a huge difference. It's now going on six months of relief, and I can feel twinges of the old pain creeping back, so it will be time for another one, probably by summer. All of this stuff -- surgery, meds, therapy and injections -- doesn't hurt, but it doesn't always help as much as we had hoped. (Ask me about dry needling. Yuck.) Keep the faith, though!
Doc, thank you for sharing your very thoughtful views on these matters. You bring so much to this board and we are fortunate to have you as such an active member here. 8)
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Re: Well, three not one...

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Bill in Oregon wrote: Wed Mar 22, 2023 12:56 pmDoc, thank you for sharing your very thoughtful views on these matters. You bring so much to this board and we are fortunate to have you as such an active member here. 8)
I’m not a real doc; I just play one on levergunscommunity.com:lol: :shock:
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Re: Well, three not one...

Post by Old No7 »

Prayers up for you Jay -- you deserve BETTER!

Now let's find you a new Doc...........

Oh wait! Just look up above!! Make sure you're using all all five drawers of the tool chest!

Doc -- that was brilliant!! Thanks for sharing!!

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Re: Well, three not one...

Post by Ysabel Kid »

Thanks fellas. Rotten timing on my part after Mrs. YK's fall just before Christmas. She's on the mend though, cussing through physical therapy. No word from WC yet, but I would have been stunned had they responded in a day. :roll:
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Re: Well, three not one...

Post by lthardman »

At least it IS a diagnosis and a plausible explanation for your pain, Jay. Sorry you have to go through this, but perhaps some real relief is on the way. Good thoughts your way.
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Re: Well, three not one...

Post by RIHMFIRE »

YK
I was in a bad wreck a few years ago....broken neck and messed up back.
after my neck healed, i went to the gym. gained a bunch of muscle in my back and neck...
and the problem is gone. try it
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Re: Well, three not one...

Post by Ysabel Kid »

lthardman wrote: Wed Mar 22, 2023 7:58 pm At least it IS a diagnosis and a plausible explanation for your pain, Jay. Sorry you have to go through this, but perhaps some real relief is on the way. Good thoughts your way.
Gary, that was my thought as well. I wasn't thrilled to hear that the issue has spread, but happy to hear that the MRI was definitive. Would have really stunk had the imaging been inconclusive...
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Re: Well, three not one...

Post by Ysabel Kid »

RIHMFIRE wrote: Thu Mar 23, 2023 6:30 am YK
I was in a bad wreck a few years ago....broken neck and messed up back.
after my neck healed, i went to the gym. gained a bunch of muscle in my back and neck...
and the problem is gone. try it
I think that is why I am still mobile. Dropped a lot of weight in 2015 (62 pounds). Have put some of it back on (like most people through COVID :oops: ), but walking daily and staying active sure helps a lot.

Stay healthy!!!
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Re: Well, three not one...

Post by Sixgun »

Where else can you go to get a detailed explanation with the explanation being 100% from the heart and brain with a large dose of professional common sense thrown in…Thank you Doctor AJMD……and we are sure “the Kid” feels the same way….

Where were you (I didn’t ask) when my Meniers kicked in hard for several years and 9 doctors and 3 ENT’s just shoved me from doctor to doctor with 50 tests thrown in when I cured it myself from the internet.

Not many, if any, doctors like you….thanks Doc…——006
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Re: Well, three not one...

Post by AJMD429 »

.
Get (bio available or ‘free’ - measured, not calculated) testosterone and estrogen levels optimized (within IDEAL range, not just ‘reference’ range). May help muscles respond better to workouts.
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Re: Well, three not one... (update)

Post by Ysabel Kid »

Well fellas, I got darn lucky, but I suspect it was really due to your prayers. Instead of taking weeks to approve my new injections, Workers Comp approved them in a little over a week. And even better, my doctor had a cancellation for today and got me in! Two injections (L5/S1 and L4/L5), 10 minutes, and I'm home recovering. Thanks all!
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Re: Well, three not one...

Post by Old No7 »

Glad to hear that Jay -- good luck!

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Re: Well, three not one...

Post by Sixgun »

Good news Kid! ——-6—————-00
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Re: Well, three not one...

Post by gamekeeper »

Old No7 wrote: Mon Apr 03, 2023 9:23 pm Glad to hear that Jay -- good luck!

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Re: Well, three not one...

Post by Bill in Oregon »

Hope they work really well, Jay. I finally had one that performed up to the billing and it has been such a blessing.
It's funny -- some outfits make you strip to your shorts, put on the gown, get an IV placed and make you wait on a gurney almost like surgery, while others just say pull up your shirt, unbutton your jeans and hop up here on your stomach ...
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Re: Well, three not one...

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Bill in Oregon wrote: Tue Apr 04, 2023 6:03 am Hope they work really well, Jay. I finally had one that performed up to the billing and it has been such a blessing.
It's funny -- some outfits make you strip to your shorts, put on the gown, get an IV placed and make you wait on a gurney almost like surgery, while others just say pull up your shirt, unbutton your jeans and hop up here on your stomach ...
That was mine, but I elect to do it that way. I think they offer full anesthetics, some heavy lu-lu drugs, then my way - a little injection at the injection site, but otherwise, you just feel it all. They like the latter because the patient can give them oral feedback. I like it because I'm in and out of there quick. Some of my oral feedback has been a little "salty"! :wink:
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Re: Well, three not one...

Post by Bill in Oregon »

"Some of my feedback has been a little salty ..." :lol: :lol: :lol:
I don't have anyone to drive me, so I have managed to talk my guys into letting me skip all the stuff -- Xanax, etc.-- and just "git her done." Thank gosh there is so little feeling in the skin over the sacrum.
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