Darth Stenosis, an MRI Report, and a Clarification

Bad Genes

“My father has it. I have it. My sister has it.”

Yesterday I was talked with my sister who is 2 1/2 years younger than me. She said she’s having back pain. She does not read my blog. I asked her to describe it.

Pain in the outside of her lower left leg. Pain when walking that is reduced when she leans forward or leans against something like a grocery cart. Pain that kicks in after about 50 yards. She can’t trust her left leg; it feels like it’s going to give out.

Gregor Mendel, phone home.

MRI Report

My MRI report confirms that my spine is FUBAR. Most of the pathology doesn’t seem to be causing me pain. I have moderate disc bulging and thinning here and there. And there is some stenosis in various places in my mid to upper spine. Mostly this seems to be the cause of mild discomfort as well as numbness in my feet and hands from time to time. My lower back gets achy when I stand or walk for long periods but muscle spasms are rare.

Near my 4th and 5th lumbar vertebrae, however, the report said:

There is severe left foraminal stenosis with indentation of exiting left L4 nerve root. The right foramen is moderately to severely stenotic with indentation of exiting right L4 nerve root.

This is consistent with my recent left leg problems. My guess is that’s where the epidural will go.

The same MRI center had a record of my 2014 scan. The report noted that a disc extrusion (i.e., bulge) found back then no longer exists. This is one reason why back patients are told to give it time. Many of these abnormalities resolve on their own, as did my 2014 problem.

A Clarification

In yesterday’s post, I described a conversation with my friend Julie who is a Rolfer. I may have given the impression that she is reckless or aggressive in her methods. If I did, I apologize to her and want to clarify.

Recapping: a Thai massage therapist skipped past my thighs when I indicated that the therapist had hit a sensitive nerve. What Julie meant when she said she’d “dig right in” to nerve pain was that ignoring the problem as the massage therapist did is unhelpful. The objective of massage is to grant short term relief and reduce tension. Oversimplifying, the objective of Rolfing (and for that matter Feldenkrais) is to reduce pain and stress in the long term by improving how body parts interact. Rolfing focuses on connective tissue called fascia that wraps around muscles and nerves. The end result should be pain and stress reduction on an on-going basis.

For now, I am focused on getting the offending nerve to calm down. Once I get the pain under control, I can consider how to deal with the situation longer term. My guess is that I’ll be doing some combination of yoga, PT, massage, Feldenkrais, and Rolfing.

 

 

Advice from Alaska

For the last several days I’ve been staying off my feet and taking over-the-counter pain medication. When I walk, I generally use a cane (if I haven’t left it somewhere). As a result, my pain level has been greatly reduced. I have no intention of sitting around for the rest of my days, however.

I am still riding but the arrival of winter has nudged me into dialing back the mileage and intensity. On Saturday, I rode Big Nellie in the basement for 80 minutes. It’s a nice change of pace and infinitely preferable to riding while anxiously looking for icy patches on the pavement. Yesterday, I rode the CrossCheck outside. Temperatures declined into the 30s and winds picked up with each passing mile so I cut the ride short at 17 miles.

As I may have said earlier, I quit PT and Feldenkrais, at least until I give the pain doctor a shot (so to speak) at my problem. My friend Julie (a Rolfer, jewelry maker, proud momma, and Alaska backcountry bad ass hiker) said that I should give Structural Integration a try. (This should not be confused with Functional Intergration which is the basis of Feldenkrais.) In my current physical state, I will have to take a pass on her advice; Rolfing (one method of Structural Integration) can involve rather aggressive manipulation of body parts (in contrast to Feldenkrais which more closely resembles Reiki).

Julie’s Rolfing suggestion follows up on part of the conversation we had in Astoria, Oregon at the end of my cross country tour. I mentioned to her that a few years ago I had a problem with sharp pain in my right leg. While having a Thai massage, the therapist hit the problematic nerve in my inner right thigh and I flinched in pain. The therapist decided to skip over that part of my body. Julie said that if it had been her she would have dug right in.

It’s interesting that massage, Feldenkrais, Rolfing, and, for that matter, chiropractic, all profess to address the same body problems. Whether one method works probably depends on the pathology involved. At the moment, I know from x-rays that my back is showing numerous signs of age-related deterioration, complicated by my genetic make up, a previous back surgery, and a whole lot of wear and tear. Hopefully, tonight’s MRI will give an better view of what is causing the specific pain that I’ve been dealing with.

In a few weeks, I may be able to ramp up my activity level without pain.

I met Julie the day after I reached the Pacific coast on my 2018 bucket list cross country bike tour. I was feeling what I called afterglow. I want to feel that way again.

Thanks, Julie, for your suggestion. One of these days I hope to meet again. Come to think of it, I haven’t ridden a bike in Alaska yet.

 

 

 

Moving on to Plan B

I went to the orthopedist today. He took x-rays of my back. The short version: my spine is about 20 years older than the rest of me. Bone spurs. Narrowing of discs. One slightly bulging disc. Arthritis. And curvature of the spine probably caused by the excruciating pain I was in during the x-rays.

As the doctor said, clearly Plan A failed. Plan B is an MRI (next Monday) and a referral to a physiatrist, a pain management and rehab specialist. She will be giving me a cortisone epidural in my lumbar spine. My appointment is for a week from Monday. (This allows time for insurance company hassles and other administrative whatnot.)

I actually had a reasonably comfortable morning. I have been putting ice on my lower back and hip and it does reduce my pain somewhat. I went for a very windy 25-mile ride without any significant pain. After getting home I did a tiny bit of PT, took a shower, and ate lunch without pain. Just as I was wondering whether I’d be going to the doctor with no symptoms, I walked upstairs and the pain came rushing back.

Despite all this nerve pain, the doctor noted that I still have plenty of leg strength. He  called a physiatrist and they chatted about my case. I can get an epidural before the MRI but it likely be more successful using the MRI for targeting the injection.

My doctor says I can have up to three epidurals. He says that for many patients, epidurals do the trick. Fortunately, I can still ride my bike which is as important for my mental well being.

If the epidurals don’t work, I’ll be moving on to Plan C. C in this instance stands for cutting.

Eek.

Not exactly an encouraging day

I was awoken by pain in my left ankle at 4:30 this morning. Apparently the acetaminophen I took had worn off. I relocated to the couch were I could more easily hang my left leg off the side. The pain abated after a half hour and I went back to sleep.

I made it through breakfast before the leg started barking at me. The ankle had calmed down but the calf ache was back, as was a new symptom that feels like a wad of clay inside the outer part of my left hip. Between the wad of clay and the nerve pain, my bio-mechanics are all messed up.

So I went for a bike ride. (You knew that was coming.) Within a mile or so my leg calmed down. I rode to the Lincoln Memorial and back on another exceptionally nice March day, except of course for the fact that it is mid-January. The CrossCheck and I are getting along very nicely.

I got off the bike a few times during the ride. As of two weeks ago, all the symptoms that bothered me during last summer’s bike tour had faded away. Today, when dismounting, the pain in my outer left hip came back. It feels like my leg is going to collapse. What fun.

After 30 miles I called it a day. If I couldn’t ride, I am pretty sure I’d lose my mind over this nerve problem.

I went to my second Feldenkrais appointment in the afternoon. The therapist observed my posture and my gait. She accurately noticed that in medical terms I am all kinds of messed up. Then she examined my neck and shoulders which seemed to be awry during my little walk across the room. Very tight.

Next she had me do some movements to loosen the muscles in that area. The movements actually work pretty well and are surprisingly simple. The idea is to learn or perhaps re-learn how to move making best use of the entire body. The best analogy I can come up with is learning how to throw a baseball. If you only use your arm, you can’t throw very well. If instead you involve the arm, the shoulder, the hips, the legs and the back, you can bring some heat.

After that, the therapist was going to examine my back as I lay in a prone position. My left leg decided to start barking again so I rolled on my left side and assumed a fetal position. The therapist spent ten minutes feeling various parts of my back and backside. She noted that my lower left back is very tight and suspects that this new symptom might be the result of a bulging disc. Oh joy.

Long story short, she said that I was a pretty complicated case. It probably has been developing over a long period of time and would take a long time to reverse (with, of course, no guarantees).

I have to agree with her. It seems like every day I get a new symptom. They all seem to conspiring to keep me moving like a robot and to keep increasing my pain and discomfort.

I have to say that I am disappointed. I thought the idea of these sessions was to teach me how to do a regimen of movements to alleviate my pain symptoms, but that didn’t much happen. I realize I can’t expect immediate results, but I feel like I’m treading water. In any case, we agreed that I would keep next week’s appointments on her schedule for now.

Tomorrow I go back to the orthopedists to get his take on my situation.

In for a nickel

Today I did a one-on-one Feldenkrais session. It was mostly an evaluation of my physical situation. We only did about 15 minutes of movement, but I felt less pain when I was done.

After a long discussion of my physical abilities and disabilities. I walked across the room from corner to corner. It hurt and I had a pronounced limp.

Next, I assumed a fetal position on my right side on a padded table. My head was supported by a pillow. I looked at a spot on the wall, put my left hand on my head and raised my head up. Slowly. Just a few times.

Next I raised my left arm over my head as if I were doing a layup. Then I raised my feet. Then I combined the layup with the feet.

All of this was done gently.

When I started back was tense. When I finished it was loose. I walked across the room with only very minor discomfort and no limp.

Interesting.

We discussed next steps. I’m going to do 2 of these sessions each week for four weeks. They are not covered by insurance so it’s going to be expensive but no less so than three months of ineffective PT.

No guts. No glory.

Riding with the Climate Devil

Something is definitely not right. Yesterday and today we had temperatures in the 70s in January in DC. I could ponder the fact the planet is going to hell. This would be depressing. Instead I went for a couple of bike rides on my CrossCheck.

Before I left the house, something really unusual happened. My bike had a

flat rear tire. The CrossCheck came with nobby tires that offered little flat protection. When I had my first flat, I decided to swap them out for something more robust. I put Schwalbe Marathon Plus tires whichIMG_3328 are advertised as flat free tires. When I took of the rear tire, I noticed that the tread was nearly gone. In spots the green puncture underlayer was exposed. There were several large gashes in the tire, but only one small, very sharp piece of glass made it through to the tube. I am guessing this tire had over 8,000 miles on it. Not bad.

Yesterday’s ride took me downriver from Mount Vernon. I rode 20 miles to Mason Neck. On the way there I took a hilly route that avoided US 1. After about 14 miles of ugly suburbs, the remaining ride to Mason Neck seemed rural. A new bike trail made the ride fairly peaceful too. My return route used the bike lane on US 1. I do not recommend this. The speed limit is 50 miles per hour and the bike lane is nothing more than paint.

I didn’t get killed. I left US 1 to ride to Mount Vernon. In the circle in front of the entrance were two EMT vehicles and a police SUV. A police officer was stuffing a bike into the back of the SUV. The bike didn’t seem to be in bad shape so maybe the EMTs were called for some non-bike-related calamity.

Today’s ride was a bit more ambitious. I rode from Mount Vernon to Bethesda, Maryland and back. The round trip was 51 miles. The route there involved the Mount Vernon Trail, the new smooth sidewalk over the Memorial Bridge, the Rock Creek and Potomac Trail (basically a sidewalk), the Water Street cycletrack in Georgetown, and the Capital Crescent Trail. Of the 26 miles, I spent about 3 on unprotected’ low traffic roads.

On the way back I took Rockville Pike to Jones Bridge Road. This would be suicide on a weekday but on a Sunday it was nearly pleasant. Jones Bridge leads to Beach Drive in Rock Creek Park. On weekends most of Beach Drive is closed to cars. That and the new pavement make it perfect for riding a bike or rollerblading.

Once out of the park I rode down Ohio Drive to the 12th Street Bridge, crossed into Virginia and rode home on the MVT.

The weather made me feel like a cheat.

I didn’t feel any discomfort to speak of in my left knee or hip for either ride. Even the sore spot on the outside of my hip was calmer than usual. I declare my bike tour injuries to be a thing of the past.

Unfortunately, after about 30 minutes on my feet, my stenosis pain came back. I have taken to using a cane to get around. This allowed me to go to the movies and dinner last night. Unfortunately, the aching came back at bed time.

So it goes.

 

 

 

A Day of Frustration

Today was a day of promise and frustration.

Last night I set my alarm to get up for Friday Coffee Club. I woke up at 3 am went downstairs and noticed that it was 2 am. Somehow my alarm clock had been changed. Rather than wake up Mrs. Rootchopper, I just put it in my head to wake up on time. And I did.

I slept well. My back was very relaxed from the Feldenkrais class.

The ride to Friday Coffee Club was easy. I had taken yesterday off from riding and I had a tailwind. There was a sizable crowd at Swings. I met a Twitter follower and re-met someone who is currently living in New York City. The latter reads this blog and is considering a cross country tour this summer. To him I say: DO IT!

The group at my table traded medical war stories. One person had had back surgery that worked except for the fact that part of one foot is numb. Another person had a DVT and a pulmonary embolism. Still another told is of how his Achilles tendon ruptured when he dismounted his bike last summer. None of these three people is over 45 years old. We’d all be wolf dinner if we’d lived a few hundred years ago.

Today was apparently Wear-Strange-Things-on-Your-Helmet Day.

Standing at Swings was not agreeable to my left leg so I ended

up sitting for most of the get together. I rode home 15 miles without a problem. This stenosis thing is just bizarre. I can ride all day but can’t stand for ten minutes. For the next couple of hours, I had no leg pain.

Mrs. Rootchopper and I decided to run a few errands. First, we went to the bank to get a document notarized. Next we went to the phone store for new cases for our cell phones. Next up was the post office to mail our notarized document. Our final errand was to the Apple store at a mall to get a new battery for my phone. I walked maybe 100 yards to the store from the parking garage and stood around for a few minutes. My leg pain came back so strongly that I had to sit.

The battery was only charging to 65% of capacity. While Apple replaced it we went to the food court. By the time I got there, on a scale of 1 to 10, my leg pain was a 9.5 .

After an hour of sitting, we went to pick up the phone. Again I had to sit while the phone was brought out from the back of the store.

On the way home, the pain went away. I started charging the battery. I checked the software. The maximum capacity of the battery was 65%. Did they forget to replace it? I’ll see how the phone performs before going back to the store.

In the morning I made an appointment with the Feldenkrais instructor for an hour-long session next week. I am hoping that some good will come of it. I am not at all hopeful that Monday’s PT appointment will be worth the bother but I am going through with it.

After today’s pain party, I have decided to reschedule my orthopedist appointment to next week (from the week after).

No mas.

Maybe this will help. Or not.

Today was a kinda sorta cold day so I decided to take the day off riding. I went out for breakfast at a diner, read some of my new book (Bill Bryson’s The Body, A Guide for Occupants), picked up my car at the garage, meditated, took a nap, set up some 2020 401K withdrawals, and then went to my Introduction to Feldenkrais class.

The class took place at a rec center in Arlington. It began with a body scan meditation, something I’ve done many times over the years, although never in a room full of a dozen people. Next, came a series of very gentle simple movements lying flat on our backs. As we were doing them, the instructor gave specific instructions as to where to focus our attention. Imagine a narrow beam of light shining down the length of your body from head to toe. The movements were to the left and right of this center line. Knees. Hips. Torso. Arms. Head. All building to a combinations of sideways movements.

You pretty much have to give yourself up to the concept otherwise you’d get about ten minutes into the class, get up, and go get a beer. The rational side of your brain is asking “How can this possibly do anything?” As the movements progress, however, the body becomes more and more relaxed, more and more limber. After an hour, my body felt like it had gone on a nice, little vacation.

Then I stood up, my left leg came back to reality. Ugh.

It was an interesting experience. Pretty clearly, if you are in a high-stress job or life situation, you’d really benefit from Feldenkrais.

I want to see how my body feels in the morning before deciding whether I will do more.

 

 

 

Adulting. Riding. Aching.

After yesterday’s non-storm, we has some minor melting and refreezing. Since the local trails were not treated, I decided to wait until late morning to go for a ride.

First, I drove my car to a mechanic to have its annual physical. Suffice it to say, sometime tomorrow I will be out about $1,000. I expect this will be the last money I spend on the car until 2021. Knock wood.

I brought the CrossCheck with me to the mechanic and rode off to the pharmacy to pick up my asthma medicine. As it turns out, the $10 per month deal I had been getting on this medicine expired on New Year’s Eve. The non-discounted price is $72.

I rode home to get a new discount coupon from the manufacturer. I messed up the data form and the website would not allow me to make a correction without which I would not get the discount. Off I rode to the doctor’s office to get a new coupon. Then I rode back to the pharmacy and got my $10 medicine.

Having now blown an hour of my day, I headed up the Mount Vernon Trail for a relaxing roll. Some of the wooden bridges on the trail still had icy spots. There were no such icy spots on the George Washington Memorial Parkway just 30 yards away. Bicycles are not allowed on the parkway. And you wonder why bicyclists get angry and frustrated.

I ended up about ten miles north in Crystal City where I used streets to return home. The weatherman was nice enough to provide me with a strong tailwind. On the way I swung by my local bike shop which has been closed since a fire broke out in an adjacent business. I rode through the parking lot in the rear. It appeared that the roof has been replaced. As I came close to the shop’s rear door, I saw one of the shop’s bike mechanics wheeling some debris to a dumpster. I waved and said hello. Next I swung around the front of the store. The door was open but the place clearly was not ready for prime time. And the sign saying the store was”closed until further notice” remained in the shop window. Sad face.

At home, I did my stenosis exercises. By the time I was done my leg was aching. (It ain’t working.) In the spirit of Feldenkrais, I tried a 25-minute guided meditation while lying down. When the instructor said, “Pay attention to your left shin and calf,” I thought “I’d rather not!” The meditation didn’t do much good.

While I was enjoying the pain party, I washed some of my holey sweaters and a load of laundry.

So despite my pain, I had a productive day.

Tomorrow promises to be similarly productive. In the evening, I go to the re-scheduled Feldenkrais class.

 

 

 

 

S-no-w day

We had a horrific storm in DC yesterday. It rained all day then a half inch of snow fell. Arlington County cancelled its rec center classes so my Feldenkrais class was cancelled. I have signed up for a make-up class tomorrow night.

In the meantime, I rode 24 miles without incident. Oddly, after doing my yoga/PT routine for stenosis, my nerve pain flared up big time. As my mother used to say, I can’t win for losing.

The rest of the day was spent reading Labyrinth of Ice by Buddy Levy. It tells the story of an 1881 expedition to the arctic region near northern Greenland. If you liked the tale of the Endurance or John Krakauer’s Into Thin Air, this one’s for you.