epidural injections – A Few Spokes Shy of a Wheel

My Ow History

A couple of years ago, before and, especially, after my 2019 bike tour over the mountainous terrain of Colorado, Utah, Nevada, and California, I was in a world of hurt. My left knee and hip were screaming at me. I had some symptomatic relief from cannabis edibles I bought in eastern Colorado. Back home, I went to an orthopedist who gave me cortisone shots in both areas. After two rounds, my pain all but disappeared. But I was still in pain. Whenever I walked, my lower back and left leg became progressively more painful. The situation escalated to the point where I could not walk 100 feet without excruciating pain in my lower back and left leg. My orthopedist examined me and concluded that I had classic symptoms of spinal stenosis, a narrowing of the spinal canal that pinches the nerve roots emanating from the spine. The orthopedist referred me to a physiatrist, a medical doctor who specializes in pain management. I will henceforth refer to her as Doctor Pain.

Dr. Pain, I Am at Your Mercy

Step one in my treatment was an MRI. This helped identify pinch points and the interesting fact that I have six vertebrae, not the more common five. Step two was listening to my description of specifically where I felt the pain and what made it worsen or abate. Dr. Pain determined from this information the likely location of the irritated nerve roots.

I laid face down on a cushioned table. Using a needle, the doctor applied numbing medicine to the skin and muscle near the injection site. The pain from this was similar to having a novocaine injection for dental work. Not fun, but not the end of the world.

Next she and an assistant positioned an x-ray guided injection machine. This machine placed a targeting cross, like you’d see through a rifle scope, on the area of interest. Then the fun began. The doctor proceeded to inject anti-inflammatory and numbing medicine into the specific areas near the disturbed nerve roots.

Because my nerves were so inflamed these injections hurt like hell. With each injection an electric shock shot down a nerve in my leg all the way to my feet. Dang! I lost track of the number of shocks. Afterward, I waited a few minutes to make sure I didn’t grow a third leg or have other ugly complications and went home. Free to do whatever I wanted.

The injections worked pretty well. They calmed most of the pain and allowed me much more movement. I was going to have a second round of shots but the pandemic hit. Then Dr. Pain left her practice. So I decided to do daily physical therapy exercises to help calm the pain beast.

Shoot Me, Round Two

By January of this year I was starting to have increasing pain and discomfort, especially in my lower left calf, so I googled Dr. Pain and found that she was back in business at another practice. I saw her two weeks ago. She agreed that another round of shots would help. She reviewed the MRI and her notes from 2020, and we repeated the discussion of where my pain was located. She concluded that my leg pain was probably from stenosis but that the ache I was experiencing across my lower back pain was likely caused by arthritis.

We agreed to treat the stenosis first. Before continuing, however, she sent me for a doppler ultrasound to rule out a recurrence of a deep vein thrombosis (DVT), a painful blood clot that I had in my left calf in 2017. It caused me to develop dangerous pulmonary embolisms.

I had the ultrasound on Monday. It was painless. Since the tech did not send me to an emergency room, I knew I did not have a DVT. Today I went back to Dr. Pain for round two of the epidural injections.

We went over my symptoms again. She reviewed her notes from 2020. And we decided to move the injections down a notch in my spine. Again, I was placed face down on a padded table. Working with a technician, the doctor, as before, injected the muscle in my lower back with a numbing agent. Then she positioned the machine of certain agony and started the epidural injections. Not that I could tell. I could feel pressure from the insertion of the needle and feel the location on the needle but i experienced no pain. Hmm.

She continued until she made the money shot. BANG. She hit the irritated nerve. An electric shot when right down my left leg. I could feel it travel through my thigh and knee then into my calf. At their direction I did some deep breathing, then she injected me a few more times. These were painless. Thank you, Jesus.

Next Steps

After a short precautionary post-injection wait, I was sent home with no restrictions on activity. The leg felt a little numb but I walked without any pain back to my car. This afternoon, with temperatures nudging 70 degrees F, I went on a 30-mile bike ride, deliberately cranking big gears for the last ten miles. I walked a few hundred feet in my yard afterward. Only after going inside and crossing my legs at the kitchen table did I feel minor discomfort in my calf. I uncrossed my leg and it went away.

I’ll be keeping a pain diary for the next three weeks. I’ll be taking short walks to test things out. Then Dr. Pain and I will do a follow-up visit remotely.

I noticed a sore throat coming on a few days ago. I thought it was just the aftereffects of a smoggy temperature inversion the likes of which Los Angeles had not seen since, well, Monday. No such luck. I had a full on head cold on Wednesday. I treated it with extensive napping, Netflix (Philadelphia), and, very unwisely, a bottle of Clos du Bois Cabernet Sauvignon.

I slept not a wink Wednesday night. After my bi-weekly diner breakfast with Mrs. Rootchopper, we went to the library while our house was being cleaned. I put on my headphones, played some woo woo music, and promptly fell sound (and I do mean sound) asleep. Two hours later we went home.

The weather outside was cold and wet so I rode Big Nellie in the basement. (For the uninitiated, Big Nellie is my recumbent bicycle which I have attached to a resistance trainer. Get your heads out of the gutter, people.)

Later that night I took a couple of Nyquils and fell into a deep slumber.

This morning I woke up groggy and stayed that way through four cups of coffee. I then went to the physiatrist, also known as the pain doctor. After a bit of a wait, the doctor came in dressed in black. She had on what appeared to be a black butcher’s apron over her black outfit. I was half expecting her to speak with James Earl Jones’s voice. With an incongruous smile she said, “You’re on deck.”

Oh joy.

Soon I was escorted into white room which contained what appeared to be a giant white C-clamp from Goldfinger’s laboratory.

No, Mr. Rootchopper, I expect you to die!

This fluoroscope is an x-ray device used to guide the doctor to the appropriate trouble areas of the spine. I lay face down on a padded black table, my face in a donut shaped extension which allowed me to do such helpful things as breath, drool, and, as it turned out, cry out for my Mommy. The doctor’s assistant (what is the female of Igor anyway?) positioned a small padded chair for me to place my hands on.

After the assistant used freezing cold solutions to clean and disinfect my lower back, the doctor came in and fine tuned the position of the fluoroscope. The doctor mentioned that, as we discussed in our previous meeting, I have a transitional (i.e., abnormal) lumbar spine, one with an extra vertebra. I was relieved that the doctor was taking care to find the right section of my spine to inject.

Out of the corner of my eye, I spotted two needles that looked somewhat like artillery shells in my doctors gloved hand.

I. Am. So. Screwed.

Then the poking began.

The first few needle insertions felt like getting a flu shot. Not so bad.

Then the money shots into the spinal canal, no doubt, started.

One after the other. A series of, I think, four shots into my spine. The first shot sent an electric shock down a nerve in my left leg. My hands clenched together on the seat beneath my head. I tried to breathe meditatively to disassociate my mind from the pain, from the anticipation of the next shot. I told the doctor that she had the correct spot as the electric shock exactly matched the pain I have been experiencing for months.

Then came the second shot. Fuck all! That hurt. So much for breathing techiniques.

I groaned. The doctor apologized. Then she said, “Take a deep breath. Now, let it out slowly.” (She was on to me.)

The third shot was doozy. OWWW.

“Sorry.”

Then the piece de resistance. The mother of all injections. It sent a bolt of pain straight through my butt, my knee, my calf, into my ankle and foot. Had I not had my hands clenched together, I’d have come off the table.

Lordy.

Done. The doctor left. (I swear she said, “BWA HA HA!” under her voice as she exited.

I sat up. My left leg was numb from my hip to my toes. I gingerly plopped into a wheel chair and was rolled out into the waiting room. I struck up a conversation with a forty something man who had a walker. He was a retired Marine who had 16 years of pain after 20 years of service. The VA and Walter Reed had done all they could for him. He’d had the same injections that I had. “I can’t have any more,” he said.

As he rose to go into the examining area, he turned and quietly said, “Oorah.”

Semper fi, dude.

Count your lucky stars, I thought.

The feeling in my leg returned in stages beginning in my foot and working its way up. I left with only a slight numbness in my thigh after 50 minutes.

I refrained from leaping for joy and yelling “I’M CURED!!!” Mostly because the doctor’s self care sheet said the shot wouldn’t really take effect for a week to ten days. I can take OTC pain killers. I must keep a day-by-day account of my pain progress. In a month I go back to Dr. Pain to see if I need another set of injections.

I hope not.

Before I forget, I need to welcome back Jessica from her adventures around the Pacific Rim. I started nearly every day of this pain party reading one of her upbeat posts on Facebook, often documenting her doing inane things such as rolling down a hill in a giant translucent ball or lowering herself into a Viet Cong tunnel. From time to time, she recapped her antics in her blog, which I highly recommend. Thanks for keeping my spirits up, Jessica.