Tag: leg pain

The Return of Dr. Pain

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.

A Little to the Left, Doctor

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.

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.

I won’t stand for it

Yesterday turned out to be a pretty miserable day. I spent the morning at a brunch, the afternoon helping my daughter move to a new apartment, and the evening at a holiday party. I didn’t ride my bike and did only a few gentle stretches for my back before the day got underway.

At the brunch, my aching leg made it impossible to stand. This was okay since we were mostly just eating and chatting. Several people went for a post-food walk in Rock Creek Park but I decided not to on account of my back.

During the move I found that standing around made my leg ache. Walking up and down the hallway, sometimes carrying lightweight items for staging at the elevator, actually relieved the pain somewhat.

After about three hours of this, my leg started to ache. We drove to the party and, by the time we arrived, I couldn’t stand. Fortunately there was an ample supply of chairs and red wine.

We arrived home at 11:30. My leg was on fire. I could now feel pain in my left butt cheek and it wouldn’t go away. I lied down on the couch and gently stretched my lower back by raising my knees to my chest. After about an hour, fatigue conquered pain and I fell asleep.

At 2 am I awoke. Once I stood the pain came back. I did some gentle pelvic tilts in my easy chair and the pain subsided. I went to bed for five hours.

In the morning I had breakfast. As long as I wasn’t standing there was no pain. After breakfast I went back to the couch, put on headphones, and meditated for an hour.

Now I feel okay but I know that once I stand the pain will come back.

It’s cold and windy outside. I’ll probably go for a ride after lunch. Then, I’ll attempt some stretching exercises.

I am not having fun.

The saga continues….

Today I cancelled Monday’s PT appointment. Yesterday I did a two-hour recumbent ride in the basement. My wonky left leg felt fine throughout. When I walked away from the bike, the ache in my leg returned.

I did a very abbreviated PT session, took two Tylenols, and chilled.

Today, my leg felt fine for a few hours after waking. Then, as I was telling Mrs. Rootchopper that my leg felt pretty good, the ache returned.

I went for a 30-mile ride to test out the repairs done on Little Nellie. The shifting works fine in the front. I still get some chain misbehavior in the rear but that’s the norm for this bike. I wonder if there isn’t some kind of flex in the frame caused by the folding mechanism.

In any case, my leg felt absolutely fine for the entire ride. The left knee hurt a little going up hills or grinding big gears. There’s a small painful spot on the outside of my hip, as well. I don’t know if the leg could handle a mountain out west but for present purposes it’s okay. I stopped to shop at a store and within a few minutes my leg was aching again. I think weight bearing is triggering the pain.

When I got home, instead of PT, I did a short version of my old yoga routine. There are over 30 poses involved. I spent about a minute on each. By the end, my leg was very achy.

It has been suggested by several people (my physical therapist and my brother, a retired nurse, who has similar back problems) that this ache is referred pain from a pinched nerve in my lower spine. My lower back doesn’t hurt any more than usual. It’s always stiff thanks to the family genome. I’ve had sciatica in the past as well as a herniated disk. My current symptoms don’t follow the classic knife pain from butt to calf of sciatica, nor do they follow the aching thigh numbness of my slipped disc. Still, some sort of nerve compression in my lower back is a pretty good candidate for the cause.

So I looked up yoga videos for lower back pain. The three that I found all include positions in my routine. Most include extending the leg away from the body, either while doing a standing yoga position or a kneeling one. (Some of them involve reaching back and pulling the foot back toward the body.  Ain’t gonna happen.) The level of difficulty of these is easy to moderate, for me anyway. If I had full blown sciatica, they’d be impossible.

Another candidate for the pain in my calf is repercussions from my blood clot episode of two years ago. It turns out that some people who have had a blood clot called a deep vein thrombosis (DVT) in their leg have residual pain that can show up much later and last a life time. The pain is caused by the body reacting to the DVT by redirecting blood flow around the DVT. After the DVT is gone, the blood flow gets discombobulated and pain and swelling results. (When I had the DVT,  I had no pain or swelling. It was a sneaky little bastard.) Depending on how my visit to the orthopedist goes on Monday, I may make a follow up appointment with my hematologist.

Digression: one way to tell that you are old is by the number of medical specialists you see. My specialty list includes ophthalmology, neurology, hematology, pulmonology, endocrinology, orthopaedics, and physical therapy. If this goes on much longer, I’m going to need a psychiatrist. As long as my list does not involve a mortician, I’ll consider myself ahead of the game.

A third possibility is acute Christmas cookie intoxification. ACCI is a bitch. The only known cure is January.

I happen to have a vibrating massage gizmo that I acquired during one of my many episodes of back pain many years ago. It’s basically been useless until now but it turns out to be surprisingly effective in calming my calf muscle down. This device can target the muscle tightness much better than a foam roller, massage stick, or a lacrosse ball.

So for the next several days it’s biking, yoga, massage gizmo, Netflix, and pills.