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.

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.

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.

 

 

 

 

Marking time

Today was an up and down day. I rode to PT where I went over various yoga exercises. My therapist pointed out the ones that would aggravate my stenosis symptoms. She and the trainer gave me a new core exercise to do involving stretchy bands. Unfortunately, the exercise strained my shoulders which have compromised rotator cuffs and, since the exercise is done while standing, my stenosis pain came on while I was doing it.

So I used Feldenkrais techniques to gently get rid of the pain while lying down. It took more than five minutes before I could move on to my PT routine which now involves stretches and core exercises from a prone or supine position.

I got through it all without pain.

Afterwards I got on my CrossCheck and rode the Arlington Loop, a 16-mile circuit, including some roller coaster hills, around Arlington County. By the time I reached home I had ridden 36 miles. I could have gone farther but I’m trying to be careful.

I spent most of the rest of the day sitting or lying on the couch reading.

 

 

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.

Now if only I could walk

Today was another successful bike jaunt. I intended to do an easy 20 miles but ended up doing 26 even though it was raining. I am really amazed at how good I am feeling on the bike. And, more importantly, how the pain in my left knee and hip has seemingly disappeared. Happy New Year to me.

I still have a hot spot of pain outside my left hip. It goes away after I ride. It doesn’t seem to be my iliotibial band and it is no more painful now than anytime in the last year. It just is. Go figure.

As for the stenosis, it’s still hanging around. I feel fine for the first few hours of the day when I’m doddering around the house. Once I start walking more than 30 feet or so, the ache returns. Last week I bought a cane. I can’t bring myself to use it.

In the comments yesterday, my brother who is a retired nurse with apparently the same defective back gene suggested I try a chiropractor. Many years ago I tried one. One treatment made me worse off. Of course, he wanted me to come back for weekly adjustments.

I tried acupuncture for my shoulders. One therapist managed to fix my right shoulder with one treatment. Another therapist didn’t do a thing for my left shoulder. Of course, he said that if only I come back for regular treatments, I’ll get better. No thanks.

My friend Kathy with whom I stayed on my 2018 tour recommended trying Feldenkrais. She and her husband have been doing it for years and swear by it. Feldenkrais is a strange blend of martial arts, engineering, and meditation. It involves monitoring your body through very controlled, gentle movements. I watched a few videos online. I was thinking “No way this is going to work.” Then I tried a few simple exercises. I was barely moving but damned if it didn’t work.

During her recovery from getting bowled by an SUV, Mrs. Rootchopper took a Feldenkrais class in nearby Arlington, Virginia. She said it helped and that, strangely, she felt a couple of inches taller when she walked out of the class. I am intrigued. I signed up for a one-hour class next Tuesday night. If this pans out, I may buy some audio tapes that Kathy recommended.

My father used to say that you should never have surgery unless your ailment prevents you from working. Too many things can go wrong. I think my stenosis falls into this category. I am in no rush to go under the knife even though my back surgery 30 years ago was a success.

One way or another I’ll get through this. I have some bike touring to do this summer.

 

Leg Pain Whack a Mole

It’s all very frustrating. my hip and knee pain seem to be gone but now I have to deal with this stenosis-related pain.

Last night I watched a movie (The Danish Girl) while lying on the couch. By the time the movie was over my leg pain had quieted. I slept through the night without use of pain medication.

My leg stayed calm through noon. Since it was pretty nice day outside, I did a somewhat hilly 36-mile ride on my Cross Check. Lowering the seat has greatly improved my pedaling. Still no problems with my knee or hip, although the pain outside the hip seems to be sticking around. Riding did not bring on stenosis-related pain as far as I can tell.

When I finished my left leg felt fine. Once I started doing my stenosis exercises, however, things took a turn for the worse. Certain exercises that are supposed to help actually hurt. I know I need to do the exercises but I also know that if I keep pinging the nerve while I’m doing them, I am defeating the purpose.

Right now I feel general soreness in my left butt cheek, outside my left hip, my inner left thigh, and in my left calf. On a scale of 1 to 10, the pain is a 3. On a scale of frustration, I’m at about an 8.