Tag: steroids

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.

Happy camper on a bike

For the last six days I’ve been taking a declining dose of the steroid prednisone to calm the irritated nerves in my back and legs. Prednisone pills taste gross but they are very powerful. My pain became tolerable after a day. Although I didn’t notice, they improved my mood and, my wife and daughter report, even made me chatty. As I said, it’s powerful.

Until I took prednisone, I couldn’t tell where in my lower back my nerve problems were coming from. Now I can feel tension above my left butt cheek. Hello, you little bugger. I’m coming after you.

The best part of this pill party is that I am riding my bike like it was the summer of 2018. I have nearly zero discomfort, I am accelerating like a boss, and can cruise 20 percent faster with practically no effort. In five days, I’ve ridden 159 miles. Each day I stop long before I get tired. I could easily have ridden 50 miles today but decided to err on the side of caution and quit after 36. The Mule abides.

My leg ache comes and goes and the hot spot outside my left hip is still there, but otherwise my body is so much happier. I go up hills without a care. My back, arms, and shoulder feel relaxed as I pedal.

All of this makes me wonder if my hip and knee problems have been a side effect of stenosis, rather than in addition to stenosis. If I’ve been in low level pain for months, it’s no wonder my riding has suffered. Not the mileage, but the enjoyment. Riding across Kansas this year was work; riding across North Dakota and eastern Montana last year was play.

While I have the pain at bay, I have been blending yoga with my physical therapy. Up until now I had been doing PT in a very regimented fashion. This many repeats. Hold for this many seconds, etc. The idea was to build strength in particular muscles, mostly in support of my hip and knee.

Now I am letting my body dictate what to do. I am flowing from one position to the next, concentrating on keeping my motions fluid.  The regimented aspect has been one of the reasons I hate yoga classes. (And don’t get me started on yoga teachers who physically move you into the “proper” position. Must not kill!)

Instead I’ll hold a position for as many seconds as seems helpful then go right into another one without stopping. If a posture causes something to ache, I stop and move on to another posture.

A typical sequence might be (PT exercises in italics):

  • Step over a horizontal pole for 25 repetitions (A warm up that helps me getting on and off the bike.)
  • Stretch hamstrings
  • Stretch quads
  • Stretch iliotibial bands
  • Runner’s calf muscle stretches
  • Shoulder scrunches
  • Add standing yoga positions
    • Rishi’s posture
    • Chest expansions
    • Deep breathing
    • Toe touches
    • Side bends
    • Trunk rotations at the waist
    • Neck rotations
    • Squats
    • Dancers posture
  • Lay on the floor and do
    • Open book shoulder exercises 
    • Pull knees to chest, first one leg, then the other, then both
    • Ankle over knee and pull legs toward torso
    • Sway back and forth with bent knees at the hip
    • Hurdlers stretches
    • Groin stretches
    • Neck pushes
    • Toe touches
    • Back bridges
    • Side planks with torso on ground
    • Side planks with legs on ground
    • Bird dog
    • Cat/cow pose
    • Planks
    • Cobra pose
    • Locust pose
    • Twist torso while lunging
    • Lunges
    • Child’s pose
    • Shoulder stand
    • Plough
  • Sit ups (or crunches)
  • Set of super six exercises on a foam roller

That’s over 30 different exercises. And I left a few out. I have all of  them written down but I tend to do whatever seems to make sense in the moment. If I’m doing a pose while lying on my back, I might pop into a shoulder stand, for example. Then I’ll gradually fall into a plough (legs extended over head while on my back) and roll out of the plough and do a back bridge.

I’m trying my best to be gentle and not strain. Some of the positions are a little beyond my ability right now but I’ll get there.

Hopefully, I can get this routine established quickly. I have only three more days of prednisone pills, and then the effects will wear off.  And they can wear off rather suddenly if my prior experience with oral steroids is an indication. Taking them for long periods of time results in side effects like osteoporosis, cataracts, and growing a second head. (Okay, I made that last one up.)

Cheers.