My Own Disc problem

A month ago I was dead lifting too much weight in the gym and felt a sudden shift in back at the base of my spine. I had severe pain and fell to my knees. I instantly knew that I had messed something up. I struggled to get up and walk and felt severe spasm. I could barely get dressed and take a shower and a few hours later I had realized that seeing patients would be impossible. I headed home and my wife found me after an unsuccessful 20 minute attempt to make it up our main staircase. I spent a few hours in bed, really unable to move without severe low back pain with cramping and knife like spasm. After a few hours like this I knew I had to do something, so I had my wife take me back to the clinic for an epidural. My partner John Schultz squeezed me in over the lunch hour where he performed a left S1 transforaminal injection of anesthesthic and anti-inflammatory (putting medicine right between the disc and the nerve root). The pain I experienced when the medication got near the nerve root was the most unbearable of my life, with cramping and spasm down my left hamstring and calf. This felt like an ultra severe a tooth ache in the leg. However, after a few minutes, it subsided as the numbing medicine kicked in. While I barely limped in to the clinic without crutches, almost aflling several times, I walked out after the epidural normally with no pain. I can say now that the decision to get a very early epidural was a great one, as I was back to the gym in a limited capacity a few days later and have since regained pretty much all activities (except dead lifts).

The helplessness and utter depression I felt when I was in severe incapacitating pain was a great lesson for me. As a pain management doctor, I have treated countless patients in similar circumstances, without ever fully understanding (at more than an intellectual level), the depth of their sorrow or the utter helplessness that they feel. I'm also a bit saddened that so few of my patients will ever get the chance for the instant relief and early intervention that I received. There are all kinds of good reasons why everyone in that situation should get an immediate epidural to control pain, reduce atrophy of key stabilizing muscles, and reduce the likelihood of other side effects caused by the pain or the pain medications. However, some doctor long ago started a myth unsupported by any science that people in that condition should "wait it out" without any intervention except medications and physical therapy. While this recommendation may be smart for those with a mild low back sprain, for those in my condition, it's lunacy. Regrettably, this is the nature of what I call modern "beer and pizza" insurance guidelines. Since there is no research data on this topic (early epidurals for patients with severe neurologic pain after a disc herniation or bulge). the insurance companies assume that they somehow have the right to pull guidelines out of thin air, or as I like to say, get a bunch of guys like me together over beer and pizza to make up some guidelines that everyone else has to follow.

I am genuinely thankful for being "vertical" as one of my patients loves to say. Here's to early intervention.