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Herniated disc at c5-c6, in pain and full of questions.
April 13, 2009 7:57 AM   Subscribe

Is there an orthopedist in the house? Herniated disc at c5-c6, in pain and full of questions.

I've been dealing with pain in my left shoulder and upper back, tingling, numbness, and general weakness in my left arm for a year now.

The US medical system being what it is, it took me a year to get an ortho referral. I finally got an MRI last week. An image from it is here and this is the radiologist's report:

There is a 4-5mm C5-C6 broad-based central, left paracentral disc protrusion contouring the thecal sac and narrowing the AP diameter of the thecal sac down to 8-9mm, causing mild central spinal canal narrowing, without significant foraminal stenosis.

Okay, so a herniated disc. Met with the orthopedist on Friday, who spent about two seconds with me, told me there's no risk of paralysis (whew) so surgery isn't the option (whew again), gave me a script for Darvocet and sent me on my way.

Turns out I'm allergic to Darvocet (took two over the weekend, got hives). Getting a script for Vicodin instead, which I know I can tolerate but am not crazy over taking. I'm also waiting on a referral to an acupuncturist, which I doubt my craptastic HMO will approve.

So, questions. First, if anyone else here has dealt with this diagnosis and is willing to email about it and tell me of your experiences, please do! And now on to my questions:

Is this a permanent condition?
Will it get worse?
Are there activities I should or should not do?
How did this happen?
Does sitting at a desk for 10ish hours a day make things worse?
I can't turn my head enough to see sideways when I drive without causing great pain. I live in Los Angeles, where driving is a must. By continuing to drive, am I re-injuring myself?

Apparently the ortho doesn't have more than like five seconds to spend with his patients before the prescription pad comes out. Would love to hear from any MeFites who have the time and experience to answer my questions. Thanks much!
posted by chez shoes to Health & Fitness (18 answers total) 3 users marked this as a favorite
 
I am not even close to a doctor, but I practice workers comp law so I see a lot of similar medical records. A "protrusion" is not the same thing as a herniated disc. It's closer to a disc bulge. I am surprised that your ortho didn't recommend physical therapy. You may want to ask him about it; it would probably help.
posted by amro at 8:00 AM on April 13, 2009


I was just recently (by which I mean this morning) diagnosed with the same thing between my L4-L5.

Before I say anything, remember that everyone is a little bit different even with the same injury, and what applies to me may not apply to you. (For example, I have an L6 vertebra...I bet you don't.)

First, it sounds like you need a new orthopedist. Don't put up with a doctor who won't talk with you or explain things to you. I know they're busy, but they should be too busy to give you proper care.

Second, in my non-professional opinion, it sounds like he should have recommended physical therapy.

As for your questions:

Is this a permanent condition? -- If not treated properly, maybe. I've had mild back pain for about 7 years.

Will it get worse? -- Possibly. My "mild back pain" turned into "can't walk" two weeks ago.

Are there activities I should or should not do? -- Rest is good short-term. Stretching and exercise is better. You should see a physical therapist to see how to do this properly. The wrong exercises could make it worse.

How did this happen? -- Stress over time plus genetics, probably.

Does sitting at a desk for 10ish hours a day make things worse? -- It sure doesn't help. Get up and walk around as often as possible. This relates to the exercise mentioned above.

By continuing to drive, am I re-injuring myself? -- Probably not, it's just increasing pressure on the nerve. But of course, I can't tell you that for sure. You need to see an orthopedist who'll talk to you.
posted by CrayDrygu at 8:11 AM on April 13, 2009


You really need to get a second opinion. If you walked away from your diagnosis with no information and/ or referrals for physical therapy and only a prescription for opiates- your orthopedist dropped the ball completely.

If you have been experiencing tingling and weakness for over a year there is definitely nerve involvement and this should be taken seriously. Not b/c of risk for paralysis per se- but you are at risk for long term nerve damage, long term numbness, weakness, etc....

I strongly suggest you find another orthopedist and/ or consider seeing a neurosurgeon in addition or instead. This is not to say that you will require surgery, but in my experience with lumbar disc herniation and nerve compression, it has been really helpful to get the perspectives and advice from BOTH kinds of specialists.
posted by hellboundforcheddar at 8:22 AM on April 13, 2009


I had the same diagnosis at the C6-C7 level.

Is this a permanent condition?

I was told that mine could be, but YMMV. I finally couldn't stand the pain any longer and had surgery to correct it.

Will it get worse?

Mine did. It started as an annoying twinge, and eventually I had pain so severe it left me in tears and unable to move (or sleep).

Are there activities I should or should not do?

Sitting at a desk for 10ish hours a day comes to mind. Also, lifting anything, regardless of its weight, with poor posture, especially with your arm away from your torso.

How did this happen?

YMMV. In my case, I suspect it was a combination of factors: poor posture throughout my life, attending one too many heavy metal concerts in my youth (serious headbanging) and many many years of sitting slumped at a computer, with my jaw jutting forward.

Does sitting at a desk for 10ish hours a day make things worse?

It could. Try raising your monitor up higher for a start. Make sure you have good lumbar support, which will align your entire spine. Keep your head centered over your spine.

By continuing to drive, am I re-injuring myself?

Rather than "re-injuring", you are probably continuing to stress the area in question, which a) can't be good for healing, and b) may make it worse.

Get a second opinion.

Painkillers may help temporarily, becasue without that constant pain, your muscles can relax and stop that constant spasming, which may help everything kind of realign itself in your back. But my neurosurgeon told me that even if the offending disk slipped back into place, it and the surrounding structures were now weakened, and thus it was likely to bulge out again. (Of course, take that with a grain of salt - to a surgeon, the cure for anything is surgery).

Physical therapy helped me at first, but surgery was the permanent cure for me. (Note, I would not suggest surgery as your first choice. I still think I should have given another round of PT a try.)
posted by SuperSquirrel at 8:46 AM on April 13, 2009


Nthing that normally you'd probably be referred to physical therapy, as discussed above, and could see some improvement with that. There are other options between PT and surgery, as well, but they're less consistent with the results and are things your doctor should discuss, if they're options in your situation. At this point, a neurologist or neurosurgeon might be more useful than an ortho, but your primary care may also be able to handle the referral to PT.
posted by dilettante at 8:49 AM on April 13, 2009


Physical Therapy and this book will heal you.
posted by ranunculus at 8:53 AM on April 13, 2009 [1 favorite]


Acupuncture will do nothing but give you a placebo effect.

From my minorly informed standpoint as a neurobiology undergraduate student, I suggest you should probably go see your orthopedist, but get the number of a good neurosurgeon just in case. If PT is possible, do it, but get a second opinion. If you have tingling in your arm, there is a nerve issue, and you should consider consulting a good neurologist, since nerves branch out to your arm around your cervical vertebrae.

Take it easy, too, so you don't have to have surgery. Spinal surgery is a bitch.
posted by kldickson at 9:19 AM on April 13, 2009 [2 favorites]


My husband has had a couple of bulgy disks lower in his back (L-something). He was prescribed physical therapy. He also had at least one epidural steroid injection. The thing that has made the biggest difference when things are really awful was a course of methylprednisolone.

He takes Mobic as needed for pain. (He used to take Vioxx, but, well...he got a pulmonary embolism. And then they took Vioxx off the market.)
posted by leahwrenn at 9:58 AM on April 13, 2009


Acupuncture will do nothing but give you a placebo effect.

Everything you do will give you aplacebo effect... because the pain comes from your mind.

There is no medical proof that bulging, ruptured, herniated discs or copressed nerves in the spine cause pain.

Yes- your pain is real, but it is psychosomatic- which means you can make it disappear by thinking the right way.

Drop me an email or google "Dr. John Sarno". It will change your whole attitude towards pain and what really causes it.
posted by Zambrano at 10:11 AM on April 13, 2009


Uhm,

As someone who had/has a herniated L4/L5, please don't listen to Zambrano.
posted by Comrade_robot at 10:27 AM on April 13, 2009 [2 favorites]


Zambrano, pain does not work that way. Some pain can be psychosomatic, but pain has a function. In this case, it is telling chez shoes there is something wrong, and her spinal cord and arm are doing the right thing by saying 'WTF help me!'. So one needs to take painkillers and fucking fix it.

Compressed nerves BY DEFINITION are going to do something, which usually includes pain.

Please take your unproven alternative medicine and shove it up your ass.
posted by kldickson at 10:54 AM on April 13, 2009 [3 favorites]


Wow, interesting responses so far, thanks all! As expected, much more information here than in my ten minutes with the doc.

I should mention that I've already done 12 weeks of PT and was in excruciating pain the whole time. So, I'm not ruling it out, but would only do it if I could see someone else. Of course, our wonderful HMO system doesn't allow for this.

I'm thinking my next step is to request a neurologist referral. So back to my primary physician I go...
posted by chez shoes at 12:29 PM on April 13, 2009


12 weeks of PT? Okay, that's definitely not helping you. Find another orthopedist if possible, and go to a neurologist, preferably one that works with a neurosurgeon .
posted by kldickson at 12:44 PM on April 13, 2009


That herniation looks really nasty.
posted by kldickson at 12:45 PM on April 13, 2009


In our area, we have physiatrists, which is a back person who doesn't do surgery. It might be a different word to look up.
Based on my experience with the same area, you want to be very careful about pillows. Most of them are too high. The best is the sandbag kind with beans hulls in it or whatever that is. You want your spine to be straight while you sleep from the back up to the neck.
IANAD, but my doctor got the same thing and fixed his with a pillow. (His was brand new, not established; old cases are not as responsive.) Ice is good for muscle spams, if you have them.
posted by unrepentanthippie at 2:23 PM on April 13, 2009


chez shoes: make sure you see a neurosurgeon- not a neurologist. Different specialties.
posted by hellboundforcheddar at 4:08 PM on April 13, 2009


I herniated C4-5 about 8 years ago.

Is this a permanent condition?
No, but it took about 3 months for the pain to go away.

Will it get worse?
No, but when it gets better it does so quite rapidly.

Are there activities I should or should not do?
I couldn't even stand up or sleep, so anything more exciting was out of the question.

How did this happen?
I was playing soccer and looked over my left should while running.

Does sitting at a desk for 10ish hours a day make things worse?
That's what my job involved, and I had to lie on the floor periodically to get past the pain. If it wasn't a call-centre job at my university, I probably would have gone on disability. It hurt too much to sit still for more than a few seconds.

I can't turn my head enough to see sideways when I drive without causing great pain. I live in Los Angeles, where driving is a must. By continuing to drive, am I re-injuring myself?
Possibly. Keep going to a physiotherapist. The only thing that helped me was having my neck in traction.



I went off meds (Tylenol 3s) after 10 days due to their potential for addiction. It just took 3 months of physio and sucking up the pain before it went away.
posted by krunk at 5:19 PM on April 13, 2009


Yes- your pain is real, but it is psychosomatic- which means you can make it disappear by thinking the right way. Drop me an email or google "Dr. John Sarno". It will change your whole attitude towards pain and what really causes it.

Zambrano, come clean, now -- you're working for Dr. John Sarno, aren't you? You talk about him in every pain-related thread.
posted by EmpressCallipygos at 10:02 AM on April 15, 2009


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