The next step…since the last step

I had another follow up appointment at Bone and Joint this week.  I am really getting sick of going and seeing them every couple of weeks.  This time was to talk about the effects of the steroid injection I got a week and a half ago.  I haven’t experienced the relief I had hoped from this treatment.  That sounds like a broken record.  This whole process has been less than I hoped. 

I talked with the doctor about the pain I was having.  We discussed the differences I experienced when I extended my back vs when I flexed my back.  Most of the pain I have right now is from bending.  The treatments up to this point have been geared toward pain during extension.  Does this mean that the treatments are working?  Does it mean that the core exercises I’m doing with PT are working?  Does it mean I just had a day when it hurt more to flex than to extend?  Who knows.

What I do know is that I still have pain.  The doctor is getting frustrated.  She pretty much told me that she thinks I should get a second opinion.  She knows I am frustrated and depressed and at my wits’ end.

We looked at the MRI images from back in May.  We talked about the torn annulus.  Her opinion is that the tear can be causing the pain when I bend forward.  The (conservative) treatment is to do an epidural.  The other treatment is spinal surgery.  She told me about her brother who is a spinal surgeon in Washington.  His patients are never allowed to run again.  I decided that spinal surgeons are the devil.

So, the next (last) treatment option that I have with this particular physician is to do an epidural injection on November 7th.  The process will be the same.  I’ll need a driver and I can’t eat or drink anything the morning of the procedure.  She will use a big needle, under X-ray guidance to get to the right area in my back (L5).  Here is an excellent website that explains the process of the epidural injection.  It will be a caudal injection, meaning that she will enter from the bottom-most portion of my spine.  My favorite part of this website is:

One study showed over 80% good to excellent results for caudal epidurals in managing back pain with or without disc herniation. These amazing results lasted for upwards of a year.

I hope that I fall into that 80%.  On a related note…is anyone available to take me to the appointment on the 7th?  My dad will be snowbird-ing in Texas by then.

I also talked with the doctor about my work restrictions.  She had written ‘moderate’ restrictions for me and my employer had been looking to get new, updated information from the doctor regarding my ability to perform my job.  I told the doc that I was able to do everything asked of me without violating the restrictions she had written.  So, she was able to return me to work without any restrictions…with the understanding that I am still going to be careful and not do anything that could cause pain or injury. 

The other thing we talked about was my running.  I told her that I was running a mile, slowly, most days of the week.  She seemed to think that this was fantastic.  That this was what I wanted.  I wanted to run.  I was reaching my goals.  I refrained from telling her what I really thought of her assessment.  Instead, I told her that I wanted to be able to train.  I wanted to really run.  She reminded me that running is putting a lot of pounding on my joints and my back.  But that she understands how much I want to be able to start training again. 

I am willing to adjust my expectations of my future performances.  I may never be able to qualify for Boston.  I may not be able to run a marathon a month.  I won’t be able to run seven days a week.  But I do want to be able to put in some quality training—speed work, intervals, long runs.  I want to be able to run a handful of half marathons a year and maybe one full marathon a year.  I feel like I still have PRs left in me.  I want to be able to work toward those goals.

In the meantime, she did say that I could increase my mileage by half a mile per day per week.  So, now that I have been running one mile a day for a while, I can take it up to a mile and a half.  Once I do that for a week or so, I can increase to two miles.  By then, it will be time for the injection. 

We are doing a family 5K Thursday evening.  There is a local Pumpkin Run.  Tim is thinking of shooting for a PR.  Jaden and I are going to run/walk it together.  At his pace, I shouldn’t be straining myself at all.  It is going to be nice to do an actual race, even if I won’t be racing it.  It is only my 2nd race of the year.  It will be Jaden’s 4th 5K of the year.  He is pretty excited.  I hope it doesn’t rain.  If it goes well, I may try to do another race with him in a couple weeks.  It is another local 5K we have done the last couple years.

Anyone else doing a Pumpkin Run?

Any experience with caudal epidurals?

A cortisone injection

On Friday morning, I had my dad drive me back to Bone and Joint for a cortisone injection into the pseudo-joint at S1/S2 on the right side of my lower back.  Just like the prior injection appointments I’ve had there, I was checked in and taken back to the pre-op area where they made me pee in a cup for a pregnancy test (it was negative).  Then they checked my vitals and the doctor came back to check on me. 

After about an hour of waiting, they wheeled me back and had me move onto the other bed.  I was face down and they prepped my lower back.  They set up the X-ray machine so that the doctor could be certain that she was in the right spot.  After a lot of poking on my back, she double checked the placement of the needle by injecting a contrast dye to make sure it was in the right spot.

She injected a steroid and a pain reliever (lidocaine/bupivicaine).  The injection burned a little bit, but that is to be expected.  After the injection, she asked me to rate my pain.  Honestly, there was no difference.  After they wheeled me back to the recovery area, and I got up to use the bathroom, the doctor came back to see how I was doing.  She asked me to stand and bend and to rate how I was feeling. 

I didn’t notice anything different.  Actually, I was hurting more because I had been lying down for a while and I felt tight and stiff.  She told me that if this didn’t do anything for my pain, that the only other option she had was to address the SI joint.  She didn’t go into any details about that.  I will follow up with her in another week.

She told me to take it easy the rest of the day.  I could use ice for pain relief, but I should avoid using heat.  She also told me to hold off on physical therapy until after I follow up with her.

To day that I am disappointed would be a huge understatement.  In the couple of days since the injection, I have been holding onto a glimmer of hope that the pain would decrease.  No luck.  I guess  I will wait until my follow up appointment to talk with her about what the next step is.

On Friday afternoon, I saw my primary care provider for my yearly physical.  I love her.  She is really fantastic.  She is a runner who knows what it is like to be inured and not able to do the things that I want to do.  We chatted about how I was feeling and how I was dealing with not being able to run and always being in pain.  We came to the decision that it makes sense right now for me to go back onto an antidepressant. 

I don’t think that antidepressants are bad or wrong or evil.  I know that many people need them and that they can be very effective.  I took them for a time after my older son was born, to help treat post partum depression.  When I was pregnant with my second son, I went back on them because I was so concerned about getting PPD again.  I thought that running was going to be the thing that saved me from ever having to rely on medication again.  And it did for a couple years.  But I haven’t been able to run with any intensity since February.  I have been in pain every day since the end of January.  And all of this has significantly effected my mood. 

So, I’ll go back on the pills.  We decided to start with half of the typical lowest starting dose.  If the the side effects are too bothersome, I will probably quit taking it.  But I will try this for a couple weeks and see if it helps. 

In other news, I registered for a race!  Actually, the whole family did.  There is a local 5K in a couple weeks and I registered Tim and Jaden and I to do it.  Jaden set a goal to run five 5Ks this year and because of my injury, he has only done three so far.  Tim and Jaden can run the race and I will walk it (I’m still allowed to run one slow mile).  I wish I could be competitive, but at least it will give us a fun family activity.

Hope

I have another doctor’s appointment this Friday.  This time, the doctor is focusing her energy on my S1-S2 area of my lower back.  She is going to do a cortisone injection in the hopes of (finally) getting rid of the low back pain that has plagued me since the beginning of the year.

I am trying to be optimistic.  If I’m being honest, it is really hard to do that right now.  I’ve tried so many things this year to try to get better.  To be able to run again.  To live without pain.  I feel like I am grasping at straws.

To add insult to injury, when I got to work today, I had to listen to one of the anesthetists tell me all about his race at the Twin Cities marathon last weekend.  The marathon I was supposed to run.  The marathon I was going to try to run under 4 hours.  MY marathon.  I tried to smile and be supportive and encouraging.  Inside, I was miserable.

So, I’m really hoping that this treatment works.  I would give anything to be able to run more than my one mile every other day.  I want to start training again.  I want to feel those endorphins again.  I want to feel strong and capable.  I want to run!  (And I want to be able to tie my shoes and fold the laundry without pain.)

The injection will be Friday morning.  I am asking that you all send your positive thoughts and prayers and any other good things you can my way.  I am hoping. And praying.  And pleading.  I really need this to work.

Thank you.