Caudal Epidural

Last week I had an epidural injection into my lower back to make one last attempt at dealing with my chronic back pain.  I’ve held off writing this for a while.  I wanted to see what I would feel like a few days after the procedure. 

For this injection, I was able to go to Medford instead of Wausau.  It is a much shorter drive, but I still needed a ride, so I had a friend of mine take me.  She was running a little late, but so was the doctor, so it worked out ok. 

The nurse in the preop area reviewed all my meds and my history and I had to take yet another urine pregnancy test (negative).  The doctor came in and marked the area for the injection and then I got a wheelchair ride to the procedure room.

Once in the room, I got onto the surgical table on my stomach and they prepped my lower back and buttocks.  Because this was a caudal epidural, the injection site was different than the usual lumbar area.  This time she inserted the needle into the very bottom of my tailbone and threaded a wire up the length of my spinal column (through the epidural space) to the L5 area where the disc is bulging out of the torn annulus. 

She numbed my tailbone with lidocaine prior to inserting the needle.  She used Xray guidance to ensure that the needle and wire were in the appropriate places before she injected the meds.  Once she started with the meds, I could feel a little bit of pressure .on my abdomen—but it felt like it was coming from inside my body.  It was an odd sensations.  There wasn’t any pain from the injection, only some discomfort and pressure.

The procedure didn’t take long.  She did say that the medicine seemed to want to go to the left side and she had to adjust the wire to make sure the medication went to the right area.

After the medication was injected, she pulled the wire and the needle out while injecting a little more numbing medication.  Then the nurse cleaned me up and I sat up and looked over the Xrays with the doctor.  I was able to see exactly where the needle and the wire were and where the medication was injected.  I love that stuff!

Everyone started asking me how I was feeling and if I had any weakness or tingling in my legs or feet.  My legs felt fine, but my butt felt like I had been sitting on a block of ice for an hour.  It was completely numb.  I got off the table and got a wheelchair ride back to the recovery area.  They made me sit for a bit and gave me some water to drink.  Once they were sure that my legs were stable and that I wasn’t going to fall over, they took me out to the waiting area and I went home.  I was back in my house by 10:30.

It took a couple hours for the numbness to completely wear off by my tailbone.  But once it did, I realized that it hurt!  And my tailbone continued to hurt for a couple days after the procedure.  I used ice packs and ibuprofen to deal with the discomfort.  I had to be conscious of how I was sitting because any extra pressure on my tailbone caused more pain.  The pain eventually subsided after a few days.

As for the back pain…well, initially I was pretty pleased.  I felt less pain when I was bending or twisting or just going about my daily activities.  But, I probably did too much in the first couple days after the injection.  The very next day I ran/walked a 5K with my son and the day after that was Tim’s first marathon and I biked all over Madison cheering him on (race recaps are coming).  So, on Monday I was a little sore.  And I was still sore for the first few days of the week.  I was getting pretty discouraged thinking that the injection didn’t work.  But then, I would have several hours or half a day when I felt pretty good and I would think that maybe it did help.

It may seem weird, but my barometer for how bad my pain is involves using the bathroom.  One of the most painful activities for me is bending to lift the toilet seat lid when I go to the bathroom.  It hurts so badly.  Especially first thing in the morning.  So, if I can go to the bathroom and lift the lid without pain, then I am doing pretty well.  If that hurts, then I know I am having a rough day.  If I’m having a rough time with that, I usually don’t even try to empty the dishwasher or the dryer because I know it will just hurt too much.  In case you were wondering, and I know that you were, today is a good day so far.

My follow up appointment is on Tuesday.  I don’t know what to expect as far as duration of pain relief.  This is only a temporary fix.  Most people will experience relief for weeks-months.  It is highly individualized.  I’m hoping to feel better for a while because I don’t know how frequently this procedure can be repeated.

As for my running, the doctor gave me clearance to continue to slowly increase my mileage.  I’m at two miles a day, most days of the week.  I am allowed to increase that to 2.5 miles next week.  Still no high intensity work.  I keep walking and I swim once a week.  I just have to stay active to try and keep my attitude from slipping.

I’ll be back next week with an update after the follow up appointment.  Hope everyone is doing well.

Forty five 2014

I’m a day late on the weekly photos.  Please forgive me.  I spent yesterday chasing my husband around Madison as he completed his first marathon!  Super proud of him.

Jaden-Running his fifth 5K of the year.  Love to see him accomplish his goals.

Logan-first day of preschool

October month in review

Second month on the new job.  I am really enjoying it.  I even got to ‘solo’ my first cases.  Every day I am learning more and more and occasionally I don’t feel completely incompetent.  I won’t be through the orientation process until the end of February, but I’m sure it will be at least a year before I feel like I have a good handle on what is happening.

I have been consistently going for a walk during my lunch break.  The loop around the hospital campus is exactly a mile and if I book it, and can finish it in under 13 minutes.  That doesn’t leave much time for me to eat (I only get a 30 minute lunch break), but the fresh air and the movement helps me to clear my mind and keep me focused for the afternoon.  At some point it is probably going to get too cold to continue this tradition.  That will make me sad.

My running improved to 1.5 miles a day.  I still can’t go fast.  I have to take it easy…between a 10-11 minute per mile pace.  And I’m walking before and after my allotted running mileage.  It feels good to move, but it is killing me that I can’t start ‘training.’ 

All that being said, here are the totals for October.

Running: 32 miles.  That beats September’s total of only 10 miles.  Part of that was even at a race.  I ran/walked a local 5K with Tim and Jaden.  It was my slowest 5K ever (I think), but I got to chat with some friends and it was a lot of fun.

To put that in perspective, last October I ran 142 miles, including 2 half marathons.

Walking: 78 miles.  If I add those together, I put on over 100 miles for the month.  I guess I should focus on that, right?

Swimming: 3.38 miles.  I am swimming on Wednesday afternoons after work.  The pool at the high school is open for an hour on Wednesdays.  I change into my swimsuit before I leave the hospital and I try to get close to 2000 yards before they kick me out.  The biggest problem is that there are a ton of kids playing in the pool and they don’t care that I am trying to get a workout in.

As for the injury…well, I had a completely ineffective steroid injection on October 10th.  I had hoped for a positive result, but no luck.  Much like every other treatment option we have tried.  At the follow up appointment, we decided to try one last-ditch treatment—a caudal epidural.  That will happen next week.  She also told me that I can slowly continue to increase my running mileage. 

November will surely bring much colder weather-a challenge to my daily lunch time walk.  It also brings Tim’s first marathon—that I was supposed to run with him.  Instead I will bike around the course harassing him cheering him on as he tackles this huge accomplishment.  Then I’ll take him out for dinner and ice cream.  I’ll try not to be super depressed watching everyone else running when I can’t.

I’m really hoping that the epidural works.  Oh, and I am going to run one more 5K with my son in November.  The run/walk method isn’t my favorite, but the time I get to spend with him can’t be beat!

Tell me what you accomplished in October.  Let me live vicariously through your accomplishments.

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?