Second opinion

Today was the day of my second opinion appointment at Bone and Joint.  I have been looking forward to this day in the hopes that someone will have a clue what is wrong with my hip and will have an idea of how to fix it.  And because I hate crutches.  If I’m being completely honest, it has been a challenge to maintain non-weight bearing status for two weeks.

When I met with the doctor today, I knew I had made the right choice in going to Bone and Joint for my second opinion.  He walked in and we talked a little bit about my history.  He had the notes from my previous appointments and we talked through them.  He pulled up both the X-ray and the MRI from my previous appointments and we discussed what he saw.  He showed me the images and pointed out the one area where he was concerned.  Then he did an exam and had me bend and twist and reach.  He tested my reflexes and nerves.  The exam was unremarkable.  As usual.

He decided to get an X-ray of my lumbar spine, which they were able to do in office and we looked at it right away.  His idea, based on the old MRI and the new X-ray is that I might have a posterior annular tear.  It is hard to tell from the MRI, since it was focused on the pelvis, and the part of the MRI that made him suspect this diagnosis isn’t a really clear picture.

The annulus is is the outer band of tissue that surrounds the disk between each vertebra.  In looking at the MRI that was taken of my pelvis, there was just enough imaging of the lumbar spine to see that the disk between L5 and S1 was compressed and had a small pouch that bulged slightly into the area posterior to the disk (toward the spinal cord).

The X-ray that he took today confirmed that the disk was slightly more compressed than the other disks. 

He ordered another MRI, this time of the lumbar spine.  I have that scheduled for Wednesday afternoon.  I will follow up with the same doctor next Friday. 

Another reason that I liked this doctor is that he really seemed to understand me.  He walked in and found me a box of tissues because he knew that I was a runner who couldn’t run.  We talked about how running is my anti-depressant and how stressful it is when you can’t engage in your stress relieving activity.

We talked about how we were going to move forward.  He said that we could keep trying different options.  If one option didn’t work, then we would know that that wasn’t the source of the problem.  He asked my opinion of the outlined treatment plan thus far.  He really made me feel like we were going into this together.  And that he wasn’t going to give up on me.

He did prescribe a few medications in the hopes of giving me some pain relief.  The first one is a steroid, methylprednisolone, to decrease inflammation.  He prescribed it as a step-down dose.  I will take six pills today, 5 tomorrow, 4 on Sunday, etc. for six days.  Steroids are great for this type of problem, but they are not without side effects.  Things like mood swings, anxiety, insomnia, increased appetite and depression.  Fun.  I warned Tim that I might be a little irritable. 

The second medication he prescribed is gabapentin.  It is specifically for nerve pain and it might be a stretch as far as it treating my particular conditions.  He suggested that I start by taking one pill at bedtime and increase to two pills at bedtime if I tolerate it well.  But I shouldn’t start taking it for a few days.  If there are any side effects from the steroids, we don’t want them to be masked by, or mistaken for, side effects of the gabapentin.

He also told me that I could forget about the crutches!  Yippee!!  I didn’t feel that they were decreasing the pain and if the problem is a disk issue, the crutches won’t help anyway.  When I see him next week, he will likely write another order for physical therapy.  Once we see what the MRI shows, we will have a better idea of what type of therapy may be beneficial.  In the meantime, he did give me a few back extension exercises I can do.

I am really hoping that the steroids give me some relief from the pain.  I am looking forward to the MRI on Wednesday—not because I particularly enjoy lying completely still on a hard, metal table, but because it may help us determine the cause of the problem.  And if we know the cause, we are more likely to know how to treat it.

I am hanging on to a thread of hope that I may be able to run again.