It still hurts, but now I know why
So, in December of 2000, I started physical therapy for my back pain. I still didn't know what was wrong with me, I just knew that it hurt. Everyday. It seemed to be getting worse instead of better.
My first appointment at the physical therapy clinic was mostly a consultation with the physical therapist. He was a Captain and seemed like a genuinely nice guy. I described my symptoms to him and he started an exam. At the time, I had pain in the center of my lower back, that got worse with pressure at the site. I also had a sharp pain running from the top of my right butt cheek and down the back of my leg to my knee. At the origin, it felt like a pinch or a stab from a sharp object, deep under the muscle.
He had me lie down on the table and he checked my flexibility and pain response. In the end, he decided to start me on traction therapy and told me to take a back class. He also checked my referral for my CT scan and told me we'd stay conservative until we got the results. He also gave me instructions to continue icing the site and/or using a heating pad depending on what provided the most relief. He then gave me some quick instructions on things I should avoid.
I attended therapy sessions for a month before I could get in at radiology at Tripler. During that time, I went in three times a week for traction therapy. Traction therapy requires you to be trussed up in a set of belts, one just beneath the ribs and one around the hips. They have a series of straps and rings that get attached to static points at the head of the table and to a machine at the foot. The belts need to be incredibly tight to prevent them from slipping off during the session. So tight, that on some sessions, I could not take a deep breath. After getting into the straps, I would lie on my back with my lower legs up on a stool. Then, the machine would be set to pull at a constant weight for 10 minutes. It was uncomfortable for the first minute or two, but once I got used to it, it wasn't so bad. When the session was over, I'd get unhooked and stand up. I was literally an inch or two taller after these sessions. The difference was so great, I could actually notice the difference in perspective this made. It would only last a short time, but it was an odd feeling every time.
It took a little over two weeks to get the results from my scan. During that time, I just continued the traction. When I got the results, the physical therapist had me come in to his office and he showed me the problem. He had a really cool spine model that he showed me. He told me that I had two herniated discs in my lower back. L4-L5 and L5-S1, to be exact. He told me that the odd thing was, my symptoms made him believe that the problem was L5-S1, but the fact was that disc wasn't herniated all that badly. What was causing me problems was the L4-L5 (higher) disc. It was so bad, that it was actually causing the problems I described at a lower level in the spine. He recommended that I continue the traction and that I go to physical medicine at Tripler to determine what my next step should be.
I continued the traction, only by this time, I'd worked my way up to changing position. We restarted at a lower weight and I started doing the traction laying on my chest now. I also was able to attend the back class. It was three days a week for two hours each day for two weeks. During this class, I learned a number of back exercises to help strengthen my musces and develop flexibility. I also learned how to do a lot of everyday tasks in a new way, so as to not reinjure or aggravate my problem. I relearnd how to do such simple things as getting out of bed, getting up off a chair, getting out of a car, and standing up from a prone position on the ground. By this time, I was also getting some relief from the worst pain, but it was still a daily issue. I was finally able to get my socks and boots on most days without help from my wife. I was able to walk two miles in about 50 minutes at PT, which was better than a month before when I was walking only one mile an hour.
I was able to get in at physical medicine in Feb 2001. The doctor there was another good guy that took the time to go over my records with me and asked a number of questions about my progress. He told me about my options. There were basically three. I could do nothing different than what I was doing now. Just stay the course and hope for the best. I could also try some steroid injections. He said that would provide me some temporary relief that would also help in my long term recovery. He also said that surgery was an option. He told me that he didn't recommend that at the time. He said he'd prefer that we try to go a non-surgical route for a while first since there was the possiblity of progress that way and that surgery was often inconclusive. He said at times, surgery could make things worse immediately or later in life. I wasn't keen to go under the knife right away, so I told him I was willing to try the injection. He talked to me about that procedure and then we set up an appointment for me to get it done.
I went back to the unit and talked with some friends about the injections. What I learned really scared me. I had three friends that had received injections into various body parts and none of the stories were good. They all had different things injected and none of them had the same procedure I was going to get, but it was still enough for me to doubt the wisdom of my decision. The common part of their stories was how painful the injections were. One had his knee done, one had his elbow done, and one had his shoulder done. The last guy told me that he passed out from the pain during the procedure.
On the day of the procedure, I expressed my concerns to the doctor. He told me that he would be using a local anisthetic as he did the injection, so every time he moved the needle, he'd preceed it with a little bit of the local and wait a minute. He told me that if it ever started to hurt, to let him know and he'd slow down. He introduced me to the others in the room. There was an operator for the flouroscope (sp?) and another doctor that would be overseeing the procedure. He told me that it was policy that a senior doctor watch a junior doctor during these procedures. I got on the table and we started.
It was not nearly as bad as I had worried. For the most part I never felt more than a pinching type sensation. The only complication arose when they realized their angle was off and that they weren't going to be able to clear my pelvic bone. They realized this when the tip of the needle tapped my pelvic bone. They verified this on the scope and realized that they'd have to pull the needle almost all the way out and restart with a slightly different angle. I was bothered by this a lot less than you might think. I mean, I was pretty happy that it wasn't nearly as painful as I had worried, so this was really minor to me.
I had been warned that when they got to the right spot, I might feel a flash of pain. They were right. It felt like a shot of lightening from the site all the way down to my toes. The doctors saw my leg jerk and figured they were in the right spot. They checked again on the scope from multiple angles and deteremined that they were indeed in the right spot. They then warned me that I'd feel pressure at the site as they injected the steriod. Again, they were right. I felt a cramping/pinching feeling in my butt and hamstrings of my right leg.
After the procedure was complete, it was just a matter of waiting at the recovery station to make sure I didn't show any ill effects. I spent about 20 minutes there and was cleared to go home. I have never enjoyed riding in a wheel chair when I could have walked, but hospital policy required me to ride the entire way to the parking lot.
Two weeks later, I had a follow up with the doctor from physical medicine. I told him that I had recieved a fair amount of relief from my pain and was feeling much better. The problem was I wasn't feeling as much relief as he had predicted. He asked about my activities from the past two weeks and if I had done anything to aggravate my injury. I told him that my unit had conducted 'range week' during that time frame. During range week, we spent an entire week at the firing ranges and trained with all the weapons we were assigned. Most of the Soldiers had to walk to the range with rucksacks and rifles, but I'd been allowed to drive in a military truck. I still had to wear my helment and web gear and carry my rifle every day, but I was allowed to leave the range area and take off my gear as necessary.
This news made the doctor a little upset. I hadn't thought to tell him about range week prior to the injection and he hadn't asked. He told me that if he had known I was going to go off and do all that type of stuff, he would have written me a medical exemption from doing any of it. He said this impacted the results of the injection and that if I decided to do another injection, he would give me stricter limitations during the two week period. He ended the follow up by telling me that I was welcome to come back in the future to get another shot. He also told me that if I changed my mind about surgery, he'd be willing to talk to me about that, too, but he still didn't think that was the way to go.
Just before I left, I asked about my chances of full recovery or how close to full recovery I'd ever get. He told me he wasn't sure, but he thought with proper care and exercise, I'd get better, just maybe not 100%. He told me that at some time in the near future, I should stop renewing my temporary profile (doctors note of limitations) and ask for a permanent one. He also told me that doing situps were very bad for my lower back and that I shouldn't do them any more than absolutely necessary. I thought, great, that will help my PT test score.
I never did go back for another injection. I honestly don't know why. I got a good bit of relief after the first, I had a free pass to return, and it wasn't nearly as bad as I thought it would be. I just never went back.
Well, this has gone on longer than I thought it would so I will end here. Next up - my permanent profile and how it affected me. Also, my last ride in an ambulance.