More on Piriformis Syndrome

I have now had two steroid injections into the piriformis. The first one was great and I felt normal for a short time. The second time, the radiologist managed to hit the sciatic nerve and that was a bit disastrous. I completely lost any feeling in my right leg. I couldn’t believe that the hospital let me go. They just told me  to be careful. But the leg wouldn’t take any weight and it felt like my knee was going to bend backwards…my husband had to get me out of the car and to the bottom of the stairs and he hurt his shoulder. I had to climb up the stairs on my bum and for the rest of the day, I had to ask for help to move. It was unbelievable.

The next morning there was still parts of my foot that were “frozen”. And the sciatic nerve was really irritated. Totally different. It took about a week for the irritation to go away but the piriformis is still hinkey although it is better. On Sunday Oct 11 the muscle went into spasm and would not stop. Horrible. The next day, the leg was so fatigued I couldn’t walk around the block. It’s coming and going which I’m grateful for. Before it was spasming all the time.

I saw Dr. Devonshire on Friday and she agreed that it was time to do the Botox. At least there will be a more lasting effect. I asked her what would happen if the nerve got hit again and she said that it would stop the pain fibers which is all right by me.

I have had tremendous relief from the lift in my shoe. I also had the left shoe built up all along the bottom. It is unbelievable what a difference this has made. Physio said that my leg length discrepancy was only seen on standing. Anyway, the lift puts me back in a more neutral alignment. That translates into less pain. All of a sudden I am standing straight. It’s so strange. I have exercises to do to strengthen the surrounding muscles (first stretched the piriformis but now it’s good). And we’re trying to move the ribs separate from the hips. I have been locked for a long, long time so even being able to do the side bend and move the ribs separately is a huge big deal. I”m just watching the end ranges of movement. Also strengthening proximal hamstrings. Amazing how those little things are so hard to do. One day I expect to get back on that reformer. I’m also doing the elliptical everyday or walking.

Still Doing Well

I feel quite fortunate to be able to say that even though the piriformis is still inflammed, I’m able to manage things. It is taking a little bit to get used to the new drug regime – cymbalta and nortriptyline – but I am getting  used to it. I really felt out of it for the first 5 weeks. The doctor told me to play around with the timing and I think that I have found a balance. I take the cymbalta at 1:30PM instead of at bedtime. I had a terrible time with my gut and pain which is what prompted the desire to change. That has been resolved and I am also no longer sleeping so much. I awake on my own between 6 and 7 which is my normal time.

Neuropathic Pain

I find it very interesting to see the pain managed so successfully with non-narcotic drugs. I’ve been in pain for years supposedly from my arthritis although my case is quite complicated. But isn’t everyone’s case different and complicated in other ways?

NSAIDs (non-steroidal anti-inflammatories) helped the pain but this was far from complete. And these types of drugs are not meant to be taken forever. The ideal case is that you get an acute inflammation from something eg spraining your ankle and you go on the NSAIDs for 10 days to aid with the healing.  Arthritis, however, is not an acute situation but rather is chronic. People go on the NSAIDs because of the pain and the drugs help to different degrees.Unless the patient is persistent about their level of pain, it often stops here. And the patients’ don’t know what is “normal” pain from arthritis. The one thing that they do know is they can’t manage many “normal” daily tasks and this can impact their quality of life (QOL) to varying degrees.

Update August 21, 2009

Well, I can hardly believe the difference between now and the last post. Let me start off by saying that the pain is well under control. In fact, most of the time during the past week I have not had any pain. That’s a show stopper.

Two weeks ago, I had to stop taking my Arthrotec (an antiinflammatory) because I was having the steroid injection into the piriformis muscle. I began taking Cymbalta several weeks prior to that. I’ve had to stop the NSAIDS before and couldn’t wait until the time I could start them again because of the increase in pain. Believe it or not, I didn’t even notice the difference. I was stunned. After a couple of days I thought the inflammation would come back and the pain would get worse. Nada. And now it’s been two weeks and I haven’t taken a single antiinflammatory.

Feeling a Lot Better Then Not

Yesterday, I felt terrific. It gave me new hope. The cymbalta is definitely working. Each day it has been a little better and then yesterday, I almost felt normal. Well you know how that works.

I did a nice walk – managed to go a little faster without trying. I was out there for about 30 minutes. Nice. Sunshine. Walking straighter. I really did feel better. By the time I got home, Bill was waiting to go to the beach where the Harmony Art Festival is taking place. I had thought we were going on Sunday or I wouldn’t have done my walk. Whoops. I didn’t say anything and without taking a little rest, we went to the beach. We were there about two hours. It was fun to walk around and see the different craft booths and the gallery. Outside they were doing art demos and Alan Wylie was there. Bill loves his stuff so he sat on a log and watched. I tried to sit next to him but after five minutes I knew it wasn’t a good idea. OK. I went to lawn and sat in one of the chairs.

Bill could tell I was reaching my limit but he wanted to see the gallery. He found a book there by an artist he would like to take a course in. Then we walked around the lawn area, found the schedule for the art demos and just wandered. I think I did something then. I was a bit of a tough go on the lawn, not even ground and there was a dip that I didn´t see. Darn. I could feel something in my back but it wasn’t sore immediately after.

Around and Around We Go

Well, there is no shortage of changes, no shortage of frustrations and sometimes no shortage of hope. The most recent news is difficult to get through. The physicians are getting risky with their suggested treatments and I’m really having to decide just how much I am willing to gamble. I feel, after the hyperthermia trial in Holland, that I am done with the experiments.

Now I am at steroid injections and am stopping that unless they are done radiographically. I was a neurologist’s office last week and she gave me 6 injections trying to hit the piriformis muscle. I feel terrible now and over the last week it’s been hell. I was supposed to go today for a shot into my neck and begged off. She’s made an appointment to do a repeat one radiographically but this being Canada I have to wait a couple of months…She wants to do botox injections into the muscles. I am totally uncomfortable with that and want a second opinion.

Update on Bone Scan

Hi Everyone

I know it’s been ages since I’ve posted. I’ve had a lot of trouble with pain management and everything seems to go okay for a time, then it’s definitely not okay…

I had a repeat bone scan and found out that have lost 10% bone mass. That is in spite of having been on Fosamax. Geez. So the Fosamax is not working.

Doing some blood work to check out what’s going on. There are rarely any answers. My hip and wrist are okay but my back is definitely not.

And the last MRI found anterior wedging at T5/6. That’s bad but thank heaven it was minor. However it means no more head off the mat and start to take some serious precautions. Wedging can lead to vertebral fractures…don’t want that.

So life is kind of like that. One of my best friends has lung cancer metastisized in the bone. That sucks. Besides that, it means I’m still doing okay. You gotta keep it relative.

Take care.
Darlene

Walking, Reformer and Yoga Going Well

Click on the link to see the video: http://www.viddler.com/darmorrow/videos/40/

Things are going well. Did a 15 minute walk, 45 minutes of the Yoga for Scoliosis DVD and also worked on the Reformer. All on different days.

Going on the elliptical now for 30 minutes. Feeling pretty good.

Starting a New Video Group at Viddler

I’ve started a video group on Viddler. If you have webcam and microphone, please come on over and share your experiences. Viddler is free, it actually works and it’s a great way to share info and to put a face with a name.

Please come join us at darmorrow | http://www.viddler.com/groups/backsurgery

Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain

The complete article is free. It’s well worth visiting the link because there is also a 12 minute video explaining what the Alexander Technique is. I’ve posted the abstract below.

 http://www.bmj.com/cgi/content/full/337/aug19_2/a884

Published 19 August 2008, doi:10.1136/bmj.a884
Cite this as: BMJ 2008;337:a884