Question
Do you have any information on epidurals? I injured my back in July and the recovery has been slow. I have been seeing my chiroprator and he has said that it's just going to take time. The workmans comp insurance company has insisted that I see an orthopedic specialist who is actually into pain managment. My first visit was 5 weeks ago and my second was this week. He ordered an MRI but it did not show the disc (L4-L5)
which is hurting. He says that it is coverd with arthritis so he doesn't know if it is torn or what. He wants to do the cortisone shot saying that this will remove the pain.
I am taking anaprox 550mg twice daily, which I would have to stop to get the shot. He also said that I would need to have someone to drive me home, but that I would be able to go back to work. I'm having a big problem with his reasoning as I am a otr driver and he is not willing to write me off work for any amount of time. I have managed to get the insurance company to agree to a second opinion and a delay of the shot until then. Am I being crazy to be skepitcal of this doctor? Any information would be helpful. Thanks
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Answer
Harley,
I find it interesting that your first choice of treatment was a chiropractor. That is usually the direction people go when an orthopedic can't solve their problem.
The cortisone injection is one that will MASK the symptoms. It is by no means a cure all. The discomfort will return until the problem itself has been corrected.
May I ask if this is an orthopedist you have chosen or one that the work comp people sent you to?
I would suggest that you first research the workers comp laws pertaining to your state. They vary a great deal from state to state. For instance, in Maryland you have the right to chose your physician. The company can also require you to be seen by theirs, but if the injury is compensible they will pay for the visits to the physician of your choice as well. When there is a conflict between the company physician and yours, an Idependent Medical Evaluation (IME)is usually ordered and a third physician is consulted. However, chiropractors don't count as a physician in our state.
Be very careful here. You may need to consult an attorney who specializes in comp cases to help guide you.
You mention that there is a great deal of arthritis on the MRI. This may actually result in the comp carrier saying that this is not a compensible injury.
Unfortunately back injuries can be difficult to treat. And difficult to prove.
I am willing to bet that one of our resident authorities on alternative treatments is going to have some great suggestions for your situation. NY2, RSL, your opinions are needed here.
By the way Harley, would you mind sharing the history of how your back injury occurred?
Any physician who tells you that the treatment they are going to perform is going to cure you and you will be able to go right back to work is stepping over the line. Medicine is NOT a black and white science. There are so many variables that come into play with each and every individual.
I would thing he would say something like "In most cases, this treatment will reduce your pain and allow you to return to work mcuh sooner" But to predict you will be cured is a bit much in my opinion.
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Keeping you safe, healthy, and on the road.
Nurse Red
Visit us at www.Truck.net/abmsVisit us at
Answer
When it comes to your back that is just such a complex issue with no easy answers. First of all, your chiropractor is right, it is going to take time. In medicine we don't have that magic bullet to cure back pain or back injuries.I think that a second opinion is not out of line either.
With all that said, how did you injure your back? And if you are have arthritis and you are not a young person, have they done other tests like blood work, urine tests, PSA test. In other words, have you had a good work-up? Have you had time for that, driving a truck? See, you may have injured your back, but many times what is really going on in the body does not show up until it is that final event that signals us that the body can no longer compensate for what's going on. A simple blood test can determine fi you have an infection or arthritis or even is there is the presence of a disease such as cancer that may be causing the symptom of back pain.
There are several tests that help the specialist see the nerves, discs, and vertebrae fo the spine more clearly.
CT SCANS--Computed tomography uses a sophisticated X ray machine and a computer to generate X rays of the back. Unlike standard X rays, Ct cans show soft tissue structures such as discs. The patient lies on a special table thah passes through the center of a large scanning device. Ct scans--like X rays--are painless, but they do require you to be perfectly still while the machine scans the body. (This may be hard if you have back problems)
MRI--Magnetic resonance imaging scans. Unlike X rays or CT scans, which emply radiation to develop an image of the internal body, MRI uses a nagnetic force along with a computer to assemble a view of the body. Like CT scans, MRI reveals discs, nerves, and bones, but in a different fashion.
EMG's--Electromyograms are often performed by a neurologist to determine if there is nerve or muscle damage. Tiny needles connected to a special instrument are used to apply pinpricks at several points along the patient's leg or arm. The slight pinpricks are more uncomfortable than they are painful. The purpose of the test is to determine if the muscle signals and nerve impulses are normal. This helps to determine if there is a pinched or damaged nerve.
BONE SCANS---Through a painless test, a radioactive material is injected into the blood stream. This material then settles into the bones. Using a special instument not unlike a Geiger counter, this radiation produces an image similar to an X ray. Bones that are undergoing rapid cell growth--as in the case of bone infection or fracture--then show up in this picture as a dense black area called a "hot spot".
MYELOGRAMS--A myelogram is a diagnostic test that alos can give information regarding the relationship of the nerves to the other spinal elements such as the discs and bones. During the test, a dye is injectd into the spinal canal. The person lies on a table that is tilted so the dye slowly travels along the spine, filling the spaces surrounding the sinal nereves. The dye shows up as a white substance on X rays, while obstructions such as herniated discs or bony overgrowths causing nerve impingements are revealed as dark areas. The myelogram, while an important test, is now used less frequently since the CT and MRI's have burst on the scene. As just an aside, they have discovered over the years that this test is probably the most diagnostic. MRI's don't always show the true picture.
DISCOGRAMS--Like a myelogram, a discogram is a test that can help the surgeon decide where the pain is coming from. During a discogram, dye is injected directly into the disc. In a normal disc, the fluid would be unable to escape and would then show up as an oval on an X ray. If the disc had herniated, creating an opening in the wall of the disc, the dye is shown leaking out into an adjoining area. Because part of the nature of the test is to reproduce the pain experienced by the individual accurately, a discogram can be painful.But again, it can be a valuable test in helping to ensure that a diagnosis is correct and plays an important role in resolving difficult cases.
Now about EPIDURAL STEROID INJECTION--in this procedure, local anesthetic and cortisone are injected into the space around the spinal nere. If a person has signs of sciatica with back and leg pain, an epidural may help alleviate the patient's pain.
FACET injections are used when pain is felt to be coming from the facet joints. Injections of cortisone directly into the joint help many persons.
TRIGGER point injections are sometimes used to treat an area that is tender to the touch. While this area may not be the source of pain, it can act as a trigger for the onset of disabling pain.
Epidural and facet injections can be used as a diagnostic technique prior to surgery to target a problem area, or as a way to relieve pain. Sometimes pain is relieved long enough for the person to strengthen the supporting ligaments and muscles and then surgery can be avoided. The problem here is that pain is your body's way of signaling that bending,lifting, sitting, etc--is a place you don't want to go if it increases as you do those activities. It is your body's way to protecting you from further injuring yourself. Once you have the epidural and it works--there is nothing to tell you for the time it is in effect--to limit activity--or how far you should go with your activity before injuring yourself further. If you have an epidural, are they proposing you go back to work soon after? Remember pain is only a symptom, not the problem. The underlying problem has to be treated, then the pain will lessen or in a few lucky cases disappear altogether.
While most doctors are capable of treating simple back strain, the challenge of treating complex back problems is rapidly becoming a superspecialized task. Much of this specialization is caused by rapidly changing medical technology and the the volume of new researchpublished annually. Spine care, like sports medicine, has come a long way in the last 15 years.
First there was perfection of such things as percutaneous discectomy, in which herniated discs are removed through a needle rather than major surgery. Just this month, Emory U in Atlanta, has announced a breakthrough in treating arthritis of the spine (due now to osteoarthritis)for people who were crippled to the point they could no longer work and were on tons of pain medication. On an outpatient basis, they are implanting artifical disc material to replace severely degenerated discs and having tremendous success with it.
Specialization in the field of back pain can occur as a by-product of years of experience in treating only back patients, or by attending a fellowship training program that combines education with real-life experience. Most superspecialists in the field of spine care tend to be either orthopedic surgeons or neurosurgeons. Another way to measure specialization is to ask doctors if they treat anything other than the spine. A true specialist will focus on spine patients only. Also, ask how many and what kind of therapists the specialist has on staff (or if they use therapists from a nearby hospital--that's acceptable. A large therapy staff can indicate that the specialist emphasizes nonsurgical treatment, or at least good rehab after surgery. Having no rehab staff usually leaves the surgeon with only one tool in his medical kit: a scapel.
There is a wonderful place near you (relatively speaking) called the Texas Back Institue located in Plano, Texas near Dallas that Dr. Ralph Rashbaum and Dr. Stephen Hochschuler co-founded together in 1978. Over 80,000 back sufferers travel there each year from across the United States. This may be an old number but their backpain hotline number is 1-800-247-BACK. They emphasize good diagnosis, back care (a sports medicine approach to recovery from a back injury), exercises for the back, proper diet to limit bone loss, etc etc., and only as a last resort and only if totally justified, surgery.
Answer
Harley, I posted my reply before Nurse Red's reply appeared on my server (we live out in the boondocks). What she says is right on the money. To have an epidural and go right back to work is spelling disaster because the underlying problem has not been dealt with. And the workman's comp company doctor is there to serve them, not you because the price tag of back pain is huge. Liberty Mutual the largest single payer of worker's compensation claims in the United States pays out over $1 million every working day to cover low back pain claims by injured workers.
When Nurse Red said get a workman's comp lawyer--that is excellent advice. I will relate a personal story. In 1992 I fell (not at work) directly on my lower back in a sitting position. The way the accident happened was absolutley hilarious and I laughed too. But not for long. Within a month my L-5 had ruptured and I was down in Birmingham seeing a specialist. Well, oddly enough several of my friends had injured their back at work and were seeing a workman's comp doctor. So I could compare what happened with them with what happened to me. My doctor was not under any pressure to "get me back to work." I did have an MRI, although he recommended a myelogram which is much more diagnostic (I refused because I was allergic to IVP dye). And knowing what I know today, probably would go through with the myelogram. The MRI showed a huge rupture of L-5. The doctor said that normally he doesn't recommend surgery, but "in your case you need surgery right away." Then he tried to be nice and said, "Well, the profession I see most of are nurses and truck drivers." (Can you imagine a practice made up of mostly nurses and truck drivers? Having the two most opinioned types of people on earth-- that must have been the practice from hell) "On a scale of 1-10, where is your pain?" he asked. You know Nurse Red, that stupid pain scale we are supposed to ask our patients if they are in pain, so we can gear treatment or response to treatment? Well, I said, "Let's throw that pain scale in the garbage. How about my pain feeling like an 8,000 watt cattle prod has been applied to the nerves of my back." I don't think he thought that was too funny and I didn't either. I could only think of those people I had shared a waiting room with for two hours waiting to see the doctor. The ones with multiple back surgeries--nothing helped--on tons of pain medications and tranquilizers never able to go back to their jobs.Tranquilizers because backache can cause loss of a job and it is common for a person's psychological state to be affected as well. Instead of just having back pain to worry aobut, all these life problems arise--like how is going to pay the bills now that I can't work? Can I find another job? Will I ever work again? Boom, throw a case of depression on top of back pain. NO NO NO, no way was he going to do back surgery on me because I could see my life as a nurse suddenly end and that was depressing and scary. Meanwhile my friends were seeing their doctor and finally most of them had surgery. I did too, but with the surgeon of my choice, the one in Birmingham. I had surgery a month after my MRI after trying everything else I could. And yes, I had arthritis already in my spine. The doctor could see that when he did the surgery. Which makes one important point-- although many back problems end up as on-the-job injuries, they don't necessarily start there. Back pain does not occur all of a sudden at a specific time and place. It is in fact a gradual process. Had I known then what I know now, I would have been taking better care of my back long ago. The end of the story: None of my friends were ever able to return to work. With proper treatment and care I was able to get up two hours after my surgery, totally pain-free. Could have gone home the night of surgery, but my doctor said "No" I went home the next day and returned to work in 3 months. Continue to lift, pull etc on my patients to this day without ever missing another days work because of my back.
So choose your doctor wisely, get the proper care and treatment, and get a lawyer.And educate yourself on how to take proper care of your back. As a truck driver you sit all day in your truck. Your back muscles lose their conditioning because you don't lift anything heavier than the cigarette to the mouth or the CB microphone to the lips. Then you go to unload something, not necessarily heavy. Or tarp a load, or throw chains over a load of steel roof joists,or or or..... and suddenly you are crawling back into the truck three inches shorter than when you started.
A herniated disc is often referred to as a "slipped disc." This implies that it has been slipped out of place and can be manipulated back into place. But you know discs can't slip because they are attached by connective tissue to vertebrae above and below. When a disc herniates, the jelly center squirts out of the disc wall to put pressure on the nearby nerves. When this event occurs, believe me, you will know this has happened.
While the disc is self-lubricating and injury resistant, it can't repair itself when it is torn. Worse, age is not on our side because blood supply to the disc itself stops around the age of 20. The disc can go into a state of slow degeneration where it can become drier, flatter, and more susceptible to herniation as we grow older. By doing flexibility and even aerobic exercises, we help the disc to lubricate itself as well as stay healthy from the increased blood flow to the areas surrounding the disc space. That reminds me about aerobic exercises (one of those "don't you just love it things")-- if you are hooked to PNV and turn on that set in the early morning hours, you always see a bunch of babes jumping around, doing their aerobic exercises--so well-tanned and so untired looking-- you wonder what planet they are from.
Anyway, good luck. The proper diagnosis is always the first and best way to start. 99% of getting cured is making the right diagnosis. Back pain is an unwelcome visitor. It comes without warning, it takes too long to leave, and once it knows your address it returns too frequently.
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These injuries require rest. The jouncing up and down in the seat is never going to give this problem a chance to recover. As for Workman's compensation it is a bad system that is sorely in need of overhauling. People with injuries such as yours are really treated badly. I have my own opinion of workman's comp attorneys, but I couldn't print it here.
You might try hydration therapy, involving eight to ten glasses of water every day, in addition to everything mentioned above by Runningsolate and Nurse Red.
Long term use of corticosteroids invariably pushes the chance of a malignancy way up. Not a way to go, Sherlock.
Laminectomies are popular surgical procedures to remedy this kind of problem, but there are several varients. If you decide on this make sure you go to a place where they do a lot of em.
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You know, the really sad part of this is that back pain is the most commonly used complaint in worker's comp. cases where fraud is involved.
So many patients and physician's make serious money for a prolonged back injury. Insurance companies have a tendency to push the patient back to work or deny these claims. This robs the truly injured person of thorough medical care. This seems to be what is happening with Harley A.
Given the fact that arthritis is showing on the xrays, I am surprised that the comp carrier hasn't denied the claim stating that it is a 'pre-existing condition' or some such nonsense. Of course they have no concept of the fact that a life time of truck driving has attributed to this pre-existing condition. DUH!
And I agree with NY2. The worker's comp system DOES need a major overhaul. But we would need to start a whole new topic for that.
But I am still curious as to how the current injury occurred.
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Keeping you safe, healthy, and on the road.
Nurse Red
Visit us at www.Truck.net/abmsVisit us at
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Thanks for the information. I'm sorry that I didn't reply sooner, but had to make a run.
This back injury occurred on July 20th. My co-driver and I were told to stop and help another driver move some freight so he could get past a scale. Turned out that the freight was bags of cinnimon which weighted 61 kilos. Trailer was loaded to the rear and stacked high. It took all 3 of us to move 1 bag, 2 pulling and 1 lifting. Since it was a 53' trailer, the bags had to be moved atleast 40' toward the front. We moved 18 of them to get him legal.
I had been diagnosised in 1988 with having bulging dics sysndrome. This was after a car accident in 1986. I would get better, go back to work driving for a couple of weeks and then be off again, taking muscle
relaxers. after trying several anti-inflamatories, found one that worked and had NO PAIN until this happened.
I have been seeing a chiroprator for several years, this started after a home remodeling
session. I usually see him about once a month for a general adjustment, not bad considering the state most of the highways are in.
The chiroprator is my personal one and he is in a practice that includes my personal physician. The specialist is the workmans comp doctor. When this happened I asked if I had to see a specific doctor and was told to see whoever I wanted. I had a complete physical with all blood work before I went to see the specialist, and everything was fine. (This did not set well with the specialist when I informed him that I had had a physical to rule out other causes for some of the pain.)
At my first visit with the "real" dr.,every other statement from him contained the words
"pre-exsiting condition". However, the workers comp has agreed that this is a new injury because there are no records of any problems. Now, on my second visit, this Dr. has tried to tell me that this is all caused by pregancy and child birth! (I guess I forgot to say I'm a woman) And I guess men don't have these problems. My daughter is 23 yrs. old and my son is 24. Both were normal pregancies and I had no back problems
other than what I 've told you about.
I am exercising and walking as much as I can.
I go to the gym when home, but so far I sticking to just cardio and upper body strenght training. I use the elpictal(?) EFX
machines, no jaring of the body with no impact. I have not been able to tolerate the weight machines that work the legs yet.
I have found that the truck seat is much more comfortable that the ones in the office doing computer work. And since I drive team, we normally work on a 8 and 8 schedule, not, 10-10. I'm not supposed to unload anything as we are line drivers for an LTL carrier on the west coast. and you can bet that this girl isn't doing any more favors.
At this point, I don't think that the shot is really going to help. I had been thinking that a lawyer would be my next best step. I am also thinking that a complaint to the medical board might be in order. I have written the workers comp about the doctor and they seem to have a problem with their doctor as well.
Anyway, thanks for the information. I appreciate it more than you can know. I'll try to keep you posted on what happens.
harley a
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I am probably in a minority in this opinion, but I believe you have to stay away from the gym for a while. There are many sides to the exercise coin, but disc compression injuries are not helped by gym workouts, even those which do not directly compress the verterbra.
That darned inflamation has to go down.
You have to worry when taking medication that the pain will be so "masked" you may undertake activities which will cause further damage.
Sometimes the damage to the cartilage or disc is so bad it simply will not repair itself. I know two New York City Fireman who returned to full duty following laminectomies.
Be careful getting climbing and out of the rig and especially jumping down from the trailer floor to the ground.
Pain from this kind of a problem comes and goes over the years. The workman's comp system virtually forces an individual to "fib" to fall within the guidelines. Not a good situation for the ethical person. It is sometimes impossible to pinpoint the incident/point where these injuries occur. Workman's com doesn't want to hear that.