Hoping For Insight in Tulsa

[Dutch]

Warm greetings from Tulsa. I am pleased to find this forum and hope to learn a lot about what has worked for others in situations like mine.

In March 2009, I was stopped at a traffic light (in a Mazda RX-8) and saw an older full-sized truck closing in fast (and unfortunately had my neck turned to watch him in the rear-view when he hit me). It is not clear either way, but the driver was not paying attention and I don't think he made much/any effort to stop. My car was totalled and two more vehicles in front of me were damaged.

I had immediate symptoms of neck pain and headache. Cervical x-rays at the ER showed no fractures and following a CT scan I was diagnosed with "cervical sprain/strain" and sent away with a handful of strong pain pills and ordered to follow-up with my PCP.

Neck pain, right shoulder pain, mid-back and low back pain were unbearable by the next day. My doctor prescribed hydrocodone, Soma (muscle relaxer) & Meloxicam (anti-inflammatory). Per his orders, I completed an initial round of physical therapy (painful, but critical to helping me maintain mobility). Following a re-eval, I did another 3-4 weeks of physical therapy and then continued (still do) the basic stretches/excercises they had me doing.

Continued pain radiating through shoulder led to my being put on Lyrica which I discontinued due to side effects (feeling "hot" and being irritable). My doc added Lidocaine patches instead. Headaches (along with dizziness and persistent neck pain) resulted in MRI of brain & cervical spine. Cervical MRI noted "minimal broad-based disk bulging" from C4-5 through C6-7. They also made note of "small central disc protrusion" at T3-4 and "minimal broad-based disk bulging" at T4-5.

I discussed these results with an orthopedic surgeon who referred me to a well-respected chiropractor and said he didn't see any need to "fix" anything. I saw some further improvement with the chiropractic care (pain levels WITH MEDS were reduced from 8 or 9 to a 5 or 7).

After many months of hearing "these things just take time", I requested referral to a pain management doc to discuss next steps for improving my pain levels (extra challenging since I own my own business and can't afford to just be doped up until the pain is gone).

In January, I had injections done in my neck and low back. Low back pain was slightly reduced for a couple of months but little/no improvement was seen in neck pain.

Throughout the last two years, I have had persisting (and increasing) problems with numbness in my fingers on both hands - as well as some loss to grip strength. This has become more noticeable and troubling in the past 6-9 months and the pain management doc (like all the other docs) figured the symptoms were related to carpal tunnel. With that assumption, I've largely ignored or been unconcerned about the symptoms until I recently figured they were getting bad enough I should take the next steps to see about having the CTS correction surgery.

Last week I got a real kick in the teeth when I went for the EMG/nerve conduction tests and the report revealed:
1) "Right median neuropathy at the wrist graded mild in degree" "0.4ms latency in right median forth digit" (Mild carpal tunnel?)
2) Left C7 radiculopathy graded mild to moderately severe (). Report also states: "All muscles on the right were normal but on the left there were moderate reduction of the recruitment in the triceps and extensor indicus proprius muscles with mild chronic motor unit changes." There were no numbers or percentages in the report, but the neurologist said something about 25% (loss?) at the time (along about the time my arm was shaking like a leaf trying to push against him when he was testing the tricep).

Now I'm somewhere between confused and terrified. I have heard and read everything I could absorb over the weekend and in typical internet fashion, I'm more confused than ever. Some things seem to indicate that this is no big deal and will go away on its own. Some make me think I dismissed this as carpal tunnel for too long and will be unlikely to recover the lost motor function. Finally, there are a few "you better get into surgery or you will be dragging a useless limb around with you" and a similar number of "avoid surgery at all cost or you will be dragging a useless limb around with you".

I am here out of a solid mix of panic and a well reasoned desire to make the most informed decision I can about how to proceed. At this point, I have requested (and am scheduled for another MRI tomorrow to do a comparison with the one from 2009).

I have two goals:
1) Retain lost motor function (or at minimum prevent any further loss).
2) Reduce/eliminate the chronic pain which has been debilitating and reduced my quality of life (preferably without continued use of pain meds which reduce cognitive function and energy)

I will continue reading through these forums, but I would be most appreciative of anyone who can provide specific feedback or guidance.

Thanks in advance for letting me hear your stories and get some advice/support from those who have been in my shoes.

Regards,
Dutch

[KanRunMo]

The MRI that you are getting tomorrow is your best bet of finding out what is going on. Is there some other reason they thought it was carpal tunnel syndrome? With your MRI in hand, an appointment with a neurosurgeon might be your next step. There are many on this sight that may have had symptoms similar to yours. We will be anxious to hear what you find out.

[spinches]

Hi Dutch, Welcome!

I have similar cervical issues to yours. My left forearm went numb in January quite suddenly. I think it may have been a delayed reaction to a fall I took on my deck in November. I have had carpal tunnel syndrome for years and my primary care physician thought the numbness might be related.I was referred to a neurologist, who tested me and told me I had irreversible loss of innervation in my left triceps as well as the acute problem in my forearm. She said this state of affairs implied an advanced state of degeneration in my spine. I was terrified! She didn't advocate any particular further action, but I insisted on an MRI.

The radiologist who interpreted the MRI went on and on about moderately severe to severe foraminal stenosis, and moderately severe central stenosis at C 5-6, an annular tear at C 6-7, and so on. The MRI images were horrifying to me, especially the cross-sectional ones.

The neurologist told me I would probably lose a lot of my fine motor abilities in both hands over a period of 10 years, and have other losses of function due to spinal cord compression. She told me to start looking for a surgeon, which I did.

I consulted 7 surgeons altogether and finally decided to have ADR surgery in the UK. I am scheduled for surgery in 3 weeks. I don't have many active symptoms at this point, but I don't want to wait for irreversible spinal cord damage or more cervical nerve damage before I have surgery.

I completely empathize with whatever shock and terror you may be feeling at this time, so soon after hearing the MRI results. Sitting here 6 months later, and having heard 9 differing interpretations of the same results, I am better able to get my mind around my clinical situation. I can predict with confidence that you will also get to that point, but it does take time, work and support. A lot of intelligent, thoughtful support is available on this site to help you get there, so keep posting.

Sandra

[KBear]

Dutch- First Welcome and sorry you have to be here. I'm your 'neighbor' to the South, just north of Dallas. Speaking of Tulsa, I'm going to the OU vs. Tulsa game soon. Hubby is a huge Sooner fan and has lots of family in Oklahoma. Anyhow, on the back issues...

I totally get scared of surgery; but not being able to live like you are. You can see in my signature my spine history. One piece of advice we always give is to exhaust all conservative options (and give it at least 6-12 months to work). It sounds like you have exhausted those treatments and in 2 years of having the pain, it doesn't sound like it's going to just go away on it's own. Most of us are diagnosed with degenerative disc disease, which is unfortunately progressive. Surgery can be a good or a bad and that varies from person to person. If you do your homework, that greatly increases your odds of a positive outcome. For me, I did the research on my condition, treatments for it, got multiple surgical opinions and made the best decision I could with the information I had. I chose surgery because I couldn't keep living like that. I went in knowing that regardless of outcome that I had done all I could to ensure a great outcome. First suggestions would be to research, read all you can on the forum, ask questions (there are not dumb questions when it comes to spine surgery), get multiple surgical opinions and ask why they do or do not recommend certain treatments. You can find links to some top notch surgeons in the travel forums.

On the wrists and arm pain... I also have that; but all my problems are lumbar. I was also in a wreck and my family dr. felt that my gripping of the steering wheel while being hit could have exacerbated my carpal tunnel (I had it minor before the wreck). I also was tested for carpal tunnel (more than once) and was not formerly diagnosed with it. I wear wrist braces at night and that really helps. I finally had injections in my wrists that helped tremendously. Since you have cervical issues it could definitely be that too. Also, many have seemingly 'normal' MRI's and tremendous pain; so that isn't definitive either. Pending your MRI, I would then get a copy of it, as well as all of your medical records and then start getting surgical opinions.

Best of luck,
Kathy

[Dutch]

Thanks so much for your thoughtful replies. I wish you the very best with your surgery, Sandra! Thanks for sharing your story, Kathy. It is refreshing to see a success story and hope to find myself "pain and medication free" sometime soon...

As an update, the EMG I had done seems to have set off a severe inflammatory response that has caused considerable nerve pain in my left shoulder, arm and hand. My left hand is next to unusable and I've lost most of the fine motor control in my middle finger, ring finger and pinky. The intense pain (and edema which hit my hand last Saturday) sent me to the ER where I tried to get a neuro consult, but instead they just said "well, your neck is really messed up" but there's nothing "emergent" we can do to help you. Then they sent me home with pain meds. Glad I waited 8 hours for that...

MRI results came back with a useless report from a lazy radiologist who noted "minor disc bulging". I found and utilized an exceptional service provided by RADIIA. They are a group of sub-specialist radiologists that perform initial reading for some facilities and they also offer "second opinion" services for patients, physicians or attorneys. I uploaded my images from the CD and with their optional expedited service I had a thorough report within 12 hours (and I submitted it at 11pm). I also opted to have the optional consultation with the radiologist. The founder of Radiia (Dr. Gregory Goldstein) called me the following morning to discuss the results. If you find yourself in need of a more thorough review (or simply want the peace of mind knowing nothing was missed), I HIGHLY RECOMMEND their service. I have attached a copy of the report so you can see how thorough they are at both review and documentation of their findings.

That said, the problems presented on the MRI don't necessarily explain the severity of the symptoms I'm having. The Percocet and Valium prescribed by the ER doc have only been marginally helpful at reducing the acute increase in my pain levels since the EMG was performed on 07/28.

My pain management specialist has scheduled ESI injections tomorrow to try to break the cycle of inflammation and buy us some time to determine a course of action.

I have an appointment with a neurosurgeon on Friday afternoon. Once I get a clear sense of how he thinks this should be addressed (to prevent further nerve damage and/or permanent motor function loss), I will be seeking out the best possible facility and surgeon to get this done.

I have seen some positive things about the Texas Back Institute on these forums and may look in that direction since it is within driving distance...

Regards,
Dutch

Radiia Report.zip

[spinches]

Thanks for the well wishes for me and for your detailed update on your own situation.

I'm sorry to hear you had complications from the EMG. I was advised about risk of infection, but not about anything like what you are experiencing.

The radiology service sounds like a terrific resource! I am growing to love these medical specialists who make themselves available to patients for second opinions. Not only is it very empowering for patients, but I believe that the quality of medical service improves when patients are the direct customers.

If you go to Texas Back Institute, be prepared to request a specific doctor. If you don't they will assign you to someone who has caseload openings. The TBI docs who are often mentioned on spine support sites include Blumenthal, Zigler and Guyer. I haven't had any personal experience with any of these doctors, but other SPS members might be able to offer more information about them. I hope you will post your experience with surgical consults, if you feel comfortable sharing them. Good luck!

Sandra

[SemperFi]

Sounds like you're on the right track w/your thinking/proceeding.
Just to let you know although as you were told, often what is written in the radiology report will not correspond with subjective complaints.

I've had 2 spine surgeries and was offered a 3rd (many times now) and if the surgeons went solely on what was stated in radiology reports no one would have offered me surgery and would have not even seen me in their busy office most likely.

I have heard that my reports didn't correspond with the degree of my complaints in the past once or twice though after someone has seen me as a regular patient or I've been referred by someone who saw me as a regular patient it was clear that the complaints were not there just because I felt like making things up for whatever reason (or malingering and so forth).

So don't be discouraged by the reports. I always have asked for a copy of the films to take w/me wherever I was being seen anyway so that the surgeon could review films him/herself.

Thanks for the link you provided for services utilized. That was a very good idea so you do sound like you are on top of things and making headway. Good luck with your upcoming consultations with whomever/wherever you go. I had 6 consultations for my 3rd spine surgery which I didn't have (they were even pretty much in agreement and offered/recommended surgery.

[Catherine]

Hi Dutch,

I'm surely sorry for what you have been going through and I understand your frustration and fear all too well. I was injured in a MVA (rear ended) in 1992. I went through 9 months of conservative therapies and finally found a Neurosurgeon with the U of Cincinnatti that I was completely comfortable with. I didn't have any of the nerve damage that you have, only pain and weakness in my right arm. He did a one level ACDF at C6-C7 and used my hip bone for the fusion. It completely took away the pain and the only time I have ever had any other problems (with my neck, that is) are in times of great stress. Of course at that time we didn't have ADR, so the fusion was my only option. I'm only relaying my experiences to you, certainly not advocating surgery. I wish you best in your journey, and will be reading to see what you decide. Best of luck. Oh yes, I always keep copies of all images and radiology reports with me. That's very good advice.

Catherine