There was a YouTube channel that Bee used to like to watch when she was a little younger and was starting to learn nursery rhymes: The Mother Goose Club. It has a catchy jingle that sticks in your head which I suppose is what you want when you're promoting language acquisition. For adults, luckily, it fades from the memory before annoyance hits. But the song keeps popping into my head every time I think of the latest clubs that I am now a card-carrying member of.
I wish I could say the same about the rhythm that's colored my life as of late: sciatica. The name of the condition is cool sounding, latin in origin and pronunciation. Back in the day, when I used to have low back pain that was largely stress-related (but in poring over old results, probably did have a physical component that's rearing its ugly head today), I used to come across the term sciatica in my Google searches and, although some symptoms are hard to completely rule out, sciatica-like leg pain was always off the list. The problem occupied a "type of back pain other people have" sort of category, one that mystified and slightly intrigued me, but as long as I didn't have to deal with it, fabulous.
Fast-forward to this summer, when a lot of different things were happening. I was traveling a lot with my family and for work. I went to the Yucatan Peninsula for the first time with my parents and brother, and to a nearby National Park with Bee and her Dad and some close friends. I went on 3 long distance trips by myself (without colleagues- y family accompanied me on the last two). The nearly 3 months of heavy traveling was sandwiched in between training high seasons at work- long days with relatively higher stress levels (Good stress! But stress nonetheless...). It was a heady summer. I was feeling great.
But most of August, which is when the last two work trips occurred, I kept feeling this burning sort of pain in my right leg that wouldn't go away. It was weird because it was a pain I'd never felt before. But I didn't pay much attention to it- first, because I was busy traveling, and second because I often have pains that come and go. Just that, this one wasn't going away, and it took me a while to realize that. Actually, I never did fully come to the realization that something serious was happening on my own. My body had to sort of whack me over the head and smack me around seriously in order for me to pay attention. I am sorry I didn't listen sooner.
The weekend after an important training week at work was a three-day one, and I was jazzed because I'd finally made an appointment for acupuncture in San Miguel, and to go to the hot springs as well. (See, I do practice self-care... ;-) The stretches and physical therapy exercises for my hip that I'd been trying all week weren't doing much to help my leg, and in fact, my middle lower back had started to ache as well, which was somewhat concerning. I was unaware of the physical train wreck I'd been holding off for a month.
The Sunday before Labor Day, I woke up in terrible pain in my lower back. I basically could not sit straight or stand unassisted. I was only able to go to the bathroom with my arms around my husband's neck. I sort of freaked out too, because this was not my first time my back has gone out, and I know how it can sideline you. But once my tears of embarrassment, and of frustration, had abated, the tears of genuine pain were ushered in. This level of pain is on par with childbirth. After trying several different kinds of medication, none working, and a humiliating 30 minutes on the floor at one point in a botched attempt to crawl to the bathroom (Lest you think otherwise, Margo did try to prevent me from trying), I knew I had to do something else- I was picturing myself getting carried out of my house on a stretcher, and really did not want that to happen. I made a few phone calls, finally spoke with a doctor who recommended a specific medication, which ended up working, and I was able to sleep through the night.
This apparently, in the case of what occurred to me, was somewhat of a miracle, because the next morning I got up out of bed and was able to walk without assistance. Various trips to the doctor and MRI results later, the verdict was in: I had a very large L4-L5 disc hernation and sciatica. And just like that, I was unceremoniously inducted into the Sciatica Club.
I won't get into the gory details of my less-than-pleasant exchange with a rather knife-happy orthopedic surgeon who wanted to operate on me immediately (hey--maybe he'll end up being right in the end, but where I'm from we don't take the recommendation of surgery by scaring, insulting, threatening, and making ultimatums to patients very well, and so no, you are off my doc list although you did recommend quite a nice medicine, thank you very much). Or another questionable doctor who I went to see the day after, desperate for a second opinion, who was the closest thing to a quack that I have ever experienced personally.
Since then, I´ve also been inducted into the world of IMSS specialty medical services, where state employed doctors maintain their private practices and skim off the patients who have private insurance and want better care than the government is prepared to provide. I was out from work for a week on sick leave, another week on temporary disability, and a few days of personal leave. I have attended 8 physical therapy sessions, have had better days and worse days, but I have not had a day yet where my symptoms disappeared.
In retrospect, the sciatica was happening most of August, I just didn't recognize the symptoms. We can't really pinpoint when I herniated my disk, but it's likely that it happened on one of my trips in June, where I fell twice, and also lifted something rather heavy by myself. The natural history of herniated discs and the evolution of sciatica is something I've read more about in the last two months than I probably did reading for my Masters thesis project (Ok, maybe I'm exaggerating). But suffice it to say it's an incredibly complex process that is not yet fully understood.
Part of what's not understood is a large discrepancy between pathology and symptomology. That's to say, some people who have very small hernias have more pain than large ones. And what's more, some people can have large hernias with no symptoms at all, and some people with no hernias have terrible symptoms. Finally, some people spontaneously heal with little downtime and intervention, whereas others go on to have symptoms for years. Doctors and medical researchers do not have a full grasp as to why this is although many theories are being studied in clinical settings.
Going back to the first doctor's threat of this being an immediate surgery situation... Having had a history of stress-related pain and other disorders (IBS, situational depression), it has been hard for me to move to a mindset where I can accept a situation that's not mind over matter, and that surgery might be necessary. I am overweight, I am not always careful with my diet, and so I feel that there is still a lot that I can do to "lessen the load," so to say, on my hernia, and allow it to heal. I am also concerned about potential negative effects of surgery, or even worse, the possibility of a botched or useless surgery (in case you don't believe me, search "failed back surgery syndrome"). Having the appendix out for emergency surgery is one thing, but messing with the spinal cord is another. I am not alone in my concerns...most online literature that I've read, either on spine institutes, research papers, or medical websites, cite that only 1 out of 10 herniated disk patients require surgery.
This must seem like poppycock to most orthopedic surgeons in Mexico, especially that first doctor, but I have find, quite serendipitously, a couple doctors who share my opinion- albeit with reservations. In a number of different online sources, I've read that surprisingly enough, the largest disc herniations tend to be the ones that are resorbed (healed) to the greatest extent. The reasons for this, again, are not fully understood, but do give me a great deal of hope.
However, the caveat is that for those patients whose symptoms do not improve in 6 weeks to 6 months, the longer you postpone surgery, the higher the chances are that surgery will not resolve your condition. This has to do with the potential for nerve damage- in sciatica, the prevailing theory is that the herniated disk presses on and compresses the sciatic nerve, which runs from the tailbone down to the knee (where it splits into 3 branches that run down to the ankle and foot). Most of what I've read explains that the higher risk situations are where the patient has significant muscle weakness or loss of sensation in their extremity- the classic emergency situation is the cauda equina syndrome, where one loses control of bladder and bowels. The worst I've had so far is leg, gluteal, or calf pain at a moderate level that just doesn't go away, or a tingling sensation in the top of my foot, back of my calf, or side of my thigh, so I am not too worried about permanent damage (although it's definitely made my list of troubling possibilities about this episode) although the annoyance factor is a totally different story.
I've never been good at accepting when I'm sick, much less hurting, but I managed to get through several years of occasional bouts of back pain in my twenties. But these bouts never last more than a few days to a week, and so these two months of nearly non-stop pain have been a new realm for me. Even though the one terrible Sunday in early September was the only day I had severe, disabling pain, in the last two months, a day hasn't gone by that I haven't had pain or numbness in my leg. And that's even though I have been on medication as well- and I probably haven't had another severe event for the same reason. I haven't been able to get comfortable or go back to regular activities, and that's taken a toll on both me and my family physically and mentally. Not being able to lift heavy stuff or perform load-bearing activities (read: my daughter, laundry baskets, doing dishes, or luggage), creates a challenging dynamic. Not being able to sit in one position for more than a half-hour, and needing to lie down regularly to take pressure off the disc has led to awkward situations and difficult conversations at work. Being dependent on others, when I have always been highly independent, is just plain hard.
The idea of taking disability or being disabled is getting wider acceptance in our society especially as self-care and patient advocacy increases, but at the end of the day, the stigma remains, and the stark truth that you're just not as productive as you normally are brings it own set of complications to the recovery scenario. How are you possibly supposed to focus your energy on healing when all you can think about is; how much have I paid in medical bills this month, will I get reimbursed, will I make it through the work weeks once temporary disability is up, how can I make it up to my husband, my daughter, when I can I start to exercise, will physical therapy work...will I ever get better?
The whole situation is enough to depress anyone, even if you're taking a peck of supplements, watching your nutrition, and getting enough sleep. After exhausting my readings on disc anatomy, sciatica mechanics, physical therapy, surgery options, hernia resorption, sciatica forums, ad infinitum I have drifted into the "chronic pain management" websites, because, like it or not, I have a de facto membership in the Chronic Pain Club.
There are often silver linings in situations like these, and my case, is no exception. I need to lose weight, urgently, and although I continue with thyroid issues, this will motivate me more strongly to control calories in the hopes of shedding some pounds and taking some load off my back. To help with this, I have also looked into the anti-inflammation diet by Dr. Weil, which is largely vegetarian, which is a goal I'd been wanting to move toward anyway. Money issues and pain will be a factor, but I am going to try and join a gym to start swimming regularly. If I can, it will be meeting a goal for regular exercise that I've also been wanting to accomplish for some time.
Finally, although it's always important to be mindful and compassionate with others, there is nothing like a time of illness or pain for you to become more aware of what others in your same boat, or worse, are dealing with. The forums I've lurked on in the past month are filled with individuals going through so much pain and suffering that it's almost shocking to think that I don't run into more people with these type of issues on a regular basis- or perhaps it's our tendency as a society to minimize these types of issues for the same stigmatic reasons I mentioned above.
In any case, if there's anything I have realized as a result of this, is that I am definitely not alone in this, it's quite a common condition, and what a shame, because for how painful and disruptive it is to life, I really wouldn't wish it on anyone. Human evolution to walk upright was an amazing and wonderful thing, but the long term impact on our discs and spine of being vertical was one thing evolution really got wrong. Believe it or not, it's believed that disc degeneration begins in adolescence. I can only pray with time science and medicine--and popular culture--can implement ways to prevent and treat these type of problems, starting in early childhood, because no one deserves membership to this club when it could be avoided.
I wish I could say the same about the rhythm that's colored my life as of late: sciatica. The name of the condition is cool sounding, latin in origin and pronunciation. Back in the day, when I used to have low back pain that was largely stress-related (but in poring over old results, probably did have a physical component that's rearing its ugly head today), I used to come across the term sciatica in my Google searches and, although some symptoms are hard to completely rule out, sciatica-like leg pain was always off the list. The problem occupied a "type of back pain other people have" sort of category, one that mystified and slightly intrigued me, but as long as I didn't have to deal with it, fabulous.
Fast-forward to this summer, when a lot of different things were happening. I was traveling a lot with my family and for work. I went to the Yucatan Peninsula for the first time with my parents and brother, and to a nearby National Park with Bee and her Dad and some close friends. I went on 3 long distance trips by myself (without colleagues- y family accompanied me on the last two). The nearly 3 months of heavy traveling was sandwiched in between training high seasons at work- long days with relatively higher stress levels (Good stress! But stress nonetheless...). It was a heady summer. I was feeling great.
But most of August, which is when the last two work trips occurred, I kept feeling this burning sort of pain in my right leg that wouldn't go away. It was weird because it was a pain I'd never felt before. But I didn't pay much attention to it- first, because I was busy traveling, and second because I often have pains that come and go. Just that, this one wasn't going away, and it took me a while to realize that. Actually, I never did fully come to the realization that something serious was happening on my own. My body had to sort of whack me over the head and smack me around seriously in order for me to pay attention. I am sorry I didn't listen sooner.
The weekend after an important training week at work was a three-day one, and I was jazzed because I'd finally made an appointment for acupuncture in San Miguel, and to go to the hot springs as well. (See, I do practice self-care... ;-) The stretches and physical therapy exercises for my hip that I'd been trying all week weren't doing much to help my leg, and in fact, my middle lower back had started to ache as well, which was somewhat concerning. I was unaware of the physical train wreck I'd been holding off for a month.
The Sunday before Labor Day, I woke up in terrible pain in my lower back. I basically could not sit straight or stand unassisted. I was only able to go to the bathroom with my arms around my husband's neck. I sort of freaked out too, because this was not my first time my back has gone out, and I know how it can sideline you. But once my tears of embarrassment, and of frustration, had abated, the tears of genuine pain were ushered in. This level of pain is on par with childbirth. After trying several different kinds of medication, none working, and a humiliating 30 minutes on the floor at one point in a botched attempt to crawl to the bathroom (Lest you think otherwise, Margo did try to prevent me from trying), I knew I had to do something else- I was picturing myself getting carried out of my house on a stretcher, and really did not want that to happen. I made a few phone calls, finally spoke with a doctor who recommended a specific medication, which ended up working, and I was able to sleep through the night.
This apparently, in the case of what occurred to me, was somewhat of a miracle, because the next morning I got up out of bed and was able to walk without assistance. Various trips to the doctor and MRI results later, the verdict was in: I had a very large L4-L5 disc hernation and sciatica. And just like that, I was unceremoniously inducted into the Sciatica Club.
I won't get into the gory details of my less-than-pleasant exchange with a rather knife-happy orthopedic surgeon who wanted to operate on me immediately (hey--maybe he'll end up being right in the end, but where I'm from we don't take the recommendation of surgery by scaring, insulting, threatening, and making ultimatums to patients very well, and so no, you are off my doc list although you did recommend quite a nice medicine, thank you very much). Or another questionable doctor who I went to see the day after, desperate for a second opinion, who was the closest thing to a quack that I have ever experienced personally.
Since then, I´ve also been inducted into the world of IMSS specialty medical services, where state employed doctors maintain their private practices and skim off the patients who have private insurance and want better care than the government is prepared to provide. I was out from work for a week on sick leave, another week on temporary disability, and a few days of personal leave. I have attended 8 physical therapy sessions, have had better days and worse days, but I have not had a day yet where my symptoms disappeared.
In retrospect, the sciatica was happening most of August, I just didn't recognize the symptoms. We can't really pinpoint when I herniated my disk, but it's likely that it happened on one of my trips in June, where I fell twice, and also lifted something rather heavy by myself. The natural history of herniated discs and the evolution of sciatica is something I've read more about in the last two months than I probably did reading for my Masters thesis project (Ok, maybe I'm exaggerating). But suffice it to say it's an incredibly complex process that is not yet fully understood.
Part of what's not understood is a large discrepancy between pathology and symptomology. That's to say, some people who have very small hernias have more pain than large ones. And what's more, some people can have large hernias with no symptoms at all, and some people with no hernias have terrible symptoms. Finally, some people spontaneously heal with little downtime and intervention, whereas others go on to have symptoms for years. Doctors and medical researchers do not have a full grasp as to why this is although many theories are being studied in clinical settings.
Going back to the first doctor's threat of this being an immediate surgery situation... Having had a history of stress-related pain and other disorders (IBS, situational depression), it has been hard for me to move to a mindset where I can accept a situation that's not mind over matter, and that surgery might be necessary. I am overweight, I am not always careful with my diet, and so I feel that there is still a lot that I can do to "lessen the load," so to say, on my hernia, and allow it to heal. I am also concerned about potential negative effects of surgery, or even worse, the possibility of a botched or useless surgery (in case you don't believe me, search "failed back surgery syndrome"). Having the appendix out for emergency surgery is one thing, but messing with the spinal cord is another. I am not alone in my concerns...most online literature that I've read, either on spine institutes, research papers, or medical websites, cite that only 1 out of 10 herniated disk patients require surgery.
This must seem like poppycock to most orthopedic surgeons in Mexico, especially that first doctor, but I have find, quite serendipitously, a couple doctors who share my opinion- albeit with reservations. In a number of different online sources, I've read that surprisingly enough, the largest disc herniations tend to be the ones that are resorbed (healed) to the greatest extent. The reasons for this, again, are not fully understood, but do give me a great deal of hope.
However, the caveat is that for those patients whose symptoms do not improve in 6 weeks to 6 months, the longer you postpone surgery, the higher the chances are that surgery will not resolve your condition. This has to do with the potential for nerve damage- in sciatica, the prevailing theory is that the herniated disk presses on and compresses the sciatic nerve, which runs from the tailbone down to the knee (where it splits into 3 branches that run down to the ankle and foot). Most of what I've read explains that the higher risk situations are where the patient has significant muscle weakness or loss of sensation in their extremity- the classic emergency situation is the cauda equina syndrome, where one loses control of bladder and bowels. The worst I've had so far is leg, gluteal, or calf pain at a moderate level that just doesn't go away, or a tingling sensation in the top of my foot, back of my calf, or side of my thigh, so I am not too worried about permanent damage (although it's definitely made my list of troubling possibilities about this episode) although the annoyance factor is a totally different story.
I've never been good at accepting when I'm sick, much less hurting, but I managed to get through several years of occasional bouts of back pain in my twenties. But these bouts never last more than a few days to a week, and so these two months of nearly non-stop pain have been a new realm for me. Even though the one terrible Sunday in early September was the only day I had severe, disabling pain, in the last two months, a day hasn't gone by that I haven't had pain or numbness in my leg. And that's even though I have been on medication as well- and I probably haven't had another severe event for the same reason. I haven't been able to get comfortable or go back to regular activities, and that's taken a toll on both me and my family physically and mentally. Not being able to lift heavy stuff or perform load-bearing activities (read: my daughter, laundry baskets, doing dishes, or luggage), creates a challenging dynamic. Not being able to sit in one position for more than a half-hour, and needing to lie down regularly to take pressure off the disc has led to awkward situations and difficult conversations at work. Being dependent on others, when I have always been highly independent, is just plain hard.
The idea of taking disability or being disabled is getting wider acceptance in our society especially as self-care and patient advocacy increases, but at the end of the day, the stigma remains, and the stark truth that you're just not as productive as you normally are brings it own set of complications to the recovery scenario. How are you possibly supposed to focus your energy on healing when all you can think about is; how much have I paid in medical bills this month, will I get reimbursed, will I make it through the work weeks once temporary disability is up, how can I make it up to my husband, my daughter, when I can I start to exercise, will physical therapy work...will I ever get better?
The whole situation is enough to depress anyone, even if you're taking a peck of supplements, watching your nutrition, and getting enough sleep. After exhausting my readings on disc anatomy, sciatica mechanics, physical therapy, surgery options, hernia resorption, sciatica forums, ad infinitum I have drifted into the "chronic pain management" websites, because, like it or not, I have a de facto membership in the Chronic Pain Club.
There are often silver linings in situations like these, and my case, is no exception. I need to lose weight, urgently, and although I continue with thyroid issues, this will motivate me more strongly to control calories in the hopes of shedding some pounds and taking some load off my back. To help with this, I have also looked into the anti-inflammation diet by Dr. Weil, which is largely vegetarian, which is a goal I'd been wanting to move toward anyway. Money issues and pain will be a factor, but I am going to try and join a gym to start swimming regularly. If I can, it will be meeting a goal for regular exercise that I've also been wanting to accomplish for some time.
Finally, although it's always important to be mindful and compassionate with others, there is nothing like a time of illness or pain for you to become more aware of what others in your same boat, or worse, are dealing with. The forums I've lurked on in the past month are filled with individuals going through so much pain and suffering that it's almost shocking to think that I don't run into more people with these type of issues on a regular basis- or perhaps it's our tendency as a society to minimize these types of issues for the same stigmatic reasons I mentioned above.
In any case, if there's anything I have realized as a result of this, is that I am definitely not alone in this, it's quite a common condition, and what a shame, because for how painful and disruptive it is to life, I really wouldn't wish it on anyone. Human evolution to walk upright was an amazing and wonderful thing, but the long term impact on our discs and spine of being vertical was one thing evolution really got wrong. Believe it or not, it's believed that disc degeneration begins in adolescence. I can only pray with time science and medicine--and popular culture--can implement ways to prevent and treat these type of problems, starting in early childhood, because no one deserves membership to this club when it could be avoided.
