Friday, September 24, 2010

SNRB and other such terms I'd never heard of...


I'll try and keep it brief.

We returned from a terrific family holiday in Portugal's Algarve on August 18th.  On August 19th the back pain I'd been feeling for a while exploded like a hand grenade someone had secreted deep within my gluteal muscles.  The pain radiated down into my leg and I had a sinking feeling about the whole thing.

Over the next few days I managed to complete my duties with work whilst the pain became far, far worse.  I'd written a letter to my GP and booked an appointment with him the following week (he's a popular man).  In the letter I'd described my symptoms as 'searing pain radiating down the outside of my thigh, down into my shin and foot'.  By this time I was unable to sit down, stand, drive or think straight.

I took an emergency appointment with a locum at my GP's surgery and he felt it might be piriformis syndrome.  I'd looked at this myself and initially had the same thoughts but something was telling me more and more that this was disc related.  I was referred to a local physiotherapist who immediately voiced her concern that something was wrong with my back, probably an L4/L5 disc problem.  (The L refers to the 'Lumbar' part of the spine which, I now know, is labelled as four different parts, each with their numbered vertebrae.)  My trip coincided with a phone call from my GP who had seen my letter and immediately diagnosed the same issue, referring me (at my request) to a specialist spinal surgeon.

The pain, by now, was at its most intense.  I was taking industrial strength prescription painkillers called Tramadol.  These are an opiate based (addictive) painkiller and usage is capped at 400mg a day.  But they simply didn't touch the agony I felt whenever I moved and at the height of the problem I was taking 2 x 50mg tablets six times a day.  Each time I took the Tramadol I'd also take two 400mg paracetamol tablets.  In the evening I'd take 50mg of Amytriptylene (a drug initially designed as an anti-depressant but now used almost exclusively for nerve pain) to help with my attempts to sleep.

It doesn't take a genius to realise that this was not a good situation to be in.

Over the next three weeks or so I learned to live with the problem and travelled the long road through diagnosis and treatment.  I say the 'long road' but I was phenomenally lucky to have private health and this expedited matters considerably.  Within four days of my GP's call I was seeing a specialist surgeon.  The next day I had an MRI scan.  Six days later I had a consultation that revealed a laterally herniated disc in the L5/S1 vertebrae.   A lateral herniation is when - unusually, the disc (the disc is the cushioning membrane between vertebrae) 'slips' or moves out of line not to the back and into the spinal canal but out to the side.  This herniated disc was/is pressing on the nerve that runs from the L4/L5 joint, giving similar symptoms of sciatica to a conventional L4/L5 herniation.

My specialist - Jon Kitson - advised a SNRB injection, a procedure where cortisone and local anaesthetic is injected into the nerve root close to the disc affected.  The hope is that this will 'shut down' the nerve and result in partial eradication of pain in the leg.  The procedure has a 75% success rate and, if successful, can have an effective  lifespan of anything between two days and forever.  The hope is that by eradicating the pain in the leg (which is 90% of the debilitating nature of the condition) the patient is equipped to lead some kind of normal life and to progress with re-habilitation.

A note here on 're-habilitation'.  It was explained to me that in 95% of cases, this type of disc herniation will heal naturally.  All the people I spoke to - from the anecdotal man in the street, through GPs, physios, chiropractors, those who had suffered with the problem through to my surgeon himself - everyone to a person said that surgery was absolutely a 'last choice' option.  I'm happy to go along with that.

I underwent the procedure last Monday at Spire BUPA Hospital in Harpenden.  I was in and out in a day and the results are encouraging.  It is now 96 hours since the needle and the pain in my legs has reduced to something like tolerable.  I am pain free when lying down and becoming much more mobile, able to drive myself short distances.  I've come off all the medication, partly to assess the success or otherwise of the injection and partly just to rid myself of that awful, drowsy, drugged feeling that the painkillers brought.  The pain now is in my glutes and lower back and there is also a pain that recurs in the lower leg, outside the shinbone.

I'm able to commence physio exercises to engage my inner core and sleep - whilst not perfect - is now at least possible in sporadic bursts.  I look forward to returning to the marital bed though that is another story.

There is, of course, a considerably large sword of Damocles hanging over my head in that the efficacy of the procedure could cease at any time.  The thought of being faced with that kind of pain again fills me with dread so I'm dedicating myself to a regime of self healing which will hopefully speed up the shrinkage of the disc back to its normal position.  This includes, but is not limited to, ongoing physiotherapy and stretching, posture revisions, diet change to include more natural anti-inflammatories, a regime of vitamin supplements including omega 3, Vitamin C and Glucosamine Sulphate (which I already take anyway) and more alcohol.

I could be joking about the alcohol.

So that's where we are.  It may heal, it may not.  It may take a few weeks, it may take months, it may take years.  I may be ready to begin training for an Ironman in January, I may not.

Those of you who know me won't need me to say that I'm contemplating nothing other than a full recovery in the optimum amount of time that leaves me fitter and stronger than ever before.

But I've said it anyway.

This post is by way of letting everyone know the current situation.  You will all have had a link to this site and it's impossible to name you all.  You are my physiotherapists, chiropractors, surgeons, family, friends, fellow athletes and fellow warriors against back pain.

But know this... your support, advice, guidance and assistance has been and will continue to be invaluable.  Please keep it coming.  It helps so much in the fight to return to normal.

Finally, a special thanks to Fiona, who has looked after me, ferried me around, fetched me things,  and generally performed a service above and beyond the call of duty with a smile and dedication that I should not be surprised about.  And, to tell you the truth, I'm not.  But it would be remiss of me not to tell her how much I appreciate it.

Treasure your spine.