I am in the throes of physical therapy for my lower back, specifically a right side L4-L5 disc herniation. This is not my first rodeo (but my fourth) that the disc between these two vertebrae has spilled onto the nerve root. So, yeah, we have history.
In 2010, this same disc spilled over on the left side and sent me screaming to the Emergency Room (ER). A dear friend was good enough to drive me and let me lie down in the backseat of her car, leg straight up, foot planted on the car ceiling (I’m short).
Upon arrival, the ER attendant said, “Why didn’t you call us?”
Money is the short answer but more importantly, I had no clue about pain, going to its core and stripping away all the drama to reveal the root cause. I didn’t know life turns on a dime and voila! A new life lens whose view is nothing like the flip side.
That night I was remembering what had happened in the emergency room in 2003 when the disc squirted a bit more of itself onto the nerve root. I was given a hefty pain medication injection and sent home with enough pain pills to get me to the orthopedic surgeon who did the same surgery as he had done in 2000.
The 2010 flipside view proved a new life lens is just that, new. For reasons not clear to me or to my friend, the ER attending physician decided I didn’t have a disc herniation so I had no pain. After a while, I think he offered me a tramadol, something I scoffed at because I had tried that at home.
To be fair, I don’t think there’s any medication that stops nerve pain at its source, and the physician may have said something to that effect but I was in full fight/fear mode, and we were there for hours while my fear raged. I have since discovered that heat and a hefty dose of prednisone helps most but a nerve on fire, pinched in a disc spill over, will have its day.
At some point it was decided I would have an x-ray. I wasn’t about to let any ER personnel help me onto the x-ray table but, of course, I couldn’t do it. To this day, I remain grateful to the radiology techs who were quick to help. I would lie on that table for quite some time after the x-ray was taken.
In the radiology tech booth there was a lot of repetitive discussion.
“No, she doesn’t.”
“Yes, she does.”
And then more of the same medical jargon before the attending physician shouted, “What do you mean there’s a (medical jargon with swears)! There can’t be!”
And the radiologist explained the X-ray results again to the attending physician who responded, “She can’t have!”
“Yeah, she does,” the radiologist said.
After I had been returned to my ER cubicle, the attending physician stuck his head around the curtain and said, “So, you’re Huber?” Neither my friend nor I could have anticipated that question; one or both of us agreed that I was.
Immediately, it was apparent that the attending physician thought I was someone else. It would be another emergency room physician who would explain about the herniation and provide me with a prescription.
Before we left, the initial attending physician made a bad situation even worse by kissing my hand and offering a groveling apology. I’m still amazed that I did not go off on him but my friend and I were tired and hungry, and my pain was better—maybe because I was vindicated, maybe because my fear subsided, maybe because….
Within a few days, I would have my third surgery, and the pain would be gone. I do remember the neurosurgeon saying “no wonder, no wonder” regarding my pain, and he cleaned up the mess the orthopedic surgeon had left in 2000 and 2003.
In 2022, the jelly has spilled out of the disc doughnut yet again. I am needing the same surgery by the same neurosurgeon, a 40-minute procedure. However, he’s also offered that “about 87% of these” (herniations) resolve themselves.
The pain did not send me screaming to the ER—just a lot of stay-at-home F-bombs—so impossible to ignore, and in the beginning so severe, I had to use my wheelchair any time I cooked or did the dishes. Standing was almost impossible so getting into my tub/shower was out of the question. It was bathroom sponge baths and washing my hair at the kitchen sink, while sitting in my wheelchair for about two weeks.
Still, I am reluctant to pursue a fourth laminectomy so I am playing the neurosurgeon’s percentages but without Sue, my favorite physical therapist who has seen me through two hip replacements and a fractured pelvis. However, she did do the initial physical therapy (PT) intake.
Ours was a long conversation, and the flipside view of this turn of the dime was once again not what I expected.
Sue all but said I should have the surgery followed by physical therapy (PT) rather than PT and then surgery.
“I have history with laminectomies, remember?” I start to tell her the 2010 ER story and she waves me off.
“This pain once sent you screaming to the emergency room, and with you, that’s saying something,” she says, and then checks off boxes on her tablet.
“But then, I did not understand the nature of pain,” I start to explain and stop. Zen is… otherworldly to her, so I say, “I have a neurosurgeon who is suggesting physical therapy and a physical therapist who is suggesting surgery.”
Sue doesn’t disagree before she explains, “We don’t really know how to fix backs—not medicine, chiropractors, physical therapy, or acupuncture.”
I nod. I have tried them all, even naturopathy but I keep that to myself.
“We treat symptoms with a 50-50 chance for success. In comparison, the success rate for knee or hip replacement is 96%.” Sue throws up her hands as if to say, get it?
She knows I have wrapped my head around that 87% figure of this herniation resolving itself with physical therapy and the few yoga poses I can do. As in 2010, I’m not seeing that the dime has turned but Sue has.
In what appears apropos of nothing she says, “You know with myelopathy all bets are off.”
I nod. My spinal cord is short circuited— it has dead spots in places—a daily mystery as to what nerves will fire when or if at all.
“At some time, whether it’s today or years from now, you have got to get a power wheelchair,” Sue says. And I know she says this with 30+ years of experience as a physical therapist who truly loves her profession.
Using the manual wheelchair is exhausting and not a good fit with the nerve damage in my hands and arms. And it’s heavy for my friends and Lyft drivers to maneuver. A lightweight, foldable power chair would take me to my apartment building lobby to get my mail, allow me to take my recycle items to the bins, keep me out and about without the constant concern of falling.
My gut tells me Sue’s right but her words land with a thud. I didn’t think I was “there” yet and why does that bother me so much? It feels ableist because it is. It is eerily reminiscent of the ER attending physician only this time, I’m the one with the attitude.
“Maintaining my independence is based upon my not falling,” I say, as I look at Sue who clearly has nothing more to say.
A power wheelchair will mitigate the risk of falling just as my three-wheeled walker still does but myelopathy is progressive so it…progresses. A disc herniation is a distraction, a weakness with no spinal cord involvement, but nonetheless a signal of the flipside view of life’s turning dime.