Monthly ArchiveJune 2008



Writer's Block 24 Jun 2008 10:19 pm

Writer’s Block June 24

June 24, 2008

Can Herniated Discs Really Heal?

mailman

Reaching into the old mailbag again today.

Here’s a question from a reader who is concerned that her herniated discs won’t heal because she read that they have no blood supply.

Dear Dean,

I have been to your website several times and re-read many of the articles. Here is my story: In late May 2007 I started having low back pain on my left side.

My past history has been bouts with this (so I had been going to a chiropractor 1-2 times a week for several years – I was fine (pain free) – until May when I started to have problems. He increased my visits to 2-3 times. I did that till the end of this past Aug. 2007. I really was hurting and couldn’t stand for longer then 10-20 minutes.

Then I ordered Lose the Back Pain (workbook & videos) tried that for about 3 weeks (dedicated) nothing seemed to even be happening. Then I went to have DRX9000 – decompression pulls (18 pulls). They were horrible – I screamed, passed out after the 18th one cause of shooting pain and muscle spasms after getting off the machine. The Doctor agreed that 2 more (20 was the prescribed treatment amount) wouldn’t make a difference. I finished those about 3 weeks ago. Now $6,000 later I feel no better. Promises,promises!!!

[snip]

My concern is the 1st L5-S1. I understand what you mean about having herniated discs with NO pain – but the pain I’m feeling in my lower left back – which sporadically shoots out to the hip like a knife brings forth screams, and tears.

[snip]

[I read] that discs cannot heal because there is no blood supply. Can you please give me some more insight on everything I’m hearing about?

I await your reply,
Carol

My response…

Hi Carol,

Stories like yours make me very, very sad. It’s unfortunate that we consumers have to wade through so much misinformation, ignorance and foolishness before we (if ever) find the truth.

Herniated Disc

On the subject of healing: It’s true that disks, ligaments, tendons and nerves all essentially have little or no significant blood supply but this does not prevent them from healing. It just means they heal slower than tissues (such as muscle and skin) that receive their nourishment from blood.

Here’s what the medical experts are saying…

“Herniated discs can occur anywhere in the spine, but most occur in the lower back. Most herniated discs heal on their own over time (one to six months).” [1]

“In summary, when faced with a disc herniation… Don’t panic. As long as neurological deficits are not deteriorating, observation is warranted… Consider exercise a treatment for acute disc syndrome. Most patients get well on their own and many disc herniations disappear.” [2]

” … In fact, some of the worst looking disc herniations on scans produce very little and sometimes no symptoms at all… Furthermore, large disc herniations often shrink and totally disappear on scans reflecting the body’s ability to heal.” [3]

So you see, herniated discs can heal despite the fact that they have little or no blood supply.

I hope that clears up some of the confusion.

Sincerely,
Dean

References:

1. Herniated Disc, Cedars-Sinai Health System

http://www.csmc.edu/3003.html

2. Nelson, B. The Herniated Disc: New Concepts and Treatments. Physicians Neck & Back Clinics [2005] http://www.pnbconline.com/research/herinated_disc.htm

3. Nelson, B. Disc Syndromes. Physicians Neck & Back Clinics [2005] http://www.pnbconline.com/research/disc_syndrome.htm

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Writer's Block 21 Jun 2008 05:18 pm

Writer’s Block June 21

June 21, 2008

Sciatica and Epidural Injections

Here’s another good question from this week’s mailbag:

Hi Dean

After four weeks of severe sciatic pain and not being able to walk more than a few yards, I finally got in to see an osteopath last week. He said I might want to consider cortisone injections as part of the physical therapy. I read about epidural steroid injections in the forum but I’m wondering what you think of them.

Any advice would be appreciated.

Allen

syringe2

My response…

Hi Allen,

I’m glad you asked this question because I’ve been meaning to address this subject for some time now. Initially, I was skeptical of the use of steroids or other pharmaceuticals for treating back pain because of my long history of being a natural health nut.

There was a time when I viewed anything coming from conventional medicine — and especially the big pharmaceutical companies — as some sort of toxic poison.

I’m still not crazy about “artificial ingredients” so to speak, but I’d like to think I’ve gotten a little smarter when it comes to science, medicine and health over the past few years.

Which Brings Us to Epidural Steroid Injections

My first experience with the therapeutic use of steroids came about in an unlikely and rather unpleasant fashion.

A couple years ago one of the family cats came home dragging her hind legs. She was obviously injured so we rushed her to the Vet. Long story short, he gave her a steroid injection and sent her home with oral steroids to be given daily for the next week. Within a few days she was back up and around like nothing had ever happened.

We still have no idea how she injured herself, but we were sure she was going to be crippled and would probably have to be put to sleep. Instead, she fully recovered.

That was a real eye opener.

Then Came the Knockout Punch

howard cosell

Not long after that Ken (a.k.a. krd) started posting in the forum his experience with the epidural injections and how they knocked down his sciatica symptoms like Muhammad Ali taking on Howard Cosell.

I couldn’t ignore the evidence after that.

So now I’ve come around 180 degrees on the subject of steroids for the treatment of sciatica. If your doctor is recommending them for you, I believe they are definitely worth a try.

Keep in mind that they don’t work for everyone. This is probably due to the fact that sciatica has many possible causes and simply eliminating the inflammation may not do the trick.

Also, keep in mind that the epidural will not heal anything. It only eliminates the inflammation and swelling, which should give you relief from the pain. This relief is your window of opportunity to proceed with physical therapy to correct the cause of your sciatica.

As always,
Dean

References:

1. Singh V, Manchikanti L. Role of caudal epidural injections in the management of chronic low back pain. Pain Physician 2002;5: 133-48.

2. Carette S, Leclaire R, Marcoux S, Morin F, Blaise GA, St-Pierre A, et al. Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus. N Engl J Med 1997;336: 1634-40.

3. Koes BW, Scholten RJ, Mens JM, Bouter LM. Efficacy of epidural steroid injections for low back pain and sciatica: a systematic review of randomized clinical trials. Pain 1995;63: 279-88.

4. Watts RW, Silagy CA. Meta-analysis and the efficacy of epidural corticosteroids in the treatment of sciatica. Anaesthesia Intens Care 1995;223: 564-9.

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Writer's Block 14 Jun 2008 05:48 pm

Writer’s Block June 14

Okay all you fellow writers and blog surfers out there, if you get off on shows like ER, Rescue 911… and my personal favorite the late, great Third Watch… you’ll love my pick for this week’s edition of Writer’s Block.

I just discovered it this afternoon and I could tell right away that I’d found a winner. I’ve bookmarked it and added it to my blogroll so I can return to it again and again. And I think you’re going to want to do the same.

It’s Michael Morse’s blog, Rescuing Providence.

Now if you’re a little squeamish, you may want to proceed with caution. Not everyone is comfortable reading about stabbings, gunshot wounds, car accidents and sore throats. (Sore Throats?) What, you never called an ambulance for a sore throat?

Anyway, this is not some fictional TV drama. It’s a very realistic look into the world of our first responders. It’s very much like riding shotgun with the EMS guys as they respond to emergency calls in the city of Providence, Rhode Island.

Now you may not think of Providence, RI when you think of big city drama, but apparently they get their fair share of the action.

But wait, there’s more. (This is “Writer’s Block” after all.)

Morse is not only a firefighter, EMT and medical blogger, but a fellow author as well. Turns out, he’s written a book about his experiences as an EMT entitled – what else — Rescuing Providence.

Here’s a brief snippet from what I believe is the cover jacket:

In Rescuing Providence, Lieutenant Michael Morse of the Providence, Rhode Island, Fire Department takes you along for 34 nonstop hours in the life of a big-city fireman/emergency medical technician.

Ride through the tough streets of South Providence, the historic mansions on the East Side and the tattered but emerging West End as Morse and his EMS team respond to drug overdoses, heart attacks, car accidents, gunshot wounds, suicides, alcoholics, premature births, broken bones and other medical emergencies that are all in a day’s work for them.

The brave men and women who make up our nation’s EMS system willingly risk their lives every day to save people they don’t know and often cannot communicate with. See for yourself how difficult, frustrating and at times heartbreaking this job can be, as lives are lost, scarce medical resources squandered, futures altered, and hope abandoned and then reborn.

I thinks this is one you’re going to want to add to your reading list.

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June 13, 2008

Mysterious Morning Neck Pain

What do you bet Homer wakes up with a crick in his neck?

homer_sleep

Speaking of waking up with neck pain, here’s part of an email I received the other day…

Dear Dean

I’m 48 years old, self-employed and I don’t have insurance. I woke up this morning with severe neck pain… I had a whiplash injury several years ago and this feels exactly the same. Is this possible? Can you get whiplash in your sleep?

Signed,
Don

After my usual, “I’m not a doctor” spiel I wrote…

Hi Don,

It sounds like you may have just strained a muscle or ligament in your neck either while sleeping or perhaps sometime during the previous day. It’s also possible you slept with your head at a bad angle and simply need to give it time to relax.

I’ve never heard of anyone actually getting whiplash while sleeping. Whiplash is usually associated with a sudden accident…

A (whiplash) sprain is a stretch or tear in the ligament resulting from a sudden movement that causes the neck to extend to an extreme position. For example, in the rapid deceleration of a car crash, your head and neck can stretch far forward before stopping. [1]

Whiplash injury is the effect on the neck of a sudden stop in forward movement, for instance in a car crash… In a sudden stop, the head is thrown forward violently, putting a brief but extreme strain on the neck. This stretches muscles and ligaments in the neck. This is immediately followed by a reflex contraction of the overstretched muscles, so that the head then jerks in the opposite direction. [2]

Whiplash – a soft tissue injury to the neck – is also called neck sprain or neck strain. It is characterized by a collection of symptoms that occur following damage to the neck, usually because of sudden extension and flexion. [3]

What Causes Neck Pain?

1574R-019176

Don, the most common cause of neck pain is muscle or ligament strain. Naturally, since this is the same type of injury as your previous whiplash, it would feel very similar.

In most cases the pain will subside within two to ten days without medical attention. However, if it lasts longer than that, you should see your doctor.

Also, see your doctor if:

  • Your head is off-center and you can’t hold it straight.
  • Your neck pain is the result of a recent, serious accident.
  • You have pain in your wrist or hand accompanied with a feeling of numbness or “pins and needles” in your fingers.
  • You are having severe headaches that just won’t go away.
  • Your pain is getting worse instead of better.

Hope that answers your question,
Dean

References:

1. Whiplash and Neck Sprain. Your Orthopedic Connection. American Academy of Orthopedic Surgeons. [May 2000]

2. Whiplash injury. NHS Direct Online Health Encyclopaedia. [Jul 2002]

3. Whiplash. NINDS Whiplash Information Page. National Institute of Neurological Disorders and Stroke. [Mar 2005]

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