24 Year Old with Prolapsed Disc Needs ADVICE

[JeeMzt]

Hi,

I am 24 and been suffering with a prolapsed disc for 2 years now.

I cannot tell you how relieved I am just to find this discussion board!! Finally feel like I am not alone in my illness!!

I have been in physio for 2 years on and off, and that has not helped me at all.

I've been taking DICLOFENAC and CO-DYDROMOL and DIAZEPAM for the pain and recently I have been prescribed Amiltryptaline, which is an anti-depressant that I do not want to take because I don't want all the horrid side effects of anti-depressants.

My pain is with me all the time, and is EXTREMELY bad when I am in bed or I try and lie flat on my back.

My kind friend has now kindly paid for me to go and see a private osteopath this evening and I have found a private hospital who will give me an MRI scan for £400 because they specialise in scanning the area affected, as opposed to the whole body (which is £800!)
I cannot afford any of thisbut I cannot sit back and wait for the NHS to finally give me the scan.

I have spoken to my mum whose friend in Birmingham was given an MRI scan this week after first reporting his problem 6 months ago. I have been suffering for two years, but because I am in North London where NHS resources are exhausted, I still have not been referred for an MRI scan.

All I want is to know exactly what is going on in my back.

Can anybody please advise on how I might get the MRI scan quicker through the NHS?
I thought about joining a GP in Birmingham but that would mean travelling all the way up there for every appointment.

Also, do you think that, if I pay to have the MRI scan done on my lower back privately, the NHS would then look atthe resultsand treat me accordingly?

Sorry to sound so negative guys, I am just having a real tough week, in a lot of pain, and feeling pretty helpless right now!

Thanks very much.

Thom

 

[pxaxcgpy]

Sounds tome like your dr has you on appropriate drugs.
Diclofenac for inflammation in the disc and pain killer - sightly stronger than Neurofen.
Co-Dydramol - reasonably strong pain killer (Contains Paracetamol and Dihydrocodeine)
Diazepam - for muscle spasm
Amitriptylline - low dose for nerve pain (unlikely to get side-effects at this low dose, these generally only occur at anti-depressent doses which are at least 3 times higher)


Whatthe MRI will tell you is:
Do you really have a prolapsed disc, is the spinal cord squashed, is there an infection inone of the discs, are the vertebrae too close, etc.

The treatment is exactly the same with the exception of antibiotics if you have a discitis (infection in the disc), which is the least likely.

So, question is: Do you want to pay $400 for an MRI which will probably not add anything to amending any drugs, but may potentially give surgery as an option (and an extremely poor one I personally would not take)?

On the other hand, seeing a good osteopath or chiropractor is a GOOD idea.

 

[Julieann]

The MRI can be v useful.

It may show the true cuase of the problem or it can be used to discount any possible causes. My MRI discounted any major disk or joint degeneration. The only problem with that was Dr's and "back specialists"

Came to the conclusion that I had nothing wrong my back or gave me diagnosis such as "mechanical back"!!
However I recently mangaged to find a very experienced physio who has also trained in osteopathy - he takes the best from both professions! He looked at my scan and came up with iades as to why I had symptoms of "sciatica". Many Dr's think that only disk problems can cause sciatica but there are many many more causes….
He took things from my scan such as I have an excessive curve in my lower back and that my back muscles were very weak compared to stomach. one side of my pelvis is slightly tilted forward, weak ligaments (very hard to spot) etc etc
He's looked at all possibilities and now put a treatment plan in action accordingly. Unfortionately too many professionals make rush the diagnoses and therefore give the wrong type of treatment ie many manipulation techniques are very inappropriate for weak ligaments, hypermobile joints and SI disfunction
As you've had the problem for a while its definitely a good idea to really get to the bottom of whats going on so it can be treated appropriately
If your willing to travel you can get an MRI scan for £200 at cheltenham and im pretty sure there is a place at either birmingham or leamington that does cheap MRI's also. Scan on the NHS will take 6 months in many areas once the've agreed to give you one!
Be patient as the wrong type of treatment can aggrivate problems further…
Good luck

 

[Graybeard]

Hi there

I too am a sufferer with two prolapsed discs. Not nice at all.

I have been hospitalised 3 times within the last 5years and in absolute suicidal pain with it.

Funnily enough the smaller hernia of the two is the one that causes all the probs.

I found McTimoney chiro is the only thing that works for me.
My ligaments are 'too long' to hold the discs in place so I cannot have manipulation such as 'normal' chiro or osteopathy.

Also, I found laying on my front with my head resting on my hands or gently pushing up from the floor (arching the back) slightly a speedier recovery.

I have been offered surgery but have chickened out. Perhaps now, after 20 years of pain, I should reconsider.

I do know what you go through. You are not alone. Excrutiating is not enough to describe the pain.

Stay sane.

 

[Gardauuara]

Hi,
sorry to hear about your ongoing pain! Have you tried any holustic approaches as mentioned above? I would suggest Cranio sacral therapy,or Bowen technique, both of which are gentle yet very effective.

If you want any info let me know, I'm sure one of my colleagues would be able to suggest someone in your area!

Lisa x

 

[Surender Rao]

The Amyltriptilene is to help you sleep, I had a prolapsed disc in my neck C5/6 so I know what you're going through, I too was on the tabs you have been prescribed, altho I now only take co dydramol and Ibuprofen, Diazepam my Dr will only prescribe 15 at a time. I had a discectomy last March, and I have recently gone back to the surgeon as I am still in pain, so another MRi has been requested, like you, I don't know when it will be. Good luck, and let us know of your progress x

 

[Tamara]

Dear Thom

Sorry to hear you're having so much grief. Unfortunately pain alone isn't regarded as a serious neurological 'sign', but a symptom.

A sign being something that the doctor/practitioner can objectively test for, whereas a symptom is what the person reports.

I gather you do have one or more signs otherwise you wouldn't have been diagnosed as having a prolpased disc in the first place. Although I don't see anywhere that you actually say where the problem is, so I'm guessing - low back, therefore the signs would be in your legs.

Appropriate examination tests would include reduction/loss of 'power' in the different muscle groups of the lower limbs, change in your reflexes (knee/ankle/sole of foot) & skin sensation tests for numbess.

More on what are serious signs & symptoms for lumbar spine disc problems here - http://www.massageplanet.net/forum/showthread.php?t=19

On the issue of MRI's, then some herniating (bulging) discs don't show up on an MRI unless they are weight bearing. So if the scan is done with you lying down, then you're taking the weight off it and any bulge may reduce. It's only fairly recently that this has been taken on board & acted on. There are some new MRI scanners out there that accomodate for this, but as they are hugely expensive, then your local NHS hospital may not be able to afford one any time soon.

I support MaceUK's advice in consulting an osteopath or chiropractor. At the very least you'll be sure of getting a thorough examination from someone that deals with this sort of thing every day. Also, at the very least - if all indications are that you do need an MRI or referral to a neurologist, then they can write to your GP based on their clincical findings. Whilst they can't insist that your GP refers you, any such letter legally has to go in your medical records. Should anything go wrong, it wouldn't look good if they had ignored such advice based on any serious clinical findings.

Hope that's some help - Andrew.

 

[pypePlayera]

"My kind friend has now kindly paid for me to go and see a private osteopath this evening and I have found a private hospital who will give me an MRI scan for £400 because they specialise in scanning the area affected, as opposed to the whole body (which is £800!)"

Thom- you don't need to pay this amount for a private scan. There are several reputable places in the West Midlands who will do an lumbar spine MRI and issue a report for around £200. Watch out for any extra charges though- some charge you for a copy of the scan on CD (which is useful if you need to copy it).
As far as I know there is only one centre in the UK (in London) that does upright scanning and this is a gimmic. If a disc only prolapses on weight bearing why do most episodes of disc prolapse occur at night?
Be that as it may, the scanning centre I work in also accepts referrals from osteopaths and chiropractors but you should always keep your GP informed as he has no vested financial interest in your condition and should give you honest advice

 

[nobdepot]

Weight bearing MRI's are available around the country now as mobile units.

I didn't say that discs only prolapse on weight bearing. They probably do, but that's not the point. What I am saying is that a herniation is more likely to be evident on a scan if it is weight bearing. Reduce the pressure and the herniation may reduce in some case. Also, this would explain why lower limb symptoms are worse in some when they have been weight bearing for a while.

Simillarly a degenerative knee can show a normal joint space on x-ray when non weight bearing, whereas a weight bearing x-ray will give a better indication of the actual thickness of the cartilage.

Symptoms of a discal injury are typically worse at night in bed, as the reduction of movement during rest impedes the inflammation from draining from the local area. So the inflammation builds up in the area and it's inflammation that causes pain at end of day. Typically it's worst on initiation of movement after rest.

Andrew.

 

[Shivon]

Sadly no longer; they have put their price up to £218 and also charge £22 for the CD. If you need a contrast injection (usually only required if there has been previous surgery) they charge £498. However you don't have to look too hard to still find somewhere that charges £200 without contrast and £272 with contrast for the equivalent scans. You can compare prices if you do a google search.

 

[fwrgqsji]

seeing a chiropractor or osteopath is exactly the right thing to do; you'll be having a clinical history and physical examination by an expert in the field. They ought also to keep your GP informed of their findings. They may or may not then recommend an MRI scan - as mentioned above, there are reputable options around the £200-£250 region, and the chiro/osteo should explain fully the results of this scan to you, if done.
Most disc injuries don't need to be scanned, though it's generally a good idea; and can be treated conservatively; the chiro/osteo should go through a couple of treatment options with you, and discuss the risks and prognosis associated with each, though prognosis is often simply "guarded" (ie, fairly unpredictable, but worth a trial of care).
In my personal opinion, I would avoid spinal manipulation until it stabilises to a degree, I always start out with mobilisation techniques such as flexion-distraction, and I can only think of 1 patient where this has let me down; though there are, of course, many options.
Whatever treatment option is recommended and taken, various exercises should be introduced at the appropriate stages, to help strengthen the back again; this may be McKenzie exercises, rehab, pilates, yoga etc etc as is appropriate for the individual patient. I personally use McKenzie and co-contraction then refer for rehab/pilates, but wish I had facilities to do the rehab properly myself.
Another useful tool is a portable TENS machine, purely for pain management, very effective, and without the nastier potential side effects of medication; you'd probably need a physio to explain it properly though, as electrotherapy is an area traditionally ignored/looked down on by chiropractors, and I believe osteopaths too (I'm correcting this for myself, but holds true as a generalisation).

Hope that helps
Aidan (DC)

 

[Bogey]

BIA,

interesting that you say you should avoid spinal manipulation to start with if you have a possible disk injury. Would HVT be a contra indication for all disk injuries.

Also from your experience have you ever come across many patients with hyPERmobile segments in the lumbar spine and whats usually the best way to approach these - would HVT be a contra indication for hypermobility?

I like what you write about using a multi treament approach ie stregthen, mobilse and electrotherapy. I've found it very hard to find

I've been to a range and chiros, osteos and physio who have failed to take this approach and in fact quite rudely slag off other professions eg "physio can only deal with soft tissue injuries and chiros only manipulate" - i've found this very unprofessional and quite narrow minded

its quite a shame as it seems there is a great deal that all three professions (osteos, chiros and physios) can learn from each other. do you think this is begining to change or will the divide always be present?

thanks

 

[stigmajones]

Nope, not at all. SMT (spinal manipulative therapy) is a good and effective treatment for most disk injuries (especially gonstead if you believe the theories - I'm sceptical, but undecided), the trouble is, that the risk of aggravating the injury is higher than with mobilisation, so I would mobilise until stable, then manipulate with care in the later stages of treatment plan. In my experience, I have access to flexion distraction as a form of mobilisation, and so can take it much further than is the norm, and as patients have come to know, accept, and benefit from it, they rarely tolerate SMT later on, but that's their decision, not my professional recommendation.



Not quite, I've written a little on it elsewhere, classically speaking, the root problem behind DJD (misnomer-dly known as osteoarthritis) is hypermobility, either habitual, long-term hypermobility, or short, one-off trauma type. The response to this excessive movement is the body's attempt to stabilise the structure with muscular hypertension/spasm and eventual boney butressing.
It needs to be treated (IMO) by firstly, getting the joint moving again, but in a way that doesn't stress it (so mobilisation, rather than manipulation), then strengthening the core muscles, whilst relaxing the more superficial muscles, though an element of mobilisation is likely to be needed for life - this can mostly be done at home, and form part of the rehab programme.
Hypermobile SI joints are much more easily treated than facet joints, and SOT would be the treatment of choice is most of these cases.
In essence, hypermobility is a comparative contraindication, not an absolute, and don't forget that a habitually hypermobile joint can become transiently "fixed" too, the DJD explanation demonstrates one such mechanism, and the joint still needs to move (that's it's job).



You need a fairly open minded therapist (or therapists) to get this approach, though what you've outlined above in terms of mixing and matching from SMT, mobilisation, electrotherapy, rehab, dry needling etc are often provided by one therapist; you also need a therapist that will give you long enough in a session, and in some cases, have the space &/ equipment levels to do so.

I've also written a short note elsewhere on my views on the antagonism between the professions, especially between the 3 you've mentioned.
Basically, we only see each other's patients when they've failed, by definition, the patients I succeed with, don't need to see an osteopath, he'll only see my patient if I didn't work, so we all get a very biased view of each other. I personally think all 3 can learn a lot from each other, and I make a point of doing the majority of my CPD through physio organised courses (osteopath courses are more difficult to get into, and tend to have much greater cross over / less difference than the chiro courses).
Rehab has always been a key part of chiropractic treatment, though often done poorly through lack of time, facilities, and formal training; this has been changing for the last 6-7 years at student level. Electrotherapy is very much frowned upon by chiropractic community, especially at college, which I think is tragic, and I'm trying hard to "catch up" with my knowledge in this, though I still probably under-use it through time/boredom factors of the treatments, and the cost of some of the most effective (eg. PSWT). I'm sure the open minded osteopaths have their own examples, I'd personally estimate to do with the specificity of their SMT.
My personal opinion is that the physios actually over use SMT, as it forms a minimal part of their training (compared to chiropractors and osteopaths), and I'm not convinced they're fully up to it, especially in delicate areas such as the neck, arthritic joints, disk injuries etc. I'll add in here, before I get attacked, that my ex-fiancee was a physio student, then physio whilst in that relationship, so I'm talking from a position of knowledge - the questions she and her colleagues asked me about rehab were very good questions, to the same level as my knowledge; whereas the questions she asked me about SMT made me scared that she was then going on to treat someone with it.
I feel that there is a place for specialisation withint the 3 professions, with physios knowing a lot more about a larger range of conditions than I do, but consequently, being generally much less knowledgeable in my areas of specialisation.

Don't know if I've answered your question, or just waffled for a few minutes, happy to answer any further questions if I've missed your point / explained myself badly

 

[canizzy_123]

After suffering 5 months of Sciatica I went to see my NHS doctor who wrote to Walsall Manor Hospital to request an MRI scan. I really cannot complain - I saw the doctor at the end of November, had my MRI scan 3 weeks later, saw the doctor again who then refered me to the Osteopath and had my appointment on 11th January 2008. I am now on the waiting list for the discectomy of which I am assured will be musch less than the quoted 20 weeks waiting list. So if this is indicative of the Walsall Manor then I supposed 6-8 weeks from GP to Consultant and getting on the operation waiting list is very good indeed.

 

[g m]

Sounds like a pretty good experience Nico; and an enlightened GP for sending you to the right place.

Personally, I wouldn't want to operation to come around too soon, as you need to give the osteopath a chance to actually do something, and take you off the op list.


Out of interest, you say the GP referred you to the osteopath; did you mean refer or recommend (if a referral then the GP's still in charge, and the NHS pays; VERY few practices still have this sort of contract, and I'm part of a group trying to negotiate just that sort of contract at the moment).

 

[Smoochy "Heathen"]

Thanks for the reply.

Yes, to clarify - the NHS GP refered me directly to the specialists at the Walsall Manor Hospital who initially did the MRI scan. I was then refered by my GP to the consultant NHS osteopath at the Manor Hospital who then put me on the list for surgery.

So it was the NHS osteopath that has told me to have the operation. So I guess if the osteopath says it needs to be done I cannot see any reason to argue. He said that discectomy was routine at his hospital and it was not unusual to have 4 or 5 done every week.

I would love to have found an alternative - but I have seen my MRI scan and the disc looks scary - half out of the gap in the vertebra and clearly sticking into the nerve fibres and even pushing its way downwards. This will never pop back into place in a million years - whatever the chiropractors may tell you.

Thanks for the interest, and I will post an update when I get it done!

 

[pinscherpuppy]

That sounds like an amazing situation you've got there, I'm impressed.

Is the osteopath actually treating you at all, or just referring you on?

A massive herniation doesn't mean that it can't be treated conservatively, though yes, expectations will change.

And anyone that tells you that the disk will "pop back into place" is lying (either deliberately or in ignorance), and completely missing the point of treatment.

 

[Idrigemayn]

Hello,
I have had a prolapsed disc (L5,S1) since May, It has got better 3 times it just keeps re-occuring, I have had a MRI scan that confirmed the disc had popped out.
The last time it went was on Dec 6th during the night, no idea why, I stayed in bed until the 19th Dec, I gave up on the NHS in Reading, they are a joke, I ended up having a Spinal block, well I was told that they inject an anti-inflamatory and steroid into the area of the damaged disk, it helped a lot, 3 days later I was able to go back to work, from bed to almost normality, 4 weeks on and still at work, back doing ok, still some pain but nothing i would complain about.

I have also booked onto a course to do the Alexander technique, I know 2 people that have done this over 30 years ago and have not had any further problems, one of them has been a builder for the last 30 years and at 71 just built a 200ft stone wall.

Look in to the alexander technique, anything is worth a try, also try cold (ice) packs in the area of the damaged disc.

 

[Pompal 09.]

Hi Thom, I know what you're going through!! Hasn't been quite as long but I've been suffering with the same thing for 11 months. Have taken pretty much every drug under the sun, only thing that really helped was Diazepam, but the Doc wouldn't give me any more due to the long term effects. Now just take Diclofenac with as many other pain relief tablets as I can force down my throat without dying!

I was seeing a chiropractor for about a month, which helped the pain, but seeing them three times a week was getting into serious figures, if only they took Monopoly money! Stopped seeing them a while ago and pain came flooding back.

I got an MRI scan through a group called Alliance Medical, they have been draughted in to ease the stress on the No Hope Service(NHS). I went to my GP a thousand times, who put me onto an orthopaedic consultant, who put me into a spinal clinic, which lost my notes, so I was referred to a neuro surgeon because I've damaged my sciatic nerve due to the constant pressure on it, and finally I saw a consultant who has been brilliant. I'm currently waiting for my results(which have taken four weeks because they needed to be processed in South Africa because the NHS "doesn't have the resources"! Then it looks like it's surgery time, should be about 2015 when I'm fixed!

Don't know if I've said anything which has helped you, but I hope you do realise you're not alone, the NHS is going, and has been going horribly wrong for a long time, but stick in there, and keep annoying your Doc, they will eventuall give in and get you booked in for the scan.

All the best.

Matthew.

 

[Rachael Smith]

TOM I AM IN LONDON MANOR HOUSE NORTH , my doctor heron pratice cant understand i got a appointment to st lenoards within three weeks and physio and mri scan have prolapsed disc too l5 s1 have injection no better now i do pilatse and try to live with it try the in health netcare and it is free prvt but through national health good luck