Not Doing Well

Lori is not doing well at all again. Her mother was in the hospital for almost 2 weeks including 2 days in intensive care. Between the stresses of her Mom not doing well and the extra burden of out of town relatives staying with us Lori is completely drained both mentally and physically. Her mom was moved to a rehabilitation facility on Sunday. Hopefully she will be home soon.

Lori has spent a lot of time sitting up. This is really creating a lot of pain for her with her back/leg. She has overdone it, that’s for sure. It was really hard for her with her mom in the hospital. She wanted to be with her the whole time but just couldn’t. With her mom in Rehab it has relieved some of the stress but I know Lori won’t be happy until her mom comes home.

We had our follow up visit with the Physiatrist (Dr. Brown) last week. The appointment went as expected. Since the SI Joint injection did not work Dr. Brown is going to treat Lori for Chemical Radiculitis(1). The plan is to use two separate Epidural Injections(2) spaced two weeks apart. Our 1st appointment April 25th. The second one is two weeks later. If this process does not work she will have to pinpoint the specific nerve and perform a nerve root block(3).

It has now been 4 months of increasing pain. The pain pills offered some relief at the beginning but do not do much now. Lori has been taking stronger medicine, which again worked for a bit but is loosing its effectiveness. Lori is also concerned with becoming addicted to them.




(1) Chemical Radiculitis - The discs between the vertebra are like gel filled sacs.  When the outer covering of the sac gets a hole in it, the contents can leak out rather than pushing out (as in a herniated disc).  When the gel leaks out over time, it can lead to an inflammatory condition known as a chemical radiculitis.  This is usually best treated using epidural steroid injections or selective nerve root blocks.   If the inflammation isn't reduced, scarring around the nerve roots can develop.

(2) Epidural steroid injections have become a mainstay in the treatment of pinched nerves and herniated discs.   The procedure is done under fluoroscopy (a real time x-ray so the doctor knows where the needle is going) and involves injecting anti-inflammatories around the nerves in the spine.  Since many herniated discs involve some chemical radiculitis, this can help calm down the swelling and prevent scarring around the nerve roots.  Expect to be numb for a few hours after the procedure, then sore for a few days (after the numbing medicine wears off and before the anti-inflammatory kicks in).

(3) A selective nerve root block is what it sounds like.  A needle is placed near the exiting nerve root in question using fluoroscopy (a real-time x-ray that helps the doctor see where the needle is going).   Anti-inflammatory is injected around this nerve in an attempt to calm it down and reduce the symptoms of a herniated disc or radiculitis.  Since the needle is in an exact spot (unlike an epidural steroid injection which is more of a general approach), this technique can help identify which specific level is involved.