Two discograms in my Christmas stockings

[annapurna]

As you can tell from the subject header, this post is from Annapurna's husband; no one looking to get two discograms would be eager to joke about it.

We've mentioned before that after three positive medial branch blocks and one failed rhizo for the L5-S1 facets, Laura's PM doc decided that he was sure that his rhizo was done correctly and the medial branch blocks (two done by him) might have been false positives. Today we went back to find out more about this theory and plan the next step.

Before we went we had plotted out a flowchart (yes, we're both engineering geeks) with what we knew, what we thought, and what we wanted to know along with what we thought we reasonable tests to answer our questions. The first words out of the PM doc's mouth confirmed my opinion that he was good to work with, "This," indicating the flowchart, "is good." It was nice working with a doctor that decided we might actually be concerned with our own health and be working our hardest on it in between visits.

The theory about the false positive medial branch blocks is this: the anesthetic can sometimes, but not always, leak out beyond the intended area and anesthetize more structures than what was intended. The doc said that it is standard practice to use small quantities of anesthesia to prevent this but he had seen cases where dye was used that showed that the injection had leaked far beyond what was desired. Given that, it was reasonable to assume that the false positive was possible. We even asked if it was possible to unwittingly anesthetize a painful posterior annulus left behind after ADR. He said that it was, but we failed to probe if this was a "Yes, it is possible" or a "Yes, it is vanishingly possible and Laura's such a difficult case that it might have happened here."

The final plan we agreed to was a discogram at L5-S1 for the possibly painful annulus as well as a discogram at L4-5 to see if that is the cause of Laura's greatly increasing sitting intolerance. She missed getting it on Christmas day but it is scheduled for 12/28 so we could call it a late delivered Christmas present.

[mmglobal]

Jim,

I'll be very interested to hear how the discogram goes... especially on the level with the Charite'. I've seen Bertagnoli perform a discogram on a level with a ProDisc and get a positive response. I believe that it is possible to get a false negative on such a test because of the potential inability to generate pressure. Getting the needle between the plates of the ProDisc is probably easier than with a Charite' because of the configuration of the core. It will also depend on whether or not the posterior annulus and PLL even exist.

Interesting stuff... I know things are tough now, but I hope you and Laura have a pleasant holiday and a great New Year... let us know how it goes.

Mark

[letteski]

Jim and Laura

Yikes..... glad it�s after Christmas and not before. May want to add some diamonds to that stocking while your add it

So they can check the annulus with a discogram after ADR? I take it that Laura still has her annulus, some doctors remove it and some leave it in. Can it be removed if it's a pain generator after ADR?

Sure hope this provides some answers for you. I will say tuned.

Merry Christmas and God Bless

[annapurna]

What I am hoping will happen is if the discogram itself is unsuccessful, the doc will choose to put a little anesthetic into the region of the L5S1 annulus to see if he can shut off some of the pain. It will leak all over but it's worth a try now.

Laura remembers that the posterior annulus was left in to provide a small amount of torsional rigidity. If it turns out to be a/the pain generator, I'm not quite sure what we'll do but Laura's been discussing the possibility so I know there are several ideas we can pursue.

[ans]

I hope you guys can figure out and fix what's broken. Most docs would freak out if a pt. brought in an intricate flow chart.

Have a better New Year. - Allan

[annapurna]

Oddly enough, even outside of spine doctors just about every doctor we see likes notes or a flowchart or a written series of questions from us. It got to the point where one doctor was annoyed that Laura didn't bring in written questions for him.

We may have lousy osteopathic support here in Utah but at least we found some good doctors.

[ans]

You guys are in fantastic Utah; I"m in LA.

[Mariaa]

Hmm, I've brought in pain journals and not gotten much elaborative response on them except from a really good anesthesiologist that used to do my ESIs and the one that did my last discogram in SF~ he was awesome in terms of wanting info and sitting down explaining "everything"..
He even injected some Marcaine in the disc areas pressurized to help relieve the pain afterwards.. it really made a diff from the first one in terms of painfulness afterwards~ tho by 3 days after each discogram (2) I was functioning pretty well and w/o much pain for a while~
Good luck to you Laura, whatever the outcome, wishing you some serious lasting relief!

[Jim M2]

Laura,
Here's hoping you have an unambiguous outcome. I'm anxiously awaiting your results and conclusions.

Jim

[annapurna]

Laura just completed the discograms. L4-L5 looks fantastic. The injectionist couldn't get the needle anywhere near the L5-S1 disc region and was stopped a good distance away from the PE spacer on the Charite. He didn't know what was going on and suggested that we contact someone more experienced with ADR but failed to get the needle in place after two trys with flouroscopy.

As far we can guess, we're going to work on why the needle couldn't get near the disk and see if that indicates something then go back to working on SI vs L5-S1 facets as the pain generator.

Guess she'd have been better off with coal in the stocking. On the other hand, at least there isn't a painful L4/L5 on top of painful facets and SI joints. The injectionist promised to review the results of all the recent injections and see if anthing else occurred to him. At least the doc is willing to put some thought into things.

Best to all!