My Second Steroidal Epidural Procedure!

Posted on January 15, 2012 by osc

A Patient’s Journey to Pain Relief with OSC Orthopedic Associates

After my initial epidural procedure failed to give me as much pain relief as I was hoping for, Dr Mark McFarland recommended I try a second cortisone procedure before moving to the surgical option to remove the herniated disk.

I head into to see Dr. Raj Sureja for my second cervical epidural – cue dramatic drum rolll please

I found this great Youtube video by Dr Sureja explaining the process of injecting cortisone into the spine and why this helps relieve pain:

This time, I am much less anxious about what my experience will be. Knowledge is power, right? I know that I might get dizzy or feel faint, but I also know that the epidural really doesn’t hurt and that it will be over soon.

Dr. Sureja comes in and is his usual gentle and wonderful self. He decides to do my epidural at a level below the last one, to see if this time, I get some relief from the medication.

I lay down on my stomach on the table and again, during the procedure, I being to feel faint. I hate the fact that I just get so faint whenever I am scared or feel pain. Dr. Sureja says it is the Vagus Nerve Reflex that causes this and that it happens to other people as well. Luckily, this time, I recover from my faintness very quickly and my blood pressure does not drop as low. After a short waiting period after the procedure, I am released into the care of my long-suffering in-laws, who have again volunteered to pick me up and take me home.

Dr Raj Sureja with orthopedic colleague, Dr Jenny Andrus of OSC

When I arrive home, I quickly get my ice pack and head for the bed, to lay flat and to ice the injection site. I pray that I will not get the severe headache that I got last time, so I try to lie still, watch TV and nap. After a few hours, my husband comes home from work and fixes me dinner. I am just fine to get up and eat at the table. Later that evening, I do experience some leg jitters and insomnia. However, these side-effects are nothing compared to those that I experienced after the first epidural. Hallelujah, no headache, no flushing and no other problems! The whole experience seemed to go much more smoothly, in large part, because I wasn’t so afraid and I didn’t work myself up before I went to have the injection. Now, the fun part begins…waiting to see if I feel better.

Next time…..Second Time is a Charm!

Pain Relief Results After a Steroidal Epidural

Posted on January 13, 2012 by osc

A Real-Life OSC Patient Tells of Their Pain Relief Experience

My last post dealt with the yucky after-effects experience with the epidural were over (1 day max), I eagerly began waiting to see if I would feel relief.

When they put the steroid medication into your epidural space, they use numbing medication. This numbing medication does provide temporary pain relief, but the real relief that I am seeking can come several days to a week after the injection.

Epidural Injection of Steroids for Pain Relief

For the first few days, I really did not feel that much of a difference in my pain. After about 4 days, I started to notice that my arm did not hurt quite as much. Then after about a week, I noticed a small improvement in my shoulder and neck pain. This improvement however, was not the big payoff that I had hoped for or expected from the epidural.

As a matter of fact, I really did not see a huge difference in my pain level from before. So, being a good patient, I waited for a whole month to see if things would change. To my chagrin, they did not. So, I went to talk to Dr. Mark McFarland, one of the spine specialists here at OSC, to tell him the epidural had not given me the relief that I sought.

Dr Mark McFarland OSC orthopedic associate

Dr Mark McFarland examines a patient's spine

Dr. McFarland listened patiently to me as I opined that I would be headed for the surgery table because that silly epidural did not work and there was no hope for me, except to be cut open and have the offending disc herniation removed. Dr. McFarland surprised me when he suggested that I should head back for yet another epidural.

I guess he saw the surprise on my face and explained to me his rationale.

He told me that many times, the first epidural does not reduce the inflammation around the nerve as well as it might. So, they do another epidural in a different area or even a level above or below the herniation. Many times, this second one does the trick and relieves the patient’s pain significantly.

Hmmmm.

I guess I lived through the first one, I guess I can try again and see if it will work this time for me. I am willing to do anything to feel better, so here goes.

Next time – My second cortisone injection epidural!

Two Easy Ways To Improve Bone Health

Posted on January 11, 2012 by osc

Diet Advice for Orthopedic Health from OSC

At Orthopaedic & Spine Center we encourage our patients to have routine bone density tests and provide patients of ways to keep their bones in good health. Genetics do play a part in how healthy a person’s bones are, but that’s not the only factor. There are ways a person can reverse poor bone health such as eating the right foods and exercise.

OSC's Team of Orthopedic Physicians

People have grown to believe that dairy is the leading food group to provide strong bones. This is true to a certain extent but the calcium these products supply to our bodies also needs vitamin D to absorb the calcium. Leafy greens are also a good source of calcium someone should consider when planning a healthy bone health diet.

The OSC Physical Therapy Team

Not only is eating right helpful in creating strong bones but exercise as well. Weight bearing exercise can help to strengthen a person’s bones. Exercises include swimming, lifting weights, yoga, etc.

Performing these routines in your daily life will not only make your bones stronger but also help physical and mental well being. OSC encourages all of our patients to live a healthy lifestyle, and by doing this will be able to live a longer healthy life.

How Active Can I Be After Spine Surgery?

Posted on January 2, 2012 by osc

OSC’s Dr Jeffrey R. Carlson, MD Explains What You Can Do After Surgery on Your Spine

Patients often ask about the activities that they will be allowed to participate in after they have spine surgery. Many fear that they will not be able to return to their previous level of activity and are doomed to a miserable future as an overweight couch-potato. Spine surgery can be concerning enough without the patient worrying about the consequences of the surgery itself.

Dr Jeffrey Carlson preps for surgery

There was a school of thought that suggested that patients who undergo spinal surgery should never participate in sports and should change jobs to less heavy labor positions. Now, there are several studies that show professional football players are able to return to their original starting positions on the field after disc removal, or microdiskectomy. Obviously, these are some of the top athletes in the country who should have better pre-operative fitness than the average patient. There is currently a study in the journal SPINE, which looks at patient’s perceptions of spinal surgery and their post-operative activities. As the physicians in this study found, patients who were more fearful of moving after surgery, had more pain and dysfunction after surgery than those patients who were more confident in their attitudes about moving.

Evaluation for Spine Surgery

One of the goals for most spine surgeries is to restore the patient’s activity levels to normal. The spine specialist should address any expected limitations after surgery, before the surgery is performed. This conversation should include the ability to walk, bend, lift, turn and any type of brace that will be needed. For example, after a typical spinal fusion, there will be some limitation in lifting and exercise for the first 6 weeks from surgery. After the first 6 weeks, patients should be allowed to return to their normal activities. Depending on the patient’s pre-operative health and fitness, physical therapy may be needed to get the patient back to their normal routines and exercise.

As a practical matter, if the spine surgeon does not present a surgery that will return you to your previous level of activities, the surgery should not be performed.

Dr. Jeffrey R. Carlson attended medical school at George Washington University, completed his residency at Harvard University Combined Orthopaedic Program in Boston, MA and has fellowships in Orthopaedic Spine Surgery and Orthopaedic Trauma Surgery. Dr. Carlson currently practices as an Orthopaedic Spine Specialist at the Orthopaedic & Spine Center in Newport News, VA.

After my Cervical Epidural Injection

Posted on December 12, 2011 by osc

What Happened After my Cervical Epidural Steroid Injection

I went home after my epidural and continued to experience light-headedness, so I went and got in bed, laid flat and watched TV. OSC’s Dr Sureja gave me an instruction sheet to help after the procedure, and I immediately followed the instruction to ice the injection site, so I did.

My instruction sheet also gave a list of potential side-effects and complications to watch for and what to do should those occur. Infection, nerve damage, bleeding, and a dural puncture were all discussed as rare, but possible complications. More commonly, the side-effects possible were dizziness, pain at the injection site, flushing, leg pain, headache, high blood pressure, elevated blood sugar, anxiety or irritability, weight gain.

Dr Jenny Andrus

Unfortunately, I experience several of the side-effects, starting with leg pain and heaviness. I also experienced a lot of flushing and feeling hot. However, armed with the knowledge that these side-effects were common and although uncomfortable, not life-threatening, I dealt with them. I took a long hot bath as I was having leg pain and I could not sleep. I continued to ice my neck throughout the night, on-and-off. I started getting a headache early in the morning and by 9:00 AM, it was very bad. I did not go in to work.

So I called the practice and Dr. Sureja’s partner, Dr. Jenny Andrus at OSC, phoned in a mild pain prescription for me. She said to let her know if I did not get relief in a few hours. I took the medication and quickly started to feel better. I felt pretty much back to normal in about 24 hours after the epidural. After that time, I did not experience any more or continued side-effects. Dr. Sureja told me that the epidural might work well within a few days, might take a while to feel better or might not work at all. I certainly wanted it to work and I was willing to wait a few days to see if I began to feel relief from my chronic neck and shoulder pain.

Next time….Pain Relief…YES or NO????

E (Epidural) Day – Interventional Pain Management

Posted on December 11, 2011 by osc

Pain Relief through an Epidural

Following from my last post, with much fear and trembling, I checked in to the OSC MRI and Fluoroscopy Waiting Room for my Cervical Epidural. I was taken into the Fluroscopy Suite by Mary, Dr. Sureja’s nurse and by one of our Radiology techs, Debbie. They gave me a gown to change into (although I could keep on my bra and everything from the waist down), put on a surgical cap (kind of like a shower cap) to hold my hair, and helped me to get situated on the procedure table.

The procedure table is very comfortable. I was told to lay on my stomach with my face in a round cushion, which was open so that I could breathe and see. Kind of like a massage or PT table. Dr. Raj Sureja came into the room and started talking to me and he was so kind and reassuring. He explained every step of the procedure and told me exactly what to expect. He told me that he would talk to me to keep my mind off of what was going on OR that he would be quiet, if that would help me get through my fear. I told him to talk to me, so he did.

First, he injected numbing medication into the area where he would do the epidural. My injection area was in the back of my neck, near the intersection of my neck and shoulders. This shot barely hurt at all and only for a moment, but I still started to feel hot and faint. Mary and Debbie turned on a fan and blew it on me to cool me off. Dr. Sureja took pictures of my spine and herniated disc with the fluoroscopy machine and then inserted the catheter into my neck, through which he would place the steriod medication. He continually took pictures of my spine to make sure he was placing the medication correctly. He was very gentle and I cannot say this enough, patient and kind. Although, at this point, the epidural did not hurt, I must say it felt weird.

It was over very quickly and unfortunately, I was very faint feeling, so it took me a while to sit up and feel better. They got me some water and let me sit awhile until I started to feel better. They were concerned because my blood pressure dropped and that was why I was feeling so light-headed. They put me in a room and continued checking on me and taking my blood pressure until I felt normal. Then they released me to go home, with an instruction sheet and into the custody of my in-laws, who drove me home. When you have an epidural, you have to have someone to drive you home, because you may experience dizziness or headache or just feeling funny. It was nice to have someone to worry about the driving. All I wanted to do was go home and rest. Even though I got faint and felt silly, I made it through the procedure! Hopefully, it will help!

Next time, the day after!

Preparing for my Cervical Epidural Steroid Injection

Posted on December 8, 2011 by osc

Interventional Pain Management with OSC’s Dr Raj Sureja

Okay, I think that I have told you in my previous blog posts that I am a BIG CHICKEN and TERRIFIED of needles. So, it should come as no surprise to you that I was facing the prospect of having an epidural injection into the space surrounding my spinal column with great fear and trepidation. I could lie to you and tell you I had no fear, because I work for OSC and have faith in the physicians here. But, no matter how much I trust them and their skill level, I was still scared to death.

A needle, not only in my back, but in my spinal canal???

Am I crazy???

: Schematic of Epidural Injection

When the pain becomes so bad, that your life is affected everyday by your plans to manage your pain and how many activities you can complete during the day before your pain gets too bad, and how much time do you have to spend in the tub or lying on the heating pad before your muscles relax enough so that you can get some sleep, you become willing to do things that you never thought you would or could do to get relief. Hence, I made an appointment with Dr. Raj Sureja, Interventional Pain Management Specialist at OSC, to perform my cervical epidural.

: Dr Raj Sureja with OSC’s Dr Jenny Andrus

In preparation for the epidural, you are given a sheet of instructions that are easy to read and follow. Mostly, you are warned against taking anti-inflammatory medications of any kind for several days before your procedure (this includes Advil and Aleve). They are concerned about the effect that the medications will have on bleeding and any complications that could arise from having the procedure done while on these drugs. The OSC personnel also asked if I had any known allergies to drugs or if I had ever had a reaction to dye during a radiologic procedure. They also checked to see if I could possibly be pregnant or have any other condition that might make having an epidural dangerous.

Given the go-ahead, I stopped taking my anti-inflammatory medications, switched to Tylenol and waited for my appointment! Next time….E-Day!

Disc Herniation Treatment Plan with Dr Jeffrey Carlson

Posted on November 25, 2011 by osc

Dealing with My Neck Pain

I think what most surprises me about working at OSC is how many people say to me, “I’m not going to see an Orthopaedic surgeon…all they want to do is cut on me to make money!” I can tell you for a fact that in all but the most extreme circumstances, surgery will NOT be the first, second or even third treatment option you will be given. In fact, the OSC doctors are very conservative and seem to try other therapies before recommending surgery.

Dr Jeffrey Carlson Performing Surgery

This is exactly what happened in my case.

Dr. Jeffrrey Carlson reviewed my MRI with me and then told me my treatment options. I honestly expected him to recommend surgery and I was fine with that, IF it would provide relief. However, I was somewhat taken aback when he first suggested physical therapy and treatment with prescription anti-inflammatories. By this time, I had been in pain, which was increasing in severity, for almost 3 years. I was ready to do anything to feel better. But, I took his advice and began Physical Therapy. I also continued taking my medication. I was in therapy for several weeks and noticed no improvement, in fact, my pain seemed to be getting much worse…almost intolerable.

OSC's Physical Therapy Team

I was seen again by Dr. Carlson and again, expected him to recommend surgery. NO, he instead suggested another treatment, an epidural steroid injection. I have to admit, I was afraid of this….I hate shots! I know, name a person who loves injections and I will sell you some ocean-front property in Oklahoma! But, I REALLY hate to get a shot…so much so that I pass out cold. I have to lie down to get them and sometimes I still pass out. I have a bad history of this and it was not comforting at all to think about this happening in front of all of the people with whom I work. However scared I was, I decided to trust Dr. Carlson and give it a try. I was in so much pain at that point that I really did not care, I just wanted to feel better.

Next time….cervical steroid epidural! EEEEEK!

MRI Results with Dr Mark McFarland Orthopaedic Associate

Posted on November 14, 2011 by osc

Diagnosing Causes of Orthopedic Pain in the Neck and Spine

Almost immediately after my MRI was completed, I was able to walk over to the OSC physician station where Dr. Mark McFarland was working and have him pull up my MRI results. Dr McFarland is one of only two doctors on the Peninsula to be fellowship-trained in performing cervical and lumbar disc replacement surgery as well for surgery for pinched nerves. I guess that is a benefit of working at OSC! Between patients, Dr. McFarland pulled up my MRI images on OSC’s digital imaging system.

Orthopedic Associate OSC Mark McFarland MD

Dr Mark McFarland

I must admit, it is pretty amazing to have a complex imaging test done and be able to view the test images immediately on the system. Dr. McFarland looked at the images with me and was immediately able to point out the cause of my neck, shoulder and arm pain…I had a spinal disc herniation at level C4-5.

MRI Scan of Patient (side view)

Dr. McFarland showed me how the MRI images looked as if my body had been sliced in half at the level of my disc herniation, so that I could actually see the detail of where the disc material was bulging out, pressing on nerves and causing my pain. I also saw a side view which showed my whole cervical spine and could see the herniation from that view as well. Although I did not want to get bad news about my spine, I was relieved to know that there was a specific reason for my pain. I felt comforted by the knowledge that now we knew what was wrong, we could treat it most effectively!

Next time….the treatment plan to relieve the pain in my neck!

Having an MRI Test with OSC’s Open MRI

Posted on November 8, 2011 by osc

Open MRI Scanning Technology at OSC

After my initial examination by an orthopedic associate at OSC I had my MRI, which was not unpleasant at all. Many people become claustrophobic inside enclosed spaces, but the MRI at OSC is open in the back and on the sides (an “Open MRI”), so it certainly doesn’t not make you feel as claustrophobic as one of those “tube” MRIs might make you feel.

Open MRI Technology at Orthopaedic & Spine Center

I checked in for my appointment and was told to change into a gown, but that I could leave on everything from the waist down. I put my clothes into a locker. I was then escorted into the MRI room itself. The machine is kind of imposing-looking, but our MRI technicians are so warm and friendly, they put you right at ease.

They told me that I would be able to talk to them at any time and that if I had a problem during the MRI, that I could let them know. I was told to lie down on a table that was attached to the Open MRI itself. They put a bolster under my legs to make me more comfortable and gave me a blanket. They told me that the table on which I was lying would move into the actual MRI and that when inside, I would need to lie very still. All I had to do was find a position for my hands that would be comfortable and one where I could hold my position without wanting to move. They also asked me if I would like to listen to music and even put on the kind of music I liked!

Once I was comfortable, they pushed a button and the table moved me inside of the MRI machine. Lying face up on my back, the top of the machine was about 6 inches from my face, but the sides were open and I could feel cool air coming from behind my head, where the machine was also open. They asked if I was okay again and then said that they would start the test.

The MRI tech left the room and went to sit in a windowed control room where they could operate the MRI and watch me at the same time. They talked to me over a speaker that I could hear inside the MRI and said for me to cough or clear my throat and then to be still for about 10 minutes. Soon after, they told me I would hear some noises and that the test was beginning. The noises I heard were not scary, but kind of funny. One of the sets of noises I heard was kind of like a horse clip-clopping, then I heard a variety of noises, some metallic in nature, some kind of like a beat from a New Wave 80′s Band! I love music and enjoyed listening to all of the different sounds. It didn’t frighten me or annoy me at all…I found it to be most entertaining!

After about 10 minutes, they told me I could cough or clear my throat and then I had to be still again. This went on for about 30 minutes and then the test was complete. The MRI tech came into the room, pushed a button and my table moved out from the MRI machine. I got up, got dressed and was finished with my test in less than 1 hour. The experience was not painful or difficult in anyway.

Having an Open MRI at OSC was convenient and easy!

OSC – Orthopaedic & Spine Center

Welcome to OSC! Our staff of orthopedic doctors and specialists is committed to providing you with the best orthopedic care available anywhere.