Pleasant surprise

Well I ran out of pain meds yesterday and did not have a refill on the scrip so I have to call it in to the pharmacy and then they check with the doc to see if he will refill it. I called it in first thing in the morning in hopes that it would be done by 1500 as that would be when my other meds should be gone.

I called the pharmacy at about 1430 and they said it was refilled but that my insurance company said that it was to soon to refill and they would not pay for them until the 18th. Not sure WTF is up with them but since it was a generic refill it was only $26. My wife went and grabbed it for me and when I opened the bag I found that not only had my doc authorized the refill, he gave me enough refills for another few months worth. Seems like after our last conversation he has come around to really understand that my pain is something that is not going away any time soon.

While I am a little miffed with my insurance carrier about the co-pay I am glad that I at least have insurance and do not live in a socialized healthcare country. I have read to many accounts of people living in the UK and Europe where they have to deal with socialized healthcare and they wait and wait and wait just to see the doc to be told they will know have to wait again to see the neuro or whoever else they will be referred out to see. In the time I was diagnosed with Spondy and had my surgery (about 1 year) some of them were still waiting to see the docs. Ouch!

Sweating and Arachnoiditis

About Arachnoiditis - General Information: "Autonomic: bladder/bowel/sexual dysfunction; excessive or reduced sweating; heat intolerance; difficulty swallowing (and sometimes related chest pain); limb swelling; blood pressure disturbance"

I have been experiencing periods of sweating even though I am not hot. I was not able to place this and decided to hit the web and do some searching. Looks like it is autonomic reaction that I will have to deal with. It is not often so far but just one of those little things that adds up with all the other little things to make you uncomfortable.

Pain today is moderate and it is still rainy and cold out and looks to stay that way for a few more days. Very lazy days indeed!

My life with adhesive arachnoiditis

My life with adhesive arachnoiditis

Here is another blogger who has been diagnosed with Arachnoiditis. While I am sorry we have to meet this way it is nice to have someone else's perspective on how they are doing and dealing with this disability.

Prognosis of Arachnoiditis - WrongDiagnosis.com

Prognosis of Arachnoiditis - WrongDiagnosis.com

Another interesting site that I have spent some time on. The above link will bring you to the page where I will be quoting from but rather then have a long post here I will just use snippets.

Prognosis for Arachnoiditis: There is no cure for arachnoiditis. For the majority of patients, arachnoiditis is a disabling disease causing intractable pain and neurological deficits. As the disease progresses, some symptoms may increase and become permanent. Few people with this disorder are able to continue working. In some cases, progressive paraplegia may occur.

As stated, there is no cure for this and so far out of all the people that I have spoken with about ARC very few have been able to continue to work. Those that do seem to be either self employed and thus can tailor their work to their physical needs or they have jobs where they have the ability to work around the ARC. In my case I will most likely (99.99% sure) never be able to return to my previous position(s) as they all required the heavy lifting or long periods of standing/sitting and none of them certainly would be ok with the use of prescribed narcotics which I spend a good amount of time on.

forgetfulness: A lot of people experience memory lapses. Some memory problems are serious, and others are not. People who have serious changes in their memory, personality, and behavior may suffer from a form of brain disease called dementia. Dementia seriously affects a person's ability to carry out daily activities. Alzheimer's disease is one of many types of dementia.

While I do not think I fall all the way into this category I do believe that it has affected me. Maybe not in the sense that I can not remember t all but more likely a combination of the pain and meds that cause me to space out. I would add this to the list of reasons I have imposed self limits on my driving car. Since I can longer predict when my back may flair up or I might "space out" I do not drive much and usually I only drive to drop off and pick up my son from school.

There are many other issues the site deals with but they are going to vary from case to case. Some ARC patients are or will suffer from Cauda Equina Syndrome where the person has difficulty in either holding their bowels/bladder or has difficulty determining when they need to use the restroom. I do not have this symptom, at lest I do not think so and I was not diagnosed with it, however I do have occasion where a need to use the restroom sneaks up on me or there are times when it feels like I need to but do not really have to. This is one that I keep track of and my be a psychological reason that I do not venture far from home.

Robert Wood Johnson University Hospital

Robert Wood Johnson University Hospital

This should be interesting. It is going to be a live webcast of minimally invasive spinal surgery. Obviously not the same type of surgery I had but it should be interesting to watch. Looks like they have some other webcasts they will be doing as well.

Slip sliding away

A cold day today. I don't think we hit but 55F for the high and this is supposed to be one of the warm days this week.

I love the cold but this is going to suck if the weather is going to play with my back. Seems the colder it gets outside the more my back hurts. Not a burning pain but more like a stiffness in the joints. Simple tasks like bending over to change the baby are difficult to perform. I can bend or kneel down depending on where I am, but recovering to the standing position can be a bit painful. Once I am up I feel ok but just getting up sucks. I try to limit myself but when it is me and the baby at night someone has to change him. Bath time can be tough as well but we bought him a special seat for the tub. It keeps him from slipping so he can play without me having to be down on the floor with him. I can pull the chair in with us and watch him.

I got out and about for a bit today. Nothing fancy, just hit wally world for some batteries and tape. Seems like Christmas is coming earlier every year. Halloween has not even happened yet they had like 5 aisles of nothing but Christmas items while they had about 1.5 for Halloween. Nothing says holiday like corporate America! Pretty soon they will be setting out the Christmas stuff during the Fourth of July.

Right now I am just relaxing and watching a movie (Dumb & Dumber) as there is not much else to do this evening. Both the boys are in bed and snoring way which is where I plan to be here shortly. I did not sleep well last night, in part because of my back but the baby was restless last night.

Rest In Peace Superman

Movies - AP
AP
'Superman' Christopher Reeve Dies at 52

10 minutes ago


By JIM FITZGERALD, Associated Press Writer

MOUNT KISCO, N.Y. - Actor Christopher Reeve, who soared through the air and leapt tall buildings as "Superman," turned personal tragedy into a public crusade, becoming the nation's most recognizable spokesman for spinal cord research — from a wheelchair. Reeve went into cardiac arrest Saturday while at his Pound Ridge home, then fell into a coma and died Sunday at a hospital surrounded by his family, his publicist said. He was 52.

His advocacy for stem cell research helped it emerge as a major campaign issue between President Bush and his Democratic opponent, John Kerry. His name was even mentioned by Kerry during the second presidential debate Friday evening.

Reeve, left paralyzed from the neck down after a riding accident and who pushed for funding to help others like himself, was hospitalized the following day. In the last week Reeve had developed a serious systemic infection from a pressure wound, a common complication for people living with paralysis.

Dana Reeve, Christopher's wife, thanked her husband's personal staff of nurses and aides, "as well as the millions of fans from around the world who have supported and loved my husband over the years."

Reeve's life changed completely after he broke his neck in May 1995 when he was thrown from his horse during an equestrian competition in Culpeper, Va.

Enduring months of therapy to allow him to breathe for longer and longer periods without a respirator, Reeve emerged to lobby Congress for better insurance protection against catastrophic injury and to move an Academy Award audience to tears with a call for more films about social issues.

"Hollywood needs to do more," he said in the March 1996 Oscar awards appearance. "Let's continue to take risks. Let's tackle the issues. In many ways our film community can do it better than anyone else. There is no challenge, artistic or otherwise, that we can't meet."

He returned to directing, and even returned to acting in a 1998 production of "Rear Window," a modern update of the Hitchcock thriller about a man in a wheelchair who becomes convinced a neighbor has been murdered. Reeve won a Screen Actors Guild (news - web sites) award for best actor.

"I was worried that only acting with my voice and my face, I might not be able to communicate effectively enough to tell the story," Reeve said. "But I was surprised to find that if I really concentrated, and just let the thoughts happen, that they would read on my face. With so many close-ups, I knew that my every thought would count."

In 2000, Reeve was able to move his index finger, and a specialized workout regimen made his legs and arms stronger. He also regained sensation in other parts of his body. He vowed to walk again.

"I refuse to allow a disability to determine how I live my life. I don't mean to be reckless, but setting a goal that seems a bit daunting actually is very helpful toward recovery," Reeve said.

Before the accident, his athletic, 6-foot-4-inch frame and love of adventure made him a natural, if largely unknown, choice for the title role in the first "Superman" movie in 1978. He insisted on performing his own stunts.

Although he reprised the role three times, Reeve often worried about being typecast as an action hero.

Though he owed his fame to it, Reeve made a concerted effort to, as he often put it, "escape the cape." He played an embittered, crippled Vietnam veteran in the 1980 Broadway play "Fifth of July," a lovestruck time-traveler in the 1980 movie "Somewhere in Time," and an aspiring playwright in the 1982 suspense thriller "Deathtrap."

More recent films included John Carpenter's "Village of the Damned," and the HBO movies "Above Suspicion" and "In the Gloaming," which he directed. Among his other film credits are "The Remains of the Day," "The Aviator," and "Morning Glory."

Reeve was born Sept. 25, 1952, in New York City, son of a novelist and a newspaper reporter. About the age of 10, he made his first stage appearance — in Gilbert and Sullivan's "The Yeoman of the Guard" at McCarter Theater in Princeton, N.J.

After graduating from Cornell University in 1974, he landed a part as coldhearted bigamist Ben Harper (news) on the television soap opera "Love of Life." He also performed frequently on stage, winning his first Broadway role as the grandson of a character played by Katharine Hepburn (news) in "A Matter of Gravity."



Reeve's first movie role was a minor one in the submarine disaster movie "Gray Lady Down," released in 1978. "Superman" soon followed. Reeve was selected for the title role from among about 200 aspirants.

Active in many sports, Reeve owned several horses and competed in equestrian events regularly. Witnesses to the 1995 accident said Reeve's horse had cleared two of 15 fences during the jumping event and stopped abruptly at the third, flinging the actor headlong to the ground. Doctors said he fractured the top two vertebrae in his neck and damaged his spinal cord.

While filming "Superman" in London, Reeve met modeling agency co-founder Gae Exton, and the two began a relationship that lasted several years. The couple had two sons, but were never wed.

Reeve later married Dana Morosini; they had one son, Will, 11. Reeve also is survived by his mother, Barbara Johnson; his father, Franklin Reeve; his brother, Benjamin Reeve; and his two children from his relationship with Exton, Matthew, 25, and Alexandra, 21.

No plans for a funeral were immediately announced.

A few months after the accident, he told interviewer Barbara Walters that he considered suicide in the first dark days after he was injured. But he quickly overcame such thoughts when he saw his children.

"I could see how much they needed me and wanted me... and how lucky we all are and that my brain is on straight."

Yahoo! News - Pain relief a human right, leading professor says

Yahoo! News - Pain relief a human right, leading professor says

Someone finally gets it. This is a step in the right direction but now all we need to do is get the doctors onboard. My time with pain has shown me the different kinds of doctors there are. Some will give you what ever you want if you ask, others will skimp on the pain meds and after so many weeks will cut you off for fear of addiction. My current PCP seems to have finally turned the corner on this though as after denying a refill several months ago but with me still being in pain he finally ordered the MRI that diagnosed the arachnoiditis. It was only then that he started to realize that this was not in my head and that my pain was real.

This is perhaps one of the biggest things I deal with everyday. When I am in pain I am not rolling around on the floor nor am I screaming at the top of my lungs. I tend to just find some place comfortable and settle in with a book, the laptop or just take a nap. People have a hard time understanding that I am in fact disabled. No walker, cane or wheelchair for me so I look like almost everyone else out there. It has given me a new respect for people I see parking in the handicap spots though. Just because you do not see the handicap does not mean it is not there.

While I understand that narcotics are addictive and can cause other problems many of us are facing lifelong illness that cannot be cured. Not to say they are the same but with diseases like cancer there is at least hope of going into remission, removal of the affected organs/tissue and other treatments that can allow a normal pain free life. With arachnoiditis there is no cure right now and there is very little they can do other then treat the pain.

Failed back surgery syndrome & Arachnoiditis

Failed back surgery syndrome or FBSS is a generic term used for any back surgery that is not deemed a success. Funny thing is that in my reading up on this they say that a common treatment for FBBS is epidurals which are a known cause of arachnoiditis.

Almost seems as if you are damned if you do and damned if you don't. I was in pain before the surgery but at least I was able to work. Don't get me wrong, I am not mad or upset that I am where I am but it does suck from time to time.

The most common causes of arachnoiditis are iatrogenic with Iatros meaning physician in Greek and genic meaning induced. This may be one of the reasons this problem is so under diagnosed. I mean what doctor would want to admit that something they did would be this devastating. Like I have said before, this can be induced by a number of things like surgery, epidural steroid injections and myleograms. There are other causes like menegitis and even TB as well as blood making it's way into the spinal fluid.

I had all the above procedures done and not once during the tie I was having them do I recall the possibility of arachnoiditis being mentioned. Doctors may be facing higher malpractice premiums but what about the patients like myself who know face a life of pain? How about the life of having to get up and take meds all day long just to get through it? Worse, how about never being able to play with my kids like I used to be able to?

I am still fairly healthy and am trying to stay ahead of the arch. by going to the gym when I can and riding the bike and doing some light weights. It helps but at the same time I pay for it the next day or so. The movement iritates the arch. which in turn obviously causes more pain. On the COFWA website the say

One doctor has likened the pain of AA to that experienced in cancer, but without the relief of death. Indeed, some sufferers become suicidal due to the unrelenting pain and the neurological deficits they experience.

Now I don't know all about the suicidal part but I guess I could see someone thinking that was the only way to end their pain. I would have to believe though that those who consider that option would have to be those who suffer far worse then I. It is the "like cancer without the relief of death" that got my attention.

I am sure that as time goes on my arch. will get worse as we caught mine in what appears to be the early stages. I was diagnosed less then 1.5 years from the surgery date and within 2 years of the first epidural. Seems that most of the reading I have done has people being diagnosed further along then that as well they say in some cases it could take 20 years for the symptoms to show and be diagnosed. Again though I would think that to be the extreme edge with people being like myself and diagnosed in the first several years.

Quality of life is always a consideration for people with arachnoiditis. Both the patient and the family. I try to keep up with them but sometimes things that used to be simple tasks like walking for long distances are now more difficult. When I was in Junior High School I started running cross country. I was running 6 minute miles when I was in 7th grade. By the time I left the Army I was smoking the PT run (2 miles) in low 11's and on occasions sub 11 minutes. Big change from those days. I never really liked to run, I was just good at it and could go long distances without problem. Now walking 1 mile hurts. Just one more thing I guess I took for granted was that I would always be able to run like that.

Enough for this evening.

Saturday in the park...

It was an interesting debate last night. John Kerry must have said "I have a plan" 100 times but that is about all he said. President Bush did much better this time then last but I would like to see him bust it out for the last one.

I woke with another headache and a throbbing back. Of course a few minutes later the baby woke up so know we are downstairs and he is playing with his lego's. Darvocet is helping a bit but since it is such a mild pain med if the pain gets much worse it does not do much. My guess is the arachnoiditis is progressing a little faster then they anticipated. Heck, they diagnosed it much sooner then most of the studies say it is generally noticed.

I read somewhere yesterday that it can stay localized but it can also spread up the menengies. As the scar tissue grows and surrounds the nerves it cuts off the blood supply and this means the oxygen as well. Basically what you end up with is a dead nerve. Enough scar tissue and you lose feeling in the effected section of the body. This is what is going on with my left leg/foot.

I have done the NSAIDS and medrol with some relief but the benefits I would say were outweighed by the side effects. Some of the NSAIDS they have tried with me are now being recalled. They are the Cox-2 inhibitors Vioxx and Celebrex (not yet recalled) and I have taken Mobic as well. Vioxx and Celebrex worked ok in conjuction with other meds but the Mobic did not do squat. I take that back, it made my stomach upset even when take with food.

More later, time to grab some yogurt and feed the baby breakfast.

Fell behind a bit

Spent most of yesterday in the recliner trying to get comfortable. My left foot was burning and my leg was numb, it got bad enough that my whole leg buckled while I was walking up the steps. I decided to take it easy and relax for the afternoon as I had some shopping to do last night.

We went to Sams club to do the bulk shopping and I am glad that I rested for the afternoon. If you have never been into a Sams Club it is pretty much a warehouse and if you walk the whole thing on some of their larger stores I am sure you will log a few miles just cruising the aisles for what you need. The toughest part was having to carry all the stuff from the car to the house. Sams club does not bad as it helps cut down on costs and for most of the items they are oversized so good luck on fitting them into a bag. I spent about an hour getting it all put away which includes breaking down the meat which is sold only in bulk, usually 5lbs or more.

This morning was a rainy one. It actually rained for most of yesterday and was still going this morning. Just one of those blase days but I got a lot of stuff done.

Right now I am watching the debate while sitting in the glider chair upstairs. Once I put the boys in bed for the evening I just like to relax and grab a few minutes to myself. The back though is not happy and darvocet is not touching it this evening.

Missed a day

Damn, I missed posting yesterday.

It was a pretty dreary day and I spent most of it in the recliner. We had some pretty vicious thunderstorms most of the afternoon and evening so I stayed away from the electronic stuff.

We waited until the evening and the ran to Sam's Club to finish the shopping. We ended up spending a good 2 hours running through the place but were able to fit it all in the car. I always forget they do not have bags and unless you find some good boxes you have to load it loose. Once we got it all home I had to divide out all the meat into usable portions. After all the lifting and carrying my back was done and screaming for a break.

I did not sleep to well as I kept getting spasms down my back and leg and I ran out of muscle relaxers. I should have the refill this afternoon, but wish I had them yesterday.

AAOS Online Service Fact Sheet Spinal Fusion

AAOS Online Service Fact Sheet Spinal Fusion

My surgery included fusion at the L5/S1 and I remember all to well the pain I was in after the surgery. It went away in about 2 weeks, or at least the major pain did and after that it was ok as long as I avoided certain things and remembered to "log roll" to get up out of bed.

They can do the graft a few different ways. They can harvest from the patient or they can use donor bone (cadaver bone). My surgeon opted for the donor bone as it would be easier and less painful for me. If I remember correctly the chances of the fusion taking were about the same with either way but if we used my bone I would have additional pain from the harvest site. I am glad they used the donor bone!!!

After surgery I did wear a body brace for several months to help keep the fusion from moving and allow it to heal. I did get some strange looks while wearing it and during the summer months it was hot but without it I did not have the stability. When the cooler months hit I hid it under a sweatshirt.

Physical Therapy Corner: Spondylolisthesis and Spondylolysis in Gymnasts

Physical Therapy Corner: Spondylolisthesis and Spondylolysis in Gymnasts

A pretty good site for physical therapy for those with Spondylolisis and Spondylolisthesis. It has a fairly straightforward and simple explanation of the two as well as the grading percentages for slippage involved with spondylolisthesis and a listing of some of the people who might be at greater risk for spondy then the general public.

Being grounded

My wife called me from work this evening to ask me some questions and a few URL's as one of her fellow workers has an 11 year old daughter who just had surgery to correct her scoliosis.

I can only imagine the pain that poor girl is in. I know that when they do the surgery for that they put in a lot more hardware then I have and it can not be feeling good. She must be a tough trooper to go through that. Hopefully I will get a chance to sit down and chat with her.

I met one other girl who had that surgery. It was about 4 months after mine and we were out eating. I noticed the girls sitting with her back to me had a similar scar like mine but it went further up her back. I did not want to be rude but felt like I had to talk to her. Turns out she was only a few weeks post op for scoliosis but was feeling very good. She seemed to be in good spirits and was certainly doing more then I was doing that close after surgery.

This evening has been fairly painful. Not sure if it is the weather but the barometric pressure was shooting up past 30 last I looked and the temp was starting to drop quickly which can only mean one thing in the plains, RAIN!

Right now I am sitting in the glider upstairs waiting for Law and Order to come on and watching my youngest sleep. He is so peaceful when he is sleeping. I cannot help but smile as I watch him just lying there. I remember doing the same thing with his brother (my oldest son). I was in the Army back then and spent a lot of time out in the field. What little time I did have at home was spent playing with him and spoiling him as much as I could. His mother and I were divorced when he was about 1.5 and she had custody until he was 4. He has been with me since then and is a great big brother.

Anyway, I had to pop some of my pain meds to get through this evening and will have to take another before I rack out. I am hoping it will be just enough to let me get a few hours of decent sleep as tomorrow is a busy day.

What the hell is that noise

So for the last few days we have been hearing a scratching sound from behind the TV stand not constant and sometimes with a good few hours inbetween. A search behind the stand with a flashlight did not reveal anything so I figured whatever it was might be in the wall and beyond my control right now.

So I am sitting here this afternoon and trying to enjoy a quick nap. As soon as I get comfortable the damned noise starts only this time it is loud enough to make me rethink the wall thing. I pulled the bottom draw out of the cabinet and slid the whole thing forward only to reveal an old mouse trap. One of those with the hinged doors (humane trap) and it had to have been under there for some time as we bought those when we bought the house 3 years ago. I grabbed a lacrosse stick so I could scoot the trap forward and I'll be damned if there wasn't a little white mouse stuck in the thing. Poor thing must have been in there for a week as evidenced by the droppings. I took him out back by the shed and let him out and he made a beeline for the old wood pile to find some food I am sure. LOL.

Funny thing is we bought those traps like a month after we moved in after we saw a small mouse run through the kitchen. This is an old house (100+ years) and I expected a few of them but until this week that was the last one I saw. My guess would be the cold weather at night drove him inside and he smelled the trap. The trap used to have peanut butter smeared in it but just a thin coat for the smell. Guess I will have to clean out the trap and put it back under there to see what happens.

Adhesive Arachnoiditis

Here is a pretty good site with the definition and some of the key terms concerning arachnoiditis.

It is part of the Circle of Friends With Arachnoidtis.

The biggest thing I think most people do not understand when you tell them about the arachnoiditis is that there is no cure for it and it is usually induced by a treatment such as ESI's, Myleograms or surgery but there are cases brought on by meningitis as well.

Like the Spondylolisthesis exhibition of symptoms is not the same as say a person who has MS or CP. I look and almost walk like anyone else except for a slight gait or "waddle" every know and then. The biggest problem I face from the day to day symptoms is the inability to sit or stand for long periods of time without having to re-adjust myself or change positions entirely. Sleeping can be difficult as I need to change from side to side through the night other wise I wake in a fair amount of pain.

Other then that I am good to go. Some days are good and some are bad as evidenced by some of my entries. I am optimistic that the good days outweigh the bad and even when I have a bad day there are some that are tolerable more often then there are days that I just cannot do much at all.

I hate microsloth!

I spent most of today trying to get the freaking database to synch together only to have it not work. Followed the whole process like it said to, assigned the undock license and set the synch time. Four hours later and Nada!!!

Got frustrated with that and decided to work on something else. Seems while I was working on that, my computer downloaded XP SP2 and installed it. I do not remember setting this up to auto updates but it did it somehow. So when SP2 installed my wireless LAN settings got all FUBAR. I ended up having to uninstall and re-install several items and then go into XP and turn off half the crap it installed or "fixed".

Arrrrgh!

Much needed relief

I awoke this morning rather sore from yesterdays mishap and the freezing temps we are having at night. Now I need to break out the humidifier as well. Seems the one we have running off the furnace is not doing a good job. I spent some of the night with a very dry cough.

Anyway, I came downstairs about 0600 and grabbed some coffee and a bagel and set about catching up on the mornings blog reading. While I was rummaging through the cabinet I found some Lortab 7.5/500's that I forgot I had. Normally I do not like it as it leaves you "woozy" but this morning it was a welcome find. It is providing the perfect level of relief so I can continue the days chores.

I am a technical recruiter when I am not being dad to my wonderful boys (11 & 2)and I run a database that has all the info I use daily. Since I bought the new computer I need to get it up to speed with all the same info from the desktop PC. The program is set up to "synch" them but I was having some trouble getting the computers to see each other on the LAN. When I got that fixed I found that I had improperly set up the undocked license for the laptop. Know that I have all that fixed it is chugging away and updating. I figure it should be about 3 hours total to get it all done.

In the meantime I will make some calls and then I need to run to the book store and grab a book I have been waiting for to come in.

Adult Isthmic Spondylolisthesis

The spine is made up of a series of connected bones called "vertebrae." In about 5 percent of the adult population, there is a developmental crack in one of the vertebrae, usually at the point at which the lower (lumbar) part of the spine joins the tailbone (sacrum). It may develop as a stress fracture. Due to the constant forces the low back experiences, this fracture does not usually heal as normal bone. This type of fracture (called a spondylolysis) is simply a crack in part of the vertebra (Figure 1) and may cause no problem at all. However, sometimes the cracked vertebra does slip forward over the vertebra below it. This is known as adult isthmic spondylolisthesis

Spondylolisis cn also be caused by what is known as a pars defect which occurs in a portion of the spine called the pars interarticularis .

What are the symptoms?

Isthmic spondylolisthesis may not cause any symptoms for years (if ever) after the slippage has occurred. If you do have symptoms, they may include low back and buttocks pain; numbness, tingling, pain, muscle tightness or weakness in the leg (sciatica); increased sway back; or a limp. These symptoms are usually aggravated by standing, walking and other activities, while rest will provide temporary relief.

Studies have shown that 5-10 percent of patients seeing a spine specialist for low back pain will have either a spondylolysis or isthmic spondylolisthesis. However, since isthmic spondylolisthesis is not always painful, the presence of a crack (spondylolysis) and slip (spondylolisthesis) on the X-ray does not mean that this is the source of your symptoms.

For me the pain started gradually, almost feeling like a pulled muscle. When it did not go away after reasonable time I went to the doctor where they took an xray looking for sciatica. Lucky me, I did not have sciatica!!!

How is it Diagnosed?

Your doctor will begin by taking a history and performing a physical examination, and may order X-rays of your back. However, sometimes it is difficult to see a crack and/or slippage on an X-ray, so additional tests may be needed. A computed axial tomography (CAT) scan can show a crack or defect in the bone more clearly. A magnetic resonance imaging (MRI) study may be ordered to clearly show the soft tissue structures of the spine (including the nerves and discs between the vertebrae) and their relationship to the cracked vertebra and any slippage. It also will show whether any of the nearby discs have suffered any wear and tear because of the spondylolisthesis (slippage).

If isthmic spondylolisthesis is present, it can be graded as I, II, III or IV (Figure 2) based on how far forward the vertebra has slipped.

After the xray showed the spondy I was given a CT scan to confirm the xray. No big deal as I was only a grade I spondy at the time. I was given some stretching exercises and a hot/cold treatment to follow. The main reason my spondy progressed is that I was still working and my job required a lot of heavy lifting.

What treatments are available?

If your doctor determines that a spondylolisthesis is causing your pain, he or she will usually try nonsurgical treatments at first. These treatments may include a short period of rest, anti-inflammatory medications (orally or by injection) to reduce the swelling, analgesic drugs to control the pain, bracing for stabilization, and physical therapy and exercise to improve your strength and flexibility so you can return to a more normal lifestyle. If you are told to rest, follow your doctor's directions on how long to stay in bed. Generally, if recommended at all, this would be limited to a few days. (Strict bed rest is usually not necessary.) Ask your doctor whether you should continue to work while you are being treated.

Your doctor may also-sometimes with the help of a nurse or physical therapist-begin education and training in performing activities of daily living without placing added stress on your lower back.

If a combination of medication and therapy fails to provide relief, however, your doctor may order additional tests, which will provide greater detail so he/she can plan further treatment.

Medications and Pain Management
Your doctor may use one medication or a combination of medications as part of your treatment plan. Medications used to control pain are called analgesics. Most pain can be treated with nonprescription medications like aspirin, ibuprofen, naproxen or acetaminophen. Some analgesics, referred to as nonsteroidal anti-inflammatory drugs, or NSAIDs, are also used to reduce swelling and inflammation that may occur. These include aspirin, ibuprofen, naproxen, and a variety of prescription drugs. If your doctor gives you analgesics or anti-inflammatory medications, you should watch for side effects like stomach upset or bleeding. Chronic use of prescription or over the counter analgesics or NSAIDs should be monitored by your physician for the development of any potential problems.

If you have severe persistent pain that is not relieved by other analgesics or NSAIDs, your doctor might prescribe narcotic analgesics (such as codeine) for a short time. Take only the medication amount that is prescribed. Taking a larger dosage doesn't help you recover faster. Side effects include nausea, constipation, dizziness and drowsiness, and use can result in dependency. All medication should be taken only as directed. Make sure you tell your doctor about any kind of medication you are taking-even over-the-counter drugs-and inform your doctor whether or not your medication is working for you.

There are other medications that also have an anti-inflammatory effect. Corticosteroid medications-either orally or by injection-are sometimes prescribed for more severe back and leg pain because of their very powerful anti-inflammatory effect. Corticosteroids, like NSAIDs, can have side effects. Risks and benefits of this medication should be discussed with your physician.

Selected spinal injections, or "blocks," may be used to relieve symptoms of pain. These are injections of corticosteroid into the epidural space (the area around the spinal nerves) or facet joint (between vertebrae) performed by a doctor with special training in this technique. The initial injection may be followed by one or two more injections at a later date. These are most often done as part of a comprehensive rehabilitation and treatment program.

Nonsurgical Treatment
As you begin a physical therapy regimen and/or exercise program, your doctor may prescribe therapies like ultrasound, electric stimulation, hot packs, cold packs, and manual "hands on" therapy to reduce your pain and muscle spasms. At first, the exercises you learn may be gentle stretches or posture changes to reduce the back pain or leg symptoms. When you have less pain, more vigorous aerobic exercises (such as stationary bicycling or swimming) combined with strengthening/stretching exercises will likely be used to improve flexibility, strength, endurance, and the ability to return to a more normal lifestyle. Developing your back and stomach muscles will help stabilize your spine and support your body. Exercise instruction should start right away and be modified as recovery progresses. Learning and continuing an exercise and stretching program are also important parts of treatment, as is maintaining a reasonable body weight.

The presence of this "cracked vertebra" (spondylolysis) or "slippage" (spondylolisthesis) by itself usually does not represent a dangerous condition in the adult. Therefore, treatment is aimed at pain relief and increasing the patient's ability to function. Although none of the nonsurgical treatments will correct the "crack" or "slippage" they can provide long?lasting pain control without requiring more invasive treatment. A compre-hensive program may require three or more months of supervised treatment.

What if I need Surgery?
Surgery is reserved for that small percentage of patients whose pain cannot be relieved by nonsurgical treatment methods. The pain may be caused by a pinched nerve, movement of the unstable cracked vertebra, or from nearby discs which are being affected. If a spinal nerve is being compressed by the forward slip, surgery may be needed to reopen a "tunnel," or space, for the nerve.

In addition to relieving pressure on a nerve around the crack or slippage, a stabilizing procedure or fusion may be recommended. This will stop any further slippage of the vertebra and also will prevent recurrent nerve pressure from developing at this site. Occasionally the "crack" in the vertebra can be repaired by placing bone graft from the pelvis to the site of the crack. A fusion can be performed from the front (anterior approach) or the back (posterior approach). Both require the placement of bone graft or bone graft substitute and/or instrumentation between the vertebrae being fused. The choice of approach to the fusion (front/back) is influenced by many technical factors including need for spur removal, location of the spurs, anatomic variation between patients and the experience of your surgeon. The success rate of fusion surgery for relief of isthmic spondylolisthesis is over 75 percent. After surgery, you will remain in the hospital for at least a few days, and most patients are able to return to work within six to nine months. A thorough postoperative rehabilitation program is advisable to help you resume the normal activities of daily living.

I did lot of non-surgical treatments in the year between diagnoses and the surgery. It involved everything from epidural spinal injections, narcotics, PT etc... I spent a good deal of time with the neurosurgeon prior to deciding that none of them were as successful as we would have liked them to be. For me the decision to have the surgery was more about the quality of life then anything else. The pain was tolerable with the meds but the numbness from the nerve damage was the deciding factor for me. They tried several meds for it including some anti-siezure meds like neurontin. They would offer some relief but never enough.

My surgery was anterior fusion at the L5/S1 with inter body fusion and cage as well as a lamenectomy to relieve the pressure on the nerves. All in all the surgery was a success and I spent the next year feeling great before I developed the arachnoiditis.