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I'm working on a figure skating story at the moment, and I need to make sure that all my facts line up, and that I have a realistic idea of a timeline for this character's medical experiences. Basically, at the start of the story, one of the protagonists (a competitive pairs skater,) gets a serious spinal injury. Jump forward several months, he's had a surgery, and is doing physical therapy, but he still has a lot of pain, and hasn't been able to get back on the ice. Doctors eventually recommend a spinal fusion, which should help with the pain, but will effectively end his competitive career. So I guess my questions are: 1. What injury could he have? I did a little research on this stuff like a year ago, and I think I was going with a herniated disk, but now I'm not sure if that's serious enough. 2. Are my ideas relatively correct, in that a less invasive procedure would likely be attempted before going for a spinal fusion? 3. How much time would be spent on PT after an initial surgery, before a doctor would bring up a spinal fusion? Months? A year? Multiple years? 4. Am I even correct in thinking that having vertebrae fused would pretty much put an end to competition level figure skating? 5. I would also love to know if there's any specific medical jargon a patient would be likely to hear, or see in paperwork. Any help or ideas would be greatly appreciated, or if anyone can PM me an email for a professional who might be able to help, I would love that too. I just want to do this element of this story justice. Thanks. 
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Apr 29, 2019 22:23
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uberwekkness posted:I'm working on a figure skating story at the moment, and I need to make sure that all my facts line up, and that I have a realistic idea of a timeline for this character's medical experiences. Bad spine haver here. I also have an ex who had a lumbar fusion (L5-S1) while we were dating. So take everything I say with a grain of salt as I am not a medical professional, just slightly better acquainted with spine problems than your average person. 1. A herniated disc can be anywhere from totally asymptomatic to debilitating depending on the severity and location. I have herniations from C4 to C7 and I have frequent aching shoulder pain and paresthesia (numbness, pins and needles) in my right hand. Both come and go. Other people (see: Lowtax) can have numbness, paralysis, severe pain. Go read his threads if you want a real spinal horror story. 2. Usually, yeah. Physical therapy and epidural injections are the things they try immediately. Also, some medications can help. Muscle relaxers are common (I get tramadol and cyclobenzaprene), and in cases of severe nerve pain, they may prescribe something like gabapentin. Doctors avoid prescribing opiates, in general. In some cases they can also do a laminotomy to decompress the nerve. Artificial discs are also an option for some people as an alternative to fusion. 3. When I do PT, they send me for a month or two. At least in my experience, if medications, epidurals, and PT don't help, the next step is a fusion. If they try those things for a few months and symptoms don't improve, they'll recommend it. I did 3 epidurals and the first and third ones did nothing, and the second caused pain significantly worse than what I'd been experiencing prior to the epidural. Some people have great results from them. I was not one of those people. 4. Probably not. You lose some spinal mobility after a fusion, but how much and how severe depends on the location. Peyton Manning had a cervical fusion and still plays professional football, which I would wager is rougher on the human body than figure skating. However, there are plenty of cases where the surgical outcome isn't great. The fusion is fine, but the nerve damage is done and permanent, so pain, weakness, or numbness remain. The latter two would probably be career-enders if the injury was in the lumbar region. 5. I posted a thread last year in the goon doctor forum where I shared my MRI results. New Yorp New Yorp fucked around with this message at 23:32 on Apr 29, 2019 |
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Apr 29, 2019 23:26
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uberwekkness posted:I'm working on a figure skating story at the moment, and I need to make sure that all my facts line up, and that I have a realistic idea of a timeline for this character's medical experiences. I had a spinal fusion back in 2012. It was misdiagnosed by two doctors initially. Started with pain in my left shoulder which the first doctor misdiagnosed as a strained rotator cuff. He sent me to PT and after the first session, the therapist determined that it was not my rotator cuff. Second doctor misdiagnosed it as bicipital tendinosis (strained biceps tendon) and sent me back to PT. Same result. By this time the pain was getting slightly worse so the third doctor sent me for an MRI. MRI results came back as a bulging disc between C5/C6, and I was referred to a neurosurgeon. The neurosurgeon said I needed surgery. I asked if there was any other more conservative treatment and he said I could get a cervical spine injection, but that would only be postponing the inevitable. I was referred to a pain clinic and had a series of three injections in my neck over a nine-month period. Each one relieved the pain and numbness temporarily. After the third injection, the doctor at the pain clinic said there was nothing else we could do, and that I should go back to the neurosurgeon. By this time, my left arm was in so much pain that he prescribed me Oxycontin. I went back to the neurosurgeon and scheduled surgery. I had an Anterior Cervical Discectomy with Fusion (ACDF) where they removed the bulging disc between the C5 and C6 vertebrae, and replaced it with a cadaver bone, then put in a titanium plate with four screws to hold it together. The first thing I realized when I woke up was that I was no longer in pain. Recovery was two weeks wearing a plastic neck brace 24/7, and two more weeks wearing it during the day. No driving, no bending, and no lifting more than 5 pounds, and no exercise more strenuous than a brisk walk. There was no PT involved, as recovery was just the incision site healing and the bone fusing together. The hardest part was being an active person and not being able to do anything but walk for a total of 12 weeks. Once the recovery period was over, I was pretty much good as new. I have complete range of motion in my neck, and can do everything I could before the surgery. Hope that helped.
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May 8, 2019 17:54
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Cat Army
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I suppose I've had a more positive experience than most with back problems, so I'll post too. I haven't gone as far as a spinal fusion, but I have had an L4/L5 microdiskectomy. Like a burst jelly donut, essentially; an extrusion (e: the hernia, couldn't remember the word) was impinging on the nerve canal behind it and causing severe sciatica symptoms. Essentially all the surgeon did was open a line down my back, remove a small 'window' of vertebrae bone, and scoop out the now-excess material, relieving the pressure. After surgery I was bedridden for two days, excrutiatingly-slowly mobile for a week, and slowly mobile for another month before I'd essentially returned to a healthy (if not especially strong, lift-strength-wise) back. It aches easily if I sit badly for too long, but not much worse than that. Pretty sedentary lifestyle though, so I don't have any input on the sports side (though fwiw I can ride a bicycle perfectly fine). Spinal fusion may be in the future if any of the remaining disk material degenerates any further, but so far so good. Ciaphas fucked around with this message at 18:06 on May 8, 2019 |
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May 8, 2019 18:00
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MightyJoe36 posted:MRI results came back as a bulging disc between C5/C6, and I was referred to a neurosurgeon. It's interesting how quickly medical science advances -- I was told by the neurosurgeon I spoke to that the downsides of surgery outweigh the benefits for my specific case, at least unless/until it gets significantly worse. Of course, I'd have to have at least a two-level fusion, which changes the equation a bunch. Any fusion puts extra strain on the discs above and below the point of fusion, leading them to start degenerating. It's not uncommon for a fusion to directly result in needing additional fusions down the line. I was also told that there have been significant advances made in all sorts of alternatives to fusion. Artificial discs are getting better, there have been good results with lab-grown discs in animal trials, and various stem cell therapies are undergoing trials at various phases right now. I'm almost 37, so I figure if I can make it to my mid to late 40s without a fusion, they might just be able to hit the "eject disc" button on my neck and pop some new ones in, problem solved.
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May 8, 2019 18:19
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