Mar 19, 2014

Calling Dr. McDreamy

I keep starting this post and don't know exactly where to go with it. So it's just going to be a brain dump. You've been warned. If you haven't been following along - you might want to start here with the origins of my back pain.
On Monday, the triage nurse from my OBs office (the one who suggested I see a chiropractor) called to follow up on my back pain. (Have I mentioned how much I love this office!! Great doctors. Great nurses. Great staff. Seriously amazing care!) I was still in pain and still had tingling all through my foot and loss of sensation in two toes. She was concerned by this and said in most cases piriformis syndrome remains above the knee. While it CAN cause symptoms like this in the foot, it only does so in the MOST severe of cases and she wanted me to get checked out by a neurologist. Within the next 48 hours.
So began two hours of calls between nuero offices, myself, and the amazing triage nurse trying to find a doctor who is accepting patients, sees pregnant patients, and had an opening. Thankfully, one of the nuerologists they normally refer to had a cancellation.
My mom came down and picked up the boys and I to drive to the neurologist on Tuesday morning. And he was really very good. He wasn't Dr. McDreamy (but really who is?). Dr. J was very blunt and very direct. But he did a great job explaining everything and answering my questions. He didn't sugarcoat anything or try to hold my hand. And I appreciated that. I need my doctor to tell me what's what. And he did.
The boys found an empty cabinet in the office and it entertained them for almost 20 minutes!
Needed entertainment during our hour long wait!
Given the severity of my pain, severity of the weakness in my leg, and the tingling and numbness, the most likely cause is a bulging disc in my spine putting pressure on the sciatic nerve. (Pretty much textbook symptoms.) While it can clear up on its own with rest, pain management and physical therapy, this is less likely due to the increased weight and posture issues associated with pregnancy. So the treatment is surgery. Which can't be performed while I'm pregnant. (And might not be necessary if I wasn't. Catch-22!)
If I wasn't pregnant he would have ordered an MRI that day to confirm his suspicion.
But I am.
So he couldn't. (Well, you can do MRIs while pregnant but drs don't like to unless it's absolutely necessary.)
He also said my piriformis muscle is abnormally tight and clearly spasming. This could be a reaction to a bulged disc. It could be piriformis syndrome. It could be both. It could be "something else" (And I didn't ask the logical what else follow up question. My brain was still processing that "the most obvious cause" would require a surgical fix. AFTER delivery.) So, something is going on with my piriformis muscle but it is unknown at this point if it is the cause or effect of the sciatica.
Therefore, Dr. J wants to treat the piriformis muscle issue. So, we will treat it like piriformis syndrome for now. Because that we can treat. Sort of. The normal treatment involves anti-inflammatories. Which I can't take. Because - pregnant. So, I got a prescription for a muscle relaxer and a steroid on Tuesday morning. This should decrease the pain level and increase my mobility. And hopefully it will completely eliminate the pain!

He wants to give the drugs two weeks to do their job and have me continue seeing the chiropractor 2-3x a week. At the end of the two weeks if I still have pain he will do an EMG which looks at nerves. I'm not exactly sure what he would be looking for with this test - I guess the "something else"?
In the meantime, the primary nurse for the "referring physician" from my OBs office (who is not my normal OB although I have seen her before and she is a great doctor) called Tuesday afternoon after getting the results from the neurologist. They wanted to rule out one additional possibility: deep vein thrombosis (or in less fancy language: a blood clot). So this morning I headed to the hospital imaging center to have an ultrasound of my leg. I don't have official results yet but word from the ultrasound tech is that patients with DVT are admitted and immediately put on anticoagulants. I was allowed to go home.
So, drawing conclusions here, one possibility ruled out!
The other promising thing the neurologist said: (I'm paraphrasing with probably more than a few liberties here) nerves are confusing little buggers and we don't always know the cause of nerve issues and pain. We also don't know why they sometimes just go away all on their own. So I could wake up 100% pain free any day! AND since I'm pregnant this is even MORE likely because my body is going through so many changes and the relaxin is causing my hips to widen the pressure on my nerve could just disappear. So yay!
So basically:
  • I have a tight and spasming piriformis muscle. Either causing, caused by, or in some other way associated with sciatic nerve pain. And potentially sciatic nerve damage.
  • We still don't know what the issue is. But will slowly rule things out.
  • Most likely given my symptoms: bulging disc.
  • Worst case scenario: bulging disc.
  • Also likely (and perhaps present in conjunction): piriformis syndrome
  • Treating as if it's piriformis syndrome for now.
  • And it seems to be working!
    • I'm still in pain but I can walk!
    • I'm still in pain but I can pick up my boys!
    • I'm still in pain but I can function!
So now we are hoping that I continue to get better! We are so grateful for our families this past week who have stepped up in a major way to help take care of Tripp and Davy when I couldn't. We are so very very fortunate!

1 comment:

  1. How exciting that you're narrowing things down... And how much MORE exciting that it could just go away on its own! Prayers for you!