Re: Don't bother.

[Guest guest]

Three messages, two of them yours, just made it through the email to me today, after several weeks or months. My experience with is that this happens from time to time for seemingly no reason.www.OldElmTree.com - Right Where You Belong. From: <Katzfilm1@...>Subject: Don't bother.Spinal Stenosis Treatment Date: Thursday, December 23, 2010, 9:03

PM

Because none of my respectfully asked and carefully crafted messages were posted to this group, I am moved to ask: Who knows why? There is no list administrator, there is no moderator, there is no one to ask. While Fran is an excellent resource, a knowledgeable and experienced adviser, she cannot help. But because none of my three postings to this list ever made it -- and I mean none -- I am convinced that many others have experienced the same thing.

[Guest guest]

,I'm not sure if the problem is a group problem or a problem. I received, I think it was 2 or 3 of your posts in my inbox yesterday plus this one.In the past few weeks, it appears that has been having some email issues, as I've been getting emails that where sent several days before receiving them and not just from a group.If you where looking for medical advise from a doctor, PA or spine specialists or responses from medical professionals from the spinal stenosis group, well, there are none on the group and never have been.The spinal stenosis group was formed by others that have spine issues and there was never a medical advisor, just others with spine problems.FranFrom: <Katzfilm1@...>Subject: Don't bother.Spinal Stenosis Treatment Date: Thursday, December 23, 2010, 9:03 PM

Because none of my respectfully asked and carefully crafted messages were posted to this group, I am moved to ask: Who knows why? There is no list administrator, there is no moderator, there is no one to ask. While Fran is an excellent resource, a knowledgeable and experienced adviser, she cannot help. But because none of my three postings to this list ever made it -- and I mean none -- I am convinced that many others have experienced the same thing.

[Guest guest]

On Jan 8, 2011, at 8:44 PM, Fran Barron wrote: I received, I think it was 2 or 3 of your posts in my inbox yesterday plus this one.Me, too! I'm not proud of my snarky tone, but I am relieved that I wasn't worse. Could be , I guess. Never heard from the administrator, though I wrote several emails to those credited with being list administrators. Go figure.there was never a medical advisor, just others with spine problems.No, in fact I'm not. I want to share my experience and learn from others' experiences. Really that's all. I am seeing physiatrists, neurologists, and not surgeons, though as I have written, it seems every spinal stenosis story begins with epidurals and ends with surgery.Thanks for your email.

[Guest guest]

On Jan 8, 2011, at 8:15 PM, Studebaker wrote:

> My experience with is that this happens from time to time for

> seemingly no reason.

Thanks, . I despaired perhaps too publicly. I belong to a half

dozen that have never had a problem, so I was in

disbelief. I wrote emails to the list administrators but never

received replies. I am relieved to see my posts on the list.

[Guest guest]

:

I am one of those that started with PT, had epidurals, ended up with the Neurosurgeon and lived to tell about it. I had bad spinal stenosis. I am 72. I then fell and broke my foot then had hip replaced. I am glad I did it all and now I take no medications and go to the gym at least 3-4 times a week. I'm doing fine. Worst part is going to the airport and going thru security, but that has nothing to do with the back! This was all since 2008.

lie

[Guest guest]

lie wrote: <<I am one of those that started with PT, had

epidurals, ended up with the Neurosurgeon and lived to tell about it.>>

Wonderful! I love to read accounts of successful surgery! I was told

(by a friend who is recovering from an L4 L5 L6 laminectomy that his

doctor said) positive surgical outcomes are a fifty-fifty

proposition. Bravo for being back in the gym! And congrats on your

excellent quality of life.

[Guest guest]

,The usual reason that you find spinal stenosis cases go from the conservative treatment of PT and epidurals to surgery is that these are only temporary treatments to ease pain and do not last.If a disc is bulging etc and is not caused by stenosis, it can heal on it's own over time and the epidurals will ease pain and inflammation, allowing for a more successful round of PT and core strengthening.Spinal stenosis is a narrowing of the canal that the nerves pass through in the spine and that can cause the disc to bulge or leak fluid out which either inflames the nerves because of the fluid or puts pressure on them.Epidurals can ease the pain for a time but it doesn't last and the only sure way to "cure" the stenoisis is surgery to widen the area that is to

narrow and causing the nerves to be compressed and/or bulge the disc to press on the nerves.From my own experience and what I see and have seen at my spine surgeons office, simple surgery for stenosis can be done and have great success and the patient goes on to live a normal life and normal function.An important consideration in opting for continued epidurals to relieve the pain is that the longer nerves are compressed, the higher the risk for permanent nerve damage and nothing will be able to relieve the pain or associated problems that can result from permanent nerve damage.How long that takes to happen is variable from patient to patient, but it can happen very quickly or take a long time, even years.Another consideration is that epidurals should only be given a few times a year and spread out over the year as well.There are associated

risks with steroids as well and they can create their own complications in usage when used, especially over a long period of time, and there does come a point where they will not be as affective as they used to be.I'm another one of those success cases as well, 2 surgeries for spinal stenosis on 2 different levels, no fusions, in and out the same day and I'm back to living my life and functioning as I was before any spine issues reared their heads.Fran I received, I think it was 2 or 3 of your posts in my inbox yesterday plus this one.Me, too! I'm not proud of my snarky tone, but I am relieved that I wasn't worse. Could be , I guess. Never heard from the administrator, though I wrote several emails to those credited with being list administrators. Go figure.there was never a medical advisor, just others with spine problems.No, in fact I'm not. I want to share my experience and learn from others' experiences. Really that's all. I am seeing physiatrists, neurologists, and not surgeons, though as I have written, it seems every spinal stenosis story begins with epidurals and ends with

surgery.Thanks for your email.

[Guest guest]

Fran wrote: << I'm another one of those success cases as well, 2

surgeries for spinal stenosis on 2 different levels, no fusions, in

and out the same day and I'm back to living my life and functioning as

I was before any spine issues reared their heads.>>

I appreciate your recap of the issues and solutions associated with

spinal stenosis, Fran. And I'm encouraged by your success story.

Epidurals are not magic, they are serious medicine and I get that they

only treat the symptom, not the condition.

As ever, your wise counsel is graciously offered. Thanks again.

[Guest guest]

,I'd be interested in knowing exactly what your friends doctor actually means by his statement "positive surgical outcomes are a fifty-fifty proposition."Since there is really no standard definition of "positive surgical outcomes for spinal surgery", what does this doctor define as positive surgical outcomes?Some doctors define positive outcome as successful surgery, meaning no complications, no infections, the surgery site healed properly and or fusion occurred.It does not take into account how well the patient him/herself functions after surgery, returns to "normal" or close to "normal" function.Some doctors define positive outcome at relieving some or all pain, as well as the above but doesn't include how well the patient returns to

function and how close to normal the patient can function once healed.Other doctors define positive outcome as defines positive outcome including both of the above and that the patient is able to return to as close to normal function as possible.Unfortunately some things are really out of the hands of the doctor and can't be known until after the fact.Such things as post op complications do occur as do infections. Spine surgery and any kind of orthopedic surgery do have high rates of infection, always have and always will.Doctors can't fully determine before surgery if there is any real permanent nerve or muscle damage caused by the spine problems before surgery is done. Many times that can't be determined until well after post op and PT is done.Doctors usually don't have any way of knowing if the patient will develop severe scar tissue prior to surgery, unless there is a history of this happening with the patient in the past, and scar tissue can be a serious problem.Doctors can't be held responsible for a patient that doesn't cooperate with the post op restrictions, nor can the PT be held responsible for a patient that doesn't cooperate with the PT and follow through with exercises at home. If that isn't done and the post op orders from the doctor

aren't followed, delayed and complications in healing can and will occur.Doctors can't be held responsible for a patient not fusing or fusing properly, sometimes this does just plain happen and happens for no reason. It just can't be explained.There is also the huge issue of the correct surgery being done for the correct reason and it's unfortunate that far too many times, a spine surgeon will do he wrong surgery for the specific

problem and of course that will end in not having positive results.And there is the issue of the patient not hearing or understanding exactly what he doctor i saying about what the results of surgery will be and the patients expectations are one thing that are not realistic, but the doctor was honest.Sometimes that can be classified as a not positive outcome by way of the patient and end up being listed as such, when in fact it really was as successful as it could have been for the specific patient.Then there is the problem of fusions being done and when one is done it puts increased pressure and usage on the levels above and below that fusion and in time, it will cause problems that may or may not require further surgeries or fusions.those sometimes are then classified as not positive outcomes, but when in reality it can be something to potentially expect.There

is also the issue of doing more surgery than is necessary, going with the "old standard" instead of the new ones today. They create more problems this way and it ends up being a non positive outcome.For example:The gold standard for a bulging disc has been laminectomy and disectomy. Today there is the microdisectomy done with a tube or what is called "an open microdisectomy done with a 1 inch incision. To reach the disc,

instead of a full laminectomy that removes the entire lamina and can make the spine unstable, it should be done with what is called a laminotomy. That is when only a tiny section of the lamina is removed, just enough to gain access to the disc and keeps the spine stable, less likely to slip and ultimately require a fusion in the future.Once a laminectomy is done, it can be very difficult to another one without causing instability and slippage of the spine, whereas with a laminotomy, it is very easy and safe to do more than one or even 2 without causing any problems.Unfortunately far too many spine surgeons are still doing the gold standard and going with the full laminectomy and creating big problems with patients, many of which end up with fusions at a later date and their first surgery ends up being classified as not positive.Another problem, a huge problem is the lack of acceptance of something called lateral recess stenosis. Many spine surgeons don't accept and believe that there is such a problem and/or diagnosis and ignore the lateral area of the vertebrae with spinal stenosis, yet it is a very common cause

of it.I ran into 6 of those spine surgeons in 2006 while getting different opinions on my stenosis before having any surgery.All 6 of them gave me a totally different diagnosis than my original spine surgeon, all told me, when I questioned them on that diagnosis, that there was no such thing, but my own research told me how common it was and all my symptoms where classic of it.All 6 told me I had central canal stenosis and needed the central canal widened and if that didn't work I would require a fusion but they would not take out the disc, since there was no reason to do so.I opted to go with my original spine surgeon and the diagnosis of lateral recess stenosis and had that area of the L4/L5 vertebrae widened, and had a laminotomy done gain the access to the area needed.That was in June 2006, and i have been fine since. Had I gone with one of the 6 other surgeons I got opinions from, their surgery would have failed, I would have had a fusion with the disc left in place and the lateral recess area left alone and the disc would still have been pressing on the nerves because of the narrowing of the lateral recessI would have had an extremely long recovery from fusion surgery and still been in the exact same pain as I was in before the surgery because they didn't correct the problem.That would have been a not positive surgical outcome.Ironically, this is still one of the biggest reasons for failed spine surgery and failed fusion surgery, the correct surgery was not done for the correct problem.Which still leaves us with some big issues, finding a good spine surgeon that knows what he/she is doing, is competent and trustworthy and that is still far too hard to find.And it still leaves us back with my original question, how does the doctor define and positive outcome with spine surgery.Fran <<I am one of those that started with PT, had

epidurals, ended up with the Neurosurgeon and lived to tell about it.>>

Wonderful! I love to read accounts of successful surgery! I was told

(by a friend who is recovering from an L4 L5 L6 laminectomy that his

doctor said) positive surgical outcomes are a fifty-fifty

proposition. Bravo for being back in the gym! And congrats on your

excellent quality of life.

[Guest guest]

On Jan 10, 2011, at 6:25 PM, Fran Barron wrote:

> exactly what your friends doctor actually means by his statement

> " positive surgical outcomes are a fifty-fifty proposition. "

(I understood my post-surgical friend to say his surgeon meant that in

only half the outcomes was the patient pleased with the result.)

Your carefully detailed explication of the many " positive outcomes " of

surgical intervention will be an exceedingly useful tool for me to

evaluate my own choices and expectations.

Recently brought to my attention is the work of Dr. E. Sarno and

his postulated theory of Tension Myositis Syndrome.

<http://en.wikipedia.org/wiki/Tension_myositis_syndrome>. Fascinating.

<<Sarno wrote about his experience in this area in his first book on

TMS, " Mind Over Back Pain " . His second book,Healing Back Pain: " The

Mind-Body Connection " ,has sold over 150,000 copies. Sarno's most

recent book featured chapters by six other doctors and addressing the

entire spectrum of psychosomatic disorders and the history of

psychosomatic medicine.>>