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Having severe episode of sciatica. Prescribed steroids. Suggestions
Question: I am a 57 year old white female, single, who is a student, and presently not working.I am having a severe episode of sciatica, on my right side, like I've never experienced before. It started when I did some crunches which I was asked to do and record, for my Wellness class that I take online. I just did the curls, and didn't feel any pain doing them but the next morning I woke up totally incapacitated. On top of that, I fell in my Lab class for my microbiology class, and honestly, I just tripped on my own shoes, and fell on the other side of the affected hip. Got a huge bruise on the left leg, and sprained my left wrist, as I fell on it and skin was pushed into my watch band, That was last Wednesday. By Saturday last week, I went to the emergency clinic and was prescribed steroids. I had a script already filled of prednisone, 10 mg pack, so I took that, but the script was for the Medrol pack. It didn't even scratch the surface of my pain. I got not relief at all, and I knew I was in trouble when by the third day I felt no relief. I don't have health insurance, and the doctor at the clinic did not order an XRay or anything. I have been taking percocet, since I have shoulder problems and have a pain management doctor, but I felt no relief. I visited the emergency clinic on Saturday, one week ago. By Monday I had to find someone to drive me to the ER, since I figured they might do an X Ray or an MRI. X Ray it was, and a shot of Dilaudid 1 mg, plus Toradol, don't know the dose of it. I was referred to a free clinic, and still hoping for a cortisone shot. Thursday I went to see the Dr. at the clinic. He prescribed Flexeril 10 mg, TID. Diclofenac 75 mg BID. no pain medication, and said that what could help me would be to see a chiropractor. He also said that since the steroids didn't work, that a cortisone shot would not work either. I am struggling with that, wouldn't a shot on the lumbar area, wherever the sciatica travels help? Or, can't I take another round of steroids? Maybe the prednisone was not as good as the prednisolone (Medrol pack)? I am an LPN, thus the medical vocabulary... I am just very upset about this, I am currently without a job, going to school to get done with my pre-reqs for RN bridge program. I have not been able to study, or to find a comfortable position. I can say that I did go to a chiropractor, and I felt that I was walking a bit straighter after the adjustment. But the dull numbing pain in my lower leg and ankle, plus the top of the foot is driving me crazy. I will return to the chiropractor on Monday, but I can't believe that I feel crippled, and not much encouraging treatments were offered me. The doctor did mention a epidural, but they don't administer it, and I am sure I cannot afford it. What I feel is that I have to get this under control or I will not be able to continue forward with my plans for graduating and becoming an RN. By now I am looking at having to withdraw from my class, as I can't be on my feet even to fix myself a toast at home. I just need to get better. Of course, the stress of all of these things contributes to my pain, and having to quit school is really upsetting me. But when I start thinking of studying I also start feeling spasms on my back and leg, so that tells me that I need to stay away from stressful situtations. I hope I have given you enough information. BTW, I don't even know how much this costs, so don't know if I can pay to get the answer. I didn't mention that the X Ray only showed that I have a lot of arthritis on my back, nothing else. The Dr. at the clinic said that if I don't get better in 3 months, that I might be able to be allowed an MRI... that sounds like a very long time to me.
Brief Answer: Cortisone is also a steroid, may not be helpful. Detailed Answer: Hello, Thanks for the question. I have carefully studied your problem and I sympathize with you, I can understand your distress and suffering. From your description I could fish out these questions which you need answered. 1. Can you take a continued course of steroids for your condition, and will the steroids be of much use. 2. What could actually be going on with you? Is it sciatica or is the problem somewhere else? 3. How to deal with the stress and what is the best treatment option available for you. The answer to your first question would be, Yes you can take a further course of steroids, but I am not convinced that it will be of much help to you. I say this because, I am doubting your diagnosis of sciatica, in your case, you exercised and when you woke up on the next day, you had this severe pain. In such a case I would suspect the cause to be muscular in nature. To add to this you also fell, but on the unaffected side, even though you fell on the opposite side, the jolt could be sufficient to cause further muscle sprain or spasm. After going through your entire history I feel the problem is due to muscular spasm and strain, and probably some amount of nerve entrapment leading to the classic presentation of sciatica. For your kind information, I would like to point out that Diclofenac is a non steroidal anti inflammatory drug, that has very good analgesic effects too. So please be assured that pain medication was indeed prescribed fro you. As for steroids (prednisone), if the problem is a muscle spasm, steroids will be of little use. You have also mentioned that getting stressed worsens the problem, this also indicates the problem is more to do with muscle spasms than an actual nerve entrapment. My suggestions to you based on this discussion. 1. See a physiotherapist and get a muscle relaxing exercise/ultrasound massage done, this ultrasound/shortwave diathermy/Intermittent lumbar traction/TENS needs to be applied to the lower back as well as the lower hip area. Relieving muscle spams will most certainly help you a great deal. Continue to take the Flexeril (It is a muscle relaxant) and Diclofenac (Good analgesic), if you are not getting adequate pain relief from diclofenac, you can take aceclofenac or Ibuprofen. Cortisone will be of no help to you because the action of this doesn't last much long, and it also a steroid just like prednisone. I would advice you to avoid steroid use for long as they will predispose you for infections. Steroids will not relive you of pain to a great extent, so I see no reason for you to choose steroids over other pain medicines. Please consult a physiotherapist for muscle relaxation, and you can also get a gentle back massage from a massage therapist. I am positive that these will help you the most. And as for the stress part, please relax for a week, take complete bed rest for one week and see how that helps you. I am limited due to inability to physically examine you, if that were possible then my advice to you would have been much more specific. If the X-ray has not shown any fractures, then it is reasonable to wait for the MRI, but I do certainly feel that you are a victim of the system where your inability to pay for the costlier investigations is the actual reason for the delay. There is nothing I or anyone else can do about that system and I am sure you do understand that. I sincerely hope you will recover very soon with my advice, please write back to me if you feel that I have not addressed any particular concern of yours. Wishing you speedy recovery. Warm regards, PS., I would greatly appreciate your feedback on your progress, that would give me a better perspective about your condition and will help me guide you better.
Thank you doctor, I will respond to your letter as soon as I return with a follow up visit with the chiropractor. I had written a response but it got lost in cyber world somewhere and I don't have time to write another response,e but rest assured I will reply. Thank you. XXXXX
Brief Answer: I will wait for your response. Detailed Answer: Hello, Thanks for writing back. I will wait for your response. Please make an appointment with a physical therapist. I am not very convinced about the efficacy of chiropractic therapy. Wishing you all the very best. Regards,
Hello Dr. XXXXXXX D. I was reading your response and giving my son an update, as he lives in South Korea, when I read about the piriformis muscle. Might that be what the problem is? It sure sounds very familiar to me, the tight knot feeling I always have in my buttock... like a fist. I plan on talking to a physical therapist later on this week then I will let you know what happens. Thanks so much for your time. XXXXX
Brief Answer: Quite possibly yes. Detailed Answer: Dear, You have hit the nail on the head, I avoided the medical jargon to avoid confusion. In the absence of spinal problem we consider pyriformis syndrome as the most likely cause for sciatica, in which case you will be best served by the pain killers, muscle relaxants and proper physical therapy to relieve the muscle spams. I would still want an MRI to look for degenerative disk changes as well as any neuronal inflammation or compression at the level of ishial spine/greater sciatic foramina. I am looking forward to hearing positive response from you as soon as possible. All the very best. Kind regards,
Hi Dr. XXXXXXX Today I am a lot better, as I decided on my own to utilize a refill of the steroids I had. I started last night, as I didn't want to wait another day in miserable pain, and am happy to tell you that I am feeling 70% better. I tried calling the physical therapist but didn't hear back from him, maybe tomorrow I will venture out again since I feel so much better. I do go to see a Pain Management doctor in Tampa, since doctors here in Florida are running away from prescribing narcotics, and I have had a really slow recovery on my rotator cuff surgery. This group of doctors offer MRIs for a very reasonable price, so I might do it. I have felt so far that the narcotics weren't doing much, but maybe because the nerve and muscle were so irritated, and all the rest and heat and I won't deny, the praying, have helped. Plus I did quit my microbiology class, as I felt that was adding to my distress and that I needed to focus on getting well. I have been feeling emotionally and physically drained, dealing with these aches and pains that come with age and the extra effort I need to follow the fast paced college life which is really designed for a much younger group. But I've felt a renewed love for my profession as I've been on this medical tour this past week. I am a curious person and I tend to take all my stress in. I am a chomper, and I need to wear a guard brace for my teeth, and I tighten up every time I am stressed, so the Pyriformis muscle makes so much more sense to me than sciatica, since I really didn't do anything to injure my back. For the most part, every time I stand up and have to perform an activity, such as putting dishes in the dishwasher, or even preparing my dogs their meal, I feel that knot up my buttock. So I hope I can get in with the physical therapist, hopefully without a need for a script. I will print our our chat here to substantiate my need of his help. Thanks again for the response, doctor, I have to say that this is the kind of dr. patient interaction that I like. I have always tried to be an informed patient. I think it runs in the blood, since my oldest sister is an RN and I always felt proud that she knew so much.
Brief Answer: Delighted to hear that you are improving. Detailed Answer: Hello Dear, Thank you very much indeed for writing back to let me know how things are going on with you, and I am thrilled to know that you are improving dramatically. I sincerely hope that our discussion is helping you, continue with the short course of steroids, it certainly does reduce the inflammation around the nerves if there is any. Further rest and muscle relaxation is important. I wish you all the very best with your visit to physical therapist. I am happy to know that you have made up your mind about your priorities. The less stressed out you are in your life, the better the quality of life will be. You can keep me posted about your progress if you wish, or else you may close the discussion, it is up to you. It was my pleasure to serve you in your need. Thank you for choosing XXXXXXX Wishing you a speedy recovery and a happy life. Warm regards,
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