Welcome to Running: A FEVER. My name is Michael Davis. This is a podcast about fitness, diet, and medicine. My goal is to live a long, healthy, happy, active life by loving my life enough to make it last as long as possible.
As you can see, I am on the stationary bike in my undetermined room of my house. It’s just kind of a room. It’s not really a living room; it’s just a room. Weird room. And one of the great things about exercising on a stationary bike is that it’s good for my back. I don’t strain my back because I’m not putting weight on it. So I can exercise pain-free if I have a back problem. Which I have, which is the subject of this episode.
First of all, back problems are not new to me. I’ve had my share for sure. I know that going back to episode 53, that was when I started having pain in my arm and pain in my back. I went to a neurosurgeon, and that was when my Forestier’s was diagnosed. Recently, in the past few months, I guess, when I have gone out on the Lake Fayetteville trail, where I have been hundreds of times, I would go out, and before I was halfway through, my back would start hurting, and I would have to rest, sometimes making it all the way through. I was in some back pain there. And it was soreness, and I thought it was all muscular because I was overweight and out of shape. I thought I should keep on exercising and I would work through it.
Fast forward to about five weeks ago. I was cutting the grass, and it was really hard. It had been hurting my back, but this day was particularly bad. I finished,d and I felt almost crippled really after that. That continued for a couple of weeks. At that point, I figured out that it wasn’t going to work itself out. I needed to go to the doctor,r and I did. At that time, I rated my pain as a nine on my scale of ten. They say zero is no pain at all. Ten is the worst pain you’ve ever felt. I rated it a nine, possibly a ten. It was pretty bad. I could not stand for more than a few minutes without having excruciating pain. So, doing things like making dinner was painful. Certainly, walking a long distance was out of the question. Walking wasn’t as bad as standing, but it still was very painful.
Fortunately, before I even got to the doctor, they ordered X-rays. I was at the VA for several hours that day. I got the X-rays first, then went to the nurse. Fortunately, the X-rays were processed and evaluated before I got to the nurse appointment, which is amazing considering this is the VA, the US government, and they were able to do it that fast.
I got in to see the nurse, a clinical nurse practitioner. I had been in to see her only about eight or ten days before because I had been coughing for about four weeks straight. Then, I finally decided to go in for my back. I told her about the pain. She did give me some medication for the pain. It wasn’t narcotic, fortunately. It was a muscle relaxer and a steroid, and some topical treatments that worked a little bit. They didn’t take much off the serious pain I was having, but they did help a little bit.
And then we got the report. I’ve got the report right here in my hands. So here are the findings of the radiologist who read the x-ray.
“FINDINGS: 5 views lumbar spine. Bilateral pars defects L4 with grade 1 anterior spondylolisthesis L4-L5. Lumbar vertebrae otherwise well and vertebral body heights well maintained. Endplate osteophytes of varying sizes throughout. At least moderate disc space narrowing L4-L5. Mild disc space narrowing remaining levels. Multilevel degenerative changes bilateral articulating facets. Bilateral SI joint and multilevel spinous process degeneration.”
And then the impression, which is a further summary, says:
“Bilateral pars defects L3 with grade 1 anterior spondylolisthesis L4-L5. At least moderate degenerative disc disease L4-L5. Mild appearing multilevel degenerative changes remaining levels.”
Some of that sounds pretty scary. It’s probably incomprehensible to anyone other than a neurosurgeon or perhaps a physician or clinical nurse, in my case. So, I looked up some of these things to try to figure it out myself.
A pars defect is a fracture in the pars interarticularis, which is the bone that connects the vertebrae. That seems pretty important. That bone that connects the vertebrae. If there’s a defect in that, I would think it’s pretty serious. Everything about the back is serious, but it’s not just a chip off a vertebra. It’s the bone that connects them. So that is a fracture. One good thing is that it seems to me that fractures can be healed. So that seems good amid the badness.
Osteophytes are just bone spurs.
The spinous process is the bone on the back of each vertebra that connects to muscles and ligaments. Degeneration of this process is not good because it makes it difficult to connect to muscles and ligaments, which is, of course, very important.
Spondylolisthesis — that big, long word I’ve been trying to pronounce. That happens when a vertebra
slips out of place with the vertebra below it. I’m guessing that is the main cause of the pain because, to me, when you have vertebrae out of alignment like that, there is a possibility of pinching the spinal cord, and that would be very painful. I’ve had a needle stick in my spinal cord, and that was very painful for a very brief period. So I’ve got that in my L4 and L5. It’s just in one place.
The nurse sent me to get an MRI. If you’ve never had an MRI, it’s interesting. It’s not terribly bad, but there’s a lot of noise, and for a guy my size, it was a tight fit. They roll you into this thing that’s got a big thing around it and all this machinery. It’s a big magnet. Magnetic Resonance Imaging (MRI). That got read, presumably by the nurse again, who referred me to a neurosurgeon outside the VA. The VA does pay for things outside of the VA medical system. They didn’t have a neurosurgeon at the VA here. I’m at a regional VA center, but they still didn’t have a neurosurgeon. They had an MRI machine but it was going to take six weeks to get in there. When I had the MRI at the hospital, they did it at 7:30 p.m., which led me to believe they were pretty busy too.
I’m going to the neurosurgeon, and I’m going to have, of course, two main questions for him. (1) What is the treatment? and (2) What is the cause? I think the cause is my being overweight and/or sitting at a computer for thirty years, hunched over with bad posture. I don’t know if it is connected to my Forestier’s disease. We’ll see. But I want to know the cause.
The treatments include surgery. There is not just one surgical procedure; there are several different types of surgery that you can have. I want to avoid surgery if at all possible because of the risk involved. I did have someone anecdotally tell me they had back problems, lots of back pain, and had surgery, and it completely went away. They said it was the best thing they ever did. So there is that. Surgery can help. When I looked up treatments, it said that fifteen percent of people with this disorder have to have surgery, and the non-surgical procedures did not work — the conservative treatments, they call them.
The list of conservative treatments goes like this: NSAIDs (anti-inflammatories), heat, light exercise (which I am doing now), traction (which I am familiar with), bracing, and bed rest—some of these I can already do. Ibuprofen is an NSAID I can take. I have a heating pad. I’m doing light exercise. And I can sleep and get enough sleep, a healthy amount of sleep. That may not be the bed rest they are discussing, but it may help.
The next thing to do is talk to the neurosurgeon, and we’ll see what happens there. I wish I could tell you something to do to avoid this. Hopefully, I will have that information after I see the neurosurgeon. But hopefully, this is something that will help you if you have back pain or if someone you know has severe back pain. See a medical professional because it might be something serious. It might not require surgery. But if you are in pain, it looks like there are some ways to relieve that without resorting to narcotics. So far, I have not had to have any narcotics.
Let me tell you one thing that is kind of startling to me. I was in serious pain to where I couldn’t stand up for more than a few minutes. I would be in excruciating pain. I couldn’t walk very far. I would have to sit down. And then two weeks ago, on a Sunday…Today is a Sunday. It’s Sunday, September 15th, 2024. Two weeks ago, on a Sunday, my pain stopped. And honestly, I think it’s a God thing, I really do. Because it didn’t go away gradually, it was suddenly, although I don’t think I realized that for a couple of days. But I had my MRI later, and it showed that there is still damage. So, I have not been completely healed, but the pain has gone away, so I am grateful for that.
I hope this was helpful to you or at least interesting. And remember, if you’ve got the fever, keep it burning. If you don’t, catch the fever, and I will talk to you next time on Running: A FEVER.
References:
https://www.ncbi.nlm.nih.gov/books/NBK430767/#:~:text=Spondylolisthesis%20is%20a%20condition%20that,on%20the%20adjacent%20vertebral%20body.
https://tinyurl.com/degenerative-disk-disease
https://tinyurl.com/spinus-process
https://tinyurl.com/osteophyte
https://tinyurl.com/pars-defects