after 6 yrs of no pain relief-treatment options?

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cherylzt
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February 18, 2013 at 1:56 am

Post count: 7

#8013

I have had a career in the field of Ophthalmology doing everything possible over the years. I worked usually 50hr work weeks and had a marriage and 2 boys which I was also devoted to. I have never been addicted to anything and my body does not like alot of medications. I have suffered from Depression/anxiety since my first marriage which I overcame on my own. When I am not able to contribute to family or community, I tend to get depressed and anxious about money matters. I am female, 5’3″ and used to weigh 140-now up to 230. I have however found the right husband who accepts all of me.There was no specific injury to set things in motion but I went from fulltime work fulltime school-FT work/PT school-FT work-had to quit school–to part time work and then disability in 4 years time(2005-2009)fighting it all the way.Most pain is on the right side down the right leg to the ankle bone. My daily activity is very limited now.I was told most recently I have 6 herniated discs-most pain is from L2,3,4,5,S1–mild spondylosis L3,4,–Hypertrophy L4,5 and S1–Neuroforaminal narrowing (NFN) L3,4,5 and S1–Disc Degen L2,3,4,5–Stenosis L4,5,S1 and –Arthropathy mild L3,4 and mod. to severe L5 and S1 according to the MRI and recently changes Pain Doctors. After 6 yrs. and 6 epidurals with no pain management and quick refill visits every month I felt it was time to see someone else.I put on about 40-50lbs after starting epidurals and the Dr said it was not related and insisted he was not injecting steroids. According to billing, he was. My new Dr.spent over an hour explaining things to me which no one ever had.She wants to do a facet injection as a diagnostic tool to see if the most pain is from the S1 area closest to the sciatic bundle. I have read alot the past few weeks and have many questions.Ultram is the only pain med I am on right now, I was at 6 per day which I tapered back to 3 a day as I was grinding my teeth at night.I stopped the morphine 15mg ER BID in September 2012 myself. The morphine only made me tired and was decreasing my activity with really no difference in pain. What did work best was the Oxycodone 15mg er 2x daily with 5mg Immediate release for busy days-ultram at night–I hate not being able to stand long enough for dishes, sit in the car more than 30 minutes and I really cant go grocery shopping anymore. I would like your opinion on this situation and whether you think something other than ultram is warranted. I live on $1000 income and having all these injections are costly if they are just for diagnosing. Am I really asking too much to just maintain an adequate pain level with meds and PT until I can afford all these other ideas? I live in Florida and I understand the Dr’s positions are now suspect with pain medications but I am asking for minimal MG. compared to what I was up to back in 2011- oxy was up to 120mg per day but I was taking care of my ill father and spent most evening soaking in a hot bath. I thank you for your time in reading this and any input you may have. I have copies of all my records-I am somewhat a organized, efficient person who does not let anything or anybody control me anymore.

Donald Corenman, MD, DC
Moderator

February 20, 2013 at 2:12 am

Post count: 8660

#8035

It appears that you have a chronic pain syndrome. There may be significant mechanical reasons for you to have pain. You need a consultation from a spine specialist to help ferret out the causes of your symptoms.

It is commendable that you have reduced your intake of narcotics as this is a difficult step. Narcotics are not very good for long term use in chronic pain as the body “adapts” to their use and you then need more and more to try and manage the pain. Eventually, you can be habituated or addicted and the pain will still be as bad as it was when you first started to take narcotics.

A chronic pain physician might be helpful but there are good ones and not-so-good ones. I cannot tell you how to identify who is in what category.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

cherylzt
Member

February 20, 2013 at 6:54 am

Post count: 7

#8036

Thank you for taking the time to read my dissertation and reply-I guess I didnt phrase my questions anywhere. With what I listed and the constant pain-worse when sitting and standing more than 10 min.-have limited walking and cleaning the litterbox though its now 4ft off the floor-that little bend is excrutiating. warm baths help,reclined positions help. with what you see in my 1st email diagnosis from MRI (3rd one)There was no specific injury but my life changed alot after 2004 hurricanes took my job, belongings and apartment. I had to walk everywhere, took a cleaning job for large business and went back to school for computer networking but I went from fulltime work fulltime school-FT work/PT school-FT work-had to quit school–to part time work and then disability in 4 years time(2005-2009)fighting it all the way.My depression history has always been medication free except for stressful times after each divorce and custody battle.Most pain is on the right side down the right leg to the ankle bone. My daily activity is very limited now.I was told most recently I have 6 herniated discs-most pain is from L2,3,4,5,S1–mild spondylosis L3,4,–Hypertrophy L4,5 and S1–Neuroforaminal narrowing (NFN) L3,4,5 and S1–Disc Degen L2,3,4,5–Stenosis L4,5,S1 and –Arthropathy mild L3,4 and mod. to severe L5 and S1 according to the MRI and recently new Pain Doctors
-limited funds per month Medicare covers 80% of any treatment plus, heart/bp/chol meds per month-do you think asking for a low dose of narcotic to help get some of my life back and start PT is appropriate? as I mentioned, the morphine I weened off by myself (as I did with Xanax after a divorce years ago) I dont like meds and am willing to even ask if we can possible do 1 yr on and 1yr off-whatever will work–are you labeling me with Chronic pain syndrome because you feel the MRI results do not warrant my daily limitations and pain level? I grew up with scoliosis and Lordosis and have a hunch back on my right side. There is a history of back related problems with my father and 2 sisters and my neice wore a full brace through the Shriners as she grew due to her back.

Donald Corenman, MD, DC
Moderator

February 21, 2013 at 12:39 am

Post count: 8660

#8044

Chronic pain syndrome occurs in the presence of long term pain with needs of medication to help control pain. It does not mean that this pain cannot be helped with surgical intervention.

You have multiple levels of degenerative changes in your lumbar spine. The potential for pain generation could be from only one level or multiple levels. The use of high dose pain medications in the past does put you at greater risk for a poorer surgical result.

You need a consultation with a good spine surgeon to determine what your surgical prospects are.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.

Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.
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Donald Corenman, MD, DC

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81 reviews

Eric S

Sep 26, 2021

by Eric S on Donald Corenman, MD, DC

Successful pars repair at 46 years old

Back in November of 2018 (at 46 years old) I came from Vancouver BC to have a pars repair done with Dr. Donald Corenman at the Steadman Clinic in Vail Colorado. I'm finally posting this review nearly three years later in late 2021. The reason I waited so long was I wanted to know the final result before I posted my review. Unfortunately in that time Dr. Corenman has retired. Nevertheless, I want to post this review of Dr. Corenman and his staff at the Steadman Clinic in their excellent treatment of my L5 pars interarticularis.

I fractured my pars at age 42 back in 2014 when rolling on the gym floor, and was denied treatment by the Canadian healthcare system, probably due to my age. First my GP told me there was no surgical option for a pars defect, which was quite incorrect! I tried to live with it, but the symptoms worsened (periodic random spine slippage and weeks of resultant pain after just bending over to tie my shoe, so I eventually learned to mostly squat and hardly bend). When I finally consulted with Canadian spine surgeons, I was told they believed my pars defect had been congenital (since birth). This was absurd, considering I had done extreme martial arts (including jiu jitsu) for years prior, as well as 5 years of reinforcing steel full time in my 20s, probably the hardest job on the back you can find. No pars defect like mine would possibly have allowed this--ergo it was impossible that I had had the defect since birth. I did however have an asymptomatic congenital spina bifida occulta that made me more susceptible to a pars fracture. In 2014 in one instant, I went from having the strongest back people I knew said they'd ever seen, to being unable to safely bend over and tie my shoe without a non-negligible risk of my spine slipping randomly (which would lead to weeks of pain after each occurrence). This was due to the unilateral L5 pars defect, otherwise known as spondylolysis. It was when lying in pain on the floor 4 years later after maybe the 6th spine slippage event post injury, that I had had enough, and resolved to have surgery. If Canada's "universal health care" said no, I would make lemonade from lemons, and find the very best surgeon in the world at pars repairs. That was Dr. Donald Corenman. Dr. Corenman back in 2018 ran a website https://neckandback.com/ that dedicated many pages to the science of every aspect of pars repairs, from eligibility (good discs on MRI), to best surgical techniques (minimal open compared to minimally invasive), best imaging to use (i.e., O-Arm with Stealth imaging vs. older fluoroscopy), the ideal amount of BMP to use and why not use too much or too little, and much more, all to do with pars repairs, pages upon pages of his site just on the pars, with scientific references and his own extensive expert opinion. As a health research statistician, I was very impressed with this. It was in stark contrast to the websites of other spine surgeons which barely gave the pars a word or two, focusing almost exclusively on fusions. I had found the best surgeon in the world for pars repairs, and so after Dr. Corenman personally screened my MRI to ensure my discs were healthy, I booked the surgery.

Being 46 years old at the time of surgery in 2018, with a 4-year-old pars fracture from 2014 combined with a congenital SBO meant my pars fragment was somewhat atrophied, but it was "very solid", said Dr. Corenman in the operative report. Nevertheless, it was challenging with two things to fix, the pars and SBO, and OR time was around 4 hours. Recovery over the following months was guided by a very clear "Spine binder" from the Steadman Clinic with strict rules of "no BLT" (no bending, lifting or twisting), and illustrated physiotherapy guidelines. They even warned patients to avoid fish oil supplements, which could excessively dampen inflammation and hence slow bone healing. They answered many questions I had during months of recovery, with responses coming from the very supportive Lori Fugate (then director of Dr. Corenman's practice), and Ehrich Bean (then physician's assistant at the practice), as well as a couple calls with Dr. Corenman himself after two of the CT scans. Ehrich Bean offered great advice for taking the spine binder conservatively due to the nature of pars repairs vs. fusions. The final post-op CT scan I had was a couple weeks ago at 34 months post-op, and Dr. Corenman had retired, but I got a very positive and informative call from Eric Strauch (current PA at the Steadman Clinic under Dr. Corenman's replacement there, and who had also worked with Dr. Corenman previously). The staff at the Steadman Clinic were extremely supportive all the way through the process. I should mention, the local Canadian spine surgeon did offer me very good post-operative support including antibiotics as needed to deal with a mild surface incision-site infection early on, booking numerous x-rays when I felt something was amiss, as well as booking all four of my post-op CT scans. I am very grateful for that support also.

My final result shows plenty of solid bone across the pars and a healed SBO, with my vertebral body now a solid bone ring instead of being broken at two places as it was pre-op. Does my spine hold up in the real world? You bet! I have recently dug and moved several yards of dirt and sand and gravel by myself (shovel and wheelbarrow!) to fix our water main, pulled roots from the yard, moved several "portable" (these are HUGE) air conditioners up several flights of stairs my myself, and lifted weights. I now run 2 miles (3.2 KM) several times weekly with a hard 100 meter dash in the middle. I bend deeply before each run I go on, with no spine slippage. My spine feels amazing. I can bend over to do exercise, or real word tasks, with no risk of spine slippage.

My sincere thanks to God, Dr. Donald Corenman, Lori Fugate, Ehrich Bean, Eric Strauch, and the Steadman Clinic, as well as the Canadian spine surgeon who offered me excellent post-operative care back in Canada. You have all given me a new lease on life.

Sincerely,
Eric S

Robert S

May 11, 2021

by Robert S on Donald Corenman, MD, DC

Back Fusion Surgery

I had my entire lumbar spine fused in November of 2018. I had scoliosis , with pinched nerves that were so painful I could hardly walk - and standing for more than a few minutes was impossible. Even sitting was painful.
The fusion surgery produced immediate relief! And the recovery was much easier than I expected.
To this day I can do all the activities I love from hiking, to standing in a stream fly fishing to riding my bike long distances - or just walking down the street with my wife.
Kudos to Dr. Corenman and his staff, (including the two Erics) for taking such good care of me!

Leslie R

Jul 9, 2020

by Leslie R on Donald Corenman, MD, DC

TLIF

I had my TLIF surgery on 6/24/2020 by Dr. Corenman, I can not say enough good things about the Dr or his staff. I was always treated with respect and explained everything throughly, that made it easy for everyone to understand. I highly recommend Dr. Corenman and the Steadman Clinic.

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