What it’s like to get a lumbar epidural steroid injection, and did it work?

As I wrote in January, I’ve been dealing with back issues since last November. I had started to train for another half marathon and merely wanted to ensure that my hips were aligned throughout the process. So, I went to a chiropractor here in Oklahoma City, and after the second visit, I was in tremendous pain. There’s no judgment in that statement, but the timing is fact.

After a couple months hoping it would go away, an MRI revealed a “mild” bulging disc. It turns out, according to my orthopedic consultant, “mild” is a radiographic term, meaning that in his world, it didn’t reflect the severity of my issue. It reflected what was shown on the MRI. Dr. Pat Livingston walked me through what was happening during a visit a couple weeks ago.

My disc is ruptured.

I’m still not sure I understand. There’s bulging, protruding, herniated and ruptured. Is there a big difference between any of these? And do I really care?

At worst, my pain levels would be at an 8 or a 9, but not constantly. Three Advil knock it out pretty decently. One thing I learned from Dr. Livingston is that ibuprofen doesn’t work as an anti-inflammatory unless you use it over a longer period of time. One day and one dose won’t do it. He recommended that I take up to eight Advil per day, well within the allowed daily dose. He tells me that it takes a couple of weeks for it to get into your system at a therapeutic level, working to reduce inflammation.

Dr. Livingston also said I’d be a terrific candidate for an ESI: an epidural steroid injection.

So, I got that booked and had it done last Thursday.

But first, a couple steps backward.

I’m stubborn. I don’t really put much stock in other opinions unless they jibe with my instinct. First and foremost, I wouldn’t allow surgery on my back pretty much for any reason unless I genuinely couldn’t stand it anymore. Reading the horror story of Don Dokken’s recent surgery, leaving his hands “dead” just confirmed my nightmare about that. The good news is that, it turns out, Dokken’s condition is improving, but his recovery will be long.

With that said, I’m way more apt to listen to a doctor who isn’t trying to sell me on surgery.

Dr. Livingston didn’t. He doesn’t operate anymore, but I’m told that in his day, he was considered to be a savant when it comes to issues of the back. A master surgeon. His counsel was sober: my back will never anatomically return to what it was, although that speaks both to the injury and to the aging process. My body will also never again look like it was when I was 20.

He also made no guarantees that an ESI would work. However, based on my symptoms and the tests he gave me, he thought it would do me right.

What were the tests? Mostly, he had me get into different positions, reaching one way and then standing on my tiptoes or leaning to my left or my right. I was mostly agile in doing all of those. One abnormality he noted was that back extension hurt more than it relieved pain, at least on that day. But I moved pretty well for somebody with a ruptured disc.

Through a fantastic health care program we have at work, I was able to get in to see somebody to administer the epidural steroid injection at no out-of-pocket cost to me. And that’s when I met Dr. Keith Smith, of the Surgery Centers of Oklahoma, who has made it his professional mission to offer price transparency for services and surgeries that are otherwise severely over-inflated in the marketplace.

Dr. Smith immediately relieved my concern about epidural steroid injections.

“I had it done myself,” he said.

Of course, my mind raced to what I’d be able to do after the injection, after a reasonable period of recovery. I asked him about running.

“I ran the Chicago marathon,” he noted.

Well. Son of a gun. I’ve found somebody with my maverick spirit.

Dr. Smith and the nurse, Emma, explained to me that I might need not just one shot but a series of up to three. The wisdom in the ESI world is that if three injections don’t do the trick, then you’re going to need surgery. Therefore, patients will often space the injections such that they last the longest period of time in between shots.

And that’s contrary to how it should work.

In actuality, the first injection, shot into an area to the side of the inflamed disc, allows for more blood flow to that specific area so that nerve root irritation reduces. It is quite possible that it will only reduce that irritation by X percent. One would not want to stretch out the time between injections 1 and 2, allowing the irritation to return to its zenith. You want to attack the irritation while it’s at 40 percent, or whatever it might be.

After Emma and Dr Smith explained what they’d be doing, they had me take off my shirt and unbutton my pants just to the point where Dr. Smith could see to the bottom of my spine. I sat on a bed and leaned over into a pillow on a table, clinging to it while he stuck a long needle into my spine to numb it.

It felt like a bee sting. Made me grimace but otherwise was not a problem.

And then they put what they call “contrast” into the area. To me, the patient, it felt like pressure. I’m sure it was the world’s largest needle or something horrific, but it just felt like Dr. Smith was pushing on my back. He advised me not to lean back, and you can bet that was an order I’d obey.

But after 2 minutes, we were done.

And I could immediately feel my right leg to be lighter and cooler, the result of much better circulation to the area.

Dr. Smith then talked quite a bit about the mission of SCO (Surgery Centers Of Oklahoma). They list all their prices online. He’s done segments with John Stossel and Bill O’Reilly about topics of medical pricing transparency, and I’ve since watched them all. I know that mentioning Stossel and O’Reilly will immediately turn off 47% of those reading this post, but I don’t care.

It’s worth the watch:

 

So, what now? Post epidural steroid injection
I don’t know if this ESI is going to hold me indefinitely. For many people, a second injection is needed. Dr. Smith only needed one, he told me.

What I do know is that I’m going to employ the wisdom I wrote about from Stu McGill’s book ‘Back Mechanic.’ I’m going to take it easy for the next week or so and work up to a walking regimen. I’m going to pay close attention to how I move in all facets — getting out of bed, bending over, getting into the car, etc. And I’m also getting more serious about intermittent fasting (IF), something I’ve done before but something I hadn’t thought about in a long while until Dr. Smith brought it up.

I should note: The thing that impressed me the most about Dr. Smith is that he seemed genuinely concerned and empathetic about my situation. I felt like he was talking to me, man to man, as somebody who had been there. I felt like he was telling me, “I was you, and we got this.” He asked me if I had ever tried intermittent fasting before, and I said, “Kind of. I periodically skip breakfast and go from 8 p.m. to noon the next day before eating.”

“Then you’ve done intermittent fasting,” he said.

Dr. Smith wasn’t telling me I needed to lose weight. He was giving me a science lesson. When you eat, your body spends all its resources dealing with that food — digesting it, converting it to sugar or stored fat, expelling it. When you don’t eat, your body works on bigger projects, such as healing.

I have no idea where that effort will lead, although I do know that I’m going to become much more of a student of my own body. To that end, I recently bought, “The Complete Guide To Fasting,” which while not exactly a page-turner is quite informative and well-sourced.

Three days after the shot, I’m virtually in no pain. There is still some nerve irritation, but it’s very mild compared to what it was. These injections take up to two weeks to work, although I should warn you: don’t bother doing much Internet research on epidural steroid injections. It’s all highly pessimistic, which speaks to the possible complications and side effects, rare as they may be. It also speaks to the power of a medical ecosystem that is likely still addicted to surgery.

What feels better: standing, walking. Much better in fact.

What feels the same: poor posture and bending over or stretching at weird angles. Also, sitting for too long.

But you know what? I can remedy that. Between the wisdom in Stu McGill’s book, the advice from Dr. Smith and the medicine coursing through my body, I consider myself to be very lucky. I’m not sure if a second shot is in my future or any specific physical therapy might be, but I’m going to listen to my body closely.

Something both Drs. Livingston and Smith preached to me: “If it hurts at all, do not do it.”

I can get behind that!

Image from: By Paul Anthony Stewart – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=75808444

One Reply to “What it’s like to get a lumbar epidural steroid injection, and did it work?”

  1. Good column Ryan. I’ve had two herniated discs for years. Standing in one place for too long leads to pain. Also carrying my 80-200mm lens and camera around on my neck for awhile leads to pain. However, even at that the pain level tops out at about 5-6. I’ll look forward to follow ups.

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