Last week started out with the appointment I was most dreading - the neurosurgeon. Dr Kim (aka Dr K) was quite reassuring. He went over the MRIs with me and we agreed on a number of points, primary being that I'm not a candidate for surgery at this time. (*whew*)
He also agreed with the Ortho that my arm problems are unrelated. He agreed that the problems I'm having ought to originate around C8 but that area shows no impingement. I do have significant impingement at C4-C5 but if that was causing problems I'd be noticing it in a wholly different area. Since I have no pain or other symptoms associated with that impingement he's not too worried about it. Overall, he says, my back doesn't look that different from a lot of backs he sees of men my age with degenerative arthritis and he doesn't see any reason to be alarmed. We discussed my mother's history of spinal stenosis and he agrees that there is starting to be some impingement on the cord itself but nothing too unusual (again given my age and diagnosis). There is also spurring that could be corrected surgically but that doesn't seem to be called for at this point. He agreed that the logical next step was probably a pain clinic and possible injection. See below.
Tuesday I got a massage from a woman who used a Thai technique I haven't experienced in quite some time. It's all forearms and elbows and goes quite deep. I had a lot of soreness after that but she did attack some of the knots pretty effectively. I may go see her again if I can figure out timing that works - getting to west Medford during the hours she works is not as easy as I'd like.
Friday I saw Dr Oh (yes, that's actually her name) at the pain clinic. I re-told the entire story and she had several useful things to say. Primarily, she agreed with Dr K that I should let my pain be my guide and since I seem to be improving on my own she felt that the risks of a cortisone shot were greater than the likely benefit at this time.
She agreed that the MRI-visible impingement did not seem to be a direct cause of my symptoms. She did note that in people who have discs that bulge like mine it's possible for a disc to slip and cause a muscle spasm. When the spasm ends, the disc slowly moves back.
Although we'll probably never know exactly what precipitated this incident she agrees that I should avoid back impacts and she added that I should avoid lifting heavy loads (say, over 50lb). She said it takes 3-6 months after a major incident for things to resettle fully and she agreed that continuing the PT to strengthen that area is a good idea.
It's a real relief to have some uniformity of opinion among the various providers - at this point Ortho, Neuro, and Pain are all saying the same thing so that's what I'm going with.
Oh and Lahey sent me a "how did we do" questionnaire so I told them what I thought of the PT.