NDL Forum

On the flip side, they could ask me almost anything about nephrology other than the basics and my head would explode.

Easiest and most personable fun docs to deal with....docs like Weasel.

Good job!

Cnasty wrote:Doc hierarchy in the hoods for street cred:

Neurosurgeons>>>>>cosmetic surgeons>>>>>>>ortho surgeons>>>>>>>all other docs

I worked with a guy who had a list of the three worst kinds of surgeons. Mind you, we are both anesthesiologists thus work with all the surgical specialties. This is his take:

1) Ophthalmologist: Tend to be very smart, although by and large a socially awkward bunch. The problem with them is if shit hits the fan during a case, they arent going to be able to do anything to help. They know a TON about what amounts to a very small part of the patients overall health picture (eyesight)

2) OB GYN: Its a three year residency, of which they do their surgeries for 2 years. Yet they tend to think of themselves as surgeons (who do 4 years of nothing but surgery). Theyre not. If theyre in the abdomen and get into trouble, they call in a general surgeon. Cut a ureter? Get a urologist in there. As a pain doc I do spinal cord stimulator implants. We cut down to the spine, anchor leads placed in epidural space, tunnel to a battery under the skin in the hip. Its surgery, but Im most definitely not a surgeon

3) Ortho: Very, very smart bunch, tend to get tunnel visioned even though they know better. I had a case where we were doing a knee replacement and the patient coded. We're resuscitating the patient with meds, compressions, the whole bit during surgery...surgeon asks if he can keep going.

*Disclaimer: This is a very wide-brush take and not true for all docs in those specialties

Weasel wrote:

bearass wrote:i've been having bad sciatica pain. rooted between L5 S1, is there anything besides the round of 3 epidurals they can do? They wore off after about one month.

"Sciatica" is a common misnomer, even among primary care docs. If you have a radiculopathy (pain from back radiating down the legs) it could be from a number of things (discs, facet arthritic, degenerative changes, etc), although the pain itself is usually due to the nerve root being inflamed. Hence, the steroids (steroid is a potent anti-inflammatory, less inflammation ideally equates to less pain).

To your question, it depends on what is causing the "sciatica". Physical therapy, anti-inflammatory meds, epidural steroids are all conservative measures. If its from a stenosis, sometimes decompressive surgery is needed. Also, how long did the epidural last? We limit to 3 doses of steroid in any 6 month window, so I commonly have patients who regularly get 4-6 weeks of relief from the injection, deal with the pain for for a couple weeks, and get an injection every 8-10 weeks.

Without knowing someones medical history and the knitty gritty details, these questions generally suck because there are so many variables.

TLDR: It depends.

I have a small bugle in my disc between l5 s1 that is pressing on the nerve root that runs down my right leg. The disc pressing out to the front of my body and is causing some narrowing. Not stenosis at this moment in time was the thought by my MRI. i did PT, chiropractor, have tried some meds which work zero (Pain and Gabapentin). I had a round of 3 from end of January to march. I had 2 weeks between 1 and 2 was feeling great so waited on #3 and it came back in about 3 weeks so i had my last shot in march around the 15th. It is beginning to hurt like before and causing me to not be on my feet more than about 15 mins. I can sit and it relieves the pain fairly quick then i can carry on. Pain management doc said they could give me a 4th injection now going in at a different angle but then it would be 4 months before anything else. Or if i can hang in til July i can get another series and this time i wont skip #3 if im feeling better. Mainly i am asking if this is pretty normal for this problem, i am confident in my docs but this is all new to me. I am hoping some things lifestyle wise are helping but its hard to get in good exercise with the pain, IE yoga... Are there any treatments i should ask about or is this all pretty standard?


the MRI results show my bulge to be pretty mild its just in the right spot to cause me the pain and discomfort. I absolutely do not want to pursue any back surgery at this time in my life.

Everything you're describing is very typical. The "different angle" is likely referring to a slightly different technique for the epidural which targets the nerve root, this may be more helpful

my bulge to be pretty mild

I’m so immature.

Cnasty wrote:

my bulge to be pretty mild

I’m so immature.

Funny, I was honestly thinking the same thing as I was reading that.

bearass wrote:

Weasel wrote:

bearass wrote:i've been having bad sciatica pain. rooted between L5 S1, is there anything besides the round of 3 epidurals they can do? They wore off after about one month.

"Sciatica" is a common misnomer, even among primary care docs. If you have a radiculopathy (pain from back radiating down the legs) it could be from a number of things (discs, facet arthritic, degenerative changes, etc), although the pain itself is usually due to the nerve root being inflamed. Hence, the steroids (steroid is a potent anti-inflammatory, less inflammation ideally equates to less pain).

To your question, it depends on what is causing the "sciatica". Physical therapy, anti-inflammatory meds, epidural steroids are all conservative measures. If its from a stenosis, sometimes decompressive surgery is needed. Also, how long did the epidural last? We limit to 3 doses of steroid in any 6 month window, so I commonly have patients who regularly get 4-6 weeks of relief from the injection, deal with the pain for for a couple weeks, and get an injection every 8-10 weeks.

Without knowing someones medical history and the knitty gritty details, these questions generally suck because there are so many variables.

TLDR: It depends.

I have a small bugle in my disc between l5 s1 that is pressing on the nerve root that runs down my right leg. The disc pressing out to the front of my body and is causing some narrowing. Not stenosis at this moment in time was the thought by my MRI. i did PT, chiropractor, have tried some meds which work zero (Pain and Gabapentin). I had a round of 3 from end of January to march. I had 2 weeks between 1 and 2 was feeling great so waited on #3 and it came back in about 3 weeks so i had my last shot in march around the 15th. It is beginning to hurt like before and causing me to not be on my feet more than about 15 mins. I can sit and it relieves the pain fairly quick then i can carry on. Pain management doc said they could give me a 4th injection now going in at a different angle but then it would be 4 months before anything else. Or if i can hang in til July i can get another series and this time i wont skip #3 if im feeling better. Mainly i am asking if this is pretty normal for this problem, i am confident in my docs but this is all new to me. I am hoping some things lifestyle wise are helping but its hard to get in good exercise with the pain, IE yoga... Are there any treatments i should ask about or is this all pretty standard?


the MRI results show my bulge to be pretty mild its just in the right spot to cause me the pain and discomfort. I absolutely do not want to pursue any back surgery at this time in my life.

How did a bugle become lodged in your spine?

I know when I was having back problems in the army (getting disability for 3 degenerative disc and arthritis in the back as well as other things) I went thru physical therapy and they focused on my hamstrings and stretching them. Worked wonders for me.

Weasel wrote:Everything you're describing is very typical. The "different angle" is likely referring to a slightly different technique for the epidural which targets the nerve root, this may be more helpful

Thanks for feedback

LetsGoPeay wrote:

bearass wrote:

Weasel wrote:

bearass wrote:i've been having bad sciatica pain. rooted between L5 S1, is there anything besides the round of 3 epidurals they can do? They wore off after about one month.

"Sciatica" is a common misnomer, even among primary care docs. If you have a radiculopathy (pain from back radiating down the legs) it could be from a number of things (discs, facet arthritic, degenerative changes, etc), although the pain itself is usually due to the nerve root being inflamed. Hence, the steroids (steroid is a potent anti-inflammatory, less inflammation ideally equates to less pain).

To your question, it depends on what is causing the "sciatica". Physical therapy, anti-inflammatory meds, epidural steroids are all conservative measures. If its from a stenosis, sometimes decompressive surgery is needed. Also, how long did the epidural last? We limit to 3 doses of steroid in any 6 month window, so I commonly have patients who regularly get 4-6 weeks of relief from the injection, deal with the pain for for a couple weeks, and get an injection every 8-10 weeks.

Without knowing someones medical history and the knitty gritty details, these questions generally suck because there are so many variables.

TLDR: It depends.

I have a small bugle in my disc between l5 s1 that is pressing on the nerve root that runs down my right leg. The disc pressing out to the front of my body and is causing some narrowing. Not stenosis at this moment in time was the thought by my MRI. i did PT, chiropractor, have tried some meds which work zero (Pain and Gabapentin). I had a round of 3 from end of January to march. I had 2 weeks between 1 and 2 was feeling great so waited on #3 and it came back in about 3 weeks so i had my last shot in march around the 15th. It is beginning to hurt like before and causing me to not be on my feet more than about 15 mins. I can sit and it relieves the pain fairly quick then i can carry on. Pain management doc said they could give me a 4th injection now going in at a different angle but then it would be 4 months before anything else. Or if i can hang in til July i can get another series and this time i wont skip #3 if im feeling better. Mainly i am asking if this is pretty normal for this problem, i am confident in my docs but this is all new to me. I am hoping some things lifestyle wise are helping but its hard to get in good exercise with the pain, IE yoga... Are there any treatments i should ask about or is this all pretty standard?


the MRI results show my bulge to be pretty mild its just in the right spot to cause me the pain and discomfort. I absolutely do not want to pursue any back surgery at this time in my life.

How did a bugle become lodged in your spine?

I eat a lot...

The_Niddler wrote:

Cnasty wrote:

my bulge to be pretty mild

I’m so immature.

Funny, I was honestly thinking the same thing as I was reading that.

GeorgesGoons wrote:I know when I was having back problems in the army (getting disability for 3 degenerative disc and arthritis in the back as well as other things) I went thru physical therapy and they focused on my hamstrings and stretching them. Worked wonders for me.

And getting carried in every game you play does wonders for your back.

BFiVL wrote:

GeorgesGoons wrote:I know when I was having back problems in the army (getting disability for 3 degenerative disc and arthritis in the back as well as other things) I went thru physical therapy and they focused on my hamstrings and stretching them. Worked wonders for me.

And getting carried in every game you play does wonders for your back.

Except when you and Badger are involved, gotta stretch out before and afterwards

GeorgesGoons wrote:

BFiVL wrote:

GeorgesGoons wrote:I know when I was having back problems in the army (getting disability for 3 degenerative disc and arthritis in the back as well as other things) I went thru physical therapy and they focused on my hamstrings and stretching them. Worked wonders for me.

And getting carried in every game you play does wonders for your back.

Except when you and Badger are involved, gotta stretch out before and afterwards

Stretching your mouth and other orafice for badger is something you do on your own.

BFiVL wrote:

GeorgesGoons wrote:

BFiVL wrote:

GeorgesGoons wrote:I know when I was having back problems in the army (getting disability for 3 degenerative disc and arthritis in the back as well as other things) I went thru physical therapy and they focused on my hamstrings and stretching them. Worked wonders for me.

And getting carried in every game you play does wonders for your back.

Except when you and Badger are involved, gotta stretch out before and afterwards

Stretching your mouth and other orafice for badger is something you do on your own.

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