No advice but my heart and prayers go out to you.

Vickie B>

One thing, Squirrely, is that I'm NOT over-walking ;-)  In fact, my rheumy
has "pushed" some kind of exercise, but no matter what I try, I go into pain
flairs.  This was worse than usual, thus it was ME who suggested taking an
x-ray (we really do have to help look out for ourselves in our medical care,
don't we).  At least the doctor and I now know what we're working with - 2
large bone spurs, one on each side, involving lumbar areas 4 & 5.  Nanny

Okay, back experts, I'm waiting.........in the meantime, thanks Nann.  Nanny

Ah great, here's Rosie :-)  I'm already doing a couple things you mentioned,
yet will take all your suggestions to heart in helping what I have left of
that area.  Here's how my rheumy worded it, "We (get the *we*) have a couple
options.  I (meaning the doctor) can give you the shots right here in my
office as you've done before, OR you can go to the hospital and they can see
on a screen exactly where they want to put the shots".  I said probably the
hospital would be better.  He said, "I think that's a wise decision".  Just
heard from the hosp. today and I go in this coming Tuesday for the first
time.

Rosie, I knew of someone who had these, and yes, they did do a series of 3
injections spaced 2-3 weeks apart, I'll let you know for sure when I go.
Nanny

correction - trans-laminar injection were done, one injection on each side
of the lamina, not on each side of  the facets.  duhhhh . . .

kate
hi nanny!

i can certainly empathize with you and your back pain.  some suggestions
that help back pain:  heat, ice, leg elevation, leg and back stretches,
carrying things close to your body, not reaching too far above your head
without the aid of a gopher, lifting things correctly/bending your legs to
pick up things, massage, whirlpool/jacuzzi/hot tub, tens unit,
anti-inflammatories, muscle relaxants, breathing meditations, traction
(physical therapist, inversion table, drx9000), chiropracty, acupuncture,
lazer therapy, and there's a bunch more i cannot think of at this time,
besides surgerical options.

to answer your other question--in the past few months, i've been through a
series of 3 treatments in my L-5/S-1 (epidural, nerve block, trans-laminar
and trans-facet);  a single treatment of T 7-8 trans-facet injections (two
injections, one in each of both sides of the lamina, done just once); and a
single treatment of C-6-7 trans-facet injections (two injections, one into
each facet of the joint).  generally speaking, a pain specialist does not
want to go over 4 doses in a year, of the several different types of
steroids he has available to use.  rare exceptions to the contrary, as you
can tell from above that i'm past that limit, when the nerve issues impair
limb function or other bodily functions.

as you can ascertain from my discription above, there are several injection
techniques that can be utilized by a good pain specialist (and there are a
couple more than i've described, that haven't yet been described to me by my
pain specialist.).  generally speaking, whichever technique is used, the
process itself, from the patient's vantage, is virtually the same.

since you asked for it<smile>, here's how the process goes:

first off i had a consultation with the physician.  s/he needs to know
specifics--where i hurt and at what level of the pain scale; how this pain
is limiting daily life; what other symptoms i was having, like numbness or
muscle spasms; are there functional issues involved (questions like--at
cervicle level nerve issues, are you dropping things or having difficulty
swallowing . . . etc.; or at lower lumbar/sciatic level nerve issues, are
you limping or tripping or falling or cannot sit or stand for very long . .
. etc.)

secondly, you (i'm switching pro-nouns, to make it easier for me to stay
with one) will probably have an mri done to follow up on these reported
issues/symptoms and to give the specialist visual internal information of
where and what the most likely problem/s might be that might or might not
benefit from the injection procedures.

thirdly, after your specialist has had time to review the mri films to
determine an accurate assessment, a diagnosis and prognosis, a course of
action, an individually designed treatment plan specific to your needs, and
the particulars about which techniques might be most beneficial for your
particular needs, s/he will review these things with you.  you may or may
not, have your first injection treatment that day.

if you have been informed that you will have the procedure following this
review, make sure you stop taking your pain meds 8 hours prior to the
procedure and stop taking nsaids and asa meds 24 hours prior to the
procedure (this is important, because the doctor needs to know when and
where you feel familiar pain during the procedure); you may take other
necessary meds with just sips of water;arrange for a driver to take you home
from the procedure; do not eat or drink 2 hours prior to the treatment; give
the doctor a list of your meds and the meds you are allergic to;

fourthly, on the day of your treatment, you will be asked to partially
disrobe, to put on a hospital gown or a set of scrubs.  you may be offered a
valium cocktail before the procedure, to relax you during the procedure.  my
reccommendation is for you to take it.  (i've done this so many times, that
i no longer take it, mainly because i drive myself.  but i suggest you do
take it and don't drive yourself, if you don't have to drive yourself.)

then you will be led into the procedure room.  you will be asked to lie face
down on an operating table.  you will be prepped by an assisstant, who will
swab and drape the area for the procedure.  they may want you to have a
pillow positioned under your chest or abdomen area to help spread your
vertebrae; and a pillow under your feet, to bend your knees for your
comfort.  then, the doctor enters the room.

a C-frame flouroscope (a kind of multiple-axis, realtime x-ray machine) will
be positioned over and around the table and you.  during this positioning
process, images will be taken to locate the exact areas in which the doctor
is going to work.  these images will be seen on a television-like screen,
which will later, in turn, be transferred to a larger multiple- image larger
screen to enhance detail.  once that c-frame is in the correct position, for
the doctor's purposes, s/he begins the procedure.

you will remain awake for the procedure.  you need to stay completely still
for it.  s/he will position a thin needle, incrementally, into the structure
or space that s/he will be treating.  (sometimes, the doctor uses a numbing
agent on the way down, sometimes not.  it depends upon what s/he needs to,
or will, do.  this is not painful, as it is a very thin needle, like a
pinprick.)  once s/he reaches the structure or space, s/he will inject a
contrast dye to confirm needle position and xrays are taken to record it.
you will be told when to hold your breath and when it is ok to breathe
again.

when s/he confirms the needle position, s/he may then inject a combination
of anti-inflammatory (steroid) and anesthetic medication to ease your
original pain complaint.  (s/he will use short-term acting anesthetic on the
way down to the position and longer acting anesthetic with the steroid.)
you will feel pressure and/or discomfort at this time. ****it is very
important, during the procedure, that you give your doctor feed-back; let
him/her know when s/he has stimulated the original and familiar pain that
brought you to this procedure for relief.**** if this discomfort differs
from your usual symptoms, s/he needs to know this, too.  this stimulated
discomfort is valuable and important information for the doctor, to help him
know if s/he's in the right area or not.  (i won't kid you, for me, when he
is in the correct spot, it can be very painful, but very briefly so, because
he immediately anesthetizes the area, when he has that information.)

the procedure generally takes around 10-20 minutes.  you may or may not be
asked to wait up to 30 minutes, before going home, just to make sure there
are no complications.  they also want to make sure that your pain level has
returned to the base-level you were at when you came in.  (most of the time,
by then, my pain level has already improved over base-level.)

post-op - there may be some numbness for 4-6 hours (i only had that happen
once and it lasted about a week, but is gone now.).  your usual symptoms
might return the night of the procedure and may even be more intense for a
day or two, until the steroid begins to kicks in.  so, take your pain meds
when you get home and lie down for awhile, nap if you can--that actually
helps the injected meds to work better.

the benefits of the steroid usually take about 3 days to take effect, but
can take up to 7 days for full benefit.  keep track of how your body
responds to the procedure, on a day to day basis--write it down and give it
to your specialist when you next see  him/her.  you may have a headache, hot
flashes, facial flush, insomnia (or sleepiness when you get home, if you
take the valium cocktail<smile>).  these are common reactions to the
procedure.  (i had facial flush, but nothing else.)

less common reactions are hiccups, increased heart rate and fluid retention.
if these don't go away within 3 days and they distress you, call this doctor
about them.  normally, your specialist's assistant will call you, to see how
you are doing, within a day or two of the procedure.  that's about it.  i
know this was lengthy, but i hope that it helps you, nanny.

kate

Along with Fibro, I also have OA and RA.  I've lived with pain for a very
long time; however, the pain has been getting more and more intense in my
lower back so that it  hurts to even sit.  So, today when I saw my Rheumy, I
told him about it, and said I couldn't remember having any back/hip x-rays,
at least for a long time.  So they did several x-rays right there in the
office complex, and the result is that I have 2 large bone spurs on Lumbar 4
& 5.  He is sending me to the hospital soon to get the shots where they can
see the needle on a screen go to directly to the site, rather than giving me
a trigger point injection in the general area.  What should I expect?  Also,
any tips you can share in coping with this type pain?  Thanks!  Nanny

Wow, very thorough indeed, Kate.  Thanks! (I think :-)  No, actually, when I
know a little about a test before hand, I'm not as fearful than if I don't
know what's coming next.  I've printed this off.  Be assured I WILL take the
valium cocktail!!!  Thanks again.  Nanny

Okay, DeeTee, I hear ya!  From what I hear, there will be some pain
involved, but they'd better give me something to help it along.  It is true,
then, that you don't feel absence of pain until the medicines kick-in (over
2-3 days?), the ones they inject in your spine?  I almost canceled out the
other day, but then a nurse called and they had all the arrangements made,
so I thought, okay, I'll never know if this procedure will ease the pain
unless I give it a fair chance.  I'm a little nervous, but I plan to go
through with it.  Nanny

Oh, goodie, I hope it happens to me in that way.  Remember the times as kids
and adults that even the best of us would cringe or beg off when we had a
dental appointment?  Now, many years later, I don't think I have anymore
dental fears.  I've had so much done over the years on my teeth that I just
look at it as an inconvenience in my day ;-)  Just last week while getting
my 6-month exam, my dentist determined that I need 2 teeth pulled (by an
oral surgeon), one capped, 1 filled, and after all that - he has to make me
a bridge or a partial.  I prefer the bridge, because it feels completely
normal when it's in.  But, he doesn't think I have a strong enough tooth on
which the partial would have to link up with.  I have a bottom bridge.  I
hate the feel of it in my mouth!  It's in my dresser drawers.  Nanny.