Back Pain

After the last physio appointment on August 19th 2020 my pain stepped up and my activity stepped down. I was facing pain every day and finding it difficult to be at work and on my feet for 8 hours a day. As I mentioned earlier I had turned into someone who had not taken a single sick day in 6 years until my hip replacement into someone who was struggling to be at work.

The pain was excruciating and almost unbearable. The pain was just below waist level at my right lower side and would sometimes graduate to my shoulder blades or move towards my abdomen.  After the last physio I had several days where I would be ready to set off for work and just not be able to go. I have never been prone to vomiting ever in my life, other than motion sickness and migraines, so this nausea from pain was disturbing.

Covid 19 and Medical Issues

I finally phoned my doctor in mid September 2020 and tried to book an appointment. I had to leave a voicemail and when they returned my call it was to ask me to email the doctor in detail what my problem was. I had asked for painkillers and was put back on Tramadol for the day and Percocet at  night which were the  medications I was on before hip surgery. I was also having severe abdominal pain as well at this time. It took me a couple of months to realise that I got pain from eating when eating salads. Salads are something I had eaten almost all my life but it appeared to be the cause of some pain. I stopped eating the salads and instead ate cooked  vegetables with either meat or fish and felt better almost immediately.

My back pain was not improving and there were days at work when I just could not be there. I was in pain no matter what I did and it became unbearable. The doctor made an appointment for me for October 29th 2020. I fully intended to go to work and then leave for my appointment. The previous day was my scheduled day off and I had not been well for the majority of the day. I called in sick to work that morning and went to see the doctor later on. I had told her I was unable to be at work with the pain I was in and she agreed and signed me off work for a month. That was on October 29th 2020.

Tests

X-rays

Hip checked and back checked

Everything appeared normal. I was worried about my hip although I knew I would be in pain if there was a problem and with a possible issue when standing. This was not the case but at times like this it is always good to have it confirmed. I do feel a little stiff at times in my groin and I miss swimming as a way of keeping the joints fluid. Hence the exercise bike comes in handy. I watch Netflix or Prime and sometimes do trivia on Amazon Echo with Alexa whilst pedalling away.

Ultrasound Abdominal – September 30 2020

Report

Gall bladder, bile ducts, spleen, aorta and pancreatic head and body are unremarkable. The pancreatic tail is obscured by bowel gas.

Liver measures 14cm in length and demonstrates diffuse increased echogenicity with no focal abnormalities seen.

Right kidney measures 10.6cm in length with mild separation of intrarenal collecting system. There are punctate echogenic foci identified measuring 1cm mid to lower pole and 9mm lower pole.

Left kidney measures 11.4cm in length. There is a 3cm cortical cyst upper pole.

Summary – Two stones identified right kidney measuring 9 and 10 mm associated with mild dilation right renal pelvis, Further assessment could be made with a renal colic CT/CT urogram.

Incidental left renal cortical cyst. Normal sized echogenic liver in keeping with fatty infiltration.

Pelvis Ultrasound – September 30 2020

Report

Transabdominal and trans vaginal imaging was performed.

There is a bulky anteverted inhomogenous uterus with poor definition of the junctional zone.

Endometrial thickness measures 3mm.

Both ovaries and adnexa are unremarkable.

Summary

Bulky uterus with sonographic features suggest the possibility of adenomyosis. If clinically appropriate further assessment could be made with MRI.

 

Abdominal CT urogram (renal colic) – October 10 2020

Report

Unenhanced CT abdomen pelvis using renal colic protocol

Limited assessment of solid organs, vessels and bowel without contrast. Portions of the liver and spleen are not included on the images using this protocol.

Streak artifact from right total hip arthroplasty obscuring adjacent structures.

Visualised liver demonstrates mild diffuse fatty infiltration with focal sparing adjacent to the gallbladder. No biliary dilatation. Visualised unenhanced spleen, pancreas, adrenals unremarkable.

In the right kidney there are 2 non- obstructing stones in the renal pelvis measuring 13mm and 10mm. There is a non-obstructing mid to lower pole calyceal stone measuring 10mm.

No other urinary tract stones are identified. No hydronephrosis or perinephric stranding on either side.

Left kidney demonstrates a couple of cortical cysts.

Urinary bladder appears unremarkable.

Normal caliber aorta, There is fusiform dilation of the celiac artery measuring 13mm.

Uterus is anteverted and appears bulky suggestive of myomatous change.

No bowel  dilation. Small fat-containing umbilical hernia. No free fluid.

IMPRESSION: Non-obstructing right nephrolithiasis.

Bulky uterus suggestive of myomatous change. Correlation with pelvic ultrasound recommended.

Fusiform celiac artery aneurysm. Further evaluation with CT angiogram is recommended.

CT Scan – November 13 2020

This was a CT that was of the abdomen and pelvis as a follow up of the X-rays. 10 minutes prior to the end of the CT scan a dye was injected in order to highlight  the arteries.

Findings

Lower thoracic and abdominal aorta are widely patent, non-atherosclerotic
and non-aneurysmal.

Celiac artery is widely patent. Fusiform aneurysmal dilatation of the
celiac artery measuring up to 1.3 cm in maximal diameter.

The aneurysm begins 1.3 cm from the origin of the celiac artery and extends over a length of approximately 2.0 cm.

Gastroduodenal artery and left hepatic artery arises from the aneurysmal segment.

Ultrasound Vascular – December 5 2020

Due to the finding of a celiac artery aneurysm of 1.3mm. an ultrasound was performed at the surgeon’s office.

This was to check whether or not the aneurysm had grown.

MRI Pelvic – December 9 2020

Purpose was to rule out adenomyosis. I was not really sure why they wanted to do this after menopause because I had no symptoms but I figured it was part of the whole health check up.

FINDINGS
The uterus is anteverted. It measures approximately 10 cm in length. It is enlarged in diameter on the short axis measuring 7.6 x 7.1 cm.      The junctional zone is thickened and there are small pockets of high T2 signal identified in the thickened junctional zone.                              This is in keeping with diffuse adenomyosis.
The endometrium is not thickened. The cervix is unremarkable.
Follicles identified in both ovaries.
There is no pelvic mass identified. The urinary bladder and the visualized portions of the digestive tract are unremarkable.                              No free fluid.
Incidental note is made of a right hip prosthesis.

OPINION
Diffuse adenomyosis.
There is no pelvic mass identified. The urinary bladder and the visualized portions of the digestive tract are unremarkable.                              No free fluid.
Incidental note is made of a right hip prosthesis.

MRI Thoracic – December 27 2020

Purpose of this is to rule out nerve impingement. Thoracic area was done due to receiving a spinal anesthetic before hip surgery. Also due to the lower back pain radiating upwards to the right shoulder blade.

FINDINGS
There is no abnormal signal or mass within the thoracic portion of the spinal cord.
At T2/3 there is mild encroachment of the left neural foramen secondary to facet hypertrophy.
At T9/10 there is mild encroachment of the left neural foramen secondary to facet hypertrophy.
The remainder of the thoracic levels are within normal limits without disc herniation, central canal stenosis nor encroachment of the neural
foramen.

Vascular Phone consultation/results – January 7 2021

The celiac artery aneurysm has stayed the same since the initial finding and another scan will be performed in 3 months. If at that stage the aneurysm has not grown in size it would be checked every 6 months. If however it had grown in size it would be checked every 3 months with a view to surgery. We also discussed other health issues as the doctor wanted an overall picture and on telling him that my foot and toes were still numb from hip surgery he then decided at my next ultrasound that he would also check my leg and foot.

Pain Clinic January 12 2021

I went there with hopes of them helping in some way but ended up being disappointed. It seemed they were more concerned with nerve pain and were not really sure what it was if it wasn’t that. They told me they would contact a pharmacy, which turned out to be in London Ontario, who would contact me about my symptoms and make up a topical cream for me to help with the pain. They also gave me spine stretching and spine strengthening exercises to do. I did these as told which was every day for 6 weeks. I gave myself Sundays off. Other than that I stuck with it and saw no difference. Some days I felt it helped, most days I felt it did nothing, some days I was in worse pain and ended up just doing the stretching rather than the brutal strengthening exercises.

Spine Stretching and Strengthening Exercises

Getting Started

Warm up. Before doing the following exercises, warm up with 5 to 10 minutes of low impact activity like walking or riding a stationary bike.

Stretch. After the warm up, do the stretching exercises, then move on to the strengthening exercises. When you have completed the strengthening exercises, repeat the stretching exercises to complete the routine.

WARM UP, STRETCHING, STRENGTHENING, STRETCHING.

Do not ignore pain. You should not feel pain during an exercise. If you experience pain then talk to your doctor or physical therapist. Also if you are unsure how to do an exercise then ask your doctor or physical therapist.

 

STRETCHING EXERCISES

(TO BE DONE BEFORE AND AFTER THE STRENGTHENING EXERCISES)

Head Rolls. Reps 3 Hold 5 secs

Can be done sitting or standing. Roll your head clockwise and hold for 5 seconds to the right, back, left and then once back at the front, repeat. Then do the same anti-clockwise. Repeat 3 times each side.

 

Kneeling Back Extension. Reps 10 Hold 5 secs

Begin on your hands and knees with shoulders positioned over hands. Rock forward onto your hands, round your shoulders and drop your lower back to the floor. Hold for 5 seconds.

Rock backwards and sit your buttocks as close to your heels as possible. Extend your arms and hold for 5 seconds. Repeat 10 times.

 

Sitting Rotation Stretch. Reps 4 Hold 30 secs

Sit on the floor with both legs extended. Cross one leg over the other. Slowly twist towards your bent leg putting your hand behind you for support. Place the other arm on the side of your bent thigh to help you twist further. Look over your shoulder and  hold for 30 seconds. Slowly return to the centre. Repeat on the other side. Repeat entire sequence 4 times.

 

Modified Seat Side Straddle. Reps 10 Hold 5/30 secs

Sit on the floor with one leg extended and the other bent. Keeping your back straight, bend from the hip towards the foot of your straight leg. Reach towards your toes and hold for 5 seconds. Slowly round your spine and bring your hands to your shin or ankle (do not force). Bring your head to your knee as close as possible. Hold for 30 seconds, relax for 30 seconds. Repeat on the other side. Repeat entire sequence 10 times.

 

Knee to Chest. Reps 10 Hold 5 secs

Lie on the floor on your back. Lift one leg bringing your knee to your chest. Grasp your knee or shin and pull your leg in as close as possible. Tighten your abdominals whilst pressing your spine to the floor. Hold for 5 seconds. Repeat on the other side, then pull both legs in together. Repeat the sequence 10 times.

This is the end of the stretching exercises. 

 

STRENGTHENING EXERCISES

Bird Dog. Reps 5 Hold 15 secs

Begin on your hands and knees with shoulders positioned over your hands and your hips directly over your knees. Tighten your abdominal muscles and raise one arm straight out to shoulder height, level with your body. Hold until you feel balanced, Slowly lift and extend the opposite leg straight out from your body i.e. left arm, right leg and vice versa. Tighten buttock and thigh muscles and hold this position for 15 seconds. Slowly return to the start position and and rest for 30 seconds. Repeat with other side. Repeat entire sequence 5 times.

 

Plank. Reps Hold 30 secs

Lie on your stomach with forearms on the floor with elbows directly below your shoulders. Tighten your abdominal muscles and lift your hips off the floor. Squeeze your buttocks and lift your knees off the floor. Keep your body straight and hold for 30 seconds.

TIP If you are unable to do this, bring your knees to the floor and hold with just your hips lifted.

Slowly return to the start position and rest for 30 seconds. Repeat 5 times.

 

Modified Side Plank. Reps 5 Hold 15 secs

Lie on your side with top leg straight and bottom leg slightly bent. Elbow should be directly under your shoulder with with your forearm extended on the floor in front of you. Tighten your abdominal muscles and raise your hip off the floor. If you can, straighten your bottom leg and raise your knee off the floor (as shown). Keeping your body straight hold this position for 15 seconds. Slowly return to the start position and repeat on the other side. Repeat this 5 times on each side.

 

Hip Bridge. Reps 5 Hold 15 secs

Lie on the floor on your back with arms at your sides. Bend your knees with your feet flat on the floor. Tighten your abdominal muscles and buttocks and lift your pelvis, keeping your body in a straight line from your shoulders to your knees. Hold this position for 15 seconds. Repeat 5 times.

 

Abdominal Bracing. Reps 5 Hold 15 secs

Lie on the floor on your back with arms at your sides. Bend your knees with your feet flat on the floor. Tighten your abdominal muscles so that your stomach pulls away from your waistband. Hold for 15 seconds. Repeat 5 times.

 

Abdominal Crunch. Reps 10 Hold 2 secs

Lie on the floor on your back with knees bent and feet flat on the floor. Place your hands at the back of your head with elbows open wide. Tighten your abdominal muscles and lift your head and shoulder blades off the floor. Keeping your back flat to the floor hold this position for 2 seconds. Slowly lower and repeat. Repeat this 10 times.

Physiatrist Phone Consultation – March 15 2021

This phone consultation was to go over my condition and medical history. From this conversation an appointment was made to see her in person 3 days later.

Physiatrist Appointment – March 18 2021

The physiatrist had looked over the files that my family doctor had provided her with and the results of tests. She seemed very surprised that there had been no MRI done of my lumbar spine and would set that up for me. That came back for July 4th 2021 which was not my choice of birthday celebrations for myself!

She explained, as well as showing me on a chart, where the facets are and how that can deteriorate which is what needed to be checked on the lumbar MRI. When emailing my doctor later to update her she told me that there had been an X-ray done of my lumbar spine and nothing looked out of the ordinary. At this stage I could not remember the X-ray of my spine but looking back over my notes it was done along with the hip X-ray as the first test.

She had me stand and bend and looked at my posture and then said she would arrange for the MRI. She completed the form along with my family doctor to send to my insurance company to support my claim for long term disability payment.

 

Ultrasound Vascular (aneurysm/leg/foot) – March 22 2021

The vascular surgeon has his own office with ultrasound machines and it is far easier than trekking to the local hospital. As of yet due to Covid 19 I have no idea what this specialist looks like as the technicians do the scans and then he phones me with the results. This time I was escorted to a different room with different machines. Rather than just an ultrasound for the celiac artery aneurysm near my sternum this one incorporated an ultrasound of both my right leg and right foot. Although originally it was for the aneurysm he was concerned about the numbness still in my right foot. This took about 40 minutes to do and blood pressure was taken in a couple of places along my legs which was a weird sensation. Also my big toe was  monitored.

 

Neurologist Appointment (EMG) – April 13 2021

The doctor checked my leg and foot with electric stimuli which is small electric shocks. This was not a pleasant experience although not really painful . Basically parts of my leg and foot were given electric shocks to test reactions. I know the reaction was slower on some parts of my right foot but there was still a reaction. She started with pin pricks, asking me if I felt it and then graduated to shocks. The most unpleasant part, which I was warned about prior to her proceeding, was when she did electric shocks back to back for several seconds. That was not at all  nice and was very unpleasant. As soon as it’s over though you do not feel anything. No wonder dogs stop their behaviour with a shock collar.

 

Vascular Consultation/Reports – April 26 2021

This was a phone consultation that was moved forward from 2.30pm to 12.30pm the day of the consultation. The problem was that the receptionist had already given the doctor the phone list before she phoned me and changed it. Hence as I was about to phone the office on a different phone I finally got my call  an hour late at 1.30pm .

Everything is in order and there was nothing found with my leg and foot. As for the aneurysm it is still the same and has not enlarged. Initially I was told it would be looked at every 6 months but the doctor decided that a yearly check up would be sufficient. I was told that when, or if, it gets to 2mm (currently 1.3mm) then they will intervene with surgery. The surgery is as non-invasive as possible and is apparently not much of a deal. I asked if it was rare as I had read so and he confirmed he had seen a few but it was relatively rare. I read that statistics say 4% of all aneurysms are celiac artery ones.

1st dose of Pfizer vaccine – May 26 2021

Despite my reluctance to a vaccine that has not been time tested I decided to go ahead with the first vaccine. My reluctancy stems from my mother being offered Thalidomide for morning sickness (which for my mother was round the clock every single day for 9 months) while pregnant with me. Thankfully she refused and I did not end up being born deformed like so many other children. I was also reluctant due to the news that the Astra Zeneca vaccine was related to blood clots. Already having an aneurysm I was wary. I also, being English, read British newspapers online and was hearing about Astra Zeneca issues way before I heard about it in Canada. On many things we seem to be behind Europe here in Canada. Once the options were down to Pfizer or Moderna then  I decided to go ahead. I suspect that in the future for travel purposes it would be an issue if you could not prove vaccination and although travel is  not in my plans I decided the time is right to just go ahead and get this done.

I went to a nearby Ice Rink for the vaccine and it was extremely well organised. I had booked online a week prior and turned up on time and barely waited 5 minutes. Everyone had to sit in another area for 15 minutes afterwards to ensure there were no immediate adverse affects, The 2nd dose automatically booked online in the booking system when booking the first dose but since then the Ontario government have declared that they want to speed up the 2nd doses and have everyone vaccinated by the end of August 2021. It is staggered depending on the date of the 1st dose but we shall see what transpires. As it stands now my 2nd dose is set for September 15th.

Physiatrist phone consultation – May 28 2021

The physiatrist confirmed that the neurologist had not found any issues with the EMG. I am bemused as well as the doctors because my foot and toe are still numb 2 years after hip surgery. The physiatrist is waiting for the MRI in order to assess my lumbar spine but did suggest that I was a candidate for injections. Exactly the details of those injections I do not know  but should it come to that I will ask those important questions then. I sometimes get the impression when talking to doctors, especially about results, that I ask more questions than they are used to. I seem to have to interrupt to ask questions but then again in Covid world the face to face interactions have become phone consultations and there is no body language to gauge.

During this conversation we discussed how the physio was going and as I was not feeling any benefit after 6 sessions the physiatrist advised me to stop going until after the MRI and when we get the results from that we can take it from there.

Medication Issues

Unknown to me, my family doctor placed a 28 day repeat on my Tramadol. As yet I am not sure about the Percocet or Meloxicam at this point. I only found out about the limit on the Tramadol when I phoned the pharmacy because my husband was unable to pick the meds up for me at the weekend. I phoned and talked to the pharmacist who explained that the doctor had put a 28 day repeat on the Tramadol and he could not renew that prescription until the 29th day. I emailed the doctor (because of Covid this is still the protocol) and explained that it meant I was left on day 29 without meds until I went to collect them and that caused severe pain to do that. I got a terse reply with an explanation that it was a controlled drug and it was the only way she give me repeats. I am waiting for reply back to my email stating that this is the first time this has happened and I have had Tramadol previously with repeats without a 28 day repeat. I really am at a loss as to what has changed and the reply to my email came back as an automated email to tell me that the doctor is on vacation for the next 2 weeks.

 

MRI Lumbar – July 4 2021 (my birthday)