Mayo Visit Today - What I Learned...

Got checked in at 7:15 for a 7:30 appointment and was called back at 7:35 where I waited a long time.  I can only assume the doctor was reviewing my information.  She was very thorough.  She first asked a lot of questions, all of which I had answers to written out ahead of time for her.  She reviewed my document but did not keep it since I also had to fill out another form there with similar information.  After answering lots of questions about pain levels, history, what I've done thus far, complicating factors, etc. she went into a very thorough review of my films.  The X-Rays (where I bend forward and back) shows arthritis in my back.  I didn't know that!  The MRI shows that my discs are relatively healthy (plump, full, etc.) although L4/L5 is what she would describe as "stenosis" but she would not call it "severe degenerative disc disease" as it's been called locally.  When she switched views on the MRI from a side view to a cross section, she called the L4/L5 area "angry looking."  It is the source of all of my issues, including the slippage (spondylolisthesis) causing instability.  We then switched to a physical exam.  She did a neurological exam and tested strength.  She quickly found the "ouch" spots - the L4/L5 location as well as the tailbone.  She referred to both as "tender."
She explained that surgery is called for when you have three issues:

1. Weakness (I have none)
2. Loss of control of bladder and/or bowel (thankfully not)
3. Pain that is not resolved by other means (this is the category I fall into...but we've not yet exhausted other means)

Bottom line:  We are going to try gabapentin (Neurontin) because the pain that causes me the most issue is nerve pain.  The nerves are compressed at L4/L5.

Other stuff I learned:

She is OK with putting off surgery because my neurological exam was "reassuring."  She realizes that for me, one surgery is really two since I'd need to do neck surgery first to resolve the hyperparathyroidism.  She did say that most of her patients in my situation do opt for surgery and that planned elective surgery is much better than emergency surgery.  But for now, we will exhaust other options.

She is a big fan of Physical Therapy and is glad I did it and wants me to continue the exercises daily.

The epidural injections are "useful" from time to time and she said to continue doing that locally at the pain clinic as I see fit - not to exceed 3-4 injections per year.  I've only ever done two.  She suggested injecting at L5/S1 and letting the medicine "spread" from there.  I'll mention that to the pain clinic.  I'll plan an injection before vacation.

For tailbone pain she suggested a cushion with a cutout.  Mayo has a great store, so I bought one there for the ride home.  It did not help one bit.  Oh well.

The physical therapist has me doing a "nerve glide" or "nerve flossing" exercise.  She said "it can't hurt" but she doesn't know if they help any.  I'll keep doing it - it takes 1.5 minutes a day.

No chiropractor care allowed.

She said some of her patients get relief with acupuncture.  There is no literature to support that, but she said "it can't hurt" so I can try that if I want to.

She does not prescribe back braces that often.  I'm using one from the surgeon.  She said she prefers that I do core strengthening to create my own "corset" made of muscle, but if the brace reminds me to not bend at the middle, she is OK with it.  I sensed she really is not a fan, so we'll see if that's something I can minimize.

Stretching - she said to be careful as it can aggravate the nerves in the legs.  She noted that my hamstrings are very tight and said to "go easy" with stretching.

She said weight loss is always a good thing, so I need to keep at it...I fall on and off the Weight Watchers wagon several times a week...gotta get it in gear!

Swimming - she loves that I'm in the pool.  She said pool exercises are great and to keep that up.

Please pray that the gabapentin provides some relief without side effects.  Biggest side effect is sleepiness.  If that's only at night, this might be a good thing ;-)

As always, the pain gets lifted up in prayer as a reminder of how blessed I am.