Prolapsed Disc

[Plan 10]

Well, further to the previous kerfuffle about the NSAID's and flying, it's all come down to an L5/S1 prolapse, aka your common or garden slipped disc. Two months in the horizontal plane coupled with Physio and the course of drugs means that I'm now in the position of having been direct pain free last 10 days or so, though still mild anaesthesia and deep calf pain in one leg, and a stone-in-shoe type pain in foot... none of which are requiring pain killers to control.

Problem is this. Surgeon will operate, or epidural, but recommends a period of waiting, and I'm not keen on either of the first two options with no direct pain. Only way to see how this will stabilise is to get back in the saddle. But the recertification process will place me fully fit (ie fit to operate a full roster) where all concerned reckon that it would be best to ease back in for a period.

How to go about that is my current dilemma. I feel fit to operate for sure now (though would like 10 or so more pain-free days just to be absolutely certain), but do not wish to launch into an intensive series of shorthaul rotations straight away. It feels like a Catch 22 situation right now, but I realise I am too close to the process to have relevant perspective.

Would appreciate some thoughts, input and experience from all with some knowledge of either the condition or it's impact.. Also anyone who has had a discectomy or epidural procedure and returned to flying, would be very keen on your experience of managing the process.

Thanks a lot in advance, theres some great gen to be had in this little part of the site.

Plan 10

[DX Wombat]

Was this a work-related injury to start with? If so, it would be worth your while speaking to your Union Representative. Might be worth doing that anyway as he / she should be able to give you appropriate advice.

[GK430]

Went through this about 12 years ago - sure didn't fancy the thought of an epidural.
Brilliant Orthopaedic surgeon put me in a plaster jacket for six weeks. Felt as though I would fall over when it came off, but with care, returned to full fitness.
Make sure you have good lumbar support whether it be flying or driving!

[TTail]

Sorry to hear about your condition. I'm in the same situation, however x-rays show another prolapse in the same area as well. I have tried alot of different ways to fix this and the pain was at times so severe that I saw no hope.
I tried physotherapy, chiropracty, accupuncture, Feldenkreis,massage,health club,painkillers and I almost paid off one of the best surgeons around to have him operate on me. Fortunately he was a man of integrety and because of my symptoms - or lack thereof - when not in accute pain he would not do surgery. Then I discovered the thing that worked magic for me, the McKenzie method. It's so easy you wouldn't believe it's true but fact is that I now am able to manage my back, stay painfree and slowly picking up all the sportsactivities I have been forced to give up for the past 15years.
Look it up on the net, buy a book, but try this ! It will cost you nothing and the potential benefits are huge. From sometimes having to crawl out the cockpit door I now do long-haul ops without any difficulty at all.
Best of luck to you.
TTail

[QDMQDMQDM]

Glad to hear you're feeling somewhat better, but it does sound like you're caught in a Catch 22 where you can't be 'half' fit for flying.

The only thing I can add into the mix is that I have had two patients recently who have had lumbar microdiscectomies and the results have been excellent. Much better than the lengthy grinding agony which most NHS patients have to put up with before they eventually, gradually improve.

Interestingly, the patient I saw today had the op 1 month ago and he is now fine, but his surgeon told him to wait 12 weeks before going back to work. (He is a dairy farmer, though -- slightly more strenuous than pilot!) The surgeon also told this fellow that pain-wise the evidence is that microdiscectomy patients do better up to four years post-event, by which time the conservatively treated patients catch up and are just as good. Four years, though, is a long time to have a bad back.

QDM

[Plan 10]

Thanks folks,

Yes QDM, very much a product of my own reticence here... not having been blessed with a gardening accident, or a bad heavy lift to blame it on, it really has to come down to the sedentary nature, and whilst I could easily be considered fit to fly, I would rather not leap straight back in to a full time roster, as i believe it was the exposure to the seating position (plus my blatant ignoring of the pain mind you) that led to this in the first place

I do suspect the confined-legs twist used to pick up a heavy tech log from behind and beneath a significant factor.. what DX may consider work related injury, but proving it a different kettle of fish. Anyway, the mechanics of where I stow heavy items that require retrieval from the seat will change in the future.

I should have added that I was given Mackenzie Group exercises from Day one of physio, and that plus Interferential and some manipulation have i feel contributed significantly to lowering the pain levels. With pain where it is now, almost gone, I would certainly not elect for surgery; would rather leave that for a last resort.

Appreciate you all taking the time to offer your experience here.

Plan 10

[Croqueteer]

I had a disc operated on about 7 years ago, (lapidectomy?) due t0 severe leg pains. Fortunately the company provided us with private health, and when I got to the point where I could hardly get up, and was drugged with pain killers, I was refered to a consultant in Little Aston BUPA hospital (BHX) Three days later, I was given an MRI scan (another story) and the consultant showed me a perfect picture of the problem, the disc looked like a chisel trapping an electric cable against a wall in the fourth disc up,and he said when that was removed, the pain would go. A couple of days later he operated and I have never had a twinge since. Apart from the skill of the surgeon, the MRI scan was the clever bit showing exactly where the problem was allowing the surgeon to go directly to the spot with a minimum cut. The recovery time to medical back is about three months. This was after trying all the other remedies without success. Three collegues also had similar surgery about the same time, all with success, although if the disc has calcified around the nerve, the op can take a long time. Go for it.

[Loose rivets]

It sounds to me as though you have been given good advise, but do not be in too much of a hurry. While there is some indication of pain / strange sensation in your leg / foot , there is a reason.

Just in case, I will mention that it is my earnest advice to NOT to have any form injections etc. or probes or devices such as catheters, heated or not, put into the disc. A very experienced spinal surgeon mentioned to me the other day that there is always scarring following these procedures (hindering subsequent surgery) and the attempts at “cooking” the disc (to shrink and stabelise it) have been very harmful in the long term for many people.

Don’t hurry back, letting this become chronic will not help your career.
Where possible the middle route is the best way. Very mild traction in your local hospital is often good, but avoid any form of manipulation other than the McKenzie, unless it is approved by a surgeon. It is astounding how so-called skilled people will launch into vigorous procedures without any knowledge of the individual injury. So, very gentle traction and exercise during a long healing period first. Weeks not days. Slow increase in use and avoid any twisting under load, and lifting anything heavier that a tech-log. Swimming is good. If all trends show an improvement, however slow, there is light at the end of the tunnel

There are still two imperative points. There must be a steady improvement on stomach and back muscle tone. And absolute vigilance about not letting the damaged area become inflamed. Flying is not the problem if you are in a well engineered seat, (tightening stomach muscles every time you lean forward will help) it is more likely that you will irritate it by long drives. The vibration is sharper edged than turbulence, and given that disc pressures are at their greatest when seated, the vibrations cause peaks of pressure that may do harm.

As an aside, there has been some research at Birmingham and in the US, on treatment of long term pain with the same antibiotic that is uses to treat teen-aged spots! This followed finding this bug in some L5 annular tears. The feedback however has not been very encouraging, as it is believed that the absence of normal blood supplies makes the delivery difficult. There is a huge amount of info on the web on this and other facets (’scuse the pun ) of lower back pain.

[Paintbox]

Plan 10. If you haven't tried it yet, see if you can get your doctor to refer you to a physiotherapist that does the Alexander Technique. It sort of realigns the body, corrects bad posture and may be helpful. Worth a try, and would be unlikely to do any damage.