could be a work thread. Should I not go to work and do physio instead?

[PavlovtheCat]

Struggling with ongoing back pain due to disc problems. Saw spinal pathway team today to look at next steps including surgical options. Been given asked to try physio for a couple more months before further MRI to see if I need discosectomy (?). Anyway. The consultant (senior physiotherist who is back specialist working with neurosurgery team) said I need to do exercises each day as often as poss and also to ramp it up, push myself hard. He said if I do it right it is going to really hurt and advised me to up my painkillers to get through it and keep it going for several weeks.

I told him my concerns re painkillers namely i simply cannot function on a hire dose of painkillers and have tried different ones already. He looked at me in a you need to consider taking time off work for a while' manner, and says I need to do it if I stand any chance of recovering from this, but if I do it, then I do stand a chance of recovering from it.

So, want I am mulling over and would ice some advice and opinions on is

1. Is is ok to deliberately cause myself more pain knowing it will render me incapable of working, although it will put it in best position of recover long term? I could do the exercises and see how I get on without upping my painkillers, but that means I could render myself unable to work due to too much pain. But maybe it won't
2. Is taking very strong medication that helps with the pain a valid reason for not going to work? I could up my meds in anticipation of the pain, which is what he is indicating, but this will render me incapable of working due to the side effects of the painkillers I am taking.
3. Should I consider just not doing my exercises as thoroughly as physio has suggested?

I have been doing the excercises. They hurt, so I have not been doing them as much, or with as much vigor as I need to really, he wants me to up it as of now. A bit worried about work, but also about my long term health, need to give it my full attention for a while now I have proper guidance (finally).

What are your thoughts?

Anyone about? Am in a lot of pain right now anyway he made me do lots of tests and practicing a new physio exercise, and it hurts so much I am trying not to cry in front of kids.

Do you have to drive to work? I think taking the painkillers AND driving would be a no-no.

What sort of work do you do?

I have had to have time off due to back pain myself... nowhere near as bad as yours though by the sound of it. I found taking the painkillers and forcing the exercise was worth it in the long run.

pavlov go to your gp and either get signed off or a fit to work note for reduced hours. You need to look at the long term. I am currently on half hours partly to allow me to exercise and recover from that exercise.

you have had so many conflicting opinions? Do you feel that this guy is really on the right track?

denial I am not sure. He seems much more confident than pretty much everyone else I have seen, apart from the last physio I saw, who referred me to the spinal pathway team, both he and the guy I saw today are senior physics and back specialists, so yes I think so. He actually showed me my MRI results, not the report, but the scans themselves, showed me what was degenerating, and why based on that scan the only surgery that would help would be spinal fusion. They don't do that at this hosp as they don't believe it works. He can transfer to other hospital where it is done, he has seen succes but said this is last resort when nothing else works. He has said that it is entirely possible that the tear has worsened or the disc is bulging further. If it is the bulge they would cut that away, less evasive and highe succes rate. But he wants me to try the aggressive physio first. If in two months leg pain has not eased or worsened I will have MRI and discussion with neurosurgeon colleague, and some more nerve blocking injections etc etc if not surgical route

He has said, even if this is not bulging more, these episodes are going to continue for 'several years' as often people go through cycles of pain that tend to last years. I think in with that was the fact thAt the torn disc will crumble away completely eventually and will no longer cause pain. I suspect that is what he thinks will stop the pain and is giving it several years to happen.

He has made much much more sense than others I have spoken to. And I feel it is the right place to be. Can't think where else seems to want to fight my corner for me and get me mobile again. But, key to success is clear that i will have to do physio, and it will hurt. If I do this I might be able to avoid surgery.

I am so fed up with letting my work down though only just back as it is. Do you think physio would be able to feed into reduced hours while I do the exercises? Or is it always the gp? I work in customer focused role, with very vulnerable members of society, need to neon the ball, but I also do risk assessments, maybe I could ask to not do face to face so if I am high as kite I can just get my head down, drink coffee and do risk assessments.

thenifhtsky while there is some element of travel to some aspects, I have already been taken off those duties due to not being able to drive well in pain, and to restrict my movements at work. Dh drives me arm, I usually used to walk or get the bus.

denial the worst advice was from the stupid osteopath. My gp should have referred me straight to physio as they have been the ones to get things moving in the right direction. And quickly too. 7 months of osteo doing nothing but fobbing me off. 3 weeks since first physio and I have had a further 5 sessions, and a referral to spinal pathway AND the appt with spinal pathway taken place.

That has to mean this is the right guy...

Pavlov - I have seen your posts on another thread. I can only advise you from my experience. The likelihood is that where you work will never thank you or think you have done anything special if you try to soldier on (sorry if that sounds cynical). What you face is really choosing between short term misery and pain for long term benefit, maybe in the long run making you more able to work effectively and with less time off, or trying to please your employers to the detriment of your own health. In your shoes I would say sod it and really go for it, do as much as you can do to put yourself right, which will also benefit you in your home life too. I also know that if you were to ask work the official line (never mind the I-have-just-eaten-a-lemon-faces) the party line would be that you put your health first.

I think it helps to look at this in terms of what might you regret most if you didn't do it. Would you regret not having your career or not having tried to regain your health? Which would be the better option in 20 years time, to be doing well at work but still in pain and struggling or to be in better health but maybe not working? I think I would always go for health personally (bit like the nobody on their deathbed wishes they'd spent more time in the office thing)

I don't think any reasonable employer would expect you to put work before health. I suspect that even if it is just a small chance of recovery you could regret not trying for it.

fen yes, I think you are right. I think I know that I need to do this. But, it's just all such a mess. And it is going to be an awkward conversation to have. ESP as my boss noted how much less in pain I appeared today. before I was and poked. And colleagues have noticed how much straighter and easier I am walking. Because I am leaning on a crutch. And how much jollier I seem. Because I am on tramadol now not codiene!

Should I just make the decision and tell my boss tonight I won't be in tomorrow and why? Then see gp for sick note. Or hold off physio exercises and see boss at work and tell her I won't be in next week and will get gp note to cover. Or should I go to gp in the morning, and talk it over with him? My concern with that is if he signs me off, I won't have given my boss notice, she won't know til I call her after appt. if I tell her tomorrow, she will have time to cover my work, a little at least (only working tomorrow this week).

I might do that...go to see boss tomorrow, give her heads up ...

I am with fengirl on this.

Last year I had two weeks off because basically I and the professionals dealing with me thought I was miscarrying/about to miscarry because of the type of back pain I was having. I didn't miscarry thankfully but no reason was found for my back pain and it continued, plus as I entered the second trimester I started being violently ill travelling. I was in bits but I came back to work after those two weeks even though the docs would have signed me off for much longer as I was in such a state.

How was I rewarded for my diligence and hyperresponsibility? I was sent to work on a project that involved a two hour commute each way. Did I object or then get signed off? No siree. Do you think that was best for me? . Did I get any special thanks? Erm, no. In fact I ended up having to work for two weeks after the start of my maternity because I was so behind as I'd been struggling. I pointed this out to my manager in a matter-of-fact maybe I could be paid for working this extra time/not have these holidays taken off me yet and she just shrugged and said "that won't be possible but you MUST make sure you get it all done before you leave". Or what??? I was so resentful that one day I had said I might come in (this was my annual leave!) I decided not to bother and I had messages from two managers asking where I was as they were expecting me! They fully knew I was on annual leave before maternity as it had been signed off!

Just ask yourself what you would advise a friend. This is a no brainer. Don't take chances with your back, it's forever. Work is just work.

Pavlov - see gp and get signed off. Don't engage with work - from the sounds of it they will only try and make you feel guilty. You NEED to do this.

thanks ladies for your ever continuing support.

dh thinks i should work on reduced hours and see how i get on. he thinks i will benefit from routine of work and that i will isolate my employers and colleagues further if i take more time off now.

I see his point. but, not sure i agree. he does accept the decision is mine to make and he will support me whatever i decide to do. i think i will sleep on it and make a decision in the morning.

i am leaning towards going in tomorrow and getting it over with, then i have 4 days to crack on with physio before i am due back at work, so can talk to gp and get signed off next week if i am in a lot of pain/on higher meds with it, which is likely.

you are all right. i have to put myself first, for my own sake, and that of my family, and it will benefit work too long term.

I think you need to fully engage with the physio. I think you will never forgive yourself if you don't. Sounds a bit dramatic I know but we are talking about your mobility.

Physio did say to me 'this does not have to disable you...if you don't let it' and I guess that it what he means. I feel ok today, enough to do my current phased return hours of 6. so, my plan is to go in, and tell my boss that I am starting full on physio today and the likely outcome of that. I am not at work thurs and Friday this week, so no work to cover for rest of the week, that gives her time to cover me next week for a couple of weeks, unless i find by Friday that I can manage some hours ok, then I will probably opt for that. But am aware that some hours then struggling and having to stop completely is messing them around more than if I just accept I can't work for the time being. I know it is about me and not them but I have worked there for 10 years, and it is my career job. I have already had to postpone my diploma as I cannot manage it at the moment.

I will though, absolutely take this seriously, spent a lot of time awake last night as meds keep me awake, and thoughts about where I want to be in 2 years. I want to be body boarding with the kids, kayaking, feeling good about myself, I want to be fit and well, so, I have to do this now.

You are all right, if I reach 40 and I am disabled and I look back and think 'I could have done more to prevent this' I will regret it. If I try, and that happens anyway, I will know it was nothing I did or did not do.

Many places don't do spinal fusions as there is no evidence that they work. Really surprised that he has suggested/recommended this.

Also surprised at the 'push yourself hard' advice. I thought building up gradually/pacing was the advice to people in your position.

Hands up, I've not worked in this area for a while but have friends that do and this agressive approach seems quite extreme, especially if you've only had the problem for a few months. (I use the word 'only' relatively of course)

Have you discussed your concerns with him. Where is this advice coming from? I'd be wanting to see the research which demonstrates the efficacy of his approach.

Have you been offered/had an epidural?

Hope I've not thrown a spanner in the works. Almost didn't post but felt I should offer a fresh perspective.

I feel for you. I am going through horrendous back problems too although I'm not in the UK so I think the approach is a bit different. I am just about to have a discectomy and spinal fusion which is really my only option. I was really scared of any surgery, but having talked to lots of people and researched a lot have realised it can be the right option in certain circumstances. One reason for the fusion is with no disc left the bones will rub on each other causing additional problems that often neccessitate fusion plus other things at a later date.

As regards work/physio/medication- you have to do what is right for you and be selfish about it to protect your health in the long term. You need to remember your goal and desire to body board, kayak etc with your family and make the decision that is right for you to get to that point. I run my own business and worked for as long as I could which distracted me from my back problems to some degree and kept things slightly normal, however I got to a point when it was detrimental to my health so stopped. This has caused no end of problems to a lot of people but I had to do it, not a decision I took lightly though. If you stop work, have something to focus on other than your back to help with that distraction and to maintain some normality otherwise your emotional state can be even more affected.

Good luck,remember what you are wanting to do with your family. You have had to endure so much already so you need to do the best thing for your recovery.

captain he has said spinal fusion is not done at my current hospital for those reasons. He has not recommended it, he has said it is an option in the long term once everything else has been tried.

I have had this problem get steadily worse over the last 2 years, and since christmas much much worse, and significantly worse 'episode' since beginning of June. I have had one caudial epidural which worked well for about 2/3 weeks, this guy said there are more accurate ones as the caudal one is quite hit and miss. Also had some acupuncture and will be having more most likely as part of physio. And before June I was relatively fit as I had been doing Pilates etc to get myself strong again, song with swimming and body balance.

His view of pushing myself was on the basis that I am in a lot of pain anyway, I need to get straight or else nothing else will work, and I need to strengthen my muscles, and this is going to hurt more in the short term. He has said to pace it, but not as slowly as we have done so far, but that slowly is going to be pushing myself and will hurt, I canot avoid it hurting more whatever I do to help. I think I trust him. It can't make it worse really can it?

Anyway, I went in today, and spoke to my boss about physio, she said to me before I did if I needed to not be at work for a while , or at least reduced hours. I said reduced hours for sure, possibly not at all for a couple of weeks. She was very supportive about it, encouraged me to do what I needed to do to stand a chance of recovery and reduce likelihood of surgery in the future. She then went and told my colleagues! Well some of them, my admin support, and now I look well flakey! So, work is covered next week, in case I am not in, and by next week I should know if it will be more than one week off if I am not in, or have an idea about reduced hours, chats with gp would have taken place.

She is also referring me to something to do with disability support, which is a policy that means I think, we can look now at plans in place for if/when my back goes again in the future after this period, look at things like if I need new desk, or whether at certain times working from home using dictaphone/encrypted memory sticks possible etc. boss herself has a disability and she has used this support to have a computer with voice recognition and has additional admin support to type her notes for her. It is not OH, it is about inclusion and ensuring those who are protected under the equality act are looked after. Or something like that.

The only problem with it all is I saw the resentment in some of colleagues faces, that 'here we go again' look and I had to stay longer to help ensure things were covered/urgent things done before I left. Glad I did, but I was fading by the time I left!

Did exercises this afternoon, doing some more in a mo. and yes, it hurts afterwards!

catper oh your poor thing. I hope the surgery brings you some relief from pain. My l5s1 disc is dehydrated badly and consultant yesterday and osteo I saw a while back did tell me that eventually (few years?) it will be gone completely. I asked what would hold my vertebrae apart and he said they would fuse themselves together ( ie collapse and fuse) but it seems not necessarily, as clearly not for you. That sounds so painful. I am not looking forward to when that happens.

Pavlov- Thank you. I would not worry about colleagues who just don't get it. This is so hard emotionally as well as physically that you do not need extra pressures. Sometimes the medication can make everything seem so much worse. My problems are L5 S1 with the disc completely out of place and sitting on nerve roots. I am under Orthapaedic Surgeons rather than a neuro team who explained how the vertebra could fuse on their own but also explained what that meant for me ie. on going pain etc. I am not looking forward to the surgery but know there is no way forward from where I am without it. So I either stay as I am or have the surgery that will be painful and hard work, but is going to put me into a better place than I have been for a few years although not back to 100%.I can live with that!!

I found some temporary relief with accupuncture and a TENS machine was good as it distracted me - multiple different sensations instead of only painful ones. I haven't been able to do any exercises for fear of permanent nerve damage by my medical team but can understand how painful that would be. Keep focusing on where it will get you too by going this now. Best of luck and take care.

I really hope it is successful for you. When do you have the op?

My op is on Wednesday.

How are you going with the exercises? Hopefully once they start taking affect you will be feeling much more comfortable.

Wow that is really soon. How long is recovery? About 3 months ? How long in hospital? Are you paying privately or are you covered by insurance?

Exercises are hurting a lot. Funnily at the time I am doing them it is not too bad, but as soon as I stop, lots of pain, and the hours after pain increases. This morning my back is very sore and stiff. But, the sciatic pain does not feel worse (although not better either, yet). In addition to the exercises I am trying to walk straight and stand straight. That is making sciatica worse. But, I have to give it time and keep trying.

I feel for you with the exercises as I know the pain is bad enough before trying to do anything. Keep persevering- remember where you are heading. Try and be as comfortable and distracted in between the exercising so you are not focusing on pain all the time.

Everything has moved really fast for me- its all effectively through the public health system. I ended up being rushed through a series of appointments/MRI scans after things got pretty bad (I have been under somebody for the last couple of years though with back problems). That whole process from first specialist appointment to op would be 4 weeks and about 8 weeks from the injury that caused the latest problem to surgery.

I will be in hospital for 5-6 days and have a very specific regime of sitting/lying/walking that I then have to follow with my local physio. We live in a rural area, a 4 hour drive to the hospital so I may be in a little longer than usual due to this. I could be off work for 3 months although that would be really bad for me so really hoping I can return before then. My job, my own business, is very physical which makes this harder. It is a 6-9mth recovery with a lot of hard work in terms of exercising.

It was a big decision to go for the surgery, but having discussed with 4 different specialists including a couple of family friends who are Ortho consultants from the UK, they all said that I needed the discectomy/fusion.

How are you getting on pavlov?