Not sure if what I am experiencing can be linked to PCa. What started out as leg cramps evolved into excruciating nerve pain similar to Sciatica but emanating from L5. I had such pain that I was awake all night for 3 nights in a row. I was unable to find any comfortable position Found relief in a Canabis product only made and sold in California, THC 100 Releaf capsules. They shut down the pain completely however All I want to do is sleep.
Any thoughts on the connection?
From todays MRI
CONCLUSION:
1. There is evidence of bilateral sacral alar fractures, which appear new relative to prior imaging. Patient does have a history of osteopenia diagnosed via DEXA scan on 10/28/2021. The possibility of the development of osteoporosis with insufficiency
fractures of the sacrum should be considered.
2. Multilevel disc disease and facet arthropathy throughout the lumbar spine, most pronounced at L4-5 where there is moderate central canal stenosis, severe bilateral subarticular stenosis and mild to moderate bilateral neural foraminal stenosis. Please
see the body of the report above for further specific details regarding degrees of stenoses at each individual lumbar level.
Dictated by (CST): Malik, Amaar, DO on 1/03/2023 at 1:51 PM
Finalized by (CST): Malik, Amaar, DO on 1/03/2023 at 2:05 PM
Narrative
PROCEDURE: MRI SPINE LUMBAR (W+WO) (CPT=72158)
LOCATION: Edward
COMPARISON: EDWARD , MR, MRI PROSTATE (W+WO)(CPT=72197), 4/20/2022, 12:23 PM. North Naperville, XR, XR HIP W OR WO PELVIS 2 OR 3 VIEWS, RIGHT (CPT=73502), 12/15/2022, 5:04 PM.
INDICATIONS: Low back pain radiating to right lower extremity with weakness.
TECHNIQUE: Multiplanar T1 and T2 weighted images including fat suppression sequences. Images acquired in sagittal and axial planes. Intravenous gadolinium was administered followed by multiplanar post-infusion T1 weighted sequences.
PATIENT STATED HISTORY:(As transcribed by Technologist) Patient complains of lower back pain and right lower extremity weakness.
CONTRAST USED: 17 mL of Dotarem
FINDINGS:
LUMBAR DISC LEVELS
L1-L2: No significant disc disease noted. Mild bilateral facet arthropathy and ligamentum flavum thickening. No evidence of stenosis.
L2-L3: Mild disc desiccation and bilateral facet arthropathy. There is a small right posterolateral disc protrusion into the right subarticular zone measuring 6 mm in the AP dimension, best seen on sagittal T2 image 14 of series 5. There is secondary
mild to moderate right subarticular stenosis. No central canal or neural foraminal stenosis.
L3-L4: Mild disc desiccation with mild disc height loss and mild broad-based disc bulge. Mild to moderate bilateral facet arthropathy and ligamentum flavum thickening. There is mild central canal stenosis, moderate to severe bilateral subarticular
stenosis and mild to moderate bilateral neural foraminal stenosis.
L4-L5: There is mild to moderate disc desiccation with disc height loss and broad-based disc bulge. Moderate bilateral facet arthropathy with hypertrophy and ligamentum flavum thickening. There is moderate central canal stenosis, severe bilateral
subarticular stenosis and mild to moderate bilateral neural foraminal stenosis.
L5-S1: Moderate disc desiccation with disc height loss and broad-based disc bulge. Moderate bilateral facet arthropathy with ligamentum flavum thickening. No significant central canal stenosis. There is moderate bilateral subarticular neural
foraminal stenosis.
PARASPINAL AREA: Normal with no visible mass.
BONES: There are bilateral sacral alar fractures with surrounding bone marrow edema and surrounding enhancement. Mild to moderate multilevel facet arthropathy throughout the lumbar spine. No lytic, blastic or destructive osseous changes are noted. No
evidence of lumbar spondylolysis.
Pain Dr. who ordered MRI is going to inject Cortisone to releave pain. Any thoughts?
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Could you do the nuclear medicine bone scan to see if you have any bone fractures?
I hate such a detailed reports and you and up with cortisol despite a possibility of having bone fractures?
I am not a doctor but I would go mad with such a report.
That is good that you did the MRI first to see are your nerves and spine compressed or not.
I believe you need a nuclear medicine bone scan and the CT scan to see better your bones, fractures etc.
How your PSA is doing? What is it? Is it going up?
The PSMA PET CT would show if it is a cancer doing a job?
Therefore MRI, then bone scan and possibly PSMA PET CT scan if you believe that the pain is cancer related. You may be able to SBRT the cancer if it is a cancer growing. If the pain is related to fractures than maybe you should be careful to use cortisol injections.
As someone who has suffered back muscle spasms and issues with symptoms related to sciatica which have been debilitating in the past, imo you need to decompress your spine.
The easiest way is to get a pullup bar (from target etc $30) and just hang from your arms (not neck, yet (jokes)). Do this several times per day for as long as you can. In several days your muscles will relax a little and enable you to slowly decompress your L5 discs. This is not a quick fix. This is something you may (and should do forever) to reduce the risk of injury and reoccurrence.
Progress to pull-ups if possible to strengthen your core and back muscles. There are plenty of videos on Youtube from 'Bob and Brad' and others to guide you.
1. There is evidence of bilateral sacral alar fractures, which appear new relative to prior imaging. Patient does have a history of osteopenia diagnosed via DEXA scan on 10/28/2021. The possibility of the development of osteoporosis with insufficiency fractures of the sacrum should be considered.
And you're on ADT and have been for some time.
My WAG (and I just basing this on some of my experience with a terrible bad back) - damage from activities in your younger days does eventually catch up with all of us. But that can be made worse by the ADT treatment.
That's one possibility made more likely by the ADT.
Strangely - this paper just arrived today. It's a bit old (2008) but the subject isn't time sensitive or the results being changed by advancing treatments.
At baseline, 53% of patients had osteopenia and 5% had osteoporosis. Within 6 months of starting ADT, general side-effects and bone-specific side-effects of ADT were documented as being discussed with 26% and 15%, respectively. Clinicians recommended lifestyle interventions to 11% of patients. Pharmacological interventions (calcium, vitamin D, and/or bisphosphonates)were recommended to 18% of all patients within 6 months of starting ADT, and to 26% and 67% of osteopenic and osteoporotic patients, respectively.
CONCLUSIONS
A minority of patients is being informed of bone-specific side-effects of ADT. Lifestyle and drug interventions to prevent declines in BMD were recommended uncommonly. Practices around bone health for men starting ADT are suboptimal.
(Bold added by me..)
In reading your bio which is quite complete, I didn't catch anything about any treatment or supplements to avoid osteoporosis. That's not a surprise to me, since I was never really warned about the possibility aside from my MO insisting I take fairly strong doses of calcium and vitamin-D. I've never been tested for osteopenia, before, during or after ADT.
I'd have to agree with the conclusion above - suboptimal (aka - sucks.) And the report on your recent MRI appears to reinforce this. What to do? Dunno - that's where the MO should be consulted.
sacral fractures occur following radiation. I was warned before I got radiation but it seemed unlikely. They are probably much more common than is realized. People blow them off as back pain. I know about them because I have them now and I’m struggling with them.
I Requested DEXA scan a year ago based on info from other posters on here. I saw the MRI results today and there is clearly some pinching going on near L5. Does not appear to be cancer related. However it could be due to aging accelerated by my total lack of Testosterone.
Oh - to your question - is the pain caused by cancer (I assume you mean a tumor) - from your MRI indications, that basically says no. I think it's up to your MD to interpret it for you, but my WAG (and it's just my WAG, nothing more) - it's age, existing damage perhaps getting worse due to the ADT. Still sucks, but it probably won't kill you.
It seems to me it is not the cancer but the degenerative disease of the spine which is compressing the nerves and causing the pain. The steroid injection if it works well could be of great help. You do not lose anything with given it a try.
Does it feel better or worse if you stretch or move?If the pain changes it is unlikely that it is from cancer.
E2 helped me on ADT. How are your electrolytes? Posture? Are your hamstrings tight? I had back pain in the 90s. At times I couldn't touch my knees. Custom orthotics did the trick. Chiropractors didn't help.
My wife gets almost instant relief from an inversion table.
I have bad joint pains unless I hydrate and take electrolytes. The pains make me think bone mets or arthritis. My MO looked at my labs and immediately said that my electrolytes were to blame.
Can’t really help or answer your question, but we found that magnesium flakes in the bath were quite helpful for Brian. Much more effective than epsom salts which also helped some. His spine Mets were extensive but he also had degenerative disk issues prior so he was a bit of a mixed bag on what the problem was. I wish you best of luck!
Sorry, but can you tell us what the difference is between Epsom salts and Mg flakes? I thought Epsom was Mg... are the flakes in a different form, or different potency? Do you have a brand you recommend? Thanks!
We preferred the magnesium chloride flakes. We used several different brands, easily ordered off Amazon. Someone turned us on to them at an alternative medicine type boutique. We were sold, but it really did seem to help more. Definitely dissolves easier into the bath which supposedly helps with absorption. They dissolve quite nicely, not leaving the grit. It’s probably all a bit of pseudoscience but if our minds told us it helped, it helped! Plus, it gave us an excuse to take a relaxing bath.
Fun! Best of luck. We spent more time on pain management than we wanted to but we made the best of it. Sometimes things would work, sometimes they wouldn’t but it was always a time for us to be in the trenches together. One day, ice would help, next day heat. Relief was always a time of bliss and we relished those moments.
We also noticed too he would have pain flares in specific areas. We’d get those under control, then it would start up somewhere else. Lower back would bug him awhile, then go days or even weeks when it didn’t. Then the shoulder, or the knee. Palliative doctor explained to us that often times the brain can only focus on hurting in one spot at a time. Weird. His mets were quite extensive though, unfortunately and he had all the regular problems of aging that most people have anyway.
Also, if you dont already have a massage table I suggest that as well. We just bought a portable one off Amazon as well as microwave spine length microwaveable heat pad. Brian said that table was the best $150 he ever spent 😉 I also second the inversion table IF doc says safe for you. He found all of these things helpful. He also did a lot of marijuana but it kept his opiate usage minimal even toward the end. Pain management consumed more time than we wanted but we made the best of it. If you have to make a spa at home, make a spa at home. Best wishes to your and your beautiful lady. Glad you have her!
A similar thing happened to my husband over New Year. He couldn't sleep at all. He has seen a physio a couple of times since and this has helped. This injury followed on from a painful muscle injury a couple of months ago that he sustained simply from walking up a steep hill - that injury took weeks to improve. Every time there is an ache or pain it is so worrying but I suppose the reality is that we are all getting older and the drugs certainly don't help in that respect. Good that you were able to get a scan to ease your mind. Pull up bar sounds like a good idea. I'm off to buy one.
Scout, sorry to hear about the pain. If your Dr. okays it, I get a lot of relief from my inversion table. Don't know if its appropriate in your condition, but might be worth checking it out if the cause is chronic aging and the long-term impact of cumulative wear and tear.
PS - Like the new photo of you looking all James Bond. And Coco looks stunning as the latest Bond girl
I can't speak to the fractures but have degenerative disk disease @ L5-S1 and while I use non medical terminology here (when my back goes "out") the pain is tremendous and relief is the extreme - Oxy for 5 days. When it happens, the pain is typically on my left side, travels around my hip and down to my ankle, but feels like it's on fire @ L5-S1. Fortunately I have only needed that about once a year over the last decade and I would never suggest it as a solution. I address the pain preemptively by stretching. I do that yoga frog pose every morning and once in the shower, touch my toes and hold there for at least 30 seconds, always dipping my knees when I return to standing upright. I know that laying around for days never helps me personally and walking does, even if I need to grab a cane, walking always helps but again, don't have fractures and am not a doc. Anything can cause it - a sneeze, cough, etc. You're physically active and thin so that is in your favor. I hope this is of some help. Oh and fwiw, been this way since my early 20's and not cancer related.
Hey swwags ! I have djd in every joint . An ortho doc told me that I now have no disc from L-5 down . I had a discectomy in the L-5 15 years ago . Somehow I’m not in pain yet? I’m Sorry that you’re suffering so much ..🥺
It’s a natural thought that any new pain could be a met. Our bones and joints are whittled down by treatments adt and no T . I’m thinking that this is not a met but your pain now is Osteo from APC treatments .In my first two yrs I had muscle and joint pains a plenty as I was stripped . So many of us go through this . Whatever it takes to help , do it! Hang in there ! 😎✌️
Any previous injuries or inherited problems are sped up on us . You know the saying “ If it doesn’t kill you , it makes you stronger “ that doesn’t apply to cancer treatments . They all deplete us . I told my new MO that I’ve aged in dog year since dx . I felt like 83 at 53 . Now im 61 feeling like 80 ,but still here .. Sorry you’re in pain . Feel better! 🙏
An indica thc edible should help you sleep. I haven't taken any for pain but for sleep. My girlfriend says I sleep more still (not as restless) when I take some. It keeps the monkey-mind quiet too which is the main reason why I take them. I was having some really persistent anxiety around the PCa that would keep me up at night - a few nights with an edible and things are under control.
I’d like to get me some of that thc100? Thanks for mentioning it . I need some sleep . Good luck ridding the pain .. Good thing ! coco is there ! ❤️🙏
My dad also experienced nerve pain which was originally said to be sciatica. He tried a lot of things (Epson Salt baths, sleeping with his legs elevated, inversion table, Aleve). The thing that helped the most was the medication Gabapentin (or pregabelin). It’s a nerve blocker. After seeing him in pain, I’d highly recommend asking your doctor about this.
As someone who's had 11 spine surgeries over the course of 80s-early 90s, none of which related to cancer, but due to horrific car crash, I can tell you what put my constant debilitating lower back pain out permanently is the aforementioned inversion therapy (decompression). I have an inversion table (Amazon) and use it 15 mins daily.
And what really muted the pain via anti inflammation was full spectrum cannabis oil straight indica strain. Not CBD oil, full spectrum indica strain cannabis with full THC, also known as RSO (Rick Simpson Oil).
THC is one of the most powerful antiinflammatories in nature. Narcotic pain meds of all types including oxycontin, vicodan, Percocet didn't touch my pain whatsoever. Nor did muscle relaxers, sedatives, nerve blocks.
I tried the cannabis oil reluctantly and was amazed, and I'm still amazed of how it takes the pain (inflammation) away.
The initial psychoactive ("high") effect I felt was managed by taking at bedtime which also was a Godsend for my insomnia, waned after a few weeks and I'm basically immune to the psychoactive effects now and function normally.
I also do the hot Epsom (magnesium sulfate) baths at least 3x a week before bed.
I occasionally cease the cannabis oil just to see, and within 3 days the paralyzing low back pain returns. No other drug or OTC pain reliever touches it for me.
I personally do not have pain issues, but I just want to thank you for sharing your experience in dealing with pain management. These type of inputs are valued.
i am no expert but when first diagnosed I had pain radiating down arm and what felt like sciatica pain down leg,After bone scans and usual stuff,The scan showed the cancer was pushing on the brain stem and could have caused paralysis.Urgently zapped with targeted radiation.This occurred round C4&C5 ,pain gone the next day.This could be happening on your lumber area?? Best wishes
that sounds like a radiculopathy. With your PSA of 0 I do not think it is from the cancer. Common thing happen commonly. Can’t rule out pain from the fractures but you might expect bilateral and it would normally be much worse when weight bearing.
injection of the most suspect neuroforamina with corticosteroid and local anesthetic should be done under direct x-ray visualization by an experienced doctor at this. That will confirm the precise site of nerve compression causing the pain. Then you will need a neurosurgeon well experienced in microscopic decompression surgery to decompress it. Recovery from that must be slow and measured to permit healing without relapse. Think six months.
As for the fractures in the sacrum, they will probably just be allowed to heal. Continue with your bone protective regimen as you are advised. Testosterone can help greatly in spine healing, both bone and nerves. See if you are in a status for ADT vacation or even a few cycles of a BAT protocol.
I speak from similar experience. The pain can be terrible. Paul
I have also been having some lower back pain recently, probably not PC. Took Oxy and THC a few times when it was severe and got relief, but when I experienced shooting (nerve) pain down my left leg the other night, I had an experience similar to yours: unable to find any position of comfort, moaning and sleepless for hours with no relief from Oxy + THC. I added some lorazepam (NOT recommended, a dangerous combo) just to knock myself out.
When I talked to my daughter (a doc) the next day, she told me opioids are often ineffective for nerve pain, and gabapentin is a much better choice. (Also can help with sleep!) I had completely forgotten that is the primary use... I had a bottle sitting in the other room that I used to take for hot flashes, and stopped taking. Duh! Potential relief was a few steps away and I didn't even realize it!
I agree with others that a lot of our back pain may be more a result of cancer treatments (ADT) than the actual cancer, in addition to the wear and tear of a lifetime and to the degenerative disease that comes with age. And just think of how many younger people have these kinds of back problems even without cancer or cancer treatments. With PC, our instinct is to blame all problems on the PC, but that is sometimes not the case.
My L4 and L5 issues were helped by Tramadol. Almost a miracle in just 1 week. (I physically injured them when I slipped on stairs. The rumor that I was drunk is unfounded.) After several years now, they seem almost cured. Almost. Best of wishes. Sounds like your issues are somewhat different.
My PCP prescribed morphine 15gm works whereas nothing else did. (spell checker does not like morphine. Warning, if you are on abaterone acetate don't expect any paon relief fro
Also i have peripheral neuropathy which makes typing even more of a challenge soon? i might be trying speech recognition
Good idea but this is sounding like some of the pain is related to sacra-iliac (SI). A fracture in the sacrum also points this way. A back belt around the waist does not assist this (but useful for sciatica and spinal related pain). An SI belt goes around the very lowest part of the hips and stabilises the sacrum - iliac joint which connects the top part of the body to the lower. Cheap, available - look for SI belt. To diagnose, put an ordinary belt across the low hips and tighten as much as physically possible. An immediate reduction in pain or better spinal stability means get a proper SI belt. I try to wear mine a few hours a day. Not all the time. It looks ridiculous in public. Facebook videos from Bob and Brad are also very good. But there are probably quite a few other sources of pain acting at the same time.
Hi Art, I'm really sorry that you are in pain. I can't give you any advice on pain that competes with these experienced warrior's advice. I thank you for posting this as I will save it for a knowing future date with the beast.
I guess the pain has been distracting me a bit but we are also fostering a 5 month old Jack Russel Terrier with some medical issues. Will post a QOL soon.
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