A Reluctant Candidate
The courageous case of Ray began in late 2014. He was a mid 30’s male who came to seek our help with an 8 mm prolapsed intervertebral disc on his L5-S1 which means he was going through some of the severest of conditions. He walked in with his wife and newborn child limping. He had himself a classic motor issue of “drop foot” down his left leg and pain in all positions in his lower back and his limp.
He was desperate for help, coming in with sweat not because it was hot outside but the sheer struggle to breathe and his nervous system heightened due to the intractable pain.
I recall there was no position he could sit in or stand in or lay down in that would offer comfort.
He said to me one resounding thing. “I want to avoid surgery!”
It is something, I often hear at Rehab and Revive. It’s true if we can prevent surgery the original parts are often better than the new ones. Most operations these days that require “parts” still need more time to be precise for our biomechanics.
Often, I feel that people neglect themselves and think it will go away (please read my past article about ignoring pain -- Read More). Regardless, to get to this point with an 8mm herniation. I believe someone has to work very hard to ignore it missing all the warning signs along the way. (Okay, I’m off my soapbox)
So What Will It Be Doc?
I had his report right in front of me, and there wasn’t anything I could think of that I could do to help. It was a problematic evaluation and revelation to me that this patient was asking me to perform a near miracle.
Being a dutiful provider, this was a cross between being negligent and being a hero. I reported the correct information to Ray, despite my bleeding heart telling him to help. Previously, with a 4 mm herniation, I recommended surgery. I explained to him the likelihood of traditional PT working was poor. But once again, I realize I wasn’t your run-of-the-mill PT.
He considered what I had to say and kept saying, this is why I chose you! I want you to help me get better without surgery.
I think a bead of sweat formed on my right brow and I would be lying if I didn’t say I was a bit afraid. I hesitated and muddled some words together sounding like “I’ll try my best.” I also said it might take some time and I’ll give him three weeks to start making some little improvements to gain confidence in my decision to help or push him back to the surgeon.
I called my friend and colleague Glen, who was my trusted confidant from my studying days. He said to me, "well what do you have to lose? You have everything to gain. This patient is pretty much giving you the 'okay' to try anything it takes to get better." Glen asked me a simple therapist question, "what would you do with someone with less than 4 mm?" He was right! So I did the same thing. There was a lot of potential with this mindset.
One Step At A Time
Three weeks passed, and he improved little by little. The first function returned, I used that as my gauge but hesitantly proceeding every week updating Ray with my thoughts. Over time, pain and numbness moved from his leg to his lower back. Which is exactly the update that I wanted.
After three months together of intensive therapy and manual techniques. We helped eliminate Ray's numbness, get stronger, and return to everyday life with his son, wife, and work.
At his third month follow up he brought in a CD and some radiographic film, he said it was about his “friend” and wanted me to look at it. I popped it in and I thought the lower back pain was near pristine. He smiled and said this is my back.
Sometimes it takes a patient who has full faith that pushes me beyond what I previously thought was impossible, 8 mm was just a hurdle for us to all clear.
Somewhere a long time ago I heard that “Nothing is impossible the word itself says ‘I’m Possible’” by Audrey Hepburn.
A patient like Ray will push us past our limitations to expose the potential within. Ray showed me something unique about determination, willpower, and intention.
Walls Are Just Meant To Be Climbed
He intended to get better and believed in me, even when I did not. He forced me to break through the walls of my own beliefs to come out on the other side a stronger therapist for all who would come to my table in the future wanting to avoid surgeries.
For every problem, there is a solution waiting to be found and transmitted to others to discover. Faith gives us a glimpse of imaginative curiosity with the potential of unbounded optimism. In hindsight, from the perspective of a patient, the pathway to a healthy lifestyle.
Heal smarter, not harder.
Dr. Justin C. Lin