On first reading I figured the **** was a synonym for "poop". On second reading I now think it may have been something else.

Yikes, that sounds worse than my back was. I could get up with help, I couldn't lie down. A couple weeks after I got hurt I was able to drive and went down to the chiro that was in my complex. He tried to help me lie down on his table, but my screaming scared him enough to suggest I take an ambulance to the hospital.

How are you going to lean over a patient if you have to?

This is way to tl/dr response, but you did ask.

Calli is right in that your spine (or vertebral column) is comprised of a series of bones stacked upon one another with a disc between each of them that provides a cushion or shock absorber to distribute the forces more-or-less evenly when your back comes under a strain like when lifting or jumping or even walking. The main part of each bone is called the body and basically looks like a cube when viewed on an X-ray or other scan. It is far and away the strongest part of each vertebra. However, some other bony parts of the vertebrae form a kind of bony ring that encases your spinal cord and provide other contact (or articular) surfaces with the vertebra above and below that level. Surrounding and between the vertebra are various small ligaments as well as a some large muscles that run up and down your back.

By a large margin, the most common injuries that affect the back involve straining the paraspinous muscles or even spraining some of the small ligaments between the vertebra. This is the injury most people suffer when trying to lift heavy objects or sustain whiplash type injuries. They almost always get better with conservative treatment in a few days or a week. However, despite the relatively benign and self-limiting nature of these injuries, they continue to be a source of significant medical and legal expense because folks will continue to complain of pain in an effort to obtain narcotics and /or a legal settlement "from that guy that rear-ended me." A long time ago, a lawyer pal of mine told me that "the lumbar spine supports the upper two thirds of the body and the lower third of the Bar."

Another smaller, but still common group of problems involve the disks themselves. As we age, those shocker absorbers become less elastic, desiccate or dry up and get smaller. Under certain circumstances, they can rupture and their contents push into the spinal cord, or more commonly, impinge on the nerves that come off the spinal cord between each vertebra. The symptoms will entirely depend on where the rupture occurs. Rupture a disk in your neck and you're gonna have arm and/or upper torso trouble. Your hips and legs will be affected by a lumbar disk rupture. It is noteworthy that ruptured disks occur commonly in the neck and low back, but are very rare in the thoracic (mid back) disks.

Another group of injuries are called "compression fractures." Simply put, these occur when an external force-usually traumatic in nature- is suddenly distributed to the vertebral column but is not uniformly distributed through the vertebral bodies. The result being that the vertebral body is "squished" or compressed and fractures. This injury is most common in the elderly with osteoporosis where the force necessary to cause a compression is greatly reduced. These injuries almost always result from a fall in which someone lands directly on their tailbone or, interestingly, when they land directly on their heels and keep their legs straight in the process. They are common among roofers and other people who jump off ****. Since the force is applied from the lower back upward thru the spine, it should come as no surprise that these injuries are most common in the lumbar area, less common in the thoracic spine and almost nonexistent in the neck.

Unless there is involvement of the spinal cord, treatment of these injuries is conservative. Medications and occasionally a back brace. Incidentally, cord involvement with these injuries is exceedingly rare for a couple of reasons. First, the compressive force simply flattens the vertebra and the bone is contained in place (as opposed to a "burst fracture" which shatters the bone and spews fragments in multiple directions). Second, the spinal cord gets smaller as it goes from the neck down the back and, fortunately, the spinal canal (you remember, the canal formed inside the vertebra thru which the cord travels) gets larger. The cumulative effect of all of this is that your spinal cord is much less likely to be injured or affected with mid and low back compression injuries.


Narcotic "samples" are nonexistent these days. Many years ago, the DEA required strict accounting for all narcotics, especially at the point of distribution. That was pretty easy for pharmacies with their point of sale and inventory software. Samples given to, then distributed by, doctor's offices were not easily accounted for and resulted in nightmares for docs. But the real reason that docs don't have narcotics in their office- samples or not- is the substantial risk of robbery and break-ins.

Regarding the cost of MRIs, here's helpful hint that will allow you to know the minimum price the hospital would potentially accept as payment. Call your insurance company and ask what their allowable reimbursement is for the test. That number may vary a bit depending on your provider (the larger the insurer, the lower the reimbursement). Whatever that number is- and you're likely to be surprised how low it is- you can rest assured the hospital is making a profit at that rate. MRIs will never be considered "loss leaders."


Pretty much all correct, but a few points. There are 7 cervical, 12 thoracic and 5 lumbar vertebra. MRI description is correct and it's great at detecting local edema (unlike CT) because of what it measures. In my case, it not only showed the compressed vertebra, but also the edema in and about the fracture site.

Regarding the drugs, I was having involuntary and debilitating muscle spasms when I went from a supine to an upright stance. Oddly, this only happened when trying to arise from lying flat on my back. Since the MRI required me to do so, I got "stuck" on the stretcher until a little pharmacological help arrived. And yes, the Ativan was used as a muscle relaxer, altho I'll admit had that ordeal have gone on for another ten minutes, the STFU part may well have come into play.

Call Howard for any future clarifications.

I can flex my back to a pretty significant degree without pain. If I have to pick something up, I just lower my body by flexing my knees.

I got lightheaded while reading that.

My bad. I didn't have time to write a shorter post.

"The lumbar spine supports the upper two thirds of the body and the lower third of the Bar."

Thanks for the explanations. Leo, you going to have a brace or just wing it with some pain killers and anti-inflammatories?

Out of curiosity what kind of conservative treatment? My "treatment" consisted of waiting to see if it got better by itself, then eventually a chiro.

I did call, which is why I knew they would only cover $450. I would have to pay the rest out of pocket, so I didn't get it.

That's not too terrible then although I'm sure it feels like it. I had to order pizza and sandwich delivery for two weeks before I could walk to my car.

For what it's worth, I am dealing with this right now: I managed to rupture a disc at L4-L5, which I gather would not be unusual but for the fact that I am in my 20s. My impression is that "conservative" treatment just means "not surgery."

As an additional data point, I ended up using insurance (like a sucker, apparently) and got charged about $660 out of pocket.

This thread gives new meaning to the phrase, "I'm busto and looking for a backer."

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Good luck with the injuries guys.

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Luckily I've never ruptured a disc. My worst injury was a knee dislocation when I was 22. I still gotta wrap in up in an Ace bandage when I go skiing.

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Oh good morning and salutations.

See Smitty's post below. Conservative treatment is basically anything noninvasive and nonsurgical. Meds, external bracing and physical therapy are the mainstays. My "treatment" will consist of whatever gets me horizontal with the wife in the least amount of time.

I know it's hindsight, but I'm wondering what would have happened if you'd have called the MRI facility and said, "My insurer will pay $450, will you accept that? If not, what kind of deal can we work out?" I would be most inclined to try this with a free-standing MRI facility.

I'd also include epidural injections in the invasive procedures.

I would have been a "sucker" too had I not got pissed that I was getting jacked around in the pre-cert process. I knew that hospitals give substantial cash discounts when paid up front. E.g., Our hospital gives an immediate 70% discount on ER visits just for the asking. I guessing a little "hard times" pleading would further lower that number.

I'm going to PM you later about some peculiar considerations regarding lumbar disks.

Mine was getting a little better as time passed, so I only went to a miracle chiro a co-worker reccoed. She told me to see a real md after about 5 weeks. He did an x-ray and didn't find anything other than what "might" have happened, but said it was likely a slightly herniated disc which had healed by that time to where an x-ray didn't show a lot.

I said almost that, they basically said "I don't know what to tell you, we would bill $xxxx and whatever else happens is between you and the insurer". I took that to mean I'm on the hook for the balance since that's what happened with every other claim I had made. I may have been just talking on the phone to lower level people that had no decision-making powers tho.

Realistically, my coverage is basically worthless unless I have to get admitted. And it satisfies IRS requirements. Otherwise I'm paying a lot of money every month for nothing. That's why I dropped my dental coverage. Their reimburse price for a simple filling was $45, my dentist charged $120. I got covered at 70% since he's out of network, so my "covered procedure" costs me over $90, which I bet I could beat if I Leo Docced the dentist up front.

You know your weekend will be devoid of poker when you wake up on Friday morning shivering uncontrollably when the thermostat reads 70.

Conspiracy to take out all the SSLHErs IMO. Someone's gonna clean up at the tables this weekend and doesn't want us in their way.

Check your tea cup for polonium.

Hi Everyone!

hello!

hi leo doc - hope you have a speedy, not-super-expensive, and sex-filled recovery

Thanks for the well-wishes.

Brag: I'm on the mend.

Beat: I'm still sleeping on the couch.

Variance: The relatively high dose steroids I took for eight or nine days caused me to develop ****ing Shingles yesterday.

http://www.mayoclinic.org/diseases-c...n/con-20019574

But did you get laid?

My vet is a reg at Talking Stick's spread limit who recommended Hanson's site when I asked what might help my game. Yesterday I plopped into a 2/3/300 to give it another go (what a boring horror) and some man starts chatting me up. I know that I know him from somewhere and ask from where. DOH! So he asks how Andy is. Then I think he's from here! Ofc it's the vet who looks like he's only 22 w/o the white coat.

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So I also snuck off to the high limit BJ room and was playing alone at a table when two mid-20's really hot (and I mean hot!) women approach and ask 'Can we play with you?' I had a spasm, bent over double, head nearly hit the table, I can hear them asking the dealer 'What's the matter w/ him?', I finally surface and answer 'You can play with me as much as you like.' And they didn't appear to get it.

Yes, Howard has finally gotten so old that even creepy jokes don't go over.

Beat: No.

Brag: Other accomodations were made.

Variance: None.

Oh ****! BTDT. Luckily I was prescribed the usual anti-viral within three days and I had a fairly easy time of it.

Do the steroids weaken your immune system?

Yeah, they do. The virus lays dormant just waiting for your immune system to be compromised and, boom, a really painful experience.

Running pretty bad Leo.

Today I was sitting next to a super nitty (never raises preflop), super grouchy old regular in my East Coast game. I raised AJo from UTG (8 handed) and won a hand. After the hand, he was mumbling under his breath "this guy raises with AJ - I don't play that California poker."

I think he meant that as an insult.

'I play California poker because East Coast poker is for poor people!'

Poker gods update: I donked a set the other day and was suitably punished for it. They are always watching.