I have been diagnosed with something called PIVD or similar.
I experience pain throughout the spine down till the lower end. Then there is this particular nerve on the right side starting from my right hip.
This nerve gives a stinging pain and because of that I am not able to walk sit run stand or stretch to much extent. The pain is so much that even when in the morning I am rinsing my mouth and bend over to the wash basin, i am just not able to. I need to spread my legs wide apart and get into some comfortable position.
I am suffering from this for the past year and a half.
So i visited ortho doctor and he gave medicines named prega-doc, equiflex and few more. Now I was told that these medicines contain some steroids. My weight has now shot up from 60 kilos to 100. Clear case of obesity with BMI 32 for my height.
I am really worried about my health as because of back problems I have been asked not to get into any exercises too. Now I stopped alopathic and started homeo.PLEASE HELP
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replied September 3rd, 2012
Especially eHealthy
PRoy,

PIVD, or prolapsed intervertebral disc, is also called a herniated, ruptured, or "slipped" disc. This a condition where there has been a tear in the annulus fibrosus, which has allowed some of the nucleus pulposus to leak out. The annulus is the outer cartilage ring of the disc complex. The pulposus is a jelly like substance, which is located in the center of the disc.

The pulposus is very irritating to nerve tissue. It can set up quite a significant inflammatory response. This is why steroids are usually used for this condition. However, usually, the steroids are given in a “dose pack” which tapers the dose over about 10 days to two weeks. It is usually not necessary to continue patients on steroids for an extended period of time for this condition.

The body will usually sequester the disc material after a short time and it is no longer irritating to the tissue. However, it can continue to put pressure on a nerve root, if it is located in just the right place. If it is doing this, then the patient will usually have radiculopathy symptoms. The symptoms of numbness, tingling, weakness will be in the area innervated (supplied) by the nerve. For example, if it is the L5 nerve root which is being compressed, then the symptoms will be located on the dorsum (top) and side of the foot.


From your description of your discomfort when leaning over at the waist, it is much more likely for your pain to be coming from some of the muscles which stabilize the pelvis and/or the SI (sacroiliac) joint, than from a PIVD. The herniated material may cause some discomfort in the spinal region, but this is usually it most intense early on in the course of the problem. After a while, the symptoms which are caused from a PIVD are almost always in the distribution of the nerve root affected, not in the back.


Long term use of corticosteroids is well known to cause weight gain. You might want to speak with your surgeon about tapering off of the steroids. Usually, patients who have been on steroids for an extended period of time cannot stop them abruptly and, as such, their dose should be tapered slowly. Again, their prolonged use for PIVD is not really recommended.


The usual treatment for PIVD is a short course (or dose pack) of Prednisone. NSAIDs can be used in some cases instead of the steroids. Muscles relaxants are given mainly because of their sedating properties. Many patients with back pain do not sleep well and the muscle relaxants will provide some sedation. In fact, Flexeril, Soma, and the other muscle relaxants have no actual effect on muscle tissue. Again, they are usually prescribed for their sedating effects. If a patient is actually having muscle spasms, then a benzodiazepine will need to be prescribed. Valium (diazepam) is the most commonly one used.

The patient should be placed on reduced activity for a few days. But, strict bed rest should be avoided (never more than 48 hours). Bed rest just causes the patient to decondition, which makes the problem worse. After the acute pain has subsided, the patient should be started in physical therapy or in a conditioning program. Aerobic exercise, such as walking or swimming, should be emphasized. Weight reduction or maintenance is essential. Cardiovascular fitness is also a priority. Stretching and strengthening of the core muscles should also be part of back patients’ routine.

Massage, chiropractice, biofeedback, relaxation, TENS, or any numbner of other alternative treatments can also be used for back pain.

If medication and therapy do not alleviate the radicular symptoms, and the patient has a concordant MRI which shows the specific nerve root being compressed, then surgery to remove the disc material can be performed. Discectomy has a high success rate, when done for the proper indication.


But, again, your weight is probably contributing to your back discomfort. And, prolonged steroids are usually not recommended for PIVD. There are several significant health problems that can be caused by extended use of systemic corticosteroids (besides just the weight gain). You might want to speak to your surgeon about getting off of the steroids.

Good luck.


PS: While a BMI of 32 is obese, usually morbid obesity is defined as above a BMI of around 40 (depending upon who is doing the defining; ranges from 35 to 49.9). Another definition of morbid obesity is being 100 pounds over your ideal weight. However, a BMI of 32 defiantly needs to be addressed. Good luck.
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replied September 4th, 2012
Dear Gaelic,
My condition has been this way for past year and a half. L5 area.
And till now not much relief. Had electro-therapy and magnet heating also done.
And for the high BMI I just do not understand what to do.
It is forming a viscous cycle. Because of pain I cant workout, gain more weight, and because of the weight it is paining more.
Please help!
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replied September 4th, 2012
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PRoy,

Again, your weight gain is probably due to botht the steroids and your decreased activity level.

Usually, the weight gain from steroids has a typical appearance. They often cause a rounded face and extra pounds around the mid region.

As to activity that most spine patients can participate in, walking is a great exercise. Start slowly, possibly only walking for 10 to 15 minutes. But, gradually increase the distance and time. Soon, you will be able to walk several miles. Walking is great for overall fitness, cardiovascular fitness, and weight reduction.

Water aerobics are also great for patients with spine problems. The buoyancy of the water takes the pressure off of the back, allowing the patient to exercise more comfortably.

Usually, exercise is mostly overcoming inertia. Just starting the program is often the hardest part. But, do not set yourself up for failure. Start a reasonable program, one that you can succeed at right off the bat. Then gradually increase the amount and intensity. Again, you just have to start doing the exercise. One can come up with a lot of excuses to not do exercise, but your health is a great reason to do it. Again, start slowly.


Good luck.
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replied June 10th, 2013
hi PRoy...advise me!!!!
hi Gaelic and PRoy,
this is affy, on 1st march i had a problem in lower back which dint allow me to stand properly for a few days, the problem was abrupt and from normalcy though i had been experiencing a minor pain in the region fr a few days prior to that.i I consulted an ortho and a neuro surgeon almost the same day. i was advised a bedrest for 15 days a MRI to be done which stated the following
1)Early degenration of L4-5 and L5-S1 discs
2)early PIVD of the same discs
and osteophites were also seen.
Later i was advised to wear ASH BRACE and few exercises to strengthen my lumbo sacral region.
in the past 3 months i have been better and am now in good condition but yes have put on a few pounds though.
On my recent visit to the doc , After all the bending and stretching tests , he advised me to undergo Diathermy as i had a pinch of pain while bending backwards.
he constituted that it might be because some fibres of the discs might need some relaxation.
my question to you guys is , Will i be able to revert back to FIT nature ever and carry on with my work which involves some tedious physical labour as i am a MARINE ENGG by profession.
Is there a permanent cure to this problem, cause eventhough i feel normal now but i experience this denseness and stiffness in my lower back at times.
i fear in lifting any weights or do my proper chores all the time.
my futures at stake as my career had just started.
my doc said that i could resume my job by end of june this year but still i have my inhibitions.

i am getting mentally down thinking all this .
help me out here please.
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replied June 10th, 2013
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Afti,

Sorry you are having problems.

Your MRI states that your degenerative changes are in the early stages and are therefore mild.

Unfortunately, there is no "cure" for degenerative changes. This is just part of the aging process. As to how early the degenerative changes start and how fast they progress is very variable. It is unique to each patient.

Though many people (and physicians) believe that degenerative changes are made worse by heavy lifting and doing heavy manual labor, it is not exactly that simple. Just like the degenerative changes seen in the hips and knees, the degenerative changes in the spine, are most likely genetically determined. In the degeneration of the hip and knee, it is not related to sports or heavy manual labor. There are many people who are able to run their whole lives, even running marathons up into their 50's and above. It is well known that the degeneration in the joints is related to genetics. If a person's parents had early degeneration of the joint, then they too would most likely have early degenerative changes. So, back to the spine, there have actually be a few studies done which basically showed the same thing as in the joints. Degenerative changes in the spine are mostly genetically related.


So, it is basically up to you, as to how much you want to put up with and as to your personal pain tolerance level. You will need to keep your trunk muscles very strong from now on, especially if you want to continue on in your current career. You will also need to focus on the muscles of the back. You will need to keep your weight in a proper range and maintain aerobic conditioning.


By doing these things, yes, you could continue in your current career. But, again, it is up to you.


Good luck.
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replied June 10th, 2013
Thanx gaelic for such a prompt revert.
i suppose if degeneration of the discs is irreversible ,so will be PIVD.
i have been put through a strict exercise regimen by my doc, but lately i have been finding it too frustrating cause this denseness in my spine has somehow become permanent though there is no sense of pain.
I am only 26 and i have my whole life ahead of me so i think i wont compromise with my career right now.
And i see that i have to get out of the shell and work harder to sustain .
Thanx again.
Would love to ask a few f my queries.
But some other time, its late here
Regards
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replied June 16th, 2013
Hi Gaelic,
A few of my confusions and queries, kindly clear them.

is PIVD permanent?

I am working on my weight, but still almost all the time i feel this stiffness in my lower back region, should i start to live with it thinking tht it would never subside or it would still need some more time for healing?

Does early PIVD as stated in the MRI observation constitutes that it could be controlled?

Will i never be able to lift or work with even smwll or moderate weights stuff n things.

Can i work out my daily things with a lumbo sacral belt around , will it prove help full and and avoid further herniation of the disc while working on ship.

My futures been all hazy now..i am finding it difficult to live normally...and this is impacting my thoughts....and i am all these thoughts of geting over my life n every thing..my futures finished i suppose..feeling an outcast right....thinking i would not be normal again.

Help please....
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replied June 17th, 2013
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Afti,

PIVD (prolapsed intervertebral disc) is a degenerative process, so in that since, it is "permanent".

But, that is not to say that the symptoms that go along with it are not "reversible". It would help tremendously to get your weight to within a "normal" range for your height, of course. Especially since the radiologist listed the PIVD as "early".


Stretching and strengthening of the trunk muscles is also very important, as is an overall aerobic cardiac conditioning program.


So to how one patient will ultimately do is always difficult to say. But, again, your PIVD is in the early stage. It is going to be a lot of hard work (to lose weight), but you can do it.


Also, if you feel that you are becoming clinically depressed, get help for that. It is hard enough to lose weight and rehab a back problem, but to do it with depression is almost impossible.


Wishing you the best. Good luck.
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