My Single Mom Life

Let's begin at Thursday the 10th and taking Mark to the orthopedist.
This is going to be a long one, sorry, a lot has gone on here since Thursday.

When Thursday came around, I started to feel like total crap, I felt lightheaded and nauseous, I was basically feeling like I just got hit by a bus and I had to take Mark to his doctor appointment with the ortho.
Mark's Big, George, took us there and to the pharmacy after, and then home again.
The doctor took about 8 xrays of Mark's spine from all different angles and views, and then he sat down with us to tell us the news.
Mark does not have scoliosis, but he does have problems with his spine, it's genetic, what he has, all of his problems are genetic.
Mark has Spondylolysis and Spondylolysthesis.

The spine is made up of a series of connected bones called "vertebrae." In about 5% of the adult population, there is a developmental crack in one of the vertebrae, usually at the point at which the lower (lumbar) part of the spine joins the tailbone (sacrum). It may develop as a stress fracture. Because of the constant forces the low back experiences, this fracture does not usually heal as normal bone. This type of fracture (called a spondylolysis) is simply a crack in part of the vertebra and may cause no problem at all. However, sometimes the cracked vertebra does slip forward over the vertebra below it. This is known as adult isthmic spondylolisthesis.

What are the symptoms?
Isthmic spondylolisthesis may not cause any symptoms for years (if ever) after the slippage has occurred. If you do have symptoms, they may include low back and buttocks pain; numbness, tingling, pain, muscle tightness or weakness in the leg (sciatica); increased sway back; or a limp. These symptoms are usually aggravated by standing, walking and other activities, while rest will provide temporary relief.

So Mark has that, his L5 and S1 vertebrae are pointing down and in toward his stomach, and they will continue to "fall down" if steps are not taken to try and straighten them out.
He also has arthritis, this too is genetic, so the arthritis combined with Spondylolysis and Spondylolysthesis, is what is causing Mark so much pain in his lower back.
The ortho doc is trying to get Medicaid to approve a couple of MRIs to fully see how bad the Spondylolysis is, and from there, he will be able to determine how to treat this.
He did say that Mark is way too young in his opinion for spine fusion, but if L5 and S1 continue to fall even after a series of physical therapy, maybe a back brace, that spine fusion would be needed to fix this.

Spondylolysis and Spondylolysthesis, is nicknamed "swayback", your back sways "in" which causes you to lean forward and hunch over.
This is something I have always been yelling at Mark about while he plays video games on the pc or the xbox, "stop hunching over! sit up straight!" and he'd always tell me that sitting up straight hurt, that leaning forward felt better, and I know that it does, I know leaning forward feels better because I too have "swayback", my spine not only curved side to side from the scoliosis, it also curved inward at the L3 to S1 vertebrae, so that's one of the many reasons that my surgeon had to fuse me so far down, all the way down.

To help you see what I'm talking about in regards to which vertebrae are affected in both myself and Mark, you can click on this chart and see those affected areas.
There are 4 sections of the spine, and each section is then broken down to individual vertebrae.
There's the Cervical spine, C1 - C7, the Thoracic, T1 - T12, the Lumbar, L1 - L5, and then the Sacrum, S1, and the coccyx which is also known as the tailbone.
I have been fused from C1 all the way down to S1, the very top to the very bottom, and S1, or the sacrum, and the coccyx, are actually connected, so when I was fused, it really was from the very top of my spine to the very bottom of my spine, stem to stern as one doctor said.
Mark is affected at the L5 and S1 areas.
His sacrum (S1) and L5, are pointing down and in instead of up and straight like you see on the chart.
I didn't have my camera with me on Thursday, and I don't think the ortho would have liked me taking a picture of the xrays anyway as Mark is a brand new patient of his, we don't have an ongoing relationship with this doctor like I do with my surgeon.
I have been with my surgeon since November 2005, and because I've been with him so long, he doesn't mind me taking pictures of my xrays and stuff when he puts them up on the lightboards.
But because I didn't take my camera with me, I couldn't take a picture of Mark's xrays, but this is a pretty accurate image of Mark's "spondy" or "swayback" as it is nicknamed by different doctors.
My surgeon calls it swayback, Mark's ortho called it spondy.

The third image (left to right) is exactly how Mark's spine looks, it is down and in exactly like this drawing.
Along with the spondy, Mark has arthritis in his spine as I said above, and he also has stenosis and some nerve impingement as well.
The ortho did a few strength tests on both of Mark's arms and legs, and he is definitely weaker on his left side, and he does not have as much lower body strength as he does in his upper body.
His upper body is very strong while his lower body and his legs, are very weak, and his left leg is much weaker than his right.
The ortho also noted the nerve damage by pinching gently on his fingernails and toenails.
If you take your index finger and thumb of one hand, and use them to pinch down on the fingernail of your other hand's index finger, you see how long it takes for the color to come back in the skin under the nail.
Pinching the nails makes the skin underneath turn white, un-pinching them allows the blood flow to come back, and the longer it takes tells the doctor if there is nerve damage or pinched nerves in the hands and feet and how severe it is.
The fingernails on both of Mark's hands were ok, a little damage on his left, but both of his feet, especially his left, took a bit of time, so this told the doc that there is definitely some nerve impingement on his left side.
Once medicaid approves the MRIs, the doc will be better able to see just how much nerve damage and stenosis he has, and he will also be better able to see the "spondy" and how bad it is.
Once he sees that, he will then figure out a plan of action for Mark which will probably be a combination of bracing and some really tough physical therapy to strengthen his core muscles and use the physical therapy to try and pull the spondy out of the falling down pattern.
The physical therapy will improve his strength and flexibility in his core, as well as teach him how to properly move his body so he does not damage his lower spine any further.
Moving your body the wrong way can cause the spondy to fall even more and cause much more pain.
His ortho gave him Tramadol and Mobic (NSAID) for the pain he is currently having, and he was told to rest as much as possible.
Trying to make an 18 year old lay down on his bed or the couch for a few hours while alternating between heat and ice to reduce the inflammation and reduce pain, is like trying to teach a mosquito to not suck your blood.
Basically, he's not doing it as long as he should, I can only get him to lay perfectly still for about 1 hour. I do 30 minutes of heat, and then 30 minutes of cold, and that's it, he can't stand it anymore.
Now we are just waiting for the ortho to call us and tell us when to come in for the MRIs if and when medicaid approves them.
That was Mark's update, sorry it took me so long Mom and Dad, I know you've been waiting for this news.