Yoga with Cervical Radiculopathy Pain

Following on from the advice of two of the surgeon’s I consulted with, which was to get back to exercising and normal activity, last night I took a yoga class for the first time in about three months. I survived!

My right arm is still intermittently painful, usually only slightly. Of course, as I type this, it is probably more painful than it’s been in a few days, I think due to a combination of last night’s yoga along with the car ride here to this Starbucks I’m working out of for the afternoon.

So the day before yesterday, knowing it was time to try a yoga class, I figured I’d better test out this arm before getting there and finding out it’s just not going to work. To test it, I fired up my Apple Fitness+ membership on the TV and chose a 10 minute yoga session. I’ve tried the Fitness+ yoga before, after I was actually in pretty good shape and had been doing strenuous yoga classes at my gym for quite some time. I found them pretty challenging, but they’ve since added a lot more and I suspect toned things down some.

It was tough, but not too tough. Only one potential “showstopper” – while I can push and pull just fine with my arms, and can hold myself up at the top of a plank/push-up, once I begin lowering down my right arm seemingly gives out and I drop. I’m able to muster enough to avoid completely collapsing, but it’s neither graceful more pretty. After finishing the one session I started and finished a second 10 minute session with the same instructor. Fortunately there were only a few plank to up dog movements. I was worried though, because that movement, which is part of the sun salutation and is a staple in every yoga class at my gym, is something I can’t avoid.

So I show up to last night’s ROOT yoga class at Lifetime Fitness. Andy, the instructor, is awesome. I’m very picky about yoga instructors. There are a couple of simply avoid altogether. There are three that are great, and two are my favorites. Andy is one of my favorites, as his classes are always so well programmed. I know this because I almost always leave his classes feeling both like I got a great workout but also like I added to my body. Nothing is overemphasized, e.g., legs vs upper body, etc.

I was extremely nervous all day leading up to the class. Even though I tested the right arm and knew I’d probably struggle with the downward strength movements, I wasn’t sure how much it would negatively impact me. Thankfully, I think we only did that movement approximately five times all class. Aside from that, some poses were really awkward, particularly reverse triangle. I’m just out of shape and it was clear to me. Shockingly, my ability to hold balance poses was no worse than before, and having reserved a spot in the back corner, which I think is where the astute beginners all like to be, I was comforted in noticing others around me were struggling. A few months ago I felt like an advanced yogi (which is and was wishful thinking). I surely felt like a beginner yesterday. I’d like to say it was a great class and I was thrilled to get through it. And I guess it was, and I am. But I also realized how difficult a struggle this is going to be to get back in somewhat shape. My lower body is sore today, but not overly so. The only pain during the class was during shavasana. Shavasana, for you non-yogis, is simply a rest period where you lie on your back for a few minutes. My right shoulder/back were in some pain but not unbearingly so like it was before. While not comfortable, after the first minute or so I got used to the pain and could reflect on the class. Honestly, a few times I looked around during class and started to tear up, wondering if this was my last one. I did my best to put those thoughts out and just focus on breathing, which I did a pretty good job of considering my lack of fitness. When class ended I showered and went home to watch the playoff basketball game. For the first hour or so post-class I felt kind of worn out and the shoulder/arm pain was there. Then, while watching the game on TV, I noticed it was gone. My arm felt stronger and, hard to describe but, more normal than it had in a while. Went to bed and hoped for the best, as that night’s sleep would dictate my yoga future, at least for the short term.

Next morning I woke up around 6am and felt phenomenal. No arm pain and it retained that stronger, more normal feeling. I was stoked…enough to not allow me to go back to sleep for another hour or two : ( I also got the itch to turn on my side, which resulted in the pain coming back a little : ( I finally got out of bed around 8am.

Not sure how well it comes across in this post but, basically, as of right now I’m thinking that yoga is the best thing I can do for this condition. So long as I don’t overdo it. I packed my gym bag for today with the intent to get to the gym and just do some cardio and maybe lift some weights. I’m not so sure about that now. I reserved SOL yoga class tomorrow, taught by my favorite instructor. She practically taught me yoga, as I was crazy enough to go to her class as a complete beginner, even though no beginner has any business going to SOL as it is a fairly challenging class. I stuck with it and am so in tune with her voice/instructions/pace. It’s usually a small class and with my having disappeared for a few months she’ll surely ask where I’ve been and I’ll have to rehash the story, if only to alert her to my likely flopping down awkwardly during sun salutations due to my dead right arm. If I can make it through SOL and not cause added pain as a result then I will keep going.

Aside from that, I am expecting a decision later today or tomorrow from a top cervical spine surgeon based out of Cornell, who is slated to review my images and reports remotely. Curious to hear what he says.

Diagnosed with Cervical Myelopathy (Part Two)

I recommend you read part one here if you haven’t already.

Shortly after the initial diagnosis and recommendation of surgery, I asked the surgeon if I could hold off safely until October, so that I could enjoy the summer. He agreed that, while there are risks, that sounded reasonable. We left it at that.

A few days later, the arm pain got so severe I couldn’t function. Couldn’t sleep. It was terrible. I messaged the Penn team (thank goodness for the modern portals these hospitals all use nowadays and, more importantly, that the team assigned to me at Penn responds very quickly). They prescribed meds which I avoided until it got so bad I had no choice. I began taking a combination of the prescribed single 300mg Gabapentin before bed, along with my wife recommending I take Aleve. I had tried that along with lidocaine gel and patches, ibuprofen, etc. to no avail over the prior days. Eventually, what worked was my wife insisting I take Aleve on a set frequency, and not just when I felt pain coming on. A few days of that – 2 in the AM and 1 in the PM, got the pain down substantially, from a 6/10 (min/max) to a 1/5. I was able to sleep again!

I stopped the Gabapentin right away. If you Google that drug you’ll likely come away with even more concern over it than I had (and still do). Fortunately for me I only took it for maybe 5 days max, and a small dosage at that.

In the meantime, I went to Rothman Orthopedics for a second opinion. This surgeon reviewed my MRI and x-rays and insisted that I get a four level fusion from the front (anterior) along with supporting rods and screws (posterior). I was devastated. I told him what Penn recommended. He responded by saying “the Penn guys do things we would never do.” He said it condescendingly. I asked him about loss of mobility (“30%”); how urgently I should get the surgery (“Asap. Within the next couple of months max.”); etc. My wife and I had additional questions but apparently a 25 minute consult total, including the physicians assistant exam and MRI review, was too long for that guy. He clearly rushed us out of there and said he’d like to see me back in two weeks. We reluctantly left, even more devastated and confused than we had thought was possible.

The next morning I texted a friend of mine who happens to be an anesthesiologist. I explained the predicament and that I was in need of a third opinion to help me decide between the hybrid surgery and the four level fusion. What a choice! : ) He texted me the name of the guy he said had the best reputation at his hospital. I got an appointment to see him the next afternoon.

So I go see the third surgeon. Before the appointment I remember watching a promo video of him on the hospital’s website. He states that he avoids surgery whenever possible, promoting physical fitness etc. I momentarily dreamed of him telling me he agreed with the first surgeon, as I dreaded the likely lifelong repercussions of a four level (front and back) fusion. I then snapped out of it and told myself to brace for the worst.

That next day I’m in the exam room waiting. He walks in doesn’t say much other than a quick hello, sits down and reviews the MRI and x-rays. He then turns to me and asks what my story is. By that time, the radiculopathy pain was mostly gone (in hindsight, it was about 75% gone, and has since gone down to about 98% gone, only noticeable when I am sitting awkwardly). I tell him about the first two surgeon recommendations. He says to me that if he were to do surgery he would do a fusion of C6/C7 and, even though I’m asymptomatic on the left side, since he was in there already and C5/C6 is so herniated and compressing the spinal cord, he would replace that disc and then, “Call it a day…but you have to decide whether you really want surgery or not.” I was perplexed at that last sentence. I told him, “I don’t want ANY surgery, but these other two guys told me I had to get it asap or I risk paralysis!”

Long story not so long….he recommended against surgery. Said monitor it and come back in three months. He said, “There’s no way, if it were me, that I’d get a four level fusion at 50 years old! Do you want to live with a four level fusion for the next potentially 30 years?!?” As for the first surgical recommendation, he took great exception with “skip a level” surgeries. Said he never heard of that being done.

In a nutshell, his thesis is that I likely have had this compressed cord for decades, yet aside from some nerve pain which is mostly gone now without surgical intervention, he thinks it’s likely I would have died an old age and never known I had this condition. He told me if things get worse call him, otherwise come back in a few months and we can assess, then six months, and then in a year take another MRI and compare.

I left elated. I couldn’t believe it. That seemed like a totally logical approach!

It’s been two weeks and I’m not so sure now. While the arm pain is gone, my right arm is definitely left weaker. I’m concerned I’ve taken that first dreaded “step” in the wrong direction that is a progression of what is called cervical myelopathy, sometimes referred to as cervical spondolytic myelopathy. While some never degrade, others progress through a series of steps over time, first step resulting in what I have now, for some worse, then weeks, or months, years or decades later (no one knows) the next step might result in a loss of balance. Eventually paralysis.

The only way to stop progression is by decompressing the spinal cord through surgery.

So talk about a gamble. Do I get surgery? I’m convinced I will get it. Problem is, I don’t even have a recommended consensus on what type of surgery!

I sought out who the absolute best cervical spine specialists are in the country and two names popped up. One is at Cornell. This guy is so in demand that you don’t just make an appointment with him. You submit all of your images, fill out questionnaires, etc. and then he reviews and decides whether your case warrants his attention. I will hear back from him this week.

The other, a local guy, is a colleague of the four level fusion guy I mentioned before. But I heard he often disagrees with his colleagues, so worth a shot. Hard to get an appointment with him, but that’s probably for the best now I think. I see him in late June.

And, to add to the confusion, surgeon #1 called me on Friday afternoon to tell me, given my pain has gone away without intervention, he now recommends against immediate surgery. “Let’s monitor it! In the meantime, go back to exercising.”

I’m approximately seven weeks out from a week long vacation at the beach with family. Just enough time to drop the ~7lbs of fat and 1″ of extra waist I’ve accumulated during this stretch of inactivity. Frankly I’m amazed that’s it.

So, with two of three surgeons now recommending I get back to my life, I am scheduled for tonight’s yoga class. I’m, quite frankly, very nervous. More scared than nervous. I did two back-to-back ten minute Apple Fitness+ yoga classes yesterday to test my right arm. It held up, with some slight twinges in the forearm, and overall I am in bad physical shape right now – it felt like I was brand new to yoga. Even my breathing was heavy, labored. While the rest of my body is suffering from lack of exercise, that will be quickly remedied over the coming weeks. But will this “dead” right arm bounce back? I’m hoping it’s just weak from my not using it and favoring it for the past few months. If it fails me tonight, then reality will set in that this is a new normal, and I’d be itching to get surgery as soon as possible and forego the vacation. But I don’t even have a verified surgical approach. Ugh.

Stay tuned.