Major Surgery or Minor Procedure?
The Amazing Difference
Mike and His Sore Calf
The pain in Mike’s right calf started out at about a three on the “pain” scale. For someone in his mid-seventies such minor annoyances were common, and he more or less ignored it for several weeks. Until the pain level was at about a six. That was the only thing that seemed to change: the pain never spread beyond one specific place in the calf, and it didn’t appear to have “traveled” from anyplace else. It was, he told the first doctor he visited, as though someone had stuck a very pointed knife in the muscle.
Mike was a well-versed layman when it came to medical issues and he researched the problem on the internet, looking for clues as to the likely cause of the pain and from whom he should seek help. Living in a thriving Florida city, home to many retirees, Mike had many choices among physician specialists, and he decided he could easily make the right choice among the myriad orthopedists, neurologists, physiatrists, and phlebologists in his city.
He decided that since the pain was growing in intensity, he would start with someone used to dealing with wide ranging physical issues, whether they related to bones, tissue, vessels, or other possible sources of his pain. He chose to see a well-regarded physiatrist who put him through a series of tests concentrating on nerve conduction. While the doctor did not profess to have isolated the cause of the now-rated “level 7” pain, his best answer was that since the spot Mike indicated as the location of the pain showed an obvious vein blockage, he had little doubt that was causing the pain. He referred him to a venous surgeon who subsequently agreed with the diagnosis and stripped the appropriate vein from Mike’s leg.
The pain continued to get worse.
The physiatrist then referred Mike to a pain management specialist, essentially deciding to treat the symptom and not necessarily the cause. The pain specialist prescribed a nerve blocking medication that he knew would stop the pain, hoping that time would take care of the rest. Mike couldn’t abide the medication and decided that pain management wasn’t the appropriate long-term solution. He then made an appointment with his family physician, having given up relying on his own efforts.
Just before visiting his family physician Mike was able to add one more symptom to his localized pain, a symptom that his research told him would at least allow a physician to know from what part of his anatomy the pain was emanating. He suddenly developed what’s called “foot drop”, where the forefoot literally drops due to weakness, irritation or damage to the fibular nerve, including the sciatic nerve.
His family physician agreed with the idea that the sciatic nerve was the culprit. Mike visited his orthopedist, underwent an MRI of his spine, and discussed the results with the doctor. It turned out that there were two issues affecting the L4 and L5 areas of his spine. The first involved a small bone spur that might have been impinging the L5 nerve and the other was, as the physician put it, several dislocated and degenerated discs. He immediately suggested a spinal fusion to correct the problems and was confident the calf pain was due to the impinging of the sciatic nerve from the disc problems. The pain he said, did not have to “travel” down the nerve to his calf, but as sometimes happened, it simply jumped to the calf.
The doctor explained that the surgery involved would be complex, require about 6 months of relative inactivity and physical therapy, and would cost anywhere from $75,000 to $125,000. Mike then asked him about the bone spur and if it could be causing his symptoms. He said probably not, and after asking him “If I was your dad, would you recommend starting with the minor procedure of removing the bone spur or the fusion?“ The doctor took a long pause to consider the question, and then said he’d recommend the fusion. Mike replied that with all due respect, if it took him that long to decide, he would opt for the removal of the bone spur and if that didn’t solve the problem, he would probably undergo the fusion.
Mike had the bone spur removal procedure performed about two weeks later. It was out-patient surgery with a one inch incision. He went home two hours later, rested a day, and then played golf. The total cost came in around $1500, fully paid for by insurance.
The pain was gone and has not returned in the ensuing 6 years.