Sunday, April 10, 2011

'I nearly gave up': Ulrika Jonsson on her agonising back condition

By Ulrika Jonsson

Looking forward: Ulrika today is coming to terms with the back pain which has blighted her life since 2007

Back pain - the words alone don't seem enough to describe what we go through. I have been a sufferer for the past four years and, as it no doubt is for thousands with the same problems, life has been at times a living hell.

I remember days last summer, lying flat on my back with my children playing happily downstairs, wondering if I would ever lead a normal life with them again. I couldn't eat, or sleep.

And despite injections of painkillers, steroids, physiotherapy, osteopathy and a number of other treatments, nothing could end the agony. In those darkest moments through a thick fog of disordered reason, a demented mind and the very deepest frustration, I simply didn't want to go on.

In June 2007, before this all began, I was an active, fit mother of three who - as any other mum will attest - spent much of my time picking up things off the floor.

I was at my local chemist's, bending down to tidy up the products my (then) three-year-old daughter Martha had knocked over, when suddenly it felt as if acid was being poured down the very lower parts of my spine, my coccyx and down my left buttock.

It was so weird, I don't think I even cried out. I repeated the move to see if it was a one-off - it wasn't.

As a keen runner, I had suffered various snags - painful hips and minor knee injuries - most of which resolved with a bit of physiotherapy. But this pain I felt deep inside my lower back was so much worse than anything I had experienced before, and it did not relent.

Fighting back: Ulrika and family after Malcolm's birth in 2008. She put on 5st while pregnant and was told to lose weight and strengthen core muscles to ease her pain

The very next day, I visited my physiotherapist, who suggested it could be sacroiliac joint problem - these are the bones at the bottom of the spine that attach to the hip.

I had been moving house in Sweden a few weeks before and had been lugging heavy boxes. This, she said, could have triggered the problems.

I went home with some gentle stretching exercises and the expert's reassurance that it would probably get better in a few weeks.

But after two months the pain had still not subsided, so I went to see my GP. He immediately referred me to a neurosurgeon - which sounded rather extreme - concerned it could be a neurological problem.

Although an MRI scan ruled that out, it did reveal that the vertebral discs - cushions that act as shock absorbers between the bones of the spine - were degenerating in my lower back.

Apparently, fluid was leaking from them, pressing on nerves and causing the pain.

Even worse, although for some patients surgery is an option, in my case he wasn't sure it would help.

Brighter outlook: Ulrika in her weather girl days before her back problems

I felt disheartened. My pain was so very clear to me and to hear there was nothing much that could be done was frightening. It should improve in the next three months, I was told, and I should keep taking the painkillers and anti-inflammatories I had been prescribed.

The neurosurgeon told me that if I was desperate, I might be helped by epidural injections in my spine, similar to those given to women in childbirth, combining an anaesthetic and steroids, which dampen inflammation. I certainly was desperate, but I had a trip to Sweden booked to celebrate my 40th birthday and I wanted to give it time to see if it would improve, so I decided to wait until my return.

My husband Brian and I had been trying for a baby for the previous five months - my fourth and final child - and I was again reassured my condition was probably a flareup that would soon settle. I had no reason to think otherwise.

A month later, in September 2007, I fell pregnant, but instead of the terrible, relentless pain having improved as the neurosurgeon and physio had suggested, I was no closer to having any relief. Elation at the news of my pregnancy soon turned to concern as I knew I'd have to give up the painkillers.

With the pain so acute and unrelenting, I resolved to investigate the injections. I was referred to pain-relief expert Dr James Foster at The Princess Margaret Hospital in Windsor. Not only did he confirm that I was suffering from degenerative disc disease and a problematic sacroiliac joint, I also had a good dose of arthritis in my hips.

He said he couldn't give me the injections: I was pregnant and as they are performed with the aid of an X-ray machine to make sure they get the needle in the right place, that could pose a risk to my unborn child. I walked away feeling despair and resignation.

The pregnancy continued much as I had expected - my increasing weight putting further pressure on my back, added to which I also suffered from symphysis pubis dysfunction. This is a condition brought about by the pelvis becoming misaligned through excessive movement.

It caused me terrible pain, especially during the last trimester of pregnancy, and I sought momentary relief from a great osteopath. Of course all this was a small price to pay to bring a child into the world. But the pain was constant.

I gained an unbelievable five stone and eventually gave birth to 10 lb of Malcolm in June 2008. The next month, I made my way back to Dr James Foster, who duly administered the injections.

It was hard to gauge how much exactly they helped. They definitely gave me some relief but the pain in my left buttock and thigh, which stopped more or less behind the knee, remained.

Dr Foster advised me to lose weight and strengthen my core muscles so they would support my lower back. 'Think Darcey Bussell, think Darcey Bussell,' he urged.

I felt more like a sack of sprouting potatoes . . . but started on a programme of Pilates and physiotherapy. Then one morning a couple of months later, I woke up incapable of moving at all.

Busy: Before her condition Ulrika was an active, fit mother-of-three who spent much of her time picking things up off the floor

When I tried to get up, I was paralysed with pain. It took my breath away and I couldn't even call out to Brian. Eventually, when I did manage to let out a scream, the look of sheer terror on my face, and tears (which don't normally come easily) streaming down my cheeks frightened him and the children.

I was terrified because I had no idea what the pain was. With Brian's help I eventually got upright and called Dr Foster, who agreed to administer some more injections.

I was instructed to persist with the physio exercises in the hope I would not only strengthen my core stability but rebuild my muscles on the left side of my buttock and thigh.

I am a diligent pupil but my pain persisted, and moved position from time to time. I stayed on the anti-inflammatories and another year or so passed. By last year, depression had begun to creep in.

Pain is incredibly isolating. We live semi-rurally so everywhere is reached by car - but I couldn't bear the thought of sitting in a car seat. So I couldn't take the children out. I didn't even go out myself. I spent days on end behind closed doors.

I don't go out socially very much, so that was no great loss. But I didn't want the days to begin and I couldn't wait for them to end. I was incapable of tending to my children - indeed, I wasn't able to be left alone with my youngest for fear of not being able to pick him up if he fell.

I had also chosen a new profession - that of writer, which involved sitting at a desk - and I couldn't even do that. I feared for my future - psychologically, professionally and maternally.

By April last year the pain had worsened again and I found myself back in Dr Foster's office. He ordered another MRI, gave me more injections and started me on a very low dose of amitriptyline, a tricyclic antidepressant that is helpful in treating chronic pain.

At the time I was filming BBC2's Shooting Stars and struggling to stand up, let alone act in some of the sketches. I think what I hated most of all was the idea that I wasn't able to just get on with it, as I've always done all my life.

I hated being the one who wasn't able to feel normal. I was furious with the pain and I couldn't bear even to have a conversation with people about it.

The injections gave me relief and, courtesy of the amitriptyline, I was starting to get some better sleep.

By last July we were between houses, renting, and I was in such agony that I didn't know where to put myself. I'd pace the house all night because lying, sitting, standing or even walking did not alleviate my suffering. I truly felt as if I was being driven insane.

I couldn't see past this pain. I couldn't imagine it ever subsiding.

Dr Foster found me in his office in absolute pieces. I couldn't even sit still on the chair opposite him. I tried so hard to hold it together but the floodgates opened and the tears poured out. I was angry, hurt and exhausted. He understood. He read in my eyes that I couldn't go on any longer; that I was close to giving up, that I saw no way out; no way of life without pain.

He prescribed pregabalin, a powerful drug that works by stabilising electrical messages in the brain, also used to treat epilepsy. After that, I seemed to cope much better. I still have the pain, and some days are considerably worse than others.

One of the side effects has been the impairment of my short-term memory. I sometimes struggle to find words which, in turn, leads to momentary frustration.

For the past three months I have gone swimming religiously, every second day. At times the pain feels as if it has subsided, at others, during times of stress or sitting down for long periods, it flares up. Some days are considerably worse than others.

What I have lived through these past few years has been life-changing. I have seen the world in a different light, from a different perspective: one of lying flat on my back. We were building a house and at one stage I thought we should consider making a bedroom downstairs for me to live in.

And now I remember my father and his parents' constant complaining about their bad backs. Why didn't it dawn on me earlier that I may have inherited a problem like this?

My condition is degenerative - it is not likely to get better. I know I'll be back for more injections and that doesn't faze me at all. I will do whatever it takes to help myself.

I will continue swimming because the feeling of being mobile in the water exhilarates me each and every time. My aim is to reduce my intake of painkillers and anti-inflammatories.

I feel stronger psychologically and my appetite for life has returned. I am determined not to be beaten. I may not win every battle, but I'm extremely determined to win the war.

Fixing the spine's shock absorbers

Degenerative disc disease is a term used to describe the changes in the spinal discs that occur in some patients, writes Dr James Foster, Consultant and Hon Senior lecturer in Pain Medicine.

It appears to be part of the ageing process but can occur with athletes or be a result of heavy lifting. Genetics and lifestyle (smoking and obesity) may also be factors that cause disc disease.

The spinal discs are fluid-filled, compressible cushions between the vertebrae, which act as shock absorbers for the spine.

Degenerative disc disease can occur anywhere in the spine, but most often occurs in the lower back and in the neck. Age-related changes in the discs include a loss of fluid, reducing disc height and the ability of the discs to act as shock absorbers.

With age, the discs are also more likely to tear, leaking fluid into the spine, or bulge, resulting in pain.

Treatment at first is usually painkillers (anti-inflammatory drugs), physiotherapy and lifestyle changes (such as weight loss and stopping smoking). Exercises that strengthen the core stability muscles, such as Pilates and yoga, are also helpful.

If these treatments do not help, then injections into the spine - using local anaesthetics and steroids or radiofrequency lesioning, which interrupt nerve signals that transmit pain - can give patients significant relief.

Surgery is also an option. This usually consists of either spinal fusion, in which sections of the spine are fused using metal rods or bone grafts, or the newer artificial disc replacements.

Alternatives to surgery are interventional pain management techniques including spinal cord stimulation and implantable drug devices. The advantages of these over surgery is that they have fewer complications and if they are not effective, the devices can be removed without damage. If surgery fails, the patient is often in a worse situation than before.

There are patients who are never free of pain. Pain-management programmes are useful treatments for these patients as they use a holistic approach, involving psychologists, physiotherapists and other health professionals.


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