I admire the shit out of you for being professionally successful in a very tough career, super smart, and hilarious. I can certainly see why you don't have the time and energy for all the other things you'd like to do, given all that you already do (way more than 99.97% of us).
> I’m also dealing with piriformis syndrome with sciatic nerve involvement and anterior hip impingement, so I’m always in pain at a level of 6 or higher.
I have had this type of pain in the past to the point that I could barely walk, and it was/is due to having a flattened lumbar curve. I was able to almost completely cure it using this book:
Just want to pass that along in case it might help.
This book has been pretty good - https://www.amazon.com/Treat-Your-Back-Robin-McKenzie/dp/0987650408/ref=sr_1_3?crid=VCFBPVK1RDX8&keywords=treat+your+own+back&qid=1566594860&s=gateway&sprefix=treat+your+o%2Caps%2C168&sr=8-3
Sorry to hear about your diagnosis. Herniated/bulging L5/S1 here, 28 years old, been dealing with this since I was 23. Injured it in the back of a box truck hauling firewood after college - my employer convinced me not to file as workers comp. I'm sure it would have happened elsewhere with my parents genes, but that was when this all started.
I usually spend about a month a year off my feet due to aggravated disc. Sometimes more, sometimes less. This recent episode has taken me out for a month and I'm just starting to recover - starting a fresh round of PT with a Mackenzie Method certified (MDT) therapist this Friday. This bout might've been the worst so far; pain was at about an 8/10 for over a week. Sitting on an airplane from NJ to FL was excruciating. When I got there, my 87 year old grandma was moving around better than I was. Left leg in shutdown, tingling down to my feet, real bad. I get the epidural shots every six months or so it seems, with the most recent round about a week ago. As of this writing, pain is at a 1 out of 10 and I'm confident that I'll once again be able to return to full form.
The symptoms vary and they're hard to keep up with. Sometimes it'll be acute. BAM - just triggered it, here we go again. Sometimes I wind up just feeling stiff. Like I cant unfold myself when I stand up. Sometimes it shoots down into my butt and my leg, sometimes it feels like someone punched me in the spine. The impact on my head is always the same. I get frustrated, panicked, start feeling sorry for myself. I mean, shit, my injury is at the very center of my being. It feels like being unmade. Being in pain is tiring - I empathize with those who have chronic pain. I'm seeing a therapist for this and other issues. I fear that a lot of this burden will fall on my fiance, and I want to make sure she still looks forward to coming home (hard to do with a guy groaning in pain on the couch refusing help). I've also realized that getting all of my non-work, non-relationship fulfillment from physical fitness is a dangerous game.
My approach to fitness has changed. One example, I stretch for 40 minutes every morning to keep everything attached to my back loose and put my spine in extension as much as I can (I work at a desk, it's a real challenge with this injury. Standing desk has been huge.) Its a fine line. The exercises I need to do to maintain core strength and protect my spine are the same ones that might trigger another episode. I'm still trying to find that balance. I'm still struggling to nail down a good routine. Next attempt is going to be the GMB (https://gmb.io/is/#choose) Integral Strength program. I'm also going to make it clear to my new PT that my main goal is to find a way to safely build strength in my core. Again, have to find a way to keep strong.
In between flare-ups, life is pretty normal and definitely pain free. I'm in the gym, running, riding my mountain bike, commuting to work on my bike, hiking, climbing etc. Figuring out what I can and cant do has been difficult. Mountain bikes are a go, golfing is something I dont get to do anymore. Jury is still out on climbing. I believe that a stagnant lifestyle will do more damage than this disc ever could, so I keep trying to do everything I can. Sometimes I push it too far and trigger another bout. Recently, it happened at the climbing gym after I did the full recommended routine from r/bodyweightfitness and then started bouldering. The warning signs were there - I'm learning to listen to them as this continues. Each bout feels like new iteration with new lessons learned. Moving around and using my body is the only way I can ensure that I'll be able to keep doing that into my older years. Like Robert Mackenzie said - if you do back bends every day there never needs to come a day when you cant do them. Buy his book and read it - It's short and informative.
This has been expensive. The shots are expensive, the specialized care is often out of network. I see an out of network pain specialist who, through some good fortune, has agreed to really work with me on making my care affordable. They bill insurance, insurance tells them the allowable amount that ends up contributing to my OON deductible ($430 out of the $13,000 bill), and the doctor charges me that amount. I also have to wrestle with the impact on my work life. When it hits, I'm off my feet for three days at minimum. On those days, I either have to stand or lay prone. Not conducive to an office environment. I've been fortunate that my work understands and lets me work from home those days, but it adds to the anxiety wondering if it affects the way my company perceives me. Compounding that anxiety, its an invisible injury and I am in good shape. When the lightswitch flips the other way and I feel better after those three days, I almost feel like I have to fake a limp going into work so they dont think I'm faking it.
My doctor has recommended a new treatment called PRP (Platelet Rich Plasma). They take your blood, centrifuge it, pull out the platelet rich plasma and inject it into your disc. No risk of rejection as its your own blood. Disc's have bad blood flow and can't heal properly. This provides the material necessary to heal the damage and is billed as a one time fix. Insurance doesnt cover it because its so new, but the papers I've read make it sound promising. I'm skeptical, but I think I'm going to go for it once this episode calms down. Too tempting to ignore. Still havent entertained or felt the need for surgery.
Thats the story. I wish I could say it isnt that bad, but it is one of the primary struggles in my life. Like a demon that lays dormant. Sometimes I cry, sometimes I get so mad, sometimes I can remember I dont have it that bad. Its helpful to remember that this is remarkably common, so you can arm yourself at least with knowledge and good habits. I know I'm more likely to trigger my back taking my bike off the roof than I am out on the trails. If you're gonna hang up your bike, make sure you find something else to fill that gap. Otherwise you're just resigning and that doesnt do anyone any good. I dont feel any moniker of victory or anything, but I'm learning to adapt.
Also, check out Bob and Brad, the two most famous physical therapists on the internet. In their opinion of course. Wealth of information there.
Treat Your Own Back https://www.amazon.com/dp/0987650408/ref=cm_sw_r_cp_apa_i_oxqbDbX2SGTYH
It is all in a book https://www.amazon.ca/Treat-Your-Back-Robin-McKenzie/dp/0987650408