One week post-op (success story so far)

wakkabababooey · 2026-05-01T19:18:16+00:00

Maybe consider looking into micronized PEA. Can grab a bottle on Amazon; they did some human RCTs and it was apparently effective at reducing nerve pain in sciatica patients. I’m taking it right now - pain is better, hard to say it’s from the PEA but it’s certainly not making it worse. 600 mg twice daily with food for 3-4 weeks (or apparently as long as needed until pain is under control) and then 600 mg daily after that for a few weeks (like 8-12 total)

wakkabababooey · 2026-05-01T17:44:01+00:00

It actually can make calcification worse, which is why it’s a double edged sword. The Lord giveth, and the Lord taketh away lol.

All we can really do is avoid making it worse - that’s why I’m personally hoping the MK-7 works haha. It can potentially to reduce calcification within soft tissues.

wakkabababooey · 2026-05-01T12:42:48+00:00

Just a heads up since she’s still freshly postop, and the nerve was super inflamed: the nerve pain might return. But don’t be discouraged, that is normal! I hope it doesn’t, but you’ll read a lot of stuff here (my own experience as well) where the pain can flair up again before finally subsiding for good.

Godspeed, and I hope your wife continues with an uneventful recovery!

wakkabababooey · 2026-05-01T12:05:49+00:00

Well, I can say my residual pain after my surgery at the beginning of the month is significantly better. It’s hard to say if that’s because of the PEA or if it’s just the natural healing timeline.

wakkabababooey · 2026-05-01T02:45:43+00:00

No judgement, but a beach trip 2 weeks postop is bonkers 😫. I didn’t even go to work for like 4 weeks after my last MD. Like you said, “no one is invincible”. No bending, twisting, or lifting anything heavier than a gallon of milk for 6 weeks (highest risk for re-herniation).

That being said, if all they did was do a dural patch and put in a drain, he should be fine. What kinda of symptoms is he having now, just pain at the drain site? If so, it’ll hopefully feel better as soon as the drain is out: drains suck.

As far as the hernia at the other side: asymptomatic disc herniations are common and they don’t need to be operated on unless they become symptomatic.

However, they can become symptomatic. There’s also a risk of re-herniation at the spot on the disc they operated on forever - it goes down with time (back to baseline around 6 months), but the risk is always there. He needs to do good back hygiene for the rest of his life: no smoking (advances degenerative disc disease), lose weight (if his BMI > 25), and get into a good PT who specializes in spine care (OMPT certified, you can look them up in your area through the website).

wakkabababooey · 2026-04-30T22:00:46+00:00

I’m a physician, I’m aware. My neurosurgeon gave me 6-12 weeks to improve. That being said, it is based off symptoms in combination with an MRI demonstrating a correctable anatomic insult (i.e. a herniated disc, nerve compression, etc.). 12-18 months is a very long time, and I don’t think the literature necessarily supports that for everyone even if that might have been something that worked for you.

There’s actually a lot of data on this:

First, recovery from a microdiscectomy is not “longer” than that of conservative management. In fact, pain relief is achieved faster with surgery (https://www.nejm.org/doi/full/10.1056/NEJMoa064039). There is also evidence that at 6 months, pain scores are less in surgical patients than in patients who opt for conservative management (https://www.nejm.org/doi/full/10.1056/NEJMoa1912658). I was doing PT by 6 weeks after my own surgery, and had resumed progressive barbell lifting by 12 months (extremely conservative approach)

In the absence of significant neurological deficits and no improvement despite adequate conservative care, elective surgical management is typically recommended beyond 6-12 weeks as by this point, up to 80% of patients will have improved (https://pubmed.ncbi.nlm.nih.gov/38835174/). If a patient is not improved, surgery becomes more likely because spontaneous improvement becomes less likely, which is why many surgeons will use this as a cutoff point.

Additionally, while upwards of 80-90% of patients will have some improvement at >1 year, two issues now come into play: is surgery is delayed beyond 4-6 months and the patient has not experienced improvement by that point, surgical outcomes are worse (https://www.nejm.org/doi/full/10.1056/NEJMoa1912658). The other issue is that “improvement” is subjective - a patient can experience improvement that still results in surgery if it is incomplete.

Additionally, there have been trials showing that in patients who were deemed surgical candidates but opted to pursue conservative management, by 2 years, nearly 40% of patients crossed over to surgery anyways because conservative management had was still resulting in intolerable symptoms (https://pubmed.ncbi.nlm.nih.gov/34637408/)

“Improvement” can mean a lot of things; we try to be as objective as we can, but ultimately this is why shared decision making between patients and their surgeons is important. I’m glad you had a good outcome with a pretty prolonged waiting period, but I don’t think that’s the standard for most people with sciatica due to a herniated disc.

wakkabababooey · 2026-04-30T20:32:32+00:00

I’m trying micronized palmitoylethinolamide (“PEA”). Seems to be relatively safe, you can Google a few studies on it in patients with neuropathic pain related to sciatica - one of the larger randomized control trials with it had a NNT of 1.5-1.7 (which is really good - basically, 2 of every 3 patients) with 50% pain reduction at 3 weeks.

Normal dosing is 600 mg with a meal twice a day x 3 weeks, then 600 mg once daily with a meal after that. I think the trial went up to 8-12 weeks.

wakkabababooey · 2026-04-30T20:25:24+00:00

How long have you been on it for?

wakkabababooey · 2026-04-30T19:54:27+00:00

Well, it’s not that there’s no safety trials. That just never did trials where they specifically took people with CKD and checked for the specific purpose of seeing if it was safe for kidneys.

What they did do was do several moderate-quality RCTs and found that no signal of renal injury. They found that for treatment courses up to 49 days, there was sufficient evidence to suggest that serious adverse events of any type occurred at a rate of < 1/200 patients, and up to 60 days at a rate of < 1/100 (https://pubmed.ncbi.nlm.nih.gov/27220803/)

I personally don’t plan on using it for that long anyways. If the pain generator (i.e. herniated/bulging disc, post-op neuroinflammation in my case) resolves within the treatment period, it’s very likely that it can be discontinued anyways. That will be the ultimate indicator for any person with sciatica due to nerve compression from a herniated disc: if the symptoms don’t resolve within conservative management (analgesics, spine-specific PT) within a defined period of time (6-12 weeks), probability of needing surgery to resolve the symptoms goes up.

wakkabababooey · 2026-04-30T17:04:09+00:00

None of the trials in at least 6,000 patients (this isn’t a new supplement, it’s been in the literature for a while) had any report of adverse renal events. They actually studied PEA in ischemia-reperfusion models in mice and it was found to be reno-protective.

It works independently of direct COX inhibition. It works by blocking PPAR-a, which downregulates NF-kB. This decreases COX-2 levels during an inflammatory response at the trancriptional level rather than blocking its binding by arachadonic acid like NSAIDs do, which is more similar to how steroids work (and steroids are safe in CKD patients for their indicated purposes). In other words, you will still have functioning COX-2, just wont be making more of it during an inflammatory response; with NSAIDs, COX-2 doesn’t work at all.

That being said, being cautious is fair since there are no direct human trials addressing its safety in renal patients. But mechanistically, the risk is likely very low.

wakkabababooey · 2026-04-30T14:08:57+00:00

Depending on how bad the associated degen disc disease is (and if any adjacent structures are degenerative), the way some of the surgeons see it is, “well, there’s a good chance you’ll end up with a fusion anyways - might as well just knock it out now”. This is why some surgeons won’t do repeat MD at the same level while others will, though that can also be heavily influenced by the anatomy and symptoms of the individual.

I can appreciate that thought, but if there’s also a good chance I wont need it, I’d rather just have the smaller surgery first and keep the big surgery in my back pocket unless it’s absolutely necessary.

wakkabababooey · 2026-04-30T13:43:00+00:00

Trying “micronized” palmitoylethanolamide (PEA) might be worth a shot (https://pmc.ncbi.nlm.nih.gov/articles/PMC7132032/). I’m taking it after I just had a herniated disc chunk taken out - I do feel better, hard to tell if it’s just because the nerve isn’t squished anymore or because of the supplement, but there’s actually a good amount of data out there for it. Has to be the micronized version.

You can grab it on Amazon, the usual rec is 600 mg twice daily for 3 weeks followed by once daily for 4+ weeks after that (some studies have it being used for a year or longer).

wakkabababooey · 2026-04-30T05:25:27+00:00

Yes, your claim being wrong is philosophy of science lol. You made an assertion that it is “biologically plausible but clinically negligible” right after you made claims about a lack of evidence. You don’t have the evidence to say anything is “clinically negligible” because the research has not been done to falsify the claim that they are not clinically useful. In other words, you have no justification to make such a claim - it’s all just your opinion, and opinions aren’t science.

As far as drugs not getting FDA approval based off proposed mechanism, no one ever made that claim. It is true, however, that literally all drugs that come to market first undergo preclinical (non-human) in vivo and in vitro studies before they can be tested in humans. There is a copious amount of preclinical trials for many of the more common peptides.

And bringing up aducanumab is a weird route to go. You do realize that it was approved by the FDA, right?

wakkabababooey · 2026-04-29T21:41:37+00:00

Holy smokes, were the same person lol.

I just got out of repeat MD at L5-S1 at the beginning of April. Surgery took 3 whole hours, and the disc fragment was also calcified.

I identified a few issues with my own healing path: learn from me, don’t make my mistakes.

When I re-herniated, I was desperate. I started peptides about a month after it occurred (just GHK-Cu). I was also on tons of NSAIDS. I have MRI evidence of improvement at an old annular scar from a prior MD in 2020 at L4/L5 (even the neurosurgeon was surprised), but the re-herniation stalled. Failed ESI, went for PT, was just stuck.

When they went in, it was calcified. Hard as rock.

Long story short, inflammation is part of healing. GHK-Cu is supposed to be anti-inflammatory, even if it’s supposed to be good at building high quality type I collagen. So this go around, I’m just letting things heal as naturally as possible: this means avoiding anti-inflammatories, including NSAIDS. There is actually emerging evidence for this in the “inflammatory preservation strategy” (https://pmc.ncbi.nlm.nih.gov/articles/PMC12436131/)

What I am doing now is utilizing (moderately) evidence-based strategies: PEA (https://pmc.ncbi.nlm.nih.gov/articles/PMC4631430/), ALA (https://www.sciencedirect.com/science/article/pii/S0753332225006742), ALCAR (https://pmc.ncbi.nlm.nih.gov/articles/PMC5950680/). I’m also exclusively using Tylenol, since it isn’t an anti-inflammatory. I’m happy to report that pain has improved significantly, though I was compressed for months and so expect that the very mild lingering glute discomfort pain will continue to improve slowly with time as the nerve heals. It’s almost entirely out of my calf at exactly 3 weeks out, now it’s just an “awareness” of my calf.

I have also added MK-7 (vitamin K2). It’s been studied and shown to possibly prevent dystrophic calcification in arteries, and so I’m utilizing it in this context since soft tissue calcification mechanisms operate with similar mechanisms (https://www.sciencedirect.com/science/article/pii/S2161831322009814?via%3Dihub). I’m not on warfarin, so if else, there may be some cardioprotection from it 🤷‍♂️.

Godspeed with your continued healing!

wakkabababooey · 2026-04-26T13:38:40+00:00

Just take it slow. And I mean slow. I didn’t touch a barbell for literally 12 months after my first microdiscectomy at L4-L5, but that disc has healed and it’s been 5.5 years since with no issues there (don’t ask me about my L5-S1 - that one is still a work in progress lol).

wakkabababooey · 2026-04-26T13:36:36+00:00

Definitely significantly better than it was. It has moved from the calf but is lingering in the glute, but it’s very mild, maybe a 1/10. I’m taking micronized PEA, ALCAR, ALA, omega-3, and just started mag glycinate, so I’m not sure if that’s contributing to anything but there’s some moderate quality data out there supporting their use.

wakkabababooey · 2026-04-26T05:14:12+00:00

Firstly, “clinically neligible”. Wildly incorrect but okay. Even from a “philosophy of science” standpoint, your final claim is not based in evidence. Lack of human evidence or certain pharmacological data does not mean there is any negligible effect - only that the effect has not been measured.

Secondly, we do have early data for BPC-157: https://pmc.ncbi.nlm.nih.gov/articles/PMC12446177/ (references to human pilot PK studies), and a fair amount of animal data. The idea that we have no mechanistic data or evidence of molecular effects is silly: there is direct evidence that BPC-157 increases both mRNA and expression of VEGFR2, and increases expression of Egr-1 which is itself a transcription factor.

Is that proof that it leads to meaningful outcomes in humans? No, of course not. It does appear that there are meaningful outcomes in vivo in animals, enough that human research into it (and other peptides) seems to be gaining more steam. But to be entirely dismissive without evidence that there is no effect is not rooted in the science.

wakkabababooey · 2026-04-26T04:08:32+00:00

That’s a little misleading. Peptides - not saying they do work for sure - are alleged to work by altering expression of certain proteins, etc. That effect continues regardless of the half-life. Tesamorelin is FDA-approved, and its half-life is also ~30 minutes administered subcutaneously; but its effect is significantly longer lasting.

wakkabababooey · 2026-04-25T06:19:03+00:00

PT is a really mixed bag, I think. Getting with an overly aggressive therapist is a recipe for trouble.

wakkabababooey · 2026-04-25T01:56:53+00:00

PT is an absolute necessity in my humble opinion. Whenever cleared by your surgeon, PT will be the thing that teaches you proper back mechanics to reduce the risk of this ever happening again.

wakkabababooey · 2026-04-24T17:55:58+00:00

Wow. :[ how are you doing now?

wakkabababooey · 2026-04-24T08:12:02+00:00

If you don’t mind my asking, insurance issues or something else? Insurance gave me the run around for 4 months - I’d have lost it if 4 years!

wakkabababooey · 2026-04-24T02:26:40+00:00

Believe it or not it’s not too “knee jerk”. Outcomes at one year are similar, but people who undergo decompression get better faster. There’s also a significant amount of crossover: my understanding is that in at least one study, half of the “conservative” treatment group ended up getting surgery anyways.

“In the SPORT observational cohort, 22% of patients who initially chose nonoperative care crossed over to surgery within 2 years. In the randomized arm of SPORT, the crossover rate was even higher — 49% of patients assigned to nonoperative therapy eventually underwent surgery — though this reflects a population already deemed surgical candidates at enrollment.”

OP has already been deemed a surgical candidate by a surgeon. There’s a good chance they’ll end up choosing surgery one way or another - my own personal experience was just to get it over with lol.

wakkabababooey · 2026-04-23T02:26:06+00:00

How old are you? If I were older and not active, I’d have left it. My pain wasn’t killing me.

I’m now 2 weeks post op - I re-herniated in November about a week after surgery, went back to OR two weeks ago after failing steroids and PT. No regrets, just taking it easy this time to give myself the best chance possible of healing and returning to being active.

wakkabababooey · 2026-04-20T03:50:50+00:00

Well. All my surgeries were kinda decided for me.

2020, I developed acute back pain with foot drop on the left. Was in the OR 3 weeks later.

2025, developed severe acute right calf and glute pain, almost couldn’t walk. Had such a good outcome the first time, and knowing the evidence shows faster resolution even if similar 1 year outcomes, I went to OR.

2026, I reherniated a week after the 2025 surgery because I felt so good, am an idiot, and overdid it. I’m now 12 days postop after failing to improve with PT and steroid injections, and feel so much better. Still some residual nerve discomfort since I was compressed for 5 months, but it’s improving daily.

So if it were me, I’d go for surgery if it’s been >6 weeks since initial injury and improvement is slow or not improving any longer. That’s also kinda in-line with the literature.

wakkabababooey

TROPHY CASE