Monday, February 10, 2014

I need to stop using superlatives

On Friday, I had two medical experiences. The first one was mentally painful because the orthopedic surgeon wasn't able [didn't want to take the time?] to explain my injury to me any better than the PA and his long term plan for my injury kinda sucked. He wants me to go through a series of three spinal injections that have about a 50% chance of working for pain relief, and even if that doesn't work, his only recourse was nerve pain medication, which will just mask the symptoms, if it even works at all. His whole plan hinges on the belief that if we just wait long enough, my back will heal itself. While that would be awesome, I'm not going to be able to live for months with the kind of pain that makes me need a shower stool because standing for ten minutes is unbearable.





He also didn't explain the nerve medication to me at all and just gave it to me because I was there complaining about pain, so I'm not even sure I feel comfortable with taking it. My husband had a similar medication and he said that it made him periodically very confused and disoriented.

I have an appointment with a neurosurgeon and I'm probably going to hold off any any nerve pain medications until I meet with him and discuss risks/benefits and whether it's even a good option for me.

When I had my MRI on Monday night and I had to lay on my back for the scan, I thought to myself "This is the worst pain I have ever felt". Prior to that, I thought the worst pain I had ever felt was straining an intercostal muscle between my ribs during pregnancy.

I decided on Friday that I need to stop using superlatives to describe pain because sometimes "This is the worst pain ever" can't describe some experiences.

On Friday afternoon, I had my first epidural steroid injection (ESI) in the lumbar area of my back. (Originally it wasn't scheduled until the 13th, but the radiologist decided to move my appointment up.) I read about the procedure on WebMD before I went and they said many patients ask "Was that it?" at the end of the ESI experience, so I felt like the biggest challenge would be not thinking about the needles going into my spine.

Before the procedure, the very personable doctor came into the pre-op area to talk to me about everything. I wasted my time trying to get answers from the orthopedic surgeon that morning because I should have just waited to talk to Dr. Camden. He was able to explain the whole procedure and he was also very familiar with my MRI images and he told me details about my injury.


1. I have what is called "transitional anatomy" at my S1/L5 junction. That "dried up degenerated disc" the PA told me about is actually a vestigial fusion.



Basically, my spinal anatomy is differs from the standard because two of the vertebrae are fused together. This means there is no disc to absorb impact between those two fused vertebrae and that can put more strain on the disc above, and that's the disc that I ruptured.


2. My disc isn't just herniated, it's also torn. I don't know what that means in terms of recovery, but the torn disc releases chemicals into the body that cause a pain reaction, which could account for some of my severe pain.


3. The ESI, if it works, won't kick in from anywhere to 3-7 days after the procedure. If after 10 days I feel no difference, then we can say the shot didn't work. Then I would need to schedule a second shot and he would try approach the problem differently to see if he can provide relief. 


4. If the ESI is successful, the results last 3-6 months and in some cases, up to a year. Also, I can only get 3 shots in a physical year. A year is 12 months and if the shot only lasts for 3 months, you can see a potential problem there.





I took a Valium so I'd be nice and relaxed for the procedure, but even with the drugs I felt pretty nervous about the whole thing. It started with them wheeling me to a special room equipped with X-ray equipment so the doctor can see what he's doing with a fluoroscope. I had to lay face down on a X-ray table, which unfortunately was a painful position for me. They inject something to numb the skin so you don't feel the needle(s) during the procedure, but you can still feel a little pressure and if you look up, you can see your spine on the big screen with the needle poking around (public service note: don't look up.)

Finding the nerve in question and injecting contrast wasn't too bad, but when it came time to inject the steroids, that's when shit got really intense and I went from nervously chatting with the nurse to crying like a little bitch and begging them to please stop.





The doctor let me take breaks to catch my breath and he tried to go slowly, but it was still the most intense pain I've ever experienced. The doctor said that he had to inject it directly on the nerve, because there was no space next to it. I guess if you have that space, life is pretty fucking sweet. Basically, for some people, it doesn't hurt at all and for other people, it redefines how "10" on the pain scale really feels.

They told me my whole right leg would be numb after the procedure because the doctor would be injecting anesthesia into my spine, so I was under the misconception that a numb leg would equal no pain for the rest of the day. No, it just meant I needed help getting up and down the stairs but my leg still hurt. Having my whole leg numbed really drove home the point to me of how little of my leg I can actually feel. The only thing I really noticed was that my knee was numb, and the rest felt pretty close to my new "normal".

As a bonus, now my back is really sore from the procedure and I'm even more incapacitated than I was before the ESI. The best part will be going through all of these again soon if this first shot doesn't work. The doctor told me "it's usually less painful the second time" but I'm pretty sure that's a lie they tell people so they'll come back. I guess it's foolish to hope for a pain-free remedy for pain.





One thing I learned from that ESI procedure is that the quality of your care can really make a difference. While the ESI was way more painful than my MRI, I will remember it more fondly because of how hard the doctor, nurses, and staff tried to make me more comfortable and how compassionate they were to me, even when the pain made it impossible for me to do anything beyond pant like a panicked Chihuahua and stare at the wall.


There, there 


I did end up filing a compliant about the MRI tech from Monday night and the Director of Imaging from the hospital personally apologized to me on the phone and in person, and I feel comfortable that it was an anomaly in otherwise fantastic care. Hopefully, I can stop racking up personal experiences at the local hospital. I'd like to just be a normal non-broken person again.






This week is a waiting game to see if the shot worked. If by next Monday I feel the same then I'll have to schedule a second epidural injection procedure. For now, I'm actually in more pain than I was before I had the shot done. I used to have most of my referred pain in the side of my hip and quad and now I have acute pain on the side of my calf which is both new and fun. It's hard to compare, but I also think my numbness and sensation loss is worse. At least everyday this week I can hope "Today is the day the pain will get better and maybe I'll even get sensation back!" even if I'm not feeling too optimistic about it at the moment.



If you had to bet, would you put money on this shot working? Remember, the odds are 50%. Flip a coin! Amuse me by guessing.


Do you have any anatomical abnormalities? In addition to my fused S1/L5 vertebrae, apparently my bottom ribs are also shorter than they should be. I guess that accounts for my delicate and feminine waist line.

26 comments:

  1. No sarcasm today. This makes my heart hurt. I'm so sorry you're going through this. I can't even begin to imagine how frustrated you are.

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  2. I'm sorry that things are still crappy. At least you had a pleasant experience with the staff instead of having them tell you how your pain is ruining your day!

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  3. Stop lying, the doctor told you that ultra running fused your vertebrae and you're too embarrassed to admit it, aren't you?

    Also, I've heard herbal tea and vitamins really help with pain management.

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    1. I find that Vitamin Percoset is pretty helpful.

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  4. Christ, I HOPE it works! I may have missed an earlier explanation, but I wasn't sure if this was an actual RUNNING injury or just something that happened to you, and it sounds like it would have happened regardless of running? Either way, hope you can get back to feeling good soon and sorry you're such a delicate, feminine freak of nature.

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    1. It's likely caused by a combination of the relatively recent pregnancy and always carrying my fat baby on my right hip, and having a high impact hobby certainly didn't help. It's not technically a running injury, but it will change how I approach running in the future.

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  5. I'm going to skip the sarcasm as well and hope really really hard that you have some relief. I'm not the praying sort, so that's out, so hoping will have to do. At least you are in the best area for medical care. I'd have to drive to Boston for that.

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    1. Even tiny small hospitals do this procedure. Source: I live in the middle of nowhere and went to a tiny hospital :)

      I will have to drive to see a neurosurgeon. If I need it, then I don't really care I guess.

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    2. Yes, even small hospitals do this. I'm in NH and had to have an ESI for an issue with S1/L5 and a small hospital here did the procedure.

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  6. I really hope that this shot works for you, and that you find some relief soon. I'm glad that the staff doing the ESI were so compassionate and gentle (as much as they could be) with you. It goes a long way knowing that someone cares about you and wants to help you feel better, even if they unfortunately have to inflict more pain to help. I'm also happy that the Director of Imaging called you and personally apologized for the rude behaviour of the MRI technician. The MRI techs I've had were understanding of the pain I was in and worked hard to get me feeling as comfortable as possible, so I hope that you just got a bad apple, or maybe she is generally nice but someone shit in her cornflakes that day. Either way, it sounds like they took your complaint seriously and dealt with it. I really, really hope that you feel a bit better soon.

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  7. This is horrible to read, I'm so sorry for you that this happened and I hope that the shot does work. Best of luck x

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  8. Speaking optimistically I sure as hell hope this works for you. I have a disk issue with S1/L5 and had the ESI and NOTHING prepared me for the amount of pain having that shot in my nerve would be. I too laid on the table just sobbing it was so bad. But, I too, had doctors and nurses during the procedure that were really warm and reassuring and it sounds like you did as well.

    This sucks, and I'm really sorry your dealing with this crap.

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  9. Sorry this is sucking so much. Hope the shot a) works and b) relief comes quickly. Thank you for the crying Tobias gif. I don't blame you for not taking the new nerve medication without knowing anything about it. Bad dr. Glad the MRI peeps apologized. I envision - once all this is behind you- an animated (gif) ranked pain scale. Or maybe a display of perceived unbearable levels of pain (first time marathoner, first time through child birth, nerve problems, needle in the nerve, etc).

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  10. My mother has gone through this. I'm convinced there are not many things worse than back pain. She went through three doctors before finally finding a Harvard graduate out in Seattle that she travels to now. She has had more hardware taken in and out of her back then I care to remember and she's actually getting ready to have more work done in a few weeks. The good news is that medicine has come a long way and I bet they get you fixed up soon. The hard part is figuring out what works. You're a strong fucking cookie, if anyone can get through this, it's you! :)

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  11. I'm going to guess yes because I'm trying to be better about thinking positively so more positivity comes into my life. So I think it should work for you too.

    But seriously, I am so impressed with you. I would be a disaster during all this. You are handling it like a rockstar. I really hope you feel better soon!

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  12. I remember my boss (who'd had steroid injections in her shoulder) explaining to me that steroid molecules are really big so the needle is really fat...like a drinking straw. I didn't look when they did mine.

    Yes, I was born with some issues. Aside from my big nose, I have abnormally narrow hip sockets (dysplasia) which is why I need a replacement at my tender young age. I was also born with a lung issue that caused my lung to spontaneously collapse when I was 22. That was some freaky shit.

    I really hope you have success with this shot :)

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  13. Oh god I hope this works.

    Genetically, the only quirk (that I know of!) is that I was born with a small hole in that little piece of cartilage that hangs out in front of your ear...the one sort of over the hearing hole? I love my scientific terms. Anyway, it made it look like I was a badass 5 year old with that...thing...pierced. Way ahead of my peers, most of them didn't start getting ridiculous piercings until high school!

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  14. I'm going to opt for positive in your million dollar question and say that the injection will work. At least I hope it will.

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  15. I hope it helps and that you find some relief!

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  16. i'm sorry to hear this, but i think that having a good experience friday means that things are turning around for you! (at least, fingers crossed that's what it means)

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  17. Hope this works! And glad you had some decent medical providers to work with at last!

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  18. I am really sorry that you are having so much pain still; I am glad to hear that the people working with you this time were so much more compassionate. I really hope the injections help.

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  19. Anatomical abnormalities: transitional segment lumbarization with spatularization, bilateral pars defect, facet tropism in my L5 and sclerosis of the acetabulum. Any of those sound like your back stuff?

    I'm so sorry that you've had all this pain. What a bitch. I'm voting yes it'll work bc you need to catch a break!

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  20. Same as above -- no sarcasm, dick jokes, or anything glib. I hate this is happening to you, and hope for the best with this treatment.

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  21. I really hope that the injection works, and that your injury does eventually heal itself. And hooray for a doctor who finally gave you some useful information.

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  22. Best of luck! I read this in the morning but didn't get a chance to comment until now. My fingers are crossed that something works, and soon.

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