Hello everyone, time for an update. I’m so sorry that I haven’t been around for so long. It’s been our rough few months, and while I’ve started to post many times, it’s difficult for me to post bad news. Over the years I’ve posted every victory and setback (in perhaps too much detail), warts and all. Perhaps the procrastination has paid off, at because now I have a little good news to go along with the bad news.
I’ll recap the situation briefly and bring everyone up to date. I seemed to be recovering nicely from my April surgery. I had my knee very strenuous and stressful trips to Germany with clients for surgery in May and again in late June/early July. Things became more and more difficult through the summer with advancing pain in the middle of my back, below my shoulder blades. My fifth trip this year was in mid September. During that trip, things got much worse. With the April surgery having been cervical disc replacement that spanned C3-T2, and my new pain being below the surgery site, Dr. Fenk-Mayer and Dr. Bertagnoli decided that the first step was to determine whether not my pain was from my cervical slash upper thoracic pain, or below it. We did bilateral facet injections from T2 to T8. We only used local. There was no steroid in the injectant. These injections seemed to be positive. However I was in so much pain before they were done and the apparent relief was relatively short lived, I wondered about the validity of the test. I wondered if there was a placebo affect from the injection. It was a really hard to sort out. I also questioned whether or not my pain could be the facets in my thoracic spine. (I’ve had several thoracic MRIs, including a one in March, and my facets have never been called out.)
I struggled through the rest of the trip in came home on September 20th. For a couple of weeks after that I continued to try to work. On a good day I might spend 4 or 5 hours at work. On a bad day I would just go in for a very short while before I gave up. Since then I’ve not been out of the house except to go to a doctor, pharmacy or to run a brief errand (very rare and only when absolutely necessary.) I’ve been able to keep the business going with my staff coming and working out of my house. Good days are very rare and should not be considered good days. They might start off with 3 or 4 hours up and about, around the house, before things get bad. Bad days grind by with a minimum pain level of 6 or 7 and with frequent bouts of 8 or 9. There’s not a single day that doesn’t include several hours of 7, 8 or 9. One thing that makes it so bad is that when the pain levels get up there, there’s nothing I can do to get comfortable. Sitting, standing room, lying, walking… no matter what I do, it stays bad.
I’m still grossly under-medicated at 3 x 10mg/day Oxycontin, plus ½ Norco 2 – 4 times/day between Oxy doses. I’ll likely be going to 3 x 20mg/day Oxy soon. All of the nonsense that goes along with this is happening in spades. The pain management doctor’s office and insurance company have been particularly difficult. On the prior two refills, even though I started a week ahead of time, they still ran me all the way out of meds up. Even with that experience, on the last refill I really had to fight with them so they would allow me to refill the prescription before the day it ran out. It’s kind of a catch 22. If you push back when they treat you like a drug-seeker, it makes you look like a drug-seeker. It doesn’t matter that their office snafu and insurance snafu’s cause you to get a 20-day refill instead of 30-day because the insurance company fights tooth and nail against 3/day dosing.
On to the good news! It’s taken me two months to push through the office and insurance difficulties, but I finally got the first round of injections here approved and we did them yesterday. We did bilateral medial branch blocks (diagnostic facet injections) from T6 to T8 (that’s two levels). The most likely level is T7-8. Dr. Barreto really impressed me with his needle skills. He was fast, accurate and generated and minimum amount of pain with the injections. I was quite disheartened when the pain and pressure I felt during the injections did not seem to be at my pain site. However, just a few minutes later I seemed to perceive relief. I was going to go work at my office for a couple hours as the true test, but decided to do something pleasant instead. I called a friend and we went down to main street for a sandwich. (it’s been several months since I’ve done anything as active as that!) For the next couple hours I “seemed” to feel better, but just like with the last set of injections I wondered about placebo affect. (Although this time the results seemed more dramatic.) The real result came at the end of the test. At about 2 hours post-injection I started to get uncomfortable and at 2 ½ hours my old pain came back very strong. This put to rest any reservation I had about the test. This morning I was a little better than usual. I don’t know if there’s residual anesthetic or perhaps lubricating that joints helped them. By noon everything was back to full on strong. Hopefully tomorrow or Sunday the steroid will kick and an ill get some relief from that as well. (I forgot to mention that in late October I had taken a Medrol dose-pack with no relief.)
I’m pretty blown away by the positive results because I did not think that this could be my facets. I thought that facets would come on slowly over the years and would be episodic to have it come on strong and last for months now does not seem like a normal presentation. I believe that what has happened is that my T7-T8 level has been bad for years, had quit moving, and was asymptomatic. In the months following my cervical surgery I did physical therapy that was specifically aimed at mobilizing my thoracic spine. My guess is that re-mobilizing this level, caused the previously asymptomatic problem-level to become symptomatic.
I have been very discouraged because the feedback that I’m getting from the surgeons about potential thoracic repairs is not good. The positive facet injections represent wonderful news. I may be able to effectively deal with this problem with something as simple as a rhizotomy. I meet with my pain management doctor on Thursday. I don’t know how long it’s going to take to push through this but with my lousy insurance I’m sure all be waiting until at least January before I can proceed.
Again, I’m sorry I haven’t been around. I hope to participate more in the weeks to come.
All the best,
Mark
|