CT Guided Costovertebral Nerve Ablations

[mmglobal]

Hooch, thanks for bringing up the facets... it may lead to an interesting discussion on how the degeneration and imaging may be involved here.

I asked Dr. Reul to 'overlay' the part of the story that imaging will tell in my case. I would have been happier if he said, "yes, all your other costovertebral joints look perfect, but these two look severely degenerated." That would have been peirfect, but he did NOT say that. He simply said that in my case, imaging added NOTHING. I'll speak to him today and try to get him to show me good vs. bad costovertebral joints. Apparently, my painful ones still look good, or others look worse.

In December when I had my injections, I noticed on the monitor that I have what looks like a grade 4 (end stage) facet lower in my t-spine where I don't think I have any pain. It's kind of wacky that some can look great and be pain generators, while others can look awful and be symptom free. I believe that this is why there are so many failed surgeries. In some cases, it's impossible to get an accurate diagnosis no matter how much resource you throw at it. In other cases, a quick decision to do surgery based on how an xray or mri looks is medically inappropriate.

Spine sucks. You have very few options and they are all bad. I'm glad that I've been able to take the longer road and improve my chance of a positive outcome dramatically. ( I hope I'm not speaking too soon!) I'm glad that I can help my clients to do the same. But when all options suck, and we are just trying to find the one that sucks the least, it is important to do your homework and make informed decisions about your treatment. Sadly, for the average spine patient, it's impossible to unwind all the conflicting information you are getting and not fall prey to the doctor who promises too much and tells you what you want to here. Or the one that is uninformed about the technology that he or she cannot use, or is informed, but won't tell you about them.

Spine sucks... sorry for the long rant.

BTW, more on topic... I'm glad that I decided to stay down and not go out last night. Shortly after my post, I believe that the local that Reul injected wore off. I feel much worse today... like I've been kicked by a horse where the injections were. However, the increased pain from the injections has brought me back, only to where I was before the ablations. I feel about the same as I did yesterday morning. So, still good news so far.

Mark

[Hooch]

That's the truth of it, we're trying to pick the option that sucks the least. 100 years ago appendicitis would kill you. 100 years from now they'll probably have a lot of this sussed.

[Rob Wilson]

Mark,

The problem could be strained soft tissue (i.e. ligaments). These can cause sever pain. Most SI joint and low back strain (iliolumbar ligament) are due to soft tissue not discs or facets.

[Maria]

Regarding your costovertebral joints. Hope you'll be able to post more about the overall status. Interesting that the facet that looks so bad doesn't seem problematic. I'm guessing that's a good thing isn't it? Just hope you can get some very targeted lasting relief.

[dshobbies]

Mark,

I think we may have spoken about this - and I know your father has a 'bad back'. How much of your spinal problems do you think comes from heredity and how much from hitting the ground when you jump out of airplanes? Even those with a family history don't usually suffer lumbar, cervical and thorasic issues.

I'm not saying you shouldn't have done something you love but if you knew in advance you'd pay a price, would you have still done as much jumping as you did?

I had the opportunity to meet a gymnist in the later years of his life. His body riddled with arthritis, he could barely walk, yet he felt his pain and suffering was simply the byproduct of doing what he loved.

Your thoughts -

Dale

[mmglobal]

I had dinner with Karin Buettner-Janz, the co inventor of the Charite’ ADR) at a party in New York a few years ago. She was a world class gymnast to competed in 68 and 72 Olympics. (Much to her chagrin, those will be remembered as the Olga Korbut and Nadia Comăneci Olympics.) She has (I think) 6 medals, including gold. She also has the very important European All-Around Champion’s title. I asked her about the damage that Gymnastics had done. She has none. That isn’t to say that others have not suffered severe damage.

I know the ravages of the NFL, especially when compounded with high steroid use, leads to a horribly painful middle age and older years.

We make the best decisions with the information we have at the time. Kicking yourself for that is pointless. Having said that, if I could go skydiving tomorrow, I would. I will skydive again. (Shhhh…. Don’t tell Diane.) I do not believe that skydiving played a part in my spine problems. I have no injuries other than a sprained knee and never had a hard fall or impact. I know people with 20,000 skydives with no back problems. Consider the camera jumpers. Until the mid-90’s, they wore heavy SLR’s (often multiple) and old video and movie cameras on their helmets when they jumped. I know many with many thousands of camera jumps without problems. I don’t think that skydivers as a cross section of society will have more back problems than whuffo’s (non-skydivers for the uninformed.) They may possibly have less problems because of the general fitness level and hearty life. . (Nightly applications of liquid anesthetics may help!)

I am certain that if I was playing basketball every weekend instead of skydiving for most of the 90’s, I would have had many more injuries and be in much worse shape.

Most people who have cervical problems will also have lumbar, and vice versa. T-spine problems are more rare and are less of a problem because of the lack of motion there. I don’t know why I’m so lucky. I was the kid who liked to jump off the roof and would swing on the rope or jump or climb over things that nobody else would. I don’t know if I may have injured myself as a child??? Remember that I was happy and healthy until a car accident in 1997.

Looking back, I don’t know that I’d change anything. I miss my life. I miss opening my trunk and seeing it filled with my rock-climbing gear, soccer gear, skydiving rigs and more. I miss playing soccer 6 days a week.

The premise of Dale’s question is false. If I knew what I was doing would cause me to be a chronic patient more than a decade (and maybe more to come), would I have done it? If the premise were correct, the answer would be “no”. But, the premise is not correct. I don’t believe my problems stem from soccer or skydiving. It’s just life. Some of us wear glasses from childhood. Some get them when they turn 40. Dr. Reul told me this morning that he doesn’t wear ‘goggles’ and he’s older than I am. (Older than dirt.)

Skydiving…. Soccer… SCUBA…. Count me in. I’d go now if I could.

Mark

PS, Dr. Reul told me and Lauren about a study he did on amateur divers (who go deep enough to do ‘decompression dives’) having disc problems related to the nitrogen bubbles that cannot be eliminated fast enough and cause damage to the annulus. Interesting stuff.

PPS… I’ve never been deeper than about 90 feet… never done a decompression dive.

[Shebo]

Thank you for all of the information in your post. I have been dealing with thoracic pain (exactly what you described) for over a year. I actually think I have been dealing with it for several years. My doctor kept telling me I had kidney stones and to go home and lay down for a couple of days. I would get tested and no stones. But I would feel better and they would say "Oh well, you must have passed the stone." Until I ended up in the ER last year and they said it was a stone and sent me home. The pain never went away. I kept asking the doc for an MRI and she said to me that "It is absolutely impossible that this pain is from your back." I found another doctor and had an MRI done. And here I am...I spend most of my time in a recliner now.

All of the doctors that I have seen, just say the surgery to fix these discs is very difficult. You don't want that surgery and they send me on my way.

I don't want surgery - I just would like my life back.

I am so happy for you and I hope this works for you and gets you out of pain. You are definitely and inspiration for me and this gives me hope. (I hope I'm not too much of a downer on your happy day.)

Safe travels.

[Aaron]

Rooting for it to work for you Mark. I am following my recent mini-success of the epidural injection at my tear site with another round. Will ask for just the tear level vs. both herniation and tear level. Signifigant stabbing reduction for a while. Always interesting to have some new treatmeants out there just sorry you had to endure that much pain to get them.

[Aaron]

Shebo,

I get so mad when I hear there a dr. say there is no way your pain is coming from something. I recently spoke to a Dr. who just trained in torn labrums and did the first surgury on the hip in 2008 in my area. He said no telling how many people we sent away and said it could not be that or we did not know. ONly after his own hip problem had a hard time being diagnosed and had to fly to chicago did they find the torn labrum, did he get interested. Long story short I had my surgury in 2005 and all the same dr. including him told me it could not be that instead of just checking. It took alot of reasearch from myself and a dr. who left his ego at the door and said I cant help you but I will get you to somone who can. It took 1 day vs. 2 years for a diagnosis in houston, tx. 45 min surgury and no more hip pain. I just feel there could always be a chance until everything is ruled out.

[jsewell]

I'm rooting and praying for you too Mark. That thoracic and rib pain is horrible. Probably more so that people don't think it can happen and the thoracic spine is so stable. bla bla bla...........
What is an MVA if seen it on a few histories and am wondering.,

I used to have to lay flat on my back to get the thoracic pain to a level that i could go on walking, Embarrassed my kids a lot one summer at the airport when it hit and i headed for a out of the way wall to lay down at.k

I would take off running up a mountain if i could too . Not sure it caused any of this, but may have contributed. I already told my hip surgeon ,who is awesome that if it just meant replacing my hip a few years earlier i would run a few days per week. Now I think for the first time my spine surgeon would say no to running, but i may ask him just for kicks. That was my passion and stress reducer . Especially here in Southern California in the mountains.
judy

[Shebo]

MVA = Motor Vehicle Accident

Until I am able to get some relief, it's unacceptable to me when I hear "there is not anything else we can do" or "your pain isn't from your back". I just keep looking like everyone else. I wonder how many people accept those answers and go home to live with the pain in silence?

I hope this is the answer your pain, Mark.

[cherylstewart67]

As you can see from my sig, I have recently had this done. They usually won't do more than one level at a time, something about sever dizziness. It helped the left side, the right side not so much. It feels like a ligament pulling in between the joint somewhere. I may look at having it repeated just to see if purhaps they missed the spot. It's only early Feb and I have alreayd met my deductible. I did however manage to go one year without having anymore surgery!

[mmglobal]

Friday is certainly a 'turn the corner' day. Not only did I wake up NOT groaning and reaching for my meds, but I didn't take any breakthrough (1/2 Norco) until 2pm. I'm normally taking that very early and usually take 3 or 3 halves each day.

I FORGOT my 3pm dose of oxy until almost 6pm... that is always a great sign when you can forget to take your meds.

Lauren and I toured the old church this morning and spent all afternoon in Rembrandt's house. This museum is a must-see here in Amsterdam. We hope to see the Van Gogh museum tonight. It's open till 10pm.

I should note that even before the t-spine pain started, the museum stroll was very difficult for me. The remnants of my lumbar problems make standing still or slow-strolling very painful. I'm pleased with my tolerance so far. We've seen a lot on this trip! I wish I had more time and energy to process the pictures for posting here.

Mark

[dshobbies]

I'm waiting for the post 'forgot to take any meds all day...' Until then I guess forgetting for hours will have to do.

[jsewell]

Motor Vehicle Accident i guess this is my brain on drugs that i could not figure that one out.
I am charting what i take and when , only because i was forgetting when i took anything. i love when i look at it and realize i have gone like 12 hours with no pain pills. Of course i am sleeping for about 14 of them!!!! Still nice to not be on a 2 or 4 hour schedule.
I have been taking oxy straight since my hip replacement of june 2008 and for a while have taken 20 mg as a dose. My pm doc never writes the prescription out that way, only for 1 every 4-6 hours. But she kind of gives me just enough, not any left over, maybe this time if i keep sleeping so much. I guess it is bad to write it on a prescription although i would have thought i was not alone in this dose with others much higher.

Cheryl i saw that you had C3-4 done or higher, i forget one second later after reading something. Anyway if my screws are put in higher it would be around the C3 area, i think. What motion did you loose with that ?
thanks everyone
That is some serious touring Mark, How old is Lauren?
judy

[mmglobal]

Lauren is 22 and is my youngest of 3. She finished her undergrad degree in cellular bio at UCSB last year and will take the MCAT soon. Next year, she should be in med school. I am a proud Papa as she is my tour guide. She lover her AP art history and AP European History classes and her retention is amazing. I ask a question about a painting and she not only gives me the history of the painting and artist, but also fills me in on the politics that surrounded the work!

This has been a wonderful trip. (Pictures coming soon!)

Mark