"Treat the disease, you win some, you lose some. Treat the patient, you always win."
~Patch Adams~

Sunday, February 12, 2012

What a pain!

Hi everyone, I am back among the vertical (more or less). Sorry I wasn't able to post last week, I woke up during the night last Sunday/Monday with severe back pain......different than the back pain I experience on a daily basis from the long ago car accident. This pain was centered over my spine (so I was terrified I had disrupted another disc), and it was nearly impossible to turn in bed. Getting up Monday morning took almost 10 minutes, and getting a shower, dried and into a pair of shorts and a sweatshirt took nearly and hour (I am one of those people who refuses to stay in my jammies all day------).

Tried to deal with it with my meds, Motrin, and heat all day and through the night on Monday; Tuesday I conceded defeat and had one of my good friends take me to the nearest Emergency Room. The nurse who checked me in very stupidly started palpating my back (hard) before I was even into my gown, I have substantial sensitivity to touch on the right side of my spine on a good day, so he made a bad situation worse. Jackass.

The doctor who came in looked bored, but went through the usual questions (and interrupted half of my answers). I finally convinced him that I didn't do anything unusual to set the pain off, that it wasn't a urinary/bladder/kidney issue, and that if my pain management doctor had been in town (he was at a conference until mid week) that I would be there instead of the ER. The whole time I'm on the gurney (not an optimal place for someone with bad back pain), I'm wondering how in the hell I would tolerate an MRI, xrays, or a CT scan if that's what needed to be done.

Much to my relief, the doctor seemed to finally believe me that I was suffering from severe back spasms, and told me that he could give me a shot of Atavan and wait 30 minutes, if it relieved some of the pain, then we had a diagnosis. He would then give me some oral Valium (it's a muscle relaxant) and I could follow up with my pain management doctor. Thirty minutes later, with a shot of atavan in my hip, the pain had lessened by about 30% (which may not seem like much but really did make a difference). Got my prescription for about 3 days worth of Valium, and was out of there. Oh, yeah, out of the many reasons I did not want to go to the ER in the first place-----here in Charlotte we are having a substantial outbreak of the Noro Virus, which is causing bad gastrointestinal upset in whoever is unfortunate enough to catch it. The nursing homes are full of it, as are many of the schools. My friend Katie is the mom of 9 year old triplets, and I was in no shape to be throwing up for several days-------but my pain won out. Fortunately, I think we were the only ones in the ER at the time I got there, so we dodged a big bullet!

I've slept more in the last 7 days than I probably have since the first of the year (the bioidenticals help, but chronic pain screws up my sleep most nights) with the Valium, and so once I got home I was pretty much in bed period. I felt so lousy I didn't even knit or read, and I am here to tell you TV sucks. I listened to the radio some, threw in some DVD comedies (I love MASH) to pass the time. My friends were wonderful to bring me lunch, fix whatever I needed----I'm a very blessed puppy.

Dr. Hines (pain management) was back in the office on Thursday, so I got in to see him late that morning. By then, the pain had subsided a little, although I still wasn't able to bend forward more than about 20-30 degrees (I can usually put my hands down on the floor flat, that's how hypermobile I am). I'm still dreading that I am going to need some sort of xray/scan, etc, and since I was still in a considerable amount of pain, I was dreading the appointment. The minute Dr. Hines came in, I told him what exactly was going on, where the pain was, when it started, I hadn't done anything out of the ordinary, the pain was not neuropathic (burning pain, when it comes from the spine it often causes the burning pain in the legs), nor was it radiating. I've been Dr. Hines' patient for over seven years, and I love him to death----he is great about patient education, and he always makes sure patients understand it is their body and that they have choices. When I got done, Dr. Hines told me that "as long as the pain isn't radiating, and there's no neuropathic pain, we don't get excited. We feel bad for you, and we know you hurt, but we don't get excited because no burning and no radiating means it's likely not a disc." I was so relieved I couldn't stand it!!!!

We talked and he said that it was likely one of two things: either an acute flare up of the arthritis in my back that just went kind of nuts, or that an adhesion or scar tissue in my spine had worked loose and irritated something that just set of pain receptors. (The explanation he gave me was far more detailed---you are getting the condensed version). He then addressed the options I had for treatment, starting with doing exactly what I was doing, meds, heat and rest, with encouragement to get back in the pool as soon as I could to gently start moving my back and spine around to increase blood flow to the spine and to limber up, also to keep as much strength in my back as possible (I am all about core strength when I exercise because I know it helps my back). He offered me the option of five days of steroids to further reduce the inflammation (I declined----steroids make me very anxious and agitated---he was fully supportive). He talked to me about other options if this didn't get better or recurred, including pain injections and some other similar types of treatments if needed. He said he didn't need to do any diagnostic studies right now, we would cross that bridge if we came to it down the road. I was one happy and relieved puppy!

It's now Sunday and I am amazed at how much better I am doing. I rested the rest of Thursday, and then Friday I slowly loosened up and then made myself walk around the house as much as I could, with short laying down breaks in between. It was pretty funny, I had done two loads of laundry just before I got sick, and they were laying on the sofa in the small third bedroom (my catchall room). I used my "grabber" (one of those utensils you can use to pick stuff up off the floor when you can't bend over) to get a couple pieces of laundry, fold it, then take it to where it needed to be. Then I decided to clean up the dining room table (I had my glass pendant making supplies laid out all over), and again, did it very slowly. Saturday I usually have lunch with friends, so Karen came and picked me up (I started weaning down off the Valium on Saturday but she didn't want me to drive just yet) and I went to lunch----so much fun! We stopped at the Dollar Tree on the way home, I walked around for about 20 minutes, and did really well. It was very exciting. I rested most of the rest of the day (I fell asleep for almost an hour ----- all the excitement of the day). Today I went solo ------ drove myself to Walmart and poked around for about 30 minutes. I did fine, am still using my cane as sort of a back up, but hope to put it back in the closet for good within the next couple days.

Part of my reason for detailing this story is that I am so glad my health care providers made a diagnosis and gave me options for treatment without immediately sticking me under an xray machine or sliding me into an MRI tube. Aside from the discomfort factor, I have had so many radiologic testing procedures done over the last 20 years (since the accident) that I try to minimize my exposure whenever possible. Besides that, those procedures are very expensive, and although I am covered under Medicare (because of my disability), I think we all need to take personal responsibility to keep costs under control whenever possible. It was serendipitous that I read this article from KevinMD.com about a patient who had a diagnostic procedure done and is now paying dearly for it in the form of difficulty in getting insurance coverage. I thought the article was important to share with all of you because we are too often unaware of how such a seemingly innocuous diagnostic procedure gives the insurance companies ammunition to deny coverage to an otherwise healthy patient. This kind of crap from the health insurance companies drives me nuts.

I hope to be back with regular postings by tomorrow-----I'm keeping my schedule deliberately light this week so that I can ease back into the swing of things. The whole experience, while not something I care to repeat any time soon, did teach me a couple things: 1. I have amazing friends, 2. I am not going to take my mobility/independence for granted any time soon, 3. I sometimes fill my days too full just to prove to the world and to myself that despite my physical limitations I have a busy life----being forced to slow down (hell, I was just about stopped this week) made me see that sometimes it's ok to be home for most of the day and it's ok to just slow down when I need to.

Enjoy your week, everyone-----happy Valentines' Day! Let's not forget to wear red on Tuesday to remind everyone of heart health!!!!!!