Random Ramblings: Changed the date of my doctor appointment and had a tweak from a bike

I finally just decided that I wanted to bump back my appointment with the doctor “House” type doctor until my husband can drive me. It’s just that … I’m a terror in the car. It’s just so painful to sit there. I get cranky that we aren’t making the lights fast enough. I also get cranky if you drive too fast because then I’m worried about stopping. Plus, my husband is used to how much pain that I am in. If the doctor office is taking too long to see me, he won’t hesitate to say something. I need that. I need someone to have my back. Not that my friend won’t … it’s just that with her there, I would be more likely to try and grin and bear it because I don’t want her to think I’m a baby. Plus, with my husband, if I can’t make it, I can’t make it. He will understand. If we have to abort mission on the way there, he will know why. He will know that I’m not being a baby. I need that kind of support, especially since I’m so nervous about this appointment.

Plus, I had a minor/moderate tweak this week.

Here’s what happened. I was doing slightly better! My stretches were going well. I was able to walk farther and with less difficulty. I was also able to stand at my work desk for longer and without too much pain. You know, the kind of pain where you can’t stop digging subconsciously at your back because it hurts so much?

So, because of this, I decided to get a stationary bike.

When I was doing better, at PT, I rode one. I thought, well, I’ve done it before, why not get one for the house?

Therefore, I went online and tried to find one. It’s hard in San Francisco because there really isn’t a place that has a large selection of bikes that you can try out. I did find Sports Authority and they had several bikes online, but only two in the store. My husband went to see the one I liked and he bought it. When it was delivered everything seemed fine. My husband was going out of town and wanted to see me ride it before he left. I’m only telling you this because it adds to why and how I hurt myself again. First off, it was late. I wasn’t thinking clearly, I was already spent from my whole day, and thus, I wasn’t really focused. Secondly, he was in a hurry because he needed to go to bed since he had to be up at 4:00am for an early 6:00am flight. Therefore, everything was kind of rushed.

I tried to lift my leg over the middle of the bike and it was quite high. Again, I didn’t feel anything tear or anything like that, but I knew it was too high (after the fact). We aborted mission and hoped that nothing would come of it.

Sure enough, the next day, the annular pain was back in full force. It was hard to sleep, hard to stand, and just generally more painful. As the days have gone by, about 6, it has sort of gotten worse. It’s almost like the annulus hurt, then it moved to the nearby muscles, and it just keeps spreading as each new muscle group gets more and more tired from compensating. Writing this blog now is difficult. I have a burning pain just over my right butt cheek where the butt meets the pelvis. That’s on top of the annular pain and the erector spinae muscles screaming at me.

I’m also telling you this to learn from my mistake. My husband and I made up some new rules.

– No new activities after 6.

– No being in a hurry.

– No rushing each other. If someone wants to talk it over again, so be it. Better to over analyze everything than to miss something.

– Go slow in case there is something that might have been missed.

Words to live by!

I’ll let you know how long this setback was/is. I was thinking about the setback with the car, thinking maybe it was three or 4 weeks … SEVEN! It was SEVEN weeks! That was a long time!

Oh, and if you are wondering why I didn’t just get the same bike from PT, it’s because that bike was $2000!

The internet is just so hard to gauge sometimes.

Best of luck to you all!

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Madeline Fresco is a novelist who lives in San Francisco. She is the author of CROSSED THE LINE, available for Kindle at Amazon.com, for Nook at Barnes & Noble, and as an ePub at other eBook retailers. You can also listen to her novel as a free, serialized audiobook at madelinefresco.com.

Annular tear doctor appointments: Tricyclic Antidepressants

One of the things my pain management doctor RS suggested was taking antidepressants. I know, I know. The last time I took an antidepressant, Venlafaxine, I didn’t like it and had horrible withdrawals.

 

However, he stated that he thought this class of antidepressants would be better.

 

He probably went on about the Tricyclics for thirty minutes or so of the appointment. He felt that they had a lot of benefits — more so than the class of antidepressants that I went on early.

 

The Venlafaxine was supposed to prevent a chronic pain syndrome from occurring. Well, we all know THAT didn’t happen. Yet, this time, he spoke about the drug having anticholinergic effects, antihistamine effects, and about locking pain signals from reaching the brain.

 

I just copied and pasted this from Wikipedia (thanks Wikipedia!):

 

Chronic pain

The TCAs show efficacy in the clinical treatment of a number of different types of chronic pain, notably neuralgia or neuropathic pain and fibromyalgia.[11][12] The precise mechanism of action in explanation of their analgesic efficacy is unclear, but it is thought that they indirectly modulate the opioid system in the brain downstream via serotonergic and noradrenergic neuromodulation, among other properties.[13][14][15] They are also effective in migraine prophylaxis, though not in the instant relief of an acute migraine attack. They may also be effective to prevent chronic tension headaches.

 

However, because of the awful withdrawal from the Venlefaxine, I called my primary care physician and asked his advice on whether or not he thought it was a good idea, especially since the Venlafaxine didn’t help at all. He said he would try it if he were me. He said, unlike the Venlafaxine, which he stated I had to be on for a good three to 6 months to see if it was working, that the Tricyclics I only needed to be on it for a few weeks.

 

We went back and forth, but I agreed that I would try it for a good 4 weeks to see if it would work or not. I have to admit, not having to commit to them for 3 to 6 months helped my make the decision. Oh, and the best part? He said, unlike the Venlafaxine, that the Tricyclics were easier to withdrawal from.

 

Phew! That’s all I needed to hear.

 

I like the fact that I don’t have to commit to it for that long and that the risk of withdrawal symptoms are minimal.

 

There was a snafu though. I called the pain management doctor’s office to tell them I’d go on the meds. They called me back later and said that they needed my pharmacy’s phone number so they could call in the Cymbalta. Thank God I am a nurse, and for whatever reason, remember that Cymbalta and Venlafaxine are in the same antidepressant class! I was like, woah, wait a minute, I don’t think Cymbalta is a Tricyclic. Sure enough, they were going to order the wrong med for me! Ugh! People! You HAVE to check up on your doctors!

 

So, I have been on the drug for 8 days now. Quite frankly, I have not noticed a difference. It has helped me not drink though, which I am grateful for. The side effects can be drowsiness and I just don’t want to be walking around like a zombie.

 

There is one side effect, that I can’t tell if it is from the Desipramine or the Forteo, is that about 30 minutes to an hour after I take it, I really have to pee. Like, a LOT. I have even tested emptying my bladder right before I go to bed, but, sure enough, 30 minutes later … it’s like a racehorse. It really is disturbing my sleep.

 

Oh, and yesterday I moved up from 1/2 a pill to a whole pill.

 

I’m gonna give it three more weeks, but, if I don’t see a difference, then I will stop taking it. There is no need to be on any more drugs than I need to be.

 

There it is! I’ll keep you posted.

 

P.S., the picture in this blog is of Olympian Gus Kenworthy. He decided to stay a few extra days in Sochi in order to adopt some of the stray dogs there so that they wouldn’t be shot by the Russians. He deserves a gold medal for that! Good job Gus! Way to be a stand-up human being!

Annular Tear Doctor Appointments: Pain management, original doctor revisited

IMG_0389I saw the original pain management doctor who did my epidural steroid injections, RS. I should have been seeing RS all along. He had so many suggestions for me. He thought we could try antidepressants, Valium, (for pain relief), he thought about doing PRP, minimally invasive fusions, and perhaps disc replacement. He had great suggestions for doctors. He also took all of my questions and thoroughly explained all of them. I was probably in his office for about an hour and a half. Even as we were walking out the door we decided to try, and schedule, a medial branch block of L4-L5 and L5-S1. I had the medial block last week. It told me a little bit. It gave me a 30-40% pain reduction. However, it’s hard to tell if that is because the Lidocaine numbed the muscle and ligament that has been giving me problems or if it really was just the nerve. After much discussion, and a lot of back and forth with phone calls, we are going to try another medial branch block a little higher up. Hopefully, my insurance will cover it, but since it’s not the actual “spot” on the MRI, they are feeling doubtful. Oh, well, I still need to know what is going on with my back, so it would be in my best interest to get it done.

The only sad thing is that he is going out of town for three weeks, so I have to wait for him to come back before I can get the procedure done. That sucks a bit. I tried calling his office on Monday and leaving a message, but the receptionist said she never got it. I tried back today and got an appointment. Part of me wonders that if perhaps I had gotten through on Monday that I would have been able to get an appointment. However, she made it sound like there were people far worse off than me, and that she may have not “given” me an available appointment that day anyways. So much for trying to get this all done before he left for his trip. I was hoping to get this test done, and then, based on the results, determine what to schedule for when he got back.

Well, at least I have an appointment with him post procedure to talk about it all. That should help expedite as well.

Annular Tear Doctor Appointments: appointment with endocrinologist for Forteo

So I saw the endocrinologist on 1/30/14 to get the Forteo pen. The needle is so small, I’m not too worried about it. It seems fairly straightforward. I put on a need, twist it on to secure it, pull back the plunger, insert the need subcutaneously, and then depress the plunger.

I’m a bit concerned still about actually having to inject myself though! That will be a unique experience.

The doctor said it should take a few weeks to see any results, but it will be hard to gauge. I mean, how does one tell overnight if they are healing more. We presume that after 4 weeks I should be able to tell. I mean, I’ve made such little strides with my improvement thus far, that any real improvement might be able ot be contributed to this drug.

So I am to start this week and once per day and see how I do. This would be the week to see if I have any nausea or any side effects from the hormone. I need to be careful of my calcium, so I will get my blood drawn every three days or so.

Alright, I guess we will see how it goes …

Pain Management Doctor Appointment

Well, not the greatest doctor visit ever.

I saw a pain management specialist yesterday to see if there was anything that they could do to help alleviate the pain and to maybe think of some things we could try to help the muscle and annular tear heal.

She wasn’t very helpful on either front.

Dr. T.P. was very thorough in her health history and seemed to be taking very good notes the whole time. She asked what things I had tried and seemed very impressed(?)/astonished(?) that I had tried so many avenues. What did she think? That I would just be laying around for a year and half twiddling my thumbs? Of course I would be proactive!

Yet, she didn’t have really much to offer on pain relief. She gave me a cream to try out, but I was hoping for something, I guess, more substantial. She had no suggestions on things that I could do to improve the annulus, or to improve the muscle. She said no way on IDET, no on disc replacement, and no on further epidural steroid injections. The reason behind no more epidural steroid injections was that she said it does wonders for people who have sciatica, not for the type of diffuse, generalized pain I am having from my annular tear. She had no comment on fusion and complete disc removal. What she did suggest was trying the PRP. She really wants me to try and tough it our for a few years until stem cells are available. She thinks that’s the wave of the future.

So really, leaving her office, what it boils down to is that I will have this back pain for years to come, with no relief in sight, and with the hope that stem cells will cure/fix me.

That caused some tears last night. No kids. No adopting. No job. No sitting. No life.

Ughh.

Random Ramblings: New Year, new doctors

It’s been way too long with this back pain. After some much needed tough love from my family, I am attacking this new year with new doctors. The ones I am with just aren’t working.

I have now made a new doctor appointment with my primary care physician to see who he can recommend. I have also made appointments with the pain clinic at UCSF and the spine center at UCSF.

I really don’t like the idea of going to a pain clinic. It makes me feel like I have failed. I shouldn’t have to be going to a pain clinic — I feel like I should be better by now. Yet, I am not. It also makes me worried that they are going to prescribe a bunch of pills that simply mask the pain and that I won’t actually get any better. Another big concern of mine is that the masking of the pain will actually cause more damage. I injure myself so easily. Sometimes I don’t know how much until the next day when a simple pain, or a non-felt pain materializes the next day into a full-blown problem.

But, I will try this pain clinic because what do I have to lose? I know, that’s what I said about the physical therapist and I am a million times worse now because of them. Oh, how I wish I had never gone to that physical therapist. Sometimes, well a lot actually, it keeps me up at night thinking about how that one physical therapy visit changed my entire life.

Doctor visit update and new ultrasound results

Well, finally got some good news from the doctor’s office today. I had him do another ultrasound of my back. He said that it looks much better than it did the first time he did an ultrasound. Good news!

I love dogs

However, I did try and get him to pin down if it was better than the last time. He really did a great job of evading that answer. I’m gonna let it go though. As long as it shows that it’s healing, that means that it CAN  heal. I mean, that’s my biggest dilemma. For some reason, my body just doesn’t heal as well as other people.

I also wrote him two days ago in regards to my muscle taking so long to heal. I asked him about maybe, finally, trying to do more blood work outside if a CBC and a Chem 7.  I thought maybe some kind of rheumatology blood work, perhaps a muscle biopsy, and even test for heavy metals. Who knows? Maybe all those years of riding my scooter to work behind people’s exhaust pipes did a number on me.

He referred me to someone else. However, this person is all the way in Mission Bay area, which is 20 minutes from my house. Considering I barely made it home from Marina Green the other day, that drive seems highly unlikely.

I debated not asking him, but then though, screw it. I asked him if he would place a phone call to the doctor for me and have a consult. Here’s the thing. I don’t want to drive ALL the way down there only to have the doc ask me to bend a couple of times and then suggest all the same stuff everyone else has. I want a different outcome, and if I’m not going to get one, I don’t want to put my back through the drive.

So there it is. A bit of good news. I’ll take it. It doesn’t mean my pain is going to be gone. It just means that if I can get this muscle to heal, then I will know more about what is causing the residual pain.

Oh, and one more thing. I did not take that apartment. It was entirely way too small for way, way too much money. I can’t even believe how much they were asking for it. I know my husband was thinking at least I would be able to walk around whenever I wanted, but still. It had to have been less than 400sq ft for $2850/month. I couldn’t even fit my bed into the bedroom. It would only fit in the family room.

Oh, well. Back to the drawing board.

Random Ramblings: Follow up doctor appointment post trigger point injection

Happy Halloween

Two weeks ago I got the trigger point injection near L5-S1 in the erector spinae muscle. I have to say, when I get the prolotherapy injections, usually within three days I can’t feel the injection site anymore. With the trigger point, it took about a week in a half. That made it a lot harder to tell if it was “working” or not.

Yet, within the last two days I was able to walk farther, I was able to bend a little bit more, which was very rewarding.

I saw him today and he was pleased with my progress. That made me feel good. I hate it when I go, like the other day with my Endocrinologist, and he/she seems disappointed or discouraged. Because I had made some progress, he wanted to wait on giving me oral steroids. He seems pretty opposed to them. I asked if it was because they can cause weaken the ligaments and tendons in the body, and I have this problem where I don’t seem to heal as easily as other people — he said that wasn’t it. He said that it was because it can cause necrosis in something in the hip? That seemed rare to me and I didn’t probe any further.

However, at the end of the appointment (stupid me!) I asked what stretches I could do to help loosen up the lower part of my back now that I seem to have much better range up top. Hmm. That didn’t go as well. First he had me sit in a chair and put my feet up on a stool out in front of me. I just teeter-tottered back. I had to openly laugh out loud at my rigidity. Sometimes, how unwell I am makes me laugh. Then he tried taking the stool out. That was better. But. We HAD to take it a step further. I pointed to the spot where it was tight. He decided to then place his thumb in that area and press really, really hard. I asked him what the goal of that was, and he said to loosen up the scar tissue that had formed there. However, he kept having me bend forward while I did it. As we all know, I can’t ever tell when I am doing something if I am hurting myself. So, now I’m a bit on the freaked out side that I might have done something stupid. Remember, my last set back was, and still is ongoing, 9 weeks ago. When all of this started, I only had a T10-T11 ligament tear. It was after one stupid move at the physical therapist office that caused an annular tear in my L5-S1 disc. I have to be so very careful every time I do something since my body is so fragile.

Now it’s a difficult wait game. I will at least not freak out tonight. If I wake up tomorrow morning and I am significantly restricted or in pain, then I will very much start to worry if I actually set myself back.

Next appointment is in three weeks on November 20th, 2013.

On a side note, Happy Halloween everyone.  Halloween is actually my favorite holiday/non-holiday. It’s all about having fun, being a little goofy, and candy! There is no family drama wrapped up in this day, and everyone gets great pictures out of it.

Enjoy. And, if you are in pain, just watch  spooky movie with some popcorn and some candy. Partake as much as you can!

4 days post trigger point injections

How do I feel a few days post trigger point injections?

Eh.

It seems to help the pain in the muscle a bit. But it really does highlight the fact that it is more than just the muscle. It really starts to ache right in the middle of my spine at the L5-S1 area, and, I have to say, just a bit lower than that also. Not sure what that means, but I will ask.

 

Was a bit sad today. Tried to get it together — hard to. Hard to be missing out on so much. Hard to get over my can do attitude of just pushing through. I can’t just push through. It makes me feel helpless.

Interesting day at the doctor’s office

Was supposed to get PRP today. That’s platelet rich plasma. Actually, I was supposed to get it last week, until I realized that I was on Celebrex and that meant that I couldn’t get it done. Funny, my doctor didn’t realize it, I had to tell him.

 

So I get there today, and he tells me that we can’t do it because he doesn’t have the right equipment. Really? I had to secure a ride, go off my anti-inflammatory, and suffer the pain of driving there — for him not to have the equipment? That’s just so irresponsible.

 

The other issue I have is that I talked to him about maybe some questions I might have about an alternate way to go — the whole steroid route. Someone in my life was questioning whether I should or should not have the PRP. So I simply asked. Well, before I know it, I’m getting steroid injections. Now, I’m going down the steroid route. That means two weeks from now if the trigger point injections don’t work, I will then take an oral dose pack. If that doesn’t work, I will also have an SI trigger point injection.

 

I’m a little miffed at myself, because, again, I let myself be swayed. I wanted the PRP. I should have stayed with that. I’m also a little perturbed that the doctor was so easily swayed. He should have stuck to his guns if he thought the PRP was the way to go. It should have still been the way to go even if he didn’t have the kit.

 

We will see how things go.

 

So now I have a follow-up appointment in two weeks. Who knows? Maybe this will help. I really have to say that I doubt it, but I will cross my fingers.