Posted by: Kate | May 23, 2009

Um… OW.

So, yesterday, I had this medical procedure.

It’s called a medial branch nerve block. Basically, the specific part of my spine that shows the most damage (both formation of arthritic bone spurs and disc degeneration) is in the lumbar and sacroiliac regions – think, the range of waistbands you see on most jeans today. I get pain from the high-waisted ’80s-style waistband area to the modern inappropriately-dressed-teenager waistband area. According to both my PCP and the pain specialist to whom she referred me, my x-rays and MRI both showed the worst problems happening at the facet joints – the sticky-out spots on the side of the spine.

Both insisted that this was the cause of most of my pain. I shrugged; who knows? All I know is that my back hurts. That walking slowly makes it worse, as does sitting still for too long, impact (even just hard shoes on hard floor), and trying to go from sitting to standing and vice-versa. That leaning way forward, to touch my toes, hurts and feels really, really good, all at the same time. That I cannot sleep for more than three hours at a time; a feeling of grinding, aching pain and a desperate need to stretch wake me up a few times each night. But, lacking omniscience (don’t tell my kids) or a perfect knowledge of precisely which neuron is firing at any given moment, I didn’t know exactly which nerves and joints were causing the most problems. So, I was willing to accept their belief that the culprit was those facet joints.

“Sure,” they said. “And you’ll be able to tell, because the most painful things to do would be to bend over backward or twist from side to side – especially if you tried to twist to the side while bending over backward.” Well, not one to burst into limbo at odd moments, I hadn’t considered this before… but I tried it, and… no, actually, not especially painful. A little sore, but more in the straightening-up-again stage than the rest.

But still, they insisted, it was a problem with the facet joints. Therefore, they wanted to perform two rounds of medial branch blocking, as a diagnostic test – but they were really pretty sure they already knew the answer – and then, when (not if) that worked to temporarily decrease or eradicate the pain, they would perform a radiofrequency neurotomy, a.k.a. an RF ablation, which effectively severs those nasty, guilty nerves.

I wasn’t immediately sold on the idea of severing any of my nerves at all, even if the pain would go away for a while, what with the concepts of “severing nerves” and “right next to my spinal cord” not seeming like things that should occur in the same sentence. But, in my ongoing quest to be a good patient, I was willing to at least try the medial branch block and see what happened. I read up on it, saw that the long-term risks were comparatively minimal, and learned that my doctor had done this procedure many, many times in recent years… so, OK, let’s try it.

I went in yesterday afternoon – the Friday of Memorial Day weekend – and got ready. They hooked up an IV of saline, got me suited up in a very sexy johnny and my own jeans, and wandered me into the procedure room. I had to lie on my stomach – oh, right, another very painful thing for me to do – and they added a shot of Fentanyl (pain medication) and Versed (sedative/amnesiac agent) to the IV. Both the Fentanyl and Versed were in small doses, so I still felt plenty o’ pain and I remember every second of it.

They cleaned my back with alcohol or whatever – something cold, anyway – and then turned on the x-ray machine that was hovering over the table. The doctor came in, and gave me four shots down the right side of my spine, at four consecutive facet joints.

It hurt.

A lot.

A really, really lot.

I cried. I forgot to breathe. I laid as still as I could. I asked for more Fentanyl.

They offered to stop right then, but it seemed most logical to me to just plow through it and get the left side done as well, rather than dragging this out. They gave me more Fentanyl, and the left side wasn’t as bad – still very painful but not excruciating.

When I entered the building, I happened to be having an unusually good day, back-pain-wise. They’re really, really big, in the pain-treatment world, on using a scale of 1-10, and I guessed I was at a 2. Just a slight nagging awareness, nothing that even required medication.

When I left the procedure room, I was at a 6 or 7. Bad enough that I couldn’t ignore it, and could not find a position that was anything other than acutely miserable. Bad enough to bring on a spontaneous migraine, for which I received Fioricet, my normal medication, not particularly strong but it does the trick if I take it early enough. Happily, I did, so I spent the rest of the evening with back pain worse than any of my medication could address (I take ibuprofen and Ultram, which is stronger than what you can buy over the counter but not as strong as Vicodin and the other fun ones, no blissed-out feeling for me on it), but no migraine.

The doctor evaporated the moment the procedure was done, before I even realized that the pain was increasing and not due to the needle sticks (I know needle pain, from my various IV adventures – this was more obviously a grinding/inflammatory sort of gig). The nurse who came to check on me and sign me out had changed out of scrubs and into shorts and a t-shirt, and was obviously dying to get out of the office and start her weekend. No one seemed especially concerned that the procedure had not only failed to help me feel better, but had actually made things worse. No one but me and Willem, that is.

I had difficulty getting into the truck when Willem drove me home. I needed his help to change from jeans into yoga pants. I went to bed at 8:30 because sleep was preferable to awareness of how bad my back was, and I was up at 7:00 on a Saturday – before the kids – to take a hot shower and try to work some of the stiffness and soreness out.

So, no. The procedure was not a success.

I’m a bit better now, having stayed on ibuprofen/Ultram all day and moving carefully. Being a long weekend, everything’s closed until Tuesday, so I have to wait to find out whether they expect me to go through this again “just to be sure” or if one failure is sufficient.

I’m trying to focus on the fact that at least now I don’t have to make a decision about the RF ablation, because that was making me uncomfortable just thinking about. But the awareness that I have one less option to even consider, as far as pain control is concerned, isn’t sitting especially well with me.

Advertisements

Responses

  1. Oh No! I am so sorry that it made things worse rather than better! I hope as the weekend goes on you are feeling some relief.

  2. That sucks — mainly that the procedure made things worse, but also that the stupid medical “professionals” (term used loosely) were so quick to bolt before finding out how you were. I hope by now you’re a bit better and are able to enjoy some of the weekend.

  3. That sucks big time. I hope you are doing better. Sending you a big hug!

  4. They’re trying to talk me into this for the bone spurs in my cervical spine, from C2-3 to C5-6. Given that I’m not in excruciating pain ALL the time, I’m not so sure of this. I take two half-Vicodins a day for the pain, along with naproxen, and have for the past five years ever since the original injury. The foramen that the nerves to my right arm travel through is stenosed shut, mostly, and they’ve discussed surgery — but given that they can’t guarantee I won’t be worse off, I’m just as happy to leave things the way they are. I keep arguing with the pain management people about it…in fact, have to go back and see them again so I have enough meds for vacation — and she asks things like, “don’t you want to be out of pain?” Given that I have pain from other sources as well, and my medication use has been rock-stable for years now, why tinker with a known formula?

    Sorry it didn’t work, but you’ve given me ammunition to just keep saying “NO” loud and clear to the nerve blocks!


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Categories

%d bloggers like this: