A SECOND OPINION.

Today is my last day at work before officially going on a medical leave of absence. To be honest, I am relieved beyond words. I am relieved to not have to navigate airports and lift luggage and deal with client visits right now. I am relieved to not be limping around the office hallways with people thinking whatever it is they are thinking bout me. I am relieved to not have to focus on solving crises and interact with uncooperative colleagues while hopped up on pain medication. I am relieved to not have to go through my morning routine of getting showered and getting dressed, which leaves me exhausted before I even get into my car. I am relieved that I do not have to squish into work clothes like a sausage in its casing - the last few months of physical inactivity have left me with a good extra 15 pounds on my frame.

The outcome of the diagnostic procedure mentioned in the last post was interesting. For the first time in a long time, I hardly had any pain, but the procedure itself was extremely painful. I have had several lumbar epidurals over the years that were performed under sedation; I was completely unaware of what was going on and didn't feel anything other than some tenderness after the procedure.

With this particular procedure, the doctor needs you to be awake to comment on any pain you feel. Let me tell you - it hurts. I had ten injections of anesthetic between the vertebrae , all of which I could feel. Afterwards, the doctor advised I treat this as a "test drive" of what to expect with a spine fusion. He asked that I do something physical within the next six hours that I would not normally be able to do.

Bolted Bionic Husband took me to the mall and we walked around, something I would not have been able to do on a normal day, and interestingly enough, I only felt pain in my thoracic area (the upper back) but none in my lumbar. However, when the anethetic wore off, it really wore off: I was in tremendous pain. The doctors request that patients stop taking pain medication one to two days before this diagnostic procedure so that the outcome is more realistic of your actual pain level. And as many of you trying to manage chronic pain know - it is all about being ahead and in front of the pain with your medications. In addition, there were so many injection sites that when I showered for the next three days after the procedure, the injection sites would burn and sting.

My doctor called the next day and asked for my report. I told him that I had less pain than I had had in years. And during my next appointment he advised that I seriously consider a spinal fusion.

The next step is the second opinion which I decided to get at the University of Utah Orthopedic Center. My father is a physician and believes that the University of Utah Medical Center is a Medical Heaven on Earth. His physician referred me to Dr. X, who is considered an expert in spinal conditions. If he tells me I need to do more stretches or yoga or Pilates, I think I will truly lose my composure right in his office. There is nothing that I can physically do, not enough downward dogs or sun salutations, not enough consumption of green leafy vegetables or supplements or acupuncture or aromatherapy that I can do to make this better. But something tells me that once he sees those two discs that barely exist anymore, he'll at least have something to say.

THE LAST RESORT.

After trying what has seemed like everything, I finally visited a spine surgery specialist who sent me for new MRIs. The findings:

"Progressive 3-4 mm L1-L2 subligamentous disc extrusion extending to the L1 inferior endplate and causing central canal stenosis (8-9 mm AP canal diameter). Disc protrusions at L3-L4 and L4-L5. Multilevel lumbar central canal stenosis due to discogenic disease and congenital short pedicles (8-9 mm AP canal diameter at L1-L2, L3-L4, and L4-L5)."

In layman’s terms, I have five discs in various stages of herniation with significant spinal stenosis. Two discs were barely visible in the films (see black vertical stripes in picture above). In addition, my gelatinous disc goo in these two discs looks as if it has melted around the spinal cord and the nerves, causing significant impingement (see the masthead picture above - that is my L3).

My specialist's recommendation: undergo a diagnostic procedure where the two worst discs are injected with a powerful anesthetic. If I am pain free for up to six hours afterwards, than we can determine that these discs are the culprits. And the most effective treatment for these virtually nonexistent discs is to remove them and fuse the vertebrae around them together to support the spine and relieve pressure on the surrounding nerves. This is called a spine fusion.

Whoa.

TAKE SOME PERCOSET, NEUROTIN, TRAMADOL, CYMBALTA, AND SOME SOMA AND CALL ME IN THE MORNING.

This is the morning pain pill cocktail I have been throwing back for almost four years now, the only variance being that the dosages of these medications have continually increased since they were first prescribed. Let me clarify: this is what I took to start the day and does not include any medications taken during the remainder of the day. IIt can certainly add up, can't it?

Despite all I was doing and had been doing, the pain returned with a vengeance. I can no longer twist or bend - no more yoga or Pilates. I didn't finish the ski season and spent the last day of it knitting in the lodge while my husband and friends partied on the slopes. I don't walk my dogs now - walking at a brisk pace causes bone to grind on bone in my lumbar area which panics me to no end – what if it severs something I really need? What if I end up in a wheelchair? What if it creates even more pain?

At the time I was working for a software vendor and was traveling at least once a week. I would wake at 4am and immediately take the Cymbalta, Tramadol and Soma, even before I had my coffee. That way, it could start working while I took a hot shower to soften my muscles surrounding my spine that are always tight. I would haul a laptop and a rolling suitcase to the airport by 5:30 am, lifting both on the security x-ray, taking off my belt and shoes, walking through x-ray, putting my shoes and belt back on and lug my gear to the gate (by this time I couldn't wear any kind of shoe that wouldn't slip on. Anything with buckles or laces were impossible as I could not bend forward to buckle or lace them without tremendous pain).

By 6:30 am, I was in alot of pain and exhausted. Once I boarded the plane I would lift my suitcase into the storage bin, and lift it back down at the end of the flight. Once I arrived wherever I was scheduled to be, I would then take a Percoset and the Neurotin as needed (and it was always needed) throughout the day. I would repeat this entire process - airport, security, lift suitcase up, lift suitcase down -  around 7 pm the same evening, taking an additional Tramadol or Soma with a plastic glass of cheap Chardonnay.

I was exhausted, in tremendous pain, and clinically depressed. To be perfectly frank, there were several times I wished a semi would run the red light of an intersection and hit me. Other times I hoped to slip on the kitchen tile and quickly break my neck or trip and fatally split my head open on a blunt object just to not have to deal with this anymore. Plus the added pressure of trying to perform to my previous standards at work while I was having this physical and emotional meltdown was taking its toll, and I began to feel like I could not do anything well. At this point only a handful of my coworkers knew I was sick. Then, when pinched nerves in my left leg created a significant limp, it wasn't as easy to hide how I felt physically when walking around the office. I was also becoming less capable of keeping my opinions to myself and took issue with things that would not have bothered me in the past. FYI, coworkers and bosses, especially, do not appreciate this. Things were going downhill in  a hurry and I knew it was time to try something else. This was no way to live.

AND BACK TO THE DRAWING BOARD.

When the pain unexpectedly crept up again a few months later, I added acupuncture to the mix, thinking that Eastern medicine would do the trick. While I believe that there are many positive and effective outcomes to Eastern therapies like acupuncture, I personally experienced no relief.

Again, I increased my medications and even began a controversial therapy of injecting human growth hormone, shown in various research to speed healing and cellular regeneration, into my abdomen on a daily basis. I started testosterone therapy as well, with the goal of building more muscle to support my spine. Every morning like clockwork, I rubbed testosterone-laden cream on my body like Jergen’s lotion. One thing about these therapies? They are EXPENSIVE, and due to their controversial nature, they are not covered by insurance.

When the pain grew worse I started doubling some of the medications prescribed by the pain management physician. I would frequently do this while putting on my ski boots, determined to participate in "normal" activities with Bolted Bionic Husband, while chasing my “pill cocktail” with a Bloody Mary - extra vodka - at the lodge’s bar. This may work for rock stars but for me, not a good quality of life choice.

MERRY CHRISTMAS AND HAPPY HANUKKAH!

The following December I was in a MRI chamber, willing myself not to open my eyes while the machine drummed away, knowing that if I opened my eyes to complete darkness I would freak out and embarrass myself in front of the staff. It occurred to me, a little too late, that I could have sedated myself just with what I had in my home medicine cabinet.

The result: four discs in various stages of herniation and/or degeneration, with the beginnings of spinal stenosis (for those of you new to “spine-speak” that means "marked narrowing of the spinal canal"). I began physical therapy which consisted of traction three times a week to decompress the discs and take the pressure of the nerves that were sending severe bolts of pain down my legs. I also began doing basic Pilates exercises to strengthen the abdominal core which supports the spine.

At the same time and over the next few months, I endured four sets of lumbar epidurals in each disc to reduce the inflammation that was putting pressure on the nerves, and to anesthetize the radiating pain. I attended a yoga class twice a week to augment the twice weekly Pilates sessions I was also doing in physical therapy. And to wrap these therapies all up, I visited a pain management physician who prescribed a combination of drugs to manage the break-through pain.

I was in less pain for the first time I could remember since June 2004, and felt almost normal: I was walking my dogs regularly, still doing Pilates and yoga, and skiing regularly with Bolted Bionic Husband. Due to the Pilates and yoga, I was also in the best physical shape I had been in since college and my body took on a beautiful new shape. I felt like I had put this behind me. I felt that I had recovered.

I was wrong.

AND IT BEGAN . . .

June 16, 2004.

I woke up to indescribable back pain I had never before experienced in my lifetime. Stabbing pain in my lower back layered over a dull, throbbing ache. I had burning in my legs that rushed down to my feet, often resulting in loss of sensation in my feet and toes, making walking and driving difficult since I could not feel what my feet were doing. Years before, I had bouts of back spasms that would crumple me to the floor until they subsided, but this was a hundred times worse.

At the time I was working over 65 hours a week implementing new computer systems in a very large company. It was a fast-paced, stressful environment that I had thrived upon, but now, everything I did caused pain and moving around was simply exhausting. I would come home after work, take some pills, chase them with a glass a wine, and stretch out on the couch until I could summon the resolve to move to the bed. Life became not so fun.

I knew I had a serious problem when my assistant, who was such a kind soul, would do everything she could to prevent me from having to get up and walk: picking up documents from the printer, getting office supplies, a cup of coffee, sometimes lunch. I still love her for it.

Since I was so busy with work I put off seeing the doctor, thinking I must have twisted wrong or pulled a muscle unloading the dishwasher or something, and that the pain would eventually go away given some time to heal. Little did I know at that time that this pain would transform my life over nearly a five year period. This was just the beginning.