Tag: pain management

The Return of Dr. Pain

My Ow History

A couple of years ago, before and, especially, after my 2019 bike tour over the mountainous terrain of Colorado, Utah, Nevada, and California, I was in a world of hurt. My left knee and hip were screaming at me. I had some symptomatic relief from cannabis edibles I bought in eastern Colorado. Back home, I went to an orthopedist who gave me cortisone shots in both areas. After two rounds, my pain all but disappeared. But I was still in pain. Whenever I walked, my lower back and left leg became progressively more painful. The situation escalated to the point where I could not walk 100 feet without excruciating pain in my lower back and left leg. My orthopedist examined me and concluded that I had classic symptoms of spinal stenosis, a narrowing of the spinal canal that pinches the nerve roots emanating from the spine. The orthopedist referred me to a physiatrist, a medical doctor who specializes in pain management. I will henceforth refer to her as Doctor Pain.

Dr. Pain, I Am at Your Mercy

Step one in my treatment was an MRI. This helped identify pinch points and the interesting fact that I have six vertebrae, not the more common five. Step two was listening to my description of specifically where I felt the pain and what made it worsen or abate. Dr. Pain determined from this information the likely location of the irritated nerve roots.

I laid face down on a cushioned table. Using a needle, the doctor applied numbing medicine to the skin and muscle near the injection site. The pain from this was similar to having a novocaine injection for dental work. Not fun, but not the end of the world.

Next she and an assistant positioned an x-ray guided injection machine. This machine placed a targeting cross, like you’d see through a rifle scope, on the area of interest. Then the fun began. The doctor proceeded to inject anti-inflammatory and numbing medicine into the specific areas near the disturbed nerve roots.

Because my nerves were so inflamed these injections hurt like hell. With each injection an electric shock shot down a nerve in my leg all the way to my feet. Dang! I lost track of the number of shocks. Afterward, I waited a few minutes to make sure I didn’t grow a third leg or have other ugly complications and went home. Free to do whatever I wanted.

The injections worked pretty well. They calmed most of the pain and allowed me much more movement. I was going to have a second round of shots but the pandemic hit. Then Dr. Pain left her practice. So I decided to do daily physical therapy exercises to help calm the pain beast.

Shoot Me, Round Two

By January of this year I was starting to have increasing pain and discomfort, especially in my lower left calf, so I googled Dr. Pain and found that she was back in business at another practice. I saw her two weeks ago. She agreed that another round of shots would help. She reviewed the MRI and her notes from 2020, and we repeated the discussion of where my pain was located. She concluded that my leg pain was probably from stenosis but that the ache I was experiencing across my lower back pain was likely caused by arthritis.

We agreed to treat the stenosis first. Before continuing, however, she sent me for a doppler ultrasound to rule out a recurrence of a deep vein thrombosis (DVT), a painful blood clot that I had in my left calf in 2017. It caused me to develop dangerous pulmonary embolisms.

I had the ultrasound on Monday. It was painless. Since the tech did not send me to an emergency room, I knew I did not have a DVT. Today I went back to Dr. Pain for round two of the epidural injections.

We went over my symptoms again. She reviewed her notes from 2020. And we decided to move the injections down a notch in my spine. Again, I was placed face down on a padded table. Working with a technician, the doctor, as before, injected the muscle in my lower back with a numbing agent. Then she positioned the machine of certain agony and started the epidural injections. Not that I could tell. I could feel pressure from the insertion of the needle and feel the location on the needle but i experienced no pain. Hmm.

She continued until she made the money shot. BANG. She hit the irritated nerve. An electric shot when right down my left leg. I could feel it travel through my thigh and knee then into my calf. At their direction I did some deep breathing, then she injected me a few more times. These were painless. Thank you, Jesus.

Next Steps

After a short precautionary post-injection wait, I was sent home with no restrictions on activity. The leg felt a little numb but I walked without any pain back to my car. This afternoon, with temperatures nudging 70 degrees F, I went on a 30-mile bike ride, deliberately cranking big gears for the last ten miles. I walked a few hundred feet in my yard afterward. Only after going inside and crossing my legs at the kitchen table did I feel minor discomfort in my calf. I uncrossed my leg and it went away.

I’ll be keeping a pain diary for the next three weeks. I’ll be taking short walks to test things out. Then Dr. Pain and I will do a follow-up visit remotely.

The needle and the damage done

Today was the big day. I went to a physiatrist, a pain doctor, to see about fixing the stenosis pain I’ve been enduring for the last three months.

The doctor took my history. When I mentioned that, after inadequate pain relief from ibuprofen, I switched to marijuana edibles in Colorado during last summer’s tour. She was not at all surprised at the relief I experienced. She said that for most people edibles work for pain relief only when they contain a substantial amounts of THC. (In Virginia, CBD edibles have only trace amounts of THC and, therefore, tend not to work so well. Your mileage may vary.)

The doctor brought me to another room where she examined my MRI on a computer with her physician’s assistant. The doctor explained that I have a transitional lumbar spine. Transitional in plain English means abnormal. Most people have five lumbar vertebrae. Some people have four or six. I have six. (Thanks Mom and Dad.) This explains two things. First, the location of my previous back surgery is either L3-L4 or L2-L3 depending on where you start counting from, top or bottom. Second, the surgeon who did the operation cut too low and had to extend his incision. This is no big deal except that it means the recovery time, mostly associated with getting the back muscles to work together again, is a little bit longer.

That old surgery involved removing a disc in my spine. My pain doctor thinks this is the source of my problem. In the area around the missing disc, the spinal canal, through which the spinal cord passes, is narrowed. This stenosis is causing further problems downstream in my lower back. Thus, the pinched nerve root in my lower back, she thinks, is the product of the stenosis higher up. The stenosis in my upper lumbar region also likely explains why my lower back gets achy when I stand for a long time, as I do at concerts.

My physiatrist clearly loves what she does. She seemed quite confident and upbeat about my case, saying that one or two cortisone shots in the problem area should fix me for five or ten years.

Bring it on.

But wait. I have to get approval from my health insurer. So, I go back for the injection a week from Friday, or sooner if she gets a cancellation.