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.

Moving on to Plan B

I went to the orthopedist today. He took x-rays of my back. The short version: my spine is about 20 years older than the rest of me. Bone spurs. Narrowing of discs. One slightly bulging disc. Arthritis. And curvature of the spine probably caused by the excruciating pain I was in during the x-rays.

As the doctor said, clearly Plan A failed. Plan B is an MRI (next Monday) and a referral to a physiatrist, a pain management and rehab specialist. She will be giving me a cortisone epidural in my lumbar spine. My appointment is for a week from Monday. (This allows time for insurance company hassles and other administrative whatnot.)

I actually had a reasonably comfortable morning. I have been putting ice on my lower back and hip and it does reduce my pain somewhat. I went for a very windy 25-mile ride without any significant pain. After getting home I did a tiny bit of PT, took a shower, and ate lunch without pain. Just as I was wondering whether I’d be going to the doctor with no symptoms, I walked upstairs and the pain came rushing back.

Despite all this nerve pain, the doctor noted that I still have plenty of leg strength. He called a physiatrist and they chatted about my case. I can get an epidural before the MRI but it likely be more successful using the MRI for targeting the injection.

My doctor says I can have up to three epidurals. He says that for many patients, epidurals do the trick. Fortunately, I can still ride my bike which is as important for my mental well being.

If the epidurals don’t work, I’ll be moving on to Plan C. C in this instance stands for cutting.

Eek.

Oh Doctor! Please Help Me. I’m Damaged.

I finally decided to stop trying to heal myself and go to a pain specialist, a physiatrist. His office is about 200 yards from my house as the crow flies. I, not being a crow, had to take the roads which made it 1/2 mile. I debated on whether to drive there which would entail getting in and out of the car. Given the fact that I was standing like Quasimodo, I thought it would be less painful to ride Big Nellie, my recumbent. It was less painful getting there but parking the damn thing nearly did me in. I had to find a street sign which was in a landscaped berm on a hill in the parking lot. (This is Fairfax County Virginia. We don’t do bike parking.)

Once in thedoctor’s office I filled out a stack of forms while sitting next to some pretty sorry looking patients. None of us was having much in the way of fun.

At exactly 10 am, my scheduled appointment time, I was taken through the door of relief. As the nurse weighed me she set the heavy weight on 150. I moved it to 200. She was surprised. I guess my skinny bikey legs threw her off. I weighed 212 pounds. Yes, I have gained some weight but I was wearing clothing and had pockets full of stuff and had just eaten breakfast and was still carrying dinner around. (Icky alert: back pain often causes constipation.) So on a good day I figure I’m in the 205 neighborhood which is to say 2 long bike rides from the Mendosa line. Vain? Moi?

The doctor came in stinking of gin.

Well, no. He was sober. He asked me what was going on and took extensive notes. Then he pushed and pulled on my legs and systematically examined my back one vertebra at a time. He spent well over 1/2 hour with me. He wrote down four possible diagnoses based on my story and my symptoms. Each has an associated treatment, Each treatment involves injecting something into the problem area. One of the diagnoses was for lumbago. I cracked up. The last time I heard the word lumbago was during an Alan King routine on Ed Sullivan. (“My lumbago is acting up.”)

The good doctor prescribed muscle relaxants and pain killers with tummy medicine so that I don’t end up making an offering to the porcelain god. He then sent me to the hospital for seven x-rays of my back. And submitted a request for approval of an MRI to my insurance company. This doctor is pressing all the right buttons with me.

I climbed on Big Nellie and rode around the corner to Mount Vernon Hospital. (Helpful real estate hint: if you have orthopedic issues buy a house 1/2 mile from an orthopedic hospital.) Miraculously I found a bike rack next to the emergency entrance. After locking up and going inside I discovered that radiology was on the other side of the building. So I hobbled through the corridors which helpfully are lined with rails for pathetic creatures just like me.

The registration clerk was a helpful 30-something guy who referred to me quaintly as “Buddy.” If I had a cane I would have clubbed the young whippesnapper. (Actually, he was saying it tongue in cheek so it was pretty funny.)

The radiology tech had me put on a gown. The first one came down to just below my personal area. She got a good laugh out of it. Not wanting to awe my hospital peeps with my awesome bikey legs I switched to a long gown and was taken immediately to the x-ray machine. (From bike to scan in ten minutes. Not bad!)

The tech was gentle and made sure I was in minimal discomfort. Having digital x-rays is great because the tech can tell if the picture is usable. We had to take 2 repeats probably because I spasmed during the exposure.

Ten minutes later I was on my way to the Hollin Hall drug store. The ride was two miles and it was not a lot of fun. My back was getting sorer by the minute. I had to wait ten minutes while Eun the pharmacist called the doctorand my insuranc company to cleared up some problems with my prescription. She was so good on the phone. (“He’s in a lot of pain.”) Thanks, Eun.

Back on the bike I rode back past the hospital to Sherwood Hall Gourmet to buy lunch. I didn’t have to order. They know I always have a Gary’s Lunchbox roast beef sammich. I rode home and celebrated five whole miles of biking. Then I told my boss that I wasn’t coming into the office. I would spend the day writing a paper for work at home. (To my surprise I actually knocked off a pretty good first draft.)

I can’t tell if the medicine is working but I can tell that I still can’t come close to standing upright. The weather is perfect for bike riding and I am sitting here on my deck wanting sooo much to go for a spin.

@bobbieshaftoe just tweeted “Who’s riding this weekend?”

ME!!!

I wanna cry.