One Day at a Time

Things continue to improve and over the past two months I've made some real progress.  I haven't missed a day of work, I'm able to do more around the house, and I've even started to pick up my children from time to time.  I'm not pain free (not even close) but the pain is much more manageable than it had been. 

I went to a shoulder specialist to get a better idea about my missing trapezious muscle and to better understand what I should do to accommodate for this deformity.  It was a complete waste of time.  He X-rayed my shoulder and then told me there was nothing wrong with the joints or bones.  When I asked about the impact of the trapezious muscle, he said that I had made it this far without it and I would be fine.  That was it.  Well - except when I asked him how to relieve the pain, he told me to revert back to my prior (poor) posture.  I explained that the poor posture led to my ruptured disc and he told me I would have to choose my pain.  Seriously - this is one of the most respected shoulder specialists in the area.  I got the distinct impression that I was wasting his time, and in hindsight I guess I was.  I didn't need surgery and he's a surgeon.  He seemed under whelmed at the idea that I was missing a trapezious muscle.  He did confirm that I have at least some of the upper part of the muscle, although he agreed that in the MRI the thoracic part of the muscle was not there.

The good news, however, is that I think I am on a really good path right now.  While I still have pain, it is considerably less than six weeks ago and if I can keep this progress up I should be able to resolve this problem over time.  The hard part is finding the time to do all the work that I need to do: I have an Active-Isolated stretching program, stretches and exercises from my physical therapist (whom I am no longer seeing), posture stretches and exercises from a personal trainer that I've started seeing and some strength-building exercises from my chiropractor/Active Release Technique practitioner. Throw in visits to my doctor and chiropractor as well.  Today I spent over two hours in the gym. With a full-time job, a wife, two small kids, a dog, a cat and a house to take care of, finding time to fit in two hours of exercises every day is extremely difficult.  I've been managing about three days a week, but that's not really good enough.  I'd like to fit in at least five days every week.  That's an optimistic goal, but I truly think that's what I'll need to do if I ever plan on overcoming my injuries.

I've also made some attempts at running.  Nothing significant yet, just a quarter-mile or so.  I'm not ready to say I'm back running yet (by any stretch of the imagination), but I'm starting to see a light at the end of the tunnel.

Trapless

It's been quite a while since my last post.  A lot has happened.  The thoracic steroid injection didn't work.  At all.  This seemed to surprise my doctor.  I guess she figured that since the lower back pain was from my ruptured L4-5 disc, my upper back pain was similarly related to the bulging T7-8 disc.  Certainly a reasonable hypothesis, unfortunately it was just flat wrong.  The pain continued to get worse.  As my doctor suggested to back off stretching and exercising in an attempt to let the stress fracture heal, the muscles in my upper back seized up and I was in a world of hurt.  In December I started trigger point injections along with restarting physical therapy.  I also started seeing a chiropractor who practices Active Release Technique.  The combination of these three treatments, along with rest and a strict dedication to regular stretching and exercising seems to be having a positive effect.  The first week of January showed clear signs of improvement.  The second week wasn't as good as the first, but I never really expected linear improvement.  This week has been mostly good, except for my shoulder.

My shoulder.  I forgot to mention one of the more subtle diagnoses that my doctor didn't even address until a couple of weeks ago.  In my thoracic MRI from a few months back, the report included this observation:

Complete absence of the visualized portions of the left trapezius muscle.

In other words, I don't have a left trapezious muscle.  It's not there - never has been.  At least no portion of the muscle that would be seen in a thoracid MRI (which is a lot).  My doctor doesn't seem to think this is a big deal, "you have other muscles that have obviously been compensating".  I can't disagree, because I never noticed an issue in the roughly 4 decades preceding the diagnosis.  Still, I can't help but think that not having a left trapezious muscle has contributed to my current condition.  My left shoulder is out of place and doesn't work correctly.  Coincidence?  Probably not.  As I work on correcting my posture, I'm starting to get more and more pain in my left shoulder.  Today was the worst yet - it's been searing (I also still have pain throughout my upper back, in the right side of my lower back and in my left knee - but these all play second fiddle to my left shoulder).  My physical therapist and chiropractor have been trying to help, but it seems that in order to fix the problem, I first have to go through a grueling and painful process to build the proper strength in the related muscles and work to keep my shoulder in its proper place.  It's a very slow process.  I see my doctor on Monday.  I hope she has some insight, because I don't think a trigger point injection is going to help this.

Faith

On Monday I received a thoracic epidural steroid injection. Apparently these are riskier and more complicated than I first understood.  The doctor was a nice enough guy, giving me the rundown after a very uncomfortable three hours in the waiting room.  When he went through the risks, he began to tell me how with lumbar epidurals there's really no risk of hitting the spinal cord but with thoracic epidurals, those risks are far more relevant.  As is the risk of puncturing a lung. 

Great, just what I needed - more stress. 

After momentarily considering backing out, I fell back on the fact that this hospital is consistently ranked as one of the best in the nation.  These docs are pros and if I'm ever going to have this procedure done, now is certainly the time and this is certainly the place.  Then I made a monumental mistake.  In an effort to reduce my own fears, I calmly tossed out "So, how many of these have you done?" to the doc, figuring that hearing the number would make me feel more at ease.  His answer?  "Well, I've done many, many lumbar epidurals, but thoracic ones are very rare.  This will be my first."

WHOA!!!!  Hold it!  Hold everything!!!  I'm risking paralysis to a rookie?  No way - not in a million years.

Just as I was wrapping my head around what I was going to say to back out of this, the doctor (who must have figured out where my mind was racing to by the look on my face) explained that this is a teaching hospital and that he would be doing the procedure under the guidance of another doctor, who had done many.  Just at that moment, a more experienced doctor entered the room, introduced herself and very calmly put my fears back to rest.

For the next hour I was in and out and in and out and in and out of a CT scanning machine while they did the procedure.  Apparently they would take little baby steps and then check their progress with a quick CT scan to make sure nothing was going awry.  That probably would have been good information for me to have up front, but all in all the procedure went fine and I really can't complain.  The doctors were excellent and everything went according to plan.

So now I sit here and wait.  Again.  This time its to see if the cortisone actually has any effect.  They said it could take up to a few days to know whether or not the cortisone will help reduce the inflammation and ease the pain.  I don't even want to think about what it will be like if this procedure doesn't work.

I guess that's where faith comes in.  At some point through all of this, I've come to realize that I just need to have faith that everything is going to work out.  Naive?  Perhaps.  But isn't that what having faith is all about?  For me, faith is based on a Catholic upbringing.  I was part of a very catholic family (my father had studied in the seminary and my mother's cousin was an arch bishop and cardinal in the Church) but surprisingly my parents were never overly demanding about adherence to church rules.  My father liked to say that God gave us a brain so that we would use it, and although he was a very diligent Catholic, he didn't get too hung up on the rules.  I would say that my basic faith is in tact, and by that I mean that I believe whole-heartedly in Jesus' teachings.  What has been shaken to the core, is my trust  in the Catholic bureaucracy.  I won't get into all the details here, but I will say that my faith is still important to me, even if I at times disagree with the Church.

My faith has helped me in my darkest moments.  My father died when I was fourteen and it was a very difficult time for me.  My family, my friends and my faith got me through.  Actually, so did running - but that's a story for another day.  I learned that there aren't always logical reasons for things and sometimes you just had to stop trying to figure everything out, go with the flow and have faith.

So I'm trying that now.  It's not easy.  But then again, since when was faith ever easy?

SCREAM!!!

AAAAAAAAAAAAAAAGGGGGGGGGGGGGGGGGGGGGGHHHHHHHHHHHHHHHHHHHHHH!!!!!!!!!!

That's the sound you would have heard from me if you were in the passanger seat of my car this afternoon on my way home from work.  No, I wasn't in an accident.  I was screaming as a release - as a way to relieve stress.

Last night my wife and I were talking about how I don't have any good options to relieve stress right now.  She reminded me of something I had once told her, that sometimes when I am really stressed and I just need to let it out, I scream at the top of my lungs while I'm in my car.  I had forgotten all about it, but thanks to my wife's superb (sometimes frightening) memory, I had the tool at my disposal this afternoon.

I struggled with going in to work today - I was in a lot of pain, but I'm also running low on sick/vacation days.  In the end I made the decision to try and gut it out.  It didn't take long to realize that it wasn't a matter of will-power, the pain was intense and I couldn't possibly focus on my work.  Unfortunately I wasn't able to get the thoracic epidural steroid injection scheduled until Monday, so it looks like I'm out of options until then.  On my way home, between all of the pain that I'm in, plus the stress from the toll these injuries are taking on my job, my family and every other aspect of my life (not to mention having to deal with endless healthcare red-tape),  I just needed to let it all out.  So I screamed.  Loudly.  Then I screamed again.  And again. 

You know what?  It felt great!  Did my back pain go away?  Of course not.  But did I have a release of tension and stress?  Absolutely.

I think everybody should try screaming at the top of their lungs on a regular basis.  It's wonderful.  I remember in college, during the week before exams there used to be some time set aside every so often for people to step outside and scream.  Fortunately, if you're alone in your car, it's a pretty good way to let it all out without infringing on anyone else's peace and quiet.  Just remember to take long, slow, deep breaths and to try not to beat up your vocal cords too much (try to avoid the scratchy sounds down low in your throat).

Am I Really in Pain?

One thing I've realized is that my pain is the real deal.  After nine months, being in pain has become my new normal.  It is no longer a question of if I am in pain, but how much pain I’m in.  I've become so conditioned to it, that sometimes I don't realize how bad the pain gets.  I try to minimize what I’m feeling and convince myself it’s not that bad.  I have to force myself to stop and pay attention to my body and rate my pain. 

Not surprisingly, my pain has gotten worse since I was told not to stretch or exercise.  Unfortunately it has gotten to a point where it is increasingly difficult to manage my daily routine.  Spending a day at work has become torturous.  Working from home is feasible because I have a zero-gravity chair that I can sit in for hours without pain (if you have back problems and you're not familiar with zero-gravity chairs, I recommend you look into them - they're expensive, but I have found mine to be incomparable for pain relief), but commuting to work and spending the day in a normal (ergonomically correct) office chair, walking around the office, attending meetings, etc. gets to be excruciating by the end of the day. 

I called my physiatrist to ask her what could be done about the pain.  She recommended a thoracic epidural steroid injection.  I've had two lumber epidurals, so I'm familiar with the concept but I'm told the thoracic injections are a bit trickier (and riskier) because of the spinal cord.  In fact, my physiatrist originally told me that an injection wasn't an option (see My Diagnosis - Part II) - I guess they wanted to make sure I really needed one.  Also, because thoracic injections are more specialized, they need to find the right doctor to do it.  That's taken two days so far, and still no word about who that doctor might be or when they might be able to administer the injection.

Since I’ve had some time to consider if I really want to get the thoracic epidural, I decided last night that I needed to test my commitment to getting the thoracic epidural.  Going back to the concept of minimizing what I’m feeling, you can probably imagine the conversation in my head:

Maybe I don't need the injection.  Maybe I'm just making a big deal out of nothing.  I can probably just suck it up and get through it.  It's not that bad...

So I went in to work today and spent the day in the office.  I was in constant pain and the pain was legitimate.  The pain was more than simply legitimate, it was intense. It didn’t take long for me to realize that I can’t “just gut it out” – that I either need to be able to work from home for the next 6-8 weeks (which isn’t realistic) or I need to try the thoracic epidural injection. 

Now that I’m on board with this procedure, I just need a doctor and an appointment…