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.

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.

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?

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).

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…

I've been pretty stressed and somewhat down lately.  The pain takes a toll and it's really been doing a job on me.  One thing that I've noticed is that I've been using my back pain to justify actions that aren't really in my best interest.  I've been watching more TV, getting less sleep, eating less balanced and healthy meals, doing less exercise (even if walking or a recline bike is all I'm permitted right now).  I've let my pain become an excuse for becoming undisciplined.  It makes sense, after all it's hard to get through the day like this and taking some solace in these things helps manage the pain in the short term.  The problem is that it doesn't work so well over the long term and like it or not, I'm in this for the long-term.

So I've decided to do something about it.  Starting tomorrow (why wait?), I'm going to start focusing on activites that are better for me in the long run.  I'm going to watch less TV and get more sleep.  I'm going to get more exercise.  I'm going to plan my meals out better and reduce my caffine intake.  I don't plan on going cold-turkey.  I'm more interested in making slow, steady improvement in these areas.  I'm still going to watch some TV.  I'm not going to be concerned if I don't exercise on any given day.  I am not going to restrict any particular foods or count calories.  I just want to put a little more effort back into taking care of myself.  It's easy to let self-care slip away when you have a really good excuse like having to endure a LOT of pain.  The problem is that easing back on self-care just makes things worse in the long run - and that's the last thing I need right now.  I need to remember to focus on what's important.  I need to keep reminding myself, "Bí dílis duit féin" ("To thine own self be true").

I've been dealing with near-constant pain for nine months.  I've been in physical therapy almost that whole time.  I've worked my tail off for months and yet I am not the tiniest bit closer to my goals.  I've done everything my doctors and physical therapist have instructed me to do, but at the end of the day, things seem to be getting worse.  It impacts every aspect of my life.  Stress continues to build, but my most effective stress relievers (running, physical activity) have been taken from me.

My mind has been starting to play tricks on me:  "maybe you'll never recover", "maybe you'll be in constant pain for the rest of your life", "maybe physical therapy isn't going to work", "maybe you're wasting your time", "maybe your doctors won't be able to figure this out." 

Constant pain combined with demoralization is a bad combination.  I'm tired.  I'm mad.  I'm frustrated.  I'm bitter.  I'm cranky.  I'm down.  I'm dejected.  I'm spent.

So how do I turn this around?  It's all perspective, right?  I'm down because I think there's little hope of recovering from my injuries and being pain free.  Is that factual?  Not exactly.  It's true that I haven't made the kind of progress I (and my doctor and physical therapist) expected.  It's true that as I've addressed one problem, another, more challenging problem has surfaced.  It's true that after nine months I still can't pick up my kids, go for a run, or even just be pain free for a day. 

It's also true, however, that each injury I uncover brings me closer to a full recovery.  Part of the problem is the expectations.  When I ruptured my disc in February, everyone thought I just ruptured a disc - there was no understanding of the underlying issues.  Those issues did exist, they just weren't apparent.  So while I didn't recover in three months like I originally expected, I now know that those expectations were unrealistic.  Knowing what I know now, I actually have made considerable progress.  My lower back isn't a major issue - it's still a concern, but it's not the limiting factor for me right now.  My upper back is being addressed.  The pain in my side that originally ended my competitive running career in college 18 years ago is finally being diagnosed.  I have found the best doctor on the best staff and I am working with a truly great physical therapist. 

So how do I turn around the funk that I'm in?  Focus on the good.  Have faith.  Believe in myself.  Do not accept what is unacceptable.  Be relentless in my optimism.  Dig down deep and stay disciplined in doing the things that will help and avoiding the things that won't. 

Of course that's easy to say...but how do you DO it?  Well, I imagine it's different for everyone.  For me there are a couple of tricks up my sleeve that I go back to:

• Who do I want to be?  I have a personal mission statement.  It's something I wrote up years ago to remind me what's important in my life.  It helps to re-read that mission statement.  If you don't have a personal mission statement, I strongly encourage you to take the time to write one.
• Who do I want my children to see me as?  The depressed failure that gave up?  Or the man that would never give in and persevered through the darkest of days?  My experience has an impact on them, whether I want it to or not.  I have an opportunity to make a postiive impression.
• Who did I promise my dad I would be?  My dad passed away when I was young.  He was a remarkable man and when he died I promised I would be the man he would have wanted me to be.  I committed myself to live up to the standard he set. 

And then there's one last trick.  Music.  There are strands of music lyrics that run throughout this blog - some are obvious and some are not.  I have always felt a deep connection with music and have found that it has a remarkable affect on my mood and my state of mind.  The right music can turn me around.  I've developed some playlists to help me - playlists that speak to who I am, playlists that help energize me, and of course, playlists that help me put things in perspective.  The band Great Big Sea has a wonderful song called Ordinary Day that is on one of those playlists.  It's one of those songs I just can't listen to without feeling a little bit better about things - without thinking that as bad as today might be, it's really just an ordinary day and it's all about my state of mind:

It's a beautiful day, but there's always some sorrow
It's a double edged knife, but there's always tomorrow
It's up to you now if you sink or swim,
Keep the faith and your ship will come in.

And I say way-hey-hey, it's just an ordinary day
and it's all your state of mind
At the end of the day, you've still got to say,
it's all right.

So that's how I'm going to end this day, "It's all right."  Tomorrow's a new day.

You've been disturbed from your sleep
You've been laid down on the floor
You've been looking around for your family
Now your body's tired and sore
Well there's rest that's in the water
And there's an answer on the streets
And if you take the time to listen
There's a chance you will meet
Your soul
This is it
This is your soul
This is it

These back problems that I’ve been dealing with have impacted every part of my life and have made even the most minute of tasks difficult.  I’m not as productive at work, I’m grumpy at home, I can’t do much to help my wife with the kids, the house, cooking, etc.  I can’t relieve stress by running (my “go-to” stress reliever) – in short there’s not much I can do and I’m fairly miserable most of the time. 

When your world falls down around you
Not the most comfortable place
You've been looking into a room full of strangers
But now you recognise one face
It's a reflection on the water
It's the word that's in the street
Saying now's the time to listen
Take the time to meet
Your soul
This is it
This is your soul
This is it

It’s funny, too, how people try to help.  Most people mean well, they really do, but when they try to relate my situation to their own experiences - their own back pain - they just don’t get it.  It’s not the same.  They don’t want to hear that, though – they want to offer some glorious insight that I haven’t thought of that will miraculously solve my problems.  “You need to do yoga.”  “You should try Pilates.”  “You ought to see my chiropractor.”  “Acupuncture will solve all of your problems.”  They don’t understand, nor do they want to hear about the constant pain, the endless physical therapy, the heat, the ice, the resting, the ergonomic chair, the therapeutic pillow, the stretching and all the other things I do just to make it through from one day to the next.  They don’t want to hear that I’ve been to general physicians, orthopedic surgeons, physiatrists, chiropractors, podiatrists, acupuncturists, physical therapists, massage therapists, naturopathic physicians, and who knows what else. They just assume they know more about my condition than I do.  It’s amazing, it really is.

And they're talking at you not with you
And you're bored with what's around
And you've tried all the quacks, all the doctors and all you really need
And all you really need is a healing sound

Somehow I manage to get by, though.  I do it by striving to be true to my core.  In this journal I’ve talked about being true to myself and focusing on who I am and what’s important to me.  In their song, “This Is It (Your Soul)” the Hothouse Flowers remind me of this, to be true to myself.  To listen.  To meet my soul.  To set free my soul.  

But just listen to the waters
Find the answer on the street
Because now it's time to listen, now it's time to meet
Your soul, now this is it
It's time to meet your soul
Your crying soul
This is your soul
Set free your soul

It’s not about what other people think.  It’s not about how much pain I’m in or how many doctors I’ve seen or how many treatments have failed.  It’s about what’s important to me and how committed I am to my values and goals.  It's about embracing who I am down deep, regardless of the circumstances.