Cutting Edge

One modern imaging test and a consult with the appropriate expert, and the verdict is in.  My September pain will be relieved by surgery to my neck sometime in the next couple of weeks.

The nerve root of T7, for those of you with a techno bent, is being pinched by a foramin stenosis at C6-7. In misery index terms, I have had unrelenting pain originating behind my left shoulder blade and pulsing down the outside of my left arm for almost three weeks now. First numbness in my ring and little finger, followed by worsening numbness in my other fingers. My best friend and worst enemy is Vicodin, 1/2 tab welcomed every 4 hours, begrudged more often. My MO is to reluctantly take Vicodin for a couple of days following some painful medical crisis, and then toss the prescription a couple of years later when I clean out the medicine cabinet. I don't do well on pain meds, so I take them sparingly and infrequently.

I am no stranger to this malady or its treatment. Ten years ago, I could trace the origin and insertion of the nerve that was being pinched at C5-6 from my right shoulder blade to my right hand. That surgical intervention followed weeks of "aggressive conservative" treatment of physical therapy and anti-inflammatory drugs. Surgery stopped the pain, but did not occur soon enough to prevent loss of function. I lose my grip without warning, especially when I'm tired. (Yes, I know, there's a pun hiding in there.) My dogs, who are constantly underfoot in the kitchen hoping for a dropped or proffered morsel, are conspicuously absent when I load the dishwasher at night. The doc makes no guarantees about relieving symptoms or improving hand function this time, only that the pain from the pinched nerve will stop.

The last time I had neck surgery, it was a "day surgery" but they didn't get me out the door until very late in the day because every time I put my legs over the side of the bed, my BP shot through the roof.  The next morning when I woke up, all I could think of was that some Indian had snuck up behind me and sunk a tomahawk in the back of my neck.(I know, so politically incorrect, but I am so NOT PC most of the time anyway.) 

This time, they will schedule me as an inpatient. The surgeon will need to go in thru the front, and because he will have to cut away bone to reach the back portion, he will put a bone shim in between the vertebrae and a titanium plate to fuse them afterwards.  I'm told it won't be as painful as when they cut from the back through all of that muscle tissue, but I won't be driving anywhere the first week because of pain meds.

The surgery will cause trauma to the nerve to my voice box, causing hoarseness at best or Julie Andrews syndrome at worst. I'm still mulling over the voice box issue.  He said they could go in from the left and avoid the nerve, but it would be harder to do than going in on the right side and having the angle to work with. My call in the end.

That's about all that I know at the moment. I'm not supposed to lift anything, so most of my busy projects are nixed for now. 

I'm thankful that we are supposed to have sunny days all week.

A Taste of Medicine

Long Story, Long.

Early Friday morning, I awoke diaphoretic with my heartbeat pounding in my ears and experiencing a bit of discomfort in my chest. Left chest, to be exact. I got up, drank some water, and sat down at the computer. After posting a few 3 AM notes and emails guaranteed to raise eyebrows for their sent time, this activity had its desired effect, and I was off to bed.

I was sitting at my computer around 9 AM when I experienced the same symptoms of the early morning. Soon, however, I also had a sharp knife-like pain in my left shoulder blade that very quickly started shooting down my arm. Hmmm. Three for five of possible signs of a heart attack. I debated because I didn't feel that bad. In pain, yes, seriously ill, no. Choosing to feel stupid for being overly cautious over feeling very stupid for ignoring classic symptoms, I went to Legacy's Salmon Creek ER.

I told them I was having chest and back pain and I just wanted to make sure I wasn't having a heart attack. The only thing that will get you admitted into ER faster than those two words is a chauffeured ride in an ambulance. The triage nurse did my vitals, including O2 Sat, right there. 

As soon as I was in a room, an IV was started with the rainbow set of blood drawn (one of every color tube just in case), and an EKG was done, which proved to be normal. I was hooked up to all of the monitoring equipment, including an automated BP cuff, electro heart leads, and O2 Sat. Then began the grading of pain levels followed by the administration of nitro under the tongue, reassess; more nitro, reassess; Vicodin, reassess. The second nitro seemed to help, suggesting a cardiac component. But, the cardiac enzymes came back normal as did the D-Dimer clotting test. 

At every step of negative results, the staff complimented me on my decision to come, saying that I was exactly where they would want a relative of theirs to be. Not out of the woods yet, the ER doc wanted to admit me overnight for observation. My ER nurse Sterling coaxed me into staying by relating his own story of being exactly where I was and telling me how nice the rooms were upstairs. OK. Even though it was mostly CYA medical practice, it was also pragmatic. I also think my ER nurse was growing fond of me for my sense of humor. Every time he scanned the bar code on my ID bracelet I asked him if I was on sale yet or if it was the PLU code for the meds/test.  He also liked that I was, like him, a fiscal conservative. We agreed on the likely effect of Obamacare on health care.

So, I made a few calls to alert family and close friends of my plight and to insure care of my garden. I soon met my admitting doc, an Indian lady with an accent that infuriates me on the other end of computer technical problem calls with "Shirley," but seems to dignify her profession. It was quite a wait for a vacant room in PCU (Progressive Care Unit). In all, I spent 4.5 hours in the ER.

The PCU nurse and technician were most solicitous as they redid my vitals and hooked me up to their heart/BP monitor. In case you've never had the experience, that middle breast pocket in your hospital gown is not for your cell phone, but for the remote heart monitor, whose leads snake through the back slit in the pocket to the color-coded sticky pads on your chest and abdomen. 

Since I had had nothing to eat all day and it was now mid-afternoon, I asked if I might get something to eat. They suggested a sandwich; I suggested yogurt. I got both the yogurt and the insides of the sandwich. (It is worth noting that this was one of 4 times that I was meticulously asked about my food allergies. Of the three meals I got while there, only one was gluten and egg free. Even so, milk and custard or pudding came with every meal.)

"Anything else you need?"

"Do you have anything to read?"

"Yes, we have a library; I'll ask them to come by."

They did. I picked 3 paperback books, just in case I picked poorly. I didn't last long reading. Too many pain killers on board, but not enough to stifle the boredom. Gorgeous weather outside my window and nothing on TV on the Friday afternoon of Labor Day Weekend.

Dinner was a welcome interruption. And, I could actually eat the turkey divan (overdone), wild rice and carrots (also overdone). I did not get through all of the salad since I couldn't eat the dressing, but I gave it a good try. No go on the chocolate pudding or low-fat milk.

My big brother Lynn arrived from Seattle around 9 PM to check on me and get a key so he could spend the night at my house. By then I had just about decided that my scapula felt out of place, and I asked him to press on my back... Right. There. Best course of treatment so far. Big brothers will be big brothers, and I have one of the best.

The second set of cardiac enzymes came back negative. Good news. I settled down for the night with only 1/2 a Vicodin tablet and a warm blanket to ease my back pain. That in spite of learning that nightly meds in PCU routinely included the anti-acid Pepcid (your symptoms may be caused by indigestion) and sleep aid Ambian (not, as you might suppose because it is notoriously difficult to sleep in noisy hospitals, but because most people are anxious when hospitalized). That dose of Vicodin was followed by the same dose about every 2 hours throughout a restless night. 

Shortly after 5 AM, a lab tech interrupted my cherished sleep to draw my blood. I have to say, having done that to hundreds of patients during my career, I had little room to complain. But, I do have to mention that his technique would result in retraining were he on my staff. (Yes, I guess that is a complaint... leaving the tourniquet on while assembling tubes and putting a needle in the vacutainer holder not only prolongs the patient's discomfort, it elevates K+ levels, which are most significant in cardiac patients. And re-probing the vein after cleansing the area with alcohol is well... just stupid when you’ve walked away for 3 minutes after cleansing the area so you don’t remember where it was. Not to mention that my vein practically flashes neon to mark its location.)

I was feeling nauseous, so much so that I was not overly put out that my breakfast had only one thing I could eat... and the oatmeal didn't taste at all good to me… or likely anyone else on the planet. Of course, my mouth tasted like I had been taking Vicodin all night. I wished that my breakfast of scrambled eggs, pancakes, & OJ had come before Lynn asked me over the phone who served breakfast close to my house. Still, I made several passes at the oatmeal, but ate little. Maybe Elmer's was the best choice for him.

My doc stopped by to tell me that the second set of cardiac enzymes were negative. Woohoo! I asked if she might have any idea of the origin of the pain I was experiencing. Her guess was that it was muscular-skeletal pain. For about the 12th time since I arrived at the hospital, I was asked if I were active.

"Yes."

"Are you doing any new exercise routines?"

"Yes."

"Well, that is important information (spoken like I had been withholding this valuable piece of the puzzle up to now.). That could very well be your problem. But, we will do 3 views of your chest just to be sure nothing major is going on like a tumor or a broken bone."

"OK."

"And then you will likely be discharged later today." Double Woohoo! 

But, a stress test should be scheduled as an outpatient.

I missed a call from Karel while in the bathroom peeing in the half-hat to measure "output" and returned it late enough that I thought I'd miss her, but the Wilmoths hadn't left for the beach yet. So, I caught her up on my prognosis. Triple Woohoo on the negative cardiac tests.

Lynn and I watched college football games routs and noted with delight that Oregon was playing LSU later. Lynn texted DIL Anna (from Shreveport) with "Go Ducks," but received no reply.

Lynn's stomach was upset and the cafeteria didn't open until 11 AM, nor could he find any vending machines. So I asked the tech for some yogurt and 7-up the next time she came by. I ate the yogurt and gave the 7-up to Lynn. Good thing. In less than an hour, everything I had eaten came right back up. The garbage bag attached to my bed was not made for liquids, but it worked as an emesis bag in a pinch (BTW, have you seen those new emesis bags? They don't LOOK like something you would throw up in. Wink, Wink). The tech responded quickly to my call, though, and in a flash, so did my RN— with an IV push of anti-nausea meds. I kept saying that I felt much better after throwing up, but that did not prevent the administration of drugs. Their arsenal of drugs is not only extensive, but the first line of defense.

My lunch of allergenic food went untouched except for the custard, which Lynn ate.

It was late afternoon before the ER demands of the weekend radiology crew slowed enough that I got my x-ray. And, as I lay waiting for the transporter to take me back to my room after the x-ray series, the many voices somewhere in the bowels of radiology made me wonder if the shortage were only in transporters, because no one else seemed to be busy.

When my doc came to tell me nothing obvious showed on x-ray, she also recommended that I stay another night for observation and pain moderation. No, no, no. I hadn't eaten in 24 hours by then, and I so wanted to be home in my own bed. She somewhat reluctantly agreed and wrote about a zillion scrips for me with my discharge notes.

We left my van at the hospital after agreeing that I had too many pain meds on board to be trusted to drive. And, we stopped on the way home to pick up a burger. Yes, I stopped at BK on the way home from a hospital stay for observation for cardiac disease. But, that's our secret; you won't tell, right?  Actually, I had planned to eat soup, but had no meat thawed, and Lynn wanted something more substantial. He got a Whopper, Jr. Meal and I got a Whopper Jr. Sandwich, no mayo, catsup or bun. And when we got home, I warmed up the roasted veggies from the fridge. So, we ate veggies with our red meat. Smile. Oh, did I mention the brownies (for Lynn) and frozen yogurt for dessert?  Thought not.

We watched the ducks get plucked by LSU until mid 3rd quarter, and then we went to the garden to pick tomatoes. Lots of tomatoes. Except for the mosquitoes, I love going to the garden at dusk. So very peaceful. Puts me in touch with my farmer roots. Now, THAT'S therapeutic observation, unlike spending another night in jail the hospital. Lynn picked more tomatoes than he had since his gardening days in Richland three decades ago. While I watered the plants, Lynn investigated the other garden plots in our church property community garden. The mosquitoes found him. We came home to see how bad the score was and found that a few more feathers had been plucked from Oregon.

Neither of us lasted long after that, and I made it through the night with a couple of doses of Ibuprofen and woke feeling better than the previous morning in spite of not sleeping the night through. After a leisurely breakfast, Lynn headed to Seattle via the hospital parking lot to drop me off to pick up my van. I stopped by FM on the way home and filled the Rx for Vicodin, but none of the others. Again, that's our secret, right? And so far, I'm getting by with just the Ibuprofen every 2-3 hours.

I will probably follow up with the stress test, but I'm counting on an appointment with Dr. Whitmire to diagnose the pain I'm having.  My greatest fear is that it is a pinched nerve since the symptoms mimic the pain I had on the other side previous to my C5-C6 radiculopathy.  That surgery is very painful and the recovery is very long.

This part of the story is over with a good result, but it isn’t finished yet.

Long Story, Longer.