Monday, March 7, 2011

One Sore Belly.

A couple of weeks ago, when I got the results of my colonoscopy, I asked Dr. Spier (whom I really like to the point that I WISH this had been my colon) if he would give me a referral to the Advanced Pain Center in Bloomington.  I did this because I had a hunch that I didn't have some kind of internal medicine problem, but rather some kind of nerve pain.  I had to wait, though, two weeks to get in.  In the meantime I saw Dr. Kaeser, who verified that my pain was of a physical nature--myofascial pain syndrome (MPS) of the abdomen as well as some diaphragm issues and pinched nerves.

Today I finally got in at the pain center.  I saw Dr. Lysandrou (hereafter Dr. L).  He is an anesthesiologist and board-certified in pain management.  Last night, I took a look at their website.  Right there on the home page where treatments were listed:  "Injections for treatment of myofascial pain syndrome."  Well, you know that at that point I was dead set on getting an injection when I got there.  I went in and had to again explain to the nurse this whole sordid tale.  However, she was more interested in why I was getting a PhD in nursing (I had listed that I was an RN and a PhD student on my intake form under occupation).  "Why would anyone do that?"  Sigh.  Really?  Today?  Today you're going to make me defend why nurses should have PhDs?  I wasn't angry at her.  It's just a constant justification that nurse scientists have to make.  Before I could speak, she said "I mean I just don't understand it, you know.  You can have a 2-year RN degree and work at the hospital making $32/hour.  Why would anyone go and do what you're doing?"  Maybe because I'm an idiot and a complete glutton for punishment.  I really, really miss making good money and working three days a week.  And not having to write and read all the time and....  But I collected myself and explained to her that a PhD in nursing prepares one to conduct research and to teach in academia--at the highest level...all the way up to doctoral courses.  And we all know the nursing shortage stems from the faculty shortage.  She still looked at me like I was nuts.

Dr. L came in and asked me what was going on.  So, I explained the situation again.  I told him with what Dr. Kaeser had diagnosed me.  Before examining me, he said it sounded like one of two things:  MPS or floating rib syndrome.  He checked my ribs and didn't feel anything abnormal.  Then he palpated my right rectus abdominis (ab) muscle and said "Oh, yeah.  I agree with the MPS diagnosis.  Your muscle here is one big trigger point."  So it's not that I have trigger points dispersed throughout the muscle.  Nope, that only happens to normal people.  My left side is not nearly as bad, though.

I refrained from screaming "Inject me please!" and let him continue on explaining.  He said that moderating the running would be a good idea.  I explained that it is a huge part of my life and that I don't want to moderate it.  He agreed that if it improves my quality of life (which I am sad to say that nurse didn't get to hear--that's what nurse researchers are all about improving) I should be able to do it.  So we'll treat it aggressively, he said.

Before he explained the treatments, I asked him "Will this ever go away?"  "No.  It will always be there."  I had read that, but I wanted his take on it.  He explained that it is treated with periodic steroid injections.  I asked about medication, muscle relaxants.  He said that sometimes helps.  Also, pain patches--non-narcotic, but things like Lidoderm.  I asked when we could do the injections.  "Today."  HALLELUJAH.

But wait--what should I expect from the injections?  He said that it should provide much relief within 2-7 days...but I may not be pain free.  I told him my race is May 1, and he suggests I come back in 2 weeks, and then again 2 weeks before the race.  He asked me to point to where my belly hurts when I run.  Well, it kind of gets diffuse, so that was hard to do.  The way cortisone injections work is that, regardless of how many spots are injected, you can only have so much cortisone.  If it's all in one spot, that spot gets a big dose.  If it's a bunch of them, each one gets a smaller dose.

He said we should probably focus most of the medicine on the right side, as it feels "like a rope."  And we'd do one on the left.  I tried to find the most painful three spots on the right (which was hard because the whole thing and surrounding muscles hurt), and then the worst spot on the left.  I got on the table and took note of the needle he was holding.  14 gauge.  That's a big boy.  I wasn't at all nervous.  I wanted that needle in me SO badly.  Reflecting on that, that is so strange.  No nerves.  Eagerly awaiting a huge needle being not only gauged, but "fished around," in my abdomen.  Chronic pain is an ugly thing, people.

They sprayed me with the cold spray (which, btw, doesn't really work) and I felt the first poke.  It hurt, but in a good way.  Not only did he poke, but he dug around, twisting the needle and injecting different areas of the muscle.  I felt the urge to cheer him on.  "Yes, get it!  Get it!"  He asked if I was okay.  I was perfect.  Keep going.  After the three on the right were done, it was time for the left.  Shockingly, that one hurt badly.  But it was over quickly.  I sat up, and noticed something--my right side, which has ached for so many months...did not hurt.  I pushed on it.  Nothing. doesn't hurt!  I knew it was temporary, and from the lidocaine that went in with the cortisone, but I still savored the moment.  Pretty quickly, the lidocaine wore off and gave way to some pretty severe soreness.  I managed a nap and, when I woke up, it felt like my sides had been split open.  I may have to bag tomorrow's run depending on how this goes, as even I don't think I could run through this.

So, Dr. L is another name that is probably going to end up on the singlet.  I see him again in two weeks. Counting. The. Days.  I won't know how it's gone until I run, and the cortisone won't have set in until at least Friday/Saturday.  So I'm not going to worry if I have pain.  But, if you read this blog very often, you know my worry radar is pretty sensitive.  I'm now worried that I didn't have him inject the right spots.  I told you it's a pathology.

One last update--I heard back from Dr. Houze.  As I mentioned a few days ago, he's a chiropractor in Bloomington who has a lot of experience with difficult cases.  I had emailed him telling him about my situation. He emailed back saying that he has dealt with this before and would like to meet with me and try to help me.  I am blessed with people who want to help me.

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