Friday, May 20, 2011

I Survived Radiofrequency Nerve Ablation Because God Has My Back

My latest round of treatment began with cervical facet injections as the test for RF (Radiofrequency Ablation). The test was positive, meaning that there was some relief that tells the physician that the procedure will work effectively to reduce chronic pain. And although I have endured two other rounds of cervical facet injections before, this one was more difficult and worrisome. You see, this time the procedure was performed on C2 – C4 bilaterally.

I arrived at the surgery center one hour before my procedure so that paperwork is processed, vitals are taken, and I can be positioned and readied for the procedure in the outpatient surgical room. I am placed on the OR table, face down, and my skin is cleaned and prepped. Once my physician arrived, the fluoroscopy equipment is turned on and my spine comes to life on the monitor. My physician positions my neck and head in an attempt to locate the facet joints in my cervical spine.

The facet joints are real joints, responsible for motion or articulation. They can bend forward and backward.  Each vertebra has two sets of facet joints; one pair faces upward, the other downward, forming a hinge-like joint at the back of the spine to connect the vertebrae together.  There is synovial fluid and cartilage between each joint which acts as a cushion, assisting in all the twisting motions of the spine.

In my case, I have a C3-C4, C4-C5, C5-C6 three-level anterior and posterior fusion, which stops all motion of these joints. The movements of my neck are all produced from the joints located below and above the fusion, causing them to “wear out” at an alarming rate along with the threat produced by my osteoarthritis and degenerative disc disease. My facet joints rub against each other, bone to bone, with each movement of my head which makes driving, computer work, sitting, standing, walking, and even reading a book a painful challenge.

My skilled physician numbs the area before using a long needle to probe the space between the facet joints, taking extreme care to ensure that the spinal cord is not touched or damaged during the procedure. My doctor has difficulty getting into the joint on this day, and he hits the bone on two occasions while trying to inject into the C2 facet joints on both sides of my neck. The pain that I feel is something that I can’t describe, but I elected to do the procedure under a local anesthetic instead of light sedation or MAC anesthesia. I am having second thoughts about my decision. My physician asks me to open my mouth wide, then shut, then open again. My teeth are obstructing his view of the C2 facet joint. After a couple more attempts, the medication is finally injected into the joint, the procedure is over, and I am removed to the post op recovery room.

I am alright, although feeling very shaky. The first thing I do is thank God that I can feel my hands and toes, reassurance that all has gone well. Over the next couple of hours I notice that my pain level has decreased significantly. My constant ear, jaw, and back of the skull pains are better, but before I can get too excited over it, the pain returns and I caress my ice pack. I remind myself that this is only the test, not the treatment. RF is scheduled to occur in two weeks after a short recovery period. This will be the third time that I have had the RF procedure, but because of the difficulty obtaining access to my C2 facet joints, I am nervous.

At the end of the two week period, I report to the surgery center again and everything is repeated just like before. I opt out of the MAC anesthesia again, in favor of a local, however I begin to wonder if I am crazy. The facet joint injections take 5-10 minutes, but the RF procedure will take more than 20 minutes. Even so, this still is a very short period of time and I know that it is just better to skip the anesthesia unless absolutely necessary. After all, a radiofrequency nerve ablation is not as nasty as a colonoscopy!

After my skin is numbed, the RF needle or electrode is inserted. The electrode carries pulsed radiofrequency electric energy that will stun the nerves. The electrode is much larger than a regular needle and it does smart. The correct location is quickly found this time and my physician uses the pulses to twitch muscles and stimulate tingling sensations to assure that the needle is properly and precisely positioned next to the offending spinal nerve. Once confirmed, the nerve is “stunned” for 2 to 4 minutes before removing the electrode and proceeding to the next facet joint. Before long, the procedure is again over and I am whisked to recovery. I feel disoriented, dizzy, and more than a little unsure of myself as I am rolled onto my back to a new gurney. The room spins; vertigo is not fun, but slowly the spinning stops and I begin to feel more like myself. These vertiginous sensations are normal when RF is preformed on the cervical spine.

Once I leave the surgery center with my ice pack, I am excited that the procedure is over and I am anticipating the rewards; decreased pain! The RF procedure went smoothly without complications or difficulties, unlike the facet joint injection. I am grateful that the ordeal is behind me and I know that I can just ride out the next few days of increased discomfort. To my surprise, the next few days pass quickly without much pain, just muscle soreness which is easily tolerated. I notice that the constant, horrible head pain at the very base of my skull is gone. I am overjoyed and happy about the instant, positive outcome. This is the first time that I find myself without this chronic pain from my never forgotten cervical fusions.

But within a couple of days, the pain begins to creep back as I slowly try to increase my activities. Driving or riding in the car becomes too painful. I can’t use my laptop or cook a meal. Sitting in a chair increases my pain level. Nothing has really changed. I believe the procedure has failed. So I restart my usual existence; 40 to 45 minutes of activity followed by 15 minutes of rest with ice packs applied to my neck. I limit my daily activities to reduce the horrific head pain and blinding headache. There are no tears. I do not cry.

I get angry and I allow my anger to rule every aspect of my life. I bark at my husband. I yell at the man who cuts our lawn. I sneer at the woman who is overlooking the coupons I have given her while I roll my eyes at my husband who begins to bag our groceries in paper bags. I hate paper bags. I walk away towards the car alone and I want to get in and drive away, forgetting my kind husband who is pushing the cart towards me. And then my anger begins to boil over and I scream at God. He has forgotten me. He hasn’t answered my one prayer that would be simple for the God of all creation. Heal me! Make this unending pain go away! Let this procedure work! I am tired of daily pain, and I am tired of living a limited existence. I want to look normal and wear normal clothes and shoes. I want to work and love life, but all I feel is anger. I forget that I spend part of my days encouraging others who I correspond with through social networks; telling them not to give up, showing them the love and grace of God in scriptures, and showing them the signs of God’s everlasting love and care that is all around us. Now all I can see is darkness, a blackness that swallows me whole. I have given up hope.

My husband tries to remind me of the Father’s sacrificial act; He gave up His only son so that my sins could be washed clean, but I sputter and grind my teeth as I say, “He doesn’t love me! He lets me suffer and it will never, ever end until I die! God doesn’t listen to me anymore, He is just sick of me and I have given up because God gave up on me!” My husband keeps trying. The more he tries to reach me, the angrier I become. I think that my husband doesn’t understand because he doesn’t cry out in pain like I do, and I don’t want him to find out what it is really like. No human deserves to live like this year after year. I skip church. It’s much too emotionally painful to go there. I can’t see God’s face right now.

Then I receive an email message from a new friend at a social network for those with invisible disease, My Invisible Disabilities Community. She writes that God will use this to teach me something, reminding me that there is something to learn from all of this. She tells me that the enemy, Satan, does not waste time on those who are mediocre with God, they are easy prey. He tries to destroy the ones with the strongest relationships with the Lord because they are a threat to him. The enemy plants seeds of doubt in our thoughts when we have been knocked down. She encourages me not to let those little seeds take root and to stomp them out by speaking God’s Words, God’s promises. She tells me to use God’s gift wisely, and be patient because God will show His goodness. And she writes four words that make all the difference; “God has your back.”

I doubted that God was still listening to my prayers and He used a friend over the internet to talk directly to me. I know how much God loves me, but I couldn’t see anything through the disappointment and anger from the failed procedure. God restored my hope, my dreams, and my strength through a virtual friend. My anger dissipated. The shadows of darkness are gone as I speak His Holy Scriptures, and peace flows over my body, changing my color from red to yellow. I skip blue because the Lord forgave my weaknesses and tormented doubt with a warm embrace. I have returned home. I can wait. God’s love is eternal and I am priceless to him. He handles me with extreme care even when I deserved to be dropped. But instead, He marks me fragile for now, but just until I regain my strength.

My pain decreases along with my anger. The spasms in my muscles soften, then stop. I believe that my anger created more physical pain in my body than I should have ever endured. Maybe the effect of the RF procedure is just going to take a little longer this time and I was too impatient to wait until the nerve irritation from the “stun gun” stopped. I am taking my medication as prescribed as I wait for my supernatural healing from God, and I know that God has a higher purpose for my life than living a meager existence of chronic pain. I survived radiofrequency nerve ablation without any complications. I can survive the pain until it stops completely because God has my back.

Friday, April 8, 2011

When Should We Trust Our Own Intuition over Medical Expertise?

A couple of months ago I wrote a blog after an extremely bad ER visit called, Why Are We Treated with Indifference by ER staff?  I had developed a severe blinding headache, one of the worst ever, and my pain management physician told me to take a Percocet. The pain increased and I started vomiting about every 10 minutes. I had taken Percocet before without any side effects, but I knew that something was not right, something was wrong. I was instructed to go to the ER and unfortunately, the ER physician treated me as if I were another addict who had come to "get more drugs" and left me to suffer.

Last week I saw my neurosurgeon to follow up on my cavernomas or brain tumors that are made up of blood vessels. He was very concerned about my severe headaches. My last brain MRI was done in 2009 so he sent me for another one. I just got the results. My cavernomas have hemorrhaged recently and most likely it was when I had that horrific headache and vomiting that sent me to the emergency room. Since there was no MRI done at the time of the ER visit, there is no way to know for sure if it happened then. But it is more than a pretty good guess since the pain in my head was so severe that a morphine IV didn't help very much at all. I just rolled around on the gurney in the ER in agony and was unfortunately, ignored for the most part.

I thank God that the hemorrhage was considered subacute and has not continued. Because of the location of my tumors, they are inoperable and my severe headaches are best treated by my pain management physician as long as the tumors do not continue to hemorrhage. My neurosurgeon told me that they have to be more closely followed now since this last episode and I have to be more careful about severe headaches. Yes, I did the right thing when I went to the ER, but I did not insist that they do an MRI immediately. I was too ill and I relied upon the physician’s medical expertise. And it's hard for me to know when my headaches are severe enough to warrant an emergency MRI, but after this unfortunate episode, I will now error on the safe side. If it ever happens again where I am ignored by a physician in the ER, I will demand better treatment!

I do thank God that He watches over me, and I know that I am blessed. God can take a terrible ordeal or illness and somehow turn it into something good! Through my trials with chronic pain and illness, He encouraged me to write a book, "Heal Me, Mend Me, Use Me, Send Me." And God has made a way for it to be published so that it reaches others and encourages them.

Two months ago when that terrible headache struck, I was in the process of the first round of conceptual editing of the book. After the ER visit, my vision remained blurred, my balance was affected, and my pain had increased to the point that I doubted that I would be able to work on the manuscript at all. I struggled through it, tolerating only a few minutes at a time, and of course, I missed the deadline with the publisher by over 30 days. Again I was blessed with a publisher who was gracious and understanding. But little did I realize at the time that I was under a tremendous, vicious attack from the enemy, Satan’s little demons, to keep my book from being published. The book is now in the final editing phase with Tate Publishers. If my book helps one person, then God has turned my tribulations into joy!

Wednesday, February 16, 2011

Why Are We Treated With Indifference by ER Staff?

All of us who suffer from "Invisible Chronic Pain" know what it is like to visit the Emergency Room! It is absolutely the worst place for a chronic pain patient to be! Sometimes it becomes inevitable, and circumstances that are beyond our control lead us to this place that should be a healing place.
I understand that ERs are for accidents, injuries, and serious medical events. Unfortunately, as a chronic pain patient, our pain levels can get out of control and it becomes a serious medical event. Our pain management physicians will send us to the ER when they know that nothing else will help, but the staff there has other ideas about us.

My recent experience was caused by my physician trying a different medication for break through pain. It caused uncontrollable nausea and vomiting. When you are dependent on pain medications, and you are unable to keep anything in your system at all, you quickly can get into a “pain crisis mode.” I became severely dehydrated and was experiencing excruciating pain because I had missed both my narcotic pain meds and nerve pain medication for over 12 hours. This left no other choice but to visit the healing place, the ER.

When I arrived, I informed the triage nurse that my pain management physician had sent me there. She took a brief chief complaint, and took me directly back into a treatment room. I was fortunate to have gone when they had a lull in the ER and would be seen quickly. I was left in that treatment room for over 2 hours before anyone walked in again. I had to search for my own basin since I was there because of the non-stop vomiting.

Finally, a physician came in. Asked what was causing my vomiting and I told him about taking a Percocet for break through pain. He said, “Ok, I’ll get you something.” and left. A nurse appeared to put in an IV and inject medication.

 “What is in the syringes?” I asked.

She said, “Nausea med and pain med.”

“No, I asked a question.” I said. “What is in them? Your triage nurse and your ER physician have not bothered to ask what medications I am on.” I handed her a list of my meds which she looked at. “Will any of these meds interfere or are contraindicated?”

The nurse said, “I don’t think so, but I guess I had better check.”

When she returned, the nurse said, “I entered the meds into your record. You were right. We didn’t ask. The doctor said that it is fine to give you Zofran for nausea and 4 mg Morphine sulfate IV.”

I asked, “Did he order fluids?”

She said, “Nope.” The nurse injected the medication into the IV line, and left again.

Two hours later, the physician returned. He said, “How are you doing now? All better?”

“No,” I said. “The nausea has stopped, but the pain has not.”

“Ok,” he said. “I guess I can give you a little more morphine. Why are your lips so chapped and dry?”

“I told you that I had been vomiting for 5 hours when I came in, not including what has happened here. I am so dehydrated that I can’t blink my eyes without scratching them and my tongue is sticking inside my mouth. Since you are not starting fluids, can I start drinking?”

“Well, I really can’t give you anything to drink. It would probably start the vomiting again. I do see now that you are very dehydrated, so I should get some fluids in you first.” Again he left and the “happy” nurse returned.

“I’m starting fluids and giving you 2 mg more of morphine sulfate,” she said.

 Before she left, I asked, “May I have a blanket? It’s cold in here and the IV fluids are making me even colder.” She didn’t answer because she was imputing into the computer. Instead, she held up a finger to me, motioning for me to wait a minute. Little on the rude side, but I didn’t say anything. She left the room again. The IV was finally running after being in the room for over 4 hours. Why didn’t the physician start it when I came in so dehydrated?  It seemed that he just didn’t care about my condition. I was trying to be optimistic, not assuming that it was because I was a pain patient.

Thirty minutes later, the same nurse walked past my room and I called out, “Nurse, can you please get me a blanket?” Oh, there was that finger again, signaling for me to wait just a minute and she kept going.
Thirty minutes later, another nurse finally came close to my room. (I was in the far corner of the ER) I called out, “Nurse, would you please get me a blanket?” She came in with two blankets and covered me. “Thank you so much!” I said. “Sure. You’re welcome,” she said.

My IV completed, but no one came in to check on me. Another hour passed. The nurse had put the rails up on the gurney. I couldn’t get up on my own. I was too weak to get up anyway. There was no call button, or any way to get in touch with any of the staff. I thought about calling them on my cell phone! But just then, my heart, BP, Pulse monitor started to alarm. Finally, the doctor came towards my room. He stood in the hallway, texting on his cell phone, and then approached. “Why is that going off?” he asked.

“I’m not looking at it. I don’t know, but I’m having chest pain along with my neck, jaw, and the middle of my back.”

“Well, your BP is dropping really low, setting off the alarm. That’s from the morphine I gave you. Let me listen to your heart,” he said. This was the first time the physician had actually touched me! I had been there for over 5 hours and he hadn’t examined me at all! “You’re having palpitations. Oh it’s the morphine and I can’t give you any more of it now,” he said.

“I don’t want any more. I just want to feel better so I can go home,” I said.

“A….hmmm….sure,” he said. “You can go home.” And there it was! He said it all without verbalizing it. There is another addict in my ER.

“Happy nurse” came in next. She handed me a script for Zofran for nausea and vomiting and said, “You should see your pain management doctor. He should be the one to change your medications, and you shouldn’t come here for that. We can’t help someone like you.”

I had my very own “Nurse Ratched” from One Flew Over the Cuckoo’s Nest! “I didn’t come here for that, dear nurse! I came here to stop the vomiting so that I could keep my pain meds in me and control the pain,” I said. “But my pain levels spiked because I hadn’t taken anything for hours. Once pain gets out of control, it’s difficult to get it back down. Don’t they teach that in nursey school anymore?” I declared with attitude!

Nurse Ratched looked at me and said, “You can leave anytime you’re ready.”

“And what do you mean by telling a patient that you can’t help “someone like me?” I asked. “Just because you can’t “SEE” someone’s pain or illness, doesn’t give you the right to treat them any differently. I don’t visit your ER chronically. I came because I was in a crisis and my doctor sent me here.”

“Sure,” Nurse Ratched mumbled. “Anything you say.” That was the last time I saw her. As I left the ER, the doctors and staff were sitting around the station, talking, texting, etc. It was a slow night in the ER, but unfortunately that didn’t help me at all.

This place of healing had been turned into a cold, heartless place. I have worked in the medical profession for over 30 years. I know what it is like to care for the ill, sick, and injured. I’ve even worked in the ICU too, and I’ve seen my share of sorrow and suffering, but I never lost my empathy for patients. I never tried to humiliate my patients even when some of them were in fact, unreasonable.
When people are sick or injured, they are scared, frightened, and hurting. They need compassion and comforting, which goes along way towards recovery and healing.

 I’ve had the pleasure of working with many caring nurses and many of them are my friends. I’ve encountered countless nurses and doctors who give so much more with their gracious hearts and altruistic approach to patient care. They are the ones who are a credit to the medical profession, while apathetic and callous doctors and nurses are nothing more than a debit.

**I’m planning on sending a copy of this blog to the administrator of this hospital. I’m not sure if it will help, but maybe the next patient who comes in suffering from chronic pain will be treated appropriately**

Thursday, February 3, 2011

Chronic Pain Is a Story Unto Itself

There are approximately 50 million Americans who suffer from chronic pain, back pain being one of the leading causes of disability. And unfortunately, about 80% of Americans will suffer from back pain at some point in their lives. Statistics show that low back pain is the most common type of pain, followed by severe headache or migraine, neck pain, and facial pain.

It is easy to understand with these statistics why chronic pain has now reached epidemic proportions, and when it lasts for long periods of time, pain controls every aspect of a person’s life. People with chronic pain are four times more likely to have attempted suicide than others not suffering from persistent pain. Patients with chronic pain are discriminated against in the work place and even their symptoms are discriminately categorized by race, gender and age by many medical professionals.

There are many books written about living with chronic pain, coping with pain, and understanding pain. There are numerous health guides to treatment and causes of chronic pain along with societies, communities, organizations, blogs, and support groups on the internet for people who are living with chronic pain. All of these resources are extremely helpful, however; they are crucial evidence that patients who suffer from chronic pain are seeking comfort, coping skills, and affirmation of their daily suffering.

With all of this information readily available, why did I write another book about a chronic pain story? The answer is simple. I am a chronic pain patient with a twenty-five year history. I chose the medical field as my profession long before I suffered from chronic pain and even with my medical expertise and all the advantages I had to the best healthcare providers, I still became a statistic. I endured five major spinal surgeries which created the perfect environment for unrelenting pain that medical science could not cure.

So I wrote a realistic, inspirational story about a woman whose chronic pain takes on a life of its own, a demon that destroys her spirit, breaks her body and damages her mind. The book “Heal Me, Mend Me, Use Me, Send Me” follows many of the same circumstances that shaped my life as I lost my husband, my family, and my career before I was humbled by total disability. And just like the main character in the story, God was able to restore me through His mercy and grace. I no longer suffer from depression or alcohol abuse as I continue to live with my sometimes overwhelming pain.

But most of all, I live with hope. There is hope because God is able to restore our lives. He performs miracles today just like He did as recorded in the Bible, for He is the same today as He was yesterday. And I hope that this story can introduce you to the Great Physician, for He alone can do what medical science can not accomplish; He can heal.

I am anxiously awaiting the d├ębut of my first book, “Heal Me, Mend Me, Use Me, Send Me” which is being published by Tate Publishing, and I have already begun a sequel novel with a surprising twist that I hope you will enjoy!