amanda_lodden | Entries tagged with back pain

First, I would like to say that I have awesome and caring friends.

Second, I would like to point out that some of you have more anger/fear issues with medical professionals than I do, and you might want to talk to someone about that.

Because [B] asked me to make note of certain things, including pain levels when I woke up this morning, I ended up keeping a short journal for yesterday and this morning which I printed out and took with me. I arrived early while [B] was still working with another patient. Normally, I would just catch his attention long enough to let him know I was there and then start in on a warm-up and my exercises until he was ready for me. Today I located my chart and put the printed-out journal on top of it, and then took a seat in the waiting area. (In addition to the increased back and hip pain from yesterday's experiment, I had stumbled a little on the stairs on my way out to PT today and my ankle was bugging me-- nothing serious, but enough that I wasn't willing to climb onto the elliptical and piss it off further.) My appointment went something like this:

[B]: "You wrote a journal? That's awesome!"

Me: "Eeehhh, you might want to read it before you declare it awesome."

{Note: This is exactly what I handed him, except that names have been redacted to protect the innocent and terribly guilty alike. Numbers are from 1 to 10 on the pain scale, and yes I do routinely use halves when judging pain.}

10:50am - left [Physical Therapy Location]. Told [B] I'd keep track of when/whether I did the exercises, and what effect they had.

10:50 - 11:15am - drove to [work location]. My hip hurt like hell (5, which is higher than it's been in years). Decided to keep track of more than just exercises, because damn. Someone remind me to punch [B] for doing this to me.

11:15am - Getting out of the car marked the first time I can remember my hip hurting LESS when standing than when sitting. Not because standing was any better than normal (3), but because sitting in the car had been so painful.

11:30am - The new sitting position is awkward with the desk, but it does drastically reduce hip pain (2). Also took 4 ibuprofen.

1:45pm - I was doing mostly okay (2) until getting up for lunch. Sitting at the restaurant, my lower back hurt more (3) than my hip (2ish). After walking back and sitting at my desk, my back is a little better and my hip is pissed off. Toe touches did not help. There's no good place to do the lay-on-my-back thing here. Going home now.

2:30pm - [B] deserves more than just a punch. Driving is more pain than I've had in a long time (5). The stairs were not as bad as I'd feared. but still not fun to get up them (4). Took two acetominophen as well. Would take more if I could, but I'm already at the max doses for both drugs. I'm afraid to lay on my back with no one else home, because I'm not confident I could get up afterward. I had really hoped that the initial pain was just from new movements and would fade by now.

Somewhere in the middle of reading this, [B] looked up at me, then moved to the other side of the table, putting himself out of punching range.

5:30pm - sitting with minimal movement for 3 hours leads to stiffness, and I should know better. It also leads to a reduction of pain, though (2 low back, 3 hip, and I need a better stool for the house). Toe touches helped with the stiffness but didn't change the pain. Laying on my back helped my hip slightly (2.5 hip) but made my lower back spasm and ache (4 back); it got better when I stopped trying to put my feet up and just put them flat on the ground (2.5 hip, 2.5 back).

6:30pm - Still achy. Took 4 more ibuprofen.

7:30 - 9:00pm - Soaked in a warm bath with epson salts. (1.5 hip, 2.5 back) May not have to maim [B] after all.

9:00pm - midnight - made the boy rub my back while we were watching TV, then read in bed. Effects of the bath wore off a little by the end. (2 hip, 2.5 lower back)

9:00am - Woke up. (2.5 hip, 3 lower back) Sleeping on my right side for some of the night did not result in intense pain. Back to mostly "normal" before we started really doing any therapy.

9:15am - Scratch that "normal" comment. Going downstairs for breakfast wasn't too bad, but the 5 minutes of walking around gathering things was painful by the end. (2 hip as it seems to have loosened up a little, 4.5 lower back).

[B]: "Sooo, we're just going to take that therapy model from yesterday and throw it out the window, and go back to what was working."

Me: "Good plan. Though in fairness, the 'sitting with your feet up and your back in flexion' thing did help, and we could keep that."

So my fears regarding therapy were unfounded, though my fears regarding "less than an hour can still undo all of my progress" are still apparently valid-- we did go back to IT Band work, and things are better, but there's still more pain and tightness than I had two days ago before we tried the new bits. That officially makes yesterday a setback. However, now that I've acknowledged the emotional backlash that came along with the setback, I can also acknowledge that it's the risk you take when you experiment. And I don't want to stop the controlled experiments, because that's how we found the IT Band problem in the first place.

Let's pretend I wrote a journal entry yesterday about how my physical therapy was going. (I've been meaning to.) It would go something like this:

I started physical therapy for my back again at the beginning of the year, at my request. It helped my back a great deal a couple years ago, but the pain never completely went away and instead settled into a lowish-level of chronic pain, and I'd really like to have it go completely away.

I'm going to the same place, because I really liked the therapists there, even the ones that I never actually worked with but were just "around" at the times I was there. There was really only one person that I didn't like, a brash young guy who may or may not have been interning there (I was never all that clear) who pushed too hard even when I said "No, that movement hurts" to the point that he made me cry. So I called up and made an appointment and told them that I'd worked with [K] a couple of years ago. We worked out a time, and as we were finishing up, the receptionist said "Okay, that's 12:30 with [B] on Monday. See you then!" and I said "Sounds good!" and hung up and said "Wait, which one is [B]?" and started wracking my brain, going through each of the therapists I could remember, and then said "Oh, crap, I think [guy who made me cry] is [B]."

I debated about what to do about it for the entire weekend prior to my appointment, and ultimately decided to give it a try anyway. Maybe [B] was a different person entirely. Maybe [B] was the same guy but had gotten better-- he did look pretty aghast at making me cry back then, so maybe I had been an object lesson in listening to patient feedback. Also, in the intervening years I have gotten better about communicating clearly, and I've got a better handle on what movements I can and can't do, so even if [B] was the same guy and hadn't gotten better, *I* had gotten better. I was there entirely at my own option; if I didn't like how it was going, I had options for demanding a different therapist or a different location, so there was no point in punishing a therapist for being an asshole without giving him a chance to actually be an asshole first. (As a side note: that's actually a pretty good rule of thumb no matter what the situation -- if you're going to punish someone for being an ass, make sure you've given them the chance to actually be an ass first.)

I went. And [B] turned out to be the guy who had made me cry last time. And I sucked it up and treated him as though he were a brand new person I'd never met and gave him a chance, and he turned out to be absolutely fantastic-- better than [K], and [K] had been really good. In part BECAUSE of his "Let's try this and see whether it makes a difference" attitude that led to him insisting I do the move that made me cry the first time, he found a tight muscle in my hip (my IT Band) that was contributing to a lot of my pain, and I feel better than I have in years-- and that muscle is in my hip, where I've been saying for quite some time that something is wrong, and kept being told that it was referred pain and the real problem was in my lower back. So in addition to providing some serious pain relief, this new "work on the IT Band" regimen has come with a heaping side order of vindication as well.

Aaaaaaand then there was today. [B] took a class on low-back pain this weekend, and he was eager to apply the new teachings to my back. He asked if I was willing to do a little evaluation worksheet with him, and I said yes. This was my first mistake, because while it started off pretty innocuous, midway through it I complained "you said eval, not torture." The movements and positions pissed off both my hip and my lower back, and I've been popping pain pills like I did when I first hurt my back.

Of course, this new class of [B]'s taught that pain in the hips and legs of a back patient is still centered in the back and should be treated by treating the lower back, so the things that help my hip feel better didn't happen today either. And despite [B]'s promise that we would still work on the IT Band as well but he just didn't have time to do both today... I have this crushing fear that we'll revert back to the "standard" back treatment that left me with the low level of pain that Just. Would. Not. Go. Away.

Today has been a lot of crying, partly from the increased pain but mostly from the emotional baggage that comes from realizing that all of the progress I've made can be undone in one fell swoop, and at the behest of an expert who supposedly knows what they are doing (*). Then there's the fear I mentioned earlier, not just of having to put up with a therapy regimen that doesn't help as much as I know it could, but also of having to fight tooth and nail to have someone LISTEN to me about what hurts and what just isn't right. It's so very, very frustrating to KNOW that something is wrong and have doctors and nurses and therapists and other people who don't live in your body tell you that it's something else, and then have all the treatments for that something else still leave you feeling that the thing you've been saying is wrong is still wrong.

(*) I am not intending that in any sort of sarcastic tone. [B]'s earlier efforts resulted in such a tremendous leap forward that I will not deny his expertise, though at the moment I am seriously doubting the credentials of whoever taught his damned class this weekend.

[This should rightfully have been posted yesterday. Ah well.]

Last week, my doctor gave me amphetamines. Officially, they are to help kick-start weight-loss, because my back and my knees and my ankle and my diabetes would all be much better if I lost weight, but three of the four actively prevent me from doing a lot about it.

Unofficially, this week with drugs has made it clear to me that it's not just laziness or mild depression keeping me down (though those are both still definitely factors). The round of lab tests that came with the new prescription included a thyroid test, and I wouldn't be surprised to discover that there's a problem. This week is the first week in a loooooong time that I've truly felt like a human being. I hadn't noticed the downward spiral as it was happening, but the contrast with now makes it obvious.

Is it working? On the official front, I'm down two pounds. For a week that included Thanksgiving and a birthday party, that's pretty good. On the unofficial front, this week was the first time in roughly 5 years that I crossed more things off the List of Tasks That Must Be Done than I put onto it. I'll reiterate: that includes two days that involved social obligations instead of Getting Stuff Done.

The amphetamines do not provide motivation, so there's still plenty of sitting in front of my computer playing games. They also don't include magical back-healing properties, so it's ridiculously easy for me to overdo it. As long as I keep the games in balance with getting-up-and-moving-around tasks, I'm good. It's only when I spend 6 hours all at once at the computer and then get up and try to do 6 hours of activity that it all goes to shit.

Saw the pain management doctor today. Despite my irritation at how long I had to wait for the appointment (why, WHY on earth would an office specializing in pain management make someone wait nearly a week for an appointment? I called for an appointment last Thursday!), I really like the doctor. He coddled my inner techno-geek by going over the MRI films with me, explaining what I was seeing and which specific pictures contained the problem, which is so amazingly cool I can't begin to explain it. We discussed drug options (I'm allergic to codeine, Darvocet makes me unpleasantly loopy and it's pretty much the weakest narcotic there is, and the only non-narcotic non-over-the-counter pain medicine gives me migraines that are worse than the pain it masks), treatment options, and he was understanding about the fact that I'm going to fly to California then get in a truck and drive across country next week come hell or high water. His only response to that was "Well, I would normally have you come back to this office on Monday for treatment, but I don't think you should fly the day after, so we'll set you up with an appointment for an epidural at the Bloomfield Hills office tomorrow instead."

The upshot is that tomorrow I will get jabbed in the back with a large needle full of steroids. It's intended to help heal the bulging disc rather than to control the immediate pain, and because the pain stems from pressure on the nerve and the injection will put more fluid into the thing putting the pressure on the nerve, there is a possibility of even more pain for two to three days afterward as the disc heals. (Hence the "It's not a good idea to fly right afterward.") Once that pain subsides, it should take a lot of the existing pain with it (in a real, heal-the-underlying-problem manner, rather than in a mask-the-pain-so-you-don't-feel-it manner), and it should make the cross-country trip substantially more pleasant.

When the doctor described the procedure, he indicated that it would be a local anesthetic and "pressure" with the potential for some pain during the actual injection, which would take about 30 seconds, maybe a minute at the outside. When I went to set up the appointment, though, the nurse(?) asked if I wanted to be sedated. Given a choice... yes. The upside is that there will be no pain during the injection, and probably not for many hours afterward. The downside is that I can't have anything to eat or drink after midnight, so I had to choose between getting up early or starving. With my Hobbit-like attitude towards food, I took the "be here by 7:45am" appointment.

Wish me luck!