Still in pain

I was up at 4 to take my first Norco and then, as I was making my tea, I had this thought…what if I never get any better? What if I have to endure this pain forever? I didn't like the thought at all. Okay, I need my antidepressants and soon.

Really. I was (and still am) depressed about the continuing pain. I think I'll go back to a full dosage of Neurontin next week and see if that helps. Is it a terrible pain? No, I can stand it for the most part as long as I have Norco to fall back on when it's at its worst. But I was hoping that at some point I could say goodbye to pain…forever. But now it looks as if pain will always be my companion. And I will always be taking Norco…3 or 4 a day. Forever.

What's my pain level? It's always at level 3 or 4 until the Norco begins to work.

3 Tolerable		Very noticeable pain, like an accidental cut, a blow to the nose causing a bloody nose, or a doctor giving you an injection. The pain is not so strong that you cannot get used to it. Eventually, most of the time you don't notice the pain. You have adapted to it.
4 Distressing		Strong, deep pain, like an average toothache, the initial pain from a bee sting, or minor trauma to part of the body, such as stubbing your toe real hard. So strong you notice the pain all the time and cannot completely adapt. This pain level can be simulated by pinching the fold of skin between the thumb and first finger with the other hand, using the fingernails, and squeezing real hard. Note how the simulated pain is initially piercing but becomes dull after that.

That's the difference…adapting. And it's the Norco that helps me to adapt. I noted the other day that it was always about an hour after taking a Norco that I would suddenly feel pain free and I was so happy when it happened. Euphoric! No pain! That feeling would last about three hours and then gradually fade until I needed another Norco. Or I would try to wait as long as I could. If it's getting close to bedtime, say within a few hours, then I do without most times, knowing that sleep will 'cure' me until I wake, in pain, in the early morning and start the cycle all over again..

We're going to be walking again this morning and I know it will be painful at times, so I will take another Norco at some point during the walk or just before. Hopefully, that will last me until late in the day. I had a four Norco day not too long ago and I would rather not have them. The side effects of opioids are no fun!

Better!

Now, what has happened to me? I'm getting better! It's all very odd as I was still in pain and walking slowly when I went into the Lowe's store yesterday morning and by the time I came out, I was literally running! Without pain! Yes, the pain has come back briefly and lightly and I'm willing to deal with it because I'm getting better! I am in a time of awe and wonderment as I try to envision a life without that constant pain and the drugs to combat the pain.

I had a moment or two of weird thoughts as I came up with the idea of the 'Miracle of Lowe's. Why not? There is 'The Miracle at Lourdes' in France where the faithful come to be healed and buy water from the spring there. And just like Lourdes, I can see a pile of crutches, canes and wheelchairs by the front door at Lowe's, left there by those who were healed. Lowe's doesn't have a grotto and spring as Lourdes does, but they could just leave the water running at the drinking fountain in the back, near the restrooms.

Yikes!

Update

(Yesterday) Here I am again, three days later and I'm much changed. Very much. First, the pain has been reduced greatly. I really want to cry about this and I will, but I'm still at a stage where I don't quite believe it has happened. Two full years of pain. Pain that would never quite go away, even with all the narcotics I was taking. Pain that was masked but never absent. And now it's negligible. Sure, I have some pain right now but I can tell that most of it is from the surgery itself and it will go away in time. As a graduate student of pain I know the difference.

The surgery itself took a little over four hours, about twice as long as my surgeon had hoped for. He described the process for me; cutting away at the scar tissue from the previous surgery bit by bit while looking for the offending nerve and being extremely careful. Of course. Unfortunately, nerves and scar tissue look very much alike. When he found the nerve he followed it down the tiny tunnel that led away from the spine until he found the 'sharp pointy thing' that was pressing into it. Carefully moving the nerve out of the way, he excised the 'pointy thing' and all of the material nearby. He also opened up a much larger tunnel for the nerve to reside in and that is where it is right now; bruised and somewhat angry, as only nerves can get. But…the main source of irritation is gone.

(Today) I feel odd and words are not coming easily these days. I'm sure it's because I am not entirely certain of the success of the surgery and all my attention is focused on how I feel and then trying to sort out the pains. Is that pain, ouch! from the surgery or is it from the condition that existed before surgery? A new pain? Ouch! What's the cause for it? I'm afraid that all of this detective work uses up most of my mental capacity for reasoning.

    I need to get over it and concentrate on the fact that I do
feel better. A whole lot better! And I have to realize that this process of pain reduction will take some time. And some effort on my part as I must be exercising and walking daily. I'm only four days post op and I still have surgical pain to deal with and that will take some time. Plus, I have to stretch the nerve pathways every day with a set of exercises that bring me pain. Okay, the word 'pain' is still going to be part of my everyday vocabulary but I will have room for other words now and that is what I wanted from my surgery.

Recap

The day of surgery is rapidly approaching (Jan 26^th) and I couldn't be happier. The surgery will be exploratory at vertebrae L5 and S1 and then, if everything is okay he will perform a Foraminotomy at L5. The intent of all this is to remove the pain. That was also the intent of the first surgery, six months ago. When the pain did not go away after that surgery, an MRI was done and it was determined that there was still an impingement on the nerve, something that couldn't be seen during that surgery. Then we had a five month wait until the bone grafts were strong enough for the second surgery. A CT Scan a few weeks ago confirmed that my grafts were strong enough to withstand the pressure of the operation. But…there's always a 'but' isn't there? The chances of failure have now gone up because it is the second surgery. Even so, I am eager; it's been two years of mind numbing pain and two years of having my mind numbed even further by the drugs that are supposed to ease that pain. Norco and Dilaudid have become more than mere acquaintances, they are now my best friends and that's a bummer! And the pain? It never went away. And after a month or so, the Norco and Dilaudid were losing their effectiveness. Another bummer! Or, as a friend once said; a stone bummer!

The plan, my recovery plan, starts with the third day after surgery and I should be home by then. The doctor says a one or two day stay after he has reamed out the foramen. Ouch! But…the nerve will be free after that and he said that as soon as I wake up I should feel the difference. Viva la difference! Back to the plan; it starts with walking at the park and doing a half mile. I want to increase that by a quarter mile every two days. I will do five or six days at the park and then a day of rest which allows the body time to rebuild. By the middle of spring I want to be doing 5k distances and at speed. I also want to make sure I can return to my race walking form; that's the only way I can get back to the 11 minute miles I do for a 5k race. Or, I used to do…

Marathons are out for this year and iffy for the next. I need to be in great shape before I go for my sixth medal and the all important t-shirt. At that point, I just want to be among the other athletes, enjoying the marathon vibes, I'm not going to be trying to set a personal record, I'm waiting till I'm seventy five for that.

Recap and the future

As it is the first day of the New Year, I should bring this blog back up to speed. My last entry was more rant than fact and was drug induced; pain drugs, and those do odd things to my mind while easing the body.

Enough of that, here is where I am in my plan to get back to racing, even if it's only 5 or 10K races.

Flash back to my surgery in mid July. The surgical pain was manageable and after the normal amount of R&R I was told to begin a recovery program of daily walks. This went well and I was soon up to four miles a day and getting faster all of the time. Then, something happened after one normal day of walking, I got out of the car to begin and I could tell something was wrong. I thought that perhaps I had strained something the day before but couldn't recall such a thing. Anyway, I was barely able to make it around the park, in fact I couldn't. Laurae had to go and get the car and come back for me. And so it went. All downhill. The pain increased and my mileage went down quickly. I was lucky to do a mile. And then, the pain afterwards was tremendous. Saw the surgeon and he knew there was something wrong as soon as he saw how I was standing. An MRI revealed that the L5 nerve on the right side was caught in the foramen and anything could make it hurt. Any movement at all. He told me that I would need additional surgery to free up the nerve as there was nothing that I could do via the exercise route to ease the pain. In fact, he said it would get only get worse during the time it took to get ready for surgery. Yes, I had to wait for about two months while my bone grafts from the initial surgery strengthened enough to support me after the next surgery. He gave me an appointment for a CT Scan in late December and then a consult immediately afterwards.

Okay, I've had the CT Scan and the consult and now I must wait for a surgery date. We assume it will be very soon as that was what the surgeon indicated that he wanted. We all do, because, as he predicted, the pain has only become worse. Much worse than it had been before the first surgery. Crippling pain. Yell out loud pain. Yes, he gave me enough drugs for the pain; at least I haven't been burdened by one of those sanctimonious surgeons that are afraid to give their patients any relief. But if I took all that was available, I would be semi conscious at best…tempting at times! But, I do see a resolution to this, surgery will be done and I will get better and I will be walking a 5K race in November, the Turkey Trot, and then another in March of 2011, the Almond Blossom – the one that I have won so many times. I want to do it again. Another marathon is possible in October of 2011, the Portland Marathon, my favorite!

Here again

Yes, I'm still here. Awake and wondering about the new day. What will it hold for me? Pain, of course, although I just took the morning trio of the right drugs and I'm waiting for the curtain to drop and give me some relief. My surgeon told me that I would remember him for the rest of my life; every morning when I got out of bed, I would mention his name and he's right, I do and I damn him.

Okay, that's a little strong for me, I really do appreciate his skills and his honesty. He said it would hurt me every morning for a very long time and it has already started. I've only 3 or more months into it; the real test comes with time. And see, as I type, the pain recedes a little bit. No, it's not due to my typing skills but to the passage of time and the speed and efficiency of the drugs as they move throughout my system.

Later…I have posted a lot of nonsense to my Projections blog and that was my 'smarts' for the day. I'm at a point where I'm slightly brain dead and dysfunctional. Could it be drugs? Of course it! Everything in my life is about drugs, as it should be. Pain=drugs. Simple. Seriously now…I'm half in and half out of my previous minute or two of euphoria induced by the 'Big Three' and I'm coming out the wrong end; into pain again. But relief is just a few steps away. What a life, it's all pain and then the side effects of the drugs used to fight the war against pain. Hmmm? Why, if we have a war against drugs, why don't we have a war against pain? Why, when we are in pain, are we told to suck it up? Who gave those people the moral authority to say such a thing? Tell them to get lost! Better yet, wish the same pain upon them. Cruel? You bet, but those who say 'suck it up' are far more cruel. And stupid.

Looking at my journal

I was just thinking, once again, that this year's Journal has devolved into one sad story. This year and the last have been filled with pain and more pain along with an ample dose of frustration. I'm certainly tired of it and I'm sure that any reader would be as well. I think I will open up last year's journal and see what was happening on this day a year ago.

Okay, the 25^th was a Saturday in 2008 and apparently I was doing the very same thing I'm doing today, browsing my Journal.

It's close to 6 now and I'm feeling awake but not all that thrilled with the day. Of course it's the pain. And the fact that I may have made a mistake by reading through my journal for this year. I read where I first became aware that the pain was more than just a temporary setback to my marathon training. I called it Piriformis Syndrome because that was what I wanted it to be. It wasn't and that was back in March. And I read about the times that I had to wait to see a doctor. 3 months of simply waiting in 6 week segments. 6 weeks where nothing happened to improve my condition. An unknown condition? And more waiting, in 2 or 3 week segments this time.

Wow! March of 2008 was when I decided that I had Piriformis Syndrome and that was only after I had suffered from pain since when? Here's a clip from the first day of 2008.

Since it's the first day of the year, I suppose I should include a physical assessment. I know that last night, as I was putting on my pajamas, Laurae commented that I was certainly making a lot of noise with my groans of discomfort. Oops! It's true, stretching causes some pains in my joints, but I reassured her that although my body might be failing, my mind was still medium sharp.

And then in the middle of January…

I don't know why I'm feeling so sore today. I didn't do that much out of the ordinary, but I'm moving slow and painfully. Is this what old age is all about?

And just a few months before that, November 27^th of 2007…

I ended up with a 24.5 minute time for the second half. That's 12.25 minute/miles and it felt pretty good. 4.68 miles total

In November of 2007 I was good, very good. I guess I could say that January of 2008 was the 'official' start of my pain and the beginning of my slide downhill to my present condition. I was looking for the account of my early morning race where I felt that I had actually done something bad to my body. I thought it was in December of 2007 but who knows. I do remember the event because I had been training and feeling as if I couldn't go very fast at all and had been disappointed by my time and the persistent pain I felt in my hip. It was a gray morning and I was walking back to my car when I saw a racewalker go by, on his way into the park. He was moving fairly fast and since racewalkers were and are rare sightings, I decided to chase after him. My goal was to catch up with him by the one mile marker. He had a good 50 yard head start so I had to pour it on to catch up. And I did. Right at the mile marker I caught up to him and then stopped to walk back. A long and painful walk back. I was very proud of myself and quite sore. That pain never went away.

It seems as if I'm closing in on the two year anniversary of my 'Pain' and it's painful results. What a trip this has been. A trip I certainly didn't want to take and one that I wish I could end on a happy note. I'm still looking for a repeat of the 12.25 minute/mile and I'm not giving up.

More

I'm somewhat wordy this morning. I suppose that's good and I should be happy that my mind is still sharp enough to string a few words together. But what am I thinking? What am I going to do with the day? And that's going to be the question for the next three months. With surgery not even on the calendar yet, I'm facing a long wait with my days and nights filled with drugs to keep me pain free or as close to pain free as the chemicals will allow. But…narcotics don't stop nerve pain. They just muddle your head enough to make you less aware of the pain. This works. Sometimes. Believe me, an offended nerve will cut right through a narcotic haze to deliver its message! I will be taking two other drugs that are prescribed just for nerve pain. One doesn't do anything at all; it's the one I've been using for the past three months and the other one may or may not work but the significant side effect is that I will become lethargic and my mind will slip into low gear. Which won't bother me because I will be beyond worrying. Just cruising.

But wait, I didn't even mention why I'm waiting for surgery again. Since my post-op pain was not decreasing but instead was increasing, the surgeon wanted another MRI, one with contrast and one without. And since my laminectomy had removed the overlaying bone, this latest MRI revealed the fact that the nerve root on the right side of L-5 was caught in the foramen, the hole in the bone, and scarring and bone growth was holding it firmly. In the previous surgery, he had probed that nerve channel for 5 cm and found it free, that was standard, but his probe couldn't reach behind the pedicle where the nerve was caught. So, a Foraminotomy is going to be scheduled sometime in the first part of the new year. It's a major surgery with a few days of hospital stay but I don't anticipate having to donate my own blood for it as I did last time. And why are we waiting so long? Because the bone grafts from the previous surgery have to be strong enough to support me after he cuts away some of bone that is causing so much pain for me.

No Marathon This Year

Tomorrow morning is the start of the Portland Marathon, my favorite, and I can use my imagination and see the crowds in the early morning darkness. I can feel the jostling as the participants move about in the street, trying to keep warm and stay focused on the event ahead. But I won't be there and I'm only tormenting myself with these thoughts…I suppose I should recap all that has brought me to this point in time; now. I'm two and a half months post op and I still live with pain 24/7. Yes, it's better than it was immediately after surgery but now it has become static, nothing is happening to change the situation. I do my walking, my exercise and I take my pills and still the pain is there. Disabling me mentally as well as physically. My mind is no longer my own since pain and its attendant medications have taken up residence there. I take an average of five Norco a day for pain and it has been that way for close to two months now. I even take Dilaudid on those occasions when Norco won't do the job; it's rare, but it happens. Those really scramble your thoughts.

I've been to see my surgeon and as soon as he walked into the exam room he saw that there was something wrong; 'What's going on?' he asked and then I proceeded to tell him. He was quite serious as he did a quick neurological exam and then told me that he had expected to see me in much better shape that I was in. He said the nerve that passes through the foramen on the right side of L-5, the last lumbar vertebra was the culprit and he was at a loss as to why. He ordered a 'with and without' MRI for me as soon as possible. (That's one with contrast media injected and one without) Then he will meet with us as soon as possible after that. He was nice enough to go over his surgical notes with me and showed me where he had explored the channel for the L-5 nerve for a distance of 'x' centimeters and had concluded that it was free of anything that might injure the nerve. He said that it might very well be that the previous nerve injury, the crushing of the nerve that had brought me to him to begin with, had injured the nerve beyond repair. Nerves normally repair themselves without a problem. You can cut a nerve and the two halves will eventually find their way past the scar that obstructs them and rejoin. Anyway, it's all conjecture at this point and he needs the MRI before he can come up with some sort of plan.

I asked him about the drugs and the amount I was taking and he said that they were not a problem. Pain control was first and he said that we would confront the addiction problem afterwards. In the meantime, I was to take them whenever needed. And as he said, they really do very little for nerve pain. The pain remains when you take them but your mind is muddled enough so that the pain doesn't seem quite as important as it was.

Once again I'm without a plan. This is where I was a year or so ago. Waiting for relief. And another marathon.

Recap

It's been a month since my surgery and so it's time for a recap. First, the surgery is not for the faint of heart. It took 6 hours of cutting and grinding on my spine before the surgeon called it good and sent me to the recovery room. Now, to be honest, this surgeon did his best to make sure I understood what was going to happen. His words to me, a year and a half ago, were, 'I'm going to put a world of hurt on you.' And then just before the surgery, You've never felt pain like this. You ready?' And he was right. I had a thoracotomy about 30 years ago and I thought that was the most painful thing I had ever endured. So now I have a new benchmark for pain, a four vertebrae laminectomy.

The pain was managed quite well in the hospital because the meds are almost always given by IV and the effects are felt right away. At home I have to use the oral route and means a good thirty minutes might pass before I see any relief. Plus the fact that nerve pain is very difficult to manage. Only opiates can touch it and then not well. Bone pain is also one of the worst to try and manage. It's the same story; opiates are the only thing that control bone pain. The pain from incision site and the muscles beneath is a distant memory, if there ever was any pain at all? Truth, I don't remember it.

Today, a month later, I can usually manage the pain with Norco and nothing else. I do have some Dilaudid if I need it, which is rare. Even with the Norco, the pain is always there, just muted. Early mornings are some of the worst times as the Norco has worn off and the first one of the day hasn't begun to work. Plus, I've been laying flat for six hours or more and muscles are stiff. I have to 'log roll' to get out of bed and sit on the edge. My walker is a few feet away from me and I have to stand and reach for it. Painful! And it continues as I shuffle into the kitchen to make some tea. It usually takes thirty minutes or more before I can say that the pain is now in the background and I can think of other things. Does it ever go away? Never.

That's probably the thing I hate the most; the pain never goes away. And the management of that pain is now my life. Early in the morning, it feels hopeless and I'm quite depressed about it. But, at seven, I take my antidepressants and that feeling goes away. 'Better living through chemistry!' I can handle the pain, most of the time, throughout the day. I even abandon my walker! Luckily, the day always includes a two hour nap, which gives me a break from reality. By evening I'm quite conscious of the pain again and try to do as little as possible. 'Let sleeping dogs lie.'

I will be seeing the surgeon next week and will learn more about my future. I know, because he told me, that I have six months to a year to recuperate from this surgery. And I know I have only put in a month so far. So I must hope that it gets easier. Not much else for me to do…

I’m Walkin’

OK, I'm 12 days post op and things are looking up. Pain is still a constant and it appears that the doctor expects that. He prescribed a bottle with 200 Norco in it and 2 refills. That scares me when he thinks I will need 600 Norco! Norco, of course, is my new best friend, followed by Dilaudid. Or maybe it's the other way round? Sad, but I have no refills available for the Dilaudid, though I will ask for one this week. Dilaudid makes the mornings bearable. And the evenings. Twice a day is all I need and I will have to tell him that. I'm also taking Tizanidine, a muscle relaxant to help with back spasms.

I'm getting around more with my walker and taking longer walks. I try walking without it and find it to be moderately scary and don't get too far away from the walker. Also, I have to be picky as to when I go walking. The pain meds allow a short window of opportunity between the times I take those meds. I have to start walking about 45 minutes after taking my Norco and I must end it about an hour before the next one. Even with those restrictions, I have about 2 hours in which to exercise. If I'm not napping.

I just had a brain flare! Maybe I will paint my walker. It's mine after all and I do have some incredible paints. Maybe Sharpies would be the way to go? Why should walkers be industrial gray in color?

Can’t be mine…

Walkers. I used to be one and now I have one. What a letdown.

It wasn't too long after surgery, maybe a day, when I noticed the walker laying up against wall across from the bed. It didn't take me long to figure out that there was a good chance that particular walker was mine. It wasn't there by accident. This was confirmed by the nurse when she told me, "We'll get you up and standing in your walker while we make the bed." My walker? Later in the day, I was given a quick lesson in its use and was told once again that it was all mine and that I would only get one like this, free, in my lifetime. If I lost it, I was out of luck!

OK, I'm home and the walker came with me. I'm even appreciative of its presence, despite the fact that it has left 'walker tracks' all around the house; thin lines in the carpet left by wheel and brake as I drag myself around. Hey, it's definitely better than crawling!

Post-Op Day 6

Life goes on. Painfully. I don't know where the pain came from last night as I was getting ready for bed, but it was shockingly intense. I had wakened from napping on the Lazy Boy, had navigated to the kitchen for two of my pills and then into the bathroom. Even now, I can't remember where the pain came from; I was moving between the toilet and the countertop when it struck. BANG! This was the kind of pain you would expect to leave scars on your psyche. It may have.

It's been 5 hours since that event and I don't think I'm recovering at all from the pain of last night. And I've been up every two hours since that time. Most of the time, it's because I need to urinate and that's a good thing. I'm hoping that the increased urination will draw fluids away from my ankles, which were looking particularly swollen; a bad sign. As of this hour, I have urinated 3 times since midnight for a grand total of 43 milliliters.

Funny, ever since my year of Medical Miseries began with surgery to repair my umbilical hernia back in October of 2008, I have become quite comfortable with all of the different medical terms for peeing and pooping and how often those things should occur. Plus, the doctors and nurse are quick to discuss just what portion of your anatomy they will be caring for. It's all so familiar that we think nothing of discussing these matters in mixed company and even with strangers; as long as a few of them have a white coat on. Yes, all modesty is abandoned once you go through those hospital doors. Modesty only gets in the way. When I needed my catheter reinstalled late one night, I never even though about the gender of the one to do the chore. OK, I did think about it, but only briefly.

Here I am, I've got a few pills in me; Norco and Tizanidine. That makes me close to comfortable but offers no cures. And the Tizanidine is the one that gives me hallucinations that are more enjoyable than not. In another fifteen minutes, I can take a Dilaudid. An even better chance for fantasy! By the way, fantasy is 100% better than pain. Most of the hallucinations have been of a parallel universe. I live in this one but dream/live in that other one and sometimes they twist and loop and become one universe for a moment or two. Strange things can occur.

But, right now, the pain is affecting my memory and that makes writing very difficult for me. And, when I read over what I've written, a lot of it makes no sense. I may have to go and sit for awhile; in the dark.

 

 

It’s over…sort of

I'm 5 days post op and 2 days post hospital. Life goes on. And let me tell you about the pain! Yesterday afternoon, I was pretty well armed with my new drugs to stop pain. Norco, Neurontin, Tizanidine, Dilaudid and etc. I was sedated as much as I could be without falling over, but the only pain relief came when I was asleep. It's the same thing this morning; once I'm upright, the pain strikes me from every angle. Yikes! Did I do too much on Saturday morning? And how much is too much?

Well, I'm off to do a walk. From the study to the kitchen and back. Can I make it? (Minutes go by…tap your foot in frustration) OK, I'm back. I found that the trip down was very comfortable. I opened the door for the cat, heated up my creamer and made my cuppa tea, took my temperature (99.4) and then found that I hadn't included the Tizanidine in my 3:30 round of pills, so I took one. Up the hallway I rolled and then sat at here at the desk, still upright.

Anywho…what I discovered while making this trek was the fact that the pain decreases in a direct relationship with my speed. The slower I do anything, the less pain I have. So now I go slow, very, very slow, and it's enough to make my head explode. I'm the guy that hates to wait for anything and now I find myself waiting for…me.

Well, I'm certainly well medicated. There is still a lot of pain in my right hip and thigh and that comes right through the drugs, ripping through! I'm also quite 'spacey' this morning; I can't depend on 'me' for anything at all. I better explore and see what I really can do and what I think I can do..

I'm back and can report that I'm feeling better. My posture also dictates my pain levels, so I have to spend some time getting settled into just the right spot. Also, I have to move my fingers slowly on the keyboard or I am very frustrated by the many misspellings. And have I told you about the hallucinations? They would be scary if I weren't medicated to the brim. Plus, I talk to myself a lot; or I talk to the mysterious people that are here in the room with me. I only see them briefly and then they move to a place behind me.

 

Finally

Life goes on. And what is today? It's the day before, of course. The day before a whole new life for me. Tomorrow at this time I will be getting ready for the trip into Chico; to Enloe Hospital and my long awaited surgery. A laminectomy, foraminotomy and spinal fusion with instrumentation, to be a little more exact. And if the surgery has the expected outcome, I will be pain free for the first time in…oh, let's say 20 months.

OK, not completely pain free; not at first. I will still have to deal with the surgical pain. Dr. Mimbs, my neurosurgeon, has told me that immediately after the surgery, I will feel as if I've been run over by a truck. His truck. He apologizes for that, but it's to be expected. And he tells me that I will be in love with the 'clicker' for my PCA. (Patient Controlled Analgesia pump) That's the pump that delivers morphine as needed. I can certainly understand that kind of love! But, he also told me that I will not feel the pain in my hip and legs that has plagued me for so long.

Recovery will take from 6 months to 1 year. Which is a whole lot better than 'no recovery', which is what I had to look forward to if I didn't have the surgery.

That's the physical effect of this surgery. There is also a mental effect to deal with. I will have to become a person who is not in pain. That pain has controlled every aspect of my life for the past 20 months and it has changed me in ways that even I do not know of; yet. I have to imagine life with hope. I have to imagine life without Vicodin.

And it all starts tomorrow at 7:30, the expected time for surgery. After waking up in the recovery room, I can expect to enjoy a week in the hospital. I doubt that I will be allowed to use my netbook computer while I'm there. I'm taking a notebook and pen so that I can continue my daily journal in written form. That's what I'm hoping that I can do. I'm not sure how well or legibly I will be able to write while using the PCA, but I will give it a try.

And after all of that, I can begin dreaming of marathons again…

The Real Deal

The surgeon's office called yesterday and gave us some times and dates so now we feel like it's official and that the surgery really will happen. It is scheduled to start on the 14^th at 7:30 AM and we have to be at the hospital at 5:30. Back in the old days…you would have been there overnight, having checked in on the previous day. We have to be at Enloe Pre Admission this Thursday at 10 AM for some additional lab work. Then we have an appointment to see the doctor, my surgeon, on the 9^th for a final consultation. His office will also be sending us additional information via the post office. It's been a long time coming!

An odd thing I noticed; as the date for surgery draws closer, I find myself picking out old racing souvenir t-shirts to wear. Yesterday I was wearing the shirt from the Rock and Roll 1/2 Marathon in Phoenix that I completed in 2007? I think I'm being positive…I will be racewalking again!

Getting Closer

Life goes on. I've had my morning fun with Boo the Cat and made sure that I didn't bend too fast or anything foolish like that. Which I did yesterday and turned it into a very bad day! Apparently the best way to start the morning is to make no sudden moves. No bending. No stooping. Move slowly; like an old man. OK, it's not fun but it does save on the early morning pain. No wonder the old guys like it! But what is disturbing to me is the fact that no matter which way I move or how slowly, I can feel the pain just waiting for me to make a mistake. It's just a dull ache right now; a sort of tension in my right hip and leg. I know, absolutely, that if I make the wrong move, the pain will descend on me like an angry bear! So I sit…carefully.

And I wait. It's just 3 weeks till the day of my surgery. A surgery I'm so looking forward to! I'm even entertaining thoughts of racing again. OK, maybe not, but I can dream. I still subscribe to a couple of running magazines just because they are so uplifting to read. Although, I have never been a runner; I've always been a racewalker, but there aren't any good racewalking magazines so I make do with the next best thing. It's all about the race anyway. Not a race with others, but a race with yourself. That's what I've always loved about the marathons and half marathons; you're all alone in that crowd. It's all about your mind and your body. That's your competition…and the running magazines capture that feeling quite well.

Progress

How very nice! I'm having one of those 'It's a Miracle' mornings and the pain ranges from non-existent to minor. I have no idea as to why this happens every few weeks, but I do know that it's an illusion. I'm certainly not calling the doctor and cancelling the surgery. A year ago I might have considered it, but I've had these rare days come and go so often that I'm pretty much immune to the dreams of a real miracle. This is just a break in the action and I'm going to enjoy it for what it is.

On a secondary subject; my recent PVP surgery – after calling the doctor yesterday, I've been cut free of my second catheter now and all is well. My wounds are healing and I'm looking forward to my next surgery in less than a month. Yes, looking forward to it! It's been 18 months, more or less, of failed therapies and broken dreams to get to this point.

I will be donating my first of two units of blood next Monday and then again on the following Monday. That would be the 29th and just a little over two weeks from my surgery date…

The Good News

The good news is…the surgery is now scheduled for the 14^th of July. I have a real date that I can put on my calendar and count down the days.

Am I nervous? Yes, a little bit, but I do have the advantage of past medical training and I do know exactly what will be happening during this particular surgery. I even have prior experience with the same surgery, a laminectomy/foraminotomy/spinal fusion. As a Navy Hospital Corpsman on an orthopedic ward, I worked for a neurosurgeon and I took care of fusion patients. But that was close to 50 years ago and the procedure is much better today than it was back then. 50 years ago, some doctors would not even attempt a fusion like this. They only had wire to work with, plus some bone fragments from the patient's own hip. Now they have titanium rods and screws and polyaryletheretherketone cages to hold the biological bone growth material in place. High tech indeed!

Also, I have been educating myself as much as I can about the procedures. The current wisdom says that a well informed patient is less fearful and will have better results from the surgery. So I read and then I read some more. I have also looked at some of the videos that are available on-line. Those are hard to take at first viewing; after all, you are looking at a very large incision in the patients back and abdomen, with exposed bone, blood and lots of stainless steel hardware being used in some 'innovative' ways. The video I was watching was of a laminectomy being done in New Zealand and it was very graphic. But, I will view them again, just to be certain I know what will be happening.

As for the results, those will be up to me. Again, current wisdom says that the patient must take an active role in their own recovery and that means walking, walking and more walking. Starting the day after surgery, you have to be on your feet and moving. Pain must be secondary and must not interfere with your progress. Pain meds will be prescribed and only the stupid would refuse them for the lame reason that they don't want to appear to be weak in some way.

OK, it's easy to write this stuff today; what will I be saying the day before the surgery and the weeks after? Time will tell.

 

Plans

My, how my life has changed over the past 5 years. The 'golden' years of my retirement. I really don't think this current 'life' is what I had in mind when I decided to retire. In fact, I'm sure it isn't. I had this idyllic vision of care-free days at home; and plenty of racing or race training. At least one marathon a year and two of them if I had time. I had a list of marathons that I was going to enter. There would be lots of exciting weekend travel for us during the racing season. I had joined the local racing club and had met some local racers. I was going to be fit forever…or until the day I died. None of my plans were about 'winning'. They were only about 'doing'. And I was going to enjoy each day with plenty of mind expanding reading and conversation. I was going to hang out at local coffee houses after my morning workouts and read the newspapers. I had visions of meeting others with the same lifestyle and interesting conversations would ensue. I was going to expand my own version of creativity with all sorts of art classes and even more exposure to art and artists. That was the plan.

OK, this post is not supposed to be about 'poor little me', it's only about change. I fully intend to do something different if I can't return to racewalking after the surgery. I will not be sitting around and moaning about my bad luck. That is
the plan!

Here I am…again

All present and accounted for. OK, now that I have started the day, in which direction should I head with my writing? Should I ignore the obvious? Nah! I will have to write about what is happening and what's happening is more of the same old, same old…pain.

That's right; this blog is all about me and what's happening in my life. You can have your own blog if you want to read about you. And since this is my blog, I'm writing all about the pain…again. I was very depressed because of it yesterday and I think it was because I was watching a 75 year old guy painting my family room. Something I can no longer do for myself. It was very much a 'pity me' moment. Not that there is anything wrong with that, there isn't, as every once in awhile you have to be vulnerable and human. Besides, pity is sometimes therapeutic. It's a place to recover your perspective on life. I'm trying.

Now, on to today and the subject at hand. The pain is back with a vengeance. I don't know what I did to cause it, but there's no escaping it. The drugs aren't even touching it this morning and so I must wait and then wait some more. I know that patience is needed more than drugs and that the injured nerves will quiet themselves eventually, until the next time I stand or sit or walk or lean or bend...

Ah! There it goes…it's slowly fading as the nerves in my lower spine become used to this new and unique position; sitting. I really don't know if the drugs do much at all for the pain itself; perhaps they are simply making me a dull boy that forgets things like pain. Well, whatever works.

But what I really want is relief forever. I want to become 'normal' again. Any kind of normal will do. And that depends on the surgery and that's still a month or more away. I don't even have a date for it as the surgery schedules are all messed up because of the lack of specialized surgical suites; the room they do the surgery in. It has to be a sterile laminar airflow surgery unit and there is only one of those in the immediate area. There used to be two available, but one is being remodeled.

Remember when America was the leader in health care around the world? Well, I could have gone to Thailand this spring and had my surgery at Bumrungrad Hospital in Bangkok and I would be home now and recovering…and the cost would have been around $8,000, not including airfare.

Bumrungrad Hospital Link

Back to Reality

Here I am. Back again. Although I was actually fearful of going to sleep last night, because I didn't want to wake up with the same pain as yesterdays, I did sleep, and this morning's pain is down to a 3 on the pain scale. That deserves a Vicodin, but only one for now.

It's slightly cooler this morning; a good thing. I've opened the windows to remove the heat in the study. It was 78 in here about ten minutes ago and now it is 68 and falling. It's amazing how much heat the electronics in this room put out. It's always about 5 degrees warmer than the rest of the house in here.

OK, time for the second cup of tea and a slow walk down the hall. Slow is my world now. A little earlier, I had my first cup of tea in my hand and Boo the Cat demanded some attention, much as she is doing right now, so I put the tea down and then knelt to play with her. It took forever for me to get down on my hands and knees and then to get back up. And I felt very fragile while I was doing it; as if I could easily slip and hurt myself. Frail. Old man.

Ack! What's going on here? My perception of myself is changing and I'm not sure that I like it. 'Perception is reality' has been my mantra for years; taught to me by a lawyer whose job was to change people's perceptions. Create a new reality for them. (That is what lawyers do…) But…my old reality was just fine; In it, I was an elder who was fit and athletic. I looked younger. I thought like a younger person. I was optimistic and, sadly, I was also vain. But now? Who am I?

Well, this new reality is still shaking itself out and it may take awhile before the new me appears. I intend to remain optimistic, though some things cannot change by my altering of reality. My physical decline cannot be wished away. I do look older and I'm no longer fit. That is real. But that does not give me permission to lay down and let infirmity happen. And what does that mean, looking 'older'? I look like me, that's all. Did I really expect to be 40 or 50 years old forever? Of course not. But, in my heart of hearts, I wanted to be…

This aging process seems of no importance when you are in your 20's and all of the way up to your early 60's. Though it was very important to me when I was a child and wanted desperately to be older. And now I am. Much older. And once again, aging is important. If I let it be.

OK, I have been skipping all around the subject of aging for the past few paragraphs; what am I trying to say? One, my new reality is that I have some severe medical problems that will require major surgery to correct. Age did not cause the problems and I might have required the same surgery when I was 20…but here I am and I'm 68. That part of reality I cannot change. Two, aging does happen to us all. If we're lucky, we will all become gray and wrinkled. Eventually, if our luck holds out, we may even become feeble! Yahoo! And three, it's all good.

Now that I have preached, I must go out and practice. Until it's time for my next reality change…

Mistake

I definitely made a mistake last Saturday. I was feeling real good about the decision to have the surgery and so I decided that I could do a little gardening; just a little and so I completed the drip irrigation system, thinking that since I was only bending over half a dozen times and not doing any lifting or pushing, I would be safe. Wrong. 30 minutes of fun in the garden has given me 5 days of severe pain…so far.

So life goes on. And here I am; early in the morning and I have my cup of tea in one hand and my first of many doses of Vicodin in the other. Both items are needed each morning when I first become vertical. Yes, the pain is still with me and it's just as severe as it was yesterday and the day before that and the day before that, etc, etc. I guess I will have to grit my teeth and wait.

Waiting is what I do. I do have a promise of surgery in a 'couple of months' but no actual date. Nothing to pin my hopes on. No date to underline on my calendar. I've been told that someone from the surgeons office will be calling, soon. And so I wait. And then I wait some more.

Back in the day, this blog was all about my racewalking 'career' and it was fun to share the various races with family and friends. Then, about 18 months ago, it became a pain blog as I tried to figure out what was happening to me. And now it's about to become a medical experience blog; for at least a year. Will it ever return to being a racewalking blog? I was talking to my son last night and he says 'kayaks' are where it's at. So, maybe in another years time, this will be my kayaking blog.

Decision made

We're back from seeing the doctor (yesterday) and I have lots of news. First; I'm going to have the back surgery, just as I anticipated. The surgery will take place in about 2 months time and it will be, in the surgeon's words…

"An L3-L5 Decompressive Laminectomy, Foraminotomy and Instrumented Fusion using PEEK Cages anteriorly in the disc spaces and pedicle screws posteriorly.

I have explained to the patient that this is a huge undertaking and would require about a 5 to 6 hour operation, hospitalization for about a week, maintenance in a brace for two to four months and restriction of vigorous activity for about 6 months."

Well…life goes on. And I'm quite happy this morning, but with an undercurrent of fear. Slight fear. That was a big decision that we made yesterday. My life will change, our lives will change. But hey, that can happen accidentally anytime, so changing it on purpose is just part of the rhythm of life. And life will go on as before. But better.

And I've done all, or most, of my homework on this. I've had plenty of time to do the research and since I still have my interest in all things medical; ever since my days as a Hospital Corpsman, (I used to work for a neurosurgeon and we had to take care of all of the spinal fusion cases on our surgical ward.) I have found this research to be both enlightening and fascinating. It's been close to 50 years since I last worked on those cases and surgery has changed a thousand times over since then; except for the basics. Anatomy and Physiology are still the same, so my A&P classes weren't wasted, and the goal of the surgeon hasn't changed. But the rest of it? Wow!

During the past year I've read all sorts of papers on the techniques used and watched many of the different videos on laminectomies and fusions. Yet Google tells me that there are even more papers to research and more videos to watch. When it comes time for the actual surgery, I will be a very well informed patient.

And now that we've made this decision, the daily pain is no longer an issue for me. I will do what I can; vacuuming, cooking, painting, etc, and when the pain arrives, as it will, I will stop, take a pill and not worry about it. Real relief is now in sight; just weeks away.

And a year from now? Will I be training for my 6^th marathon? That's still the plan. Even if I have to walk the 26.2 miles at a very slow pace, I want to do it again.

 

 

Losing

Did I mention that I've been losing weight? About eleven pounds in the last month. From April 9^th (225#) to May 2^nd (214#). And all from reducing portion size. And some caution when it comes to high calorie foods. Since I can't exercise right now, portion control is my only option to get the weight off. It's a slower way to lose weight, just a little over two pounds per week, but it works. An example was our dinner on Saturday; I cooked two skinless chicken breasts for us with a tasty baked coating of bread crumbs, parmesan cheese and mayo. We ate ½ a breast each and saved the remainder for Sunday night. I almost always ate a whole chicken breast before embarking on this.

My motivation for the weight loss is the fact that my increased weight has to be hastening the deterioration of my lumbar/sacral vertebrae and I know it will help my recovery after the planned surgery.

Looking back to when I first became aware of the Lumbar Stenosis pain; (end of December…2007) it was during that period when I first began to train and I was 20 pounds overweight from all of the holiday meals. I should have known better. Racewalking, or running, should only be attempted when you are within your target weight. Besides, exercise like that doesn't take off pounds as fast as dieting does. And you're risking your health when doing strenuous exercising while overweight.

I don't know if I could have avoided the Stenosis problem altogether if I had been in better shape when I first began to train; arthritic bone growth can't be denied, but I bet I could have gone a longer time without pain and that would have been nice!

6 more days

A week to go before I see the surgeon and possibly make plans for the laminectomy and fusion that I need. I can't get my hopes up yet. It seems like it has been forever since I walked in the park, let alone competed in a race! A distant and past life…so far.

I had a more painful day yesterday but I did without any Vicodin, despite the urge. I find that if I grit my teeth and wait for awhile, the pain subsides, unless I do something foolish, like moving. I know it doesn't make any sense to not use a painkiller when you're having pain, but I'm not happy with the effects of Vicodin and so I try to minimize its use.

The pain has become my life and if I look back in my journals, it's been my life ever since December of 2007; that is close to a year and a half. I'm at a point now where I worry when I don't have any pain and I welcome the pain back because that is 'normal'. I know it makes no sense when I write it down like that, but it's how I feel. Imagine having a headache for 18 months; sometimes a splitting headache and sometimes far less than that, but still a headache, wouldn't you be worried if it suddenly went away?

So this morning I can safely report that the pain is with me. Not very bad at all at this moment in time; maybe a 2. I still limp a little because of the pain in my left heel and that's part of the Stenosis pain in my right hip and leg. They're connected. And I know; I can sense, that all I have to do is to sit 'wrong' or bend over 'wrong' and the pain will quickly escalate to a level 5. So I don't dare to do very much and that contributes to a deterioration of my overall health.

But on the plus side, I have lost about ten pounds during the past two months and I did it without exercise. I did it with smaller portions and smarter choices.

Philosophy

Life goes on. And of course…wait for it! So does the pain. A tiresome subject for someone reading this and very tiresome for the one living it. Pain; it's making me old. I know my appearance has changed dramatically over the past 12 months. Of course I'm still the same guy under the new wrinkles, but a tired guy now. I didn't realize how tough it was to get old. It was easy to pass from childhood to the teenage years; easy and very much desired. The same with adulthood; I wanted to shed the teen image and take on the important role of adult and citizen of the world. But elderhood…that was something that I never really thought about. Until it was happening to me. The only planning I had was financial and nothing at all for the physical at this stage of life. My role models for elderhood were all fit and smiling at the age of 90. I never thought that they represented a miniscule percentage of the elders. And so I learned…and keep on learning.

Anterior Lumbar Interbody Fusion

Also from eOrthopod.com

I think I would prefer the Posterior approach...

Posterior Lumbar Fusion

From eOrthopod.com

The Pros and Cons

of Spinal Fusion Surgery

Good news here...

Spondylolisthesis and Stenosis

Causes, Symptoms, Diagnosis and Treatment:

"Spinal fusion surgery for a degenerative spondylolisthesis is generally quite successful, with upwards of 90% of patients improving their function and enjoying a substantial decrease in their pain. The hospital stay typically ranges from one to four days. It is a difficult surgery to recover from as there is a lot of dissection, and it can take up to a year to fully recover. Usually, most patients can start most of their activities after the fusion has had three months to heal. Once the bone is fused, then the more active the patient is the stronger the bone will become."

An interesting article. And I have to say that the internet is a great tool for medical research. My kind of research… no rocket science, just facts. But, at the same time, I find all sorts of advertising on the sidebars that leave me conflicted; will my surgeon use the latest and greatest of the various hardware sets available? (Instrumentation) Sometimes too much knowledge is a real pain. Did I say that?

Decision Time

OK, I have made the decision. We went to the 'second opinion' surgeon yesterday and he told us just what the first surgeon had told us, 11 months ago. A laminectomy was needed, with fusion. L3 through S5. He explained it all while we looked at the MRI views and there didn't seem to be any way out. If I want quality of life later, I need to do this now.

As he explained; it's big surgery. 5 or 6 hours in the OR and then the possibility of a week in the hospital. Then 6 months to 1 year of recovery. He also explained that it may be possible to return to racewalking. If that's what I want to do and if I heal properly; a slight chance…but no guarantees. There was also the distinct possibility that I would have to give up that dream altogether. I liked that; he wasn't telling me fairy tales.

11 months ago, the first surgeon told me to explore all conservative methods of treatment and I've done that; PT, acupuncture and epidural injections. Nothing worked and so I had the choice of living with it forever or doing something about it. I've seen too many elders that have decided to live with it rather than have the surgery. I don't want to be one of them.

So it's onward and upward…as soon as the first surgeon, the one I like, comes back from vacation and works through the backlog of appointments. I can see him on May 8^th, a month from now. And then the surgery comes later. How much later? I think I will call today and see if he will see me when someone cancels. If someone does.

Why not the second opinion surgeon? It all comes down to likeability. And I didn't like him. He has a great reputation in the community, everyone knows of him, but I want to be comfortable with the guy that holds the knife…silly, I know that.

Soon?

Where are we in relation to a cure? Who knows! I'm a little over a week away from seeing a second surgeon for a consultation. Consult, not cure. We will talk and that's all we will do that day. But maybe…just maybe he will have a good idea as to how I can get back to being a productive member of society; maybe even a competitive member. One must hope.

Let's say he tells me that surgery will do that for me and I can get it done relatively quickly, maybe late spring; that will give me summer and fall for physical therapy and then in January of 2010, I can resume training for the marathon I missed in 2008. I like that thought!

Why Me?

Do I sound depressed? I try not to, but I wonder if the Wellbutrin is working as it should or as I hoped it would. I put on a good face, a smiling face whenever I can. But the grim reality of my situation doesn't go away with a grin. This morning I was thinking that perhaps, I should just go to Bidwell Park and start training again; go for a fast 3 miler. Ignore the pain and perhaps it will simply go away. I'm tempted. But I doubt that my legs would sustain me for that distance. Yesterday I noted that I had lost a lot of muscle mass in my legs. They are becoming skinny legs. Chicken legs. It's now been a year since I trained. Training for my 6^th marathon; the Portland Marathon to be exact and the 4^th one in that lovely city. That's not happening. And now my marathon blog has become a pain and frustration blog. I suppose it's a good enough spot to vent my frustrations; as good as any.

Speaking of frustration; I have two+ weeks left before I see the surgeon for a second opinion. And then…how long before the actual surgery, if he agrees that surgery is the cure? And that is not certain. As I was telling a friend the other day, I just want to know my true situation. Can the Spinal Stenosis be 'cured' enough for me to resume my life as it was? I would even agree to give up racewalking if I could just walk and work normally again. Or, if this is the way it's going to be, for the rest of my life, tell me. Then I can get on with my life. I can adapt and learn to live with it, Right now, I'm in limbo and I don't like it.

Gabapentin

OK, I guess I have enough out there on my other blog for now. Time for another cup of tea and then some serious web browsing. I want to find out more about the Gabapentin, see how effective it might be. I've only been taking it for a week and just went to full dosage yesterday. It takes a couple of weeks, but still I wanted to know more…

And just like that, I found an article that proclaimed that Gabapentin worked in a test group.

Methods: Fifty-five patients with LSS, who had NIC as the primary complaint, were randomized into 2 groups. All patients were treated with therapeutic exercises, lumbosacral corset with steel bracing, and nonsteroidal anti-inflammatory drugs. The treatment group received gabapentin orally in addition to the standard treatment.

Results: Gabapentin treatment resulted in an increase in the walking distance better than what was obtained with standard treatment (P = 0.001). Gabapentin-treated patients also showed improvements in pain scores (P = 0.006) and recovery of sensory deficit (P = 0.04), better than could be attained with the standard treatment.

Conclusion: Based on the results of our pilot study, extensive clinical studies are warranted to investigate the role of Gabapentin in the management of symptomatic LSS.

But, just as I was feeling good about what I had found, I found out that I could go no further in my reading. Page two of this study required that I be a 'health care professional' and log in. What's up with that? I'm the affected party. I'm the one with a need to know! Jerks!

OK, so I move on and browse some more, finding another article that tells me that Gabapentin probably won't work…

Link to first article

Link to second article

Some Day

Something new for Spinal Stenosis

But...it's still going through clinical trials and the closest one is in Santa Monica...

And another article...

It looks like I may have to go to Europe if I want relief.

Less Pain? Painless?

Yes and no. A new day and I do feel better than I did yesterday at this time. The pain is minimal right now and that's a relief. I had to take Vicodin again last night despite the fact that my morning, from 7 until about 1, was relatively pain free. Not completely, but bearable. I even did some cleaning work in the garage and I started the pool cleaning chores. Later, I went back to the garage and became involved in some art work, something that I have really missed doing. I couldn't sit or stand for very long, but it was still nice to feel a touch of creativity. This morning I will be taking more Neurontin and I'm hoping that it is the reason for the lessening of the pain in the morning. This is my 5^th day with Neurontin and so I must hope. I understand why I might have more pain in the evening, but if I can have relatively pain free mornings, I'm going to be very happy! And if it continues to help, I can think about walking again. Maybe even the bicycle? I can almost see the possibility of training once more. It's a glimpse!

In the meantime, I must wait for the surgical consultation next month.

Alternate Medicine

I was just putting another log on the fire and Boo the Cat was sleeping in front of the woodstove. She looked up briefly as I opened the door and placed the log on a bed of coals. Then she returned to her nap. A few years ago she would have bolted and run to another part of the house as soon as she saw me with something in my hand. Why do I write about this? Because Boo the Cat has become quite important to me. It's a fact that cats will reduce your blood pressure. Yes, they will. Dogs can't do that. Not that dogs aren't talented in their own way, they simply don't 'do' blood pressure. And pets relieve pain. That's something that dogs and cats can do together and with equal talent.

So Boo the Cat has now become my alternate pain reliever as well. When I lay down on the couch for a nap and a moment or two of pain relief, she will soon notice me and leap up onto my chest. Now she weighs about 7 pounds, but she can land light as a feather when she wants to. Once on my chest, she slowly moves up until she is snuggled under my chin. And we sleep.

More Complaints. Bah!

Life goes on. And I am very much aware of what kind of 'chemical stew' I am putting into my body these days. Part of me says, 'Stop' and then a more rational voice says that I'm tired of being depressed and in pain; these drugs might change all of that. I have to try. But, at the same time, I have to be very much aware of what my body is telling me and be prepared for any and all side effects from these drugs.

Now, to compound the problem, I am going to make an appointment to see the urologist for my BPH symptoms. There is the distinct possibility that I will have to begin taking one more medication for that condition. How will all of these drugs interact with each other? Well, I search on-line and I read everything I can about them and the more I read, the more worried I become.

I was reminiscing last night and remembered that it was just a year ago when I went to see a doctor about my pain; self diagnosed, Piriformis Syndrome. I was certain that I had an athletic injury; after all, I was an athlete. At the time I only knew one doctor and had only seen him twice, for my annual physicals. I was taking no drugs, not even vitamins and I was quite proud of that fact. OK, I was taking caffeine, about 6 cups a day.

At that time I was in training for my 6^th marathon. Now I look at myself a year later and I have been more correctly diagnosed with Spinal Stenosis (L-4, L-5 and S-1). I know 4 or 5 different doctors by name and I have visited a pain specialist, heart specialist, urologist, general surgeon and neurosurgeon. I have been to labs and to radiologists, and I'm waiting to see another neurosurgeon for a second opinion. On the plus side, I'm only taking 2 drugs for now, Wellbutrin and Neurontin, plus the occasional Vicodin whenever the Tylenol fails to stop the pain. I've seen elders my age that are taking a dozen or more. And no, I'm not training anymore.

How did all of this happen? How did I fall into the medical trap? I guess it's simply aging. It was time. That and the fact that I had abused my body for a good twenty years as a Sheetrocker. Lifting 120 pound sheets of drywall, bundles of studs and track plus all of the other equipment that came with the job. I carried 10-15 pounds of tools around my waist and climbed stairs, ladders and scaffolds. I pushed, I shoved and I lifted all day. And when we took a lunch break, we would sometimes challenge each other to see how far we could lift a 120 pound sheet of drywall by simply gripping it with two hands along the edge and pulling it up, flat footed. Once you had it off the ground, how long could you hold it with just the strength of your gripping hands? These contests were all very manly and established some sort of pecking order among us, but what fools we were. We simply never thought of the consequences or of the fact that we would all age eventually. We were all young and strong and would be that way forever.

And I really thought that my chosen sport, racewalking, was the very best thing I could do for my body. It's a very low impact, high cardio form of exercise. Sure, it looks funny and there are very few racewalkers in America, but I found a club and began training. Soon I was competing in short races and getting better at it. I was getting into the 10+ minute per mile class and I could sustain that pace for a 5K race. But I really wanted to do marathons and more; I wanted to become a Centurion, that is someone who can walk 100 miles in 24 hours. It wasn't a dream, it was within reach, after all, I was doing a marathon with a 13+ minute mile average and to become a Centurion only required a 14.4 minute per mile average. I could do it.

I think I better put that dream away for now. I really don't know whether I will ever do another marathon or not. I want to. And I remember my first marathon when I passed a guy at the 13 mile mark and was competing with an artificial leg. That meant he was faster and ahead of me for 13 miles. So maybe I can do it after I have surgery and rehabilitation. It will take time to get myself back in shape, to regain the endurance, but if a guy with one leg can do it, I should be able to do it as well.

MEL, anyone, anyone?

One of the pitfalls of having a fitness blog (this one) that has evolved, in the course of one year, into a sob story blog (also this one) is the fact that it can quickly become depressing; both to read and to write. Hey! Maybe I will be able to do another marathon; I shouldn't rule it out. In the meantime, I'm looking for a surgeon that does Micro-Endoscopic-Laminotomies; MEL for short. That is the surgery that I think will do the most good for me. (remember when doctors used to tell you what was good for you? – You're on your own now!) Luckily, the internet has given me an abundance of resources; information that I can use to put together an informed decision.

Ouch!

I definitely had a bad night last night. The hip pain woke me up half a dozen times. I hate to start taking Vicodin again, but the acetaminophen just isn't doing the job. Big sigh! I have a feeling this isn't going to get better soon. And I have my own ideas as to why; the medical community doesn't see spinal Stenosis as much of a problem. After all, most of the victims are old. We're not going to be around that much longer. Most doctors that I see have no words of hope. They commiserate with me but they don't offer me a chance to regain what I've lost. So do I just get used to it?

"Currently, it is estimated that as many as 400,000 Americans, most over the age of 60, may already be suffering from the symptoms of lumbar spinal Stenosis"

And it's only going to become worse. "the number of persons aged 60 years or older estimated to be nearly 600 million in 1999 and is projected to grow to almost 2 billion by 2050, at which time the population of older persons will be larger than the population of children (0-14 years) for the first time in human history."

Big Sigh

It's been awhile since I posted anything here, on what used to be my racing blog. So, to keep things updated, here is where I am physically. The last of the benefits from an corticosteroid injection into the right SI joint is fading away. It's been about a month since that injection. I was told that it might be a good idea to have one more epidural injection at the L-4, L-5, S-1 site. No thanks. After 5 different injection during the past 6 months, I'm out of patience. And 'might' is not a word I care for.

I asked our GP to refer me to a physiatrist, a doctor specializing in physical medicine and rehabilitation. The GP thought it was a good idea as well. Then, after a long week, the consulting physician called and told the GP that there was nothing he could do for me. He had read my charts and that was that. Back to square one.

Major depression. OK, could the GP call a surgeon for a second opinion consultation? Yes, but since there is only one neurosurgery practice in town, he might not be able to get that second opinion. We'll see.

So, in the meantime, I read all I can on Spinal Stenosis and the prognosis for those that have it. If I have conventional surgery to relieve the pressure on the vertebrae, it's a given that the pain will still be there, but reduced. No cure and no guarantee that I can return to racing.

And then I read this, "Surgery is typically less effective for age-related or arthritic spinal stenosis. It may provide reasonable short-term relief, but long-term relief is less certain."

And I also read that physical therapy is important in the treatment of Stenosis. I had PT at the beginning of this episode in my life, but it was prescribed for what I thought was Piriformis Syndrome. So I have never had PT for Stenosis and nobody has suggested it. Why not? Apparently I need to mention that to someone.

And as I read, I was reminded once more about the possibility of MEL (Micro-Endoscopic Laminotomy) being used for surgical relief of Stenosis pain. Is there a surgeon around that can do this? This excites me.

And last, because of my being depressed about all of this, I have decided to try knitting as a method to take my mind off the pain. The knitting is not going as well as I had hoped for. (though it does change my mood) And I'm a long ways away from a scarf! I have learned to 'cast on' successfully and I know the theory of knitting. It's the actual practice of knitting that eludes me. My hands are like those you see on cartoon characters; big white gloves and three fingers. I've tried 3 different needle sizes without much luck. Maybe I should blame it on the yarn?

Link to eMedicine article

And a link to MEL article

All Good

I just finished my (almost) daily Wii Fit and Weights routine. It all adds up to about 30+ minutes of exercise each day. And it's paying off. I've been doing it for close to 80 days now so progress hasn't come quickly, but it is doing good things for me, things I can observe and measure. My stomach is becoming measurably smaller as is my waist. My feet are not swollen any more.

Yes, I'm losing weight; not a lot and certainly not as fast as used to lose it when I was training for a race. And I'm toning muscles, especially those needed for core strength.

Part of my weight loss has to be attributed to diet changes, as the Wii Fit exercises rarely cause me to break a sweat. I've eliminated some favorites from the menu and I'm trying for smaller portions. Portions are the key to losing weight; go on a 1,000 calorie a day diet of anything and you will lose weight. And this new diet has paid off because my last blood cholesterol screening put me into the 'safe' zone again. At the same time the doctor told me that my blood sugar levels had been rising as well and now they were normal once again.

OK, so I'm not racing right now and I don't know if I ever will again, but I'm making some kind of progress and that's good.

More Dreams

I've been to the pain clinic once again and this time I had an injection of corticosteroids into the SI joint space on the right side. Ouch! The plan as I now understand it, will be for me to recuperate overnight and then proceed to live normally. (normal? Hah!) In one week I will report back to the clinic and discuss what we will do for Plan B if the pain has not been relieved. Right now, I think Plan B will become a reality.

At this point, my dreams of another marathon seem like just that…dreams. But – I'm always a little bit down after a visit to the clinic. I may awake tomorrow with an entirely different outlook. And my dreams renewed.

Dreaming

On to the second cup of tea and more thoughts; such as… I've been pretty regular in my Wii Fit use. I try and get in at least 30 minutes a day and then I do a short routine of weight lifting for upper body strength.

I know the Wii Fit is doing me some good, but it also reveals how much core strength I've lost during the past 9 months and that is depressing. The Wii trainer says, 'It looks like your right side is a little unstable.' 'No kidding!' I reply, 'You think I don't know that?' as I yell at the image on the screen. OK, a little venting is good for me.

Yes, it's the second night in a row that I've had a dream about racewalking. Last night I was doing the Portland marathon again, but I woke up too soon and don't how well I did.

Update

I was dreaming about racewalking, but this morning's real world includes the usual aches and pains and that doesn't make me happy. It's been a full year now of varying degrees of pain. Some enough to make me howl, but mostly just enough to cause me to whimper. I'm tired of it.

I'm going in for my last of 3 corticosteroid injections in a week or two. I'm not hopeful. The first injection gave me a week of relief and second one gave me two weeks. The third will give me…what? Three weeks? It's not worth it. And after that? Maybe surgery. I'll keep you posted.

Spinal Stenosis, the 'creeping paralysis' is far too common. I was really hoping for a rare but easily curable condition.

Link to article…

http://www.spineuniverse.com/displayarticle.php/article1423.html

Somehow

Life moves along. Here I am, early in the morning and not feeling too bad. The left heel pain is absent again this morning and yet the right hip pain remains. It's a 'deep' pain; one that can't be eased with warmth or cooling. I'm back to using ibuprofen regularly again and avoiding the Vicodin when I can.

I did a lot of standing yesterday and that didn't help at all. The hip pain did return quickly and stayed with me for an hour or so.

Here's my take on the epidural injection. It won't work. Yes, the left heel pain is gone and the right leg pain is moderated. But it feels tenuous. Maybe it's early yet and I should wait before making an decisions? What I do know for sure is the fact that I don't want any more epidural injections without sedation. Lots of sedation. Well, I have an appointment to meet with the doctor and review all of this on the 23^rd of this month. I'm sure we'll talk about it.

I found this bit of text written on the 23^rd of February. Back when I didn't know what was wrong with me and was getting ready for the Durham Almond Blossom 5K… "I have taken a dose of ibuprofen early this morning and I will take a few more just before I leave the house. I want to make sure I can avoid the sore hip that has been plaguing me for the past few weeks." The drugs must have worked as I ended up that morning with a plaque that says I was the fastest in my class. But who knows what I did to vertebrae while I was racing? The ibuprofen and the adrenaline masked my pain that morning.

Ha! If only that was all I needed. A few ibuprofen. Close to 9 months later and I still don't have a real solution for the pain of Stenosis. But I've met a lot of the members of the medical community here in the north state! And I feel that I will be meeting even more of them.

But…back to my marathon plans. Yes, I still have them. I still find it hard to describe the incredible feeling of accomplishment that comes with the crossing of the finish line after 26.2 miles. And I want that feeling again.