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Aug. 2nd, 2011 11:54 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
tylikHad an appointment today with... another Dr. S. Call him Dr. Sa, as distinct from Dr. S aka Dr. Awesome and Dr. Sh the procedure doc who moved to another facility. And if this gets more complicated I will make a dramatis personae thingie and just link to it.
So, I like him, and I think I trust him. He had been told that I was a professor of anatomy - which I corrected, though apparently for his purposes the distinction was kind of moot. This might be the nurses keeping him up to date, and it might be about notes in my file from Dr. Twit - I need to get Dr. Awesome to check in those notes. (My advisor read me kind of the riot act about not allowing notes about being a difficult patient to be in my file. And all things considering, in this case I shall push the point.) He also saw me without sending in a resident first, which leads me to suspect notes.
Anyhow, after going over my records and examining me, and a lot of discussion, he is of the opinion that the intra articular facet joint injections probably won't help. And, sadly, I'm inclined to agree. His argument (somewhat informed by his own having problems with cervical facet joints) is that I'm hypermobile, and this doesn't seem to be much of a factor in my pain. If nerves were getting squished in the joints, they'd get more squished when I moved - especially that much - and I'd know about it.
I'll run this logic past Dr. S, but yeah, I'd wondered a little about that myself... And feel like I should have wondered more, now.
So, he wants an MRI of my shoulder, just to rule out the problem isn't starting there. (This is possible, and he concedes its unlikely. But it would be so nice - shoulder problems would be so much easier to deal with.)
But the most likely diagnosis is chemical irritation from the annular tear, and really, we start talking about surgical options. We talked a little about fixation, and why I don't want it. And a radio frequency procedure that attempts to seal the tear (which has risks, but some real advantages if it works, it sounds like). And disk replacement.
Anyhow, none of this is really happening until after my trip. Hopefully I'll be in reasonable shape on my trip.
Mostly I've been pretty cheerful and upbeat and enjoying life. I mean, pain is no fun, but I've gotten a lot better at managing it and managing its effects on my life. The last couple of days... they're not *bad*, and I'm sure some of it is hormonal*, but I'm noticing the cognitive deficits more. No, actually, I think they're just bothering more. It's been a little bit harder to just kind of go "it is what it is" and easier to slip into the embarrassment of walking around stoned all the time. (This week I tried twice to lower the gabapentin dose. Both failed really badly. The second was inspired by the fact that that day I was just going to be sitting and teaching taiji, which is a lot less strain on my spine. ...and yeah, it fell apart when I was on the computer between the two, so it wasn't a complete failure, except that I think it was falling apart before that, and that was just when the pain became crushing.)
I'm not really worried about the emotional stuff - it's only been some tiny slippage, and it's dealable. I guess what I am worried about is that the emotional slippage is because I'm not controlling the pain as well, and that I'm on a downward slide and it's going to get horrible when I'm on my trip. (Heh. Though of course, that would indicate I should stop the experiments with lowering the dose on my meds.) And this is why I write these things out - because I've had several points this last week where I felt good enough that I messed with my meds... and that always takes a bit to stabilise. Which doesn't mean things might not fall apart horribly, but that's life - there are plenty of other things that might also go wrong.
* Though really, getting my period over now before I fly? I'm all for that.
So, I like him, and I think I trust him. He had been told that I was a professor of anatomy - which I corrected, though apparently for his purposes the distinction was kind of moot. This might be the nurses keeping him up to date, and it might be about notes in my file from Dr. Twit - I need to get Dr. Awesome to check in those notes. (My advisor read me kind of the riot act about not allowing notes about being a difficult patient to be in my file. And all things considering, in this case I shall push the point.) He also saw me without sending in a resident first, which leads me to suspect notes.
Anyhow, after going over my records and examining me, and a lot of discussion, he is of the opinion that the intra articular facet joint injections probably won't help. And, sadly, I'm inclined to agree. His argument (somewhat informed by his own having problems with cervical facet joints) is that I'm hypermobile, and this doesn't seem to be much of a factor in my pain. If nerves were getting squished in the joints, they'd get more squished when I moved - especially that much - and I'd know about it.
I'll run this logic past Dr. S, but yeah, I'd wondered a little about that myself... And feel like I should have wondered more, now.
So, he wants an MRI of my shoulder, just to rule out the problem isn't starting there. (This is possible, and he concedes its unlikely. But it would be so nice - shoulder problems would be so much easier to deal with.)
But the most likely diagnosis is chemical irritation from the annular tear, and really, we start talking about surgical options. We talked a little about fixation, and why I don't want it. And a radio frequency procedure that attempts to seal the tear (which has risks, but some real advantages if it works, it sounds like). And disk replacement.
Anyhow, none of this is really happening until after my trip. Hopefully I'll be in reasonable shape on my trip.
Mostly I've been pretty cheerful and upbeat and enjoying life. I mean, pain is no fun, but I've gotten a lot better at managing it and managing its effects on my life. The last couple of days... they're not *bad*, and I'm sure some of it is hormonal*, but I'm noticing the cognitive deficits more. No, actually, I think they're just bothering more. It's been a little bit harder to just kind of go "it is what it is" and easier to slip into the embarrassment of walking around stoned all the time. (This week I tried twice to lower the gabapentin dose. Both failed really badly. The second was inspired by the fact that that day I was just going to be sitting and teaching taiji, which is a lot less strain on my spine. ...and yeah, it fell apart when I was on the computer between the two, so it wasn't a complete failure, except that I think it was falling apart before that, and that was just when the pain became crushing.)
I'm not really worried about the emotional stuff - it's only been some tiny slippage, and it's dealable. I guess what I am worried about is that the emotional slippage is because I'm not controlling the pain as well, and that I'm on a downward slide and it's going to get horrible when I'm on my trip. (Heh. Though of course, that would indicate I should stop the experiments with lowering the dose on my meds.) And this is why I write these things out - because I've had several points this last week where I felt good enough that I messed with my meds... and that always takes a bit to stabilise. Which doesn't mean things might not fall apart horribly, but that's life - there are plenty of other things that might also go wrong.
* Though really, getting my period over now before I fly? I'm all for that.
