Botox in the forehead is pretty painless, a
quick pinch. Botox in the back of the head and neck is another story. I’m face down on a table, my chest resting on a line of small pillows
to keep my neck straight. My doctor does a lot of poking and pressing into the
trouble areas to locate pain and determine where he wants to shoot the drug. He
marks these with a pen. With an ancient electrical impulse machine. he jolts the
muscles he intends to inject. This doesn’t hurt, exactly, but the Botox needle
immediately following is pretty bad. It’s not a quick stick but rather a lot of
rough jabbing in each marked spot. It feels like the syringe is very full and
it takes a while to empty Botox on the upper part of my right shoulder, back
of my neck, and, most excruciating, the occipital nerve area of the back of my
head (you can feel a tender spot on each side of your own occiput the size of a
dime). I whimper when he shoots this last area.
This is my third Botox treatment. Each time I’ve been sore
for a few days, but this time, the occipital area gets inflamed afterward, and instead of
the normal low-level grinding pain of my headaches, I feel like I have a knife
sticking out of the back of my head, a steady, sharp pain. I’m terrified that
my doctor has done some permanent damage, but I call and am told to ice it for a day, which does the trick. After
the soreness fades, I am left with . . . my headaches.
So ten days later, I come to the office again for the
cortisone, but this time to the “surgery center” instead of the regular office, where I
put on robe, booties, cap and have an IV put in my arm for fluids and later,
anesthesia. Because, hell yes, I get put under for this one.
The first time we discussed steroid shots, my doctor asked
if I wanted to be awake or asleep. Ever the good patient, of course I said I'd stay awake. Dumbass. I was on my back and the nurse put a piece of paper over my
face. My husband jokes that it was to hide my expression from the doctor and
his attendants. Maybe it’s to hide my eyes from the apparatus. Many of you may
have had cortisone shots in ankles, knees, lower back. I’m sure it hurts, but
there’s something spectacularly awful about shots into the joints of the neck.
And it felt like more than shots, like things went in and stayed in, moved
around. The initial shots of Novocain kept it from being painful, but it was
uniquely uncomfortable. And long.
Out of curiosity, I found a video of the process. I had to
stop watching after a minute. Maybe you can watch the whole thing:
Later I asked my doctor after the first what he would do if he were the patient, and
he laughed and said he’d be out. So for every cortisone injection thereafter (I’ve had four
total), I’ve opted for the sweet, short nap of twilight anesthesia.
This most recent time, I feel silly.
It’s not real surgery. It’s a lot of fuss with the anesthesiologist, the oxygen.
This time I actually start laughing when they wheel me in to the OR. Five
medical personnel, machines everywhere, live x-ray—all for a few shots. But it
would be the same scene even without the anesthesia. While no one’s cutting me
open, these shots are invasive.
I come to in the recovery area, and a nurse brings soda and a
bag of pretzels to break my fast from the night before, and my husband comes back from the waiting room. Soon my doctor checks on me. He tells me the Novocain should keep the headache away temporarily
while the cortisone gets ready to either work or not work. If the Novocain
works, it tells us that the nerve ablation will work in the event that the
cortisone doesn’t.
I’ve found that psychologically, I like to know two
procedures ahead. It keeps me feeling optimistic. So I ask if the cortisone doesn’t
work and then the nerve ablation doesn’t work, what’s left?
“Decapitation,” my doctor deadpans.
My husband laughs. I laugh. But it’s not funny. I’m so used
to failure that I am losing confidence. If the nerve ablation doesn’t work, my
doctor is out of tricks.
I am headache free for the next 48 hours. In this time, I
have a seven hour wait at the airport, miss a connecting flight and spend the
night in Chicago, and arrive in New Orleans 23 hours after I left Philadelphia.
That I am cheerful and relaxed is testament to how lovely it is to be
pain-free, if just for a few days.
But soon, the headaches are back. They are pain scale 5-6, 2
mg Zanaflex pain, sometimes even 4 mg pain. They are worse than ever.
Because the Novocain did work temporarily, I am a very good
candidate for the nerve ablation. But insurance companies won’t cover it
without two nerve blocks. The cortisone Novocain counted as the first, and in
two weeks I go in again and get the second, just Novocain, no steroids. If it
works, then a few weeks after, nerves will be smoked.
Again, a video for your curiosity. I can’t watch. From what I’ve
read, I’ll have to be awake for this one, although I think they administer
Valium. Oh, they have to.
Cervical radiofrequency ablation
Cervical radiofrequency ablation
I find it both amazing and terrifying that modern medicine
can do this. My doctor first suggested nerve ablation about a year ago, and
the idea scared the crap out of me. The first Botox treatment was an
alternative to that, and when it worked, we hoped I could just get Botox every
three months and stay pain free. Alas, that wasn’t my path. Now I am ready. I
really hope the nerve ablation works. We might have to do it again nine months
to a year later, but my doctor says he has many patients who just go on without
pain thereafter.
Zanaflex
Zanaflex, a muscle relaxer, is the only pill that has ever relieved
my headaches completely. We have a love/hate. I love it, because I don’t know
where I’d be without it. I get a headache at some point every day, but as soon
as I feel it getting strong, I take a pill, and in an hour, I am headache free. I’m
not sure why it takes so long but it does. Even while I wait for it to work and
am feeling pain, I know it’s finite. The pill will work and the pain will go
away. Finite pain is tolerable, no matter how hideous. I don't know what I would do without it-- medical leave of absence from work, deep depression.
I hate Zanaflex because it dulls me. I
am not high, I need to be clear about that. I don’t drink or otherwise partake,
and I don’t take meds like opiates that might be compelling. Zanaflex isn’t
compelling. It’s sedating, dulling in degrees, but it doesn’t feel good, other than headache free. Still, it alters me, and at first, that freaked
me out. I haven’t been drunk in 22 years. The first time I felt Zanaflex in my body, only half a dose, felt my mouth get dry and my thoughts slow down, I felt bizarre.
Then there’s the teaching/not teaching on Zanaflex.
I don’t feel so sedated when I take Zanaflex outside the
classroom. I can take it and go out to dinner, have a conversation, and I just
feel tired and a little stupid. But when I'm teaching, it's a whole other drug, which I think is a testament to how full-cylinder my
brain is when I’m in front of a class. I only take it when I am in so much pain
that I’d just be miserable and snarly with my students, and I only take half a
dose. Tony says pain can be as disabling as medication, and I agree. When I have
a headache, I’d be okay if all I did was lecture. But when students ask
questions or I want to ask them questions and have a discussion, pain just
grinds me down into someone who is short, impatient, and tortured.
At least the Zanaflex keeps me from being a bitch, but I am
still not able to teach the way I want to. I’ve realized that good teaching
means accessing the whole brain, all the files, every example, anecdote,
alternative explanation. It’s the only time in my life I am 100% focused, 100%
on. If I’m sedated, even a tiny bit, I can’t be that way. It’s awful. I feel
this barrier between me and my students, between me and the knowledge I have
about whatever I’m teaching. I feel like I am moving underwater.
I wouldn’t truly grasp the intensity of my job if this hadn’t happened,
if I hadn’t experienced teaching when I’m less fit. It’s pretty amazing. It’s
one thing not to be able to make a quick joke in book club because I’ve taken a
Zanaflex, but it’s another to watch the clock in the classroom, hoping no one
asks another question because I won’t be able to answer to my satisfaction.
Zanaflex is temporary medication I’ve taken nearly every day
for over a year. Last summer when I enjoyed Botox success, I loved looking at
my untaken Zanaflex and hoped I’d never take it again. But I’m grateful that it’s
there for me, and other than the dullness and some wicked dry mouth, it’s kind
of miraculous. I can get three to five hours without a headache.
Alexander Technique
While I’m waiting for the nerve ablation, I’m trying one
more “alternative” treatment. All I really know about Alexander Technique after
one lesson is that it’s about restoring a natural relationship between the head,
neck and back, and that it’s expensive. While my headaches are structural, I know
there’s something about posture, the way I hold tension in my neck that
contributes. And there’s the no-stone-unturned superstition. So I’m going to take
lessons once a week and see.
I have to say, though, that when I told my teacher about the
treatments I’ve had and the upcoming nerve ablation, she winced in that familiar alternative healer way. I don’t like
how alternative medicine often scoffs at western medicine. So far I’ve had zero success
with alternative modalities. My only pain relief has been with injections and
medication. I get defensive, like the scoffer thinks the pain is a minor
annoyance. I wish accupuncture/massage/chiro/PT/yoga/myofascial release/cranial sacral therapy
and whatever else I’ve done worked. I don’t enjoy needles in my neck. I don’t enjoy
taking a pill three times a day. But there it is.
I don’t think Alexander Technique will fix me, but I do
think I can learn some things about how I hold tension in my body that might
enhance whatever I am doing medically.
