Pain-free is so lovely.

The latest rhyzotomies are  a failure (it’s been seven weeks--can you freaking believe they didn't work??!!). The post-burn stabbing pain nerve freak out is still happening, although in the last ten days, I think I’ve found a way to control it.

A few weeks ago, my doctor suggested I try a med called Neurontin. It’s an anti-seizure that’s also used for nerve pain. I actually had a huge bottle of it that my last doctor prescribed, but I’d never tried it because of anecdotal reports of major weight gain.

But since the rhyzotmies, I’ve been in pretty significant pain. Prednisone didn’t help, and neither did cortisone shots in my head and neck. Zanaflex wasn’t doing much, and Percocet might as well have been Sweetarts. I was so frustrated and also freaking out as I moved into the end of the semester and finals and a massive grading load.

So I finally tried Neurontin. It worked right way. I still have to take the preventative regiment of Zanaflex and Mobic (an arthritis med I’ve taken since this all started). About once a day, a big nerve pain spike breaks through and I take a Vicodin to get it down. I’m hoping as the rhyzotomied nerves settle, I won’t have to take that anymore.

The last ten days have been amazing. I’ve been more social than I’ve been in a year. I have been in a great mood. I have felt more optimistic about pretty much everything in my life, which is a testament to how shitty pain really is.

I talked to my doctor a few days ago, and he’s happy with this med combo. He still thinks the rhyzotomies might work (hilarious). He wants me to call again in a few weeks and check in. If I’m still in pain, he’ll start test-blocking more levels, and try more rhyzotomies.

Except I think I’m done with that. I just can’t handle it. I’ve done a lot of thinking and reckoning in the last few weeks, and I finally get that this is just the way things are. I’m always going to have these headaches. There is no magic fix. I have to learn to live with chronic pain. Doctors like the ones I've had are fix-it guys, not pain management guys. So I might have to find someone new.

It's actually been a relief to come to terms with this. My life is no longer on hold. I get to lift up the pause and go back to how things used to be and figure out what still works. The last week of social activity was part of that—I just can’t isolate anymore. I have to see people. I have to go to parties. I have to maintain the very awesome friendships I’ve been lucky enough to develop over the years, because they just don’t stay alive by magic.

So I think this means meds for life. This is the hardest thing to handle. Right now I take a f%^*-ton of pills—a Mobic in the morning, five Neurontin three times a day, one Zanafex every four hours, and the aforementioned narcotic when the pain jacks up in spite of this.  I have a pillbox in my purse. I sometimes have to take a pill in the middle of class (Zanaflex is a demanding mistress—if I am 15 minutes late, the pain comes on, and it’s impossible to get rid of. So I’ve taken to setting a freaking alarm on my phone so I stay on top of it).

I never thought this would be my life, but when I think about what so many other people go through, including headache sufferers who can’t even find meds that work, I’m pretty lucky. So far the meds don’t have side effects, just some cotton mouth with the Zanaflex, but that’s it. Zanaflex is interesting, because when I first started it three years ago, it just knocked me out. An hour after I took it, I’d have to take a nap. But now I rarely feel any sedation at all, and I take many times that original dose. I’ve researched these meds a lot, and that’s how Zanaflex works.

Sucky McSuck

This pain is bad. Not all the time, but at least some part of the day. It's been nearly six weeks since the rhyzotomy, and I'm in lousy shape. I'm back to my round-the-clock Zanaflex and since I've run out of Percocet, I take Vicodin several times a day. This really sucks.

I had a decent Thanksgiving weekend, although the headache was always just around the corner, and six loud and rambunctious nieces and nephews meant I was cranky Aunt Juju, not a role I enjoy playing. I was pretty good at school this morning until around noon, and then the pain just settled in and got to excruciating points several times.

I don't think the rhyzotomy is going to work. When I don't have the stabbing pain, I have my regular old headaches. I can't fucking believe this. TWICE this year I had this stupid procedure, when meant a total of twelve weeks of intense nerve inflammation, and just regular shitty headaches the rest of the time. I am so over it. I don't deserve this. I do everything I'm supposed to do in life. I know that no one with health problems deserves them, but this just feels like punishment. I am so angry.

My new doctor said that if this doesn't work, he'll test-block more medial branch nerves and keep going. I just can't see it. Each nerve block is another day I have to get covered from school, and then if any of them work, another rhyzotomy means another six weeks of hell. But what else am I supposed to do? Three solid years of trying everything under the sun has been for naught. I really feel horrible, about all of this.

I have this med called Neurontin. My spine doc prescribed it to me, and my new doc suggested it. I've hesitated because it can cause major, rapid weight gain. Officially, this only happens in 3% of those who take it. But anecdotally, in my Facebook headache group, many people say they gained a lot of weight, like 60 pounds.

I want my life back. In some ways, it feels like it's over.

I just want someone to FIX ME. I want it to be a physical therapist, where I do a ton of hard exercises and whatever bulging discs, pinched nerves, bone spurs, whatever get pushed all back in their right places and this pain goes away. But I've been to at least five physical therapists, plus a bunch of other body work people, and nothing's helped.

Sorry I'm such a bummer. Sorry I don't have success to report.

Grim

It’s been almost a month since the rhyzotomy and I’m still in severe pain from the procedure itself. In attempts to quell the nerve inflammation, I’ve taken a course of prednisone, and a week later, my doctor shot cortisone into the nerve at the back of my head. Neither helped at all. Percocet doesn’t work anymore, and Zanaflex doesn’t either. Right now, it’s just me and the pain. It’s not the headache. In fact, it makes me miss the headache. This pain is vile. It’s sharp and stabbing, and it’s located exactly where this needle hits in this picture. Then it radiates over my head to behind my eye.

The past weekend was grim. My husband worked and I was alone, trying to grade papers, icing my head, and taking pain medication that did nothing. I got very, very depressed. I felt incredibly lonely, but didn’t want to talk to anyone. Pain absolutely warps my thinking. I got a little crazy and very twisted, feeling like I caused this. I felt guilty, dirty. I thought about how people must think I’m making this up. I wished someone would call me and ask me how I’m doing, but then I didn’t want to talk to anyone. I felt like I made this up. I felt like my subconscious mind wants an out, for everything, and this pain does the trick. I felt like there is no turning back from this. I miss my life. Pain has taken over everything. I am really, really angry.

I had pretty serious depression through my teens and twenties. It was a burden I was never unaware of. It kept me apart from other people. It made me want to sleep a lot. It made me do a lot of drugs, some of which actually worked for a time. It ruled my decisions and my choices in friends, boyfriends, jobs. I became a thrill-seeker of sorts because that would bring me out of the depression, temporarily. Being depressed sucked. Everything was flat and monotone, and it got to where I couldn’t take pleasure from anything. So when I finally went on medication when I was 27, it was amazing. The loss of the burden was palpable. I felt buoyant. I felt free.

I’ve been on antidepressants for 23 years now. I do many other things to stay undepressed. I see an amazing therapist. I worked hard to find a career that would be meaningful to me. I make sure I have a decent social life and time in the woods so that my life feels balanced. Periodically I think I might not need medication anymore, so I go off it for a year or so, and then the symptoms creep back, now in the form of anxiety as I get older, and back on I go. I am very successful at staying out of depression. I am proud of that.

Except this is exactly like depression. Same ball and chain. Same isolation. Same hopelessness. Same loss of pleasure. I really resent it.

I’m in two Facebook groups for people with headaches. I’m also in an aspiring novelists’ group. Both are similar in that everyone has a specific goal and is doing whatever he or she can to achieve it. The thing is, most members of both groups are not succeeding, not the vast majority. The headache sufferers are in pain, and the novelists are unpublished. It can seem pathetic sometimes, these hundreds of people looking for the right medication or the right agent, the right physical therapy or the right small press, and never getting it.

And there’s me with my three unpublished novels and my three years of headaches. I’m just like everybody else. I keep pushing, getting treatments and sending query letters, and I keep not succeeding.

At some point I may have to accept that I’ll never publish a novel. Not publishing is the norm; publishing is rare. So is curing a headache, especially one like mine.

Today was a shitty day. For three years I’ve found a way to still be decent in the classroom (mostly by using small amounts of Zanaflex). This new pain has pushed me over a line where teaching is misery. I stand in front of the room and I feel like I have a knife sticking out of the back of my head. Today my very engaging morning class helped push it to the side a bit, but my afternoon classes are impossible because by then the pain has really kicked in for the day. I have hundreds of papers to grade before the end of the semester, and three more weeks of class. I can't even think clearly. I adore my students, and I they know a bit about what’s going on (especially since I had to get subs when I was getting the tests and the rhyzotomy). They are so sweet, but it's just awful. We're working on their toughest essays of the semester, and I need to be on my game, but I'm absolutely clawing my way through.

Then I went to a meeting after class. I’ve cut way back on meetings lately, but this was important. I sat in the back near the door. My eyes watered because the pain was searing. I stayed for the whole thing and talked a bit afterward. On the way home, I thought about what it would mean to live with this.

I have absolutely thought of suicide since this started. I won’t do it because of the people and animals that I love, but it’s there as an idea, an escape hatch. I am so angry that this is happening. I was so angry when I was depressed. I didn’t ask for this. I didn’t do anything wrong. I got Lyme disease and then I hit my head. Big fucking deal. Suddenly this giant thing was dropped in my lap and its eating all the good parts of my life.

I’m not the same teacher, not the same member of the college community, not the same friend, sibling daughter, wife. I am a drag. I have a hard time enjoying things. I just want to stay home. But if I’m not going to kill myself, I have to figure out what I am going to do.

I read this piece in the NY Times the other day, about a woman who survived a near-fatal illness and afterward failed to make the proper transformation that she thought the people in her life expected. I feel the same sense of failure toward every person who asks how I am doing, whether things are getting better. I want to have the right answer. I want to make you smile and say you are glad. That I can’t makes me feel like a failure. It makes me think you think I’m not trying hard enough. Jesus Christ, I let a doctor burn fucking nerves in my spine!!! I am definitely trying hard enough. It’s just not working.

Best, best, best case scenario, this rhyzotomy turns out to be a success and I have a year without headaches. Hurray! Then the nerves grow back and I have to do it all over again. I have to go through this bull-fucking-SHIT recovery inflamed nerve spasm crazy person can’t function pain again. What? I don’t know that I can do that. So every year I have to give a month, or even two, over to recovery pain. Over and over, year after year. What, maybe I make it my summer break project so I don’t have to suffer while I’m teaching? Awesome! Yes, who needs camping and the beach and my garden when I can lie on the couch with an ice pack and take medication that makes me seasick?!

Maybe I just have to live with the headaches. Maybe I have to accept that I am a Chronic Pain Person. Maybe I have to find a therapist who specializes in pain and can teach me how to wrap my head around it. My last physical therapist actually recommended one, but at the time I had no intention of being a chronic pain patient, so I passed. Maybe I have to figure out if isolation is really helping me, since time with my students and the breakfasts and lunches I sometimes have with friends do pull me out of it a bit. This weekend alone was a big mistake, all that time stuck in my head.

For three years I’ve been waiting for my headaches to be over so I can go back to things like my bike, the gym, having people for dinner, going to shows, galleries, etc. Maybe I just have to do those things even though I’m in pain.

Maybe I have to stop talking about it, especially with my colleagues at school. At first I wanted people to know, because I was participating so much less and was in a crappy mood a lot. But now I think it’s counterproductive. When people ask me how I’m doing and I tell them I’m not so great, I feel not only like a buzzkill but like I'm letting them down. Everyone wants a victory. Maybe I should “act as if” I’m feeling okay. Maybe talking about it just makes it worse. At this point, everybody knows about it, so maybe I leave it at that.

New meds, new perspective

So this weekmy nerves are super pissed and the pain is much worse, stabbing and intense. I can toss back pain pills like they are nothing, and they hardly work. So I called my doctor. "The pain's like a bad sunburn, right?" he asked. "The pain is like a knife stuck in the back of my head," I replied. Ah. he got it. So he prescribed Prednisone, which he says will reduce the nerve inflammation and help with the pain. I'm on day two of the taper, so I am hyper, sweaty, and in a particularly good mood. And the pain is pretty mild. I'm going to Buddakan for dinner tonight, and I'm going to chow!

The strangest thing has happened at school. In spite of all this bullshit, I'm having maybe the best semester of my career, and I feel more connected to my students than I ever have. First, I'm teaching English Composition and Research Writing, two classes where I've got a solid system and great material. So there's no stress there. Second, something's happened in the last year, and I'm not sure if it's because of chronic pain, or turning fifty, or what, but I'm finally able to relax and enjoy my students as people. I've always known how awesome they are and what incredible strife so many of them go through just to be in college. But I just really LIKE them. I like getting to know them, I like hearing what they think about the material and about the world, and I love having them come to office hours for advice that turns into a good chat.

It's as though I didn't know I was allowed to enjoy them so much, like I had to keep a wall up and be "professional." My first ten years, I wore suits and kept my hair in a bun at the base of my neck. I was terrified they'd find out I was a fraud.

Well, I'm not, and I suppose ultimately this is about teaching confidence. I'm 22 years in, and I got it. Overall, this means my job is way more fun, and while I'm super strict about attendance and deadlines, I no longer have any adversarial attitude, like I have to control it all. Ironically, my classroom is more orderly and productive than it's ever been.

My favorite thing is students who take me again for the next level of writing course. They are always people I really like, and I help them with academic advising and mentor them a bit more. I haven an especially great group of frequent fliers this semester, and I'm thinking of having them to my house for a holiday party once the semester ends. I've taken students on field trips and once took a class to an Ethiopian restaurant after we read What is the What, but I've never had students to my house. More than anything, I want them to meet each other and become friends. Most of them are really strong students, and I think they can form ties that might last beyond our school and even into the professional world. They are veterans, and single mothers, and older people coming back, and felons, and immigrants. They are superstars. When I think about the typical college student, 18, supported by parents, living in the dorm with a high school education that actually prepared them for college, my students simply blow them out of the water in how much harder they have to work and what they have to juggle. They are amazing.

Anyway, even though this nerve pain is bad, things are looking up, and I'm glad I'm able to look at my whole life and see all the good stuff.  Oh, and this week I heard from two agents who want to read my whole (first) novel! So it's good!

Spazzing out!

I'm right where I'm supposed to be eleven days after the nerve ablation. I'm in a LOT of pain a little bit of the time. But I have meds that work, so I'm okay.

My regular headache is dull and grinding . This dying nerve pain is sharp and searing. It comes on very suddenly and intensifies. Fortunately, 5 mg of Percocet usually knocks it out in a half an hour. But it's gotten worse in the last few days, and several times the pain didn't go away after an hour and I had to take another pill. This afternoon, I had to take another still.

But, as I think I wrote back in April, Percocet is so preferable to Zanaflex, the muscle relaxer I've used every day for the past two years. I have been taking very little of that since the rhyzotomy, so I am less tired, less dulled, more buoyant. Even though the nerve pain is much worse than the headaches, I'm overall feeling better.

I wrote about my weird reaction to narcotics. They make me a bit hyper and chatty. I can only take the smallest amount at one time because I get super seasick and anxious if I take more. I asked my pharmacist whether there were other sorts with better side effects, and he suggested Tramadol. Well, I tried it. . .

Sat down with my husband to watch our guilty pleasure, Sons of Anarchy. I was old cold in half an hour. Later,  I woke in the middle of the night to a young man with a huge mass of curly red hair standing beside my bed, about to kill me. I screamed like a lunatic, woke Tony, woke myself (although it felt like I was awake the whole time). I've NEVER had this kind of experience. And I never want to have it again. So no more Tramadol!

So far, I'm tolerating the Percocet, even when I have to take another pill. I think spacing them out is good. My doctor also prescribed Nucynta, a newer pain med. He thinks I can double up on it if the pain gets really bad and not have the weird seasickness. And like I said, I'm just happy to be using less Zanaflex. It's really been a lifesaver in the last few years, but it's yucky. I've had moments in the last week where I've felt more like myself than I have in a long time, and more engaged with the world, and I think it's the absence of that drug.

So this might work after all. A friend asked me how that felt, the idea that I might soon be headache free. I said that I didn't quite believe it. I said I wondered if some of the ways I've changed from the headaches might be permanent. I like to keep to myself. I like quiet. I prefer to be at home. Maybe that's just who I am now, and that's fine. I get more writing done that way.

I had this one beautiful weekend earlier this year where I'd had some kind of block into my neck joints, and I was pain free and med free for about 48 hours. It was fantastic. I went to New Orleans for a friend's birthday, and I had the best time. I didn't even mind flying. I loved being around friends, and I loved being packed in crowds. I loved hearing live music. It was amazing.

That kind of elation is a tall order, but maybe that's where I am headed. It's hard to remember a time when I didn't have headaches every day, but I know I was happy. In fact, I traveled and camped cross country for five weeks right before everything started, and I remember thinking I was the happiest I'd ever been in my life--I had my husband, my dog, our tent, the open road, the gorgeous national parks, and a new novel rattling around in my head.

Since then, I wrote that novel and overhauled another. I published a handful of short stories. So this "sick time" or pain phase or whatever it's been hasn't been a total wash.

Still, I'm not into a life of pain. I know the rhyzotomy is temporary and in a year or so the nerve will regenerate and I'll have to have it again (unless the physical therapy I plan to do once I'm out of pain actually fixes the problem).

But I've changed. I've had to. I can empathize with others. The thing is, once I became open about my headaches, a ton of people opened up to me about their pain, students, colleagues, friends. I never had a clue about living with pain and was, in fact, sometimes dubious, like pain was something people "invented" because they didn't want to deal with their lives. Now I am in awe of these people and the load they carry (some much heavier than mine).

I have what I think of as a "fun" marriage. We don't have kids together, have secure incomes, a very sane mortgage. We both write and read and edit each other's work. We love to cook, and we can talk forever. We adore our animals. Much of our life is like one long good date. So this has been a bit of a test--my shitty moods when the pain is bad, my retreats into sleep, the long, long days when I have procedures and he is my ride and has to stay in the waiting room for hours. He's been amazing. He has never let me down or complained at all. I am not elegant about any of this. I'm a whiner. He is the best.

Hopefully, the next time I check in here, it'll be with good news. If not, it'll be with a new plan.

Rhyzo repeat

I still have headaches every day. My medication (Zanaflex) still helps, though lately the sedation has returned, which makes teaching a daily choice between pain and stupidity. I don't understand this at all--how can a medication you'e taken for years suddenly affect you differently? Some days it hits me like a truck. I've tried halving it, but it doesn't touch the headache. Whatever. It still works. Except for the four or five days a month when my 4 mg every four hours regimen just doesn't work, and a headache gets away from me and kind of goes crazy.  I don't understand that phenomenon either.

I'm having two nerves burned on Wednesday. = If you recall, I had this procedure done back on April--four medial branch nerves between four vertebrae allegedly shut off with radiofrequency ablation. Kind of a bear of a procedure, and a really sucky recovery, but then it just didn't work.

So new doc, new series of tests, and here we go again. I'm very nervous--that it won't work again, mostly, and that the recovery will be just as bad, and here I am in the middle of the semester.

I'm pretty annoyed that Percocet and Vicodin make me feel horrible, because they are what's on the table after a rhyzotomy, for the week or two of nerve spasm that follows until the nerves die out. I can handle 5 mg of Percocet (which helps sometimes on those days the headache is crazy, but then sometimes it does nothing). But that's not enough post-rhyzotomy. When I took 10 mg last time, my heart raced, I was dizzy and very nauseous and super anxious. I hated it. I didn't even notice whether it helped the pain because I felt so yucky.

Anyway, my pharmacist says he has the same reaction. He suggested I ask for Tramadol instead, so that's the plan. If you have any other suggestion, let me know.

It's been a decent fall, regardless. I'm very busy with school, am steadily working on a novel, get out to the woods a fair amount, have spent time with my family in Lancaster and been able to socialize a bit. It's maybe 2/3 what life was before the headaches. But there are also days that are a complete wipe out, where teaching is SO HARD because of pain, and I drag myself to my car afterward and sleep the rest of the afternoon. At least I can sleep. But we've had some gorgeous days recently, and sleeping through them just feels awful.

Anyway, I like my new doctor. He's very confident. All week I've thought of changing the appointment until after the semester ends, but Tony's convinced me I need to just do it. I'll write again on the other side. I'm really hoping it's not too bad.

looking forward

Some good news, finally.

I’m seeing a new doctor who has decided the best course of action is to redo several of the rhyzotomies (nerve ablations) that I had done in April, the idea being that those didn’t work (and they seem to have made my headache worse).

But before he can do these, he has to test block each joint to see which has the nerves causing my headaches. He puts lidocaine into the joint and I keep a headache log for six hours. And he has to block them twice to be certain (and for insurance purposes).

In August, he blocked C1-C2 (the top joint in the neck). It didn’t work. So last week he blocked C2-C3 and C3-C4, and it worked, no headache for an hour and then a very slight one for the next five. So next week he’ll do the test block again, and if it works again, we’ll schedule the rhyzotomies.

The blocks are a pain in the ass. I have to take the whole day from work (getting classes covered by really sweet colleagues), and Tony has to drive me and stay the whole time. I have to fast starting the night before. I can’t take Zanaflex,or drink water all day, so I have a killer headache when I go in. My new doctor is much-sought-after, so the waiting time is insane. This last time, I stayed at the surgery center for four hours. The shots themselves took about two minutes. The rest of the time I sat in gown and booties in a small room with the lights off (for my headache) with an IV of fluid, waiting. Bad headache. Teary. Unable to read. Then I finally went into the operating room where I got a tiny bit of IV pain meds to take the edge off (the reason for the fasting, and not at all worth it), and bam, the shots. Then I sat in recovery for half an hour and drank water and talked to the doctor. Not a day I’m eager to repeat. But I’ll do it again next week.

I miss the ease of procedures with my last doctor. This guy is highly recommended as someone who specialized in upper cervical procedures and headaches like mine, but his practice is so much more complicated. I would have been out in an hour and a half before.

At any rate, I’m moving forward. This looks promising.

The thing is, the rhyzotomy is not a fix. It’s a long-term pain management procedure, and will give me up to a year without headaches, if it works this time. That’s after the procedure itself, and the painful recovery, and the month or two it will take for the nerves to really die. And then they regenerate in nine, twelve months, and the headaches come back. And we do it all over again.

I want a real fix. So while I’ve taken meds every day and pursued various spine procedures for the last two years, I’ve also always done some kind of physical therapy. This summer it was Neurokinetic Therapy, in August it was regular PT, and right now I’m doing the MacKenzie Method with a practitioner that a colleague eagerly recommended to me. And before that, I’ve worked with three other physical therapists, three chiropractors, and a myofascial release therapist.

While none of this has worked so far, I still want something a mechanical cure, something I do to my neck, to fix the problem. If not, I will spend the rest of my life getting injections, nerve burns, taking meds, and doing whatever other new techniques pain management invents.

I don’t understand why it’s been so hard to figure out how to get rid of my headaches. So many more serious medical issues are easier to solve. But the truth is, headaches are a conundrum. Doctors are never sure exactly what is causing them, and treating them seems to be a “throw everything at the wall and see what sticks” kind of process.

I’ve joined a headache group on Facebook, and people mostly post about their latest meds and injections. It’s helpful to read about what others have tried, and also overwhelming. Most group members have had migraines for years. As far as I know, there is no cure for migraines. I feel really fortunate that mine are not migraines, and that I might be able to fix them. It’s just a matter of finding the treatment. So far, the Mackenzie Method is promising. My neurologist at Jefferson Headache recommended it last year, but it’s taken me this long to stumble on a practitioner.

It’s rare that a medical doctor would promote something a PT method for headaches. Usually, I find MDs promote meds and procedures and are not encouraging about physical therapies at all, and physical therapists believe their practice will work permanently where the medical modes are just temporary at best, and damaging to the body at worst.

But I don’t have time to mess around. These headaches have already done enough damage to my life. So I’m pursuing both. My hopes are on PT, but I’ll take the relief of injections/nerve ablations in the meantime.

Drugs and books and heroes in white coats

When I started this blog, I thought I'd post more often. I do have a lot to say, but I've grown weirdly shy as my headaches dominate my life. I don't want to whine. I don't want to be a downer. The solution would be not to link each post to my FB or my twitter, just let it hang out there in space, but, perversely, I do link them. I want you to read what I write. I want you to know who I am. And if you have headaches, I hope you find my experiences informative.

Where I am now: taking 4 mg of Zanaflex every four hours, which mostly keeps the headaches under control. I'm also very recently under the care of a new doctor who specialized in cervicogenic headache and treating C1-C2. So I am nearly pain-free but seriously medicated, and I have hope for a more permanent drug-free fix in the near future. Huzzah. No exclamation point.

A few weeks ago, I read about the use of Zanaflex as a preventative, a "prophylactic." None of my doctors has ever mentioned this. The protocol is 8 mg three times a day, beginning in the morning, and the idea is to keep the headache from beginning in the first place. This was a revelation. I've been using Zanaflex as an "abortive," after the pain began, and then spent most of the day chasing after the headaches, often unsuccessfully, as I've written before. I started taking 1 mg of Zanaflex about 18 months ago and have had to increase the dose to 2 and even 4 mg as the pain warranted. The whole idea of taking medication before pain begins is foreign to me, and as a sober person, makes me think I'm "using," even though that's ridiculous. But the more I read (if I haven't mentioned it, I read about headaches a LOT, daily, obsessively), the more it seemed like the correct way to use the medication.

I knew 8 mg would just knock me into next Tuesday, so I start my day with 4 mg. I know this medication so well now, how it works in my body, its phases. It's my constant companion. For the first hour after I take it, I feel normal. Sedation starts after about 70 minutes. If I take it with food, I get sleepy much more quickly. As long as I stay active, I don't get falling-asleep tired, but I'm loopy. I can't drive a car or have any kind of higher-level conversation. This phase, remarkably, only lasts about 20 minutes.

After two hours, I get wicked dry mouth. The inside of my lower lip feels like paper. Water, endless glasses, bottles. Then I'm cool. I'm great. I feel 80 percent normal, except that the 20 percent that is missing is completely essential for teaching. That 20 percent contains my entire knowledge of grammar, literature, writing style, and the random knowledge about the world that comes up about 100 times in every class hour. This is a huge problem.

But it's summer. I don't go back to the classroom for three weeks. I'm at home almost all the time. I've learned from trial and error that 4 mg every four hours is THE regimen that works for me. (Of course every few days I screw with it, try to take less, and get a horrible headache). The Zanaflex has dried up a lot of my ambition and my need to physically move. A common side effect is asthenia, or muscle weakness. I definitely get this sometimes, and it's gross, like I'm suddenly 85 years old. Aside from walks in the woods with Buddy, I don't exercise. Intellectually, I long to be on my bike or back in my little running habit, but my body is just too leaden. I do some gardening, a lot of lying on the porch reading and watching hummingbirds. Some napping. And a fair amount of writing.

My main priority every summer is writing fiction. While I haven't done nearly as much as I'd fantasized I would, I've done a good bit. This summer's project was revising this novel I've been working on for the last eight years (wrote another book in the middle of those years). I've revised about 120 pages this summer, with some major overhauling. I'd hoped to revise the whole 300 or so pages, but oh well. I've also revised several short stories that had been lying around in various states of disarray, and that makes me very happy. And I've written two personal essays on pain, more artful and more revealing than what I write here. I may or may not post them, depending on my feelings about exposure. I might try to publish them somewhere else.

I write in short, compact bursts of intense focus. On a good day, I string together several of these and I get a good amount accomplished. This works well with my headaches and the medication roller coaster. I've been able to concentrate in the way that I need for fiction. This concentration, apparently, is very different from the focus needed for teaching. I find this all really interesting, what parts of my brain are just deadened and what parts still thrive. Zanaflex accommodates the floaty logic of narrative, it seems. I've been writing easily, with frustrating plot holes filling themselves almost effortlessly. When I write this summer, I am experiencing flow. Yes, corny, but true. My writers' group has been very positive.

I go days without seeing anyone but my husband. He's been exactly the way you hope a partner would be if you had a stupid, seemingly endless medical odyssey and felt crappy a lot of the time. He is completely kind, adjusts himself to my changing mood and energies, doesn't seem to mind that I am lazy, listens to me talk about treatments and research. Holds me when I cry (not so much in pain but in frustration). Tony and Buddy and our kittens and our cat and our bright, beautiful house and my wild, overgrown garden are keeping me afloat. I can't imagine what this would be like without them.

I hardly ever see anyone. This is the worst part. Because I'm so isolated, I feel rejected. In my darkest hours, I worry that all my friends have abandoned me forever. The truth is, right now I've abandoned them. I almost never reach out and ask anyone to do anything. I'm just too tired. Wandering around my house and yard and the woods is hard enough.

What's weird is that the times I have socialized have lasted for days: two camping trips and a weekend-log wedding where I was with people all the time. So this means other people are witnessing my Zanaflex impairment and, occasionally, my pain. I am not myself with other people. I can be myself-ish for a one-hour lunch or a walk in the woods or a swim at the pool, but I'm not myself hour after hour, day after day. If I spend a lot of time with someone, afterwards I obsess over how not-me I was, how loopy, uninteresting and self-involved. I think I've been able to focus on whoever I've been with to some degree (and this summer, they've all been people I care about a lot), but my focus withers with pain and meds.

I am SO self-involved! All I think about is pain and medication and water when I have dry mouth. It's so fucking boring. I have a few friends who ask about it and I actually like talking about it with them, but then I feel sure that I've alienated them and bored them to tears.

I've had some really nice visits with my parents this summer. When I'm with a lot of my family at the same time, I get overloaded and headaches come on much easier. But one on one for a few hours is great. My parents will come to our house and we'll go to the pool, swim and eat at the picnic tables under the trees. I can manage the Zanaflex and I don't have pain. But once they stayed into the evening to see Tony's band. I forgot to medicate on schedule and got a killer headache. Then I had to take a lot of Zanaflex and I became a zombie. I think my parents had fun anyway, but while I was with them physically, I wasn't there at all.

I am grateful for Zanaflex. It works. Without it, my headaches quickly grow to unbearable, debilitating heights where the back of my head is just a hot angry fist  and it feels like I'm being stabbed in the eye, and I am stumbling until I can curl up somewhere and hold my head. I know that sounds insanely dramatic, but that's where the pain goes unless I stop it. It's taken over a year of wrestling with Zanaflex to learn how to use it as a shield against my pain. Both my spine doc and my neurologist agreed that I might be on it forever, since no other kind of intervention has worked.

But I can't live like this. No way.  I'm only marginally functioning. I'm not myself. I'm dull, leaden, slothful, inert. And I still have breakthrough pain, deeply painful headaches, many times a week. This is not my life. It can't be my life.

Enter Dr. Kline, my new pain management doctor who, in two weeks, will block the top facet joint (C1- C2) of my spine by injecting it with lidocaine and asking me to monitor my pain for six hours. If I'm pain-free for those six hours, then he'll go in and burn the nerve just like my last doctor burned the four facet joint nerves below. If it doesn't work, he'll block C2-C3, which was already burned but may not have really worked. He's certain one of these will work.

Dr. Kline says at least 50% of his patient are cervicogenic headache sufferers. What?? Where the hell has he been the last three years?  NO ONE who has treated me has treated many cerviconic headaches--not the chiros, the PTs, the neurologist, no one. I've never met anyone with them. Even thought I read about them a lot online, I've come to assume they are very rare.

But this doctor says he's treated thousands. As usual, the journey to find him was circuitous. My spine doc sent me back to my neurologist to see about a different med. Neurologist, agreeing that a life on Zanaflex was probably my fate, mentioned in passing that I might think about an upper spine guy. But they are hard to find, and, who knows, maybe they couldn't help me either.

I called and my spine doctor referred me to Dr. Kline, who was knowledgeable and matter-of-fact, looked over the inch-thick files the spine practice had sent him, and declared that he'd do these blocks and go from there. No need for more images, no new drugs. Just block/burn/pain free. He said that 50-60% of the cervicogenic headaches he treats come from C2/C3, and 8% come from C1/C2. He was very confident.

I had a follow-up with my (beloved) spine doc today, and everyone sang Dr. Kline's praises. He does the unusual stuff, the daring treatments. He gets results. I told my doctor that cervicogenic headaches make up more than 50% of his practice, and my doctor nodded. Yeah, there are a few guys like that. Then I asked him if he treated many of them and he said no, hardly any. I must have had my "then why the hell didn't you refer me to this guy two years ago" face on, because he then reminded me of how successful our early treatments were, and how frustrating it is for everyone in his practice to not be able to solves cases like mine.

And then he suggested I try Neurontin, a nerve pain med that no one has suggested before. It also has drowsy/dizzy side effects, so he recommended slow titration over a few weeks. The thing is, this medication takes several weeks to work, and I'm getting that nerve block . . . . Who knows? I started taking it today anyway.

So here I am: summer almost over. I have general sense that it's been mostly pleasant, but very low key. I'm glad of the camping (another trip next week in Vermont), and two amazing trips to Ithaca, and my garden, and especially my writing. I'm sad about my introversion and I hope it's not permanent. I hope I still have friends when I come out of all of this.

I'm ready for school in the lesson/assignment/syllabi sense (not changing much from last semester) but I'm terrified of the pain/med balance that will keep me from being the teacher I've always been. I hope the nerve blocks/ablation/recovery happen quickly and successfully. I hope there's some nice weather to get on my bike again before winter. I hope to feel my lively unmedicated self, my brain firing thoughts all over the place and my body never wanting to be still. I hope I have people to dinner in the yard and am able to be present. I hope and hope and hope.

False alarm

Nothing's working. I hate when I announce some new "solution" here only to have it backfire. Right now my headaches are worse than they've ever been.

Because I keep a detailed pain/meds journal every day, I can see that about five weeks ago, I had about fourteen days in a row with really minimal pain. They were heavenly. They coincided with a number of changes: new pillow, no Diet Coke, new PT exercises, reading from my Kindle in bed instead of the iPhone. I backslid on many of them (changed PT exercises) and the headaches returned. So one by one, I introduced each change again, but I still have headaches.

In fact, they are worse. About a week ago, I turned my head to the right and felt a searing pain go up the back of my head, in the usual headache pattern. For the rest of the day, I was in a good amount of pain, and Zanaflex wasn't really touching it. The next day, I was okay, but every day since, the pain is more and more intense, until today it's about as bad as it's ever been, on par with the nerve irritation after I had the rhyzotomies. I am taking four times my normal doze of Zanaflex, which should put me in a coma, but I am still in pain (and not sedated at all).

My spine doctor suggested I check back in with my neurologist to talk about different meds. The neurologist prescribed a time-release version of Flexeril, hoping it would have fewer side effects than Zanaflex, but it doesn't work at all. He also suggested I see someone who treats C1 C2, the top two vertebrae in the neck. My spine doctor doesn't do injections or rhyzotomies there because it's dangerous. But he gave me a referral to a pain management doctor who does, and I see him next week.

I also called my spine doctor today because the turn-my-head thing worries me, and I don't get why my headaches are so much worse right now.

I love summer. Usually my headaches are better because a) that's when I've coincidentally had successful treatments and b) I am just less stressed since I don't teach in July and August. So right now this level of pain is pretty annoying when I want to be doing all the things I love, which are outdoors. It's been okay some times-- good times at the pool, two nice camping trips at the beach, lots of hiking in the woods with my dog, and a fair amount of work on my fiction. But I want more! I wanted to be back on my bike this summer. I wanted to be finished revising this novel by the end of August (I won't be). I've had too many days like today, hard pain, lots of meds, sleep all afternoon.

I'm a bit panicked that things still aren't resolved, or at least better. I'm still seeing my physical therapist, and we started a new regimen last week (which might be why the pain is worse, come to think of it). She's asked me to get and use a home traction device, not the over-the-door kind but a professional-quality pneumatic device that costs a bundle and may or may not be partially reimbursed by my insurance. I'm nervous about using it because another PT had me use one in the office and my headache got worse almost immediately.

I also read and read and read, constantly trying new search combinations. Now it's "headaches C1 C2" and I've read about Nucca chiropractic adjustments, which only one guy in the Phila area does-- which focus on the top two vertebra.

All this reading and searching and hoping for the next possible cure is so demoralizing. I feel like some fool looking for a magic weight loss pill. But a solution has to be out there, doesn't it? Whether it's this new doctor addressing C1 and C2, or prescribing a better med, or an alternative modality that works, or something.

School starts back in a month. I'm still not better. Right now I'm worse, so much worse that I'm afraid I wouldn't be able to teach if this continues. But panic doesn't help and definitely makes it worse.

Something's working. . . but what?!

I think if a major procedure doesn't work, a sensible next strategy is to throw every possible intervention at the problem and see what sticks.  It's been almost three months since I had pain-transmitting nerves burned in my neck, and that's officially a failure. Yet I've had whole days without pain in the last two weeks, and many days where I only have one headache late in the day. What's the fix?

In the last month, I've been:

Continuing with physical therapy, specifically Neurokinetic Therapy.

Taking magnesium citrates (500 mg) for muscle spasms.

Practicing yoga at a class in the park on Thursday evenings.

Sleeping on a special pillow that keeps my neck in the right position.

Not using the ergonomically-absurd computer podium in my classroom.

Hitting my neck with capsaicin cream at the slightest spasm.

If I had to bet on the winner, I'd say it's the pillow. Maybe it's a little bit of everything, but this pillow is amazing. By nature, I am a stomach sleeper, which could not be worse for someone with neck drama. In the last few years, I've trained myself to sleep on my back, and it hasn't really helped, so I've backslid. But this pillow keeps my head in position while I'm on my back, and then if I turn on my side, it's has side panels to keep my neck straight.

I also can't say enough about capsaicin cream, and the benefit of applying it at the first twitch of pain (that's the whole key with pain management, getting in front of pain as soon as possible so you aren't chasing after it all day). Capsaicin isn't like Icy-Hot or Ben-Gay, which contain menthol to kind of distract from pain. Capsaicin actually interferes with the chemicals that allow pain transmission in the nerves. And in hot weather, it can really burn the skin, especially when sweating. But it's a good kind of pain, especially since it's blocking my headaches! I have tubes of it all over the house, in my car, my bag, etc.

Additionally, yoga is fantastic. I'm taking a vinyasa class and it's pretty tough. I don't do any inversions or anything too funky on the neck, but I do everything else, and afterward, I always feel really good. I want to build in another class or two during the week as well.

As for the PT, the exercises are so subtle that I have a hard time believing they make a difference. But maybe. My therapist also has me to "restorative breathing" exercises when I'm there. I'm going to keep going-- I like my therapist a lot, and I like having someone to check in with each week. And I'm covered for it, and it's close by, so why not?

The thing with the computer podium is insane. In recent years, I've embraced all the great stuff I can do with my composition classes using a computer podium and the overhead projector. Most "smart" classrooms have equally smartly-designed podiums, with adjustable stools etc. But in this particularly building, when I stand at the podium, the keyboard tray comes about to my fingertips, so in order to type, I have to hunch over and stick my neck out like a turtle. And I'm 5'8". I can't imagine taller colleagues even bother. Whoever designed the podiums is an idiot. In the last few weeks of summer session, I wasn't using it so much. But last Wednesday, as my students took their final exam, I decided to go ahead and grade their final papers (I use an online submission/grading program). Within a half an hour, I felt a headache coming on, so I stopped, and reached for my meds. I'd left them at home, which I NEVER do! So I did some exercises, but by the time I got out, my headache was really bad, and it was too late to really stop it. I took meds when I got home, slept, got up and was in pain for the next eight hours. This wasn't all bad, though, as it showed me how important ergonomics are, and how much posture plays a part for me. And in thinking about how I prefer to teach, I've realized that technology is super important to me-- my students' most amazing breakthroughs happen when I put anonymous samples of their drafts together in a document, project it on the screen, and we work together to make revisions as I type at the podium. I'm not going to give that up, so my employer has to step up.

I'm so thrilled to not be in pain, but equally thrilled to not take medication. In the winter, it's one thing to take a muscle relaxer and nap all afternoon, but in this beautiful weather, it's nihilistic and awful. As for Percocet, it's really just too hit or miss. Sometimes it helps for a few hours and sometimes it doesn't do anything. I liked it better than Zanaflex because it didn't make me feel crappy, but if it only works intermittently, it's a loser. I'm glad, because daily narcotic use, no matter how not-high it makes me feel, is just not good.

Last week, I got a new MRI of my neck and had a follow-up with my spine doctor. Everything is the same-- I have a particularly arthritic facet joint between C3-C4 with bone spurs. If the headaches get bad again (I'm teaching in the same building in the fall, and lobbying for a stool as a ADA accommodation), my doctor wants to do another cortisone shot there. He says they sometimes work better after a rhyzotomy fails. Or we can discuss some epidural steroids shots.

I plan to spend the rest of the summer with the pillow, the PT, more yoga, and the rest. Summers are traditionally great for me anyway. Both my first successful cortisone and Botox shots were in early summer. And I know not teaching is great for stress, much as I love my job. But I'm thinking that if I can continue with these practices and keep them in place, the fall might be okay.

When nothing works

It's been two and a half months since I had a cervical nerve ablation. . . and nothing. It didn't work. My headaches are back to the same quality and intensity as before. My doctor is holding out a very faint hope that I might need a full three months to see results, but we both know that's not going to happen.

I'm kind of stunned and kind of amused. I mean, the procedure was a BEAR. It was so painful and then the recovery, as the nerves flared up like crazy before their presumed death, was just nuts. I only went through all of that because I thought it would work!

I feel like I've been in a crazy-intense romantic relationship that had all the possibilities in the world, and then it just fizzled into nothing. So now I'm back on the market, looking for another option, sad and beaten and still hopeful.

For the last three weeks I've been seeing this married couple, chiropractors who also practice various physical therapy modes. The wife is doing neurokinetic therapy with me. "NeuroKinetic Therapy is based on the premise that when an injury has occurred, certain muscles shut down or become inhibited, forcing other muscles to become overworked. This compensation pattern can create pain or tightness. By applying light pressure that the client then resists, the practitioner can evaluate the strength or weakness of each muscle, revealing the sources of injury and retraining the client’s body to remove the compensation patterns—reprogramming the body at the neural level" (from Neurokinetic Therapy: An Innovative Approach to Manual Muscle Testing by David Weinstock).

For the first week, it was fantastic. I had several pain-free days in a row. I thought this had to be the solution.  And so simple! But then it stopped working. I've had this happen so many times. Often the first time I try something-- cortisone shots, Botox, myofascial release, kineso taping-- I enjoy fantastic success. But then it never works again. Doctors and practitioners tell me this happens sometimes, that the body initially reacts to something new and then goes back to it's old habit.

I'm going to keep seeing this couple, but I'm quickly losing hope that the new exercises or anything else they can do with me will work.

As for my spine doctor, he recently prescribed this crazy compounding pain cream, chock-full of three muscle relaxers, bupivacaine, lidocaine, clonidine, ketamine, and a half-dozen other heavy hitters. The idea is that by applying it topically, you'll get the benefits of each medication without the full-body side effects that you'd get with pills. It doesn't do jack.

I called a week after he gave it to me, a bit despairing, he suggested I get another MRI on my neck and also see a neurologist at Jefferson. I reminded him that I'd already been to Jefferson, and they sent me back to him. He was sorry to have forgotten.

So where does this leave me? Without immediate prospects, that's where. So much of this journey has been about "the next thing." When the headaches are at their worst, I lie around researching doctors/articles/practitioners, and I get really pumped when I find something promising. Right now, I have nothing. There's no reason the nerve ablation (aka rhizotomy) didn't work. As I wrote before, when my doctor sent electrical currents to the nerve endings to test them before he burned them, they lit up perfectly, recreating the pain pattern like mad. And then they were so damned angry after he burned them, the searing pain like no headache I've ever had. They were supposed to be dying. They are still alive. It doesn't make sense.

I'm trying not to get discouraged. I take medication every day and while it works somewhat, keeping the pain down so I can teach and not be too cranky, so I can be quasi-social,  it's not a solution. I'm walking around with medicine bottles in my purse, logging in every twinge of pain, timing each dose so I stay ahead of the pain. The magic trick is half a Zanaflex and half a Percocet. I don't feel side effects from that dose of either, and I'm mostly pain free for about two hours. But it's ridiculous to take medication like that every day, and it doesn't always work. Today I waited too long, and I've been screwed ever since. I came home from teaching in pain, took more Zanaflex and slept three hours.

The waiting too long to medicate thing is weird. I think, at heart, I am a ridiculous optimist. When I get the first twinges of pain, I think it won't get worse (despite nearly three years of evidence to the contrary). When I take pills at this point, I feel like a faker. I feel like I'm exaggerating. But if I take them, the tinge of pain goes away and I feel pretty much pain-free. But if I decide not to be a "faker" and ride it out, the headache gets worse and worse, until it's the only thing I can see in front of me. At that point, meds don't really work, unless I take enough Zanaflex to knock me out, which I did today when I got home.

And then there's the Percocet. It's a new addition to the repertoire since the nerve ablation. I find it enhances the pain-relieving ability of the Zanaflex and also weirdly makes it non-sedating. If you recall, at first I took half a Percocet after the procedure a few times and it worked. But when the nerves started actively "dying" (clearly they weren't, so what the hell were they doing?), I needed to take more and I couldn't handle it. It just made me feel like hell, dizzy, nauseous, the worst kind of seasick. Those were some mighty dark days. 

Now I take a half once and maybe twice a day along with the Zanaflex and it's getting me through. But now I'm a sober person who takes a narcotic every day, and while it in no way gets me remotely high, it's still weird. I'm glad I can only take this small amount and that taking more makes me feel gross. It's like build-in abuse protection. I don't want to get high. But I know that medication can be insidious, and that many sober people before me have fallen to prescription pain meds. But I also know that many sober people have taken them successfully and not relapsed. I don't think they are going to be a problem for me, but this whole deal is also a reason why I hold off on medicating when a headaches starts. It's kinda fucked.

If I ran into you on the street right now and you asked me about my headaches, I'd probably lie and say I am fine. I don't have any new treatment to tell you about. I am not looking forward to anything right now. I'd put off the nerve ablation for so long, and it loomed before me as the great big hope for so long. Now that I've done it and it's failed, like Gatsby's green light, my "count of enchanted objects had diminished by one." Very corny, I know, but the sentiment is true. 

I worry that, at this point, it seems like I'm making all this up. Like for whatever reason, my psyche has manifested this pain. I've been assured by trained professionals that this isn't true. My headaches are real. But who goes on this long without a solution? Hundreds of people on the internet, apparently. Spine and neurology message boards are filled with tales just like mine, many worse. Some have been trying to fix their headaches for decades. Their messages end in a catalog of the medications and procedures they've tried over the years, their failures. Am I one of them now?

I'm going to get my MRI and keep doing my exercises. Maybe my doctor will see something new on my scans and suggest something else. I'm going to keep taking pills, as sucky as that is. And I'm going to work in my garden and ride my bike and revise this novel and camp at the beach and cook summer vegetables and do everything else I want to do this summer. As much as I can.

Never say chronic

It's been five weeks since the rhizotomies and I'm still experiencing the sharp nerve-dying pain. I've called narcotics a failed experiment and instead rely on my trusty Zanaflex, although now I need four times my original dose to get any effect.

It's still possible the rhizotomies will work, and I have not given up. It could take up to two months. I really need them to work. It was such a stressful procedure; it can't be for naught.

Zanaflex at this dose knocks me on my ass. So treating the pain has an apocalyptic feel-- take this pill and life is completely suspended, for at least two hours. Whatever plans I have are scrapped. I can't meet you for lunch. I can't go to the union meeting. On a sunny spring afternoon when all I want is to be out in the woods with my pup, this is really a drag.

I spent last week preparing for my own 50th birthday party, something I'd planned to do for about a year. Every time I make long-range plans, I assume I will no longer be in pain. At heart, I am on optimist. Generally, I love giving parties. I love getting my house and yard ready, buying new drapes and putting in flowers. I love days of cooking, often my most labor-intensive recipes. Before I had headaches, these days of industry were some of my happiest times, better than the actual parties themselves.

I assumed by now I would be out of pain. When I wasn't, I thought of canceling the party. But all along, I've been loathe to let pain take away too much, lest the ensuing depression just make the whole thing worse. So I decided to have the party, albeit a relatively small one (maybe 20 people). Still, I had to go all out with preparation: massive gardening and spring house cleaning, marathon cooking sessions. I was in and out of pain and Zanaflex zombiedom the whole week. I began drinking really strong coffee so I could stay awake through the sedation, and I felt like I was doing speedballs. But not in a good way. One of my best friends came in town the night before, and I loved hanging out with him. One-on-one with someone I am so comfortable with is great, and even though I was dampened by Zanaflex, we had a great time. The actual party was objectively awesome, but I felt cranky and overwhelmed and less than sharp. I hate that. The wasn't really about me turning 50, but rather a way to celebrate all the lovely people in my life, have them in my house eating my vegan soul-food feast. I wish I'd been able to be more present.

Sometimes I feel like I'm making all of this up. It's so ridiculous and unnecessary. I still don't know why I developed bone spurs in my neck. These days I'm tipping the blame toward the late-stage Lyme disease I was treated for in 2001. Lyme disease can manifest in different systems of the body and cause all kinds of bizarre havoc: neurological symptoms that cause mental confusion, heart problems. For me, it was mostly in my joints with migratory arthritis. The worst was in my neck, and before I was diagnosed, I was baffled by the pain I felt every morning, my neck almost paralyzed by pain and stiffness. I had to push myself off the pillow in elaborate contortions. I figured it was ergonomic and I bought new pillows. I adjusted parts of my bike. I saw my first chiropractor, who kept adjusting me to no effect. It was nine months before my physician sister, worried that I had MS, told me I had to see my doctor and get some tests. It turned out to be late stage Lyme, curable with massive antibiotics and about six months of serious fatigue. After that, I moved on. I never thought the Lyme had any lasting effect. But now I'm not sure. In my reading, I've discovered that if left untreated as mine was, Lyme can cause permanent joint damage. This may have led to the development of bone spurs. I'll never know for sure, but I do like having something to blame.

I'm teaching first summer session and I have awesome students. Lots of energy. I wake with a 2 headache every day, and can't take Zanaflex because because I wouldn't be able to teach. So by the middle of my second class, the pain is on front of me, a 4 or 5, and it's bad. Everything annoys me: the side conversations in the back of the room, the ladies who feel they must rustle through their handbags while I'm talking. I try very, very hard not to let my irritation show. I am the fun teacher! I am in my element! But I know it comes through; it has to. I being the class in a great mood and I end feeling embattled. I leave class palming my bottle of meds. The Zanaflex is in my mouth before I leave the building. Then it's home to happy dog, happy husband, and I say hello and goodbye as I make my way to bed.

Happy dog is a special comfort. On the worst days, he never leaves my side, my loyal attendant. I don't know how I got so lucky.

By any measure, this is chronic pain. It has been going on for thirty months now. But in my mind, I don't have chronic pain. Instead, I am on a constant quest for treatment to relieve this temporary pain, and while I've found bursts of relief, nothing has lasted yet. The truth is, even if the rhizotomies work, the nerves will grow back in about a year, and I'll have to get them again.

I don't live in the moment, because many moments kind of suck. I live in the possibility of the future. I live in the idea that there are pain-free days ahead. I've had them. I'll have them again. They have a currency I never thought possibly, the breezy luxury, the golden days.

There is some good that's come from this. First and foremost, it's shown me the wonders of my profession. When I am in pain or on medication, it's difficult, because teaching is an all-cylinders-firing pursuit. And it's pretty cool to have a job that uses the best of me that way.

It's also shifted my priorities. A few things have fallen by the wayside, particularly cycling. I used to ride a road bike pretty seriously-- maybe 100 miles a week on my own, and 75-100 miles charity rides throughout the season. The decade I rode was the most athletic I've ever been in my life. But in the last two years, I've barely ridden at all. It just isn't fun when I am hurting. It's dangerous when I'm on Zanaflex. And when my neck pain is extreme, it's nearly impossible to be in the head-forward position of a rode bike for hours at a time. I definitely miss it. I am determined to ride again this year, although I will probably never ride as  much as I used to.

I also socialize much less. I've had periods in my life where I socialized in an almost manic fashion, went out a lot, had a million friends. These days, I'm a homebody. I like to have a few people for dinner sometimes, and I go to a few parties a year. I can't deal with a fracas when I have any degree of headache. I don't go see bands. I don't go to the movies. I'm not much for loud restaurants, busy art openings. Weirdly, I prefer it this way, and that's not just because of headaches. I think I might actually be more of an introvert than I realized. I like to be alone. No social activity makes me happier than going to the woods with a friend and our dogs. I sometimes think the hyper-socializing helped me avoid something.

I've cut way back on stuff at work, committees etc. I used to be really involved. I was an assistant department head for six years. I served on tons of committees, gave presentations regularly. But these days I just can't. Most of this work happens in the afternoons, and that's when my headaches are the worst. I teach classes in the morning and there's just no way I'm sticking around afterwards if I'm in pain. I'm lucky to make our monthly department meeting. I can't commit to anything beyond that right now. If I make myself attend something, I'm either in a total crap mood or half-asleep from Zanaflex. I don't feel too awful about this because I was so involved for so long. And I know I'll be involved again, once the headaches are gone.

But I haven't been willing to do less or opt out of everything because I'm "sick," This is most true with my family. I have a big, loud, active family, and holidays get pretty chaotic. I would never stay home, so I end up with lots of headaches, on lots of medication, taking lots of naps, always pretty cranky. I wish this weren't true. I barely remember the holidays this year.

I still garden, take my dog to the woods, keep my house relatively together. I've finished a novel since this whole thing started, as well as numerous short stories. I can't stop writing or I will feel like my life has fallen apart. I don't write nearly as much as I want to/should, but I do it. When writing is going well, that lovely "flow" state I get into is somewhere beyond pain, at least for awhile. That's pretty cool.

I've learned how to conduct a medical odyssey, how to push and see specialist after specialist until I find something that works. I've learned a lot about alternative modalities. I've learned that different health care practitioners approach the body in radically different ways. I've read and read and read about my condition, in professional journals and websites and discussion boards alike.

I don't get too twisted about much right now. I don't have time to obsess over who said what to me and whether it was insulting. I don't much care that I've gained some weight. A lot of my mental space is taken up with evaluating my pain, thinking about when to take medication, anticipating the next treatment, planning a nap. I'm very well-rested.

I really don't worry that this pain is permanent. Because it can't be. I can't live with it; I really can't. It's too intense and too limiting. That may sound suicidal, but it's not. I just mean that I will keep pushing until something works. I have to live my life and I can't imagine throwing in the towel, going on disability, becoming a permanent pain patient. Right now I am managing things with the Zanaflex, losing some hours to the naps I end up taking, and while that's not at all ideal, it's bearable. I still think the rhizotomies are going to work. Any day now. And if they don't, I might end up exploring treatments like nerve decompression surgery and a spinal cord stimulation implant-- treatments that seem crazy to me now like nerve burning seemed six months ago.

Pain changes us.

It's been twenty days since the rhizotomies, and for the last week, the pain has been pretty severe. From what I read on discussion boards, this isn't uncommon. Many people report "angry" nerves for about a month, a sharp increase in pain before the nerves shrivel up and die.

As I've said, my doctor gave me Percocet for after the rhizotomy. I've been super careful, and at first, I only needed 5 mg here and there. For a few days, some carefully-spaced-out Alleve was like magic. But since last Wednesday, I've needed more medication than I can handle. The pain is in the 5-7 range, burning, searing, and it is totally in my way. Far from getting me high, the amount of Percocet I need to manage it makes me sick—super dizzy, nauseous, restless, shitty. My heart feels like it's pounding out of my chest and my ears get stuffed up. The Percocet pushes the pain down but makes me feel the worst kind seasick. I hate it. 

In the next four days, I need to grade 95 papers (some 15 pages in length), host my school’s creative writing and photography magazine release party as I’m the faculty advisor, and attend my college’s graduation which, from robing to dis-robing, is four loud, crowded hours long. The graduation I can beg out of in an emergency. But I have to grade the papers, and as I’ve written before, pain makes some levels of focus nearly impossible, and grading is pretty intense, and I have to host the release party, which won’t be as hard as happy, positive interaction with others is actually pain-relieving in a way. It’s just all the set up etc. for the event that is tough. Seriously, I haven’t got time for the pain.

My doctor called in Vicodin this morning. It’s not as strong as Percocet, but has fewer side effects. However, it’s not doing jack, and I’ve already taken as much as I’m supposed to. I just took a Zanaflex, which might put me to sleep for a while, so hopefully when I wake up I will have some good grading hours. Because 95 papers is no joke, even if they are final papers and don’t need extensive revision notes.

I have to believe this is temporary. It has to be. No one can live with pain like this. And there is no plan B after the rhyzotomy, at least not with my spine doctor. The only other treatments I’ve read about are pretty freaky: nerve decompression surgery and a spinal cord stimulator implant. Google them if you want; I can’t. The pictures made me ill. I used to wonder if at some point I would end up in “pain management,” which could mean taking narcotics on the regular. This would be a treatment of last resort to me and not how I want to live my life. But now I don't see that happening. The Percocet sickness is actually as bad as the pain, and if I react so badly to it, I can't imagine other narcotics would be better.

Yes, this is a super self-pity post. I apologize. I’m a bit frantic. So I’ll segue into the post I’d been planning in my head before this weird nerve tantrum started.

There is a silver lining to my headaches.

I've had a lot of time to think about pain on a more philosophical level, what it is, what it means. I have amended my actual definition of pain: it is whatever gets the way of living your life the way you are supposed to. It's whatever takes your focus off the real, important things going on, and forces you to obsess, ruminate, look for fixes, treatments, cures. Pain isn't just physical discomfort. It’s also grief, depression, anxiety. It’s whatever makes you say about the future, “I can do that whenever I get past xxx.”

Compared to many people, I have led a charmed life. Other than clinical depression when I was younger, I’ve experienced little in the way of true suffering. I grew up suburban, middle class in nice mostly-functional nuclear family. I never wanted for anything materially. I did well in school. I went to college. The only people in my life who died were grandparents. Outwardly, things were pretty sweet. Inwardly, I had my share of mood problems. I treated these myself with certain street drugs and later, a doctor very successfully treated me with Prozac.

I’ve also been fortunate to find the right profession. I love teaching (well, except the 95 papers). I love my students. I love the college where I work, its role in the city. I love my colleagues. I love the freedom to choose my own course material, and I love the literature I ask my students to read. I love having students come to my office to talk. I love listening to them. I love encouraging them. I love seeing them in later semesters, running into them in the hall, watching them walk at graduation.

But their lives are often complicated, much more than mine, so I have felt this invisible wall between us as I listened to them tell me about their upcoming court date or their mother’s cancer or their brother in prison. I could listen all day long; I could sympathize, but I could rarely empathize. Until now.

These headaches have been the worst thing that had ever happened to me. They have, more than anything else, by my definition of pain, been in my way. Getting rid of them has been my central obsession. Talk about self-absorbed. . . .

Except they’ve also allowed me to empathize in a way I never could. The hundred and twenty-odd students I just finished teaching this semester have so many problems, it’s a miracle many come to school at all. A house fire, a miscarriage, a seriously assaulted teenage son, legal problems, family problems, mysterious pain in the stomach, ear infection, strep throat, rotator cuff surgery, breakups, dying parents, bed rest for a pregnancy. That’s just this semester.

The two who affected me the most are a young woman with Tourette’s who jerks and seizes every waking hour of her life, and a former Marine who stepped on an IED in Afghanistan and suffered traumatic brain injury. They both finished the semester successfully, in spite of physical pain, lack of sleep, and, for her, deep embarrassment. I listened to them talk about things, and while their problems are definitely worse than mine, I felt a connection. I didn’t feel like “the caring professional” as I have for so many years. I felt like a fellow. They know a little about my stuff because I had to cancel class two different times for various procedures I had. They know I have pain. But when I listen to them talk about their pain, I listen in a whole new way. 

They have both been in pain for years now. She’s 19 and has had Tourette’s since she was 12. He was overseas a while ago. She’s pushing to see a new neurologist who, interestingly, is using an experimental brain implant. He is on new meds for a ruptured eardrum that has become infected. He hates the VA and its shitty medical treatment.

I don’t pretend that my “enlightened” views on pain are changing anything for either of them. But they both completed my class and are both taking me again in the fall. They know I will listen if they need to talk.

More than anything, relating to my students and their pain has changed me. It’s made me fully human. Incidentally, in the last two years, I have also lost more people I care about than I have ever lost ever in my life. That has also made me feel more human, less the product of a rarefied suburban biosphere.

And here’s the thing: as I wrote the first chunk of this post, I was in a lot of pain. Small wonder that writing about pain would be painful! But when I started writing about my students and took the focus off myself, I lost myself a little. Right I am not in as much pain. Now it could be that the two Alleve, one and a half Vicoden, and two Zanaflex are finally working. They are, sort of. But it’s also the way pain disburses when it’s shared among us more equally.

Now onto those 95 papers.

PS—comment, why don’t you? I’m not looking for head pats, but want to hear about your experiences, your thoughts, what’s worked for you for your own pain, what hasn’t etc. You can comment anonymously.

About pain.

First, there are different kinds of pain. What makes one pain worse than another isn’t just the severity; it’s also the context. While my headaches aren't excruciating, they are chronic.  Low-level pain day-in and day-out is exhausting and depressing. Demoralizing.

But, perhaps, the end is in sight. Twelve days ago, I had rhizotomies (burning of nerves that transmit pain signals) on four medial branch nerves in my cervical spine, where heat was applied to the nerve endings that transmit the pain signals that cause my headaches, creating lesions that will ultimately cause the nerves to die. I was told I’d be completely sedated at first when my doctor would insert the cannulas (tubes that would hold the probes). I would then be brought into a “light” consciousness during actual procedure so I could tell him where I felt sensation. In reality, I was unconscious for the beginning and wide, wide awake for the rest.

I was face down on the table, oxygenated, monitored. As each nerve was tested with an electrical  impulse, my headache flared to absolutely breathtaking intensity. I cried out; I moaned. It was excruciating. . . for a few seconds. But it was also amazing, because the pain so perfectly replicated the pattern of my headaches that I knew the procedure would ultimately work. This was good pain.

The whole thing took an hour, and then I was wheeled back to the recovery bay where I got to eat pretzels and drink Diet Coke since I'd gone without food or water since the night before. My doctor came to give me discharge papers and a prescription for Percocet, which might have been a tip-off. Nothing really hurt yet, but I knew it would. I had that dumb, post-procedure hangover feeling.

My husband, aka the driver, took me out to lunch, and as we sat in a beautiful upscale mall-chain Mexican restaurant, I realized  I was in pretty solid pain, a kind of post-operative, there-were-foreign-things-in-me kind of stunned pain. I took a quarter of a Percocet after my husband cut it in pieces with his pocket knife. After 40 minutes, I still had the same level of pain, so I took another quarter, for a total of 5 mg. Soon the pain went away.

The next day I had the same pain and there was something scary about it, some promise of worse pain in the future.  I took another 5 mg of Percocet, and the pain again went almost completely away, just a low-level hum under the skin. Then I was completely out of pain for about three days. The doctor had shot steroids and long-lasing something-cain in my facet joints, so I had a few awesome days, along with a very numb neck that I kept thinking itched, but I couldn’t feel it when I scratched, so did it really itch? I’ll never know.

Then facet injections wore off, and now I’m in the nerves-are-dying phase. This pain is really different. The back of my head and upper neck is super sensitive, tingly and burning sometimes, and I’ve had various levels of a more distinct, hard pain (think hit in the head with a baseball bat) than regular headache pain. Ice isn’t cutting it, nor is Ibuprofen or Zanaflex. I’ve take half a Percocet maybe six times in the last week. Even though this pain is more severe and has warranted narcotics, which I would never take on a regular basis (more later), it’s infinitely more bearable because I know it will pass. It can take a few weeks for the nerves to die, and apparently they do not go gently into that good night.

As an aside, I get basal cell carcinomas on my face. About seven years ago, I had one recur, so I was sent for a procedure called Mohs. Basically, you stay in the dermatologist’s office much of the day as he numbs the skin and cuts a large layer of skin around the tumor and packs the wound with dressing as they biopsy the layer in the office. If the borders still show cancer, he unpacks the wound, goes back it and takes another later. This can go on all day, until the borders are clear and you get sewn up. In my case, the tumor was about an inch under my left eye, in a thin-skinned, fleshless area, which made the Novocain shots super painful. Also, sitting there fully conscious, I could see the scalpel moving on my face, could smell the flesh burn as it was cauterized, could actually see the freaking giant hole (size of a quarter, not cool) on my face if I looked sideways, which I tried not to but of course did anyway.

The whole took about thirteen beautifully-rendered stiches (the Mohs specialist is very special doctor) and then I had black eyes for a few days and a temporarily deformed left side of my face (nose pulled over, eye drooping, obvious stitches) for some weeks. Not too much pain, but plenty of discomfort. It wasn’t an experience I was anxious to repeat.

So I was pretty unhappy when I had another spot biopsied last week (I get yearly checks) on the same side, even closer to my eye, and the sample came back positive for basal cell. Because it occurred on the old, perfectly healed, no-one-even-notices scar, I have to have the Mohs all over again. Much closer to my eye. My appointment is on May 30th and I am praying for a cancellation so I can get it over with sooner.
 

That’s another kind of pain—just the grossness of the whole thing. I KNOW I am whining—it’s not melanoma. It’s not life threatening. But the doctor won’t know how deep the tumor is until he starts cutting, and I’m afraid it will be worse this time, will fuck up my eye, the hole and scar won’t heal so perfectly. I’m afraid of the procedure. I’m afraid I’ll look at pictures on the internet the night before and get hysterical about it like I did seven years ago. Ug. Don’t want to think about it.

Back to this treatise on pain in general. . . Pain is so subjective. I read a lot of spine/neurology/pain message boards, and people talk a lot about pain. It’s interesting and confusing. Some claim they are in an 8 all day, every day. I kinda. . . am skeptical. You probably wouldn’t be sitting at the computer posting on a message board if that were the case.

I tend to be pretty conservative when I rate my pain. The worst pain I ever felt was an acute gall bladder attack about 13 years ago. It began in the morning as a feeling like indigestion (I’d had the old Silk City’s chocolate bread pudding the night before and figured that was the culprit). Later that day, I had to attend the very sad, very long Quaker funeral of a friend who had shot himself. The pain worsened, and I sat in the beautiful old meeting wishing I could focus on the Quaker-funeral spontaneous sharing about my friend instead of focusing on my pain. I felt like an asshole.

The day went on and eventually I ended up in the ER, alone, doubled over, nearly delirious. That was pain. That was my ten. I had a gallstone stuck in the bile duct, and my glass bladder had become infected and nearly septic. I had emergency surgery to remove the gall bladder a few hours later and have been fine ever since.

My headaches haven’t come close, and I tend to use that experience as a gauge. This is the “pain scale” I’ve developed for myself: My 1 headache is pain just announcing itself, very bearable. I can laugh and interact, which I do sometimes out of spite, to taunt the pain. But a headache that’s a 1 comes with a sense of doom, because I know sooner enough it will get worse.

With a 2, I have a headache, dull and constant pain. I’m never not aware of it. I can still teach and interact with people, but I’m not as buoyant. I often rub the back of my head, and I start to think about medicating it.

A 3 is full-on, and if I’m out or at work, I just want to go home. I’m very irritable and everything is hard. Now I take a Zanaflex (muscle relaxer), knowing it will take about an hour to work. Why I don’t take it when my pain is just a 2 is interesting. I have a good bit of trouble feeling okay about taking medication (more about that later). With a 3, it’s hard to grade papers, to read, to have a conversation. I can watch mellow TV, anything not terribly stimulating.

If the pain gets to a 4, I’ve let it go too long. Now the headache is in my eye, bad, and I’m pressing my palm into the socket because I find that soothing. I’m completely distracted and I can’t do anything. I want to be alone, prone.

For me, a 5 is the worst headache. I’m dizzy, stumbling. The pain is sharpest in the occipital region at the base of the skull (right side). I can’t focus on anything but the pain, and I feel despondent. I almost never let it get to this point, because I always have Zanaflex with me.

For the purposed of this post, I just looked up the “official” explanation of the pain scale. It seems I’ve been of one or two points too low in my numbers. My headaches have actually been in the 3-7 range. The gall bladder pain wasn't actually a 10-- it was a 9.

THE PAIN SCALE (healthcentral.com)

0  –  Pain free.

Mild Pain  – Nagging, annoying, but doesn't really interfere with daily living activities.

1  –  Pain is very mild, barely noticeable.  Most of the time you don't think about it.

2  –  Minor pain.  Annoying and may have occasional stronger twinges. 

3  –  Pain is noticeable and distracting, however, you can get used to it and adapt.

Moderate Pain – Interferes significantly with daily living activities.

4  –  Moderate pain.  If you are deeply involved in an activity, it can be ignored for a period of time, but is still distracting. 

5  –  Moderately strong pain.  It can't be ignored for more than a few minutes, but with effort you still can manage to work or participate in some social activities.

6  –  Moderately strong pain that interferes with normal daily activities.  Difficulty concentrating.

Severe Pain – Disabling; unable to perform daily living activities.

7  –  Severe pain that dominates your senses and significantly limits your ability to perform normal daily activities or maintain social relationships.  Interferes with sleep.

8  –  Intense pain.  Physical activity is severely limited.  Conversing requires great effort. 

9  –  Excruciating pain.  Unable to converse.  Crying out and/or moaning uncontrollably.

10 –  Unspeakable pain.  Bedridden and possibly delirious.  Very few people will ever experience this level of pain

So about meds. I’ve been sober for 22 years. Like many sober people, I have a healthy respect for addictive medications and mood-altering medications. I took Percocet once before, the day after my gall bladder came out, and I didn't like it. I felt dizzy and restless. I took ibuprofen after that and was fine. 

Nothing helped my headaches before Zanaflex. I tried all the OTCs, as well as supplements and one migraine preventative. Zanaflex was a revelation. It takes about an hour to work, but then my headaches will disappear for about three hours. But it comes with a price, which is sometimes sleepiness and a depressed feeling and less than razor-sharp cognition, which is only actually noticeable when I’m teaching or trying to have a complex conversation. While it “alters” me, at least for the first half an hour, I am not high. I am not even happy. I'm just not in pain.

Even though my doctor prescribed it to me, I haven’t been comfortable with it, because it does make me feel a bit dulled and because it’s not a sustainable solution. But it’s also been a lifesaver. If I didn’t have it, I honestly think I might be out of work on disability. With headaches realistically in the 5-7 category, I wouldn’t be able to teach. But I still lament the months I've taken Zanaflex, come home from work and slept for hours, hard, only to wake up groggy and grade some papers, watch some TV and go back to sleep. Zanaflex, as well as the pain, has been debilitating. Every day has been a tradeoff.

So right now I don’t have the actual headaches, but I have this new, temporary post-rhizotomy pain. Ibuprofen and Zanaflex don’t work. Only Percocet does. So several times, I have taken a half a pill, 5 mg. And I go through a whole crazy torment of guilt and second-guessing each time I do. I discuss it with my husband (who would rather I didn’t, that I just take it when I need it, but I tell him so I am accountable). I wait an hour before I succumb, then sometimes another hour. I debate whether use of narcotics is only warranted if the pain is excruciating. I debate how bad it really is. I take it when the pain is super distracting, when I am too irritated to continue whatever I am doing. I take it so I can keep living my busy, active life for the next few hours.

The rub? The most addictive, dangerous, easy-to-relapse-on category of medication has zero side effects. I don’t feel tired, groggy, dulled. Neither do I feel high. I just feel mostly out of pain (which, as I’ve written before, is its own amazing high). This pisses me off. Why can’t the completely non-addictive Zanaflex be like this?

It’s hard to talk to other sober people about using pain medication. I think they are judging me; I think they think it’s a slippery slope and I am flirting with disaster. Some of the sober community has this idea that every recovering person secretly wants to abuse drugs all the time and always will want to. Well, the truth is, I don’t want to get high. I’ve found the slightly loopy feeling of Zanaflex really uncomfortable. I don’t want to feel altered. I want to feel sharp. I want to be fully awake and aware and participate in everything I love to do. That’s what’s been so sucky about the headaches, how much I’ve had to dial back the cool stuff in my life, my bike, my social life, my enjoyment of teaching.

This last week has been pretty awesome, as I’ve mostly been pain free. It helps that it’s spring, and I’ve spent hours doing hard labor in the garden, hiking in the woods. I’ve napped maybe once in ten days. The Percocet has really helped, and I know taking it is a short-term thing, just when the pain is bad, just while the nerves die. I am very, very careful with it.

I’m pretty confident the rhyzotomies will  work for a while (maybe up to a year). I’m glad I had it done. I wish I’d done it a year ago, when my doctor first suggested it, but it just sounded too bizarre then.

If you’ve read this whole post, I hope it’s either resonated with you and your own pain (I’m sorry) or made you grateful you don’t have it (yet. We will all have pain sometimes). I also hope it lets you know a bit about what chronic pain is like. We can't see another person's pain, and sometimes a person who always seems to be in pain might be. . .suspect to us. Chances are, that person isn't faking it. The pain is real. I know this blog is a bit self-centered. But for some reason I find it helpful and comforting to write about this experience, to think about it and analyze it. To know you are listening.

ETA
Five days since I wrote the above. The pain has gotten much worse, which is not uncommon from what I've read about this procedure. The cortisone has worn off and now I feel the full agitation of the nerve. I've had several days in a row where the pain stays pretty low through the work day, but by the afternoon, the burning becomes searing, up to a 6 or a 7, and makes me pretty useless. Then I really get in touch with Percocet-- and I fucking hate it. Of course this all coincides with some serous deadlines at work, which means hard focus at the computer, very painstaking, careful work. Five mg Percocet wasn't touching it, but 10 mg makes me feel so awful: dizzy, nauseous, anxious. One night I had two clear, pain-free hours to work before the nausea came on, but then I couldn't get rid of it. That night, my sleep was part-dreams and part awful hallucinations. My husband said I moaned and muttered all night.

Yesterday and today, I've just used naproxen, with one 5 mg. Percocet for a serious patch. The naproxen is pretty great. It tamps the pain down to almost nothing. I have a follow-up this Thursday, which will make three weeks. I'm really hoping those days earlier last week were the peak, and I'l be through with all this business of dying nerves and have some headache-free months ahead.