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.
Monday, July 28, 2014
Thursday, July 3, 2014
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.
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.
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