Friday, April 28, 2017

Falling Apart -- The Saga Continues

"What a drag it is getting old..."

Welp, they hauled me off to the ER early Thursday morning, as I had reached the point of immobility and excruciating pain thanks to what I recognized was a sciatica episode, and Ms. Ché and I agreed there was nothing for it but to get checked out and treated in the nearest emergency room.

After calling my Senior Plan's 24 hour advice nurse -- she was a sweetheart, too -- and getting her recommendation that I "be seen" pronto (call 911 you old codger, it could be worse than just sciatica which is bad enough!) I called 911 and shortly four burly EMTs showed up, two from the local fire department and two from the local ambulance provider. We discussed how best to get me to the gurney since they couldn't get the gurney inside.

I said I would try walking but I would definitely need help. Sure enough, fifteen or twenty minutes later, I made it to the gurney, an EMT in front and one behind, the others riding shotgun. The pain was just incredible, but I made it.

The drive into town takes 40 minutes at a good clip, and it seemed like the ambulance driver was booking, so we may have made it in thirty or so. At any rate, the first vitals check after they hoisted my bulk into the ambulance was pretty scary. My BP was high, much higher than it has been anytime recently (in fact I'm not sure I recall my blood pressure being that high), and the EMT said that it was often the case that people in pain show high blood pressure.

Just before we got to the ER, he checked again, and it was closer to my norm, though still high compared to my usual.

I felt like I was being loaded into a warehouse at the ER. There was nobody around except for the woman who buzzed us in, but we seemed to pass by an endless number of empty cubicles on our winding way to wherever. Finally got to cubicle #13 and there I was deposited.

Service was pretty quick and efficient if largely impersonal and soon enough I was seen by a Nurse Practioner, apparently the only ER quasi-physician on duty. My experience with NPs in the past has been very positive.

Anyway, we went through my symptoms and signs again (third time, I think, since calling for the ambulance). The NP determined that it was indeed sciatica (without additional complications) and offered several different injection options to try to control the pain. I chose cortisone injection because that's what I'd had before and it seemed to work remarkably well and quickly too.

Interesting that this time it seemed to work almost instantaneously in reducing the pain level from a 9 or 10 to a 4 or 5. The next issue was to see if I could now walk on my own. This proved a challenge, to say the least, but I made it to the rest room and back to my cubicle (peeing on the way) so that seemed a good sign.

But the pain was coming back. So the NP gave me another injection, which seemed to work as before, but by the time they got the paperwork ready for my discharge, I felt just about the way I did when they brought me in. Hm.

It seemed like the cortisone was wearing off very quickly.

Another check of the vitals, and I was free to go.

Go where? This was the most bizarre part of the whole episode. Having been discharged from the ER I was now on my own, to find my own way out of this maze of cubicles, and to go wherever I wanted.

Ms. Ché had not arrived yet, and I had no idea how to get out of the place. I stood in the doorway to the cubicle looking miffed and lost. "Free to go where?" I asked the disinterested nurses at the counter. "Home or wherever you want," one of them said. I said "I don't know how to get out of here." One of them pointed to a corridor that he said led to the exit, all I had to do was turn left and continue down the hallway. OK.

So I start on my shuffling way, in great pain but determined to find my way out. The exit corridor seemed long and intimidating. But I shuffled along, and who do I spy coming through the exit door way down the hallway but Ms. Ché looking thoroughly annoyed that I was attempting to walk on my own when it was obvious that I was barely mobile. Suddenly, the NP appeared and said he would walk me to the waiting room. Ms. Ché then bolted to get the car, which she said she'd parked quite a distance from the ER wait/deposit room. The NP got me to the waiting room, said I could sit until my wife arrived, and wished me well. I had already told him I was pissed at being told I was free to go without the slightest instruction of how to get out of the ER, and staff seemed to be uninterested in providing such information without a special request. I told him it was "weird." Well, yes.

He said he'd look into it, but I doubt he did.

Meanwhile I sat down, omg -- the pain, and waited for Ms Ché to arrive. It seemed to take a long time; she must have parked very far away. But once she arrived, the struggle to get me to the car ensued, starting with getting me up from the chair. Omg. Again. Well, I finally got up, but all that one foot after another business to shuffle me out the door was proving near-impossible. A security guard poked her head out the ER door and said, "Would he like a wheelchair? I see you're having some real difficulty." Both Ms Ché and I said, "Yah," and she brought one over and got me into it without too much trouble and wheeled me to the car. The load-in wasn't as painful as I thought it would be, and we thanked the guard profusely for her help. As is the case around here, about all she said was "No Problem," as she cheerily wished us well.

We drove home into the sunrise and as I was sitting in the passenger seat, the pain was solid but not intolerable. I didn't realize I was seizing up, however.

We discovered that when we got home. At first I could not figure any way to get out o the car.  But after a number of false starts, I managed to bull my way into an upright position. OK. Now what? I couldn't walk, even after Ms. Ché brought  me my cane. I was stuck. What to do?

After the last episode of sciatica, I bought a "seat-cane" that I took with me to Trinity Site just in case I wasn't able to walk the site unassisted. It proved a god-send, really. So Ms. Ché found it and dusted it off and brought it to me to use along with my usual shillelagh-cane. Would you look at that? As long as I had enough support on both sides, ta da, I could make it into the house and eventually back to bed.

I'd been given a prescription for muscle relaxant at the ER, but there was no way I could pick it up myself. I called the pharmacy and asked if they had received the prescription. They said, "No." I asked if my wife could bring the hard copy in and pick up the medication. They said "Sure, no problem." Sure enough, within another half hour or so, she came back with 20 tablets of cyclobenzaprine, whatever that is, and I took one as directed, and almost immediately fell asleep -- as did Ms. Ché who'd been up fretting terribly since my first expression of "extreme pain." We both slept for several hours, and when I woke up, I was still very stiff and sore, but the pain had diminished considerably. Yay.

Another muscle relaxant, back to sleep. This time when I woke up several hours later, I thought I could actually get out of bed without assistance and shuffle to the bathroom to pee. I managed to do it, though there was still a lot of low grade pain, but I found I couldn't get back in bed without assistance as my left leg was still pretty numb and I couldn't lift it onto the bed. Ms Ché helped, and it was back to sleep for both of us.

Several hours later, I took another muscle relaxant tablet, and after a few minutes fell asleep again.

When I woke up about 8am Friday, it felt like the pain was almost gone. I could get up and walk albeit slowly and carefully. I could sit down in a chair. I could use the bathroom. I was still stiff and sore as heck, but it didn't hurt nearly as much. Double plus Yay.

Ms. Ché was delighted if a bit wary. She planned to go to school today -- she missed classes on Thursday -- but she was worried sick that if she left me alone, I'd be in distress. I said, "No, I feel OK and I can walk. You go ahead. I'll be OK."

I've spent the day in  a kind of dream world, able to get around, but lacking energy and seeming to float. The pain has almost disappeared which is great.

I had to cancel two appointments, one with my primary care provider on Thursday. Couldn't make it, sorry. Another with the infusion center where I was supposed to start Rituxan infusion Monday. Couldn't imagine sitting seven hours while they do their thing.

But all in all, this has turned out to be one of the worst bad and quickest resolved sciatica episodes I can remember. The last time, I didn't get treated at all because it seemed mild and I knew it would pass in a few days or a week. It did, but not without reminding me how frail I was.

This time, it seems to have passed in two days. Amazing, though I wouldn't want to push my luck.

And next time? Who knows.


  1. Che, my brother,

    Mrs Junior has been reading your medical posts. She has been so taken aback by the doctor's reluctance to prescribe opiate pain relief, as, of course, have I. I can't recommend looking for Mexican heroin. You have to smoke it, for God's sake. But is there any way you can get ahold of some good old-fashioned marijuana?

    It is actually more potent when you eat it than when you smoke it. Just take one eighth of good indica or sin semilla and bake it in one eight-inch square pan of brownies. Cut it into sixteen brownies. You should only need one half of a brownie or less to provide some relief.

    1. Medical marijuana is more or less legal here, but I have no idea where to get it. There are dispensaries, but they keep a pretty low profile. It's not likely, but it's possible that one of my physicians would prescribe it if nothing else works on the pain.

      The cyclobenzaprine (whatever that is) seems to work remarkably well all things considered. When I pointed out that I had taken Tylenol 3 to try to control the pain, and it had no effect whatever, the NP tsked-tsked and said it was an opioid, and what he was going to prescribe usually worked better. Sure enough.

      As for failure to prescribe opiods or any other pain relief during this saga, I'm going to have to ask about it, because it seems odd. There is a history of opioid abuse in New Mexico going back long before the current panic over it (but it only affected "the Mexicans" so who cares, right?) I suspect the reluctance to prescribe now is a consequence of that -- and relatively strict laws about it.

      I had no trouble at all getting opioid prescriptions in California. It was taken for granted that patients in so much pain they presented at the ER needed something stronger than Aleve.

      While I had no trouble getting pain meds in California, I didn't like taking it. 1) it didn't always work. 2) side effects were unpleasant.

      Anyway, thanks for your concern. I'll get through this one way or another.