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.

The Silk Pillow Effect

Silk Pillow

I've been out for the last few days with an episode of sciatica, a recurring problem I've had for the last ten years or so. This is the first time it's happened since we've lived full time in New Mexico.

There was a precursor episode about ten days ago, when I knew a sciatic attack was underway, but the symptoms were mild enough that I wasn't particularly bothered. I could walk, sit, stand, and the pain was relatively mild, focused on the left side of my lower back. It felt as if a vertebral disc was protruding and pressing on the nerves that ran down my left leg. I've had this before, and it's annoying. Sometimes the leg goes completely numb, but more often, my left foot is numb which can make it difficult to walk without lurching and limping about. Usually the pain is mild and can be controlled with Advil or the like. Initially, too, I applied Holy Dirt from El Santuario de Chimayó, which caused immediate and lasting pain relief. Milagro! I can't explain it, but that's what happened. I knew that there was still a sciatic condition, for I could feel the disc protrusion, but the nerve pain was nearly completely gone, and I was quite in wonder at the miracle of it all. I think I then became somewhat complacent. Mistake.

On Friday I woke up in real agony, with intense pain in my left hip, so intense that I was unable to sit or stand or walk for more than a moment or two without experiencing excruciating pain, and so,  for all intents and purposes, I was confined to bed. This was the worst episode I'd had for close to ten years, and the evocation of what I went through back then was not pleasant. Something had happened during the night to force the disc out further and press even more severely on the nerves involved thus producing a constant intense pain. Movement of any kind was difficult. Sleep was impossible.

I came very close to calling Emergency Services, even though it would mean transport by ambulance over 40 miles to Albuquerque's Presbyterian Hospital emergency facilities. This was not an idea I enjoyed at all. Bad as I felt, the thought of an extended trip in an ambulance to wait in an emergency room for essentially little or no treatment and then a ride back home in the car (would that even be physically possible?) was daunting.

I would just have to tough it out somehow.

Sciatica is the set of symptoms signifying a nerve condition in the lower back and hip region often affecting one leg as well (rarely both). It can cause extreme pain and discomfort, numbness in leg and foot, and difficulty walking, sitting or standing normally. As it is right now, for example, although the pain is mostly gone, I can only walk with a very pronounced limp and may have to start using a cane. The cause, in my case, is a herniated and protruding spinal disc that presses on the sciatic nerve that runs down my left leg.

Yes, when it is bad, it hurts like almost nothing you can imagine. There is no escape from the throbbing, shooting pain that lies so deep in the tissue of the leg and hips that it seems to come from some mythic place you didn't know existed. In my case, it was impossible to sit or stand or walk for more than a moment or two, and even lying down could be fiercely painful. Adjusting positions could become an agonizing trial. 

As I say, I've had the condition for ten years or more, the first episode occurring when I was getting out of the car one day and twisted my back just so, causing the spinal disc to protrude. I knew something had happened, because I could feel the protrusion before the pain started. Once the pain started, I couldn't move without extreme pain, and had to be transported by ambulance to the ER where I was promptly seen and diagnosed, but apart from a cortisone injection (which really didn't help much) and some meds, there was nothing, they said, they could do. It would have to heal itself, which they said would happen in a few weeks -- or months.

True enough. The pain gradually dissipated to almost nothing, though leg and foot numbness was constant and relatively severe. In about three months, I felt the disc pop back into place, and the pain -- and most of the numbness I'd been experiencing -- promptly went away. But not completely. In fact, ever since, I've felt consistent numbness in my left leg and foot, sometimes mild, sometimes relatively severe, and I have had modest difficulty walking and have a slight limp favoring my left side. It's been very difficult for me to bend down to pick something off the floor, and there have been other issues, especially around driving long distances (which I used to do quite a lot). For all intents and purposes, sciatica is a chronic condition for me, sometimes debilitating, typically merely annoying. One learns to cope.

This was the first time a severe episode had happened in several years, and it was the first time I had experienced it since moving permanently to New Mexico. Now that I have Medicare Advantage through Presbyterian (one of the major health care providers in New Mexico) at least I have access to medical care if I need it. The problem is that Presbyterian's services are located in Albuquerque, and we live out in the country 40 or more miles away from the closest Presbyterian clinic or hospital. There are alternative services closer to us, but they tend to keep banker's hours and are not equipped for emergencies. If I were to use these out of network clinics, the financial consequences would be essentially the same as if I had no health insurance at all. One thinks long and hard before doing so. On the other hand, when we actually did have no health insurance, we had to use an urgent care clinic for a badly infected wound, and the cost was surprisingly modest, the service competent and quick. The really major expense was for antibiotic medications, not for clinic services.

In this case, since I knew what had happened -- oh yes -- and knew from previous experience that except for certain prescriptions (and possibly a cortisone injection), there was nothing that could be done about it except to grin and bear it and let it heal on its own, I decided to forgo medical treatment altogether. I had enough meds from the most recent episode, a nice cozy bed, and I'm always more comfortable at home than in the noisy, frantic atmosphere of a hospital, especially the emergency room, in any case.

I came to suspect my cozy bed itself was part of the problem. It has one of those memory foam mattresses, which at first was extremely comfortable but over time -- we've had it well less than a year -- began to develop rather more permanent depressions where we sleep than returning to shape as advertised. We have another bed with a more traditional innerspring mattress in the south bedroom, but that room isn't heated during the winter due to our energy conservation routine (we close off unused rooms during the winter, so as to heat the least amount of floor space we can. Still heating costs are quite high as energy is relatively expensive in this part of the country -- about twice the rates for gas and electricity we were paying in California, for example). There was no way we could exchange the mattresses between rooms in my condition. So, we had to figure out if there was something we could do to modify the foam mattress enough to support my hip rather than let it sink in.

This is where the Silk Pillow came into play. The pillow is usually on Old Joe's chair, the one item of furniture we retrieved from Joe's house next door in California after he passed away. Frank and Rosemary, who had been taking care of him, were clearing out the place preparing it for sale some weeks after he died. They thought the old chair was worthless and were grateful that we wanted to take it for the memory of him. It's a very '40's style rounded upholstered chair, beige, very much like Joe himself, and we treasure it. For a time, it was my main seat in the living room, but I traded it out for another old leather covered chair we have some time ago. Old Joe's chair became the "sickie-chair." When we are feeling under the weather or one of the cats needed care, we'd use Old Joe's chair because it was snug and comfortable, and we all seemed to heal better and faster there. The Silk Pillow was on top of the seat cushion as extra padding, just enough, it seemed, to make the chair quite soft and supple. We decided the Silk Pillow was needed on the bed to support my left hip, and that's where it went.

Relief began almost immediately, though the pain continued to be quite severe nevertheless. From Friday to Sunday, there was no let up in the pain, though I could tell it wasn't getting worse -- a good sign -- and I was gradually able to move somewhat more freely. By Monday, I was able to get up and get around, not exactly freely, but at least I could become physically more active and walk -- or hobble -- to the bathroom, that sort of necessary thing. I had a very pronounced limp, though, and nearly fell over a number of times. It was as if my left leg had shortened several inches. Sitting was still a problem, but as the day wore on, even that became less and less troublesome.

Finally, by the end of the day yesterday, I could say with fair confidence that the pain was gone, though numbness continued in my leg and I still have a significant limp. I can still feel the disc protruding, though not as much it did during the worst of the episode. Pressure on the nerve is mostly relieved, whew.

In the course of this episode of sciatica, I've used several tactics to control and relieve pain, some of them remarkably effective, if only for a short while. The Holy Dirt was the first thing I tried, and it worked -- miraculously -- until Friday when the pain became severe and the Dirt didn't work when I applied it. Well, I shouldn't say it "didn't work," because it did, sort of. The pain near surface level immediately vanished, but the deeper pain continued unabated. Something else would have to be tried. The medications I had included Darvocet, Vicodin, and Valium. I took them at recommended dosages, not really expecting much relief (as I'd used them before, briefly, and didn't think they helped much) but I was willing to try again. In fact, this time they did work surprisingly well though not perfectly. Pain was controlled for as long as a couple of hours, which was better than nothing and allowed some sleep. We used ice packs on the affected hip (actually frozen vegetables wrapped in a towel) which was a real, if temporary, relief. Thanks to a recommendation, I tried a topical analgesic "StopPain" -- which at first seemed to make the hip pain much worse -- OW! -- but after fifteen minutes or so, the pain was literally gone, and the effect lasted for about another fifteen minutes. Hmm. Success, modest though it was. The Silk Pillow continued to support my hip so that there was lessened pressure on it and thus less pressure on the nerves that were being squeezed by the protruding disc. And that, in the end, seemed to do the trick. As the pressure was relieved, the pain lessened to the point that it was practically unnoticeable.

And then there was the cat, "Girl" she's named, who recognized right off I was in distress and she wanted to help. Cats are very sensitive that way. Unfortunately, she wanted to help by curling up tight on my right arm -- which strangely made the pain in my left hip and leg flare up. So I told her, "No." She didn't understand at first, and then it occurred to her that she could help by lying closer to the source of the pain, but not actually on me,which she did. By golly, it did seem to help, and she seemed so pleased and proud of herself to have aided my recovery. She liked the Silk Pillow, too.

And so, there's the story of sciatica and the Silk Pillow Effect.

We do what we can... ;-)

At the After Hours Clinic Yesterday

Well.

Yesterday, I went to Kaiser for the first time since this spring when I was being treated for pneumonia (that had been suspected erroneously to be tuberculosis, which was repeatedly tested for and never found. Oh. Whell.)

I had to go because I'd developed an annoying and painful rash, much of which had appeared suddenly, overnight. Good gott, what was it? When I called up the advice nurse, she went through the flow chart routine, "Does it hurt?" Yes. "Is it blistery?" Yes? "Is it on one side of the body?" Yes. Etc. She said there were no appointments available, but she could have a doctor call me in half an hour or so. Ok.

Doctor called, went through the symptoms again. She said, "Have you ever had shingles?" No. "Chicken pox?" Yes. "How far away are you?" A few miles. "Get over here, quick." She told me where the clinic was, and she said she'd expect me within fifteen minutes.

Sure enough, she took one look, said, "Shingles." Oh fine. Said it was going to get a LOT worse -- it has -- and there wasn't a lot they could do, but she would prescribe ointments, anti-viral drugs, and Vicodin. If it got way worse, come back, otherwise, endure it.

How long? I asked. She said, "You don't want to know." I repeated, how long? She said, first time outbreak like this, could be months. And it can get very painful. If the pain gets out of control, call back, she'll prescribe something stronger.

Great.

It was a quick evaluation, to say the least, but I had realized that it was shingles when the flowchart of the advice nurse pointed there. Actually, the earliest symptom was a sharp burning pain deep in my leg that I attributed to a recurrence of the sciatica that had cropped up a few years ago. When I saw a small skin eruption on my leg, I did not relate it to sciatica. Instead, I thought it might be incipient melanoma -- what my father died of. But it didn't really fit any sort of melanoma symptom set I could find. It was something else, I was sure. When a few days later, the eruption spread suddenly, I still didn't connect it with shingles, though I was trying to figure out some connection with the nerve irritation and pain of sciatica.

When I talked to the nurse, the "ah ha!" moment arrived. Sure. That's what it is.

It is painful, annoying, interferes with sleep. I hate taking codeine. But it seems to control the pain (and scramble my brain!), so... one does what one must.

I asked the doctor what could have caused it. She said it was probably just my age and the fact I had had chicken pox when I was younger.

Thanks.

Grr. Talk about poison. Well, there you are.