Tuesday, January 12, 2016

Updated Diagnoses of Spine, Lower Extremities & Chronic Pain Disorders

I hope that this blog post finds everybody well and off to a great New Year!

Some may remember that I had a procedure done in the middle of December that was outpatient. This was a CT Myelogram. The myelogram itself is a procedure in which they inject a contrast dye directly into the spinal canal (much like an epidural, except more fluid), then manipulate the body (and actually tip you on a table) to let the dye flow into the desired areas of the spinal canal and nerves surrounding it. The technicians then take pictures while the patient is in each position, all under radiofrequency equipment, to see what areas of the spine are damaged. After the myelogram is complete, the patient is then sent to the CT scanner while the contrast fluid is still in the spinal canal, allowing for better visibility of possible abnormalities. The myelogram itself is a painful process simply because of the positions they put you in after the dye hits the damaged nerves (which hurts terribly - multiplies your pain by 10x at least). But in the end, the clear picture of damage is much better than any MRI or CT (by itself).

This year, they found more damage in the cervical spine (neck). I have 4 bulging discs in the neck that we were not originally aware of. That makes for 7 bulging discs in the spine total. They also were able to see (miraculously) the impingement of the L4 nerve. To actually SEE evidence of an impingement is pretty note-worthy. I have EMG studies that have found nerve damage from the age of 24, but they could never see it on a study. They also found that my discs are beginning to collapse on one another at the L4 & L5 levels.

Much of the other findings were things we were already aware of, such as the progressive degenerative disc disease, spinal canal & foraminal stenosis, bulging discs & bilateral foraminal narrowing, etc.

Spinal & Chronic Pain Conditions:
* Hypertrophic facet disease
* Facet Arthopathy
* Progressive degenerative disc disease (cervical and lumbar)
* 2 collapsed discs in lumbar (L4, L5)
* 8 bulging discs in lumbar & cervical spine (C2, C3, C4, C5, C6, L3/4, L4/5, L5/S1)
* 2 torn discs (L4/5, L5/S1)

* Thecal sac compression (L3 & L4)
* [Visible] nerve root impingement (L4)
* Gross spinal instability (lumbar)
* Spinal canal & foraminal stenosis

* Bilateral foraminal narrowing (L3/4, L4/5)
* Ligamentum Flavum Hypertrophy (not connected with Hypertrophic Facet Disease)
* Bilateral sacroiliac (SI) joint dysfunction syndrome
(SI joints aligned and 85% relief from surgery -   SI joint bilateral fixation with screws)

* Piriformis Syndrome (80% relieved due to surgery - Piriformis Release)
* Mild Scoliosis
* Peripheral neuropathy in both legs and feet
* Bone tumors in cervical spine (neck)

* Chronic Pain Syndrome (CPS)
* Fibromyalgia

* Myofascial Pain Syndrome (MPS)

The following diagnoses are impacted by the spinal & chronic pain conditions:
* Insomnia
* Adrenal Fatigue, Stage III (out of IV)
* Chronic Fatigue Syndrome (CFS)
* Chronic Migraines (with ocular changes)
* Vertigo

That's a total of 40 diagnoses (if you count each damaged disc as a diagnosis, as they do in the medical field). 33 of those diagnoses are oriented of the spine. The remaining 7 diagnoses are usually linked to my chronic pain in some way, yet separate from the actual disorders of the nerves and spine.

Although the diagnoses keep adding up, so do my blessings. I'm alive. I have great access to healthcare. Yes, I struggle with bad days just like anyone else does, but I also have great days. God gave us emotions for a great reason. But I also need to trust God, and not my heart, not my emotions. And let me tell you - with that trust, God brings us a great hope for today and tomorrow!

2 Corinthians 4:15-16 (NIV)

All this is for your benefit, so that the grace that is reaching more and more people may cause thanksgiving to overflow to the glory of God.
Therefore we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day.

Review of Sacroiliac Joint Surgeon, Physical Therapist & Hospital

Well, it's been 9 months since my last update on my blog. I never intended to lag behind so badly, but with the recovery of major back surgery from March 2015, attempting to homeschool two 4-year old boys [using my own curriculum], and so much more, I simply put blog updates on the back-burner. But I'm back, and although this blog is by far not my priority (but rather a hobby), I hopefully can update every month or so with a blog post.

So I wanted to briefly touch on my surgery experience following the Bilateral Sacroiliac (SI) Joint Stabilization Surgery and Bilateral Piriformis Release performed by Dr. David Weiss in Gainesville, GA. First off, I do not get any sort of benefit from promoting Dr. Weiss or his business. I say all of this simply to share information for those who might be in the situation I was in, and with limited options as I was faced with.

As with any health organization, there are pros and cons. I'll start off with the only complaint I had, which in hind sight is very small in comparison with the great results of the surgery and the excellent staff that worked with me. When going the route of using Dr. Weiss' office, they have to facilitate the use of a Physical Therapy office that at the time [the office] struggled to communicate the charges (outside of insurance - not a copay) that would come up during the time I was under their care (application charges, initial appointments, pre-op appointments, surgery day OR charges, and post-op visitation charges). If you need this surgery and are interested in using Dr. Weiss, you have to go through the physical therapy office they use, as the therapist assists him in surgery. My personal recommendation is to sit down (or call) the office manager (not the financial manager - she did not give accurate quotes) and have them explain each and every charge that will come up - from the initial visit to post-op visits. If you can, record the conversation so that there is some accountability, and make sure you take the person's name whom you are speaking with, the date and the time.

Myself with Vikki Sims, Physical Therapist
Having said all that, let me say once again that this was the only complaint I had the entire time I was going through this process for spinal surgery. The physical therapy office space itself was excellent - it was extremely spacious, was very clean, had great waiting rooms, restrooms, exercise space, individual patient rooms, private meeting rooms, etc. The staff was very professional. The actual Physical Therapist, Vikki, was absolutely AMAZING. She is known cross-country for her expertise of the Sacroiliac Joint and Spine. She had a fantastic bedside manner and was extremely knowledgeable. Vikki and Dr. Weiss work as a team in the Operating Room. Vikki meets with the patient prior to surgery to teach the patient and spouse, if applicable, how to set the Sacroiliac joints back into the groove of the joint, and has you watch a video about the surgery & gives you material to read. This better prepares the joint and anatomy surrounding the area for surgery. When surgery day does come, Vikki sets the SI joints into place in pre-op and after they move you onto the table. She double checks everything before they screw the joints in place. They also use radiofrequency guidance. I can't say enough to ensure you how excellent of a job Vikki does, all around.

Dr. Weiss was absolutely fantastic as well. His office was a clean facility, and his nurse was very personable and gave quick call-backs if I had questions. My initial exam with Dr. Weiss was to see if I was a candidate for surgery. The exam was extremely thorough, including an X-ray done in his office and by his staff (at the angles he wanted to see), and his nurse dictated notes throughout the exam. The initial visit lasted approximately 2 hours, and Dr. Weiss spent 45 minutes to 1 hour with us in the exam room. He went through every single option with us and answered any questions we had. He did not seem to be in a hurry, and I left feeling relieved that the option of surgery was finally on the table.

The hospital in which surgery took place was Northeast Regional Medical Center (NRMC) in Gainesville, GA, and it was a fantastic facility. Coming from a family of nurses, I have pretty high standards for healthcare. I've had plenty of experience with hospitals, and the only other hospital before my experience with NRMC to meet my high standards for healthcare was UABH (University of Alabama at Birmingham Hospital). I stayed for two nights at NRMC following my surgery and felt more than cared for, had my pain fairly well controlled, and knew I was in good hands, even when the doctor wasn't around. I was listed as a "spinal patient" with "spinal precautions" and couldn't get out of the bed alone, but nurses or techs would gladly come to my aid within 2-4 minutes of my request to get out of bed. The friendliness of the staff was absolutely fantastic. I never felt like an inconvenience, no matter the request. I rank this hospital stay as #1 in my experience.

I will soon post a blog about my 9-month post-op progress, which has been great compared to where I was prior to surgery. As always, please feel free to ask questions! My hopes are that this "review" helps those who are looking into this surgery know a little more about this option.