sympathetic nerve block –day 120 (17wks 1 day)
One day short of exactly four months, I returned to the hospital where I had my surgery – this time to have a sympathetic nerve block.
As directed, i showed up an hour early, filled out paperwork, got put in a ‘room’ (partition), got my stats taken, and got an iv. (Though painful, this one was nowhere near as bad as the one I got pre-op…I still hate getting them though!)
And then, I got to wait…and wait..
Similar to last minute thoughts I had last night – such as for the first time, starting to really think about the procedure and immediately finding myself queasy, I began to worry.
Amazingly, for the first 20minutes of waiting, I managed to ‘read’ the only magazine there was nearby..but then i reached the end and…my brain began..I’d never met the anesthesiologist before..as per his online profile, he’s a year younger than me (a. makes me feel old since i’m transitioning from the world where all doctors are always at least 20yrs your senior…b. makes me feel that he can’t possibly know anything/be an experienced doctor if he’s only my age!..)…anyway, my brain began a stream of doubts.
He arrived about 10minutes late – which, for my brain, was just in time as it only allowed a good 5minutes of spinning last minute doubts. Were he an hour late, I would have either needed a sedative, would have left, or would have again entered the zen calm that from time to time i find myself oddly falling into during this process when I know that there’s nothing i can do to change things and..what happens..is. (Perhaps it’s some kind of ..so anxious that you come full circle, breaking through to the side of complete acceptance?)
So, he showed up and almost instantly, I thought he was great. He reminded me of my surgeon which is a wonderful thing..Unlike the MD I met with at the pain clinic, he seemed a lot more approachable/reasonable/open..
He pulled out a piece of paper that gave a basic overview of the process. While showing it to me, he said that there is an organization that makes the rules and declares specific criteria for CRPS. And some people clearly follow in that criteria – they have a, b, c, d and have them all at the ‘expected’ levels. But not all people are that clear…some have some symptoms but not others..and it’s not a straight forward condition. So, he prefers to go off of clinical analysis and looking at the particular patient instead of simply, blindly following the exact specifications declared. This was actually quite similar to what my surgeon had said previously (e.g. the concept that it’s not black and white like a broken bone).
Following this, he stated that this procedure wasn’t to eliminate my pain, it was a diagnostic test for CRPS. This was the first time anyone had said this to me – as per his assistant? for all intents and purposes, I’d be pain free for a long time..No one – while making the appointments, or when first calling me back to bring up the block – said why/what the block was really for. I figured it out based on the procedure he was doing, but if I hadn’t, I would have been in for quite a surprise given what I was told.
He showed me the overview paper while stating that the other doctor at the pain clinic might have already shown me this..I said no..I told him I had asked the other doctor about a block as my surgeon had sent me to the clinic listing it as one of the things they could do for me, but was told that I didn’t need one..and then the next day, got a call that he (the anesthesiologist/head of the medical section at the clinic) had reviewed my file and wanted to schedule a block. He then said something along the lines of ‘yeah, that’s basically what I was saying along the lines that some people follow the strict a,b,c whereas i look at the individual case and try and see if there’s something we can do that could help this patient.’
The likely underlying message got through, though he said it pretty tactfully – but then, entertainingly, he followed it with something along the lines of ‘that’s my politically correct reply’.. Which made me think he was all the more spiffy as I really didn’t bond with the other MD…The other MD seemed a black and white a2+b2=c2 approach while…patients are people and don’t always follow in the spots you have preformed over the many years you’ve been an md.. (maybe the fact that the anesthesiologist was my age isn’t such a bad thing after all)..
Anyway, it was something along the lines of …i felt quite frustrated after the clinic…wasn’t warm and fuzzy about the md I met there…this made me feel all the more stuck with this whole thing…meanwhile, i’m meeting another potential md that i might be able to work with and not only do i feel like he’s easy to talk to, he seems to have some similar opinions as i on treatment/patient approaches…andddddd i was in high-worry mode as it was right before the block – and he immediately put my mind at ease. so, all of this combined meant I thought he was mighty spiffy.
Soooo on to the point – he showed me the sheet. None of it was unexpected as I of course had already read all about it 🙂 But it had the basic outline – they give the local anesthetic, followed by ink, followed by the final anesthetic. He then took the temperature of my feet and went in to the room where I was to meet him..
The nurse wheeled my bed into the room (holy cold!). She was there, an x-ray tech, and of course my doctor.
They had me get on a narrow table, put a pillow under my hips, one under my head, and one under my feet. They lifted my shirt, pulled down my pants in back a bit (plumber level) and tucked the blanket into my pants. My back was cleaned and then they started doing who knows what to prepare. During this, my anxiety began to increase..I was partially okay – I knew why I was there, liked the doctor, and was okay with it..But I was also part…quite afraid…So I was contemplating asking if they could give me something and right then, the nurse verified with the doctor that she’d be giving me fentanyl and versed. Woo.
When she said it, I asked if she was referring to a pre-procedure calming thing…The doctor then said yes, but i could have as much as i wanted – was i worried about being given it? I replied emphatically that I was worried about not being given it…Please, make my iv worthwhile!
And so she did.
Within moments, the world was okay..whatever they were going to do was…okay..
The doctor asked what music I liked to listen to and much to my surprise, he found it with his iphone which he then put on a table near my head…This was even more surprising to me as – I had music with my mri – but it was in horrible old airplane style earphones…this – we were all in a small room together – what i heard is what they heard…so, i thought that was pretty great..Though as soon as I realized what was going on, I thought (but didn’t say as i was..out of it) that it should be what he wants to listen to – after all, he’s the one with a needle near my spine.
He then gave me the local anesthetic injection and oh yeah, it hurt…One of those moments where you tap your foot/your fingers/squeeze your hands together…anything in an attempt to distract and offset while waiting for it to be done..Undoubtedly though, the pre-procedure drugs helped..
A short moment later, he began with the dye and then the final injections..With each needle push, there was definite pressure..It did Not feel good..It wasn’t sharp pain like the local, but it was not a pleasant thing..again though – i’m thinking it would have been quite worse if i didn’t have the iv drugs..At the very least, I would have tensed up, anticipating each future push of the needle – which definitely would not have helped anything..
Three songs later, and he was done.
Again – three songs..about nine minutes…no iv drugs..i wouldn’t have held up so well.. with them..it was done before it began..
He then showed me the x-ray screen – where the dye was and where they don’t want it to be (which, it wasn’t). Again, the temperature of my foot was taken and I was wheeled out.
My foot definitely began to warm and turn red.
After about 30min, he finished with another patient and came out to measure my foot’s temperature again. He then tested sensitivity to touch which, same as before, most spots on my foot were dandy..But to my surprise – the yucky lateral spot (which I have been working on desensitizing *every* day) – it felt weird…not ideal…I wouldn’t seek out someone to touch it, but…I would be fine if I went to PT and they wanted to massage the area..it would no longer make me smacky..nor did my foot auto-jerk away when he touched it.
That was quite a change..But I wanted to know about what was far more important to me – walking.
So, I got to try it. And I could walk!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
It hurt. Oh yes indeed. But I was able to heel-toe push-off with NO crutches.
My knee didn’t buckle..again – pain and then some, but it hit a 7-8 while I completed each step. Normally, it hits an 8, my knee buckles as any further pressure would hit a 9+ and I don’t even have the option of carrying on..
I was elated. On the one hand, given what the response to the block could mean, as mentioned, I don’t want it to work..but…all the same..to be able to walk again – if only for a day..even in intense pain…to even be able to..four fucking months…it’s crossing from the acute to the chronic…it’s begun to raise the question if i truly will ever really walk unassisted again..the longer it continues, in my mind, the more it raises the potential for my body to begin making permanent/associated changes…changes that lock in this new way of being…the – i can fix it now..but if it’s not shifted back to normal now…this will be the new normal..
To walk…no boot…no crutches…
Part of me wanted to cry.
I was given a pain diary sheet to fill out and was released…
When I got home, I couldn’t sit down. Though irrational, I had this feeling that if I stopped…as long as I kept on my feet, kept walking, I could keep the miracle alive..but once I sat…once I rested…it would all be over.
I put away laundry, put together some IKEA boxes while standing (and doing a heel-toe rock that had full weight on my bad foot)..ate while standing/pacing…anything to keep on my feet..
During this, the pain actually dropped a bit – from a 7-8 to a 7 – with at least a layer of the pain being an arthritic stiffness/lack of proper use for 4months..
I then remembered my treadmill that has begun to gather dust…I walked 1.2 mph for 10 minutes…By the end of the ten minutes, the pain had begun to increase..It had been about two hours since I got home, so even had I sat instead, I think it was simply..time was up…
During the last two minutes, I had to use the treadmill’s bars to hold some of my weight…and, shortly after, though I was still trying to continue on unassisted, I had to go back to one crutch.
What it all means…perhaps placebo effect…perhaps the pain killing power of the fentanyl + the relaxation of the versed made it possible…perhaps it was the block…I don’t know..And what happens next…I’m still trying to get a follow up appointment scheduled.
But for those two hours…I once again was full of awesome. Full of pain, yes, but..I was on top of the world..I was walking again..
pttd surgery 
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