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Monday, January 27, 2014

new plan

It's been a tough few weeks and days for me. My pain levels just haven't let up, which means I've been spending more time than I want to be "laying low". I was organizing medical expenses for my taxes the other day and calculated just shy of $10K that I've paid out of pocket this year alone. That's a lot of moola to wrap my head around, especially when that's year #3 and I'm starting a new year without any less pain. I've also been feeling discouraged after trying CBD (cannabidiol) over the weekend without any alleviation of symptoms. CBD does, however, make me feel very tired. But it turns out pain + drowsy doesn't feel any better than regular ole pain.

And then there's the anxiety that's been leading up to today, the last day of my extended medical leave from work. I thought I was mentally prepared to give my official notice of leave this morning but it's still been an upsetting process for me. If you had asked me when I graduated college, this certainly isn't the career move I would've anticipated making four years down the road. But shit happens..I'm doing what I need to do to get better and the only direction to move from here is forward. I'll lose my benefits starting next week, but thankfully will be able to go straight on to Craig's health insurance.

Ok, now to the good stuff. So we've been waiting to hear back from Dr. Crutchfield in Baltimore, who was reviewing my records before deciding whether I should fly out for a consultation. Craig's been communicating with a case manager from his office, who's been incredibly helpful. This morning Dr. Crutchfield called Craig to propose a new plan of attack.

Dr. Crutchfield acknowledged the ligament laxity I have going on at C1/C2 as a likely source of my head pain. He explained to Craig that the the excess motion of C1 ("rocking") can irritate the spinal nerves, which turn into the greater occipital nerve. Where the occipital nerve passes through the trapezius muscle can cause a trigger point, which could be a likely additional source of my headache. (Holy shit, that could explain the chronic tension in my traps that no amount of manual therapy will get rid of?!?)

It's not uncommon for irritation of the occipital nerve to trigger a "central headache", which would manifest as dizziness with eyes closed, sensitivity to light and sound, etc. Dr. Crutchfield was very happy to hear that I DON'T have those symptoms and therefore feels confident that my pain is caused by peripheral irritation. He explained that treating my symptoms with drugs and joint mobilization are therefore, not the answer...which makes so much sense to me.

Even though I may or may not have cried like a baby when Craig told me that Dr. Crutchfield doesn't want me to come out there yet, all hope is not lost (which I learned when I let him finish talking). In fact, hope is something we have more of now than we've had in a while! Here's what's about to go down...(drumroll)...

-Starting tomorrow (when it arrives in the mail), I'll be wearing a soft neck collar 24/7 with the goal of completely shutting down movement of my neck and giving the ligaments a chance to self repair. Part of me has a little anxiety attack when I think about the implications of being in a neck brace. I won't be able to do anything that involves neck flexion, extension, rotation, etc. I'll also need to avoid creating tension in the surrounding area, including my traps. No lifting, no yoga, and...wait for it...certainly no mountain biking. But hey, I can deal with that. Nine weeks seems to me like a small price to pay.

-In 6 weeks (or maybe a little less), Craig and I will fly out to MD to meet with Dr. Crutchfield. He'll perform some trigger point injections with a steroidal anti-inflammatory where my greater occipital nerve goes through my trapezius. We'll do this again a few weeks later, and possibly again a few weeks after that. According to the doc, it takes an average of 2.3 injections for patients in my position to get better. He gave Craig the option of finding someone here in AZ to do those injections, but we both felt most comfortable going straight to Dr. Crutchfield and avoiding any possibility of this process not going as absolutely perfectly as it can. When my symptoms have alleviated, whenever that is, we'll redo an x-ray to make sure the amount of rocking has decreased (this time just through an open mouth static x-ray to calculate how much excursion C1 has on C2).

So there we go. Tomorrow I am still going to my appointment with Dr. Anghel (a referral from Dr. Schurgin, who didn't feel comfortable discussing potential nerve blocks/ablations at C1). We'll hold off on any procedures while we pursue this new plan with Dr. Crutchfield, but figured we may as well get his insight since we already had this on the books). We'll also be turning the focus of my rehab appointments to creating the best healing environment in my body. It turns out that I don't have a shortage of other issues to address, so we figure this is the best time to do so.

Maybe next time I'll keep things entertaining with a little neck collar visual (but maybe not).

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