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Friday, February 21, 2014

Hruska recap

Craig and I arrived home from Lincoln, NE last night. Aside from the disappointment of returning home with the same headache I left with last weekend, we both feel like the trip went as smoothly as possible. We have more clarity around the mechanisms of my pain, more confidence that it can be fixed, and a solid set of tools at our disposable to make it happen.

Picking up where I left off in my last post, which provided a detailed account of my first day at the Hruska Clinic, Tuesday consisted of another session with Ron (this time along with the optometrist, Dr. Weiss), a visit to their dentist to get my mouth piece molds made, a second PT session with Torin, and a visit to the vision center to get my glasses made.

After thinking more about my case between Monday and Tuesday, Ron offered us some additional insight. Though on the surface I appear to be more of a "head/neck patient", he explained that in his eyes, I'm actually more of a "hip patient". This didn't blow us away, as the hip connection has been something I've explored with several other therapists. I know mentioned this a while back, but in 2010 I had arthroscopic surgeries on both hips to repair labral tears. My left hip hasn't been an issue since, but my left one does irritate me quite a bit (what I would describe as a "pinchy" feeling and the constant need to "get at" my TFL with a tennis ball). To be honest, though, the severity of my head makes any other aches and pains seem negligible.

Anyway, Ron thinks that the issues I'm experiencing with my head are ultimately being driven from my hips, specifically my hip flexors. My left femur is too far forward and my left too far back. The rehab exercises that we spent the next few days learning with him and Torin are therefore focused on the connection between my left quad, glute, and abs. By getting me out of extension, he thinks that this will be able to remove the tension in my low back and neck, which are contributing to the "twisting" of my cranium. I have a series of exercises and progressions that I'll spent the next few weeks focused on mastering. I wear my glasses while doing my rehab (along with some work around the house) and my mouth piece at night with the goal of maintaining neutrality (mental image real quick: neck brace, mouth piece that causes my bottom lip to stick out, glasses...you're welcome) As of right now, I'll likely be going back to Lincoln at some point in the next few months, but just taking it one step at a time.

Looking ahead, Ron is also totally aligned with us pursuing the course of treatment with Dr. Crutchfield, which includes continuing to wear the neck brace for another couple of weeks before we head out to Baltimore for my first set of injections.

All in all, Craig and are both very happy that we made the trip to Lincoln. It can certainly be difficult for me to stay positive when I'm having to relearn movement patterns, breathing techniques, and trying to "feel the floor under my feet" when all I want to do is make my f-ing headache go away. I understand the theory and the science but sometimes the emotional frustration of chronic pain can make calm and logical thought a bit blurry. Craig has been explaining it to me like this: We have two goals. The first goal is to get rid of my pain and the second is to restore optimal function to my body. Even though the first goal is our top priority, we have to chip away at the second one right now in order to make the first one possible. So after an exhausting week, I appreciate his ability to stay strategic, focused, and optimistic more than ever.

On a final, happy, nothing-to-do-with-having-a-headache note, I am SUPER excited for this coming Monday because I'll be starting a four month program with Seed Spot, a local business incubator that supports early stage social entrepreneurs who are launching ventures that create a positive impact in the lives of people and communities on a local, national, or global scale. I've had an idea brewing for quite some time, and though I'm not yet in a position, health-wise, to launch into it full speed ahead, I'm looking forward to getting the wheels churning in what seems like an incredibly innovative and supportive environment. More to come!

Monday, February 17, 2014

Day 1 at the Hruska Clinic

Craig and I touched down in good ole' Nebraska yesterday, leaving the 80 degree sunshine and greeting the midwest with open arms. We were so grateful to have friends "gift" us the flight with their extra miles and have an apartment-style hotel to stay in with pretty cheap patient rates for the week (a mile away from Whole Foods, might I add). We even scored a 3 day free pass to Aspen Fitness across the street, so while Craig worked out this morning, I was able to get in my bike sprints in a spin studio full of KEISER bikes! (It's the little things, right??)

After grabbing lunch and walking around the University of Nebraska campus for a little bit, we headed over the Hruska Clinic for my first visit with Ron Hruska, MPA, PT. Going into the appointment, we both knew that his approach would be unlike anything we've experienced thus far (with the exception of the introduction to PRI that I've had with Joe over the last few weeks)...and we weren't disappointed.

After talking through my story and evaluation, Ron explained that he really isn't too concerned about the instability in my upper cervical spine (which as a refresher, is the reason I'm in the neck collar). Instead of nerve irritation caused by the instability, he believes that my pain is likely originating from two alternative sources...

1. I have cranial pain caused by torsion through my skull. Basically, my sphenoid is twisted and my temporal bone is positioned too far back. That twisting of my sphenoid would also explain why every time I open my mouth, the disc gets displaced anteriorly and my jaw pops. Ron feels confident that this CAN be corrected through visual integration. If you're interested, you can learn a lot more about the science behind PRI Vision here , but the basic idea is that by wearing eyeglasses with a very specific and specialized prescription, your brain and nervous system can re-wire themselves to restore proper communication between the brain and body.

2. My foramen magnum (that large opening in the base of the skull through which the spinal cord exits the cranial vault, pictured below) is too far forward. This is creating contact with my brain stem, which has become a stabilizing strategy, creating more tension on my brainstem. This actually makes a lot of sense to Craig and I because my most recent MRI showed a basilar invagination in my brain stem (which looks like a little "kink") but no doctor has really been able to make much of it so it hasn't been really on our radar as anything significant. He also said that my brain is perceiving the floor at my thoracic spine (around T4), which is putting more stress on my brain stem to create stability.

Ron laid out the course of treatment today, which will consist of wearing the glasses and also wearing a bite plate part-time (removing contact between my teeth will be part of the process of restoring temporal-mandibular-cervical-cranial function. We tried a few different lenses today, which corrected my hip and neck mechanics (in profoundly obvious ways). A "normal" person should be able to feel a difference wearing the glasses standing up, but I couldn't feel anything (even with stronger lenses) which I think reinforced that we've got some real work to do. When Craig put them on for comparison he almost fell over. I didn't have any pain relief today but we definitely have a lot of information to carry us into the next few days. Tomorrow I have 3 appointments - one with Ron and the optometrist, one with the dentist to get an impression for a bite plate, and then one with another PT, Torin.

All in all, quite an educational day for us. As much as I would love for there to be an off switch to my headache (I actually had a dream there was during my nap from Omaha to Lincoln yesterday, haha!), I know it's still a process so the most important thing is the we're pursuing the right steps. More to the come in the next few days, for sure.

Tuesday, February 11, 2014

Nebraska bound!

First things first, a quick update before I dive into our next jet-setting adventure.

I'm still rockin' the neck collar (week #3, but who's counting?). Perhaps my discomfort tolerance is a bit skewed these days but it's actually not as bad as I was anticipating. Aside from when I'm breaking a sweat (which just feels gross and makes me thankful it's not 115 degrees), I just try to imagine that I'm wearing one of those cozy airplane neck pillows...or a unique scarf...or really stiff turtle neck? It is funny when random people approach me in public and drop one of these -- "Ohh, looks like THAT hurts!" or my favorite one from earlier today..."Somebody had an ouchie!" One guy even came up to me at Whole Foods last week and without saying anything, flipped me his business card. A chiropractor? Shit, I wish I had thought of that! Haha, oh man..

Unfortunately, the brace has had zero impact on my pain...but Dr. Crutchfield did warn us that might be the case. He even said the pain could increase a bit. The goal of stabilizing my neck with the collar is to allow the ligaments a chance for self-repair. Not that lessened pain wouldn't be welcomed, but it isn't necessarily expected if the nerves are irritated, hence the series of injections I'll be starting on March 10 when we fly out to Baltimore to see Dr. Crutchfield.

It is really frustrating not having an "in the mean time" source of pain management. I ended up making a trip back to the dispensary last week and bought a new bottle of higher dose CBD drops to try. I took a full dropper and a half when I got home, which made me drowsy just like the other kind I'd tried, but didn't do anything to my headache. Being "stuck" in pain has come to feel really panicky for me. Sure, I can try to distract myself by doing something I enjoy like being outside or talk through my frustrations with Craig or even just say "f-it" and let the tears flow (all necessary things, by the way), but the reality is, those things don't take away my headache.

As far as my activity level goes (which, as it turns out, has a strong correlation to my sanity levels), I've been trying to do at least something every day. We live just minutes away from some beautiful trail systems so have been walking/hiking a few days per week, squeezing in some stationary bike sprints, and have been going to Pilates at AZ Body Mechanics 4-6 times per week. I've been to some so-so Pilates studios since living in AZ but this is the real deal, and having incorporated some Pilates work with Anna over the past few months, I was thrilled to find this spot. There are some modifications I have to make on the reformer and tower in order to avoid flexion/extension/rotation of my neck and tightening of my traps, but the instructors have been super helpful in providing alternatives.

Ok, so you're probably wondering where Nebraska comes in to play. A few weeks ago, the PT Manager at AP, Tony, suggested to Craig that I have a visit with one of the PT interns, Joe, who has experience in something called PRI (Postural Restoration Institute®). Here's an outline of the basic concepts of PRI:

-The human body is not symmetrical. The neurological, respiratory, circulatory, muscular and ocular systems differ on each side of the body with different responsibilities, functions, positions and demands. The asymmetry balances the body—for example—the torso is balanced with a liver on the right and a heart on the left.

-PRI trained therapists recognize these imbalances and typical patterns associated with system disuse or weakness that develops because of dominant overuse. This dominant overuse of one side of the body can develop from other system unilateral overuse.

-This asymmetry compliments the special functions of the two sides of the brain. Although the two hemispheres of the brain share responsibilities for some functions, each hemisphere controls the opposite side of the body. PRI trained therapists understand how the two hemispheres of the brain affect the balance of the body.

-When these imbalances are not regulated by reciprocal function during walking, breathing or turning, a strong pattern emerges creating structural weaknesses, instabilities or musculo-skeletal pain syndromes. All PRI trained therapists incorporate reciprocal function to balance muscle activity around the sacrum (pelvis), the sternum (thorax) and the sphenoid (middle of the head).

-Different factors can all influence asymmetrical tendencies and patterns. Other animals have their own tendencies. Toads use their right forepaw more than their left, chimpanzees hold a branch up with the left hand and pick the fruit with their right hand, and humans usually balance their center of gravity over their right leg. PRI trained therapists recognize the common, integrated patterns of human stance like extremity use, respiratory function, vestibular imbalance, mandibular orientation and foot dynamics and correct these patterns through exercise programs.

So I started working with Joe last week, and based on his assessment, he thought it would be a smart decision for me to go straight to the Hruska Clinic in Lincoln, NE, whose services are based on the philosophic and integrative concepts of the Postural Restoration Institute (also where the founder, Ron Hruska, MPA, PT practices). Thankfully, we were able to get the ball rolling pretty quickly. Joe had me get an eye exam last week for him to send directly to Ron along with a summary of his evaluation and they were able to get us on the schedule for next week! At the Hruska Clinic, in addition to the application of PRI science, treatment can include integration of complementary disciplines, including dentists, podiatrists, pulmonologists, chiropractors, optometrists, osteopaths, etc. We won't know for sure who will comprise my team of practitioners (though we're speculating vision will be a piece of the puzzle) but we have five appointments set up over the course of four days. I should have a better idea after the visit with Ron on Monday.

So there we go. Both Craig and I are hopeful that this could be a promising step for me. It doesn't change anything we have planned with Dr. Crutchfield - just trying to attack from all angles. I'm REALLY looking forward to next week's trip and will plan to post an update while I'm there.