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Saturday, April 19, 2014

dorsal root ganglion blocks

Good morning friends. I haven't posted in a few weeks because I've been a little busy hanging out at the Surgery Center of Scottsdale. Hah, but seriously, I've been there 4 times in the last week and a half.

Last week, I started with two medial branch blocks at C2-C5. They like to perform the left and right sides on separate days because the blocks can interfere with proprioception. The procedure itself isn't too painful. I opted out of sedation for both because I don't like feeling groggy afterward but mostly because you can't eat for 6 hours prior (hah!). After the doc injects a numbing agent, he injects the 3 spots with saline and some type of steroidal anti-inflammatory. These injections were just meant to be diagnostic, meaning that if they provided some temporary relief in the next few hours (or potentially even day or so since the steroid can take longer to kick in), we have some indication of the pain source and could proceed with the radiofrequency ablations.

Unfortunately, I hadn't yet experienced any changes in my 6.5-7/10 pain levels when I returned the next morning to have my right side done and by the time I returned to AZ Pain Specislists for my post-procedure consult later in the week, I had no changes to report on the second side either. Bummer.

Our next step, as explained in my previous post, was another set of diagnostic blocks, this time of the dorsal ganglion root at C1/C2. To recap, the dorsal root ganglion blocks the root of the nerve just as it exits the spinal column (including the same image again because it's a good visual). The "ganglion" is essentially a cluster of nerve cell bodies in a dorsal root (a branch of a nerve carrying mostly sensory signals into the spinal cord).

This past Monday, I had the DGR block on my left side. I returned to see my doctor that afternoon to discuss my (lack of) response and determined that we'd move forward with the second side. The only changes I experienced were in the middle of the night on Monday, when I woke up from my sleep in pretty excruciating pain. It turns out it's not that unexpected for the procedure to elicit this response. So with dwindling patience, I was back on the table Tuesday morning for the right side.

I had started physical therapy at EXOS last week and we'd decided that since I hadn't any soft-tissue work in my traps/neck for a while, it would be worth trying to incorporate back into my rehab. I had a massage scheduled at EXOS with Eric on Tuesday to work on all of those deep neck muscles. My sternocleidomastoid, scalenes, splenius capitus, splenius cervicis, etc. were incredibly lit up, as usual, so he focused on trying to alleviate trigger points in these areas.

I went to bed Tuesday with my normal pain levels and then...


Wednesday morning I woke up in MUCH, MUCH LESS pain. I think I told Craig I was down to a 4, which may not seem a lot less than than a 6 or 7, but when you're in pain 24/7, every tenth of a point is absolutely significant. Between the blocks and soft-tissue work, it was hard to know exactly what had created the change. When I went back to see Dr. McJunkin on Thursday, he felt confident that the right side block had provided us some key information about the pain source and recommended that we proceed with the radiofrequency ablation. I was already scheduled to see Eric for another session on Friday so we all agreed that how I responded to that treatment (likely on Saturday) could confirm whether it was the massage or the block that gave me some degree of relief on Wednesday.

So after a very painful Friday, I woke up this morning without a break in pain. I know there is some major dysfunction in my soft-tissue but perhaps this could mean that the pain-spasm-pain cycle just doesn't start with the spasm and the RF could help to break the cycle. I'm trying to remember that each step, whether it works or doesn't, is an additional piece of information that takes me closer to the solution. But holy shit, that is not easy to do.

The dorsal root ganglion RF will likely be scheduled for the week after next. In the meantime, Craig and I fly back out to Baltimore for my third and final round of occipital injections with Dr. Crutchfield this coming Monday. We're also scheduled for a 10 day trip to Newport Beach, CA at the beginning of May to see Gail Wetzler, PT, who is the mentor of Veronika, the PT and visceral manipulation practitioner that I've seen here in Phoenix for a while. I have a series of sessions with her spread out over the course of our visit. At least I'll be able to squeeze some beach time into that one!

Thanks for reading! And one more things... if you are physically able to do something active today, go do it! We never fully appreciate how lucky we are to have something (like physical health) until it's put to the test. I know that when my head stops hurting, I'm going to wake up every morning feeling so grateful that I'm pain free. (Then go for a mountain bike ride.)

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