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Monday, September 22, 2014

C1 Nerve Root Block

Long day...but my C1 nerve root block (left side) is complete! So far, I'm not feeling any changes, but Dr. Chong has warned me that it could take up to a few days to kick in...so I'm trying to stay positive. Regardless of the outcome, the procedure will still serve as a helpful piece of information in trying to uncover the source of my headache moving forward. Depending how I feel in the next few days, we may also decide to proceed with the identical procedure on my right side next week.

Though I've had several nerve blocks/ablations done in the last 1.5 years, they've all been pretty low-risk outpatient procedures at various pain clinics. Today's procedure at Mayo Clinic felt a little different from the start, simply due to the greater risk of working at C1.

Allow me to explain with these 3 (somewhat humorous) things I learned today...

1. A C1 nerve root block has never been performed at Mayo Clinic (AZ or Rochester).
2. When you Google "C1 nerve root block", the first hit that appears...wait for it...MY BLOG. Not a medical journal. Not a pain clinic. Not a health organization. My blog.
3. When I was sitting in my hospital bed during recovery, I overheard a few doctors/nurses who were walking by say to each other... "There's NO room between the vertebral artery and C1!"

So, as you might imagine, our excitement was rivaled by some warranted anxiety. But Craig and I both felt incredibly confident in Dr. Chong and felt 100% certain the potential benefits far outweighed potential risks.

I checked in around noon and spent the next hour or so getting prepped by the nurses and meeting with the anesthesiology team that would be in the room "just in case". Originally, Dr. Chong hadn't planned on needing them available, but after planning for the procedure and consulting with some colleagues here at Mayo Scottsdale and in Rochester, MN he decided that would be best. The target space for the needle was very small and IF it had moved into the epidural space, I would have gone numb from the upper neck down, which would have stopped my breathing. If that was the case, they would have been there to intubate me. This consideration also changed the position I was in the table. Originally he was going to have my lie in a prone position, but I ended up propped up onto my right side so that they could have got to the leeds on my back in a shorter amount of time if there was a breathing emergency.

(Paparazzi snuck in)

Before he got started, Dr. Chong had Craig come into the OR to explain his exact plan of attack, complete with several helpful anatomy diagrams and cadaver images. I wish I could include the ones he showed us, but here's some visual to show you where the needle went...

Follow the arrows I stuck in there...

To give you a better sense of where the vertebral artery is in relation to that first vertebra, check this next one out. A needle accidentally hitting that would result in stroke...eek!

The procedure itself wasn't particularly painful (I had a little bit of sedative to take the edge off) but lasted longer than the other blocks I've had to date. Since it was performed with CT guidance, Dr. Chong used a contrast dye that allowed him to see exactly where he needed to be (which felt strangely hot as it shot through my body) and then injected the lidocaine and celestone bit by bit to ensure I was tolerating it well.

I'm back home now, feeling "normal" pain-wise and pretty groggy/in need of a good night's sleep. Hopefully I started feeling some changes in the next few days.

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