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Thursday, March 12, 2015

holy serratus

It's only been a week since my last post, and although I seem to have slipped back into my "normal" headache since the few days of sustained reduction a week ago, I do have some interesting rehab progress to report.

First though, a quick update to the ozone IV therapy from last Wednesday. I hadn't felt anything unusual except for maybe a little fatigue when I posted my most recent blog entry on Wednesday evening. But by about 9 pm that night, while lying on the couch (getting our nightly fix of House of Cards, obviously), I started feeling really dizzy. Dizziness and nausea are typically NOT symptoms I experience with my headache so I knew it was likely a reaction to the ozone treatment. The dizziness progressed pretty quickly over the next few minutes until I was throwing up an equally impressive and disgusting amount. There's nothing quite like a night with your head in a bucket to make you and love and appreciate the guy holding your hair back. Am I right?

So it really took me a few days to recover from that little episode...aside from feeling generally lousy, my headache had spiked back up to a high-normal range...where it's stayed for the past week-ish.

I had decided to stop seeing Dan Daliman for PT. Recognizing that I had made some significant progress with him over the last 6 weeks in strengthening my deep flexors while maintaining my c-spine alignment, I felt that we had hit a bit of a plateau and it was time to figure out the next step.

"Figuring out the next step" isn't a straightforward process, but the longer I've been in pain and seeking treatment, the better I've become at trusting my own intuition. When dealing with a chronic health condition of any kind, the ability to confidently weigh in your "gut feeling" with the advice and expertise of those around you isn't always easy, but so important. After all, there is not a single person in the world who knows and feels your body the way you do.

With that said, I've been growing increasingly frustrated by our inability to connect the dots between my headache and the chronic tension in my upper left back. As I've explained before, the "tightness" has felt so deep and SO connected to my pain above, yet has been completely unresponsive to all tried modalities by the best practitioners in their fields over the last several years...massage, dry needling, cold laser, ultrasound, acupuncture, cupping, various injections...the list goes on and on.

Of course, we don't for sure if this "tension" is manifesting as a response to my pain rather than the other way around, which is one reason that chronic pain is so tricky. I've talked about the pain-spasm-pain cycle before and the complexities of centralized pain but as a refresh, the longer you're in pain, the easier the brain's ability to properly process pain perception can change, becoming hypersensitized to pain input. It's a self-feeding mechanism...and a really shitty one at that. We're still trying to figure out the best way to tackle this possibility. So far, I have tried quite a few things that can be effective in treating more centrally-driven pain, from various medications (including the ketamine infusion) to other less invasive treatments like brainwave optimization, transcranial magnetic stimulation, eye Movement desensitization and reprocessing, etc.

But because I just refuse to give up chasing down this left upper back connection, we've decided to try a few new things. Earlier this week, I met with Tony, one of the PT's at EXOS who I've seen in the past. He pointed out how much less thoracic rotation I have on my left side and so decided I'd spend a few sessions trying to tackle that.

Yesterday, I also saw Jeff Beran, PT who I started back in the fall of 2013 (yikes!). After Craig and I caught him up to speed with findings from the past year since we last saw each other and he evaluated me, it become clear to him that my scapular mechanics are disrupting my cervical spine mechanics. This disruption was further evidenced by a few observations: my left shoulder is lifted about 1 inch higher than my right when lying supine, and my left pec minor is significantly tighter than my right.

Jeff hypothesized that the specific spot I feel on the left side is likely referred pain from the C5/C6 level, which is being affected by the scapular dysfunction.

It all makes a lot of sense to me, based not only on my understanding of the anatomy (see below how the levator scapulae connects the c-spine to the scapulae) but really more so what I FEEL is going on in my body.

It's turns out that I haven't been activating my serratus muscle (see below). Like is so often the case, it's not a matter of strengthening a muscle but actually re-learning how to fire it correctly. Proper activation of the serratus (see below in red) keeps the scapulae in better contact with the rib cage.

You can physically see my serratus "turning on" in this video.

And then, when we try to progress to lifting one arm (which we soon found out I wasn't ready for), you can then physically see my levator/traps taking over. I KNOW that the "tension" of those muscles is part of my headache and really feel like this discovery is an important breakthrough in cracking the code.

So the plan now is to do these serratus-activating exercises until they're boringly easy and then I'll go back to see Dr. Beran to keep progressing them. I've been activating my serratus all day long like a f-ing champ and the exciting news is that even in this short time I can already feel a significant difference in the tension through my upper back and into my neck. The hope now as I continue is that pain reduction will follow!

I'm also still on a once-weekly acupuncture schedule. In today's session, Sara tried a bit of new approach based on everything that's happened with my PT visits this week. Team effort at its finest.

Wednesday, March 4, 2015

March update!

I'm happy to finally be reporting some encouraging updates today! Oh how I've dreamed about these blog posts. I still have a ways to go with my headache, but it seems like progress is finally being made.

Over the last few weeks, I've stayed pretty busy with my rehab, continuing my weekly physical therapy visits with Dan to strengthen my deep neck flexors while maintaining my new alignment. We've incorporated some other things into my treatment, including exercises to strengthen my external shoulder rotators. We've figured out that the soft-tissue dysfunction and chronic tightness on the left side of my upper back (which goes all the way back to my original bike accident, and therefore has always felt - at least to me - connected to my headache) is coming from my 5th rib. At this point, it's so hard to know what's driving a problem and what's a symptom, but the current approach is simply to attack it all and trust that pain reduction will follow.

Along with my PT, I've had a few more sessions with Anna at Movement Rev as well as acupuncture treatments with Sara Asadoorian-Vagianos at Advantage Sports Acupuncture. My visits with Anna have been focused on opening up my lateral line and superficial front line to aid in my thoracic spine mobility and improved diaphragm function, and improved deep frontal line function. The goal of this is improve the mobility of my spine and hopefully take some of the pressure off my neck.

Even though I've had a lot of dry needling in recent months, it had been a while (i.e. pre- corrected C1/C2 alignment) since I'd had traditional Chinese medicine acupuncture. These treatments with Sara have focused on releasing heat and stagnation in my body, and to restore energy flow, blood circulation, and function along the Urinary Bladder meridian (which runs from the corner of your eye, up and around your head, down along the paraspinals, down the sacrum & hamstrings, and ends at the corner of your pinky toe). Sara told me that releasing any blockages or adhesions along the UB meridian will open up the spine on both the functional and energetic level.

Up until about a week ago, I wasn't feeling any changes but then something started to subtly shift and my pain levels were in the "low normal" to "below normal" (as anyone who deals with 24/7 pain can relate, a 1-10 pain scale becomes impossible to use). This past weekend, I even felt good enough for a day trip to snowshoe in Flagstaff. Charlie's first romp in the cold, wet, white sand. Pure amazingness.

On Tuesday (yesterday), I was scheduled to see my naturopath, Dr. Popiel. He had recently reached out to Craig and I to tell us about a new treatment I might be interested in trying, Prolozone Therapy. See below for a description from the American Academy of Ozonotherapy website:

Prolozone® is a homeopathic/oxygen-ozone injection technique developed and pioneered by Dr. Frank Shallenberger. It is excellent for all forms of musculo-skeletal and joint pain including chronic neck and back pain, rotator cuff injuries, degenerative and arthritic hips and knees, degenerated discs, and shoulder and elbow pain. Because in many cases Prolozone actually corrects the pathology of the disorder, there is a 75% chance for the chronic pain sufferer to becoming permanently pain free.

Prolozone is a form of non-surgical ligament reconstruction and is a permanent treatment for chronic pain. Prolozone is a connective tissue injection therapy of collagen producing substances and ozone gas which can reconstruct damaged or weakened connective tissue in and around joints. These substances are injected into the damaged connective tissue in and around a joint to rebuild the damaged areas.

By repairing the connective tissue this is all that is needed to permanently reverse chronic pain.

Prolozone Therapy is an injection technique similar to Prolotherapy that uses ozone. The use of ozone causes the joint to heal much more quickly than in traditional Prolotherapy. This is because ozone is a highly reactive molecule and when injected into a joint capsule it is able to stimulate the fibroblastic joint repairing abilities.

Prolozone is derived from the word ozone and the Latin word “proli” which means to regenerate or re-build. It literally means re-building tissues with ozone. It is important to understand what the word Prolozone actually means. “Prolo” is short for proliferation, because the treatment causes the proliferation (growth, formation) of new ligament tissue in areas where it has become weak.

Ligaments are the structural “rubber bands” that hold bones to bones in joints – acting like the body’s shock absorbers. Ligaments can become weak or injured and may not heal back to their original strength or endurance. Ligaments will also not tighten on their own to their original length once injured. This is largely because the blood supply to ligaments is limited, and therefore healing is slow and not always complete. To further complicate this, ligaments also have many nerve endings, and therefore the person will feel pain at the areas where the ligaments are damaged or loose.

We can think of our joints as the hinge on a door. Until the hinge is fixed the door just isn’t going to open or close right and it’s the same exact story with our joints. If we are athletic or if we are just getting older there is some gradual and natural degeneration of the moving parts of the body due to ongoing recurrent mechanical stress, and failure of tissues to repair. This can come from lack of nutrients, lack of circulation, aging and inflammation. When this happens the ligaments, tendons, and cartilage become dehydrated and weaker. This results in laxity and more abnormal mechanical stress and shearing forces on the joint. Abnormal shearing forces and torsion cause more joint dysfunction. This leads to a progressive separation of the ligaments from the superficial covering on the bone called the periosteum. This pulling on the periosteum creates a space, which the body fills in with new bone. These new parts of bone are called osteophytes. They are the premier signs of degenerative arthritis in & around the joint. Osteophytes and joint laxity result in a reduced range of motion, which causes strain on surrounding muscles which then become either over or under worked leading to more dysfunction & pain.

Prolozone causes repair and tightening of the lax structures, partially torn connective tissue and ligaments. Prolozone halts the pain/inflammation cycle. This allows for better circulation, increased blood flow carrying nutrition, and hydration of the damaged tissues. This allows for a healing environment within the joint to develop and results in increased range of motion and decreased pain.

Keeping with our "attack it all and trust that pain reduction follows" approach, this seemed like it was worth a shot, especially given the overwhelming evidence that even in correct alignment, my soft-tissue seems to be a driver (or at the very least, strong contributor) to my headache. So yesterday, we went in for my first Prolozone injections. Since there's always a risk of flare up with injections, and because I had experienced such a bad flare up with my lidocaine injections just a few weeks before, Dr. Popiel agreed it was best to be a bit conservative with volume. He injected just a few spots (six, I think) along my C-spine, my left levator scap, and my right and left trapezius.

The injections themselves felt a bit different than regular injections. As the ozone gas went in, I felt a tightening/pressure and a few hours later, was even able to press down on the injected areas and hear a "crinkling" of the gas. Not painful, just weird! And we felt a pretty good spasm in my left scap when the needle went in....more confirmation of the connection to my head.

Within just a few minutes, I for sure felt a sense of relief from the treatment. I was already having a "good" day so the extra bump in pain reduction was all kinds of amazing. I took it easy the rest of the afternoon, though my pain creeped up a little by last night. Still way better than normal though, so I'll take it.

We had also decided yesterday that I would come back today to try an IV ozone therapy. The goal of trying IV is just to deliver a more systemic dose. We don't know what will be more effective, so why not try both? So this afternoon, Dr. Popiel drew some blood, infused the ozone into blood, and then added it back into my body. It's only been a few hours, so it's hard to tell how different I feel...but we'll see over the next few days and as long as I'm not feeling worse, I'll plan to go back for more IV therapy next week.

So for now, I'm taking it one day at a time...plugging away with my rehab and treatments, enjoying every moment I have with lower pain, and staying positive that there are pain-free days in my near future.