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Tuesday, December 10, 2013

post-nerve block follow up

This morning, I had my follow-up appointment with Dr. Schurgin. As I indicated in my last post, I was keeping my fingers crossed that my 30-50% pain reduction in the 3 hours after last week's nerve block would qualify me for the pulsed radiofrequency nerve ablation on the 19th.

After looking at my pain log, Dr. Schurgin explained to Craig and I that he really likes to see over 50% reduction and some insurance companies actually require it to be over 60-70%. This is so frustrating to me because any "pain scale" is so subjective (which he was the first to recognize and admit that the diagnostic process is far from ideal). I was pretty upset this morning because my "return to work" date is scheduled for January 9th, and after factoring in the appropriate notice of leave time (if it comes down to it), I'm realizing that I only really have a handful of days before I need to make a decision. My hope was that we would proceed with the ablation on the 19th and I could potentially be feeling relief by Christmas, not to mentioned early January. So thankfully, while these thoughts ran through my head and I worked on emptying another box of tissues, Craig was able to have a more coherent conversation with the doc.

Here are the takeways:
1. Dr. Schurgin suspects that zeroing in on C2/C3 could have actually been too narrow of a focus. After some poking and prodding at my neck, he proposed we schedule another diagnostic nerve block and this time hit C3/C4 in addition to C2/C3. When Craig asked if that would be different than the C3/C4 blocks I had done in the spring, Dr. Schurgin confirmed that the real value is in the aggregate effect. Luckily, we were able to get the procedure scheduled for this Thursday, with another follow up next week.

2. He also briefly discussed with us the emotional toll of chronic pain and its role in the pain cycle, specifically from a chemical perspective (which wasn't new information to us). Pathways in the brain that are responsible for receiving pain signals use some of the same neurotransmitters (like serotonin and norepinephrine) that regulate emotional function, which is how chronic pain is similar to chronic depression in that can alter the nervous system's function and operate in a perpetual cycle. He strongly suggested that we continue the conversation and that I start researching Cymbalta, an antidepressant commonly used for musculoskeletal pain in conjunction with the emotional effects that accompany it. I get it...and as I've already explained, I fully recognize that I'm not in a position to be close-minded to any particular approach. With that said, I still find this conversation so incredibly frustrating. I know this is completely irrational, but it FEELS like someone is telling me I need to take an anti-depressant because my broken arm is making me upset (not the same, just how it feels).

3. Dr. Schurgin is concerned that I haven't yet properly addressed my TMJ/TMD symptoms, which is perhaps playing a more significant role than we've thought. He referred me to a TMJ specialist that is his "go-to-guy", Dr. Cohen. I'm scheduled to see Dr. Cohen next Tuesday.

A frustrating day for me but as Craig continues to remind me, every step forward is closer to the answer. In the meantime, I'm continuing my rehab with Veronika (saw her yesterday), Anna (yesterday and tomorrow), and Jeff Beran (Friday). I'll write up a summary of that later this week. Here's a little sneak peak at my session with Anna, which included some good ole' cupping to try to open up my intercostals so I could expand my ribs better for breathing (attractive, huh?), followed by a shot of someone who REALLY loves that I am home from work :)

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