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Friday, March 14, 2014

First visit with Dr. Crutchfield

Monday's visit with Dr. Crutchfield in Baltimore went as planned. Fortunately, he had already received ALL of my records back in January so at least it didn't feel like we were completely starting from scratch. Based on the examination and review of my fluoroscopic motion x-ray, he didn't see any signs of traumatic brain injury (always a good thing), and agreed that all symptoms are likely coming from the rocking of my C1/C2 vertebra and the consequent inflammation around my occipital nerve (also known as "occipital neuralgia"). By definition, occipital neuralgia is caused by the occipital nerve being trapped and irritated by the tendons of the back of the neck. Every time my head moves (which, let's face it...is pretty much all of the time, even when my activity level is modified) the nerve will be irritated and can cause a headache that extends over the top of the head to the temples and behind the eyes (exactly where I feel my pain).

The doc was so "impressed" by the clarity of my instability that he asked my permission to use the imaging for a presentation at an upcoming neurology conference. Knowing that some doctor (and ultimately, patient) out there could potentially learn from the journey I've been on, even if just from a single step, is at least a gratifying feeling.

So Dr. Crutchfield proceeded with the first round of injections as planned, which contained Lidocaine (a local anesthetic) and Kenalog (an anti-inflammatory corticosteroid). On the right side of my head (which is the better of the two) the needle slid right in, but on the left side I literally heard and felt the "crunch" of the needle going in...proof of just how inflamed the area is. Gross.

He reminded us that in his experience, it takes an average of 2.36 injections for patients in my situation to feel relief, with an ultimate success rate of 86%. I'll continue wearing the neck brace and before I head back to Baltimore for my second round of injections in about two weeks, I'll have another x-ray taken here in AZ. When Dr. Crutchfield looks at the x-ray, the instability should ideally be improved, given that I'll have been in the brace for 9 weeks by then. IF there's still too much mobility at that 9 week mark, we'll talk about another approach to PT to focus on my deep intrinsic neck muscles.

If the injections DON'T work, it could be because of accumulated scar tissue. If that's the case, he would refer me to one of his colleagues, Dr. Ducic at Georgetown University Hospital, who performs nerve decompression surgery. He's actually the surgeon who performed Brianna Scurry's surgery from that story I mentioned a few posts ago. That surgery has a 91% success rate. I REALLY don't want it to come to surgery, but still lots of hypotheticals between here and there so for right now, I'm trying just trying to take it one step at a time.

I left my appointment on Monday with prescriptions for three different medications, which I've been on now for a few days...
1. A Methylprednisone Dospak - the anti-inflammatory steroid
2. Tizanidine - a muscle relaxant to help my neck muscles calm down
3. Gabapentin (i.e. Neurontin) - an anti seizure drug to help bring the pain down (also the one I was on last summer and stopped taking because it made me feel like shit, but this is a much, much lower dose)

I'm not a huge fan of being on this stuff, but I've had to just accept that it's not a long term solution, but simply part of the process. When I expressed my concern about side effects to Craig, he reminded me of one possible side effect I hadn't mentioned...pain relief. Touché.

So, that's the update. In case you haven't figured this out by now, my body likes to make things interesting...so, no...I haven't yet felt any relief from the injections or medications this week. Given the statistic he provided about the average number of injections needed, I shouldn't feel too discouraged, although he did say that he would expect at least SOME relief to justify performing the next round. Right now we're waiting to hear back from him to figure out what to do if I don't experience any changes before the end of the month when we're scheduled to fly back to Baltimore.

Thanks all for reading...and for all of the love and support along the way :)

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