Well, here's my final update and blog post about my neck pain and left arm dysfunction.
On Thursday, my MRI showed mostly moderate generalized stenosis along my spinal column. Some foraminal stenosis was shown for all the vertebrae from C4-T1. In addition, there appears to be some disk degeneration from C2-T1.
The most notable findings were at C5-C6 & C6-C7. These areas showed moderate disk degeneration and moderate to severe central and foraminal stenosis. It appears that much of my recent pain has been associated with these two areas.
In the region of C7-T1 the disk generation and stenosis is accompanied by spondylosis, or spinal osteoarthritis, which is often associated with aging. I guess I'm getting old!
After seeing the MRI, the neurosurgeon referred me to a neurologist for further testing. On Monday I saw Dr. Julia Jones, a delightful and compassionate specialist. As expected, she subjected me to electromyography (EMG) tests. Basically, they shock my nerves and muscles to determine nerve and muscle function. I know I'm crazy, and I probably wouldn't do this voluntarily, but it was fun! Yes, it hurt, but Dr. Jones and her tech, Ron, bantered back and forth with me so much during the testing that I left in a great mood.
One of the interesting things about the EMG was the tools. Ron used what is equivalent to a "cattle prod" device. Having grown up on a farm and having used a cattle prod myself on occasion, I noticed the similarity immediately. And boy does the EMG "human prod" make you jump like a cattle prod! Of course, Dr. Jones did not use the cattle prod; she used long thin needles that she plunged deep into my arm muscles; and from there she delivered "delightful" electric shocks to my muscles! Ouch!
Kidding aside, the results of the EMG were encouraging. First, Dr. Jones found no permanent damage to the nerves and muscles in my left arm. She expects a full recovery of the strength in my left arm, or at least nearly full recovery. She said I may experience some minimal loss of strength, but most of my strength will return if not all of it. That's very good news.
Dr. Jones also found that my left arm pain and loss of strength is not due entirely to my recent inflammation of spinal stenosis. In addtion to the complications of my stenosis, I also suffer from Thoracic Outlet Syndrome. Basically, the nerve bundles that come out of the spinal cord at C5-T1 travel from the spinal column along the clavical and through the shoulder down into the arm. Somewhere along this route the nerve bundles that service my arm muscles are being compressed, probably in the area of the shoulder. This is causing me pain in my shoulder and arm, and is affecting my left arm's ability to function properly. So, I have one more problem!
However, the news is good. Both Dr. Jones and my neurosurgeon think that I may be able to avoid surgery for the time being. Because of the recent improvement in my pain levels and arm strength (I'm slowly getting my strength back!), my doctors would like to try physical therapy for six weeks, accompanied by a regimen of medicines, and see if this will help postpone my need for surgical intervention for a longer period of time.
Thank you all for your kindness, your prayers, and your many words of encouragement. My pain is not "gone" but it is manageable at the moment. I am still unable to sleep through the night; though my pain is much less than it was even a few days ago. My neck pain has dwindled to a chronic low-level pain for much of the time. As long as I'm careful, it's manageable. My left arm pain is worse as night, but I only infrequently need pain medicine now. My left arm strength is not 100%, but I can sense the improvement. The arm weakness and severe pain only return when I look down for too long or turn my head certain ways. So, I just try to avoid those positions!
I know so many people who have gone through their neck problems in silence. I have never heard from them about their pain or struggles. It is not that I needed to know. I just feel that a blessing is missed when we keep our pains and sufferings to ourselves. I know that I personally struggled whether or not to publicize my painful path these last few weeks. But I am thankful that some of you have encouraged me to do so.
Your words of wisdom have opened up many blessings from so many people that I cannot adequately express my gratitude. I think this is why it can be good for us to share our sufferings with those we love and care about. I did not want to sound like I was complaining, but at the same time I wanted all those for whom I care so much to know how much I was struggling and how much I needed their prayers and words of encouragement. And I have found myself so blessed by those who have responded to my "public suffering" with such generosity, love and encouragement.
Please know that YOUR PRAYERS AND WORDS OF ENCOURAGEMENT have greatly impacted me and have sustained me in this time. YOU HAVE BLESSED ME SO MUCH THROUGH YOUR KIND WORDS, YOUR GENEROSITY, AND YOUR ENCOURAGMENT. When we share in each other's sufferings in this way, we are all lifted up and made stronger. Thank you for walking with me in this journey. Do not discount your simple Facebook posts of "I'm praying for you," or "What's going on? Are you okay?" Even the smallest gesture of concern has been richly appreciated.
To think I have been blessed by such beautiful and wonderful friends as you... THANK YOU.
David A. Adcock
College Station, Texas
Thursday, September 24, 2009
Thursday, September 17, 2009
Update: MRI 9/17/2009
Well, there is much to tell about my MRI adventure today.
First, the results. The MRI proved to provide more questions than answers, which is unfortunate. Whether or not spinal surgery is in my near future is now uncertain. The MRI revealed a definite narrowing of the central opening of the vertebrae around the spinal cord in both the cervical and thoracic regions. The surgeon described the findings as a "fair amount of spinal stenosis." However, he stated that the stenosis, while generalized and extensive, did not appear severe enough to be the source of my current pain and deficits in left arm function.
My surgeon explained that spinal stenosis can be associated with a narrowing of the space around the spinal cord, called central stenosis; but it can also be associated with a narrowing of the "side holes" along the vertebrae where the nerves go out into the periphery of the body (like the arms), which is called foraminal stenosis. Compression of the spinal cord or the nerves radiating from the cord can occur in either case. While the doctor did acknowledge I may suffer from both problems, the MRI did not clearly indicate this to be the case. To complicate matters, the quality of the MRI was disappointing. He graded the MRI quality at a B-, not a good grade for this kind of problem. This means that I may need to repeat the MRI and undergo the risky anesthesia process again. It's not something I would like to repeat!
The bottom line of my case, however, is my surgeon does not think the MRI revealed significant enough stenosis to explain my particular constellation of symptoms. He appeared very disconcerted by this, and wants me to undergo more tests. He has therefore referred me to a neurologist for further testing of my nerve function. If all goes well, I will see her on Monday or Tuesday, and will undergo evaluation, plus an EMG, to test the nerve function in the muscles of my left shoulder, arm, and hand. I can look forward to lots of little electric shocks in my arm next week! Oh, goody! :-(
So, what's wrong with me? Well, the surgeon thinks that there may be one of three causes of my pain and left arm disfunction. 1) Nerve compression due to the stenosis or some other cause (as originally diagnosed, but which will require a follow-up MRI to confirm); 2) some kind of demyelinating process in which the nerve sheaths are being damaged (like Multiple Sclerosis, which he thinks is not very likely, but is a remote possibility); and 3) diabetic plexopathy, which would then be the cause of some kind of inflammation of the nerve roots, thereby affecting my spinal cord and left arm. It's hard for me to believe that #3 is the case, since the onset of my pre-diabetic condition is fairly recent, and my symptoms have been slowly progressing over many years, but I'm no expert. Multiple Sclerosis may be unlikely, but that does not mean that some kind of progressive demyelination is not occurring; again, not good. So, I'm kind of in limbo again. It's strange, though; what I was dreading, cervical stenosis, is now my "first choice" of neuropathies among the three possibilities!!!!
Now, to the technical stuff for my medical friends. The surgeon described my condition as "polyradiculopathy." That's a fancy word for "varied" kinds of nerve "damage" in my shoulder, arm, etc. In addition to a moderate "generalized central stenosis" of both the cervical and thoracic areas of the spine, the surgeon noted a pronounced atypical kyphosis (forward curvature) of the thoracic spine. He noted that this could be genetic or due to osteoporosis, but did not notice any other lesions related to this. As he pointed out, there is no surgical treatment available for this, and it's probably not needed anyway. It is certainly not the cause of my current problems.
After the surgeon reviewed the MRI, he repeated the neurologic exam on my left arm, to attempt to differentiate the nerve impairment and determine specific vertebral involvement. From his repeat physical exam he found the following damage:
C5 - reflex "slightly present"
C6 - no reflex at all ("not working")
C7 - decreased reflex
C8 - minimal reflex
T1 - also impaired
Essentially, the nerve bundles that come out of these cervical and thoracic vertebrae provide the motor function to my left arm. All of the nerve bundles coming out of C5-T1 demonstrate significant impairment. But the MRI did not definitively reveal WHY this is the case. So, he wants to do MORE tests. On the bright side, at least he's actively searching for answers.
So, the bottom line is that I definitely have generalized cervical and thoracic stenosis (from C2-T7), much worse for my age, but perhaps not to the extent to explain my particular constellation of symptoms. I must endure my pain a while longer.
As an aside, I'd like to share a little humor about all this. As I stated in previous communiques, I am unable to endure an MRI while awake. So, I required general anesthesia for today's procedure. Well, before the MRI, I was taken to the surgery pre-op area to get ready for general anesthesia. Not one, but THREE anesthesiologists had to take care of me, not because I was anxious or difficult, but because the anesthesiologists were uncomfortable with my procedure. They even tried to talk me out of undergoing general anesthesia, because they felt it raised my level of risk too high. As one of the anesthesiologists put it, I was at greater risk than ordinary surgery because they couldn't be in the room with me as the MRI was taking place. I thought it was kind of funny that the doctors were more concerned than I was, and that it took THREE anesthesiologists to get me through one MRI! My sister pointed out that they probably gave me the same drug that killed Michael Jackson; she was right! One of the four anesthesia drugs they gave me was Propatol! And to think I may have to go through this once more!
Well, in conclusion, I came through the MRI and recovery okay. I didn't expect anything different. I was groggy and a bit slow in recovering from the anesthesia, but I'm back to normal now. My pain is still there, but I'll manage. At least, the search for answers is still ongoing, and hopefully, I'll find the right ones soon.
Thank you all for your prayers, well wishes, and compassionate concern!
David Adcock
College Station, Texas
First, the results. The MRI proved to provide more questions than answers, which is unfortunate. Whether or not spinal surgery is in my near future is now uncertain. The MRI revealed a definite narrowing of the central opening of the vertebrae around the spinal cord in both the cervical and thoracic regions. The surgeon described the findings as a "fair amount of spinal stenosis." However, he stated that the stenosis, while generalized and extensive, did not appear severe enough to be the source of my current pain and deficits in left arm function.
My surgeon explained that spinal stenosis can be associated with a narrowing of the space around the spinal cord, called central stenosis; but it can also be associated with a narrowing of the "side holes" along the vertebrae where the nerves go out into the periphery of the body (like the arms), which is called foraminal stenosis. Compression of the spinal cord or the nerves radiating from the cord can occur in either case. While the doctor did acknowledge I may suffer from both problems, the MRI did not clearly indicate this to be the case. To complicate matters, the quality of the MRI was disappointing. He graded the MRI quality at a B-, not a good grade for this kind of problem. This means that I may need to repeat the MRI and undergo the risky anesthesia process again. It's not something I would like to repeat!
The bottom line of my case, however, is my surgeon does not think the MRI revealed significant enough stenosis to explain my particular constellation of symptoms. He appeared very disconcerted by this, and wants me to undergo more tests. He has therefore referred me to a neurologist for further testing of my nerve function. If all goes well, I will see her on Monday or Tuesday, and will undergo evaluation, plus an EMG, to test the nerve function in the muscles of my left shoulder, arm, and hand. I can look forward to lots of little electric shocks in my arm next week! Oh, goody! :-(
So, what's wrong with me? Well, the surgeon thinks that there may be one of three causes of my pain and left arm disfunction. 1) Nerve compression due to the stenosis or some other cause (as originally diagnosed, but which will require a follow-up MRI to confirm); 2) some kind of demyelinating process in which the nerve sheaths are being damaged (like Multiple Sclerosis, which he thinks is not very likely, but is a remote possibility); and 3) diabetic plexopathy, which would then be the cause of some kind of inflammation of the nerve roots, thereby affecting my spinal cord and left arm. It's hard for me to believe that #3 is the case, since the onset of my pre-diabetic condition is fairly recent, and my symptoms have been slowly progressing over many years, but I'm no expert. Multiple Sclerosis may be unlikely, but that does not mean that some kind of progressive demyelination is not occurring; again, not good. So, I'm kind of in limbo again. It's strange, though; what I was dreading, cervical stenosis, is now my "first choice" of neuropathies among the three possibilities!!!!
Now, to the technical stuff for my medical friends. The surgeon described my condition as "polyradiculopathy." That's a fancy word for "varied" kinds of nerve "damage" in my shoulder, arm, etc. In addition to a moderate "generalized central stenosis" of both the cervical and thoracic areas of the spine, the surgeon noted a pronounced atypical kyphosis (forward curvature) of the thoracic spine. He noted that this could be genetic or due to osteoporosis, but did not notice any other lesions related to this. As he pointed out, there is no surgical treatment available for this, and it's probably not needed anyway. It is certainly not the cause of my current problems.
After the surgeon reviewed the MRI, he repeated the neurologic exam on my left arm, to attempt to differentiate the nerve impairment and determine specific vertebral involvement. From his repeat physical exam he found the following damage:
C5 - reflex "slightly present"
C6 - no reflex at all ("not working")
C7 - decreased reflex
C8 - minimal reflex
T1 - also impaired
Essentially, the nerve bundles that come out of these cervical and thoracic vertebrae provide the motor function to my left arm. All of the nerve bundles coming out of C5-T1 demonstrate significant impairment. But the MRI did not definitively reveal WHY this is the case. So, he wants to do MORE tests. On the bright side, at least he's actively searching for answers.
So, the bottom line is that I definitely have generalized cervical and thoracic stenosis (from C2-T7), much worse for my age, but perhaps not to the extent to explain my particular constellation of symptoms. I must endure my pain a while longer.
As an aside, I'd like to share a little humor about all this. As I stated in previous communiques, I am unable to endure an MRI while awake. So, I required general anesthesia for today's procedure. Well, before the MRI, I was taken to the surgery pre-op area to get ready for general anesthesia. Not one, but THREE anesthesiologists had to take care of me, not because I was anxious or difficult, but because the anesthesiologists were uncomfortable with my procedure. They even tried to talk me out of undergoing general anesthesia, because they felt it raised my level of risk too high. As one of the anesthesiologists put it, I was at greater risk than ordinary surgery because they couldn't be in the room with me as the MRI was taking place. I thought it was kind of funny that the doctors were more concerned than I was, and that it took THREE anesthesiologists to get me through one MRI! My sister pointed out that they probably gave me the same drug that killed Michael Jackson; she was right! One of the four anesthesia drugs they gave me was Propatol! And to think I may have to go through this once more!
Well, in conclusion, I came through the MRI and recovery okay. I didn't expect anything different. I was groggy and a bit slow in recovering from the anesthesia, but I'm back to normal now. My pain is still there, but I'll manage. At least, the search for answers is still ongoing, and hopefully, I'll find the right ones soon.
Thank you all for your prayers, well wishes, and compassionate concern!
David Adcock
College Station, Texas
Tuesday, September 15, 2009
Update: Surgery in my near future???
Well friends, today I traveled to Houston and met with my neurosurgeon, Dr. Heilman. And I have news. Upon examination, it was discovered that I have significant loss of strength in my left arm and hand, and have a total loss of muscle/tendon/nerve reflex in my left arm and wrist.
The loss of strength in my left arm was to be expected. I could already tell that I had some weakness on that side. I assumed it was residual effect of the paralysis that occurred a little over a week ago. But then the doctor performed another simple test: a reflex test.
He tapped my right elbow and it reacted normally. He tapped my right forearm in a particular spot and the result was the same. Again, he tapped my right wrist and I had a normal reflex reaction. Then he checked my left elbow, forearm and wrist. ABSOLUTELY NO RESPONSE. I was stunned. He performed the test several times in each area. No change. I had not expected that.
After more questions and more examination, Dr. Heilman gently suggested that surgery appeared indicated, but that he wanted an MRI to visualize the extent of spinal cord compression and the extent of the spinal damage. As I suspected, he feels this has been slowly developing over many years. He seemed to feel addressing this sooner rather than later is to be preferred.
I informed Dr. Heilman that due to my inability to lay on my back for more than a few seconds or minutes at a time, plus my neck pain and recent development of mild claustrophobia, I was unable to undergo an MRI. He pressed the issue and decided it would be best to put me under general anesthesia and get a good MRI, rather than obtain less detailed imaging from a CT or myleogram, or even an open MRI.
So, he referred me to their anesthesiologist, and ordered pre-op blood work as well. As my wife put it, pre-op blood work is good only for two weeks; that means he expects I'll need surgery, AND SOON. [If any of you know Dr. Heilman's reputation, he is generally very conservative and performs surgery only as a last resort.]
With all my pre-op work done, I will be scheduled for an MRI on THURSDAY 9/17 at the Houston Orthopedic Hospital and Fondren Orthopedic Clinic (located on Main Street just south of Greenbriar). I will undergo GENERAL anesthesia for my MRI, which is not ideal, but oh well. The anesthesiologist will be only about 10 feet away monitoring my vital signs while the imaging is going on. After the MRI, I'll be moved to recovery for about an hour, and then await the doctor. Beyond that there is not much more I can tell you at this time.
Lisa will drive me to the hospital, but will be unable to sit with me, because she is having her monthly cancer therapy on the same day. I have asked a couple of friends to sit with me at the hospital before and during my MRI and my time in the recovery room. Hopefully, I'll have some "comfort companions" to help me through this. I'm not too worried, but I don't want to do it alone. Okay, I'm a whimp. I admit it.
Thanks for all your prayers. Keep them going.
David Adcock
College Station, Texas
The loss of strength in my left arm was to be expected. I could already tell that I had some weakness on that side. I assumed it was residual effect of the paralysis that occurred a little over a week ago. But then the doctor performed another simple test: a reflex test.
He tapped my right elbow and it reacted normally. He tapped my right forearm in a particular spot and the result was the same. Again, he tapped my right wrist and I had a normal reflex reaction. Then he checked my left elbow, forearm and wrist. ABSOLUTELY NO RESPONSE. I was stunned. He performed the test several times in each area. No change. I had not expected that.
After more questions and more examination, Dr. Heilman gently suggested that surgery appeared indicated, but that he wanted an MRI to visualize the extent of spinal cord compression and the extent of the spinal damage. As I suspected, he feels this has been slowly developing over many years. He seemed to feel addressing this sooner rather than later is to be preferred.
I informed Dr. Heilman that due to my inability to lay on my back for more than a few seconds or minutes at a time, plus my neck pain and recent development of mild claustrophobia, I was unable to undergo an MRI. He pressed the issue and decided it would be best to put me under general anesthesia and get a good MRI, rather than obtain less detailed imaging from a CT or myleogram, or even an open MRI.
So, he referred me to their anesthesiologist, and ordered pre-op blood work as well. As my wife put it, pre-op blood work is good only for two weeks; that means he expects I'll need surgery, AND SOON. [If any of you know Dr. Heilman's reputation, he is generally very conservative and performs surgery only as a last resort.]
With all my pre-op work done, I will be scheduled for an MRI on THURSDAY 9/17 at the Houston Orthopedic Hospital and Fondren Orthopedic Clinic (located on Main Street just south of Greenbriar). I will undergo GENERAL anesthesia for my MRI, which is not ideal, but oh well. The anesthesiologist will be only about 10 feet away monitoring my vital signs while the imaging is going on. After the MRI, I'll be moved to recovery for about an hour, and then await the doctor. Beyond that there is not much more I can tell you at this time.
Lisa will drive me to the hospital, but will be unable to sit with me, because she is having her monthly cancer therapy on the same day. I have asked a couple of friends to sit with me at the hospital before and during my MRI and my time in the recovery room. Hopefully, I'll have some "comfort companions" to help me through this. I'm not too worried, but I don't want to do it alone. Okay, I'm a whimp. I admit it.
Thanks for all your prayers. Keep them going.
David Adcock
College Station, Texas
Friday, September 11, 2009
Cervical Spinal Stenosis with Radiculopathy
9/11/2009 12:30pm
For many years I have suffered with back and neck pain, often with radiating pain down my left arm. Back in the 1990s, I thought the problem was associated with either a developing heart problem or with a back & neck injury I suffered on July 8, 1991, after a nearly 30 foot fall at an amusement park in Houston. The pain often coincided with difficulty breathing (dyspnea).
I sought out professional help from a wide variety of specialists. The variety of diagnoses ranged from depression/anxiety (sic!) to natural aging to insufficient mattress support. With the exception of one doctor, none took seriously my back injury, and even that doc felt that a few weeks of rehab therapy might 'fix' the problem. Of course, I endured test after test, including stress tests for the heart, pulmonary tests for my dyspnea, X-Rays, MRIs, and CTs. Each time the doctors could find no reason for my pain; so, they would eventually give up.
Part of the reason for the nearly 20 year trail of failed diagnostic work is connected to how the medical profession works. Part of the blame falls on my inability to assess what has really been going on with my body. My symptoms have been processed through my own concerns, like worries about heart disease or blockage, or other unrelated medical issues. But part of the problem has been that each physician I consulted searched for only one thing at a time; they addressed only one problem at a time. There was never any over-arching plan to thoroughly test each potential cause. They would focus on one issue and once that was resolved, they would consider their work done. In short, they tried to treat the "problem" at hand, but never treated ME.
For instance, if I mentioned that my shoulder sometimes ached during an episode of back pain and difficulty breathing, my physician might send me for an X-Ray or MRI of the shoulder. When they could see no cause, they would refer me to a heart specialist, who would only look for heart disease or bloackage. One doc would take X-rays of the neck and back, but when s/he couldn't see anything, they would conclude that no further imaging studies were needed, and either consider their work done, or pass me on to someone else.
For nearly 20 years, my condition has slowly progressed, sometimes seemingly improving, other times worsening. My unrelated health issues like the creeping obesity I've suffered since 1991, and other age related problems with cholesterol, blood sugar, abnormally low hormone levels complicated matters.
Finally, I gave up and decided to just bear my burden and accept my fate. I learned to manage my dyspnea through self-developed relaxation techniques. I kept the back pain to myself most of the time, and in later years, began a daily aspirin regimen, just in case the real cause of that chest and back pain was my heart. The aspirin significantly improved my dyspnea, so I took whatever improvements I could get.
But without realizing it, my periodic back, neck and left shoulder pain slowly increased in intensity. The tingling down in my left hand and down my left arm, period left arm weakness, etc. were intermittent, so, somewhat bearable. But the episodes tended to linger longer as time progressed. All the while, specialist after specialist chased phantoms and arrived at no definitive conclusions.
Then I moved to College Station in 2008. My new primary care physician (PCP) continued the mishandling of my medical management, focusing on ordinary age-related issues like cholesterol, blood sugar, and obesity. For my other symptoms, he simply referred me to his doctor friends, who generally didn't search any further than my docs in the past.
Then in September 2008, seemingly from nowhere, I had my first major attack. My neck, back and shoulder pain became extreme. I could feel the pain in a much more localized area of my neck. The pain radiated down my arm. I experienced loss of motor function, in addition to numbness. The pain was so severe, my PCP decided I needed to see one more specialist.
By 'accident,' I was misreferred to an orthopedist who specialized in sports medicine. But it turned out for the best. With a single CT scan and a few X-rays, he diagnosed me with cervical spinal stenosis. The radiological studies were largely inconclusive. The radiologist's report of Sept 2008 remarked that there was mild cervical stenosis, but nothing else out of the ordinary. But my orthopedist decided that a short term steroid course might help, and prescribed a 6-day 'weaning' regimen of Methylprednisolone. He explained why he thought my primary problem was stenosis and encouraged me to give the steroid regimen a try.
A week later, my pain was gone, and it was clear to me that the steriods made the difference. I learned from my wife how steroids help reduce the inflammation associated with a pinched nerve or spinal cord compression, and how this reduction helped ease the pressure on the spinal cord or pinched nerves. My orthopedist was satisfied and suggested that we try to manage my problem in a similar fashion if the condition flared up again. He thought that I would eventually need surgery, since cervical spinal stenosis is generally a progressive disease, but that he hoped we might be able to avoid surgery for a few years.
Well, I experienced another 'flare up' in February, 2009 and again two weeks ago, beginning August 29, 2009. The steroid approach quickly resolved the February episode, but it has only partially helped this last time. The orthopedist came to the conclusion that it was time to consider surgical options. Once again, he referred me to a surgeon in his group, rather than consider my best interest first. Fortunately, the physician to which he referred me is not within my health insurance's "network," so my insurance won't cover me if I see him.
I will say here that this latest episode has been the most extremely painful experience of my life. The neck, upper back, and shoulder/arm pain have been so severe that I have slept little this past week. On more than one occasion the intensity of the pain has driven me to tears. I have found little relief during the worst periods of pain, which usually occur at night. For a few hours last week I lost total use of my left arm, due to near complete paralysis, and even after the paralysis passed, was unable to dress myself without help until a couple of days ago.
I have been unable to lay down without a high level of pain, and no change of position seems to result in any lessening of the pain. I have been relatively sleep deprived for the last 10 days, even with the heavy pain meds, muscle relaxers, NSAIDs (Aleve) and steroids. I can tell the heavy meds are helping dull the edge of the pain, but they do not seem to be working as effectively as they have in the past. I am still significantly impaired, with my left arm remaining compromised and head/neck movement severely restricted.
Well, today, I finally found a surgeon in Houston who will see me next week: Tuesday, 9/15/2009 at 9am. He is both a board certified orthopedic surgeon and a board certified neurosurgeon. His specialty is cervical spinal stenosis, and he is an expert on minimally invasive surgery techniques specifically for spinal stenosis surgery!
My condition is technically called CERVICAL SPINAL STENOSIS with RADICULOPATHY.
Until recently, I didn't know that my two brothers also suffer from this condition, and that my grandfather was paralyzed by this very condition back in the 1970s. In the past, this degenerative condition was called "creeping paralysis," because there was little doctors could do to stop the progression of this disease. Sometimes the more severe conditions would lead to death. Both of my brothers have required surgical intervention for their stenosis, one of which has endured TWO surgeries.
I am not certain that my neurosurgeon will start with surgery. I suspect, he'll want to do some imaging studies first, and may try a direct injection to alleviate the pain, if he thinks the condition is not severe enough for surgery yet. I just know that I can't handle this pain much longer. We'll see how things progress.
For everyone's information, cervical spinal stenosis is essentially a narrowing of the spinal canal in the neck, usually producing cord compression and thereby impairing nerve function, and often causing pain. There are a number of causes for this 'narrowing,' including bulging disks, bone spurs and calcification, disk compression, and even degeneration of the canal itself. My condition appears to not be related to disk misalignment, but rather is due to a general degeneration and narrowing of the spinal canal. As I noted above, in my case, it appears an inherited genetic condition.
Radiculopathy, implies that the compression on the spinal cord or nerves is affecting one of my arms. In my case, the cord compression is affecting my left arm, which is my "writing" arm. As stated above, I have experienced a lot of numbness and pain in my left arm, as well as impairment and temporary paralysis. I still am unable to lift my arm higher than horizontal to the floor. What's worse, if I then lift my right arm, my left arm falls helpless to my side, and I am unable to use my left arm until I put my right arm down. There is uncertainty whether surgery will restore my left arm motor function back to normal, but it should take care of the pain.
So, that's what is going on with me at the moment. I have been reluctant to share all this with everyone until I know more. But with the increasing number of inquiries from all my WONDERFUL, DEAR friends and family, I think it's time just to tell you everything.
Thank you for your kind words and gestures of concern. You are all the best. I will keep you informed.
David Adcock (2pm)
daadcock@suddenlink.net
College Station, Texas
For many years I have suffered with back and neck pain, often with radiating pain down my left arm. Back in the 1990s, I thought the problem was associated with either a developing heart problem or with a back & neck injury I suffered on July 8, 1991, after a nearly 30 foot fall at an amusement park in Houston. The pain often coincided with difficulty breathing (dyspnea).
I sought out professional help from a wide variety of specialists. The variety of diagnoses ranged from depression/anxiety (sic!) to natural aging to insufficient mattress support. With the exception of one doctor, none took seriously my back injury, and even that doc felt that a few weeks of rehab therapy might 'fix' the problem. Of course, I endured test after test, including stress tests for the heart, pulmonary tests for my dyspnea, X-Rays, MRIs, and CTs. Each time the doctors could find no reason for my pain; so, they would eventually give up.
Part of the reason for the nearly 20 year trail of failed diagnostic work is connected to how the medical profession works. Part of the blame falls on my inability to assess what has really been going on with my body. My symptoms have been processed through my own concerns, like worries about heart disease or blockage, or other unrelated medical issues. But part of the problem has been that each physician I consulted searched for only one thing at a time; they addressed only one problem at a time. There was never any over-arching plan to thoroughly test each potential cause. They would focus on one issue and once that was resolved, they would consider their work done. In short, they tried to treat the "problem" at hand, but never treated ME.
For instance, if I mentioned that my shoulder sometimes ached during an episode of back pain and difficulty breathing, my physician might send me for an X-Ray or MRI of the shoulder. When they could see no cause, they would refer me to a heart specialist, who would only look for heart disease or bloackage. One doc would take X-rays of the neck and back, but when s/he couldn't see anything, they would conclude that no further imaging studies were needed, and either consider their work done, or pass me on to someone else.
For nearly 20 years, my condition has slowly progressed, sometimes seemingly improving, other times worsening. My unrelated health issues like the creeping obesity I've suffered since 1991, and other age related problems with cholesterol, blood sugar, abnormally low hormone levels complicated matters.
Finally, I gave up and decided to just bear my burden and accept my fate. I learned to manage my dyspnea through self-developed relaxation techniques. I kept the back pain to myself most of the time, and in later years, began a daily aspirin regimen, just in case the real cause of that chest and back pain was my heart. The aspirin significantly improved my dyspnea, so I took whatever improvements I could get.
But without realizing it, my periodic back, neck and left shoulder pain slowly increased in intensity. The tingling down in my left hand and down my left arm, period left arm weakness, etc. were intermittent, so, somewhat bearable. But the episodes tended to linger longer as time progressed. All the while, specialist after specialist chased phantoms and arrived at no definitive conclusions.
Then I moved to College Station in 2008. My new primary care physician (PCP) continued the mishandling of my medical management, focusing on ordinary age-related issues like cholesterol, blood sugar, and obesity. For my other symptoms, he simply referred me to his doctor friends, who generally didn't search any further than my docs in the past.
Then in September 2008, seemingly from nowhere, I had my first major attack. My neck, back and shoulder pain became extreme. I could feel the pain in a much more localized area of my neck. The pain radiated down my arm. I experienced loss of motor function, in addition to numbness. The pain was so severe, my PCP decided I needed to see one more specialist.
By 'accident,' I was misreferred to an orthopedist who specialized in sports medicine. But it turned out for the best. With a single CT scan and a few X-rays, he diagnosed me with cervical spinal stenosis. The radiological studies were largely inconclusive. The radiologist's report of Sept 2008 remarked that there was mild cervical stenosis, but nothing else out of the ordinary. But my orthopedist decided that a short term steroid course might help, and prescribed a 6-day 'weaning' regimen of Methylprednisolone. He explained why he thought my primary problem was stenosis and encouraged me to give the steroid regimen a try.
A week later, my pain was gone, and it was clear to me that the steriods made the difference. I learned from my wife how steroids help reduce the inflammation associated with a pinched nerve or spinal cord compression, and how this reduction helped ease the pressure on the spinal cord or pinched nerves. My orthopedist was satisfied and suggested that we try to manage my problem in a similar fashion if the condition flared up again. He thought that I would eventually need surgery, since cervical spinal stenosis is generally a progressive disease, but that he hoped we might be able to avoid surgery for a few years.
Well, I experienced another 'flare up' in February, 2009 and again two weeks ago, beginning August 29, 2009. The steroid approach quickly resolved the February episode, but it has only partially helped this last time. The orthopedist came to the conclusion that it was time to consider surgical options. Once again, he referred me to a surgeon in his group, rather than consider my best interest first. Fortunately, the physician to which he referred me is not within my health insurance's "network," so my insurance won't cover me if I see him.
I will say here that this latest episode has been the most extremely painful experience of my life. The neck, upper back, and shoulder/arm pain have been so severe that I have slept little this past week. On more than one occasion the intensity of the pain has driven me to tears. I have found little relief during the worst periods of pain, which usually occur at night. For a few hours last week I lost total use of my left arm, due to near complete paralysis, and even after the paralysis passed, was unable to dress myself without help until a couple of days ago.
I have been unable to lay down without a high level of pain, and no change of position seems to result in any lessening of the pain. I have been relatively sleep deprived for the last 10 days, even with the heavy pain meds, muscle relaxers, NSAIDs (Aleve) and steroids. I can tell the heavy meds are helping dull the edge of the pain, but they do not seem to be working as effectively as they have in the past. I am still significantly impaired, with my left arm remaining compromised and head/neck movement severely restricted.
Well, today, I finally found a surgeon in Houston who will see me next week: Tuesday, 9/15/2009 at 9am. He is both a board certified orthopedic surgeon and a board certified neurosurgeon. His specialty is cervical spinal stenosis, and he is an expert on minimally invasive surgery techniques specifically for spinal stenosis surgery!
My condition is technically called CERVICAL SPINAL STENOSIS with RADICULOPATHY.
Until recently, I didn't know that my two brothers also suffer from this condition, and that my grandfather was paralyzed by this very condition back in the 1970s. In the past, this degenerative condition was called "creeping paralysis," because there was little doctors could do to stop the progression of this disease. Sometimes the more severe conditions would lead to death. Both of my brothers have required surgical intervention for their stenosis, one of which has endured TWO surgeries.
I am not certain that my neurosurgeon will start with surgery. I suspect, he'll want to do some imaging studies first, and may try a direct injection to alleviate the pain, if he thinks the condition is not severe enough for surgery yet. I just know that I can't handle this pain much longer. We'll see how things progress.
For everyone's information, cervical spinal stenosis is essentially a narrowing of the spinal canal in the neck, usually producing cord compression and thereby impairing nerve function, and often causing pain. There are a number of causes for this 'narrowing,' including bulging disks, bone spurs and calcification, disk compression, and even degeneration of the canal itself. My condition appears to not be related to disk misalignment, but rather is due to a general degeneration and narrowing of the spinal canal. As I noted above, in my case, it appears an inherited genetic condition.
Radiculopathy, implies that the compression on the spinal cord or nerves is affecting one of my arms. In my case, the cord compression is affecting my left arm, which is my "writing" arm. As stated above, I have experienced a lot of numbness and pain in my left arm, as well as impairment and temporary paralysis. I still am unable to lift my arm higher than horizontal to the floor. What's worse, if I then lift my right arm, my left arm falls helpless to my side, and I am unable to use my left arm until I put my right arm down. There is uncertainty whether surgery will restore my left arm motor function back to normal, but it should take care of the pain.
So, that's what is going on with me at the moment. I have been reluctant to share all this with everyone until I know more. But with the increasing number of inquiries from all my WONDERFUL, DEAR friends and family, I think it's time just to tell you everything.
Thank you for your kind words and gestures of concern. You are all the best. I will keep you informed.
David Adcock (2pm)
daadcock@suddenlink.net
College Station, Texas
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