A Jawdropping CT Scan

The most recent CT scan study of my Thoracic spine follows.

After a fusion, it is common for the levels above to become weaker and possibly herniate.  I used to joke that my discs would just keep herniating up the spine as each level is fixed.

Unfortunately, that is not a joke anymore. 

The report is three pages long, chock full of great medical terms to review, such as 'Schmorl nodes' (which is simply herniation of the nucleous pulposus) and reads like a medical school freaky-spine to study for what you do not want to see as a doctor having to deal with a patient housing such a network of spinal pathologies.

The Radiologist starts at Thoracic Spine vertebrae #1, and Thoracic Spine vertebrae #2.  This is written as T1-T2.  Levels are read in 'doubles' as each bony vertebrae joins together to the one above and below.  The disc, made up of a gelatinous material, lies in the middle of the two joining vertebrae, cushioning the large body of each vertebrae.

And off we go..... 

 T1-T2:  There is a 1-2 mm circumferential disc bulge noted.  Costovertebral hypertrophy is noted.  Foraminal compromise identified.

Yikes!  Right off the line and already starting off with a messy first level.  The Thoracic spine is the rarest area to have problems.  Herniated discs, osteophytes, etc, are not seen in the T-spine as often as they are seen in the Lumbar spine. OK, on we go... 

 T2-T3: There is a 1-2 mm circumferential disc bulge noted.  Costovertebral hypertrophy noted.  Foraminal compromise identified.

 T3-T4: There is a 1-2 mm disc bulge noted.  Costovertebral hypertrophy noted.  Foraminal compromise identified.

T4-T5: There is a 1-2 mm disc bulge noted.  Costovertebral hypertrophy noted.  Foraminal compromise identified. 

Did I just write the same thing four times?  4 herniated discs--multiple levels--and I am only on the 4th level of 12 vertebrae of the Thoracic spine.  Costovertebral hypertrophy is the area the rib joins the vertebrae and it is abnormally large. Foraminal compromise means the foramen—the opening in the vertebrae in which the nerves pass through—is compressed and narrowed. This often leads to neuropathy and other nerve-related conditions. I consider myself very fortunate with so many levels in which the foramen is compromised, to not have severe and painful nerve issues in these four levels. 

T5-T6: There is a 1-2 mm disc bulge noted.  Costovertebral hypertrophy noted.

(That was #5 herniated disc in as many levels.)

T6-T7:   There is a 2 mm circumferential disc bulge noted.  There is a right paracentral disc protrusion that indents the Thecal sac.  It measures 6x3 mm in the transverse and AP dimension.  There is bilateral foraminal compromise.  At the level of the disc protrusion right of the midline, the AP dimension of the canal is on the order of 9mm.  Costovertebral hypertrophy noted.  Foraminal compromise identified. 

T7-T8:  There is a circumferential disc osteophyte complex that is prominent to the right anteriorly.  There is a right paracentral calcified disc protrusion that measures 6x3 in the transverse and AP dimensions respectively.  There is indentation of the Thecal sac.  Bilateral foraminal compromise and moderate costovertebral hypertrophy at this level.

T8-T9:  There is a bulky right anterior disc osteophyte complex that measures 1.5 x 1.5 cm in size.  There is moderate bilateral costovertebral hypertrophy, slightly greater on the right.  There is calcification of the Ligamentum flavum.  There is a right paracentral calcified disc protrusion that indents the thecal sac.  It measures 5 x 3 mm.  There is bilateral foraminal compromise.  There is indentation of the thecal sac. 


**I am at level nine out of 12 levels of the thoracic spine.  Not one level has been untouched by disc protrusion/herniation, foraminal compromise, bone hypertrophy, osteophytes, and the last 3 levels show the thecal sac is indented. The thecal sac is a membrane covering the spinal cord, which contains CSF or cerebral spinal fluid. We do not want to see thecal sac indentation, that is getting too close to the spinal cord which brings a whole other set of very serious potential problems.

T9-T-10:  There is a 2mm disc osteophyte complex.  There is a right paracentral calcified disc protrusion that indents the thecal sac.  It measures 3 x 3 mm on the transverse and AP dimension.  There is moderate bilateral foraminal compromise.

T10-T11:  There is a 2 mm circumferential disc osteophyte complex eccentric to the left posteriorly.  Bilateral foraminal compromise.  There is resection of the left costovertebral joint and portions of the left rib with some bone fragments remaining in the postsurgical bed.  There is hypertrophy of the left transverse process.    

**T10-T11 is where my second open Thoracic spine surgery was, called a Costotransversectomy and fusion. My neurosurgeon called it, “The Big Surgery”, with stern warnings about the post-op pain and realistic recovery time. The name suggests the surgeon used a transverse approach, removing parts of the left rib along with part of the joint where the rib meets the vertebrae. He then removed the herniated disc he accessed when the rib was out of the way, followed by a fusion using the bony fragments of the rib and CV joint. Fusions are commonly done with cadaver bone or a metal of sorts.  He opened my back in a straight incision above my spine, then went in on the side at the ribs to perform the transverse entry.

 

T11-T12:  There is a 2 mm circumferential disc osteophyte complex eccentric to the left posteriorly.  Bilateral moderate foraminal compromise with probability of impingement of the exiting nerve roots.  Ligamentum flavum hypertrophy and mild facet hypertrophy noted bilaterally.

**This level shows the nerve roots with ‘probability of impingement’ due to moderate compromise of the foramen bilaterally (both sides). And again, I am so thankful that up to this point I do not have neuropathy in this area. 

T12-L1:  There is a 2mm circumferential disc bulge noted.  There is mild left foraminal compromise.  There is no nerve root impingement.
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Knowing what I do from my past surgeries, my experience as a spine surgery patient, and my medical knowledge as a nurse, my spine is  "really messed up."  These words were spoken by the kind pain management doctor that saw me for the Morphine pump.  As he read the CT results, he looked at me to say how bad my spine is, and my eyes clouded with tears.  I knew already that what was there, and what had been fixed surgically, was already a 'huge mess'.  Yet this CT scan showed me exactly why my pain has been rising steadily and is becoming out of control.  

I was told by a close friend the other day, just how strong I am.  She saw me after a long, very active day- and my pain was crazy-high.  Yet somehow I was able to press on and do the things that I needed to do.  It felt good to hear that.  Yet even I do not know where the incredible strength comes from!  How I am able to push through the barrier that occurs when pain hits hard and I am unable to rest, and just keep going?  It is from God.  For if you saw me on the street, you would never know my name was on a CT result such as above.    

I may have severe spinal issues.  I may have a spine that will never allow me to return to nursing.  (THAT alone causes the tears to well up.)  But I will never allow all of this to keep me down.  I refuse to fade off into the background while life goes on around me.  I would much rather experience life and all that it brings, in severe pain, than to not have those experiences.  Better to live my life in pain than....well, what is the other choice?  NOT live?  Actually, that IS the reason we have many deaths by suicide in the chronic pain community.  For there is NO other choice than to learn to live with the crazy pain.  

And I would rather feel life in all it's wonder......and in pain......than to feel nothing.       

 
Gentle Hugs....

Stay strong~
                     ~just for today~

What Would You Do?

Tomorrow is the appointment for my consult with the physician who places IDDS.

Having waited over a year for this, I am extremely excited and will write about the outcome ASAP.   

Over the weekend I saw an old friend and I am very concerned.  This person is under a doctor's care for pain management.  However, when we met, I was astonished at the state that this person is in.  This is one of my biggest worries--those who take their medications improperly, yet are being followed by a physician.  Something is wrong with this picture.   

Is the physician aware that this patient is totally over taking medications?  Leaving them in such a state that they are unable to drive, unable to speak clearly, unable to make proper decisions.  I care about this person personally and find myself at a loss of what to do. 

We both know each other very well, and yet the addiction to pain pills goes unspoken between us.  Here I am, writing about those that take pain meds, and how I am in favor of Opiates for the use of pain management in cases where the patient will benefit from such medications; and yet I see this person totally out of it and I am stuck . This is not like me.  Maybe because it has hit close to home, it bothers me so very much.

I care about all people who are in pain.  I seek to educate and advocate for pain patients.  However, when a patient is clearly non-compliant, I feel angry to see it in action.  I feel sad to know that this person is ruining their life, and it can only go down from here if the pills are continued to be used for more than pain relief.

It is a slippery slope to begin Opiates.  The prescribing physician needs to do a complete assessment of the patient who is going to embark on a regimen of opiates.  Do these patients present as clear headed and compliant when in the presence of their physician?  Is this just to get the prescription in their hands?

When I speak of compliance, I am very serious about this subject, and pride myself of being a totally complaint patient.  This includes doing everything that the doctor wants to include in the treatment program.  If Physical Therapy is prescribed for instance, the patient is expected to attempt therapy.  It may not be easy, it may not fit into everyone's schedule, but it must be tried.  It may be uncomfortable, the patient may not be ready for that at this time, but it must be tried.   

If someone wants their pain to be lowered, become a level that can be tolerated, they must go along with what their doctor wants to try.  Not doing this shows that a patient is not interested in getting better.  A patient who is being treated for pain, can not just take pills all day and expect to get better.

I have been forced into physical activity that I didn't know I could do; over the past 7 months.  I am thankful that everything worked out the way that it did, for I have found that becoming physically stronger has lowered my overall pain levels!  This is exciting and rewarding.  Constantly a challenge, I have learned that my body can do much more than I thought previously.  Sometimes in life we must be forced into a situation that allows us to see just how strong we are--both physically and emotionally.

Yet when I see a person that I used to know as a vibrant person, gone down the drain so fast into a painpillheadthatdoesntmakeanysense, slurring words, eyes clouded, unable to remember what was just said, my heart is heavy.  I know that addiction runs rampant in this persons life.  Not seeing someone for a few months, then seeing them and being aware of the level they have sunk to, and all because of over taking their pain medications...well I am at a loss for words.

What do I do?

What would YOU do?   

Gentle Hugs....

Intrathecal Drug Delivery Sytems: How Do They Work?

As the day approaches for the consult with the physician that will put in the IDDS/Morphine Pump, I am researching the subject over and over again, and reading everything I can about the pumps.

Of course I have done this before, but I wanted to get some up to date information and post a few pictures of the pump so everyone can understand at least what they look like, and how they work.

The pumps that are made by Medtronic, are about the same circumference as a tuna can, (the small ones) and since I am quite thin, I have been told that mine will probably show.  The pump holds the medication that is then 'pumped' to the intrathecal space.  There is a catheter that goes from the pump, to the spot where the end of the catheter is, and the medication is then in the spinal column's intrathecal space.

Is it decent-looking to walk around with a 'tuna can' in my abdomen that is visible to others??  Well, guess what--I don't CARE!!  I have never cared what others think, and now is no different.  Especially if it has to do with a reduction in my pain levels.  I will be the first one to put on a bikini, get to the beach, and swim in the ocean--one of my favorite things to do, which I haven't been able to do for years.  Tuna or no tuna, I'm there!!!  Just thinking about the world that will open back up to me is nearly unbelievable.   

One of the huge benefits of the IDDS is no more oral meds.  I know that many, if not most, of the pump recipients, still need to take some oral medications.  Breakthrough pain can still occur with the pump running, and oral medications may need to be used for the BTP.  Also, other medications can be put in the pump, such as Baclofen, which is a muscle relaxer, but if that is not used with me, I may still need to take something for the severe muscle spasms that I have.  The idea here is that a small fraction of the oral dose of medication can be used with the pump, since the medication goes directly to the spinal canal or intrathecal space, and disrupts the pain signals from being broadcast to the brain. 

I have talked to a 'Pump Ambassador' with the Medtronic Tame the Pain program, who told me everything about her pump trial, and subsequent implantation.  I was giddy after our phone call, and very excited.  This was quite a few months ago, and I am going to talk with her again since this is all going to hopefully happen very soon for me.  She told me the nurses would hang out in her room (more like hide in her room) because she was the only non-demanding patient during her trial, as her response was excellent and she had nearly complete relief of her pain.

I am very realistic and know that this could be a total failure. I have a large amount of scar tissue in my spinal area, which got in the way of a Spinal Cord Stimulator being placed for pain relief during the trial for the Stimulator.  Strange, I was not told about the pump at that time when a failed Stimulator trial occurred.  But I have always believed that everything happens in it's own time, and at the right time.

This link will take you to a very short video that shows how the pump is placed: 

http://www.medtronicaseanneuro.com/Pain_intro2idp.html

Much more to come on the pump, the trial and what that entails....

Gentle Hugs....