My vacation from blogging

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Our first snow of the season is falling outside, an inch-deep Alberta Clipper. I am long past the cozy enchantment of anticipating snow drifts and the like. I’d rather watch it through the safe distance of film or video than experience it firsthand.

I’ve refrained from writing posts for the past couple weeks because I thought that doing so would be akin to pouring salt on a wound. Now that the worst of the nerve pain that plagued me through late summer to mid-November seems to be behind me, I have been quite angry over what happened. I am mad that I waited so long for relief (which, by the way, came randomly with the pulling of a heavy drawer while bent over at an awkward angle).

I am not exaggerating when I say that this interlude of nerve pain was the worst thing that has ever happened to me. Maybe there is something in the nature of pain that inclines a person to believe that the latest acute episode is the worst one, sort of a photo negative of one’s love life, how often we hear that a person’s current lover is the best one ever. With that aside, I will tell that I really did feel worse than I ever had.

I am no stranger to pain. I had a radical mastoidectomy, wherein a damaged part of the skull that borders the ear is removed. I was in labor for 44 hours when I had my daughter, and I had no pain medication for 24 out of those 44 hours (and this was back labor). I would add this year’s spinal fusion surgery to this list, but the pain of that procedure and its recovery were nowhere near as bad the preceding two events in this paragraph.

I know that there are millions, if not billions, of people in this world who’ve lived through pain far worse than I have. I can only attest to my own pain, and I am mad when I think of all the effort I devoted to finding a resolution to my recent pain. I don’t think I was taken seriously because I could still walk on my own and keep a straight face while doing so.

It must be hard for orthopedic doctors to understand that the pain of a patient who can work and communicate as normal can be important. In any given day or week, they see patients who’ve been broken through traumatic accidents, people who arrive for their appointments in a wheelchair or on a stretcher. So when someone like me comes knocking, a patient who seems to walk with apparent ease and can report their symptoms in a near-clinical tone, they must be tempted to assume that such a patient is just worried but well. I was not.

After three months of asking for an explanation for why I suddenly felt so bad six months past my surgery, I learned a few things through an MRI and physical examinations. I am healing well from my L4/L5 fusion surgery. This does not surprise me because the pattern of my nerve pain was markedly different than what I experienced in the months leading up my surgery. Back then, I had numbness in my left knee and part of my foot, with flares of sciatic pain that struck at random. This time around, I had awful nerve pain in a band from my outer left hip to the inside of my left knee, only when I stood in place for more than a few minutes or walked more than a hundred yards or so.

It turns out that my L2/L3 and L3/L4 discs have degenerated more in the past year, but neither are in bad enough shape to qualify for more than conservative treatment measures. I also have bursitis in my hip and strain in a tendon that leads from my hip to my knee (ITBS, or iliotibial band syndrome). I’ve been doing physical therapy exercises for the bursitis and ITBS, but the aches and pains of those issues aren’t completely gone.

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I do not yet have clarity on what I can do to prevent further flare-ups of nerve pain. No one has offered me a prognosis or definitive reason for why my orthopedic problems continue. Last year, I heard that my lumbar degeneration is hereditary. This makes sense given that I have several close relatives with similar problems. However, there isn’t enough similarity between our symptoms and course of disease to model a course of action based on what has worked for the others.

I wish I knew if I there was something I am unwittingly doing that could be making things worse, that some qualified person could take me in hand and tell me that I should change my life in such-and-such ways because of my spinal stenosis. It seems I must draw that map myself.

I don’t think I have accurately conveyed how active I must be to lead the life that I do. Both my job and my life at home require all sorts of walking. Below is a chart of all the walking I’ve done since my surgery in March (from my Fitbit account, btw):

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I’ve discovered through long experience that the only sure thing that keeps my depression at bay is walking. I thank God that the chief prescription for my surgical recovery was walking. What would I do if my spinal stenosis progressed to the point when I couldn’t walk much at all? I’d practically need to remake myself.

I’ve watched far too many episodes of Agatha Christie’s Poirot lately. There was something Poirot said in the episode called “Appointment with Death” that is one of the most inspirational things I’ve ever heard:

“There is nothing in the world so damaged that it cannot be repaired by the hand of almighty God.”

A Rainy Saturday Morning

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Around 11 last night, it started raining hard enough to turn all the pipes on the roof into little dissonant steel drums. My sense of what keeps a house from surrendering to noxious fluids and vapors is vague at best. It’s only during a hard rain that I know for certain where the all the exhaust vents emerge atop the house.

I awoke to the sounds of the same hard rain this morning. I’ve already done the dishes, started the laundry, and done some basic grocery shopping this morning. I really should fold the clothes. When the dryer starts dinging, it’s like a siren call of domestic duty–fold me now, lest you need to dust off the dreaded iron.

I will resist that call in favor of writing a bit. I don’t think there’s anything in that dryer that can’t be unwrinkled with a few minutes of fluffing.

I suppose it’s a cardinal sign of self-absorption to the start several paragraphs in a row with the word I. Indeed this post focuses on me and my recent struggles.

In sharing these problems, I hope that I am not merely alienating my readers. It is not impossible that some of you have endured the same or similar trials. If that is the case for you, I hope you find some solace in seeing a kindred spirit emerge from similar adversity.

I am just arising from flare-ups of chronic pain and depression that spanned three months. It began with hip pain and ended with the worst variant of sciatica that I’ve ever had the misfortune of feeling.

I did have a few random days I felt no pain at all. All the while, I had no pain unless I was moving. To feel no pain at rest is a blessing ordinarily taken for granted. I recently joined a Facebook support group for people who’ve had spinal fusion surgery. My first impression was how fortunate I am among that cohort of patients. Compared to that group of patients, my burden is light. I don’t struggle to sleep because of pain. I can work.

Here is the thing I gleaned from reading those stories: The only pain you know is your own, and it should not be discounted just because someone else has suffered more. There were moments of my most recent sciatica episode that afforded me the worst pain I’ve ever felt. It’s a pain that does not season you pleasantly with wisdom or humility. Instead, it just makes you bitter that it happened, a rude surprise that you still had a little innocence left to steal.

It all ended with a moment akin to the last bolt of lightning that flashes at the end of a storm. I was putting away laundry and leaned over to open one of my clothes drawers, a drawer that is heavy with clothes that need pruning. I felt rushed (for no good reason) to finish the laundry, so I stayed bent over at the same awkward angle as I closed the drawer. As I pushed it closed, I felt a bizarre stretching in my lower back, and the ends of my spinal fusion felt like they were sparking with a bit of heat.

I straightened myself out, dreading that I might have complicated hereditary lumbar degeneration with a careless accident. As I walked down the hallway from my bedroom, I realized that something quite different had happened. My sciatica was gone. My awkward maneuver made a supremely lucky adjustment, one that I couldn’t repeat in a hundred tries.

I am still contending with the ordinary legacy of ongoing recovery from my spinal fusion surgery, which presents a random array of numbness and nerve pains. It is a calm I’ve not known for long since the height of summer.

I’m devoting this time before the holiday rush to some deeper rest. I’ve been digging into some Agatha Christie stories, both in print and on television. Actually, Agatha Christie is an author I willfully ignored until now, dismissing her body of work as trite without having read a line of her work. I’ve been pleasantly surprised at how witty and sometimes bawdy her prose can be. The stories I’ve read and seen on screen are reminders that the moral compass of humanity isn’t degenerating more with each succeeding generation. The good and bad have always existed, only the fashions and technology have changed.

I’ve been pleasantly surprised at how witty and sometimes bawdy her prose can be. The stories I’ve read and seen on screen are reminders that the moral compass of humanity isn’t degenerating more with each succeeding generation. The good and bad have always existed; only the fashions and technology have changed.

With that written, I will now attend to folding the laundry, avoiding any foolish haste with the pushing and pulling of drawers.

October Hibiscus

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Last night the temperature dipped into the low 40’s, yet my hibiscus plant is still making a valiant effort to rebloom. This year’s garden has been a welcome distraction from my ongoing orthopedic problems (and a depression whose volume is directly proportional to how much pain I’m feeling on a given day). I see inspiration in the partial blooms on that hibiscus plant. It keeps going, even when no pleasant outcome is guaranteed. It grows with an unspoken knowledge that it will persist over the years. All of this blooming is just a bonus, a nod to its kind that it too hopes for a little immortality.

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The Long View

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As the summer season draws to close each year, I am reminded that taking the long view forward can have a toxic impact on my mind. There’s nothing like stacking everything that’s needs done in a year or more to provoke depressive feelings in me.

The half spent sawtooth sunflower shown above well represents where I stand at this time. If I focus on what is best in the present tense, I feel well, but if I mull over what is painful or yet-to-happen, I feel a bit crushed. It’s like dismissing the beauty of this plant just because it blooms for such a short time.

I’m already feeling a bit of nostalgia over my medical leave for back surgery this past spring. It’s not like this small era was packed with halcyon days. For two months, I had time to delve into the tangential things my ordinary schedule does not permit, yet I did not have the energy to accomplish much at all. Four months later, I regret that I tainted this time with any expectations beyond healing.

At the time, I wrote that my expectations were very low, but I now realize that such writing was my hope of deflating then-impossible goals. No, I was not going to craft a cookbook bursting at the seams with recipes both cheap and easy. I wasn’t going to document the daily unfurling of early spring with perfectly focused images. Worst of all, I would not have a house that was truly clean.

I did accomplish what needed to be done. My back is still fusing ahead of schedule. I was able to drive during my daughter’s spring break, so we were not stuck at home during the days of her vacation. After I came home from the hospital, I maintained my usual weekday wake up time (5:30 a.m., no less). This provided continuity for my family and ensured that I wouldn’t feel jet lagged once I returned to work.

Twice the time I had for leave has now passed since I returned to work. I can’t claim that the surgery was entirely successful. The symptom that made this procedure (an L4/L5 fusion) necessary was increasing numbness in my feet and in one of my knees. I had a long-term ruptured disc that exerted considerable pressure on my spinal cord. I had sciatica for a three month span prior to my surgery, but I didn’t have much pain obviously related to my back before that symptom began.

My MRI and surgery revealed that my disc ruptured 10 to 15 years ago. I had developed extensive arthritis and hypertrophy in my lumbar spine over that time. I’ve written previously of being stunned at my mental oblivion regarding this disease process. I literally had no suspicion of this degeneration, despite having several family members who’ve suffered from similar problems.

Looking back, the whole long interlude reminds me of that movie The Others starring Nicole Kidman, (spoiler alert) wherein she crafts an entire reality based on denial of her and her children’s passing. She has all sorts of elaborate excuses for why they can’t do the same things living people do, such as her warning to the children that they musn’t open the drapes because they are allergic to sunlight.

During Trick or Treat nine years ago, I barely endured walking my daughter around for a couple hours because my lower back was aching. Rather than go to a doctor about it, I decided that my problem was entirely due to obesity and lost 130 pounds over the next three years. I didn’t make any medical appointments whatsoever during that time (and for another year afterward) except for ear treatments I couldn’t avoid. Why? Because I assumed that almost every symptom I had was due to my weight, and my diet was the slow cure. How absurd that seems now!

Once I went back to my family doctor for myself for the first time in four years, she was so shocked at my change in weight that she sent me straight to a GI specialist. After running all sorts of tests on me (including colonoscopy, endoscopy, and biopsies), the GI doctor informed that I was the first 40 year old patient he’d seen who’d achieved a 50% weight loss without gastric bypass surgery or the misfortune of cancer. My advice to those who are planning a diet beyond a 10% weight loss: keep your doctors informed, or else they might assume the worst.

Now I wonder if my ongoing lumbar degeneration dampened my appetite. I didn’t struggle with eating less and walking more during those years. Now that I’ve had the surgery, my appetite and weight are much more of a challenge. I’m in the midst of trying to lose the 25 pounds I’ve gained over the past year, and the losing has been very slow this time around, 6 pounds in 8 weeks so far.

I started this post with the notion that looking too far foward can be depressing, but most of the foregoing is a backhanded homage to my recent past. The subject of my spinal woes is one in which I am better off lingering on the past than thinking too far into the future. Once I had my surgery, I started getting mild to moderate muscle spasms on the left side of my back and my left thigh. Physical therapy helped dampen this problem by strengthening these muscles. If I don’t do those exercises, the spasms are sure to be worse. Now here’s how I could depress myself with contemplating the future: I am not going to retire until I am 67. If I consider that I might be working with spasms for 22 more years, I feel steamrolled flat at the prospect of it.

If I take this problem day by day, it is just a pain that is fleeting, a sensation that reminds me that I need to keep building my strength.

Monday

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I am now in week seven of my medical leave, and I think that my recovery has jumped to an improved level after stalling out with some flare-ups of sciatica over the past two weeks. When I called to report the return of this nerve pain to my surgeon, he ordered some physical therapy which seems to have already helped more than I expected.

The physical therapy clinic suggested that working on the strength and flexibility of my hips could dampen my sciatic pain. I was tempted to dismiss this suggestion, which I guess would invest this therapy with the opposite of a placebo effect. Despite my lack of confidence in the capacity of this therapy to help me, I am happy to report that I am having less sciatic pain already.

I anticipate that my surgeon will release me to work in a week. I heard that this was the projected course of my healing before the surgery, and I am pleased that my recovery is proceeding according to schedule.

I also made a choice last week concerning the medications I’ve been taking that some may consider ill-advised, but the only advice I took on the matter was my own.  I had been taking prozac and gabapentin since mid-December to help ease the depression and nerve pain leading up to my back surgery, and my surgeon and primary doctor agreed that it was ok for me to stay on those meds during my recovery period. There was no plan for me to continue these prescriptions indefinitely, as was the case when I took antidepressants during my years of major depression.

Last week I considered that it was worth trying to discontinue these meds for three reasons: the 15-20 pounds I’ve gained while taking them (depending on the degree of bloat on a given day), the oddball return of my nerve pain, and memory issues. I wondered if it was possible that the gabapentin in particular had outlived its usefulness. As for the memory problems, last week one of the physical therapists took the time to prove to me (by reading from my session records) that I’d already been shown a particular exercise when I insisted that it seemed completely new to me. As she read the session notes to me, I suddenly remembered that I really had done the side-to-side squat walk with resistance band before. Such moments have happened to me all too often over the past four months.

I will preface the issue of returning nerve pain by saying that I believe that medications have a subjective experience that is particular to the patient, in addition to their clinical effects. I think of this as a quasi-placebo effect that endures over the course of treatment. Obviously, there are limits to how strongly one’s mind can influence the effectiveness of a medication. No one can make snake oil a true cure-all, and as far as I know, tales of Rasputin aside, a steel will hasn’t spared anyone the deadly effects of cyanide.

With that aside, I will disclose that my chief motivation in stopping the gapapentin was to see if this substance was perpetuating the need for itself. Was the return of my nerve pain a month after surgery, with no plausible reason such as injury, like a rebound headache? I have had this experience with over-the-counter pain relievers. Also, I had begun having flares of nerve pain in my hands, and there is no reason at all for that to be happening.

My nerve pain diminished rapidly once I discontinued the gabapentin. Where it seemed that I was having flare-ups of sciatica I am now just having ordinary, minor muscle pain. All the while I had been afraid of what this nerve pain would feel like without medication. I’m glad I decided to test whether the medicine itself was amplifying my perception of pain instead of dampening it.

Now that my time with gabapentin is done, I feel like it worked more on my anxiety than it did on my pain. I can see now that anxiety was a greater struggle for me than any of the physical symptoms I had with my back problems. I’m not sure why this medication is not considered a first-line prescription for anxiety. I felt almost no anxiety whatsoever during the four months I was on it, and I cannot overstate what a medical blessing this was for me. Better yet, I am not feeling any rebound anxiety or withdrawl now that I’ve stopped taking it, too. I had four months of experiences free from my usual fears, which was long enough to show me that my anxiety did not help me, even though it seemed to be the trusty advisor that kept me safe.

Now it is time for me to attend another physical therapy appointment. At least this time I can well recall what happened during the last session.

A New Year, or Better Living Through Chemistry

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This New Year’s Day began with heavy frost that melted under full sunshine and temperatures that climbed into the forties. This is rare for northern Ohio, where a year typically begins with overcast skies at best and a winter storm at worst. I was able to finish a three-mile walk outside today, and I cannot recall conditions so ideal for a walk at this time of year. If it ever happened deep in the past, I lacked the motivation to take advantage of the weather.

I start this year with the benefit of Prozac, which was the only antidepressant that ever had any real impact on my depression in the past. I took it for four years, and it did so well by me that I did not need an antidepressant for seven years afterward. With the ongoing limbo of my back condition that masqueraded as a knee problem, I felt too worn down and vulnerable to a deeper depression that would be harder to treat and possibly a real threat to the equilibrium of my life that took so long to establish. I cannot consider the return of Prozac as some sort of defeat. Depression crept in, and it needed treatment before becoming a bigger problem.

When I start taking a medicine, I am vigilant to see if it changes my perspective, however subtle or fleeting the alteration may be. For instance, I briefly took Zyprexa, which my then psychiatrist hoped would augment my antidepressant. The Zyprexa added a predictable fifteen pounds to my body in the month I took it, but it also offered the illusion of hypervision. It seemed that I could read tiny disclaimers with ease, and my analog TV looked as detailed as UHD (which was then 12 years away from existence). I omitted this side effect when I asked to discontinue this drug, lest it lend credence to the notion that I needed such a medicine.

With the reintroduction of Prozac, I also started a new medicine for my sciatic nerve pain, Gabapentin. This second medicine is sometimes used for psychiatric reasons, but in my case, it was only used for neuropathy. The combination of Prozac and Gabapentin, each at a low dose, was the mental equivalent of a spent car battery getting jumped back to vitality. During the first day I had the reaction that I had always hoped a medicine would have on my depression. It was like I had been waiting in a room that had slowly filled with uncertainty, dread, and gloom. By the end of my first day on these medicines, it was like I walked out of that room and shut the door, moving on toward better things.

I feel so much better that I recall an early fake Saturday Night Live commercial that starred Jane Curtain and advertised a product called Angora pH Formula 23. When I first saw this commercial, I split hairs over the product title, arguing that it could only be the 23rd formulation since 23 was an impossibly caustic pH. Now that I am well into my years of parenting and housekeeping, I can very much relate to the character that Jane Curtain portrays in this commercial, a woman who has a skin care regime that “washes my brain as well as my face.”

I wish this commercial was available online so I could share it here, but, alas, I have not found it.

I feel like this medication combo has washed my brain as much a possible while letting me retain my authentic self. Sometimes suffering is not an experience that burnishes the self into more wisdom and clarity. When it is nothing more than an aggravation, I appreciate the opportunity that medicine can present to alleviate it.

A Reprieve

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I used my last personal day for this year today. I decided I’d be a gentle activist for my own interest. I spent five hours on the phone, one hour in a doctor’s office, and few minutes at the pharmacy. Each conversation granted me a little more of the clarity I needed to go forward. My visit to my family doctor as a walk-in was very fruitful. I just showed up there and called upon their compassion to fit me in. Thank God they did!

I still will be waiting until late January to see the spine specialist. In the meantime, I have a prescription for Gabapentin to dampen the nerve pain that has worn me down into depression. Sciatic pain is oddly parallel to labor pain in one way. Each has a beginning where one thinks this is not so bad, and I am tough enough to handle this. Then eventually a door is opened where reason cannot enter. You’ve had enough. Screw any sensible information to the contrary.

I didn’t want to spend the next six weeks slipping in and out of that irrational state with each flair of sciatic pain. Thank God I don’t have to endure that now.