In Praise of Invertebrates

No one has ever called me “spineless,” yet there have been times when I’ve sorely envied those creatures without one:

Give praise to the invertebrates, for they shall inherit the Earth.

I don’t know who said that.  Thought I did, but looked up the source and it wasn’t where I thought it would be.  But never mind. For the past, oh, month or so, give or take, I have been limping around on one or another of my limbs.  My knee locked up; my hip hurt; and now my back has eclipsed the rest. My back has been, for me, a symbol of the level of support I am getting from those close to me.  And while some may argue that what’s physical is physical, and that the mental/emotional/psychosocial arenas cannot cross over purely physical lines to cause or worsen structural damage, I disagree.

My point of view lines up with that of the “biopsychosocial model” on which I was nursed and weaned by my Very Special Medical School, the University of Illinois at Champaign Nirvana Urbana, smack in the middle of Corn Country, Illinois, USA.  The biopsychosocial model, as it indicates, teaches that our health and wellbeing are not compartmentalized, but a living organism that is affected by everything in our environment, inside and outside. There is certainly a genetic component to my spinal maladies: my dad started having awful back problems in his early thirties, just as I did.  So I guess I have him to thank for that, along with a lot of other inherited traits, most of them good.

My adventures with Degenerative Disk Disease (DDD), which is a progressive disintegration of the intervertebral disks, started in 1987, in the Big Yellow Truck that carried our little family away from Champaign Nirvana, into the uncharted territory of Rochester, NY, which is even colder than it sounds, being just across the lake from Ontario. I should define terms here, in case there are people reading this who have the good fortune not to know them.  An intervertebral disk is an ingenious structure composed of a thick outer wall of tough yet supple ligament, filled with a gel.  It is in the shape of a hockey puck, and alternates with the vertebrae, insulating them from shock and serving as the means for our spines to be flexible.  Think of gymnasts, or contortionists, or Tango dancers and you’ll get the picture.  Speaking of pictures: Here is an X-ray of a normal lower back.  Note the clean lines and clearly defined spaces between the vertebrae, which look like boxes with little things sticking out of them. Here is a nice comparative image of a normal lower back, top, and its unfortunate cousin on the bottom.  Mine looks like that one, only worse. lumbar_degxray_vertical   All sorts of treatments and non-treatments exist for this extremely painful and often debilitating condition.  I have experienced quite a few of them. When we were driving from Champaign Nirvana in the Big Yellow Truck (or “Big Lellow Truck,” as my son called it, being two at the time and in awe of the Ryder Rental), I noticed that I couldn’t find a comfortable way to sit.  When I was driving, a hot river of molten pain flowed down my right leg into the accelerator.  When I was riding shotgun, the only way I could sit even mildly-to-moderately comfortably was cross-legged, bolt upright.  No sleep on that trip.

When we arrived in Rah-cha-cha, there was far too much to be done to pay attention to a mere case of low back pain, so I forged ahead with helping to unload the van, unpack, set up, and immediately start my internship in Pediatrics. By then I had developed a matching pain in my neck, such that I had to build a set of pillows molded around my neck so that I couldn’t move–or else I would wake up suddenly paralyzed with pain. But I had an internship to start, and my ex had a post-doctoral fellowship to start, so I soldiered on and started my residency.

As is the nature of things, before one starts anything significant, one has to sign all the papers first.  That was a good thing, in the case of the residency, for it gave me something I had been lacking and would be needing shortly: insurance. At that point in my internship/residency program, we were fully staffed, so “call” duty was every third night.  That meant that you came in at your regular time, 5 am, then worked until 5 pm sign-out rounds.  You met with the lucky creatures who were going home, and conferred with them about their patients, whose care you would be assuming until 8 am sign-in rounds the following day.  Then you would continue your work-day till 5 pm, when you “signed out” your patients for the night, went home, and fell on your back in the bed, staring at the ceiling and feebly trying to repel your husband and child, who are trying to greet you after your long absence.

As luck would have it, my first night on call was Night One of my internship.  It was the debut appearance of the infamous “black cloud” that would follow me throughout my medical career.  My neck had been in spasm all day, but I did my best to ignore it and soldiered on.  Sign-out rounds came and went, and I was on my own with my resident.  It was just the two of us to cover all of Pediatrics, Labor and Delivery (the baby part), Newborn Nursery…and admissions from the Emergency Department, which seemed to be a very busy place that night.

My neck felt like it was trying to rip itself off my body and fly away on its own.  I was wishing it would. We admitted a sick little girl with a fever of 104 F (40 C), to the toddler ward for diagnosis and treatment.  Part of the diagnostic work-up involves the collection and subsequent examination of every kind of fluid there is in the body (gas, oil, antifreeze, brake fluid…just kidding).  You have to collect things in a sterile a manner as possible, so as not to introduce germs from the outside of the body into the fluid samples.

Long story short, we needed to get a sterile urine sample from this little girl, and that involved a catheter, and cleaning the “outer parts,” and someone with experience to do that part, and anyone at all to do the all-important Holding The Patient Down part.  I shudder.  I was once Held Down for a medical procedure when I was 5, and I still remember it.

At last we had the hapless little girl spread-eagled and ready for the 30-second procedure.  My job was to keep her in that position, so that 30 seconds would remain 30 seconds and not, say, 20 minutes, which is what might happen if we messed up the first try and had a furiously fighting toddler on our hands. So I got a good grip on the little chubby thighs, and prayed that my superior would get the job done chick-chock, which is Hebrew for “right now.”

She missed.

The outraged little victim jerked her leg away from me, and looking me straight in the eye, kicked me a good one right in the center of my forehead. POP. That was the annular ligament of C5-6 you heard popping, there.  In layman’s terms, the tough outer covering of the disk between the 5th and 6th vertebra in your neck, of which there are seven, gave way and all the gelatin from the center of the disc poured out like fire, compressing the nerves that emanated from my spinal cord at that level.

I was paralyzed with pain.

But I would not give in.

This was my first  on-call night of my internship, dammit, and besides, where would we get a replacement for me at 2 am?  I have always said that the reason more people don’t die during their residencies is that the program does not allow time to attend one’s own funeral.  So I soldiered on, until sign-in rounds, where the Chief Resident noticed that I was in agony and sent me to the Emergency Room.

There I was examined by a medical student, an intern, a resident, the Chief Neurosurgery Resident, and finally, the neurosurgeon himself, who looked at the X-rays and agreed with all the others that I had an acute rupture of C5-6.  They sent me home to rest for a week, with a prescription for Tylenol with Codeine.  I rested, felt absolutely no better, and went back to work.

Another week, and another on-call night, and I truly felt like my head was going to just fall off and roll around on the floor, because my neck could no longer bear its weight.

Another morning in the ER for me.  This time the neurosurgeon just happened to be in the building.  He stopped by and saw me. “What, are you here again?” angrily joking.  “What’s the problem this time?”

I sheepishly explained that I couldn’t move because of the pain in my neck.  I got a terse lecture regarding the subjective nature of pain, that it was “only pain,” and that I really should suck it up and go back to work.  But my hair was all wet from my tears, so in obvious disgust he ordered a CT scan of my neck.  MRIs did not exist yet. He looked at the scan himself, and his attitude flipped 180 degrees.

“I’ve never seen such a huge rupture in someone your age.  The nucleus (gel center) is sitting completely outside of the disc space!  We will schedule surgery.  Until then, you will wear this spiffy hard cervical collar and don’t take it off.” Surgery was a week from then.

I spent the time arranging for child care (my ex was not good at that), and begging for insurance coverage.  My insurance, you see, did not kick in until I had worked a full week in the program.  Somehow, in some office, someone was compassionate, and I got my insurance.  I was kind of eagerly anticipating surgery, hoping that it would get rid of the awful pain that had somehow become my entire life. To be continued…….

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16 Comments

  1. Anne

     /  February 9, 2014

    How miserable, Laura. What a horrible story.

    Reply
    • Thanks, Anne. Yeah, it is pretty miserable. I really don’t understand this business of biped-ness, although other animals do get spine problems–I used to work with a veterinary chiropractor and acupuncturist who specialized in horses with sore backs! Her license plate said “Vududoc” because all the “straight” vets called it voodoo…but it worked wonders, so the heck with them, I say.

      Reply
  2. Laura-
    I have been thru a very similar thing, and still from time to time find myself waking up unable to move. Luckily, it is less often now, only a couple of times a year. i never had to have surgery, (thank goodness!) although if the pain shots in the epidural dont work, then surgery is my next step. i developed my back pain issues while pregnant with my 2nd. the doctors laughed at me and poo-poohed me that i couldn’t handle pregnancy pains. they did not get that i really had to be carried to the bathroom by my husband, turned by him, carried to appointments by him. i spent 4 yrs without being treated by anything except ultram and vicodin, which did nothing. finally, some doc somewhere thought to take an MRI, and then they said they couldnt believe i was even walking at all (by then, my right leg was completely numb, freezing cold, and stiff. so i had worked out a kind of limp/drag/step kind of ambulation. lucky for me, they gave me 3 epidural shots in 3 months, and after the last one, i had no pain for 9 years. now, they will only give me facet injections which may last 3mos to a year. so far, so good with those. sorry for your pain and hoping it lets up soon!

    Reply
    • What a hair-raising story! Glad the epidurals worked. I had one which did nothing. I might get another one, if this doesn’t settle down soon. It’s been slightly better (thank G-d) for the past two days, so maybe it’s on the mend by itself (hope, hope!). Hoping that yours behaves itself as well. Thanks for the well-wishes and support, as always–you are a loyal friend.

      Reply
  3. It must be painful Laura but I pray that you find some relief and yes our environment does affect us in so many ways.

    Reply
  4. I agree with everything you said and I’m hoping for a positive ending. Somehow good ending seems the exception and not the norm. So sorry Laura.

    Reply
  5. teddymear

     /  February 10, 2014

    Hi Laura~ I am a new subscriber to your blog. What a writer you are…I felt every bit of your pain. Thank you for sharing your story. I’m so sorry you had to go through this and that you continue with chronic pain. I also worked in the medical field. I worked as an RN and loved my career. I sustained a brachial plexus injury over 14 years ago. It left me with Reflex Sympathetic Dystrophy in my right upper extremity and I can no longer work. I now have DDD, C5-6 C6-7 are herniated and my osteopenia is almost at the point of osteoporosis, all due to the RSD. I don’t know if you have ever heard of it, I had not until diagnosed. Here is a link…
    http://www.webmd.com/brain/reflex-sympathetic-dystrophy-syndrome
    It’s a day at a time for me. I always say that if I can stay upbeat mentally, it’s been a great day. As excruciating as the pain may be some days, nothing is worse than not being in a good place in your mind. You are in my prayers Laura. As they say in the pain support groups I am in…sending you some “gentle hugs” 🙂

    Reply
    • Hi Teddy, thanks for hopping on board! I am soooooo sorry to hear of your brachial plexus/RSD awful injury. I actually had that exact thing for a year after my C5-6 anterior diskectomy. I guess they must have traumatized my brachial plexus somehow during positioning or whatever, who knows, I was anesthetized at the time. Anyway, you know what happens, but to fill in our other Bloggie friends reading this, what happened in my case of Reflex Sympathetic Dystrophy was that the nerves in my entire arm from the armpit to the tips of my fingers got riled up and the whole limb got red and swollen, as if it was infected, and the pain was off the charts. I have never had, and pray never to have, pain like that in my life. The neurosurgery people refused to treat the pain, because they “didn’t want to make a drug addict out of me.” So I lived with it for a year, and after that it blessedly went away, and came and went for another few years. I am so so so sorry that you still have it. I pray fervently that it will leave you. Have you tried acupuncture? That helped me A LOT. Like, A LOT. You are so smart to be in support groups! Gentle ((hugs)) to you too!

      Reply
      • teddymear

         /  February 10, 2014

        Oh Laura, I cannot imagine the pain you went through for that year + !! My heart goes out to you. On the other hand, I am so pleased that you went into remission. There one day since my injury that I have been pain free. It has become my new normal. I had stellate ganglion blocks at the beginning at one of the top hospital pain clinics in Boston with little effect. They then tried steroidal injections into my shoulder and along my winging scapular which gave some relief (several days). Tried the acupuncture, chiropractor, IV lidocaine with no effect. Physical therapy actually aggravated it. I do best moving at my own pace and still have fairly good ROM it is just that it hurts like hell to move the arm/hand repetitively…e.g.writing, stirring, typing, raising my hand /arm up at all, etc. And forget someone touching it. I’m sure you get it. I went in to be assessed for a spinal cord stimulator but I am not a good candidate because my pain is spread out too much for it to be effective. My shoulder pain got so bad that I opted for surgery in 2009 and the RSD eventually spread to the left hand as well. I have been on medications from the beginning to take some of the edge off but the pain is always there. I use Lidoderm patches and a machine called the RS-41 Stimulator. Similar to a TENS but way better…it’s for muscle and nerve pain. It helps get your mind off the pain by causing a tingling sensation. Also helps loosen the muscles a little. It might help you…
        http://www.rsmedical.com/product_rs4i.asp
        Looking forward to your next post!
        gentle hugs

        Reply
        • How frustrating and, well, painful it must be to have this RSD pain dragging on and on for 14 years….how do you manage? I don’t know that I’d be able to take it for that long. You must be a very strong person…Blessings….

          Reply
  6. Eeeek. I am in pain just by reading this. From a chronic pain sufferer to another, a big gentle hug to you!

    I remember all too well those call nights/days and being in so much pain that after a while, pain was the only thing in the universe. In fact, pain was THE universe.

    How and why do we soldier on?

    Reply
  7. Oh dear….sorry to add to your already epic pain! Sigh. I’ll take the hug, please.

    I don’t know how YOU soldiered on, but I know why I did. I will sheepishly admit that the only thing that got me through some nights/days/who knows/who cares, was to chant to myself “One hundred ten thousand, one hundred ten thousand,” which was the approximate number of US dollars I owed for my education. How else could I possibly repay that, outside of finishing my residency and getting a good job??? That, and the fact that I am stupidly stubborn, and once I have closed my jaws upon something they will not open, even if I am beaten with a truncheon. I have mellowed in my old age due only to ill health. Otherwise I would still be in the trenches soldiering on for some other reason, hopefully love of medical practice, although the way they’ve mangled it nowadays I doubt I’d want to.

    Reply
  8. PsiFiGal

     /  February 10, 2014

    Owww! I have my pain problems, but wow, that sounds awful! I hope you’re able to take it easy. I’ve been thinking of you and your father, hoping you are able to be with him as much as you can. Take care Laura.

    Mary

    Reply
    • Thanks, Mary! Thank goodness I’m feeling much better now, still a bit tenuous but hopefully will continue in the better direction. Yes, I’ve been seeing a lot of my dad.
      Take care you too,
      Laura

      Reply

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