freak of nature
1 July 2008So that Monday, I went to see the head of dermatology at UCSF, or according to his nurse, I was “introduced” to him. Evidently, he is something like the House of Dermatology, except not grumpy and no cane. Anyway, when he finally came in and looked at my legs, he said it could be either one of two things (neither good).
Option 1) I was having a abnormally severe allergic reaction to “something”. More specifically I was having an erytherma multiforme reaction. You know how you hear about those people who don’t know they are allergic to shellfish and then they eat some at a restaurant, then next thing they know they can’t breathe? Yeah, well, I guess that’s the same kind of reaction except I would have got my reaction just by touching something. Which would make me one of a handful of cases in medical history. Awesome.
or…
Option 2) I walked through photo-toxic grasses. I guess they are grasses that secrete a chemical onto the surface of the grasses, which is harmless by itself, even if you get it on your skin. But if you have it on your skin and then your skin is exposed to UV light, it goes through a chemical process that changes it into a super toxic poison that absorbs into your skin and basically burns the crap out of all your layers of skin. Equally Awesome.
To confirm which freak of nature I was, they took a skin biopsy on my knee cap, so I couldn’t bend my right leg very well. In fact, I ended up getting a cane. I figured “Hey, why not? I’ll probably needed for my back at somepoint.” The results were expected to take a week and in the mean time, I was suppose to just “stick it out.” They put me on a double dose of prednisone in hopes that it would relieve some of my swelling, but said I could stop it at anytime. I ended up feeling so good by the end of the week that I stopped taking my prednisone 3 days early.
Its a good thing my dad is a pharmacist cause the day after my last dose I was feeling so horrible, I was scared I was going to have to go back into the emergency room. My whole body felt like one big bruise. It hurt to lay in my bed cause the pressure of myself on myself was too much. I called my dad to see if he could help. We figured out that my pain was because I didn’t taper off my prednisone. I love my dad; a brilliant, brilliant man.
Anyway, to finish off this now long side story, the biopsy results came back: negative for both, which means they have no idea what caused my reaction, so the freak show continues.
My theory is that I’m allergic to the Manzanita tree. I know we definitely he hiked through manzanita trees, my friend and I had a discussion about it. Nerdy, but what can I say? Then 2 days before I wound up in the ER, I attempted to try a homeopathic topical treatment called “Manzanita Magic Potion”. I know what you are thinking, it sounds kinda random and sketchy. I was desperate. Anyway, I lasted not even 10 minutes after putting it on until I was sprinting to the shower. The lotion felt like liquid fire. 48 hours later? I was in the ER. Then to top it off, I took the Magic Potion into the dermatologist appointment (when he gave me the inconclusive biopsy results) and was showing it to him asking if maybe that could be the cause when I got a couple drops on my hand. What happens 48 hours later? I get another breakout. This WHOLE thing just blows my mind. Its been an ENTIRE month since I went backpacking, and I’m just now feeling healthy again. RIDICULOUS.
I’ve gotta try putting on the Magic Potion again and see if I break out. If I am THIS allergic to a TREE, I’m gonna laugh myself stupid. Anyway, its a total side track from my back blog, but I just had to share.
To top off the whole month of June, my back has been unusually worse, I’m going to chalk it up as decreased pain tolerance due to this whole rash thing. Plus, there is a whole epic drama regarding my insurance that has happened in the interim, but I’ll save that for my next post.
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When it rains, it pours…
29 June 2008So you know I said that I went backpacking, yeah. That was a BAD idea. Note to self: Don’t go ever again, well at least not for a very long time.
It doesn’t have anything to do with my back, but hey its health related and it’s pretty comical so I figured I share. Plus it explains why I haven’t posted in a while.
So about 4 days about getting back to civilization, I had a series of small bumps that showed up on my legs. They were red, itched and we HAD walked through poison oak, so even though I have never had an allergic reaction to poison oak in my life (and I have been exposed before) I figured that’s what I had. Poison oak. Well the redness and itching didn’t get better, it just kept getting worse. Then the inflammation started. My legs felt like they were on fire. I couldn’t sleep unless I had ice packs on my legs. I was waking up at about 2 hour intervals. Pure fire.
My sister had plans to come visit. I had been looking forward to it, and wasn’t about to let my rash get in the way. I held my own until last Saturday. We were out walking around the city when the heat managed to get even worse. I started to swell. We were standing in a shopping store, my sister was waiting to try something on when I decided to go see how bad it had gotten. I went to the bathroom and about had a panic attack. My legs were double size. I was starting to have trouble walking. After talking to my dad on the phone, we decided it was time to go to the emergency room. Something was wrong.
When I finally got admitted and changed into that humiliating gown that exposes your butt, the parade of doctors began to enter my room. Slowly, one by one, a new ER doctor would trickle in, ask me my symptoms, look at my legs and each doctor would say the same thing: “Huh. Yeah, I’m not really sure WHAT that is.” Yeah. Awesome, right? Four ER doctors all said this same thing. They tried calling some Dermatology doctors. It’s Saturday night, about 9pm, not much hope. Interestingly, there just happened to be a graduation ceremony going on for the dermatology department, so infact they managed to get ahold of a bunch of dermatology doctors. I felt like my luck might actually be in my favor for once. Then they realized that they had all been heavily celebrating for quite a while already and doing a diagnosis over the phone was, well, not gonna happen, at least not an accurate one.
So the ER doctors did what they do best: Make sure I wasn’t about to die. Since I wasn’t about to die, then they sent me home, with a prescription for vicodin and an appointment with the head of the dermatology department that coming Monday.
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Mind vs Body
28 May 2008I use to be an active person. I was usually up for trying anything. Rockclimbing, trailrunning, backpacking, snowboarding, soccer, even concrete canoe racing (college engineering thing, it’s complicated). I was still being pretty active up until about 3 years ago, when the pain just started to be too much. I started cutting out activities piece by piece, in a triage fashion. Today, I’m down to taking walks, modified yoga, and swimming. (Wow, I’m actually getting emotional right now thinking about how much my life has changed.)
About every couple months, I suck up the pain and do something to satisfy my mental unrest. Last weekend, it was backpacking.
I told myself, hey, what’s the worst that can happen? I mean, I’m already getting surgery. It’s not like I’m gonna do any damage to anything that they aren’t already gonna fix. Plus, I knew I had vicodin I could resort to if I needed.
We had to cut the trip short, not for me, thankfully, but I was glad we did, nonetheless. And even though my friends helped carry my gear, I have been in ridiculous amounts of pain for the last 3 days. Last night, I fell asleep in the fetal position after taking 800mg of advil and a vicodin. Today has been electro-stem therapy on and off all day with frequent stretching breaks. I attempted to go to yoga but spent half the class in the child’s posture (thats where you lay down and curl up in a ball).
I’m writing all this for two reasons:
The first being hopefully that next time when I think it will be a good idea to take a 20 mile hike into the wilderness with a 23 lb pack, I’ll remember today (and hopefully cut it back a bit).
The second reason is to give a piece of advice about the mental stresses of transitioning to a more sedentary lifestyle when it’s not by choice. Ok, ready? Repeat after me: Find a new outlet.
Physical activities, whether you intend them to be or not, are stress outlets. If you cut out physical activity because of a condition, you should compensate by finding another outlet. Meditation, music, blogging, hell even coloring in a color book. It doesn’t matter. Find something you enjoy doing where you can really focus your mind. I found this out the hard way. Initially, I didn’t pick up any new outlets and as a result, I got depressed, irritable and anxious. It almost caused me to lose a relationship with a really great guy.
Once I figured this out, I was able to recognize my mood shifts and try to put my negative energy into something positive. Even with hobbies, being physically restricted is still really frustrating. You’ll want to do things you’re use to doing and when you can’t because of your body’s limitations, you can start being hard on yourself. Don’t be. I know its easy to say and hard to do.
Also, the other important and difficult transition for me was learning to ask for help and admit something is just too much for me to handle. I’m still learning how to do it. (Example A: last weekend.)
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T-minus 29 days…
22 May 2008Posted in Uncategorized | Comments (0)
Trial and Error
11 May 2008How do you diagnose a patient with chronic pain when standard lab tests and talking with them doesn’t really reveal any single answer? Trial and error my friends, trial and error.
When I think of trial and error in medicine, I immediately imagine some House episode where Dr. House inevidably is unable to diagnose someone based on their symptoms or patient history. Without fail, his trial treatments usually push the patient to the point of dying. Then, miraculously, there is a last minute “AH-HA” and he saves the patient. If you haven’t seen house, it’s a good show, I recommend it. Of course I kinda just gave the entire show’s recipe, sorry.
When I left my doctor’s appointment that day with my box of tissue, he also gave me is first trial treatment: a prescription for 6 to 8 weeks of physical therapy. Sometimes real life can’t compete with the drama of prime time television.
Now, I know it kinda sounds like I’m knocking physical therapy. I’m not. The reason physical therapy is a good starting point is because it usually works. Most people with back pain can reduce or eliminate their back pain by strengthening key muscles that help stabilize and support the spine.
The transverse (properly named: transversus abdominis or TvA) are muscles deep abdominal muscles that help with stabilization of the spine. If you try and draw your belly button to the spine (not just “sucking in”), that should engage those muscles. (You should be able to breathe normally and keep your belly drawn.) Some days, when I’m in a lot of pain, I can actually feel some pain relief when I really engage these muscles. It’s kinda weird that it works that well, but I’ll take it.
I know there is bound to be someone that says: “But I work out my stomach on a regular basis. Weak stomach muscles can’t be my problem.” I know there is bound to be someone that thinks like that because I used to be that person. Now, I know that even if you have a toned stomach, your stablizing muscles can still be underdeveloped. Lots of exercises that help develop the surface abdominal muscles (aka Rectus Abdominis or the “Washboard Abs”) don’t do anything for the transverse muscles. So its entirely possible to a rock hard 6-pack, but have weak deep abdominal muscles.
In addition to adominal muscles that can help the spine, another important muscle group to develop is the multifidi (aka multifidus). This muscle spans between 3 joint segments; so Its a little guy, but it give the vertebras stiffness and stability.
There are many other muscles that play an important role to a strong and stable back like the interspinales muscles and the obliques, and the perineal muscles (yes, even those muscles).
Now, I know I’m not a doctor, in fact, I’ve had no formal education about the human anatomy in my entire life. But I know all of this, because I listen. (Again, Mom, if you are reading this, please don’t leave some comment saying I never listen. Seriously, please don’t.) In addition to teaching me exercises, my phsical therapists would explain the importance of the excercise, and what muscle I was working out. I am a firm believer in physical therapy. It wont resolve everyone’s pain; it didn’t for me (and I’ve probably done 6 to 12 months of it over the years). But its important to have a strong supportive muscles; it will help reduce degeneration in the long run.
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hello world.
6 May 2008Maybe it was the time when I was jumping on a trampoline one summer at a family friend’s house in Idaho, and while playing popcorn someone “popped” me. I remember instead of being launched like a rocket into a low orbit, my legs just kinda rumpled beneath my body like a rag doll. I couldn’t really do much for the next couple days beside lay on the couch and drink iced tea. I was about 8 at that point.
Or it could have been the time when I went to turn off a light at the top of some unfinished stairs that my dad was building in the garage and they gave way beneath me as I took my first step on the way back down. I fell about 12 feet onto the concrete garage floor. The doctor’s said I just buckle fractured my wrist. That happened when I was about 12.
Maybe it was the time when I went swimming at the arboretum on Lake Washington. There is an unfinished freeway onramp that people use to jump into the lake. Everyone said I landed with the right form but when I hit the water after the 40 foot jump, I really thought I was paralyzed. I was afraid to try and kick cause I was scared nothing was gonna happen. The doctors said I just compressed my spine. I was 20.
Maybe it was none of these; maybe it happened when I was too young to remember.
Even though I can’t pinpoint when it happened, I do know I slipped a disc in my lower back, between my L5 and S1 vertebrae. I know this because about 2 years ago, shortly after I got my first “real” job with “real” insurance, I decided to finally see my first spine specialist. I was 24.
The conversation kinda went like this:
Doctor: “So what brings you here today?”
Mind you, I was at medical center that specializes in spines. So I attempted to answer this obvious question: “Well, I kinda wanted to know why my back always hurts.”
He inevitably asked the question: “How did you hurt it?”
I didn’t have an answer; I tried to answer it with: “I don’t know.” But, seeing as he really wasn’t satisfied with that, I followed it with: “As long as I can remember, its always just kinda hurt.”
Seeing that the interview process wasn’t that helpful, he tested my reflexes, the strengths in my legs and arms, asked me to lean back, forward, and twist. Asked if I had any numbness or tingling. Everything appeared fairly normal. So, he ordered up the usual concoction of tests, couple X-Rays, a few CT Scans, and a dose of MRI’s.
…I’m not sure why campfires and laundry tumbling in front-opening dryers are so fascinating but I would put being able to see an image of my insides in that same category. Seeing all my bones with the surrounding muscle tissue and then the blood vessels are just kinda scattered everywhere, and actually seeing nerves…. Sorry, getting back to the tests results.
So as my doctor was going over these test image results with me, pointing out things and naming long-worded medical conditions like: mild spinal bifida occulta at my C1, minor scoliosis, narrowed spinal canal, reduced vertebral spacing, and lateral reverse slippage of my L5-S1… i kinda wished I had been taking notes so I could translate everything later on google. At the time, all I heard was something that sounded like this: “Well you see this here, this is bad news, and over here is some more bad news, and this right here, this is bad news, oh and that little bit down towards the bottom, yeah that’s also bad news.” I felt like my back was junk and I started crying. Evidently, I’m a crier when it comes to patient-doctor consults. He gave me an entire box of kleenex.
It’s at this point that I want to say that it’s amazing how much folic acid can effect the development of a fetus’s spine, or lack thereof. If you are reading this and you are a pregnant woman, please, take your folic acid. I left the doctor’s office with my box of tissues and called mom and proceed to interrogate her as to her diet and vitamin intake when she was carrying me. She claimed she took all her vitamins and she didn’t drop me. And Mom if you read this, just know, I do love you, but I’m just a bit skeptical.
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