Wednesday, July 28, 2010

So What Happened To Me? Part 4

To catch up to this point:

I went to the pain clinic I was referred to and was told of my treatment plan - up to 3 selective nerve root blocks, which would be at least 2 weeks apart.   I avoided a 3rd due to these being unsuccessful.  I was anxious to move forward with the SCS trial and had been waiting patiently. 

What is a selective nerve root block?  Click HERE. 

Caution - there is a limit to the number of steroid injections a patient should have in any given 12 month period.  If your doctor has not mentioned this, please do research and ask at your next visit.  Many patients use injections to put off surgery for years and put their bodies at great risk to the side effects of cortisone.

Long-term risks of corticosteroid injections depend on the dose and frequency of the injections. With higher doses and frequent administration, potential side effects include thinning of the skin, easy bruising, weight gain,  puffiness of the face, elevation of blood pressure, cataract formation, thinning of the bones (osteoporsis), and a rare but serious damage to the bones of the large joints (avascular necrosis).
Insurance companies often play a strong role in the required procedures that must be done prior to the bigger, more expensive ones.  Hence, my forced "useless" injections.  Made insurance happy and proved to my Neurosurgeon (NS) that I was, indeed, a candidate for the Spinal Cord Stimulator.

I was first sent for a psychological evaluation, usually required by most docs and most insurance companies, to make sure I was mentally an ideal candidate to have something implanted (sort of like the bionic woman, I always say.  lol)  For some folks, this is a 30 minute visit.  For me (and patients of this particular NS), it was very involved.  I was told to expect a 2 hour visit.
First, I had a 30 minute chat with the psychiatrist and that went well.  He asked how I was and why I wanted this procedure.  I simply told him that if this nerve business could be taken care of, the "old" Cheri would come back.  I told him I was so sad and tired of living 23+ hours a day in my recliner. 

After the chat, he gave me a psychological test to take, the MMPI -2 (Minnesota Multi-phasic Personality Inventory).  This had 567 true/false questions and normally takes 60 to 90 minutes.  Yes, you read that right - 567 questions.

I, at this point, was already in horrid nerve pain from sitting for 30 minutes chatting with the doc and the 25 minute car ride to the appointment (my son drove me, and hubby was picking me up).  I was out of "time" for sitting.  (My limit was only 30-45 minutes before I would be in a massive pain flare causing incapacitating pain - this was the life I wanted changed.)  I'll cut to the chase - within 20 minutes, I was hysterical from pain and my only choice was to get flat on the ground.  That being a hard, concrete floor.  I had a scan tron sheet to color in my answers and the question pages.  I laid flat on my back, held the questions over my eyes shielding the light and did my best to color in the scan tron.  This took F.O.R.E.V.E.R.   The concrete floor was causing even greater distress.  

The doc walked by and saw me bawling with tears streaming as I tried to read through the tears and fill in the little circles with my answers.  He ran and brought me a pillow to put under my head, but I was a basket case.  This was almost "go to the ER level pain", but I had to finish.  I had no choice.

4 hours later, I was finally done.  My husband was beside himself worried it was taking me so long.   My "psych eval" took 4.5 hours total.  UNBELIEVABLE.   I was so worried that my massive pain meltdown would hurt my chances of being approved.  I worried for nothing - the report came back that I was cleared for any and all procedures that might be done on me EVER in the future.  What a relief.

Why the psych eval?  
  1. Make sure patient is psychologically fit
  2. Make sure expectations are reasonable - this is not a cure
  3. Make sure the patient can handle having equipment implanted in them - some people completely freak out.

Spinal Cord Stimulation has been around since the 1960's, but most people don't know that.  
An SCS system looks and works a lot like a pacemaker. In fact, SCS systems are sometimes called “pacemakers for pain.” An SCS system generates mild electrical pulses and sends them to your spinal cord. These electrical pulses replace the feeling of pain with a tingling or massaging sensation.

What typically happens is the pain clinic doctor (an anesthesiologist) will do the trial, as it is supposed to take around 30 minutes and be done easily.  I however, had already had 3 lumbar back surgeries and was full of scar tissue.  Apparently, this doctor did not know that, or did not read my files.  We to this day do not know that answer.

During the procedure, one or more leads are placed in the space along the spinal cord. The leads are typically inserted using a needle. The exact placement depends upon the location of your pain. When the leads are positioned in the best location, they are connected to a portable, external generator. Once connected, the system generates mild electrical pulses that will be programmed to replace your areas of intense pain with a more pleasant sensation known as paresthesia.
 Here is a short video on the SCS:

How Spinal Cord Stimulation (SCS) Works | St. Jude Medical

I will end this post at this point, and start fresh with the SCS trial details.  



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