Wednesday, April 27, 2011

Physical Therapy Tests

Today was a particularly good day painwise from sleeping so long and being relatively inactive yesterday.  I just recently restarted PT after being very inactive for a few months on request of doctors to see if that helped which as we know did nothing.  My physical therapist has noted that I do have a particular weakness in my big toe, as well as very little reaction to the knee reflex test, and right leg sensation tests.  He also did a few stretches on me showing that the pain that radiates down to my hand in fingertips is mostly in my middle finger/ring (thought it affects all of them).  We will start more back stabilization exercises, traction, and deep tissue massage early next week.

Monday, April 25, 2011

A tiny clarification, notcing of hand feeling sensation, and new suggestions

I have noticed a small loss of feeling in my right hand as compared to my left.  My hand often feels clawed and is pain after a long day of standing and walking but I have noticed just resting them on the keyboard that it simply doesn't feel the keys as tactile as the left does.  I have also noticed that when I walk, stand, or swim that my penis gets especially small and even cold, whereas in the past it would usually expand to an above-average flaccid state for myself.  I believe this again shows a possibility that the physical activity putting pressure on my back may cause this, paired with the fact that achieving what I generously call a partial erection only seems possible when lying on my back.

For a little clarification on the urologist visit:  I am still in the process of obtaining the urology reports, however, I do remember that the Doctor said that they judge venuous leaks on a scale of something like 1-10 and 1-5 level of leakage is entirely normal and I was a 5.1, which even at that, should never be having problems with morning erections or penetration.

The last doctor has suggested a discogram but made clear that they are excruciatingly painful, I am uneasy since she said it most definitely is not worth enduring the pain if it comes out inconclusive but the braver part of me says to remember that I should exhaust every option.

Disc Decompression was also suggested by the last doctor so I visited his specialist who consulted with me.  The specialist told me very coldly that he only helps people he knows he can help, or he thinks he has a chance at helping, and always turns away people he thinks he cannot help.  He said, that on this scale, I am an outlier in the category of "I have no idea,"  when I asked for a percentage chance he said that there is no percentage he could attribute as my symptoms are so wide spread that even attacking just one problem at a time may be difficult and takes a serious time commitment.  I am going to continue to contemplate getting the treatment for the next week or so until I am done with class and have a little more free time.

Current attitude:
Either way, I am not going to just give up and will come out of this stronger for having fought as hard as I can.

Thursday, April 21, 2011

A picture of the pain

Here is an idea of how the pain has pretty much always been. 

Thorasic Park & The Claw: April 2011

Another set of back injections are completed with no results, I decide these will be my last injections ever.  I believe I have had six overall or maybe more at this point.

After building up to short, light jogs, I notice severe clawing in my right hand and foot.  So I conclude that this problem is likely coming from the back and my discs are being jolted a bit when I do a light job (jog for about a minute or two, walk for a minute, jog a minute, overall for about 30 minutes)

Have seen a re-surgence in facial and right bicep/arm/deltoid pain after beginning to swim and do abs again.

A thorasic MRI is ordered to check on the increasing pain in the middle of my spine, the only area that has gone undocumented by MRI scan so far.  Here is the best overall MRI I could find of my Lumbar for first time viewers, I believe this is from winter 2011.

Strange Sexual Symptoms: Early Spring Overview

I've noticed that not only that I cannot achieve even a partial erection without a lot of stimulation, but that my flaccid penis is very noticeably smaller and not getting the normal amount of bloodflow (perhaps?) that it normally would in it's flaccid state.  It also often takes on a strange hour glass shape instead of its normal state.  I also notice that it is often cold, and I am starting to lose sensation, especially in the tip.  Cialis and Viagra prescribed a few months earlier, help very little, though they do help a tiny bit, and give the outside cavernosa a little extra rigity at this point, but still not enough for penetration, however, masturbation is possible with some work.  Climax and erection cause some pain in the saddle region and running down to the tip of the penis, as well as the lower back.

I am prescribed 5mg daily Cialis trial to see if this can at least help me with my symptoms for a month.  I have yet to check back with the urologist but the daily seems to at least be helping me a tiny bit with the flaccid state.  Side effects however are bad with severe headaches, dry eyes, and constant stuffy nose.

The Numbness and Thorasic Pain: March 2011

The tip of my right index finger and thumb begin to become completely numb for hours at a time, even while sitting and walking around.  This is a rare occurence but still seemed worth noting.  Also, I begin to notice some tingling sensations in my fingers and toes (on the right side as usual).  My foot begins to claw and cramp more often, along with my hand with any walking or physical activity for a short period of time.  All exercise has been stopped since January with hopes of improving symptoms, I have been sleeping on a moderately firm bed for a few months.  The pain in the front of my right lower leg has become very bad, however, I would say overall my leg pain has slightly subsided or plateaued at about a cosntant 5-6, which I would describe as high level of discomfort when not doing activity to a low-medium level of pain (6-7) while doing activity.  This is obviously terrible but it seems to have hit its peak, however, back pain, especially while sitting is worsening and is almost as uncomfortable and painful as my leg pain.  Back pain is obviously very severe during activity and having correct posture is almost impossible at this point, which I had had my entire life before the injury.

What's most disconcerting, is the high increase in pain in the dead-center of my back, above my lower back and below my neck.  It has hurt before maybe in the 1-2, but never as bad as my lower back, which now it does.  Whether this is due to a changing posture, muscle loss, etc I do not know but the pain is reaching the level of my shoulder and lower back.  It also shoots pain across the right middle back of my body to my underarm and front abdomen area.

Pain in my saddle area also starts to become a problem (2-3?) with a pressure feeling when I sit and a noticeable reduced anal tone and feeling like I have an object in my saddle.  Though a third urologist visit concludes that I am able to void completely, and another vasodilation test concludes that the genitals are again, not having a problem from leakage or a genital related disease, I feel that my power of my stream has become very reduced.

A New Pain & Serious Dysfunction: Winter 2010/2011

My face/shoulder pain turns into full blown arm pain, similar to my legs.  The pain seems to travel from my right neck and face into my deltoid, my front bicep, the top of my forearm, and into my fingers.  When asked, I would say the pain in my fingers is mostly located in the middle finger and sometimes index.  The pain also travels down the center of my right tricep and makes even my lighter lifting load extremely difficult.

EMGs are ordered in both my leg and arm and again prove negative.  Cervical MRI's reveal only a slight bulge in my cervical spine and possible an overly straight neck that may have been caused by muscle tightness from the affected nerve(?) in my arm.  I am not prescribed Lyrica, which like Neurontin, gives no aid whatsoever.

Brain MRI's also prove inconclusive.  I am ordered to see urologists for my increasing sexual dysfunction which has become very severe. Two urologist visits with doppler tests and injected vasodilation tests show that venuous leakage is very minor, if any.  Both urologists conclude that the problem is likely not related to genital or vascular function, and unlikely to be mental since I am handling the stress well at this point and have had zero problems with performance anxiety in the past.  I would rate my erection rigity at maybe 50% of what it used to be, with the only way to achieve erection with both visual and physical stimulation, focus, and laying on back.  Most noticeable, the underside and glans of penis can temporarily inflate when i bear down and clench my anus in but immediately unballoon.

I am on about my 4th nerve root injection, which at times can reproduce the same pain down my leg, but not make symptoms any better.

Possible Cyst & Amitytriptyline (sp?)
Amitytriptyline is prescribed to try and treat my worsening facial/neck pain with no results besides some side effects.  Multiple MRI's are ordered with and without contrast of my Brain and Pelvis.  The pelvis MRI reveals what I am told is a cyst in my pelvis.  I am told the cyst "may or may not" be causing any sexual pain or the earlier tailbone pain, but the Doctor believes probably not, and "even if it was the root of the pain, taking it out might be a little tricky".  So I am told to stop physical therapy, continue swimming, stop [attempting] light lifting and jogging.

Multiple MRIs were ordered on my sacral plexus and pelvis with and without contrast, I am not sure where the cyst is but here is a sample of images from one of the scans:

Traveling symptoms, things get worse: Fall 2010

Tailbone pain has almost entirely disappeared, being replaced by a sort of dull, numbing sensation in my tailbone area.  I am noticing a serious decrease in my erections and noticed that I have been without morning erections for some time, though, I achieve a partial morning erection at times when I have to urinate quite badly.  I would put the rigity of my erections at around 60-70% of what they used to be at this point, where most of rigity has been lost in non-balooning glans and the bottom side.

I also start noticing a strange facial/shoulder pain that I would put at about a 3 on the pain scale, and is similar to the pain I feel in my leg, and is unlikely to be a pull since I have considerably lightened my workout load.  I see a neurologist who is a family friend and am put on the maximum dose of Neurontin.

Here are some images of my Cervical Spine that are ordered later, as addressed in my later post, I am just trying to spread out the images per post:

A strange twist in the symptoms: Summer 2010

Late Spring/ Early Summer
After a first round of oral steroids proves worthless and the pain on the outside of my right knee is at an all time high, I am given another round of oral steroids and set up for future nerve root injections.  The pain is so severe that I have trouble simply walking home from class or walking around the boat on a cruise, with the majority of pain focused on the outside right of my knee and right calf, with medium pain down my right leg.

Early in the summer I begin my second round of steroids, after they run their course, I notice a steady decrease in my sharp sitting tailbone pain to a more numbing sensation over the course of a month or so.  Whether this is due to a changed sitting position, the oral steroids, or just the progression of the disease, I do not know but am incredibly relieved that it has become easier for me to sit at work and at the gym etc.  What's slightly disconcerting, is that a few weeks (maybe even a couple months?) after the pain almost turns into this numbing sensation while sitting, I begin to experience slight sexual dysfunction, with the ability to achieve erections much more difficult than before, as well as the absence of random erections and morning erections. What's more, I would rate my normal rigity of erection at about 75% of what it was just a few months to a season earlier.

My leg pain is increasingly worse, making it hard to walk simply from the parking lot to work without severely limping, I try to explain to coworkers who ask me why I am always limping that I am just going through some back issues and figuring things out at the moment, as I have been for almost the past year.

A random set of images from a lumbar MRI for a summer update:

A new height of pain: Spring 2010

By Spring I was barely able to run, though I continued to try on and off, I could only run for a few minutes before having to stop from pain in my leg.  The pain had become very sharp and shooting now into my calf more than anywhere in my body.  Lifting went from the passion of my life, to an uncomfortable annoyance, to extremely difficult with the amount of pain.  Both of these activities were done with extreme caution and new, light weight, more reps style.  My tailbone pain was at an all time high and my PT became quite worried by worsening symptoms, he sent me back to my orthopedic surgeon who referred me to a partner and practicing neurosurgeon who prescribed oral steroids and back injections.  An EMG is ordered on my right leg which comes up completely negative for any nerve damage.  Steroid injections are done on the right side of my knee to try and curb inflammation with little results.

Discovery & More Symptoms: Late Fall/Winter 2009

Over the course of a few weeks in the Fall, I began experiencing at first a small, sharp pain in my tailbone when I sat down, which grew into an intensely sharp pain that was worsened by sitting on a hard surface for even a few minutes.  The pain would subside if I flexed to push my tailbone off the surface a bit or if I got up and walked around or layed down.  If I sat for too long the pain could get so intense as to shoot into my saddle area.  My physical therapist, directed me to see an orthopedic surgeon and get my back looked at, and start seeing another physical therapist who specialized with tailbone problems, who tried to multiple tailbone "resets" on me by pushing the tailbone from internally with no results.
These may not be from this specific MRI but here are some images of my back:

The new orthopedist immediately recognized a slight bulge in my L4/L5 as well as DDD in my L4/L5 and L5/S1.  It is also discovered that I have one extra vertabrae, like 5-10% of the population.  He prescribed more PT for the back then would consider oral steroids and injections in the future.  At this point my physical therapy focused on deep tissue massage, building more strength in my already strong back and core, and rebuilding what appeared to be some already atrophying muscle in the right calf and leg.

The Beginning of Symptoms: Late Summer/Early Fall: August/September 2009

After some more time off from running, I decided to begin jogging and lifting again.  My right leg was now in more discomfort than ever before, despite giving myself plenty of time off, but I was still able to run close to what I did before, if not for an aching lower back and right leg afterwards.

As I continued to lift/run/and swim the pain became severe in the period of about a month.  With the pain evolving from the classic feeling of a dull ache from a healing pull or tear, something I was very aware of and not a stranger to.  To a searing, sharp pain down the outside right of my leg.  Swelling was bad on the outside right of my right knee, my lower back was getting much worse at a fast rate and I believed I had some sort of bursa on my knee so I pursued a sports medicine Doctor at OSU.  The doctor took some X-Rays and chalked the injury up to a hamstring injury and a pulled back muscle so I began physical therapy.  After a few months of therapy with only worsening symptoms my PT referred my back to the doctor, who sent me for blood tests, a pelvic bone scan, and a knee MRI.  All of these yielded negative results with exception of the MRI which only revealed some irritation of the IT band on the outside of the knee.  I was ordered back to physical therapy.

The Injury and Aftermath: June/July, Summer 2009

As the injury happened quite a while ago, keep in mind that the dates may be off a bit from such a long recall.

Towards the end of my summer semester, in late June/Early July, I was doing bent-over rows when I experienced almost a popping sensation and immediate, intense pain in my lower back.  It took my a full minute or so to fully stand upright from my bent forward position and decided that further lifting would be painful and impossible.  Instead of my normal light jog after my lift to cool off, I decided to walk back to my house.  The pain became much more severe and I decided to take a week or so off of lifting, but continued to try and jog a few days later, which proved to cause a slight pain in my lower back.  At this point, I felt the injury was minor and only a pulled back muscle.

When I returned to the gym a few weeks later I felt OK, not great, but definitely in good enough condition to return to my routine.  While there, I idiotically did the same lift and experienced the exact same pain in the same spot, this time with more intensity.  I was in agony at this point and decided to walk home again, this time taking some more time off lifting.  I could barely walk out of my room and coming down the stairs was a burden.  Even laying in my bed was a problem because of how soft it was, coughing and breathing caused slight discomfort.

After a just a week or so, the pain in my back subsided considerably and I decided to return to running.  At this time I was constantly continuing swimming since, although much discomfort came from back, it was not painful and actually felt better afterwards.

When I began running I noticed a higher level of discomfort in my lower back, as well a tiny amount of pain in my right buttock and IT band and hamstring area.  After the run, I went to get dinner where I experienced what can only be described as a full-body cramp.  Every single muscle I had plus some I didn't know I had, including muscles up my neck to my skull and face fully cramped for what was probably 30 seconds to a minute but felt like an eternity.  My friends wanted to take me to a hospital but I thought it was probably just lack of water/nutrients from getting back on my rigorous running routine (though I make sure to keep very hydrated and take vitamins).  My entire right leg would not stop cramping on and off for hours, I chugged Gatorade, ate a banana, and iced and massaged my leg, and got relief about an hour or so later when the cramping and muscle facillation subsided.

A Random X-Ray of my ok knee a few months after the injury just for some imagery:

Welcome & Pre-Injury: Summer 2009

Welcome to a personal journal of my fight against chronic pain caused by what is probably a mix of spinal issues.  The purpose of this blog is to give doctors and friends an overview to the history of my pain, as well as help me keep a more detailed record of my constantly evolving symptoms and attitude towards the problem.

Before the injury occured, I had never suffered any disease, serious injury, or affliction I know of besides a torn hip flexor a year before which may have slightly altered my gait, and a few broken bones in the past, neither of which were serious.  I have no family history of any type of disease or biological problem except for bad backs: my Father slipped his L4/L5 playing golf, suffered severe sciatic pain for a few months, got a lamenectomy (or possibly disectomy?) and was back to normal within 3 months, with no pain since then.

I was a lifetime athlete, playing a contact sport throughout college and was a workoutaholic.  Before my injury, I was running, on average, 2 times a day, with the addition of lifting 5 times a week and swimming 5 times a week, plus abs every day.  At this point, I was averaging easily over 100 miles a week.  My typical day consisted of Waking up, going to class, going for a jog, lifting, swimming, eating, doing work, then going for my endurance/long night run, then eating and relaxing.  I drink in moderation and ate relatively healthy for someone my age, weighing in at my all-time best of ~210+ pounds at just under 6' 4".