2nd opinion – ulnar nerve

Today’s appointment was the  polar opposite of yesterday’s appointment.  The nurse brought me back about 10 minutes early to thoroughly go through my paperwork.  A few minutes after that the doctor came in.  She wanted to see my cervical reports and wanted to make a clear determination of pain stemming from my elbow v. pain stemming from my neck.  She said that what I have is called “double crush syndrome”.  This led to doing many different tests.  A few showed “Wartenberg’s sign” where I am unable to keep my pinky finger squeezing my ring finger.  The tests were timed and by the time they were done both fingers were far apart from each other.  Another test showed my incredible weakness in my left arm.  I was not even aware it was so weak.  It seemed like one of those illusions.  She scratched along the nerve and did strength tests and she easily pushed my arm towards me.  Unlike yesterday’s opinion, she said the EMG had shown severe compression and my nerve is working less than 50%.  Due to all of the above, the only solution would be surgery on my left arm.  She said it was beyond the realm of physical therapy or just wearing a brace at night.  Also, the other surgeon suggested decompression surgery.  This surgeon disagrees.  She states decompression usually ends with another surgery down the line to move the nerve.  Therefore, the surgery would combine both decompression and transposition of the ulnar nerve.  From what I have read, a lot of patients agree with this approach and do not understand why their surgeons only opted for decompression.  She also thoroughly went through the surgery process and will have a pre-op with me to review the surgery and all my instructions.  She said to bring a list of questions.  Wow!  The other surgeon was not going to have a pre-op.

Surgery is scheduled for Friday, August 25th and the pre-op that Monday, August 21st.  She was so thorough that I currently cannot think of any questions! Three days after surgery is Roger’s 1st day of 1st grade.  I am hoping to be on my feet to see him into the doors of the school with Rob.  These next few weeks will be crazy and the following six will be in recovery.   Full recovery takes 3-6 months.  Roger was happy to announce that in 6 weeks after surgery, I can tie his shoes again!  Silly boy!

 

Ulnar nerve entrapment, 1st Opinion

Today, I had the first appointment with a surgeon to discuss my ulnar nerve entrapment.  After a large packet of paperwork was completed, I was brought into the back by the nurse and/or surgeon’s assistant.  He led me through a series of tests and questions (a lot that I had just answered in the pile of paperwork).  After about 10 minutes, he said the doctor would be in.  The doctor repeated a couple of the tests I had just done and really did not ask too much about symptoms.  Maybe he read the paperwork!  He said there were two options:  1)  sleep in a brace to improve the symptoms, which would take roughly 3 months or 2) cubital tunnel release surgery.  He said since the muscle in my hand is not atrophied, surgery is not the only option.  I forgot how he worded it, but my retort was, “Well, I do not want to wait for atrophy to have the surgery”.  He said since my nerve entrapment is severe, he recommends surgery but wanted to give me another option since some patients want to avoid surgery at any cost.  He did not go into the details of the surgery at all.  I had a few questions for him regarding the surgery and recovery.  If I had not asked any questions, the appointment would have lasted maybe 3 minutes with him.  I said I would like to schedule the surgery and he said, “My staff will come in to schedule, I’ll next see you at surgery”.  Lack of bedside manner is an understatement.

From the get-go, I was a little hesitant of this appointment.  When I left the pain doctor, she said I needed surgery and had 2 recommendations but knew my primary care physician would want to give her own referral.  When my PCP’s office called to discuss the EMG and referral, the nurse said my doctor wanted to use this practice and the nurse saw there was a specialist in hand, wrist, elbow at the Flower Mound office.  It was a recommendation for a practice, not a doctor.  I still kept the appointment due to good online reviews of the surgeon (and would still use him, if need be).  However, I reached out to my pain doctor for her recommendations and have a second opinion appointment scheduled for tomorrow morning.  I am hoping to get a better vibe from this doctor.  I know this surgery is inevitable, I would just like a surgeon who discussed it further with me, rather than me having to pry information out of them.

ACDF 2nd Opinion

Today I had my second opinion for ACDF surgery with a neurosurgeon.  I already scheduled ACDF surgery with an orthopedic surgeon for October 19th.  I spent a long time with the nurse going over my back pain history, therapies, treatments, and doing some reflex and strength tests. Once that was completed, the nurse said the surgeon would come in to discuss the results of my MRI.  He plainly stated that he only urges surgery if 1) the spinal cord is compressed or 2) weakness. Since I don’t have either at the current time, he does not recommend surgery now.  He did say, though, that I will need surgery in the future due to the disc degeneration/spondylosis.  He recommended traction kit to use at home for 30 minutes a day/daily for 3 months.  He  put off having ACDF surgery on himself for 10 years by doing traction for 3 months, every two years.  He said he knew it was time once traction no longer worked.
At first I was relieved.  I am looking at a possible surgery on my arm/elbow and cannot imagine two surgeries in such close proximity of each other.  However, then I was wondering how long do you put off surgery?  I have read of individuals who waited too long and had the surgery but the nerves could not recover.  I will reach out to my PCP and let her know and ask her thoughts, since my thoughts are overwhelming!  

End of Week 9, Beginning of Week 10

The end of last week started Roger’s 7th birthday celebration.  Thursday night he could not sleep because he was so excited for Friday night’s Queen concert.  He was tossing and turning all night, sounding like he may be sick, and awoke at 4 am.  That day his sitter was sick and he had to occupy himself while I worked.  In the afternoon, we met his first grade teacher, looked around the classroom and around the school at some new things going on.  He was even given a kit kat for that night and some M & Ms from his principal.  He was thrilled, especially as she announced his birthday on the loudspeaker as we left the building.  I had an afternoon dentist appointment, which the candy made Roger hyper for but he did well waiting for me.  Luckily, I got him to take an hour nap before we left for the concert.  He enjoyed the show and was very excited during “Crazy Little Thing Called Love” but starting crashing at 10:30 pm.  However, when we got in the car, he perked up and fell asleep around 12:30.  Unfortunately, he woke up at 6 am on Saturday for his birthday.  Saturday was a pretty full day that started with gift opening.  We also had our dogs’ obedience class, followed by lunch, a classmate’s birthday party, School of Rock, pizza and cake with my parents and his best friend, Amanda, and her family.  Finally, he fell asleep around 9:30 pm and woke up at 7:30 am.  He NEVER sleeps that late.  It was amazing!  Sunday was his formal 7th birthday party at Bach to Rock.  It was the latest party we have had for him — ending at 4:30.  We were exhausted afterwards.  The birthday weekend ended with some lego play and Mooyah for dinner.

Last night an allergy attack woke me up around 4 am.  To say that I am a little tired is an understatement.  So, the start of my day was trying to fall back asleep followed by some Buzzfeed, mail, facebook, etc.  For some reason starting a new week put my mood in a bit of a damper.  In the past (even recent past), weekends seemed more stressful than weekdays.  Possibly, that is due to the fact that I like structure.  However, the past few weekends have relaxed me quite a bit.  I was blaming some of my back/arm pain on lack of sleep.  My pain levels have been pretty low Friday and Saturday which does not correlate with the lack of sleep.  It doesn’t even correlate with stress levels.  Setting up the house and the party are both stress factors for me, but neither aggravated my upper back/neck/head aches.  This week I have my 3 important surgeon appointments while experiencing virtually no pain.  My left arm was in a ton of pain last Thursday but that feels like a lifetime ago.  My headaches have been very mild the past 1.5 weeks.  I feel like my body is correcting itself before I make a commitment to surgery!  Due to no known nerve damage, I am pretty sure I will not opt for neck surgery .  The severe damage to my left arm nerve (assuming ulnar nerve entrapment) may force me to have surgery, pain being present or not.  If the time allots, I will give a brief synopsis of my appointments Tuesday, Wednesday, and Thursday.

 

Medications

Yesterday, I felt some of the side effects of the migraine medication.  First off, the neurologist told me I would be groggy in the morning.  I usually am groggy, so I did not think it would be a big deal.  However, that grogginess was present the whole day.  I even had afternoon coffee and was exhausted.  Another side effect I had was intense abdominal pain/cramps.  That is seen as a severe side effect and may be caused due to an interaction with fluoxetine.  That made the decision for me:  I’d rather have these headaches than suffer the side effects.  Usually my headaches are just annoying, like the constant ringing.  I’d take that issue over the intense fatigue or increased fogginess (the side effect of the other medication he was going to prescribe).  I also looked up the drug interactions between the muscle relaxer, anti-inflammatory, fluoxetine, and simvastatin.  The muscle relaxer and fluoxetine have a severe interaction — can cause serotonin syndrome.  Therefore, I have decided to forgo the muscle relaxer as well.

This morning Roger woke us up late — 7:30!  I am virtually pain-free today in my neck area and right arm.  My left arm has discomfort from the ulnar nerve issue.  However, this may be a big indication for me to forgo ACDF surgery.  I have the second opinion next week and, after our weekend away to Galveston, I will stop the anti-inflammatory to see how my body is feeling.  I cannot be on an anti-inflammatory long-term, so if the pain is manageable sans medications, the surgery decision is made.

 

Week 9 of Summer

It seems like I miscounted the weeks in my previous blogs.   We have entered week nine of summer.  This has been a week of some resolutions:   as per the neurologist, my chronic headaches are migraines and I started medication last night and, second, as per my pain management doctor, my EMG shows severe ulnar neuropathy with the recommendation of surgery on my left arm.

Upside of neurology appointment:  he thinks the my migraines may be causing some of my back pain and, perhaps, the medication will lessen the pain (as well as stop the headaches).  Also, he was not convinced ACDF surgery is necessary.  He is the first professional who has given me that opinion.  I have a thorough appointment regarding a formal second opinion of surgery with a neurosurgeon next Tuesday.  After facing surgery for my elbow, I am hesitant about having a second surgery this year.

Next Wednesday, I have an appointment with an orthopedic surgeon who specializes in the elbow, hand and wrist.   His nurse told me that he is scheduled out about two weeks for surgeries.  Hopefully, I can schedule a surgery sooner than later because the pain is worsening during the day, as well as the tingling during the night.  It seems like those days off I was hoping for when Roger would be back to school are coming…although I did not want surgery to be the reason why!

Remainder of Week 6 and Week 7

Life has been completely overwhelming!  That, actually, may be the biggest understatement I have made in a while.  I do not do well with stress, so for others, these weeks may not seem like such a big deal, but for me they have been hellish!

Tuesday I was completely overwhelmed, but, as has been the case, blogging helped me snap out of it a bit.  Also, my son graduated his level of swimming and went up to a level 4.  Having a child with autism who has fears is  a double whammy – we have tried lessons year after year, but putting his head under water ended each attempt.  Now, he is constantly going under water.  It is amazing to watch!

The remainder of my week was haunted by bad back and neck pain and headaches.  I had several appointments:  physical therapy, psychologist, and my orthopedic surgeon.  As usual, my pain increased after having physical therapy and remained high through the weekend until Sunday.  From this correlation, I decided to stop going to PT.  It is no longer necessary, the doctor told me, unless it was helping.  After 6 sessions, the pain was exacerbated.  I had felt more at ease with my decision to have ACDF surgery as the doctor explained and answered my questions during my appointment.  But I also made an appointment for a second opinion, since I do not want to rush into surgery.

I have an appointment next Monday for a neurologist.  However, looking up my symptoms, my continuous headache sounds like a tension headache.  I still need to find out if there is any other issue regarding the tinnitus and dizziness, as well.  Tension is the key word of these past few months!

Yesterday, I had my EMG.  The EMG was interesting, getting shocked by a mini car battery and then needles put in my arm, moving them, while pushing against the doctor’s hand on demand. I found out that I now have to go to a hand specialist due to a nerve that is very compressed/blocked in my elbow. Add those appointments to the roster!  The upside: that was the only damaged nerve.  Those results did not help me with the decision for ACDF surgery, as I had hoped, all it did was set me up for another potential surgery on my elbow.  Great, more to obsess about!