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.

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!

Week 6 of Summer

Thus far, for me, summer is a bummer!  I just can’t find my happy.  I know I am being vague.  I really don’t feel like writing but hoping it may get me a tad out of this bad mood.  I felt pretty okay the end of last week.  Saturday was very stressful for various reasons regarding our dogs and pain and workload and energy.  However, Sunday I felt much better.  Unfortunately, that feeling was fleeting.

This week began in a shambles.  Monday I had a sitter for Roger, since there was no camp and no therapy that day.  I felt like a prisoner in one room to get my work done.  Yesterday, I also had physical therapy.  It lasted longer than intended and I started stressing about all the time I am missing from work for all these therapies.  This morning I woke up feeling much the same, stressed, tired, terrible headache and tinnitus that I just cannot ignore anymore.  Again, I had another physical therapy appointment and, again, stressed over missing work time.  The headaches and tinnitus are just so constant as of late.  This headache must be at least a month old.  The tinnitus is about a decade old but the volume of the past week has increased greatly.  I feel like it is making me completely crazy.  I am in such a bad mood all day long.  I feel terrible for my son and husband, but especially for my son because he does not understand why I am in a bad mood so often.  He asked my husband what was wrong with me on Saturday.

Today, I called my therapist and made an appointment for tomorrow (even more time to make up for work) and had a friend recommend a psychiatrist.  I am getting so depressed as of late that I don’t want to keep sinking deeper.  This calendar is filling up pretty quickly with more and more appointments.  Now, I just have to figure out when I can have a full day of rest.  I do not know if I can wait until the end of August!

Downer Update

I reposted yesterday’s blogs in some of the FB groups I belong to for cervical issues/ACDF surgery.  I received a lot of acknowledgement of what I have been feeling and dealing with.  I think venting helped my mood a bit.  In the evening, I took my son to him swim lesson and went to the pool afterwards for 2 hours.  My back was in lots of pain, but I did my new exercises from physical therapy that day after dinner.

This morning I woke up, again in pain, but feeling a bit more stable mentally/emotionally.  I made a few decisions that I think were partly to blame for yesterday’s mood:

  1. Do not try to start work before taking my son to camp.  I was already feeling overwhelmed/stressed from the work emails before the day really began.
  2. EAT before going to an 11 am physical therapy appointment.  I only had 3 cups of coffee and water in the morning.  As I was waiting to begin therapy, the hunger crept in.
  3. Do my exercises first thing in the morning and after dinner (on days I have physical therapy).  On days I do not have PT, add another set before picking Roger up from camp.

The exercises are hurting me and the pain is probably worse than before my first day back at physical therapy.  The headache is a bit more intense as well.  I will bring it up with her today.

This week and next are filled with appointments:  Tuesday – PT, Wednesday – PT, Thursday – Internist, Friday – PT, Monday – Pain Management, Friday – Orthopedic Surgeon.  PT wants me to come 3 times a week, so I am guessing that will fill my Tuesday – Thursday.  I can only do one appointment a day due to work.

Another interesting thing occurred yesterday.  I am not sure if it changed my mood for the better or had much of an effect at all.  I was called to schedule my ACDF surgery.  I am still unsure if I will have it and will see how therapy goes, as well as getting a second opinion.  I scheduled it for October 19th, with my pre-op on October 4th and post-op on November 1st.  Sounds like it’s so far away, but in actuality it is only 14 weeks.  It is enough time to see what is working/what is not/and make an informed decision.