After

    After some questioning and reassurance that my steroid shots wouldn't be sourced from New England Compounding Pharmacy, I accepted the procedure as scheduled. The nurse at the pain management doctor was very kind and informative, and the doctor was too. The procedure was uncomfortable but well worth it if it helps.

    My neurosurgeon's thinking is twofold concerning the cervical facet block injections. First, maybe it would help relieve some of the pain resulting from my neck popping and cracking. Second, it would be diagnostic, such that if it does help, then we can talk about further, more permanent solutions including surgery. The popping and cracking haven't gone away, but the pain seems a little less so far.

    My pain doctor has me keeping a pain diary for the next two weeks so we can see how well the shots helped. I'm supposed to rate my pain three times a day on a scale from one to ten. So far, I'm hanging out in the six to seven range, but hopefully the steroids kick in over the next week and bring that number way down.

    One unexpected side affect of the steroid shots was the horrible waves of nausea I felt this morning. I didn't expect that at all. The pain doctor told me to call if I developed a fever or chills, or if I started getting severe headaches that went away when I laid down. I don't know what the nausea was all about, but it wasn't any fun and it lasted well past noontime.

    I did get in to see my primary care physician today so we could synchronize her record of my activities and so she could see how I looked herself. She updated my company's FMLA and disability documents for the additional missed days from work and she checked out the injection sites to make sure they looked okay. Finally, she wrote me a referral for some physical therapy. Even though the muscle relaxer is working well, she still detected how stiff my neck muscles are and suggested that PT could help loosen me up and increase my strength. I'll call to set an appointment for that after my three week wait to see my pain doctor is over and I see what he says.

    There is one very pleasant development to add. The pain nurse took my blood pressure three times yesterday, once before the shots and twice afterwards. Each time, my bp was perfectly normal, which is great because it's been running high for the last several years. My primary care doctor also took it today and it was also perfect. She confirmed what I thought, which is that stopping the ibuprofen and adding the muscle relaxer was helping my heart and kidneys work better, thus lowering my blood pressure. We'll see if this keeps up, but it's good news.

    I'm scheduled to meet the company nurse practitioner tomorrow at work after the shop's morning meeting. Hopefully I feel well enough to go and hopefully she clears me to get back to work. That would be nice.

Fear

    So I'm all set to see the pain management doctor on Tuesday for a cortisone shot in my neck to relieve my facet bone pain. The neurosurgeon and the pain doc think that all the popping in my neck is from the little bones between the vertebrae, called facets, possibly rubbing or being too close to each other. That's why I need to crack my neck constantly, why it keeps locking up and hurting.

    I am happy that the new muscle relaxer seems to be working well. Despite my worry, it isn't putting me right to sleep like the past two prescriptions and it does loosen my neck muscles up.  I have been able to turn my head more comfortably this weekend, definitely far better than the past week when the pain and stiffness kept me in a recliner with a heating pad most of the time.

    No sooner do I make the decision to have the shot than I happen to catch a news story about tainted steroids used for spinal injections causing fungal meningitis, sickening over 90 people and killing seven so far. Apparently, a compounding pharmacy in New England starting shipping poorly prepared steroids all over the country to pain doctors wanting to save some costs. The compounded medicine isn't well regulated by the FDA, so their standards can be lower and their costs can be less. Doctors trying to maximize profits or trying to charge less for their services in a competitive pain relief market found this attractive, and it worked until the pharmacy didn't keep their product clean.

    Meningitis is an inflammatory condition of the brain and nervous system. It can be viral, bacterial, or fungal, with fungal being the most difficult to diagnose with several non-specific symptoms. The fungus in the cases that are occurring now are the same as can be commonly found in the air and soil and which don't generally hurt us. But contaminate a medicine injected directly into the spine and the fungus has an express path to the central nervous system. Meningitis wasn't something I was worried about last week when I casually made the appointment for the seemingly routine procedure.

    Needless to say, I have several important questions to ask the pain doctor tomorrow morning. If I don't like what I hear, I obviously won't be getting the facet shot on Tuesday. I am so tired of my neck locking up but I doubt fooling with meningitis is worth the risk, do you?

Pain

    I don't know what started it. Lately, I'd been feeling well enough to join my shop's softball team. We weren't very good, but it was fun and it was exercise. I had been doing more bicycling with my sons and I had really started to get more serious with my photography. Work was satisfying and home was good. We had finally sold the other house so the dual mortgage baggage had been thrown to the curb. Why did my neck have to start hurting again?

    Four years ago, I was still in the Navy and living in Virginia. My ship had completed a shipyard refit and we were getting ready to go underway in preparation for deployment. It started as a mysterious weakness in my left arm. I had trouble lifting my towel in the morning. I could force myself to do it but it took an effort of concentration. Not normal for me, that's for sure. I had been riding the exercise bike in the ship's gym for a few months at that point and I was getting fit. I don't like the recumbant style of cycle, so I rode the upright with my body in a roadbike tuck, watching the TV and trying to keep my cadence up. My neck must have complained, but I never noticed.

    Some time passed and the weakness morphed into pain, radiating down my left arm through the tricep, across the hollow of the elbow and down to my index and middle fingers. I sought help at ship's medical, and the good doctor tried to help. After a few experiments with some mild pain reliever and nerve blocker, he decided I needed to seek some specialized help at the naval hospital. I had only been to Portsmouth Naval Hospital a couple times previously, once for some stitches and the other to visit a Sailor of mine. The increasingly debilitating pain in my arm and the path of numbness into my fingers told the neurologist what he needed to know. It appeared I had a pinched nerve from a collapsing disc in my neck.

    Some x-rays and an MRI later, we had some confirmation of the diagnosis. Told I had degenerative disc disease, I decided to not rush into surgery despite what my ship's doctor wanted, and I began several rounds of traction and physical therapy to try and relieve the pain in my arm. The neurologist also tried steroid injections into my disc twice. I also was on a high dosage of nerve blocker and narcotic pain reliever. None of this made my arm hurt less but by then I had transferred off the ship for medical reasons and my mom had come to help me with transportation and company since my wife and sons had their lives in Maryland. This extended time with my mom as an adult is one of the treasures of my lifetime.

    The neurosurgeon, arrogant and confident as surgeons usually are, seemed confident that surgery would eliminate the pain in my arm by lifting the disc pinching the nerve. The choice was between disc fusion and installing an artificial replacement disc. Fusion was tried and true, but also would reduce my range of motion. The Pretige disc was fairly new at the time but seemed promising and would allow my neck to turn and flex fully. I was not yet forty so the choice was easy. In April of 2009, with my wife at my side, I had the first surgery of my life and gained a stainless steel body part.

    The artificial disc did its job. After the normal healing and wound care, the pain in my arm did go away, leaving only the finger numbness from which I stiff suffer. A byproduct of the extended time the nerve was pinched, it may never fully recover. My neck muscles were tight but I assumed that would subside over time. I was able to slowly start living my life again, exercising more, sleeping in a bed instead of a chair, playing with my kids. I retired from the Navy, moved to Maryland with my family, and looked for work. I eventually started doing some business development work for a small defense contractor and I took some college classes at the local community college. My neck was doing okay but the stiffness and tightness in my neck never went away. I weaned myself off all the pain killers and nerve blockers, but I still needed 2400 mg a day of ibuprofen to keep the stiffness tolerable so I could work.

    Time went on, my mom passed away, and I had to empty out her house to settle the estate. I spent weeks unloading stuff from her house into dumpsters or into a truck to take to the scrap yard. My neck worked fine during all of that heavy labor, but the painful stiffness continued to be a bother. I needed the ibuprofen like clockwork or I would end up fatigued and drained like I had the flu. My neck would get tender and tight and the pain would get worse. I rarely felt any pain in my arm again, but my neck was a constant issue. At one point, my neck was so stiff my doctor tried giving me a muscle relaxer that ended up affecting my vision. He then prescribed twelve weeks of physical therapy, which did improve my range of motion and probably reduced the stiffness temporarily, but even continuing the exercises didn't let me eliminate the kidney-damaging daily overdose of ibuprofen.

    In 2011, we moved to Calvert County, MD, where I started my new job at Calvert Cliffs Nuclear Power Plant. Things went well at work, especially for the first year when I was in training most of the time. My neck grew stiff from the sedentary nature of classroom study, but nothing I wasn't used to by then. Unfortunately, training ended, which put me in the field (where I wanted to be) but my neck didn't like it. I felt well enough to bike and play first base, but it couldn't last. The stress of high heat and poor lighting combined with abnormal body positioning to put my neck under terrific strain, which I tolerated well some days and suffered in great pain on others. I also developed a new condition in my neck whereby I felt the need to pop my neck constantly. I could feel the vertebrae locking together and I seemed to need to pop them loose. This sometimes resulted in a strong tug down my spine. It also caused a metallic pinging sound inside my neck and head, which only I could hear but which was very real.

    My new family doctor again tried a new muscle relaxer which might have helped but also put me to sleep so it wasn't a viable solution. Heat also relieved some of the stiffness but only while it was applied. I missed enough work to need a Family Medical Leave Act and Disability case assignment. I had x-rays and another MRI done so I could see a neurosurgeon in Annapolis to make sure my artificial disc was still properly in place. He confirmed that it was and that I could see a chiropractor if I desired to, but he thought it might be a good idea to get a couple flexion x-rays to verify the disc flexibility, which I did, and to see a pain management doctor about a cortisone shot into the disc above the artificial one. I consulted with the pain doctor who prescribed yet another muscle relaxer, which seems to actually lessen the stiffness without knocking me out. The locking sensation didn't go away, so I agreed to return to the pain doctor for the spinal cortisone injection. I have been missing more work because of this again so I hope the injection and the muscle relaxer does the job long term.

    We'll see how it goes on Tuesday.