Chronic Pain 101: Insights for the unafflicted.

This last Saturday I got up early, took a leisurely shower, washed and conditioned my hair and then set off with my husband for our local warehouse store for the monthly bulk purchase of staple goods. After the store, we took the purchases home and put the 9 lbs of butter that was on sale into the freezer, then headed out for a late breakfast and our weekly grocery shopping. After unloading the groceries we again headed out, this time to a hobby shop he’s been dying to go to, then a stop for a late lunch, then on to the supermarket-sized plastics store where I was finally able to find the food storage containers I have been needing and even the kitchen scale that was, surprisingly, not stocked by the warehouse store. From there we went home for a little TV and R&R.

Unremarkable? Maybe for you, but it has been more than a year since I have been able to take on such a day without being sidelined half way through it with crippling, unrelenting back pain. The day was more like a miracle for me because only one week before, I had been unable to take on even half that without resorting to opiate pain meds and stops to rest and release the muscle spasms in my back every ten minutes or so. Then, a week before this remarkable day, I was treated by a neurosurgeon with massive injections of corticosteroids in my lower back. Within hours my stamina had improved and within a week my ability to stand and to walk had reached near normal.

But it was a long road to this juncture, this point where I was able to return to near-normal functioning (I still have to wear a back brace and lose some weight), a road fraught with scepticism, doubt, dismissal and frank disbelief on the part of people around me, doctors included. I had had several x-rays that disclosed arthritic damage to my lumbar spine, but it was decided, by those who did not share my pain, that the damage was not sufficient to induce the kind of debilitating pain I was complaining of, and so it was dismissed with the trivializing “lose some weight.” Nobody wanted to hear that the back pain pre-dated the weight gain…everybody, friends and family included, simply decided if I was thin, my back wouldn’t hurt. As a result, I not only did not receive adequate medical intervention, people treated me as if the pain did not exist (it’s my fault, therefore I deserve no sympathy, therefore they can expect me to perform as if the pain did not exist). Worse, I took to dismissing it myself. Finding no avenue of relief other than spending as much time as possible sitting, the weight didn’t shift but the back pain slowly grew into a monster that controlled my life.

You cannot explain to a person what a pain feels like. It is simply not possible. And chronic pain is in a class by itself, even if it is not high level. People whose experience with pain is brief and acute…a prolonged labour is brief and acute compared with months and years of daily, hourly, every-waking (and sometimes sleeping)-minute pain…simply cannot relate to the chronic pain sufferer and how it shapes virtually every choice in their lives. Without the empathy that sharing the pain can bring, people can easily judge the chronic pain sufferer or, simply, over time, become exasperated with him/her and lose all patience…and perspective. We, the pain sufferers, learn to shut up, to stuff our feelings, to attempt to do more than we should in an effort to not alienate family and friends, to not get fired for being a malingerer, to get through the day. And still, even with superhuman effort, we must fall short of our goal to “live normally” because the pain makes choices for us, choices we would not make outside it’s pernicious influence.

“Wanna go on a 5k run with me Saturday?” a friend might ask then, remembering you have back pain, amend it with “you can walk…” No, friend, I can’t walk 5k…I can’t even walk to the other end of the house some days without having to sit down.

“I’ve got vouchers for this great food and wine fair…wanna go with?” Does the venue have lots and lots of seating scattered about? Will there be non-alcoholic drinks because I can’t mix booze with my pain meds. Is the parking close to the venue? Because unless the answers to all three questions are “yes,” my back won’t let me go.

Chronic pain, regardless of where it resides, can influence virtually every decision a person makes. Drive to the market and find the parking lot crowded…drive home because there is no way you will have the stamina to walk from the furthest reaches of the parking lot, do the shopping in a store that provides no benches to rest on, and then walk back to the car…never mind having to unload the car and unbag and store the groceries. Grocery shopping can be an overwhelming task for those of us whose pain only waxes and wanes but never subsides.

The worst part is living with the eventual impatience and lack of empathy from close friends and family members, the resentment that your limitations imposes on others. Recently my husband and I went to a resort. He had to partake in some of the resort’s activities solo because I just couldn’t walk that far, participate, and then walk back. One excursion had my back exhausted when we had walked only half way to the venue.

But worst of all is dealing with doctors, particularly those who dismiss the pain. “Lose some weight” a rheumatologist once told me, and refused to treat me until I did. What part of “I cannot exercise…I cannot even walk for a single city block…with this pain,” did he not hear? Or how about the doctor who read the x-rays and decided that his interpretation of the x-rays told him more accurately about my pain than my personal experience and therefore no procedure or pain-mitigating drug was warranted.

I recognize that recreational drug-seekers make it tough on people who have legitimate pain, but that doesn’t excuse dismissing someone with long-standing chronic pain. How do you tell them apart? Well, maybe you can’t, but is it better to send someone in crippling pain away untreated or to mistakenly treat someone who is faking? The dismissive attitudes I have encountered with regard to my pain have, over the years, driven me to conceal it, to “suffer in silence” as it were, and to live my life increasingly homebound. When someone rolls his eyes or exhales a huge puff of exasperated air because I can’t walk “that far,” it used to irritate me…how insensitive can a person be, for mercy’s sake, I am hurting here. Now I feel hurt…and guilty…that I get no empathy and that I cannot just make a wish and the pain will disappear.

This neurosurgeon was a breath of fresh air. A couple of weeks after seeing him, I was being interviewed by a physician as I was joining a diabetic clinic. I put my meds bag in front of her so she could see what I was taking on a regular basis and when she pulled out the pain meds from the neurosurgeon, her eyebrows rose. “DF 118?” she said, her voice surprised. “You must be in some serious pain.” Yes…serious pain…and after more than a dozen years of suffering with it, I finally found a doctor who takes my serious pain seriously…although the clinic doctor probably did not until she saw the degree of pain relief the specialist had prescribed for me.

If you must interact with a person who suffers chronic pain, here are some things you need to know, understand and practice.

1. They aren’t doing it on purpose. Chronic pain has a mind of its own. Depending on the condition, the person can be relatively OK one day and barely able to move another. This does not mean that s/he is using the pain to excuse her from what she does not want to do. Some days I could bend over and pick up a pin from the floor…other days I was doing well just to touch my knees.

2. Losing weight is not a panacea. Yes, it may be helpful to some people with some conditions, but you simply cannot dismiss chronic pain in a person as the result of excess weight. Some of us got the pain first and the immobility dictated by the pain helped the weight to add up. Even it the pain is caused by excess weight, telling the person to lose weight neither ameliorates the pain nor makes exercise a feasible suggestion. Have some compassion—and if you can’t, then keep your mouth shut.

3. Come up with compromises: rather than expect the person with the pain to come up to your level, throttle back your expectations to theirs. Instead of a day walking around the mall followed by walking around a museum or aquarium or outdoor market, plan a day that includes frequent rest stops…sitting on a bench to look at a display window, stopping at a café for some coffee, breaking up the day with a movie. Don’t wait for your friend to expire with pain and be forced to beg a rest…offer a rest periodically…it will do both of you good.

4. Never dismiss someone’s pain, not even with your facial expressions. No eye-rolling (“oh no, not again!”), no “are you sure it’s that bad?” no “Oh, c’mon, it’s just another block…” Trust me, by the time the chronic pain sufferer brings it up, it is already at the unbearable stage. I have walked in malls until my back hurt so badly I could barely move my legs. This, of course, slowed me down, which slowed my companions down…do you think being annoyed with me would have made it any better?? Being impatient or dismissive or exasperated is unproductive both for you and for your friend in pain, and it actually adds to the pain with feelings of guilt. Believe me, if your friend could wave a wand and take the pain away, she would, in a heartbeat, and then run circles around you.

5. Don’t offer a host of non-traditional remedies, if you must make suggestions, stick to conventional medicine. Why? Because the time for non-traditional treatments is after the conventional workups are done and such things as tumours, bone spurs, infections, ruptured disks, broken bones and other things that could be causing the pain are ruled out. My grandmother had an infection in her spinal column that kept her bedridden and on antibiotics for weeks until it cleared up. Had she opted for some non-conventional treatment instead of the investigation that found the infection and the drugs that cured it, she may well not have made it to her 84th birthday…she could have died of encephalitis, had the infection remained untreated and it migrated to her brain.

6. Don’t tell the person to “ignore it and it will go away.” Pain is a symptom that something is wrong. It is like shouting: the worse the problem, the louder the shouting (the more pronounced the pain). Too often well-meaning people use this phrase in a misguided effort to help but believe me, if the pain is truly chronic…which means it has existed over an extended period of time…the sufferer has already exhausted his ability to ignore it and the pain has broken through that barrier. Don’t suggest hypnosis, either…the only thing to suggest is to see a doctor and if the sufferer has done that and gotten nowhere, then suggest different doctors or simply shut up and empathize. I quit trying to find a doctor to treat the pain for years simply because the doctors I did see were so dismissive…if they gave me drugs at all, they wouldn’t kill a headache, let alone chronic lower back pain. It was not until it got so bad I couldn’t stand long enough for a proper shower that I started going to doctors again…and this time I got lucky.

7. Try to up your own empathy and patience quotient. It will not only be helpful in dealing with a friend or family member who suffers chronic pain, it will help you in many other areas of your life as well. People who hurt can be depressed, angry, impatient, despondent, and difficult in other ways as well. They need compassion (not pity) and patience (not long-suffering on your part) and a willingness to accommodate their limitations without rancour.

Life without pain is preferable, but for some of us, it is an elusive goal. If there is someone in your life who suffers chronic pain, try to remember that it is not a chosen way of life and most of us are simply doing the best we can with what we’ve got. Give us some encouragement…and a break.

Chronic pain: the unwelcome life’s companion

Until it starts to abate, I don’t think even the suffers realize how much long-term chronic pain can diminish their lives. It does more than limit activities that exacerbate the pain, it affects and informs virtually every aspect of life, from mood and sense of well-being to sleep to willingness to go and do and simply experience life. It limits not only motion, but endurance as well, both physical and mental. Chronic pain, even with palliative treatment, can be exhausting.
And that’s where I have been over the last weeks: an unwilling and increasingly debilitated subject of acute and chronic lower back pain, a legacy of too many unwitting injuries coupled arthritis in the lower spine. I had reached a point that nothing I did…from buying a new mattress to loading up on OTC codeine meds…gave me any appreciable relief. I would awaken dreading the activities of the coming day, knowing that the only question regarding my pain would be “how bad?” and “how soon?” There was no pain-free day or even time of day…it was all a matter of degree.

On a good day, fortified with pain medication, I could make it through the supermarket without bending over and leaning on the trolley to take some pressure off my lower spine. Most days, however, were not good days. Walking through the mall became an exercise in bench-spotting: if my back got so bad my legs were starting to give out, where were the benches? Pain even dictated where to park the car: if we couldn’t find a space close to the business we wished to patronize, Hubby would drop me at the entrance to begin the shopping (or find a bench) while he found parking.

Pain circumscribed and dictated my world. I could not participate in any activity that required walking more than five minutes; I could not participate in anything that required prolonged (more than five minutes) standing. Queues at supermarkets, banks, even waiting lines at restaurants, were daunting as standing in one place was even more painful than walking. The pain awakened me at night when I tried to roll over in bed. I began sleeping with a pain tablet and drink on the nightstand next to the bed.

My doctor knew of my back pain but I had not discussed its steady increase in intensity with her. My husband was sick and my focus, medically, was more on helping him. But the day came that I could not prepare dinner…not even peel and chop an onion…without sitting down to “rest” my back. I could not put it off any longer.

Doc started with x-rays, anti-inflammatory drugs, muscle relaxers, and more potent pain killers—and a prescription for physiotherapy. Six weeks later, I was not improved…in fact, despite treatment, it was slightly worse. The x-rays revealed some lumbar facet joint arthritis, likely the source of my pain, but the treatment she prescribed had had no effect. She renewed my prescriptions to try to keep the situation from deteriorating further, and referred me to a neurosurgeon for a more detailed workup and treatment.

Have you ever had an MRI? If you have even the slightest tendency towards claustrophobia, I recommend against it! It took only twenty minutes—and my eyes were closed the whole time—but it was one of the more unnerving experiences of my entire life. And God forbid you should have an itch or a cramp or some other compulsion to move because you have to lay as still as the dead while inside what feels like a coffin, the upper portion of the machine literally inches from your nose! Then it shakes, vibrates and quivers while making the most horrific noises, everything from a deep rhythmic thrumming to an eerie space shipish sound. I endured, of course, as many before me have done, but the experience would not be on my list of things I’d enjoy doing again!

The result of the MRI was pretty much as expected: degenerative stuff due to aging and repeated injuries (accidents with horses, motorcycles, cars, stairs), slightly bulging disks, but nothing worthy of surgical intervention, a mixed blessing because it spared me another trip under the knife but limited the treatment options. He gave me some new prescriptions, this one for a high-level pain killer and a nerve-stabilizing pain reliever, prescribed a back brace and scheduled me for a procedure to have steroids injected into my back.

I left his office with mixed emotions: on the one hand, I was looking forward to the pain becoming just an unpleasant memory; on the other hand, anything involving needles and tender parts of my anatomy (my back was even tender to the touch) did not inspire great waves of enthusiastic anticipation!

The new drugs were an improvement over the old but still not able to adequately mask the pain. I hurt less, definitely, but my ability to go and do was not appreciably improved. The relieved the intensity of the pain but didn’t make it go away so, despite my trepidations, I was almost looking forward to the procedure.

It was amazing. Within hours my stamina had tripled: where before I had to sit down about every ten minutes while out on an excursion, two hours after the procedure I was walking around an antiques show and only had to sit down three times in an hour. The very next day I was able to take a shower and wash my hair without taking a break to sit down and rest my back and within days I was doing the grocery shopping without having to lean on the handle of the trolley for support. Before the week was out, I noticed my outlook was improving, that I felt more energized, less immobile, more willing to go out and about, looking forward to excursions rather than fearing them.

The back brace is a miserably uncomfortable thing, but it works synergistically with the continuing pain meds and the injections. I am returning to physical therapy and soon I shall see a biokeneticist to create an exercise plan to strengthen my back without risking the fragile progress we have made against the pain.

I’m feeling so much better, in fact, I’m beginning to feel like writing again…

Old age ain't for sissies

You’ve heard the expression “old age ain’t for sissies,” right? Well, I’m here to tell you it’s true.

Next month I am going to be 64 and I cannot believe how much my body has deteriorated over the past decade…especially the last year. I have been reasonably healthy most of my life…ok, I’ve had some serious challenges from time to time, but I’ve pretty much conquered most of them…but lately I find myself facing certain—shall we say “structural”—challenges that are almost certainly more related to aging itself (and the result of body abuse in my youth) than anything else.

Most people express surprise when they find out how old I am. I am fortunate in my genetic heritage because, despite my age, I am still regularly perceived as being 10 to 15 years younger than I really am. I don’t have much grey in my hair, and what I do have I have coloured away…a nice, natural-looking strawberry blond that suits my complexion and doesn’t scream “she dyes her hair!” In fact, it is close enough to my natural colour that when it starts to grow out, it is barely noticeable. I don’t have much in the way of wrinkles…I am podgy and that helps to plump out the facial skin…and I use a very good (read that “costly”) moisturizer to keep the dry skin at bay. I have always had dry skin (not much in the way of pimples as a teen, either), but as I age it gets drier and flaky.

But in just the last couple of years, not only is age beginning to show, I am beginning to really feel it. Suddenly…just since my cataract surgery in October…I have permanent bags under my eyes: dark hollows surrounded by puffy bags so pronounced, I can see them if I look down. Last year I tripped up some stairs and broke a bone in my foot: the x-ray revealed a big toe so afflicted with arthritis it should be immobile from the damage (it isn’t…I can flex it fine…but sometimes it hurts like a mutha…).

When you get older, your body begins to deteriorate and, popular wisdom aside, your diet and fitness levels in your younger years have much less effect than you would like to think. We each carry a genetic timebomb that, like it or not, will begin to assert itself despite our best efforts, provided we live long enough. This is why, despite all the hype about diabetes, for example, being a lifestyle disease, you will find fitness freaks who discover they are diabetic anyway…those genes trump anything and everything you might try to do to overcome them! (We have fat, sedentary diabetics in my family…we also have slim, active ones.) That’s no reason to let yourself go and court the Big D, of course, but if you are counting on stringent dieting and arduous gym visits to keep it away, you are starving and punishing your body for nothing. If you’ve inherited the genes for diabetes from both of your parents, the best you can do it stave off its onset…I wasn’t diagnosed until 63, my husband’s grandmother wasn’t diagnosed until her 80s…but you cannot turn off your genetic inheritance with diet and exercise, no matter how fervently you believe otherwise.

One thing young people don’t take into consideration is the kind of damage they might be doing to their bodies with their diet and exercise programs. Sounds counter-intuitive, but the things you do in your youth can come back to haunt you, big time, in later years. A youthful diet low in calorie-laden (but calcium rich) dairy products, for example, can set you up for bone density problems later in life (most of those calcium tablets don’t have much benefit aside from enriching the companies that make them…your body simply excretes calcium that is not taken in through diet); regular strenuous exercise can wear or damage tendons, ligaments, even muscles and joints…things you won’t think much of as your young body heals up…things you will remember and regret when, in later years, you develop chronic tendinitis, joints aching from wear, even surgeries to repair damaged muscles. In my early 50s I had to have surgery to repair a torn abdominal…originally damaged in my youth due to exertion and exacerbated by pregnancy. Over the years it grew from a little “lump” next to my navel to a tear so big I now have a scar more than 12” (30+cm) long on my tummy and two Kevlar patches inside!

Young active lifestyles often include lots of outdoor activities…I spent a lot of time on horseback, on motorcycles, driving a convertible, laying on the beach in skimpy swimwear, hiking in the boonies…lots of outdoor stuff with lots of skin exposed. I am fair skinned and light eyed and in my youth, sunscreens had not yet been invented, nor were UV-protected sunglasses widely available. Despite public pronouncements by a certain arrogant and grossly misinformed supermodel, you do need sunscreens, especially if you are light skinned because skin cancer is a reality, it is the most common form of cancer, and sun exposure is the leading cause. And, believe it or not, those cute, cheap sunnies from the drugstore or trendy boutique are not doing you any favours…if they lack UV protection and you have light coloured eyes, you will end up like me—cataract surgery a full 10 years (or more…my late husband had cataract surgery in his 40s) before the average: UV rays not only damage your skin, they damage your eyes as well.

How many times have you fallen off a horse or a bicycle, while roller blading or ice skating, while skiing, or playing some sport like basketball or volleyball? We often just shrug off the bumps and bruises, but sometimes they are more serious than we know: George Eads (Nick Stokes on CSI) fell playing basketball and actually fractured his lower spine. But because he could walk around he never sought medical treatment for it. Ten years later his spine was x-rayed, the fracture discovered, and he now has five screws in his back, holding his spine together properly. When he hits 60 or so, its gonna come back to haunt him even more.

I have a condition in my lower spine called “lumbar facet syndrome.” Six years ago, in response to my complain of crippling pain in my lower spine, I was x-rayed and told I had degenerative disc disease. No cure, not even palliative care…I just had to live with it. Last year it was x-rayed again, this time I was told the condition was facet syndrome. Again, no cure, no palliative care. And so I live with it…but it has its costs.

I trip a lot…I trip because the problem is worse on my left side than my right, and when I walk, my left foot doesn’t raise as high as my right, so any unevenness on the pavement, a tile that is not laid exactly flat, a lump in the carpet, a dog toy I don’t see…any one of these may catch the front of that foot and trip me.

I have trouble getting up from low seats, even if they have arms. Between the compromised abdominal muscles (yah, they are “repaired” but that doesn’t mean they are as good as new) and the fact that the left leg doesn’t have the strength the right one does (the facet syndrome involves nerves being pressed upon, causing both pain and weakness), if I sit in something where my butt is significantly lower than my knees, I may need help getting back up.

This, of course, means I can’t sit on the floor…or even get on the floor to look under the bed for my shoes. It means going up stairs is a problem because only my right leg is strong enough to lift my body up the steps. Getting things out of low cupboards can be daunting…I have bend from the waist and hope I can find the desired item before the blood rushes to my head and I pass out.

Long walks are out of the question unless I load up ahead of time on codeine (a medicine that is blessedly available over the counter here). A shopping expedition always begins (and often ends) with a codeine tablet.

My Grandma Violet lived to be 89 years old. In her later years, she had trouble sleeping, often waking at 4 am and unable to go back to sleep. For most of my life, I have slept like the proverbial log, but after I broke my foot last year, sleep became elusive. Now I have my delicious “log” nights intermittently, sandwiched unpredictably between “wake up every hour” nights and “can’t get to sleep, can’t stay asleep” nights. All things being equal, it appears that aging is beginning to affect my sleep as well as my waking hours.

It is easy to be contemptuous of the aging and the aged. And it is so easy to say 1) “I’ll never be like that,” 2) “I’d rather be dead than old or infirm,” or 3) “I hope I die before I get that way.” But saying and doing are very different things. My late husband had a dear old auntie who was horrified at her brother’s last decade: a stroke victim, he spent his last 10 years of life paralyzed and being cared for my his wife and, later, by a nursing home. So horrified was this auntie that she told all and sundry that if she had a stroke, she was not to be kept alive through “artificial” means (like IVs, feeding tubes, etc.). In her 90s, Auntie had a stroke…and I discovered that even the most horrific averse training…like watching your brother taken care of like a baby for his last ten years…can mean nothing when you are actually facing the Grim Reaper. Auntie changed her mind in the hospital bed and spent her own last days in a nursing home, unable to swallow or speak, communicating in writing and being fed and hydrated through a tube.

And so I say again, old age ain’t for sissies. It takes guts to get up and do the necessary tasks of living when every bone, joint and muscle hurts and you know that it will not only be worse by bed time, it won’t be any better tomorrow, either. It’s easy to suffer through a painful tendinitis when you know with therapy and meds, it will be better in a few days or weeks…it’s not so easy when you know that if you stress that wrist just a tiny bit…like pick up too many plates from the table at one time…it is going to pain you for days…possibly forever. When you have to decide on how much necessary work you will do based on your ability to stand, walk, or bend, your life becomes controlled not by your desires…or even your pocketbook…it becomes controlled by pain and endurance, one of which increases, the other of which decreases, based on the things you did decades past and thought nothing of.

Most of us either think we will never decline in our later years…or that we will simply not live to pay the piper. But if you look at the numbers of Baby Boomers entering retirement age every year, you have to face the fact that the odds are that you will get that old…and unless you live in a padded cocoon, you will begin to experience physical decline. And it is then that you will discover just how strong and indomitable you really are.

Old age ain’t for sissies

I have been in near-constant pain for almost two months…on bed rest for nearly half of that now, and it is really, really getting old!

It all started on 12 March...Hubby and I went out for dinner and while awaiting dessert, I decided to make a trip to the loo. It being a balmy night (March is the end of summer in South Africa), we were sitting outside on the patio; the loo, however, was inside and, from the server’s directions, apparently at the back of the dimly lit dining room.

The floors were tile; there was a raised dining area to the left, accessed by two or three steps, also tile. They were also the same colour of tile as the main floor, they had no edging to indicate that there were steps there, and in the dim light, they blended right into the floor. I hit the steps with my left foot…which had only the flimsiest of sandal on it…and fell up the steps…leave it to me to find a way to not only fail to see some steps, but to manage to fall up them!

I really didn’t think I was badly hurt. OK, I had two small scrapes where my ankle and the top of my foot impacted the leading edge of the steps, but I neither reported it to the restaurant nor told my husband. I felt foolish, after all, tripping over steps because I was more focussed on finding that elusive ladies room than looking for virtually invisible obstacles in my path.

When I first started feeling pain, it wasn’t in my foot or ankle. Two days after I managed to embarrass myself in the restaurant, I awakened with what I thought was a sciatica attack. I’d only had sciatica a couple of times before and it had always resolved within 24 hours, following a good sleep, so I was puzzled when I awakened the following morning and not only was the pain still there, it was moving down my leg. Sciatica is the inflammation of the sciatic nerve which goes from the lower spine through the buttocks and down the back of the thigh. Not only was the pain still burning from my back, through my bum and down my thigh, it was moving further down my leg than any sciatica attack had ever gone before, and the pain was more diffuse than I remembered it. But, true to form, I just assumed it would get better in a day or two, as my aches and pains generally do, and ignored it. That, as it turns out, was the wrong thing to do.

Pretty soon the pain had gone down my leg to my foot, and from there, into my big toe. I knew it wasn’t gout…I’d been tested for gout and DVT (deep vein thrombosis) only a few months back. The foot started to swell up…and before long I was having pain so acute I couldn’t stand even the weight of a sheet on the skin. It burned, my skin was tender to the touch and just when I thought it couldn’t get any worse and I had to see a doctor about it, I caught the flu and my entire body ached so badly I couldn’t isolate the leg pain from the flu pain. I was a mess!

Slowly, the flu symptoms subsided, leaving me with the pain from my lower spine down to my big toe, but with a new twist: it began to spasm at night. Now, even with OTC codeine-and-paracetamol, I couldn’t sleep more than two to three hours at a stretch. Then one night Hubby woke up and found me sitting in the big chair in the bedroom, quietly massaging my foot and ankle, where the pain was the most acute, and silently crying. The following morning, after learning that the doctor wasn’t able to see me, we walked…well, he walked, I hobbled…into the ER at our nearest hospital, ready to put my misery out of me.

It was the 9th of April, nearly a month since I lost the skirmish with the stairs…but we still had not made a connection between a pain that seemed to start in my spine, radiating down my leg, to my klutzy moment at the restaurant. During this month we had driven down to Durban and back, viewed a dozen or more houses, tramped through several malls, and generally lived our normal life, sore leg and all. Every night I had gone to bed, expecting the “sciatica” to have taken its leave while I slept, and each morning I would awaken to the burning pain running down my leg, now with the addition of hot splinters of pain throughout my foot, ankle and great toe. It was time to get a proper diagnosis.

I’ve always felt quite comfortable in South African hospitals. I have never received anything less than first rate care, and usually more promptly than in American hospitals, too. The ER doctor was a pretty young blonde who listened well and asked the right kinds of questions. When I pulled up my jeans so she could see my foot, I saw the healing wounds caused by the stairs and, on the spur of the moment, told her about my clumsy meeting with the stairs. She duly noted it but, like me, was focussed on the pain radiating from my lower spine. She ordered a series of hip and back x-rays and, as an afterthought, ordered a couple of x-rays of the foot, “just in case,” she said.

At this juncture, I have to warn you about those automated blood pressure cuffs…they kept trying to get a blood pressure on me and the readings were stroke level! Now, I’m 63 and I’m fat…nobody expects my BP to be 120/60 any more…but they were getting readings in the 240/190 range and I knew that had to be wrong…over the past five years of so, I have consistently had readings in the 135/80 to 145/85, depending on how stressed I was at the time of my doctor’s visit. I almost titled this entry “Near Death by Sphygmomanometer” because I swear to you, that machine was out to kill me!

The nurse wrapped that cuff around my arm, switched on the machine and I knew almost immediately that something was wrong because it didn’t stop inflating until I was holding my breath and squirming against the pain. It started deflating, automatically searching for the arterial pulse that would give it its first reading but apparently is couldn’t find it, and the thing began inflating again! My fingers began to turn purple, my hand started to swell up and I could feel my eyeballs start popping out of my head. I cried out a couple of times and when nobody seemed to think anything of a patient writhing in pain and turning blue and purple over a blood pressure reading, I began to yell “Take it off! Take it off me!” Tears spouted out of my eyes and just as I was about to frantically claw it off my arm, one of the nurses announced a reading of 240/190 and the doctor nearly stroked out! Once the feeling came back into my hand I suggested that the reading was that high because the machine had nearly amputated my arm and the doctor suggested that maybe we should let the pain shot she had given me take effect and we’d try again after the x-rays.

Well, the x-rays were a revelation…they indicated I had some damage to some spinal joints…fairly common at my age…and there was narrowing in a couple of nerve channels in my lower spine, which surely explained my occasional bouts of sciatica. But the surprise came when they looked at the x-rays of my foot…not only did I have a seriously arthritic big toe, I had broken a bone in my foot, and that was likely the primary source of all my pain!

Well, as it turns out later, that was only part of the problem…the ER put a “backslab” half cast on my foot, told me to keep it elevated, and gave me a referral to an orthopaedist. Before they would let me go, however, they had to assure themselves that my blood pressure wasn’t going to make me keel over from a stroke in their hospital, so one of the nursing sisters began to wheel that monster machine over me and I felt myself go all balky. Shaking my head, I told the doctor I wasn’t going to submit to its not-so-tender-ministrations again. “I’m kind of afraid of it, after what it did to me earlier!” I told her. “Don’t you have an old fashioned hand pump one somewhere?” That send the staff scurrying around but sure enough, a manual sphygmomanometer was scrounged up and everyone heaved a sigh of relief when the doc gave my reading as being only slightly elevated, most likely because of the continuing pain, the shot they had given me having had no appreciable effect.

By the time I was able to get in to see the ortho, another two weeks had passed, weeks in which the pain in my leg and hip had pretty much subsided, but during which the pain in my foot and ankle had intensified. I was now unable to sleep more than a couple of hours at a stretch, despite the pain meds the ER doc had prescribed, and was in some degree of pain 24/7. The ortho said the bone was healing well…it was now about six weeks after I had had my losing altercation with those steps…and he took the back slab off, ordering me to buy a pair of athletic shoes with a sturdy arch support and to wear them when I was out and about. He further told me that I should be walking around…not too much…but to start exercising my foot and ankle with mild walking so that I didn’t develop thinning bones. And he gave me what he said was a stronger pain prescription and told me to come back in two weeks if I was still having pain.

OK, this guy is a specialist…a very expensive, Royal College of Surgeons in Edinburgh kind of specialist, who charges significantly more than our medical covers. When the two weeks was almost up and 1) the pain meds were essentially useless and 2) my foot hurt even worse and 3) I figured out for myself what was wrong with me and now knew what my course of treatment needed to be, we made an appointment with our new GP and took my aching foot and ankle for her to take a look at.

On 3 May I hobbled into her office, gave a brief rundown of my condition to date, then told her I thought I had a bad tendinitis, something I had suffered before…but not in my foot. My symptoms…including the “worse at night” phenomenon…were consistent with tendinitis and, when she saw and probed my foot, she agreed. But, before I could ask for the magic bullet that cures tendinitis in a matter of days…a cortisone shot into the affected area…she announced that, because my foot was still tender over the broken bone, cortisone was out of the question at this point in time. Cortisone, apparently, retards bone growth, as does aging, and so the bone needed a little more time to heal. But she seemed to have an idea of what had caused my various…and seemingly unconnected…pain experiences. She felt I really did have a form of sciatica, but one caused from the trauma of slamming my foot into those steps…the wounds, after all, were still visible six weeks later! The shock of connecting, full force, with those immovable steps (and tile over concrete is very unforgiving) probably sent a shock up my leg, causing some kind of trauma to the nerve, which explains why the sciatica didn’t go away overnight as usual. The way my foot connected with the steps caused it to violently snap back into an exaggerated ballerina’s “en pointe” position, aggravating the tendons in the ankle and top of the foot. One of those tendons anchors near the base of the big toe, which is already inflamed from arthritis, causing even more pain. Don’t ya just love hindsight? Three more weeks, she told me. Three weeks of anti-inflammatories, pain meds, and “keep that foot elevated!”

That was two weeks ago. My next appointment is 25 May, and I’m keeping that foot elevated. Unfortunately, however, either I’m resistant to the pain meds that have been prescribed for me or I’m just a wuss because the best I get is a dull throb and the other night it was so bad that it the pain woke me from a sound sleep and I sat up for over an hour, massaging the sore tendons, waiting for the next dose of the pain meds to throttle it back down to that dull throb, and trying to cry quietly so that I didn’t wake Hubby…it’s not his foot, it’s not his pain, and he has to go to work in the morning!

So, that’s what I have been up to for the last few weeks…hope you have been doing better!