Tag Archives: SI joint

The Day of Surgery

Now that I’m back on the blog, I might as well head back to the day y’all last heard from me….the day I had surgery. In case you’ve forgotten what was going on, you can read this post as a refresher. I went in for a left sacroiliac joint arthrodesis (fusion). Basically, I had three titanium rods hammered into me to connect the lower part of my spine to my hip because the joint wasn’t stable and kept causing me a lot of pain. 

Surgery

Pre-Op

I had to be at the hospital at 6am on the morning of my surgery. My mom had just arrived the day before, so she and Dave were with me on the drive downtown. Once we arrived, Dave came with me into the hospital and my mom went back to the house to take care of the dogs (she brought her two – Abby and Mischa – down from Canada with her, and of course we have Katie). We had to wait a bit to register, but the registration process itself was a breeze because I had done the pre-registration questionnaires over the phone the week before. Then we were lead up to the surgical waiting room, where Dave was given a pager and a special number he could use to identify me on a screen in the waiting room that would tell him where I was in the process of things. 

We had to sit in the waiting room together for a little bit, and that was torturous. Of course I was kind of nervous about the surgery to start with, but they also had fresh coffee brewing for the friends and families of the patients. Do you know how hard it is for a caffeine addict to ignore the aroma of fresh brewed coffee at 6:30am when you can’t have any!? Let’s just say that it was horrible for me. Thankfully it wasn’t long before me took me back to the pre-op prep area. Dave was actually allowed to accompany me, which was nice. I got to give a urine sample, rub myself down with disinfectant wipes, put on a gown, have my temperature and blood pressure taken….all that kind of stuff. During this time I also got the first glimpse of my friend Colleen, who was working as the pre-op pharmacist. It’s so nice to have a friendly face around (other than out family) when you’re heading into surgery. While the nurses were bustling about the neurosurgical resident came by with a med student in tow to mark the leg they were supposed to be operating on with a sharpie. Then my neurosurgeon, Dr. Rodgers, came by before heading into the OR to make sure I didn’t have any last minute questions. Finally….my anesthesiologist came by. As a pharmacist, my primary concerns were all drug-related, so he was the poor guy who got peppered with a million questions and concerns from me. As soon as I started talking it became very apparent that I wasn’t some Joe-schmoe patient, so it didn’t take long for the anesthesiologist to figure out I was a pharmacist and start talking to me like a real person and not some kind of imbecile (which is how I feel when health care providers start talking to me like they do to every other normal patient….not that I blame them, I talk to patients in the exact same way). So once the anesthesiologist and I got talking on the same level, I quickly got the assurances I needed. Then it was time for me to get on the gurney. Colleen stopped by for a quick “see you later” and I said goodbye to Dave, and the anesthesiologist wheeled me away.  Continue reading The Day of Surgery

Surgery

Surgery

This post is scheduled to go live the same minute that I’m scheduled to be wheeled into OR #4 at Methodist Hospital in downtown Indianapolis. I’ve mentioned this surgery before on the blog – it seems like just yesterday that I was writing about my emotions before going to the appointment with the physiatrist and not knowing for sure if I would be referred to a surgeon. Obviously I was referred to the surgeon (rather quickly, in fact) and was scheduled for the operation today. 

I’m having a left sacroiliac joint arthrodesis. I know that sounds big and complicated, but it’s not. The sacroiliac joint is where your spine (sacrum) connects to your pelvis (ilium). It’s held together with really strong ligaments so it doesn’t move around a whole lot. In fact, it’s barely supposed to move around at all, unless you’re giving birth. About 10 years ago I managed to damage those ligaments. Think of it kind of like a sprained ankle but in your hip / back. Because the area doesn’t get a ton of blood flow, the body can’t do a great job of healing and tightening those ligaments back up on its own. So my sacroiliac joint shimmies around a bit whenever I do just about anything, which then aggravates the nerves in the area, causes things to get inflamed and muscles to spasm, and then I get to feel a lot of pain. It’s not a whole lot of fun, and I really don’t recommend it. Unfortunately, sacroiliac join dysfunction isn’t the easiest thing to diagnose, which is why it took me so long to get here….to surgery. I’ve tried pretty much every non-surgical option in the book, and apparently I’m the perfect candidate for the surgery….unless you’re my insurance company, who apparently disagrees with about 5 different doctors and doesn’t think I need this surgery at all. Their recommendation? Do nothing. Just live in pain. The good news? When I get super fat from sitting around doing nothing because I’m in so much pain, I can get them to cover gastric bypass surgery. But the surgery that will allow me to lead a healthy active life and not get to the point where I need gastric bypass? No dice. Go figureContinue reading Surgery

Fear

I’m scared. I’m scared of the unknown. I’m scared of change, and I’m scared of things staying the same. 

Today, just a few hours after this post is published, I’ll be sitting in a doctor’s office. A new doctor – one of many who I’ve seen for my back / hip / leg pain. 

My problem started in December 2005. I was a freshman in college, and a member of the Butler University women’s golf team. December is the off-season for us, but we worked out together as a team several times a week. It happened during an evening workout session. I remember the football team was working out too. We were doing walking lunges down the hallway of Hinkle Fieldhouse. Lunges where we held a weight with both hands and twisted in the opposite direction of the leg that was going forward. I remember everything about that moment. The smells, the sounds, and of course….the feeling. The feeling of something being wrong. It wasn’t some acute moment where I fell to the ground, screaming in pain, not able to move. Part of my left leg just felt….numb. Tingly. Not right. I could still walk, and at first I really wasn’t in pain at all. 

I don’t remember how long it was until I first started feeling the pain. A day or two maybe. At first it was mainly just below my knee. Sometimes it went all the way down to my ankle. Keeping me knee bent made it worse. I had trouble sitting unless I could constantly shift my leg and stretch it out. Plane rides were agony unless I could get an aisle seat and stretch that leg out. I can’t tell you how many times I’ve had people on airplanes trip over my leg stuck out in the aisle….or how many times it’s been run over by the drink cart. Walking down hills when I was playing golf was the worst. Every step down the hill would result in a sharp acute pain that felt like someone was digging a knife into the side of my knee. 

I stopped playing golf my junior year. I stopped cold turkey. It was my life and my identity, and then….it wasn’t. I didn’t quit just because of my leg pain. There was a coach change, and our new coach wasn’t understanding of the fact that my academics had to come first. I was on an academic scholarship, not an athletic scholarship, so my grades absolutely had to be my first priority. I was having a difficult time balancing everything, and something had to give. That “something” was golf. 

By that time, my pain had changed. It was no longer just bellow my knee and down to my ankle. It was also in my lower back, by hip, and down the outer side of my left leg. By that time I had already seen several physicians and been given a variety of diagnoses. The theories involving my knee being the primary source of the pain no longer made any sense. The source of the pain was obviously higher up. The first physician who identified my back as the issue was in Chicago. The pattern of my pain was classic sciatica. By that time I had received X-rays and multiple MRIs on my knee, all showing that it was perfectly healthy. The physician in Chicago was the first to send me for an MRI of my back. He was certain that it would show a bulging, or herniated, disc in my back. It’s a weird feeling to hope for something to be wrong with a scan or a test, but when you don’t have answers, finding an answer is all you really want. Turns out, my discs are just fine. A couple years later I had a repeat MRI and a test to check my nerve function – again, everything was okay. 

I lost hope for a while. I lost hope that I would ever know what was wrong, and without knowing what was wrong I wouldn’t be able to find a solution and ever feel better. After we got married, my husband became frustrated with my limitations. Our dog has back problems and needs to be carried up and down the stairs of our third floor apartment, which is something I am unable to do. I struggle to carry groceries up the stairs, so he has to do a lot of the grocery shopping. He convinced me to go see a DO who specialized in osteopathic manipulative medicine. He got a recommendation from a friend who is a DO, and it turns out the guy he recommended is literally the guy who wrote the textbook on the subject. He quickly diagnosed me with sacroilliac (SI) joint dysfunction. I was skeptical at first – after all, I had received many diagnoses before which has all turned out to be incorrect. But when I went home and started researching the condition….it was the first thing that had ever made complete sense. My symptoms all fit the condition perfectly. For the first time, I had a bit of hope. I started seeing the DO every week or two, but it became apparent that I wasn’t going to be an easy case. I was grateful to be pain free after my sessions, but it only lasted a few days at most. We couldn’t get the adjustments to stay.

In June last year I drove out to Buffalo, NY at the urging of my family to have a consultation with a neurosurgeon. After more MRIs confirming that my back is still perfectly normal, I was again given the diagnosis of SI joint dysfunction, and presented with my options. The first step was to find someone in Indianapolis who performed SI joint injections to confirm the diagnosis. The “gold standard” for diagnosis is to inject lidocaine into the joint so that it is numbed, and see if the pain is mostly or completely relieved. If it is, then it indicates that the joint is the source of the problem. I waited until my annual physical to get the referral from my family physician – someone who I trust immensely. The injection confirmed the diagnosis – I felt great for a couple of hours. Then the lidocaine wore off. I was also injected with a corticosteroid to help reduce the inflammation in the joint. For some people, a few injections of the corticosteroid is apparently enough to fix their problems. The injections are done a month apart. After three of the injections, it was clear that I wasn’t getting any long-term benefit from them. Because the injections need to be guided by fluoroscopy, which involves radiation, it’s not advised to have the procedure done on a continuous basis. That meant I was on to the next step – a referral to physical therapy and a physiatrist. 

For the last month I’ve been in physical therapy. There’s no doubt that I’ve gained strength and flexibility. Some days, my pain is different. The pan down my leg isn’t as bad, but the pain in my lower back / hip is worse. Apparently, that’s a good thing. I’ve always struggled with delayed pain. I can walk a while and feel okay. If I really walk a lot, then I will start to feel it immediately, but for the most part I don’t feel the majority of the pain until several hours later. It’s easy to push myself too hard, because things don’t hurt while I’m doing them. That’s been the biggest problem with physical therapy. My therapist was impressed by my progress after our first session that she ramped things up quite a bit, which felt fine at the time, but I was almost unable to walk for the next couple of days. We’ve had to be cognizant of my limitations since then. 

Today is my appointment with the physiatrist. I don’t know if I’ve ever been so scared of an appointment with a physician – at least, not since I was a kid and terrified of needles. I know I shouldn’t be scared. She comes highly recommended, and by all accounts is incredibly thorough. I’ll be in good hands. I’m scared of the outcome of this appointment. The purpose of this appointment is to evaluate me for surgery. Right now I see a few potential outcomes, none of which sounds particularly appealing:
a) I’m referred to the surgeon right away
b) I’m sent for more physical therapy with a re-evaluation in the future
c) I’m not a candidate for surgery, and I need to rely on physical therapy 

You would think that option c is the best, but I fear that I’m going to need physical therapy for the rest of my life, and while I don’t mind doing physical therapy in the short term, I don’t want to be there twice a week for my entire life (plus all the exercises that I have to do at home twice a day can become time consuming…). Option b just means more waiting….and I’m ready to get on with my life. So why isn’t option a what I’m looking for? It’s surgery. I know it’s a relatively safe and minimally invasive surgery, but I’ve worked in health care and I know every possible thing that could go wrong. In this case, my knowledge is a detriment, not an advantage. 

Part of me feels like I should be excited because I actually have a chance at complete recovery, of being able to live a normal life again. Don’t get me wrong, I’m grateful for that because I know a lot of people in chronic pain don’t have the option of a permanent solution. This appointment is probably going to be a good step for me, but I still fear the unknown, fear the process that will result in change, and fear that things will stay the same. 

Until later, Ashlen

Five on Friday

{one}

Ok, I know I’ve posted enough about our cabinets here and here, but I have even more updates. The guy who was designing and ordering our cabinets gave me a call yesterday, and that definitely helped ease my mind even more, because I know that he knows what he’s talking about. He gave me more details about our kitchen cabinets. Turns out we weren’t notified about the back order of our cabinets because he thought our order got put in early enough not to be affected. He realized I probably had a near heart attack (I did), and apologized, but he didn’t even know we had got the back order substitute until my e-mail to the builder was forwarded on to him. Turns out the bathroom vanities were his mistake. We’ve decided to keep the sarsaparilla in the Jack & Jill bathroom. Our master bathroom has sarsaparilla, and we’re using the same granite and paint colors in both areas, so I know it will still end up matching all of our other selections. Unfortunately, the sarsaparilla will not work in the basement bathroom, so an umber replacement has been ordered. 

In other wonderful cabinet news, Dave went out and checked on the house yesterday and found that all the cabinets for his wet bar have been installed! (Before only the lower cabinets have been installed, not the upper cabinets). He’s thrilled with how they look, and from the pictures, I’m thrilled too. 

Wet-Bar Continue reading Five on Friday