Kiss that doctor!
After a WONDERFUL (if excessively late) night with Nic and Andrew (with the pleasure of spending time with Jason and meeting BeerGoddess and her other half), it was off to Toronto this morning for my long awaited appointment with a pain specialist. After 8 months of waiting for this appointment, NO, I wasn't going to try to get something closer to Ottawa. Good choice.
Dr. Deshpande was incredible. He was running on time, was polite and friendly (I'm used to doctors treating me fairly callously or even rudely because of my weight) and VERY thorough. We talked for half an hour to 45 minutes and then he did the exam. I don't think I have ever had such a thorough neurological exam. It's about time.
I was there to address 2 issues: #1 - my migraines (this is the biggie), #2 - osteoarthritis in my SI joints (not as big an issue, but seriously hampers my mobility at times).
First, let's talk about #2. While he's going to x-ray me to be absolutely certain, he found no evidence of osteoarthritis. Zero. Zip. Nada. And no, that doesn't mean that he was telling me it was all in my head like that stupid doctor I saw 8 years ago. Apparently I have Piriformis syndrome. Woohoo!
Why am I pleased about that? Well, unlike osteoarthritis, piriformis is not degenerative. It also responds well to therapy, in his experience. He says it may take months to help it, but since I've had the problem for 11 years now and was expecting to just keep losing my mobility, I'm thrilled.
Piriformis syndrome is a condition in which the piriformis muscle irritates the sciatic nerve and causes pain in the rear and may cause pain along the back of the leg and into the foot (similar to sciatica pain). Piriformis syndrome is most common among women. While there is some controversy in the medical community, many health professionals believe that an accurate diagnosis and comprehensive management approach are critical to alleviate the sciatica type of pain caused by piriformis syndrome.
The piriformis muscle is a small muscle located deep in the rear (behind the gluteus maximus).
The piriformis muscle:
Starts at the lower spine and connects to the upper surface of each femur (thighbone).
Functions to assist in rotating the hip.
Runs horizontally, with the sciatic nerve running vertically directly beneath it.
Piriformis syndrome can develop when the piriformis muscle becomes tight or spasms and places pressure on the sciatic nerve that runs beneath it. The pressure on the sciatic nerve can cause low back pain and/or pain that radiates to the rear and down the leg (similar to sciatica pain). From a technical standpoint, piriformis syndrome does not cause true sciatica (as sciatica is usually defined as a radiculopathy, or compression of a nerve root as it exits the spine). However, just like sciatica, piriformis syndrome can cause pain, numbness and tingling along the sciatic nerve, which runs down the back of the leg and into the foot.
Now on to the biggie - #1 - my migraines.
My migraines have been debilitating for the past 7 or 8 years. They impact every area of my life. I have tried every drug or treatment my various doctors have ever suggested and will always be willing to try new things. I'd be crazy not to.
He thinks he can make a significant improvement in my migraines for me and has a distinct game plan for doing so. Since I live so far away he's going to let my family doc implement the plan, but if the plan doesn't work I'm to go back to him for a follow up and we'll come up with plan #2. Yay!
So, apparently one of the problems with treating chronic pain patients is the rebound effect. If you take an opioid (like tylenol #3, morphine or dilaudid) for a while, your body will cause spontaneous pain when you don't take it. So on days when I might ordinarily be pain free, the painkillers cause a rebound headache so I have to take the painkillers again. This is apparently a feature of opioids, not a feature of being a chronic pain patient. Statistically, chronic pain sufferers don't abuse pain meds -- are you kidding? I ration the bloody things because I can only get more once a month and I never know how many REALLY bad days I'm going to have.
Since I am in pain most days, Dr. D says it makes the most sense to treat me like patients who are in pain 24-7. Ok. This means putting me on a slow-release opioid, which will keep a low level of pain killer in my system at all times. Not enough to make me stoned (trust me - I can drive after taking 8 mg of Dilaudid at this point ), but enough to keep the low level pain under control and avoid rebound headaches completely. I keep the quick release opioids for "break through" migraines that hit me without warning, but should need a lot less.
Along with the slow release pain meds, there is a new drug on the market called Lyrica.
The central nervous system is made up of millions of nerve cells. In people with nerve pain, some cells are over-excited because they are damaged. This may cause the cells to fire too many signals throughout the body, resulting in pain. Neuropathic pain generally does not respond to treatment with opioid or over the counter pain meds. At high doses Gabapentin has proven effective against neuropathic pain, but Gabapentin did absolutely nothing for me. Lyrica is proving as effective at low doses as Gabapentin at high doses and doesn't have the side effects of the older drug. It also seems to work for some people who got no results from Lyrica.
The only catch is, it's not covered by ODB (Ontario Drug Benefit). They're currently designing the Section 8 (to apply for an exception to get the drug) and it should be available in the next couple of weeks. Hopefully I'll qualify.
The final piece of the puzzle is biofeedback. Since my migraines are aggravated by stress, he thinks this could help significantly - not on its own, but with the other treatments. We'll have to think about that, since it's not covered by our health coverage.
All in all a great day! Later I'll write about the fabulous day that my boys had. They had an absolutely wonderful afternoon in Toronto.
Oh, and I picked up Julie's book and my beautiful sparkly bookmark! Wheee!
Dr. Deshpande was incredible. He was running on time, was polite and friendly (I'm used to doctors treating me fairly callously or even rudely because of my weight) and VERY thorough. We talked for half an hour to 45 minutes and then he did the exam. I don't think I have ever had such a thorough neurological exam. It's about time.
I was there to address 2 issues: #1 - my migraines (this is the biggie), #2 - osteoarthritis in my SI joints (not as big an issue, but seriously hampers my mobility at times).
First, let's talk about #2. While he's going to x-ray me to be absolutely certain, he found no evidence of osteoarthritis. Zero. Zip. Nada. And no, that doesn't mean that he was telling me it was all in my head like that stupid doctor I saw 8 years ago. Apparently I have Piriformis syndrome. Woohoo!
Why am I pleased about that? Well, unlike osteoarthritis, piriformis is not degenerative. It also responds well to therapy, in his experience. He says it may take months to help it, but since I've had the problem for 11 years now and was expecting to just keep losing my mobility, I'm thrilled.
Piriformis syndrome is a condition in which the piriformis muscle irritates the sciatic nerve and causes pain in the rear and may cause pain along the back of the leg and into the foot (similar to sciatica pain). Piriformis syndrome is most common among women. While there is some controversy in the medical community, many health professionals believe that an accurate diagnosis and comprehensive management approach are critical to alleviate the sciatica type of pain caused by piriformis syndrome.
The piriformis muscle is a small muscle located deep in the rear (behind the gluteus maximus).
The piriformis muscle:
Starts at the lower spine and connects to the upper surface of each femur (thighbone).
Functions to assist in rotating the hip.
Runs horizontally, with the sciatic nerve running vertically directly beneath it.
Piriformis syndrome can develop when the piriformis muscle becomes tight or spasms and places pressure on the sciatic nerve that runs beneath it. The pressure on the sciatic nerve can cause low back pain and/or pain that radiates to the rear and down the leg (similar to sciatica pain). From a technical standpoint, piriformis syndrome does not cause true sciatica (as sciatica is usually defined as a radiculopathy, or compression of a nerve root as it exits the spine). However, just like sciatica, piriformis syndrome can cause pain, numbness and tingling along the sciatic nerve, which runs down the back of the leg and into the foot.
Now on to the biggie - #1 - my migraines.
My migraines have been debilitating for the past 7 or 8 years. They impact every area of my life. I have tried every drug or treatment my various doctors have ever suggested and will always be willing to try new things. I'd be crazy not to.
He thinks he can make a significant improvement in my migraines for me and has a distinct game plan for doing so. Since I live so far away he's going to let my family doc implement the plan, but if the plan doesn't work I'm to go back to him for a follow up and we'll come up with plan #2. Yay!
So, apparently one of the problems with treating chronic pain patients is the rebound effect. If you take an opioid (like tylenol #3, morphine or dilaudid) for a while, your body will cause spontaneous pain when you don't take it. So on days when I might ordinarily be pain free, the painkillers cause a rebound headache so I have to take the painkillers again. This is apparently a feature of opioids, not a feature of being a chronic pain patient. Statistically, chronic pain sufferers don't abuse pain meds -- are you kidding? I ration the bloody things because I can only get more once a month and I never know how many REALLY bad days I'm going to have.
Since I am in pain most days, Dr. D says it makes the most sense to treat me like patients who are in pain 24-7. Ok. This means putting me on a slow-release opioid, which will keep a low level of pain killer in my system at all times. Not enough to make me stoned (trust me - I can drive after taking 8 mg of Dilaudid at this point ), but enough to keep the low level pain under control and avoid rebound headaches completely. I keep the quick release opioids for "break through" migraines that hit me without warning, but should need a lot less.
Along with the slow release pain meds, there is a new drug on the market called Lyrica.
The central nervous system is made up of millions of nerve cells. In people with nerve pain, some cells are over-excited because they are damaged. This may cause the cells to fire too many signals throughout the body, resulting in pain. Neuropathic pain generally does not respond to treatment with opioid or over the counter pain meds. At high doses Gabapentin has proven effective against neuropathic pain, but Gabapentin did absolutely nothing for me. Lyrica is proving as effective at low doses as Gabapentin at high doses and doesn't have the side effects of the older drug. It also seems to work for some people who got no results from Lyrica.
The only catch is, it's not covered by ODB (Ontario Drug Benefit). They're currently designing the Section 8 (to apply for an exception to get the drug) and it should be available in the next couple of weeks. Hopefully I'll qualify.
The final piece of the puzzle is biofeedback. Since my migraines are aggravated by stress, he thinks this could help significantly - not on its own, but with the other treatments. We'll have to think about that, since it's not covered by our health coverage.
All in all a great day! Later I'll write about the fabulous day that my boys had. They had an absolutely wonderful afternoon in Toronto.
Oh, and I picked up Julie's book and my beautiful sparkly bookmark! Wheee!