Retrospective – 100 Days

I thought this would be a good time to reflect on my recovery and to remind myself how far I have come in a relatively short period of time. These are posts from my CaringBridge site. I set it up prior to my surgery to help me communicate with my friends/family. Hope this is of some help to those of you who are just beginning this journey. Search my site for more retrospective posts. 

The “100 day” Post-op update:

We have now passed the 100 day mark (actually did that just over a week ago), and to mark the momentous occasion we schlepped our way to Houston and back to see my doctors. After the mandatory X-rays and MRIs, I am happy to say that I have been given permission to start gentle bending and stretching. For those of you who have been following my recovery, here is a rundown of my current condition:

Pathology reports indicate that the tumor was an extremely rare type of spinal tumor: a melanotic schwannoma. They will continue to monitor me to make sure the tumor behaves in a benign manner. To that end, I have to go back in about three months for my next check-up.

Progress
– Neurosurgeon says they did remove all of the tumor and it looks like the recovery is progressing well.
– Reconstructive surgeon says the soft tissue seems to be recovering well.
– I can walk several miles at a time over most surfaces (inclines and cobble stones still cause problems) at my pre-op pace.
– I can tie my own shoes (with some difficulty, but…).
– I have transitioned back to sleeping in my bed now that I do not need to be so careful about my sleeping position.
– I can pick things up myself when I drop them (as long as they are not heavy).
– I have a prescription to resume physical therapy (three times a week for three months – to work on strength and flexibility).
– With increased ease of movement, my pain levels have improved (but I will be working with someone local to try to get the remaining pain/discomfort completely under control).

Continued challenges
– Sitting is still uncomfortable, and riding in a car is still torture (makes the daily commute really fun).
– Although I can walk (and look fairly normal doing it), I do not feel stable doing it – so crowded places make me very nervous.
– I experience a lot of tightness/discomfort in my back which throws my gait off when I walk. When this is combined with the continued nerve issues in my left leg, it means I must concentrate on walking. It is not something that happens naturally. Walking and talking at the same time can present a challenge.
– Climbing stairs is still a challenge. I can do it. I do it every day at work, but you don’t want to get stuck behind me.
– I have what seems to be intercostal neuralgia (perhaps as a result of the nerve root they had to sacrifice to get all of the tumor out). Hoping we can get improvements with physical therapy, massage and pain management.

The doctors say I should expect the pain and discomfort for at least the next year. Most of it should diminish with time, but some of the nerve pain may be here from now on.

 

 

 

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For that we have each other…

The first time I heard Andra Day’s song, Rise Up, I immediately thought of it as a survivor’s anthem. I heard the refrain, and I thought about my daily struggles, and the effort I make to rise up and face each challenge.

Then I saw the video, and I realized that I was so caught up in my own drama, I hadn’t even noticed some of the lyrics. Clearly this is a song of solidarity, but I hadn’t heard the “we” because I was too focused on the “I”. As I watched the video, I immediately thought of all the things my husband does every day to help me find the strength to keep on keeping on.

“You’re broken down and tired of living life on a merry go round, and you can’t find the fighter. But I see it in you, so we gonna walk it out and move mountains” from Rise Up sung by Andra Day

I was very fortunate to have people to take care of me during the early phases of my recovery. I can’t imagine what I would have done without my husband, my mother, and my father.

I know it hasn’t been an easy year for them. They have had to take on more responsibilities, and they have had to make sacrifices to make sure I have what I need. In fact, even now that I am back at work and getting stronger by the day, they are still making little daily sacrifices to make sure I am cared for and comfortable. For that, I am so grateful. So I am going to post the video here for all of the people who are caring for me and my fellow SCT survivors.

We will rise up!

Retrospective: Month Three

I thought this would be a good time to reflect on my recovery and to remind myself how far I have come in a relatively short period of time. These are posts from my CaringBridge site. I set it up prior to my surgery to help me communicate with my friends/family. Hope this is of some help to those of you who are just beginning this journey.

February 15

Week nine post-op report:
It is hard to believe my surgery on December 13 was only nine weeks ago. It seems like it was a lifetime ago. For those of you who don’t know, the surgery was to remove a tumor that was growing on my spinal cord. It was causing neurological damage that would have eventually left me paralyzed. The goal of the surgery was to remove the tumor while causing as little damage to the spinal cord as possible. The hope was to be no worse off after the surgery than I was before the surgery.

In the days immediately following surgery, just moving in bed was a challenge. With the help of my physical therapists I managed to get out of bed and using a walker, I made a victory lap around the nurses’ station. But it was clear that I still had neurological issues in my left leg/foot. For eight days I stayed in the hospital, getting stronger and learning to adjust to the restrictions the doctors put on my movement… no bending, lifting or twisting.

Since then I have contended with a cerebral spinal fluid leak, neurological pain, banding, muscle spasms, restrictions on my movement, and a host of other issues. Some of the pain and discomfort I am dealing with has improved with physical therapy, but I will probably continue to have muscular/neurological issues for quite some time. Fortunately, despite the discomfort, it seems I will eventually be able to regain most of my physical abilities. I am walking well (though I still lack confidence when walking due to persistent balance issues), and I am hopeful that the bending, lifting, twisting restrictions will be removed at the end of March.

I am still spending about 3-4 hours daily doing my exercises, stretches, and massages as part of my physical therapy, and I am going to start driving short distances. I still have a lot of pain/discomfort when sitting, so sitting in a car is like torture, but I have to do it to get back to my normal life/routine. I will also start transitioning back to work. I am going to work four hours a day from February 19-March 1. That will allow me to continue with my intense physical therapy schedule.

Wish me luck as I enter this new phase of my recovery!

 

February 18

This is what recovery looks like. Still have a long road ahead of me, but I am making progress. Top left chart is my daily runs before my surgery. Then there are three in the bottom row from the weeks immediately following surgery showing my daily walks. Finally you have my daily walks this past week.

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March 1

Week eleven post-op report:
Tomorrow will be my first full day back at work. This recovery is the most difficult obstacle I have faced in my life. I am trying to stay positive and draw inspiration from any possible source. Here is my quote for tomorrow – “Success is not final, failure is not fatal: it is the courage to continue that counts.” – Winston Churchill

March 10

Week twelve post-op report:
This week’s milestone was my first day back in the classroom since the surgery. Between the killer commute and the unrelenting pain/discomfort, this has not been easy. However, I have been surrounded by amazing people who are cheering me on and encouraging me when I feel like I can’t keep going. A special shout out to all the people at work who have made me feel the love the past two weeks with your flowers, chocolates, donuts, messages, smiles, hugs, and positive energy! You have no idea how much your encouragement means to me! Thank you!

Tame the Beast

Pain is one of the biggest complaints that I hear from other SCT survivors. I know it has been my greatest challenge. This video does a great job of explaining persistent pain.

Explain Pain Author on YouTube

In my last post I wrote about a book that my physical therapist asked me to read. Since then, I have been trying to find out more about the authors and their approach to pain. I found this video to be both informative and entertaining. If you have a few minutes to spare, you might give it a go.

Review – Explain Pain

Right now, I am at a point in my recovery where pain is my primary focus. My motor abilities are improving day by day, but the pain… that nagging, ever present pain… that is my primary concern. I have recently started seeing a physiatrist (if you don’t know what a physiatrist is, don’t feel bad – a month ago, neither did I), and the physiatrist has sent me back to physical therapy, but this time instead of working on balance and movement, we are working on reducing my pain levels. On my second visit, the physical therapist handed a book to me. She told me that she thought it might help me to understand my pain. The name of the book was Explain Pain

explain-pain-cover

The book was written by Drs. David Butler and Lorimer Moseley from the University of South Australia. According to the University’s website, Dr. Moseley is a Pain Scientist with a background in physiotherapy, neuroscience and psychophysiology. Dr. Butler is the Director of the Neuro Orthopaedic Institute.

The book, which sells for a shocking $94.22 on Amazon.com, summarizes research from a number of different fields to provide patients with an understanding of factors that influence their pain levels. They manage to do this with very little jargon, so people with limited understanding of human biology can follow along. Despite the simple explanations, they also succeed in not talking down to the reader.

While I think that this book can provide SCT patients with a better understanding of their pain, and by extension a better perspective from which to manage their pain, I do not think it is worth close to $100! If you can find it used or borrow a copy from a local library, I would definitely say it is worth a read.

They have another book, The Explain Pain Handbook, which is $36.10 on Amazon.com. I think I might give it a try. It is supposed to be a more hands-on guide to help patients take control of their pain using techniques that are based on the research that was presented in Explain Pain.

Have you read either of these books? If so, I would love to hear what you thought about them. Have you read any other good books on pain management?

The Good Old Days

When I was first diagnosed, I was furious with the universe. I remember thinking it was so unfair. After three years of sacrifices while juggling my career and classwork for my doctorate, I was ready to ease back into my “real” life. I had trips to take. I had family to visit. I had friends to reconnect with. Suddenly I felt like it was all being stolen from me. All I could see in front of me was a black hole of uncertainty.

I am now one year out from the diagnosis and seven months out from the surgery, and while the anger has subsided, I still miss the good old days. I long for a time when pain was not my constant companion. I wonder what I might have done differently had I known what the future held for me. Would I have spent so many extra hours at work? Would I have put relationships on the back burner to focus on my education? Would I have travelled more? Risked more? Played more?

My old life feels like a distant memory. I think this is probably something many SCT survivors can relate to. When I heard Macklemore’s song, Good Old Days, it really resonated. I was particularly struck by the following lyrics:

Never thought we’d get old, maybe we’re still young;
Maybe you always look back and think it was better than it was.
Maybe these are the moments;
Maybe I’ve been missin’ what it’s about
Been scared of the future, thinkin’ about the past
While missin’ out on now.
We’ve come so far, I guess I’m proud
And I ain’t worried ’bout the wrinkles ’round my smile.
I’ve got some scars, I’ve been around.
I’ve felt some pain, I’ve seen some things, but I’m here now.
Those good old days… 
Those good old days.

Grit: The Courage to Continue

The past five months have been a real challenge. Some days I don’t even know who I am because constant pain has taken over my life. But I keep showing up day after day. I keep trying to fulfill my responsibilities to the other people in my life. I keep trying to make it through each day with as much grace and as little whining as possible. That is what grit really is, and it is what the people in these photos represent. They really are an inspiration. If they can do it, so can I.

Steve McCurry's Blog

Tibet

Success is not final, failure is not fatal:
it is the courage to continue that counts.
– Winston Churchill

Nepal

Kathmandu, Nepal

Over time, grit is what separates fruitful lives from aimlessness.
– John Ortberg

Charikar, Afghanistan

Johnstown, PA, USA

Grit is not just simple elbow-grease term for rugged persistence.
It is an often invisible display of endurance that lets
you stay in an uncomfortable place, work hard to improve
upon a given interest and do it again and again.
– Sarah Lewis, PhD

Calcutta, India

Afghan Border, Peshawar, Pakistan

Afghanistan

Childhood doesn’t have to be perfect, and children don’t
have to be beautiful. From a bit of grit may grow a pearl,
and if pearl production doesn’t materialize, the outcome will
still be preferable to the shallowness of vanity.

– Laurie Graham

Java, Indonesia

Angkor Wat, Cambodia

Philippines

Porbandar, Gujarat, India

Heroes are never perfect, but they’re brave, they’re authentic,

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Opioid Induced Hyperalgesia

My Informal Disclaimer: Let me begin by saying I am not a doctor, nor am I trained in any medical profession. I do not pretend to be an expert; I am simply a person who is trying to make sense of her own experience. I am sharing what I learn and experience here because I know how lonely the road from diagnosis to recovery can be, and if I can help even one person, the time I spend writing these words will be worth it. 

One theme that comes up time after time on the SCTA (Spinal Cord Tumor Association) Facebook page is pain management. Since opioid pain medications play a role in pain management, there is a lot of discussion about the proper use and distribution of these medications. While some of the members of the SCTA seem to be able to cope with the pain without opioids, there are others who report taking these medications for months or years without improvements in their pain levels. So, when I heard a report on NPR (National Public Radio) about opioid induced hyperalgesia, my curiosity was aroused.

The author of the report, Clayton Dalton, is a resident physician at Massachusetts General Hospital. In his report, he presents research that suggests long term use of opioids leads to hypersensitivity to pain. Going back to 1870, Dalton cites evidence of the pain magnification that accompanies opioid dependence. What does this mean for spinal cord tumor survivors and others with chronic pain? Well, it seems to be a clear message that the opioid based drugs that appear to be an elixir in the early days following surgery can quickly become a major part of the problem.

“This could be a major factor in the opioid crisis,” Arout says. “People have worsening pain, and so their dose is often increased because they are thought to be tolerant.” But the result is that some patients may find themselves taking dangerously high doses while their pain continues to intensify. – From Clayton Dalton’s NPR report on opioid use.

There is no doubt that spinal cord tumors (and the spinal cord injuries that often result from the surgery to remove them) cause pain. And now, this report suggests that opioids intensify that pain if taken for an extended period of time. Suddenly bells and whistles are going off in my head. This explains so many of the posts that I have read on the SCTA Facebook page. Many of the members of this page experienced pain for years before getting their diagnosis. They might have bounced from one doctor to another searching for answers, and in the interim, the puzzled doctors may have prescribed opioid medications to numb the pain. This would have been okay in the short run, but as the patients migrated from one specialist to another, days turned into weeks, weeks turned into months, and months turned into years – while well meaning doctors prescribed increasing doses of these medications thinking the patient was just developing a tolerance to the pain medication. The patient was, unfortunately, being made more sensitive to the pain they were trying to control.

Now we have large numbers of people whose years of opioid use have, according to the information in this report, lead to hypersensitivity to pain. The pain is not imagined, and they are not weak. They need alternatives to opioids that will cut through the pain and allow them to get on with their lives. What are those alternatives? Some people report that physical therapy can help. Others rely on non-opioid pain medications, massage, meditation, acupuncture, or other non-traditional treatments. For those who live in states that allow the distribution of medical marijuana, that seems to be a promising option. However, once a person has developed hypersensitivity to pain due to prolonged use of opioids, how long does it take to retrain the nerves? Are these alternatives able to stand up against heightened pain? Or are they more helpful for patients who have not experienced long term opioid use? There are so many implications and so many questions that need to be answered because SCT survivors desperately need tools to help them cope with their pain.

Hopefully, researchers are aggressively working to find answers to these questions, so people living with chronic pain can find some relief and get back to the business of enjoying a life lived without pain.

If this topic interests you, here are some articles you might enjoy:

When Opioids Make Pain Worse – National Public Radio

Treating Pain with Fewer Opioids – National Public Radio

Would be interested to hear what you have to say on this topic. I know it is something many SCT survivors have strong opinions about.

Do What You Can’t

I know… it is an advertisement, but I saw it during my first week back at work after my spinal cord tumor surgery, and I have to tell you that it really resonated with me! I was feeling so broken, so fragile, so incapable of facing the challenges that were bombarding me. Then I saw this ad and my eyes filled with tears. Do what you can’t… that is my calling for the next year as I tackle this recovery. DO WHAT YOU CAN’T.