Tuesday, September 17, 2013

Pit bulls steal challah bread...

Pit bull update - Malia and Casey are getting along swimmingly. They apparently had only one tussle -- and it was over a loaf of challah bread!

I had left it too close to the edge of the counter in the kitchen and we went out to run errands. I know it was Malia (since Casey isn't bold enough to counter surf). She must have filched the bread, then pulled it into the living room and she and Casey must have had a short fight over who got the loot.

We came home to some plastic from the bag that the challah was in, but no sign, no crumb of any kind. They were laid up, fat and happy from engorging themselves.

Here's Casey (top) watching Restaurant Impossible while Malia puts her head in my lap.

As expected, Casey, who is about 2x Malia's weight was the wimp. She ended up with a boo-boo on her nose that has left a scar, but otherwise you'd think nothing happened.

They really do love one another -- they play fetch and tug of war, sit together on the sofa, and even sometimes sleep in the too-small-for-two-dogs bed. Malia gives her kisses, and, as the new dog, always looks to Casey for guidance.

It has been a great match; it's wonderful to give another pit a forever home.

RA update: travel success + methotrexate = proceed with caution

Some good news and bad news. At my rheumatologist visit last Friday I was able to tell her that there's a definite difference in pain relief when I take both methotrexate and Enbrel. I went on Enbrel alone for two weeks (dosing on Fri), was sick about half the weekend, and my relief lasted from about mid-day on Monday-Thursday. By Thursday evening, it's like a wind-up doll that's kaput and someone took out the key. I am toast, and in searing pain.

On the MTX plus Enbrel, my relief is from Monday AM to Friday afternoon. That's not bad. I'm dosing only 4 pills rather than 6. I was having way too many adverse side effects from the MTX -- GI problems, depressed mood, severe fatigue, aches and pains. On the lower dose I have little mood effect, and less-severe overall symptoms. [The only problem that has cropped up, and it's a weird documented side effect, are nose sores/nose bleeds. Oy, it's annoying and painful at times. Will have to mention that at my next visit.]

So that's the overall good news. The bad news is my last labs showed a spike in some of my liver numbers. MTX affects the liver and there's enough concern that they asked me to come back in 2 weeks for another blood check. I already come once a month for blood work, so my guess is that staying on MTX is in jeopardy if my numbers don't look good.

Some other good news is that I was able to successfully travel for work last week. Successful as in I didn't need wheelchair assistance, I managed stairs, and was able to work well at the conference during the day. Thankfully one of my colleagues (thanks, Lee!) who was attending the conference volunteered to help carry my bags at times, and drove the rental car so that I didn't have to endure long walks or drives.

At night I was toast by about 7:30, and went back to the hotel to crash, re-medicate, apply all my liniments to my sore joints and get in the sack so I could be productive the second day.

I actually had to go into the office the day after the trip; it was questionable whether I was in good enough shape to get my sorry ass into the office, but I did for an important meeting. However, I was out Friday, and then most of the weekend I was in misery, recovering from the travel's impact on my RA and fibromyalgia.

I know for a fact that if I hadn't done the Enbrel/MTX combo, I would have been much worse off post-travel. So, I hope that, despite the pretty nasty MTX side effects, I won't have to discontinue it since it has done some good in getting my constant pain at a liveable, if not enjoyable, level.

Tuesday, September 3, 2013

Aw, crap - disc re-herniation...and other fun news

I've been avoiding this topic for a while because, well, I figured there's not a lot to done about it.

I had a bilateral L5-S1 discectomy in January; it brought me great relief from severe sciatica pain. Instantly. Over the last 8 months the normal post-op numbness had been retreating down my left leg to just above my left foot; there was a chance that my ankle and foot would remain numb because of damaged nerves. That was fine.

But over the last month, my left leg  started to go numb, the sensation creeping back up my leg to just above my left knee. My leg was also markedly weaker again. I was afraid that I had somehow re-herniated my disc (though I am careful about lifting heavy objects) so I went to my surgeon and he had an MRI done.

Got my results today and it was a bit surprising -- I have re-herniated, but on my RIGHT side:

There's a lot of technical jargon up there, but essentially, the surgeon explained that the probably cause of the symptoms on the left side is from the general degeneration of the disc, or as he said "it's probably shot -- fragmented and compressing/collapsing." The only solution for this is fusion.
Lumbar spinal fusion is a type of back surgery in which a bone graft is inserted in the spine so that the bones in a painful segment of the spine fuse together. The fusion aims to stop the motion at a vertebral segment, which should decrease the pain caused by the joint. After the surgery it will take several months (usually 3 to 6, but sometimes up to 18 months) before the fusion is set-up. This surgery has been improved over the last 10 to 15 years, allowing for better success rates, and shorter hospital stays and recovery time.
Right side, reherniated (the bubble you see see).
Another view -- I may not feel pain on the right because the prior surgery created space, relieving pressure (white space).
I'm not in what I consider acute pain, just a lot of numbness and general discomfort. My leg drags a bit. The surgeon and I agreed that it's not time for surgery. Walking long distances for exercise has become painful again, recovery from the pain inflicted from impact is draining.

From the left side, the murky area full of scar tissue;
notice the compression in that disc vs. healthier 
one above.
Well, in my case even if I did want to have surgery I couldn't -- I don't have enough FMLA to cover the recovery time. Yes, that's right. I have to work with a herniated disc until it becomes an emergency situation, as it did for me back in August. 2012. He said it's hard to get Blue Cross/Blue Shield to approve a fusion otherwise anyway.

Regarding the issue of the herniation on the right side, it makes no sense to operate unless there is acute pain involved, and there is not --  I'm asymptomic on the right side, save the neuropathy that pre-dates the spine injury.

So my options from his POV are PT, pain medications and/or epidural steroid injections, until the disc degenerates enough to require surgery. I'm going to tough it out with Aleve and occasional pain meds I use for my RA.

Not sure how this will affect my travel (I have a couple of upcoming trips and they will do me in re: my RA anyway; nothing like wondering if you're going to re-herniate yourself into the ER. But I cannot live trapped by the "what ifs".

* Back to work...butthurt begins in the chair
* Cleared to go back to work!
* Working my way back to trek across the Brooklyn Bridge for my big 5-0
* Milestone: tanking up...and a good day for PT walking (finally)
* RA rears up and says "don't forget about me."
* Can put on jeans again!
* Not so fast, young lady...your back is still f'd up
* Post-surgery update: tail end of flu; may need another MRI
Week 3 post-spine surgery, week 2 of the flu
Week 2 post-L5-S1 slice and dice: good news, not so good news
News on life after the L5-S1 slice and dice