on april fool's day (i suppose that date should have triggered  an internal
warning system of some kind within me), i had my first thoracic epidural.
that appointment didn't go exactly as i expected it to, because i had
already completed the lumbar series of epidurals and thought this too would
be, "no sweat; and maybe, a continuation of great results".  that appoinment
began with dr. alex beginning it with a consult, unlike the last injection
series.  i thought that was odd, but hey, i was already there.

i was taken to his office and told dr. alex would be with me shortly.  there
were four high-backed, rolling leather chairs for me to choose from.  i
chose the one next to and on the left side of his desk.  while seated, i
couldn't help noticing two opposite and adjacent walls full of framed
degrees, certifications and licenses.

i thought, "w0w.  all the doctors in this pain clinic hang their authority
on these painted walls."  curious about the other doctors in this clinic, i
rose to check out who they were, what they knew and where they had been,
from these dozens of framed documents, which were from dartmouth, cornell,
yale, and the university of california medical schools and lots of specialty
documents.  i was a bit stunned to discover that all of these documents
belonged to only one doctor, mine.

i sat back down to wait for the doctor, thinking the particular chair i'd
chosen was making me uncomfortable.  so, i got up and rearranged the
furniture, selecting and moving the leather chair i felt most comfortable
in, so that my short legs would touch the floor and not pull on my lower
back.  yeah, i know, a bit nervy of me, but hey, it's my back and the chair
i needed was against an opposite wall.

shortly after i had done that, my doctor entered his office.  i could tell
from his facial expression that he had some serious stuff on his mind, and
it made me a little nervous (as if i hadn't already been that morning,
because i always am in medical venues).  so, i told him he had very nice and
very expensive wallpaper, excellent taste.

he laughed and it cut the ice for both of us.  he said, one day, he might
take the time to figure out what that wallpaper cost by the square inch of
each degree.  i laughed and said i didn't know anyone who'd done that
before, and that it might be an interesting exercise.

he told me he studied my MRI films more than once since he received them,
because the report bothered him a lot.  it turns out the MRI report on my
thoracic spine was in error and inadequate.  he said that was because "most
radiologists do not know what the doctor who orders them is looking for and
most radiologists are nihilists"; asked me if i knew what the word
"nihilist" meant.  (i'm still laughing about that, because i must have had
the blank look of a dullard on my face and wonder if i had drooled, while
patiently waiting for the first shoe to drop.)  he said they were especially
nihilistic when it came to thoracic spine films, because radiologists know
little is done by doctors about thoracic problems.  so, radiologists treat
the evidence as if it were of no importance or simply didn't exist.  he
said, the report was misleading, because much more needed to be reported
than was.  he told me there was nothing mild or moderate enough about my
thoracic spine to have ignored so much information, as was done by the
radiologist in the report about my thoracic spine.   i felt a fuzzy,
hard-soled slipper land on a tender spot.

towards the end of that revelation, he said that he was going to re-write
part of the thoracic MRI report as addendums to it, because he felt my rd
and my pcp needed to know they are dealing with very advanced degenerative
disease, "because of the amount of unrepairable damage in your thoracic
spine and the amount of pain you must be feeling."  yes.  he did indeed say
"unrepairable".  reinforcing that, he said that there is nothing that can be
done, currently, with today's medical knowledge to repair or correct the
damage, because of where it is located.  he mentioned that if it had been
lumbar or cervical damage to that extent, they could and would do surgery,
but the damage is too close to my spinal cord.   ouch!  "buzzzzzz---zap!"
the fuzzy slipper turned into a lead boot that struck my chest, which
somehow numbed my brain.  i sucked air, because of the impact.
next shoe . . .

then he told me that he needed to inform me that there are increased risks
with this particular thoracic epidural, because of my spinal cord being
right there.  wanted me to know that sometimes there are complications.
said it's not as safe a procedure as the lower lumbar injections where there
is no spinal cord. (the second fuzzy slipper landed)  but, he said he knew
how to safely do it; had done more than two thousand of these same kind of
procedures; does a hundred or more a year; and the real time imaging
equipment minimizes risk of mistakes and complications.  said he couldn't
guarantee it will relieve me of all or most of my pain, but there was a good
chance it would at least help with some of it, based on my wonderful lumbar
response (which had been what i was thinking).   he felt the risk was
warranted, justified and had good potential.  and then, he said, "you need
to know, i can't use anesthetic that close to your spinal cord, because of
the risks, but i can keep you comfortable on the way down to the area we
need to get to with the steroid."  meaning, one has to be awake, aware and
have no pain pills in one's system, because one needs to give the doctor
doing the procedure feed-back about his stimulating pain that he must not
numb that close to one's spinal cord.  the second slipper de-fuzzed and
morphed to match it's mate.  i swear i heard a "thunk!" that time.   my
brain hurt.

so, i asked him if i could have a couple of minutes.  and he left me alone a
few minutes in his office. i told myself to ignore the first boot and deal
with and process the second one.  i set my things down on his desk, grabbed
the arms of the chair and slid out of my shoes.  i wanted to feel something
that didn't seem surreal, like the floor under my feet.  in the short time
it took for me to consider the status quo versus possibility, i eventually
surrendered to hope and went for the procedure.  i knew i did and do trust
him completely.

that procedure went well and had good results--no back spasms, so far for
the first ten days of eleven, which are generally a daily occurrance for me.
the spasms are much milder now and my meds are handling discomfort better.
sneezing or coughing didn't cause any pain or that pain cause muscle spasms
until yesterday and that's been worth it.  BUT (and here comes the wussy
part), ohhhh myyyy, there definitely IS a sense of an element of
self-inflicted pain to this thoracic procedure, during the time and in the
area he cannot use anesthetic.  one dasn't move a hair during that time, and
must accept and allow, even though it feels sooooo counter to one's
impulses.

sooo, i'm sitting here, "looking forward to" (not) tomorrow's challenging
rerun, thinking . . . i really like the "run" part of that word.  i know i
won't run, but i have to confess, it IS more than just a little appealing.

kate