Heartbeat

We saw the heartbeat Monday.  Now I can exhale...

I am off the Flexeril entirely.  I don't think it was helping much with either the muscle spasms or the sleeping problems.  I am sleeping better at night and feeling less pain now that I've found those gluteus medius stretches.  So I'm just on Tylenol now, and I also have a referral in to physical therapy.

On the emotional side, I have been dealing with people who question my choices and capabilities in caring for my kids and the new baby as well. So I have to grit my teeth as they tell me how hard my choices will be on me, as if I hadn't considered the challenges or consequences, or as if I am incompetent.  Perhaps their comments aren't meant that way, perhaps they are just trying to empathize, I don't know.  But it comes across critically. 

It is so vitally important to surround ourselves with people who will be supportive.  People will question your choice to have surgery.  People will question your choice to have another child.  But ultimately, if people can't trust me to make an informed decision based on facts, then those people don't know me and don't need to be speaking into my life.

Exercise

Last Friday, in my zeal to "get on the floor," I overdid my lower back exercises.  Any other area, if you overdo, you're a bit sore for a while.  But when you overdo and throw out your lower back, you are incapacitated for two days. YIKES.  It was lots of ice and rest and Flexeril.  I also used my thera roll after the first 24 hours.

When I was finally feeling strong enough and healed enough, I got back on the floor and did about half as much lower back work.  I did find a couple stretching exercises for the gluteus medius, which is a bugger of a muscle involved in all this, and the stretches help more than anything else I've done for them.  I will link them here for you: ONE and TWO.  The links will open in a new window.

Tylenol Arthritis

The extended release tabs are really doing the trick for me at night.  Before the pregnancy, I'd pop two aleve before bed.  But NSAIDS are a no-no, so Tylenol Arthritis it is.

My morning sickness and exhaustion (partly from the Texas August heat) has been trumping my need to walk.  I've been doing some floor exercises in the air conditioning, but not enough.  It's hard to motivate yourself to exercise when you are nauseous.  But then I remind myself of the last pregnancy and how my lack of core strength contributed to SIJD, and I get on the floor.  But not often enough.

17,000

My hcg levels have doubled perfectly and are now 17,000.  Still have two more weeks until the ultrasound where I will hear a heartbeat, Lord willing.

My last Botox injection has definitely worn off.  I am waking in the night needing Tylenol.  I will buy some of the Tylenol arthritis version today which is extended release, so hopefully it will hold me longer at night.

Walking

So I went for my first walk since being home from Scotland and Ireland.  I walked a great deal while overseas for two weeks.  I used a lot of icy hot patches for my back, and tylenol, and occasional Flexeril while we were there.  But when we got home, I found out I was pregnant and I took a week off from walking to kind of recover from the trip.

So yesterday the walk went pretty well, I tend to have piriformis spasms while I walk of course, but I just adjust my stride and don't push myself.  When I got home, I did sit-ups, the plank, and stretching.  And I did fine all day on just tylenol!  The worst part was simply the pregnancy nausea while I was walking.

2200

Last week when I first tested, my hcg levels were at 40.  Today, 8 days later, they are at 2200 (I'm 5 weeks pregnant).  That is good news that we are heading in the right direction.  They even did a vaginal ultrasound on me today since I have a history of miscarriage (only one, thank God), and I have a bicornuate uterus.  I got to see the gestational sac, and see that it's not ectopic.  So, all around received good news today.  I have been surviving on tylenol just fine for the last couple of weeks, for my piriformis syndrome.  However, since I've been waking at 3 a.m. every day this week, I asked if I could take 5 mg of flexeril as well, just at night.  There's no problem with that -- it's as safe as tylenol apparently.

I have also been using a thera roll and it helps a great deal.  So far, so good, but I'll rest a lot easier when I can hear a heartbeat.

Treatment Timeline

I will begin this journey by sharing my SIJD story. 

May 5, 2008: pain begins in late pregnancy – visit PCM (Primary Care Manager)

July 1, 2008: physical therapy

August 2008-early 2009:  PCMs try oral medications, no effect

January 2009:  PCM orders chiropractic consult, only for active duty military, so continue oral med experimentation

June 2009: x-rays at army hospital, and MRI at civilian hospital.  L4-L5, L5-S1 osteoarthritis and degenerative disc disease.  PCM wants to keep trying oral meds.  No effect.

August-September 2009: chiropractic (out of pocket) for lumbar.  No effect.

November 2009 – January 2010: two separate injections (one in Nov, one in January) at pain management, both times at L4-L5 & L5-S1.  No effect.

February 2010: physical therapy begins for lumbar, no effect.  PT switches to treatment for SI Joint – first relief ever experienced.  However, relief is minor and short-lived.

February 2010:  PCM orders MRI of hips – normal.

March-April 2010: chiropractic (out of pocket) for SI Joint –provides minor, short-lived relief.

Late April 2010: third injection, in SI Joint as well as L4-L5.  No effect.

May 2010: buy inversion table per pain management instructions, no relief – increased pain in right buttock when inverted.

May 25, 2010: bone scan at Army Hospital - normal

June 1, 2010: fourth injection,on right side of L4-L5.  Minor relief of aching pain allowing sitting for a little longer (still no standing or walking for any length of time), relief lasted 2 weeks.  No relief of sharp pain in buttock.

June 29, 2010: orthopedic appointment.  Opinion is also that it is SI Joint causing the problem, with poor prognosis.

July 6, 2010: fifth injection, at S&W pain mgmt, in SI Joint – numbing agent gave relief for 1.5 hours.  Medication changed from Gabapentin to Lyrica.  Started sleeping on ice. 

August 4, 2010: neurology appt.  His physical exam indicated no nerve root damage, but he wasn’t familiar with the treatments I asked about for SI Joint Dysfunction.  Did not offer any solutions or treatments to try.

August 9, 2010: sixth injection, at S&W, this time a caudal catheter in low back and another injection at SI Joint.  50% relief for the next two weeks.  Ice sleeping reduced. 

November 23, 2010: seventh injection series @ S&W: injections on the right side of spine from L4 down to S2.  Diagnostic for RFA (Radiofrequency Ablation).  75% relief first day.  Minor relief in the week following.  Schedule RFA for Feb 2, but insurance denies authorization.  Resubmit RFA request, RFA denied second time.  Medication changed back to Gabapentin from Lyrica, which had no effect.

February 22, 2011: same injections as Nov 2010, in addition to an SI Joint injection.  No significant relief.  Pain continues to increase.  Continue sleeping on ice or heat, depending on how the pain responds.

March 15, 2011: Found a doctor familiar with SI Joint Fusion Surgery in Tyler, TX – Joseph Conflitti.  Dr. Conflitti performs examination and reviews case history and medical records.  Confirms Sacroiliac Joint Dysfunction.  Performs pre-op evaluation for SI Joint Fusion surgery.  RFA request resubmitted again and denied again, appealed and denied a fourth time.

May 24, 2011: ninth injection series – 5 injections on the side (branches) of L4 down to S2.  Additional injection in SI Joint.  Minor, short-term relief.  Surgery request denied.

July 13, 2011:  Received fifth and final denial letter for RFA procedure.  Proceed with surgery which was appealed and approved in June.  www.si-bone.com for the procedure details.  Could not bear weight for 6 weeks post-op.

August 19, 2011: Post-op exam in Tyler with Dr. Conflitti.  Pain still continues but it is too early to call the surgery success or failure.  Conflitti confirms that if my pain has not improved by 6 months post-op, it very likely will never improve.

September 13, 2011: Tenth injection, @ S&W, this time in the piriformis muscle for Piriformis Syndrome, a common problem alongside SI Joint Dysfunction.  Piriformis Syndrome causes sciatic pain.

September 22, 2011: Post-op physical therapy evaluation.  PT states recovery will be 2 – 3 years.  Physical therapy begins on September 27.

September 27, 2011: PCM visit for walking cane prescription

November 10, 2011: Eleventh injection series @ S&W – branch block right side of L4/L5 and S1.  Relief of pain for several hours (not of sciatic pain however).  PT is continuing twice a week.

January 2012: Finally feel better post-op than pre-op.  PT discontinued due to significant progress.  No nerve pain, just muscle spasms.

March 6, 2012: Botox injection in piriformis at pain mgmt.  80% relief for 8 weeks.  Discontinue all meds except Motrin and occasional Flexeril.

June 2012:  Begin walking 1 mile several times weekly.

June 11, 2012: Botox injection in piriformis at pain mgmt.  80% relief.

July 2012:  Pregnant.  On Tylenol only at this point.