Sunday, June 29, 2008

Back On Steroids

I was on steroids from March 2007 until April 2008 on various doses, including a high of 375 mg per day of solumedrol during my eight-day hospital stay last July.

Because of the high doses I was on -- usually 50-80 mg per day -- I was convinced that the corticosteroids (usually Prednisone but also a month or two on Medrol) didn't bother me unless I was at 60 mg per day or higher, at which point they drove me crazy. Literally. I needed anti-anxiety medicine to cope.

I weaned off steroids in the spring, and was steroid-free starting about in May. But my immunologist put me back on Prednisone last week because of my asthma flare during my first antihistimine-free week. (My lungs are still nasty so I suspect I'm not going to get my vaccine allergy test this week either. :( )

It's just 20 mg per day, so I figured no big deal. But after nearly two months of no steroids, even 20 mg has a noticeable effect. Not on my lungs, but in other ways. Since I started them on Friday morning, I've noticed:
  • Increased appetite. This morning, I woke up so hungry that it was like I hadn't eaten in a week. And trust me, I haven't missed many meals! I'd actually been noticing the past few weeks that my appetite was a lot smaller than "usual" although that didn't always keep me from comfort eating. But once I got used to it, I liked that a lot better than being so hungry all the time and it seemed more appropriate for the lack of exercise I get these days.
  • Sugar cravings. I've always considered myself something of a sugar addict, but this is a noticeable increase in intensity than my normal sugar cravings.
  • Sleeplessness. The Prednisone doesn't combat my fatigue at all, but I'm so jittery that I have trouble actually falling asleep. So I actually feel even more zombie-like than normal because I'm missing my naps.
  • Crankiness. I find myself more easily irritated and frustrated than normal. I'm definitely using my anti-anxiety medicine (Klonopin) to help me through it and hopefully keep me from driving my husband crazy.
I'll be calling both my internist and immunologist on Monday to see what to do. I expect I'll need to see one or the other to get checked out for bronchitis, which is what I fear my cold has evolved into. I'm slightly wheezy (not horribly, but noticeable without a stethoscope) and my phlegm is getting worse. I can never remember what it means when it changes colors, either. I know pediatricians no longer ask about (or care) what color snot the kids have with their colds anymore, but I'm always getting asked what color my phlegm is and whether it has changed lately. (For the record, it was clear through Wednesday and then turned a lovely shade of green on Thursday or Friday. TMI, I know. :)

Anyway, I'm really hoping that this course of steroids is a short one. I don't see that they're helping anything, really, but maybe my lungs would be even more junky if I weren't on them. (I'm also using Advair 500/50, Singulair and my albuterol inhaler. I miss my Allegra.)

Friday, June 27, 2008

Memory Foam Mattress Topper, Take 2

So I mentioned awhile back that I had bought a memory foam mattress topper for our king-sized bed in the hopes that it would make sleep a little easier and more comfortable for me by eliminating the pain I get from pressure points.

The first night was awesome -- absolutely no pain in my shoulders and hips from lying (with extra pillows for support) on my sides.

Unfortunately, after a little over a month of sleeping on it, I can't say that has held up. I still find it painful to fall asleep on my side because of the pain caused by pressure on my shoulder and hip (which don't typically hurt me during the course of the day).

But it is more comfortable than sleeping on the mattress alone, so for that I'm glad that I got it. Anything that improves the quality of my sleep these days is worth every penny, and I think I wake less frequently now than I did sleeping on the bare (pillow-top) mattress.

Scott, my husband, hasn't raved about the memory foam either, but he also hasn't complained about it, which is good.

Wednesday, June 25, 2008

So Much For That!

Well, my immunologist sent me home without the allergy testing today.

That cold bug I mentioned? I knew I had a cough and some phlegm, but apparently my lungs are worse than I'd realized. When I was there a week ago, my lung function test said I was at 102 percent of normal (which isn't even my best). Today, I was at 72 percent of normal.

They gave me a nebulizer treatment and my lung function improved to 92 percent of normal, but Dr. DeMerell said my lungs were still wheezy and he didn't want to risk a serious reaction to the allergy test when my lungs were already compromised.


So I'm officially back on 20 mg of Prednisone a day for the next week, and he put me back on Advair 500/50. (Three weeks ago, he didn't think I needed that strong of a dose and lowered me to the 250/50 dose. He also questioned repeatedly if I really had asthma and had been diagnosed by a doctor. Today, he stopped questioning that.)

Assuming my lungs are in better shape next week, I'll go back to his office next Wednesday for the vaccine allergy testing again.

The Whirlwind Of Doctor Appointments

Boy, I was so exhausted after last week's whirlwind of doctor appointments, and then an overscheduled weekend, that I'm falling behind here once again. Sorry about that.

I saw my internist last Friday to discuss all the specialists and what they thought. She had an interesting suggestion for me to help combat my fatigue: she offered me some stimulants, essentially. She said she would probably start with Provigil, which is used to treat people with narcolepsy, she said. Other options include medicines usually used to treat ADD, such as Adderall or Ritalin. I agreed to do some research (which I haven't gotten to yet) and get back to her on whether or not I'm interested.

It's tempting because I'd love to have more energy and not sleep 12-14 hours a day, sometimes more. But sleep is also a good escape from my joint pain, and if I'm awake more hours, that just means I'm probably going to end up taking more pain meds.

My mom suggested that I get some to try, and that I only take them on days when I need extra energy for special events, like when Ellie has a birthday party to attend as she did last Saturday night. It's a thought. But I'm also reluctant to start yet another habit-forming medication that might be hard to stop taking if/when I get better.

Meanwhile, I'm back to the immunologist today for the allergy testing to the pneumonia vaccine. I'm a bit perplexed on what they think will happen since my reaction back in March 2000 to the vaccine took longer to kick in than the three hours they told me I would be there for. But we'll see. I'd like to get the results of testing post-vaccine that will prove whether or not I have an immune deficiency as it appears I might. Many thanks to SharonMV who suggested this route of testing and for the detailed comment on my post about the original set of test results from the immunologist.

I'll try to update later today or tomorrow about how the allergy testing goes and whether or not I was able to get the vaccine.

Meanwhile, what I thought was a reaction to my having to stop taking allergy medicine for five days prior to today's tests appears to be a cold-type bug because my husband has the same symptoms, and he hasn't discontinued his allergy medicine. Just what I needed, eh?

Thursday, June 19, 2008

The Rheumatologist, In Brief

The summary of today's visit with the rheumatologist: No change.

He says he is not willing to write off the parvovirus as a possible explanation for my ongoing illness. In fact, he says he won't consider diagnosing anything else unless I'm still sick in another year. Can I just say that didn't leave me feeling very enthusiastic.

He still considers lupus to be a possible diagnosis, but says there's no benefit to me to make that diagnosis right now. (Except that I'm considering applying for social security disability, and I understand it will be almost impossible for me receive benefits without an official diagnosis. Of course, the approval process takes 2-5 years with appeals so if I start now, I might have a diagnosis by the time I would get an appeals hearing. Or I'd be healthy.)

He commented that I appear to have a pale malar rash right now. It comes and goes. It's definitely not the dark mask I saw on a terminal lupus patient when I took that class on living with a chronic illness. But it's also not my normal coloring.

I currently have no visible swelling, but unfortunately that hasn't brought along a decrease in my pain levels.

Dr. Wernick said at some point, we might have to consider a diagnosis of fibromyalgia/chronic fatigue syndrome (which he considers the same disease, but the research I've done suggests otherwise). However, he agreed with my internist's opinion that the FM/CFS diagnosis should only be given when there is no objective evidence of any other diagnosis, which is not the case in my situation.

I have:
  • an elevated SED rate (which fibromyalgia does not cause);
  • I have a positive ANA, indicating an autoimmune disease;
  • and I tested positive for anti-Cardiolipin somethingorother, which is often seen in lupus patients.
There's something else I tested positive for too that I can't remember off the top of my head ...

The rheumatologist admonished me for using ibuprofin frequently lately because of my history of peptic ulcers. He said I should stick to Percoset if regular Tylenol isn't helpful. I've been having frequent headaches the past month or so that the Percoset doesn't touch but 800 mg of ibuprofin really tackles.

At the end, he said that essentially there's nothing more to be done for the meantime. I didn't tolerate the Salsalate or the Plaquenil, and he doesn't see a reason to turn to the next level of Lupus/RA drugs which can cause their own set of problems. He told me that right now, I just need to continue taking pain meds as necessary to treat my symptoms, and to come back in September.

He did order a urinalysis just to make sure that, if it is lupus, my kidneys aren't involved. He says I need to have those every three months until/unless they can rule out lupus.

He also said he would call my internist to tell her to keep me on the megadose of Vitamin D (50,000 IU once a week) for at least three months. I had been scheduled to take my fourth and final dose tomorrow. I wasn't too happy about that because I'm convinced the megadose of Vitamin D is the cause of my headaches.

Oh, and he said there was no way that my tethered spinal cord was causing the joint pain in my extremities and said the surgery would not be my miracle cure that the neurosurgeon got my hopes up about.

Next up: I see my internist tomorrow. I don't expect any major new developments. It's just my monthly check in.

I also return to the immunologist on Wednesday for allergy testing of the pneumonia vaccine. I'll be stopping my allergy medicine on Saturday for the testing, and expect to be cranky and stuffed up/sneezy/etc. for five days until I can resume it. I hope it won't make it even harder to sleep at night.

The Immunologist Visit

This is just a quick update on yesterday's visit to the immunologist. I need to head out to the rheumatologist soon, so this is just the basics on my test results. I'm sorry that I haven't been posting much lately, but I've been on a downward trend for the past few weeks and it's been hard to spend much time online. Apologies also to those who have emailed and I haven't responded to. :(

I had neglected to ask during my first visit what blood tests he was going to run, so it was a little bit of a surprise when he gave me the good news that I'm HIV negative. Of course, I knew that. It's state law to test pregnant women in Oregon, so I was tested back in 2004. But it's always nice to get confirmation that it's still true. :) I also found it interesting that there's now an HIV-1 and an HIV-2 test. Both were negative, which is always nice.

The immunologist apologized for not telling me in advance they were running the HIV test. Apparently, they're supposed to. But he said it's standard protocol to run that test when they suspect any immune problems, even when they don't expect the patient to have HIV.

My tetanus antitoxoid antibody was very strong at 6.08. Anything over 0.15 IU/ml is considered a protective level. (I had a little trouble with the concept of "protective level" rather than positive/negative or high/low. This is all so new to me.)

He also ran an Immunoglobulin G subclass panel and serum level. Those were all within normal range, as were my Immunoglobulin M and E levels.

My Immunoglobulin A level was low at 50 mg/dL. Normal range is 81-463. My doctor said that's sort of a nebulous test result. It says something is going on, probably, but it's very unspecific. He also says many people have low levels of it with no symptoms whatsoever.

Since we had discussed my frequent sinus infection and rounds of bronchitis and pneumonia over the past couple years, he also wanted to look at how well my immunity to those kinds of infections were. The test name is streptococcus pneumoniae IgG AB (14 serotypes). The doctor said this test essentially looks at how well the immunoglobulins actually work when faced with the disease even though the overall immunoglobulin levels are fine.

The paperwork says any S. pneumoniae type-specific antibody levels of about 2.0 were considered protective against the disease. The doctor says the typical person is protected on 75 to 100 percent of the serotypes. I was above the 2.0 level on four of the 14 tested plus a fifth was at 1.9, which is essentially at the protected level.

I was below 1.0 for seven of the 14 serotypes, and at 1.2 for two of them. He found that concerning.

Normally, the next step is to give the patient a pneumonia vaccine and then run those serotypes again four to six weeks later. But as in everything else medical, I make that complicated. I had an allergic reaction to the vaccine in March 2000 that resulted in an ER visit five days later, when my arm was red, hot and swollen around the injection point pretty much from elbow to shoulder, I was running a fever and I had started having trouble breathing. They gave me a shot of something and put me on Prednisone.

So I need to be allergy tested before they will administer it. I go back on Wednesday for a three hour visit where they will do a series of tests to see if I react. If not, they will give me the injection at the end of the appointment. If I do react, I don't know what happens next.

The immunologist said that because of my serotype test results that even though the immunoglobulin tests were mostly normal, he would do a more indepth test looking at the cellular structure of my immunoglobulins.

So, on Saturday I have to stop taking my allergy medicine because I need to be off all antihistimines for five days before they can test me. I also will need to change pain meds because I currently have to take Benedryl to counteract the itchiness I get from Percoset, a mild allergic reaction I'm told.

What sucks is that I asked if at the same time, they could do the full allergy testing, which the doctor had told me he was going to want done at some point. But because I've had a reaction to the pneumonia vaccine (which he told me is very rare -- aren't I lucky? :), they can't risk not being able to tell whether a reaction is caused by the vaccine or the other allergens.

I have horrible, year-round allergies and I just can't imagine going five days without medication for it twice. Sigh. But at least he's not saying I need to do the full panel anytime soon so maybe I can wait long enough to forget about how horrible it is without allergy medicine before I have to do it again.

Also, the immunologist did say that he doesn't really think my main problem is going to turn out to be an immunology issue. He said he is fairly certain it's an autoimmune disease and that he would lean toward believing it is lupus. Of course, he says he defers to my rheumatologist to make that diagnosis.

The immunologist is also going to continue to monitor me for my monoclonal immunoglobulin issue (MGUS), which is sometimes but not always a precursor to multiple myeloma. That's a relief because I found out recently that my hemotologist is getting married and moving to Medford, OR, at the end of July and I really don't feel like starting a relationship with another new doctor right now.

Yikes, now I'm late to leave for the next doctor appointment! I'm definitely supporting the Portland medical community this month with my almost daily doctor appointments.

Friday, June 13, 2008

The Angst of Motherhood

"I want to be just like you, Mommy!" my 3.5-year-old daughter said to me recently.

I have another blog focusing on my daughter, and I wrote about it there and how cute it is that Ellie wants to be just like me, from my curly hair to the shoes I wear.

But I didn't mention how I try not to cringe every time Ellie says that to me, or a version of it.

Like any mother, I want so much more for her.

I want her not to inherit my food issues or my struggle with my weight and the low self-esteem that it causes. More than anything else, I want her to be healthier than I am, both physically and emotionally.

And I want her not to inherit my worried nature. Although I think it might be too late on that.

Already, she asks me every day about the various body parts she has heard me mention as painful.

"Are your knees better today, Mommy?" she asks. "Are your wrists better, Mommy?"

Sometimes it seems like the body parts she asks about are almost random, like she's going through anything she can think of that might hurt. "Is your tummy better, Mommy?"

That last one hasn't been a chronic complaint since her infancy, when I finally seemed to heal from the chronic peptic ulcers that plagued me for five years. So she's never really heard me complain about stomach pain on a regular basis. Although she might ask me about it because it's one of the questions we ask her when she's ill and we're trying to figure out what's wrong with her.

"My tummy is all better," I tell her. "It doesn't hurt at all."

And that was when I realized that my chronic illness really upsets her, more than just the way her life changed when I got sick and she had to start going to daycare instead of playgroups. She worries about me.

When I told her my stomach was all better, she got this look of amazement on her face, followed quickly by pure joy.

And then we had to go through all the parts that do hurt, which aren't all better.

I try to be positive when I talk to her. I tell her that no, I'm not all better, but I'm getting there. And I'm working really hard on it.

"You need to go to the doctor, Mommy. Tell the doctor she should make you all better!" Ellie says.

If only it were that easy.

Thursday, June 12, 2008

A Visit With The Neurosurgeon

I had a very confusing and slightly overwhelming visit with the neurosurgeon today to discuss the results of my cervical and lumbar MRIs.

I don't know if I was booked for a really short visit or if I was just in a brain fog because I've had a lousy week, but I felt like he was talking a mile a minute while I was falling farther and farther behind him.

It's not that he's a bad doctor who doesn't take the time to talk to his patients. I think this is the third time I've seen him, and I really do like him. And he's well respected as one of the top (if not the top) neurosurgeon in Portland.

Here's what I got out of it:

  • He wants me to have an EMG done, which I think measures nerve conduction. I've had it done on my arms before and it's quite painful. He says it's likely that it will turn out normal, but if it's abnormal, it will give him good information for whether it's my tethered cord or my bad disks.
  • He says I have very significant nerve compression in my neck. The MRIs are all digital now, so he could show me on his computer what the space looks like between my cervical disks that are normal and where it gets teensy tiny where the nerve compression is.
  • He still believes my cord is tethered and showed me on the MRI photo where my spinal cord reaches down farther than it should. His opinion contrasts with the radiologist this time around who said there was no evidence of a tethered cord. I think that's because it's not as significant a tethering as some people have.
  • He believes that most of my back and leg pain is caused by my disk problem and that fusing at L5-S1 will most likely have the greatest impact on my back/leg pain.
  • He says he would do the fusion from the front, which he says is a much faster recovery than the traditional way of doing it from the back. He says patients know within 4-5 days of surgery whether it was a success and are recovered in about three weeks. (He did not explain exactly what he means by "recovered." My experience in the past is that doctors often declare surgical patients recovered long before pain and movement issues are completely resolved.) He said it compares to a minimum recovery time of three months if fusion is done from the back.
  • He said the untethering of my cord would be a faster, easier operation to recover from and that it might make sense to do that first and then decide if the other surgery is necessary. But since he thinks most of my back pain is caused by the disk, he would actually recommend doing it in the opposite order -- fusion first, then untethering the cord if necessary.
  • He said the cyst at the base of my spine is inoperable. It was the first I'd heard about it and I'm unclear whether he believes that's responsible for any of my issues.
He looked at the cervical MRI first, then said we'd come back to it to discuss what, if anything could/should be done there after we discussed my lumbar MRI. Of course, by the time we were done with that, I was feeling quite overwhelmed and didn't remember that we were supposed to talk about it until I was out of his office and heading for the elevators. When I said, "Oh, is that why my neck hurts?" He said yes, it was some pretty serious damage in three disks in my neck.

So, what's next?

His assistant told me I should hear from the folks who do the EMG in 7-10 days to get on their calendar. Once I have that appointment, I'm supposed to schedule back to see Dr. O'Neill again.

Scott and I need to talk (he's putting Ellie down to sleep), but my inclination is that any back surgery should wait until I'm feeling better. I didn't really talk to Dr. O'Neill again about whether he still believes that my ongoing, year-plus illness symptoms could all be related to the tethered cord, as he said last time I saw him. And if that's unlikely, I don't know that I want to deal with the pain and recovery from surgical trauma on top of everything else I'm dealing with. It just sounds too overwhelming to me.

Coming up next week:

  1. I see the immunologist again to get the results of a bunch of tests he ran last week to determine if I have an immune deficiency. That's on Wednesday.
  2. I see the rheumatologist again I think on Thursday. We will talk about what to do since I stopped Plaquenil because of side effects as well as the results of my myriad of blood work since the last time I saw him. We will also discuss this theory that a tethered spinal cord could be the cause of all or many of my symptoms. (My internist is very skeptical about that.)

Tuesday, June 10, 2008

Time Versus Energy

My husband and I have a classic case of envy going on.

He envies my "free time." I envy his energy and health.

Don't get me wrong -- he is an incredibly supportive and empathetic spouse. I read about marriages breaking up over less than my illness. We even know one couple where the wife nursed her husband through cancer and then had a cancer scare herself. When she was finally cleared of it, he left her saying he wanted to focus on being healthy and her chronic migraines and other health issues that interfered in some of the activities he loved were a downer.

I am blessed that my marriage is a strong and healthy one.

But still. We're both human and sometimes we're envious. And sometimes we get our feelings hurt inadvertently by the other.

Last night at bedtime, as I put aside the book I was reading -- The End of the Jews by Adam Mansbach -- I commented that although it started out sort of slow, it had developed into one of those books I could stay up all night to finish. Not that I would, but it was that engrossing.

Scott said something about how it must be nice to even think of doing so.

And as I'm an emotional rollercoaster these days, I took it personally.

It reminded of how, back in 1997 or so, when I was working just half-time because my first shoulder surgery went so poorly and working on a computer all day pushed my pain levels through the roof. (Although it wasn't really half-time. Instead of four hours a day, I rarely made it out of my office in less than six. But it was better than the nine or ten hours or more I would have spent if I didn't need to go home and take pain meds.)

Scott and I were dating back then, and I was living in Yakima, Wash., while he was in Portland, Ore., about 200 miles away. We talked on the phone pretty much daily in those days, and I think it was one of those days I stopped at the video store on the way home and stocked up. They had a deal on older movies, something like 5 movies for $5 for 5 days, so I'd grabbed a bunch that I'd always meant to watch but hadn't and had finished watching the first one and was part-way through the second during our phone conversation. Like these days, Scott was swamped at work, putting in late hours, and tossed off a, "Must be nice!"

And well, yes, in some ways it is nice. But I would much rather be busy running around with Ellie doing errands and having playdates and taking her to classes than being in pain and so tired I'm afraid to drive, not to mention the myriad of other symptoms I deal with.

And back in the '90s, I hated the fact that I couldn't do my job I loved the way I wanted to. It was a huge loss of self-esteem to not be the go-getter at work because my entire identity was wrapped up in what I did for a living. Just like it's currently a loss of self-esteem to be a stay-at-home mommy who had to put her kid in full-time daycare.

(I never know what to say anymore when people ask what I do. Invalid just doesn't seem like a good answer. But I'm not a stay-at-home mom, really. Nor can I honestly call myself a homemaker. I guess I'm a housewife ... but I don't know that anyone uses that term anymore.)

And, as I pointed out to Scott, I've always been a voracious reader who could happily spend an entire weekend with my nose in a book and would periodically stay up way too late on work-nights because the book I was reading was just that good. (I did have to stop reading for awhile right after Ellie was born and I was too sleep deprived to focus on the printed word. But other than that, I've always been a bookworm. I remember the many times in my childhood when my mom would confiscate my library books and kick me out of the house for the afternoon because otherwise I would spend my entire summer indoors reading.)

I think it's a classic case of The Grass Is Always Greener that gets hold of us. I even envy Scott's horribly limited hobby time because my hands, wrists and other parts hurt too much to resume quilting. I envy that Ellie knows that Daddy is the one to go to for fun playtime. (OK, that was always true to a degree. :) Mommy, meanwhile, is pretty much only good for making sure she's clothed (include clean laundry), shod, has kisses on all her owies, has help using the potty and has new library books.

Meanwhile, Scott's plate is overflowing with responsibilities as breadwinner, parent, homeowner and spouse. And it doesn't help that work is crazy for him these days.

In a perfect world ... well, I guess we all know the world isn't perfect. And I guess if my world was perfect, I definitely wouldn't have a blog called "Sick Momma."

Sunday, June 1, 2008

Continuing the Confusion ...

So of course, by the time I saw my internist, by fever from last week was gone. We never did figure out what caused it. Her best guess is that it was related to my general illness. Apparently people with inflammation disorders, like rheumatoid arthritis or lupus, sometimes get unexplained fevers as part of their symptoms.

I've officially started on the once-a-week-for-a-month 50,000 IU of Vitamin D supplement. Hopefully, I'll remember to take the others on time. I wrote them on my calendar, but on really bad days, I don't always look at the calendar. The lab report indicates that my level of 14.4 ng/ml (?) is "insufficient" (as is anything under 32.3) but would have to be 9 or less to officially be "deficient."

I found it odd that she put me on the Vitamin D supplement, but didn't mention my iron levels, which were pretty low. Apparently I've moved up (down?) in the world from my "borderline anemic" label I've had since adolescence. My iron was 19, and the lab says anything under 50 ng/ml (?) "indicates iron deficiency likely." I'm going to try to dig out my iron supplements from when I was anemic after Ellie was born and see if they're still any good.

After hearing about my chicken pox vaccine experiences and reading the comments posted under my last post by SharonMV, my internist has recommended I go see a clinical immunologist to discuss my case and be checked out for an immune deficiency problem. I just love being a medical mystery. :)

Meanwhile, my internist also gave me copies of the MRI reports. As you may remember, I had a panic attack during my MRI of my lumbar region on May 13. I went back last weekend, armed with Xanax, and made it through my cervical MRI no problem. (Then promptly came home and fell asleep for 7 hours, rousing briefly a couple times when the phone rang.)

I'm pretty confused because this radiologist, even having my last round of MRIs, said he saw no evidence of tethered spinal cord. But my neurosurgeon didn't rely on the written report last time around; he looked at the images and circled exactly where he saw a very clear tethering of my spinal cord. I get to find out what he thinks about these new images and the reports next week (June 13, I believe).

But there was still some interesting detail, which I haven't seen or heard before.

My back problems center on the L5-S1 region, with some issues at L4-L5.

The lumbar MRI says: "L4-L5 shows a concentric broad-based disk bulge and mild thickening of the ligamentum flavum. L5-S1 shows a broad-based disk bulge and mild bilateral facet arthritis. There is a tear of the posterior annulus just ot the left of midline, measuring approximately 9 mm in length. Perineural sheaths (sic) cysts are noted incidentally in the sacrum. ... On the right, there is mild foraminal narrowing at L4-5 and L5-S1. On the left, ther eis mild foraminal narrowing of L4-5 and mild to moderate foraminal stenosis at L5-S1."

I find the bilateral facet arthritis interesting specifically because do not remember that being noted previously and I did undergo a number of injections into my facet joints as attempted therapy for my back problems (which stem from an August 2006 car accident). The IME had recommended additonal facet injections despite my lack of improvement from the previous three rounds, and I had been warned by friends online that the injections could cause new damage to my spine so I refused when the insurance company tried to force me to follow the IME's advice.

Meanwhile, from the cervical MRI, which I'd never had before:

"There are degenerative marrow endplate changes present at C5-C6. Mild to moderate endplate spurring is noted at multiple cervical levels. There is slight reversal of the normal cervical lordosis.Cervical cord is normal in caliber and signal intensity. Cerebellar tonsils are normally located."

I've also had neck problems since that 2006 car accident. When I was undergoing acute treatment for the accident, I kept getting asked which was worse (and which they should focus on), the back or the neck. The back was/is way worse, and somehow, my neck never really got much treatment or attention. The IME declared it completely healed, which was news to me since I still have trouble turning my head far enough when driving and trying to change lanes, not to mention pretty frequent neck pain. No, it's not severe when compared to my back or, now, my other joint problems, but it didn't hurt before the damn car accident and I continue to think that means the insurance company should offer a bigger settlement. Hopefully my lawyer will be able to use these reports to good benefit.


I went to physical therapy on Friday for my knee. I had been just once before, a week earlier, for intake and thought the therapist understood my overall health condition better than he apparently does.

The exercises he gave me to do at home were manageable, particularly broken up throughout the day. (Which he understood I was going to do and even recommended it.) But apparently he really didn't understand because on Friday's appointment, he expected me to do various exercises and stretches for 30 minutes straight. My pain levels were through the roof by the time I left, including severe chest pain (which I still don't understand since my heart is fine, they tell me). I've had to go back to the much higher levels of pain medication that I've been trying hard to cut back on just to get my pain to an almost-tolerable level. And it's not like I'm doing much but I'm so exhausted still from the experience. :(

We amicably agreed that he couldn't do much for me. He referred me to a place that has a therapy pool and classes for people with chronic illness and disabilities. So I'm going to check that out once I'm feeling recovered from Friday's PT session.