Tuesday, 21 May 2013

Working to Stay Ahead of the Pain

I think I've mentioned in the past that I am a patient at my local hospital's Pain Clinic, here in Ottawa. Because my spine fractured in several places before I even got my breast cancer diagnosis, one of the first things my medical oncologist tackled was getting my pain under control. That's where the wonderful nurse Gini comes in.

Gini's focus is on the palliative side of cancer care, relieving the pain. She saw me before and after my pelvis broke and put me on the waiting list for the new Pain Clinic. Before long, my pain had receded to the point that I no longer needed the pain pump full of Dilaudid. In fact, it was putting me to sleep as I ate breakfast! She kept me at the clinic, although my pain was manageable. I think she had a feeling...

When I saw Gini at the clinic in early February, things were so stable we decided I didn't need to come back for three months. Unfortunately, I didn't realize the effect some treatment changes would have on my pain in the interim. In late January, after a short chemo break, I was switched to daily Tamoxifen pills. My late January CT scan found a tumour on my right femoral neck that put me at risk of fracture and was subsequently treated with radiation. In March, I started a double-blind clinical trial where I was either continuing my bone-building Pamidronate treatment (but every four weeks instead of three) or I was getting Zometa, a similar drug. Put them all together and my pain, or rather my pains, increased. I was taking long-acting hydromorphone contin (a narcotic), Lyrica (for nerve pain) and Naprosyn (an anti-inflammatory) as well as hydromorphone (AKA Dilaudid) for breakthrough pain. I was taking enough to address the bone and nerve pain caused by my tumours and fractures, as well as the pain of chronic problems I have with my jaw and wrists. However, by the time I returned to the Pain Clinic in early May, I was taking several doses of Dilaudid for breakthrough pain each day. I returned to wearing my bite guard at night, as well as my wrist braces. Something had to change.

The young doctor I saw took the time to fully understand my history and the pains I was now experiencing. She consulted a senior anaesthesiologist and returned with a proposal. First, we adjusted my medication, increasing the Lyrica dose and changing the hydromorphone contin from twice to three times a day. Second, she proposed that I return at the first available appointment (early June as it turns out) to have a caudal epidural.

With the aide of a skeleton, she and the senior anaesthesiologist explained that a needle would be inserted in my tailbone and a catheter would be fished up my spine to where my compression fractures occurred and the pain relieving steroid would be released there. The procedure is safer that a traditional epidural for labour. The tailbone injection site is farther from the spinal cord and therefore less likely to cause an injury. Also the placement of the catheter will be guided by X-ray. The relief from this type of nerve block can last as long as six months, generally less than that for cancer patients.

I learned about nerve block's from one of my favourite bloggers, Scorchy at The Sarcastic Boob.  Her recent posts, "Rear View Mirror" and "Paincation Redux" tell her tale of pain and relief and explain the nerve block she gets (it's a little different from the epidural). Thank you, Scorchy for introducing me to the nerve block! It meant that when I went to the Pain Clinic I knew there were options. I didn't have to live with pain. And living is what I'm trying to do.

7 comments:

  1. I am so very glad you are going to get some relief Kate. I'm just shaking my head at the pain you have been trying to manage, and how you still seem to bring smiles and strength to others. The connections that some share across the blogs dear to us are so important, touching, and real... Kudos to Scorchy for sharing her pain so that you could find out about nerve blocks. Crossing fingers and toes that you have a relatively pain free summer with your daughter... I wonder if our good nurses know just how much we think of them... many hugs...

    ReplyDelete
  2. Pain BEGONE! Don't let the door hit ya! Adios--you're not my amigos!

    I hope this giv you relief and you can get about the business of living well and not hurting so much. It's very hard to live with pain. ((((((((((HUGS))))))))))

    ReplyDelete
  3. Thank you ladies! The change in medication is already making a difference. I have my appointment confirmed now for the epidural. What difference may that make? Could I unload the dishwasher, clean out the fridge? What fun awaits this summer? I wonder if I can take a bike ride?

    ReplyDelete
  4. Oh my gosh, Kate, you have been dealing with so much. I'm sorry about all the pain you've been trying to manage. It's wonderful to read about this block's potential for bringing you some much needed relief. You deserve it. I hope you get to take that bike ride soon! Big hugs to you.

    ReplyDelete
    Replies
    1. Ah, it's not so bad most days. But I do hope the block works.

      Delete
  5. I was just wondering if you had read Schorchy's post. I hope so much this block works for you and you can have some relief.

    ReplyDelete
    Replies
    1. I did, Catherine. I was sorry to see that the block's don't always work. Scorchy has given me tons of encouragement, though. I will try it and hope for relief and for more mobility. I'll let you know how it goes.

      Delete