Tuesday, May 26, 2009

Cervical Radiofrequency Ablation

I know every one is dying to see pictures from Shaun's procedure he had last week. The first one is from the latest procedure. Yes those are needles in the picture. I will write about more about this procedure at the end.

He has had two actual procedures and two pre-procedures to test if he was a candidate for the actually procedure. The actual procedure is not too far more painful than the pre-procedures, but the healing is much more difficult. After all, they all involve a needle in your spinal area. I will explain each of the procedures and if you really are that interested or have nothing better to do just read along.


This is from the first procedure. It is called the Cervical Facet injection with steroid. I guess the picture is of blood vessels. Not sure what we are even looking at, but hey they gave us the picture, why not blog it.
Any way the first one was to see if he responded to the treatment. They took a needle to the branch of nerves located in the C 2 and C 3 area. This area is known to trigger headaches in some people. It is a last resort of things doctors recommend to those who have not responded to other treatments. This time they did not do anything long lasting. They used some lidocane and a steroid. He was told to keep activity levels down for the first 24 hrs and most of the next 24 hrs. We found he had pain in the area for about 5 days and his daily headache was gone immediately and did not return until day 8. We had to record daily pain levels for the first week. Every one found this to be good and so we proceeded to the next step.


This one was done by the same doctor. There are three pictures. The first one shows the needle really well and the other two have pen marks pointing to the area they targeted. This one was more of a targeted nerve block. The goal was to target the actual branch of nerves that was causing the headaches. They used lidocane to isolate the area and see how long relief lasted in a temporary state. This time no bed rest, but was asked to moderately do activities that would normally increase his headache. We had to record every half hour starting just prior to the procedure and for the following six hours. It was different from the other procedures in the fact that his headache was still present following the procedure. Went from an level 8 out of 10 down to a 3 out of 10. It continued to decease until 2 hours after the procedure it was gone and then returned slightly at 5 hrs post and maintained that level for the duration of our recording. It was nice that he was finally able to do some household things during that time and still felt fine. (Any Exertion activities normally caused a more severe headache to the headache that was always present, such as mowing lawn, running, lifting items that require a bit more effort, and sudden adrenaline response (like braking quickly in the car). This time he was sore after the injection for about 24 hrs.

Now the third one was done on Christmas Eve. It is called Cervical Radiofrequency Ablation. It was to be the last step to end all headaches. At least so we hoped. It was done by a different DR, he gave us only one picture, but a bigger version of it. Yes that is two needles. The goal was to add a little steriod and lidocane, additionally the needle would heat to a high tempeture to cauterize the nerve. The headache was gone immediately. Recover was hard. It required him to be in bed and use of ice and regular use of pain meds. This came with episodes of vertigo. He was told to take it really easy the first week, and that it sometimes takes a couple weeks for the pain to go away, but things are usually pretty good by day 10. Well, Shaun took off from work from Christmas Eve on until New Year's Eve, which he needed to work, so others could have the day off, since he got Christmas Eve off. He was lucky to be able to come home early that day. Friday was Jan 2nd and was day 10, his first full day back at work. I remember him coming home after working the full day and seeing he was in excreciating pain. He described the pain felt like a severe burn. We later found out why he felt that, but thought that was strange at the time. We made it through the weekend with no improvement and were able to call the doctor's office first thing on Monday. He was told that he had inflamation of the nerve. It is a rare side affect that can happen occationally. He was told to lay down as much as possible, use ice to reduce swelling and use pain medications. One thing we noticed as the swelling increased so did the vertigo. If we could keep the swelling down then he would be fine with his balance. He was told to not lay on this side at all and that in time the pain would go away. It took another week for the pain to noticable decease and from there it went away quickly. All in all, about 4 weeks to get back to feeling normal.

This was great. No headaches and we were free to live life normal. (Finally after 10 months of very rough times.) Only thing was a spot on his neck that had no feeling.

Over time the spot gained feeling and then the headaches returned gradually. We knew then the nerve was growing back, but hoped the daily headache would not return. But then it did. We were told the procedure was expected to last 3 to 18 months and each time the nerve grows back slower. Even with the regrowth of the nerve, there was a chance he would never have those headaches again. So this time we got 4 1/2 months and we hoped this was his only time to need this procedure. So now we know we were wrong, but at least we know what we need to do to get on with life.

Today is day 5 from his latest procedure, and he is still in quite a bit of pain. He has to stay on the ice and not be up much in order to keep the swelling down, but we have great hope that in a matter of days he wil be feeling well and that recovery won't be quite as long as last time, but time will tell. This time he is not going back to work until day 11 (Monday) and if need be he will work half days for the first few days. I hope it is pretty much better by Monday for his sake. All in all we are lucky with the weekend schedule and Memorial day, he is only taking 5 actual days off from work.

http://www.pain-docs.com/painprocedures/radiofrequencyablation.html

*****UPDATE******7/9/2009 This last procedure healed much faster than the first. Back at work on day 11. Work almost a full day and then full days after that. Each day was better and he was not wiped out from work like the last time. For those wondering how long the pain last. Hang on. It does get better and your quality of life will improve hopefully. Best advice to give is ice will be your best friend until it stops hurting. The more ice he used, there was lessened inflammation and it helped with the pain. So stay on top of the ice.