Saturday, May 05, 2007

On Pins and Needles

It's been a while since I last posted. A lot has happened. A lot of Good has happened.

In my last post I mentioned that I had been feeling blue, and had been having a lot of doubts about myself. I even wondered if I might be suffering from depression. I think I have gotten over that hump. Some things have really changed for the better. Other things will be changing for the better in the near future. There is light at the end of the tunnel, and I don't feel so helpless, or hopeless anymore.

In my last post, I mentioned that I was about to undergo an EMG test -- which tests nerve response. Let me say, now after having undergone this test, that if you are about to have this test, that you should be prepared to become a human pin cushion.

When I was escorted into the exam room, I got to dress up in one of those delightful hospital gowns.

Next thing I know, the doc comes into the office sharpening his needles like a chef wielding his knives at Benihana. He explained that these were very small needles -- only 26 gauge!

I'm here to tell you that 26 gauge or not, by the time you get poked more than 50 times by these needles, that they all feel like blunt pencils being shoved into you!

The doc was accompanied by a very nice, and very young, medical assistant. She was all of about 20 years old. Take nothing away from her, she did a very good job of working the very complicated diagnostic equipment. As it turns out, she was from the small town of Fredonia, Arizona -- and was very impressed that I actually knew where she was from. I told her of a trip our family took a few years ago to Kanab, Utah. We went through her home town on that trip to the North Rim of the Grand Canyon.

The testing started out with a few "warm ups" for my nerves. The idea being that the test would better gauge my nerve responses if they were properly "warmed up" prior to the testing. The doc stuck a needle in my leg just below the knee, and another one in my ankle. Then they hooked a couple of alligator clips onto each needle and sent a "mild" electric shock through them. Next thing I knew, my leg was uncontrollably kicking. Then another set of needles were inserted above and below my ankle, and the electric shocks were sent through, and my ankle started flailing about like a fish out of water. Several other nerve groups were "warmed up" too. Now I was ready for the real test to begin. To be honest, I had had just about enough during the warm ups alone!

The needles for this test were always inserted in pairs. Every time a test was run, it had to complete a circuit. All the nerve groups from the lumbar area of my back down to my toes were tested. This included the rather indelicate testing of the nerves in my gluteal muscles. Let's just say that the medical assistant deserves to get combat pay. She had to see places where normally the sun doesn't shine -- we're talking the dark side of the moon here folks!

Another thing about the test. You not only have the pain from the prick of the needles, but when the electrical charges pass through, they have to turn up the current, until basically, it starts to hurt like heck. I always knew if he got a good reading or not, because if it didn't hurt, it didn't read.

As the test went on -- first up and down one leg, and then up and down the other -- we chit-chatted about various things. We (the doc and I) talked with the young medical assistant about her hometown of Fredonia, an how it is the gateway to the North Rim of the Grand Canyon. As it turns out, her parents own cafe's in Fredonia and in Kanab. We continued gabbing on about various other things -- which helped to pass the time during the test -- AND helped me to keep my mind off how much pain I was experiencing.

At one point about half-way through the test, the doc asked me if I was enjoying myself. I had to answer with an honest, "No, not really." I think this poor doc is beginning to get a complex about not being very well liked by his patients. He looked rather resigned when I gave him my matter-of-fact answer. It is my understanding that this doc specializes in these kinds of diagnostic tests at the Spine Clinic. This doc has a really nice bedside manner -- for a guy who is constantly needling his patients all day long. (Pun intended!)

We kept on chatting through to the end of the test. Although I was in pain during the test, I tried to be as pleasant as possible throughout the procedure. I didn't yip, or spit, or curse, or anything! Near the end, the doc commented that I should be teaching a patient education class about proper decorum and behavior for an EMG test. I guess some folks really have some negative reactions to being poked, shocked, and jolted like that. I like to think that I proved to be a welcome respite for the doc and his assistant from patients who might have a very unpleasant reaction to this test.

The results of the test were kind of mixed. The good news was that I don't have any serious nerve damage coming from the nerve roots out of my lower back. He did find that I might benefit from a steroidal injection to the left side of my lumbar area. That surprized me a little, because I feel like I am having more trouble with my right side than with my left. Especially with my right leg going numb after being on it form more than about 15 minutes at a time.

This test also confirmed what I already knew to be true. I have peripheral neuropathy in both of my feet. Although my symptoms were consistent enough for a diagnosis of peripheral neuropathy, this was the first objective test that definitively proves that what I am suffering from is in fact neuropathy. This diagnosis also came with a bright side. He told me that the nerve "wires" were not damaged. The problem stems from the fact that the sheathing around the nerves has been damaged. This results in far too much input being received by the nerves, which results in the weird combination of numbness, tingling, a burning sensation, and pain.

Since the problem is with the sheathing, and not the actual nerve itself, that means that there is a chance (but no guarantee) that in time, the sheathing could re-generate, and this condition could diminish, or go away altogether one day. The time period for this potential regeneration will not be measured in weeks or months - but probably years. Maybe as much as 5 years.

It's now been about 1 full year since the onset of this condition, which was a result of a side effect from the drug Flagyl. Flagyl is a nasty drug, and is only used in extreme circumtances -- which I was in a year ago. I have since learned some really nice things about Flagyl. Here are some excerpts from a statement on Flagyl from the FDA:
Metronidazole (Flagyl) has been shown to be carcinogenic
in mice and rats. (See PRECAUTIONS.)
Unnecessary use of the drug should be
avoided. Its use should be reserved for the conditions
described in the Indications and Usage
section below.

And then there is this regarding peripheral neuropathy:
Two serious adverse reactions reported in patients
treated with Flagyl (metronidazole) have been convulsive
seizures and peripheral neuropathy, the
latter characterized mainly by numbness or paresthesia
of an extremity. Since persistent peripheral
neuropathy has been reported in some patients
receiving prolonged administration of Flagyl,
patients should be specifically warned about these
reactions and should be told to stop the drug and
report immediately to their physicians if any neurologic
symptoms occur.

I honestly don't remember if I received this warning or not about Flagyl. I did call my then Dr. at the time (no response from him for a couple of days). With no response from my Dr. I called the home health care pharmacist. I explained that I was having this constant pain and numbness in my feet, for about the last week, and I wanted to know if any of the medications I was taking might be causing this. He promptly looked it up, and said that Flagyl might have that effect. He told me to not take any more of it until he could consult with my Dr. Somehow, he was able to get through to my former Dr. (when mere a mere patient couldn't get through) and confirmed with him that I should stop taking this drug.

I don't harbor ill will for the Dr. Flagyl may very well be responsible, at least in part, for saving my life. It's true that I have since changed doctors, because I felt like he was too slow to act, and not aggressive enough when my health was headed for crisis. If I wanted to, I could point the finger of blame for getting me into that crisis in the first place, and blame him for the after effects that may hamper me for years to come, if not for the rest of my life.

For now, I rely on heavy doses of neurontin and and ibuprofen every day, just to keep my neuropathy controlled to the point that I can function.

So the EMG test confirmed what I already knew. Not that it really makes a difference. However I now have proof, if every anyone questions me, that I really do have peripheral neuropathy. It's not just in my head --- its in my feet!