DOES PAIN EQUATE TO TISSUE DAMAGE?
Part 1: My most humiliating day ever!
By: Dr. Kim Leis-Keeling
How boring would life be if we can’t laugh at ourselves and find the humor amidst the craziness? This is my tale of finding humor in a moment of humiliation. About two months ago, I had an episode of acute lower back pain. I was leaning over to put something in my bag after playing basketball and BOOM – I felt something slip in my back. Since I was familiar with this type of pain from my previous episodes (and we work with patients with this daily), I knew how to manage it: ice, cold laser, tape, modalities, bracing and treatment from my amazing chiropractor, Dr. Amanda Boccio. Over the next 2 weeks, it gradually got better to where the pain was completely gone. I felt amazing. Then I had this great idea to go pull weeds and spread mulch. BAD IDEA! My ego got the best of me with too much too soon. That night I was changing my clothes and BOOM, it happened again. But this time it was much worse than ever before. I knew immediately that the disc just herniated. I couldn’t stand upright and had radiating pain into my left leg and thigh.
The next day I was already scheduled for my lumbar MRI. (Since I had so many reoccurring episodes, I wanted to see exactly what was going on). But I couldn’t get out of bed. Every time I tried to move, I would get excruciating pain in my back and down my leg. There was no way I was going to make it through that MRI without the some pain medication. Meanwhile, since any amount of pressure on my spine increased the pain tremendously, I had to have my husband hold tension on my left leg by pulling on it. Here is the scene at my house: I’m screaming in pain, my daughter was sitting next to me, terrified and not knowing what to do, my husband pulling on my leg and getting annoyed with me (this is really going to put a wrench in his day), and my son was in his bedroom cruising Instagram - oblivious to anything going on. This could have been an episode of a sitcom. We debated about calling an ambulance…but no, I thought I could make it to Urgent Care to get the medication. So my husband bear hugged me and hoisted me out of bed, down the stairs and to the car.
Now for the crazy part. We made it to the Bone & Joint Center, but I have to keep leaning on a wheelchair to keep pressure off my spine. I got to see the doctor, he wrote the scrip for pain meds and we started to leave. But I couldn’t move! I screamed for my husband to pick me up to get the pressure off my spine. He couldn’t put me down or I’d start screaming again. I began sweating profusely and I could feel myself starting to black out. The last thing I remember was saying “I’m passing out!” (Just a side note, this happens to every time I’m in extreme pain – strange I know. More stories for another day). When I woke up, I was sitting in the wheelchair. Within seconds I started to feel the awful pain. So I screamed for my husband to pick me up again. I’m confused as to why he put me down in the first place - doesn’t he know by now that the pain is much worse when I’m sitting? Being the super husband he was that day, he picked me back up. This is when I felt that my legs were wet. My initial thought was “how much was I sweating?” Apparently, when I passed out, I had lost bladder control and peed my pants and on my husband. OH! That’s why he put me down - opps! This was a true test to the strength of our marriage! The nurse called the doctor back into the room, I panicked because there is a condition called Cauda Equina Syndrome in which you lose bladder and bowel control due to too much spinal cord compression. I asked the doctor if this was happening to me, he said no, because I didn’t lose bowel control…yet. In that second, I could feel that I was going to lose my bowels. I begged my husband to drag me to the bathroom…sparing any pride I had left. I made it to the bathroom…just in time.
By now, the ambulance team was banging on the bathroom door. Someone handed me a lovely pair of blue paper shorts to change into. They finally got me out of there in style with a personal escort service from the Albany PD, firetrucks and ambulance. I can proudly say that I bet there is a short list of people who actually left the orthopedic center in an ambulance… I should get some sort of “Most Memorable Patient Award” for this! I begged the paramedic to give me something to stop the pain, so he started an IV and suggested Fentanyl. I’d never heard of it but it sounded beautiful, let’s do it! It did nothing. Once in the ER, I was given a cocktail of morphine, hydrocodone, diazepam and steroids. Finally there was some relief. I managed to make it through my MRI. I was nervous to see the images and results because I was sure there would be a disc completely blown out. The results came back and showed a small disc herniation at the L3-4 level (the new injury), degeneration at L4-5 (which means it is an old injury) and a tear in the disc at L5-S1. You have to be kidding me…that’s it? All that pain for those results. While I knew that I herniated the L3-4 disc based on my symptoms, I expected it to be much worse.
So what is moral of my humiliating story? PAIN DOES NOT ALWAYS CORRELATE WITH TISSUE DAMAGE! So what happened that caused all that pain and drama? As physicians, we deal with this daily. Some patient’s symptoms do not match what the tests and images show. Some things are difficult to explain because, based on results, there may not be anything abnormal. In next month’s article, I’ll explain more about pain, inflammation and tissue damage. So stay tuned for Part 2. And as an update on my attempt to save face with the orthopedic center, despite my humiliation; I did treat the nurses and staff to a healthy dose of chocolate. The doctor received a bottle of scotch as a token of appreciation for taking care of me. That wasn’t my best first impression but I’m sure they will never forget Dr. Kim Keeling.
As always, if you have questions about this article please feel free to contact me at the Sports & Spinal Wellness Center at 518-869-3415. Follow us on Facebook or visit our website at www.sportsandspinalwellness.com.