Here is a quick log of my diagnostic injections / ablations here at the BetaKlinik:
December: My first costovertebral joint injections. Single panel of 6 injections. Dramatic immediate success, followed by several days of feeling better than in years. Undone by difficult travel home about 4 or 5 days later.
February, targeted injections at same joints…. One at a time, wait an hour between. 2 absolutely positive… provocative value like discogram. That’s my pain, that’s where I feel it. All others negative. Based on great results, we ablated those 2 joints. No benefit from ablations.
July. Wednesay, 4 injections. Dramatic positive result. I’m confused because it lasts longer than local should and before steroid should have kicked in. I was good all day into the wee hours of the morning. Backslide the next day, so about 16-24 hours good? This is explained 2 days later by Dr. Reul. He did not use typical local, but used a long-lasting local.
I’m very glad that I did not know. I would have blamed placebo effect had I known.
Friday, Dr. Reul does 5 more injections. 4 at the 2 levels above Wendesday injections, plus 1 repeat at the likely offending joint. Note that these injections split the 2 culprits from February. Wednesday did the lower one… Friday did the upper one (and the lower single one – left side only.)
Friday afternoon, clear positive. Friday evening, it seemed to wear off. Possibilities:
1. Reul used medium length local?
2. Effect would have been longer, but checking out of hotel, dropping off friend and bags at train station, throwing around my own bags and making my way to another location caused earlier setback.
3. Maybe my brain thinks of medium local and caused expected result. This is all so confusing.
Saturday was amazingly good. I went to a family party with a dear friend in the Netherlands. I sit all afternoon without squirming. It feels strange to smile a natural smile instead of forcing one out through the constant tight jaw grimace that I have 24/7.
Sunday, back to slightly better than normal. I still get mid-thoracic pain when typing. I’m pacing when talking. Not sitting still for too long. Again, better than normal, but NOTHING like yesterday.
One thing to note. I was hoping for extreme positive result from the 2 positive joints that were ablated in February. This is not realistic… they’ve been ablated, so the response is muted.
I’m encouraged by the clear positive result, but still question that it might be the cumulative value of multiple injections. (If they injected steroid in my hip, it would help my back.) Still, I can’t ignore the predictable course of the longer lasting local, that I DID NOT KNOW ABOUT. So, this is good news.
However, this does not point a clear path to a solution. I would like to redo ablations at the two positive joints from Feb, but with more aggressive application of energy. Dr. Reul was conservative then, so he did not risk giving me the permanent wrap around band of numbness that is possible with more aggressive ablations. I think I’d like to risk it.
I meet with them in the morning and could probably redo the ablations then. They have that kind of flexibility here. They own all the equipment and I’m treating with the doctor who runs the clinic…. It would just take a few minutes. However, I fly home a couple of hours later. I don’t think I want to risk getting on a plane 3 hours after the nerve ablation… sounds like too great a potential for having a problem on the flight home. I’ll wait till next time. Or, I’ll do what Dr. Reul recommends. I trust him.
This log will be used as the basis for our discussion early tomorrow morning. Wish me luck.
Mark
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