Tuesday, July 10, 2012

Pain Meds When You're a Drug Addict

If you read this entire blog from the beginning, then you know that I am a drug addict.  Specifically, I was addicted to cocaine for 3-4 years and nearly died from it.  I am now in remission, have been clean and sober (I believe alcohol is a drug) for 3.5 years.  I am active in recovery (although there have been long periods of time that I am not) and I follow a 12 Step Program (Narcotics Anonymous).  So I believe that I suffer from a disease of addiction, that can be contained but never cured.  It is like having diabetes- you can't have too much sugar. You have to do a number of things to make sure your blood sugar levels are safe, you have to maintain your disease by doing certain things- some of which may be uncomfortable.  And you will always be a diabetic.  That's how it is for me.  I have to do certain things so I don't relapse.  And I will for the rest of my life.

So what happens when a doctor says to the drug addict, I will give you pain medicine (narcotics) to help deal with your chronic pain?  Do you do it?  At what cost?  It scared me.  I wasn't really addicted to narcotics, cocaine was my "drug of choice..." but it really doesn't matter.  I am a drug addict and should avoid any mood/mind altering substances. Some people in NA are hard core, and believe that an addict should NEVER take anything addicting or mood altering; as in no anti-depressants, no drugs that help reduce cravings, no other medication to help through initial drug detox, and no pain medicine.  I believe it is a personal choice for each individual to make, along with help from their sponsor. 

I had become lax in maintaining my disease...it doesn't matter how many days or weeks or months I have clean- the addict inside of my is alive and well.  It tells me that I am doing great and don't need those meetings.  It tells me that nobody gets me and that I am different from all those other addicts.  It tells me that a sponsor doesn't really know me.  And when I feed that voice, I start to think I am normal and stop all my recovery stuff.  Usually, I tell myself that if things get bad, I know where to go.  Well that is also addict-talk.  It took some comments from my parents to help me see where I was headed.  So I got my ass back to meetings.

My sponsor and I discussed my situation...we decided that I did not need to be a martyr.  I could find a way to take the pain pills safely and as prescribed.  My fear was that if I did not get control of the pain, then I would get more and frustrated and tired and hopeless and eventually start using my drug of choice for some relief from all the discomfort.  Far better to take narcotics safely and control my pain so I don't go wacko.  Some addicts that take pain medicine have a non-addict hand then their pills.  I did that at first- my father would leave only enough for me for a few days at a time.

Honestly, my addict is so strong, that she even told me that I couldn't go to meetings if I was taking pain pills.  And then I lied and told my mom that's why I didn't go to meetings. Not true.  My addict will make me lie to myself and anyone else nearby.  My sponsor helped remind me that what I do regarding this is MY business, and I don't have to share all the details with everyone in the program.  And I don't.  I share enough to get support and to give support.  I have an instant family when I am active and go to meetings.  People that do know me and how I feel.  That is the truth.  The other things my addict tells me are lies.

When I started seeing the pain management specialist, The doctor told me how proud he was of me- that I came on my own for help, and was honest about my disease and recovery.  The doctors in his office make me drug test occasionally and bring in the pills I have left over so they know exactly what to prescribe.  They speak to me about limits.  They have me try other medications other than narcotics for pain.  I feel so much better, knowing I have someone watching me, monitoring me.  It doesn't show my weakness, it shows my strength and wisdom. I am strong enough to take the right precautions, knowing that I have a disease of addiction that can kill me.  And I am not going to let my battle with AVN take me there.

Friday, July 6, 2012

2nd, 3rd and 4th Opinions

It was time to take a good hard look at where I was.  I forced myself to take the emotion out of my situation. Yes, I was angry at Dr #4- but that anger wasn't going to help me figure out what to do about my AVN.  I pushed all that anger, and the fear, shame and shock out of my head.  That stuff I would deal with in my NA meetings and by working with my sponsor.  But outside of that, I needed to get a good doctor that respected me and was competent dealing with my diagnosis.  Someone who would present me with all of the options and help me make a decision that was right for me.

So I got on the phone.  I know plenty of people in the medical field!  My parents had friends that had had hip replacements!  And my back surgeon (Dr #3) had a partner that was a hip specialist.  I had plenty of resources to work with.  I made some calls and soon I had a list of 4 doctors that had good recommendations from people I know.  I got on the phone and made appointments.  One couldn't see me for over a month, so that wasn't going to help much.  In the meantime, spent more time online, learning as much as I could about AVN and all the current treatments.  When I went to all these doctors for their opinions, I wanted to know enough to at least ask the right questions.  I went to each one of them with copies of every MRI and Xray, and the all the radiologist reports.  I'll basically summarize what they said:

1.  This doctor said he thought that my pain was just from arthritis.  He suggested no weight bearing on my left hip and to take anti-inflammatory drugs and the pain would subside in about six months.  He actually said "I think you should do nothing- people live with AVN their whole lives without doing anything surgical about it."  He did say thought that there was a good chance that my femoral bones would collapse, and then I would need a THR.  This just didn't sound right to me.  I had done enough research to know that AVN doesn't get better, and there are options to at least explore besides just waiting for my bones to collapse and then being forced into the only option at that point.  And what about the pain I was in?  What good did taking all the pressure off my left hip, if I had AVN in my right hip as well?  Just didn't make sense.  I thanked him for his time and left.

2.  This doctor basically discussed total hip replacements.  He said that he didn't think core decompressions had a good enough success rate, especially with the severity of my lesions.  He talked about the minimal approach THR.   When I asked about the Free Vascularized Fibular Graft (FVFG), he said it had a better success rate, but good luck finding someone to do it.  He did agree that if you had a surgeon trained to do it, it was a reasonable option for someone my age, but he didn't know anyone who did it.  He said that a prosthetic hip's life expectancy is directly related to the amount of impact you put on it.  He admitted that I would most likely need 2 revisions in my lifetime.

3.  This doctor went over all of the options I mentioned above- from doing nothing, all the way up to THR. He explained to me his approach- that the goal of medicine should be to preserve a patient's own body as much as possible.  He talked a lot about the FVFG and said that if it works, you have your own body parts with no limitations.  He said with artificial hips there are limitations- yes people chose not to abide by them, but that shortens the life of the artificial hip.  I asked about the success rate of FVFG and he told me it was quite good, especially for my staging, and told me about the work being done at Duke.  He was honest about the long recovery process.  He then went on to say that I was lucky because one of the surgeons who trained at Duke when the procedure was being developed in the late 70's was very close- at USC.  He gave me his name and number and said go see him- what have you got to lose.  He said if I was you, I would be getting the grafts.

I had gotten good information from three different physicians.  On one hand I was frustrated by a disease that had such controversial treatment options.  AVN was NOT an easy disease to treat.  On the other hand, I was grateful to have options available.  And I realized that Dr #4's outburst was a gift in disguise.  He did me a disservice by how he treated me, and I didn't even realize it til I got all of these other opinions.  He did not realistically discuss all of my options.  He quickly dismissed them saying they didn't work, rather than explaining them to me and letting me choose.  But he is a joint replacement specialist.  Most of what he knows revolves around replacing joints.  For all I know, maybe he realized this, maybe he felt that he had led me too quickly into a THR and didn't really consider the other options.  Maybe his pride got in the way, and instead of just telling me that he should have reviewed other treatment options with me, he had to blame it on me and what I hadn't done.  Or maybe it wasn't that complicated- maybe he was just mad that I hadn't quit smoking and simply didn't understand addiction enough to be compassionate about his approach.  He was right- I needed to quit.  Whatever happened, he was still one of my least favorite people (he really was so mean), but in the end, his freakish behavior turned out to be a very good thing for me.

Regardless, I knew my next step.  I called USC and made an appointment with Dr. Milan Stevanovic.  I would see him in about two weeks.  And in the meantime, it was back to the computer to research everything I could about FVFG.

The light goes out

I was looking forward to my appointment with Dr #4.  I had questions about surgery (THR) and recovery.  I was excited to get on with things.  I had lined things up with friends and family- we were all ready for surgery- now just 3 weeks away.  But the appointment did not go as planned.

It was like someone took the Dr #4 that spent so much time with me and was compassionate, and replaced him with a monster.  Remember, I am a nurse.  My dad is a surgeon.  My sister is a surgeon.  I have worked with doctors for over 20 years.  I know the personalities.  I'm okay with demanding and arrogant personalities- to an extent.  I am not even sure that I can accurately convey how I was treated during that appointment.  I was yelled at.  I was treated like an idiot.  I was accused of not taking care of myself.  I have never, ever, in all my years as a patient, as a nurse, as a daughter heard a doctor speak with such disrespect toward a patient.  And that patient was me.  Dr #4 was obviously pissed off that I hadn't quit smoking yet.  He berated me for that.  I was so disappointed because he is a physician.  I am a drug addict- yes I am in remission and clean, but I will always be one.  I understand addiction as a patient and as a nurse.  It is so shocking that those in the medical profession refuse to understand what addiction is.  I am addicted to cigarettes.  I wish it was easy to quit on demand.  I wish I didn't love smoking.  But that's not how it works, and instead of approaching it that way, as the disease and medical model of addiction, my doctor tried to shame me in submission.  That doesn't work.  Ever.  I wanted to be strong enough to laugh in his face when he implied my weakness- I wish I could have looked in his face and said- "Now hold on doc- I quit cocaine!  But it wasn't because some incompetent fool yelled at me!"  But instead all I could do was choke back the tears.  And at that point, I completely lost faith in him.  And he has a reputation for being the best doctor for hip replacements.  What a let down.

He went on to say I should get a second opinion.  He then ripped me apart because he accused me of not being prepared for surgery, or understanding it and the recovery process.  He said I wasn't using the walker all the time, like he said to (which he did not).  He was all over the place.  Even my dad was fuming.  At the end of all of this, I told him that I didn't understand why last week he was so willing to set a surgery date and now, 7 days later, he was suggesting a completely different plan.  What changed? Didn't he understand what this means to me?  I have been in pain for 7 months!  I thought we were headed towards surgery and then this was thrown in my face.

My father and I walked out.  I was shaking and sobbing.  I felt like the roof had just caved in and I was lost again.  I wish that Dr #4 could have been me, and really appreciated how he made me feel.  My dad didn't know what to say to me.  I actually think he was a bit embarrassed on behalf of his profession.  But mostly, I think his heart was breaking watching his daughter struggle through this.  Watching me crumpled and humiliated and full of shame.  He saw me like this before- when I went into rehab.  And then he watched me work through it, find myself and my strength.  He saw me work hard to get my life back.  To crawl out from the shame.  And then, today, he witnessed a stranger bring me right back to that ugly place.

All I knew at this point was that I was back at square one.  I couldn't let that man touch me.  I don't care if he was the best hip surgeon.  It takes more to be a good doctor than technical skills in an Operating Room.  I went home, crawled in bed and slept.  

Walking towards the light

The next month was a blur at first.  It really took me about a week to just adjust to my new diagnosis.  It was strange- the gamut of emotions that I was feeling.  The most surprising to me was that I felt relief!  I felt validated- that my pain wasn't in my head.  That what I was feeling, subjectively, was due to something really wrong with me- something that could be seen, objectively!  One of the worst things about pain (for me) is that unless you are bleeding or obviously broken, or showing some signs of trauma, people don't get it.  It's almost like they are skeptical.  And I have been guilty of this.  I am a nurse! I had to listen to patients complain about pain all the time.  I had to judge whether their symptoms matched their complaints.  And often they did not!  There was a whole movement years ago about whether we, as a medical community, were addressing and treating pain appropriately.  That's why nurses and doctors ask us to rate out pain (you know that 1-10 scale...) over and over again.  It's an attempt to objectify and subjective feeling.  And with the rise of the abuse of pain medicine, sometimes this assessment/treatment thing gets very tricky.  But I digress... It felt good to know that there was a reason for my pain.  A diagnosis.  Other people have this!  And better yet, there are treatments.  There is controversy over the particular treatments I had to chose from (as I would learn in even more detail later), but there were treatments! Choices!  Some patients have none.  For this, I felt gratitude.

But that was pretty much it for the positive emotions.  I also felt anger (why me?).  Sadness (why me??).  Confusion (why me???).  Despair (why me????). I threw a pretty decent pity-party for myself.  It lasted about a week, and I threw a darn good one.  I was irritable.  I snapped at my kids and family.  I slept a lot.  I smoked a lot more (no I wasn't one of those patients who after smoking for so many years suddenly stopped when learning that my smoking was finally showing how unhealthy it was).  I isolated.  I cried.  I cursed.  I let those horrible visions of the wheelchair-living, donut-eating, cat-breeding, disability-getting lonely lady fill my head.

But then I stopped.  I threw myself deeper into my recovery and 12 Step program:  Started working with my sponsor more, going to more meetings.  I went to the pain management doctor and committed to work with his team so that I treated my pain correctly.  I wasn't going to be a martyr, but I was worried about addiction to the pain meds. I reached out to friends again and shared what was going on, talked about it.  I spent hours and hours online, researching and looking for anything I could about my diagnosis.  I practiced asking for lots of help.  I practiced accepting lots of help.  I started taking care of myself again, and being kind to myself.  I started a diet- a serious one.  I used the Medifast program and stuck to it.  It's hard to lose weight when you can't exercise- but I did it.  I made another appointment and got my hair done.  I got a few massages.  I took a trip- so see my college roommates in Phoenix.  I wasn't sure about going, but my mom actually encouraged me to go, I hadn't seen those friends for so long.  And I needed to get away from the stress.  When I got back, I helped my best friend plan her wedding.  I started reading again.  I started listening to music again.  I started enjoying my kids again.  I started doing more.  Even if it hurt.  I took my pain medicine and got outside.  I was determined to be emotionally and physically prepared for surgery.  I wanted to be normal again.  I wanted to not be in pain.  I wanted to move forward, fix my problem the best I could, and resume life...

My biggest hiccup was the smoking.  I cut way down, I really did.  I had been a half to full pack a day smoker and I was down to less than half a pack a day, usually less.  But I hadn't quit.  I couldn't even use nicotine gum or patches.  Remember- it wasn't the "smoking" part he was worried about- it was the nicotine and how it caused blood vessel constriction that was my biggest enemy.  I had to just stop.

About four weeks after seeing Dr #4, I suddenly started having much worse pain.  I could barely walk.  Sometimes my pain would "flare up" for a day or two and then back off if I slowed down and rested.  But this time it didn't, no matter what I did, it was worse.  So I called the doctor.

Dr #4 was very kind when we spoke on the phone.  He said that it was time I started using a walker- to get the weight off the left hip.  This was for my comfort, and also to prevent the femur from collapsing (some of you may be wondering why he didn't have me on a walker or crutches to begin with.  It's a good question.).  He told me to use it when I was hurting a lot.  He didn't want me to stop moving, but also didn't want me needing more narcotics.  He asked me how the smoking was going.  I told him the truth.  He said he needed me to be smoke-free when he operated.  The he asked me when I would like to have surgery- a total hip replacement (THR), i.e. what date in the next month works with me in terms of getting the help and support I would need afterward.  He reminded me that I would be able to do anything I wanted to once I had healed, that my life would be perfectly normal, no restrictions. We chose a date.  He told me to call his office back that afternoon and schedule an appointment with him for a week before surgery, and also said there would be some other things I would need to do to prepare that his assistant would go over with me.  I reminded him that I had an appointment with him in a week, and ask should I keep it?  He said he had forgotten, but keep it and we could talk more about the surgery in detail.  He even joked and said don't forget to bring your dad!

In the next week, I had gotten a walker and a cane.  I was down to about 5-6 cigarettes a day.  I was down 10 pounds already too!  My family and friends had the surgery date on the calendar and we were starting to makes plans for it.  I let my boss at work know the latest and was finally able to give them a tentative idea of when I may be back.  I wasn't happy about getting a fake hip, but for the first time in months, I could actually see light at the end of the tunnel.  Even if I was limping toward it, I was making progress!

Wednesday, July 4, 2012

The only way out is through

My father and I drove home.  I don't think either of us said much in the car.  We got to my condo and I headed to the patio for a much needed cigarette.  I think I was numb.  When I came back inside, I immediately opened up my laptop and put "avascular necrosis" into Google and began my search.  My father was doing the same thing on his iPhone.  A few minutes later, Dr #3 called and told me to call Dr #4- his office was going to try to get me in that afternoon.  When I called, they actually had an appointment open in just an hour.  I remember then calling to cancel my hair appointment.  It made me very angry to have to do that.  I hadn't had my hair touched since all of this madness started.  I had dark roots and gray hair which certainly wasn't helping my pudgy-faced steroid look.  I hadn't been able to get my hair done because I couldn't sit for that long.  But I finally decided that it was time to do something nice for myself and had made the appointment a few days ago.  Was it symbolic that I now had to cancel?

For 45 minutes, my dad and I quickly received an online education about avascular necrosis, or AVN.  It was not common.  It usually affected men more than women.  Known causes are excessive alcohol intake, and long-term high-dose steroid use.  About 35% of cases are idiopathic- no known cause.  I was a drug addict, but I did not have excessive alcohol intake, and the steroids I had over the past few months, while it was a lot, wasn't long-term or high dose.  As far as treatments- well there weren't much.  AVN turns out to be a very challenging disease because there is no medical management, and the surgical interventions vary greatly in their success rates.  There is core decompression, bone resurfacing, bone grafting (transplant)... The only "successful" treatment is a total hip replacement (THR).  "Successful" because it removes the dead bone completely and replaces the joint with a prosthesis.  But even that doesn't fix the problem for good, because the materials used for THRs wear out over time.  The younger you are, theoretically, the more revisions you will need.  The less impact you put on the artificial hips, the longer they last.  So depending on how long you want your new hips to last, your high impact activity may be limited.

An hour later we were in Dr #4's office.  He was loud and a bit arrogant.  But it didn't bother me.  My dad was a surgeon, and I had worked with this personality for years.  I was actually quite impressed with the time he spent with us.  He explained that my MRI showed that my left hip had about 35-40% necrosis and the right side had 30-35%- both of which are pretty large lesions.  The regular x-rays showed that the femoral heads were still the correct shape- rounded.  When the necrosis gets bad enough, the bone will eventually collapse, which will cause more pain and difficulty with range of motion and weight bearing.  Once the bone collapses, the only choice is to do a THR.  The choice about other treatments- to avoid or postpone the need for THR- is the controversial one. In his opinion, none of the other interventions had a good enough success rate to justify trying.  Basically, his thought was that when the pain got unbearable, the best option would be to do the THR.  At this time, this made sense to me.

Dr #4 was concerned about a number of things.  First, I was a mess in his office.  I was crying and very emotional.  I had already been depressed, this certainly didn't help my outlook at this point.  He observed this and said that I needed time to let this all sink in and get emotionally prepared for the surgery and recovery.  I was a little bit embarrassed- yes I was pretty shaken up.  But I am not by any means a weak person in general.  At this moment in time, I appeared to be falling apart.  I remember him doing something that was pretty powerful- he grabbed hold of my hands and looked me in the eyes and said "Look- this isn't cancer and it isn't a massive heart attack.  You won't die from this.  And young patients with THRs live as full a life as they did before the surgery."

Second, the pain issues.  I was still having sciatica pain.  He was concerned that if I had this after surgery, it might negatively affect my recovery and make physical therapy difficult.  Third, he knew that I had back surgery just a month and a half ago and said it would be better to wait a bit before jumping into another surgery so soon.  Fourth, my smoking.  It was absolutely imperative that I quit.  Nicotine constricts blood vessels.  It could be speculated that my 20+ years of smoking contributed to the AVN- by repeatedly constricting my blood vessels, it could have affected the blood supply to my hips.  But more importantly, good healing needs good blood flow- especially when my bone will need to heal well around the implants.  In addition to the healing aspect, there are other concerns with my lungs and anesthesia, and the formation of blood clots.

He wanted to see me in another 6 weeks, with the goals to be that in this time period, my sciatica would be improved, I would be mentally prepared to go forward with surgery, and that I would quit smoking.  I felt this was all reasonable and made good sense.

Driving home, I felt absolutely exhausted.  It was so much new information.  I was scared.  I was worried.  All I wanted to do was smoke a pack of cigarettes.  Quitting smoking seemed almost impossible.  I was overwhelmed by all of these emotions.  I had these horrible visions of me being grossly overweight and wheelchair bound and living in a trailer with a dozen cats on a disability income.  Which was totally ridiculous.  I went home and got in bed.  I didn't really talk to anyone for a few days.  I needed to cry and yell and throw things.  I needed to go through the emotions.  It was sort of like Elisabeth Kubler Ross's stages of grief.  This wasn't easy for me.  I am a drug addict.  For years, I coped with uncomfortable feelings by taking drugs to mask them.  I numbed out.  That wasn't an option for me anymore.  I had to reach down deep, and use the coping mechanisms I had learned since becoming clean.  This was the hardest thing I had gone through since then, and it was going to be a hell of a challenge.

Tuesday, July 3, 2012

Dead bone

My father had come with me today to see Dr #3.  It was a few days before my 44th birthday.  I was getting the results of my follow-up MRIs- of my lumbar spine and of my pelvis.  The pelvis MRI was done just in case we had missed something and the pain that I was still experiencing after surgery was coming from some other place besides my spine.

The doctor told me that my spine looked fine and that the surgical area was healing as it should be- there was no re-herniation of the disc.  But the MRI of my pelvis as not normal.  He held up the actual MRI to the viewing box and pointed to some white-ish areas in the heads of both femurs- the "ball" of the ball and socket hip joint.  He said that these areas were basically dead bone- that I had "bilateral (both sides) avascular (no blood supply) necrosis (dead bone)."  I knew that this was bad.  I was a nurse.  Any time you have dead bone it's bad.  And when it is in the most weight bearing joint of your body, it's really bad.  I am pretty sure that I went pale as the blood drained out of my face.  I know that the room suddenly looked weird to me- as if I were watching myself.  I remember looking at my father, who's stunned face matched how I felt inside.  It all made horrible sense to me now- why I had pain still, why it was in my hip, why the surgery didn't help...It's ironic how getting news like this, while devastating, also brings relief.  Relief that there was a reason, a medical diagnosis, a significant medical diagnosis, that was causing my pain.  It wasn't in my head.  I wasn't crazy.  The pain I felt was real.

I am a nurse.  And I knew what the diagnosis meant, medically.  I had taken care of many people with hip dislocations, and understood that these patients needed their hips reduced (put back into joint) in a timely matter.  Otherwise the blood supply to the bones would be impaired and cause bone death- avascular necrosis.  But I was an ER nurse and that was the extent of my knowledge about the diagnosis.  The only thing I remember, sitting in that office, was knowing enough to ask the doctor "I am going to lose my hips, aren't I?"  He looked down, and then sort of shrugged and said "Maybe."  

I don't remember too much more of what we talked about, except that this was something we had to deal with right away.  He wanted me to see a hip specialist the next day.  His partner was one, but was on vacation for another two weeks.  So he told me that he was going to call another, we'll call him Dr #4, and try to get me an appointment as soon as possible.  We also discussed pain management.  At this point, even before the bad news, I was getting worried about the pain and amount of percocet I was still needing.  I was now taking a number of powerful medications that were all prescribed by different doctors.  I wanted one doctor to oversee all of these medications, and make sure what I was taking was safe, especially given my addiction history.  I was not going to be a martyr and forego pain medicine, but I wanted to do it in the safest way possible, with a doctor who understood addiction.  Dr #3 gave me the name of someone he trusted.

I remember us joking a little bit as we left.  This doctor was, and had been, very kind.  I could tell he was extremely sympathetic to my situation and to the pain I was in.  The laughter we shared was about the fact that we knew he was relieved that I was no longer his "problem patient."  He said that as soon as they got in touch with the hip doctor, they would call me.

As we exited the doctor's office building, I looked up at the sky and said aloud "Thanks a lot.  Like you haven't thrown enough crap at me already."  There were tears now.  And I was scared.  I am usually pretty good at accepting what I cannot control these days.  But on that day, I had had it and frankly I was pissed off at my higher power.  You know that saying "Whatever doesn't kill you makes you stronger?"  I was (still am) SO sick of hearing that!  (Thank you very much, Kelly Clarkson, for putting the phrase I hate the most to music that has topped the charts, by the way...)  I am as strong as I want to be right now.  But what I want and what I get are two very different things.   There are things in my life that happened to me because of my poor choices, I accept that.  And then there are things that happen, that simply JUST HAPPEN.  It makes no sense to me right now, I can't see a reason for it, or find my part in it.  But I have faith that someday I will have a better understanding.  I will be able to appreciate this experience.  There will be gifts in all of this.  It may not be clear to me now, but I have faith that it will be revealed to me when I am ready to hear it.

But that day, I was pissed off, scared, and anxious about what was to come.

Thursday, June 28, 2012

Surgery (the first one)

By now it was the end of January.  This had all started in November.  I had my appointment with Dr #3- the third back specialist.

I brought my dad to this appointment.  I respect my dad's opinion and I wanted someone else there to ask the right questions and remember what he said.  I explained what had been going on with me since I been injured, and we reviewed my MRI and xrays.  After a good discussion, this doctor felt that the next step should be surgery.  He suggested that he would do a microdiscectomy, to remove the part of the disc pressing on the nerve root.  He agreed that I may have nerve pain that continues for a few months after surgery, but reasoned that I have had pain for such a long time anyway, that it's worth doing.  He would do the surgery at an outpatient surgery center- it was a pretty quick procedure.  I would be walking right afterward and home that night.

I was so happy to be having surgery.  It's not that I wanted to be cut open- don't get me wrong.  But for so long I had been struggling with everyday pain.  The worst part for me was not knowing what would be happening.  I am not a control freak, but I do like to know somewhat what to expect or what will happen.  A lot of people struggle with this, but addicts have an especially tough time with this.  We spend a lot of time and energy trying to manipulate people and things around us, with the false belief this will enable us to control our world.  For the past three months, I had absolutely no control over what was happening to my body.  I had no idea how long it would last, or what would be happening in my life in relation to it all.  So for me, surgery appeared to be (hopefully) the beginning to the end of all of this.  I had faith that this would fix the problem and I would be on the road to recovery and get back to living.

Surgery was February 17.  It went fine.  After the surgery, Dr #3 did tell us that the nerve root looked very red and inflamed, so I should expect to still have pain for a while (possibly 2-6 months!).  When I was able to walk to the bathroom and my pain was somewhat controlled, I was discharged home.  I got a large back brace to wear.  I was told no twisting or bending.  The overall pain wasn't too bad, but certain positions were very painful.  I could not sit up in the beginning- as time went on I was able to sit for longer and longer periods of time.  Sitting to go to the bathroom was the worst.  I used a lot of ice, and took the percocet Dr #3 prescribed when I needed it.  I was still very worried about my using narcotics, and in the beginning I was trying to hold out and not take them.  My family actually had to remind me of the right way to take pain meds: keep a steady level of them in your body, so take them at evenly spaced intervals so you don't get behind the pain and have to play catch up. Things I have told thousands of patients over the years...but I was hesitant.  The last thing I needed was to get hooked on opiates. Slowly but surely the surgical pain went away and I was able to return to the level of activity I was at before the surgery.

Four weeks after surgery, I still had pain.  It was getting better in my lower leg, but I still had pain, bad pain, in my hip and thigh and knee and shooting down the back of my thigh.  I couldn't sit or flex my hip without pain.  It seemed to be activity related- the more I was up on my feet and moving around, the more it hurt.  By the end of the day I the pain was unbearable.  The longer I was flat, the better.  But then I was always falling asleep- because I was laying down most of the time.  And I am one of those people that the percocet seemed to have an opposite effect on in terms of sleep- it wired me! I spent many nights wide awake (good thing I'm a Law and Order fan!).  I tried to get into a daytime "schedule" to at least busy my mind, to give my day some structure.  The internet and my laptop became my best friends.  I started reading again.  I even started knitting scarves. And I am not the knitting type...

At my 4 week post-op appointment, Dr #3 saw how much pain I was in.  I could barely sit (and I had to wait in his waiting room for an hour before seeing him!).  We decided to repeat the back MRI to make sure everything was healing right and that I had not re-herniated the disc.  My dad was with me again, and we both asked the doctor to order an MRI on my pelvis as well.  We wanted to make sure that there wasn't something going on below my back that could be causing the pain.  He agreed.

A week later I had both of the MRI's and another week later I was back in Dr #3's office.  This time my appointment was first one of the day, so we did not have to wait as long to be seen.  I had brought my dad along again,  Good thing I did, because I was about to have my world turned upside down.

Wednesday, June 27, 2012

Steroids and the aftermath...

Two weeks after I had seen Dr #1 (I end up seeing quite a few doctors, so I figured that I would just label some of them by numbers...), I was back in the office to review the MRI results.  In the meantime, I was going to physical therapy three times a week.  I was lucky to have a therapist that knew me very well, as he has been in practice for a very long time and seen me many times after I had injured my back in the past.  I have been to other physical therapist over the years, but this one was by far the best.  Too bad that even with my insurance, it was $40 a visit.

Dr #1 said I had two lumbar disc bulges, one was significant at L4-5 and impinging on my nerve root.  This nerve  root travels down through the hip into the sciatic nerve, which reaches all the way down the leg.  He suggested an epidural injection.  A lot of you know what that is, but basically an epidural is done by an anesthesiologist, usually under sedation.  Steroids and numbing medication are injected into the epidural space, which is where the nerve and disc space are.  Steroids help decrease inflammation and also help the healing process in general.  Goal- disc bulge shrinks up and irritated root heals.   The numbing medicine is a diagnostic tool.  If, after the injection, the pain is gone, theoretically, you can assume the injection targeted the right place.  Sometimes it takes the steroids a week or two to feel the benefits of it.  The problem with the numbing medicine is that when it is injected, it can leak up and down to other nerve roots, so it's not a perfect test.  Also, usually a patient needs a series of 2-3 epidurals.  I had some relief in my leg pain immediately after, but not completely.  Two weeks later my pain was unchanged.  So I had another epidural two weeks after that.  Again, no change.  In fact, three days after that injection, I bent over to pick up a sock on the floor and when I did I felt a pull and could barely get upright.  Luckily I was steps from my bed and my sons were home.  I could barely move.  My parents came down to help me because I couldn't even get to the bathroom on my own.  I was flat on my back with ice packs for another three days.  I was in such excruciating pain that it hurt to breathe.  I finally had to take a vicodin to get some relief.  Luckily I got better about 3 days later and only had to take a few vicodin.

I called Dr #1 and we discussed options at this point.  He said that surgery would would be difficult because the surgery itself may cause nerve pain for 3 months after.  He suggested trying another epidural.  At this point, I was not any better.  In fact, The sciatica seemed worse than ever, and I was already 3 months into this.  It was time for me to think about maybe another opinion. So I asked around.  My anesthesiologist (who did the 2 epidurals) had suggested someone.  So I went to see Dr #2.

Dr #2 spent a good amount of time with me, really examined me well (Dr #1 really didn't do that).  He thought my pain might be from sacro-iliitis- inflammation of the sacro-iliac joint that is located in the hip.  He suggested an injection into that joint space- basically same medications and idea as an epidural, but in a different location.  I thought he was going to have me schedule it with an anesthesiologist but he said he could do one for me right then and there in the office.  I said okay.  My mom had come with me so I wasn't worried about driving afterward.

This injection hurt, a lot.  And I can handle a lot of pain.  He was moving the needle around deep in my hip trying to get to the right place.  At one point, I am 99% sure he hit my sciatic nerve because i felt an electric shock shoot down my leg that literally caused me to jump off the table.  His nurse had to hold me down.  I was sobbing and shaking, face down into that white tissue paper they put on the tables.  I remember it vividly because the paper, wet with my tears, was sticking to my face and I couldn't reach up to remove it because they were holding my arms down.  And I remember glancing up at my mom and she had a look of horror on her face.  Not fun.

When I left my entire leg from the hip down was numb.  I could walk but it was very difficult because I couldn't feel it at all.  So since my entire leg was numb, it was really hard to know if it helped me or not.  It took away all feeling, not just the pain! We scheduled an EMG (nerve test).  Nerve tests help tell if there is nerve damage that could be causing the pain.  We also scheduled another follow-up sacro-iliac injection- this time to be done by the anesthesiologist under sedation (thank god).

Two days later, I awoke at 3am with burning pain in my left knee and ankle.  Burning from the inside, and a sensation of my skin burning as well.  My skin was itchy and flushed on my legs.  It hurt so bad and any movement of my legs made it worse.  Honestly, it felt like my legs were on fire. I had to take vicodin, this time one didn't touch the pain, had to take two at a time to get any relief.  I called Dr #2's office later and spoke to his nurse.  She said it sounded like neuropathic pain and that she would tell the doctor but there was nothing to do.

I had a follow up appointment with the anesthesiologist the next day.  I was still in agony.  In his office, my blood pressure was 156/92 and my heart rate was 122- I usually run around 105/60 and my heart rate is usually 70.  He started me on Lyrica (Pregabalin)- it's a med for nerve pain, as he agreed that this pain appeared to be neuropathic.

Another few days later, I finally started feeling better in terms of pain, but I still has this burning sensation.  I noticed that I had a rash on the back of my upper hip.  It started in the middle and extended in stripe like pattern to the left.  It was red and raised, like clusters of small blisters.  I had SHINGLES.  Crap.  What else can go wrong?  I had taken care of patients with shingles and knew that it was painful, but I had NO IDEA how bad it was.  Now I know.  It's bad. 

The next day was my Nerve Test/EMG.  It was in the same office as Dr #2 so the nurse looked at the rash, as well as the doctor conducting the Nerve Test and they agreed that I had shingles.  I had the nerve test, which showed some abnormalities along the S1 nerve.  Which really didn't help us because that was not the nerve being pushed on by the bulging disc.  Great.

Next trip was to my General Practitioner ("family doctor") to treat the shingles.  I was started on an anti-viral, Acyclovir, that I had to take five times a day for two weeks.  Ironically, the Lyrica that I started for nerve pain is exactly what they prescribe for the nerve pain associated with Shingles.  The next day I awoke with a pasty feeling mouth.  When I looked at it, my entire mouth all the way down my throat was covered in a white film.  When I brushed my teeth, my gums bled.  Now I had THRUSH.  Super.  Steroids are great but they have serious side effects- one of which is that they surpress a person's natural immune system.  This, and all the stress I was under, probably led to my shingles and thrush.  I called my GP and he started me on Nystatin mouthwash and Diflucan.  The medication list kept growing.

I felt like I was slowly starting to fall apart.  I got pretty sick from the shingles- felt like I had a really bad case of the flu.   I was in bed all the time.  The Lyrica made me very sleepy.  I needed a lot of help at this point with the boys as I couldn't drive safely and could barely cook.  I was miserable and sick and in pain.

When I showed up 2 weeks later to have that second sacro-iliac injection, I told the anesthesiologist what had been going on.  He didn't want to inject the same place again and was hesitant to give me any more steroids at all.  He looked at my Nerve Test results and said he thought we should try to inject the S1 nerve since it was the abnormal one on the test and my pain fit that pattern.  I agreed.  But I didn't get any relief from this one either.  I checked in with Dr #1 and we discussed surgery, but he still didn't think it was a good idea.  I wasn't feeling too great about Dr #2.  The anesthesiologist looked concerned when I told him about the office injection.  I wasn't going back to see him.  A few people gave me names of doctors they had seen and thought were good, and the same name popped up a few times.  I ran it by my sister and she agreed... so I made an appointment with Dr #3.  I was turning into the patient that I hated treating as a nurse (we used to call them 'doctor-shoppers"- people who would change doctors again and again until they found someone who would do what they want).  I don't think I fit into that category, I was honestly motivated to finding someone who was committed to help me get some pain relief and get me back to work and my usual living.  But I was starting to feel like I was in an un-popular category of patients.

This time was extremely emotionally draining.  Being in chronic pain is indescribable to people who have never experienced it.  There were days that I thought it was all in my head.  I felt like people around me were watching my every move- looking for proof that I was in pain.  I had to respond to invitations or potential plans with "I will try to be there it just depends on how I feel."  I hated that phrase.  I had an appointment with my OB-GYN around this time.  On the day of my appointment, I was in so much pain that I could not get my legs up into the stirrups.  I was crying as my doctor worked with me to get the pelvic exam done in a not-so-traditional way.  We talked a bit about what was going on and she suggested I start an anti-depressant.  She prescribed Celexa, told me it was a mild mood stabilizer and began to work relatively quickly. 

The steroids had affected me. I was wired all the time.  My hands shook.  I had gained 15 pounds.  I had a steroid "moon" face.  I hated the way I looked.  Months later, my parents told me that the way I looked was so different and so awful that both my mom and dad cried one day after visiting me.  People I hadn't seen for a while told me how different I looked.  I was missing a lot of the boys activities- not all of them, but more than I wanted.  I was usually very active with their sports and school activities, and I couldn't do those things.  I felt bad for them, and I truly missed it.  I needed help with so much- shopping, cleaning, laundry, driving the boys.... and I was not good at asking for help.  I was a strong, accomplished, proud mother who had overcome some huge obstacles in my life.  I had to humble myself (like I did when I was in rehab) and realize my limits, and ask for help.  Once I did that, and realized that people wanted to help, that they were happy to help me, things got easier.  I actually got to hang out with my folks a lot, and I enjoyed that.  I was home every day with the boys- something I never thought would be possible since I had to work full time.  Things were tough but I was feeling very blessed at this point for so many things: for having people in my life that cared and helped, that I had an employer that was treating me fairly and compassionately, and that I had medical insurance...because the bills were rolling in and piling up.  Mostly I was glad that I was clean and sober so that I could make decisions with a clear mind and face this all without having to drink or drug my way through.

Sunday, June 24, 2012

And the pain began...

I moved into a condo last summer, from an apartment that had quickly grown too small.  I was thrilled to live in a complex that was quite beautiful because it was older.  It had mature trees and landscaping and large grass areas that were bigger than any yard I could afford.  It was a decent size for me- a single woman with two boys part-time.  I had neighbors that were friends of mine and that had kids the same ages as my boys.  It was literally down the street from my ex-husband's house, which made it convenient, and also close enough to both of the boys schools that they could easily walk or ride their bikes.  And I finally had a garage with my own washer and dryer again.  Simple things make the biggest difference sometimes.  Oh- did I mention that this condo has three stories? As in two staircases? (cue the eerie foreshadowing music...)

Last November I dipped into my savings and bought one new piece of furniture for the new place- a beautiful dark cherry wood wall unit.  It was delivered and put mostly into place.  I had to make some minor adjustments.  It was heavy.  And of course after I got it in place, I had to move a bunch of other stuff around.  I am usually pretty careful about pushing and lifting heavy things.  I have a long history of back and disc problems.  I had surgery on my neck about 5 years ago- a three level fusion because of three herniated discs.  I have pulled my back out many times which often left me in bed laying on ice for 3-4 days until I could move again.  20 plus years of working as a nurse didn't help it...

But being single and not having another person readily available to help move heavy things is a pain in the ass.  Too bad I was not very good at being patient and asking for help.  I had plenty of friends who would have helped me.  Instead I did it myself. I was pushing my dining room table- it really wasn't that heavy, but awkward to push, and it got stuck on my area rug.  The table stopped and I sort of kept going.  I felt a familiar ripping pain in the left side of my lower back and couldn't stand upright.  I got to the floor in sort of a crawling position up on all fours.  I stayed here for about ten minutes, hoping it was just a spasm and would pass.  It didn't.  So I crawled to the freezer slowly, got my ice packs (yes I always have ice packs handy for this reason...oh- and well I have do have two active boys...).  Then I made the agonizing crawl to the couch.  It was late, about 11pm, and slowly fell asleep.  I woke up every few hours.  When morning came, I called my neighbor, who walked over to my place (good thing I had a key outside) and she helped me get something to eat and get me upstairs into bed.  By now the pain was down into my hip and left leg- all the way to my toe. The pain was excruciating, but I had had this happen before.  Usually if I stayed put and kept icing it, I would get better slowly over a few days.

By the next day I could at least move.  I had called in sick to work.  My parents were out of the country and Thanksgiving was coming up.  I tried to get in to see my doctor right away but couldn't get an appointment.  By Thanksgiving, a week later, I was able to move pretty well, but still had pain- and the pain down my leg was worse.  With my sister's help (sometimes it's great to have doctors in my family) I was able to get an appointment the next week with a back specialist.  I saw him and he ordered an MRI and physical therapy.  He also prescribed a Medrol Dose Pack.  This is steroids you take by mouth- you start with one dose and then taper down for 5 days.  Hopefully the steroids will help any inflammation and healing in my back.  In order for me to return to work, I have to be able to pass a "lift test."  It consists of lifting 140 pounds from the floor to a table, then lifting to a higher table (shoulder tall) and then carrying it up and down small staircase.  Doctor wouldn't clear me for that, so I was to remain off.  I had to file for state disability.

I was still in pain.  I got around okay but couldn't do much lifting or bending or twisting.  The pain down my hip and leg persisted and was the real problem for me.  It was nerve pain- burning, shooting, stabbing.  I did not take any narcotics or muscle relaxants.  With my addiction history, that's a dangerous place for me to go.  I managed the pain by limiting my activity and using ice.

The thing with seeing doctors these days is how much time you spend waiting.  Before my sister helped me got this appointment, I was told from two other back specialists that it would be 3-4 weeks before I could be seen.  From my injury date, it took two weeks before I saw my doctor, and then another two before I could get an appointment for the MRI.  Most of my nursing experience was in the ER.  I think it's pretty common knowledge that ERs are overcrowded.  As a nurse, and especially as a manager, I knew the reasons why.  But now I was experiencing them first hand.  Did I mention that patience is not one of my virtues?

Grateful me...

If you are going to follow me along this journey, it's only fair you know a little about me... I could go on and on about so many parts of my life.  But I'm going to try to keep it to just enough to give you a feel for who I am and what makes me tick...

My real name is Susan.  I am 44 years old.  I am of Italian descent and was born on the East Coast, Washington DC to be specific.  We moved to Southern California in 1976.  My parents are alive and wonderful people- smart, kind, active, generous and fun.  I have one sister, and she is great person.  She is two years younger than me and we are polar opposites- physically and personality-wise.  She is tall and lean, curly hair.... I am short and curvy with hair straight as a board.  I am pretty easy-going and laid back, but I have an Italian temper.  I am extremely expressive.  I am a risk-taker (and have the scars to prove it).  I am on the messy side, and not the most organized person.  I love naps and sleeping and I cherish having free time- time to do absolutely nothing.  My sister is neat and organized.  Her entire life is planned out down to the minute.  The only time I see her sit still is to eat a meal- and even then she is the first one up and on to cleaning up before most of us are finished.  She is pretty conservative and plays it safe.  Despite our differences, we are very close.  But we both understand that we are very different people.  My whole family lives nearby- parents are five minutes away and my sister, her husband and her two kids live about 20 minutes away.  My sister and parents are all extremely successful and well-educated.  My father is a surgeon, my mom is a marriage/family counselor (2 masters degrees) and my sister is a urologist with a busy practice.  I am blessed to have have them all in my life.  I truly enjoy being with them and now that I am a parent, I appreciate them even more.

I went to Santa Clara University after high school.  My goal at that time was to go to medical school but school wasn't easy for me, and...well... I liked to party. No, I loved to party! I ended up choosing the path of least resistance, and an easier major.  Doing this gave more of that free time I love so dearly, and it allowed me to spend a semester in Rome. That was one of the most thrilling experiences of my life.  During college, I had a part time/summer job back at home in the Emergency Room of a local hospital.  It was my work there that I fell in love with Nursing.  After graduating with my BS in Psychology, I decided to go to Nursing School.  I worked and went to school full time and paid my own way.  The majority of my nursing career has been spent in an Emergency Medicine.  I also was a nursing educator and did a lot of Quality Assurance projects.  I was very involved in EMS and training for paramedics and EMTs.  I worked my way up to manager of the same ER that I worked in during college.  It had been my career goal for as long as I could remember- my dream job.  But it turned out that my expressive, risk-taking, authority-challenging personality wasn't a great fit for middle management.  Admittedly, my pride also got in the way.  Maybe with some maturity and more time I may have figured it out.  But during that time I was going through my divorce and had a whole mess of personal issues.  Leaving that job was a painful blow.  It had been my identity for so long- who I thought I was was so deeply entrenched in my job, that when the job was gone- I suddenly didn't remember who I was- who Susan was- not the nurse, but the woman.  Since then, I have worked at a few other ERs (staff position- which stung) and for the EMS Agency doing Quality Improvement.  I have worked in the recovery room at an outpatient surgery center.  My latest job was a gift and I got it because of the wealth of experience I have accrued, which felt good and sort of made up for my failure at hospital management.  I was recruited and offered a position to help develop a nursing program with the local ambulance company.  It is a critical care transport team.  I manage about eight nurses and also do patient care and marketing.  I oversee the team administratively and clinically. The clinical work is a little slow (not a busy operation) but the patients can be extremely challenging.  I also like being outside and working with paramedics and EMTs.  We have a lot of autonomy.

I married one of my childhood crushes that I reconnected with when I was in nursing school.  We dated for 6 years and then were married in 1997 when I was 31. I loved him so much and really thought we would be together forever.  I still love him and he is wonderful man, a fantastic father.  We had two boys, Nicholas and Matthew.  They are 12 and 10 years old now.  I left Bryan in 2004.  He was an alcoholic.  And despite vowing to stay with him "in sickness and in health," I still left him.  It's not that I didn't try to help him- I did.  But I was a highly skilled co-dependent, and eventually I lost myself in his problems...and then mine began.  I didn't understand the disease of addiction- which would turn out to be one of the greatest ironies of my life.  But that messy story will be another blog....

After my divorce, I was a lost soul.  I got into an emotionally abusive relationship with a physician that I worked with- it was full of lies and control and manipulation.  At that time my self-esteem was at an all time low, and I was horribly afraid to be alone.  I stayed in this relationship for years, and it tore away at my very being.  Looking back, I can hardly believe the things I put up with, just so I wouldn't be alone.  We started using drugs and alcohol together in an abusive way- mostly drinking heavily and smoking pot.  But I had partied "hard" most of my life and that wasn't anything new, although it became more frequent and I started doing really stupid things.  My drama-filled relationship was very public at work.  And then we got into cocaine.  Within three years, I went from weekend dabbling to everyday use to not being able to function without cocaine.  Everything important to me began to suffer: relationships with family and friends, my ability to parent, my job, my health, my finances- everything.  I eventually lost all of those things as I became completely addicted to cocaine and the abusive relationship I was still in.  I came close to death. The details of this part of my life are materials for yet another blog (or maybe a raunchy made-for-TV movie).  Suffice to say that when everything came crashing in on me, I finally got some help.  I went to the Betty Ford Center and then spent a long time in a recovery home in Santa Barbara.  I needed to quit cocaine... and the boyfriend.  The geography change helped a bit.  Rehab is not a resort vacation.  It is gut-wrenching work.  It was the hardest thing I ever did.  I am proud to say that I am single, and that I gave been clean and sober for 3 and a half years.  In that time I have rebuilt my life and re-discovered who I am.  Although the true search for who I am will never be over.  I had lost my home in foreclosure, had spent all of my retirement savings, and I am still paying off debt.  So finances are tight, but I can support myself and my kids.  More importantly, I have solid, caring relationships with my family again, and I have built quality friendships with so many people.  I have genuine relationships with healthy women.  I am active in recovery and a 12 Step Program.  I have healthy, happy, smart, kind and beautiful children.  I am respected in the work force.  My ex-husband and I are very close- he is one of my best friends now.  Oh, and he, too, is sober now.  Ironically we have the same sober/clean date.  Our kids will someday come to realize how lucky they are to have sober parents, parents that are physically and emotionally present in their lives.  Life isn't easy, but it's good.  I wake up and go to sleep grateful every day.

Saturday, June 23, 2012


"shoot from the hip"
  1. Lit. to fire a gun that is held at one's side, beside one's hip. (This increases one's speed in firing a gun but is much less accurate.) When I lived at home on the farm, my father taught me to shoot from the hip. I quickly shot the snake before it bit my horse. I'm glad I learned to shoot from the hip.
  2. Fig. to speak directly and frankly. (Alluding to the rapidness of firing a gun from the hip.) John has a tendency to shoot from the hip, but he generally speaks the truth. Don't pay any attention to John. He means no harm. It's just his nature to shoot from the hip.
See also: hip, shoot
McGraw-Hill Dictionary of American Idioms and Phrasal Verbs. © 2002 by The McGraw-Hill Companies, Inc.

No, this blog is not about shooting techniques...Yes, it is meant to be a direct and frank look into my life, at this particular time.  Why now?  Well I am currently going through some serious medical issues.  And my medical issues involve my hips (ahhhh- the connection!).  Thankfully, they aren't life threatening issues- but they are ones that have had and will continue to have significant impact on my life.  Experiences that will help define me.  They are ones that I never expected, because I have a whole other set of issues that are partly medical as well (and when you learn a little bit more about me, you'll understand what I mean).  What I have been going through has tested me and will continue to challenge me for some time.  I realized that in order to keep my sanity, I need to keep my mind and hands busy.  Idle hands are the devil's playground and dangerous for me.  Also, as I have done research on my specific condition, I have found very little information from people that have a similar diagnosis and have faced similar challenges.  So this blog is self-serving in one sense, but more importantly, I hope will help others who are experiencing like situations.

I have never blogged before.  On my bucket list is to write a book.  I have started many times, but been overwhelmed by the thought of writing about my life experiences.  Where I do start?  Where do I finish?  Seems that there is just so much for me to write about that I couldn't narrow it down and focus on just one aspect of it, or one time period... I'll figure that out when I'm ready.  Meanwhile, I thought I'd give this a try.  I'll spend some time catching you up... and then hope to blog concurrently at some point.  I hope you find something of value in this, and are a bit entertained at the same time!