Keep moving

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It’s been quite some time since I’ve written an update about my rib health. Since my accident in 2009, I have been very forthright about the treatments, pain, and how the injury has affected my general well-being. With all that I have been through, the last 6 months have undeniably been the hardest; writing about the continued pain, the struggles I have undergone to alleviate the pain, and what the constant nagging pain has done to my psyche is not easy. How does one write about incessant pain without sounding whiny?

At the end of May, I had surgery to remove the hardware that was installed in my ribs the previous October. The surgery itself was successful in that I recovered quickly and the removal of the hardware immensely improved my ability to take a deep breath. The surgery did not address and therefore did not fix the ongoing intercostal neuralgia.

Intercostal neuralgia is pain stemming from the nerves that run between the ribs. I have had this disorder since a few months after the accident, but there has been an escalation of symptoms over the last few months. It is pesky, hard to treat, and can render sufferers incapacitated. This type of neuralgia generally affects more than one intercostal nerve, and in my case I have 5 nerves involved (ribs 5-12).

The neuralgia hurts all day, every day, infiltrating every facet of my life. The ongoing pain affects my ability to sleep, work, socialize and train. It is constant and unrelenting. I have pain that wraps around my rib cage, like tentacles squeezing me tight. I have stabbing pain in my side, analogous to the worst side stitch ever. I have pain in my back that causes constant nausea and occasional vomiting. Some days I feel like my head might explode due to the pain. It is hard to reconcile that a body that was once so fit and willing to do my bidding is now malfunctioning unremittingly.

Unlike a muscle injury that resolves with rest or ultrasound or manual therapies, intercostal neuralgia symptoms do not respond to and are often made worse by such conventional treatments. Maintaining some modicum of physical activity alleviates my symptoms better than anything I have tried. Perhaps it is the endorphins, or maybe it is just the distraction. Either way, some form of movement helps.

Two weeks after surgery, I started a series of non-surgical procedures in an effort to calm down the neuralgia. I started with two cortisone injections into the sorest spots. I had excellent relief. It only lasted 72 hours.

The next step was a diagnostic nerve block. This is a procedure where they inject lidocaine into the nerve root to determine how much relief occurs. In order to reach the nerve root, real time X-ray guidance was used. Gigantic needles were inserted into my back. The needle actually touched the rib and from there moved to the nerve root. I had 5 nerve roots injected (ribs 8-12).

The procedure itself was very uncomfortable and my back was sore for days. I am not quite sure how I was able to lie still with those needles in my back. It took some serious concentration. I had excellent relief from the lidocaine, though. It lasted 12 hours. Since this was a diagnostic procedure, cortisone was not used, and long term relief was not actually expected.

The fun did not end there. Given that the nerve block decreased my pain markedly, indicating that the pain is indeed from the nerves themselves, I became a candidate for a pulsed radiofrequency ablation. In mid-July I had this procedure on ribs 8-12. Under X-ray guidance, large needles with an electrode at the end were used to create an electrical current with the intent of interrupting nerve conduction. I was under conscious sedation for this procedure, meaning I was awake, but didn’t give a shit.

RF bottom ribs
This is the real time X-ray of my RF ablation.

Unfortunately, the ablation did not entirely work. I got some decent relief on the upper ribs, but I am still having considerable pain in the lower two ribs. An MRI on Wednesday will hopefully reveal some useful information that will dictate the course of action moving forward.

At the start of this post, I mentioned my psyche. The unrelenting pain with no abatement in the foreseeable future has been disheartening to say the least. My life has been indescribably altered. I try hard to focus on what I can do and not on those things that I love that I have had to forgo, such as swimming, doing running races, and sleeping soundly. I do allow myself to cry on those occasions when the pain and frustration reach unimaginable levels. I will not, however, allow myself to give up on finding a solution.

I have adopted a new philosophy.

If I can’t run fast, then run slow. If I can’t run slowly, then walk. No matter what, keep moving.

My Strava training log has almost as many walks and hikes as runs, because, yes, I Strava all of my walks. It may seem silly to Strava my walks, but there is still some satisfaction in knowing that throughout this whole process, I can still go out and do something and that I will not be defeated by pain.

The future is still uncertain, but isn’t it always? I continue to muddle my way through while adapting to what is my new normal. Each week I learn new ways to cope and I fully appreciate the support of family and friends who have listened to me vent and offered kind words and a shoulder to cry on.

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