Friday, July 5, 2013

CERVICAL Nerve Block - Epidural Steroid Block - December

I just realized that this post did not get , well, posted! It got sent into my "drafts" folder.

So I have made a few edits and posted it. Sorry for the delay.

My second Cervical Epidural steroid block, for my neck pain, the arthritis or whatever you wish to call it, went so much better!!!!!  YEAH!!!!

I had it done around November 7th..

Two reasons;

1) Steroid medications generally take anywhere from 4 or 5 days to a few weeks to really kick in.

BUT, the real reason is because of the excellent nursing staff at the Unifor Pain Clinic. What I didn't know when I had the first one done was that I could have had it done at my own Pain Clinic! No one told me, they just automatically set it up at the other place, no names mentioned. Which as you saw from the above post, was a huge mistake. IV issues can be huge, even with a very trained nursing staff.

People! Do NOT take the issue of IV insertion lightly. If you ever have ANY problems with having an IV inserted into your arm, hand, etc. because of your disease (CRPS) do not hesitate to let the staff know ahead of time.

What is an ISSUE?

I will explain, since this third time I had a block done (well, third time in 2012 anyway) , I had a great nurse, great staff, and still I had an issue. Sometimes, as they say, things just happen. Plus, I made a mistake. Let me share my experience and you can see if anything similar ever happened to you.

First, my mistake.

I had blood drawn the day before my block. I have it drawn about every six months to check on my various levels, vitamins, blood counts, liver functions, white blood cells count, etc. So many diseases going on, need to keep track and make sure everything is ok. I even went to my GP's second office further away just so I could have his main nurse do the blood draw since she is much better at it and more gentle. had her her use my left arm, the crook of the arms, she used a butterfly needle, smallest there is. (always ask for this guys). She had a little trouble with the vein as usual, my veins tend to move around and disappear. This is also not unusual for CRPS patients. This is part of the problem.

For the block the next day I had shaved the top of my hand so they could set up the IV there. Yes, it is more painful there but they always have trouble setting up the IV in the crook of my arm and end up going to the hand in the end where the veins are easier to see, find, and spear.

I explained to the nurse (new to me but not to the facility) that my veins move, or sometimes they simply collapse despite the fact that as they get ready to stick me they look maH-vah-lous, as Billy Crystal would say. Especially the veins in my arms, and that she should use the veins in my hand, and yes, I knew it was a much more painful place to do it but as long as they rubbed some numbing solution on it first, waited for that to take effect, then injected some pain meds into it, waited for that to take effect, and THEN injected the needle to give me the set up the IV line.

My mistake was having the blood draw the day before my procedure. Neither myself nor my Doctor felt it was an issue at the time and he is still perplexed as to why it became one. Chalk up another one for the strange world of CRPS.

I have had countless nerve blocks over the many decades I have had CRPS. I have had many different types as well. The procedure was nothing new to me. However, the reaction that occurred, well, THAT was something very new.

So what happened?

The cervical block (upper body block) proceeded as normal. I always ask for enough meds to pretty much knock me out enough so he walks over to the bed, says "Are you ready for your block Keith?" I say, "Yup." They wheel me into the procedure room. I switch over from the portable bed to the OR bed. I talk to the nurse for a second. I make sure the blankets are warm ( see CRPS, THE HOSPITALS, AND SURGERY , specifically see number 3) and then I start counting back from 100. I never make it past around 89 I think.

Next thing I know I am in the recovery area and the nurses are checking up on me. Again, so what happened?

It didn't happen until after I got home. Everything seemed fine. Normal reaction. I left the clinic when I felt "normal" again, steady on my feet. Felt like a normal post-block time. But within a few hours I noticed that my face was starting to turn red, then my hands. By that evening my entire upper body had turned a dark shade of red; from the top of my head to my a little bit above my waist. It included both of my arms, both hands, shoulders, chest, face, etc.

It was the same shade of red that occurs when my CRPS is in flare. Some of you CRPS patients out there might know what I am talking about and may experience the same thing, where part of your body turns different colors when you have a flare coming on or during the actual flare; when the pain exacerbates (gets much worse) due to something you did, a change in the weather, stress, a medical procedure, etc.

The problem was I had never had it happen before where the entire upper half of my body went red before! Despite the fact that my CRPS is full-body. I was pretty nervous, I didn't know what was happening. I thought maybe it was a reaction to the medication they used or a dye or something so I called the clinic and they told me if it doesn't go away by morning to come in first thing. It wasn't causing me any extra pain though except in my left hand which was quite painful, the rest was just looking like I got caught in the sun.

Next day I went in to the clinic so they could see for themselves. Very weird. They had no idea, had not seen anything like it before. Since it was not causing me pain we decided to just let it be and watch it.

It lasted for weeks.  Here are a couple of pictures from that time. The first is the hand where the IV was inserted. Not sure if you can see how red my body was in the pics, it doesn't show too well. I took these about ten days into it. The purpley patch is the actual IV site.

Keith's hand - IV site

Keith's chest showing redness, reaction - cervical block

 Eventually it all calmed down and the redness went away, it took about seven weeks I believe. I was very lucky. The pain in the left hand took a little longer to go away, about nine weeks altogether before I could type with it again.

Lesson learned.

Be careful out there.

Peace, Keith Orsini

American RSDHope

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