I want a new drug
Samantha had another MRI yesterday, this one of the lumbar spine. You see, the nerves that end in the knee begin in the lumbar spine, and her neurologist wanted to check for thickening of the nerve roots, obstructions or projections in the spine impinging on nerves, and other such potential causes of referred pain.
The procedure went okay. Samantha really didn't want to be sedated -- she has my determined lack of fondness for needles -- so they tried it without sedation. During the first part of the scan she was a little twitchy because of the noise in the machine, perhaps because she just had a single pair of foam earplugs instead of both plugs and ear covers. Whatever the reason, she was moving around too much and about halfway through they took her out and said we were going to have to put her to sleep. This upset Samantha quite a bit, and she began to cry. At that the techs agreed to try once more without sedation, and this time they thought to use the ear covers as well. Samantha was great; she lay still as a statue for the second half of the scan. The upshot was that they didn't get clean data for the T1 scans, but the radiologist said that was okay as long as the T2 scans were good, which they were.
Today we went for the followup appointment with the neurologist. The MRI, as we might have predicted, was perfect. Samantha has a textbook lumbar spine, and no nerve issues that she can see. Between this and the lack of relief afforded by the neuropathic medications like neurontin, the neurologist is back to thinking the pain is somatic rather than neurological in origin, so we're changing horses on the medication plan and going with a stronger anti-inflammatory instead.
The new plan is to try naproxen to replace both the Motrin and the Tylenol, because as much as we all want Samantha off of anti-inflammatory drugs as quickly as possible, if they're the only thing that relieves her pain right now then it's better to use a stronger lower-dose version that provides enough relief for her to sleep through the night. So we're going to start with a low dose and titrate up until we hit a number that provides 12 or so hours of pain relief. As an aside, if she ends up still only getting 5 or 6 hours relief even from naproxen that's a strong indication that there's more of a psychological component to the pain than we'd assumed so far.
I'm still convinced that there's a real physiological generator, because I can't believe she's developed such a finely honed internal clock that her mind can create pain on cue just at the time that Motrin should be wearing off. It's not like she gets it at the same time every day or has these pain episodes at the same time every day, as if she were a dog salivating at feeding time. Still, it'll be interesting to try to get empirical (pharmacological) confirmation that the pain is primarily organic.
Along with the naproxen, the neurologist wants to try a low dose of tizanidine (a muscle relaxant, aka Zanaflex) to help relax Samanatha and let her sleep through the night. Although now that I think of it, if the naxproxen is knocking down the pain for 12 hours at a time she shouldn't really need tizanidine to sleep. She's got no problem falling asleep at night -- it's staying asleep that's the issue, because she wakes up in the middle of the night every night from the pain.
I'll have to talk to the neurologist about this and see whether to use the tizanidane or hold off on it at first and only add it should it seem necessary. I'm pretty determined not to over-medicate Samantha. Yes, she needs pain relievers to keep her knee from driving her crazy, but we want to stick to the minimum number of medications possible and the smallest doses that allow her to live her life normally.
As for Joshua, he's doing great. He's going to be walking soon, I think, and he remains a happy, smiley, laughing boy. He's definitely turned into a daddy's boy lately -- if he hears my voice in the other room he crawls toward me at lightning speed, and he cries if I walk by and don't pick him up. He's not quite sleeping through the night, but getting closer. He usually wakes up only once per night, and he often goes back to sleep pretty easily most of the time after a few sips of water and a few minutes of snuggling.
He still only eats things he can pick up in his hands. He's a fan of all kinds of fruit right now, and decided that he liked my noodle kugel. (Thanks, mom, for teaching me how to make that when I was a kid. It was and remains my version of comfort food.) But feed him something that requires a fork or spoon and he purses his lips, closes his mouth tightly, and pushes the spoon away from his face.
Except for ice cream. That he will eat from a spoon. Somehow he knows that it's ice cream long before it gets near his face, and he sits with his mouth open, waiting for it, like a baby bird.
The procedure went okay. Samantha really didn't want to be sedated -- she has my determined lack of fondness for needles -- so they tried it without sedation. During the first part of the scan she was a little twitchy because of the noise in the machine, perhaps because she just had a single pair of foam earplugs instead of both plugs and ear covers. Whatever the reason, she was moving around too much and about halfway through they took her out and said we were going to have to put her to sleep. This upset Samantha quite a bit, and she began to cry. At that the techs agreed to try once more without sedation, and this time they thought to use the ear covers as well. Samantha was great; she lay still as a statue for the second half of the scan. The upshot was that they didn't get clean data for the T1 scans, but the radiologist said that was okay as long as the T2 scans were good, which they were.
Today we went for the followup appointment with the neurologist. The MRI, as we might have predicted, was perfect. Samantha has a textbook lumbar spine, and no nerve issues that she can see. Between this and the lack of relief afforded by the neuropathic medications like neurontin, the neurologist is back to thinking the pain is somatic rather than neurological in origin, so we're changing horses on the medication plan and going with a stronger anti-inflammatory instead.
The new plan is to try naproxen to replace both the Motrin and the Tylenol, because as much as we all want Samantha off of anti-inflammatory drugs as quickly as possible, if they're the only thing that relieves her pain right now then it's better to use a stronger lower-dose version that provides enough relief for her to sleep through the night. So we're going to start with a low dose and titrate up until we hit a number that provides 12 or so hours of pain relief. As an aside, if she ends up still only getting 5 or 6 hours relief even from naproxen that's a strong indication that there's more of a psychological component to the pain than we'd assumed so far.
I'm still convinced that there's a real physiological generator, because I can't believe she's developed such a finely honed internal clock that her mind can create pain on cue just at the time that Motrin should be wearing off. It's not like she gets it at the same time every day or has these pain episodes at the same time every day, as if she were a dog salivating at feeding time. Still, it'll be interesting to try to get empirical (pharmacological) confirmation that the pain is primarily organic.
Along with the naproxen, the neurologist wants to try a low dose of tizanidine (a muscle relaxant, aka Zanaflex) to help relax Samanatha and let her sleep through the night. Although now that I think of it, if the naxproxen is knocking down the pain for 12 hours at a time she shouldn't really need tizanidine to sleep. She's got no problem falling asleep at night -- it's staying asleep that's the issue, because she wakes up in the middle of the night every night from the pain.
I'll have to talk to the neurologist about this and see whether to use the tizanidane or hold off on it at first and only add it should it seem necessary. I'm pretty determined not to over-medicate Samantha. Yes, she needs pain relievers to keep her knee from driving her crazy, but we want to stick to the minimum number of medications possible and the smallest doses that allow her to live her life normally.
As for Joshua, he's doing great. He's going to be walking soon, I think, and he remains a happy, smiley, laughing boy. He's definitely turned into a daddy's boy lately -- if he hears my voice in the other room he crawls toward me at lightning speed, and he cries if I walk by and don't pick him up. He's not quite sleeping through the night, but getting closer. He usually wakes up only once per night, and he often goes back to sleep pretty easily most of the time after a few sips of water and a few minutes of snuggling.
He still only eats things he can pick up in his hands. He's a fan of all kinds of fruit right now, and decided that he liked my noodle kugel. (Thanks, mom, for teaching me how to make that when I was a kid. It was and remains my version of comfort food.) But feed him something that requires a fork or spoon and he purses his lips, closes his mouth tightly, and pushes the spoon away from his face.
Except for ice cream. That he will eat from a spoon. Somehow he knows that it's ice cream long before it gets near his face, and he sits with his mouth open, waiting for it, like a baby bird.
posted by Matt | 3:36 PM
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