June , 2020
June 1 - Saw Dr. Kevin Yee, MD (Hematologist and Oncologist). 212 lbs. Nathan had to go alone, but a phone call placed to Tiersa in the car in the parking lot. Doctor said - Take 2x Omiprozal for possible ulcer and discontinue Naproxin for a month. He feels the hemoglobin lowering is due to pain and perhaps ulcer.
Also on June 1 - did Blood Panels of Protein Electrophoresis, Serum with Reflex to Immunofixation, Rheumatoid Factor, Serum, Cbc W/AutofDiv-Cho.
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| Outside after hot tubbing which Nathan did at all hours of the day and night. |
They showed nothing. No Cancer markers, no Lupus markers.
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| Pain. June 8 |
June 8 - Dr. Mirchandani DO, Second Sacroiliac Joint injection
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| The 30/45 minute car rides to Tualatin and Oregon City were so painful |
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| June 8, 2020 |
June 11 8am Phone consult - with Dr. Okunz MD. (Primary)
Doctor perscribed Trazodone and Hydromorphone 2mg, He suggested Melatonin and to begin taking Naproxin again. We reminded him that there is an ulcer to think about, But he said it should probably be Ok to take the Naproxin now??!! We were in shock at this suggestion. Silly Dr. - We're listening to the Specialist and what makes sense.
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| June 14 |
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| June 16 2020 - 212 lbs |
June 18 @ 9:30 saw Rachel Bangs, PA for Dr. Alexander Ching MD
June 18 - We really appreciated the appt with Rachel Bangs. Like her a lot. Looked at MRI and X-ray from Feb. She feels Nathan needs an additional MRI - ordered for thoracic w/o dye and wants to see him back for results. The NEW thing is that she also found a Ventral hernia during the exam, which will need fixing. THIS WAS SOMETHING NEW that would require a surgery. Now to orchestrate which comes first. Back? Hernia?
Her Assessment:
Lumbar Radiculopathy (M54,16)
Lumbar Stenosis w/o neurogenic claudication (M48.061)
Ventral hernia (K43.9)
Midline back pain that wraps around to the abdomen consistent with T10 radiculopathy
Low back pain with tingling and numbness in left leg consistent with L3>L4 radiculopathy
Lumbar MRI demonstrates L2-3 and L3-4 moderate canal stenosis with foraminal stenosis at L3-4R>L
Ambulates mildly unbalanced w/change of direction.
Lumbar Stenosis w/o neurogenic claudication (M48.061)
Ventral hernia (K43.9)
Midline back pain that wraps around to the abdomen consistent with T10 radiculopathy
Low back pain with tingling and numbness in left leg consistent with L3>L4 radiculopathy
Lumbar MRI demonstrates L2-3 and L3-4 moderate canal stenosis with foraminal stenosis at L3-4R>L
Ambulates mildly unbalanced w/change of direction.
June 19 Okuns MD phone consult - will refill Percocet. Nathan told Dr about the "moderate-sized" hernia found. Referral to Dr. Kraemer coming.
June 21 night - Nathan woke me up, he was stuck trying to get up, and had slid sideways in the bed. The hernia hurt too much to allow him to sit up.,. we worked together and rolled him up.
June 21 - Th kids came and in just a little over an hour we moved the house around to be more practical. The new bed is downstairs now and the hot tub more easily accessible.
(No, they didn't move the hot tub, silly!!)June 22 What a crazy ordeal Tiersa foun THIS to be! :
*called Insurance - they have heard nothing about MRI - but don't need preauthorization
*called MRI - they have not received the order
*called Bangs office - they said they had Faxed this morning at 11
*called MRI - They are up to date on their faxes, there are not orders
*called Bangs office - They faxed to Legacy clinic, Woodburn. Not Legacy Imaging? yes?
*called MRI - Bangs office says they sent it to Woodburn. Oh! They don't schedule there,
*called Bangs office - they said they had Faxed this morning at 11
*called MRI - They are up to date on their faxes, there are not orders
*called Bangs office - They faxed to Legacy clinic, Woodburn. Not Legacy Imaging? yes?
*called MRI - Bangs office says they sent it to Woodburn. Oh! They don't schedule there,
*we, here at Silverton/Woodburn, do the scheduling. Took their fax number!
*called NBangs - There is no effective Woodburn imaging number, you must fax to Silverton to schedule for Wooburn. While this is not a number she has, she hesitantly will fax it.
*called MRI, it arrived and Nathan is now scheduled for tomorrow.
SO..WHERE DID THE ORIGINAL 11 am FAX GO?
And, WHY 11am today - when his appt was last THURSDAY?
*****sigh.******
June 23 9am - MRI (needs to be rescheduled with sedation. Too hard without. Put in a call to Nicole to order that at Meridian Park. After not getting callbacks from the surgeon PA, I called and left a message for the surgeon and team that said, "Look! We were referred to you and haven't even seen you. Can't get an MRI with sedation due to coordination of anesthesia and MRI schedule coordination until July 24th! He's declining, hard to pee, can't walk, walker arriving tomorrow, lost 50 lbs from pain meds, Still isn't eating enough for good nutrition, can't sleep in pain of 7-9 is almost constant now. HE'S YOUR PATIENT! Please call us or see us and help us know the plan. WE NEED A PLAN!"
Their office called the next day and scheduled Friday at 8:30 - I FELT GREAT SUCCESS!!!
June 23 - Discussion with Dr. Mirchandani, who will proceed with two weekly pretest lidocaine shots to be allowed by insurance to proceed with a nerve block. He suggests upping gabapentin and reviewed the limit for Tylenol/Percocet. Back pain #1, Hernia #2. Didn't see L5 reported on in the Feb MRI. We are sorta surprised they were ordering an additional MRI.
"BIG ASS HEATING PAD" ARRIVED TODAY! It's 17"x 33"!
Tonight I decided we needed a date. It was so simple, but so memorable. We got in the car just a bit before sunset and headed out to Concomly Road. It's a road I travel to school regularly that I knew would have a vast sky of sunset. As we pulled off the road into the little spot next to the crop field, we just sat and watched the sunset. It wasn't long, but reminded us of college days when we would get in the car and just "go for a drive". Simple. Filled with love.
June 24 - While a green walker with big wheels that I ordered from Walmart was supposed to arrive today, we got a call from the Norco medical equipment that Dr. Okuns ordered Nathan a walker and it was 100% paid by insurance. Blue or Red? He chose blue and it was delivered Thurs morning.
ALSO, Voltaren Gel, recommended by Annette, works pretty well!
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| NEW: Temporary Beard and Temporary Walker |
June 25- Saw Surgeon Alexander Ching, Oregon Spine Clinic
THE PLAN HE HAS DOCUMENTED: [Mr. Helwig has relatively severe stenosis at L2-L3 and L3-L4. I think this is the source of his pain. I told him some element of his achy low back pain may be from arthritis and I can not make the arthritis type pain go away. But I think I can make his neuropathic pain better. At this point I see no role for non-surgical treatment; he has had this more than 3 months and he is functionally declining, not improving. The surgery in my hands would be a laminectomy at L2-3 and L3-4 and I think his leg pain will improve significantly, although again the achy back pain less clearly. I don't get symptoms above the umbilicus (Ms. Bangs did) and so I will not push as hard for a thoracic MRI, although he knows if we have residual after surgery, I would be inclined to look there too.
We discussed the natural history of lumbar radiculopathy, which is that up to 80% of patients with non-operative care find significant improvement within the first three months of their symptoms and select not to have surgery. When possible, I recommend that we proceed with non-operative treatment for at least the first six weeks in the hopes that they will feel better enough to avoid surgery. (He told Nathan that he would not have done surgery in February, nor early on). Non-operative treatment includes non-steroidal anti-inflammatory medications, as well as possibly gabapentin or Neurontin. Physical therapy can help with improving function in this time window as well. Epidural steroid injections have not been shown to change the likelihood of patients going on to have surgery, but can be very effective at symptom relief while we see if this will calm down on its own. After between 6 weeks and three months, then a decompression surgery may be very helpful at relieving symptoms that have not resolved. He has failed non-surgical treatment.
We discussed the risks of surgery, including anesthetic risks, bleeding, infection, dural tear and neurologic injury. The risks unique to this operation are recurrent disc herniation (which appears to be equivalent regardless of whether this problem is treated with surgery or not), and axial low back pain, which is a reflection of the underlying disc degeneration that causes a bulging disc in the first place.
I told the patient that recovery is highly variable in terms of time and from patient to patient. For a decompression operation, I tell people that the hospitalization [Nathan's will be at Meridian Park Hospital] is about overnight, that the first two weeks are pretty rough, but that I would hope to have them up and walking by the first day or two after surgery. For most people, once they are at home, they are not doing much besides resting on the couch or in a chair for the first couple of weeks, but are able to get around and take care of themselves. By about the six-week follow-up, most people are weaning down on their pain medication. At 3 months, most patients are frustrated because they feel better and feel as if they should be able to do more, but find that when they try to do it they cannot because of residual surgical pain and fatigue. By about 6 months, most patients are doing what they would like. ]
Nathan's "unpinching operation" where the Dr. will carve out inside the spine so that the spinal cord will not be pinched and the fluid will flow better, (like I-5 after a wreck is removed from the Terwilliger curves) is going to be scheduled for July 8.
We discussed the risks of surgery, including anesthetic risks, bleeding, infection, dural tear and neurologic injury. The risks unique to this operation are recurrent disc herniation (which appears to be equivalent regardless of whether this problem is treated with surgery or not), and axial low back pain, which is a reflection of the underlying disc degeneration that causes a bulging disc in the first place.
I told the patient that recovery is highly variable in terms of time and from patient to patient. For a decompression operation, I tell people that the hospitalization [Nathan's will be at Meridian Park Hospital] is about overnight, that the first two weeks are pretty rough, but that I would hope to have them up and walking by the first day or two after surgery. For most people, once they are at home, they are not doing much besides resting on the couch or in a chair for the first couple of weeks, but are able to get around and take care of themselves. By about the six-week follow-up, most people are weaning down on their pain medication. At 3 months, most patients are frustrated because they feel better and feel as if they should be able to do more, but find that when they try to do it they cannot because of residual surgical pain and fatigue. By about 6 months, most patients are doing what they would like. ]
Nathan's "unpinching operation" where the Dr. will carve out inside the spine so that the spinal cord will not be pinched and the fluid will flow better, (like I-5 after a wreck is removed from the Terwilliger curves) is going to be scheduled for July 8.
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| June 26 - discussing remote controls for the bed & new TV |
June 29- While a patio chair in the downstairs tub has been working, having a shower bench arrive today was great! (no picture of Nathan in the shower to be inserted here)
June 29 Today's 11:30 appt with the surgeon for hernia, told us that this is not a hernia, not to worry about it. It does not take any priority at this time, and really is a widening between the right and left muscles and did not find the PA Bangs's assessment of this as a hernia, as his own. His answer as we left was "one less thing to worry about" and wished us well.
ALSO - Pain Dr. Injections put on hold until after back surgery.
ALSO - Pain Dr. Injections put on hold until after back surgery.
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| 6/29/20 Waiting after arriving |
June 29 - Green Walker is "Lost in Transit"- Walmart is sending in a new order. If the other one ever arrives, keep it or donate it. They're sorry.........
Today. Yep, both green walkers arrived today.
They have the larger 6" wheels instead of the 4".
One arrived at noon, the other at 6pm, same day.