Saturday, March 3, 2012


For those that have been following this for longer than a month you will remember that I've been whining about the pain in my back from the collapsed vertebra.  About 4 months ago I did go up to UCSF's Pain Management clinic and received some injections which did work to temporarily relieve the pain.  Now came the good part.  The actual, bonafide, longer term shot (no pun intended) at relief called radio frequency ablation.  It's a procedure where they stick some electrical devices into your back around your spine and zap the offending nerves that are sending the pain signals to my brain (sometimes it takes weeks to get there but it does eventually get there) with ultra high frequency radio waves which strip the nerves of the mylin (sp?) sheath which is the medium sending the pain signal.  Every body got that?  I think that's how it goes anyway.  Jeff Jones, if you haven't given up on my blog site, maybe you could share some of your infinite wisdom about this if I'm off base.  The relief, instead of being for just a few weeks, is supposed to be for 6 months to a year.  And because I know that you are all holding your breaths in anticipation of the outcome, we will now break for a commercial from our sponsor...

My friend Wes Castro accompanied me again on this trip and he is really great company.  Thanks again Wes.  We always leave early enough to give us some room in case of traffic.  On Feb. 6th, no traffic.  Keeping it at a reasonable 5 over, we got to SF in 3 hours.  We had an hour to kill, so we went to Fisherman's Wharf so Wes could have some lunch and eat it in front of me.  They told me not to eat or drink for 6 hours before the procedure.  That was in case they needed to do general anesthesia.  More about that later.  So I'm going to give you some pictures from around FW first.  It was a beautiful day, by the way.

So walking around Fisherman's Wharf we of course saw many interesting people, and a whole lot of tourists.
We found a nice little Japanese sushi restaurant.  Wes ate a big seafood noodle bowl right in front of me.  I can't show it because it was too pain for me to just sit there and watch him eat it.  But it looked great.
Now for the fun and games.  First off I'm going to show you nurse Nancy.  She assisted in the first procedure of shots.  She's got a serious problem. She apparently likes looking at old guy buns.  Sicko.  She tells me to climb up on the table and instructs me to drop my pants and shorts.  So I'm lying there for a minute before the Drs. come in and say, "The procedure's in his lower thorasic and uppermost lumber vertebra.  His pants won't get in the way." "Oops".  Get a good look at her so she doesn't get away with that if you're ever there.
The machine that she's behind is the Frankenstein Machine.  A lot of electrical juice goes through that.
                              OK, here we go.  Now for the procedure run down.  Ready, set, zap!
I asked if they could get permission from the UCSF legal department to take pictures while the procedure going on.  With the needles and things IN my back. No go.  So we'll work around it as best we can.
Here's Dr. Naidu ready to go.  The pictures on the screen are not me.  Don't you just LOVE his prom dress.  That bright green just really just brought out the color of his eyes.  Dr. Naidu graduated from the U of Wisconsin at Madison, got his MD there, did his residency at UCLA, now doing his fellowship at UCSF.  Great guy.
      Here's the package of death and destruction to the demon nerves. Looks pretty impressive doesn't it?        They only did three of the seven collapsed vertebra as the 3 have been the worst offenders. 
So first they wheel a portable CAT-Scan machine that's shaped like a half circle to bring my vertebra up on the screen.  From those pictures they locate the nerve that comes out of the spine and wraps around to the back of the spine where they get pinched by the facets. So the object is to zap the nerve before it gets to where it gets pinched so no pain signal gets sent to the brain.  
 Above is the picture of the what the needles look like outside of the sterile pack and after they had been inserted into my back and the offending nerves.  The whole set up to the actual ablation took just over an hour and a half.  Here's how it goes...First they do numb the area of the spine where they're going to insert the needles.  They actually put a tube into the area of the targeted nerve because the needles, as you can see, are not stiff enough to be injected through the skin and into the nerve.  Plus, the tube hole directs the needles for the deadening injection just before the actual procedure.   Here's a picture of the tubes. They are about the size of the opening on the point of a ball point pen.  Not too large.  Not too small.  But just right. Ya, right.
 Next is the picture of the needles in my spine. This picture below shows two of the three needles that went into the spinal nerves.  Charlotte, the 3rd year resident, couldn't take a picture of the needles in my back, but I convinced them all that she could take a picture of the picture of the needles in the back without breaking the rules. We just sort of bent them a little.  By the way, her prom gown was a classic black and looked very good on her as you can see in the picture below.

The dark spots inside the vertebra show the kyphoplasty procedure that Dr. Burch did way back when. 
 So here's how the whole thing goes... After they deaden the area and stick the needles in their fun begins.  First they ask you to let them know when you feel the spot get "warm"  This is how they figure out that they're in the right area of the nerve they are targeting.  Then they turn up the juice and, well, it's not like having someone put your hand in a bucket of warm water while you sleep, but it is an interesting sensation. From how much juice they have to turn the machine up to they can tell if they're near or at the right spot.  So they move the needles in or out to find the "sweet spot" on the nerve.  Times three.  Then they change the zap-o-meter to a different setting.  This time the sensation is an electronic pulse. Kind of a junior taser.  My left leg would really jump.  That was a good sign for them. It kinda of feels like the throbbing of a thumb that gets hit by a hammer.  Times three.  Of course they have to move the needles in and out to find the "sweet spot" here too.  Then, when they have the right spots figured out they pull out the probes and stick in a needle with the magic juice to deaden the nerves.  Wait 2 minutes for it to take affect.  Then, they stick the actual ablation thingy down the hole, crank up the juice on the machine, and it's over.  The ablation takes less than 30 seconds each and it's over.  Kind of anti-climatic.

In and out in less than 2 hours.  Had a great visit with Dr. Naidu.  Dr. Melanie Henry, the big boss, slipped in and out without getting her picture taken.  Either that or she was in a hurry to get back to the tollhouse pan cookies Dale made for them.

There you go.  It took a week before the pain in my back from the procedure subsided enough to let me know that the pain in my back wasn't so bad.  2 weeks and the pain was mostly gone and the back pain is much less.  It makes the end of each day so much more enjoyable without the throbbing pain in my back.  Thank you to all of the Drs. and staff that did that made that possible for me.

Wes drove home and stopped in Gilroy at Applebees and had a rack of ribs each.  Oh yea.  Because I DIDN'T need any general anesthesia, I could have eaten up to the time of the procedure! So I made up for the lack of breakfast and lunch with the ribs and mashed potatoes.  Ta ta for now.  Thanks for everything.  

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