Disclaimer

I am not a doctor.  I didn’t even finish my biology degree.  I failed out of a state school with a scarred liver, severe hemorrhoids and a working knowledge of Rooskie mat (Russian cursing).  I am not giving medical advice.  I’m just going to the beach.  In fact, you should consider this entire post pure fantasy - a ‘what if’ scenario, if I could go swimming again!  If you listen to me, instead of your doctor, and act out anything documented in this blog post, you are the worst kind of fool.  Do not try this at home.

This post was a dead end treatment path for pain. Injecting your muscles to numb them is a bad idea. You need to learn to live with your pain, as I have since this post.

Prolog (Head :- Body)

I wrote a story in first grade called My Trip to the Vet.  It won some low level award for its use of big words and long sentences.  This tid-bit of encouragement got me, eventually, into F. Scott Fitzgerald and the like.  It took years of globetrotting Hemingway literary therapy for the short-sentence cure.  Which was then destroyed by Kerouac and his endless benzedrine fueled run-ons.  It didn’t hurt that I was reading him while medicated with Adderall (dextroamphetamine and amphetamine) for my Attention Deficit Disorder, so in his nonsense I felt a special kinship.

This story is like that one, just 25 years later.  I’ve changed little.

One thing has changed over the last year:

I hurt all the time.  My pain scale is different than yours.  It goes to 11.  Moving makes it worse.  Something is bad wrong with the facet joints in my neck.  The nerves that innervate my entire upper back and arms run right by these joints.  This renders me unable to use my arms for sustained periods without my pain going off the scale.  To address this problem, I’ve tried (4x) medial branch blocks and (2x) pulsed radio-frequency ablation, oral and topical non-steroidal anti-inflamatory drugs, corticosteroids, COX inhibitors, anticonvulsants, muscle relaxers, high-dose selective seratonin-norepinephrine reuptake inhibitors, heat, ice, transcutaneous electrical nerve stimulation, electrical muscle stimulation, traction, herbs, chinese medicine, tiger balms, capsaicin patches and creams, opiates, acupuncture, pain psychology, restorative yoga, vitamins and supplements, massage therapy, physical therapy, bed rest, feldenkrais, pain classes, self-help books, and via lidocaine injections - prolotheraphy.

The current drug regimen looks like this:

All the medicine and the backup regimens, plus the medical waste, look like this:

Or even:

Thats a long way of saying that my quality of life sucks, and that I’m looking for a cure.  Boo hoo.  Starving children and all that.  At least I don’t have cancer.  I’m not dying. It just feels like I’m dying.  

The severe pain that won’t go away tells my brain I’m terribly injured, and just like a house cat that runs off into the woods to die in a nook or cranny, there’s a tendency to not want to move.  Pain avoidance.  Each day is consciousness over instinct.  Knowing what my body is telling me isn’t real and overcoming it.  

Regardless, I take extreme measures to enjoy the little things.

My trip to the beach

We started by numbing the terminal nociceptors in the upper half of my neck and back with 180mg of liquid Ropivacaine (most of 10ml @ 2%).  This involves alcohol prep of the entire area, and between 20 and 30 intramuscular injections with 1/2", 28 gauge insulin needles, in those muscles innervated by the cervical nerves C3 through C7.  I’ll spare you a shot of my hairy back, but you can use your imagination via this chart:

Before:

After:

I’ve been using lidocaine patches for almost a year, and lidocaine injections for a few months.  Lidocaine is great, but patches aren’t very effective for neuropathy (or swimming), and injections only last 2-3 hours - with some lingering effect.  That means between 5 and 8 rounds of injections a day, for a total of between 100 and 240 pokes per day.  This might be a great solution if I had a nurse on hand to inject my back all day.  But I can only get so far without help, so the short half-life of lidocaine is a problem.  By the time I got home from the beach, the lidocaine would be wearing off, and I’d be in a world of pain all night - injecting over and over again, every few hours, or shaved and covered in patches and creams. 

Lidocaine is harmless stuff compared to longer acting alternatives.  You’re probably familiar with Xylocaine (lidocaine) at your Dentist’s office, and you’ve probably asked for more of the stuff through a nitrous mask.

Marcaine (bupivacaine) lasts about 12 hours, and is used extensively in epidurals and nerve blocks.  It is markedly cardiotoxic when it enters the bloodstream, and can occasionally cause life-threatening complications to patients when accidentally injected intravenously.  In my case, with daily injections, an accidental intravenous injection is inevitable.  So a safer, longer acting agent is required.

Naropin (ropivacaine) is a pure S-(-) enantiomer, an alternative to bupivacaine engineered to be less cardiotoxic. It can last as long as 24 hours.  It is new, and expensive.  And its only ever killed one person.  And I got some.  So I can go to the beach.  Without Ropivacaine, last time I went to the beach I called the emergency line at my pain clinic for an emergency prescription and stormed the aisles of the nearest pharmacy, applying topical medicine after topical medicine before paying, in an attempt to find relief.  One gets tired of going to urgent care or the ER, which looks like this after hours of waiting:

It takes about 15 minutes to saturate my lats, rear delt, neck, rhomboids (pull out your anatomy book), and several strange, scary, ropy bastards I can’t identify except in this picture and by when they are 'on’ - OW - or 'off’ - not there.

No, REALLY, my trip to the beach

I found my wetsuit in the back of my closet and threw it in the car.

I drove to the beach.  I haven’t been able to drive for a while because I was on pain medication that prevented it.  This Ropivacaine business is a trick to get round that.  Linda Mar is a few miles by Hwy 1.

The clouds blocked the sun.  It was dark by the time I got there.  Pedro’s point looks just like Goonies, huh?  In this highly medicated 80s flashback, I am Chunk and the ship is rounding Pedro’s point as the kids scream and the adults stand open mouth and dumb-founded.

I donned my wetsuit and hit the water.  It was very low tide.  I body surfed a little, jumping off the sand into each wave.  I’m not very good at that, or surfing at all, but I’m a decent swimmer.  When I’m in practice.  The water was warm - for Linda Mar.  Which means it was still freezing.  I got ice cream headache.  I love ice cream headache.

I came back in, washed the salt off under the outdoor showers that dispense mere mililiters of water per button push (push, push, push, push, push…), and went home feeling myself again.  

If only for a little while.