Rheumatoid Arthritis, Cortisone injections more musings on the field of pain relief medicine

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Lumbar Spine Right X-Ray MarkerI went back to get my spine injected with cortisone today. Back to the ‘spine guy’.  He is hard to get in to see, always booked six to eight weeks in advance, but he is worth it.

Usually when I see a radiologist for a cortisone injection, they are very specific. They will only inject one region. Only the exact region specified on the referral sheet.  On injection per appointment.  Go back to GP, get another referral, rinse and repeat.

I forgot this guy is different.

This morning I was trying to choose between my SI joint, which tends to flare horribly at night and keep me awake.  Or my facet joints which are constantly inflamed.  Both feel like knives twisting, and skin burning, but the SI joint is more intermittent.  So I was leaning towards the facet joints.  But last time I had my SI joint injected, a lot of my hip pain went with it. I hadn’t realised how much hip joint pain could actually be referred from the SI joint.

So what to do? The more intense, constant pain. Or the more intermittent, but still consistently severe pain, that could be responsible for more wide spread pain?

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I didn’t know.

So when I got to my appointment, I decided to ask the doctor.  Duh!

He said ‘Let’s take a look at how they look under ultrasound.’

Two minutes later he said “I’m going to inject them all.  You’re SI joints are very inflamed but so are your facet joints.  It will only take me an extra five minutes to do them all.”

Gobsmacked!

I think I love this man.

Usually it’s all about medicare item numbers, and how to charge and how much to charge and ‘no we need separate appointments’ and no, no, no, no, no.  Your pain is not our concern.  Only how to charge you for it matters.

It has always staggered me that, assuming its safe to do so, they refuse to treat all the areas of inflammation they can see.  It seems cruel to me, quite frankly.  They can see a problem, visible inflammation. It’s well known that inflammation causes pain.  Yet they refuse to treat it.  Not without another trip to your GP and another referral and another appointment and another few weeks wait.

This guy is different.  He’s a radiologist, (not really known for their bedside manner) but he’s different.  He has a quiet, caring manner.  He is booked solid, but he doesn’t rush.  He is happy to answer questions.  He can do two things at once.

While he was injecting my SI joint, I asked him about radiofrequency nerve ablation.  Unfortunately  it isn’t done in Canberra.  Only in Melbourne.  So it’s quite an expensive adventure.  But he explained the procedure could potentially remove all pain from my spine for up to 2 years.  What bliss!!!  He told me the best way to see, would be to inject the nerves that feed the joints with anaesthetic.  If that gives me (temporary) relief, then the nerve ablation will work.  And will be worth doing.  So he told me to come back when the pain is moderate, not yet severe, and he would do that procedure to test whether radiofrequency ablation is a good option.

He then said that injecting the nerves with cortisone could often also extend the period of effectiveness of cortisone injections.  I’d already told him that the previous round of injections had given me around 6 to 8 weeks relief and then the pain steadily worsened.   So he said (if I didn’t mind) he would like to also inject the nerve roots with cortisone, because that would also tame the nerves down.  Hopefully the procedure would last longer.

If I didn’t mind???  I said yes, please, thank you very much!

He laughed and said most people didn’t like that many needles.  I think he gave me 16 injections in total.  And yes, they do sting some, especially when he was targeting the nerves.  But it is nothing compared to the constant knives there normally.  I’m happy to have a bee sting to get rid of a broken bone.

And then he was done.  Maybe a fifteen minute appointment.  He was so efficient. And compassionate.  As he left he said “I do hope that gives you some extended relief and I don’t see you for a few months.”

He said it like he cared.

And now my spine is blissfully anesthetised.  I have to rest to let the cortisone settle in and do its job.  But it’s always a good sign when you get an immediate reduction in pain.  It tells me he’s put the cortisone in the right place.  And over the next few days I should see a big improvement.

And it got me thinking as well.  I have been trying to decide whether to go ahead and get my shoulder surgery done.  My shoulder is constant pain.  I am much weaker on that side, any overhead work is impossible and by half way through my yoga class I can’t use it anymore.  As my surgeon said when I first saw her, my shoulder is crap.

I’ve just been afraid to get it done.  But now I think it’s time.

I’m going to book the surgery.

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6 COMMENTS

  1. Clearly this guy took the FULL Hypocratic Oath… Cos, reading what you wrote about the referral, one shot, back to GP, rinse (!), repeat rigmarole, it seems to me that’s such an obvious lack of care…and leaving someone in that much pain, when a comprehensive treatment like you had today – in 15 minutes…??? Seriously???? For SIXTEEN needles???? Wow… – can offer what it’s clearly already given you. Preaching to the choir, I know, but just basic logic would suggest that the reduction in admin and running around this doc managed today HAS to be worth it across the board!

    • Yes EXACTLY Karen! Everybody’s happy today. And much more efficient on every level. The ONLY reason to insist on endless referrals is generating revenue. And while I understand that medicine is a business, and like any other, needs to make a profit, it’s primary purpose needs to be to help people.

  2. Wow he’s a keeper for sure. What a great guy, who clearly cares about his patients and not just how much money he can make out of them. That part of the medicine makes me sick to my stomach, I see too many people going without treatment/meds due to money or rather lack of it. I really hope you get fabulous relief from this injections, 16 that’s some going on your part but like you said totally worth it for the relief. Good luck with the shoulder surgery.

    • 24 hours on and I would say 60-70% better. And I can expect further improvement over the next few days, going by previous experience. I’m feeling very hopeful, and like a few things are falling into place. That’s the difference a caring doctor can make. Thanks Gillian 🙂

  3. What a difference a doctor can make! Kinda makes up for that craptastic doctor you went to last time, huh? On second thought, nah. Nothing can make up for that; he was such a egotistical, heartless s.o.b. Glad you have made up your mind on the surgery, waffling is just a bad place to be. I hope you have a great doctor to do it!
    Thinking of you…Marti 🙂

    • Thanks Marti! My surgeon is brilliant. Someone who I reckon would be fun to have a glass of red wine with ;). And you’re right – I feel better having made the decision. Onwards and upwards! 🙂

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