Pain Center First Visit

We met Dr. Stephen Coleman (click here) and he spent quite a bit of time with us (Mary, Lara and me) asking and answering questions, poking and probing around Mary's back and ribs and describing what he thinks and will be doing. As is typical with Stanford, he had a rambling resident sidekick but only a singleton.

The bottom line is that Mary is set for a procedure on March 3 -- 1st available date. This procedure, a medial branch nerve block (click here), is a probing into the area of the specific vertebrae while the doctor is being directed via x-ray imaging. In the meantime, he recommended to Mary's oncologist to write a script for Neurontin (click here) which may act directly on the pain nerves rather than the effect she is having now on morphine and fentanyl.

The suspected mechanism is not necessarily a compression fracture. He thinks it is more likely collateral damage (friendly fire?) from the radiation treatment. That is why he is recommending the neurontin to wean Mary off the narcotics.

The procedure provides both pain relief and diagnostic clues. If the pain is gone after the procedure, it tells them one thing. If it is gone for a few hours, it tells them another thing and if it is gone for a month or two, it tells them a 3rd thing. So the outcome of the procedure can be 1) no change, 2) a change lasting a few hours and 3) a change lasting a few months. Option 1 is obviously not good and we didn't talk the "what if" scenario if it doesn't shut down the pain. If it works for only a few hours, then she will be recommended to take a radiofrequency neurotomy (click here). If it works for a few weeks, then she gets put on a schedule to repeat the procedure as routine.

He also scheduled Mary with the psychologist for an in-depth exploration of her overall outlook. I think this is because she has been in such pain for so long coupled with the Sword of Damocles (cholangiocarcinoma) hanging over her head that he wants to make sure she is doing ok overall. He also thinks the session may lead her to some techniques to minimize pain through posture, breathing and exercise. Mary's response was, "Let's do it, I want this pain to go away and have a life." I think what she meant was, "Living in a narcotics cloud is not living."

This feels like progress, not activity. Lara's comment as we left the complex was, "This was definitely more than a meet and greet and very productive." I have to agree.

After this session, Lara jumped on the freeway heading home to Pasadena tonight to be with her hubby and two girls. All I can say to Lara is thank you, thank you, thank you for being here this week. And, a big Thank You to Scott, Madelyn and Emma for letting us borrow Lara for the week. I cannot express the relief at having someone home with Mary while I attempt to do my job. After all, it is my employer's PPO plan that allows Mary to pursue these aggressive and extensive treatments. Plus, Lara made three kinds of soup, baked some muffins and things all to Mary's specific, bland requirements. Mary asking for bland food? Yep, that's how out of it she is with the pain and narcotics.

The line up is:

• CT Scan on Fri the 12th
• Dr. Visser, surgeon, follow up on 19th
• Dr. Fisher, oncologist, follow up on 22nd
• Dr. Gjolgi, psychologist, follow up on March 1
• Medial Branch Nerve Block, March 3
• Dr. Stephen Coleman, follow up, March 23rd.
  

I am going to have to ask the taxi team to help out again. They were magnificent for the radiation and I hope this is not asking too much.

Also, Mary saw her opthamalogist this morning. Her eyes are good, the glaucoma is well under control and her perscription does not need adjustment. Whew! One more thing off the agenda.