Monday, September 11, 2017

Life-Altering Drugs

Something happened to me, over the Labour Day weekend, that I haven't experienced, literally, in decades. Unless you've known me since before college, you've never known me in this state.

I was told that I had to rest, to be off my feet for at least 24 hours. I could experience some pain and discomfort for up to five days. I was told that I could expect to feel the effect of the procedure in three to seven days, that if I felt nothing after a week, the procedure didn't work.

It doesn't always work.

When it does work, the relief can last for six weeks to six months. On average, if it works, I could feel this way for three or four months.

I checked in to the hospital on a Friday afternoon. The waiting area in radiology was almost non-existent: just me and a young man, with his mother. He was in his late 20s: the same age I had been when my troubles began.

Within a couple of minutes of sitting, a distractingly beautiful technician led me down the hall and sat me at a chair across the hall from the imaging room. She sat with me and explained the procedure that the doctor would perform. Three injections in each foot: the first would freeze the area around the injection site. Not only would I not feel the next two injections, but I probably wouldn't feel my feet when the procedure was finished and I would leave the room.

The second injection would inject a dye into the area around the bones, to give a clearer image of the bones and spaces around the final injection site. A live x-ray would show where to inject the third needle, which contained the steroid that would hopefully relieve the osteoarthritic pain. The live x-ray would also help the doctor guide the third needle between the bones.

With my advanced arthritis, there was little space for the doctor to work.

The technician explained what should happen after the procedure and what would happen in the days to come. She asked me if I had any questions. I told her in explaining so thoroughly what I was to expect, I had no other question than to ask if I was to stay off my feet, how was I to leave the hospital? Would I be taken to the doors in a wheelchair? How was I to get into the car? From the car into my house?

I could walk after the procedure, but was to walk gingerly and ensure that I was steady on my feet. They would make sure I could walk before letting me leave the room. I was allowed to walk on my feet, but to take it easy, to not lift or carry heavy objects, to not spend extended times on my feet.

"Put your feet up. Read a book. Watch some TV."

I also asked her if she could estimate the time when I would be ready to head out, so that I could text DW and let her know when to return to the hospital. She said that everything should be done by 3:15, so I told DW to be at the doors with the vehicle at 3:30.

The technician then led me into the imaging room.

The doctor was a young woman who reminded me of my niece, who is also studying medicine. She was professional but easy to talk to, who rolled with the jokes I cracked, the goofy comments I made.

There was another technician behind a glass wall, along a bank of screens and controls. He was young, and he was joined by the distractingly attractive colleague.

A nurse assisted the doctor at the table.

I was told to lie on my side, to turn my leg from side to side to side as the x-ray machine took images and they found the best angle in which to work. A firm but comfortable pillow was placed under my head, to make me feel comfortable. A monitor was next to the doctor but was turned away from me.

The injections on my left foot would enter the inner side of my foot, about an inch away from my ankle. Almost exactly where the scars on the side of my right foot are from corrective surgery almost 28 years ago.

The doctor counted down to the first injection: "Three... two... one... ."

"That wasn't so bad," I said. "It's hurt worse for a flu shot."

"I'm going to have to go a little deeper," she said, "in three... two..."

"You don't have to count down," I said over her counting.

"One." I felt something pop as she broke through the next layer, in around the joint. The pain was second only to root canal, when my dentist hit a nerve. It was all I could do to not move, to keep still.

The pain was short-lived. The drug that froze my foot kicked in in seconds. The doctor asked me how I felt: I said I felt nothing.

At that point, she communicated mostly with the technicians, announcing when she was injecting the dye, and then coming to a consensus with her team as to the best point of entry for the steroid. With very little to look at, I tried to find the technician who had already distracted me but she was just out of my line of vision. I could see the male technician, and every so often see the other technician's arm extend towards a monitor, a finger pointing out an area, her colleague nodding in agreement.

The first foot took just over 10 minutes. It was just after 3:00. If all went well, I would be right on schedule.

The nurse had me lie on my back for the right foot, and after some images, they decided that this injection would occur on the top of my foot, about an inch from where my leg starts.

"Okay, Ross, ready in three... "

"Please don't count. Just do it."

"Two... one." First the light prick.

"Ready to go deeper in..."

I was better-positioned to look through the glass. I found the distractingly beautiful technician and looked at her, as the black-and-white image cast her in a dim glow. I could see the reflection of the doctor's monitor in the glass, but all I could see was the dark shadow of my foot. I couldn't see where the dye was pointing the way.

The second procedure took less time. Once done, the doctor stayed only long enough to allow me to thank her and for her to wish me success. She told me that she would send results and images from the procedure to my surgeon and GP, if that was okay with me.

Of course, it was okay.

The nurse sat me on the edge of the table, told me to let my legs hang down. She asked me how I felt, made sure I wasn't feeling dizzy. I was fine.

Slowly, I stepped down from the table. I could barely feel the cold floor under me, could only feel the pressure of the weight on my feet. There was no pain, no numbness, no tingling.

Nothing.

I walked around the room, slowly, the nurse following beside me, to catch me, should I lose my balance. I had no problem, but heeded her advice when she suggested I take baby steps, rather than normal strides.

After a minute, she walked me to the door, told me to come back if I had any problems, and wished me a good weekend.

It had taken me five minutes to walk from where DW dropped me off to the imaging reception. It took almost 15 to walk back. DW had stopped a short way down from the doors, but it seemed like a country block away.

Netflix was in my future when I returned home. I was on my feet only to go to the washroom and to climb the stairs at the end of the day, to go to bed.

How my feet looked when I got home. Ugly.

Saturday was relaxing. More Netflix. A drive at sunset to capture my POTD. An evening of sitting and visiting friends—one, who has known me since before my osteoarthritis, before my Kohler's.

On Sunday, I awoke, rose from bed, and experienced, for the first time in decades, a state that had become foreign to me. I was completely pain-free.

On a scale of 1 to 10, where 10 was excruciating, where I could no longer stand and the pain was throbbing, I was experiencing zero.

I could feel my feet, but there was absolutely no pain. On a very good day, I could still feel pain at 3 or 4, but pain was  typically at a 5 to 7.

I was at zero.

I came down the stairs and entered the kitchen, where DW and the kids were already sitting at the table, ready for breakfast. I was near tears. I was grinning from ear to ear. I did a little dance and laughed.

"No pain!" I cried. "I feel no pain!"

We celebrated with bacon. The good stuff, seasoned with ghost peppers.

After breakfast, the family headed downtown, to the Rideau Centre, where we shopped for back-to-school clothes for the girls. I walked all the halls, climbed up the escalators. When the girls went into an intimate-apparel store, I searched Google for the closest corn-dog place (I hadn't had one since I lived in South Korea and I suddenly craved one). It was in the middle of the Byward Market, on Clarence Street.

No problem, I told myself, I can walk there no problem. It was raining and I wore only a sweater and jeans, but I didn't care.

On my way back to the Rideau Centre, the pain came back. At first, it was a 5. By the time I found the girls, it was at 7. By the time we returned home, it was at 11.

I spent the rest of the day off my feet. Took pain meds. Rubbed in some Voltaren. Drank some beer.

Monday was a holiday. I awoke to a dull pain in my feet. A 2. Time for more binge TV. Shameless, Top Gear, season 7 of The Walking Dead. By mid afternoon, the pain had subsided. I was back to zero, but I stayed down. I was not going to take the reprieve for granted.

I was back to work on Tuesday. By then, the medication that had been pumped into my feet had sorted itself out. The arthritic pain was gone, but I could feel one spot in my left foot that was sore: it was where the Kohler's was affecting me. The bones in that foot were still rubbing, still clicking, still sore.

But that was the extent of the pain. It's as though the steroid was acting as a filter, taking care of the osteoarthritis but reminding me that there was still work to be done on that foot.

It's been more than a week since the procedure. So far, if I'm good to my feet, they're good to me. If I lift heavy objects, if I stand for too long, if I exert myself, they let me know that while they're full of a life-altering drug, it's not a miracle cure.



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