Finding the ghost in the machine

My consult with Dr. Chen and his colleagues today was both comforting and terrifying. We went over the stuff that I already knew: the L4-L5 disk is fucked. Chen's medical assistant advised me that spinal fusion is essentially my only option. I was disappointed to find out that total artificial disk replacement for the lumbar spine is not yet reliable enough to be a viable option. I did learn something, though. I did not know is that the disks themselves are ennervated. I thought they were simply masses of cartilagenous tissue and fluid. It is possible that the nerves in the disk itself are inflamed or damaged, and that may be the cause of my pain.

Before any kind of surgical intervention, it's necessary to gather as much data as possible about the origin of the pain. Pinpoint the problem as best they can so they can eliminate it. That's just logical. Only, despite the spiffy white lab coats and expensive degrees, when it comes down to it, no doctor is ever certain about how well a surgery like this will go. They could do everything right, and end up making the problem worse. No, it's not brain surgery. It's spine surgery, and it's no less complex, except that, with all those bones in the way, the surgeon has to be part mechanic. (Note: please do not click the previous link if you're squeamish.)

To my relief, neither the doctor nor the MA mentioned anything about having to lose lots of weight before the surgery, which is good, though they did caution against smoking, which will be a challenge. I think I can cut down. Just not at the moment.

In terms of further diagnostic tests, the medical assistant told me that she would recommend a discogram. It sounds like a new dance step, but it's considerably more painful. Basically, they'd stick needles full of flouroscopic dye into my disk space to try to reproduce the pain. If it hurts, it's considered a "positive" discography. The dye also illuminates any cracks or annular tears in the disks. It sounded horrible. And fascinating, since I'm weird like that.

When I actually met Dr. Chen, he said that he was "on the fence" about that procedure, as it is invasive and extremely painful. (Whew!) He recommended another test, the EMG (Electromyogram), a type of nerve conduction test. Only slightly less disconcerting than the disco nightmare, this test involves:

You will be asked to lie on a table or bed or sit in a reclining chair so your muscles are relaxed.

The skin over the areas to be tested is cleaned. A needle electrode that is attached by wires to a recording machine is inserted into a muscle. (Into a muscle!)

When the electrodes are in place, the electrical activity in that muscle is recorded while the muscle is at rest. Then the technologist or doctor asks you to tighten (contract) the muscle slowly and steadily. This electrical activity is recorded.

The electrode may be moved a number of times to record the activity in different areas of the muscle or in different muscles.

The electrical activity in the muscle is shown as wavy and spiky lines on a video monitor and may also be heard on a loudspeaker as machine gun-like popping sounds when you contract the muscle. The activity may also be recorded on video.

An EMG may take 30 to 60 minutes. When the test is done, the electrodes are removed and those areas of the skin where a needle was inserted are cleaned. You may be given pain medicine if any of the test areas are sore."

(Plus, you're not allowed to have any caffeine or cigarettes three hours prior to the procedure. Guess who's going to the coffee house with a pack of smokes right after I'm done?)

Anyhow, the EMG test is a done deal, scheduled for Friday, September 13th (make whatever inferences you like about the date). I'm less afraid of the electric needles in my muscles than I am about doctors trying to "reproduce my pain" by essentially digging around in my spine. I will decide later if I want to risk undergoing the discofuckme test. If they determine that they absolutely need more data to proceed with surgery or any other treatment, I may consider it. Don't get me wrong, I'm pretty kinky, but the idea of lying down and having someone stick a needle in my vertebrae, squirting it full of dye and asking, "Which hurts worse, when I do this or when I do that?" just doesn't appeal to me.

So, this is all information. I'm not really quite sure what to do with it yet. My emotional response has been, thus far, one of general apprehension, but also curiosity. I think I'll try to write about my actual feelings later. I will say again that I've accepted the risks. I know that, regardless of what I do or don't do, I will be in pain for the rest of my life. At least this way, I can say that I did everything I could to fix it. Worst case, I end up in a wheel chair, and really, given how many awesome people I know who have wheels, I'm actually not that bothered about it. Yet.

(I would totally have a tricked-out chair with Nerf rocket launchers.)