Saturday morning in the ER, we all felt that Sean needed to stay in the hospital for a few days, until the doctors could get his pain under control. Since Dr. Silver practices in Raleigh, it made sense to us that he be admitted to either Rex or Wake. The ER doctors had been in contact with the on-call orthopedic in Raleigh throughout the night. That doctor recommended Sean be evaluated in their Urgent Care office, then admitted to Rex from there. This would require a car ride from Wilson to Raleigh and even though Sean was heavily medicated, he would not have tolerated a 45 minute car ride. We arranged for a transport service to pick him up from WilMed and comfortably get him to Raleigh.
The EMS guys were great. They took extra care with Sean, even taking him into the Urgent Care office on the stretcher. The PA, Laura, who evaluated Sean that morning was wonderful. We made very clear to her that we felt the best next step was a hospital admission. Our efforts to get his pain under control had been unsuccessful for too long. I had already spoken to Dr. Silver before we arrived at the Urgent Care office, so he was aware of the situation. Once Laura contacted Dr. Silver to give him her assessment and I explained to him that I didn't feel comfortable taking Sean home on stronger narcotics, he had Laura start the paperwork process to get Sean directly admitted to Rex. And by 2pm that afternoon, Sean was resting inside the four walls of Rex.
Most people probably think a hospital stay is the worst idea ever, but in this situation, we were all breathing a bit easier once he was there. Even though his pain wasn't better, he was under the care and supervision of professionals trained in dosing and administered strong doses of narcotics. The plan for the hospital stay was to figure out a regimen to manage the pain and we were hoping that by being here, we would be able to stay constantly ahead of the pain. But, Sunday morning around 4am, he woke in more excruciating pain - these episodes were unlike anything I'd ever seen. It was awful and so frustrating to experience with him. There's so little that can be done to help relieve the pain. All I could do was try and help him relax. There's only so much relaxing that can be done when you're in that kind of pain. Later that morning Dr. Silver upped the nerve meds pretty significantly. With that, in combination with the arsenal of other meds, he was able to stay ahead of the pain for most of the day, as long as he didn't do much moving.
Since it was the weekend, the Rex pain specialists were not making rounds. The nurses explained that we could request a visit from them on Monday. We had an appointment with the pain specialist at Triangle Ortho for Tuesday, but that was Tuesday. We needed some answers sooner than that. So Monday afternoon, Sean met with a nurse practitioner with the Rex Pain Management office. She did an examination and determined that the pain Sean was experiencing was definitely nerve related. When the compressed nerve became freed up after the surgery, it was pretty much just pissed off. It began firing constant pain signals to the brain. The slightest touch or sensation was a million times more intense than it should have been. Sean felt like he had a severe sunburn on his whole leg. She suggested a sympathetic nerve block procedure that could help relieve some of this nerve pain. She was unsure of whether Sean was dealing with a compressed nerve or if he was suffering from a condition known as Complex Regional Pain Syndrome (CRPS). Either way, it seemed the treatment was the same. A nerve block to relieve the pain and physical therapy to regain mobility, which would essentially re-train the nerve on how to function properly. She left that day to consult with the physicians in their practice and said that it was possible that he could have the block procedure done the next day.
That night I, of course, spent a couple of hours googling the procedure and learning as much as I could about what could possibly be going on. We said a prayer together before falling asleep sometime around 10. When the nursing assistant came in to check Sean's vitals a little while later, she noted that he had a low grade fever and his blood pressure and heart rate were a bit elevated. At first his nurse didn't seem too concerned. When she came in to give him his narcotics about an hour later, she did a routine oxygen level test. That number had dropped since her last check. So given all the changes in his vitals, his nurse made a call to the hospitalist on call. Sometime shortly after midnight, there was a knock at the door from a very kind doctor, who asked Sean how he was feeling. He explained that he felt a CT scan of Sean's lungs was an appropriate next step, in order to determine what could be causing the change in his vitals. Around 2am, after getting essentially no sleep, Sean was wheeled away for the scan. Then at about 6am there was another knock. This time from Dr. Lam, with Rex Pain Management. First off, he was the bearer of good news that Sean's scan came back clear. Then he went on to tell him that he agreed with moving forward with a nerve block. Fortunately they were able to get Sean scheduled for a block that morning.
In terms of success of the block, medically speaking it went well. Sean had quite a bit of pain relief through the day. He was able to move his leg more comfortably and looked great. They had explained that the block works in two parts. What happens is they inject numbing medicine into the sympathetic nerve region of the spine. This essentially puts those nerve to sleep for just a few hours -- actually, anywhere from a few minutes to several hours. While the nerves are resting they aren't constantly sending pain signals to the brain. The 'hope' is that when the nerves wake up, they will forget how screwed up they were and start functioning normally again. In Sean's case he got about 8 hours of pain relief, but when his nerves woke up they were still all kinds of pissed.
Sean was discharged from Rex Wednesday morning after being evaluated by the pain management folks. The previous week Dr. Silver had set Sean up with a very hands-on PT clinic. His first appointment with them was supposed to have been on Monday. Since he was still in the hospital that appointment had to be rescheduled....for Thursday. So come home from the hospital and begin PT the next day. Brutal. But necessary. Everyone had told us that PT was the answer. Nothing is going to treat the nerve pain better than regaining normal functions with the leg. Getting Sean there that morning was the beginning of a new journey. One that would finally show significant results 1 week and 1 day later. Buckle up kids, you are about to meet Flo...
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