Ok, this might be a bit long-winded, but a lot has been going on and a lot is on my mind, so please bear with me.
Most of you know that my back/spine problems have been pretty bad, and at times unbearable, since my accident. Four months of physical therapy, chiropractic, and drug after drug have not solved it. So Thursday I went up to the OHSU spine center to try to figure things out, but only came home more frustrated than when I walked in. My doctor (who is an anesthesiologist who specializes in pain management) was a bit too blunt for my taste - almost to the point of rudeness. Told me never to take tramadol again because it can cause seizures in the general public, not to mention an epileptic, yet wouldn’t give me any other options for pain control. And then when I told him I can’t work (training horses) because of the the pain, he told me I need to find “another applicable life skill, because you only get so many chances before you’re a vegetable. Riding calm horses in an enclosed space might be acceptable, but I cannot let you leave this office without strongly warning you against it.”
Then things really got fun. He poked around on me a bit, and then tried to tell me I have Fibromyalgia. Um, excuse me? I have Fibromyalgia because I am sore on at least 11 of 18 trigger points, because I have reported cognitive problems (weren’t you just talking about my TBI?), and I have a history of anxiety (which he took to be truth from the mouth of my mother, even when I specifically told him I do NOT have anxiety problems)? There’s one part missing here: I have had pain ever since a very specific date: September 11, 2010 -the day of my accident. The pain is NOT WIDESPREAD, like it is in true Fibromyalgia, it is very specific to my back and muscle groups that are involved in my seizures, which are still not 100% controlled (and I even told him that my last seizure was only four days prior to that office visit…didn’t seem to matter to him). I might not be an expert, but that doesn’t really sound like Fibromyalgia to me. AND THEN, he told me that I have a “pain disorder related to psychological factors” and that he wanted me to start physical therapy and consult with a pain management psychologist. This is AFTER he ordered an MRI of my lumbar spine…thank heavens I have the radiologist’s report on it, because he told me it was “normal”
This is what the report said:
Lumbar spine MRI without contrast 3/3/2011
Clinical history: Low-back pain radiating down right leg.
Technique: Sagittal and axial noncontrast T1 and T2 weighted images were obtained of the lumbar spine without IV contrast. Sagittal stir sequence was additionally obtained.
Findings: There are 5 non-rib bearing lumbar type vertebra. There is minimal retrolisthesis of L5 on S1. Alignment of the lumbar spine at other levels appears anatomic. The vertebral body heights are normal. There is focal disk height loss and desiccation at L5-S1. There is a tiny focal central posterior disk protrusion at L5-S1 which rests within the epidural space and causes minimal central spinal canal stenosis. There is mild bilateral facet arthropathy at L4-5 and L5-S1. Disc spaces at other levels are relatively preserved. The conus terminates at a normal level. Paraspinal soft tissues are within normal limits.
Impression: A small central posterior disk protrusion at L5-S1 causes minimal central spinal canal stenosis. No significant neural stenosis or compression is seen at any level.
Like I said, I’m no expert, and the key word to me here is that all of the findings are “mild” or “minimal”, but I still don’t think you can call that a “normal” MRI. His only solution to the problem is PT (which already failed once) and pain management psychotherapy…Long story short, I really didn’t appreciate being told that my problems are all in my head (of course I am not saying that I think Fibromyalgia is a mental disorder, I know enough to know that it is a very real physical problem, but I still just can’t believe that it is something I have).
My mom and I both left very frustrated, so we are getting a second opinion with the physician at OHSU who first saw me for Post-Concussion Syndrome. He is a sports medicine/ortho doctor, so maybe he will be able to provide some additional insight…but my appointment is not until the 15th - thank heavens my TENS unit will be here Wednesday, because I am almost out of narcotics!
But, this whole finagle brought something to my mind that I’ve honestly been keeping buried for a very long time…
It took me many months to be aware of and accept the fact that I have a traumatic brain injury and a seizure disorder, but I have finally done it over the past few weeks. I know that it is not going away, it has a real effect on my life and on my functioning (it’s the #1 reason I chose med school over vet school), and I can look at myself in the mirror and say “Megan, you have a brain injury. You have a seizure disorder.” I can do that now and genuinely like the person I see in the mirror.
But my first impression when the doctor mentioned pain related to psychological factors was anger. Lots and lots of anger. He was questioning my mental health and I just got MAD. And I don’t know why, because it’s perfectly legitimate to question it. I’ve had an on-and-off history of anxiety and depression, but it’s something that I’ve always personally struggled to deal with emotionally. My mom has been severely bipolar since many years before my birth, and as terrible as this might sound, my greatest fear in life is becoming like her. I’ve tried dealing with the problem through therapy which helped some, and I even tried SSRIs - they kept the depression and anxiety problems away, but they also unwound me so much that I felt like my emotional rheostat, which normally flipped between “EEEEFFFFFFF my life!” and “YYAAAAAAAAAAAAYYYYY!!!” was now stuck just on the “yay” side of “meh”. I didn’t like it and I felt like I didn’t have enough anxiety to get done all that I needed to get done in my crazy absolutely insane life, if that makes any sense. I stopped drugs and therapy and I got very, very good at lying to myself and really, truly believing that I was superhuman and I could do everything I wanted. So I did. And for the most part, I was successful. Then, only about two months before the accident I really started getting burned out on life and I felt like the mansion of cards I had built was crashing down, but I just couldn’t muster up out of the burn-out to do much about it until things were at the breaking point. I met with a counselor at school only about three weeks before the accident.
Then that happened. And everything was turned upside down. I went through the depression, anger, denial, grief, and anxiety that always accompany something so life-changing as that, and I fought with it and I deal with it and I overcame it. As I said, I’m at a point now where I am really, really okay with the brain injury and consequences of that because it has taught me so much and it really has made me a better person. There is a silver lining that I can use to help me and help other people.
But now, just as I have finally reached this point, that monster is back. He’s clawing at his cage and he can’t be kept in it anymore. But I just can’t seem to admit that to myself. I cannot look at myself and say “you have an anxiety disorder”. It’s a little easier to say that about the depression, because I can blame it on the brain injury (depression is so very common after TBI). And the denial has gotten to the point where I will even deny my entire past history of anxiety and depression. I will deny it to myself, to my mother, to doctors, to anyone. And I don’t know why. I think I just look at it as a sign of weakness and failure, which is absolutely ridiculous! I would NEVER think that on ANYONE who is suffering from these terrible diseases, I know it’s a physical, chemical problem of the brain, but I will think that about myself. I’ve spent so long lying to myself and convincing myself that I am a superhuman uberwoman that such a problem cannot possibly affect me. Do I have episodes of anxiety? Yes, everyone does. I might have a little more than other people because I am a pre-med major in my senior year taking insane numbers of credits while trying to juggle thirty other things all while coming back from a devastating injury with my token high-strung personality. Who wouldn’t have a bit of occasional anxiety? It’s all part of the game.
At least, that’s what I try to tell myself. I try to convince myself that if I do have a bit of anxiety, that it helps me to perform at my peak functionality, but it’s not true. There are times, usually during midterms or finals or other off-the-charts-stress times, that it gets to the point where I nearly can’t function. Then the depression sets in because my life now is so different than it was six months ago and I am not succeeding and I am not superhuman anymore, then I get more stressed about how I am going to redeem myself from the lack of success that I lose more functionality and I get more depressed…it’s a very vicious cycle.
And yet I still won’t admit it to myself. I just can’t do it. I can’t bring myself to accept that there is one more piece of me that’s not what I want it to be. Not after the brain injury, not after the back injury, not after losing so much. Then when the doctor at the spine center told me my pain is a psychological disorder, I went into even greater denial, but ironically, a piece of me believes him. Maybe it is all in my head. Maybe there is nothing physically wrong with me and my problems are all just manifesting as physical symptoms.
Anyway I cut it, I’m confused and frustrated. I want to solve the anxiety and depression, but my time-tested method of “deny it and bury it deep until it fixes itself” really isn’t working anymore. But I’m paralyzed by the fear that if I do admit it, then it really will become real and I it will eat me up and I will end up like my mother - depressed and completely nonfunctional for 20+ years. I know I need to do something, but I don’t know what. I want to go back to my new life that I had figured out after the TBI and before this. I want to be able to ride and train (myself and my horses) again. I want that feeling of control again, because right now there is no control.
I think the first thing I need to do is accept it and figure out exactly which areas of my life it’s affecting the most, but I don’t even know how to do that anymore.
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