News and Events

                   

     

Here are some of the recent updates on James's health and progress since neck surgery (Oct. 2005). 

Update: Thursday, August 26th, 2010:  Removal in June of the old pump and the insertion of the new one caused trauma enough to James's stomach area.  Since then, his suture has not closed properly, and is now infected.  The pump began breaking out through his skin, and today he is having surgery to remove it so that the infection can be cleared out.

 

Update: Monday, June 21st, 2010:  After learning that his morphine pump had run out of medicine and had burned out, today James had another procedure to replace the pump.  It had since been re-started with morphine after Dr Creighton moved down the spinal catheter to a safer region of larger vertebrae.

 

Update: July and August 2009:  James had outpatient surgery on both knees, a month apart.  The purpose was to repair some torn meniscus cartilage.

 

Update: Sunday, June 22nd, 2008:  James's morphine pump is still implanted, but it is turned off.  The stimulator has not (yet?) been implanted, as James and his doctor are inconclusive about long-term success in his case.  He remains on oral doses of methadone, Lyrica, dilaudid, Cymbalta, and methylin.

 

Update: Sunday, May 4th, 2008:  The SCS procedure took place on May 1st, em-ploying a trial set of wires and an external battery pack.  The trial ends on or about May 6th, after which James and his doctor will assess its success.   James does not like the tingling feeling caused by the electrical "stimulations". He finds it irritating and feels strongly that the system should be removed. 

 

Update: Wednesday, April 2nd, 2008:  This month poses a bit of good news, tempered by another postponement:  James's insurance company approved the pending procedure, but now we learned today that his doctor cancelled James's SCS trial for personal reasons and has reset a date of May 1st.

 

Update: Friday, March 14th, 2008:   More disappointment was encountered with the news that the SCS procedure still had not been approved by James's insurance company.  He was advised that he has to be patient for another month.

 

Update: Wednesday, February 6th, 2008:    The SCS procedure was supposed to take place on February 7th, however, it could not be scheduled in time because critical medical records were not released by his former pain mgt. practitioner until today!  New SCS trial date is March 13th.

 

Update: Friday, December 7th, 2007:  The SCS procedure, scheduled for Dec. 6th, has been postponed for up to a month because insurance approvals are delayed.

     

Update: Friday, November 30th, 2007:  Once again, James will be admitted to hospital for a trial of a new treatment for his pain.  The morphine pump will be shut off completely, and James will be outfitted with small electrodes in the spinal column.  Called SCS, or spinal cord stimulation, the process is utilized to send minute electrical impulses that cancel out other signals trying to reach the brain that are interpreted as pain.   If this succeeds in reducing his chronic pain, the pump will be removed and a small rechargeable battery pack will be implanted.   James will undergo this procedure on Thursday, December 6th.    Going forward, Dr. Paddah is James's new anesthesiologist for pain management.

 

Update: Saturday, November 17th, 2007:  The past two months have been difficult to assess and attempts to post updates have been muddled.  Although James has been free of oxycontin and has been relying on the morphine pump for his pain control, the pump has not worked satisfactorily:  James has had ongoing nausea and only moderate pain control with the pump.  He was not able to communicate well with his pain manager and sought a second opinion.  He met with a new pain specialist around the end of October, and this doctor urged James to quit the pump and try something else.   The doctor felt strongly that nausea would continue and that the pump itself was inappropriate for James's situation.  Stunned and numb, we both have been wondering "What now?   What next?"  His pump has been stepped down twice to about ¼ of the morphine dosage he had relied on; in its place small amounts of oxycontin and methadone are supplementing his pain control.  The doctor is recommending James try the SCS, or spinal cord stimula-tion, method.

 

Update: Friday, September 28th, 2007:  The blood patch seems to be working, and James's headache is gone.  Today was a routine post-surgery doctor's visit with Dr. Yi and Dr. Scarlett.  Suture staples were removed and incisions were cleaned and inspected.  As of day of surgery (9/20), James's dosage of oxycontin was dropped from 80 mg/day to 40 mg/day.  Today he was advised to drop to 20 mg/day for 3 days; then to 10 mg/day for 3 additional days.   By Oct. 4th, he will be off of that drug altogether!

 

Update: Wednesday, September 26th, 2007:  Today James went back to hospital to undergo an epidural blood patch procedure.  He had been suffering a debilitating headache for several days since his surgery, and doctors believe his spinal fluid has been seeping from the theca, causing the loss of pressure and the headache.  A small amount of his blood was drawn and injected near the leak, causing a small clot to halt the fluid loss.  He was advised that his headache should diminish over the next 24 hours or so.  He must be calm and not bend over or carry anything for the next two days or the patch could fail, requiring the procedure to be repeated.

 

Update: Thursday, September 20th, 2007:  James had surgery this morning and now has an implanted intrathecal medication pump.  It doses small, therapeutic amounts of morphine to his spinal fluid to control the chronic pain in his arms and shoulders.  Dr. Yi met with James and Rick this afternoon and said all went well during the 2 ½-hour procedure.  James will remain in hospital overnight, and should be home tomorrow afternoon.  He has a headache and some soreness in the abdominal area surrounding his incision and subcutaneous pump "pocket".

 

Update: Thursday, August 16th, 2007:  James was released from hospital today.  He and Dr. Yi agree that the pain pump works very well at controlling the pain in his neck and shoulders.  This trial seems to have been a great success:   James's pain was minimal during the test run; he looked good and sounded lucid, and he felt his vision was clearer.   It is probably not too early to say that the next step will be for James to have a portable version of the intrathecal pump implanted abdominally for regular, daily medication.  His next challenge will be to get a reservation on the surgery schedule, which could have a waiting list of one month or so.

 

Update: Tuesday, August 14th, 2007:  This morning (at Barnes Hospital) James had a trial catheter inserted to deliver pumped dosages of morphine to his cervical spinal fluid.  The purpose is to determine how effective the pump is at relieving his chronic pain.  He was feeling fairly well this afternoon when Rick visited him.  James was joking with the nurses and half-heartedly complaining about the view from his windows.  We took a walk to get some "fresh air" before he ordered his dinner.   Hopefully he can catch up on some much-needed rest during the next couple of days.

 

Update: Monday, August 13th, 2007:  James and Rick visited with Dr. Yi (who is James's anesthesiologist and pain management specialist) to discuss details of the related medical procedure and to gain an understanding of the benefits of the morphine pump and its risks.  Dr. Yi reassured us both and he is optimistic about the successful outcome of the trial run in controlling much of James's pain.                             

Update: Friday, July 29th, 2007:  James received approval from Anthem Blue Cross Blue Shield  to have benefits coverage for the testing and implantation of an intrathecal (within the sheath enveloping the spinal cord) morphine pump.                                       

Update: Wednesday, November 29th, 2006:  We have a reason for renewed optimism.  During his regular occupational therapy session, James's therapist, Cia, noticed that he is able to make and control wider circles using his upper arms in rotation exercises, evidence to her and to us that some motor nerves are indeed growing.

Update: Monday, November 6th, 2006:  James and Rick visited with Dr. Beverly Fields, a psychologist in the Pain Management Center. 

Update: Thursday, October 5th, 2006:  James is having some "good days" and more "bad days", yet even on one of the better ones, he is needing to work slower than he did just a few months ago.  Today Dr. Yi visited with James and Rick at the Pain Treatment Center.  James explained his substantial level of chronic arm and shoulder pain.  Dr. Yi agreed to increase James's dosage of Lyrica to 200 mg t.i.d., but declined to make any adjustments to his Oxycontin and Percocet prescriptions.  Dr. Yi wants to see James after one month, but also wishes for him to be examined in the interim by (another) neurosurgeon of his recommendation for an alternative procedure.  We have some hope that a pain pump may bring him some real relief.

Update: Friday, September 8th:  Another month of pain.  Dr. Yi tries a bilateral nerve block on James.  Results were unremarkable, as James was advised might be the case; he feels that the block had no effect.

Update: Saturday, August 5th:  The St. John's pain manager didn't work out, and now James has to make an appointment with yet another pain management anesthesiologist, Dr. Xiaobin Yi.  He hasn't had any medication adjustment since June.  He is trying to make the best of it in the interim.

Update: Monday, July 10th:  James has a new pain management specialist at St. John's, who is not scheduled to see him until July 24th, unless, in the mean time, there is an appointment cancellation by another patient.  Two points are noteworthy:  he urgently needs some adjustment to the current dosages in his regimen of meds, and there are sporadic new nerve firings in his shoulders (jolts and vibrations) that bring both discomfort and the coïncident, genuine hope that some nerve growth is occurring.   He remains ever the optimist!

Update: Wednesday, May 3rd:  Dr. Mackinnon saw James today and is very pleased with his progress.  She gave him permission to return to work, drive his truck, and return to all normal daily activity.   His incisions, all 27½ inches of them, are healing well, and his localized pain seems to be under control.  Now he must wait for the nerves to catch up; they grow slowly, and full recovery will take up to 8 or even 10 months.  

Update: Friday, April 28th:  After two nights' stay, James was released from hospital yesterday.  He feels and looks much better already.  His pain is under control, and the binding tape was removed from his arms.  James is uncertain when he can go back to work; he will know for sure once Dr. Mackinnon sees him on Wednesday, May 3rd, and says it is OK to return to the salon.

Update: Tuesday, April 25th:   James had a surgical procedure today to improve his ability to stretch his arms forward (perpendicular to his body).  The two surgical teams, operating on both arms simultaneously, were led by Dr. Susan Mackinnon.   The operation lasted from 11:00 AM until 5:20 PM.   We were able to visit him at about 7:00 for a short while upon his release from the recovery room.  His arms are completely immobilized, taped to his body, for the next day or so.  His cheeks and lips are swollen, and he admitted to being in a lot of pain (morphine was on the way, he was advised, and it did come with just enough time for us to say good-night before he rested). 

Dr. Mackinnon is very optimistic about his probable improvement.  The fact that she committed such a length of time to him bespeaks her feeling that his case was worthwhile.  She indicated that bilateral paralysis as in James's situation is extremely rare, such that she has seen only two or three cases in her entire career.  She found numerous nerves in his shoulders that were bunched and constricted, and she relieved their pressure by gently spreading them apart.  This may help him further at both the sensory and motor levels.   James will remain in hospital for at least two nights.

 

Update: Wednesday, April 5th:   Another surgery is scheduled.  James will have nerve transfer surgery on both arms and shoulders on Tuesday, April 25th.  Dr. Mackinnon will have two teams working simultaneously to remove one nerve from each of his triceps, and insert it in the corresponding shoulder (deltoid) muscle.  The objective is to allow James to raise his arms straight out in front of him.  This will be a 3 to 6 hour procedure, with an overnight stay in hospital.

James is eager to have this operation behind him, so that his quality of life can improve.  It is unclear whether he will be able to discontinue any or all of his pain maintenance medications.

 

Update: Saturday, March 4th:   Unfortunately, James's pain has been getting worse, and his dosage of Oxycontin has had to be increased.  This seems to have helped him somewhat, and his spirits are good; he remains as active as his condition allows.   There is no change or improvement in his paralysis; he will continue to have periodic EMG tests (electromyograms) or as his doctor calls them, the "needle torture sessions", which search for any nerves which may show some positive conduction activity.   It will be a few more months before we know if enough of the nerves will grow back in sufficient numbers to be useful to him.  We still are hopeful of an eventual recovery.  In the meantime, James is coping very well under these difficult circumstances and is mentally prepared for the possibility that his paralysis may be permanent.

Update: Wednesday, February 15th:  Yesterday James and Rick visited with neurosurgeon, Dr. Sprich, who reviewed with them the results of James's recent cervical spine CAT scan.  The good news:  it can be seen that the fusion is complete, and the new bone that had been added and secured by plate and screws in October has incorporated properly.  However, there is some stenosis visible in the left portal at C-7 where the nerve bundle leaves the spine and goes toward the shoulder and arm.   A second surgery to widen that spot may or may not alleviate the numbness in the left hand.   James will have another conduction test next week, and Dr. Sprich wants to compare the results of the complete panel of tests to determine how much variance is seen since the first (baseline) exam.  Further differential diagnosis (neural v. vascular constriction) may also be indicated before another surgery is performed.  A ray of hope:  in his conduction test last week, Dr. Phillips found a weak but positive response in one motor nerve on the right side.

Update: Wednesday, February 1st (2006):  January 2006 was a difficult month for James.  He has had to stay medicated fairly heavily for chronic pain in his shoulders and arms, while his upper arms remain paralyzed without any indications of recovery.  He observes that numbness is returning to his hands, reminiscent of his condition prior to the October surgery, and we both are very concerned about the reason(s) for this, as well as about what may be required to bring him comfort once again.    He is gathering additional medical opinions, and undergoing further testing.   It looks as though he may have to have at least part of his surgery repeated.  Meanwhile, he is glad that he is able to continue working a full schedule at the salon.

Update: Tuesday, December 27th:  James is back to work full time, and has little day-to-day pain in his neck and arms as a result of his neuritis.  He has a routine appointment with Dr. Riew on December 29th.  He knows he must be patient between his physical and occupational therapy sessions, both of which may need to be more often; we likely will have to wait a couple of months or more to learn if and to what extent his motor nerve path returns.  Future updates on this page will be infrequent unless they are significant to James's overall progress.   As do all of you, James and Rick remain most hopeful of hearing good news in 2006!

Update:  Wednesday, December 14th:  Neurosurgeon Dr. Susan Mackinnon examined James today.  She is Chief of Plastic and Reconstructive Surgery at Barnes Jewish Hospital, with a clinical interest in the brachial plexus, among other neural disorders and injuries.   She was significantly more optimistic than another neurosurgeon about the probability of a full recovery of the motor function in James's arms.  She wants to see him again in two months, on a day when another, concurrent nerve conduction examination can be performed.  This is good news and a sure cause for celebration!

Update:  Monday, December 5th:     Today James met with neurologist, Dr. Phillips, who remapped his injured nerve network with further conduction tests.  Dr. Phillips said that the prognosis for recovery of the use of James's upper arms may not be as favorable as first thought, as some of the critical nerve tissue was not responsive in the tests.  James will meet with a nerve regeneration specialist next week, and also will receive occupational and physical therapy to minimize loss of the muscle mass in his arms and shoulders. 

James continues to be optimistic in his outlook, as he readily admits he has full use of his hands and lower arms and can work a full day now without undue fatigue. 

Update:  Tuesday, November 29th:     James completed a routine follow-up appointment with Dr. Riew today, and has permission to move about the house without his neck brace.  He should still wear it while driving and when he is at work.  For now, he feels more comfortable having it in place during sleep.

Update:  Sunday, November 20th:    James is doing better, and wants to thank all of his clients for their patience during the past month.   He still has variable amounts of arm and shoulder pain, and is moving steadily, but slower than usual.  He worked a half-day on Friday November 18th, and extended a bit further Saturday.  He has appointments today from 12:30 until about 7:30 PM, and has a full day scheduled for tomorrow.

Update:   Wednesday, November 9th:

Growing, extreme pain in his shoulders, and motor difficulty in elevating his arms has caused James to cancel his appointments during the past few days. 

He met with neurologist Dr. Daniel Phillips today.  Using nerve conductivity tests and MRI, Dr. Phillips has diagnosed James's condition as brachial plexus neuritis, a/k/a/ Parsonage-Turner Syndrome, and several other names.  Despite the confusion in naming the condition, it is a well-recognized clinical entity.  He has an inflammation of the network of nerves that supply the muscles in his shoulders and arms.  The good news is  1) that his intense shoulder pain should begin to diminish soon, and 2) that the prognosis is generally good, and he should recover fully.  With some physical therapy, he should completely regain his upper-body strength.  Unfortunately, full recovery may take several weeks or even months (or longer in some cases).  Paralysis of his upper arms is a current reality.   For now, he needs to rest. 

October 19th (2005): 

James had cervical spine surgery today.  Dr. Daniel Riew performed the procedure at Barnes Jewish Hospital.  The operation is called an anterior cervical corpectomy and fusion which, in James's case, involved the removal of two discs and a portion of the vertebrae, at C5 — C6 and C6 — C7.  A titanium plate and screws were placed to secure the bone, in order to allow these vertebrae to fuse and grow as one bone.    His cushioning discs between these bones had degenerated, such that routine daily motion and activity was causing him a great deal of chronic pain, and occasional numbness in his fingers and arms.   

Surgery required  3  hours, from about Noon to 3:00 PM.   James is alert and feeling pretty well, all things considered.   He has a bit of a sore throat, due to the anterior surgical entry to his spine.    He had to spend some 4 hours in recovery, because the hospital said it had no room to assign him to.  Thus, it was 7:20 pm before Debi and Rick could see him this evening.  His sense of humor is unfailingly back to normal!  He quickly enjoyed about 6 cups of sorbet and ice cream while we talked with him.

James will recover from surgery at Barnes for another day; hopefully, he will be home by Thursday evening.  He will wear an immobilizing neck/back brace for the next 6 to 10 weeks while his neck heals.  His doctor says he can resume work as soon as he feels up to it.  He will be bored silly in no time, so please write, call, and stop by the house often.