January 22, 2008
This Mother of Twins Tried Everything to Cure Her Crippling Back Pain, but Paying for a MRI Scan Was the Turning Point …
By LAURA CUMMING
THERE are relatively few fatalities on the table," the surgeon cheerily announced, "though you obviously have to be careful with the carotid artery. We go in through the front of the neck, whip out the discs and replace them with filigree metal." At the time I thought he said something about gold but perhaps I was just flustered with amazement. For this was a revelation. Nobody had yet suggested that whatever was wrong with me might warrant actual surgery.Nine months before, writing on my laptop with the usual aching shoulders and neck, I felt fizzing in the fingers of my left hand. My left scapula began to burn with pain and within days my forearm felt as if had been flayed. The slightest pressure to the skin was as searing as acid and the only way to escape further torment, it seemed, was to avoid all human contact.
I tried typing with my right hand to meet my deadlines as an art critic. Infuriatingly slow, but I convinced myself that more thought was going into whatever I wrote. I tried swimming every other day but dragged myself from the pool worse each time. Naturally I tried Nurofen, hot-water bottles, ice packs, massage, whisky and any tips from friends. But within weeks, silent and sleepless with misery, I began yearning for a general anaesthetic.
Spring turned to autumn and the lightest coat felt like lead around my neck. I went, once again, to the doctor.
Repetitive strain injury, he concluded, proposing bed-rest and sessions with a physiotherapist. The first physio said blankly that the fizzing fingers didn't go with the burning sensations so she had no idea what to do. The second diagnosed tennis elbow. The third tried to hitch the skin of my scapula to the ridge of my collar bone with sticky tape. Did I spring forth reborn? I did not.
There are few things more uplifting to those in chronic pain than the thought of sudden cessation, of some new procedure that might interrupt the monotony, however briefly. You start out hoping for miracles but soon your expectations are at ankle-level with your sense of humour.
Even half an hour of respite would do because of its glowing promise that you might not be stuck with this axe in the back to the end of your days.
My earliest acupuncturist was an amiable hippy who burned what smelled like pot and told me approvingly of Richard Nixon's conversion to acupuncture after watching open-heart surgery performed without anaesthetic in China. I was pregnant when I first went for treatment and remember weeping at the thought that I might not be able to cradle my child because I had pretty much lost the use of my arm. The acupuncturist was convinced he could reverse my fortunes. He tried hard.
Some weeks later I lost the baby.
I pressed further along this route, foolishly making an appointment with an acupuncturist to the stars (Chelsea, but I'm naming no names). She couldn't even commence until I agreed to stew all my food and give up garlic.
The second chiropractor (Wimpole Street, also nameless) boasted that what distinguished him from the third osteopath (Lambeth, still learning) was that he took X-rays of his patients. I have it still, the meagre little image he took of completely the wrong vertebrae.
Good kind people sent Rescue Remedy, lavender oil, books of calm thoughts, that pain pen that supposedly baffles pain signals to the brain but which is about as effective as an ordinary Biro.
You try to be properly grateful even though it feels as thoughtless as telling an infertile woman to do yoga or just relax the same advice casually meted out by all and sundry to those with back pain.
By the time my 35th appointment came round I approached it with glumness and rancour, for it seemed as though my life was nearing collapse and nothing was going to prevent it. I could no longer work or rest without pain. I couldn't write the book HarperCollins had just commissioned. I couldn't sit, and stood instead all the way through meetings, dinners and journeys by train or plane.
There came a point where I thought I might never sit comfortably again. I avoided my husband's gentlest embrace.
People in pain become sombre and withdrawn. You start to live inside your own head more and more, paired off with your constant companion. You seek out biographies of those who have endured infinitely worse: John F Kennedy, never far from a doctor, surviving on 40 different kinds of painkiller, corseted, injected, trussed.
Frida Kahlo, her spine shattered by a bus accident; I can't stand the art, but her fortitude truly inspires.
BUT PAIN must have a narrative, otherwise how are you to respond to your friends' ever-patient inquiries? There came a day when the various diagnoses, all of which agreed pretty well with Google's interpretations of my symptoms, no longer held any truth for me.
So I did what anyone can now do: I went out and paid Pounds 600 for an MRI scan at the Lister Hospital. Which is how I came to be sitting in the office of an orthopaedic surgeon. Until that day I didn't know what was wrong with me.
But one look at the scan and Damian Fahy heroes will be named changed my future.
I had, I have, fairly pronounced cervical spondylosis with a couple of extra spanners thrown in for free. Spondylosis itself is so common it's almost universal.
The discs between one or more vertebrae wear thin, producing soreness and stiffness but most usually no symptoms at all. If you play a lot of sport or have made it beyond 40 you probably have a bit of spondylosis without even knowing it.
In my case three discs are pretty much shot and some vicious little bone fishhooks have formed on the rims of the cushionless vertebrae. Nerves were being impinged upon and the exits for those nerves from the spinal column on the left were narrowing dangerously as the vertebrae got closer together.
The glory, and horror, of the MRI scan is its irrefutable clarity of vision.
Unlike the X-ray, everything becomes visible. So the narrowing around the nerves was there for all to see and me to fear, which was much how I felt at first: that inside me the fine threads of existence were being sawn up by sharpened bones. One false move! I imagined it as somewhere between The Pit and the Pendulum and Tom and Jerry.
But the relief of diagnosis surged simultaneously. Now I knew where I stood. Now I understood, in fact, why standing was the only position I could endure for long. Radiculopathy, as it's called, was the real problem: pain at the roots of the nerves trying to exit between those vertebrae was radiating out through the system.
And almost everything I had been advised to do had merely sustained it: sleeping on a hard inflexible bed, resting instead of walking about, sitting for hours on end, which only tightened the nerves, letting a chiropractor crack the wrong bones.
Fahy sent me to James Bird, a brilliant physiotherapist who loosened my nerves and raised my spirits with his quirky humour. I still do his exercises, including the handy technique for self- traction that can be performed surreptitiously on a crowded Tube.
Fahy referred me to Glyn Towlerton, a twinklingly deft and sympathetic pain consultant. He performed a cervical epidural, in which cortisone and anaesthetic are injected directly into the spine while the patient is awake under continuous X-ray.
The epidural didn't help so we progressed through various drugs: Neurontin, created for epilepsy, which regulates the electric signals between nerve and brain, and Amitriptylin, antidepressant. In the end, we hit upon Tramadol, an opioid analgesic which eases the pain whenever I get it badly; which is rare these days because Fahy also introduced me to Clive Lathey.
Lathey is an osteopath who broke his back 20 years ago and has experienced everything you are suffering times 10.
He is the most intelligent and gifted practitioner imaginable. His massage is superb, his manipulations so effective that the sense of deadlock very soon vanishes. By easing the vertebrae he has kept my radiculopathy at bay for three years; I go to him every six months, more if the worst pain returns.
Dennis, my husband, did everything he could at the time took dictation for my articles, wrote my emails, fielded calls, drove me everywhere, sat up with me through the darkest hours. And then he gave me something unmaginably greater: our twins, Hilla and Thea.
They, too, have helped in a most unexpectedly effective way. The best thing you can do for spondylosis is to strengthen your back muscles as much as possible; the twins between them, at two and a half, already weigh more than five stone.
As for the operation, Fahy was against cutting my throat, not just because it can change the voice or damage the nerves but also because, for all its immense upheaval, it doesn't necessarily work. A fellow orthopaedic surgeon suffering the same condition told Fahy he would never undergo the operation he himself regularly performed.
His answer? Osteopathy, exercise, wellchosen wine and painkillers.
Laura Cumming is art critic of The Observer..
MRI scan Get a letter of referral from your GP and shop around for a machine with capacity. Expect to pay around Pounds 600 for a full back scan (www.vistadiagnostics.co.uk).
Clive Lathey registered osteopath, The Putney Clinic, SW15 , www.putneyclinic.co.uk) 45-minute consultations start from Pounds 60.
Damian Fahy spinal and orthopaedic surgeon, West London Spine Clinic, SW1 (i www.westlondon spineclinic.com). Consultations start at Pounds 250 for 30 minutes.
Glyn Towlerton consultant in pain medicine, Chelsea and Westminster Hospital, SW3 02070604362
Half-hour consultations from Pounds 180.
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