The photos are of Paula Abdul, but the x-rays are only examples...
After seeing physical evidence of a cervical fusion of multiple levels by steel plate, and after years of experience of pain management, I have concluded that Paula Abdul is not a hypochondriac, yet quite the opposite as her constant pain is very real.
This observation was made after viewing an episode of “Hey Paula”, as her doctor had her cervical x-ray on the view box.
“Its amazing that Paula Abdul can function as normal as she does. Shame on Rosie O'Donnell, for singling Paula Abdul out for her noticeable level of Pain.”
Dr. Robert Tencer
Former director of Pain Management - Chiropractic
Henry Mayo Newhall Hospital
Valencia, CA
Outpatient Pain Management clinic.
After surgery I remember waking up in the recovery room and moving my right arm. I also remember that for the first time in years, I was not in pain. After I was released from the hospital I was determined to take care of myself and heal as quickly as possible.
I was scheduled to begin physical therapy 8 weeks from the surgery date.
I used ice packs on my neck about 10 times a day. I’d keep the ice on until the pack would reach my body temperature. Then I’d swap it out with one in the freezer and continue to ice all day long.
By the 30th day after surgery, I was out at the golf range hitting golf balls. I couldn’t believe how fast I had recovered.
Eight weeks after the surgery went by very quickly. It was time for physical therapy. I couldn’t believe that I had experienced nearly 8 weeks without pain from the right side of my neck to my hand.
It was Thursday and my first Physical Therapy appointment. The therapist did some massaging around the wound area and it felt good. Later that evening I started to feel a bit of discomfort, but it went away. I had my 2nd PT appointment the next day. I told the therapist about the discomfort the previous night and she said that it was normal sensitivity. She used the same type of massage therapy. Later that evening, I couldn’t believe it when the same agonizing nerve pain that I felt prior to surgery had returned. How could this happen? My disk was removed, my C5-C6 vertebrae had been fused together and I felt as though I was healed. How could I be back at square one? I was devastated.
Over the weekend I contacted my neurosurgeon who asked me to come to his office Monday morning. He ordered an x-ray to see if the fusion had been disrupted by the physical therapist.
Monday morning’s x-ray showed excellent signs of healing and the site of the fusion looked great. How could this be? I had returned to a constant state of agony. My past of icing and bed rest was now my future.
I had made several trips to see Dr. Bray to find out what had happened to me…he scheduled me for a steroid injection which helped for a few hours.
I was very depressed with this outcome. My quality of life was very poor. I was bedridden nearly 5 out of 7 days a week and unable to do much of anything.
A month later I decided to have the shoulder surgery. I thought things couldn’t get much worse and I wanted to get the surgery out of the way. Dr. Stephen Kaye operated in September of 2000 to repair the labrum tear in my right shoulder. Unfortunately, I wasn’t thinking about what it would take to rehabilitate my shoulder after surgery. Every time I tried to move my shoulder in physical therapy I would upset the nerve problems in my neck.
I was feeling such a sense of despair…would my quality of life ever improve?
I scheduled several appointments with Dr. Bray over the next few months. I needed to know why I have the same pain, if not worse, after surgery that was supposed to stop it. He scheduled me for another C-spine MRI in December of 2000. The results showed the plate in my neck and the cadaver bone replacement disk at C5-C6 was fusing quite nicely. He could not understand the right side swelling of my neck or the pain that I was in. Dr. Bray suggested that I undergo a nerve block to help calm the nerve pain. In February of 2001 I had a CT guided nerve block with Dr. Anand. There was some relief from the nerve pain for just a few hours…then it came back to the same degree as before. Dr. Bray suggested that I see Dr. Michael Regan, one of the other Dr.’s in his office. He too was baffled at the recurring nerve pain and reviewed my history and all of the MRI’s. Dr. Regan suggested that I saw Dr. Avrom Gart in his office for more nerve blocks and pain management medication.
In March of 2001, I saw Dr. Gart and he suggested a C3-C4, C4-C5 Facet nerve block. I was scheduled and had the procedure. Again, I felt relief for a very short amount of time and was back in the same pain again. A few days later, I met with Dr. Gart to talk about medication options for pain management control. He asked me if I knew anything about Neurontin. I didn’t. He started me on 100mg. – 4 times a day.
Immediately, I began to feel some relief and could actually see the swelling in my neck go down a bit.
Dr. Gart scheduled me for a nerve conduction study to be performed in his office. The study he conducted was negative.
I saw Dr. Gart again in April 2001. He upped the Neurontin dosage to 200mg – 4 times a day, then again in December of 2001 and he upped it to 800mg – 4 times a day for a total of 3200mg daily. This went on for about 1 year and it seemed to work for me as long as I didn’t do anything to upset my neck. If I picked up a bag of groceries using my right or left hand, I would immediately go into excruciating neck, shoulder, and right arm nerve pain. Each time I had an episode, they would last for about 1 month. Bed rest and ice would be the only thing that would calm the nerve down and allow me to live a very limited life.
I tried several times to make an appointment to see Dr. Bray, but his schedule was too booked up. Eventually I gave up and sought the opinion of Dr. Martin Cooper, a neurosurgeon that was recommended to me. It was November of 2002. He ordered another nerve conduction study along with MRI’s, Cat Scans, and Mylograms. The results of the nerve studies were; an abnormal electromyogram, ongoing C7 irritation and severe right radiculopathy - truncation of the left C5 nerve root sleeve. The results of the MRI’s, Cat Scans, and mylograms were;C2-C3 problem, C3-C4 problem, C4-C5 problem, C6-C7 problem, small spinal canal right-sided extruded disc at C6-C7 flattening the right and vertebal aspects of the cord in addition to compressing the proximal portion of the right nerve root sleeve. Right neural foraminal stenosis, C4-5, based on uncovertebral hypertrophy. Left central stenosis at C3-C4 based on uncovertebral hypertrophy. Mild to moderate degree of left neural foraminal stenosis at that level. The results of all of these test are much more verbose, but you can see that there was a lot more going on here than anyone had originally found.
Dr. Cooper recommended a CT guided C6-C7 nerve block before he made any other recommendations. The nerve block was very painful. You are completely awake under a live CT x-ray machine while they poke around your neck with a long needle to find the nerve that is causing you pain and then inject the nerve with a numbing material. Already in agony, this was a very painful experience.
I met with Dr. Cooper after the nerve block and told him that it did not help at all. He recommended another surgery;
He said I should have another fusion at the C6-C7 level and C4-C5 foraminotomy.
I didn’t want another surgery…I didn’t know what to do. I decided to try acupuncture and went to the UCLA Center for East-West Medicine. I thought possibly some type of naturopathic treatment might help. I went twice and felt some relief and then the pain came right back.
Through another referral, I went to see Dr. Martin Levine in December of 2002. He was another neurologist that was recommended for pain management. He seemed determined to get to the bottom of what was causing me so much nerve pain. He added another drug, 25mg of Pamelor, to help with the nerve pain management.
In April of 2003, I was visiting a friend at Cedars Sinai Hospital in Los Angeles and I ran into Dr. Bray. I told him that it had been impossible to get an appointment with him and explained to him how much pain I was in and that I was now seeing 2 other neurologists. He told me to call his nurse on her cell phone to make an appointment. I saw Dr. Bray the next week and he scheduled me for surgery in April of 2003 for a C6-C7 posterior cervical foraminotomy to remove bone spurs that were scraping my nerve every time I moved my right arm.
Again, I felt relief right after surgery for about 1 week…then, the pain was back. I could not understand what was happening to me.
I went back to see Dr. Levine for my previously scheduled appointment in May of 2003. Dr. Levine suspected that my problem was Thoracic Outlet Syndrome and wanted me to have another MRI that was performed at UCLA under the guidance of Dr. James Collins who created this type of study; Magnetic resonance multi-plane imaging allows bilateral display of the thorax and brachial plexus in the supine position. It was a kind of 3D MRI and it cost $10,000. Dr. Levine was fairly certain that this was the cause of the problems I was having.
The results and findings of the brachial Plexus MRI performed by Dr. Collins: Vascular compromise abnormalities and Venous Obstruction in Thoracic Outlet Syndrome. Dr. Levine’s suspicions were correct. Indeed, by all accounts, I had Thoracic Outlet Syndrome. ( See diagram 5 below)
Dr. Levine recommended that I make an appointment with Thoracic surgeon and Thoracic Outlet Syndrome (T.O.S.) specialist, Dr. Hugh Gelabart at UCLA. I had a scheduled appointment in May of 2003 and met with Dr. Gelabart’s nurse practitioner for a pre-qualifying appointment. She did her usual tests and confirmed that T.O.S. was very likely. She scheduled an appointment in July of 2003.
In the meantime, Dr. Levine had scheduled a scalene muscle injection to try to help alleviate my agonizing nerve pain. The 3200mg daily dose of Neurontin and 25 mg Pamelor were no longer working for me and I couldn’t up the dosage for either medication any more. The injection worked for a very short amount of time and I was right back to my agonizing nerve pain.
In July of 2003 I had my appointment with UCLA thoracic surgeon Dr. Gelabert. He performed his usual tests for T.O.S. and concluded that I indeed had the diagnosis. His recommendation: consistent with T.O.S. - right first rib resection for thoracic outlet decompression - detach scalene muscle from tip of clavicle - neurolysia of brachial plexus
Surgery was scheduled one month from the date of my appointment in August 2003 with Dr. Gelabert…and now, we are back to where I began at the beginning of my story.
I had one month to try absolutely anything and everything to try and help myself before I had an irreversible, mutilating surgery. How could I put back my first rib? How could I reattach my scalene muscle to my clavicle? I couldn’t…and my time was running out, but I was in such pain, I would have done anything…even cutting my right arm off. Anything to stop the excruciating pain.
This is when I began to discover what is now known as VRT – Vibration Regulation Training.
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