Tuesday, 22 March 2011

Arm block, part 2...

Well i don't mind telling you, it's been a right couple of weeks! So much so I'm going to have to break it into two or three separate posts but believe me, even you will wet your pants this time! For now though I'll start where we finished, with the arm block.

When you're talking pain relief, where best to start than my angel Dr Ivan, the arm block guy.  As you know from the previous post the arm block worked like a charm and lasted two and a half blissful weeks.  Having no control over the arm was difficult at times but surprisingly enough you learn to adjust. One weird thing i did discover was that everywhere i went the toilet roll was always on the left hand side. Even in my own home! Girls will get this more than blokes but i first realised this in a public toilet. We women squat over the seat. This alone takes great skill. So there i am in position shall we say, flopsy is hanging by my side as usual, knickers down to my knees and i have to lean across myself to reach the toilet roll and of course i can't find the end. Typical! Usually there's miles of it on the floor but not today. With great skill and balance i did it though, without one inch of my skin touching that toilet seat. So now i pre-roll! Can't catch me out.

bruising caused by a combination
of trying to find the nerve space
and medication that makes me
bruise easily
As i was saying the arm block lasted two and a half weeks. The pain came back gradually up the hand and then within two days it was back full force. I could move my wrist, fingers and shoulder but not my elbow. So i was still completely floppy and now also in pain. Thank goodness my next appointment was Thursday, two days away. Instead of chewing on peanuts and gaining more weight, i just kept telling myself, two days, two days.

When we got to Dr Ivan on the Thursday the pain was starting to get me down. It seemed worse than before but I wasn't sure whether that was because I'd had a break from the pain or the fact that the tumours under the armpit were a lot bigger. So Dr Ivan went through the usual procedure. A little brandy (sedative) as he called it, although with the amount of medication i was on i don't think it made that much difference. Mum said i had a little slur. He put the local anaesthetic where he was going to insert the probe and off he went, but this time no twitching! My arm laid there as dead as a do-do! Dr Ivan explains that although he knows he's in the right place he cant put the 'blocker' in unless he's absolutely sure. In my head I'm thinking "twitch you bastard, twitch!" He tries again but still no twitching. I could tell by his face that he really didn't want to send me home in this much pain. That's why he's my angel because you can tell he really cares. It's as if he can feel the pain too. So the next thing I know hes getting an ultra sound machine sent down to the pain clinic to try to locate the right space.

When the ultra sound arrived Dr Ivan got started. My cousin Debbie had come along for the ride, so her and Connie Beachamp (my mum with too much Holby knowledge) were glued to the screen as Dr Ivan explained to them what each thing was and what he was looking for. He found the right space again but still no twitch even though he could see he was definitely in the right place. Again he decided it wasn't safe to inject the 'blocker'. I was absolutely gutted and so disappointed at the thought of having to put up with the pain again. However Dr Ivan hadn't given up. Apparently the procedure could be done under x-ray, so he made me an appointment for the following week.  

This bruising appeared after the
failed arm block for no reason at all.
The following Thursday could not have come any sooner. We turned up at the pain clinic all ready to be relieved of the pain because by this stage it was unbearable. I honestly was at the stage that i didn't know what to do with myself. I'm not a cryer, but found myself crying all the time because i was exhausted from lack of sleep due to the pain.  If i let the arm hang the pain in my shoulder was incredible, as if i had a 10kg weight hanging from it. Also because of the large tumours under the armpit, whenever the arm hung straight down it would compress the tumours against my ribs and hurt like hell. Imagine having two or three golf balls under your armpit then holding a bag of shopping with the same arm. Wearing a sling now to take the weight off the shoulder wasn't working either because my hand would begin to have an unbearable tingling sensation. A bit like when you've scraped the ice off your car without gloves and your fingers are so cold you cant feel them and then they hurt when they defrost. I couldn't win either way.  So knowing i was definitely getting the arm block today was such a relief.

This was the bruise that appeared by the
armpit. Apparently it was just part of the
nerve path but unexplained why it came
up like that. The 'easy bruise' medication
made it look worse than what it was.
Into the treatment room i go and what do i find? Dr Ivan in a leopard print lead suit. I couldn't stop smiling. Only him! He's got such a great sense of humour. He reminds me of Gino, that chef. When i took his photo i said to him
'can i take a photo of you in that suit for the blog?' and he said
'no....do i have to.... oh ok' this was all in one breath, then he struck the pose. He loves it really.

Anyway, back to the procedure. Dr Ivan decided to try it the original way first then move to the x-ray way. As usual i got my shot of brandy, then the local injection went in and then in with the probe. As Murphy's Law would predict the arm twitched like mad first time. I was so relieved it was gonna work. So in went the 'blocker' and i went back to the recovery area, where mum was, for a while where they monitor you, give you a cup of tea and see how it's worked.

At first i couldn't feel or move my hand but that only lasted 10 minutes or so. Before i knew it i had full function of my hand again except for my little and ring fingers. I couldn't move or feel them at all. Not even to touch the skin.

Dr Ivan was completely baffled as to what had happened and was going to consult with one of his colleagues that afternoon and ring me the next day with the next plan. The thought was that because i still didn't have full mobility that that somehow was effecting the block. What ever it was i was so dissappointed.  In the mean time though, Dr Ivan was very concerned about getting the pain under control. He had spoken to me weeks ago about Ketamine being excellent for nerve pain but in large doses it caused hallucinations. Aparently i didn't need to worry about that with the small dose i would be on. i knew the name Ketamine rang bells in my head but i couldn't think what for. So remembering that conversation and being desperate for something to alleviate the pain i agreed and he wrote me a prescription which had to be picked up from hospital pharmacy.

Fred Flintstone or Tarzan?
You decide, this is my Dr Angel.
When we got to the pharmacy it was a number system with only half a dozen people sitting there so at least this wouldn't take long. Yeah right!! Not today of course. Two bloody hours! I was five numbers off the number on the screen and it was going to take two bloody hours. I tell you, if the receptionist guy wasn't behind glass and i didn't have a floppy dead arm, i would have choked him.  We later learned that it's because they only keep four bottles of Ketamine on the premises at a time. At that stage i didn't know why.

As we walked back to the car, i was in so much pain and was so dissapointed about the arm block not working that i was holding back the tears but the minute we got into that car i let them out. We decided to fill in the two hours with McDonalds, perfect for depression, and some retail therapy at Hobby Craft. We got back to the pharmacy just as my number was being called. 

Part two of my Ketamine experience is soon to follow and it's a laugh from start to finish! You won't want to miss it.