A Tired Patient’s Thoughts on Ablations, Risk, and Skiing

Want to hear a joke?

Why do gorillas have big fingers? Give up? It is because they have big noses! A three-year-old taught me that joke during my ski instructor days. I think it’s funny!

The enemy of writing is tv and movies. Both of those mediums have the ability for flasher media, faster pace, and provide both the user and producer with a multitude of creative options. Writing has words, which don’t get me wrong, have a power that is hard to describe. That said, hopefully my joke was enough to capture your attention for the next few minutes as I share my most recent radio frequency ablation story with you.  

This story began last week after I noticed an increase in pain, numbness, and some other symptoms following my most recent radio frequency ablation. After trying to be a tough guy for more than a week, I called my doctor on Friday morning and scheduled an appointment for Monday at 8:30 a.m. Here is the kicker which might be controversial. Not only do I not regret having the ablation procedure, but I also don’t consider it a failure just because I'm experiencing more pain. In fact, depending on what my doctor says on Monday, the side-effects might be a positive because it could be providing new information about my conditions that are affecting my neck. Even if I don’t learn anything new about my conditions, this is still not a failure. It is simply life as a chronic patient. One final thought: I'm not practicing or preaching toxic positivity, or whatever the latest phrase is for attacking a patient with a different perspective from the norm. I’m just one tired, hurting patient who is trying his best to live a life of value and maybe, just maybe be a better person today than I was yesterday. Rebuttals will be at the bar later tonight 

Who, What, Where, Why, How of a Radio Frequency Ablation

For those of you who are new here or have never had a radio frequency ablation, here is the story of procedure day.

It’s finally time for the ablation, yippie! After checking in and going through the usual paperwork, I’m taken back to my pain clinic’s outpatient operating room. There I’m given what is called a Melt which is an IV-free conscious sedation compounded formulation. The Melt consists of midazolam, ketamine HCl, and ondansetron (Zofran). It is delivered as a single-use prescription for each patient. Since I’m the size of a small SUV or teenaged elephant, I was given 2. From what I understand it is supposed to be lemon flavored, however, I would describe it as more as a weird, bitter taste than lemon.  

The idea of a Melt is to have me “melt away” into a state of conscious sedation. To put it in normal people English, it is designed reduce or eliminate whatever anxiety and stress I might be experiencing regarding the procedure. It is not designed to eliminate any pain I might experience related to the radio frequency ablation, that is an important distinction to be aware of. Also, and I’m not sure how this happens, but a Melt is also designed to hopefully make you forget about the procedure. The doctor wants me in a state where I can still walk and communicate but doesn’t want me to remember the procedure since it is painful. I do remember though.

Once I have Melted away (about 15 minutes after taking the 2 tablets), my pain management doctor used a local anesthetic to numb the area of my skin where a needle was inserted. Now, for this ablation story, my doctor numbed the C2/C3 and C4/C5 area of my neck, both sides. When numbed, he then inserted a thin needle for which placement is guided by his use of a fluoroscope.

After confirming the placement of the needle with the fluoroscope, my doctor did a test to confirm the needle was in the proper position. The test consists of inserting a microelectrode through the hollow needle and asking if I felt a tingling sensation or discomfort or a muscle twitch. If my answer is yes, this means the right location has been found for treatment.

It is now time for the radiofrequency current to be sent through the thin needle. This ablation current heats the identified portion of my nerve to destroy that area. The hope is pain signals will no longer be able to reach my big brain which should improve my quality of life. Depending on one’s pain and health issues, more than one nerve can be treated during this procedure.

When completed, the nursing staff cleans me up and puts Band-Aides on the injection sites. They then help me return (still a little Melted at this point) to recovery where they take my blood pressure and monitor me about 15 to 20 minutes. According to the numbers, if one is going to have any type of side-effect from this procedure, it will happen during this time.

It is recommended that for the reminder of the day after the ablation, I shouldn’t lift heavy items or exercise. Basically, take it easy for the rest of the day then I can return to normal activity. Headaches are common so my doctor does recommend drinking caffeine after the procedure, big yippie. The injection site shouldn’t get wet for 24 hours afterward so no hot tubing for me after I leave the clinic.

A Skier’s Thoughts on Risk and Patient Responsibility

More and more, I believe that we don’t really understand risk and patient responsibility. Yet, we’ll still yell loudly when we think we’ve figured it out—kind of like how the U.S. Supreme Court defined porn over the years. Why do I believe this you ask? There are many in the chronic pain community that will applaud me for trying to control my pain by utilizing a radio frequency ablation. However, there is a growing group in the chronic pain community that would argue that I was stupid (yes they would call me stupid) for having the procedure because it is not safe and it is just a conspiracy to prevent doctors from prescribing me opioids (even though I have been utilizing opioids for the past 10 years as part of my pain management plan). This doesn’t make sense in my head.

Let’s look at the risk of taking the Melt. This is somewhat difficult to do because the Melt is still relatively new. I was able to find some clinics who are reporting that 90% of their patients felt comfortable and did not experience any side effects from the Melt. The remaining 10% of patients where either young, older, and had extremely high levels of anxiety regarding the procedure.

As near as I can find, timing is the X factor when it comes to the Melt. Administer the drug too early or late and the patient won’t experience the full benefit of the medication. So far research shows administrating the drug about half an hour before the procedure provides the patient with the greatest benefit. Time management seems to be the biggest risk when it comes to taking the Melt.

Let’s now look at the risk associated with having a radio frequency ablation. My risk of complications from the RFA was very low. There was a chance of permanent nerve damage which I was made aware of. In some people, their original pain may get worse. Like any procedure, I did run the risk of an infection and bleeding at the needle insertion site, but this is uncommon.

Research shows that I will eventually experience some level of pain relief. For some, the relief can be immediate; for others, it can take up to a month. Since the treated nerve can grow back, relief can last for 6 months while there is a possibility I could have several years of pain relief.

As a long-time skier, I’ve heard how easy it would be for me to fall and destroy a knee for most of my life. That skiing is too risky, and I was basically playing with fire. The trouble is the numbers do not support that logic or train of thought at all. There was a better chance of me getting into a car accident this morning on my way to feed my pumpkin spice coffee need than I ever faced skiing. Ok, there was this one time while in Snowbird Utah that I jumped into a steep chute that I had no business being in but that’s another story for a different time.

Health care is now following the same logic as non-skiers use to justify never learning how to ski even when they live 20 miles away from a ski resort. We are now conflating the responsibility of a patient to “get better” with risk management for which so called “conservative” treatment options are now replacing treatment options. Believe it or not, but opioids don’t manage nor cure many different types of pain, including my neck pain.

In my head, the biggest risk with skiing is missing out on a blue-bird powder day, not going on an epic adventure with friends at Snowbird, Utah, or just breathing clean mountain air. I look at health care with the same perspective. The risk of having a radio frequency ablation was not the side effects I’m currently navigating through, that is just living a chronic life. By not having the procedure, I was missing out on the chance of  experiencing an epic sunrise in less pain (see photo at the bottom for today’s sunrise), going to the gym in the hopes of being able to ski again later this winter despite having a neck which has fused together, or to go to dinner with my family without scaring the hell out of them because they know how much pain I’m in on a daily basis.