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Provocative Discography

Since I don’t have much to talk about right now while I’m just waiting for my surgery, I figured I’ll backtrack and talk about some of the things I’ve been through in the past year and a half. Let’s start with the Provocative Discography. It’s also called a Discogram, and it’s a diagnostic test used to determine the source of pain. As the name suggests, the doctor essentially tries to provoke the pain and the results are based on the patient’s response to what the doctor is doing. I guess it’s not easy to fake, no matter how good of an actor somebody is, because you really have no idea what’s going on. Imagine somebody screaming bloody murder when the doctor isn’t even touching them. I’d say that person could be ruled out as a malingerer, eh?

So, the doctor uses fluoroscopic X-ray to guide a needle into the disc that’s being examined and injects a contrast solution, usually also containing an antibiotic, into the disc. This will show on the X-ray if there are any bulges, tears, leaks and whatnot in the disc. In addition to the visual images, the doctor asks how it feels. If it doesn’t hurt, but just feels pressure like, then the disc is normal and healthy; if it hurts like a motherf*cker, that disc is whack. The doctor will always inject a healthy disc as a “control,” so that they know how you react when they inject a disc that is normal. I guess depending on a person’s pain threshold, someone with a lower tolerance might cry and flip out over just the fact that there’s a needle in their spine, whereas somebody who can handle a lot of pain might not even flinch.

I had a Discography in September 2011, after numerous attempts at conservative treatment had failed to give me any relief, but my pain was increasing and medication was becoming less effective. By conservative treatment, I mean 7 Epidural Steroid Injections, an SI Joint Injection, Facet Joint Injection and a Nerve Ablation, along with 12 weeks of Physical Therapy. My Pain Management doctor wanted to send me for a surgical consultation, but first he wanted to perform the Discography so that I could take the report and the images to the surgeon and show him exactly what was going on.

The nurse took me into the Operating Room, after checking my blood pressure and temperature and having me sign all of the standard release forms, and got me settled on the table, face down. The facility I go to doesn’t require patients to change into gowns or anything, so she just pulled my shirt up to my bra strap, and pulled my jeans down and tucked them under my butt cheeks. She cleaned my back with iodine and laid a paper drape all around the area. That was pretty much the extent of the prep. No IV sedative, no pain killers, nothing.

The doctor came in and cracked a few jokes to lighten the mood. I guess it was pretty obvious that I was really stressed and tense. Keep in mind, I had been through almost a dozen procedures with this doctor, but those were attempts to relieve my pain. At the time, I knew it was going to suck, but I also knew it would be over quickly, and when it was done, there would be a potential for relief from the pain. For this procedure, I knew my doctor would basically be hurting me on purpose. (I think during the procedure I even called him a sadistic bastard and asked him if he likes hurting girls. Luckily, he has a sense of humor and laughed it off.)

Then the doctor started sticking needles into my back. Holy shit. The needles themselves were no big deal at all. I was used to the needles. But when he injected the contrast dye into the bad discs, I was begging for death. The healthy discs were fine, just uncomfortable, especially in comparison to the bad discs. Actually, it was almost a relief when he injected the good discs. I was face down, so I had no clue when he was sticking me or which disc he was planning to hit. When he hit a bad disc and I started crying and yelping, he asked me to describe the pain. I had to tell him what the pain felt like (burning, pressure, sharp), and if it was like my usual pain intensified or at a different location than I was used to experiencing.

The whole process took about 45 minutes, start to finish. He stuck me in every disc from L2 through S1. I had hoped to feel relief once the needles were extracted and the procedure was over, but that fluid was still sitting in my discs, so I felt like I was still undergoing the test. The nurse helped me step down from the table, and my legs felt weak and shaky, which I’m sure was just from the adrenaline rush that was my body’s natural response to the pain. The doctor called me over to show me the images on the monitor screen, the “snapshots” that he had taken during the Discography, while he was torturing me. It was so obvious, even to my uneducated self, where the problem was, and just how severe the degeneration was.

The discs between L3-L4 and L4-L5 were slightly smushed and slightly bulging, but the disc between L5-S1 was practically flat and bulging. It’s like when you pour too much batter in a waffle maker, and it oozes out the side. My “waffle” was flat and oozing and putting pressure on my nerves. The doctor also pointed out a tear in the disc, where the nucleus was leaking out slowly, and that fluid was also contributing to the pain by irritating the nerves.

Then the nurse put me in a wheelchair and took me back to the exam room, where she checked my vital signs again. My blood pressure was really low, so I had to sit and wait for another 15 minutes and have it rechecked. The second time it was a little closer to normal, so she decided I could be released. My doctor came into the room at that point and we had a little chat about the procedure. He told me that I am definitely a candidate for surgery and would be writing a referral for me. He also asked me to come back in a week for another Epidural steroid Injection to kind of calm down the nerve irritation. I was able to walk to the waiting room. My partner was supposed to be picking me off when she got off work, but that was still another 45 minutes away, so I called her, sobbing, and asked if she could come early. It had been a lot worse than I had anticipated, and the lingering pain was intense. I just didn’t think I could sit there for another 45 minutes, and I just wanted to go home, put on my pajamas and curl up in a ball on the couch. She told me to hang in there, made another call, and our neighbor was there to collect me 5 minutes later. Thank Jesus.

After coming home, I spent the next 3-4 days just laying around. I took my painkillers, was very careful with the stairs, and did my stretching exercises. I had had the procedure on Friday afternoon, but I ended up taking the entire next week off work. I felt battered, my back was bruised, and I couldn’t imagine sitting at a desk for 8 hours a day. I went back the following week and had the ESI, which was no big deal at all in comparison to the Discography, and it did somewhat help relieve the nerve pain around the procedure site.

So that’s it. My own personal experience with a Provocative Discography. I’m not going to sugarcoat it – it hurt like a bitch. Was it worth it? Yes. Because after the procedure, the doctor was able to precisely pinpoint the location of my injury and know exactly what was causing my pain. It was very valuable information to take to the surgeons as part of my consultations, so I would definitely go through it again if I had to.

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