Oh, oh...

My c-spine film circa 1985
Well, I woke up Sunday morning With no way to hold my head that didn't hurt.
-Johnny Cash
I had undiagnosed, untreated whiplash somewhere back in the early eighties. They had me move my head through a range of motion, said, "Yup, you have a still neck." Gave me some valium and sent me on my way. The next morning I remember that I couldn't lift my head to get out of bed. About five years later, the chronic headaches started. Everyday, without fail. When I finally sought treatment films revealed a reverse curve in my c-spine. All these many years later I still have a fairly straight c-spine with just a hint of normal curve.

For about the last 5 weeks, I have had localized muscle aches and spasms along the right side of my neck annoying enough to interrupt my sleep several times each night. Monday morning I went out to feed and slipped on the icy packed snow, I didn't fall, but did a sort of chicken strut with my neck. By Tuesday morning, my entire neck was fairly stiff and sore. The case I posted about on Tuesday started at 1500 and we finished around 2200. Still I was no worse for wear. Wednesday had morphed into a full day, starting at 1100 with a laparoscopic right colectomy and ending at 1930 with an ORIF of a left ankle. The entire day my neck was killing me. Range of motion was now greatly decreased and pain and stiffness greatly increased. A "helpful" rad tech running the C-arm, poorly I might add, decided to adjust the OR light to help us see better. Unfortunately he is about 4 ft tall ( I am 6' o) and drug the light down to his level so as I stepped away from the field to switch places with the surgeon, of course I rammed the light with my head sending the jolt right down my already tortured c-spine. Lucky for him I was scrubbed in because my impulse was to pick him up by his neck and toss him across the room. I grabbed the light and sent it up to my arms length and focused it on the field from there. I made a very theatrical production out of it so that maybe he would notice? No, about ten minutes later the little bastard did it again! This time, at least I was aware of it. I ended the night with a raging neck ache and now unable to determine if the pain was muscular in nature or skeletal.

Thursday I had only one case at 0900 and we were done by 1030. My neck still screaming in agony. I had some errands to run before I could go home. I purchased a soft cervical collar. It hurts to hold my head up. One naproxen sodium the day before didn't touch the pain. One Daypro (okay they are about two years expired) the next day gave me about 1 hour of barely noticeable relief. When I got home I alternated ice and heat, ice bringing much greater relief than heat. I took two, 200mg, ibuprofen when I went to bed. I managed to sleep until 430 am when my neck would not quit screaming. I took two more ibuprofen and fell back asleep until 0930. Thank goodness I don't have any cases today.

The pain is a little more localized but no less intense this morning. It starts at the occipital on the right and travels all the way to the right shoulder at about the level of C-7, T-1. With a frightening trigger point at about c-3-4, or 4-5. My range of motion is limited to flexion and extension with discomfort. Lateral flexion is extremely limited more so to the left, and rotation to the left or right is barely a few degrees.

The good news is that my (self) diagnosis is most likely cervical strain. The differential DX is cervical spondylosis or herniated cervical disk. Regardless, both may be treated conservatively. I doubt either of the latter because I have no neurlogic symptoms in my arms, though I'm not sure how to give myself a neurologic exam ( the more I dwell on it the more I imagine weakness in both arms). I may have reached a therapeutic dose of ibuprofen as the two I just took seem to be working fairly well.

The bad news is that acute pain may take up to one week to subside I have a full week next week. I need to get hay today. Our Christmas party is tomorrow night. I have a three thousand dollar deductible I just as soon not use until 08. I have a dying dog who needs daily meds and two hungry horses so I can't do hospital time. I have no established PCP. I am a self confessed BAD patient.

I find it very frustrating and annoying to be in this position. I can't work on muscle relaxants, can I? Are there any varieties that would not impair my function? If I can just complete next weeks surgical obligations, the following week is the week of Christmas and so far nothing is scheduled, I only have a shitload of call. Perhaps I can heal. Or better yet make to 2008 when I can commit to some down time and that 3k deductible.