Autonomic Nervous System

Sympathy for my Not so Sympathetic Nerves

I haven't felt well this weekend, as often happens when I don't feel well I research.  Not sure what I think this accomplishes but inwardly it often gives me a feeling that I am still moving forward no matter how stalled out I am in real life.  I am always happy if I think I have discovered something that explains a symptom I didn't really understand before.  Again - this can be just my imagination working overtime, but at least I'm not sitting here stuck in the "I'm in pain" loop.

If you have never experienced the "I'm in pain" loop my brain thinks like this:

"I'm in pain"  (sad and wimpy)
"Ignore that!" (snappy and aggravated)
"My mind seems stuck in a loop!!??" (amazement at my genius)
"Duhhhh......" (drool from slack brain)
"Was I supposed to ignore something?" (looking for a brain cell to light up)
"I'm in pain" (see above)
"Ignore that!" (see above) ....ad infinitum [you get the picture]

It's like trying to bat a mosquito dive bombing your ear.  You wave at it and smack at it and its annoying as all get out but you just can't get rid of the little monster.  When I get stuck like this it becomes impossible to reboot my brain, so keeping it occupied (I have discovered scholar.google.com and http://www.quertle.com/ WooHoo!) keeps it moving forward.

My choice of research this weekend was my nervous system.  Dr. Welby thought it was very interesting that my GI specialist at Barnes/Wash U in St. Louis (Dr. Bellyfixer) was certain that my motility and other digestive issues were from nerve damage that controls the bowels.  In researching the innervation of this region of my body I found that is controlled by the autonomic nervous system, and the part that controls the bowels comes from the lumbosacral region of the spine - the part that the radiation treatment seems to have harmed.

The autonomic nervous system is made up of two to three different systems (there seems to be some disagreement about the third - whether it is a separate element or not).  The sympathetic nervous system governs intestinal peristalsis and some bladder functions.  The parasympathetic nervous system controls the sphincters, incontinence issues and non-specific abdominal pain that may be felt in the skin. The enteric nervous system works with gut motility and some reflexive digestive processes.

These systems work with each to complete the digestive process and to signal the body when things are right and when things are wrong with digestion and organs in the pelvic area.  If one gets out of synch they are all in danger of malfunctioning.  It is sort of a "push me pull me" type of relationship so if two sides decide to push instead of one push and one pull you get all sorts of problems happening. Sorta like The Belly and me!

The major nerve signalling chemical used by the autonomic systems is acetycholine.  One of the drugs which works the best for my motility problems is an older drug, Pamine (methscoplamine bromide) prescribed by Dr. Bellyfixer. One of the Dr. Dunces sneered at me in a condescending manner when I told him that this was really the only medication that had helped me so far.  I guess Dr. Bellyfixer (a department head working at one of the top ranked hospitals in the country) knew his chemistry and neural signallers better than all the local Dr. Dunces put together.  Pamine is an anticholinergic, a medication specifically formulated to inhibit acetycholine in the nervous system so I guess it stops some of the over signalling that is going on in my bowels!  Now I know why it works, and why it was prescribed. 

The autonomic system is considered part of the peripheral nervous system which is basically any nerve in your body that doesn't come directly from the brain or spine.  The other part of the peripheral nervous system is the somatic nervous system, which deals with touch, pain and movement.  The somatic part doesn't work very well for me either, but I think that type of damage is easier to diagnose due to weakness and changes in sensation and pain.

Enough nervous system anatomy for today/tonight.  My pain has decided to calm down for awhile so I'm going to try to go to sleep while I can!  WooHoo!!!  Trying to go without medication so I can jump to work tomorrow early!

Over the River and Through The Woods

Grandma's House is MY House Too!

A great stress free Thanksgiving.  My brother cooked almost all of Thanksgiving by himself.  I assisted with a couple of dishes with my Mom's help, and my sister brought over a lovely Waldorf salad.  I am thankful for my family.  My brother in law was able to stay, eat a wonderful Thanksgiving meal in our sun room, go into the living room and watch a football game with my brothers - the first time he has stayed this long since his stroke 2 years ago.  He had a great time, and we all did too!!  My sister was able to stay long enough to relax, and my Mom had a wonderful afternoon and evening, after a rough start this morning.  We had tornados going through last night, so we were all thankful that the damage passed us by!

Mom is 80 this year and woke up this morning with a scare being too dizzy to stand or walk.  She has had quite a few mini-strokes and has high blood pressure in addition to being a colon cancer survivor and having advanced COPD.   I try to be very cautious with her health, but she can be very stubborn about getting medical help.  I finally convinced her to take a Zofran she had for nausea, and then to eat a little something and her headache and the seasickness went away.  If it hadn't we would have been heading over to an emergency room to make sure she had not had another TIA.

She does not have a good sense of hunger since they removed part of her stomach when she had colon cancer surgery a couple of years ago, so I was not sure what she had eaten the day before.  My brothers were cooking in our kitchen, and I think she got so interested in the cooking she forgot to eat.  I got home late and asked her if she had eaten and she told me yes, but I think she misremembered since eating something this morning made her symptoms go away.  She felt fine the rest of the day, so watchful waiting tomorrow to make sure she still feels OK.  She definitely ate plenty today!!

I will find out the results of my EMG next week.  Dr. Welby was very nice and explained his preliminary findings to me yesterday.  I definitely do not have diabetic neuropathy.  I definitely do not have peripheral neuropathy.  I defnitely do not have a structural issue like spinal stenosis or degenerative disk disease.  I have normal nerve function in my lower nerves.  I have abnormal nerve function in my lumbosacral plexus which feeds the nerve impulses down to my lower nerves.  There seems to be a lot of mis-signaling going on in the plexus, perhaps due to fibrotic changes from pelvic radiation therapy.  He could tell I had abnormal nerve signalling going on as concerns pain location and perception.  He has treated one other person for post radiation lumbosacral plexopathy - a 70 yo man who had radiation for testicular cancer 40 some years ago and just NOW is having problems. 

He understood when I told him my digestive issues were thought to be due to nerve damage in the intestines rather than mucosal damage.  He spoke to me as if I had a functioning brain and not once did he try to pooh pooh my concerns (as the Dr. Dunces did).  He said I did not show myokemic discharges in the plexus nerves which very easily points to radiation nerve damage, but not everyone has that symptom.  He had a difficult time finding a functional nerve to test in my lumbosacral region.  He felt that perhaps I have damage in the cauda equina region also based on the symptoms I gave him.  Sigh...  Well at least they can't tell me AGAIN I have peripheral neuropahty or diabetic neuropathy. These have been finally and absolutely RULED OUT.  I guess I have that to be Thankful For!  Adding it to my list!!!  Just wondering what the final report will say, as I asked specifically what my future will look like.  Sigh again...

Hoping you all have great Thanksgivings and don't wear yourselves out too much.  Praying that you all have pain free holidays!

Seeing Dr. Dunce

Once More into The Fray

Had an appointment today back with my gynecologist about the pelvic pain. The gynecological oncologist, who in all his wisdom told me I absolutely could not have the problems I am having from the radiation therapy, wimped out when it came to actually telling me that yes, your problems are due to radiation therapy and referred me back to my gynecologist. This has been a four month journey in frustration that still has no resolution.

Dr. Dunce #1 sent me to Dr. Dunce #2 because Dr. Dunce #3 gave me too much radiation. Dr. Dunce #2, after stating that I could not be having problems from radiation because he Dr. Dunce #2 would never ever prescribe radiation therapy if it gave you so much touble, ordered lots of tests and then sent me to nice colorectal surgeon and nice urologist. They ordered lots of tests, and then told me my problems are due to late effects of radiation therapy. Dr. Dunce #2, who never ever told me the results of the tests he ordered (probably because the result was that I had problems from radiation therapy) referred me back to Dr. Dunce #1.

Dr. Dunce #1 says I'm a gynecologist, I don't know what to do for radiation damage. I said that Dr. Dunce #2 sent me back to you. He said "why would he do that?" I said "My question exactly, I don't have any pieces or parts that pertain to you any more." He says, Dr. Dunce #2 has experience treating these types of radiation treatment problems not me. I say "Dr. Dunce #2 doesn't want to admit that it is radiation damage, but everyone else says it is - so what do I do now? I have pelvic pain, weakness, inability to stand for long periods or walk for long periods, I have urinary and fecal incontinence. I am having to take medication daily for the pain. Who do I go see?" Dr. Dunce #1 says "See the local pain management folks" I say "They say they can't treat it unless they can inject it. There's nothing to inject" Dr. Dunce #1 says, "Maybe a spinal cord stimulator would work" I say nice urologist and nice colorectal surgeon both said radiation damage doesn't do well with stimulators because you already have leaky wiring...and I already have one in my HEAD." Dr. Dunce #1 then says "I guess you need to go to a tertiary center like Wash U in St. Louis to see what they can do. Call over there and see what they say. Maybe they are doing a study or something. These types of problems are progressive, and don't get better". No duh. Dr. Dunce #1 didn't offer a referral or department to call or anything.

No one mentions Dr. Dunce #3, who overdosed me with radiation. I guess its up to me to find my solution, just like I had to find someone somewhere who installed occipital stimulators. I'm calling Dr. Dunce #3, who I have an appoinment with in August, to see what they recommend. I expect I will be told once more, radiation therapy can't be causing these problems. Sheesh! I feel like I'm in that Abbott and Costello routine about baseball, always ending back where I began.

Who's on first? I don't know! Third Base!

On the good side, The Headache is much much better today. Hoping for a productive weekend. I have plans to go to the local tomato broker and buy some canning tomatos to supplement our crop. Then I will have fun processing and canning them!