Nerve Block Redux

About 18 months ago, I had an intercostal nerve block, which I wrote about here. In short, an intercostal nerve block is a method of injecting a numbing agent and cortisone, under x-ray guidance, right into the nerve root between a particular rib with the hope of reducing pain and inflammation. The original block I had done was at the wrong rib, so, naturally, it didn’t work. The experience was awful and I was reluctant to repeat the procedure. However, the cortisone injections I had late last year offered temporary relief and my rib pain has been escalating over the last month even with time off and reduced training; a nerve block was the next step in pain management.

I called the doctor’s office on Tuesday and had the following conversation:

     JZ: I would like to make an appointment with Dr. Tobey.

     Assistant: Have you been here before?

     JZ: Oh yes. I am a frequent flyer.

I explained my problem and she said she would confer with Dr. Tobey. An hour later she called back.

     Assistant: Dr. Tobey wants to do an intercostal nerve block at ribs 11 and 12. Can you come in Thursday?

     JZ:  Sounds good. Can you ask him if he has punch cards? You know, have 6 procedures and get the 7th free? Or, maybe I can purchase a deal on Groupon?

     Assistant: Ummm….

    JZ: I’m just kidding.

It would be an understatement to say that I experienced some anxiety about having the nerve block done.

Here is how it all went down.

I had to put on a very oversized gown that barely tied in the back. The room was freezing. How did they expect me to stay warm with a flimsy piece of cotton?

The x-ray technician came into the room. As I mentioned, this procedure is done with x-ray guidance to make sure the needle is in the right spot. We had some banal banter. I asked her to turn off the soothing music, it was making me agitated. I requested some AC/DC, but apparently that agitates the doctor.

The doctor came in and examined my ribs. He poked and prodded – yes, it all hurt.

My back was swabbed with iodine and then draped with a sterile sheet. Tobey injected a local anesthetic and then he went in for the kill. Basically, he took a gigantic needle and touched the rib with it and then came off the rib into the nerve root and injected the cortisone. Since he was doing two ribs, I endured this twice. He told me to expect a little pressure. Excuse me, but a little pressure is a Swedish massage. This felt like the massage therapist was doing jumping jacks on my back! And, the dizziness. It was overwhelming. Kind of like the bed spins when you drink too much (oh, come on, you know you’ve been there).

Tobey was making polite conversation during the procedure, presumably to keep me distracted. He asked me when I was racing again. He probably expected me to say in a few weeks. I sheepishly told him I was getting on a plane tomorrow to go to St. Louis. He was somewhat relieved when I told him it was only 8K and not a marathon.

And then it was done. I requested a photo of the x-ray for posterity and I was on my way.

Here is my souvenir! Those are some big ass needles.

Kinesio Tape and Fairy Dust

I have been dealing with my rib injury for nearly two years. I have come to view this injury as a chronic condition, not unlike my asthma. It is with me all the time. It must be managed on a daily basis. Most of the time, the injury lingers in the background, but then when I least expect it, the injury flares up with vigor and I have trouble breathing and the pain level soars.

My latest flare up occurred on Labor Day. As part of my long run, I planned to do the Boulder half marathon. I woke up not feeling particularly great, but I warmed up and I seemed fine. A few miles into the race, I struggled to breathe and my ribs started to hurt. I pulled the plug at mile 8 and hitched a ride back home.

This was the beginning of a very up and down two weeks. Workouts were sporadic – a brilliant run was followed by a run cut short – leaving me apprehensive about the Twin Cities marathon on October 2. In an effort to calm down my ribs, I stopped swimming, backed off run workouts, and changed my gym routine. I had been doing dry needling, and but now we stepped up the effort with as many as 20 needles in and around the rib cage and diaphragm. Nothing seemed to calm the ribs down.

I sought out some new help and found out that I have 4 ribs (9-12) that are hypermobile, meaning that they are moving around too much. This causes the intercostals to stretch too far causing spasms and it also makes the diaphragm incredibly unhappy. Well, that certainly explains the difficulty with breathing! The most hypermobile rib is number 12 which is dubbed a floating rib because it does not attach to the sternum. When this rib moves, it presses on a nerve, which is quite unnerving. Just to keep it interesting, there is also a lot of scar tissue around the ribs.

Much of this information is not new. I already knew that there was hypermobility in my ribs, but I did not realize how many ribs are affected, and the explanation of the cascading events that occur when the ribs move too much was enlightening.

These are the Graston utensils. There is even one called "The Pointer".

In order to address the scar tissue, the Graston technique was employed. Have you ever had this done? A series of metal tools that look like ancient torture devices are used as “an innovative, patented form of instrument-assisted soft tissue mobilization that enables clinicians to effectively break down scar tissue and fascial restriction. The technique utilizes specially designed stainless steel instruments to specifically detect and effectively treat areas exhibiting soft tissue fibrosis or chronic inflammation.”

That quote is directly from the Graston website. I really don’t think people are going to rush out and get Graston after reading that. And, guess what? It hurts like hell. Basically, these objects of torment are scraped across the injured area, i.e. my ribs, making a sound akin to nails on the chalkboard. To make sure that you remember the experience for the next few days, it causes bruising.

In an effort to stabilize the ribs, a very intricate taping technique has been employed. I had tried taping last year. The tape was magnificent – it stayed on in the pool, workouts, in the shower.  It also burned my skin so badly I had red lines on my torso for a month. This time around, my incredibly resourceful father acquired something called barrier wipes that are meant to protect the skin of patients with colostomy bags. I figure if it works for them, it should work for me!


So far the taping is working wonders. It really seems to prevent the ribs from moving when they shouldn’t and it is giving much needed support to my rib cage. Of course, in the gym locker room the ladies gasp and give me strange stares and I get the occasional, “What is wrong with you?” I am still trying to think of a better story than, “Uh, I was in a bike crash 2 years ago.” I welcome any suggestions.

I realize that tape and fairy dust are not a long term solution. I am still hopeful that a very hot, skilled surgeon with a keen interest in hypermobile ribs will swoop down on a white horse and fix me for good.

The Diagnosis

I am a scientist. As a scientist, I thrive on answers to problems, and when one is not available, I am uncomfortable until one is found.

Why Fantasy Prevailed: A Dose of Reality

Pain is a nebulous concept; it differs from person to person, can last an hour or years, and it is so hard to quantify. In December, I wrote about my experience with pain directly following the crash. What I did not anticipate was the transformation from an acute pain to chronic pain.