My back “went out” on Saturday. For the three days prior, I had hints of my upcoming misfortune, a twinge over my hip, some vague throbbing around the knee. By Saturday afternoon, I couldn’t take off my socks, touch my toes, or even get out of a car. I figured it was sacroiliitis, inflammation of the joint between the sacrum and the butterflywing-like ilia (pleural of ilium) that splay out from either side.
Ace said, “Sounds like a disc,” shorthand for protrusion of an intervertebral disc outside of it’s allotted space between the bones of the spine. ”But I don’t want it to be a disc!” My mom asked if I was still exercising and reminded me that the stability and strength of the spine depend in large part upon the strength and stability of the abdominal muscles. Thanks Mom.
I drugged myself with acetaminophen and naproxen sodium and went to bed, an ice pack propped against my back, hoping that the lovely restorative powers of sleep would work their magic. At 3 am, 2:53 am to be exact, I woke up and tried to get up to pee. My body declined to be vertical, citing lack of Substance P inhibition. In other words, ACK!
Three am is not the time to do any constructive deconstruction of events or symptoms. Three am was always a witching time for me when I was a practicing physician; I felt simultaneously exhausted, starving, anxious, and heavy. I’d drag myself from my warm bed cocoon and driving off into the dark night, into the specter of possibility.
The pain at 2:53 am took my breath away. So naturally, I freaked out. Ace abandoned our marital bed several weeks ago, at the beginning of my cold-that-wouldn’t-end. I replaced him with a lumpy pile of clean laundry and a fluffy Pomeranian who doubles as a hot water bottle.
I wracked my brain for my old nursing assistant tricks: roll up onto your side, bend your knees, use the arm not pinned to the bed to push your torso upright. By the time I got up and managed to shuffle into the guest bedroom, I was convinced I had a psoas muscle abscess + metastatic ovarian cancer + a spinal artery infarction + inexplicable acute demyelination over the left L4-L5 region.
Ace awakens poorly in the middle of the night. He generally assumes the house is on fire or intruders have breached the perimeter. I told him I felt sad and scared and we debated the situation. Was it bad enough to go to the ER? In that moment that took my breath away, yes. What would they do? Nothing acutely. They’d treat my pain and make sure I wasn’t imminently dying. I could go to the urgent care Sunday and beg for narcotics. Fun.
In the end, we went back to bed, both of us together. I felt much better, having transferred my herd of zebras* to my husband. I fell asleep, assisted by some leftover promethazine with codeine, and snored the night away. Ace slept fitfully, his dreams disturbed by thoughts of my death. How could he take over paying the bills when he can’t even see the top of my desk? Should he move to a smaller town? Take a different job?
When the sun rose, I felt a little better. My rational brain reminded me that evidence-based medicine exists. I reviewed Low Back Pain Diagnosis and Treatment on UpToDate: most people get better over a couple weeks no matter the cause, NSAIDs and muscle relaxants can be helpful, and bedrest should be avoided. (Bummer on that last one.)
I informed Ace that I had no intention of dying any time soon. We resolved to de-clutter the house anyhow. And today I’m feeling pretty good. I expect my Now-You’re-Really-Middle-Aged card to arrive any day. Do I get any special discounts?
The morals to the story:
1) don’t jump to any seriously improbable conclusions at 2:53 am.
2) share your pain with your loved ones.
3) Pomeranians snore less than spouses.
*In medicine, a “zebra” is a diagnosis that is unlikely but possible. For example, a school age child with nausea, vomiting, and diarrhea this time of year in Minnesota probably has viral gastroenteritis – this is the “cow” diagnosis if you will. A “zebra” diagnosis (we just don’t see many wild zebras wandering around in the Midwest) would be hookworm infection, unpleasant and extremely common in developing tropical countries.