Monday, October 27, 2014

Nerve Blocks.....

After two years of headaches that range from annoying to unrelenting neurology finally called us down to try nerve blocks to break the most recent run. 

Nerve blocks are basically the application of a local anaesthetic to a nerve, like when your dentist numbs a tooth.  You can do small area, or a really big one depending on the nerve you are aiming for.  Epidural anaesthesia is one form of nerve block, and in that case you can hit up to 10 nerves at a time, numbing everything from the waist down, or just one nerve, numbing part of one leg.  I wasn't entirely sure what they were going to be aiming for here.

They offered a sedative ahead of time (and finally got it phoned into the CVS nearest my sister-in-law's house).  I was quite surprised by the dose: Ativan at 2 milligrams is pretty hefty. I order 0.5 mg to sedate a grownup, but hey, maybe they know something about how badly these shots upset a kid, so I give her the pill as we are leaving for downtown.  By the time we arrived at CHOP she was drowsy and more than a little cranky.  The nurse went through the risk/benefit talk, and explained that we don't know how or why it works.  I responded that at this point it doesn't much matter if they come in with grass skirts burning incense and waving maracas.  I need Babygirl better.

The doc explained the process and asked her where the pain was.  Since it was all in the back of her head, that was where the shots were to go:  Four of them, each with one injection to be fanned out under the skin.  Then the doc started looking for anatomical landmarks.

Take a moment and feel the back of your head, where the neck meets your skull.  The bones behind your ears rise up and meet above the center of the neck, and there's a bump on the back of your skull like the keystone of an arch.  Locating the nerves is done by touch, based on these landmarks.

Babygirl doesn't have them. 

When she was born in Guatemala, her mom knew that she wasn't going to be able to raise her.  She had already had one baby, and he was being raised by his father's parents.  She didn't want her Babygirl to go the US adoption agencies and leave the country, so she gave her to a local family.  She came back a few months later to see her, and found Babygirl lying on her back, starving and nearly dead.  With no remaining choices, she took her back and went to the agencies.  Most of them turned her away because they thought Babygirl was too far gone to save, but one agency took a chance, put her in the hospital, fed her up, and she ended up becoming MY Babygirl.  But one result of this history is that the back of her skull is completely flat.

It made the neurologist's day more challenging.  He figured it out.

Her scalp completely numb, she lay down and fell asleep for two hours.  When she woke up she was hungry, thirsty, high as a kite and some teen-girl place far beyond cranky.  The first time she stood up she would have fallen down if there hadn't been a chair behind her.

The doc discharged us.  We are to come back for admission if she gets a headache again this week.  Aside from that, what happens next is anyone's guess.  Nerve blocks work not at all, immediately, for a few hours, for a few days, for months, no one knows in any one patient.

Watching Babygirl try to select coffee was entertaining. We had to go through the line twice for her to make up her mind and she was purely evil.  It was a relief to have her pass out in the car, so I drove all the way home without stopping. 

It took a leap of faith  to even consider leaving Philly without being sure she wouldn't have another headache.  But...what it she wakes up tomorrow without one finally and can go to school?  I have to have her here.  Hope is thin, but it's hope nonetheless.


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