What now?

Feb 17, 2026

It’s been 5 months today since my surgery and it’s looking like the surgery was a big mistake, as I expected it would be. The past week has been particularly miserable. I really wish I could just die. The reality is, I’m probably stuck with this pain for the rest of my life. I’d like to at least know what’s causing it.

I was originally diagnosed with Facet Joint Syndrome. I think I need to find doctors and approach it from that perspective.

• Get spinal PET scan
• Find spine doctors

Scared Shitless

Oct 19, 2025

These aren’t just dark times. I’m terrified! If the old pain continues to worsen I’m going to have two choices – suicide or medication. Medication would probably work except this country has decided to stop medicating pain patients. A small dose of methadone can relieve a tremendous amount of suffering but because it falls under the class “opiate”, pain patients are now caught up in DEA’s War on Drugs. So what happens? Doctors ignore their hippocratic oath and let us suffer, refusing to prescribe pain medication to pain patients. These patients will suffer until they can’t take it anymore so they commit suicide or go out on the streets or the Dark Web for medication. If things don’t improve soon, I’m going to have to start looking for a doctor willing to increase my dose of methadone to what the UCSF pain clinic recommended, 30mg/day. I may need to leave the country. Part of me really just wants to end it all. I’ve suffered more pain than any animal should be forced to suffer. At 65, my life is pretty much over anyway, especially if I have to live the rest of it in horrible pain, on top of all the aches, pains, restrictions and illness of old age. Is it really worth it? I could say I should stay alive for Barbara but I’m not sure I’m doing her any favors. I’m basically a burden. I can’t take care of myself. I’m probably just preventing her from living a good life.

I suppose I might be depressed. I don’t want to get out of bed. I could say that it hurts more when I get out of bed but I’m not sure that’s even true. I’m determined to start walking at least 1 mile a day. I’ve been living with Level 7-8 pain every day. I suppose the surgical pain is getting better. I’d say it’s about level 7 so while it’s not any worse than the old pain, it’s probably adding to it. I still have slim hope that as the surgical pain settles down, so will the back pain. It does kinda feel like they both involve the same nerves. What I need to do is turn my brain off because worry rarely helps anything. In fact it can be my worst enemy. I need to try and not worry about anything. I do have my 5 week follow-up meeting with Dr. Hansen next week. I need to do some research to prepare for that.

I’m going to try to start walking down to the village for lunch every day at 11pm. I’ll my alarm for 9am, do tea and toast in bed, watch TV until 11, then walk. If I can do that every day, it will be a good sign. I think I’ll go ahead and buy a Sprinter. I have to create a life outside of this bed and getting back to nature has always been good for me. I’m sure there are a lot of trout to be caught in California, even if I can’t windsurf, snowboard, eFoil, surf or all the other things I want to do. Hopefully I’ll even be able to do those things next year. Trying to think positive and not kick myself for getting this surgery. I need to suck it up and be brave. Lately I’ve been thinking a lot about suicide. Hopefully it won’t come to that. Which reminds me, it’s time to sit down with Dr. Laurencin.

Going Forward – 3 1/2 weeks post-surgery

Oct 11, 2025

I can’t dwell on whether or not I should have gotten the surgery. I did and I need to move on. The next three months will be about healing. I can’t do much. I’ve been told not to bend, twist or lift over 15 lbs for 4 months. That’s pretty limiting. So I’m trying to walk twice a day for at least two miles. So far I’ve only been doing one mile walks every 2 or 3 days. That’s not good enough. I have recently added dumbbell exercises – curls and military press. My surgical pain is just slightly annoying, maybe pain level 3. The old pain (mid-back) is pretty much the same at PL 7-8.

Assuming this surgery was another red herring, I think the next step is an MRI and probably a PET-CT (PET for diagnostic purposes, CT to check on repair structure). To get this, I think I need to find a “spine doctor”, an orthopedic surgeon or a physiatrist. It may be time to resume looking for that needle in the medical haystack. Maybe I’ll start with California Orthopedic. They have a lot of orthopedic surgeons and physiatrists. I need to find a doctor that is interested in a challenge and willing to work with me. You’d be surprised how hard that is to find in a doctor. I just want some imaging and maybe some diagnostic injections.

The other thing I should probably do is explore the idea of rectus trigger points. I should be able to explore that on my own and when healed, make an appointment with Dr. Sawyer. For now, I need to shut down my negative thinking and come up with next steps in my search for a diagnosis. I should make an appointment with Dr. Salahuddin. I should check forums for radiology places. It’s too bad we can’t make appointments with radiologists. I need to drink more water and eat better, meditate and resume projects like guitar and robotics. Most of all, I need to try to enjoy life. Hopefully it will all be over soon.

2 1/2 Weeks Since Surgery

Oct 6, 2025

OK, I went ahead and got the surgery and as I expected, I’m regretting it. I’ve let them make structural changes to my body that comprised the integrity of my ribcage permanently and I don’t think it addressed my problem. I think I had/have slipped ribs but not Slipping Rib Syndrome (slipped ribs causing pain). I.E. I think my costal cartilage on the left is the same as on the right – asymptomatic. I slept till 2pm today but when I woke the old pain was back. It started coming back yesterday. It’s probably just that my surgical pain is getting less so the old pain is once again the loudest barking dog (to use Dr. Hansen’s relative pain metaphor). I’m afraid it’s turning out just as I feared. I’ve not only added another physical problem to my list but now I’m essentially bedridden for the next 4 months to a year, going through various phases of pain, all for nothing!

So if SRS isn’t my problem, I need to go back to my list of suspects. They are, in order of likelihood…

1. Herniated left rectus abdominis, active for almost 20 years and requiring two surgeries. This is something my doctors all dismissed but that’s because most doctors are idiots and pretty much all available doctors are available for a reason. My core wreck is the only thing differentiating my left side from my right. The pain seems to radiate from the ab to the mid-back. This is common with rectus abdominis trigger points. I need to continue trigger point release, possibly with a trigger point expert. Perhaps I should consider getting the mesh removed. Unfortunately I’m approaching an age where people stop caring. However they never cared in the first place so I have to be my own doctor and use practitioners as tools. Anyway, the old 25 year old hernia is now my prime suspect.
   
2. Why is my vertebral marrow glowing? Osteitis, possibly from an autoimmune illness. In a PET scan, the vertebral marrow of my lower thoracic spine lit up like a christmas tree, with the left costotransverse/costovertebral joints as the lights. The Stanford (experimental) radiologist was sure the lit up vertebral marrow was a pain generator. He said it is seen in patients with long-standing autoimmune illnesses. This is especially interesting because I was diagnosed with PMR, then RA, then GCA, a few years ago but the pain started a decade before that. So if the pain is from an autoimmune illness, I suspect it’s one that started around 2009 or 2010. I remember feeling bad in the evenings. I was drinking too much and not taking care of myself. I need to research active vertebral marrow in PET scans. I am going to make an appointment with my old local rheumatologist (Dr. Dietz doesn’t seem open to experimental results but Dr. Biswald seems like a trustworthy source to me. But why is the pain unilateral? I think my next step here is to make an appointment with Dr. Ramanujam.
   
3. GI issue. There is definitely a GI connection. I can set off The Pain by drinking too much coffee or something spicy. The angry nerve has a branch into my stomach. While a GI problem may not be the root cause of the problem, it is definitely involved and should be considered a potential prime suspect.
   
4. Facet Joint Syndrome/Volleyball accident – This was my original diagnosis 15 years ago from Dr. Schofferman. I think I damaged the facet joint at LT10/11 in the mid-nineties. It was sore for years, then went away however if memory serves, it felt very similar to The Pain. Perhaps it is an old injury come back to haunt me. I don’t know if it’s primarily a muscle, joint or nerve problem and the pain syndrome that I have developed over time may be different from the original problem but I don’t think so. I think it may be as simple as an arthritic facet joint.

Dark Times

I wake up in the mornings terrified. I’ve been tortured for 15 years and I can’t find a doctor that will give me (my condition), the time of day. At this point I just want it to end. I haven’t given up on the Slipping Rib Surgery completely just yet but I think that’s just a matter of time before I realize that it did nothing to address my pain, it just created new issues. I’ve lost all faith in doctors. If there were a button that would end this torture (i.e. my life) I probably would have pressed it by now. It’s not that easy to kill yourself. It’s a violation of the prime objective – survival. But a life is not worth living if it is lived above a certain pain level. We euthanize other animals, why not ourselves. I don’t want to drag this out forever. Everyone will think it’s depression and maybe they’ll be right, but most people have no idea what it’s like to live with severe chronic pain. They just can’t (or choose not to) wrap their heads around it. Empathy does not come easily to the human animal. I’m trying to be positive and heal from the surgery. This surgery is nothing like the other 5 or 6 surgeries I’ve had over the years. The recovery is long and painful and my activity is very limited. Perhaps it’s good that I’m depressed and just want to sleep all day. I won’t really know if works for up to a year. I do know I’m still in too much pain to reduce my methadone. Even 1/2 mg/day change is very noticeable and as I learned at Stanford, “pain begets pain”.

Next Steps

1. Make appointment with Dr. Ramanujam
2. Find a good osteopath
3. Look into getting a PET/CT scan
4. Experiment with stomach meds during flare-ups (drink more water)
5. Research active vertebral marrow and pain that radiates to the back (from abdominal trigger points, GI, etc)

Flip-Flopping

Sep 11, 2025

I’ll probably be rapid-cycling on the decision to have this surgery right up until they put me under. My confidence that this is a good idea is down to 20%. I truly believe I will regret it. The main reasons I have to doubt SRS as the source of “The Pain” are:

1. If it’s an intercostal nerve, I’ve narrowed it down to the 10th one. However a slipped 9th rib should be irritating by 8th intercostal nerve. I have no pain at T8/9.
2. My right side is almost identical to the left (both have floating 10th ribs and slipped 9th). Ok, so the left side is slightly more slipped but still, my cartilage configuration is not giving me any issues on the right. I have a lot more going on in the left that has nothing to do with slipped ribs like…
3. A wrecked left core, especially the rectus abdominis. My hernia, twice repaired has wreaked havoc on my left core, maligning and realigning muscles and joints. However there has been a study about a link between SRS and a weak left ab. So it’s possible my hernia is combining with hypermobile ribs to cause The Pain. I’m just not sure reconstructing my costal cartilage is going to address the back pain.
4. The surgery is brutal with discouraging results. It is only 50% successful, meaning they have to go back in and fix the repair about half the time. The average pain reduction after 1 year is only 50% and that’s after a year of extreme pain in some cases. At least 5 patients want their 3.0 reconstruction ripped out.
5. I’ve read way more failure stories than success stories. This is partly because people that are still hurting tend to be online while the people that are feeling good are out having fun but still, I’d expect to see more positive results. I’m disappointed with myself that I didn’t research more.
6. There’s a good change that this procedure will increase my pain long term, certainly short term.
7. The photo above is from a “normal chest”. There is new information that we don’t have the perfect two floating and three false ribs like we were told. In fact I’ve been reading that most of us, up to 60% has 3 floating ribs, like me. Also, many people have subluxed ribs, can click them with the hooking maneuver, yet have no pain. Even Dr. Hansen has this. I can’t help thinking that if all this (pain from these ribs) were “real” it wouldn’t be so “rare”.

Here are some reasons to go ahead and get the surgery:

1. I’m desperate. If it works, the payoff is huge. Unfortunately it’s not like an injections where if it doesn’t work, no harm done. My ribs and life will probably never be the same and certainly not for a month to a year.
2. If I don’t try it, we’ll never know. ’nuff said. Everyone will think I’m crazy (or a pussy) not to get this surgery)
3. Dr. Hansen “feels strongly” that he can reduce my pain by at least 50%. Dr. Paul says I definitely have Slipping Rib Syndrome and hypermobile ribs. He confirmed tender to touch on palpation at the hypermobile ribs.
4. There is a plethora of symptoms associated with this syndrome. I should be trying to second-guess the experts at this point. I’ve become so skeptical of what doctors tell me. I just don’t trust them. Hopefully I can trust Drs. Paul and Hansen. I like both of them. They are by the way, the only two doctors I have seen, out of about 40-50, that have ever heard of Slipping Rib Syndrome. It’s been around for over a century and it’s more underdiagnosed than rare. There are a lot of reason for this ignorance but they add up to a broken medical system which is what we have in this country. Ask any chronic pain person.
5. Barbara has a 50% confidence rate. We’re both skeptics. I owe it to her to try anything and everything.
6. No doctor or practitioner has been able to figure out why my left rib cage always appears swollen. As if the muscles are inflamed. SRS is one of the few things that would explain this.
7. Floating 10th ribs can be symptomatic. I think that if I do have SRS, it is from my floating 10th rib, not my slipped 9th.

As you can see, it’s pretty evenly balanced. I travel in two days and the surgery will be two days after that. So I have 4 days to chicken out. Unless I can convince Barbara that I shouldn’t be doing this. I guess I’ll be going under the knife.

I’ll probably get the surgery. Regardless, I need to work on my attitude. I have been dragging Barbara down with me and I need to figure out how to be more pleasant. It’s true what they say “Pain is selfish”!