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.
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.
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.
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…
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”.
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:
Here are some reasons to go ahead and get the surgery:
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”!
I looked for notes about my original diagnosis and found a Google Docs document entitled Spine Injections and Imaging. Here are the contents…
MRI Thoracic Spine Without Contrast (7/26/2011)
Impression: 1. Mild anterolateral disc protrusion and endplate spurring at T8-9 and T9-10. 2. Mild C6-7 spinal stenosis. 3. Otherwise negative MRI of the thoracic spine.
Medial Branch Nerve Block (1/18/2012)
Preoperative and Postoperative Diagnoses: 1. T10-11, T11-12 facet arthropathy. 2. Thoracic pain.
Procedure: Left T10-11 (T11) and left T11-12 (T12) medial branch nerve block
“Patient had undergone previous Medial Branch Block at T9,10 but felt injection was too high/”low” despite radiographic evidence. “Dr. Schofferman has recommended Medial Branch Block T10-11 and T11-12”
Chronic Mild Schmorl’s nodes are present at T9 and T11. Mild disk height loss at T9-10. Mild to moderate facet arthropathy from T9-10 to T11-12 without significant foraminal narrowing.
mixed results, some improvement for a few months
“Mild tenderness to palpation at approx T10/11” (2013 followup notes tenderness to palpation at T9/10). Imaging shows mild degenerative disease at T9/12 and facet arthropathy at T9/10, T10/11, T11/12.
“Partial response to rhizotomy indicates facet joints may be part of the problem but not the whole problem. Costovertebral and costotransverse joints may be a source of pain. Another possibility is nerve root irritation from the lateral recess compromise.”
Left T9/10, T10/11 and T11/12
Followups: “Those definitely helped him, although for not more than a few weeks”. “Greg has chronic thoracic pain that is probably mechanical, although there could be a neuropathic component.”
“It seems we have zeroed in on the source of Greg’s pain which is in the thoracic spine somewhere between T10 and T12 on the left.” “Given the definite but partial benefit with selective nerve root injections, repeat nerve root injections could be helpful. The other option would be to inject the joints between the ribs and the vertebrae which have not been treated before.
(no followup but from what I remember these weren’t especially helpful)
““Partial response to rhizotomy indicates facet joints may be part of the problem but not the whole problem. Costovertebral and costotransverse joints may be a source of pain. Another possibility is nerve root irritation from the lateral recess compromise.”
I think this is when we got away from the facet joints. Why we never came back to them is beyond me! Probably that blotched ablation. It hurts when they fry the wrong nerves, especially when they just partially fry them around your whole body. Oh well, it would suck to get ablations every couple of years. Those fucking nerves grow back. I’m just not sure nerve frying is the solution to anything. I suppose they need some desperation options other than opiates. Maybe I just got a bad one. Oh well, that will probably be my next Hail Mary if this Hansen 3.0 doesn’t work.
All of this T9 – 12 stuff has me worried though. I’m supposed to be hurting at T8. He (as well as AI) said that I could have symptoms from my hypermobile 10th rib, even though it’s congenital and thus I suppose, my 9th. It would explain why I don’t have pain at my 9th rib tips. It would all makes sense if The Pain and those blobs were at level 8 and not level 10. But what if my ribs are the problem? I mean, they’ve been jerked and pulled around by my sports, my hernia, the 2nd surgery. Like this article says, there’s a lot moving around in there when your 10th rib is floating.
Patient Name: Gregory Payne
D.O.B.: 08/01/1960; 64 yrs, 7 mo at the time of visit
Seen by Rowan Paul, M.D.
Date: 03/05/2025
Gregory is a 64 year old man here for left lower rib pain. Feels like his pain was posterior but more unstable. Sharp knife in the back, then flank ache and has had negative rib fractures. 9./10 in the morning, has to take Methadone, Cymbalta. 4-6/10 now.
Cortisone injections was helkpful for 4 hours from the anesthetics. Steroids didn’t work.
Weakened abdominal muscles. History of diastasis recti.
Bone scan remotely was negative.
Is going to see Dr. Hansen in West Virgina for Hansen technique
Otherwise as seen in the common Electronic health record, no change in past medical history, past social history, family history, medications, allergies
ROS:
CONSTITUTIONAL: Appetite good, no fevers, night sweats or unintentional weight loss.
HEENT: No headaches, diplopia, eye pain, ear pain, tinnitus, nose bleeding, mouth sores, or jaw claudication.
CV: No chest pain, shortness of breath, dyspnea of exertion, or peripheral edema.
RESPIRATORY: No cough, wheezing, or dyspnea.
GI: No nausea/vomiting, diarrhea, abdominal pain, or change in bowel habits.
GU: No dysuria, urgency, or incontinence.
NEURO: No motor weakness or sensory changes
SKIN: No rash or photosensitivity.
MUSCLE-SKELETAL: No morning stiffness, Raynaud’s Phenomena, Positive joint pain/ muscle/tendon pain as above ENDOCRINE: No polyuria/polydipsia, no heat or cold intolerance
on exam the patient is in no apparent distress
Psych: alert and oriented,
lungs with non-labored breathing, no audible wheezing or tachypnea.
Neck is supple, trachea midline.
Extremities are warm and well-perfused, no clubbing cyanosis or edema.
Heart regular rate and rhythm,no varicosities
Skin with no visible skin lesions or lacerations. no erythema.
Neurovascularly grossly intact with full motor and sensory function besidesbelow. DTR 2+ bilaterally Patellar and Achilles, nonantalgic gait
MSK: general palpable unstable T eight,nine and T9 T10 articulation, That is tendered Touch. he also has tenderness in the T 9, T10 and to illustrate T11 costotransverse regions.
Completes nonvascular real time ultrasound examination clearly shows instability, of the T8 and T9 articulation front and back, T9 and T10 significantly in the front. I do not see major instability at T10 T11 though he does have pain under the ultrasound probe. underlying lung looks intact.
Impression/ plan #1instability, of the T8 and T9 articulation front and back, T9 and T10 significantly in the front. Likely post traumatic in the setting of Ehlers Danlos syndrome.
I recommend a dextrose based prolotherapy And Shockwave therapy as well as Class for high potency robotic assisted laser and EMT. he and his wife were minimal after risks and benefits were explained. I recommend to treating both Anchor and posteriorly based on his biomechanics. He could opt to do surgical stabilization as well.
Was crept with chlorhexidine times three. under direct needle ultrasound guidance with image documentation using a sterile 6 to 15 megahertz ultenrobe by advanced at 25GAGE needle in long axes and then short axes and injected the T8T9 and T10 cost of transverse joints posteriorly. I then injected the anterior slipping rib at T8, T9 and T10 with 4ml of 12.5 % dextrose, 2 ml of 0.2% ropivicaine.
MLS Class 4 laser neuritis setting front and back.
The patient tolerated the procedure well, no complications. Lungs CTA bilaterally after. Felt much better after. No pain.
See back in 6 weeks.
Patient was advised to seek urgent medical care if they develop any sudden worsening pain, weakness, parasthesias, bowel or bladder incontinence, saddle anesthesia, headache, fever, or chills. Medication precautions given. Conservative measures explained in detail. Activity modification discussed in detail Patient is amenable to treatment plan. Questions were answered. healthy lifestyle explained. Thank you for the opportunity to take care of this patient.
1. Slipping rib syndrome
2. Thoracic back pain
3. Fascial defect
4. Abdominal pain
Electronically signed by Rowan Paul, M.D. on 03/05/2025 1:09 pm in 
.
I was reminded today that coffee sets off “The Pain”. It’s like pouring salt on a wound except it’s pouring coffee onto the nerves in my back that hurt. “The Internet” (maybe I’ll just start calling anything from the WWW, if that’s still a thing, AI). Anyway, AI says (hey I like that term, search results are intelligence and they’re artificial! Bingo! “AI” it is, to describe any rubbish I get from my browser.
OK, sorry, back to the point of this phenomenon supporting YES on the surgery in that, SRS is known for stomach issues, Facet Joint Syndrome, (FJS, my latest theory and first excuse for backing out of my upcoming surgery), is not. but here comes a bunch of NOs…
I was originally diagnosed with Facet Joint Syndrome. I even had an ablation which may have worked but it I think it was aimed wrong, creating new and different pain. I remember my left side swelling up like a football when the ablation was over. I want to say that it did relieve my primary pain for a couple of years but I can’t be sure. At any rate, the ablation was a bad experience and for some reason, I never went back to that diagnosis. Neither did the doctors.
PET scans have detected rib joint reuptake on the left>right but no facet joint issues. Oops, there’s a big YES. I can bend backwards a long way (YES) but I do reach a point that seems to send a jolt through The Pain (NO!). This is what makes me wonder the most. But that whole area (the three joints) is bound to be inflamed and I’m sure there are limits to the others as well, they are just more protected from stupid human moves. One of the ways they are protected (the rib joints) is from their ribs’ third connection in the front, which most ribs have. Now we know we’ve been lied to our whole lives. Did you know most people have 6 floating ribs? That’s right! Most of us have three floating ribs per side, not two! Now they’re telling is it’s about half and half and three has a slight (percentage or two, or three) edge. From pictures like the one at the top, Slipping Rib Syndrome is also just a variation of the norm. They are saying that is from a “Normal Chest”! So I have two congenitally floating 10th ribs and 2 subluxated 9th ribs (the left is more so). Both my sides click the same. However I only have symptoms on one the left? Why? Apparently this “condition” is often bilateral but with unilateral pain. Perhaps my hernia made them symptomatic, or that girl who walked on my back. But that volleyball incident was a hyperextension of my spine and haunted me for years. If my memory is correct, it was the same but lighter version of my current pain (The Pain). This equates to a big NO! It says that my problem is not SRS but FJS!
So we have one YES from the coffee trigger and a couple of NOs from SRS’s nimesis, FJS. We’ve discovered that I have floating 10th ribs and my ninth ribs are subluxated up under my 8th ribs, which should be irritating my eighth intercostal nerve but it’s NOt. My pain is from the 10th rib area (maybe 9th or 11th but not 8th!). So NO! But none of this really matters. I think I have to get this surgery for a couple of reasons….
She has been a proponent of this surgery and theory the whole way. I’m much more skeptical. I’m giving it a 30/70 chance of making things significantly better but I have to do it for Barbara. It’s actually considered “minimally invasive” but I think it was Dr. Laurencin or somebody that said only a thoracic surgeon would consider it minimally invasive. I’m freaking out because Dr. Hansen basically told me it was the end of my active life, at least doing the sports I like to do. He pointed out that it should probably be that way anyway and I suppose he’s right. I was talking to Babs about it being an addiction and how it keeps me from enjoying the little things. I’m always chasing the dragon, wanting to be on the water or the trail, not in the moment. So whether this works or not, Barbara wants this surgery and ultimately I think it will be good for me to let go of my active life and pay more attention to her, enjoy the little things with her. Sigh… well at least this makes the decision easier.
I just turned 65 and my life is shit. I’m a miserable asshole who’s making everyone else’s life shit. Even if this is the red herring I think it is, it really won’t make things much worse. So there’s everything to gain and not really that much to lose. I keep hoping for a miracle cure that just isn’t coming. If this doesn’t work, I’ll turn our attention back to the facet joint. Fuck I really wish I could get a facet joint injection before the surgery.
This is driving me nuts. One minute I’m ok with the surgery, the next minute I’m convinced it’s a red herring. It’s just such a damaging red herring if it is. Here’s a quote from a paper about a swimmer that I keep running across…
Rib hypermobility caused by weakness of the rib-sternum (sternocostal), rib-cartilage (costochondral), and/or rib-vertebral (costovertebral/costotransverse) ligaments, allowing rib hypermobility, is thought to be the primary cause of slipping rib syndrome. Ribs 8 through 10 (false ribs), which are not connected to the sternum but are connected to each other via a cartilaginous cap or fibrous band, tend to be the most mobile and susceptible to trauma. Because of this, slipping rib syndrome is usually caused by hypermobility of rib 8, 9, or 10. Anterior rib hypermobility is also likely to cause problems in the posterior thoracic area as well because in a closed system (in this case, the rib cage) it is difficult for motion to occur at 1 site (the anterior portion of the rib) without causing motion to occur elsewhere (the posterior portion of the rib). So, as was the case with our athlete, the condition often results in back pain.
https://pmc.ncbi.nlm.nih.gov/articles/PMC1150226/pdf/i1062-6050-40-2-120.pdf
I guess I’m suspecting facet joint syndrome although I don’t really have the symptoms of that. I just have this gut feeling (pardon the pun), that reconstructing my costal margin is NOT going to make my back pain better. Now I’m learning that all this shit about having two floating ribs is bullshit. Turns out most of us have three! Apparently I have three floating ribs and my ninth rib is subluxated. This should be irritating my 8th intercostal nerve. That’s just to high! Perhaps it’s not the intercostal nerve at all but hypermobile ribs irritating muscle. They talk about the “closed loop” as mentioned above. If my 10th rib is causing the pain, perhaps it’s because I lack stabilizing cartilage in my 10th rib (a variation of normal).
OK, so hold on. Dr. Hansen said that the 10th rib can be problematic even when it’s congenital and there’s a lot online to support that. I was just thinking that my whole ribcage seems inflamed. Some even consider a floating 10th rib to be a version of Slipping Rib Syndrome. Bottom line is, it’s worth a shot, even though I don’t think it’s going to help. Time is running out and I’m getting desperate.
I was looking back at old journals today. There was a lot of mention of flank and rib pain as well as stomach pain. In fact I was blaming it on the stomach for awhile. They say stomach problems are very common with SRS.
I saw Dr. Hansen last week and he happened to have an appointment available on September 17th for surgery so I signed up. Now I’m freaking out. I’m just not 100% convinced that my back pain is from my slipped/hypermobile ribs/broken costal cartilage! In other words, I do have slipped ribs, I’m just not sure I have Slipping Rib Syndrome (pain from slipped ribs). Lots of peoples ribs click, including Dr. Hansen’s, but they don’t have pain. I have plenty of other physical issues on the left side of my body to cause back pain and I don’t have much pain at the subluxated rib tips (an important though not required symptom).
So I figure I have this week to decide. I can’t cancel any later than Friday. I’ll start with the things Barbara suggested:
Recently, it was discovered that I have a large blob of pain on my left mid-back, between the muscles and the skin. It has been described as spongy, like fluid, squishy. It’s very visible and baffles everyone who sees it. When people see it, their reaction is very noticeable. It’s like something they’ve never seen before. Finally! We can SEE my pain! I’m having an ultrasound Thursday. It’s like an edema, it looks like a big swollen bruise. It’s pretty large, the size of a dinner plate, and it’s where a lot, if not most, of my pain is! WTF? I’m calling this mystery blob of pain Nessy, for the Loch Ness Monster. It’s finally been photographed!
That might not look like much but keep your eye on the bump at the end of her finger.
excuse the shirt lines but you can see it above the shadow of the camera. Here’s another shot…
Above, the shark is pointing right to it. It’s my pain pillow! It hurts so much to lie prone on this blob. I didn’t even know it was visible until recently but I’ve felt it for years. The fact that it’s clearly visible, not just to me but to everyone, is huge. What could be producing such a big ugly edema?!
Hmmm, I wonder if it’s a lipoma? If it is, it could be coming from anywhere, I suspect close to my spine. If that thing goes below the surface it is definitely pressing on my spine and possibly my aorta. In some photos you can see it pushing onto the midline and the area next to the spine is the most painful spot on the blob. I’m glad that ultrasound is scheduled for tomorrow. We may have found it. This thing may have been growing for 12+ years.