Zander's Inside Voice

After talking to my wife extensively this week, I have decided that my brain is still turning to certain pathways in my brain that are well worn, but not effective. Life was different when I was just surviving and I had to do what I needed to survive. But I don’t need those coping mechanisms anymore.

I did some research on how to change the synapses in your brain. I have read about this on and off over the years and wanted to refresh the knowledge I had before. I ran across an article that talked about things you could do to help work out your brain and start building new connections. The ideas seemed really easy; things like exercise, trying new things, and other things I forgot already. But then I found a link to another article that said 4 things NOT to do when you are want to improve pathways in your brain. The first two seemed like no brainers. But the third…

Do not take Gabapentin. Gabapentin. That takes me to a place I have forgotten. 2019. After I had surgery on my right arm. When I still felt like I was dying and I was in pain every single day.

I first started feeling wrist pain in college. I thought it was from an unfortunate rollerblading accident, but it wasn’t getting better. During lacrosse season I was strong at the beginning of the season and then my throwing got progressively worse over the season. This was the worst after my senior year. After that, I didn’t use it much until I joined the Air Force. It seemed fine until about 2008, when it was just terrible. Pushups weren’t required when I first joined, but then they were after 2004. Within 4 years, I started having a ton of pain in it. My range of motion was significantly lower and my right wrist was so weak. I complained about it and got an x-ray, but was dismissed because it didn’t show anything.

Disappointed, I stopped complaining and just tolerated it until 2014, when it became unbearable and started impacting my sleep. They did another x-ray and there was mild degeneration, but nothing that would cause so much pain. That doctor finally agreed to do an MRI. At the first attempt, they could not complete the MRI. The second attempt was successful and when I returned to my doctor for the results, he told me that there was soft tissue damage. My TFCC (Triangular Fibrocartilage Complex) had a significant tear and evidence of repeated damage. The TFCC connects the bones in your forearm with the bones in your wrist. The worst part was that nothing could be done to fix it. A year later, as I was recovering from a broken bone in my hand, the occupational therapy made my wrist hurt again. All I was able to do in the Air Force was get an exemption on the pushup portion of physical fitness testing. A cortisone shot helped briefly, but did not stop the pain for more than a couple weeks at a time.

In 2019 I was at another base, with many worsening medical problems. I went to my doctor and she listened and referred me to other doctors around the medical group, such as orthopedics.

Initially I saw the PA in orthopedics who told me he would refer me to the hand surgeon on staff. I had to wait two months for the appointment but when he strolled in like a peacock with his feathers spread out, he was cocky but knew he was good at what he does. He had an x-ray machine in the exam room and he showed me exactly what was wrong. He could tell that my right ulna was likely a little longer than normal and causing my TFCC to become unstable, as well as wearing down other tissues and bone in my wrist, causing ulnar impaction syndrome. It was the first time anyone ever told me what we really wrong. I told him that I was told it could not be fixed. He did not let go of my wrist and then told me “I can fix it. I will make it better for you. I am going to write down what I want to do and I want you to google everything you can about this. I want you to understand everything about what I can do to help you. And only when you feel you can trust me, will I do your surgery.” He handed me a paper with everything on it, including his own cell number. “Call me if you have any scary questions that come up after your search. When I see you again, bring any other questions and we will talk about scheduling surgery, ok?”

A few weeks later I was back with him and told him I was ready to schedule. I could not wait to finally feel better. The plan was to put two tiny cameras in my wrist to look at my TFCC and my ulna and where it butts up against the other bones. If he saw any indication of cratering where my ulna was, he knew he was correct and we would proceed with him cleaning up the TFCC tear and the other part of the surgery…the ulnar osteotomy.

An ulnar osteotomy is fairly graphic so skip this paragraph if medical stuff grosses you out. Essentially my ulna was too long by just a few millimeters. In 2019, hand surgeons felt that you could remove 2-3 millimeters of bone from the ulna, pull what was left up towards the rest of the bone attached at the shoulder, screw a plate into both halves to hold the bones together while it healed, and then close the patient back up, this would be enough to overcome that extra length. So basically he was going to cut slivers of bone out of my ulna in my forearm and then put a plate on my arm for it to heal. It sounded awful but I did not care. I needed something to end the pain.

He gave me a bunch of medicine to take prior to the surgery. The surgery went well and he told me that he proceeded with the ulnar osteotomy and everything looked good. My arm was bandaged up to my shoulder and in a sling. I was the remain in the sling for at least 4 days and then he wanted me moving my arm in a tomahawk manner to start getting mobility back quickly. And then I would be sent to OT the following week. I had my first follow up with him already scheduled. And all of my pain medicine was already at home, so I was set.

I don’t remember a whole lot after the surgery. But I do remember that the pain in my abdomen and my general emotional health was better than it had been in a long time. I didn’t have any muscle or joint pain. It was amazing. As painkillers ran out and I didn’t need to take anything for the pain, I realized that the only thing I was still on was Gabapentin. I read up on it. There didn’t seem to be anything specific about why it worked so well, other than it’s a nerve pain medication. Happy that I had found a solution for my unrelated pain, I made a decision that was not like me and would haunt me. I lied to my surgeon and told him the Gabapentin made my wrist feel better so I could sleep.

My wrist didn’t hurt at all. I was sleeping fine. I lied to get drugs. He gave me 90 more.

It took me a long time to admit to myself that my lies made me a drug abuser. The gabapentin made me gain weight. But my pain was GONE. I knew I only had 90 pills and needed to make them last. I took the first 45 over a month and a half. I used the last 45 to wean myself off of them.

The return of my pain wasn’t great. But I was aggressively advocating for myself so I could get another surgery to remove the clips in my abdomen. I was able to get that surgery and requested no gabapentin for that. I didn’t explain why, but I didn’t think I should allow myself to have it again.

I worked hard to forget that time of my life and that time I lied to get medicine I didn’t need for the intended purpose but that made my life much better. And apparently it’s not good for brain change for some reason. No more gabapentin for me.