In 2015 and 2016 – I didn’t write explicitly about this here – I had some pretty awful back problems and a devastating surgery. My recovery was long, hard, and incomplete – it left me with chronic neuropathy at and around the (HUGE) incision on my left side, at the base of my rib cage. Since then, I have chronic lower back pain and permanent nerve damage in my left foot that causes me to limp, which, in turn, causes all sorts of other problems – hip, knees, etc.
Notwithstanding all that, I got used to it. Got used to not lying on my left side. To the chronic limp. The chronic pain. Thanks to my meditation practice, I experience that pain, mostly, as interesting, more than anything else. I watch how it changes, how it oscillates between hot and cold, sharp and dull, throbbing and aching. I wouldn’t say I’ve exactly befriended my pain but I’ve definitely acclimated myself to it.
In recent weeks, all that’s shifted a bit as I’ve developed a whole new species of back problem – this one at the other end of my spine – in my neck. It began with what I thought was just a cramped scapula. After two weeks of that, though, the pain started to spread, creeping down my arm – first just to my elbow, and then my forearm, tapering off with just a touch of numbness in my right thumb and index finger.
Worst, when I sit – anywhere, but especially in either of the two (very different) chairs in which I spend the bulk of my working hours – the pain shoots sharply down my arm. It’s excruciating. Sharp. Electrical. Unlike anything I experienced in 2015-16 or since.
The explanation was crystal clear to both Claude and ChatGPT, which I recently read tend to be better at diagnosis than human doctors: radiculopathy, most likely caused by a herniated disc at C7.
Based on your symptoms and history, the symptoms strongly point toward cervical radiculopathy, likely involving the C7 nerve root given the tingling pain in the tricep and its radiation to the elbow. The positional relief (pain reduced when compressing the head back and to the right or lifting the arm) and exacerbation with poor neck posture (e.g., lying flat without support, or lifting hands to bike handlebars or a steering wheel) further support nerve involvement.
Your previous history of a pinched nerve at C4/C5 adds context, suggesting a chronic predisposition to cervical spine issues, possibly due to degenerative changes or muscular compensation. Your posture during work and activities likely contributes to mechanical stress on the cervical spine, particularly with prolonged sitting and forward head positioning.
Assessment
1. Cervical Radiculopathy (C7 Nerve Root):
Likely caused by mild disc bulging, osteophyte formation, or muscular spasm compressing the nerve root.
Pain radiates along the C7 dermatome, involving the tricep and extending to the elbow.
Tingling and occasional grip weakness (e.g., dropping cigarettes) suggest mild nerve irritation but not severe dysfunction.
2. Muscular and Postural Factors:
Chronic strain on the neck and shoulder muscles, compounded by your work posture and cycling, likely exacerbates compression.
3. Contributing Factors:
Past cervical spine issues may have led to biomechanical adaptations that predispose you to flare-ups.
Prolonged sitting (even in kneeling chairs) and cycling could maintain stress on the cervical spine.
Immediate Strategies:
1. Activity Modifications:
Minimize time spent with your arms elevated (e.g., cycling, driving). Use wrist or elbow supports when possible.
Avoid lying flat without neck support. Use a pillow to elevate your head comfortably.
Alternate between sitting and standing during work hours. Consider adjusting your kneeling chair to reduce cervical strain.
2. Pain Relief:
Continue gentle tennis ball or foam roller massages, targeting the muscles around your shoulder blade (rhomboids, trapezius).
Apply a warm compress to the neck and shoulder area to relax muscles or alternate with cold packs if inflammation seems present.
3. Over-the-Counter Medications:
Use NSAIDs like Advil (ibuprofen) as needed, but sparingly, as you’re already taking them.
This all came to a head as T and I drove 3.5 hours to have Thanksgiving with her mom. T suggested I might benefit from a cortisone shot, and I agreed. Then, I did something that was, in retrospect, stupid. We detoured twenty minutes out of our way, to find an urgent care open on erev Thanksgiving. And – instead of presenting my problem, I presented our solution: “I need a cortisone shot in my neck/shoulder,” I told the triage nurse at 7:45 PM.
“We don’t do that,” she said.
So I packed up my marbles and left.
This was idiocy.
I could’ve been seen, and been prescribed something stronger and more effective than the cocktail of Tylenol and Advil I’d been main-lining for days.
But I wasn’t seen – not until 48 hours later, after the most painful Thanksgiving ever.
At that time, finally, I got drugs that began to make a dent in the pain – powerful muscle relaxers. Twenty-four hours after that, I saw a doctor. She added Tylenol w/ codeine and higher dose NSAIDs to my regimen, and a double-strength six-day course of oral steroids, and she prescribed physical therapy. She concurred with ChatGPT and Claude, and ordered an MRI.
The MRI is still a week off. I’ve done two weeks of PT, finished the steroids and am running out of meds.
I write this as I sit basking in the greatest sense of relief I’ve felt – a neck and shoulder massage from the lovely A – a “massage girl” at a strip club I went to in hopes of getting precisely this experience. [It was at this moment in my writing that I went back and read what I wrote five months ago when, in retrospect, it seems this problem really began – and thought, wrongly, that A was Anastasia (and not this one).]
A surprised me. She remembered me. Well. Like, a lot of our conversation. More than I remembered. By a factor of 2. Though when I went back and read what I wrote in July, it’s fair to say I caught up. Or rather, caught up with what I had learned about that A.
Anyway.
Anastasia’s hands on my neck, my shoulders, my scapula – fuck.
That’s all.