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Friday, April 6, 2018

Sluder's Neuralgia


Sluder's Neuralgia - Life changing, rare, extremely frustrating, persistent stabbing and sharp pain, causing anguish and lots of suffering, headache on localized spot on the face.

My History
In 2015, I was in the best shape of my life.  Healthy, working out every day and running in over 30 races but I also started getting this horrible headaches.  At first I didn't really notice and the headaches were coming more and more often and I was having to use sick days which I had never did before.

I started keeping track and noticed that while I ran I would always get this copper taste in my mouth. Also, the pain normally started a few hours after I ran or cut grass but not for other things like hiking or weight lifting.  They always started on the right side of my nose and eye but would travel upward to my forehead.  The pain was massive and would always lead to throwing up and last for days to weeks.

I did my research, talked to some fitness gurus, and tried so many different things:
Advil Sinus Congestion and Pain 200mg
Claritin 10mg
Simply Saline
Vicks Sinex
Afrin Nasal Spray
Nasal Rise (bottle and pot)
Air Purifiers
Cold and Hot Steamers
Essential Oils
Home Remedies
Salt tablets
Tracked my water intake
Had my house and vents cleaned and sprayed for any airborne bacteria
NOTHING HELPED!

In February 2016, I finally told my doctor about them and she said it was most likely because of not enough blood flow to my brain and put me on Propranolol 20mg daily.  I took these for a month but still the pain continued.  She also did a scan of my brain to make sure she wasn't missing something major.  It came back clean.

In November 2016, I went to see a Neurologist which said that I may have what is called "Runner's Migraines" and wanted me to only run 1/2 mile at a time to see if the headaches went away.  He switched me to Amitriptyline 10mg daily and Sumatriptan 100mg for when the headaches hit.  I still had the headaches and the Sumatriptan would help them go away but it also made me sick to take and I was only supposed to take them once or twice a week.

In April 2017 my doctor upped the Propranolol from 20mg to 40mg and now I had high cholesterol from taking the other meds so I was put on Atorvastatin Calcium 10mg to counter that.  It still did not help. 

In September 2017 the pain was so bad I had to go to get help.  The right side of my face was hurting worst then it ever had.  My upper teeth were a new added pain and I couldn't eat anything.  It just so happened to be on a holiday weekend so finding help was a chore.  I first thought it might be a toothache and tried to get into see a dentist but everyone was closed.  I ended up going to sick call with my normal doctors office.  The Doctor on call put me on Clindamycin 150mg.  The pain did not go way so the next day I went to a walk in clinic and they put me on Doxycycline Hyclate 100mg plus Ibuprofen 800mg.  The pain was worse so I finally went to the ER.  There he did a CT scan and only found a small sinus infection and put me on Levofloxacin 500mg plus Hydrocondone 325mg.  I took these for 10 days and felt better then I had for the past few years.   

At this point, I had pretty much given up ever running again and the headaches never seemed to go away.  I had sunk into such depression and these headaches had taken over my life.  As a last resort, I contacted an Ear, Nose and Throat doctor, thinking he would test me for an allergy but really not holding my breath that he could do any better then the last 5 doctors. 

Dr. Phillips listened to my story and right away thought he knew what the problem was.  He sprayed my right nostril with numbing spray and then stuck a small camera in the nose.  There he found what he thought my problem was....Sluder's Neuralgia.

My first thought was, here we go again.  Something new to add to my list of ever growing "it could be."  He brought out this little diagram and explained what Sluder's Neuralgia is.


This picture shows what a normal nose (right) looks like compared to what mine (left) looks like.  Sluder's Neuralgia (also known as contact point headache), is rare and extremely frustrating along with causes much anguish and suffering in patients.  It is a stabbing/sharp pain located in one area or spot on the face caused by a structural abnormality, where nerves are being compressed by a septal spur (or deviated septum)  and needs to be surgically corrected.  

As in my case, when I would run, the nerves would swell and hit the spur on the right side of my nose.  This would cause it to be blocked and cause the pain.

After doing my research on Sluder's Neuralgia, I noticed there is not a lot of information out there.  I was only able a few articles that seemed helpful. 

As the articles states, these headaches can go many years without getting a correct diagnosis. You can try nasal sprays, antibiotics, decongestants, see a dentist, have CT scans and MRI's but none of these will help or show Sluder's Neuralgia and is often misdiagnosed as migraines.

How Doc found it:
He sprayed numbing stuff up my nose which is nasty as it drips down your throat so be warned!  I told them they need to come out with bubble gum flavor.  After a few minutes he was able to put a small camera up the nasal passage which allowed him to find the problem.  This was painless and only a slight discomfort. 
 
He wanted me to try Afrin Nasal Spray again before we went on to surgery.  So I went on two separate runs, spraying Afrin when I felt the pain coming on, but it did nothing.
 
At my next appoint, we decided to go forward with the surgery.

Surgery:
Two weeks prior to surgery, you are not allowed to take most medications, herbal supplements or drink green tea.  The day of the surgery, you must not eat and make sure you take someone with you to drive you home because they are going to knock you out. 
 
You get an IV and need to spray more nasty stuff up your nose before they knock you out and put in a breathing tube.  The surgery really only lasts around 30 minutes.  After doc cuts out the spur, he puts in two splints inside the nose, held together with stiches. 
 
You stick around until your able to dress and leave with a cute nose guard to catch the blood.  You will need to change the gauze several times over the next 2-3 days.  It may be helpful to have extra gauze on hand in case you don't get enough when they send you home. 


Follow-up:
I went back to the Doc 12 days later and he removed the splints.  Don't be like me and watch them doing this on youtube because it's just gross.  He sprayed some of that wonderful nasty numbing stuff in both sides of my nose.  He then sprayed some cleaner and vacuumed both sides clean.  He then cut the stitches on either side of the nose and pulled the split out.  He then sprayed it again and vacuumed it clean.
 
I also got his go ahead to run so that is just what I did.  I went to the gym and did a slow 2 miles.  There was a little discomfort but I'm thinking that may have been from the splints.  The pain I normally got did not raise its ugly head but it was short lived.

Conclusion:
It has been over two months since the surgery.  I have mixed results.  The pain on the right side of my face is gone and I can breath a lot easier, something I didn't even know was an issue.  The bad side is that I still can not run without getting a migraine.  I ran in a 5k last month and ended up with a migraine that lasted 5 days.  Hiking long distances seem to be an issue now as well.  My last 6 mile hike ended up with a headache that lasted for the rest of the day.  Nothing major as before, though.  The pain is now around the superior turbinate/lacrimal sac area between both my eyes.

Doc wanted me to try Ponaris Nasal Emolient but so far that doesn't seem to be working either.

So....I'm happy to not have a pressure in my nose all the time and the surgery was great for that but I'm disappointed that I have to give up running. 

 



Thursday, November 9, 2017

Climbing Mount Fuji



In July of this year, I had this great opportunity to check off one of my huge bucket list items....to explore Japan!  A friend had climbed Mount Fuji before and I wanted to add this amazing adventure to my vacation.  It looked simple enough, just walking uphill all for the purpose of earning "stamps" with the end result being bragging rights of completion.  I always like learning the history of places I plan to see so I started my research.

History

Mount Fuji is an active stratovolcano (last erupted in 1707-08) and the highest mountain in Japan at 3,776.24 m (12,389 ft.).  This trip is really only good for climbing a few months (July-August) out of the year as it is snow-capped most of the other months.



Training for the Climb

I prepared for months by walking, stairs and climbing hills.  Lots and lots of hills and stairs.  On the weekends, I would hit our highest peaks but they maxed out at 1,368 feet.  I kept my fingers crossed that this would be enough (it wasn't).  Looking back, I should have upped my stair climbs to a few hours a day.

Packing

A good pair of broken in hiking boots
Knee socks (Compression helped)
Capris and tank (I wore this all the way up)
Long sleeved shirt and pants (I didn't use the pants because it was such a warm day)
Winter coat (Didn't use)
Rain gear (Didn't use)
Gloves (I forgot mine and had to buy there)
Hat
Sunglasses (I only used these when the wind picked up to keep the dirt out of my eyes)
Sunscreen (I forgot this and ended up with a nice sunburn)
Water (3 liters but I drank all that before I hit the top)
Snacks (Should have packed energy gel)
Small Trash Bag
Small First Aid Kit (blister packs)
Wipes
Neck Warmer (Also used to cover nose and mouth)
Headlamp (didn't use)
Money (¥100 and ¥500 coins best)
Camera
Backpack with water blatter
Advil (I took some at the first station and then more halfway down)

 

Picking the Perfect Trail for You

There is four different trails to take up Mount Fuji;  Yoshida, Fuijnomiya, Subashiri or Gotemba.  Depending on the time, fitness level and what you are wanting to see will determine which trail you want to take.

Yoshida is the most popular and recommended for first timers.  This is the trail we climbed.  It has the largest number of huts and first aid stations along the trail with great sunrise views.  There is also a different up/down route (which you will be thankful for).

Each trail will have a different starting point with different information.  It is best to research the trail you are going to take before starting this climb.  The schedules, bus locations and prices may be different.

Getting to the 5th Station

Instead of driving to the start of the path, we drove to the bus station and rode the bus to the 5th Station.  The price per bus ticket is ¥1,540 adult single or ¥2,100 adult round trip ($14 single or $19 double).  Just buy the round trip from Counter No. 2 and save yourself the extra money.
 
View of Mount Fuji from the Bus Station
 
The first bus runs at 6:30am and I recommend you take the first one if you plan to do this hike all in one day.  It normally takes about 6 hours to hike to the top but it ended up taking me 7.5 hours up and 3 hours down.  The last bus leaves from Mt. Fuji's 5th Station around 7pm so you want to keep an eye on your time going up so that you will not miss the last bus.  If you do end up missing the bus, you can take a taxi but that will run you ¥11,000-¥14,000 ($99-$126).  Also make note that you will have to pay to park your car at the bus station.  I think we ended up paying a little over ¥5,000 ($44) and the machine would only take ¥1,000 at a time.
 
 
This will also be the last chance you get to use the restroom before you have to start paying, so make time to take care of business.  There is signs posted just in case you forget how to go.  The price to use the restroom on Mt Fuji can range between ¥100 to ¥300 ($1-$2.50) depending on where you are.

 
After you have your ticket, head on outside and catch the bus at sign 7.


The bus will be packed both ways.  On the way up, we had nice comfy seats with these little fold-out seats so people in the aisles would have a seat as well.  It was different on the way back and lots of hikers had to stand.
Fold-out seats for extra travelers

The views of Mount Fuji from the bus made it look like such an easy hike.  Boy, was this a lie.  The bus ride seemed to take forever with a few stops to pick up more people, if there was room.
 
Window view of Mount Fuji from the bus

Yoshida Trail 5th Station

We got off the bus at the 5th Station which had a few different shops.  We used the restroom and purchased a walking stick which you use to grab different stamps along the trail.  Mine came with bear bells attached with blue ribbon, easy to remove.  No way could I take hearing those bells for hours and hours.  I also forgot my gloves and sunscreen.  Gloves were easy to find but sunscreen was a no go.  Make sure to pack yours!  It was a very sunny day and I did end up with a nice sunburn that took months to go away.
 
Don't forget your sunscreen!
 
Right before we took off, I took a few Advil to help keep my muscles from cramping.  I was also told that with the high altitudes, you are likely to get a headache.  I suffer from migraines so I wanted a jump start on the pain.

I poured a liter of water in my water blatter and used this to drink as I was walking.  I also carried 2 other liter bottles which I would use to drink when stopping at stations for a break.  This seemed to work pretty well but I did end up drinking all my water by the time I summited.


Leaving 5th Station and the start of the path

6th Station - 2,390 m

Once you leave the stores behind, there is a long downhill/uphill path until you hit the 6th Station (Kyogatake Peaks-I think).  From this station on, be prepared for nothing but uphill climbing with switchback paths all the way to the top.
 
View from 6th Station
View from 6th Station.  If you look toward your left in the green section, you will see the stations going up the mountain.
You will go up and come down this same section.
All smile!

7th Station - 2,790 m

This station has a First Aid Center if needed.  After this station, you will find different huts to stop and rest, use the restroom (for a fee), purchase food/items and most importantly grab those stamps for your walking stick.  I was only planning to get a stamp at each station (7, 8, 9...) but didn't pay attention that some stations were 7.1, 7.5.  Also keep in mind that some station will offer different stamps you can pick or both for a higher price. After a time, my stick was getting full so I started being picky with which ones after that.

Some of the items you can purchase were:
Flag ¥300 ($2.65)
Gloves ¥300 ($2.65)
Pin ¥300 ($2.65)
Chips ¥300 ($2.65)
Gel Pack ¥400 ($3.52)
Wine ¥500 ($4.40)
Fleece Jacket ¥3,000 ($26.43)

It was also around this time that I ran into a Japanese lady that did not speak English but really wanted a picture of me.  She kept pointing at her camera and pointing at me.  So somewhere out in the world, my smiling face is in with their other adventure pictures!  It still makes me laugh to remember her.  She followed me to another station and asked for another picture.

Looking up, you think that is the top but you would be wrong.  Keep climbing!
"He is a God known for money.  Get he's stamp and become rich!!"  Daikoku ¥400 ($3.52) 
 
Still smiling!  The path behind me was easy compared to what was coming up.  The start is a switchback path with lots of loose gravel to walk on.
This section had rope lines to mark the "safest path" to stay on but finding a place to put your feet without slipping on a rock was challenging.  This also explained why I saw so many people wearing helmets.


It's nice to look back and see how much distance you have gone.

 
Is that the top?  Nope.  Keep going.
 
Still smiling but not so big now and wondering why did I want to do this....
Above the clouds.  I got to walk through this section of clouds and it was really pretty amazing.  It was like walking through a path of mist.  It was just what I needed.  Cool and refreshing before the sun hit me again.
Check out the price for a cup of noodles ¥600 ($5.25)!  We can buy these in the states for $0.30.
Getting another stamp.
A look at the overnight rooms, if you are planning to stay.  Just enough space to lay your sleeping bag.
Some paths are nothing more than walking over loose gravel but other section take more skill with hand, foot and balance to keep from falling.  These sections toward the top were a little scary and your mind starts playing ticks after your energy starts tapping out.

This section was pretty scary for me.  I'm not sure if it was lack of energy or the heights but I slipped and almost went falling backwards.  I took a little longer break at the next station.
 
Snow!  Hard to believe that Station 5 was like 100 degrees!
Selfie time!  But truthfully, I used it as an excuse to take a break.
Altitude sickness is a real think.  He was taking a break outside of the First Aid station with an oxygen tank.  
Smile not so big now.  2.2km left (115 minutes).  Keep going.
The last of the green plant life.  Nothing but rocks left.


The mountain was laughing and reminding me how big she was.  Keep going.

8th Station - around 3,100 m (10,170 ft.)

This station also has a First Aid Center if needed.  I think these pictures were taken at that station but truthfully, I didn't care at this point.  I had completely lost my appetite and forcing myself to take one bite of a protein bar was torture.  I also started having some light pains in my stomach.
 
Will this ever end!!!!
This section looks rather easy but the loose gravel makes for hard walking.
I ran into the Japanese Military coming down.  All of them were very cheerful and happy.  "Konnichi wa (Good Afternoon)", "Good Job" and "Hello" was said by most.

9th Station - 3,600 m (11,811 ft.)

Near the top you can find a pole with the surrounding area covered with yen coins.  Climbers leave the coins for wishes.  I also spotted a few military pins as well.  I also started thinking about giving up at this point.  My mind was playing tricks and my stomach was killing me.  But I had a pretty cool friend and this really nice couple from New Jersey we had met on the trail that kept pushing me to finish the last few meters.  I could see the top and it was so close but my mind was telling me to give up.
 

Mount Fuji Summit

By the time we got to the top, most of the Stations shops were closed.  We missed out on the hot meal and drink but I really wasn't feeling much like eating anything anyway.  My friend made me eat some raisons but I really couldn't stomach to eat anything.  And for a food lover like me, that SUCKS!
 
This is the point everyone was also getting into their winter coats but I was fine with my long sleeve shirt and capris.  It felt around 50 degrees but nothing like the winters I live with in the states.
 
As I said before, I had ran out of water by this time.  They were sold out of water but did have sports drinks left so I was able to grab one of them and the sugar was something I needed anyway.  I also missed getting the last stamp because the guy said it would take him 20 minutes to warm the rod up again and I really didn't want to wait that long.  I was afraid we would miss the bus back so my thoughts were mostly to get moving while I still could walk.
 
The last few steps!
The Summit!
When I was coming out of the restroom, I saw this guy getting into this hot pink bodysuit.  My brain wasn't working right at the time but now it looks kind of funny.
What the top stamp looks like.  I took a picture from my friends who had done this trip before.

Going Down

It was either go back down the way we came or break the rules and take this different easier path back.  I normally do not break the rules but.....What sign?  The locals were doing it also, so who am I not to following the rest.
 
Before starting off, I had read about problems keeping the rocks out of your shoes.  So I wore long knee socks which I pulled down to wrap around the top of my boots.  This worked great with keeping the rocks out of my shoes.

Not many stations to stop at on the way down and what we found were closed. There were a few places to stop and clean your shoes out.

My Final Thoughts

As the old proverb reads, "You are wise to climb Mount Fuji once, but a fool to do it twice."  By the end of the day, and it was a very long day, I was glad when I walked the last few steps off the path.  I believe it took me 7 hours to climb up and 3 hours to climb down.  This was a nice bucket list item I was able to mark off and was happy to have a wonderful supportive friend that pushed me to keep going.  Otherwise, I'm pretty sure I may have given up and regretted that decision for the rest of my life.  Now I have this amazing adventure to talk about and this really cool walking stick with all the burned stamps as a reminder of this day.