Fall from horseback caused lasting pain

Teresa - TDeeter@unitrin.com

I am a 39 year-old programmer / equestrian with (I thought) a medium-high pain threshold. My past medical history includes broken bones, a torn rotator cuff, seven surgeries, childbirth, kidney stones -- none of which comes close to this pain in my tush...

I injured my coccyx in August 2001 in a fall from horseback where I did a somersault and landed in a semi-seated position. The pain was so intense, I visited the emergency room the same day (I usually get dragged into the hospital while I'm still unconscious). I was x-rayed, told that I had a "back sprain" and went home with Robaxin (methocarbamol), a muscle relaxer, and Vicodin (hydrocodone) for pain relief. I had started a new job 3 months earlier, so I didn't feel comfortable staying home and resting. I went to work each day, but the pain was so intense, I had to turn my chair around and kneel on my knees to work (I still do this occasionally).

I also have a 110-mile round trip commute, which means an hour's driving both morning and evening. In the weeks after my injury, I would drive to work with no meds, take the pills and be drugged all day, then start the drive home just as the meds were wearing off. I really think this is what has caused my pain to continue unabated for two years. If I had stayed home and rested (not my nature, sorry), I might not be in this predicament.

The initial pain was worst upon rising from a seated position (took my breath away), and when lifting anything heavier than 10 pounds or so above my head. Any jostling in the car is still painful -- sudden braking, bumping the curb when pulling into parking spaces, etc. The oddest symptom is a painless "knuckle-popping" sound / shift during bowel evacuations.

Since the first diagnosis, I have been back for more x-rays (standing vs. seated, etc.). I have been told that I have "disjointed" the coccyx, or broken the cartilage fusing which joins the bottom four vertebrae. So my "tail" wags. After two years, the chance of any improvement in pain is probably very slim. Surgery is not an option for me since I still ride horses daily. The coccyx acts like those water barrels stacked together at the exits on the expressway--they buffer the rest of the spine from injury. The pain isn't bad enough for me to give up riding forever, so here I sit all broken-butted.

I have found that 25mg Vioxx (rofecoxib) once a day has made the pain quite bearable. The pain does get worse as the work week progresses, making Friday more painful than Monday--probably related to all the accumulated sitting. I am very active away from work -- I do not spend much time sitting except at my desk. The pain relief from the 50mg dosage is wonderful, but I was told not to take this dosage for more than 5 days at a time. The 12.5mg dosage works well for the first part of the week, but by Thursday I'm behind the "inflammation curve", and even the 50mg doesn't help much at that point. The secret seems to be to take the 25mg right before I lay down at night. This way, I'm ahead of the inflammation BEFORE I get behind the wheel for an hour each morning.

While taking the Vioxx, I have noticed that it seems to work best for joint pain / osteoarthritis. It doesn't help muscle soreness or headaches, for example. However, all the little joint injuries I have had over the years have responded well to this drug. I am allergic to both aspirin and sulfa drugs, so none of the normal NSAIDS are suitable for me. I have to carry an emergency shot of epinephrine in my purse in case of an allergic reaction while taking the Vioxx. I have experienced some weight gain which I attribute to the Vioxx (a known side effect), and I have just recently started experiencing some stomach problems. But I'd rather be chubby and dyspeptic if I can still pursue a normal range of activity. This is the first long-term injury I have ever had, and I have had some bouts of depression when then pain gets really bad. But I've never been one to take "blue sky" meds, and my spirits always bounce back eventually.

I have changed cars to the Honda Civic Hybrid, which manually adjusts the seat angle to lower the rear portion. This makes for a more comfortable ride, and the excellent economy is a nice bonus. I also tell people in advance that I will punch them if they jostle me while they are driving. I know this is rude, but it's the only way I can impress upon them how sharp and unexpected the pain is when they screech to a halt or try to jump the parking spot curbs. I grew up with six older brothers and so have had plenty of punching practice. It doesn't usually take more than a couple of hard shots to the shoulder to make them sit up and pay attention, or just let me drive. And, yes, I still have a few (bruised) friends left.

Interestingly enough, I have found that horseback riding does NOT aggravate my condition. I ride dressage, and if I sit correctly (weight distributed evenly between the seatbones and down the inside of the thighs) I'm fine for most riding and weekend horse shows. When I return to work on Mondays, the pain is always better than when I left on Friday unless I've overdone it on an afternoon-long ride over the weekend.

However, I cannot BEAR to sit on a bicycle seat for more that 5 seconds--go figure. Airplane seats are OK, but the chairs in the terminal will make you cry. Hard chairs are better than soft chairs, and donut cushions don't help AT ALL. I avoid tight pants, which aggravate the injury, and I can't imagine trying to sit on the floor. At work, it helps to rest my elbows on an armrest while typing. I have a sharp "warning pain" that flares up when I rock back on my tailbone, or when I sit with my arms suspended in front of me. The pain upon rising has almost disappeared. I am very careful not to brace with my lower back when lifting or throwing hay to the horses. The pain is probably best described as a deep ache, with occasional sharp flares.

I would like to have an alternative drug waiting in the wings, in case I develop a sudden allergy to Vioxx. I would also like to explore the steroid shots. My inflammation is caused by instability and osteoarthritis, not by pressure on the vertebrae. I have been told the steroids might actually allow me to do MORE damage to the area because I wouldn't feel the "warning pain", so I have put off more intensive therapy for the time being.

My spirits would be better if everyone else was aware of just how AWFUL this pain is. I have "friends" who treat me like a big cry-baby -- the same friends who saw me riding two weeks after open-shoulder surgery (stitches still in). Everyone wants to tell me about slipping on the ice and hurting for DAYS afterward, but nobody wants to think about that same pain going on for YEARS. They got better, why shouldn't I?

I've used this website as a reference so much in the past, I finally decided I should share my "whine"...

Sitting Pretty (?),

Teresa

Updated 2004-01-04

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