Stellate Ganglion Injection

[Kathi49]

Hi All,

Before you freak out, this post is NOT about me. A friend of mine called me today after having had ulnar nerve surgery several, several weeks ago. Evidently, her arm has been imbolized from what I understand and now she can't bend her elbow at all. There is also swelling and inflammation. One doctor is checking her ANA and Thyroid...those kinds of tests. But the Occupational Therapist did not like what she saw and called the Surgeon. Evidently, the Surgeon told her he thinks her Sympathetic Nervous System is messed up and wants to refer her to do this Stellate Ganglion Injection. From what she told me he would refer her to a spine doc/anesthesiologist and this would be done under flouroscopy. But what floored me is that he told her they have to move her esophagus aside. I have NEVER heard of this. Oh, and he mentioned they would probably go in at the C6 level. She is to go in tomorrow to meet with the Surgeon who will then refer her to the spine doc. I THINK they may refer her to the same group I go to as they are right next door to each other and affiliated with the same hospital. But I am not positive about that.

Anyway, I told her I would ask the good people here that might be familiar with this because I am not. But I am hoping that if she gets the referral, it may be that her problem is something else altogether and she MIGHT not have to have this done.

So, pardon my ignorance about this...I just told her I would ask any or all of you.

Thanks!

[Jo6]

Kathi, I don't know a thing about this, but it does sound kind of "off" to me.

Before they started moving ' "parts" aside I would ask a lot of questions. Bless her, I would be insane with worry, but every body isn't like me. Good thing! lol I am interested in what this is about. I'll be thinking of her and try sending some strength her way.

You are kind to do this for her Kathi. Julia

[Maggie]

I'm not too familiar with this either, but. It sounds like they go in through the front like an ACDF. Although that is a crude way of putting it, they do have to go gingerly around the esophagus to get to the nerves.

[Kathi49]

Thanks Julia and Maggie,

I will let her know tomorrow what you have said. It DOES sound a lot like an ACDF. But, when she said they MOVE the esophagus, I about flipped. I can see going gingerly around it. But moving it???!! Anyway, she is supposed to call me back tomorrow...late afternoon.

[curiousforever]

I dunno....can she get a second opinion?

[Gimpy]

In order to get to the C5/6 area, they do have to "retract" the esophogus. I too have never heard of such a procedure just for an injection.

Sounds serious!

Gimpy

[Kathi49]

You know, maybe she misunderstood what the hand surgeon was saying. Maybe he meant something else. I was just taking her literally. But, I too, had told her I had NEVER heard of the esophagus being MOVED aside for an injection. Then again, I never knew of anyone having this type of injection. That is why I asked. It scared me when she was speaking of it so I just kept asking question after question and she just didn't have all the answers yet.

Anyway, her hand surgeon did say he was referring her to a spine doc. And, in the past, she has talked about her neck hurting a lot and/or locking up in her words. I told her before she could have two things going on.

But yesterday, I DID try to calm her down or reassure her. I think once she gets this referral to a spine doc and he looks her over, there might be something else going on or something else he can do instead. So, I just told her to to go to her appointment today with the hand surgeon, get the referral, but then WAIT and SEE what the spine doc has to say.

The thing is she is telling me this is NOT neuropathic pain. She told me she used to have that prior to her arm surgery but now it is just a deep ache. And, well, she just can't bend her elbow at all nor her fingers and that everything is very swollen. She also said she has a friend with RSD and who gets these blocks but she really doesn't think she has RSD at all. Anyway, it is very confusing at the moment.

In any case, I THINK she is being referred to a spinal PM but I will found out more later today.

Oops, forgot to add. You would think I would know more about everything being that I said she was a friend of mine. But the funny thing is we met on the hystersisters website and she noticed I lived in Indy. Then the phone calls began...but I have yet to meet her. We just talk on the phone a lot because our OTHER conditions are exactly the same. Sometime soon I hope to meet her in person.

Thanks you guys!

[lobelsteve]

Stellates are not difficult or tough to perform.
The esophagus does not get touched.
The trachea is pushed to the side by 1 finger while the carotid pulse is palpated with another finger. A single needle is placed through the skin between the two fingers that are just touching the skin to make sure the important stuff does not get poked with a needle. A fluoroscope must be used (anesthesiologists used to do this technique without fluoro and some still do but shouldn't) to identify the appropriate bone landmarks- either C6 or C7. C6 is much preferred owing to the inconsistant location of the vertebral artery at C7 (sometimes in front of the bone, often next to or behind the bone). The needle is placed straight donw on to the vertebrae and a few cc's of contrast is put in to make sure the needle tip is not in a blood vessel and that the contrast flows down to the stellate ganglion lying over C7-T1. After this, 5-15 cc local anesthetic (usally bupivacaine) and maybe 1 cc of steroid are injected to block the stellae ganglion.

The procedure takes 5 minutes from start to finish.
Redness in the eye, drooping of the eye on the side of the injection, and hoarse voice are common side effects. A warm arm is a good sign the stellate was fully blocked.

[Kathi49]

Thanks so much Steve!

I will definitely let her know this!

She DID mention the redness of the eye, dropping and hoarseness. I forgot that part.

But she also wants to know if this is pretty uncomfortable; moreso than the typical facet injections; that sort of thing. So, is this any more painful than those? Oh, and also, why would she need a series of these because that was mentioned as well? And I do know it will be done by anesthesiologist and under flouroscopy...that much I do know.

Thanks again!

[Kira]

When they said "move the esophagus", they probably just meant that it is in the way and so when they are doing the procedure, it has to get pushed out of the way while they are doing it. But, like Steve said, I don't think the esophagus is actually in the way for this. So maybe he was a little confused abou this anatomy.

Anyway, when you do surgery, it's common to have to sort of move/push stuff out of the way to get to what you're working on. They move stuff out of the way, do whatever they need to do, and then put things back where they belong. Before they finish the surgery, everything goes back to its normal position (unless there is some reason to do otherwise).

Even if they do have to "move the esophagus," they would get it out of the way, do the procedure, and put everything back where it belongs before they finished. But, from what Steve is saying, it sounds like they don't have to move the esophagus at all.

I don't know much about this specific procedure, so I can't really be any help there. But I just wanted to echo what others are saying about the "move the esophagus" thing... her esophagus will be right where it belongs when the procedure is over.

[Kathi49]

Kira,

This was in reference to an injection; not surgery. I do know what you are saying though because during our fusions they wrench us open and really move everything to the side! :eek: And I have to laugh because my esophagus STILL doesn't feel quite right. I can't hit high notes anymore that is for sure LOL! :)

I didn't know much about this specific injection (procedure) either. But she is to call me later and let me know what was said by the Hand Surgeon. And I am also curious as to what PM she may get referred to. I am HOPING it is the same guy I use but it might not be. I am just thinking that because they are all right there...next to the hospital they are affiliated with. So, I would THINK they would use the same docs...just not sure though.

I think all in all, this is all so brand new to her that she is scared. I was too when I first started having injections. It is not a pleasant thing to think about and I have had both terrible experiences and then really good ones. But, I know how she feels; it is just a matter of her getting the information she needs and reassurance. NOBODY likes the thought of needles going deep into their necks. So, being new to it all...I do understand her concern and fear. And she said something about "being careful with the pleura." And I know that scared her too.

But it is like I told her, I would do anything I could to get that arm moving again and let the spine doc figure it out. Obviously, this is not the Hand
Surgeon's forte. And, maybe just maybe, they won't have to do this. MAYBE it is something else all together. I just don't know.

But I thank you and I thank everyone else too. I hope she calls pretty soon but she left me a voicemail earlier and said it might not be until later tonight. I will post back with what she has said...later.

Thanks again!

[lobelsteve]

Here is one of the better articles on Stellate blocks. Dr.'s do these with or without Fluoroscopy and some go to C6 and some go to C7.
Pick a doctor who uses Fluoroscopy and that will inject at C6. Any other way is antiquated and puts the patient in unnecessary risk for complications.

Click Mehttp://www.emedicine.com/radio/topic902.htm

[Kathi49]

Thanks again Steve!

I did hear from her a couple of hours ago. Evidently, the Hand Center has their own anesthesiologists. I don't know who it is though and neither does she for the moment. And, yes, it will be done under flouroscopy.

Also yes, she has RSD in the arm. And the Hand Surgeon is very concerned and wants it stopped asap! Or, rather to get on it asap. He wanted to schedule the injection for Monday but she said she was too upset at the time to give her at least until Tuesday to think it all through. She's just scared.

So, I told her, Steve, about what you and others had said...just trying to reassure her that I think she should probably have it done. And of course I told her I had "lived" through all of my injections even though they weren't like this. Anyway, one of my points was that if she wanted a second opinion it would probably take awhile and I would just trust the surgeon's opinion. Oh, and she also told me they would give her some Versed.

She asked if I could forward to her what you have said. So, I will do that. Again, she is just frightened as this is all new. And quite frankly, an injection like that would scare me too. But I also told her I think having RSD would be worse!

Tomorrow I will forward this and she can read it up on it.

Thanks again everyone.

[Kathi49]

Okay All,

My friend, Lisa, called yesterday and said to tell you all...thank you very much.

She did add she is going to investigate this further. I must have misunderstood her the other day because now she is saying the nurse didn't know if they "use flouroscopy or not!" Now THAT is a scary thought! So, I told her, and this is just me speaking, if they do not have that machine, WALK!!! I'm sorry, and just me speaking again, but I would NOT let a doctor put a needle deep in my neck without flouroscopy.

And we were laughing because she said they told her NOT to go home and read anything on the Internet. So, she said, "Yeah, right! As soon as I got home, I started researching." But, we BOTH know what they really mean...just don't take everything to heart and WITH a grain of salt since everyone is different.

Anyway, for now she is reading up on RSD. But she DID say she is feeling better about having the injection done after reading what Steve wrote. So, on Monday, she said she is calling around to get some more answers. When she does, I will know more...like who is doing it and where and when.

So, that's all I really wanted to say...just to say she said thank you and that you guys and myself are her lifelines for right now. And thanks to everyone's input because she now knows some of the right questions to ask.

[lobelsteve]

It is a simple procedure in trained hands.
It is a simple procedure in untrained hands.

The risk of complications goes up exponentially when performed by untrained hands.

Get the Dr's name and look them up on the American Board of Medical Specialties website. If they are not board certified in Pain Medicine- look for another doctor. The caveat being there are many fine Pain Physicians that were not eligible to sit the pain boards due to a lot of politics in medicine. To be adequately qualified, they sat a seprate pain board certification from the American Board of Pain Medicine. I consider both to be equally qualified.

Mandate fluoroscopic guidance, contrast enhanced technique.

Mandate an IV placed in the opposite arm of the side being injected.

Mandate the needle touch the body of C6 at the junction of the transverse process. Further lateral placement is more likely to enter a blood vessel (the vessel is not supposed to be there anyway but it is in 1-5% of the time).

OK- just stop by my office and I'll do it. :D
Just make sure your doc used the criteria above.

Also, Horner's can happen but it not a good sign that the stellate was blocked- despite what you read on the internet and your doc may tell you. Horner's occurs with blocking the upper cervical and mid-cervical ganglion and not the stellate. A hot hand is the sign the stellate is blocked. Your doc should measure the temp in your hand or wrist before and after the procedure to see if it worked.

[Kathi49]

Thanks Steve,

I will tell her! I will have her fly right down to Georgia LOL!

Funny thing is...she says her hand is already hot!

No, seriously, I will let her know what else you have said.

Now, can you tell me where L4 pain is referred to vs. coccyx pain??!!! :eek: This feels LIKE sciatica might feel but the pain is not only in the back of my leg but on the top of my thigh as well and into the groin and left hip. Oh, heck, it is just my whole darn leg! Geez, I can't tell the difference between what may be piriformis, facets, disc bulge, or coccyx! Oh, well, I guess I will have to call the PM tomorrow. All I know is that I can barely sit...but walking makes it feel better.

Anyway, thank you again. I am very interested in what my friend might find out tomorrow.

[bluebirdy]

Kathi and Doc ? Steve

My pain doc gave me a stellate ganglion injection for shingles on my face/head (not arm) and I had side effects that were VERY SCARY. He wanted to schedule a second injection for a couple of weeks later and I refused in spite of the well-known pain of shingles.

I was only warned that I would feel hoarse afterwards. An incredible understatement! As I was lying there recovering from the injection, I suddenly felt like an elephant sat down on my chest :eek: I told the nurse and she blew me off, saying that was normal. I was horrified. Then I realized I could not clear my throat nor cough. The nurse also blew this off, saying it was normal and would go away when the injection wore off in 6 hours. SIX HOURS???!!!!! You look at your watch right now and tell yourself not to clear your throat or cough, even a little tiny cough. for the next 6 hours! It was SO frightening ... the feeling that you might choke on something and not be able to cough it up, and simple sniffles could not be coughed or cleared from your throat.

Steve - I don't know to this day if what I had was normal or should not have happened. btw, my pain doc did NOT use fluoroscopy for this injection - he did it on the spur of the moment. Every other injection he's done esp. ESIs have been under fluoroscope. ??

I would never, ever, ever have this injection again. bluebirdy also in GA ;)

[Kathi49]

Bluebirdy,

That would be scary!!! :eek: The girl I am referring to said her OTHER friend had had one done too but that the only thing she said in reference to her friend is that it was incredibly painful. Maybe Dr. Steve can shed more light on it in that regard. But I DID tell my friend to "walk" if there is no flouroscopy. I just can't imagine going into the neck like that without it. But that's me. And, I, personally, have never had any kind of injection without it. Well, other than trigger point injections in and around the occipital nerves in the scalp. Those were painful, but not even close to going deep. And like I told her too, some facet injections I have had brought tears to my eyes, and I would term them pretty painful. BUT...everyone is different and I found out that some doctors are better at it than others. I was just trying to reassure her. It seems like you are damned if you do and damned if you don't. I was just hoping, for her sake, it was something else. But, nope, the surgeon is saying RSD.

What I would hate to see happen is if the RSD would spead. I just don't know that much about RSD. But the impression I got from her was that it could. And my husband did work with a gal that had RSD, from what who knows? But she had to retire because of it. When we saw her one day, all I heard her tell my husband was that she was getting the "ganglion blocks." I just don't know anyone personally that has had it.

Anyway, my friend, Lisa, told me that this all began when she was diagnosed with a "frozen shoulder"...I don't know, maybe a year ago or so. And whoever the doctor was (in a different city), did an injection blindly into her shoulder according to her and it made her arm much, much worse. When another doctor, here, looked into into further, he thought that the first doctor had "blown through a nerve bundle". Or, so he suspected. And that is when, according to her, the ulnar nerve troubles started. This last surgery was her second one by the way.

Geez, this whole thing is scary to me. But I just do NOT know what else to tell her except for what Steve mentioned. I WILL tell her again today to make certain the doctor is an anesthesiologist (she has already told me it would be) and make sure that fluoroscopy is used. I hope she calls me today because I know she was going to make more phone calls to determine who, what, where and when.

Oh, and I did want to mention that when I had a selective nerve root injection done, of course it made my arm numb and weak. But what I noticed is that I felt I had something in my eye or that the eyelid was drooping. My PM said that that was part of the sympathetic nervous system and it would pass in about 10 minutes...which it did. But that was a little scary. I can't imagine going through what you did Bluebirdy!

In the meantime I need to call my own PM about this leg. All I did last night was to use heat and ice all over that leg and my backside. It is a little better this morning.

[bluebirdy]

Kathi I don't remember much about pain. But remember, I had shingles. And the shingles felt like I had an ax in my head, so I had told my pain doc he could decapitate me for all I cared! Little did I know ...

I do remember him pinching me at the base of my neck in the front, to the side, so I don't think I thought about this as a spine injection. And I remember tht he told me not to move! He did this on the spur of the moment - so I had no time to Google these injections and learn anything about them. I went into it blindly. And, it's not like my pain doc (an anesthesiologist) to not use fluoroscopy if that's the norm, so I'm surprised to hear that it is the norm with these injections.

Good luck to you with your pain, and to your friend, bb

[lobelsteve]

Kathi I don't remember much about pain. But remember, I had shingles. And the shingles felt like I had an ax in my head, so I had told my pain doc he could decapitate me for all I cared! Little did I know ...

I do remember him pinching me at the base of my neck in the front, to the side, so I don't think I thought about this as a spine injection. And I remember tht he told me not to move! He did this on the spur of the moment - so I had no time to Google these injections and learn anything about them. I went into it blindly. And, it's not like my pain doc (an anesthesiologist) to not use fluoroscopy if that's the norm, so I'm surprised to hear that it is the norm with these injections.

Good luck to you with your pain, and to your friend, bb


See if you can get a copy of your doctors INFORMED CONSENT. You need to be advised of the risks and benefits of a procedure before you can have that procedure. Not doing so may constitute a battery against you.

YOU CAN ALWAYS SAY NO.

[Kathi49]

Steve,

This is NOT about me LOL! But I will tell her. From what she told me yesterday I guess a Neurosurgeon, a friend of her family, wants to see her first...probably due to her neck problems too. But she will have to travel to Ft. Wayne to see him.

In the meantime, her words, she wants a referral to the spine group.

From what she told me, she is fearful of having the Hand Center do these injections and wants a spinal PM to do it. She just does not trust the staff at the Hand Center because she feels her arm was really messed up. But who knows? Those are just her words...so she is fearful of having anyone there do it. In particular when the nurse told her she didn't know if they had a fluoroscopy machine or not.

Soooo...

Stay tuned for the continuing saga. :D

[bluebirdy]

See if you can get a copy of your doctors INFORMED CONSENT. You need to be advised of the risks and benefits of a procedure before you can have that procedure. Not doing so may constitute a battery against you.

YOU CAN ALWAYS SAY NO.

Thanks for your reply. It's very kind of you. I'm sure I signed something - they're sticklers about that. In fact it may have warned of hoarseness in writing. But I'm ABSOLUTELY SURE that it/they did not warn me that an elephant would sit on my chest and I would not be able to cough or clear my throat - and would be sent home this way! I felt like an invalid, and worried that if we'd have an accident I would be at risk because of my inability to cough.

I was angry about all of this. And I was angry about something else. The injection DID knock out my pain - and it lasted one week. Wonderful. Here's where the the second round of anger came in: my pain doctor would offer me no other pain relief except for a second stellate ganglion injection :mad: The implicit message was that if I hurt enough I'd get another injection. But I DID hurt enough. Yet I could not go through another injection like that. For a pain patient to get shingles, to already have a Pain Doc, and yet that doctor will not relieve the pain of shingles .... it leaves me speechless now two years later.

bluebirdy

p.s. one time when I was signing a bunch of paperwork before an ESI, I asked the nurse for a copy of everything I'd signed. She glared at me suspiciously, asked WHY I wanted copies, and refused to give them to me. That's how this practice is ...

[Kathi49]

Okay all,

I had a phone call from my friend, Lisa, last night...with an update.

But first...Steve, thank you for saying MANDATE FLOUROSCOPY!

Okay, I am not going to put quotes around everything because this was a long conversation. But the first words out of her mouth were...thank you so much (to me and to the posts here). To make a LONG story short I was waiting to see what the outcome would be as she was working through this. So here goes.

Evidently, she found out that the Hand Center did NOT use flouroscopy for the ganglion blocks. In the meantime, and unknown to me, she called the Spine Group and asked to see my PM. (I kept telling her before she did anything in the neck to PLEASE let the spine docs take a look at her). I had also told her that the PM might assess something totally different but to please go for a second opinion.

So, she says while she was on the phone they were telling her that my PM was booked until mid June. And then she told them what was going on and that I had mentioned Dr. ________. Then the nurse repeated out loud...RSD. I think my PM heard that or they were talking to him because in the background she said she heard a male voice say...get her in here...make room for the end of the day.

When she was in and talking to him she said he grimaced when he saw her arm and wanted to know who had done the surgery. After touching her and I guess doing minor tests he told her right off she did NOT have RSD or else she would have been protecting her arm or flinching or crying when he touched her. Then he asked her if she had any films or xrays. I did not know this but she doesn't have ANYTHING. She is embarassed to say that the surgery was done based on an EMG alone!!! Well, I guess my PM was mad, mad, mad just because it was done based on the EMG alone. She said he couldn't believe she had no films...nothing! Anyway, he thinks she never needed the surgery to begin with because he believes it is something in the neck. And all because the pain originally started there. I mean she was having troubles there and then the pain went on down into her arm. But he did believe she needed the second surgery to fix what they had done to begin with.

When she told him the Hand Center did not use flouroscopy, she said he said...no, no, no...we ALWAYS use it. I guess he was miffed about that as well.

Okay, so he told her...first thing Tuesday morning....MRI!!! Until then he can't do much yet in the way of injections. But DID tell her...NO! She does NOT need a ganglion block and something about it not being all that helpful for what he thinks what might be going on...not at this point in time anyway. But he did start her on Lyrica to help her get by for a few days. And he ended it by saying he is not positive yet what is going on but he WILL find out. And it would make sense since there are no darn films!

So, she ended the conversation with me by saying how embarassed she was because she always thought she was or could be medically astute. Now, she feels like an idiot. But I think I know what happened. When she moved from Ft. Wayne to here, she did not KNOW of any really good doctors and was just going with what the one here was telling her. Anyway, I reassured her that I have been there myself...in the beginning. I certainly didn't know the right questions to ask. So, I think it is common and not to feel bad about it.

But she is very grateful that she went to see my PM. She says she really likes him and he appeared to be very intelligent and caring. And in the end I told her...I told you he might see it differently and to be prepared to get an MRI since the last one she had is over 3 years old. I also told her it might be a little while longer but to hang in there. Oh, she did add that the Hand Center keeps calling her right and left to set up this injection and she just didn't know what to tell them. So, I told her...tell them the truth. Tell them in a nice way that since they don't use flouroscopy, you have decided to get a second opinion. I told her she was her own advocate and there is nothing wrong with getting other opinions.

So, that is where she stands for right now but again she wanted to say thank you...that myself and Steve and others have been her lifeline; otherwise she would not have known where to turn.

[bluebirdy]

Kathi - it sounds like your friend is on the right track, and lucky to have YOU as a dear friend :) Tell her she was obstinate about the injection from the beginning - and that's the smartest any of us can be. Good for her!

Sounds like you have a good PM doc too ;)

bb

p.s. I wonder what kind of money is made off of these s.g. injections since the docs are awfully anxious to do them??

[Kathi49]

Thanks bb, :)

I don't know about the stellate injections being "money makers". I don't feel that way about my own PM because he is usually pretty conservative. He only does what I call the regular injections when warranted...otherwise...take the meds as usual or PT or anything else that is helpful. :) And she is seeing the same one I do as of yesterday. And I am not sure she was so much obstinate as she was unsure. I just didn't get that from her. She just sounded unsure and afraid. And just said she wanted more time to investigate it further which she did. But, boy, I am glad she went to see a spinal PM.

What I really think and my own opinion is, the Hand Center might be afraid they really messed up...if you know what I mean. :eek:

I just don't know. I will be anxious to hear how her MRI turns out though.

[bluebirdy]

Kathi - when I said docs were wanting to do these injections, I meant MY PM and your friend's Hand Center, not your PM. Sorry for the miscommunication. bb

[Kathi49]

bb,

No offense taken at all! :) I was just trying to clarify everything. I just wonder what the Hand Center told her today. I will try to call her tomorrow because I know she must have told them...no way!

[lobelsteve]

I'm glad she got to the appropriate venue for care.

No Fluoro = Run Away.

Stellates are not moneymakers. But if they do provide a week of good relief I would perform a trial Spinal Cord Stimulator. Right now that is a moneymaker.
Maybe some docs see the stellate as a gateway procedure to something more lucrative. THey are quick and easy to do and can provide 1 week to 6 months of relief.

In IN: Mike Whitworth, MD and Markus Niederwanger, MD are two of the best pain doctors in the state. They do not work in the same practice and both are great guys.

[Kathi49]

Thanks Steve!

I know and I agree with you about the Fluoro!

I am not sure where the doctor's you spoke of are located. But because my friend lives a lot closer to the spine group than even I do, is another reason, among many, that I recommended she go and see them. Anyway, I will be anxious to hear how her MRI turns out. But I won't know any more until probably Wednesday. I think I will tell her that as soon as the REPORT is ready, to go back and get a copy. I only did that once considering I was very anxious to read it myself. But, YES! I let the docs do the interpreting. :)

Oh, and she did say that my PM said if he had to do any form of injection, he would do it over at the surgery center because her anxiety levels are off the charts! I started laughing and said, "Well, he never offered me that!" LOL But I was so used to them by then and I KNOW how he does them. This is all NEW to my friend so she is very, very anxious. I just thought it was nice of him to offer and to consider her fear since IF she has to have an injection, at least she can be given some Versed. I just remember one time where he was doing facet injections and it was hurting pretty bad. He said I was tensing up and I didn't even realize it. And he asked if I wanted to come back another day to finish the other side. But, I said no, just get 'er done. I was already there...so what the heck! But again, that was only once where it was pretty darn painful.

Anyway, I am rambling...she is just very thankful for now that SOMETHING is being done to determine what is going on rather than blindly going in or assuming anything.