Disclaimer: I am not a doctor. This is not health advice. Work with your doctors to determine what works best for you would be best.

I’m Chris Short, and I am a disabled veteran. On October 12, 2003, during a military hurricane evacuation exercise at Avon Park Air Force Range, I managed to permanently damage my LTN, leading to the winging of my right scapula. Continued service and aging have led to multiple issues from top to bottom of my spine. All three levels of my spine have numerous problems.

My life has changed dramatically since I got hurt. Pain is something that I am constantly trying to live with and occasionally thrive with. I have more issues and diagnoses to list here, but I think listing some of them here helps.

I was in the Veterans Administration (VA) healthcare system for over a decade and have since switched to using my private insurance as the care is more modern and easily accessible. If you like the VA, good for you! However, it utterly failed me.

Issues

Winging of the Scapula

According to Wikipedia, “A winged scapula (scapula alata) is a condition in which the shoulder blade, or shoulder bone, protrudes from a person’s back in an abnormal position. It is a rare condition with the potential to lead to limited functional activity in the upper extremity with which it is adjacent. It can affect a person’s ability to lift, pull, and push weighty objects.”

My winging is “managed,” meaning the only change is when there’s an increase in inflammation under the scapula. Where it currently sits is the new normal. It took a ton of grueling physical therapy. With every round of physical therapy for this, there was a diminishing point of return. Doing physical therapy when the scapula’s position was not improving led to an increase in prescription pain medication consumption. That’s ultimately how all my stints in physical therapy end.

Long Thoracic Nerve (LTN) Palsy

The long thoracic nerve (LTN) is a nerve that arises from the fifth, sixth, and seventh cervical nerves, descends the neck behind the brachial plexus, and is distributed to the anterior serratus muscle.

Palsy is a medical term derived from the word paralysis, which is defined as paralysis often accompanied by loss of feeling and uncontrolled body movements such as shaking.

The Health Board provides one of the best explanations that I have found of what Long Thoracic Nerve Palsy is:

Long thoracic nerve palsy is caused by injury and damage to the long thoracic nerve. This nerve runs from the neck vertebrae along the side of the chest to the muscle that holds the scapula bone to the chest wall. When this nerve is damaged, the scapula — or shoulder blade — becomes abnormally positioned, resembling a protruding wing. This odd positioning has led to the name “winged scapula.” Shoulder pain and loss of movement occur as the imbalance in muscle functioning causes stress to the shoulder muscles.

Mental Health

Needless to say, having a permanent injury (aka disability) is taxing on one’s mind and psyche. Also, I worked a lot of my time in the intelligence community, mainly in joint assignments with all the services. I know a lot about the US national security apparatus and its adversaries.

My time also overlapped with Edward Snowden. I did not know or work with Snowden directly. Still, the breaking down of the walls of the compartmentalization inside the US national security apparatus has led to mental health issues. “The curse of knowledge” has a different meaning to me. Compounding matters, I had a rough childhood. I didn’t know this until I started dating my wife and saw how her family acted 110% differently than mine. Treatment led me to realize that my issues are tied to my rocky upbringing and the Snowden leaks. The leaks broke my mental model of what I thought was a solid government career in service to a nation cut short by injury. The knowledge has turned that period of my life into an 11-year regrettable moment.

If a mental health professional prescribes you clonazepam (Klonopin), fire them and find a younger one. It is a highly addictive drug that takes a long time to get off of and puts real obstacles in the way of pain management. I hope to be off these by mid-2025 (almost two years of tapering me off this med).

If a health professional in the VA ever says, “You’ll eat them alive,” when referring to group therapy that’s your queue to get out of the VA as it’s not designed for your specific needs. Trying to use the VA no matter what is not a good plan. Think about what’s best for you and not your wallet if you’re able. It’s not cheap, but private health insurance will always give you higher quality care than the VA.

Pain Relief

There is not much that offers pain relief from the nerve damage itself. Due to the winging, my shoulder and upper back muscles tend to always be sore from everyday use. But muscle relaxers are incredibly important in keeping my pain under control. Eliminating muscle spasms leads to a better life experience overall and prevents nasty flare-ups before they can start. It took ten years to realize this; others can learn from it.

NSAIDs

Sadly, I can’t take NSAIDs orally anymore due to the US military and Veteran’s Administration’s excessive prescribing of 800 mg ibuprofen over 15 years. I was often in situations where I was not able to eat but needed to treat pain to sustain mission priorities. This has led to severe digestive complications over the years. The one thing I can’t effectively control is inflammation, and it’s a big, thorny problem.

Muscle Spasms

I am taking Cyclobenzaprine (generic Flexeril) three times daily to keep spasticity at bay.

Opioid Painkillers

The Veterans Administration had tried everything up to morphine. We realized that they were going to keep medicating me until I stopped breathing. Getting off morphine is incredibly hard, and I never want to be so dependent on a medication like that ever again. But, we also realize I will need something for the rest of my life.

Narcotic painkillers have helped over the years, but their side effects have also been harmful. After years of taking some form of narcotic pain relievers, we realized that I am always going to need something better than over-the-counter (OTC) pain remedies. Currently, I am prescribed Norco, a DEA Schedule II drug, to help with breakthrough pain.

Belbuca is a recent addition to my pain-fighting arsenal. It is incredibly effective at beating back pain and keeping the baseline pain level more tolerable. I still deal with normal discomfort and trigger point pain. But a heating pad or supportive arm sleeve is usually helpful. Belbuca is only a DEA Schedule III drug, which leads to fewer questions about other medications and their interactions.

Lesson Learned

At one point, I was taking Baclofen, Cyclobenzaprine, and Methocarbamol during the day. This combination has some memory loss side effects. Once off the Baclofen, my short-term memory was better. But there are many other lessons I want to cover more specifically.

Non-traditional Remedies

I have experimented with some herbal remedies at the advice of a handful of doctors, a chiropractor, and acupuncture. Acupuncture is not effective for me. Acupuncture makes things way worse for me. Chiropractors usually increase my pain medication intake, and that’s a very, very bad idea.

After researching everyday chemicals and their ability to help muscle spasms, I added Magnesium Citrate to the mix. It helps with the knocking or tapping spasms (it won’t touch the big ones). It also supports digestive and nervous system functions. Friends have also recommended Chelated Magnesium to avoid increased digestive functions.

I have also taken turmeric to help with inflammation. However, it interacts with other meds I need to take. It wasn’t a game-changer for me. But if it boosts your anti-inflammatory response, that can’t be all bad.

I also take glucosamine, chondroitin, and MSM supplements for their joint and heart health benefits.

My primary care doctor told me to take vitamins C and D religiously. Vitamin C boosts my immune system (any sickness on top of my typical ailments is often debilitating). Vitamin D is due to the long winters in Michigan, causing a deficiency.

I also deal with low sodium levels in my blood (hyponatremia). I drink a Liquid IV every day, and when I can feel the low sodium level, I will drink two Liquid IVs daily to get it back to acceptable levels.

Injections

Trigger point injections into two regions have been the go-to relief option. However, getting trigger points in a hurry can be next to impossible. I typically get injections at least once a quarter.

If I’m struggling at points between rhizotomies and epidurals due to inflammation, I occasionally seek out toradol and steroid shots from my primary care manager. These are usually needed when I have a situation where I can’t control inflammation with any of the other methods (heat, ice, massage, etc.)

Epidurals (Nerve Blocks)

As of late, I’ve been dealing with more nerve pain than muscular. After trials of Gabapentin and Lyrica, neither drug was considered helpful for me. Gabapentin, at an adequate dose, would overly suppress the nervous system. One morning, I was found on a couch when I was supposed to watch my son back when he needed active supervision. He was fine. Everyone was safe. But, it was a real scare as it had never happened before, and I have no recollection of ever feeling tired.

For whatever reason, Lyrica puts me excessively on edge and makes me very irritable. This has been consistent over two stints with the medication. I typically stay away from this class of drugs (gabapentinoids).

As a result, we’ve flipped to superscapular nerve blocks. This is an injection of lidocaine and a steroid that floods the area in the superscapular region where the long thoracic nerve ventures further down into the body. I can get them as frequently as once a quarter, but they should last longer than that.

Radio Frequency Ablation (Rhizotomy)

The latest treatment is going into my pain management office every six months and cooking the nerves in the facet joints in the C-spine so that they detach from the spinal cord. The separation of the nerves is measured in millimeters, and as young as I am, my nerves tend to reconnect over time somehow.

The procedure is excruciating and is not for the faint of heart. Seriously consider all your options before going down this route. It’s effective for me. However, the recovery time is a week or more.

We do know after a few of these that regular doses of anesthesia are pretty ineffective. However, my doctor and I have figured out the why and what to do as a result. I mention this because when you are on as many drugs as I am, certain anesthesia meds don’t have as significant an impact, so we’ve had to go down the Propofol route (this is the drug that killed Michael Jackson)

Pulsed Radio Frequency Lesioning

While deemed “experimental” by insurance companies due to overuse, pulsed radiofrequency lesioning has provided significant pain relief to me when done on a regularly scheduled basis. However, outside the VA system, this is impossible.