vascular compressions: celiac plexus block

I've been focusing a lot on my jaw cavitations as of late, but there has been a lot in the works for my vascular compressions as well. When I left Oklahoma there was a slew of tests I need to do to help the doctor put together a plan. So far I've done all the blood labs and most recently completed the celiac plexus block and Mesenteric ultrasound.

“ET phone home” yes, this was my shining moment when I got back from my procedure ;) Ben was happy I still had my sense of humor!

What is a Celiac Plexus Block?

The celiac plexus is part of the nervous system and is a bundle of nerves in the upper abdomen that sits behind the pancreas by the abdominal aorta. They send signals to the brain and spinal cord from digestive system organs. A block is commonly used for people with pancreatic cancer or pancreatitis to help relieve pain from those nerves. In other cases like mine, it's used for diagnostic purposes.

For the block they used a mixture of 20 mL Bupivacaine 0.25% and 2 mg Dexamethasone. If it does give a lot of relief they can do a neurolytic celiac plexus block to give you longer relief. They do this by using ethanol. The alcohol damages the nerves so they can't send signals to the brain. 

I scheduled my block through Midwest Radiology. The interventional radiology from Midwest Radiology had me to go United Hospital to perform the procedure. My appointment was at 8am on January 9th, 2024. We left the house at 5:45am since there was a bit of snow that morning. To prep for the procedure, just no eating and drinking for 8 hours. I'm going to be honest, I was oddly calm going into this. I was just ready to get it done I think. I was exhausted that morning, but in a good mood. Ben drove me since I needed a driver to take me home. Once I got checked in, a nurse took me to a pre-op room so I could get my gown on and such. She hadn't received all the orders yet, so we had to wait a bit to see what she all needed to do. Her name was Cindy and she was very chatty. I quite enjoyed it. This isn't a common procedure for them so she probably asked me more questions than I asked her. I'm used to this. After some time of hanging out they did some lab tests and got my IV in. She was incredibly attentive and caring. "You look cold" and proceeds to bring me more warm blankets. I ended up with 4 or 5 of them on me! The waiting got a bit longer than I had anticipated. Had I known I maybe would have had her bring Ben back to entertain me. But I told her to let him be since he had gotten all situated in the waiting room. And for once in my life I wasn't insanely anxious. Multiple nurses and Dr. Campbell were in and out to explain things or ask if I had questions. Dr. Campbell said that due to the relaxing effect from the block I may have transient diarrhea afterwards. But it should be fine after a few days.

The gown honestly really brought out the green in my eyes!

90% of the time they have to try more than once to get an IV in my arm. Usually having to call in a different nurse. They got it on the second try right above where they took blood initially. Somehow blood managed to go all over the place. I had been talking to Cindy while another nurse put the IV in, I looked over and was like WHOAH! Blood all down my arm and a nice dose on one of my blankets.

Sometime between 9:30-10am a nice nurse named Harrison wheeled me off to the procedure room. I found out his wife is also a nurse which I thought was adorable. I had an urge to take a video while being pushed on the bed so I could say "WEEE!". But thankfully I didn't have my phone. And no, I wasn't on drugs yet. Once I got to the room, which is also a CT imaging room, they had me lie face down on the imaging table. Got me all situated so just my back was exposed. They gave me some fentanyl and light sedation. Harrison was going to be monitoring my vitals during the procedure. Ashley, the radiologist, put a graph of some sort on my back so they could take a CT scan and identify placement. The first one wasn't quite right so they moved it and did it again. I was calm and a little sleepy, but could still feel quite a bit and hear them. At the time I honestly wasn't sure exactly what Dr. Campbell was doing, but I could feel multiple pokes along my right and left side. The right side especially HURT. I tensed every time. I'm not sure how many times they did it, but I want to say roughly ten on each side. I was also in and out of the CT scan multiple times. Once they got the right location they injected the medication. They use two 21-gauge Chiba needles for this.

Just an example. The two green things are the needles.

After he was done I asked Harrison what all the pokes were! He explained it took a bit of time to get the right spot since my frame is so small, meaning smaller area to get it just right. And I could feel more pain because he wasn't able to sedate me any further due to my low blood pressure. Here is a video explaining more for people that like to geek out over this stuff with me ;) What I gathered from this video is they probably put a needle in multiple times and then did imaging to see if it was the correct spot. He didn't use an ultrasound for me, just the CT imaging. Harrison wheeled me back to my room. He was seriously so kind and empathetic. Everyone was! I get really accustomed to staff just doing their jobs and focusing on that. I don't say that as a bad thing. These people don't even know my whole story and they were just like, "you've been through so much". So anyhow, kudos to United Hospital staff in the Endoscopy/Special procedure area. Dr. Austin Campbell from Midwest Radiology was also very kind. He came in to check on me after and said we'd do a follow up call in a month. After the procedure I was required to bedrest and be monitored for 2 hours. I had zero complaints as I just wanted to sleep. So I slept over an hour and then moved to partially elevated auntil I was able to leave. I drank lots of water, but did not have an appetite. My back really hurt and so did my ribs. My guess is that this was from laying on my stomach on a hard surface. I don't have much cushion there. Once we made our way out of the building around 1pm I was starting to feel hungry! The whole goal was to do this procedure, then eat and see if I experience pain in the epigastric area from eating. We made our way to an adorable place called Cafe Astoria. I'll be honest, I hurt in quite a few places so I was trying really hard to zone in and figure out if I had pain in the area where the block was. I could still feel it but the pain was reduced. We thought maybe I should go outside of my normal eating regimen a bit to see how it goes. So many other MALS patients said they felt so good after the CPB and could eat so much food! I ordered a chicken caesar wrap with seasoned potatoes. And an oatmilk latte, of course! It was absolutely delicious. I didn't have intense pain in my upper abdomen where I usually do, so that was good. The rest of my abdomen still didn't feel real great. I was really hoping the numbing would spread further! And as Dr. Campbell mentioned, the food went right through me! TMI, but if you're someone reading this who is looking to do the procedure, it's good to know. I also had multiple occurrences of my heart rate shooting up out of nowhere. I have this happen sometimes, but not usually this bad! This maybe is a side effect of the steroid, I'm not sure.

Latte with Oatmilk and HONEY!

Chicken Caesar wrap with seasoned potatoes. I was only able to eat about half, which is pretty good for me.

We walked back to the car after to head home. As soon as we started going I got SO nauseous. Some nausea after eating is my norm, but it hit me hard since I ate quite a bit. I know people said it was hit or miss with the nausea subsiding for them after the block. I was really hoping I wouldn't have any. I reclined the seat all the way back and slept off and on the whole way home. Was kind of a bummer, honestly. I wanted to be feel-good, fun Ashlee.

I had anticipated just carrying on and going to work the next morning, but my body had other plans. I got out of bed and showered in hopes I’d come around. But it just wasn’t happening. I then thought maybe a little more sleep would be enough. That was also a no. My whole body just ached and was exhausted. It felt like when you have a fever and you just can’t function and being in bed is the only option. I got up and ate a little lunch but otherwise was in bed until 3 in the afternoon. Even just sitting felt exhausting. Haha It was ridiculous. I just leaned into it after a certain point instead of trying to fight it. I suppose my body has been through a lot as of late and just needed rest. I wasn’t even two weeks out from my second cavitation surgery, so I suppose that didn’t help. I will say that when the epigastric pain came back with a vengeance I realized the block did help more than I thought.

Fast-forward a few weeks. I had my mesenteric ultrasound January 19th. I was going to say it was painless and then remembered it actually wasn’t because she was pressing on my upper abdomen where it’s always sore and tender. BUT in comparison to the block it felt like a cakewalk ;)

They have you do specific breathing and measure the velocities of the blood in the celiac artery, superior mesenteric artery, and inferior mesenteric artery. The results showed that my celiac artery is more than 70% stenosis upon exhalation. The trunk angle of the artery is abnormal during inhalation and exhalation, meaning it’s bent down farther than it should be. There’s also some stenosis at the top of the superior mesenteric artery, but it wasn’t over the 70% threshold. I haven’t been able to talk to my doctor about any of this yet, so I’m sure she will explain it better and what it means for max this was just based on the radiology report. It was summarized as “sonographic findings are suggestive of median arcuate ligament syndrome/celiac artery compression syndrome”.

This Friday I will have my Upper GI series test done. I’m still working on getting the venogram and angiogram scheduled. But I’m getting there with completely all these tests!

Will write more soon! <3

If you like video explanations: https://youtu.be/u8sX6bPDS6E?si=s8tie4Ur9J3vBOJw

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