Tuesday 24 July 2012

Health: There's a knife sticking out of my shoulder

Okay, I don't really have a knife sticking out of my shoulder but this is a metaphor (Or is it a simile?) for an odd observation I've had during this, the worst sports injury I have ever suffered in my entire life.

During the past almost four months now, I have been diagnosed with muscle strain, a possible pinched nerve, maybe a torn rotator cuff, okay not a torn rotator cuff, a traumatised upper left quadrant, a traumatised rotator cuff, a slight separation of the bones in my left forearm and consequently a displacement of the bones in the wrist and elbow, an unseating of one of the two branches of the upper tendon of the biceps, and finally a pinched C6 nerve more than likely caused by some herniation of the C5-C6 and C6-C7 discs leading to referred pain in my left shoulder, arm and hand.

I have had an EKG (to rule out having a stroke). I have had the rotator cuff test done on me twice. I have had an x-ray of my shoulder, an x-ray of my neck, an MRI of my shoulder and an MRI of my neck and an EMG (electromyography).

I've talked with medical professionals such as my family doctor, a sports medicine specialist, a neurologist, a chiropractor, a massage therapist, a physiotherapist, a kinesiologist, an acupuncturist, plus family, friends, and colleagues. I have explained the problem I am constantly having with pain. They have collectively suggested medication, physio, massage therapy, acupuncture, chiropractic, muscle stimulator electrodes, glucosamine supplements, vitamin E and vitamin C plus magnesium, non inflammatory foods, a traction table, and one acupuncturist suggested I needed an emotional cleansing. Yes, you heard me, an emotional cleansing. She writes, "Your pain and discomfort are more emotional than physical (80% emotionally caused), I am convinced that by cleansing your emotional burdens you can be permanently relieved of your pains." I'll come back to this WTF in a moment.

I have asked myself on numerous occasions why it has taken over three months to arrive at what I now think is a comprehensive and accurate assessment of my condition. I have also asked myself why I have been bombarded over the past months with such a variety of diagnoses and opinions plus suggestions for dealing with my issue. My conclusion is this: I don't have a knife sticking out of my shoulder.

What is my little bit of humour about this? If I had a knife sticking out of my shoulder, anybody whether medical professional or layperson would easily see what my problem was. Let's get that big bad knife out of my shoulder then let the healing begin!!! Woo hoo!!! However, my problem is a herniated cervical disc. You can't see it. You can't see anything. My problem is completely invisible. I stand before you looking completely normal. On top of it, I can talk coherently, smile, and crack jokes. I can move my left arm around without pain. Okay, so where's the fire? What's my emergency?

The Rotator Cuff Test
When I first visited my family doctor with complaints of shooting pains in my left forearm, we discussed the various physical exercises I had been doing the day it all started. He tested me to see if I had damaged my rotator cuff. Basically, the doctor visually examined the shoulder, did a little poking and prodding looking for anomalies and to see if I would hit the roof screaming in pain, then asked me to put my arm in different positions. If you have torn your rotator cuff, this means you have more than likely detached or partially detached a tendon from the bone. Either you can't move your arm into a position (the tendon is detached) or you feel a lot of pain (the tendon is partially detached). For me, I could put my arm in any position the doctor wanted all without feeling any pain.

Conclusion? I had not torn my rotator cuff. And that's a good thing because if you have detached a tendon, surgery is necessary to reattach it.

Conclusion? I had strained my muscles and needed to stay off them to let them heal.

It all seems reasonable given the results of the above simple rotator cuff test. However things didn't work out as expected and my pain didn't subside, it actually shot up a few times. Okay, diagnosis number one may not have been totally accurate, what else could be wrong? Conjecture? Pinched nerve in the neck? However an x-ray of the neck at the two month mark didn't reveal anything telling. (I still wonder if the x-ray not having the same refinement of image for soft tissue as an MRI failed to show what's necessary to make an accurate diagnosis.)

Imagine me sitting there feeling all sorts of pain only to be told there's nothing wrong with me. I just have to be patient and let my body heal. Ah, maybe I haven't made myself clear. This f**kin' hurts like a goddamn bitch. Okay, I was polite; I only thought that. No, I was actually confused. I now think I was in so much pain, I wasn't thinking clearly and wasn't doing a good enough job of advocating for myself. My doctor says he's going to get me a referral to see a neurologist about a possible pinched nerve but that appointment is three weeks away. What? That means I have to sit at home and put up with three weeks, 21 days, 504 hours, thirty thousand two hundred and forty minutes of pain. (That may seem like an amusing breakdown of the time but when you're in pain; even a minute seems like an eternity.) What would my family doctor have done if I had a knife sticking out of my shoulder? Take a couple of aspirins and come back to see me next week? I am assuming (I'm hoping?) I would be whisked by ambulance with all due haste to emergency where a team of medical professionals including trauma specialists would work feverishly and tirelessly with the utmost Hippocratic dedication to get that foreign body out of my flesh.

But I didn't have a knife sticking out of my shoulder. I seemed to present a clear picture of a rotator cuff which wasn't torn but traumatised. My family doctor was going to let it ride as muscle strain but I just kept complaining of pain, some mysterious pain caused by heaven knows what. And what do we do with mysteries? We do our best then call it a day and go home. After all, we're not the one suffering from pain.

A colleague told me he had suffered a sports injury involving his rotator cuff a few years ago and acupuncture worked miracles. He mentioned it several times. He insisted. So I made an appointment and went. Of course, were our injuries the same? (no) Did he have a herniated cervical disc? (no) I can clarify my position on acupuncture by saying that this Doubting Thomas was so desperate, he would have stood on his head and spit wooden nickels if that would have helped. (It doesn't by the way. Then again, I couldn't find any nickels made out of wood so I may have invalidated the experiment.)

The acupuncturist was a nice enough lady, I suppose, but I quickly realised that with me at least, she was in way over her head. She said I would need multiple visits to arrive at more satisfactory results adding that the pain relief from this particular session would last no more than 24 hours. She went on to say that from my story, I had personal issues that had not been properly dealt with and I should consider having an emotional cleansing. I jokingly said to this, "Are you going to make me cry like a baby?" I did add that traumatising my upper left quadrant and herniating a cervical disc leaving me in constant pain might be one personal issue I had not yet properly dealt with. I don't think she got my sarcasm or she chose to ignore it.

We did the session and I left. The so-called pain relief didn't last 24 minutes, never mind 24 hours. Walking puts stress on my upper body which stresses my neck and causes the bulging disc to press against my C6 nerve resulting in pain going down my left arm. Pain relief? Don't make me laugh.

Afterwards I did some research on the Net about acupuncture and discovered that scientific literature showed that randomly sticking needles into a person produced the same results as the supposedly legitimate points of acupuncture. Using "fake needles" like toothpicks also produced similar results. What was the conclusion about people claiming that it worked? The theory was that there was a psychological effect of going through the procedure and of being touched by another human being. The patient felt he was better off not because of acupuncture but because of the power of human touch.

That was all very well and good but I was looking for somebody to "unherniate" my herniated disc. I was looking for somebody to take the knife out of my shoulder. I decided to not go back. Besides, if I had shown up at the acupuncturist's office with a knife sticking out of my shoulder, I would have been just a tad miffed if she suggested I needed an emotional cleansing.

I'm offering what I know. No more, no less.
Everybody had something to offer me. A chiropractor cracked my neck. A massage therapist rubbed my shoulder. The acupuncturist stuck needles in me. Okay, but can you take the knife out of my shoulder? No? Well, would you kindly explain to me the connection between what you're offering and the correction of a herniated cervical disc impinging on the C6 nerve causing referred pain in the upper left quadrant?

I was very much struck while sitting talking to the acupuncturist so highly recommended by a colleague that she had no training in medicine and she had no ability whatsoever to remove knives from shoulders. She knew how to stick needles in me but she did not know how to correct a herniated cervical disc. She knew how to perform this "emotional cleansing" but she was unable to remove the impingement of C6 nerve. She offered only what she had to offer. It was up to me to determine whether or not any of these people could in any way be effective in my treatment. (I do not see any of the previous three practitioners anymore.)

Desperation and Jello
Desperate people do desperate things as the saying goes. And if you're in pain, believe me that makes you quite desperate. Please! For the love of God, would somebody take my finger out of the light socket!

As I go down this list of recommendations I have gotten from both professionals and laypeople, I can't help thinking of a saying a wise woman once told me. If you throw enough jello at the wall, eventually some of it will stick. Is that the idea behind trying anything, just about anything in a desperate attempt to correct a problem? I have a knife sticking out of my shoulder. Arguably vitamin E does contribute something to muscle growth; glucosamine supplements may help my cartilage and maybe an emotional cleansing would help me come to terms with Mommy liking my brother best, but if I step back and look at the big picture, the real crux of the matter, the true source of my health issue, the principal and overriding cause of my pain is... drum roll... the knife sticking out of my shoulder.

It's as obvious as the nose on my face... as shown on an MRI
I can't help feeling that everyone, both medical professional and layperson, seems to suffer to varying degrees of this human condition or maybe failing of out of sight out of mind. I can't see the problem therefore I don't appreciate the problem. Or even I can't see the problem therefore there is no problem. I'm certain that everyone means well and sincerely hopes to be passing on to me some tidbit of wisdom but does the person in question recognise when they might not know the right answer to my particular problem?

I slap down $120 for a fifty minute session of massage therapy. This young lady rubs my shoulder and neck, puts electrodes on me to stimulate the muscles, and inserts three acupuncture needles. Afterwards the head woman comes in and tells me I need to start a weekly regiment of sessions to deal with my pain and get me back into shape. At no time did anybody investigate my herniated cervical disc. (Then again, it's not like they had an MRI scanner tucked away in the corner.) At no time did anybody discuss the impingement of my C6 nerve. At no time did anyone offer to take the knife out of my shoulder. I walked out with exactly the same level of pain as I walked in with. Walking increases the impingement of the nerve and bingo! more pain.

When I went to emergency, the doctor on call who saw me did the rotator cuff test, read the subsequent shoulder x-ray and I could say almost triumphantly announced I had not torn my rotator cuff. Okay, that was the question I had originally asked but she failed to explain my on-going pain and did nothing to investigate the pinched nerve in my neck.

What do I know now?

Wikipedia: Rotator cuff tear: Diagnosis
Since most cervical pain is commonly mistaken for shoulder pain, the physical examination should include a thorough assessment of the cervical spine in order to eliminate other contradictions such as a "pinched nerve", osteoarthritis or rheumatoid arthritis.

Both my family doctor and the emergency doctor tested my rotator cuff and concluded I hadn't torn it. Good. Unfortunately, at that point they both seem to have incorrectly concluded that any on-going pain stemmed from the trauma I suffered. Neither one of them went on to investigate the possibility of a pinched nerve. If my family doctor got me in to eventually see a neurologist for nerve conductivity tests, it was because I had arrived at a point where I wouldn't shut up about the pain.

Final Word
Do we tend to not see what we can't see? Wait. What the heck did I just say? Ha ha ha.

Okay, what I mean is this. I work in a technical area. With nearly 30 years of experience, I can "smell stuff". That is an amusing way of putting it but I mean that my experience gives me a certain intuition about things. I sit down with the new guy to look at a problem. He sees five issues to be dealt with. I look at the very same problem and I can see fifteen or twenty issues to figure out. What's the difference between us?

But what if I bring in somebody from another area and get them to look at the same problem? Heck, what if I ask my garage mechanic to look at the problem? I'm sure my mechanic would suggest an oil change. And an emotional cleansing.

Anybody can see a knife sticking out of my shoulder. But even if I show somebody the MRI of my neck, they may not be able to interpret it correctly to conclude there is an impingement of the C6 nerve.

In the above example, I say that I can see fifteen issues while the new guy only sees five issues. According to my research, problems in the spine such as a "pinched nerve", osteoarthritis or rheumatoid arthritis are ofttimes overlooked as the causes of shoulder pain. (I can state that my pinched nerve causes shooting pains in my forearm and the back of my hand coupled with tingling and sometimes numbness in my fingers.) I would hope that the professional examining me would know this but I now have the experience with two doctors who didn't.

When I was 18, I slipped on some stairs and broke a bone in my left foot. I had to wear a cast for six weeks but that was pretty much it; the entire problem was cut and dry. I would give anything to have had that happen to me. I was going to write that maybe I would have preferred having a knife in the shoulder but I've been given to understand that getting stabbed hurts like a bitch. Then again, would it have hurt like a bitch for four months with no end in sight?


Wikipedia: Rotator cuff tear: Diagnosis
Diagnosis is based upon a physical assessment and a detailed history of the patient, including descriptions of previously participated activities and acute or chronic symptoms experienced. The physical examination of a shoulder deals with a systematic approach constituting inspection, palpation, range of motion, strength testing, and neurological testing.

Since most cervical pain is commonly mistaken for shoulder pain, the physical examination should include a thorough assessment of the cervical spine in order to eliminate other contradictions such as a "pinched nerve", osteoarthritis or rheumatoid arthritis.


Site Map - William Quincy BelleFollow me on Twitter

No comments: