Saturday 7 July 2012

Health: Who knows the right answer?

I want to buy a car. I go to the Honda dealership and they tell me how wonderful their product is. I go to the Ford dealership and they me why their car is better than the others. I go to Nissan or Volkswagen or Chrysler and... well, you get the idea. Who's right? Yes, there are publications like Consumer Reports which attempt to objectively assess the quality of each automobile but what does this represent? Caveat emptor: let the buyer beware. I must educate myself about automobiles in order to make an informed decision. That's the key: I must become a knowledgeable buyer. I cannot expect that some 3rd party is going to decide for me in an unbiased manner looking out for my best interests. Who knows my best interests better than me?

Surprisingly enough, or maybe I should be saying obviously enough, the same idea is applicable to getting health care. I must educate myself so I can become an informed buyer. But as I said in a previous article, if my car breaks down I can get a loaner. If my body breaks down I'm afraid there are no loaners available. Essentially there is no backup plan. One person, one body. Do with it what you will but you ain't gittin' another.

My "Magical Medical Tour" (apologies to The Beatles) started on April 7, 2012 when I suffered the worst sports injury of my life. From there, I have visited various medical professionals, sports trainers, and possibly quacks trying to sort out precisely what my injury is. Curious, eh? I have arrived at week fifteen and I am still figuring out the extent of my injury. For some oddball reason, I thought I was going to visit my family doctor shortly after my accident, get a diagnosis, maybe some pills, then be off on a prescribed program of healing. Surprise, surprise, things have not exactly panned out like that. In fact, I have been frustrated if not angered either by a perceived lack of proper attention to my plight or possibly my own ignorance of health slash medical matters and how to advocate for myself. It seems like I went in thinking I had a 10 out of hundred problem and am slowly finding out it's a 60 or 70 out of a hundred. Excuse my French but WTF!?!

Does anybody know what the hell is going on?
You know what you know but are you smart enough to know that you don't know? (Yes, it sounds like Donald Rumsfeld. See below in References) I go see a chiropractor and he cracks my neck. I see an acupuncturist and she sticks needles in me. I see a massage therapist and she rubs my shoulder. I'm guessing that if I saw a dietitian, she would study what I eat and a psychologist would inquire about my relationship with my mother. It all sounds very well and good but what does this have to do with the price of tea in China?

When I first visited my doctor, I described how I was having sharp pains in my forearm and hand. He gave me a simple test to verify the range of motion of my left arm. He asked me to move my arm around and to put it in several positions. I did so without pain so he concluded that whatever had taken place, I had not broken a bone or dislodged a tendon. Whew, wipe my brow, it's not a torn rotator cuff. The conclusion was that I had suffered something akin to a repetitive stress injury. Prescription: don't use the arm, take an anti-inflammatory and pain killer like ibuprofen and come back in a couple of weeks. So, I'm thinking I'm dealing with a ten out of a hundred. Lie low for a bit and the body will heal itself. No prob.

During a couple of follow-up visits over a 4 week period, I emphasized that the level of pain was mysteriously not going down. In fact, at the end of a month it spiked so badly I panicked. I realised that something really really bad was going on but I didn't know what. The increase in the level of pain led my family doctor to wonder if I had a pinched nerve in my neck. I asked for more of an investigation and it was at this point, I started visiting other health specialists either recommended by my doctor or on my own.

A chiropractor gave me the once over which included cracking my neck. This didn't diminish my pain one iota. A massage therapist rubbed my shoulder, put electrodes on my neck and stuck acupuncture needles in me. That didn't diminish my pain half an iota never mind a whole iota. What else to try? My doctor got me an appointment with a sports medicine specialist and with a neurologist.

At work, a colleague in hearing my tale of woe, recommended a sports kinesiologist apparently used by at least half a dozen members of the company staff. High praise indeed. It was at this point, I realised my little problem was much bigger, like probably a whole lot bigger. While I felt better under this gentleman's tutelage, four weeks of physiotherapy did not see my pain go down In fact, he told me he was surprised I was not responding to treatment as I should have been.

I panicked again. I'm thinking that somebody has overlooked something and I may have some unknown issue which is not properly being attended to and as a consequence I am not healing or I could be getting worse. I decide to get the opinion of a second doctor and do so by visiting emergency.

I have to wait 4 hours but finally somebody sees me but they do the same rotator cuff test as my family doctor. Conclusion? I haven't torn my rotator cuff. Fine, but what about the on-going pain? No clue. I do get an x-ray but that supposedly confirms the rotator cuff is intact. Is it? X-rays don't really show soft tissues.

I go over to the States and pay to have an MRI of my shoulder. It confirms that my family doctor and the emergency doctor were right. Once again, I'm stuck. I don't have any viable explanation for my pain.

Finally, a neurologist gives me an EMG test (electromyography). This nerve conductivity test points to a nerve impingement in the neck possibly due to a herniated cervical disc. He authorises a MRI of the neck and that shows that the trauma of the upper left quadrant not only affected the shoulder, it went all the way to the neck and I've traumatised cervical disc 6 and 7. The cause of my on-going pain is the impingement of the C6 nerve and partially the C7. The MRI shows some degeneration of my discs probably due to age but I'm sure other factors cannot yet be ruled out.

Now for the sixty-four thousand dollar question. Will these discs heal? Can anything be done to help the body heal the discs? If they can't be healed, is the best I can hope for is to stop the discs from getting worse? Will the pain go away or am I going to have to deal with this for the rest of my life?

That last question about dealing with pain for the rest of my life is a doozy. It has been 15 weeks since my accident, coming up to 4 months. I have had pain each and every day. Right now I am typing this article with my right hand while I hold a cold pack with my left hand on the back of my neck over cervical discs six and seven. If I can calm those nerves down, I can diminish or hopefully stop the sharp stabbing pain I get in my left forearm and hand. While there is nothing wrong with my legs, I can't walk very well as walking puts stress on my upper body which in turn puts pressure on my neck and my cervical discs which impinges my C6 and C7 nerves causing pain in my left arm and hand. I have not had the simple pleasure of going for a walk around the block in 4 months. Now I may have to extend 4 months to the rest of my life?

Whatever the case, I now realise two important things. First of all, my injury is not a ten out of a hundred, it is more like a sixty or seventy out of a hundred. Secondly, if I thought healing was going to be from a couple of weeks to maybe a couple of months, I now know we are talking about six months to a year. Yep, the rest of the year two thousand and twelve has been wiped off the map. If I was mulling over some vacations, possibly a foreign trip, I can just forget it. I ain't going nowhere. Hell, I'd be tickled pink if I could make it around the block just once without feeling any pain.

Final Word
Where do I go from here? I have a follow-up with the neurologist in two weeks to discuss the MRI of my neck. What's he going to say? Anything earth-shattering? Everything I've read says that surgery is the very, very, very last ditch solution. Any doctor wants to wait and see what the body is going to do to heal itself. Even then, surgery isn't necessarily the be all and end all. Yes there are successes but there are also horror stories and I can't say with certitude just what the percentages are. Surgery is an invasive procedure and the more invasive anything is, the greater the risks.

Things are bleak but bleakness is relative. When I visited emergency, they first assessed my condition for triage and I was shuffled off to the waiting room where I had to wait four hours before anybody saw me. During that time, in observing the comings and goings, I realised something important about my situation: I did not show up at emergency on a stretcher. That may not have exactly lessened the pain of my boo-boo but at that particular moment I could silently say to myself as I looked upon some poor soul going by on a hospital gurney, "There but for the grace of God go I."


Wikipedia: Magical Mystery Tour
Magical Mystery Tour is an LP and a double EP by the English rock group The Beatles, produced by George Martin, both including the six-song soundtrack to the 1967 film of the same name.

After Sgt. Pepper's Lonely Hearts Club Band, Paul McCartney wanted to create a film based upon The Beatles and their music. The film was to be unscripted: various "ordinary" people were to travel on a coach and have unspecified "magical" adventures. The Magical Mystery Tour film was made and included six new Beatles songs. The film originally screened on BBC-TV over the 1967 Christmas holidays (26 December 1967) but was savaged by critics.

Wikipedia: There are known knowns
"There are known knowns" are the most well-known words of a statement to the press made by Donald Rumsfeld while serving as United States Secretary of Defense in February 2002.

U.S. Department of Defense - Feb 12/2002
DoD News Briefing - Secretary Rumsfeld and Gen. Myers
[T]here are known knowns; there are things we know that we know.
There are known unknowns; that is to say there are things that, we now know we don't know.
But there are also unknown unknowns – there are things we do not know, we don't know.

Wikipedia: What's that got to do with the...?
"What's that got to do with the -- ?" is an expression which is used to denote something which is unrelated to the current topic of discussion. A common form "what does that have to do with the price of tea in China?", is a retort to an irrelevant suggestion.

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. The shoulder will be examined to see whether it is tender in any area or whether there is a deformity. 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.

Wikipedia: John Bradford
John Bradford (1510–1555) was a prebendary of St. Paul's. He was an English Reformer and martyr best remembered for his utterance "There, but for the grace of God, goes John Bradford". These words were uttered by Bradford while imprisoned in the Tower of London when he saw a criminal on his way to execution; however, the attribution has been questioned.


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1 comment:

BigLittleWolf said...

All I can say is empathize, in a very real way. One feels anger, indignation, helplessness, anger again - as if the pain weren't bad enough, it's the seeming acceptance of a system (systems?) in which you're passed from doctor to doctor (and around again) with no resolution... and the games continue.

Look up RSD, just for fun... another one of those entertaining (unresolvable, inexplicable?) complications...

Oh, the fun, the fun...

Virtual hugs. And alcohol.