I get the mail regularly at work and bring it to the back, sort it, and deal with whatever lurks within the pages….

A large envelope arrived the other day.  A patient had provided a folder of their entire discharge paperwork and medical files for our usage.  As I was glancing at the contents to decide what to do with it, my nose began to send alarm signals to my olfactory lobe.  The cigarette odor was impressive.  To add to this moment was the third paragraph down on the first page:

Congratulations on your acceptance of participation with our smoking cessation coach…

  • effort is required to pick up the fingers
  • a good day sitting there with an ice pack
  • pain medicine is effective but so sedating has to be taken only at bedtime
  • simple movements become objects of interest
  • it’s considered good progress to touch a finger and thumb
  • pain is such a companion that you don’t even bother treating till it so level V or six
  • you sit down to write a letter and it is to the practitioner that missed the diagnosis leading to life-changing surgery.  The import of the letter is do the X-ray this way so nobody else has to go through it like I did.
  • you have to do everything with one hand and start to realize how much of life revolves around using two
  • shorts are in consistent use because putting on pants so difficult with one hand
  • given medications for conscious sedation while nervous and then waking up in recovery.  Those medications worked quite well.  Spouseinbox said they had quite a conversation with the doctor.  I remember absolutely nothing.
  • To pull the nerve block catheter three days later you realize there’s about 6 inches of tubing inside my shoulder
  • realize how many things are above the 5 pound weight limit.  I’m not even allowed pick up a gallon of tea.
  • My therapist gave me a similar speech to what I used to give my knee patients when I was in home health.  it’s interesting being on the other side.
  • I had a surgeon willing to give me the bones he removed.  I’ve been looking at taxidermist sites and other bone preservation sites to see what to do with them.
  • Since I only have one usable hand, I have been using Dragon NaturallySpeaking.  It’s amazing what words cause this program problems.  I have yet to get it to understand the word “knee”, so for those times I’m doing one hand corrections.

The place where I took my first breath was upstate New York.  it is known for HillS, tall trees, liberal intrusive government, and snow.  In reaction to the snow, and to keep some semblance of friction between the car tires and the ground, the cities apply salt to the roads.  It helps somewhat.  It has other effects though.  Cars from that section of the country are notorious for rust.  The salt plays havoc with the paint job and metal of the car and quickly deteriorates the lower seems of doors under carriages and drive train.  Its effects are not limited to the mobile machines.  There are many metal supported bridges in the area.  One of these has created a mental picture.  This bridge was designed to support a train across three lanes of road.  there were vertical supports set in sets of four diagonal attachments between each of the four these legs were supported to each other by vertical I-beams designed similarly.  We would drive under that train bridge since I was a kid not griping, I noted the rust on the structure of this bridge.  Over time, I noted how some of the small diagonal pieces would rust through.  On that rare occasion, some individual would actually have a rate of sense and believe it a good idea to fix the bridge structure. So once, maybe twice in the years I was there some new metal structure was applied and some of the rust and decay was cleaned and the metal structure repainted.

There was another obvious incident.  We were driving under the bridge and I noted this nice straight vertical column was no longer straight.  It was bent in with a sharp curve about 18 inches above the ground.  Since it was a structure, and not a single piece, the metal corners nearest the outside were compressed more than the inside corners.  These obvious marks of somebody running into the bridge.  The bridge still stood doing the job for which it was placed even though showing rust, decay, and accidents.  It continued to be used even in this state of repair, or disrepair as the case may be.

This did seem to me to be a decent allegory of what has been and what I’m anticipating.  In contrast to the bridge however, when my structure gets altered, I will not be able to support the workloads that I previously had known.  My hope is that the anticipation is, or rather will be, worse than the actual procedure and outcome.  I am standing here on the back side of the bridge watching the misguided car heading towards the upright.   The possibilities are flashing through my mind.  The desire for avoidance is palpable,  though there is an understanding that the trajectory combined with the structural presence makes the outcome inevitable.  Those moments before the accident are the periods of time I have been contemplating for the past many months.  Talk about time expansion!

Some time ago last, I broke my wrist working in the closet.  My doctor at work said that was an unglamorous excuse and I needed a better story.  I decided my glorified tale is I lost a sumo wrestling contest.  :–)  I was getting paperwork ready for a second opinion and realized the status of my wrist has been degenerating through the year.  The initial evaluation was a sprain. I was told if pain continued after two weeks to return to the clinic.  Pain kept getting worse and I returned. They did an x-ray at that time and told me there was still nothing broken. They gave me a brace and I was instructed to wear it. That was last July. I had an appointment with orthopedics and was prescribed physical therapy. They had done an additional x-ray and again told me there was no issue. During physical therapy, there was no change in having pain, however, the location of the pain changed according to the wrist position.  About October, my primary care physician ordered an MRI.  The results of the MRI told him that I had a broken wrist. I got referred to a wrist specialist in a neighboring town and they did a CAT scan.  This is now December.  I returned there in January to get the results. This time I was told my scaphoid was broken and received my first suggestion of a carpectomy.  As I started looking back through the scans and x-rays a term was starting to be used – avascular necrosis.  Another term began to show up in the reports, this was slac. Slac refers to scaphoid lunate advance collapse. The bone does not get the blood supply required and slowly dies. I went back for a follow-up in March and looked over new set of x-rays and discussed all these surgical possibilities. On this set of x-rays, the broken scaphoid was actually showing a clear crack. I was informed that the scaphoid had bent when healing was pushing on the other bones in the area and I further had a bone spur on the end of my radius – the long bone on the thumb side of the arm. The area was further described full of traumatic arthritis. Options discussed were four point fusion, cutting and resetting the scaphoid, cutting out the bone spur, cutting a block of bone off the radius and switching it in place of the scaphoid, and the limitations of each one of these procedures. The surgeon’s suggestion was the carpectomy as that would retain circumduction in the hand. I was told the bone spur would simply regrow if removed, the scaphoid could not tolerate or hold a screw, the vasculature of the area could not receive new piece of bone and survive in the long term, and the four-point diffusion would limit the hand to a hinge like fashion in two directions.

I have looked at videos and read on the procedure and looked up former patients’ evaluations of having a carpectomy.  It will retain motion so I can play the keyboard, however, I will have to stop all of my heavy building activities. The new wrist joint will not support the stresses that such activities would place on it. If I did do the jobs around the house like I have normally been doing, and injure the surgical site, the next step is a full wrist fusion.  I enjoy both fine and gross motor activities. I enjoy music, writing it, performing it, as much as I enjoy digging a post hole and expanding the backyard fence. The wider implication of this whole mess is I have to pick one of my activities and ignore the other or rather start to hire somebody else to do the jobs I normally would have done and no longer can.  In the meantime, I am on two anti-inflammatories and a nerve medication to keep the pain in the wrist at a reasonably low level.  I have been informed that one of the anti-inflammatories is known to cause kidney issues. So in the back of my head, I really can’t take an extended amount of time deciding what to do unless I want to risk another more serious issue.

If you have been wondering why it’s so quiet from this corner of West Texas, there’s your thumbnail. I have started using Dragon naturally speaking in place of typing as repeated keystrokes through the day tend to aggravate the wrist.  This is the second post I have tried with the program.  It’s still faster and much easier to type, but the pain level increases throughout the day.  I have asked for the same at work, and am awaiting their mercy.  Looking back, it’s amazing the cascade that can result from a little injury to a minor blood vessel.  I can only speculate what would have happened had the broken scaphoid been recognized initially.  That was missed, and here I am.  I told my manager that this is the map of the trip I have to travel.  I am not faulting anyone.  Each responded according to the information presented each time.

One of my jobs is to call insurance companies and provide information for a Prior Authorization.  This is done to prove to the insurance company that the medication or treatment is necessary.  There have been times I have spoke with someone who was obviously reading from a script and had no clue what the actual terminology was.  As long as I said a word that matched something in the column, we could have approval, if the actual diagnosis was a shade different, we were disapproved, or at best put on a review list for a pharmacist or doctor to review.  With the latter in mind, read this.  From my experience, I have not the slightest doubt as to the truth of the information.  After all, I am one of those on the back end of this snake getting drug through the weeds.  All the while, the patient in need of treatment, gets to sit home and wonder if she/he has been forgotten, while the ailment continues.  I have been on the back end of many of those phone calls as well.

The surgery is done.  The cancer is removed.  Spouseinbox stated that the doctor lied.  I was anticipating it, but tried not to say too much.  The presentation was sort of like this comic:

“You will be a little more sore than when they did the biopsy.” We were given Norco 7.5’s and morphine IV in the hospital room.  Yeaaaa, just a little more sore than post needle stick.  Now, I know how practitioners like to downplay the bad stuff.  We are trying to help expectations.  That strategy doesn’t really work with someone in the business.  That comic is so accurate.  Don’t think I don’t notice the preparatory medications either.   Just saying.

I had out my appendix many moons ago.  What I discovered was that lying was fine, standing was fine.  Going between them was horrible.  That said, I only took one pain medicine that first night.  That shot changed the way I give shots to this day.  I wasn’t even a nurse at the time.  Tell the patient they are going to be stuck.  I was waiting for the verbage and received a poke instead.  I jumped, looked at the nurse.  He gave an odd face, completed the injection and then told me I had just jumped off the needle and back on it again.  I got stuck twice for a single shot.  There’s nothing like personal experience to change one’s mind and approach.  That said, I decided the nurses were going to make me walk and I didn’t want to get out of bed any more than was necessary – as getting up was the worst – so I decided that I would walk out in front of the nurses station any time I had to get up for the bathroom.  It worked.  The nurses came and provided such compliments how I was energetic and walking wonderfully and they were happy with such progress.  I didn’t tell them I was just doing it so they would leave me alone.  Keep that in mind if you ever have to go to the big house.

Spouseinbox discovered that post surgery, standing was fine, lying was fine, going between them hurt.  That sounds so familiar.

Some time ago, I noted how the growth of pendulous chest area was a normal physiological response to presence of hormones.  That is called gynecomastia in men and breasts in women.  Gynecomastia in a man doesn’t change him into a woman.  It’s just the natural growth of that area of anatomy.  The cells haven’t changed.  Now we have this.  I know it seems to obvious, but for this crew an explanation must be in order.  Junior was a cute movie, comedy of sorts, and fantasy of thought.  I actually enjoyed watching Arnold go through all of the symptoms a pregnant woman experiences.  However, a uterus is required to be pregnant.  Period.  There is only one sex sporting a uterus – the woman.  Period.  When a woman is pregnant, she is called a mother.  Period.  Words mean things.  Pretending they don’t is to associate with the mental illness present.  I’m done with this.

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