Two is too many

It seems that I have been putting off writing this post until I can’t anymore.

The reason I have procrastinated so long is…well, there are two reasons: fear, and pain.

I came to Flagstaff several weeks ago in search of a hand surgeon.  I took a nasty fall over a log, as some of you might remember, and after waiting a suitable number of days to make sure it wasn’t just sprained, sought care at an orthopedic urgent care facility. 

There I met a young, arrogant, and completely disagreeable orthopedist, who humiliated me in numerous ways until his assistant hipped him to the fact that he and I share a first name, to wit: “Doctor.”  Then he became all cozy and collegial, remarking on the skill of the last hand surgeon’s handiwork, as we gazed at my Xray together.  I was musing how overexposed the film was.  He was burbling away.  I had dissociated long since and have no idea what he said after that.

But I picked up the hand surgeon’s card on my way out, and spied the spine surgeon’s as well.

The chirpy receptionist volunteered to make me some appointments if I needed them, right there on the spot, so I took her up on it.

Let’s see, hand surgeon, since that came first.  And my poor arthritic shoulders were killing me, especially after the recent acrobatic stunts.  I’d have an appointment with the non-interventionist arthritis doctor, please. 

And then there is my spine, bane of my existence since 1985.  A couple of lumbar discs ruptured back then.  In 1987, emergency surgery for a ruptured disc in my neck.  Oh, and that rupture occurred on the first night of my internship.  I drew call my first night, of course.  “Black Cloud.” 

Over the three years of my residency I would go on to rupture at least five discs.  The spine surgeons threatened me with putting metal rods on both sides of my spine.  I demurred, and opted for a custom molded hard plastic exoskeleton type of thing that extended from armpits to groin, to be worn 23 3/4 hours per day.  Fifteen minutes to shower, then back into the Plastic Maiden.

In the intervening 30 years, my spine has had its moments of freedom from having to drag me into its consciousness.  Curiously enough, my best years were when I had horses and rode daily.  The gentle rocking motion kept my spine well oiled, and the occasional eruption of a bucking episode provided any needed adjustments.

Then I got Rolfed by the former Captain of the Venezuelan Olympic Women’s Luge Team.  She was gigantic.  She was good.  It was excruciating.

My back didn’t dare go out if it meant going back to Alejandra.

After I returned from Israel to be with my father in his last years, my neck began to bother me enough so that I went to see a Physiatrist.

For those who are unfamiliar, a Physiatrist is an M.D. or D.O. who is trained in evaluating and treating musculoskeletal disorders non-surgically, with things like hydrotherapy and massage.  Sound good?

Actually, I did not choose this person specifically because she would be the most likely to send me to a Turkish Bath; it was simply a matter of Cut vs. Not-Cut.

Dr. Not-Cut did not send me to the Turkish Bath, nor even to Physical Therapy, but packed me off to her partner who does one thing exclusively: epidural injections.

Now, while I’ve had many a needle inserted into my spine at the lumbar region, I have never permitted such an intrusion into my neck, for the simple reason that it’s easy enough to prick a blood vessel by mistake, which can be problematic in the lumbar, but catastrophic in the cervical, because there is simply no room for anything like a blood clot in the spinal canal of the neck.

I went for it, purely because I couldn’t look down to tie my shoes for the pain.  My head felt like it was going to fall off at any moment, and at times I felt like beheading myself just to get it over with.

The procedure was terrifying.  It was painful.  It didn’t work.

Fast forward through several medication trials and much condescension on the part of Dr. Non, and at last I had an appointment with her Nurse Practitioner, who wisely prescribed a muscle relaxant, voila.  And a special hardshell collar to keep my head from falling off.  A wise and practical woman…And she even snuck me a small Rx for some tramadol, miracle!

And until the tumble over the log incident, that’s been keeping my neck pain down to a barely noticeable hum. 

Post-log-jam, things started kicking notches up the Pain Scale until I was hovering in the 8 range and started using my beastly hard surgical collar again.  This thing provides a tiny bit of traction, and it gets rid of the feeling that my head is falling off, but it digs cruelly into my flesh and is no fun.

I did not wear the collar to my appointment with the Instant Ortho Clinic. 

Two things you must never do, if you go to any kind of emergency services place:  do not wear a cervical collar, and never never never reveal that you have a mental illness; otherwise you will be instantaneously branded as a drug seeker, and no one will ever listen to you or even notice the bone sticking out of your leg at a crazy angle. 

And there is a third one, I have discovered, to my dismay:

Don’t be elderly.  You won’t count.

Time passes, and I get my turn with the Arizona Spine Specialist Dude, very highly Ivy League Specialty Boarded And Fellowshipped, all very nice to know.  Confidence.

He seemed like a nice chap for a surgeon.  Asked me why I was there, seemed to listen, actually examined me and discovered, dismal dismal discovery…I have lost virtually all muscle strength in my left arm.  I have no reflexes at all in my right arm, and abnormal ones in my left.  This must be why it takes me two hands to get my coffee cup up to my face.

It is no longer an issue of mere pain management.  It is an issue of preserving what function remains to me.

I need surgery.

The MRI could have looked worse.  It also could have looked better.  What is clear, is that the degenerative disease is crunching my spine like Pac Man.

I have had two appointments with the Spine Surgery People.  The first was with the actual surgeon, whom I liked, who treated me respectfully and did a good job of hitting the diagnostic nail on its head.

The second appointment was with the Physician’s Assistant.  I have no confidence in Physician’s Assistants, for the simple reason that in my opinion, there is some difference between the education of, for instance, my new Spine Surgeon, who had (after his Bachelor’s Degree) 4 years of medical school, 5 years of residency, 3 years of spine fellowship, and assorted certificates; whereas, a Physician’s Assistant has a grand total of 26 months of post-college training: the equivalent of a Master’s Degree, very nice, but not enough to develop much clinical experience.

So, with some trepidation, I met with the PA to go over my MRI results.  How could a person with so little training interpret advanced imaging and recommend treatment?

I was relieved to find out that she is, in fact, operating as the surgeon’s assistant and not as an independent entity, as so often happens today.

She had been thoroughly briefed by the surgeon on the MRI results, conveyed them to me, and explained the recommended treatment: spinal fusion at two levels.  She explained how this was done, and showed me an example of the titanium plate that would be installed, to stabilize things.

Any questions?

Uh, well, yes…what would happen if I opted to do nothing?

Well, of course, your disease would progress and those nerves would continue to lose function….

Oh.  Yes.  Definitely.  I see.

Any questions?  She gives me the crisp smile that is the equivalent of shooting one’s cuffs to glance at one’s watch.

Not at this moment, I tell her, but I’m sure I will have.

All right then, just call and let me know what you want to do.

We rise, shake collegial hands…

Several days later I realize I remember absolutely nothing about the visit.  Except the part about Surgery, and Fusing Vertebrae, and Possible Side Effects Including Quadriplegia…shit.

I called and left a message for the PA.  Two days later, she returned my call.

Yes, what was it?  Very snappish.  It’s five o’clock, poor thing must be hungry and tired…shit, there I go again making excuses for other people’s bad behavior. 

It’s that I have some questions about the surgery.

–I explained that in the office.  We place a tube down your windpipe, pull your windpipe and food tube to one side, and…(what is going on here?  She has my chart in front of her.  Why is she using the sixth grade description garbage?)

Yes, thank you, you did explain that part.  What I want to know is where, exactly, you place the titanium plate.

Exasperated sigh.  Again, with feeling:

–I told you, we move your windpipe and food tube…

Cheezes K. Reist, woman.  I want to know whether the plate is placed LATERALLY or IN THE MIDLINE???

–Midline.

Good.  How long will I be in the rehabilitation hospital postop?

–That depends on you.  She drops the phone.  Oh sorry.

How long until I am able to drive?

–That depends entirely on you.

What does that mean, exactly, please?

–That means however long you are on pain medication.  Could be two weeks, could be six weeks, depends on you.  Each patient is different.

Ah, now I have some useful information: they give you pain medicine postop!  What a good idea.

It really was like pulling teeth.  Look, if someone is going to do violent things to my neck bones, I want to know the details.  All of them.  Not the sixth grade version: for better or worse, I am a physician, and I need DETAILS.

So now I am spooked, very spooked, by the fact that the surgeon’s right hand woman is sidestepping badly.  It’s bad enough that I have to make a decision of this magnitude, without this person giving me the power trip.

I know I need the surgery.  I’ve investigated the surgeon and he comes up kosher. 

But what about this other person on his team, who seems to have enough power vested in her that she could cause me to suffer?

It happens that there is a branch of the Mayo Clinic in Phoenix, several hours from here.  I think I’ll mosey over there and see what it’s like.  I don’t believe there will be huge changes in my condition in the near term…I hope.  Maybe they have some other, brighter ideas.

And then…there is the first appointment with the Hand Surgeon to look forward to, in a week or so.  Something is very wrong with my wrist, because of the fall.  Very wrong. 

I wish I could get someone to order the MRI of my wrist BEFORE I see the Hand Surgeon, to save time.  I think I’ll call his office tomorrow and ask.  Can’t hurt.

I have waves of feelings of futility.  What is all this for?  The wrist, yes, that’s an injury and must be repaired, if possible.  But what about the spine?  I watched my father’s spine degenerate until finally he was literally a helpless bag of bones.

I must ask this surgeon, whose opinion I respect: what am I looking forward to?  How long will it be until another unstable section of my spine needs to be fused, and another, and another?  How much of this can the body endure?  Am I really buying time with this?  What sort of quality time?  How long till the wheelchair and the nursing home?  I need to know.  I will make another appointment.

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34 Comments

  1. I nominated you for the Versatile Blogger Award. Feel NO PRESSURE to participate but I am so happy I found your blog. Check it out at http://www.shithappens2u.com

    Reply
    • Thank you so much! I am touched. I really enjoy your blog too. It’s amazing the wonderful new people you meet in the Blogosphere 🙂

      I don’t “do” awards, but I so very much appreciate the feeling behind your offer. That’s what’s the most important thing, that you thought of me.

      Reply
      • Definitely. I LOVE the community and how welcoming and encouraging it has been. My blog is not even a year old but I have been welcomed with open arms. COMPLETELY understand not doing awards, but happy you sent the sentiment behind them Keep writing and being awesome…I’m reading!

        Reply
  2. Ugh, that’s a lot happening all at once.

    Mayo clinic is a very good idea. Hell, I’m not a doctor and I want ALL of the details. Is the average patient really an idiot? I’ve been told as much, but I’ve never met such a person.

    What are you hoping for if you were to have surgery? If they could give you an extra 5 years of independence, would you take it? I’m so sorry you’re in this position. I hope you can get some clearer information on what to expect if you go through with surgery, and maybe other less invasive options.

    Reply
  3. Oh, Laura. I find myself seething with anger. You are so right about one thing…don’t get elderly. They really don’t care…and they let you know it. You suddenly become senile and unable to decipher the simplest statement….even it you are highly educated. Hugs.

    Reply
    • Ehhh….too late. My hard-earned grey hair and wrinkles, along with physical ailments that should belong to someone older than my 62 years, already give me that “senior citizen” stamp of disapproval. And Medicare. Oh well.

      Reply
  4. Yes! Don’t get old!
    When your body starts to deny you of normal joys and a doctor is snide about how to fix it, life gets sucky. Doctors aren’t forced to go to charm school 😒😋
    You are your best advocate. If you have time, find another doctor you like.
    I got pretty ill yesterday. Slept it away and then realized I was past the call window. We’ll get hooked up soon, I promise 😃

    Reply
    • Oy, what happened? Are you better now? No worries, I’m just puttering around doing camp chores in slow motion today. If weather permits, I’m going to make another try for Sunset Crater tomorrow! Day by day, that’s all we can do. We’ll get it right soon! Call whenever it works for you❤

      Reply
  5. I hate fuvking Dr
    There patience is about as long as their tongue
    They haven’t any bed side manner
    They give you drugs
    And then ask you did you have any side effects
    Not the other way around
    So sorry to hear everything is acting up
    I know how that goes
    My knee decided it was time for it to go out
    Two weeks ago it was my hip
    Thank god for Reiki
    Sending lite and love
    Big hugs and Wiggles
    As always Sheldon

    Reply
  6. Oh my goodness Laura! I hope you find a good orthopedist and get things taken care of soon. Life is just so damn hard sometimes, I’m having a bout f that too. Let’s hope things get easier. Sending you love and hugs.

    Reply
  7. Well damn my comment “flew away.” I am so sorry that you are in a mell of a hess. Hugs and prayers and good vibes are being sent your way. Doctors and their “assistants with crappy attitudes make me want to scream. I am sorry you’re having such a hard time.

    Reply
  8. I once had an argument with a PA over CES. This bitch didn’t believe I had it simply because my bowels and bladder weren’t affected. I was getting so frustrated, I almost walked out. Then when I complained to my friend who refered me, she said that I couldn’t have CES because I would be shitting all over the place. I never went back for follow up. Stupid ppl

    I am sorry that you have to have surgery. I hope they do it right and you don’t end up worse than what you are. That is my biggest fear.

    Reply
    • That is the problem with PAs, that they have two years of education, no residency, and they think they’re doctors. In many states they can set up as independent practitioners! It’s so frustrating, because unlike you, most people don’t self educate about their condition. My father was converted from spinal stenosis to paraplegic by a PA who forced him to lay flat on a table for a procedure and he subluxed L4. Never walked again.

      Reply
  9. Hi, Liebe. Awhile back I read a book about this guy who, debilitated by spinal problems, trained a greyhound he had rescued to become his service dog. Eventually the man learned of a very capable spinal surgeon, who performed an operation that greatly improved his condition. Perhaps it might pay to seek the opinion of this surgeon, who’s based outside Denver. His contact info is here: http://www.coloradospineinstitute.com/subject.php?pn=about-frey-george

    (And if you’re interested in reading the book: http://www.cometstale.com/index.html )

    Reply
    • Thanks, Larry! I will definitely check this out. Colorado is now part of my stomping grounds and since I spent most of last summer camping out at Colorado State University Veterinary Teaching Hospital with my Service Dog who was supposed to have died by now but like her mom, is too stubborn to die, I am more familiar with resources there than I am here in Flagstaff.

      Blessings upon your head for popping in to visit here, with gifts, even!

      How are things where you live? I’ve been keeping up from afar, my heart in my mouth, talking with friends. I must say our brother the Na na nach warmed my heart, under the awful circumstances. If you’d like to write directly, my email is moxadox (at) g mail (dot) com. Would love to hear (more) from you. I have mostly abandoned FB, as you may have noticed! Love to you and yours, holy bro!

      Reply
  10. Loretta

     /  March 15, 2016

    Hello Laura; I’m sorry that you are suffering. Do you have someone trustworthy and nearby that you can take along to your appointment… and treatments? Mostly to take notes and do attitude adjustments to the practitioners (often Nurse Practitioners!) who forget everything but their own ego. I’ve been lucky enough to have a friend who advocated for me a couple of times when I was in too much pain to do anything but curl up in a hole when my surgeon gave me the nonhelpful (and inhumane) answer. My friend INSISTED that I be provided with care, not insincere sympathy. Lucky for me, my friend is my age and doesn’t ‘medspeak’ otherwise the conversation may have bypassed me – that is the only caution I would ask you of which to beware… your friend must be both the right temperament AND appearance so that s/he protects your relationship with your practitioner rather than superceeds it. I wish I lived close enough to offer to be of service as your Friend/Advocate as you gather information and make your decision and engage in treatment. You probably don’t NEED the notes or advocacy the way I do, but having a witness… and their handwritten notes and observations – helps to keep balance in the consultation at times when the power balance is abused. My prayers – yes, my atheist prayers – are truly with you. Thank you for posting; I find comfort in your analysis and in seeing your determination, and I hope my tentative suggestion is helpful rather than annoying. May unlimited dog hugs always be with you!

    Reply
    • Dog is love! Thank you, Loretta, for your very good advice. I was thinking that very thing the whole time I was in that office, looking at that MRI and realizing suddenly that something must be done if I am not to have a permanently paralyzed arm. I was wishing like hell for this one person, the closest person to an actual friend that I have–I think she would actually be my friend if I let her in–anyway, if she were close I KNOW she would come to the surgeon visits with me. Hell, she even came to my last outpatient surgery with me, took me to her flat to recover (read: plied me with pain meds, wine, and horse movies:-D). To tell you the truth, I’ve been mulling over asking her to come to my new surgery, just to party afterward! (And take notes what the doctor said.)

      Actually I did a mental process that I learned somewhere, and what came up is that I have lost confidence in this particular spine surgeon and his team, so I am looking into other options. It’s hard for me to “critical,” because I was taught not to, but when someone is going to be cutting on one’s spine, one had better be critical.

      Thanks again, and take care❤

      Reply
  11. All my love to you, Laura. I had to laugh when you were describing the PA trying to talk to you in sixth grade language. I can’t stand that myself, yet alone, you, a physician! The arrogance is appalling at times.
    I love your writing and laugh out loud. You will be in my thoughts, dear warrior friend. Hmmm, scanning comment above.
    *whispers* let your friend in…you need someone right now..just a thought..*
    Sending love and light -CC

    Reply
  12. F*ck. Too much pain and suffering. Love you and pray for relief.

    Reply
  13. It would be so much easier if we could just get given robot bodies when our own start to fall apart. Then all we’d need to worry about is being well oiled and avoiding excessive rain to prevent rust…

    Reply
  14. I just wanted to dropped by and see how you are Enough about me,so how is it going
    How gave you been feeling
    Hang in there
    Stay focused
    Big hugs
    As always sheldon

    Reply
    • At this moment I am camped in a juniper-piñon-Ponderosa pine forest about 10 miles from the Grand Canyon, so other than the outrageous pain I’m doing pretty well. Had a heart attack on Monday, the third, one of these will be the last.

      Love and great light back,
      L

      Reply
      • What are you talking about
        A heart attack
        No you didn’t
        Please tell it’s not ture
        Big hugs

        Reply
        • So interesting, you’re the second of my blogging special friends to say that. And you yourself, nearly squished up like an accordion! So yes, a heart attack. That happens. To me, it has happened now three times. So since I don’t want CPR and all that kind of shit, I don’t call 911. Not that I could, anyway, because the pain and pressure has me completely nailed down. I can’t move till it’s been over for quite a while. Hours. But nothing to do about it, so.

          Reply
          • Oh Laura
            The spirits didn’t want me just yet
            The Dr couldn’t really find anything really wrong with me
            They were upset
            So they sent me home with all this medicine that will supposedly cure me of all the things they think that are wrong with me
            But let me just say these Dr have been trying for years to come up with a diagnosis for me
            And they still can’t figure it out
            Normal is too good for me
            Is the dog sitting on your chest
            Or are you really waiting for your number
            Because if you would like we could wait together,I mean I could hop rite on over
            Just as soon as I stuff my brains back I to my head
            Love you Laura
            Please take it easy
            I will send you lite and love
            The Sheldon Perspective

            Reply

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