When Your Medical Practitioners Don’t Believe You

I just read this blog post, and it reminded me of so many experiences I have had with medical practitioners.  Bad experiences.  Frustrating experiences.  I’ve been meaning to blog about them for a while now.  I guess this is the impetus to do so.

As Lisa recounted her negative experiences with medical professionals, I flashed back to some of mine:

The doctor who told me, “I’m not saying it’s all in your head, but…”

The doctor who angrily asked me what I wanted from her, and angrily snorted when I responded, “Improved Quality of Life!”

The doctor who didn’t know what exactly was wrong with me, but wanted to give me Prozac to make me “easier to deal with.”

The medical practitioners (plural) who have endangered my life by prescribing medications that could cause a patient with my (known) condition to have a stroke.

The PA who simultaneously prescribed TWO medications that could give me a stroke, even though I pointed this out to him.

The pharmacist who wanted to fill these prescriptions, even though I pointed this out to her.

The doctor who prescribed a medication that caused me to lose one year of my life to clinical depression.

The doctor who refused to help me titrate off of this medication ( a gradual decrease of dosing; required in this case because stopping cold-turkey could induce seizures).

The multiple doctors/PAs who ignored symptoms that “didn’t fit.”

The multiple doctors who refused to believe that I had torn ligaments in my arm, and would not refer me for MRIs, which led to me almost losing the ability to use my wrist for the rest of my life.

I used to fly an  Air Force jet worth over $600 Million.  I was trusted to safely fly that aircraft, conduct sensitive missions, and keep all of the personnel onboard safe.  But healthcare practitioners treat me like an idiot, despite the fact that I frequently know more about my specific conditions than they do.

I respect the health care providers who say:

“You know more about this than I do.”

“You are the expert on your own body.”

“You have become your own specialist.”

“I will refer you to the specialist you are requesting, because this is beyond my area of expertise.”

I do not respect the ones who say:

“You don’t know what you’re talking about.”

“You couldn’t possibly have that.”

“I’ve never heard of that.”  (“And I don’t want to learn about it”… is implied by their actions.)

“You don’t need a specialist, I can treat this myself.”  (Usually followed by prescribing the medications that can give me a stroke.  NEWSFLASH: You don’t know as much as you think you do, and you’re gambling with MY health!)

“I don’t think the medication I prescribed is responsible for that (known) side effect.  Just give it a while longer to take effect/take these other medications to treat all of the many side effects.”

And recently, as I have explained to multiple doctors/PAs/Nurse Practitioners that I have found recent research that seems to explain EVERY ONE of my symptoms, and therefore I believe I have found my diagnosis:

“I don’t believe that’s a real thing.”  (As if ignoring research will make it go away.  If we all choose to “not believe” in cancer, will it go away?  No?  Well, then, neither will my condition.)

I have had 15+ years of frustrating experiences with Tricare, as my health condition has declined from chronic to chronic, debilitating.

I cannot work, and I cannot continue my education.

When I was healthy, I thought that doctors were like mechanics: If you “got broke,” you went in and they fixed you.

I have learned that sometimes when you get broke, it can’t be fixed.  And sometimes, doctors don’t really care if you get fixed – they get paid to see you for 15 minutes, or perform a specific procedure, NOT to think, question, or improve the patient’s quality of life.

I know that there are good healthcare providers out there.  But I haven’t met very many of them.

Bottom Line: In my experience, most healthcare providers are neither capable, nor desirous, of working with patients who have complicated health problems.

What It’s Like to Have a Visual Migraine (Scintillating Scotoma)

[This video, created by the Mayo Clinic, shows one representation of what a visual migraine, or scintillating scotoma, can look like.  Not all scintillating scotomas look like this, and they are not always associated with a migraine.]

WARNING: If you have no history of migraine headaches and you experience a scintillating scotoma, you should see your doctor, as this can be a sign of a serious health condition.

Scintillating scotomas are pretty trippy.  I’m glad I had read about them before one ever happened to me, or I might have been very concerned the first time I had one.

For people who have migraine with aura, there are other physical symptoms that go along with the excruciating headache.  A migraine is NOT just a “really bad headache” – it is a neurological event that can manifest in many different ways, such as cognitive impairment (brain fog) or dysfunction (unable to remember words); numbness, weakness, or tingling of body parts; balance and coordination problems; nausea; vomiting; fatigue; sensitivity to noise, light, odors, or touch; etc.

Please do not violate Wheaton’s Law and tell someone who suffers from migraines that you “sometimes get really bad headaches too.”  But I digress…

One symptom of migraine aura that some people are familiar with is visual disturbances.  These can be pretty spectacular.  [See some examples here. (No product endorsement implied.)]

Although I have had migraines for more than 15 years, I have only had 4 scintillating scotomas.  (In other words, it is not a common part of my migraine aura symptoms.)  The last two I have had happened while I was using my computer.  They began with slight blurriness – I wasn’t sure if my eyes were just tired, or my glasses were smudged, or something.  The blurriness starts out in a very small area, maybe the size of a dime in my field of view (but just on one side).

As I am determining what is causing the blurriness, I begin to notice that it’s actually a small blind spot.  And then when it begins to shimmer (usually at the same time I’m noticing the blind spot), I know for sure that I’m beginning to experience a scintillating scotoma.

Again, everyone’s experience is a bit different, but mine typically begin near the bottom of my field of view, and gradually the affected area expands and also moves slowly from the bottom of my field of view to the top of my field of view, then moves so far up that I can’t see it anymore.

I have experienced scintillating scotomas in each eye (they’re actually happening in my brain, but I’m describing the visual representation I perceive), but my scotomas never appear to be in the center of my field of view, or as if they are affecting both eyes at once.

In addition to the increasing blind spot and surrounding shimmering, I typically see jagged, zigzag designs around the perimeter of the spot.  My last scotoma was more bold geometric shapes than zigzags.  This portion of the image is colorful (reds, blues, greens, yellows), whereas the shimmery part is white/silver.

People who experience scintillating scotomas often describe the shape as a “backwards C.”  And I have had scotomas shaped like that.  But I think the shapes can vary.  My last one seemed more circular, with the shapes all the way around it, rather than just on one side.

The scotoma itself is not painful, in my experience.  Of course, it does disrupt whatever you are attempting to do visually.  (I had my first one right after sliding behind the steering wheel of the car one day – just sat there at the side of the road until it passed.)

The first two I experienced only lasted 10-15 minutes, but the last two have been closer to a half hour.  I find that I can see them better in the dark, and they’re really entertaining to watch (I guess I’m easily amused), so I now go into a dark room, lie back, close my eyes, and watch the show.

Of course, I typically get a raging migraine headache afterward, so I also take my migraine treatment medications at the beginning of the scotoma experience.  That’s trippy too – try walking through your house to get to your medicine cabinet with a blind spot in your field of view and possibly some balance issues too.  Then try finding your meds and taking them when you can’t really see what you’re doing due to an enlarging blind spot.

After a scintillating scotoma, some people get migraine headaches, some people don’t get the headache every time, and some people feel very weak or tired.

After the event, my vision returns to normal, although everything may seem a little blurry for a little while right afterward.  Since it’s actually happening in your brain, there are no effects on your actual eyes.

During my most recent scotoma, the headache actually started during the scotoma, and my tinnitus got very loud as well during the scotoma, but then decreased significantly afterward.  After the shimmering part and the colored shapes had disappeared, I still had a blind spot for about 5 minutes.  Then some general blurriness, and then my vision was basically normal, although I was very light-sensitive due to the migraine.

Again, blind spots can be caused by other things, such as a retinal or optical nerve issue, so please talk to your doctor if you experience a scintillating scotoma, or a non-scintillating scotoma.

But if you experience scintillating scotoma as part of a migraine prodrome, you can probably just take your migraine treatment drugs, relax, and enjoy the show before the headache begins.  That’s been my experience, anyway.

What have your experiences with scintillating scotoma been like?

 

Survival Minimalism: What Falls Away

Minimalism.  It’s a trend/movement that’s been picking up steam for at least a decade.

People are attracted to minimalism for many reasons.

Some accidentally – they travel with just a backpack, and decide life is better with less baggage.  But some become minimalists out of sheer survival – because their health is so poor they just can’t continue to live life the way they used to.

A smaller house/apartment, fewer things to maintain – choosing to downsize can make life easier to handle logistically and financially.  It can also make life easier to handle psychologically.  But, in many ways, shedding possessions is the easier course of action.

Shedding commitments is much more difficult.

Duty.  Responsibility. Taking Care of Others.  Social Responsibility.  Civic Duty.  Family.  Friends.  Job.  Church.  Volunteerism.

We are so busy, in our current culture.  We pride ourselves on how busy we are.  We compete with others over how busy we are, as if that is a symbol of our worth.  We are human doings, not human beings.

Until.

Until we get the news, or the diagnosis.  Until something happens that alters our priorities and shifts our perspective.

Until we remember that the privilege of being is the most important thing.

For a very long time, I tried to keep doing all the things.  I got sicker and sicker because I tried to power through it.  I “couldn’t afford” to be sick.  I needed to fulfill my responsibilities at work – one hundred percent or more.  I  had to fulfill my commitments to my family, and friends, and to the organizations for which I volunteered, and to the kids I mentored, and, and, and…

And then I woke up one day and couldn’t do ANY of the things.

I couldn’t keep the plates spinning anymore.  And they slowly started crashing to the ground…

I fought it for a long time, even after that.  “I can’t keep them all spinning, but I should be able to keep these three spinning.”  CRASH!  “Surely I can keep these two spinning.”  CRASH!!  “Come on! I can keep at least ONE spinning, right?”  CRASH!!!

And then I wallowed, frustrated and unwilling to believe that I could do NONE of the things.

But facts do not change simply because we do not like them.

And the fact is that I am currently dealing with either severe allergies or an auto-immune disease (or both?).

And suddenly life is becoming much more simple, due to survival minimalism.

I used to find it very difficult to get rid of papers and books.  Although I have been trying for years to downsize and become more minimalist, books and papers were the challenge for me.

I love books.  I love physical books.  I have resisted getting an e-reader because I like to hold books in my hands, and write notes in the margins, and highlight important parts of them, and even mark reference sections with book darts.  Book darts.

I once lived out of a backpack for a year – worldly possessions in storage, traveling the world.  Know what I missed?  My books.

But now… I am allergic to book mold.  And possibly to dust as well.

And, suddenly, old books and old papers cause an allergic reaction that makes me ill – for days.

So now I am parting with books, and reducing the papers (currently in binders, and in filing cabinets, and in stacks).

I will most likely purchase a high-quality scanner, to save some of the information on those papers, and an e-reader, to replace some of those books.  And, although parting with the books makes me sad, it also feels like freedom.  I don’t dither anymore over whether to keep a book or a document.

It has become very simple: It all must go, because it makes me ill.

The same thing is happening with my diet (post pending).  I have passed through the mourning period for all the foods I can no longer have (pizza commercials were torture!).  Now I can watch food commercials on TV with disinterest.  Easy to do, when you know eating it will make you sick for days…

Likewise for social obligations.  Initially, I felt guilty for all the obligations I could no longer fulfill.  But the current reality is that I can’t leave my house without getting ill.  The outside world is BRIGHT, LOUD, and full of FRAGRANCE.  Not to mention ALLERGENS.  So, if it’s not critical to my health (doctors’ appointments), I’m not leaving the house.  Sorry, not sorry.  You’re welcome to come visit me, if you’re not wearing FRAGRANCE (that includes scented laundry detergents and fabric softeners).

It’s getting all Oregon Trail up in here.

Remember playing Oregon Trail, and starting out with all the items you thought were essential, but jettisoning more and more of those items as the trip went on?  Survival Minimalism.

“But that’s a Family Heirloom!” “The Indians are gaining on us – toss it overboard!”  “But that has sentimental value!”  “The oxen are too weak from thirst – leave it by the side of the trail.”  Survival Minimalism.

Priority Shift.  New Perspective.  Life suddenly becomes very simple.

Do.  Or Do Not.  It has become a no-brainer.

I’m letting go of the things that make me sick.

I don’t “should” on myself anymore.  I do what I can for others, and I let the rest go.

The world rushes on past, in its busyness, and I am here, in my quiet eddy, learning how to be.  Striving to be…healthy.

It’s a crucible, and all the non-essential things are being burned away.

Survival Minimalism.  It’s not for everyone, but it might be for you.

Medical Procedures: Trigger Finger (Steroid Injection) Update

Update: I developed trigger finger in the same pinky finger approximately 10-11 weeks after elbow surgery (approximately 8 months after the first steroid injection), when the post-surgery therapeutic exercises began to put more strain on my finger.  I mentioned to my occupational therapist (OT) that my pinky finger was swollen and stiff, and that the joint near the top of my palm (the metacarpophalangeal joint) was very tender, sore, and warm to the touch.

My OT remembered that that was the same finger in which I had previously had trigger finger, and made an appointment for me with my orthopedic surgeon to get another steroid injection.  My ortho injected the joint approximately 12 weeks post-surgery, and said that if trigger finger comes back a third time, he would consider a surgical treatment.

Hopefully this will not be necessary, as my third New Year’s Resolution, which I did not share with you, is “No Surgeries in 2017!”

Some Thoughts on Medical Botox for Migraines and the VA

Last April, I received Botox injections for the first time to treat my migraines.  Last week I received my fourth series of shots.  Which means that when this cycle ends in April, I will have been receiving Botox injections for one year.

I had some trepidations before my first Botox injections.  But I was also hopeful that they would prevent my migraines, or at least give me some relief.  As it turns out, Botox does give me much better quality of life – for part of the quarter.

As I have mentioned before, the effects of Botox do not last a full 12 weeks for some patients.  But it could be worse:

Approximately 30% of patients with chronic migraine headaches do not respond to Botox.  For them, Botox does not provide significant relief.

Although I am VERY GLAD that I am NOT in the category of patients who do not respond to Botox treatment – i.e., for some people Botox does not seem to affect their migraines, and they get no relief – I am frustrated that the effects of Botox only last for 8-9 weeks of the 12 week cycle for me.

For me, the effects wear off 2-3 weeks before the end of the quarterly cycle, and then it takes another week to stop feeling bad after I’ve gotten the next series of shots.  So I only get relief for 8-9 weeks of the 12 week cycle.

Considering that Botox works better than any of the many, many other medications I’ve tried to relieve migraines, I am very glad that it does work and that I have decent quality of life for 2 months out of every three.

But it is so frustrating to know that I could feel better all the time if the VA would just allow a shorter interval between shots.

It takes about a week for the Botox to have full effect.  Not only do I stop feeling crappy, but my forehead stops responding when I try to move my eyebrows.  My forehead muscles are locked down, and nothing moves.

Toward the end of the cycle, I start testing my forehead muscles.  Once my eyebrows start to move again, I know the Botox is wearing off and I am going to start feeling crappy again.  The more my forehead muscles move, the less benefits I am getting from the Botox, and the worse I feel.

And there’s nothing I can do about it.

It is such a helpless feeling to know that the medication that allows you to function is wearing off, and you can’t have any more for weeks.

Can you imagine telling a patient with any other disease or condition that they must wait and suffer without medication for nearly one month each quarter?  It’s inhumane.

So today I sit and wait for the Botox to work its magic.

It’s hard to describe migraines to people who don’t have them.  It’s not just “a really bad headache.”  While the headaches can be excruciatingly painful, they are not the only symptom.  Migraines are a neurological event, which means they can affect the central nervous system, the cardiovascular system, and the vestibular system.

For me, on a bad migraine day I can’t think, because of the brain fog.  I will not be able to remember to do simple things like take my medications/supplements.  Food doesn’t taste good, and I will not be interested in eating.  Sometimes I will have nausea.  I will be incredibly sensitive to light and sound, and they will feel painful to me.  Flickering light is especially painful, and might even affect my sense of balance.  I may be dizzy and light-headed.  Smells are also very strong and unpleasant.  Even on a “good” day, if someone touches me and the odor of their perfume or cologne gets on my clothes, I will have to go home and change my clothes, or the odor may give me a headache.  If it gets on my skin, I will have to wash it off.  My senses are heightened, and sounds, smells, or light that you don’t notice can be unpleasant or painful to me.  Also, my blood pressure is higher on a migraine day.

Some people, like me, also experience migraine “with aura,” meaning that because you have migraines, you have other weird stuff happening too.  Sometimes the other weird stuff happens before a migraine headache, like a warning, and sometimes the weird stuff happens, but you don’t get a headache.  Some examples include scintillating scotomas (a visual disruption), paresthesia (a tingling or numb sensation in a part of your body), or aphasia (an inability to speak or remember words).  It is not uncommon for these symptoms to be confused with a stroke.  You may have seen this reporter having an episode on-air a few years ago:

So what this means is that, when my Botox wears off and I have to wait weeks for another dose, and a week past the injections for the Botox to take effect, I am not just experiencing a headache for which I can take pain relievers, tough it out, and go on with my day.

No, what I have is cognitive impairment (brain fog) so severe that I cannot accomplish basic functions like taking my medications.  I may forget if the dog is inside or outside.  I may forget I have a dog.  I won’t have an appetite, and may vomit, but if I do try to prepare food, I may forget to turn off the stove afterward, or I may forget the food is on the stove cooking.  If I try to speak, I may not be able to remember words or form sentences.  I may have intermittent balance problems, or I may have vertigo so severe that I cannot lie down (everything spins harder), and can only go down stairs on my butt, like a toddler.  NO WAY could I operate a car like this.  Every light in the house will be off.  Every curtain or blind will be closed.  And until it passes, I will be unable to do anything.

So, even though the Botox treatments give me 8-9 weeks of much-lessened symptoms (there are still bad or unproductive days), feeling the Botox wear off and knowing that I will descend back into that pit for 3-4 weeks is a horrible, frustrating, helpless, and unnecessary feeling that I wouldn’t wish on anyone.

To give someone relief and then take it away due to bureaucratic or monetary restrictions is cruel and inhumane.

The nurse practitioner who gives me the injections every quarter tells me he understands that the Botox doesn’t last as long for some patients, but he cannot shorten the interval unless VA policy changes.

Here are the VA guidelines I can find:

http://www.va.gov/purchasedcare/docs/pubfiles/policymanuals/champva/chapter2/1c2s22-5.htm

I have not been able to find the VA publication that includes the specific approved interval for Botox shots and the underlying justification.

Meanwhile, having just experienced the end of my Botox cycle again, I decided to highlight on my calendar the weeks that I will be unable to function at the end of this Botox cycle.  That way, I will know not to plan anything for those 3-4 weeks.

It’s a really weird feeling to plan for being incapacitated.  And it’s almost impossible to explain to others that I will not be capable of doing anything during those weeks – that I know about it in advance, and there’s nothing I can do about it.

You’re not supposed to be able to schedule being sick.  It’s something that normally happens unexpectedly.  And, in our culture, when that happens you heavily medicate yourself and try to go on with your normal schedule anyway.

Since most people don’t understand chronic illness, there’s no way they’re going to understand episodic chronic illness.

But since the VA (and many other healthcare providers) will only approve a twelve-week interval for migraine treatment Botox injections, I will have to schedule around the weeks I know I will be incapacitated.

This cycle, that includes Easter.  I will be doing nothing for Easter this year – just hiding in a dark, quiet house and praying for my next shots like a heroin addict.

2017 New Year’s Resolutions

In the spirit of mindfulness (or contrarianism), I don’t do New Year’s Resolutions “just because.”  Because it’s tradition; because it’s expected; because everyone else is doing it.

Many years I don’t make any New Year’s Resolutions.

 One year my resolution was the direct opposite of what most people do – a resolution to start a particular vice.

Although I was inclined not to make any resolutions for 2017, after reflection I have decided I have two:

  1. To get back to the practice of daily yoga and meditation; and
  2. To eliminate BS from my life.

I started 2016 with daily yoga and meditation, and definitely benefitted from it, but the wrist surgery ended that habit.  However, wrist rehabilitation has progressed to a point that I can resume (restorative) yoga, and the elbow seems like it will heal quickly, so I’m going to commit to a daily practice of  healing yoga – but not putting any more weight on that arm than my occupational therapist allows.

Daily yoga and meditation relaxes me, improves my flexibility, and makes me more mindful.  The breathing exercises give me a tool that enables me to release stress throughout the day as I encounter stressful situations.  And I hope that as I regain function in my left arm, I will eventually be able to use yoga to build strength as well.

Regarding the second resolution, well, that’s the result of several years’ worth of experience and reflection.

I have been reading minimalism blogs for about the last five years.  Simplicity blogs.  Tiny house blogs.  Minimalist travelers’ blogs.  I aspire to live a life that has less drag – less “stuff” weighing me down.  Less to clean.  Less to maintain. Less to haul around.  Less to insure.  Less to organize.

After retirement, Spousal Unit & I moved to a home that was 40% of the size of our last home in the military.  We sold stuff, and donated stuff, and packed and moved stuff, and cursed the burden of our stuff.  Despite that, we still have a lot of stuff.

I have read practically every technique or suggestion for how to get rid of stuff.  Except Marie Kondo’s book, The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing.  This book was sweeping the minimalism/simplicity blogs a while back.  I read all about other bloggers’ experiences of applying her book to their lives.  The basic premise, as I understand it, is to collect all of one type of your belongings (clothes, books, etc.), see how many you have, and then pick up each item individually and ask yourself whether that item “sparks joy”.  If not, you should eliminate it.

No offense to Ms. Kondo, but her approach just didn’t resonate with me.  I was looking for an approach that just made intuitive sense to me, an approach that was simple but got at the psychology behind my behaviors.  For many people, Marie Kondo’s techniques – “the Konmari method” – does that.  But it didn’t do it for me.

And then one day I read an article about getting rid of B.S.  Shazam!  That was my lightning bolt.

If ever there were a simplification technique that would resonate with veterans, this was it.  Just ask yourself:

“Is this B.S.?”

If the answer is “Yes,” eliminate it.

I don’t care if it sparks joy, but I am all about eliminating B.S.

In fact, the longer I thought about it, the more I appreciated the simplicity and directness of this approach.

Engineers appreciate the elegance of a solution.  An elegant solution is simple but sufficient.  It solves the problem efficiently.  The often-cited maxim of elegant design, from aircraft designer and author Antoine de Saint-Exupery, states: “A designer knows he has achieved perfection not when there is nothing left to add, but when there is nothing left to take away.”

A truly elegant solution also has broad utility.  Eliminating B.S. can apply to getting rid of possessions.  But it applies even more so to emotional baggage, perceived social obligations, and peripheral tasks that eat away at your time (a.k.a. “queep“).

The Pareto Principle, also known as the 80/20 Rule, observes that “the majority of results come from a minority of inputs,” or put another way,  80% of the results/output/profits comes from 20% of the work/employees/customers/etc.  Thus, management experts enjoin us to focus our efforts on the inputs that get results, and spend less resources on the inputs that have diminishing marginal benefit.

In other words, eliminate the B.S.

So my second New Year’s Resolution for 2017 is to eliminate B.S. from my life.  I anticipate that as I do so, I will write about it here, in a series of posts.  I hope you will join me.

Comms Check

Hey, this is just a quick post to say:

I’m still here.

This is the last weekend before my next round of Botox shots, and I feel like absolute rubbish.  There is a new post on the way, but it’s not gonna happen until the Botox takes effect and I get my brain back.  Sorry.

[Of course, I am assuming that anyone is reading this blog…  Since I don’t get much feedback, it’s hard to know whether anyone is reading it.]

In other news, the elbow surgery appears to have gone well, and the surgeon didn’t lie when he said this recovery would be much easier than the recovery from wrist surgery was.  It has been 4 weeks since my elbow surgery, and I have been pleasantly surprised at how non-eventful this surgery has been.

My arm was only immobilized for 2 days after elbow surgery, as opposed to 6 weeks after wrist surgery.  I was permitted to drive as soon as I had no narcotics in my system, whereas with the wrist surgery I couldn’t drive for 8 weeks.  Taking a shower was no big deal.  And I didn’t even have to shower with a limb in a garbage bag this time.

I am very grateful that this surgery has been so much easier to recover from.  It also seems to have relieved the elbow pain that I have had for the past 3 years.  There may still be a slight catch in the range of motion, but we’ll see what happens – maybe occupational therapy will take care of that.

So, if anyone is reading, the elbow surgery went very well, but migraines are currently kicking my butt.  And I hope to have new content up in a week or so.

Here’s to good health,

Crew Dog

 

Ending 2016 with More Surgery

I am headed for surgery on December 14th (Wednesday).  This time for the elbow.  We’re not sure what’s wrong with it, exactly.  The symptoms are obvious, but the exact diagnosis is not. [At least, to me.  My surgeon might disagree, but then perhaps he should explain things better.]

The elbow hurts (all the time), and does not want to fully extend.  It would catch before the arm reached full extension and wouldn’t go any further.  Sometimes I could eventually get the arm to fully extend after multiple attempts.  The doctor gave me a steroid injection in the elbow joint, and now I can fully extend my arm (very slowly, and I have to wait for it to clunk into place).  None of the other symptoms were cured by the injection.

There is also a great deal of crunching and popping when I extend my arm.  The confusion lies in the fact that my elbow area snaps upon extension.  My surgeon thinks that I may have a snapping triceps, but that is supposed to happen upon flexion, although this journal article says it could happen in either direction.

Elbow 101: This website explains the basics of elbow anatomy and function.

My hand is also still swollen, with some numbness and lack of strength.  February will be three years since the original injury.  My hand has been swollen for nearly three years.  It is also discolored – compared to my healthy hand, it looks bluish-purple and darker.  The forearm does also.

The MRI resulted in a diagnosis of “tennis elbow” (lateral epicondylitis).

The EMG/CNS was inconclusive.  Based on my symptoms and physical examination, the surgeon is planning to do two or three procedures: 1) percutaneous tennis elbow release; 2) transposition of the ulnar nerve; and possibly 3) correct the snapping tendon if it is, in fact, snapping.

Here are explanations of the three procedures:

Explanation of percutaneous release from Cochrane.org:

Surgery on your elbow can include making a small cut in the arm and trimming damaged tissue from the tendon that joins the extensor carpi radialis brevis (ECRB) to the bone in the elbow (called an ECRB tenotomy), or releasing the tendon from the bone with a scalpel (called an ECRB release). The tenotomy may be done ‘percutaneously’, with a much smaller (1 cm) incision in the skin, or arthroscopically from within the joint.

Transposition of the ulnar nerve (Hughston Clinic Orthopaedics):

The procedure is performed under general anesthesia or with regional anesthetic. The ulnar nerve area is located and cleaned with an antiseptic solution.  A small incision is made around the medial epicondyle and the surgeon will locate the ulnar nerve.

This nerve is then moved out of its location under the medial epicondyle and placed in a more superficial area on the front the medial epicondyle. This new position may be directly under the skin or may be within a muscle. This process of moving the ulnar nerve out of the groove under the medial epicondyle into the front of the epicondyle is called anterior transposition.

Transposition of the ulnar nerve remedies ulnar nerve entrapment.  There is another good discussion of ulnar nerve entrapment here.

This video includes a discussion of ulnar nerve transposition, as well as actual footage of the surgical procedure.  I don’t think it’s very gory, but if you’re squeamish, you may want to only watch the first part of the video.

The next video shows some footage from a snapping triceps surgery.  I think it is a bit gorier than the previous video, so you may not want to watch it if you don’t like the sight of blood and the inside of human beings.  However, I think seeing the internal mechanisms in motion is fascinating.

This surgery will be my third on this arm: shoulder, elbow, and wrist will all have been repaired.  At this point, I’m wondering if I should have opted for a bionic arm, or perhaps a robot arm like Luke Skywalker’s.  Again, I reiterate the hazards of slip and fall injuries!

Bottom Line: I will be NMC (not mission capable) through the end of the year.  I’ll let you know in 2017 how the elbow surgery went, and what the surgeon found when he looked inside.  

Here’s hoping 2017 is a year of increasingly better health for everyone.

Guest Post: What It’s Like To Try Acupuncture And Cupping

This week we have a special treat – a guest post from Doug Nordman a.k.a Nords, from The Military Guide.  He’s sharing with us his experiences with medical tourism.  He bravely (or foolishly?) underwent acupuncture, cupping, and moxibustion in Thailand.

Remember the Olympic swimmers and their purple dots this past summer?  That’s what you look like after cupping.  To learn more about these procedures, and medical treatment abroad, read on:

Thanks for inviting me to write about these treatments, Crew Dog!

I’m a 56-year-old retired U.S. Navy submariner. As a “recovering nuke,” I’m skeptical about alternative medicine. Before I believe in a medical technique I want to read a pile of peer-reviewed reproducible studies of double-blind experiments with statistically significant evidence– and acupuncture just isn’t there yet. If acupuncture achieves anything at all, it might be simply a gigantic placebo effect.

However I’ve lived in Hawaii for over 25 years, where Occidental and Oriental cultures overlap with science and technology. I’ve learned to keep an open mind when I encounter treatments which defy the explanations of medical research.

My physical therapy for joint injuries has taught me that Western medical science doesn’t always have a precise explanation for why a technique works. I’ll enjoy the results whether or not I fully understand the mechanisms. If acupuncture is simply just a gigantic placebo effect then I can live with that.

I’m also willing to try new approaches because I’m a little frustrated with my aging body. I’m encountering new limits in my maximum heart rate and recovery time. When I was in my 40s, I used to burn through the Navy’s physical fitness test and then go work out. These days, after that type of exercise I’m tempted to burn through 800 mg of Ibuprofen and take a nap. When I do a couple hours of heavy yard work, I have to be careful to maintain good posture in my knees and my back – I don’t want to end up in another round of physical therapy.

My body’s latest betrayal is my left shoulder (deltoid) muscle. Over 10 months ago I felt a small “pop” during a push-up set, and the next day I couldn’t raise my left arm above my shoulder. It slowly healed over the next six months but I kept re-injuring it. When we traveled to Bangkok, I still didn’t have full range of motion and I couldn’t put my left hand up behind my back. I was worried that I’d injured my rotator cuff and I felt like an idiot.

Thailand’s cost of living is incredibly cheap, and Bangkok’s major hospitals are a magnet for medical tourism. My spouse and I had heard about the Traditional Chinese Medicine Clinic of Hua Chiew Hospital, and we were happy to spend a few dollars to experiment on my deltoids.

Hua Chiew is definitely not practicing traditional Western medicine: the hospital takes walk-in patients. The lobby was a beehive of activity with a large waiting area by the cashier’s window. The clerk at the front desk explained (in English) that a typical acupuncture treatment would be less than 600 baht. (At 35 baht per dollar, that’s just over $17– and nobody asked us about insurance.) He entered our names into their computer system. We stopped by the next table for a quick health check of height, weight, temperature, and blood pressure before being sent up to room 504.

The fifth floor was quieter, with a few patients in the hallway and a family in the waiting area. When I walked into room 501’s open ward, it smelled like old cigarette smoke– and marijuana. (Hey, I have a training certificate from a 1980s Navy drug education class with a “test burn”.) I was greeted by an acupuncturist and an assistant who asked me where it hurt. A few minutes later the assistant was guiding me to an exam table.

“This won’t hurt a bit.”

I was asked to remove my t-shirt (which the assistant quickly hung on a hanger) and arranged on my right side with my left arm extended across a pile of pillows. While the assistant set up the privacy curtains, the acupuncturist came up behind me with a tray of needles and other tools. (Selfies were discouraged during this procedure, but I took photos afterward.) I turned my head to watch, but she politely asked me to relax on my pillow so that she could put needles into my neck.

She swabbed my skin with antiseptic and opened a package. Each needle was about three inches long with tiny coils at their gripping end, and they seemed very delicate. They must have been extremely fine and sharp because I could barely feel them going in– just a cool sliding sensation as she inserted them about an inch. My skin didn’t even dimple as she gently and quickly placed them from neck to elbow. A minute later I had a dozen needles sticking out, and she suggested that I should stay still. She even put two needles in the side of my left calf, explaining that there’s a nerve connection to the shoulder.

Then the assistant brought out a power supply and an electronics box. I later learned that this was an electrical muscle stimulation system, and the acupuncture needles make it easy to deliver the electrons directly to the injured area. She wrapped electrical wires around two of the needle coils and flipped a switch. My deltoid promptly started twitching gently, about once per second. After she checked the electronics display, she brought out an IR heat lamp and positioned that over my left shoulder. She said she’d check on me in 30 minutes and gave me a call button to push if I had any problems.

I stayed as still as I could despite being a human pincushion with my shoulder twitching like a frog leg in Dr. Frankenstein’s high-school biology class, while the lamp heated my shoulder (and the metal needles). It must have looked extremely uncomfortable.

A few minutes later I dozed off.

Judging from the assistant’s polite smile when she woke me up, this must happen a lot.

Well, technically my deltoid kept twitching while the rest of me had a very nice nap. When she turned off the machine, my entire shoulder relaxed.

She gently extracted all the needles that they’d inserted. (I kept count just to make sure.) I could barely feel the sliding sensation as they were removed, but there was no pain.

Then she picked up a tray of heavy glass cups, and I realized that I’d signed up for a bonus cupping session after the acupuncture.

Cupping

The assistant laid out a dozen cups of various sizes. They were each about 2”-3” tall and 1”-2” in diameter, made out of heavy glass. She rubbed a light coat of oil over my shoulder and back (to get a better seal).

Next she used her forceps to pick up a cotton ball and dip it in a liquid that looked like alcohol. Then she picked up a cigarette lighter, set the cotton ball on fire, and walked over to my shoulder.

An open flame. In a hospital. In a ward where there were probably oxygen canisters near more flammable liquids and oily skin. With a submariner who used to teach firefighting tactics at a training command.

I was not happy.

It turned out that the flaming cotton ball heated up the cups (and the air inside them). The acupuncturist briefly warmed each cup over the flame and then gently slapped them down on the skin that had held needles. As the air in the cups cooled and contracted, the suction drew the skin up into the cups and held them in place. A few cups were pried off and re-applied for a better seal.

As the skin on my shoulder and back was pulled up into the cups, I could feel a warm tingling as more blood was pulled up into my muscles. Several minutes later the assistant released all of the cups (with a wood tongue depressor) and wiped the oil off my skin.

The acupuncturist asked me to sit up and move my arm around. It was still warm from the treatment, and the deltoid felt particularly loose. I was happy to discover that I had much more flexibility and no pain. Wonderful!

When I checked my shoulder and back in a mirror, it looked like I’d lost a grappling match with an octopus. (This picture was taken an hour later.) The acupuncturist reassured me that the bruising would fade in a few days. In my case, the marks took nearly three weeks to disappear.

after-cupping

What happened to make my arm feel so much better?

According to traditional Chinese medicine, my body’s qi had been manipulated by the needles and the cups to bring more healing energy to my damaged deltoid.

Western medicine claims that my muscles had been stimulated by electricity, bringing more blood and lymph fluid to help repair the microtears. The heat and the cupping had brought even more blood into the muscle and skin, causing more bruising yet supplying more healing fluids. My body would focus greater effort on repairing damage in that area, which would also accelerate repairs to the deltoid muscle.

And, of course, the hour’s performance had kicked my placebo effect (and endorphins) into overdrive. No wonder I felt so good.

I’ll leave that debate to the doctors. Whatever happened during that hour, the pain relief (and the greater range of motion) was worth every penny of $17.

When I paid the bill at the cashier’s desk in the lobby, it was more like $16.75. My smartphone’s Google Translate software wasn’t much help here, but if you read Chinese or Thai then please feel free to share the details.

hua-chiew-invoice-and-patient-card

Followup

As I left the fifth floor, I was handed a small appointment card and admonished to return in three days for more treatment. My spouse and I got busy with other activities (there’s a lot to see & do in Bangkok) and we returned in nine days. When we walked in (still no appointment necessary!), the front desk checked our cards and started the routine again.

When I walked back into room 501 it still smelled like marijuana. I confidently returned to my treatment table, hung up my t-shirt, and laid down for an encore of my last visit. The setup went the same and I was soon bristling with acupuncture needles, but they didn’t haul out the electrical box.

This time the assistant unwrapped a couple small paper packages the size of a section of a Tootsie Roll. Later I learned that they held a dried Chinese herb called moxa, and I was about to experience moxibustion.

She poked two of the herb bundles on top of two of the acupuncture needles… and then lit them with her cigarette lighter. I immediately realized why the ward smelled like marijuana smoke, only it was burning moxa.

moxibustion

As she pulled the privacy curtains closed, she asked me to push the call button if my deltoid got too warm. I soon realized that moxa burns just like tobacco and it was heating up the acupuncture needles. Those, in turn, conducted the heat straight down to my deltoid muscle. I wasn’t exactly getting first-degree burns, but it was uncomfortably warm under my skin. I gritted my teeth and vowed to wait out the moxa.

It must have worked because I dozed off again. The moxa stopped smoldering in 20 minutes and the assistant followed up with the heat lamp for another 10 minutes. They removed the acupuncture needles and commented that my cupping bruises were sure taking a long time to heal, but that was the end of the session!

This time I only paid 525 baht ($15).

Long-term results

We’ve been back on Oahu for a couple of weeks, and my left deltoid is completely healed. It could be qi or it could be targeted electricity and heat therapy, but the results are undeniable. I’m back to pull-ups and push-ups and reaching up between my shoulder blades. I’m also doing more stretching and taking it a little easier with the multiple sets, but now I know what a local acupuncture clinic (or the placebo effect) can do for me.

Either way, I’m happy.

Crew Dog: Doug usually writes about Financial Independence and Early Retirement, and how he did it on a military salary, at the-military-guide.com.  He’s also the author of The Military Guide To Financial Independence And Retirement.

Have you been a medical tourist, or tried alternative medical procedures? What were your experiences like?  Comment below.

Weekly Wrap-Up (28 November-2 December)

In case you missed it (ICYMI), here’s a list of the links that appeared on One Sick Vet’s Facebook page this week:

Monday: New Post!

Health Hack: How to Eat (Mostly) Healthy for Thanksgiving

Tuesday: Urinary Tract Infections (UTIs) and Dementia

“UTIs can cause a significant and distressing change in someone’s behaviour that is commonly referred to as ‘acute confusional state’ or ‘delirium’. Delirium is a change in someone’s mental state and usually develops over one or two days. There are different types of delirium and symptoms may include agitation or restlessness, increased difficulty concentrating, hallucinations or delusions, or becoming unusually sleepy or withdrawn. Symptoms of delirium vary in severity (fluctuate) over the course of the day.

It is important that family and friends who know the person well seek medical help if they see a sudden change in behaviour, to ensure that an assessment takes place.”

https://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=1777

Wednesday:

I don’t know what the heck happened to Wednesday’s scheduled post.  Gremlins.

Thursday: Airman Reflects on Cancer Battle

“Combs advises other men that knowledge is the best weapon against cancer and not to let the “macho” view of something abnormal going on to deter them from seeking help.”

http://www.af.mil/News/ArticleDisplay/tabid/223/Article/1008949/airman-reflects-on-cancer-battle-gives-back-with-passion-project.aspx

Friday: Liver Damage from Supplements is on the Rise

“A new review suggests that many herbal remedies and dietary supplements can also harm the liver, including some that you can easily buy online or over-the-counter in drug or health food stores.

The study also found that injuries linked to those supplements are rising fast, jumping from just 7 percent of all drug-induced liver injuries in 2004 to about 20 percent in 2014.”

http://www.consumerreports.org/health/liver-damage-from-supplements-is-on-the-rise/?EXTKEY=I175E000&utm_medium=paid_social&utm_source=keywee&utm_campaign=protect_privacy&utm_content=66-ways-to-protect-your-privacy-right-now&utm_keyword=desktop&kwp_0=272572&kwp_4=1054895&kwp_1=495899