Author: Crew Dog

Desert Storm era veteran. SAC trained warrior.

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.

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

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

I will confess that I am a foodie.  I love trying new foods (and beverages), especially when I am traveling.  But it doesn’t have to be a gourmet restaurant – I’m more of the food truck, street stall, Mom & Pop restaurant, diner type of foodie.  (I’m certainly not opposed to a gourmet dining experience – I’m just too frugal to do it often.)

But, as you can imagine, my recent allergen-elimination diet has had quite an effect on my foodie ways.  

Lately I’ve just been eating to live, getting little enjoyment from the same few bland foods.

However, I was determined to have a delicious Thanksgiving meal.  It was too depressing to think of forgoing the holiday treats.

On the other hand, I didn’t want to be sicker than a dog afterward either.

So, balancing taste and health concerns, here’s the Thanksgiving menu Spousal Unit & I created:

Cornish Game Hens

  • We weren’t having a crowd for dinner, and these are easier to cook than a turkey.  No seasonings – just basted with olive oil and butter and cooked in a rotisserie.
  • We select game hens that are NOT packaged in a flavor solution, as many meats are.  These flavor solutions often contain MSG, a known migraine trigger.
  • allergens: butter (milk/dairy)

Paleo Thanksgiving Stuffing

  • We delete the onion (hard to digest if you have gallbladder issues), mushrooms (prohibited if you have a mold allergy), and pecans (because I don’t like them).  We also substituted apple cider vinegar for the white wine vinegar (more flavor, lower in histamines).
  • Rather than using pork sausage, which often contains MSG, nitrates and/or nitrites (all known migraine triggers), we buy ground pork that is not packaged in a flavor solution, and add spices ourselves.  Melissa Joulwan’s book, Well-Fed, has great recipes for DIY spice and seasoning mixes.
  • We use uncured bacon (cured foods are prohibited if you have a mold allergy) with no nitrites or nitrates (which can trigger migraines).
  • We also buy chicken broth that contains no MSG (a known migraine trigger).
  • allergens: eggs; apples; celery

Paleo Sweet Potato Casserole

  • We delete the pecans/walnuts, because I don’t like them.
  • This dish satisfies the sweet potato craving, but is less sweet than traditional sweet potato casseroles.
  • allergens: eggs; apples; cinnamon/nutmeg/allspice

Maple Bacon Braised Brussels Sprouts

  • Spousal Unit hates Brussels sprouts, but will eat them prepared like this.  If you really REALLY hate Brussels sprouts, you could make Coconut-Almond Green Beans instead (if you can tolerate the spices).
  • We use uncured bacon (cured foods are prohibited if you have a mold allergy) with no nitrites or nitrates (which can trigger migraines).
  • allergens: butter (milk/dairy)

Cranberry-Orange Bread

  • We modify the recipe from a Betty Crocker cookbook.  Instead of using all-purpose flour (which contains gluten), we substitute 1/2 almond flour and 1/2 coconut flour.  This makes the bread slightly more dense (and crumbly), and gives it a slight coconut flavor.  We also substitute orange extract for the grated orange peel, because it’s easier.
  • allergens: gluten-free; butter (milk/dairy); eggs; orange juice (citrus); almonds (nuts)

[Dessert] Pumpkin Harvest Crunch

  • This year we modified the recipe we traditionally use, substituting 1/2 almond flour and 1/2 coconut flour for the yellow cake mix.  This reduced the amount of sugar and eliminated chemical additives in this dish.
  • Instead of canned Pumpkin Pie Mix, we buy canned pumpkin and add pumpkin pie spices ourselves.  This eliminates chemical additives.
  • This year, instead of homemade whipped cream (milk/dairy), we made Whipped Cream from Coconut Milk (recipe from James L. Gibb’s book, Is Food Making You Sick? The Strictly Low Histamine Diet).  We used coconut sugar to sweeten the whipped cream, and substituted vanilla extract for caramel essence.
  • allergens: gluten-free; eggs; almonds (nuts); cinnamon/nutmeg/allspice

[Alcohol]

You may or may not be able to drink alcohol.  Alcohol is not recommended on my allergen-elimination diet – particularly fermented beverages such as wine or beer.  However, I really wanted one drink with Thanksgiving dinner.  So I selected Cranberry Margaritas, since tequila is distilled, not fermented.

  • We used agave nectar to sweeten the margaritas.
  • Be sure to select a cranberry juice that is either 100% cranberry juice, or just cranberry concentrate and distilled water – no added sugar, no other ingredients.
  • I had one margarita.  It may have affected my sleep patterns, but it did not cause my allergies to flare.

NOTE: We did not have mashed potatoes or mashed potato substitutes this year, to reduce the dairy load (and because we already had plenty of food).  If you really want to satisfy that craving, try Mashed Cauliflower.  It might sound weird, but it really does satisfy the mashed potato craving.

NOTE: We are not a gravy family.  If you want gravy, try this recipe from nom nom paleo.  We haven’t tried it ourselves, but it sounds easy and tasty. Allergens: gluten-free; butter (milk/dairy); heavy cream (milk/dairy).  See previous information on onions and chicken broth.

BOTTOM LINE: You *can* have a healthy and tasty holiday meal.  Just pay attention to the ingredients and select recipes that your body will tolerate.

DISCLAIMER: I am not a health professional.  All content is for educational or informational purposes only.  Do not eat food to which you are allergic or which will otherwise negatively affect your health.

 

Weekly Wrap-Up (21-26 November)

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: My Pillow

Have you seen the commercials on late night TV and wondered about the My Pillow? “Late-night infomercials and other ads claimed that the company’s pillows could cure not only insomnia but also such ailments as sleep apnea, fibromyalgia, and even multiple sclerosis.

Earlier this year, the consumer watchdog Truth in Advertising (TINA.org) warned My Pillow that it would file a complaint with the Federal Trade Commission if the unsubstantiated claims continued. My Pillow scrubbed its website of any health claims, but others continued cropping up on its social media sites, TINA.org reports.”

http://www.consumerreports.org/my-pillow/my-pillow-health-claims-lawsuit-settlement/

Tuesday: Dry Winter Skin

Helpful information, except that if you have mold allergies, humidity should be *below* 30% in your home.

http://www.consumerreports.org/conditions-treatments/dry-winter-skin-eczema-psoriasis-rosacea/

Wednesday: End-of-Life Planning

“93-year old psychotherapist Margie Jenkins wants you to plan a great party for the people you love, do what you’ve been putting off, and live “bodaciously.” The only catch? You have to think a lot about death first.”

This Therapist Wants to Make End-of-Life Planning Fun

Thursday: How to Make Sure You Are a Designated Representative In Case Your Loved One is Incapacitated

Heads Up! A power of attorney and a medical power of attorney are no longer sufficient. Read this article for other necessary paperwork to allow you to speak on behalf of a loved one (or vice versa):

https://www.agingcare.com/Articles/Make-Sure-You-Are-an-Authorized-Representative-for-Your-Loved-One-202376.htm?utm_source=InsightsNewsletter&utm_medium=Email&utm_campaign=InsightsNewsletterNov

Friday: Substance Abuse

“An estimated 20.8 million people in our country are living with a substance use disorder. This is similar to the number of people who have diabetes, and 1.5 times the number of people who have all cancers combined.”

http://www.npr.org/sections/health-shots/2016/11/17/502402409/surgeon-general-murthy-wants-america-to-face-up-to-addiction

Saturday: Saturday Humor

https://www.facebook.com/HeyHoldMyBeerAndWatchThis/photos/a.123836527758776.24621.123829561092806/852210164921405/?type=3&theater

Weekly Wrap-Up (14-19 November)

In case you missed it (ICYMI), here are the links that were featured on One Sick Vet’s Facebook page this week:

Monday: Don’t fall for the hype – some foods may not be as healthy as you think

“So how do you sort through the nutrition hype of all these packaged eats and treats to find the healthy gems? When checking out nutrition labels, follow these three important rules: 1. Read carefully. 2. Read carefully. 3. Read carefully.

Before loading up your grocery cart, read up on why six of the foods that you think are healthy are far from it, then swap them out with the suggested alternatives.”

http://www.nextavenue.org/fiftysomething-diet-healthy-food-swaps-0/

Tuesday: Delirium: A surprising side effect of hospital stays

“A recent meta-analysis led by Harvard researchers found that a variety of non-drug interventions — which included making sure patients’ sleep-wake cycles were preserved, that they had their eyeglasses and hearing aids and that were not dehydrated — reduced delirium by 53 percent. These simple fixes had an added benefit: They cut the rate of falls among hospitalized patients by 62 percent.”

http://www.nextavenue.org/delirium-a-surprising-side-effect-of-hospital-stays/

Wednesday: 2016 GAO report on health effects of burn pits

“It had been six years since the Government Accountability Office (GAO) last reported on the number of active burn pits in Afghanistan and Iraq and their potential harmful health effects on military personnel.

In September, another GAO report found DoD and the VA still have made inadequate efforts to collect data needed to understand burn pit health risks to troops and their families.”

http://www.moaa.org/Content/Take-Action/Top-Issues/Currently-Serving/Burn-Pit-Report-Reignites-Troop-Exposure-Concerns.aspx

Thursday: 5 simple ways to slash your salt intake

“Adults in the United States consume an average of 3,400 mg of sodium a day, more than double the 1,500 that the American Heart Association recommends. All that excess sodium contributes to high blood pressure, heart attacks and an increased risk of stroke, osteoporosis, stomach cancer and kidney disease.”

http://www.nextavenue.org/fiftysomething-diet-5-simple-ways-slash-your-salt-intake/

Friday: Something to consider as you make end-of-life plans:

“For veterans of the conflicts in Iraq and Afghanistan, even a Medal of Honor may not guarantee a spot in Arlington National Cemetery.

That’s according to a report by Arlington National Cemetery (ANC) staff.”

http://www.moaa.org/Content/Take-Action/Top-Issues/Retirees/Arlington-–-Maybe-Not-Your-Final-Resting-Place-.aspx

Saturday Humor:

https://www.facebook.com/Fun.Pics.Stuff/photos/a.547783901915385.146738.342745062419271/1551728084854290/?type=3&theater

Weekly Wrap-Up (24-28 October)

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

Sometimes the Stars Align – But You Still Have to Check Your Six

Tuesday: More problems at VA hospital in Chicago

http://www.foxnews.com/politics/2016/09/29/new-low-dead-veterans-left-in-va-hospital-morgue-for-weeks-without-burial.html

Wednesday: Wearable tech not shown to help people lose more weight than standard weight-loss techniques

https://www.ncbi.nlm.nih.gov/pubmed/27654602?dopt=Abstract

Thursday: Good news! Tricare has updated preventive screening standards to align with “the American Academy of Pediatrics’ standards for care of well children over age 6.” Tricare will now pay more (and military families pay less) for certain preventive care screenings

http://www.moaa.org/NewTRICARE/

Friday: Since the 2017 cost-of-living adjustment (COLA) is so small (.3%), some retirees may be on the hook for Medicare Part B premium increases

http://www.moaa.org/Content/Take-Action/Top-Issues/Retirees/Diet-COLA-May-Cause-Headache.aspx

Sometimes the Stars Align – But You Still Have to Check Your Six

Just a quick update to explain why it’s been so quiet on the blog this month.

I finally had the “do-over” for the surgical procedure that was cancelled when I had the allergic reaction to the antiseptic.

Because I had lost confidence in the VA hospital, I switched from handling this procedure through the VA to handling it through Tricare.

In an interesting twist of fate, my new doctor has the same rare allergy that I do, which meant I didn’t have to worry about accidental exposure to that substance in the operating room.  Bonus!

However, as it turns out, I still had to remain extremely vigilant.  Although my allergy is clearly marked in my records, few people seem to understand how this allergy translates to real life, which results in interactions such as these:

[Scene: Pre-Surgery area]

Nurse 1:  Hi, I’m Nurse NAME, and I’ll be going over your paperwork with you today.  How did you clean prior to surgery?

Me:  I took a shower last night and a shower this morning.

Nurse 1: With soap and water?

Me: Yes.

Nurse 1: Were you given the pre-surgery paperwork suggesting you cleanse with Hibicleans prior to surgery?

Me: Yes.

Nurse 1: And did you follow those procedures?

Me [mildly sarcastically]:  No.  I’m allergic to Chlorhexidine, so I thought that would be a bad idea.

Nurse 1: Oh.

[Note: This means that the military hospital gave me a standard pre-surgery paperwork package instructing me to clean myself at home with a substance to which I have a documented allergy.  There is apparently no control in the hospital procedures for this mistake.]

[Scene: Pre-Surgery area.  Later…]

Nurse 2 (LPN): Ok, I’m here to get you prepped for surgery.  Do you have any allergies?

Me: Yes, I’m allergic to Chlorhexidine.

Nurse 2: Ok, I see that in your chart.  I’ll write that on your wristband.  [Writes on wristband, and attaches it to my arm.]  Ok, now I’m going to insert your IV. [Opens IV kit.]

Me:  Are you going to use an alcohol wipe to clean the site?

Nurse 2: No, I’m going to use the wipes in the IV kit – Chloraprep wipes.

Me [Firmly]: No, you’re not.  I’m allergic to those.

Nurse 2: Really?

Me: Yes.  They contain Chlorhexidine.

Nurse 2: Oh. …  Ok, I guess I’ll go find some alcohol wipes.

[Note: This indicates that the hospital does not have special IV kits for individuals with Chlorhexidine allergies, which is somewhat understandable given that it is a rare allergy.  However, it also indicates that medical personnel are inadequately trained on Chlorhexidine allergies and required modifications to standard procedures.]

Bottom Line: Given the lack of awareness by medical personnel of Chlorhexidine allergy (an antiseptic widely and frequently used in the medical field) and its practical implications (changes to materials used in standard procedures), I am deeply grateful that my surgeon has the same rare allergy and could maintain a safe environment for me in the operating room.  I am particularly grateful for that given that (1) I had to be extremely vigilant to avoid exposure (and another allergic reaction and cancelled surgery) prior to surgery, and (2) I could not maintain vigilance in the OR since I was anesthetized.

If you have a similar rare medical allergy, please learn as much as you can about sources of exposure, and be very cautious to avoid exposure in medical environments.  Do not rely on medical personnel being informed and aware – they probably aren’t.

Note: Check Your Six is an aviation term meaning to watch for attacks from behind.  It more broadly means to be situationally aware and to maintain vigilance.

Weekly Wrap-Up (17-21 Oct)

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

Tuesday: New data may lead to better understanding of Crohn’s disease.

https://www.sciencedaily.com/releases/2016/09/160920151435.htm

Wednesday: When asked about incorrect data on VA hospital leadership replacement, VA Undersecretary for Health David Shulkin responded: “We tend to use lots of numbers and that can be confusing, and what I’m trying to do is simplify the message, so here’s my message: I need help,” Shulkin said. “I need the right leaders to come in and to take these positions of responsibility on behalf of the country, and I don’t care if it’s 90%, 80%, or 60%. I know I have openings and I don’t have the applicants.”

http://www.usatoday.com/story/news/politics/2016/10/18/veterans-affairs-managers-transfer-new-leadership-medical-centers/91965888/

Thursday: Article on living with depression. “For years I believed that I had to surmount my depression, to overcome it, to wrestle it into submission so that I could be normal. The diagnosis has allowed me to accept that “normal” may just mean being able to engage with my loved ones and my work. “Normal” means knowing I have a chronic illness and treating it so that I can do the things that make me content.”

http://www.elle.com/life-love/a39440/double-depression/?src=socialflowTW

Friday: Heads Up! Tricare approved pharmacies changing 1 Dec.

http://www.military.com/daily-news/2016/09/30/tricare-pharmacy-network-adds-walgreens-removes-cvs.html?ESRC=todayinmil.sm

Weekly Wrap-Up (10-15 October)

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: Dealing with Depression

“I’m writing this now to remind myself how wonderful it is to breathe and live and feel human, both because I need a reminder for next time depression lies to me and tells me it will never go away, and also because maybe you’re in the hole right now and need a reminder that it will get better.

It will.

And then maybe it will get bad again. The ups and downs are always there for those of us with forever broken brains. But that’s okay because you come back out. The good is worth battling through the bad. It’s so worth the meds and the therapy and the time and effort and the waiting.”

http://thebloggess.com/2016/10/10/up-and-down-and-up-again/

Tuesday: Traveling with Allergies or Asthma

http://www.michiganallergy.com/travelallergies.shtml

Wednesday: Onset Of Allergies Over Age 40
(Not as uncommon as you think)

http://www.michiganallergy.com/allergyonset40.shtml

Thursday: Relaxation Techniques

http://www.michiganallergy.com/relaxation.shtml

Friday: Article about Paralympian Sgt. Elizabeth Marks (USA)

“When I step onto the blocks, I never think, ‘I want to win,'” she says. “I think, ‘I want to pour all of myself into this race because there are people who can’t physically, mentally or emotionally, do that.’ So it’s my way of performing for them.”

http://www.espn.com/espnw/culture/feature/article/15702441/the-things-carries-story-paraswimmer-us-army-sergeant-elizabeth-marks