The Medical Professionals Who Do Bones

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Lefty’s Bruises Are Gone Now But Full Range of Motion Has Not Yet Returned

Okay folks.  Let’s add Orthopedic Surgeon and Physical Therapist to the long list of medical professionals to whom I have been referred since I turned 65, my start in the serious phase of getting old.  The most recent referral however had nothing to do with aging but with a vehicle/pedestrian accident.  I was the pedestrian in that collision.

The traffic accident I survived in December of 2017 sent me to the emergency room  of a trauma hospital. There, a lovely 50ish Asian woman ER physician (Dr ER) had x-rays of my left shoulder – which the Grand Marquis car had hit from the back –  taken to see the extent of the injury.  As soon as the image became available, she projected it on a computer monitor.  My face grimaced at the sight of the junction of my thin arm bone and the left shoulder area.  Skeletons! They form a part of the 206 bones that make up a human adult.

The humerus bone is broken but it is not broken, said Dr ER, beaming. She expounded: The ball of the arm bone that goes into the shoulder socket is broken but it is not shattered or dislocated. No surgery is needed.  The crack will eventually close and heal.  How lucky, I gushed.  DR ER recommended that I find an Orthopedic Surgeon (OS) for follow-up consultation.  The ER doctor’s job is to perform the minimum required care and move the patient out of the ER as quickly as possible to make room for new emergency cases.

The process of getting an OS involved my Primary Care Physician (PCP), who was so glad to get in on the action.  He gets a big kick out of finding what’s medically wrong with me then referring me to a specialist.  This time he referred me to Dr OS, a cheerful red-head middle-aged man.

Dr OS ordered x-rays of my left shoulder and arm then reviewed the images with me.  His verdict echoed Dr ER’s.  This is broken but it is not broken and that is a good thing, Dr OS proclaimed.  But  I’m in pain, I disagreed.  He expounded: The bones will fuse together eventually.  I’ll see you in three weeks.

The next three weeks tested my dexterity.   Bathing, showering, taking off and putting on clothes with one arm were challenging.  I learned new wiggling motions.

I’d heard of the expression “One hand does not know what the other hand is doing.”   I disagreed.   Having my left arm in a sling 24/7, I learned my right hand (Righty) knew exactly what my left hand (Lefty) was doing.  Nothing.  Doing nothing. It just lolled inside a hammock, the shape of the sling. So, Righty, in tandem with my brain, took over quite a bit of responsibilities.  Righty did not have issues about monopolizing the tasks it had once shared with Lefty, as if things had always been that way. What a hero! Of course Lefty was not totally worthless. It lent Righty a hand – pardon the expression. While doing dishes, Lefty propped the plate without pressure on itself, allowing Righty to scrub diligently.  In other words, they had each other’s back – or front. One performed token work, the other the real grunt work.

There were just certain tasks where Righty had to go it alone, like applying deodorant to both underarms. Imagine the contortions Righty had to go through to cover the right armpit.

I learned to orchestrate Lefty and Righty to attract attention for help in depositing household trash in the neighborhood trash bins.  Any able-bodied person who passed by the bin area was fair game.  A certain smile, a timid hello, a little drama by Righty struggling to lift the bin lid – they all did the trick.  The old folks in the retirement resort were genuinely happy to assist the helpless senior babe.

After two months, Dr OS told me, Lose the sling. You don’t need it anymore.  As directed, I stopped wearing the sling.  Friends unaware of the accident and happy to see me often slapped my sore left arm.

Dr OS referred me to a Physical Therapy clinic (PTC) to start the process of loosening up my left shoulder and make way for Lefty to regain full range of motion.

The intent of my first appointment was to determine how much physical therapy would be needed for my situation.  While waiting, I overheard a 40ish Hispanic woman named Michele and a 20-something named Valerie conversing about me.  Valerie asked, Is she the one? She doesn’t look like……(her voice tapered off).  I could not tell if she meant I did not look my age, I did not look like Nancy Kwan, or I did not look like an accident victim.  One tough lady, Michele commented.

During the assessment session I learned more about the physical therapy profession.  I thought everybody who works in a PTC is a physical therapist who bends arms and legs.  As Michele gently massaged my left shoulder, I drummed up a conversation: So did you need a massage background to get this job?  She laughed and said, Actually I’m a doctor.  I felt like a heel.  My turn to laugh.  What do I know? I said.  I am a retired engineer.  I only knew sewers.

Michele explained that in a PTC there are different gradations of physical therapists, ranging from on-the-job trainees to college graduates, but there’s only  one doctor. In that clinic she is the doctor.  I notice she is the only one who can massage me. All others count or time me as I rotate my shoulders, pull pulleys or rubber bands, lift weights with my left hand.

Lefty is still working to regain full range of motion.

I think I’ll put on my string bikini, soak in one of the retirement resort’s five hot whirlpools, and do some serious positive thinking.

Have you or someone you know had a broken shoulder?  How long did it take to go back to normal?

 

 

 

 

 

 

 

 

Osteoporosis

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In the middle of this February, my Smart Phone made a funny sound, alerting me to check on a new voice message.  I listened to the message.  It was from the nurse of my Primary Care Physician (PCP), the doctor whose mission is to find everything medical that is wrong with me. I thought, Now what? Our next consult is scheduled in March.  What does he want from me this early?

I found out soon enough.  The Orthopedic Surgeon (OS) who is attending to my broken left shoulder that resulted from the recent car/pedestrian collision accident, had given his report to PCP.  OS wanted PCP to get me a bone density test. The bone density test result would be a factor in determining the speed of my recovery from the accident in case the attorneys specialized in compensation for pain and suffering ask him.

I told PCP, At your insistence I subjected my bones to a density test very recently.  Why not give OS those results? He answered, That’s different.  The bone density test needed by OS is one taken after your traffic accident.  And I also need a new one to see how the medicine I prescribed to you has affected your osteoporosis.  What medicine? I asked,  beady brown eyes widened.  My reaction took him by surprise.  You didn’t get the pills?  I want to prescribe the latest good drug for your osteoporosis after I prove to your insurance company that the pills I prescribed to you did not work.  Instead of arguing,  I declared the snafu was his fault and we agreed his prescription for osteoporosis fell in the cracks because of all his referrals to the podiatrist, ophthalmologist, gastroenterologist, etc, plus orders for flu shot, pneumonia shot, shingles shot etc.  He gave me a prescription again.

I visited my colleague Dr Google and asked him about osteoporosis.  He said it is a medical condition in which the bones become brittle from loss of tissue, typically as a result of hormonal changes, or deficiency of calcium or vitamin D.

I wondered what kind of osteoporosis I have, if in fact the diagnosis is correct.  I remember the Grand Marquis car in the December 26th vehicle-pedestrian collision accident smacked  my left shoulder from the back, tossed me, and drove my face down on another paved lane.  I thought the impact of the moving car followed by the impact of the rigid pavement were enough to reduce my poor decrepit little body to a small heap of broken bones.  But no.  I shimmied out of the accident scene with a hairline fracture on the slightly dislocated left shoulder requiring no surgery.  What about the brittle bones?  My son thinks years of yoga practice have made me pliable.  I think the fish heads and rice in my diet get the credit.

Okay, whatev.  I’ll add Osteoporosis to the long list of maladies and medical terms that I have researched since turning 65.  It joins the ranks of adenocarcinoma, bunions, cancer, cataracts, colonoscopy, pneumonia, Varicella-Zoster, etc.  Love that last one in the series.  It sounds impressive but it means shingles.  Having experienced all of them and then some, I can proudly crow: Getting old is not for amateurs!

My left shoulder has loosened up and physical therapy continues until my left arm regains its full range of motion.  Then I’ll be able to tie the strings of my bikini swimsuits by myself again.  Meanwhile, I have the retirement resort’s limo pick me up and take me to a scenic area where I walk uphill then downhill then to my favorite sushi place.  This brings back memories of my days in Albuquerque city hall when I was an employed young woman engineer shunned by the exclusive world of male engineers, long before it dawned on them how awesome I was.  The draftsmen and I would eat our sack lunches in the drafting room. For dessert, we’d have Fig Newtons.  At the end of the main course, usually a home-made sandwich, I’d raise my hand with the dessert and exult: “High standard of living!” and we’d all crack up.  My happiness has always come from within.

I’d love to hear what you think.

My Trouble Finder

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The Author Did Manage to Get up From This Yoga Pose Unassisted
My day’s highlight came early. The secretary of my Primary Care Physician (PCP) phoned me to remind me of my upcoming appointment with him.  Immediately I cringed. Uh-oh, it’s time again for the good doctor to look for unpleasant issues with my body.  It’s his job, his livelihood.

So at the appointed hour, I showed up at the PCP’s office, braced to hear everything that’s the matter with me.  The handsome Southern Orange County doctor scooted into the examination room where I sat after my current weight and vitals had been established. He scoots because a water skiing accident in his youth smashed his tailbone, so I heard.

He started the session by reporting to me the results of the pre-visit blood tests.  Most results are good, he declared with a smile.  But your kidney function test numbers aren’t so good.  We call those numbers Chronic Kidney Disease (CKD) Stage 3.  Stage 3? I asked with feigned shock.  That sounds awfully close to Stage 4.  My lung cancer is stage 4. Does this mean my body is in various stages of decay? He replied, I won’t say that. The previous test results were the same, which means the CKD is stable.  Aha, I said. That would be me: Ms Stable.  Besides, he continued, with CKD your blood pressure should be out of control, but it’s great, and you don’t have other symptoms. We’ll take another blood test in a month and monitor the CKD.

He looked at my weight on the chart.  Let us see if you have lost any weight, he said.  Not me, I disagreed right away.  It’s just perfect right now for a string bikini.  He responded: You’re the hippest senior I see.  No other senior comes in here for a check up carrying a loaded backpack and wearing Z-Coil shoes.

He kneaded my neck, searching for swollen lymph nodes.  Nothing there, he announced. Then he ordered me to sit on the examination table: Get up here, Slim.  He raised the back of my aquamarine blouse to do some stethoscope motions on bare skin.  A strawberry-ice-cream-colored bra greeted his eyeballs.  Sexy bra, he said, and laughed. I’m not big on color coordinated underwear, I confessed, and we laughed.  Having found nothing wrong with me yet, he proceeded to drill a small flashlight into my nostrils.  You should have allergies, he insisted. But I don’t, I said. He saw nothing and gave up.

Tell me before we say goodbye if there’s anything wrong with you, PCP enjoined with a sense of urgency.  Under pressure I felt I had to say something: Bunion. Ten years ago I spent a lot time pondering what to do with the bunion on the outside of the big toe of my right foot.  Then came the lung cancer Stage 4 diagnosis and eight months to live prognosis.  Suddenly the bunion issue became the least of my concerns. Now it’s front and center again.  He was quick: Good!  I’ll refer you to Dr Paa (fictitious name; “paa” is Filipino word for feet).  He will advise you to either change your shoes or your foot. I exclaimed, I like it! He took advantage of my enthusiasm, I still want you to get a colonoscopy.  He was so totally pushing.  The last gastroenterologist I saw said nothing needed to be done.  Okay, I grudgingly agreed.  I’m retired.  I’ve nothing else to do.

In conclusion, PCP’s nurse gave me a pneumonia shot and a flu shot.  Then PCP gave her instructions: (a) Get approvals for a new gastroenterologist for the colonoscopy, a podiatrist for the bunion, and the opthalmologist for the annual eye exam.  (b) Prepare a requisition for kidney and liver function blood tests to be performed in mid-November.   Finally, he turned to me and said, Next time bring all the medicines you’re taking. I just feel better when I see them. My turn to think.  I suspect he remembered that instead of the calcium pills prescribed by him, I had bought calcium gummies.  I had complained that the calcium pills were too big and like horse pills.  Get the petites, he had ordered. He probably wanted to be sure next time that I am in compliance.

PCP was determined to keep the retired senior babe shuffling.

Is your PCP like my PCP?

 

 

 

 

 

 

 

 

 

 

An Appointment With the Gastroenterologist

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The Digestive System – One of the Great Equalizers in the Human Race
Between my Oncologist (Onc) and my Primary Care Physician (PCP), I have had more appointments with specialist doctors than I can remember. It’s probably a good thing because I’ve learned a lot.  Now I can decide which branch of medicine I’d major in when I grow up.  At the same time, going to and from these doctors and writing about them give me something to do, write about, and share with those who give a hoot.

The latest medical specialist who examined me was a gastroenterologist (GE), a doctor specialized in the human digestive system, which includes the esophagus, liver, stomach, gallbladder, pancreas, large intestines, small intestines, appendix, rectum, and anus. It makes me wonder, After dealing with those body parts steadily, does the good doctor eat soul food such as chitlins or the Filipino dish called “dinuguan?”

I am not a hypochondriac preoccupied with my and only my own health issues.  My Onc had sent me to GE after the liver MRI specialist already declared there’s nothing wrong with my liver, in agreement with the CTscan radiologist.  But no!  My Onc had a need to  know why a portion of my common bile duct is distended, even after I told him I’ve had that since the CO-1686 clinical trial three years ago and Dr Brevity never got excited about it.  But Onc insisted, so off to GE I shuffled for my appointment.

What can we do for you today? asked the 20-something intake aide.  I thought you’re going to tell me, I replied with a smile.  She flipped through my record.  It’s hard to find something if one does not know what one’s looking for.  I asked her, Are you the Physician’s Assistant (PA)? The PA, like the Nursing Practitioner, is the closest thing to being a doctor.  Oh no, she said.  With nothing else to do, the intake aide asked me my weight and height, told me the PA will see me in a few minutes and then took off.

The wait for PA was more like 45 minutes.  I suspected she was studying my medical records.  PA, a 35ish Chinese beauty, came in seemingly happy.  She had figured out the purpose of my appointment!  It’s your common bile duct, she said. How long have you had that condition? Three years, I answered. She asked, And you’ve had no symptoms? Like, your urine is not cola colored? Your stool is not pale? To all her questions, I answered “no.”  She instructed me to lie down face up on the examination bed. She poked hard at various points on my tummy to elicit a scream or screams.  No screams occurred because nothing hurt me other than her painted fingernails.  Finally exasperated, she said, I think an invasive procedure to find out what’s wrong with your common bile duct should not be done.  It will do more harm than good.  But I’ll ask GE. He has the final say on this matter.  I’ll phone you as soon as I find out his decision.  Great! I exclaimed. I resisted the urge to do a somersault to celebrate.

Do you drink alcohol? She asked as a parting shot.  I answered, Yes, once a week at a dance in the retirement resort.   It sounded like an innocent confession.  Of course I minimized the fact that the dance event features a live band and BYOE or Bring Your Own Everything, which is wide open to interpretation, as in bring your own everything from the cellar.  Thank goodness the dance is only from 6:00pm to 9:00pm.  With the resort’s bus limo service, I make it to my manor upright every time.

The next day, PA phoned and told me GE said there’s no need to do anything with me.  I said, Yes! and pumped my fist in the air.

Let me know what you think about GE or the weekly BYOE dance.