Ortho four

I wrote the following for my new orthopedist. He is the fourth I have seen. So, why is this worth putting in my blog? Because it illustrates what a circus a seemingly simple problem can become when put in the hands of the “experts.” These people have god knows how many years of training, yet the patient, who has no training at all, quickly sees their limitations and realizes that he must become the final authority over his own care.

You will note that I address the doctor by his first name instead of his title. This is because tokens of subordination stick in my throat. If I should be introduced to the queen someday, this could be a problem as I will refuse to so much as curtsy. Even if my resolve should weaken, and I should curtsy just to keep the old bag in good humor, my aged knees would probably become stuck, and I would have to spend the rest of my life curtsying to every man, woman, child, and dog that I met.

Osteonecrotic means dead bone.

Dear Mark,

I was overwhelmed by the prospect of verbally updating you on why I came here, so I decided to write it out.

In August of 2006, I began taking yoga for nine hours a week to strengthen an arthritic knee. A month later, I fell on my head while practicing a handstand. My neck felt compressed when I hit, but it didn’t bother me much afterwards. A week or two later, both shoulder joints started hurting almost overnight, and I was forced to give up yoga. My shoulder pain slowly got worse despite the fact that I drastically reduced my physical activity.

Nineteen months later (April 2008), I saw an orthopedist (Lisa Lamoreaux) who ordered x-rays and diagnosed the problem as arthritis. I questioned her diagnosis because the pain had started suddenly and at the same time in both shoulders.

In July 2008, I saw another orthopedist (Matthew Shapiro). He rejected Lamoreaux’s diagnosis, and said he suspected bilateral impingement. He ordered an MRI on both shoulders. He also gave me a cortisone shot in my left shoulder, and said that if I experienced relief, it would confirm his diagnosis. I experienced complete relief for about a month. He said that the MRI further confirmed his diagnosis.

I began taking an anti-inflammatory and going to a physical therapist (Lonnie Ward). I was given various band exercises to do, but they caused so much pain that I quit therapy altogether. A deep tissue massage that I got to relieve the pain made it much worse. I stopped doing anything involving my shoulders that I didn’t have to do, but the pain was so great that I was almost in tears for weeks. I was unable to even walk, bike, or drive for any distance, and sleep was nearly impossible. Shapiro prescribed Elavil, but it was woefully inadequate. By the time I obtained narcotics from another doctor, my pain level was going down, so I took very few of the pills.

Shapiro recommended subacromial decompression surgery, but said that a tingling problem in my right arm that had developed over the summer was caused by a nerve in my neck, so he wanted me to see a neurologist (Michael Balm) before he did surgery. Balm disagreed with Shapiro, saying that the tingling originated in my shoulder rather than my neck, and the tests he did in his office (EMG, NCS, etc.) seemed to confirm this. He said he would order a neck MRI anyway to reassure Shapiro. Based upon the results of the MRI, he ordered a CAT scan. Based upon the results of the CAT scan, he said that my C5 vertebra was probably malignant and speculated that the cancer had spread from my prostate.

A surgical neurologist (Andrea Halliday) biopsied the vertebra and determined that my C5 was not cancerous but osteonecrotic. Based upon the MRI that Balm ordered, she said that I had some nerves in the C6 area that were being squeezed where they left the vertebra, and she sent me to a physical medicine and rehabilitation specialist (James Kassube) for a series of cortisone shots. Halliday was confident that these shots would not only eliminate the tingling in my right arm, but would completely take care of my shoulder problems. The shots did eliminate the tingling but did nothing for the shoulders.

I went to a second physical therapist (Chris Besonis), and he prescribed isometic exercises. These also proved too painful for me to do.

I went to a third orthopedist (Thomas Peterson) because he advertised non-surgical treatments. Based upon a brief office exam, he rejected both Lamoreaux’s and Shapiro’s diagnoses, and said the problem was superior labrum anterior posterior. He gave me a numbing shot that he said would confirm his diagnosis if I got temporary pain relief, which I did. He prescribed prilotherapy injections. I didn’t consent to them because I couldn’t find evidence that they worked, and I had no idea if his diagnosis was correct.

Last week, I started going to a third physical therapist (Rachel Roach). She said that my symptoms aren’t consistent with shoulder impingement and prescribed yet another form of exercises. I don’t yet know how well they will work. I am scheduled to start Rolfing treatments this week in conjunction with physical therapy. I even went to a Japanese-style acupuncturist for two months last fall but got no benefit from it.

I have been in so much pain for so long that I would gladly consent to surgery if I could but have confidence that it would address the issue. As things stand, I have yet to find even two doctors who can agree as to what the problem is.


Kanga Jen said...

Good night. This has been going on for two YEARS?

I hope this one is intelligent enough to know that listening to and working with you cooperatively is as useful in diagnosis as are scripted tests. You deserve a diagnosis.

Strayer said...

What a nightmare! Tingling is nerve compression, but, I found out, with my neck issues, it can actually be from muscles tightening over the nerves when they exit the neck between the uppermost rib and collarbone, going to feed the shoulder, arm, hand. The muscles for all sorts of reasons, tighten over the nerves there (officially called double crush syndrome) often causing numbness besides tingling in arm and hand. I used ice to curb the nerve pain and heat to relax those muscles to stop that from occurring.

Not before I had useless carpal tunnel surgery, not caused by anything to do with my wrist tendon, so carpal tunnel surgery did nothing for me. You'd think these doctor people would learn the body is a whole system. I can't tell you how long it took me to get any action on my neck disc ruptured into my spinal cord. They called my pain and increasing bodily dysfunction "symptoms of mental illness". I almost died and could have if the disc had gone further through my cord, or I could have ended up paralized.

I'm sure you are aware of the difference between nerve pain and muscle pain. Your nerves can be pinched by bone or calicium growths as they exit the spinal cord. Or by a disc ruptured across a nerve. They can be pinched by tightened muscles anywhere, but the shoulder joint is always a suspect because of the small space for lots of bio stuff in there. INcreasing space in the joint is essential with posture betterment. Deinflamation with anti inflammatories or ice packs.

Maya said...

Rolfing? I hope you can handle it, it is not something I can even imagine letting someone do to me.

Sure hope you get help soon.

Snowbrush said...

"This has been going on for two YEARS?"

I first saw a doctor about it about ten months ago, but I have been looking really hard for relief ever since then because I have become increasingly disabled. I have to be very careful about what I do physically lest I get myself into such pain that it is almost unendurable. I feel fragile.

Strayer, I had carpel tunnel surgery in 2008 (one of three surgeries last year), and it worked well for me. Of course, if you were misdiagnosed, it couldn't have helped..

"They called my pain and increasing bodily dysfunction "symptoms of mental illness".

It's bad enough to be in pain without being told that it's all in your head. I think that's why my orthopedist didn't want to give me narcotics--he simply didn't think I hurt (physically) as bad as I said I did.

"You'd think these doctor people would learn the body is a whole system."

Generally speaking, they each have their little box inside which they practice, and they don't want to be challenged to think outside of it. My internist is different, and I value him exceedingly.

"Rolfing? I hope you can handle it..."

I'm not undertaking Rolfing without a lot of thought. It's expensive too--$100 to $130 a session here in Eugene.

Joe Todd said...

From my experience with "health care industry" sounds about right.What does your insurance say about it all? Maybe that could be another blog article.. Well sounds like golf is out of the question...For what it's worth, it is snowing in Ohio...Have a good one.