How it feels

I bore even myself with my health updates, yet of those who have read my preceding medical adventures, some might want the latest. My fellow sexagenarians will probably be the more interested because musculoskeletal problems befall us all even if we smoke Pall Mall, drink alcohol, snort aerosol, and bejewel one ball.

Peggy and I saw my new doc yesterday. I was tying a hangman’s noose when he walked in (the kind with the 13 windings). If I were a doctor, this would give me cause for alarm, and he did look alarmed and even clucked as he sat down. He needn’t have worried. I have loved knots for many a year, and I often turn to them when I am stressed. Its grisly connotation aside, the hangman’s knot is without peer, both for beauty and strength. It’s also fun to tie.

“Here’s the thing, doc, one of your fellow orthopedists says I have arthritis; one says impingement; and one says superior labrum anterior posterior. What do you say?”

“Yes.”

“Yes! What do you mean yes?”

“I mean they’re all right—they ARE doctors, you know. However, every problem isn’t contributing equally—if at all—to your pain.”

“So doc, if, being doctors, they’re all right and you’re right too, what do you plan to do about it?”

“Well, my handsome young patient, there’s choice A, and there’s choice B. Choice A is to stab you with an arthroscope and fix whatever is amiss. Choice B is to give you steroid shots in both shoulders, send you for some more physical therapy, and see how you feel in six weeks. I recommend Choice B, but you seem more than a trifle frustrated with non-surgical approaches, so it’s your call.”

I was frankly more worried about washing out with a fourth doctor (I have been to each of the three orthopedic groups in Eugene plus one loner doc) than of surgery (after 28 months of pain, I WANT surgery), so I was relieved that I liked Mark Fletcher. He listened well, took his time, seemed to care, gave me options, didn’t turn apoplectic when I called him Mark, and introduced himself to Peggy (doctors often ignore the patient’s spouse). Do I think shots and exercises will help? No, but I’ll give them a try rather than challenge his judgment. He is, after all, recommending a treatment that will cause him to miss out on a quick buck. Then too, the opinion of a surgeon who advises against surgery is not a thing to be sneezed at.

I’ve had three steroid shots to my neck, one to a knee, and one to a shoulder. None of them hurt much afterwards. These shots still hurt WAY MUCH. Without Percoet, I can scarcely move my arms, and I’m obliged to support one hand with the other when I do move them. I naturally wondered what went wrong that the other shots didn’t hurt and these do—is Mark yet another dud doc? An orthopedic website identified the problem as a cortisone flare, meaning that the drug crystallizes and stays that way for a day or two. It isn’t anyone’s fault. At least there’s that.

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.

The truth, the whole truth, and mostly the truth

If you want to know what a smart dog looks like, take a look at this (I mean the photo, not the word this). Now, I’m not one of those dog owners who thinks his dog is smarter than other people’s children because I know she’s not. I know this because I get audited every time she does my taxes. Of course, CPAs get audited too, so maybe Bonnie is smarter than other people’s children after all. Or maybe CPAs are just really dumb. Remember Arthur Andersen?


Another way that Bonnie is smart is that she always craps in the neighbor’s yard. The neighbor was pretty good about this for the first ten years or so, but then he started getting a little testy. One day he came over all red in the face and trembling. I thought he was just sick, but then he said, “If you don’t keep your goddamn dog out of my goddamn yard, I’m going to burn down your goddamn house.” I can’t describe how heartsick his words made me feel--I had really appreciated not having to buy my own lawnmower.

A few nights later, he woke me up about three in the morning. I heard screaming and cursing, and looked out to see him in my driveway buck-naked, jumping up and down, and holding a gun. I would have been hit by the first bullet if I hadn’t seen the fire leap from the barrel in time to duck. He must have stayed out there for upwards of two hours before he called it a night. Maybe he got cold, or sleepy. I never asked. Bonnie and I thought his behavior was so funny that neither of us could stop laughing for the longest, and we slept until noon. I didn’t send him a Christmas card that year because I wanted him to know that his behavior was a little off, but I did send him one the year after. He still doesn’t send me one, and he never did get me anything for my birthday. Not that I got him anything for his either, but then he wasn't forever reminding me of when his birthday was.

Bonnie is an equal opportunity biter—muscle men in their prime, little children with trikes, old ladies with walkers—she bites them all. She bites me too, sometimes. If I can see a good reason for having been bitten, I take my punishment and let it go at that. If I can’t see a good reason—or even a fair reason—I figure Bonnie is in the wrong, and I bop her on the snout. You might think it’s wrong of me to bop her on the snout. I don’t like to do it either, but when I bop her on the rump, she just bites me again. It is for this reason that I bop her on the snout instead of on the rump.

People say that dogs reflect the personalities of their owners, which means that if your dog bites people, then you probably want to bite them yourself but don’t have the guts. The trouble with this theory is that I have two dogs, and the other dog would never hurt anyone. So, I’m not such a twit after all—ha, ha, ha.

Peggy doesn’t like it that Bonnie bites. “Well, at least nobody will walk off with her,” I say, but this doesn’t seem to make Peggy feel better. One thing about her biting that does bother me is that Bonnie will bite people who not only don’t want to hurt her, but are too frail to hurt her if they did want to. That’s just how she is though—not mean like a pit-bull but wild like a dingo (which is partly what she is). She has a two-phase interpersonal problem solving system. Phase one is to snarl, and phase two is to bite. Since phase one is over in half a second, it isn’t very effective. Phase two is very effective. Whatever anyone is doing that Bonnie objects to stops immediately 100% of the time when she bites them. My own record for problem solving is nowhere near that successful. You might say, “Sure she eliminates one problem, but she creates a bigger problem when she bites someone,” but she doesn’t see it that way. Maybe if the dogcatcher threw her in the slammer she would, but that has never happened.

Bonnie is eleven, and her eyes are getting bad, so people are usually able to move their hands out of the way before they are bitten. A lot of people get really bummed about Bonnie trying to bite them, and they’ll say strange things such as, “I don’t think she likes me.” “Don’t take it personally,” I offer. “It’s just that she filled her friendship quota years ago, so you’ll need to wait for someone to die or move away.” I actually think this is true. Bonnie is very, very sweet to her friends (she only bites family members and strangers), but she doesn’t seem to want any new friends.

Bonnie snapped at one lady who then became determined to make Bonnie like her. What this lady did was to get some bologna and feed it to Bonnie by hand a little at a time. When the bologna was gone, she stuck out her hand with nothing in it because she thought that she and Bonnie were friends now (maybe she had heard the saying about the difference between a man and a dog is that a dog won’t bite the hand that feeds it). Anyway, Bonnie didn’t feel any friendlier than before, and she demonstrated her complete willingness to bite the hand that feeds her. It was at this point that the lady gave up on being friends with Bonnie. My impression was that Bonnie had snapped at the lady because she was mad that there was no more bologna, but I didn’t want to say anything that would make Bonnie look worse than she already did.

I didn’t want to buy Bonnie because she came from a pet shop, and pet shop dogs come from puppy mills. I had wanted some dog for years, but Peggy said it was so painful when our last one died that she was through with dogs. Anyway, when Peggy saw Bonnie in the window at the mall, she decided that she and Bonnie had a psychic bond, so I couldn’t very well nix getting her even if she was a pet shop dog. I did remind Peggy that neither of us knew anything about herd dogs in general or blue heelers in particular but, like I said, how could I put my foot down? A few weeks later, I came home one night, and Peggy was off the wall livid and yelling about how “that damn dog” had to go. What had happened was that Bonnie got mad at Peggy (without good reason, Peggy thought) and nailed her. I thought this was hilarious. “Hey, what happened to your psychic bond—haw, haw, haw?” I asked. This didn’t seemed to help Peggy’s mood the way I thought it would. Peggy is hard to comfort sometimes.

Something else that bothers me about Bonnie’s violent behavior is that if Peggy and I get into a fight, Bonnie always takes Peggy’s side even if Peggy is in the wrong. Peggy can literally walk up and start slapping me around (pretend slapping), and Bonnie will come running and threaten to bite me if I don’t stop. Stop what? All I’m doing is standing there getting slapped. Peggy thinks this is SO funny that she will almost bust a gut laughing, and this causes her to stop slapping me, and that causes Bonnie to go back to whatever she was doing (lying on the floor usually) before Peggy got her riled up. It’s as if Bonnie’s position is, “Okay, Peggy, anytime you want to kill your husband, just let me know, and I’ll help.” The rest of the time, Bonnie seems to like me better than she likes Peggy (I know this because she humps my leg all the time but never humps Peggy’s leg at all). She’s a very funny dog that way. Her sympathy is with whomever she considers to be the underdog, even if the underdog is beating the hell out of the overdog for no reason.

But I haven’t said nearly enough about how smart Bonnie is, so I’ll tell you one last thing. One day Peggy was throwing Bonnie her Frisbee and her tennis ball. She (Peggy) got to wondering what Bonnie would do if she threw them both at once. Would she bring back the one that she liked better (her ball), or would she bring back the one that landed first, or that hit closer to her, or that she was able to catch? Well, what Bonnie did was to catch the tennis ball and put it in the underside of the Frisbee so she could carry the tennis ball with the Frisbee. That’s pretty smart. I know I wouldn’t have thought of it. Would you? I don’t think so.