A blog/journal about my life and the stuff I like. Popular subjects include music, guitars, gear, books, movies, video games, technology, humor.
My late December medical misadventures had mostly resolved only to be replaced by dental shenanigans. I’ve had some long neglected issues that I put off because they weren’t painful and I didn’t want to fork over hundreds or more likely thousands of dollars for what was mostly just an annoyance.
Whelp, as in the past, once a nerve root gets fully exposed even the most stalwart would likely put pain reduction over pocketbook. I’ve had both a broken tooth and crown (on separate teeth) for several years, but within the last month I had a cavity in my right upper first bicuspid (I think) which revealed itself when a cute little portal opened up in the bottom. Portals can be useful things, especially if they go to magical kingdoms or take you planetside, but they are less desirable in one’s chompers.
I scheduled a dental exam with a new clinic (it was the previous clinic, Monarch, that had soured both my wife and I from going for so long), and at the time time of the exam I wasn’t yet in a great deal of pain. Fast forward to three days ago and the pain started ramping up. It got bad enough that it woke me up at midnight on Thursday/Friday and I contacted the clinic requesting a same day/walk in appointment.
The clinic is normally closed on Friday, and additionally, Dr. Nguyen who performs the root canals is supposed to be on maternity leave, but they were willing to come into the clinic and take care of my problem. The procedure went smoothly and my only discomfort was due to bladder distension (don’t drink the coffee, you’ll soil yourself) (if you know that reference you’re old too). I had essentially no dental or oral pain once I was numbed up.
Once the anesthesia started to wear off yesterday and into last night the pain came back and was almost the same severity although the quality of the pain had changed since the nerve had been removed. Now the pain was spread over several teeth and also affected my mucosa. My face has swollen up to the point it looks like I’ve got a big chew in. I just need to throw on my baseball uniform and commence to spittin’.
Nothing has really touched the pain except for warm compresses and some Orajel cream that I had same-dayed (totes a word) this morning. Unfortunately it only seems to last about an hour when the recommended dosing schedule is 6 hours. Dosing schedule be damned until this pain and swelling start to decline.
I hope the succession of medical to dental chicanery was just random chance and not a sign of a larger problem. Meaning, it’s not typical for me to have big flare ups when I have injuries or illness. The shoulder/chest whatever it was accelerated above and beyond any notable triggers. Maybe there was something there that no one including my various providers or myself have been able to sus out. Maybe my immune system is getting more persnickety as I get older. I hope not.
This dental episode isn’t too removed from previous, although the severity has been higher not to mention the facial swelling which I’ve not had in the past. It was noted that I had a few elevated inflammatory markers during the shoulder/chest extravaganza (ESR, CRP), but these are non-specific and don’t clarify the source. I’m curious if they would be similarly elevated during this dental episode. As often happens, the diagnostic studies raise more questions than they provide answers.
Hopefully this dental shindig will start winding down and I can return to the regularly scheduled programming. It’s ironic because I had made several upgrades and fixed multiple issues in both my video studio and drum rooms, but I’ve been unable to enjoy them fully due to the pain and discomfort.
I should also mention that our girls have been very sweet in noting my discomfort. They are always quick to realize when their humans are distressed or in pain, and they adjust their behavior. Instead of negotiating (begging, harassing, etc.) for treats, walks, or playtime, they typically just lay down somehere near us and give us companionship without bothering us otherwise. Even Nynaeve, who is by far the most insistent for playtime, etc. has been following her sister’s lead and just staying close without asking for anything. Of course Aeyong is perpetually on the spot to give help or comfort when I’m in pain. I mostly deal with it myself, but her willing assistance is always appreciated.
A quick addendum to the previous post…I was reviewing my health insurance account and a few of the claims had come through from this event. The hospital stay at Methodist Mansfield (which I assume to be all-inclusive but may not count the ER visit) ran up a bill of ~$33K. In the normal nebulous policy of insurance payouts, Tricare paid them ~$2.5K for the total amount. It looks like we’re on the hook for $73, which again, may be for everything or just the hospital stay. We paid a similar amount for the ER evaluation at Medical City, so who knows?
Suffice it to say that the cost of healthcare in this country is so beyond the pale it’s hard to fathom. We feel very fortunate to not only have medical insurance, but affordable insurance compared to many people. I think our yearly fees are equivalent to what many people pay each month. This was only an acute event and my total hospitalization was only about 36 hours. Granted, there were some expensive diagnostic studies included, but I can only imagine a long-term stay or the cost of a chronic disease with recurrent hospitalizations or expensive interventions.
Things are going fairly well as I type this on January 3rd, 2024. My health decided to close out the year by reminding me I’m not getting any younger. I’ve had this intermittent vague pain and paresthesias mostly in my left arm for years. I think I may have even posted about it several years ago when I had severe elbow and forearm issues that were aggravated by playing various musical instruments. That was more bilateral, but maybe the left was worse.
Fast forward to this last year and I’ve had recurrent mild issues almost solely in the left arm, starting at the shoulder and going all the way to my fingers. It seemed to predominate in a more ulnar distribution, but the entire limb can be affected. I think prolonged less than ergonomic fixed positions at my desk probably aggravated the issue.
On Christmas Eve we decided to drink the champagne that had been reserved for New Year’s Eve and that rolled into several glasses of wine as I had a pleasant evening watching the Police reunion concert and some other music videos. On Christmas Day I was slightly hungover, but not feeling too bad. I had a decent day - did some baking (rolls, cookies, pizza), walked the dogs, and felt better as the day progressed. As of dinner time, I was feeling fine, although maybe my arm had been acting up during the day, I hadn’t noted any change.
Around 6-7 pm, the pain in the arm increased in severity and was affecting the entire limb from the shoulder down. I couldn’t find a comfortable position and was unable to sit still. I got up and walked around, tried to move the arm through various rotations, and even went outside for a few minutes despite the cold. Nothing I could do was helping and the pain was spreading to my chest and then jaw, while also increasing in severity. I’d characterize the normal pain level at an annoying 2 most of the time, but this episode started as a 6 and was climbing towards 8-9.
I think I took some Tylenol and was still unable to sit still and get comfortable. I thought I might lie down and see if I could sleep it off. That aggravated the jaw and now neck pain, and the severity kept increasing. Being a PA, I recalled from my training in ACLS that one of the instructors referred to an acute myocardial infarction as “infarcting” as opposed to infarction. Meaning, the condition progresses if no actions are taken.
I was downstairs (I think to get Tylenol, but can’t remember the exact sequence of events) when Aeyong got up to get the dogs to go outside since they can be recalcitrant when the weather’s cold or rainy. She immediately noted something was wrong and I told her I thought I might need to go to the ER. She shifted to Defcon 1 in two seconds and was donning clothes and scurrying around the house to grab her purse and keys.
She was taking it more seriously than I was, although the fact this was my first ER trip in 29 years wasn’t lost on me. I decided to go to Medical City in Arlington since it had been recommended to us when Aeyong broke her wrist a few years ago. I think that recommendation was more based on the facility being a Level 1 trauma center as opposed to the quality of the ER.
To their credit, when I presented with chest pain they got me back for evaluation within a few minutes, performing an EKG, CXR, and drawing cardiac labs. We were sent back to the waiting room pending the results. I got a look at the EKG while still in the room and it was “abnormal” based on I think t wave inversion, but there was no significant ST elevation or Q waves that I could spot. Honestly, I had a low index of suspicion for cardiac since I still run regularly and although I have some risk factors, I don’t smoke and my blood pressure has been essentially normal during routine exams.
In the ER my BP was high - 162/98, and this trend would persist during most of this episode. We waited in the ER for several hours, although I think at one point one of the nurses came out and told us the cardiac enzymes were normal. This was my main concern, and with normal enzymes, I was relatively reassured that whatever was going on, it wasn’t cardiac. They kept us for six hours or so, primarily so that serial enzymes could be run and these were also normal.
Ironically, my pain was getting worse and was now becoming more diffuse across my chest, neck, and jaw. It stayed on the left side only, never crossing the midline in the chest, but it was bilateral in the neck and jaw area. Medical City did its main job, but other than that, I was underwhelmed. I was evaluated by a PA, and to his credit, he made sure the most life-threatening issue was cleared, but he never asked about my pain level from a therapeutic standpoint, and at the time he gave us the serial results his attitude was “enzymes are normal” as if there was nothing left to discuss. He never asked about whether my symptoms had changed or worsened, and he never offered any therapy or pain management.
In his defense, I didn’t ask or press the issue because I knew the ER wasn’t my PCM and it was 3:30 in the morning and we were ready to go home. The walk out to the car was some of the worst pain I had felt all night and Aeyong was asking me to go back in or to go to some other ER. I was inclined to believe it had to be neuropathic or musculoskeletal and although quite painful, not life-threatening.
We made it home and I think I took some Tylenol while we tried to get a few hours of sleep. I got up around 7ish and was able to book a follow-up with my PCM for the next morning. Throughout the day the pain never got much better so I tried a hot shower (which helped temporarily) and continued with Tylenol. Aeyong suggested her Robaxin which I tried but didn’t notice any difference. I think it was that night that I couldn’t sleep so I took some leftover Hydrocodone from a previous dental procedure. This gave me a good 4ish hours of uninterrupted sleep.
When I saw my PCM, she was concerned that this might still represent an undiagnosed cardiac or pulmonary issue so she recommended that we go across the street to the Mansfield Methodist ER. We followed her advice and were soon whisked in and went through the same initial workup. EKG, CXR, labs. The ER doc also wanted to run some additional inflammatory markers (ESR, CRP) as well as D-Dimer and BNP. Those markers were all elevated although the cardiac exam was still normal.
She then sent me for a CT Pulmonary Angiogram within the ER to rule out pulmonary embolus and this exam was essentially normal except for some nodules (benign) and a trace pleural effusion that was unlikely to be of any clinical concern. She suggested that there could still be underlying cardiac issues that would need a Cardiologist and further diagnostic studies to rule out. She recommended hospital admission to streamline and expedite the process, stating that it could take weeks or longer if pursued as an outpatient.
I was initially hesitant since this was my first ER visit and possible hospitalization since 1994, most importantly, my first since retirement and I was concerned about cost. Aeyong was adamant that I get a thorough workup and not leave questions unanswered. To her eternal credit, she is always going to push for me to get adequate healthcare and evaluation and not leave things to chance. Despite the possibility of a financially devastating hospital bill, I took Aeyong’s and the ER doc’s recommendation and decided to go forward with the admission.
Bed space was precious, so l was admitted to a just-opened room in the OB ward. The room was quite nice, almost more like a hotel with a private bathroom, desk, recliner, couch, and bed. I was kept under observation and offered some pain relief. I tried T3 with codeine which didn’t do much to blunt the pain. The pain had essentially continued but was coming in waves of severity and then settling down for no discernible reason. It seemed to be centered in the left shoulder and at times would shoot back up to a 7 or 8. After midnight the nurse offered pain relief and I said I didn’t want T3 and would prefer just a gram of Tylenol instead. She then said I could get Hydrocodone if I wanted and I related that it had helped at home, so I decided to have it.
Again, the Hydrocodone helped me get about four hours of sleep. I was NPO as of midnight so they could perform the cardiac stress test. I should mention they had given me nitroglycerin in the ER, and I think it helped some with my chest pain, but can’t state that with confidence. The one outcome I’m relatively sure about is that it gave me a headache and this persisted through the day into the evening. In the morning my primary pain was the headache, as the shoulder and chest pain had died down somewhat.
The night before and earlier that morning I was relatively certain I would need the chemical stress test as I would be unable to perform the treadmill stress test due to my headache and other pain. Once I got down to the testing suite in Radiology, my only pain was the headache and I felt capable of at least trying the TMST. I went through with it and was able to complete the test satisfactorily.
We went back to the room and Aeyong got some food so were able to share a brunch so to speak. Periodically throughout my stay, they would check vitals (Q4h I think) and at times of rest they would be more normal, but if I was up and moving around the BP especially would get higher. Thus far, most testing was normal, except for the D-Dimer, ESR, and CRP. These were all elevated, but they’re non-specific so they mostly only raised more questions rather than providing answers.
I eventually had another radiology tech come to my room in the late afternoon to conduct an echocardiogram there at my bedside. A little after 5 my nurse came in with some papers and notified me I had been discharged by the Cardiologist/Hospitalist. They were confident my issue was non-cardiac and didn’t warrant further testing or hospitalization. I agreed with them and had to get Aeyong out of bed back home to come pick me up. She had run herself ragged going back and forth between home to care for the dogs and coming to the hospital to look after me. Her gas tank is much smaller nowadays and she can quickly drive herself to exhaustion and pain when anything disrupts the normal schedule.
I’m now nine days past the initial episode. The shoulder and arm issues persist, albeit much decreased in severity. I have a follow-up pending on Friday with my PCM, Dr. Avenesyan. My working diagnosis is neuritis or radiculitis that flared up for whatever reason and spread to adjacent structures for reasons undetermined at this point. I’ve been able to walk the dogs every day and I even was able to run on the treadmill yesterday, although a bit slower (5 mph) and for only three miles. I made some changes in my office, removing the wheels from the desk so it’s slightly lower and even putting the keyboard in my lap as I type this long-winded explanation.
I’ll see on Friday whether my PCM wants to send me for further studies. I imagine a CT or MRI and possibly a Neuro/Pain Mgmt eval might be in the cards. All this rambling to relate the conclusion that my threshold for health problems is decreasing as the years pass. I had an acute episode of foot swelling this summer that I think was brought on by excessive sodium intake (snacks) as well as alcohol consumption. I hadn’t drunk any alcohol after that episode up until Thanksgiving. That week saw my frustration with Berklee at an all-time high and accelerated my previous holiday plans by nearly a month.
This rolled into drinking beer for about three weeks straight (we went through four cases of beer in that time frame) as well as not exercising or eating particularly healthy for over two weeks. Ironically, I had returned to my normal schedule for over a week and had run on Sunday without any significant issues. I don’t necessarily think the Christmas Eve champagne and wine were the direct cause of the episode, but a repeating theme in the past few years has been that my health isn’t quite as resilient as it was in my younger days.
I can no longer negate the alcohol and unhealthy food choices with exercise. Now, I have to manage my nutrition more closely than ever before. Alcohol and junk food can manifest as poor health outcomes within just a few days as opposed to being inconsequential (in the short-term) in the past. Whenever I drink now, almost every health metric starts to suffer - sleep quality, nutrition, activity level, mood, cognitive function, motivation, etc.
I haven’t sworn off alcohol permanently, but I’m going to need to shift to small amounts over brief periods, for example, a six-pack shared with Aeyong every few months and never the larger amounts consumed over consecutive days. I’m happy that I never became an alcoholic, but it’s easy for it to become more habitual if you’re complacent about it. To bring things back to the start of this novella, complacency is no longer an option when it comes to my health.
As we age, we have to an active role in managing our health or we’ll be forced to continually rely on the aid of others as we watch our health gradually decline. I’ve set a goal for myself that I won’t have any alcohol or junk food (like Doritos) until I get my weight back under 200 pounds. I had got it down under 210 just in November, but I think I probably gained back another 5-10 pounds since then. Hopefully, once I return to regular exercise and a better diet, those pounds will start coming off. I’ve been largely ambivalent about being overweight for a long time, but I’ve got to take a more holistic view because all aspects of my life tend to take their lead from my physical health.
In Texas, at least. After a slow start, it appears all of our trees, most of our shrubs and the lawn are making a full recovery from Snowmageddon ‘21. Our biggest tree, the one out front which was planted when they built the house, was probably the slowest to sprout buds. For awhile, I had serious concerns that it didn’t make it through the four day hard freeze back in February. Thankfully, it finally began to display some buds and eventually a full complement of leaves to get that good ‘ole photosynthesis jam going. By current estimates, it’s mainly some potted plants that appear to have met their demise. We have a few shrubs that look dead to me, but Aeyong is optimistic that by cutting them down to their base we’ll encourage some new growth from the roots. We’ll see. If they don’t recover, shrubs are easy enough to replace.
In that horticultural vein, I’ve taken a bit more interest in getting the yard in good trim. I apologize, that wasn’t intended as a pun, but now it is, so there. You’re welcome. We haven’t really gone to any great lengths with our yard, other than regular mowing and seasonal fertilization and occasional seeding. The front has remained pretty thick and healthy, but the backyard has some bare patches, including one large swath of dirt in the back corner. I’m going to try de-thatching and scarifying with, you guessed it, our new de-thatcher/scarifier. Hopefully it will clear up a lot of dead grass and leaves and open up the soil to allow more root growth and nutrient/water transfer where it’s needed. Along with that, I’ve got a big bag of Humic DG which is supposed to enhance nutrient absorption and improve soil structure. It’s a bunch of small spherical granules that disperse into the soil, some of which immediately break down into humic and fulvic acid, combining with essential nutrients and persisting in the soil to allow plant absorption for extended periods of time. The humate portion remains even longer, thereby further extending that nutrient cycle.
I’ve seen a few customer testimonials and just Humic DG alone can make a big difference to yards, plants, and larger agricultural applications. My plan is to de-thatch, scarify, mow up the detritus (I have so few opportunities to use that word, so back off), and then lay down probably half the 40 pound bag of Humic. I’ll be seeding and fertilizing in the near future, but I do want to give the yard a little time to recover so I’ll probably wait a few days to a week to do that. Not everyone recommends seeding in the spring, but our bare patches definitely need it. I probably need to get some peat moss to mix with the seed. Although it probably sounds like I’ve gone all 4H (when I was in school it was all farm kids, I’m probably showing my age), but I really just want a nice green lawn that I can maintain. I don’t want to spend a great deal of additional time keeping it in shape. Hopefully some well timed interventions will get it ready for summer.
In other developments, I got my second COVID vaccination last Wednesday, and the side effects were slightly worse, I suppose. The arm soreness was about the same, but I think I felt some more systemic effects this time. It’s a bit hard to tell because the day of the vaccination I also ran (a modified attempt at resumption that was triggered by the broken elliptical) and scalped the lawn. Scalping the lawn (and bagging the clippings) is something that’s useful to do 1-2 times per year based on the advice I’ve seen. It’s somewhat like de-thatching, I suppose. In my yard’s case, it takes considerably more effort to push the mower across high spots in the ground. All that to say, the additional fatigue I felt the day after was probably a combination of the vaccination and the physical efforts of the day before. I also woke up around midnight feeling febrile, but didn’t bother checking my temperature. I just took a gram of Tylenol every six hours for the first day or so and things slowly got better. As I’ve said, eminently better than getting sick with COVID.
Things at work are going well. I’ve worked in the new location the last two weekends, and it’s a nice setting. Essentially the same drive as before with the last two miles being on surface streets. VES has been keeping me gainfully scheduled, one weekend at a time. My no-show rate has dropped a bit, down to only 15% of the last two weekends. I’ve been averaging about $2500 per weekend, which is okay. I’ve been hoping to maintain closer to $3K per weekend, for a monthly total of $12K. Based on how they’ve been filling my schedule (partially) and the no-show rate, I’m not sure that’s achievable with only a two day workweek. At least it’s adequate for our financial goals of paying the house off slightly faster and maintaining a discretionary income. I only want to work enough for those two criteria, as I really value my free time.
Back to homefront matters, Aeyong is recovering fairly well. She had her cast removed the week before last, and she’s jumped back in to her normal routine. Maybe a bit too hard because she’s got some wrist swelling today and will need to rest a bit. She’s been catching up on several things she wanted to accomplish including trimming and bathing all the girls. She also has been out in the yard working, and this weekend she decided to help me out by dusting and cleaning the bathrooms upstairs. That was a nice surprise because it had been nagging me for several weeks and I had been too busy with regular work and work around the house. Still, she’s probably paying for the uptick in activity right now.
I’ve been trying to improve the garage layout the last few weeks to coincide with efforts in the yard. I installed some overhead storage shelves and moved the treadmill and elliptical all the way back against the wall. Not a huge change, but the added floor space has been nice. We took the vertical shelves that were previously on the back wall and moved them into the laundry room, giving us some more storage space in there. We had a little half shelf in the laundry room before, and now that has moved to the garage as a rolling storage cart for our air compressor and shop vac. I’ll eventually install another identical set of overhead shelves in the other garage slot and hopefully free up another section of the floor. Eventually I want to have a rolling workbench with some good working tools - table saw, miter saw, router, and maybe a few other tools depending on how things develop. I’m going to try to ease into woodworking, but I already have all sorts of ideas for projects. I don’t know if it’s just a natural part of aging, or a genetic thing I get from my father. He was definitely a DIYer at his core. Nature, nurture, or perhaps a bit of both?
After all this fairly mundane material, I haven’t stopped pursuing my core disciplines, although there have been more days “off” when I was working at VES or had my time manhandled by DIY, medical, etc. issues. I finished a Premiere Pro course, and I’ve just started a Photoshop course. I also signed up for a basic piano course, mostly to cover some fundamentals that I know I’ve been lacking. I’ve really only slowly learned songs and then just spent my time practicing them, but I haven’t spent any considerable time at learning scales, improvisation and some of the basic skill set I need if I want to advance further. The same could be said for my other disciplines as well. I’m alternating my drumming practice between Mike Michalkow’s course and trying to learn Xanadu for the eventual Rush AFTK deep dive video. Check back next year, probably. Then there’s also bass, guitar, singing, drawing, writing, learning to speak/read/write Korean. Not to mention maintaining my CMEs for work. The days are just packed, and that’s how I like it.
After a tumultuous week in the aftermath of Aeyong’s injury, we finally got into to see her pcm and had the referral submitted right then. The office visit with the orthopedic surgeon was approved by the time we got in our car, and we went and saw him yesterday. We had to go to Harris Hospital in Ft Worth, where I had my right knee surgery back in ‘81ish. I’m not sure how old Harris is, but it’s pretty long in the tooth. As we tried to find our destination, we engaged in some of our age old raving and drooling as we negotiated the turns and twists that every hospital complex seems to build into its infrastructure.
The actual entrance to the Ben Hogan facility (I think it’s mostly sports medicine/ortho) was in a loading dock, I think selected for COVID flow control. We were checked in quickly and everyone rolled pretty smoothly. They shot new x-rays and gave her a new fiberglass splint that’s going to have a shelf life of less than 36 hours methinks. Her surgery was put on the schedule for the next day (today) and we’re heading over to check in at 0630.
Dr. Niacaris seemed nice and professional. He is planning on using a plate to stabilize her fracture and thinks it’s possible she’ll need the plate removed in four to six months, since it’s a little large for her wrist size. He’s not sure, but stated the possibility was higher given that her frame is small. All the medical treatment parts of this process have been pretty good. The USMD ER visit went about as well as it could - they got her in quick, managed her pain, got her sedated and partially reduced, and then got it adequately stabilized for her to get through the week until seen by ortho.
The ortho clinic itself went well - we didn’t wait long to get in and there was no part of the process where we were kept waiting very long for them to complete all their tasks. Interestingly, there was no real pre-op other than the x-rays. I think it’s a function of COVID now that she is getting all her pre-op labs done the morning of the procedure. I assume they want to minimize the number of hospital visits.
It’s a same-day surgery, so hopefully everything will go well and we’ll be back home this afternoon. I assume her pain will be worse for a few days, but hopefully she can start healing properly and I also hope she won’t need an additional surgery a few months down the line.
Progress never waits and I had my first IMO (independent medical opinion) from VES this morning. It’s a case from last month that I had seen, and I was surprised they presented it this way because it means they actually have to pay me for it. When I checked into my VES portal, I also saw they had added a patient for March 13th. I hadn’t told them to resume my schedule, but I think I must have mentioned that weekend as my likely return. That actually works with what I’ve been thinking, so I told them to resume scheduling. This will give us a few more free weekends to get her through the initial recovery stage.
Regardless, I’m only out of the house for about 8 hours on two days, so she should be able to attend to whatever she needs while I’m out. We’ve been engaging in a bit of nail biting and hair pulling while sweating out our Tricare approvals, but so far they’ve gone through okay. We paid our co-pay for the surgery and the lady in billing stated we had $54 left in our deductible. I’m still not sure what that means, because I can’t seen anything in our Tricare self-service portal that reflects that amount.
Outpatient surgeries are supposed to have a $63 deductible, so it’s not immediately clear to me why it’s slightly reduced. We have a catastrophic cap and point of service limit, but our information indicates there’s still plenty of room within those. All that said, the estimated cost of the surgery is $63,000 and we’re paying $54 so far, so it’s completely acceptable. I think that’s just an estimate for typical procedures like hers, we’ll know the actual costs after the fact. We’re very thankful to have good health insurance, we know there are many underinsured or non-insured people who would be financially devastated by an event like this.
Continuing the running commentary del whinage, it’s been one of those weeks. A massive cold front has spread across most of the continental U.S., and when I say most, I mean like 98% or so (based on my highly scientific glance at a map on a weather site). With the cold came snow and ice, and in a fit of wintry novelty, I coaxed Aeyong into coming outside to check out the lovely white expanse.
Bad choice. In an uncharacteristic spree of high spirits, Aeyong decided to ski down the driveway and made it about a foot before disaster set in. I think she only made it to the first e of “Whee!” before her feet were launched skyward. Gravity is a harsh mistress and wasn’t offering any soft landings on the frozen driveway. I thought she landed directly on her tailbone, but it was her right wrist that bore most of the force of impact. And, in a contest between bone and frozen concrete, the latter almost always wins.
She sustained a comminuted, intra-articular, angulated and displaced distal radius fracture. In medical terms, we refer to that as “F&*# Me!” As I told her, she wasn’t fucking around. This is her first broken bone in her life as far as she remembers. If you wait until your mid-fifties to break your first bone, you should do it in style, you know the old saying. We both have now sustained orthopedic surgery inducing fractures, just in case anyone thinks we don’t go full throttle when the time is at hand.
The irony is that the rare cold front with snow/ice included that caused the injury in the first place has also shutdown most of our infrastructure, making medical follow up all the more complicated. We were fortunate enough to be able to get her all-wheel drive Toyota out and make it to the nearest ER in Arlington. We’ve subsequently learned that just another few blocks down the street is a Level II trauma center, which would have been the preferable place to go. Lesson learned. Although I’m still practicing medicine in the fringes of disability, local hospital and medical center infrastructure hasn’t been something I’ve investigated very thoroughly. I always kind of tangentially knew there was a medical center/hospital with an ER right there on the highway and down the street from our PCM, so that was always the default ER location we’d attempt first if it was beyond an acute/urgent care type visit.
Now we know to go a little further down the street if it’s trauma or more likely to require the services of a specialist. We don’t routinely need to avail ourselves of medical care in general (not counting prescription refills which are mostly remotely automated), so these aren’t issues we have a great deal of experience with in the recent past.
To add insult to extremity trauma, the infrastructure shutdown has carried across all sectors, so we couldn’t reach anyone to arrange follow up yesterday. I left messages on our primary care doctor’s site and the ER doctor had recommended several orthopedic surgeons, most of whom wouldn’t accept our insurance. Thankfully, one of them was part of our PCMs group and does accept our insurance. Their appointments department called me at the end of the day yesterday, and we’re in the process of coordinating a follow up appointment not with that doctor, but with the groups hand/wrist specialist.
Hopefully the doctor and his clinic will be open for business and we’ll be able to navigate the streets across town. The temperature hasn’t risen above freezing for a few days and that’s going to last a few more days before it slowly starts crawling back upwards. Right now it’s a sweltering 1°, and that’s Fahrenheit. But hey, no wind to speak of! We’ve had at least one set of pipes freeze for an upstairs bathroom sink that’s on the outside wall. Once I noticed, I went around and set all the other sinks to drip, but this one doesn’t seem to be budging. I really hope we don’t get burst pipes out of this, just to add onto all the other fun.
Because of the need for me to look after Aeyong, I requested VES to cancel all of my upcoming schedule until we get a better idea of her upcoming treatment schedule. Surgery will be a definite necessity and then there will likely be a great deal of physical therapy in her future. Hopefully most of that will be during the week, so I’ll eventually be able to return to work, but I imagine it’ll be several weeks before we’re on the other side of things.
I’m sure I’ve expressed my religious beliefs (lack of) here before, but I do like some of the wisdom found in tomes spiritual. “God laughs while you’re making plans.” This could also be expressed as “Life is what happens while you’re making plans.” We’ve had a year chock full of life happening in direct defiance of all our plans and expectations. COVID-19, layoff and eventual termination of my work with the VA, all the nail biting and teeth gnashing related to the state of politics and governance in this country, etc.
It’s not all bad, though. As I’ve said before, we’re among the fortunate in that we have a steady retirement income, a good home, and we haven’t truly suffered any deprivation this whole time. This injury has been the most devastating medical event in several years time, and it will be rough going for Aeyong for weeks and months to come, but we’re both still standing and we’ll come out this intact I’m sure.
The urge to dip into our retirement savings has reared it’s ugly head yet again, especially considering the prospect of not wanting to work for several weeks and wanting to maintain a positive cash flow. We’re not at a point that we need to make that decision just yet, though. Financially, this should hopefully just be a temporary setback while we get Aeyong healed and I can eventually get back to work and get some cash flow restored.
Which is not as bad as actually having Coronavirus, I’ll readily admit. The combination of being laid off, existential angst, and uncertainty have cast a pall over the proceedings in the past few weeks. I haven’t been motivated to do any of my usual practicing, studying, or creative endeavors. It’s mostly been the basic daily tasks (exercising, household chores, walking/feeding the dogs) and then maybe a bit of cooking and otherwise passive activity like reading, watching television, or playing video games.
The reduction in work schedule hasn’t been the biggest adjustment because I was already only working part-time. It has been a challenge to accept being laid off indefinitely, however. Watching our money, it appears we’ll be able to do okay for a long time if not indefinitely, but this is assuming no large scale financial or other disasters are added to COVID-19 and being laid off. We’ve already experienced a few unplanned expenses, which is honestly fairly typical in the grand scheme. I had already decided to start mowing the lawn again after our service had jacked up the price for the third year in a row. This on top of the fact that I’m pretty sure they stiffed us for two weeks worth of service at the end of last year.
With my reduced schedule at work, it only made sense to start cutting the lawn again. It’s only about a 90-minute job and the additional sunlight and physical labor won’t hurt. As luck would have it, storing a lawnmower for over three years plays a bit of havoc on the engine and fuel system. The carburetor was stuck open, so the fuel immediately began to leak out after the fill-up. I replaced the carburetor and did a bit of cleaning up and managed to get it started. It was chugging a bit so I cleaned up the now very old spark plug and can’t say whether that helped or not. All that to say at best it sounded like an asthmatic hay fever victim with Coronavirus after attempting a marathon. It was huffing and puffing with even the sparsest grass and the plugging of the carburetor leak revealed a few additional leaks on the backside of the engine.
Assuming it was going to be a cascade of equipment failures leading to parts replacements yet never achieving a satisfactory end result, I made the command decision just to replace it with a new mower. I attempted to buy one at Home Depot but found they were social distancing customers and the queue looked like it might take 30-60 minutes just to get into the store, with no guarantee they’d have what I needed. Being that the lawn wasn’t yet at the critical stage of shagginess, I decided to look on Amazon and found an electric model by the same company as the chain saw I had purchased last year. I’ve been pretty impressed with the power the chain saw motor generates, so I was more willing to go against the lifelong convention of small gas engines on mowers. So, new lawnmower is inbound for Wednesdayish.
Present circumstances have conspired to diminish the significance of this week, which is our thirtieth wedding anniversary. I think I had mentioned a few posts back (in the journal maybe) that we had canceled our travel plans several weeks ago, just assuming that we’d either be on lockdown or that it would be the prudent decision to get out when refunds were still available. So, that out of the way I still wanted to mark the occasion, so I’m thinking I’ll bake a carrot cake. Aeyong always loves them and it’ll be something different to try out in the kitchen. I need to gather a few ingredients depending on which recipe I plan to follow.
The sun has been shining, the grass is green, and summer is in the air. We're still in that magical window when it's nice to be outside for most of the day without fear of withering from the heat. The press of the last few months is just about to see its release. I've got a long weekend and then I take my board exam next Tuesday. I feel pretty confident about my readiness, but I'll still crack the books daily til Tuesday.
The transition to fee basis at work has essentially completed and my schedule has normalized itself for the most part. It's really nice to have a three day workweek at the most. It's funny how quickly that became the norm for me. The default schedule should be three days for three weeks and then a week off. I'm working half as much and bringing home more than double my Federal pay (with consideration for no increase to my pension and no 401K matching). It's really the perfect work scenario for me and my capabilities. I can complete exams more thoroughly and faster than any of the people I have worked with so far. I'm sure there are others like me out there, but we all have a fairly unique skill set that gives us distinct advantage over other examiners. Nearly thirty years of continual Federal service including the twenty three years of active duty has definitely paid off in my current job.
I haven't really been able to settle in and take advantage yet because the last few months were occupied with the end of the Berklee semester and then the beginning preparations for the board exam. Thankfully, the board schedule is transitioning to a ten year cycle after this. My goal is that by the time I take the next board, we'll have paid off this house, built or bought our house in the country and I'll be well ensconced in my bespoken home studio. That mostly depends on a steady state for my current work situation. I'm relatively confident that the C&P program in general won't go anywhere soon, and I'm mostly optimistic that the role of the examiner will stay the same as well. The prevalence of laziness, incompetence, and ambivalence in the Federal service actually plays to my advantage. There's no shortage of work for me, and this allows me to maximize my time/salary in a way that's really unmatched anywhere else in the job market that I know of.
by all involved parties. First we get smoked by our walkins today (3x the usual number) and then our staff is doing their best to give the exponentially enlarging snowball an extra kick before it gets to me. I love the fact that people who are not ultimately responsible to care for a patient are more than willing to sign them in when they don't have an appointment since it's my responsibility to take care of them. Soon I will be in a job that doesn't have walkins and I won't have subordinate personnel who can arbitrarily add to my workload.
Being a provider with a schedule of patients is an occupational experience that most people don't comprehend. When you have a schedule, you are locked into that schedule. Your day is dictated by the schedule and you must stick to it or suffer complaints and backlash from patients and staff alike. As a provider I accept this, because it's what I get paid to do. Where I get really frustrated is when other people through ambivalence, naivete or outright intention add to or otherwise complicate my schedule. I don't mind a busy, fully booked schedule. The busier I am at work, the faster the day goes by. I pride myself on staying ahead of my schedule, finishing my notes in a timely manner, and getting all the time sensitive issues handled as soon as safely possible. When it's up to me, this is very rarely a problem. The only time I typically fall behind is through the action or inaction of others.
Today we had 15 people signed in for sick call, and we only have 90 minutes to see them before appointments start. The frustrating thing is that most of these people don't truly have acute medical issues. Most of our sick call patients are here because they don't want to wait for an appointment, or they are trying to get out of work. Rarely do I see a patient on sick call that I think "It's good you came in when you did, because this was a serious issue". Most of the time I think "Why would anyone ever seek medical treatment for this issue?" This gets back to my fundamental problem with most clinic visits by soldiers which is that they get free healthcare and have the secondary gain of time away from work, duty modification, etc.
The NCOs responsible for triaging the acute patients are not very good at what they do. They have a tendency to not want to enforce sick call complaints to acute only, and if the patient argues with them or insists on being seen, they sign them in. Military patients essentially have no negative reinforcement system for spurious complaints. The worst thing that happens to them is being told they are normal or their issue doesn't require any more workup or treatment. Even in those cases, they were at least able to get out of pt and work for a few hours. Patients can no-show, malinger, drug seek, or engage in a multitude of fraudulent or exaggerative behaviors and they very rarely get held accountable. This is one of the reasons I have sought employment elsewhere. The secondary gain issue is fairly common with the normal active duty population, but it's the modus operandi of the meb patient. I don't know how any competent provider with military experience could tolerate long term employment with this population. "Never has so much been done for so few who are so less deserving" - this should be the clinic motto. I find myself less and less proud to be an American citizen and retired soldier the more of these types of patients I am exposed to. There is a significant portion of the young population who look at the world as a set of entitlements with no requirement to work or produce for those entitlements.
I'm rambling now. Rant over. I expect my relative attitude will improve here shortly.
and then hopefully <1 day of clearing. Not that I'm counting. The realtor should be coming over later today to take pictures of our house and then hopefully get it listed here in the next few days. We're going to be taking it somewhat in the shorts since we've only lived here two years and the market is pretty flat (better than most other places, though). We've accepted the loss because of all the positive reasons for the move and job change. It's also taught us a bit about the home buying/selling process.
Unsurprisingly, not everyone is greeting the news of my pending departure with words of encouragement and congratulations.
I received the offer via HR over the phone, and although it will mean a modest pay cut from my current wage it's still more than I was expecting the VA to offer. I accepted and the paperwork train is leaving the station. I'll have loads of credentialing fun as well as the requisite physical and security checks in the coming weeks. Not to mention dealing with the fall out of my departure from my current position.
fucking sucks. I don't care what Carly Simon sang. Waiting for the phone call now. And slowly dying inside...
And the "soldiers" are trying to bring me down
and it's getting very hard to stay-ay-ay-ay-ay-ay
and I'm stuck right here in jackhole town...
the "brave" lament their lot in life
they've had to deal with all this pain and strife
even though they've not deployed a day-ay-ay-ay-ay-ay-ay
just another day in jackhole town
the "intrepid" need their MRIs,
percocet and duty day profiles
why was my sergeant so mean today-ay-ay-ay-ay-ay
and I'm dying here in jackhole town
Every "fighter" has a pretty good shot
To get as much as the other "hero" got
They never sacrificed in the first place
"Heroes" throw the flag in our face, oh oh oh.
it doesn't matter if you lie
we just don't want to make you cry
soon or late you'll get your way-ay-ay-ay-ay-ay
when your a citizen of jackhole town
An interesting brief talk on the nature of chronic pain and future developments.
Our favorite thoracic shrapnel patient returned after about a month in the hospital for a check up. He is the patient that I put the chest tube in and then shamelessly hammed it up for the after picture. He is doing very well with no residual pain or loss of pulmonary function. The scar is still impressive enough for him to get sympathy dates, though. Not sure if he's tried it yet.
We lost our civilian doctor, Dr. Rahullah who had been an integral part of our clinic here. He is on my left, explaining the patient’s prognosis to her father. He apparently was killed because of an inter-family rivalry although that isn’t confirmed. He was a man who had risen so far above his upbringing and spent seven years of his life in medical school and had been working in our clinic for less than a year. As unique as doctors are in the states, they are even more special here in Afghanistan. This is a typical outcome for those who put their lives on the line to help the people of Afghanistan.
or are you just happy to see me? A couple of action shots of a guy who had what was apparently a shrapnel wound to his posterior thorax that resulted in a hemopneumothorax (blood and air in the chest cavity, compressing the lung). We started an IV, gave him some pain meds & antibiotics, and I placed the chest tube seen here. We evacuated him to our forward surgical team and he's doing well according to reports. Yeah, I don't exactly look professional in that first shot, but we tend to joke around a lot during traumas, especially after we have stabilized the patient and know that they're going to do alright.
I had assisted with a few of these during PA school, but this was the first trauma patient that actually needed a chest tube that I put in myself. During OIF 1 we just never got anyone with penetrating chest trauma that really needed a chest tube. It's surprising just how hard you actually have to push to penetrate the pleural lining, but it's very obvious once you do. After penetrating and opening the hole up with hemostats there is a great rush of air (in the case of a pneumothorax) and blood (if there's a hemothorax as well) and the patient usually immediately begins to breathe easier, which this one did. That also explains the last picture (I probably needed a face shield). I'm sure I'll get several more under my belt before I'm done here.
The vacant stare and protruding tongue are products of Ketamine, an anesthetic agent that works very well for short procedures. We have to use it fairly often for young children because they get so distressed by the environment and the procedures we perform here. We use local anesthetics first, but they usually still get very upset by the process so we often sedate them. These kids get what I call the "Ketamine Stare" where they lay with their eyes open staring, but they are unaware of what's going on. I put on a little Pink Floyd first and with the Ketamine onboard, send them to the Dark Side of the Moon.
It's now September, so another calendar month is gone by. August was a fairly good month in retrospect. I left Jalalabad on August 6th and came to FOB Blessing which has turned out to be a positive change in most aspects. I'm pretty happy with the living arrangements, and I have settled into a comfortable routine here.
In the last month I have seen more serious trauma than I saw during my whole OIF deployment. That statement must be qualified by the fact that we didn't have a steady supply of local nationals that we were seeing and Iraq hadn't really heated up yet during my time there. After four years in Occupational Medicine I was feeling pretty rusty on trauma management, but just a few weeks here can knock a lot of rust off. Yesterday, I placed a chest tube in a local national that was hit by shrapnel and then we evacuated him to Jalalabad for further care.
Things to look forward to in the next month include the completion (hopefully) of the new dining facility which will result in the relocation of the MWR facility to the former mess hall area (which will allow more room) and possibly a small PX being put into the previous MWR facility. September and October are still fairly busy from an operational standpoint, so we will probably continue to get a steady flow of trauma patients.