That's Something You Don't See Every Day, Chauncey

Watch me pull a rabbit outta my hat!

Posts Tagged ‘medicine’

IM Fun: Make it so.

Posted by kozemp on January 5, 2010

David: So surgery tomorrow morning?

Me: 800 hours.

David: Good luck, sir.

Me: Thanks.

David: What’s the objective?

Me: Removing part of my spine.

David: Will the surgery resemble anything like that episode of TNG where Crusher replaced Worf’s spine?

Me: Ah, no.

Me: It will not.

David: That would have been cool.

Me: Yeah.

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Is that supposed to be some sort of insult? I don’t actually have a spine, you know.

Posted by kozemp on November 20, 2009

Okay, so, we have presumably all heard about my adventures in electromechanical breakage earlier this week. Today, though, I managed to successfully get my MRI. The technician even complimented me on how good I was with not moving in the machine and screwing everything up.

When she said that I thought, but did not say, “it’s easy to lay perfectly still when every single byte of RAM is dedicated to keeping myself from having a claustrophobic freakout.” This is in the quote-unquote open MRI machine, mind you. The notion of the “open MRI” carefully straddles the line between pronounced exaggeration and outright falsehood. It’s only open on the sides, you see. When getting the innards of your lower back examined they still put you into the machine far enough that there is a metal plate about two inches from your face.

This is only marginally better than the giant cigar tube of a regular MRI, but in the end it comes down to coping mechanisms. To cope with the open MRI I just shut my eyes very tightly and feverishly replay Doctor Who episodes in my head. To survive a regular MRI I have to disrupt the higher functions of my brain with enough narcotic painkillers to put an Indian elephant into low Earth orbit. Open MRI it is, then.

One of my favorite new-ish medical advancements is that when you’re done with your MRI they give you printouts and a CD-R with your scans on them. For someone like me whose curiosity transcends obsessive, the chance to actually look at one’s own inner workings in the comfort of one’s own home is up there with breakfast for dinner and free cable for life.

In my particular situation, though, this becomes one of those times when obsessive curiosity becomes problematic.

Let’s first take a look at the side view.

Physiology is fun!

The technical name for this scan is "T2 DEQ SAG."

You notice the top five intervertebral discs? Don’t they look nice? All glowy and healthy and full of goo. They’re paragons of flexibility-granting, shock-absorbing spinal fortitude. Now notice the sixth one down from the top? That’s L5S1, also known as the lumbrosacral joint. It’s where your back turns into your legs, more or less. By now you’ve probably noticed that L5S1 is NOT glowy and healthy and full of goo. It is, in the words of my orthopedic surgeon, “basically broken.” It’s not white because the disc has prolapsed (fancy doctor-talk for “sprung a leak”) and the glowy goo, aka the disc’s nucleus pulposus, has been pushed out and is pressing against and chemically inflaming the nerve roots inside that part of the spine.

Well, I thought, how bad can that be? I mean, it’s all still got to be pretty orderly, right?

Looking good....

This is the top view of L2L3. That’s the little guy at the top of the side view. You can see some definition on the disc and a nice center of goo. So far, so good. Moving down the spine…

Still looking good...

L3L4 here. Again, everything looks nice. Disc, goo, everything in its appointed place and proportion. Dear gods, you’d think there was nothing wrong with this guy.

Why are we even bothering to magnetically resonate this perfectly healthy spine?

L4L5. My spine is a thing of beauty. Of BEAUTY, I say. Look at that. Who wouldn’t want this spine? I mean, yes, there’s an awful lot of that greyish stuff AROUND the spine that probably isn’t that desirable, but that’s another story. For now we’re talking spine and this spine will kick your ass right off this planet. Could the surgeons and the MRI machine be wrong? Could the side view somehow have been tricked? Has my L5S1 intervertebral disc become sentient and crafted an elaborate practical joke? Well, let’s look at the next picture to make sure.

AAAAAGGGGGHHH! AAAAAGGGGGHHHH! KILL IT!

SWEET CHRIST WHAT THE FUCK IS THAT THING?

This is my L5S1. What’s left of it, at any rate. As you can see the healthy, glowy goo which is supposed to reside comfortably in the middle of the disc has seized upon the exit at about 8 o’clock and spread out all over the place. “The place” in this instance being the spaces in my spinal column where the nerves go out to my lower back and legs. The goo is a delicious jelly-like substance made up mostly of different proteins that, while very nice and helpful when trapped inside their disc, react with nerve tissue like something out of the end of a Tony Scott movie.

Nerves (played by Michael Madsen): Hey, who the fuck are you?

Nucleus Pulposus (played by Tom Sizemore): Who the fuck am I? Who the fuck are YOU?

Other Nerves (played by Mickey Rourke): Oh, you’re DEAD, motherfucker!

(Everyone pulls out guns and starts shooting each other.)

Just think about how much more involved and invested people would be in their medical care if doctors explained things the way I do.

Hoity-toity book-learnin’ doctor-speak: “An atheromatous plaque has built up in your posterior interventricular artery that will require a percutaneous coronary intervention.”

My version: “Okay, remember the part when Vasquez and Gorman stopped the Aliens from chasing Ripley by blowing themselves up in the ventilation tunnel? It’s like that, only in your heart.”

“Percutaneous coronary intervention,” or “killing Aliens.” I wonder which is more appealing.

JLK

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Gold stars. Alone with his dead.

Posted by kozemp on September 28, 2009

My desk is pretty awesome.

As bedroom furniture goes for the most part I am very lame. My bed is just a box spring and a mattress on a metal frame, my chest of drawers is a hideous old hand-me-down I can’t bring myself to get rid of, and my bookcases are Ikea standard issue. Until a few years ago my nightstand was – I am not making this up – an old Tandy XT monitor jammed into the top of a white milk crate. For the longest time I figured “oh, well, this monitor-stuck-in-a-milk-crate keeps my glasses and whatnot off the ground just as well as a fancy-schmancy ‘night table,’ so why shouldn’t I have this next to my bed? Oh, how droll and utilitarian and twentysomething I am!”

Of course, at some point when I was 28 or so I realized, as all intelligent folk do, that utilitarianism is a joke and John Stuart Mill is a fucking dickhead. I threw out the monitor-stroke-milk crate and resolved to keep my essentials on the corner of my desk. People like me who are largely blind without their glasses will recognize the need to place them, Leonard Shelby-like, in the same place every night. So now I keep my glasses and wallet and phone and whatnot on this one corner of my desk.

And this isn’t just any desk, mind you.

From the time I was approximately seven years old until about two years ago my desk was this ancient, mirror-topped mahogany behemoth I assume was scavenged from one of my mother’s dead relatives. This was how we obtained just about all of our furniture back then. Now bear in mind two important things at that time: 1) My parents were literally the age I am now, but with two kids and a mortgage living on the salary of a schoolteacher and a part-time optometrist. 2) In the entirety of my mother’s comically-abundant extended Irish family, by some cosmic demographic hiccup we were the ONLY new family with young kids. So every time someone died – which was quite often given the sheer quantity of family members – my parents would end up with their furniture because, “oh, John and Teresa need it.” This is why my father didn’t have a reliable car until he was 40 but we have three complete dining room sets, and why as a third-grader I was given a gigantic antique for a desk.

Over the next twenty years or so I would proceed to beat the living shit out of this desk, and when I started going back to school a couple years ago I realized I needed a place to both put my computer and do homework and that my desktop wasn’t big enough for that. (The lack of such realization perhaps explaining some of my poor academic performance beforehand.) I also realized that the mirror that was the top of my desk was sufficiently cracked and broken such that if I slipped while typing my hands would be sliced off at the wrists.

So with much sadness I disposed of my old desk. My sadness ended when I proceeded to replace it with something that looked like it came from the bridge of the JJ Abrams Enterprise. This desk DOES NOT FUCK AROUND. It is acres of polished glass held up by gleaming black metal in a way that at first glance seems to defy the laws of physics. It is awesomely L-shaped so that I have, essentially, an entire desk for my computer and another entire desk for homework and reading and whatnot, with a third smaller desk in between usually reserved for laptops of dubious purpose. It has got LEVELS: one side of it has an entire second story. My desk is what you would get if you force-fed mescaline to Frank Lloyd Wright and then chained him to a drafting table and held a gun to his head while shouting: “a desk, Frank, MAKE US A FUCKING DESK!”

At the moment a significant portion of it is covered with half-painted Space Marines and a forest of medicine bottles.

For the longest time I tried to keep some order to the medicine bottles, to maintain a sort of straight line that I could go down as I needed to, but as I grew more and more resentful of the fact that I take so many goddamn pills every semblance of order faded and now there are just bottles all over the place. For the back: Neurontin, Vicodin. For the liver: Vitamin E, Milkthistle, Ursodiol. For emergencies/special occasions: Dilaudid. Now that one, that’s special. Dilaudid is what your body turns morphine into. It is wicked bad juju. When I first got the prescription my pharmacist told me, “okay, basically, never take this stuff. It will erase the world.” Since then I’ve taken it three times when the pain in my back flared to a point where I was unable to successfully prosecute my day to day life. My pharmacist’s warnings were not inaccurate. I’m going to hold on to the rest of it and give the pills out as Christmas presents; the nicer you are to me between now and then the more you’ll get.

This weekend I was down with a cold and added some NyQuil to the menagerie. My love of NyQuil borders on abuse, and not even for its alcohol content: taken at half-dosage it is the only medicine I have ever found that actually relieves my symptoms when I have a cold, and as a sufferer of chronic anxious insomnia a full dose is one of the few things guaranteed to put me to sleep. At one point this Saturday I was sitting at my awesome desk, taking my NyQuil, and as I put the bottle down it landed next to the Dilaudid. I thought, “I wonder what would happen if I mixed them,” and then realized that thoughts like that bring me dangerously closer to being a character in a James Ellroy novel. The fact that I am currently reading a James Ellroy novel probably contributed to that realization, but I stuck with that line of thought for a little. Well, let’s think, what would that be like?

I mentally composed a list of pros and cons.

Pros: an authority figure of some sort (police, FBI, etc). Get to hobnob with interesting underworld types and make lots of money. Get to experiment with heretofore unknown combinations of drugs and alcohol. Get to have sex with (inexplicably lots of) interesting women. Free to regularly indulge darkest, basest, vilest desires. Witty yet realistic dialogue.

Cons: complicity in most heinous acts of the 20th century. Tendency for every associate to be evil scumbag. Utter moral bankruptcy.

As I sat there at my awesome desk, I felt the delicious warmth of red NyQuil seeping into my tissues and I thought, “tough call, tough call…”

JLK

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My friends! I’m so glad you’re not dead!

Posted by kozemp on September 16, 2009

I’ve been having some medical issues the last few months.

Now most people who are in situations like this and choose to write about it on the internet will turn their website into an ever-lengthening series of pathetic laments about how put upon they are and how difficult their lives are and how they cannot understand why a just and loving God would make them suffer so badly, but yet they will persevere and come out of their ordeal stronger than they were before.

Needless to say I am not going to be doing any of that.

I think we can all agree that the ways in which I am put upon are of my own making (large percentages of which could be avoided if I just stayed out of Atlantic City), that 99% of the difficulties in my life are caused by my inability to deal with other people (c.f. my 30th birthday), and that it is fairly self-evident why God has chosen to make me suffer (constant profanity, repeatedly murdering children on stage, sniggering jokes made in churches during friends’ weddings about God’s inability to successfully hit me with a lightning bolt). As for persevering and all, I mean, what’s the alternative? Not persevering? Giving up? Death? Fuck that noise. I have said repeatedly that I plan to live forever, so these malfunctions have to be met head-on and with maximum force.

Suffice it to say this will not become your average illness-diary-slash-ongoing-suicide-note website any time soon.

So, starting a couple months ago, I went to the doctor because I had felt kinda vaguely lousy for a while. She did the usual stuff doctors do and ordered some blood tests. A couple days later she called me back.

“You have diabetes,” she said.

“What? What? Diabetes? Really?” I asked. She rattled off some test results and a list of other specialists I needed to see. Still somewhat shellshocked, I said again, “diabetes, really?”

My doctor said, “weeeeeeeeeelllllllll…” and I remembered that this was the woman whose ministrations ten years ago put me in the CCU at Frankford-Torresdale for a week over what turned out to be an asthma attack.

My doctor is a bit of an alarmist.

After I got off the phone with my doctor I did what I always do when presented with a new problem: I spent hours reading every single thing about it I possibly could. After these hours I had learned that undiagnosed diabetes has very specific symptoms, and that I had none of them. My test results for diabetes were extremely borderline, and there were other tests that had some funky numbers as well.

I thought, maybe it’s time to talk to those other doctors.

One of the other doctors I saw was a gastroenterologist, Dr. Codella. My GI’s practice is interesting: it’s this huge office with lots of cool stuff in a very nice building, and as near as I can tell I am their only patient. I’ve been there four times now and I’ve never sat in the waiting room for more than 90 seconds, and I’ve never seen another person there who wasn’t an employee. It’s bizarre. The first time I got there, when they brought me in the back (before I even had a chance to sit in the waiting room) the nice nurse-reception-type-person said “okay, we’re going to sit you down with Doctor Kira first. She’ll take your vitals and do your history and stuff before you see Doctor Codella.”

From the start this is mind-blowing; at every other practice I’ve ever been to the nurse does all that stuff before you see the doctor. The nurse took me into an actual OFFICE – like with a desk and all, as my GI visit becomes increasingly unusual – and told me to have a seat before Dr. Kira shows up. I looked around and saw the nameplate on the desk, and it didn’t say “Doctor Jane Kira.” It said, “Doctor Kira…” and then a string of consonants that I recognized as an unpronounceable Eastern European name (a subject I am obviously well-versed in). As I was looking at the nameplate I thought, “oh, hey, Kira is her first name.” Then a few seconds later I heard someone come in behind me and turned to see a woman in a white lab coat, and I was suddenly gripped by terror. My brain screamed at me:

Don’t call her Major Kira, don’t call her Major Kira, don’t call her Major Kira, for god’s sake don’t call her Major Kira…

I got through without embarrassing myself and eventually saw the GI, who ordered a bunch of tests, including a liver biopsy. He explained to me that it was a simple procedure whereby a tiny needle took little bits of my liver out so they could check them under the microscope and make sure I didn’t have something dreadfully serious.

It has been noted many times that I am not good with needles. Like, REALLY not good with needles. So I did another omnivorous research expedition to learn what was involved in a liver biopsy so as to soothe my needle anxiety. I learned that a liver biopsy is a simple procedure the way assembling your kid’s bike on Christmas Eve is a simple procedure: it’s only simple if it’s what you do for a living. To any third party it is dangerously complex. A liver biopsy actually involves TWO needles: the one they take the samples with is fairly skinny, with a gauge roughly on par with a simple hoop earring, perhaps. There is, however, the matter of the needle they put that needle INSIDE to get at your liver in the first place. That needle is FUCKING HUGE. It has approximately the same width as a plastic straw. The next time you’re at McDonald’s or WaWa or wherever and you’re getting a drink, take a look at your straw. Now imagine someone taking that, sharpening it, and jabbing it into the side of your stomach.

Oh, this is not going to be good.

But wait, I was told when Jeanes called me to schedule the procedure. I would be given a sedative. Actually I would be given a local anesthetic AND a sedative.

“I’m, ah…” I said when I spoke to the nurse who called. “I’m REALLY not good with needles.”

She actually laughed at that. “Don’t worry,” she said. “You’ll be fine, trust me. It won’t hurt a bit.”

Now over the course of a more-than-average quantity of medical care in my life I have learned an important truth when doctors and nurses talk about pain.

If they tell you “this won’t hurt,” then 99% of the time it actually won’t. Aside from things like the minor pinch of a blood test needle or the mild pricks from the spur-thingy neurologists use to test your skin, if they say you won’t be in pain you can pretty much take their word for it. On the other hand, if a doctor says, “this will hurt a little bit,” you are in for a FUCKING WORLD OF PAIN. Doctors have no conception of something hurting “a little bit.” There is either zero pain or the worst pain in the history of the human race. Their perfidy is understandable if not forgivable; if they told the truth and said, “this procedure is necessary to keep you alive, but while it’s happening you will wish you were dead,” no one would ever undergo these (incredibly painful) procedures.

But the nurse assured me that my liver biopsy would in fact be pain free, and while skeptical I showed up with my anxiety cranked up to only 7 or 8 (the general medical procedure level). As they performed the stuff to get me ready the one nurse told me that she had to put in an IV so I could get the sedative.

She looked at me and very apologetically said, “this is going to hurt a little.”  She could tell I knew the code.

Fuck.

I gritted my teeth, shut my eyes as hard as I could and turned my head away (a bit redundant, that) and felt first a slight pinch and then an excruciating stabbing pain in my left hand.

FUCK!

The nurse said, “sorry, sorry,” and I could tell she actually meant it. That’s actually a bit reassuring – a lot of places you get the distinct impression they don’t give a damn if they hurt you or not.

A few minutes later we were about ready to begin and another nurse came over to the gurney I was on.

“Okay,” she said, “we’re going to give you the sedation. It’s a mix of Fentanyl and Versed. You’ll be awake for the procedure but… “ She paused for half a second and smiled. “But not really.”

“Uh, okay,” I said.

She said, “your biggest problem might be the local anesthetic. It can cause a burning sensation sometimes.”

As she injected something into my IV I said, “something that causes a burning sensation doesn’t sound like much of an anesthetic.”

One of the other nurses said from the other side of the room, “I know! I’ve been telling them that for years!”

The doctor came in, a nice man with a slight Ukranian accent. He introduced himself and explained what he was going to do. It sounded like someone giving directions to a party, but instead of “then you turn right on the Boulevard” it was “then we’re going to use a pneumatic needle to extract two slivers of tissue.”

I remember thinking, oh my god this is going to be fucking horrible.

The next thing I know the doctor was looking over me saying, “okay, you did great. Have fun at the Euros.”

“Wait, what?” I said. “Nothing’s happened.”

The doctor laughed, patted me on the shoulder, and walked away.

I said, “what the hell – “

The anesthesia nurse interrupted me. “You’re all done. Procedure’s over.” She started to unstrap the parts of me that were secured to the table and move away the equipment. “You’ve spent the last half hour babbling about soccer.”

“Are you sure?” I said as they were moving me onto one of those wheeled beds. “I don’t remember anything.”

The other nurse said, “oh yes. But you did great. Didn’t even flinch when the doc hit you with the big needle. Do you want to see the samples?”

Before I could say, “uh, not really,” the nurse held a small glass jar in front of my face with two little pink things floating in liquid in it. They looked kinda like tiny earthworms.

“Bits of your liver!” she said. No one should be that happy about bits of someone else’s liver.

Still, I had absolutely no memory of any of this. As they wheeled me out I pointed to my IV and said to the other nurse, “where can I get some of this stuff?”

She laughed. “Pretty good, huh?”

“Anything that can make me not remember having holes punched in my gut…” I said. “That has to have all KINDS of uses.”

The nurse laughed again. “Yeah,” she said. “You’re not the first person to say something like that.”

“What about the burning sensation?” I asked.

“You didn’t notice. You kept asking the doctor about hotels in Kiev,” the nurse said.

I looked at the IV. “Oh MAN I gotta get some of this stuff.”

When my test results came back it turns out there was some liver damage, but nothing earth-shattering. The entire treatment for my liver problems consists of diet changes, exercise, and taking a pill a couple times a day. So that’s, you know, good news.

Aside from that, as we all know because I am pretty vocal about it, I have the ongoing problem with my lower back. I had it under control for a while thanks to a procedure called a selective nerve root block, but then I went to Bethpage and fucked that right up, and then after that I somehow did SOMETHING to it, we still don’t know what, so I had to go and get the procedure again.

Here’s the deal: one of the discs in my lower back (L5S1, for those keeping score) got pushed out of whack a couple years ago. When I stand up it presses on the nerves in my lower back. In the intervening years since I first hurt it, at some point the disc actually ruptured a teensy bit, and now in addition to pressing on the nerves there is some juicy protein stuff that leaks out which is very bad for said nerves. This, I have since learned, produces what is called chemical radiculopathy (inflammation of the nerves from the stuff leaking out of the disc) in addition to the pre-existing mechanical radiculopathy (inflammation of the nerves from the disc pressing them up against my spine).

Put more simply: my back hurts. It hurts a lot. Eventually there is going to have to be surgery done on it, but we want to hold off on that as long as we possibly can – we’re talking, like, 5-10 years if possible. One of the things we can do to hold off major surgery is this nerve block thing. The procedure is less complicated than a liver biopsy, though it does unfortunately involve more needles.

Basically what they do is they get one needle full of some jacked-up corticosteroids (like super-steroids) and another needle full of some jacked-up painkillers, and they inject them both into my back right at the spot where the nerve and my spine and the disc come together. These things combine in some magical way that I do not entirely understand, but it works like a fucking charm.

Now for whatever reason the place I get this done doesn’t offer the whole sedative thing, so I get it with just a local anesthetic. This is a case where the phrase “local” is very, very limiting: the anesthetic numbs your skin and not a whole lot else, so while you don’t feel the pricks of all the needles as they pierce your skin, you do feel them (as something vaguely akin to a slightly-blunted stick) as they press into the inner portions of your spine. While not intolerable by any stretch the procedure is not at all pleasant. It hurts. Someone is sticking metal spikes into your spine. It’s not a day at the beach.

But I knew from the last time that the procedure wasn’t THAT bad – I’ve had things, like a cardiac catheterization, that were far worse – and I knew the relief for my back would be very quick in coming, so I signed up for it without hesitation.

Lying on the gurney yesterday, though, I can hear the doctor marking the spots on my back where he is going to do the injections, and moving around the various needles he was going to use, and my anxiety levels start to rise. In this specific situation that is extraordinarily bad, since if I panic and start hyperventilating or something, all the doctor’s marks are going to get thrown off, and suffice it to say you don’t want to be heaving up and down while someone is trying to stick needles into VERY precise locations near your spine (or, god forbid, whle they’re already in there).

But I am getting more and more anxious. I can feel my adrenaline kicking up. This is not good. Something has to be done. But there’s no sedatives. Fuck! I’m going to start convulsing and the doctor is going to accidentally jab me in the wrong place and I’ll be paralyzed and FUCKING HELL how many needles does this guy need and –

Then, suddenly, something pops unbidden to the front of my mind:

I will not fear. Fear is the mind-killer. I will face my fear. I will let it pass through me. And when my fear is gone only I will remain.

I think, fuck, might as well see if it works.

So I start thinking it over and over again. I will not fear. Fear is the mind-killer.

Now I don’t know if it actually works the way it’s supposed to or if concentrating my entire brain on one thing distracted me enough to calm down everything else, but I started to loosen up and got into a nice rhythm of “I will not fear” in my head and wasn’t worrying so much about the plethora of needles getting stuck in my back.

Through the local I can barely feel the doctor mark off another injection site when he stops and takes his hands away.

“John?” he asks.

“Yeah?”

He swings down sideways so his head is at my eye level. It’s dark in the room (so that he can better visualize my back and the x-rays) so all I can see are a pair of glasses.

My doctor says, “are you reciting the Bene Gesserit Litany Against Fear?”

I am too mortified to be impressed that my doctor knows the reference.

“I thought that was just in my head,” I say.

“Yeah,” my doctor shakes his head. “It’s not.”

JLK

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