Posts Tagged ‘surgery’

Romancing the Diseases

December 6th, 2015

Cristobal_Rojas_37aSeveral physicians have told me how they used to dread the day of the month the new Reader’s Digest appeared. When I grew up, that formulaic and wildly popular little maggy featured an article on a disease. Within two days, docs would get calls from those sure they had it. That was crazy talk, but it still required diagnosis and much reassurance.

My maternal grandmother, an otherwise bright and witty human, played at that several times a year. In her defense, she lived in a small town in the eastern mountains of West Virginia. Excitement did not seek Romney out. Adding a bit of drama to a humdrum life is understandable.

Well, my grandmother, Mable, did have a disease. Several doctors had diagnosed her with nervous asthma. That is, her wheezing and shortness of breath were as real as someone reacting to physical or airborne irritants. She refused to accept that she might do something other than squeeze her nebulizer bulb. She found one GP, as they were known in the days before FPs and PCPs, who humored her and agreed that she had no control over her condition.

Wasting Envy

Her foible was small beer compared to Romantic Era poets, opera composers, painters and novelists. Check here, here, here, and here, and relish La Miseria by Cristóbal Rojas  above.) Numerous artists sincerely desired to have and die from tuberculosis, for its effects of paleness and weakness. I fear we still see such effects in thigh gaps, anorexia, obsession with wearing size 0, and countless young women who have bodies better suited to 11-year-old boys.

Being too thin, too weak, too wan sound frightful to me, conditions you should avoid through exercise, sensible diet and being sure you have good levels of hormones chugging through your veins.

And yet, a small part of me senses the glamor my grandmother sought to liven her rise-work-eat-sleep quotidian existence. For one specific for Mable, she was big boned (I inherited my big, honking feet and too broad chest from her). She truly wanted to be slight like her sister. They shared a dad, but Mable was the eldest and Anna, from their widowed father’s second wife, the youngest. They were physically unalike and Mable envied her little sister’s build.

Years later I recalled them on my first real full-time job. I went from college to be the editor in chief of the black weekly newspaper in Columbia, South Carolina. The race was important, in part because most readers and all the board members were African Americans.

So were the two everyday office staff, Ida and Jackie. They had been friends from elementary school, through college and now on the job. They were each other’s bridesmaids even. They were intimate and much of the day included personal chitchat mixed with work.

They talked a lot about each other’s bodies. They had the two stereotypical African-American women’s bodies — one short with large bust and bottom, one very slender. They each claimed regularly to want the other’s body. They would embarrass me with such talk as Ida saying her hubby, Thomas, would love to have a wife with Jackie’s sizeable breasts. While I lived with a woman, such intimate talk was not my norm.

Poetry of Illness

While not a drama queen myself (as the French might say, j’ai du sang-froid), I don’t totally lack sympathy with the disease romantics. In fact for a mild example, I recall being maybe 8 when my sister brought home one her many disease gifts. This was German measles as I remember it.

I laid n the bed febrile and covered with itching sores. I projected to various movies and Captain Gallant of the Foreign Legion (a TV show my sister and I watched). There were deserts and heat and suffering and heroism. Blah, blah.

As an adult though, I am only disappointed when my body fails me at any time. I long ago accepted that only in kiddy land can doctors fix you. They are good with acute and obvious conditions. Faced with chronic or nebulous adult disorders, they fail more often than not. “Live with it” is the too frequent prognosis.

Recently though I had minor pleasure at thinking I had rare disorders. I was not aware that desire existed at all in my brain.

Straight up, I had not heard of either polymyalgia rheumatica or macular pucker. I got diagnoses or each of those in turn. Because I have a broad general knowledge and knew of neither, with each I figured I was pretty damned special.

Wrong.

Instant Claudication

For polymyalgia, I went to bed feeling fine, but woke so sore I could hardly move my arms and struggled mightily to walk 25 feet to the john. I got slightly better over the week and decided to wait it out. A couple of weeks slithered by before I called my doc.

He knows my mild disdain for his profession and was positively chipper in being able to tell me that, “Come in for a diagnosis, but I’m sure that you have polymyalgia rheumatica.”

I had never heard of it but clicked around the tubes to see that I had the symptoms. He confirmed the initial call and hooked me up immediately with a rheumatologist. Before visiting the latter, we spoke and like my internist, he was sure right away.

The good rheumatologist Bates has a lollipop face and is young enough to have a daughter the age of my grandson. He was both very compassionate and a regular pro with polymyalgia. He squashed my romantic, special image quickly by noting that old white women frequently get a mild form of it but typically Caucasian men from 55 to 70 get it hard as I did. It is kind of like sickle-cell disease for African Americans or any of that dozen or more Ashkenazim blood disorders, a curse specifically on old white people. Fair enough.

Dr. Bates said simply, “It’s not rare. If you know a bunch of white men in their 50s and 60s, you know someone who had it.” Sure enough, I have found several peers with the condition. They don’t brag about, but deal with it.

By the bye, it used to be that just had to be crippled for one to seven years and it went away. Nowadays, steroids, typically prednisone, fix it. It requires months of dosing and one to three years of tapering off. You can relapse, often worse.

Well, it’s neither romantic nor glamorous.

Eye Trouble

My recent chance at drama and uniqueness was macular pucker, a.k.a wrinkled retina. I had blurred vision in one eye and went for my regular eye exam with my self-diagnosis of cataracts. I’m that age.

My optometrist wasn’t playing. He didn’t have all the eye diagnostic gear the surgeons do, but he knew it wasn’t cataracts.

I wanted cataracts. They are a known status and the surgery is nearly 100% effective and immediate.

Instead after a couple of visits to one set of eye specialists and surgeons, and then a second opinion by one of the super doctors, I got the pucker punch. It’s built-up scar tissue from unknown origin on top the macular and retina. It has no relation to macular degeneration. There are no drug, vitamin or exercise fix. Queue the operating room. Moreover, unlike cataract surgery, going into the eyeball to clear out the cells may or may not improve the vision.

Lord, I miss the long gone days when Dr. Newman could poke my butt with penicillin and fix my swollen tonsils.

Regardless, it turns out that my ignorance of macular pucker did not make the condition unique or even that unusual. It’s not as common as polymyalgia, but it’s not rare or romantic or dramatic.

I’m not likely as many to long for the exotic and romantic diseases. Yet, I do have a sense of what that’s about.  I think medical stasis and boredom are better.

 

Medical Sigh Science

July 16th, 2012

My comminuted (multiple breaks and pieces) collarbone got the latest treatment or non-treatment. As an example of how medicine changes and maybe or maybe not advances, conventional orthopedic wisdom has again shifted.

Pic note: Click for a somewhat larger view.

Where a badly broken clavicle used to require holding the big pieces together with a plate and screws (pins, in surgeon lingo), recent trends favor non-surgical benign neglect. This surgical info page describes the options.

Previously, the idea and ideal were to stabilize the whole bone and keep the pieces together to promote faster, stronger bonding healing. Now, according to both my ortho surgeon and physical therapist, the new wisdom is that outcomes are no better with plates/screws than letting the components find each other and form enough bone to made a renewed clavicle.

I’ve only had surgery once in my life, three-plus years ago for a badly broken leg. I shall permanently wear a titanium rod inside my left tibia from my knee to ankle. I’m not eager for more cutting, drilling, pounding, and other internal carpentry.  Yet, I already have a tangerine-sized lump above my left pec. Chums who had broken their collarbones as teens or 20-somethings have insisted I feel their residual bumps, which are much smaller. They said they had simple, single breaks, which may account for the difference.

Several other folk with related knowledge, including Uncle whose daughter is in the PT/rehab biz, concur on the shift from plates/screws. While plain old logic suggests that bones that fuse into their original alignment will be much stronger than those that lump up more randomly, the surgeons say their studies don’t support that. Hard to believe, but in my case it’s a bit late to speculate.

What’s amusing to me, even being an non-controlling participant in this current treatment scheme, is knowing that the science in medical science is mostly not linear. Unlike the concept we grew up hearing, treatments don’t inch or leap ahead to better and better outcomes. Instead, they mostly seem to move in and out like the tides.

I recall my first awareness of that when I was in elementary to middle schools. My mother ran Red Cross chapters, which included planning for and overseeing such courses as first aid and home nursing. She was really annoyed to have to replace those texts and see her instructors were tweaked as the AMA and similar bodies changed their minds with new research truths. I think of covering wounds, particularly burns. Yes bandage; no, open air; no, salve; and on and on, somethings changing with each new major study more than once a year.

Truth be told, docs and medial societies can be incredible faddists. Studies can contradict each other, despite following precise and detailed methods and even being replicated by others. The science can be approximate or fungible, which leads to funky doc punditry. It’s the now-we-know syndrome that comes with the fad of the latest findings. Generally no one dies from the sudden shifts, but I long ago lost faith in the concept of inexorable medical advances.

Certainly even worse than shifts in perceived surgical best practices is drug pushing. So many adults end up with one to a dozen or even more prescriptions. I think of my late in-laws who’d each fill a window sill with their daily meds when they visited. My wife remarked to her mother that those were a lot of different drugs. Her mother agreed and said she asked her doctor if they were all necessary. She reported that he asked her which she’d like to stop, and when she picked one said if she stopped taking it, she’d die.

More commonly, docs find it far easier to treat symptoms with drugs than actually to diagnose the cause of the symptom and, to think back to the ideal of the profession, cure the patient with the like of nutrition, behavior modification and such. So, the docs are more likely to say that taking this or that drug will add two or five or more years to the patients’ lives.

These pharmaceutical company promises may or may not have validity per patient, but we can be sure the benefits don’t compound. That is if you have six prescriptions for drugs your doc says will add those years to your life, you can’t expect the benefits to add up. If it did, we might all expect to live to 150 or longer.

I hark back to childhood when I was never seriously sick, but a pediatrician seemed magic. Swollen tonsils got a single penicillin shot in the butt and cleared up quickly. Nowadays, I”m aware people past their 20s or 30s tend to end up with chronic conditions or ambiguous symptoms. Very much unlike the mystery disease article in the Sunday New York Times Magazine or an episode of House,  we don’t get a team of dedicated, resource (including time) rich doctors who do what is necessary to diagnose and cure us. In fact, we can be pretty sure, our nurses and doctors won’t have the time and inclination to listen to our symptoms and consider our self-diagnosis.

Back to my increasingly lumpy formerly unified collarbone, I didn’t have a lot of options. In the ER and next week followup, the orthopedic surgeons said the muscles would likely keep the bones close enough. I could have insisted on a plate at the time or when I saw the big gap at five weeks, could have pushed to the then big deal of opening me up, re-breaking the bones as needed and then using the plate. So, really, no choice by that time.

Now if I don’t have another trauma to that collarbone and if normal activity including free weights doesn’t snap the new version, the outcome will be acceptable. I won’t project or anticipate. I’ll just go with the idea that the current treatment trend is OK.