It was last November the 14th, one of the first days that you could feel the winter season approaching, a cold and blustery day. I had an appointment at the medical complex in East Greenbush, and decided to wear a warm winter coat, a leather one. As I was getting ready to leave the building, I slipped the strap of my pocketbook up on my shoulder at the same time as I pushed the door open. A gust of wind forced its resistance against the door, and I felt pain in my right shoulder, in the arm I used to open the door. After I got to my car, I sat there a while, flexing my arm to alleviate the pain, and tried to rub the ache away. I assumed I'd strained a muscle; I think something like that has happened in the past and had resolved in time.
The shoulder continued to bother me, though, making it so uncomfortable to put dishes away on a higher shelf that I began to use my left arm instead. It didn't hurt to hold my toothbrush in my right hand, but brushing, or combing, my hair was a different story. Raising my right arm to the side was difficult, and painful. But more disconcerting was that I would be awakened during the night with a rather sharp, localized pain centered across the top of my shoulder.
The pain and restriction still had not dissipated three months later, so I contacted Ortho NY and made an appointment with Dr. Lee Kaback, an orthopedic specialist in shoulder repair. My appointment with him was March 11, at which time my shoulder was x-rayed before the consult with the doctor. The exam consisted of raising my arm in different positions, and resisting while he applied pressure on the arm. I could put my arm in any position requested, though in some with discomfort and or pain. Given my circumstances (meaning my age of course) I am stronger than most would suspect, and my arm didn't fall down when he pressed on it. I have since read that if the rotator cuff tear is complete, the arm will drop instantly, with no tendons to support it. I was not in that category. If he had asked me to put my arm behind my back and then try to push it straight out, I would not have been successful, but he didn't ask that.
Dr.K. said I probably was suffering from arthritis; he knew the history of my knees. The pain is probably like that, he said, but I said no, it was much more localized. He seemed to think a Cortisone shot would be a good idea, there and then, but I wasn't prepared for that at the time. He asked if I would like to have an MRI to assess any possible damage, and I agreed. I was not so concerned with the pain, though I'd like it to be gone, but more concerned that whatever damage was there could progress, and impede the use of my right arm.
On March 15, I had an MRI at ImageCare in Latham, and on April 8, a follow-up appointment with Dr. K. for the results. The first words he spoke after the requisite greeting were to say that I had "a very large tear in the rotator cuff," and that was where the pain was coming from. And my options: he loves to operate, he says, and he would do so right now, but there are issues. Older tendons don't heal as well, and the recovery period is 5 months or so. He again mentioned a cortisone shot for the pain, which he said could be effective by reducing the inflammation. He said I could try Physical Therapy. I asked if the tear would improve on its own and he said he didn't think so. I asked if the physical therapy would be helpful and he said it might be. I opted for the P.T. and he wrote me a script. I'm still thinking about pursuing that course.
4/17/2015
At my F.U. visit, Dr. K. said I had "a very large tear" in the rotator cuff tendon, and offered the above options. He didn't go into detail as he knows patients are uninformed and he doesn't have the time to educate them. After all, he had to spend much time and a great amount of money to gain his knowledge. That's why he's the doctor: I'm just the damaged piece of clay that he can mold into some semblance of normalcy, or not. He had seemed to think my problem was arthritis, but I didn't think it was. The pain was too localized. Anyway, I wanted to know more than what he told me, mainly because I want to be informed of my condition before I begin physical therapy. I plan to delay the start of P.T. until after the baby is born. I know that once the course of PT is started, it must run its course without interruption. Medicare is very fussy about any alteration to the start and finish date. So to clarify my condition, I requested a copy of the MRI report, which is a very simple thing to do, and to me, somewhat satisfying. Following is a synopsis of the 3/19/15 report:
The clinical indication was to evaluate for arthritis versus cuff tear. Finding were that while the other tendons in the shoulder, the subscapularis and teres minor, were pretty much normal, the same was not true for the supraspinatus and the infraspinatus. Now I'm not a doctor, but besides seeing them played on TV, my three years of high school Latin lets me know that the supra part is where my pain and loss of mobility is. And the report reads:
"Full thickness retracted tear of entire supraspinatus." That has to run right across the top of the shoulder because that's where the pain is.
"Tear extends posteriorly to involve the infraspinatus, with full-thickness tear of the anterior 10 mm of the infraspinatus. Posterior to this, tear extends another 10 mm posteriorly as an articular sided tear that delaminates into an interstitial tear extending to the myotendinous junction."
This taxes my cache of Latin, but helps me understand why the doctor would say only a very large tear. It seems as if the supraspinatus ran amok and took everything nearby down with it. I suppose retracted means what it sounds like----the same way a snapped rubber band behaves, turning in on itself.
Adjectives pertaining to other structures are "mild, minimal, and moderate." Somewhat jarring to see the report addresses "Bone Marrow" status. Who knew that would be on the table, but fortunately the finding was: "No evidence of fracture or pathologic marrow infiltration." Phew!
IMPRESSION:
"Full-thickness retracted tear of supraspinatus and anterior fibers of infraspinatus. Further posterior extension of tear as articular surface and interstitial tear of the more posterior fibers of infraspinatus. Probable full-thickness retracted tear of long head of biceps tendon."
It reminds me of a night last summer when I was at the computer and heard a rushing and then crashing sound, as if a train had derailed at top speed. A tall tree had suddenly snapped its trunk and its fall had impacted and thereby damaged all the structures in its vicinity. As far as I know, though, nothing retracted. I think I'll call on Monday* to check if it will be acceptable to wait until June to start therapy. I do look forward to holding a little baby in my arms.
* I never did get around to calling, so when I went to Seton and presented my script I found that it would need to be renewed. A call to the Ortho office would do it, I was told. It happens very frequently. In the meantime, they will do the assessment today. They seemed confident it will work out.
Tuesday, May 26, 2015
Tuesday, May 12, 2015
Lewis Lent Redux
What we didn't know until later, or had not connected to murder:
He was staying at the rectory of the church on Old Rte 146. He helped out by doing some custodial work there.
He frequented movie theaters; one was a short walking distance away from the theater in the mall.
A local family, who attended the Clifton Park church where Lent was staying, befriended him and he was a frequent guest in their home, where he played board games with the three younger sisters of my son's classmate.
At one time, after Lent was in custody, investigators knew he had lived nearby and searched the area near Exit 9 of the Northway for clues to, or a buried body, of the missing girl.
None of the above information was known or cared about until after he was captured. I think the family involved did not want to disclose that, out of religious compassion, they had allowed a murderer to be in contact with their 4 young children. As I remember, the oldest, a boy, revealed it as something he wasn't to talk about.
On a warm summer day, during the "U2, Rattle and Hum" afternoon showing, my son, my nephew, and I came into contact with him. Of course we didn't know the extent of danger at the time, but even the youngest knew something was amiss.
He entered part way through the movie. We three had been the only audience that beautiful day. I was sitting in the back because of the amplified concert music, while the boys, 10 and 11 or so, were closer to the front, in the center section of seats. He entered and at first sat in the left tier. Then he moved across to the center aisle, closer to the boys. One of the boys, influenced probably by the musical tastes of older siblings, was attentive to the movie. . The younger, bored after a while, engaged in flipping a quarter down the center aisle, and then retrieving it. Since the theater had been empty save for us, it caused no disturbance, and he was fairly low-key about it, and would return to his seat sporadically. The man then moved to directly behind the boys. At this move, the older boy came up to my seat,and said he thought something was wrong. Both boys then moved a few rows in front of me; it was near the end of the movie.
I kind of regret my next move, though remember times were different back in 1988 or so. We weren't nearly as aware of sexual offenders or sexual predators on children. I only knew about "perverts" who exposed themselves in theaters. So when the man left first, by the entrance to the left, I told the boys to stay seated in the back of the theater, and I walked out the same exit area the man had. It is a curved archway to the theater exit, but the man was standing there, with his back against the wall, waiting---for what? I almost said something to him, but for some reason did not. I just circled back to where the boys were, and faced the wrath of my son-----"How could you.....?
I remember telling the boys, "You've met you first pervert." As we left the theater, we spotted the man going into the men's room.
On a usual day, most likely the boys would have used the restroom before going to the McDonald's that was then in the mall.
That day, we drove to the McDonald's in Mechanicville, kind of joking about what had just occurred.
I wonder about what would have happened if the boys had decided to go to the restroom during the movie. I'm sure I would have let them go together. Old enough to be responsible, a summer afternoon, Clifton Park, not many people around. When Lent was captured, after the girl he tried to kidnap right off the street succeeded in slipping out of his grasp, he was found to have rope and tape in his vehicle. On a later trip to the theater, my son checked and said there was an exit from the men's bathroom to outside the theater.
I don't know what would have happened if I'd spoken to him. I guess I didn't because I didn't know what to say. "Why did you move your seat 3 times? Why are you standing here now?" I had passed within inches of him, and could see his face for the first time. He looked benign enough, kind of like a school teacher, I'd thought. He was wearing a short-sleeved button-up shirt, and army green khaki type pants.
He was staying at the rectory of the church on Old Rte 146. He helped out by doing some custodial work there.
He frequented movie theaters; one was a short walking distance away from the theater in the mall.
A local family, who attended the Clifton Park church where Lent was staying, befriended him and he was a frequent guest in their home, where he played board games with the three younger sisters of my son's classmate.
At one time, after Lent was in custody, investigators knew he had lived nearby and searched the area near Exit 9 of the Northway for clues to, or a buried body, of the missing girl.
None of the above information was known or cared about until after he was captured. I think the family involved did not want to disclose that, out of religious compassion, they had allowed a murderer to be in contact with their 4 young children. As I remember, the oldest, a boy, revealed it as something he wasn't to talk about.
On a warm summer day, during the "U2, Rattle and Hum" afternoon showing, my son, my nephew, and I came into contact with him. Of course we didn't know the extent of danger at the time, but even the youngest knew something was amiss.
He entered part way through the movie. We three had been the only audience that beautiful day. I was sitting in the back because of the amplified concert music, while the boys, 10 and 11 or so, were closer to the front, in the center section of seats. He entered and at first sat in the left tier. Then he moved across to the center aisle, closer to the boys. One of the boys, influenced probably by the musical tastes of older siblings, was attentive to the movie. . The younger, bored after a while, engaged in flipping a quarter down the center aisle, and then retrieving it. Since the theater had been empty save for us, it caused no disturbance, and he was fairly low-key about it, and would return to his seat sporadically. The man then moved to directly behind the boys. At this move, the older boy came up to my seat,and said he thought something was wrong. Both boys then moved a few rows in front of me; it was near the end of the movie.
I kind of regret my next move, though remember times were different back in 1988 or so. We weren't nearly as aware of sexual offenders or sexual predators on children. I only knew about "perverts" who exposed themselves in theaters. So when the man left first, by the entrance to the left, I told the boys to stay seated in the back of the theater, and I walked out the same exit area the man had. It is a curved archway to the theater exit, but the man was standing there, with his back against the wall, waiting---for what? I almost said something to him, but for some reason did not. I just circled back to where the boys were, and faced the wrath of my son-----"How could you.....?
I remember telling the boys, "You've met you first pervert." As we left the theater, we spotted the man going into the men's room.
On a usual day, most likely the boys would have used the restroom before going to the McDonald's that was then in the mall.
That day, we drove to the McDonald's in Mechanicville, kind of joking about what had just occurred.
I wonder about what would have happened if the boys had decided to go to the restroom during the movie. I'm sure I would have let them go together. Old enough to be responsible, a summer afternoon, Clifton Park, not many people around. When Lent was captured, after the girl he tried to kidnap right off the street succeeded in slipping out of his grasp, he was found to have rope and tape in his vehicle. On a later trip to the theater, my son checked and said there was an exit from the men's bathroom to outside the theater.
I don't know what would have happened if I'd spoken to him. I guess I didn't because I didn't know what to say. "Why did you move your seat 3 times? Why are you standing here now?" I had passed within inches of him, and could see his face for the first time. He looked benign enough, kind of like a school teacher, I'd thought. He was wearing a short-sleeved button-up shirt, and army green khaki type pants.
Saturday, May 9, 2015
The 100 Steps
With all the exercise addicts out there, I hesitate to reveal my daily regimen, but I can justify it by saying that I am old. Anything is better than nothing; at least I hope so. Since I finished physical therapy last fall, my daily "workout" has consisted of riding my exercise bike for about half an hour, usually while watching Jeopardy. I had moved the bike into the bedroom because it was so cold in the outside room that I had to bundle up in coat, hat and gloves. I don't set the tension on the pedals very high, and I convince myself that I am exercising, though it never makes me tired or out of breath. I stop because it is rather boring.
So with the return of nice weather, I returned to my step therapy--outside, on the steps leading to the pool. 100 steps. That doesn't take very long, but I find it much more taxing than riding a bike. My legs have to heft all that poundage up and then down 5 steps about 20 times. At first, I stopped to gasp for air at 50 steps, then 60, and 70. Today was the first time I managed to do 100 steps without stopping to breathe. I trust that no passing motorist would notice and think I had gone batty; the speed at which cars go by my house prevents anyone from seeing more than a single climb. Or at least I think so.
When I get to the top of the stairs, I stand on the deck and practice my other exercise--this one for balance. I stand on each foot for as many Hail Mary's as I can recite. Sometime I can get as far as three.
What the heck, I'm no Kelly Ripa.
So with the return of nice weather, I returned to my step therapy--outside, on the steps leading to the pool. 100 steps. That doesn't take very long, but I find it much more taxing than riding a bike. My legs have to heft all that poundage up and then down 5 steps about 20 times. At first, I stopped to gasp for air at 50 steps, then 60, and 70. Today was the first time I managed to do 100 steps without stopping to breathe. I trust that no passing motorist would notice and think I had gone batty; the speed at which cars go by my house prevents anyone from seeing more than a single climb. Or at least I think so.
When I get to the top of the stairs, I stand on the deck and practice my other exercise--this one for balance. I stand on each foot for as many Hail Mary's as I can recite. Sometime I can get as far as three.
What the heck, I'm no Kelly Ripa.
Friday, May 8, 2015
Diagnosis X
The neurologist said he had suspected a serious neurological disorder. Though he didn't specify at the time, he most likely thought it might be ALS. But the progression of symptoms and lab tests did not bear this out. Fortunately. Obviously a motor neuron disorder, but not that one.
Based on my research, which of course is googled, I would suspect PLS.
Primary lateral sclerosis "affects the upper motor neurons of the arms, legs, and face. It occurs when specific nerve cells in the motor regions of the cerebral cortex gradually degenerate, causing the movements to be slow and effortful. The disorder often affects the legs first....When affected, the legs and arms become stiff, clumsy, slow and weak, leading to an inability to walk or carry out tasks requiring fine hand coordination. Difficulty with balance may lead to falls....Affected individuals commonly experience ...an overactive startle response. The cause is unknown. The symptoms progress gradually over years...PLS is sometimes considered a variant of ALS, but the major difference is the sparing of lower motor neurons, the slow rate of disease progression, and normal lifespan. Most neurologists follow the affected individual's clinical course for at least 3 to 4 years before making a diagnosis of PLS. The disorder is not fatal but may affect quality of life."
The second sentence above may be why none of the many doctors and specialists have come forth with a diagnosis, other than to agree that neuropathy is present.
Of the hundreds of causes of neuropathy and the many forms of neuron motor diseases, PLS may be one of the most benign, but it's no picnic.
Based on my research, which of course is googled, I would suspect PLS.
Primary lateral sclerosis "affects the upper motor neurons of the arms, legs, and face. It occurs when specific nerve cells in the motor regions of the cerebral cortex gradually degenerate, causing the movements to be slow and effortful. The disorder often affects the legs first....When affected, the legs and arms become stiff, clumsy, slow and weak, leading to an inability to walk or carry out tasks requiring fine hand coordination. Difficulty with balance may lead to falls....Affected individuals commonly experience ...an overactive startle response. The cause is unknown. The symptoms progress gradually over years...PLS is sometimes considered a variant of ALS, but the major difference is the sparing of lower motor neurons, the slow rate of disease progression, and normal lifespan. Most neurologists follow the affected individual's clinical course for at least 3 to 4 years before making a diagnosis of PLS. The disorder is not fatal but may affect quality of life."
The second sentence above may be why none of the many doctors and specialists have come forth with a diagnosis, other than to agree that neuropathy is present.
Of the hundreds of causes of neuropathy and the many forms of neuron motor diseases, PLS may be one of the most benign, but it's no picnic.
Monday, May 4, 2015
The Great Outdoors
I couldn't wait for the nice weather to get here, and evidently neither could the ticks. I have personally encountered 3 ticks in 4 days. More than in my entire previous lifetime. I have taped all 3 of them to a Post-It Pad. The little arachnids have lost a few of their legs, but otherwise appear intact.
Vocabulary Word To Die For
Dermatochalasis----If you're over 50, don't look it up unless you want to kill yourself, because chances are you have it.
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