Sunday, January 24, 2010

Traction Bear

Some of you have expressed curiosity about my home traction device. Behold the bear! Note that his head is strapped in and his neck rests comfortably in the cradle. When he uses the cunning hand pump to raise the pressure to, say, 25 lbs., his head will be stretched away from his little bear body. If it is set too high, it will rip his little bear head off and his stuffing will explode all over the floor. That would be bad.

Friday, January 22, 2010

Driving My Cadillac

My little medical saga has continued since I last posted. My New Best Friend is a physiatrist at the Neurospine Center, who reviewed my x-rays and MRI and gave me a very thorough exam. The good news is that he believes he can alleviate the pain and restore some shoulder function without resorting to surgery. The less-than-good news is that the severity of my weakness may indicate that some of the nerve damage is permanent (or else the neurospine lawyers require him to say this). I am likely looking at a long course of treatment and rehabilitation with some uncertainty about the ultimate outcome. Next week he will inject cortisone directly into the site of the pinched nerve (I will be lying immobilized beneath an x-ray machine while he does this), which will hopefully reduce the inflammation over the course of several days. I also went back to see Dan, my physical therapist, who set me up with my very own Home Traction Machine.

I can only begin to guess the total cost of the various tests, procedures, treatments and toys I have received over these past two weeks. Our total out-of-pocket expense to date: zero. It has been a difficult year for Susan at the University – rescinded raise, mandatory furlough, reduced faculty and more students. But what the state of Wisconsin still provides for us is remarkable health coverage, what the shrinking number of Democrats in congress term a “Cadillac plan.” Frankly I do not think the metaphor is strong enough. It is BMW seven series coverage; an Aston Martin DB9 plan.

Each new medical receptionist I meet (and I have met quite a few lately) hands me a sheaf of papers to fill out (“Was anyone in your immediate family ever bitten by a rabid skunk?”) and takes my insurance card to copy. They handle it as if it were the Holy Grail (“Oh! No co-payment for you!”) When I made the appointment for my cortisone injection – a complex and expensive procedure – the woman looked at my coverage and grinned – “Great! No pre-approval needed!” I am glad I can make their jobs easier. Any physician treating me can order any test or procedure that he or she sees as in my best interest without first seeking permission. Of course, that physician can also order any test or procedure that is in the financial interests of the practice as well, which takes us close to the core of the health care reform debate.

Dan told me that the manufacturer of my traction machine will bill my health insurance for $725, and the health insurance company will offer them about $400. In the end, the manufacturer will have to eat the difference. If I had Chevy Malibu health insurance, that difference would have become my co-pay. I asked him where I should return it when I was done with it. “Return it? It’s yours.” When I have recovered sufficiently I will need to ponder its recreational possibilities.

Following the election in Massachusetts, I have no idea what will be sorted out in congress about health care reform. Certainly the Republicans want to drop the proposed tax on “Cadillac health coverage,” and they will likely win on that one. I am very grateful to have such coverage, and would gladly pay extra taxes to help provide health coverage for those who will never experience such privilege. A pinched nerve is no picnic and a pinched wallet would make it that much more miserable, but we could have handled the extra costs without descending into abject poverty. Many others are not that fortunate. In a moral society, everyone should be able to receive competent medical treatment without being driven to the poorhouse.

But for now I am going to go lie down in my traction machine. I am thinking I should have held out for one with surround sound.

Monday, January 18, 2010

What a Pain in the Neck!

Just a few short weeks ago I quoted John Lennon’s words, “life is what happens to you when you are busy making other plans.” Since then I have moved quickly from “my neck is a little stiff” to “my neck is stiff and my shoulder is very sore” to “I cannot lift my right arm above my waist.” I have been to a physical therapist, dosed myself with steroids, sent for an MRI and am about to meet new friends at the Neuro-Spine Center. Along the way I have learned a great deal about cervical spines, mine in particular. Who knew that “marked right neural foraminal narrowing” was a bad thing? Or that the proper name for a bone spur is an osteophyte?

The heart of the matter is that a nerve is being pinched in such a way that it no longer sends instructions to my deltoid muscle. My two challenges are pain management and finding work-arounds for the everyday tasks that my shoulder wants nothing to do with. For example, when driving I can move through the first four gears pretty well, but to reach fifth or sixth gear I have to use my arm as a sort of glorified broomstick (Susan once caught me shifting with my left hand and had some stern words for me). I can work the radio and adjust the temperature by propping my wrist on the shift knob. Applying deodorant to my right armpit involves using my left hand to place my right hand on a towel bar (friends and co-workers are grateful I figured that one out). Sitting at the computer and typing is far more of a challenge – I can do it, but it hurts like a bugger – and all of this was unfolding while Susan and I were in the throes of completing our manuscript and sending it off to our editor. They had better publish the damned book!

For those who have never had an MRI, by the way, the experience is much like being shoved into a tube and forced to listen to the soundtrack of a very bad science fiction movie that features, among other characters, a giant deranged woodpecker. At high volume. For twenty minutes. I give it two thumbs down.

So on Wednesday I will go to the neuro-spine center to meet my physiatrist, a medical specialty I knew nothing about a few days ago. His job, as I understand it, is to keep me out of surgery if at all possible. According to the way my primary care doc reads the MRI results, this could be quite a challenge. He may inject some cortisone into the site to see if it will alleviate swelling just enough to take away the pain and convince my shoulder to report for duty. He may wave chicken bones over my body and recite incantations. He may put me in traction and stretch me until I confess my sins and secrets. I am in favor of anything that might prove effective and does not involve getting cut on.

I have long thought that one of the benefits to being a skinny little dude was that I would never have back problems, but that proved an empty hope. Another word that pops up frequently in my MRI report is “degenerative.” Had I only know that by age 61 I would be a degenerate anyway I would have put more effort into at least getting some fun out of it.

Friday, January 15, 2010

Good Intentions are Not Always Enough

Certainly our hearts are with the people of Haiti – those who have died, those who have lost loved ones, those who are seriously injured and awaiting medical attention, those whose homes and communities are destroyed, those who struggle with hunger, thirst and illness. It is a disaster on a scale that can barely be imagined, and it is bringing forth an outpouring of compassion and generosity from folks all around the world, as it should.

For decades I have offered the same counsel to people who wish to do something to help the victims of natural disaster. First and above all, it is more important to give wisely than to give quickly. The needs will continue for a very long time, and many wonderful organizations will contribute not just to the immediate response, but the long-term recovery efforts in a nation that was already living on the edge of desperation. Choose an organization that you trust and give as generously as you can.

Just yesterday I was listening to an experienced relief coordinator on the radio. A good-hearted woman, a schoolteacher, called in to ask how her students could contribute to the effort. They were mostly lower income kids, and she asked if they could collect goods to send to Haiti rather than money. What sort of goods were most needed? She was thinking especially of collecting children’s books to ship. Where should she send them?

Clearly her heart was in the right place, and the relief coordinator chose his words with care. First, even if there were a way to get the goods into the country, there was no infrastructure by which to move them around. Even if there were passable roads and available trucks, the cost of moving them would be far greater than the value of the goods. Sending them might help her kids to feel good about themselves, but it would not help Haiti. Moreover, a flood of goods coming into an impoverished country is likely to make economic recovery even more difficult, since there would be less demand for locally produced goods. As gently as he possibly could, he was trying to tell her that her idea was not a good or helpful one.

She was a determined lady. “So maybe we could arrange to buy locally-made goods in an undamaged part of the country and have them shipped to where the need is?” It is a strong human impulse to wish to give something tangible rather than money. I admire the relief coordinator, who stopped short of saying “Good luck on that one, lady!”

Messages are flying around the internet urging doctors and nurses to volunteer immediately, claiming that at least one major airline is offering free transportation. This morning’s news urged medical professionals to stay away for now – until facilities are ready for them, they would just be extra bodies to feed and house.

The new technological wrinkle is that this is the first major natural disaster where people can make a gift of ten dollars to the relief effort through a text message. Everything I have read suggests that this is entirely legitimate, and probably a good thing. People who normally might not give at all or do not know how to give have a new opportunity to respond. But I also wonder how many people who are in a position to give far more generously will text their ten bucks and think “I have done my share.”

When a natural disaster strikes, we should grieve, we should pray, and then we should pause to think. Yes, if there is any compassion in us we should give generously to support relief efforts, but our dollars do not need to be the very first to arrive. Give through your faith community. Give through the Red Cross, or another fine organization you trust. Give generously, but also give wisely.

Friday, January 8, 2010

Lost in the Brave New World

It has been more than three years since I reluctantly entered the social networking world of Facebook. I was leery of its dangerous potential for wasting huge gobs of time, and the intervening years have demonstrated that my fear was justified. But growing numbers of my younger friends were employing Facebook as their primary means of communication—if I wanted to maintain a relationship with them, I pretty much had to be on Facebook myself. Then we became members of a wonderful and peculiar little church (since disbanded) made up almost entirely of folks in their twenties and thirties, and Facebook served as the church’s newsletter. Bit by bit I waded more deeply into the brave new world of social networking.

Initially I was bewildered when people I barely knew, or did not know at all, “friended” me. I learned that the most common standard of etiquette is to say “yes” unless there is a particular reason not to – in Facebook-land, the friend of a friend becomes your friend as well. It was finally explained to me that I should not think of Facebook “friends” as actual friends; I should think of them as “contacts.” So I now have many hundreds of “friends,” some of whom are actually friends.

I check Facebook for messages several times most days. Along the way I have learned the importance of the “hide” feature. In particular, I automatically hide the cute apps (applications) and endless quizzes that some folks delight in sending my way (where do they find the time?) I have seen instances where Facebook has served useful and valuable purposes, especially when a dear friend was undergoing treatment for cancer in another state and used Facebook to provide daily updates to her many friends. I have also experienced how Facebook can build community and deepen relationships. We recently observed our 40th wedding anniversary, and I posted a picture of a very young version of us to celebrate the occasion. I was genuinely moved to receive congratulations from so many friends (and “friends”) old and new. I think it is here stay and, if used judiciously, can make a positive contribution to building community and maintaining friendships.

But. But last night I made a grievous Facebook error. I was attempting to get two friends in touch with one another, and knew that they were both on Facebook. I had never used the “Suggest Friends” function to connect two people before, and had to do a bit of fiddling around to sort it out. Somehow I managed to give Facebook permission to send a note to EVERYONE in my email address book, inviting them to join Facebook in order to see all my nifty-keen pictures (of which I have very few). Without intending to, I had spammed most everyone I have corresponded with in the past four years.

So today my in-box has been overflowing. Remarkably, a fair number of people responded to my “invitation” by joining Facebook. Others sent me personal replies explaining why they were choosing not to (in each case I sent back a note of apology). But the most remarkable note came from a woman who works in the U.S. Customs and Border Protection office. She gently chided me for sending the invitation to her work email address rather than her personal one, but promised to join Facebook when she gets home this evening. I have no idea in the world who she is or why we ever corresponded in the first place. Does she actually know who I am? Or does she simply figure you can never have too many friends? If she follows through on her promise and becomes my “friend” perhaps I will find out. It is a brave new world, this social networking stuff. It is also a world in which small mistakes can instantly become very large ones. If I have inadvertently spammed you, please forgive me.