Month: October 2022

It isn’t the rail-trail, but it’s still a nice place to walk…

You will not stop them from dying.  At best, you will stop them from dying today.

-Aude Mernilliod

I saw an orthopedic surgeon and got a steroid injection in my right outer hip.  The next day, I felt significantly better.  Then things went downhill and the pain returned en force.  In addition, I now have some decreased sensation over my lower shin.  That suggests a neurological problem.  I now think I might have a pinched nerve somewhere.  The most likely place is in the spine, where the nerve root leaves the vertebrae.  From the distribution of the pain and numbness, I’d say the L4 nerve root.  So, I contact a spine specialist to get the required tests (probably an MRI) and see what’s up.  I also received a prescription for oral steroids.  They helped quite a bit which suggests that whatever is pinching a nerve has some inflammatory component.

I mention all this to open a window into how our medical system works.  I’m in a position where, being a doctor, I understand how things are done and why they are done that way.  But I am also a patient, so I live with the frustrations and challenges of having to deal with the system.  If a life or limb is not threatened, the usual process takes time.  You start out with conservative treatment, in this case that means rest, ice and nonsteroidal pain meds and wait.  If that doesn’t work, and it hasn’t for me, you try something minimally invasive like a steroid shot in the place where you believe the inflammation is, like the bursa, and you wait.

All this waiting can be very frustrating, especially when pain is involved, but there are reasons for the delay.  One reason is that we don’t have an infinite amount of resources to spend on medical care and we have to be judicious in how we use what we have.  If you have a true emergency, fine.  You’ll get what you need ASAP.  If you don’t, you may have to suffer for some time while the list of possible causes of your discomfort is explored.  You know, the etymology of the noun, patient, is the Latin, patiens, the present participle of pati, to suffer, and has nothing to do with a tolerance of waiting.  As uncomfortable as I feel, this ain’t gonna kill me while I go through the process.  I’ll be a patient patient and suffer the waiting while I suffer the pain.

The differential diagnosis of my pain is long.  Many things can cause it.  Given my symptoms and what makes them worse or better, many possibilities can be moved down the list, ordered from most likely to least.  A simple pelvic x-ray taken when I got my steroid shot, for example, ruled out osteoarthritis – an all too likely cause of hip pain, given my age.   Since I have the numbness, that reorders the list a bit more.  It also changes the level of urgency, although it doesn’t make it emergent, because compressed nerves can be permanently damaged in a short period of time.  Given the extent of my neurological compromise, though, I still have plenty of time before that happens.  The next step is a lumbar spine x-ray to examine the bony holes that the nerves pass through.  If that proves not to be illuminating, then either I get an MRI, which is really good at showing swollen tissue, or we try some physical therapy to see if the symptoms can be made better without spending the many thousands of dollars that an MRI costs.  If the neurological symptoms worsen, or the pain exacerbates to where I can no longer perform my ADLs (activities of daily life), then things get escalated another notch.  This is as it should be.  After all, it would be totally inappropriate to spend hundreds of thousands of dollars to rule out toe cancer when all you have is a hangnail.

Meanwhile, I suffer. But I can bear it and there are many people out there who need the available medical resources more than I do.  I won’t be neglected, I just have to be patient.  I don’t have to be in the front of the boarding line, the plane isn’t leaving without me.  Suffering is just nature’s way of letting us know that we’re alive.  I’m not worried.

Not worried about me, that is.  I do worry about Waldo.  He doesn’t understand what’s going on and simply feels an instinctive need to get out there and romp.  So far, I can provide him with a minimally acceptable level of exercise – mostly walking around the apartment grounds, but sometimes going to a park.   He runs a bit, sniffs a lot and, of course, carries a ubiquitous stick.  He’s happy, tail wagging, eating well and engaged with life.  I know, from prior experience, that he will get through this just fine – as long as I can continue with what I’m doing now.  If it comes to pass that I no longer can, well…   I do worry about that.

But, Waldo, he’s patient.

… and there’s plenty of places to sniff and look for rabbits.

walking around the apartment isn’t quite as idyllic…

Pain is temporary.  Quitting lasts forever.

-Lance Armstrong

This past week has been an ordeal.  It’s not unusual for me to feel some pain when I walk – back pain and muscle pain mostly.  Usually, I can ignore it, “walk through it,” as they say, and carry on.  After a couple of hours of rest in my beloved recliner, the pain is gone and I’m ready to continue the next day.  Sometimes, I’ll have an extra sharp pain, somewhere or other – doesn’t ever seem to be in the same place, and I’ll take a day off for a little extra rest so I won’t make it worse.  That works pretty well and it has always taken care of the problem.  I’m not particularly surprised when I get a pain here or there – I am 73, after all.  But for the past week, something else has been happening.

A week ago, I noticed a mild, barely noticeable dull ache on the right outer side of my hip.  Not in the joint, but on the top end of the femur at a place called the greater trochanter.  I figured it was just the usual muscle pain, an overuse kind of thing, and it would go away.  For a couple of days, Waldo and I did our usual trek and the pain didn’t get worse while I was walking.  But it didn’t go away.  On the third night, when I lay on my right side, the pain got significantly worse and the ache kept me awake much of the night, even when I rolled over.  Next morning, I decided, much to Waldo’s disappointment, to avoid the rail-trail to see if it got any better.  It didn’t.  Day by day, it got worse, to the point where it’s difficult to walk even a half-mile without periodically stopping.  Ugh.  Now I don’t even attempt going to bed – I get what sleep I can in the recliner, the one place I can get some, though not very much, relief.

I diagnosed myself with greater trochanteric pain syndrome, a fairly common occurrence, and tried to get an appointment with an orthopedic surgeon.  A surgeon can inject steroids into the trochanteric bursa which will decrease the inflammation that causes the pain.  Complete relief usually follows soon after.  However, the best I could do is get an appointment in another week – the surgeons are pretty busy.  Until then, I have to just suffer through as best I can.  Nonsteroidal pain medication doesn’t help any and ice gives only some temporary relief.  Sigh.

Over the years, I have had enough pain that when I get some, it feels like I’m meeting an old acquaintance.  An irritating, bothersome acquaintance, for sure.  But one I’m familiar with and, like a troublesome family member who overstays their welcome, I know that it will sooner or later depart and become just another memory.  Perseverating about it, trying to push it away and getting agitated about it will only make it worse.  The key is patience.  Lots of patience.  Accept it, make friends with it as best you can, and wait it out.

Pain and pleasure are different ends of a spectrum – you can’t have one without the other.  It’s all just a part of the human experience.  A bar magnet always has a north pole and a south pole.  You can never have one without the other.  They come only in pairs.  You chop a bar magnet in half and you end up with two bar magnets, each with a north and a south pole.  In the same way, no life can have only pleasure without pain.  Everyone will have pleasure sometimes, but they can never avoid pain and even the roughest life has some pleasure in it.  They’re different ends of the same stick.  Wishing life to be something it isn’t is just a waste of time.  You just cope.  Sigh.

Waldo is coping quite well too.  We only walk a half-mile around the apartment complex, several times a day, and he isn’t able to work out all his border collie energy in the distance I can now walk.  He tugs at the leash a little more than normal because I’m walking significantly slower.  But he still romps around and goes after sticks and chases rabbits, although he’s a bit more frenetic about it than usual.  He’s patient with me and seems to know that this will not last forever.  After all, he had to wait a good six weeks before we could return to our full rail-trial trek when I sprained my ankle a while back, so he’s been here before too.  But I do worry about what I’m going to do if something happens and I can’t even take him out to do his business.  I’ve not yet come up with a good solution for that.

We both take a deep breath and just sigh.

…and yet, even here, she shows off her beauty.

The band, “Tuxedo Junction,” at Branford Green.

Where words fail, music speaks.

-Hans Christian Andersen

A friend of ours. Marlene, invited Waldo and me to go down to Connecticut to enjoy an outdoor concert.  We readily agreed and drove the two hours from home to the Branford town green.  The band, about twenty instruments, including saxophones, trumpets, cornets, trombones, an electric guitar, a keyboard, a bass and drums, were setting up as we arrived.  I walked Waldo around the green, so he could do his business before the music started, and then we settled down on some portable chairs that Marlene brought.  The show began and Waldo lay down quietly in front of me — except for a few times when he dug at, and tried to eat, some weeds in the grass.

The band played old, well known music, including Glenn Miller’s “In the Mood” and “Summertime” from Porgy and Bess.  They also had a very good tenor singing along in some of the tunes and, all in all, it was a very pleasant experience.  I really enjoy concerts en plein air and, although he didn’t seem to like it as much as Marlene and I did, Waldo tolerated it well.  It makes me wonder, why do I enjoy music?  Why does anyone like music?  Why does it exist?

That’s a question that fascinated me for a long time. As far as I know, the enjoyment of music, in some form, is universal among all human cultures.  That suggests to me that there must have been, at some point in our evolution, a survival advantage that music provided for the species.  In the past, I just couldn’t imagine what it could be.  How could music help primitive man, or his ancestors, survive?  Maybe it served as a mechanism that brought people together and that helped them survive because it reinforced their tendency to congregate and socialize?  Living in larger groups clearly made it easier for humans to get along in the world, but that begs the question, why does music cause people to come together?  For years, I couldn’t find a satisfactory answer.

Then I came across a book that piqued my interest called, “Animals in Translation,” by Temple Grandin, a famous autistic woman.  In the book, she talks about animal behavior and its whys and wherefores.  At one point, she mentions a theory, thrown about by some researchers, that made sense to me.  There are some animals, like the prairie dog, that communicate using a singing type of voice.  Their songs can be very detailed.  For example, they can communicate not only that a predator is approaching the community, but also what kind of predator, where it’s coming from, in what direction, how fast and, if they have confronted the beast before, the particular animal that’s threatening the community.  They haven’t evolved the ability to use language the way we do, but they communicate, just the same, using “music,” and that helps them survive in this dangerous world.

Now, ontogeny recapitulates phylogeny, which is just a fancy way to say that during an individual’s growth in utero, human beings go through the same steps of development that our ancestors went through in evolution.  Human fetuses go through a fish-like stage, an amphibian-like stage and so on.  Which makes good sense because as our ancestors mutated and evolved, new genes would be added onto old genes, much of the time, without throwing away the old genes.  So, maybe, just maybe, our human ancestors, at some point, evolved the ability, like prairie dogs, to use music to communicate and only afterward evolved language centers in their brains that allowed them to speak amongst themselves the way we do now.  If so, then we inherited the music centers in our brains and can still communicate using music.  Those centers then evolved further to give us our love of making and listening to music.

Clearly, music does communicate something to us, at least most of us.  And what it communicates cannot, in large part, be adequately expressed in the words, syntax and grammar that our language centers use.  Music, I think, communicates something more subliminal, emotional even, than what our language communicates.  Something that enhances, deepens and broadens our ability to share the human experience with one another.  Maybe that, at this point in our evolution, doesn’t enhance our ability to survive, but, man, it certainly beautifies it.

I know that Waldo has a language center in his brain because he responds appropriately to the words and expressions I’ve taught him.  It’s well known, too, that animals respond well to some kinds of music – music soothes the savage beast.  But Waldo must have a “music center” in his brain because I can communicate with him by using different whistle tunes and he responds appropriately to them.  However, if his behavior is any guide, it would be a real stretch to suggest that he enjoys the music I do.  If he enjoys any at all, it doesn’t seem to be “In the Mood” or “Summertime.”  But, just the same, he lays quietly next to me and allows me to enjoy the band.

Waldo must have also inherited a “tolerance to human idiosyncrasies” center in his brain.

Playing “In the Mood.”