October 3, 2011

Reflections on My September Setback

Back in January on this blog, I explained why 2010 had been -- in many ways -- the best year of my life. This year was in the running for at least a silver medal, and may even have challenged 2010 for the gold.....

Until I totaled my new Honda Fit in late August (right after a three-week tour of the Pacific Northwest, probably my best-ever trip in a life full of travels). As a result, September may have been one of my worst months ever.

There will be other difficult times down the road as I get older. But, reflecting on this past month, I've learned some lessons that will surely help me weather future set-backs.

First, a brief recap of what happened:

The Crash
On Monday afternoon, August 22, I was driving the familiar route to the Iona Senior Center (a ten-minute drive from my house) for my regular Monday bridge game. A block away from my destination, I approached a stop sign with a small van stopped at the intersection. I applied the brake (I thought) and my car (a new Honda Fit) accelerated. Stunned, I reacted  by pushing harder on the pedal. The car sped up even more and crashed into the van.

The rescue squad soon arrived. I asked to be taken to Sibley Hospital, my preferred, neighborhood hospital. I was told that trauma cases like mine went George Washington Hospital.

George Washington Hospital
I was in GW hospital Monday and Tuesday nights. I was given all sorts of tests -- X-rays, MRI, CT -- and examined repeatedly by a steady parade of doctors and interns (GW is a teaching hospital affiliated with George Washington University's Medical School.)  My housemate insisted on staying with me during my first night in the hospital. He said later he was appalled at the number of times I was awakened during the night by a series of interns who asked me the same questions and gave me the same hand / leg tests.

When I finally got discharged on Wednesday (after throwing an "I Want Out of Here" fit), I was told by the doctor in charge that the tests weren't definitive, but that there was reason to suspect a problem with my neck. They gave me a neck brace and an appointment for the next Tuesday for a follow-up neck X-ray.

That next Tuesday, I asked the technician when the doctor would receive the new X-rays. He said he'd send them in the next hour or two, but he warned me that the doctor frequently didn't get around to looking at the results for a couple of days! I waited several days and then began calling the doctor's office to learn the results.

I finally got an appointment a week and a half after the X-ray. The appointment was for 2:15pm, and I arrived on time. An hour later, an assistant came in and removed the staples from my scalp wound. Two hours later, the doctor came in. She was angry that I wasn't wearing the neck brace. I said I didn't think it was doing any good, and that my problems were with back and hip pain, not with my neck. She said I still should continue wearing the neck brace. I said I wasn't going to do it. She acknowledged that the neck X-ray hadn't shown anything.

Other Doctors and Tests Confirm the Problem  Was Not the Neck, But the Back
My internist recommended a good back doctor. I found I'd have to wait several weeks for an appointment with the doctor, but could get an earlier appointment with his assistant. I took it. When I arrived, she talked with me for a few minutes to determine what was going on. Then she recommended an X-ray of the back, which was done right away. I went back to the consulting room. Within ten minutes, she returned. She immediately called up the X-ray on a screen in the consulting room. Quite a contrast with  my GW hospital experience!

Bottom line:  I had a compressed fracture in the lower spine. The assistant also mentioned that the X-ray showed evidence of an arthritic build-up in the hips, which might explain the hip pain I was experiencing.

Coincidentally, I had my regular twice-yearly checkup with my urologist a few days later. My cancerous prostate had been removed in 1995. Subsequent PSA tests showed some cancer cells remaining. I've had this indicator monitored every six months since then. The PSA readings have gone up very slowly over the 16 years since the operation.  At my last checkup six months ago, the reading was 4.01.

I seldom think about the prostate cancer these days. But the PSA reading from my September visit was 9.4. More than double the last reading! My urologist immediately scheduled a bone scan and pelvic CT at Sibley Hospital.

In the interval between the checkup and the tests at Sibley, I had lunch with a couple of friends who have arthritis. I told them I was in the strange position of hoping the tests showed arthritis, since the alternate seemed to be bone cancer.

Turned out it was neither. The bone scan showed nothing wrong. The pelvic CT confirmed a compressed fracture at the L-1 vertebrae. Whew!

My Physical Therapist Provides the Clearest Diagnosis
I am very fortunate that virtually all of my doctors have offices in my neighborhood. They are all top-rate. They all know each other and have worked together for years. And they all operate out of Sibley Hospital.
It's like having my own Mayo Clinic.

And, if they think physical therapy would help, they all refer you to Tom Welsh. I'd seen Tom several times in recent years. I now realize he had diagnosed my Parkinson's several years before anyone else did. But not being a doctor, he could only suggest that I tell my doctors what was going  on.

When I started experiencing the back pain after the car crash, I asked my internist for a referral to Tom. By coincidence, my appointment with him was for the day after the results of the Sibley tests became available. My urologist called Tom and faxed the results to him.

After checking me over, he told me that three things were going on, and then gave me suggestions on how to deal with each:

  • I have the previously-diagnosed compressed  fracture at the L-1 vertebrae, and wearing the back brace is essential to promoting the healing there. I hate to think what might have happened if I'd continued usiing the neck brace the GW doctor had insisted I wear.
  • I have lumbar spinal stenosis, which is a narrowing of the spinal column that compresses the spinal cord and nerves. It happens with aging but it also can be triggered by a car crash. Exercise is the top treatment recommendation. But the usual recommendation of walking doesn't work here, since standing and walking are painful. Tom recommended that I get (and use!) an exercise bike. I got one a few days ago and am using it.
  • The pain I've been experiencing in the hips is only indirectly related to the crash. It comes from my over-straining my muscles in that area when trying to deal with the week of bad constipation I had after leaving the hospital. This is exactly what I had diagnosed myself.
The last two diagnoses were Tom's. I'll bet my back doctor will confirm the spinal stenosis diagnosis. I looked it up on the Mayo Clinic's website and others. The descriptions of the symptoms are exactly what I've been experiencing. -- no pain while sitting or lying down, but pain while standing and walking. The pain when walking leads to walking slightly bent forward to relieve the pain. These sites also list using an exercise bike as a top recommendation for dealing with spinal stenosis.

And Tom's diagnosis of the hip pain has been confirmed by the fact that a few sessions with him working on me to relieve the muscle strain has virtually eliminated the pain there.

Lessons Learned
  1. Even top-flight doctors and hospitals can make mistakes. When in doubt get a second opinion.  George Washington Hospital has a good reputation. Hard to believe they could take as many tests as they did with me and come up with a completely wrong diagnosis that could have kept me from the needed treatment for their undiagnosed compressed fracture of the vertebrae.
  2. Listen to what you're gut instinct is telling you, but verify. My gut feeling about the cause of my hip pain turned out to be correct.   But I've had other gut instincts that have proved wrong.So insist that your medical providers check out your gut-instinct diagnoses. 
  3. Don't assume that a setback is going to last forever. One of my problems is that I've usually enjoyed good health.  I'm not used to setbacks and get overly discouraged when they happen.
  4. Find a way to keep exercising. Not knowing what the underlying problems were or how to deal with them, I barely exercised during September, since standing and walking were painful. As a result, I became semi-depressed and listless. I've researched and written about a variety of health ailments since starting this blog, and exercise almost always has been near the top of the list of recommended remedies. I've found this to be true for spinal stenosis as well. It's been a week since I bought the exercise bike at Tom's recommendation and began using it. I'm finally seeing a glimmer of light at the end of this tunnel.
  5. Find a good physical therapist and then when a problem occurs get him/her into the diagnosis game as soon as possible.  Often in these times of specialization, each doctor is looking at only his/her particular piece of the puzzle. A physical therapist will look at you as a whole and often can provide the missing big-picture perspective.

On September 26 (below), I discussed some of the things I learned from the crash. But the first thing I had to learn was that I could't blame it on the car but instead had to own up to the fact that I must have mistakenly pressed the accelerator, not the brake. That was probably the most difficult lesson to accept.

    1 comment:

    Linda Fernandez said...

    Glad you are on the road to improvement. Unfortunately, your narrative is a good snapshot of how doctors are often too busy to listen to their patients and find out what really is wrong with them. Recently we saw (and that is the correct verb) an MD who dashed out of our short unproductive "meeting" after writing a phrase on the back of his card and telling us to "google this."