Nobody likes having to guess what the 1-10 pain scale means.  What it means to one person isn’t necessarily what it means to anyone else, and people rarely ask for your frame of reference.  What if, since we’re already carrying around our meds list (you are  carrying your meds list, aren’t you?), we also carry around our own pain scale?  Here is my contribution:

• 1-2 is tolerable
• 3-4 I’ll think about taking a tylenol
• 5-6 I’ll definitely take a tylenol, and maybe some ibuprofen, too
• 7-8 there is definitely something wrong and I’m finding someone to drive me to the doctor
• 9-10 someone is dialing 911

Wishing you many days of only mild pain.

***

I might take my own short break.

Life is a little crazy around here as I’m definitely feeling part of the sandwich generation.
My mom’s having surgery and needs constant care for two weeks, but I still have my own kids.
Pinewood Derby cars to build for the big race coming up, five kids going five different directions,
AND we’re filling out financial aid forms for the first time.
It’s a bit of a trick providing tax info in January, since we don’t file our taxes until May.

***

It’s that time of year when people make New Years resolutions, and variations on exercise/get in shape/be healthier are common.  Despite my wish to be in good shape, wishing won’t make it happen.  I need concrete goals (I’ve previously written about goals here):

My resolution/goals are:

1. Develop and follow an exercise routine
2. Write weekly menus for my family and prepare those well-balanced, nutritious meals
3. Carefully keep track of everything I eat

I’ve already been working on the first one.  My family joined the YMCA, and part of the membership fee included an appointment with a personal trainer to customize an exercise program.  This was a huge waste of time.  Fortunately, I also saw a new physical therapist.  The contrast was remarkable.  My physical therapist has been working with me to find stretches and exercises that start with where I am now and will protect my joints while getting me into good physical condition.  I’m already seeing progress.

I also bought a home gym.  Do not pay full price if you decide to do this.  Craigslist is a great place to find exercise equipment.  Things tend to be more expensive when everyone is making New Years resolutions, but many people give up on their resolutions after eating tons of Valentines chocolate, and prices go back down.  Here’s what I got:

The reason I chose this model is that it includes a rowing machine, which is fantastic low-impact cardio.  I still have my elliptical, so now I have two cardio options.

One entire PT session was spent going through the exercise book that came with my home gym, with the physical therapist marking which exercises I should do and which ones should be avoided.  It was pretty interesting to see the therapist’s eyes grow big as saucers as she exclaimed, time and again, “Oh, my!  Don’t do this!  It would be terrible for your ____.”

I love having my exercise routine designed by someone who knows what she’s talking about.  Now I just have to put it into practice.

Any resolutions you wish to share?

From a medical standpoint, 2011 was discouraging.  Despite the fact that I blog about living with an autoimmune disease, I really don’t want “patient” to be my full-time job.  I don’t even want it to be a part-time job.  Given that I have to deal with an incurable disease, I’d love to be well-controlled so that I could pop in for a quick check-up with my rheumatologist every six months and forget about it the rest of the time.  What a contrast when compared to 2011′s reality!

Adding up my office visits over this past year, I had many more than two simple rheumy appointments:

• 6 Rheumatologist
• 9 Family Physician
• 3 Podiatrist
• 1 ENT (I did not go for testing, and cancelled the follow-up appointment)
• 4 GI
• 3 Surgeon

Add in:

• 1 outpatient x-ray
• 1 outpatient CT
• 1 outpatient ultrasound
• 3 outpatient trips to the OR
• 10 physical therapy session
• 5 days inpatient (numerous tests and doctor consultations while in the hospital)

That’s twenty-six office visits to see physicians and sixteen other appointments, for a total of forty-two medical appointment in 2011 – plus five days in the hospital.  No wonder I felt like I was always seeing someone for medical care.

It’s exhausting.  I sincerely hope that 2012 is better, because I am D.O.N.E!

***

Believe it or not, I have a life apart from obtaining medical care.  On a happy note, our first calves of the season arrived on Christmas day.  Twins!

Unfortunately, the mother did not feed them.  For two days we took a bottle to the pasture to feed, but when it turned rainy and the calves were looking in sad shape, my son showed up in my kitchen with a calf in his arms and asked me to get some towels to warm and dry the calf.  While I rubbed the first one down, he went after the second calf.

One of the calves was strong enough to take a bottle, but we had to feed the other one with a stomach tube.

Unfortunately, the weaker calf didn’t make it, but the other is doing quite well.  She loved to get to her feet in the middle of the night and tap-dance so we’d know she was recovering nicely.

In my book, if a calf is healthy enough to take a bottle and clomp about at-will, it’s healthy enough to move outdoors.  Lest you worry that we tossed her back out in the pasture, never fear.  She’s warm and dry, out of the wind and rain.

It’s nice to have my kitchen back.  It’s nice to know that the calf is okay.

And I’m hopeful that 2012 will have many such happy outcomes.

Wishing you a Happy New Year 

Knowing that’s how doctors feel, and having an excellent family physician who I don’t want to annoy, I was a bit hesitant to phone my doctor’s office and give my reason for visit as “I need a cortisone shot,” so I followed that with, “But if you want, you can just say ‘shoulder pain’ and let the doctor determine that I need a cortisone injection.”  That earned me a laugh and the comment, “It sounds like you’ve figured out how things work.”

The way it’s supposed to work is that patients report symptoms, then doctors consider those subjective symptoms as they decide what type of exam to perform and determine whether it’s necessary to order any tests.  This generates objective data.  Doctors then assess the information to develop a treatment plan.  The entire process is carefully documented in a SOAP note (another SOAP explanation; real-life example).

When I called the doctor’s office, I’d hoped that there would be an appointment available early next week, but by a huge stroke of luck, I got the office manager on the phone instead of my doctor’s brand-new receptionist, and was offered a same-day appointment.

Once in the exam room, I explained to the nurse that my rheumatologist offered to do a cortisone shot at my two previous appointments, but the first time I didn’t think it was bad enough, and the last time I said yes, but then she got busy confirming that other pain was costochondritis instead of a need for a cardiology referral and she didn’t do the shot in my shoulder.  I’ve been living with it, but it’s getting worse instead of better.  It hurts all the time, and I have limited range of motion that interferes with my ability to demonstrate various strokes to the kids in my swimming classes (it also interferes with my ability to dust the top of my refrigerator, but I don’t mind that nearly as much).  Constant pain is something I’ve learned to live with, but I need to be able to swim.  I doubt that I’ll ever do the butterfly again, but a basic crawl stroke is a must.  Also, it would be nice to be able to play my guitar again.  This is interfering with my life.

My doctor always reads the nurse’s notes before entering the exam room so he knows what he facing.  This time, as soon as he walked into the room, he asked, “Do you want a cortisone injection?”  It was sooooooo nice to get right to the point!  Of course he still did an exam and documented the limited range of motion, the crunching sounds, and all the rest, before giving the shot, but it was more along the lines of, “prove the patient right” instead of being treated as if I know nothing.

I like the fact that my family physician is thorough about doing an exam.  Documenting the extent of the problem and finding the most appropriate treatment is important.  The fact is, maybe I don’t need a cortisone injection.  In the past, these symptoms have led to a shot, but that doesn’t automatically mean that’s what’s best this time.  There might be a different problem, and it’s good to not make assumptions.

I’m not very appreciative when people with no training tell me how to do my job, and it’s no surprise when others – including doctors – feel the same way.  It was nice to discover how easy it can be to stick with describing symptoms, reporting facts, and letting my doctor determine the best treatment plan.

It’s pretty easy to make yourself a list and stick it in your wallet so that it’s always available.  If you need medical assistance (for instance, if you’re in a car wreck, or if you suddenly get sick and are taken to the emergency room), it’s great to have that list ready to hand the medics or emergency physician.

In the beginning, my list was the basic:

I thought it was efficient to adopt standard medical abbreviations.  I’ve discovered, however, that certain assumptions accompany those abbreviations.  There are 24 hours in a day, and it makes no sense to me that “qd” means “every day” but is assumed to be “every morning.” I’m told that it does.  Why that is, nobody has explained.  One doctor told me that if you choose to take a medicine in the evening, you’d abbreviate that q pm.  Given the similarity between the way “r” and “n” run together when typed, I’d be inclined to use capital letters to avoid any chance of confusing prn/pm.

Do people ever misinterpret your meds list?  In an attempt to remove the ambiguity, I now write, “with dinner” instead of “qd” since my once-a-day prescriptions are taken with my evening meal.  I suppose, if I were travelling, I’d change that to “with supper” to avoid confusion in those parts of the country where dinner is eaten at noon.

I also added a column explaining the purpose of the medicine, and another column indicating whether the medicine is by-mouth (po), subcutaneous (sq), or a topical ointment (ung).

I discovered a great bonus to taking once-a-day medicines with supper instead of with breakfast.  Some medical procedures require fasting.  Doctors try to balance their need for you to have an empty stomach with their desire for you to take your medications as prescribed.  If they don’t know what time of day you take your prescriptions, instructions end up being the equivalent of, “Nothing to eat or drink after midnight because it’s very important that you have an empty stomach, except you should take your dinner-time meds with a tiny sip of water at breakfast-time.”

Abbreviations are great when everyone agrees on what they mean.  With med lists, I suspect we’re better off being as clear as possible.

• Dr. Julie Levengood Worcester, MA, blogging at The Doctors’ Rheum
• Dr. Irwin Lim of Australia, blogging at BJC Connected Care
• Dr. Bruno Oliveira of Billings, MT, blogging at All Joints Considered (who hasn’t posted since June)

Gone are Rheumination, Aspirations of a Joint Doc, and Nuclear Fire/Curbside.

Also, I’ve set up a Facebook page and would love to have you drop by.
Pace yourself as you prepare for Christmas!

I sat there – not quite sulking, but almost – miffed at how crummy this year has been.  Poor me.  I was having quite a pity party, when it dawned on me that I needed a major attitude adjustment.

Instead of feeling sorry for myself for needing 28 doctor appointments, I can be grateful that medical help is so easily obtained.

Instead of grumbling that I haven’t been able to spend as much time with my horse as I’d planned, I can be thankful that I have my own horse.  I actually, really and truly finally got a horse - the exact kind I’ve always wanted.  How cool is that!

We still have an income – significantly smaller than a few years ago, but enough to pay the bills.  We still have medical insurance.  We have a nice warm house to live in.  We have land to raise our own organic vegetables and chemical-free beef. 

No more sulking.  By then I truly was thankful.  God has blessed me greatly.  I have much to be thankful for.

And then I remembered hangers.

When our children were small, my husband would tuck the toddlers into bed while I nursed the baby to sleep.  He would pray with the children, then they would lay in bed and say, “Thank you, God, for …”  The kids would take turns naming things for which they were thankful.  Once the baby was asleep, I loved to eavesdrop to see what they’d come up with.  They didn’t just name the same things night after night, but were creative.

One night, my son said, “Thank you, God, for hangers.”  Hangers????   I didn’t think that was suitable.  What about more noble things, like, family, or peace, or good neighbors?

God nudged me.  You’re NOT thankful for hangers?  I could arrange for you to not have any.  How would that be?  

I pondered for a moment life without hangers – or life without the need for hangers.  I decided that my son had the right idea.  I, too, am thankful for hangers.

It’s easy for me to get complacent, and sometimes I need a reminder of how very much I have to be thankful for – hangers and all.

May you have a wonderful Thanksgiving holiday.

Credit: Preventing Hypothermia, by ER Doc

Somewhere I got the idea that surgery involves freezing.  Nothing I’ve experienced at the hospital – either as an inpatient or as someone needing outpatient tests – made me think that warmth was an option in that building.

I was pleasantly surprised, though.  My surgeon uses something similar to my mom’s old hairdryer on his patients.

Back before blow-dryers were invented, my mom had a hair dryer with a soft hood that went on her head.  This wasn’t hard and rigid like at the beauty solon.  The hood was like an oversized soft plastic cap.  A flexible hose ran from the machine up to the hood and blew hot air that would dry a person’s hair.  That hose could be disconnected from the hood and used to dry the insides of shoes, too.  It was also a great tool for bugging little brothers.  But I digress.

While getting ready for my operation, the nurse explained that they’ve discovered that patients do better in surgery if they’re kept warm.  To demonstrate their commitment to this, she told me to remove my long underwear, flannel-lined jeans, and wool sweater, and replace them with a thin paper gown.

Once I’d done that, to further demonstrate their commitment to keeping patients warm, the nurse took away my nice, warm, thick, wool socks and made me put on some thin, ice-cold hospital slippers. Those grippers on the sole of the foot are mandatory because they don’t want any patients who get up and walk around during surgery to slip and fall.

Once I was settled in and resigned to freezing, things changed.  It was great!  Just as my mom’s old hairdryer hood had a place to hook up the hose to warm/dry the head, my gown had a place to hook up a hose to allow warm air to blow on me.  It was fabulous!

I was even given a control knob and told that I could turn the temperature down.  Why on earth would I ever want to do that?   I kept the heat cranked at 100% the entire time.

When it was time to move me into the operating room, much to my disappointment, they disconnected the heater hose.  Fortunately, that was temporary and I was hooked back up again in the OR.  They kept me warm.  It was wonderful to discover that surgery does not automatically mean the patient is going to freeze.