April 27, 2017

The Pain in My Back is a Pain in the Neck

My Primary Care Physician (previously known as a ‘family doctor’) will never get back the fifteen minutes I spent ranting in his office yesterday.  But at least it made me feel a little better.  Maybe even a lot better.
I am the not-very-proud owner of an extremely strained set of latissimus dorsi muscles.  Two evenings ago, what had been a two-month-long minor back ache turned into a full-fledged all-hands-on-deck, fifteen-minute-long spasm of my back muscles.  It happened at an especially inopportune time.  I was fifty miles from home, just finishing up a speaking gig.  I was carrying books, my laptop, and a projector out the door when several attendees stopped me to ask questions.  It was 9 p.m. and I had an hour’s drive in front of me to get home.

Instead of putting down my belongings, I continued to hold them.  After about seven or eight minutes of pleasant conversation, I turned to push open a door.  My back muscles decided this was the perfect time for an insurrection.  For the better part of fifteen minutes, I felt the most intense pain I have ever felt in my life as a wave of spasms went up and down my back.

Two of the witnesses to this event happened to be nurses, bless their hearts.  They saw the look on my face and began offering professional guidance. 

An MRI machine
In my view, those back spasms were entirely preventable.  Their genesis goes back to last summer when I had my decennial colonoscopy which showed a lone anomaly in an otherwise quite healthy colon: there was a slight indentation in a location that corresponded to my appendix.  Upon being told this by a Colorectal Specialist, I explained that my appendix had been removed at the age of 4 or 5.
 And so, to clear up the mystery, an MRI was ordered.

Think about this: I am on Medicare.  The Center for Medicare Services (CMS) has decreed that all Medicare subscribers are eligible for a $7,500 colonoscopy every ten years.  Because I dutifully agreed to have this procedure done, I am now in the hands of a Colorectal Specialist who had never laid eyed on me until last year.  My medical records from the early 1950s have almost certainly long since gone to a landfill in South Florida.  I cannot prove I ever had said appendectomy (the scar seems to have vanished).  It will take a $6,000 MRI to determine if I have an appendix and if said appendix is gently pushing into my colon.

Your appendix, if you still have one
The MRI results came back.  The Colorectal Specialist determined that I had the stub of an appendix, and that the stub appeared to be filled with some kind of fluid.  I was told I needed an appendectomy, which would be performed laparoscopically.  And so, on the eve of Thanksgiving, I went in for a $20,000 laparoscopic appendectomy (known as a “lappy appy” as the cheerful surgical resident informed me) at one of Boston’s major teaching hospitals.

Laparoscopic appendectomy
Five hours later I was sent home with written instructions: DO NOT LIFT ANYTHING OVER FIVE POUNDS.  OTHERWISE, YOU WILL PULL YOUR STITCHES AND YOU WILL REQUIRE A SECOND OPERATION.  Left unsaid but quite understood was that the fine folks at CMS would kick that bill back in my direction for full payment.  And so, for the next six weeks, including Thanksgiving, Christmas, and New Years, I adhered to those orders.  In the meantime, I also received the biopsy results of my “lappy appy”.  The full page, jargon-filled letter boiled down to one word:  “Ooops.”

There was indeed a tiny stub of an appendix, but it was not filled with fluid and it was not causing any problem.  It was all a matter of an ‘ambiguous reflection’ on the MRI.  Call it a ‘false positive’.
Like I said.  “Ooops.”

But I had emerged from my enforced inactivity at the beginning of February with some unwanted extra pounds, sort of like the ‘Freshman Fifteen’ but at the age of 67.  I am by nature an active person and I had just gone through the prime holiday period with no acceptable outlet for that energy.  And so I began doing things.  I moved furniture.  I shoveled snow rather than use the snow blower.  I carried stuff just to get the exercise. 

I tackled spring clean-up chores
with gusto
And I began to feel twinges in my back.  I ignored them.  I am a tough guy.  Spring finally arrived and Betty and I planted dozens of new shrubs and perennials.  I sawed tree limbs, raked with relish and toted brush-filled bags to the transfer station.  I was bound and determined to work off those pounds.  I also had a busy speaking schedule and I carried two bulging bags of books with me.
And so I was understandably angry when my back revolted.  And I freely admit that I was also more than a little frightened.  Which is why I called my Primary Care Physician, who cleared time for me because he could recall only one time in a three-decade relationship when I called to request a same-day appointment (it was my first encounter with Lyme Disease).

He listened to my rant.  He looked at the computerized reports.  He agreed that I had received $26,000 of ‘overly cautious’ medical attention, but that the blame lay with Congress for failing to rein in tort reform when the Affordable Care Act was being drafted. 

So, what was he going to do about my back?  After a full examination, his learned advice could best be paraphrased as “suck it up”. 

Yoga was prescibed
“I could set you up with physical therapy appointments or you could try acupuncture,” he said.  “But the real treatment is ice and yoga.  Your muscle will recover when you stop stressing it.”  

Because I whined, he also gave me a prescription for $1.86 worth of muscle relaxers, but cautioned that the pills don’t know which muscles need to be relaxed.  “They could decide to relax some muscles you’d rather keep under control.”  Message received.

And so I write this as part of my therapy.  All things in moderation.  This too shall pass.

1 comment:

  1. I feel your pain Neal. If only we could find out what is causing my hip to hurt. The MRI didn't come up with much of anything. I get a knot in my lower right lat area from time to time. Ironing is one thing that sets it off. The "child" yoga pose really helps. Also stretching that area, tummy down, on a large ball. Hope this helps!! Take care.