The needle and the damage done

There is an I.V. bag hanging in the kitchen from the pots & pans rack. Next to the knives. Something is wrong with this picture, or at least it's got a certain chamber-of-horrors quality that I don't prefer as decor most days of the year. Medical equipment and cooking utensils are just not supposed to mix. I've probably seen Silence of the Lambs a few too many times but I think I'd feel the same way even if I hadn't.

The attempt to administer Kato's subcutaneous fluids by myself this morning was not successful (at least if one measures success by whether he actually received any fluids subcutaneously). It seemed much easier at the vet's office yesterday with the tech holding him down and telling me what to do. This morning I did actually get the needle into him, but he immediately jumped down from, the, er, butcher block table, which I had covered with a towel, knocking over a glass of iced coffee on the counter (it broke) in the process. I'd put the dog in her playpen just before this and she was barking like crazy and trying to escape, perhaps worried that she'd be on the block next, but actually she just really needed to poop. As she demonstrated on the carpet as soon as I let her out.

But I was able to get Kato to take a good long drink from his water bowl afterwards, and I had another glass and enough iced coffee still in the carafe to fill it, and I picked up the poop, and here we are. It happens.

Almost Heaven...for Pharmacists

When a tag for this article came up in my Gmail, I couldn't resist clicking to see if Utah was in the top ten. It is not. With the odd exception of Iowa, the top 10 is completely dominated by the Southeast. The article links high rates of medication with high rates of obesity, diabetes, and / or tobacco usage. Not mentioned in the article, as I recall, was the fact that obesity and its accompanying health problems are linked to poverty, and poverty correlates with race. So no surprise that most of the poorest states in the country, with the highest percentages of African-Americans, are among the most medicated. Which comes back to the fact that it is very expensive both to be poor and to blithely allow poverty to persist. But maybe it's a price we're willing to pay in order to carry on with our biases.

California is in the bottom ten. You don't need a prescription for the Napa Valley (though technically you might need one for other medications grown in Northern CA).

What's next?

(Kato, relaxed and making air biscuits, a few months ago)
I don't know if I want to know what's next, actually. My tooth is much better today after a night of no mouthgard...amazing that it could be so painful and then almost fine (I can almost chew on it again!). Whatever I would have spent on the extra dental visit will now go toward Kato's vet bill though. Last night he was sitting forever in his litter box without 'results' of any kind, and he kept getting back in again, still without success. He's never had this problem before but I know cats (especially boys) are prone to this trouble, what with their little ductworks being so little, and that it is very serious. So this morning everyone was packed in his / her respective carrier and taken to the vet. Ripley had her 14-week checkup and next round of booster shots and was pronounced healthy; Kato's bladder was the size of an orange, the vet said, and he'll be staying at the vet overnight for maybe two nights (though I'm hoping he doesn't have to stay two...it's not exactly a cheap motel). He has to be anesthetized for the, er, procedure that will unblock him. Vet said I caught it early. He wasn't showing any other symptoms of illness--no fever, no vomiting--just obviously uncomfortable.

What's next

Report from week 3: On Thursday I had to lie down on the floor in my office because my lower back was so sore. All the hobbling around finally got to it. I've been using my cane instead of my crutches for several days, greedily wanting at least one free hand, and I'm wondering if I need the crutches to distribute weight better. If they might have some function other than just stability for my knee.

Heat feels good on the back, though. Still sore but I hitched a ride to the gym last night, where I discovered there is such a thing as a recumbent stair climber, with handles for upper body resistance. Such a device was never on my workout radar before but it seemed like just the thing. Also rode a stationary bike. I can't go fast enough with enough resistance to raise my heart rate much or even break a sweat. But I'm trying to remind myself that the motion and muscle strengthening is the important thing. I get that back, I can have all the cardio I want. I sat in the spa for awhile. All of it felt pretty good on the back.

So as alluded in the heading of this blog, I have some announcements. After much deliberation and cost-benefit analysis, I have decided to retire from playing tackle football. But I am hoping to try out for the position of Official Minstrel in addition to Rage Groupie, and avid team proponent, short of donating further limbs. I just can't do this again. 'This' meaning not only the colorful photos in the preceding posts but everything that goes with them; that it is a stunningly gorgeous autumn day and I'm staring at my bike and can't ride it. And I'd like to still be riding a bike in my crone years, which (whatever some people say about me) I've not reached just yet, and I'll need at least a little knee joint function left to do that. The bit of arthritis Doc cleaned up in my knee is probably more to do with all my pre-football running, but getting more beat up won't help it. And I'd still like to be able to run when I feel like it. I have talked to teammates for whom the opportunity to tear 'em down on the field is so satisfying as to be worth the risks. Maybe if I were a bit more aggressive in spirit and burly of build, that would be true for me too. If I need a combat sport outlet, and I might, I think jiujitsu might be a better choice. Something where relative momentum and mass are less important details. Meanwhile, I want to ride my bicycle.

Which brings me to the next big thing. In May 2008 I will be riding my bike in the NorCal AIDS Challenge, a 325 mile / 4 day loop of the northern Sacramento valley, to raise funds for HIV / AIDS programs. Just seemed like a great way to get my knee rehabbed and the rest of me back in shape, keep my spirits up, and do something helpful, all at the same time. The organizations benefiting from the funds are local / Sacramento area and are oriented toward keeping people housed, fed and cared for. Despite my periodic whining about sore this or that or having to ask people to drive me around for a few weeks, I know that my temporary slight disability is really quite luxurious in the scope of health problems a person can experience. So here is my official Donation Page for the ride. Feel free to visit early and often.

Hope floats

Haven't used the little condo swimming pool much. It's a tad over-chlorinated and often there are people in there, and I haven't been a much of a socialize-at-the-pool person. However, it is a place I can walk to and it's shallower and warmer (and possibly cleaner thanks to the chlorine) than the big creek pool in the park. Decided to give it a try and see if my knee would allow for swimming right now. I have been depressed by my sudden new lack of exercise since "the Pop." And, even though I hadn't yet quite mastered the art and science of tackling, the idea that I will have to wait almost a year before I can have another (legal, consensual) try at knocking the snot out of somebody is also depressing.

Anyway, got in our pool and immediately realized that this injury could be, oddly, the best thing that ever happened for my triathlon. Not that I've quite decided to be happy about it, but I see that it could have some benefit. I can't even cheat with a frog kick right now which is what I always do if I'm feeling lazy or tired. Flutter kick is the only motion both legs can accommodate. I can dolphin kick a little bit if squeeze my knees together and use the left leg to stabilize the right. And there ain't nothin' wrong with my arms. I didn't stay in very long, but it felt SO good, I cried with my goggles on. [Somewhat defeats the purpose of goggles.] I wonder if there is some sort of amphibious brace I could wear. Maybe a neoprene wrap would help. I need a little bit of motion control...a couple times my leg went in a direction that made kind of unpleasant clicking and grinding noises in my knee.

I will see Dr. Komas in 6 days. Since the last post he has received high praise from people I've talked to who have seen him. That's a relief. Talking with teammates who have had ACL reconstruction, it looks like I might be getting a piece of somebody's achilles tendon in my knee. Somebody who didn't need it any more. Maybe in the Illiad when mighty [and sulky] Achilles met his downfall with the shot to his heel, it's not so much that he actually, literally died, he was just so bummed out by not being able to fight the Trojans any more that he wasted away on the couch. If he'd had a swimming pool in his campground and a good orthopedic surgeon the story would have been much different.

is he out of his mind?

Here are some pictures of torn ACLs that are a little easier to follow than my real images were.

Made an appointment with an orthopedic / sports medicine doc today (who is in my PPO network, unlike the one to whom Immediate Care referred me). A little worried that I don't know anything about him, and a lot frustrated that the earliest appointment was two weeks away. The receptionist told me he couldn't give me any advice about what I should / shouldn't be doing until he sees me. In two weeks. Why don't I call the doctor at Immediate Care and ask him, she suggested. Oh yeah, that guy who thought I just had a sprain. For lack of other options I called him (thinking maybe he can suggest some good exercises, etc.) and his well-thought-out advice was "I see you have a complete tear. Wear the immobilizer and use crutches and don't put any weight on it." You've got to be kidding me. I live AND work on the second floors of buildings without elevators for one thing. I was feeling proud of how much better I'm climbing stairs today. OK, it was the most conservative possible advice, but it was dumb. I'll be careful, but I haven't read anything that says you can't walk around just fine with a torn ACL. Two weeks of the "immobilizer" is B.S. I think if it were necessary our team doctor (an orthopedic surgeon) would have said something when I showed up to watch Saturday's game wearing only my ace bandage (in addition to other clothing appropriate for the situation). He read my MRI report and said, "Oh, it's just the ACL. The MCL issue can be treated non-operatively. ACLs must be to him something akin to what 30-day termination of tenancy notices are to me. Our coach who is a physical therapist (and who previously tore her ACL playing football) noticed I was holding my cane in the wrong hand and showed me the correct way to do it. (Bellabell's comment on the last post hinted that it isn't completely intuitive--I didn't realize I was doing it wrong.)

Maybe I'll ride my bike to the appointment in two weeks to protest how long it took to get the appointment. If I can find a suitable hinged brace, Mom.

Magnetic resonance

I can identify some of the structures in these images but I wouldn't have been able to look at them and say ah, yes,

complete tear anterior cruciate ligament. Associated bone bruise lateral femoral condyle and posterior lateral tibial plateau. Menisci intact [Yay, that's good, right? Intact menisci are the best kind]. Soft tissue edematous changes in association with large knee effusion. There may be a partial tear of the medial collateral ligament.

There were numerous other pictures. This series was the "sagittal proton density fat suppressed" scan. All the findings in the report may not be visible in this particular series but it was a bit of work capturing the images. Had to use Virtual PC to read the disk from the MRI office that came with its own special medical industry viewing software...not the JPGs I'm used to working with. Virtual PC runs...very...slowly...on my Mac. So eventually I had the screen with these images open in Virtual PC, I took a "picture" of the screen (not with a camera--it's a feature of Virtual PC of which I now see the usefulness), got it back on to my regular Mac OS desktop, opened Adobe Photoshop, changed it into a JPG file, and voilà!

One o' these things is not like the other...

Yes, I know far, far worse things have happened / are happening in the world. I listened to NPR on the way home from work tonight re: armor piercing explosives and unfriendly Iraqi police. A man in an electric wheelchair scooted by as I hobbled across the street to an ATM. So I have asymmetrical knees right now. No big whoop. At least there's two of 'em. Still, I'm managing to feel terribly inconvenienced by it all. Perhaps I took unrestrained mobility a tiny bit for granted.

The [mostly] walking wounded

I wish there were some exciting visuals to go with this post. I wonder if there's some way to get a color copy of my right knee MRI when it's done sometime this week...be it normal or...Abby Normal. I took a hit in the Santa Rosa game yesterday at the start of the 3rd quarter (we were kicking off, I was running down to meet the ball carrier and somebody else met me first). Can't wait to see the game film because I don't really know what happened with my knee, felt like it buckled or did something untoward, then when I stood up again it felt like it popped back into the right place. Or that it popped somewhere. Tried to walk it off. Played a couple more plays and we were back on offense, I think, and I was lined up in my left side tight end spot and got knocked down in the crowd, was trying to stand up again and somebody told me to sit down and rest for a minute. Come to think of it, that seemed like not a bad idea, so I did. Then our team doctor came over and helped me walk off the field. Wiggled right knee this way & that way and compared it to the left knee, and thought the sore unstable one was too wiggly. Didn't hurt all that much. I'd always thought if I tore something it would really smart. Dr. Dotson said if it was a torn ACL (which he thought it might be but hoped he was wrong) it would likely swell up like a grapefruit by the next morning so he wrapped it and I popped a few "vitamin I" (thanks J.M. for introducing me to that term), iced it for the rest of the game and off and on throughout the evening. Woke up this morning and it didn't seem swollen at all, but as the day has progressed it's looking fatter. The doctor at the clinic back home here in Chico didn't think it was all that wiggly; he thought maybe it's just sprained. Wrote Diagnosis: Sprained Knee on my chart so it must be true. MRI Tuesday. Either way it looks like I won't be playing next week. Crap.

I went to Rite Aid and got a cane. Nothing fancy or hand-crafted but more befitting my...je ne sais quoi...than crutches.

Oh. The other thing I've not been mentioning here. It's not the elephant in the room so much as the whole house. C is hunting for apartments in SF, having secured employment there. Please think good thoughts and / or prayers, as you are inclined, for her successful housing hunt and peace of mind. And save a few for Lefty too. It's a hard change.

Child-hating congressman

Whoa, Em, that's some strong rhetoric there...wasn't Rep. Nathan Deal, R-GA just trying to protect innocent taxpayers from spending their money on illegal aliens when he and the late Rep. Charlie Norwood created the Deficit Reduction Act of 2006? Some excerpts from an update on CaliforniaHealthline.org:

Proof-of-Citizenship Rule Pushes Drop in Medicaid Enrollment

March 12, 2007

Medicaid programs in seven states have reported declines in enrollment during the past year that they attribute to new federal rules requiring beneficiaries and applicants to provide documentation proving their U.S. citizenship, the New York Times reports.

The Deficit Reduction Act of 2006 includes a provision that most people who seek Medicaid enrollment must provide "satisfactory documentary evidence of citizenship," such as a passport or the combination of a birth certificate and driver's license. Applicants are required to submit original documents or copies that have been certified by the issuing agency, some state officials say.

The law, written by Rep. Nathan Deal (R-Ga.) and the late Rep. Charlie Norwood (R-Ga.), is intended to prevent undocumented immigrants from enrolling in Medicaid. However, it "has instead shut out tens of thousands of United States citizens," the Times reports. Florida, Iowa, Kansas, Louisiana, New Mexico, Ohio and Virginia have attributed declines in Medicaid enrollment to the new requirements.

In Florida, the number of children enrolled in Medicaid declined by 63,000, to 1.2 million, from July 2006 to January. Florida Department of Children and Families spokesperson Albert Zimmerman said, "Nearly all of these people are American citizens." In Iowa, the number of Medicaid beneficiaries declined by 5,700, to 92,880, during the second half of 2006 after increasing for five years.

Iowa Department of Human Services Director Kevin Concannon said, "The largest adverse effect of this policy has been on people who are American citizens. We have not turned up many undocumented immigrants receiving Medicaid in Waterloo, Dubuque or anywhere else in Iowa."

So now that Rep. Deal knows that his law is keeping real live U.S. citizens and their kids from accessing health care benefits such as befit real live U.S. citizens, is he trying to fix it?

Chris Riley, chief of staff for Deal, said Deal believes that the law "has saved taxpayers money," adding that Deal "will vigorously fight repeal of that provision." Riley added that Deal will try to extend a similar provision to SCHIP. Riley also said that the requirement could be applied flexibly to minimize hardship for citizens (Pear, New York Times, 3/12).

Assuming there's genuine interest in minimizing hardship. Some states, not to name names (FLORIDA) thrive on it. So many vivid cliches come to mind...babies and bathwater...noses and faces...guns and feet...

So, I assert, either Rep. Deal hates children, or he just really hates non-citizens & non-citizen children and doesn't believe that people who need Medicaid are really citizens because he thinks there's an income requirement in the Constitution (hint: there's not). Or maybe in the war on illegal immigration, tens of thousands of U.S. citizens are OK collateral damage especially if it frees up our sacred tax dollars for other uses. Last I checked Georgia was not one of those states where nobody needs Medicaid so I reckon he's not doing such a great job of "Representing" y'all.

vindicated doctor visit

Some co-workers helped persuade me to drop by the clinic and have my cough checked out--I decided at least maybe I could get a prescription for something better than NyQuil to help me sleep at night even if the verdict was just that it's the bug going around.

Turns out that the verdict is bronchitis and I got Rxs for antibiotics as well as Tussionex, touted as "very strong" and capable of producing a full night's sleep. Isn't that sick, to be somewhat pleased that I'm sick? Maybe not so much pleased, but definitely validated, which is pleasing. "Your lungs sound kinda rough" declared the young PA-C. Thank you, they feel kinda rough!

cough...cof...cof....

One expects that there should be some benefit from taking nasty tasting medicine, other than the experience of choking it down. That's the last time I buy the Rite-Aid brand NyQuil Cough knockoff. I took it 45 minutes ago and can't tell that it has had any effect. C had to put in her earplugs, and we have some guests staying with us in the living room (they were warned, sort of) so I'm here trying to stifle my coughs. Lying down seems to make it worse. Nighttime in general seems to make it worse though it might only be perceived as worse because everything else is so quiet. Last night staying with a friend in Sac I took some NyQuil capsules she had on hand and slept really well once they kicked in. I should have bought more of those except that I don't have all the symptoms they claim to cover and they have a lingering zombie-like effect well into the day, maybe it's the antihistimine ingredient. I was trying to be a smart health consumer by selecting a product not too broad in scope. I think I would prefer being a well-rested (and quiet) zombie at this point to a hacking insomniac.

Overall it's trivial in the scheme of health complaints. This isn't a Wuthering Heights kind of cough or anything, but it's still a drag.