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GP Visit Number Nine
Written by Chloe on Sunday, August 29, 2010
Once upon a time, in a galaxy far away, Chloe used to experience enormous psychological stress when seeing a physician. Now, at her ninth GP visit in a wheelchair, she finds it both relaxing and entertaining.
I am asked to pee in a cup. I wonder what they do with all this pee? It’s only been four hours since I last peed, so it’s not that easy. I don’t time it, but it’s probably around fifteen minutes before I can get it going. It seems like forever. I start feeling embarrassed, wondering what people are thinking I’m doing in here. It’s a good job I arrived early.
My physician asks me if anything has changed since I last saw her. I recount the pole vaulting incident at the height of the snowmelt runoff. It had seemed like the best way to cross the stream; but the landing with my torso highly twisted to the right was very similar to how I got the original back injury in 2006. My back pain has significantly increased since that pole vault.
She looks at my blood pressure reading, way up from last time. I haven’t put on any weight, eaten a lot of salt, or decreased exercise. The evidence mounts that it’s directly related to back pain, as she had conjectured a year ago. "Do you take any pain medication for your back?" "No", I reply, "just the naproxen that I take all the time for fibromyalgia." "How do you manage the pain?" I point at the wheelchair. She nods. I add that I wore a back brace too, for about ten days after the pole vault. I don’t like wearing one in the middle of summer. It’s too hot. The weather is starting to cool off now though. She thinks it will be a good idea for me to try wearing a back brace all the time again, and check my own blood pressure every two weeks to see how it is related to back pain. I have no problem with this.
I’m curious as to what happens with my left leg as a result of hiking, so I quiz her about a few things. "I get a huge increase in the number and intensity of muscle spasms after a big hike. It only lasts around 24 hours. What’s that about?" She explains that the way I exercise my legs, in big bursts as opposed to daily, is likely to aggravate the damaged nerves and cause them to start firing off. She adds that the fibromyalgia is very likely acting synergistically to increase the intensity of the muscle spasms. I hadn’t thought of that.
She asks me if the muscle spasms have increased in general. I’m not expecting the question, so I have to think about it. Yes, if I compare it with a year ago there do indeed seem to be more, both the twitchy kind and the kicks. She asks if they have spread at all to anywhere besides the thigh. "No", I am able to reply confidently. She says that rules out a progressive disease such as ALS or MS, but the way I exercise is likely to gradually make the nerves more irritable and keep increasing the spasms. "Oh, this is interesting", I think to myself. I had wondered if I could make my leg weaker by overexercising, but I hadn’t realised I could progressively increase the muscle spasms by so doing. She asks me if I’d like something stronger than clonazepam for the muscle spasms. I decline. I like them. They are still comparatively minor. I hadn’t asked about them as something that would need further fixing, just out of curiosity.
I tell her about the two times recently when I’ve needed to put my left leg in the car with my hands after a megahike. I ask her what the mechanism of this might be. She quizzes me on some details: "Do you have any temporary increase in sensory loss along with that?" I pause. It hadn’t occurred to me to check, but I’m not aware of anything at all that makes any difference to the sensory loss, one way or the other. After a few more questions she comes up with extreme muscle fatigue as being the most likely explanation. That sounds exactly right to me. She goes on to explain about how having only partial quadriceps function will cause fatigue to set in quickly. I had guessed as much.
So the take home message here is that the increase in muscle spasms and the increase in monoparesis from hiking are from two different mechanisms. I’m not likely to be able to cause any permanent increase in monoparesis by overexercising. Oh well. On the other hand it looks like I may be able to cause a permanent increase in muscle spasms in my thigh by doing this.
After all this discussion about my leg, she says "We could just chop off your leg and be done with it." Much laughter. Maybe too much laughter. She goes to great pains to repeat that she’s just kidding. Er yes, I am actually aware of this.
We talk about all sorts of different stuff. She had suggested last time that I get my hearing tested, so I brought in the results. She looks at the rare reverse slope audiograms with great interest, and asks to make a copy for the file. I explain that I can’t afford hearing aids at this point.
A few minor intersex issues come up, anatomical and hormonal. No big deal. Then there are the usual pleasures of the annual check up: a breast fondling, and a finger up my butt.
My physician gets a particular contemplative look in her eyes when she’s figuring stuff out. I consider her to be an expert diagnostician. "Sit up", she says. "I’m going to check your back." "Okay", I reply. She feels around a bit and then starts tapping my vertebrae from the top down. I’m thinking "Are you really supposed to be hitting that hard? Hmm, I guess she knows what she’s doing." She goes lightly over T10-T12 and then gets much harder. "Ouch!" She goes farther down and then back up. I look at her when she reaches the ouch again. "What’s that?", I ask. "L5", she says. "L5???", I reply. "Yes, it looks like you have an injury at L5." I am puzzled and confused by this; after a pause I ask "You mean it wasn’t T10-T12? They got it wrong?" "No," she says, "the sensory loss on your torso goes too high up for there not to be a spinal cord injury above L5." I’m still not understanding, so she goes on "It’s not unusual to have two concurrent spinal cord injuries." I pause and say "Oh." Another longer pause as the cogs turn and I digest this. It had never once crossed my mind that I might have more than one spinal cord injury. The irony gradually sinks in. The thoughts run: "TWO spinal cord injuries!!! That’s just ridiculous. I have two friggin spinal cord injuries and neither one of them can produce so much as a permanent limp! That is SO friggin unfair!"
Back home I debrief with Alicia. I tell her about my physician seeming very confident that I have two SCIs. "Yes, I know", she says. I look at her in disbelief. How could she possibly know. "I’ve felt them", she says. Well okay, she is more familiar with my back than I am. Hmm.
Alicia helps me figure out where I can measure my blood pressure regularly. She’s not bothered by me being supposed to wear a back brace full time until my next appointment in January. She knows that Chloe comes with equipment.
Tags: Back Brace, Blood Pressure, Limp, Monoparesis, Muscle Spasms, Pain, Physician, Sensory Loss, Spinal Cord Injury, Vertebrae, Wheelchair
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2 Comments
GP Visit Number Ten this morning did not seem worthy of a post in of itself, so here is the update:
Back brace + Wheelchair = Normal blood pressure. Problem solved. Apparently BIID is beneficial for one’s physical health.
While I was there I took the opportunity of asking my GP about Lyrica. I had noticed that Claire had mentioned it was effective for the nerve pain from her self injury. I read up about it and found it was also approved for fibromyalgia. My GP listed a number of side effects and mentioned that it was expensive. We agreed that there was no point in me trying it since naproxen and percocet work well for me.
My GP commented on my orthopedic shoes, and I replied how happy I was to have a good excuse not to wear high heels in the last couple of years; no more bunion problems on my left foot. Yes, BIID is definitely good for one’s physical health!
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1 On 29 August, 2010, Sylvie said:
Chloe, you are very fortunate to find such an understanding and knowledgeable physician!