Author: Crew Dog

Desert Storm era veteran. SAC trained warrior.

Health Hack: How to Select Properly-Fitting Eyeglasses

Long ago, when I was young and had better than 20/20 vision, I sat in a briefing room for training day and the flight doc announced to us all that, despite our current acute vision, we would all need reading glasses someday – probably by the time we were forty.  Most of us, including me, scoffed.  “No way!  My eyes are great.  *I’ll* never need glasses!”

Sadly, the flight doc was right.  Just before my 39th birthday (didn’t even make it to 40 – bogus!) I started needing longer arms to read things.  Teenagers would bounce up and shove phones in my face to show me something, and I’d have to make them back up.  Whippersnappers!

I didn’t want to start wearing glasses because I didn’t want the hassle.  And I only needed them to read up close.  Solution?

I remembered a Marine aviator from my impressionable youth who used to brag that he just bought “cheaters” at the drugstore.

So I went to my local superstore and tried on the sample glasses by the pharmacy to find the right magnification, and bought a multi-pack of those magnifying reading glasses.  I don’t remember if they were one-size-fits-all, or if they came in small, medium, and large sizes.  I just opened one of the (resealable) packages, tried them on, and decided the fit was ok.

I put a pair on my desk, a pair in my pocket, and a pair in my vehicle, and that solved my problem for several years.  They didn’t look spectacular (ha!) but they did the trick.  They tended to slide down my nose a bit when I was reading for an extended period of time, but they were cheap and easy.

The cheaters solved my problem for several years, but my near vision gradually got worse.  Eventually people started to get blurry at conversational distances.  They started to feel like “close-talkers.”  I’d try to casually back up so they weren’t blurry any more, but they’d close the distance.  Can’t do that dance for long without looking like a freak.

Since I now needed glasses for more than just reading, I decided it was time to start wearing glasses full-time.  I went to the optometrist and got my prescription, but of course Tricare doesn’t cover eyeglasses.  So I went to a local eyeglass store and got totally screwed.  In the interest of blog length, I will spare you the gory details.  Let’s just say I wound up several hundred dollars poorer with a pair of glasses that didn’t fit correctly, didn’t solve my vision problems to a satisfactory level, and, therefore, didn’t ever get worn.  I went back to my cheaters.

My first pair of prescription eyeglasses are still rotting in a desk drawer.

Life went on, and I made due with the cheaters for a few more years.  My near vision continued to deteriorate, but Tricare will only pay for an optometrist visit every two years so I had to wait.  Two-plus years later, I got my new prescription and decided to buy new glasses from a membership warehouse.  I figured the glasses would be cheaper there, and they wouldn’t try to pressure-sell expensive designer frames to me.

I went to the membership warehouse and was shown a couple of frames that were reasonably priced and looked decent.  My optometrist had suggested that, instead of trying to make one pair of glasses work for everything (a tri-focal progressive lens), I get two pairs of glasses – one for computer work and reading, and one for everything else (both bi-focal progressive; one mid & near distance and one mid & far distance).  The salesperson suggested I get two different styles of frames, so I could easily tell them apart.

For less than I paid for my first pair of prescription eyeglasses at an eyeglass store, I got two pairs of prescription glasses from the membership warehouse.  Unfortunately, neither of them fit.  After several months of returning my glasses to the warehouse for adjustments, I spent a day researching eyeglasses fit (see previous post, How Many People’s Jobs Do I have to Know How to D0?).  I learned quite a lot.

I had repeatedly told warehouse employees that my glasses felt too tight on my nose.  They responded by adjusting the glasses’ arms/temples, repeatedly. Did you know that glasses come in different bridge sizes (as in, the width of the bridge of your nose)?  I didn’t.  Apparently they didn’t either.

I learned I had frames that were ~2-4mm too small across the bridge.  The temples, that I had repeatedly suggested were too short, were at least 5mm too short.

Armed with my newly acquired knowledge of frame fitting, I returned to the membership warehouse.  The pair of glasses that fit least-badly were finally adjusted to my satisfaction (more or less).  The other pair (with a smaller bridge size) were returned, and I selected a replacement pair with a wider bridge and longer temple pieces.  I would have preferred to return both, but that was the best compromise I could get.  (Initially they were refusing to replace either pair.)

How can you avoid my mistakes?  Knowledge!

Although I am not endorsing this company, this page provides a decent overview of eyeglasses frame measurements/fit.  Unfortunately, none of the websites I could find had information on how to determine your eyeglasses size if you didn’t already have a pair of glasses.  One recommended I use a ruler to determine the width between my temples, which would give me an idea of total frame width.  Others recommended I just go to a store and try a bunch on.

It turns out, when Spousal Unit got glasses for the first time, the technician used calipers to measure Spousal Unit’s various facial dimensions.  Spousal Unit’s first pair of glasses fit perfectly.  Go figure.

Eyeglasses frames are typically labeled with their dimensions: the lens width, bridge size/width, and temple length (in that order).  These dimensions look like this: 52 [symbol that looks like a hollow square] 18 140.  The dimensions may be on the temple piece (arm) or the bridge.  Sometimes the first two dimensions are on the bridge and the temple length is on the temple piece.  They might even be on the ear piece!  For examples of what you’re looking for, see here (again, not a product endorsement).

Lens width (aka eye size) is the horizontal width of the frame’s lens (in millimeters).  Lens width typically ranges from 40-62mm.  This dimension is given for one lens, so you must double this and add bridge size and end piece size to get total frame width.  [The end piece is the part of the frame that connects the outer edge of the lens frame to the temple/arm.]

Bridge size is the distance between the closest points of the two lenses (in millimeters).  This is the space where your nose goes.  Bridge size typically ranges from 14-24mm.  Temple (arm) length is measured along the length of the temple from one end to the other and also includes the bend.  Temple length typically ranges from 120-150mm, but often only by multiples of five (130, 135, 140, etc.).  It is important to have enough length so the temple sits horizontally and does not tip up over the ear.

Lens height is often not labeled on eyeglasses frames, but may appear as the last number of the sequence.  It is the height measured vertically from the top to the bottom of the lens.  Lens height is important for bi-focal or progressive lenses as there needs to be enough area for the multiple parts of the prescription.

Once you get a pair of glasses that actually fits, write down the dimensions!  (The printing may wear off your frames over time.)

When you shop for your next pair of glasses, make sure you select a pair that is +/- 2mm for the lens width, +/- 1mm for the bridge size, and +/- 5mm for the temple length (different styles may fit a bit differently).

If you are concerned about your cosmetic appearance while wearing glasses, it is recommended that your eyes be nearly centered within the width of each lens.  This site (again, not a product endorsement) gives more information on fitting glasses for various types of faces (close-set eyes, wide face, etc.).  In particular, their information on bridge location was very useful to me.  You can also google information about face shape and corresponding frame shapes.

I’ve settled for a look I call “Goofy as hell, but at least I can see and I’m not in pain from glasses that are too small.”  I think it’ll catch on. #trendsetter #form_follows_function

How to be attractive: I still don’t know.  I think I’ll just hide Spousal Unit’s glasses.

Have you figured out how to procure glasses that fit, are attractive, and don’t cost an arm and a leg?  Please share your knowledge with us.  I need all the help I can get.

Medical Procedures: What It’s Like to Have Medical Botox Injections

In my experience, this was one procedure it was best not to think too much about ahead of time: having a 30 gauge needle stuck repeatedly into your head in order to inject multiple doses of neurotoxin.

Most people think of Botox as a cosmetic procedure that reduces wrinkles.  But Botox is used medically to treat several conditions, such as repetitive neck spasms (cervical dystonia) and chronic migraines.  Botox injections work by weakening or paralyzing targeted muscles or by blocking specific nerves.  Although scientists still don’t know exactly how Botox works for chronic migraines, according to The Migraine Trust:

A recent US study by Rami Burstein et al using animal models suggested that botulinum toxin inhibits pain in chronic migraine by reducing the expression of certain pain pathways involving nerve cells in the trigeminovascular system…

Unlike many of the other conditions in which it is used, it is not thought to work by relaxing overactive muscles.

In my case, the Botox injections were prescribed to treat chronic migraines (more than 15 headache days per month) which had not responded to any prescribed medications.

Since I was a bit apprehensive, I did research prior to the procedure, and watched several YouTube videos about the procedure, which made me think a little too much about needles going into my scalp and face.

I couldn’t find a good video that demonstrated the procedure for patients – most of the videos are either commercials for the product, technical demonstrations for healthcare professionals, or patients talking about their experiences.  This video is a technical video produced for healthcare professionals, but it gives you a good idea of the procedure:

My treatment began with me lying on my back on the examination table, and receiving injections in my forehead, temples, and scalp.  After that portion of the treatment was done, I was asked to sit in a chair and put my head on a pillow on the exam table.  (My arms were crossed, and my head was resting on them, like in the elementary school game of  Thumbs up, 7-up.)

While I was sitting in the chair, injections were administered to my scalp and trapezius muscles.

Unlike in the video, my provider did not use ice packs to numb the injection sites.  Some of the injections stung a bit as the Botox went in, but they didn’t hurt as much as some of the patients on YouTube had said they would.  Also, some of the injections were more painful than others.  For me, the injections in my left temple and behind my left ear were the most painful.  That’s the side on which I get most of my migraines, so the nurse practitioner figured those nerves were hyper-sensitive.

One of the injection sites on my face bled onto the pillow a little bit when I was getting the injections to the back of my scalp, and the injection sites were a little bit red and swollen for about an hour after the injections, so I kind-of looked like I had hives (or bee stings?).

But the staff was very careful to follow sanitary procedures, including cleaning the sites with antiseptic and treating the site that bled with clean gauze.

Also, I had no negative reactions to the Botox, so it turned out to not really be a big deal at all, and my apprehension was for nothing.

The entire procedure took about 20 minutes, and the effects should last for about 3 months.  Botox injections are not a cure for migraines – they are a treatment, meaning that they don’t fix what’s wrong; they only treat the symptoms.  If the injections work to lessen my migraines, I will have to continue getting injections once every three months for the rest of my life.

After injections, results are typically felt within 3-4 days.  However, studies show that most people do not experience the full effect until 6 months of treatment, which would be after the second or third series of injections.

If individuals have not responded by two to three treatment sessions it is generally considered that the individual is a non-responder.

(In other words, like other treatments, Botox for chronic migraines doesn’t work for everyone.)

Potential Side Effects of Botox treatment: Pain, swelling, or bruising at the injection sites.  If the person administering the shots isn’t careful to avoid certain muscles, you could have a drooping eyelid – or be unable to hold your head up – until the Botox wears off.

NOTE: Even though the injection sites might feel a little weird (slightly swollen, numb), it is very important not to rub the injection sites, as this can cause the toxin to spread outside of the designated areas.

[For more information on Botox, see this 2009 New York Times article.  Note that Botox has been approved for chronic migraine treatment subsequent to this article.]

Have you had medical Botox injections?  What was your experience with them?  Please comment below.

Update: One week after Botox

Still having debilitating migraines, but I’ve started to feel a little bit better.  Still very light-sensitive.  Less motion in my forehead muscles – can still make a Spock eyebrow, but the eyebrow doesn’t go as high.  Slight furrow when I frown.  Shoulder tension noticeably reduced; able to activate shoulder muscles that had been constantly tense.  Puffy eyes.

Update: Two weeks after Botox

Still having debilitating migraines, but also a few productive days.  Still very light-sensitive.  Very little motion in forehead muscles – can’t make a Spock eyebrow anymore.  Almost no motion when I frown or try to look surprised.  Shoulder tension noticeably reduced, with better range of motion of shoulder muscles.  Eyes still very puffy – but not drooping.

Update: ~ Nine weeks after Botox

My provider had informed me that, for some people, the effects do not last the full 12 weeks.  For these people, he said, Botox wears off a week or two before the next treatment.  For me, the Botox wore off 2 1/2 to 3 weeks before my next treatment.  My migraines returned with a vengeance, like they were making up for lost time.  While I appreciated the reduction in migraine symptoms and migraine frequency for nine weeks, having them return and knowing there’s nothing I can do about it for nearly three weeks until the next scheduled treatment sucks.

[The FDA approved Botox for migraine treatment at a 12 week interval, so even if it doesn’t last the full duration, the provider cannot shorten the interval.]

Health Hack: Evening Checklist

It’s easier for me to run my nightly health and hygiene routine without needing a checklist, since I’m a night owl, not an early bird, and since there’s less to the night routine.  However, on a bad day all bets are off.

So, in the interest of symmetry, and since early birds (or off-their-game night owls) might find it helpful to use checklists at night when they’re tired and thinking less clearly, I have also created an Evening Health Checklist:

Evening Health Checklist – One Sick Vet

Again, feel free to print it out and use it, or create your own.

What will you do to hack your health today?

[In case you missed it, the Morning Health Checklist is here.]

Managing Your Own Healthcare: How Many People’s Jobs Do I Have to Know How to Do?

My personal Tricare experience: I have received several years of harmful care, after decades of inadequate care, from Tricare.

Recently, my soon-to-be-former PCM defended his negligent/health-threatening care by telling me that I had not been aggressive enough in managing my own care.  I countered that aggressively managing one’s own healthcare is very difficult when one has a chronic debilitating condition (especially a condition that affects one’s cognitive abilities).

But today I’m having a good day, abilities-wise, so let’s talk about fighting fire with fire.  You want me to aggressively manage my own healthcare?  Look out, buddy, you just summoned a pissed-off veteran, and you’re about to regret it very, very much.

A friend of mine has a saying about dealing with others, especially those who work in any area interacting with clients/customers.  When encountering roadblocks in daily life having to do with the ignorance, apathy, or incompetence of others, my friend asks exasperatedly, “How many people’s jobs do *I* have to know how to do???”  (Meaning, since you can’t do your job correctly and give me the information and assistance I need, I will have to learn all of the information, procedures, laws, regulations, etc. myself in order to get the result I need.)

We have decided that the answer to this question is “ALL of them.”

ALL of the People.  ALL of the Jobs.

To be fair, there are some *awesome* people in this word who like their jobs, know how to do their jobs well, and like helping others.  When these magical unicorns cross your path, you do whatever you can to make them stay in your life, and you let them know how appreciated they are.

For the Non-magical-unicorn days, which is most of them, you learn how to do ALL the jobs.

Alright, soon-to-be-former PCM, you want me to aggressively manage my healthcare?  You got it.

Today I visited a Tricare Patient Advocate.  I walked in to the largest MTF near me, went to the information desk, and asked for the Tricare Patient Advocate and they hunted around until they found one, who came out and spoke to me face-to-face.

[I had previously located a Tricare Patient Advocate email address for a local advocate.  I emailed in November, and am still waiting for a response over five months later.  (Not the same advocate as the one I spoke to today.)]

The Patient Advocate gave me the contact information for the DoD’s Interactive Customer Evaluation (ICE).  I am going to contact ICE and provide “customer evaluation” on the negligent care I have been receiving, such as waiting 27 months for an MRI/Arthrogram of my wrist, even after I specifically told my soon-to-be-former PCM that my shoulder orthopedic surgeon suspected that I could have a torn ligament in my wrist, and then requested that my PCM submit a referral for an MRI and Arthrogram, which he did not do.

I will tell them that I gave up on ever receiving the care I needed from Tricare, and instead requested an MRI/Arthrogram from the VA, which I received within 6 weeks and which confirmed that I have *two* torn ligaments in my hand/wrist.

There are a few other things I will discuss with ICE about the inadequate care I received from this PCM…

But, next, after speaking to the Patient Advocate and confirming that my PCM did submit a request for referral to a wrist orthopedic surgeon after I confronted him with the results of my (VA) MRI/Arthrogram, I went home to aggressively manage my referral.

I called my Tricare region’s customer service number.  I never reached a human being. (ALL of the People. ALL of the Jobs. ALL of the Computers?)  I chased menu options long enough (15-20 minutes) to figure out that I would not get the level of information I needed from a machine.

So I bit the bullet and created an account on my region’s Tricare website.  I had been avoiding creating an online Tricare account, given the government’s track record on protecting personal information.  I don’t want my health information compromised.

But I needed access to the information, which I got after I created my account.  I was able to see the referral letter and, most importantly, the authorization number.

There are several useful pieces of information on Tricare referral letters.  If you keep reading past the name and contact information of the healthcare specialist to whom you have been referred, you will see this sentence: “This authorization is valid for the dates and service codes that follow on the back page.”  Keep reading until you reach the dates and service codes.  Make sure that your treatment takes place with the date range, and that you do not receive any treatments that were not authorized, or you will have billing problems with Tricare (as in, they may refuse to pay).

If you keep reading past that section, you will see a section titled “If You Would Like to Choose a Different Provider.”

Did you know that if you are not referred to an MTF, but are instead deferred to network, you can choose to see *any* in-network provider of the same specialty?

Also, as per the referral letter, “if your authorization number begins with a 7, you do not need to notify us of a change in provider.”

[Authorization numbers can also begin with a 4, in which case, you *do* have to get prior authorization to switch providers.]

***CAUTION: “You may not switch providers if you have already begun seeing a provider for the service authorized in this letter.”

Armed with that information, and all of the research I had done on orthopedic wrist and hand surgeons since my (very-belated) diagnosis, I called the office of the in-network surgeon I had selected, and scheduled an appointment for later this week.

This probably shaved several weeks off my wait-time, instead of waiting for the referral letter to come in the mail and then trying to figure out how to change providers.

The Patient Advocate also gave me advice on how to switch to a different PCM, given the current constraints of the system (patients being forced to use PCMs at MTFs only; no network PCMs; MTFs not accepting new patients due to being over-capacity).  We decided it would be best to remain with my soon-to-be-former PCM until the wrist/hand surgery is complete, so as not to cause hiccups in the system.  But I will be switching to a different PCM and a different MTF as soon as that is complete.

Meanwhile, I continue to receive excellent care for my other health issues from the local VA facility.

As far as resolving my issues with Tricare, I followed the chain-of-command, as well as rules of common decency.  I tried resolving my inadequate healthcare issues first with my PCM, who got defensive and hostile.  Then I went to the Patient Advocate.  Next I will file an evaluation with ICE.  I will also be completing an Army Provider Level Satisfaction Survey (APLSS).  If I still don’t receive a satisfactory resolution, I will continue to pursue the matter (on the days my health permits me to battle).

I have no illusions that my PCM will change his methods as a result of these actions.  He is impervious to feedback, and I’ve seen much worse healthcare providers remain in the military healthcare system, sadly.

The best I can hope for is:

  1.  To insist I get the care I need for my health conditions and injuries
  2. To insist the providers of this care are highly competent
  3. To hold this PCM accountable for his negligent care by reporting it
  4. To provide helpful information to others who are dealing with similar situations

I suspect by the time I am done, my soon-to-be-former PCM will regret having ever told a pissed-off veteran to be more aggressive about their healthcare.  Mischief, I mean Healthcare, Managed!

Medical Procedures: What It’s Like to Have an Echocardiogram (with “Bubble Study”)

Some things are scary.  Like when your healthcare provider refers you for a procedure that involves bubbles injected into your veins and flowing through your heart.

I told my PCM the thought of it kind of freaked me out.  She said it was perfectly safe.  Just a routine procedure.  No big deal.

So I went home and researched the procedure.  I found an article from a reliable source that explained the procedure simply and thoroughly and assured patients that “The bubble study is extremely safe.”

And the rational part of my mind believed them.  But some other, irrational, part of my mind kept thinking of all the TV shows in which the villain kills someone by injecting an air bubble into their IV.  (Medical personnel hate Hollywood for this, by the way.)

I’m not the type to worry about things and get anxious, so I didn’t spend the days between the doctor’s visit and the bubble study obsessing about it.  But I didn’t sleep very well the night before, and I was pretty anxious on the ride to the hospital.  I did breathing exercises to try to relax, and, of course, cracked dark jokes about things Spousal Unit needed to know in case I didn’t survive.  (Not sure Spousal Unit appreciated that.)

What ultimately helped me relax was talking to the tech who performed the bubble injection part of the procedure.  She told me three reasons not to worry:

1) The saline solution is being injected into a vein, not an artery, and therefore there is less risk;

2) The bubbles are very small, and could not block a vein;

3) The bubbles go through your heart to your lungs, and your lungs handle them just like they handle every other gaseous fluid (bubble).  That’s what lungs are made for.

In other words, your body knows what to do with the bubbles, and it’s no big deal.

That’s when the rational part of my mind won, the irrational part of my mind stopped freaking out, and I relaxed.  More breathing exercises helped me release the tension as well.

So, what exactly *is* an echocardiogram?  It’s basically just an ultrasound of your heart.

Most of us have seen an obstetric ultrasound on TV, where the technician looks at a pregnant woman’s fetus in the womb.  The technique for an echocardiogram is pretty much the same – sound waves are used to get images of your heart.

But unlike an obstetric ultrasound, where the woman lies on her back, for a cardiac ultrasound you lie on your left side.  This helps the technician get a better image of your heart.

My technician explained to me that the ultrasound cannot get images through your bones, so they have to manipulate the wand around all the bones in your chest, like your sternum (breastbone) and ribs.  The ultrasound also cannot get images through air, so they have to avoid your lungs as well.

Since your heart is already off-set to the left of your chest, lying on your left side allows the heart to fall a bit further left, away from your sternum.

So, you take off your shirt and put on a hospital gown (open to the front), and the technician attaches some electrodes to your chest with sticky patches so they can monitor the electrical currents of your heart.  (For a good overview of the entire procedure, see this Mayo Clinic article.)  Then you lie down on your left side, and move your left arm up near your head.

The technician lubes up the wand (a.k.a. probe or transducer) and moves it around on your skin until they can get clear images of your heart.  (The gel helps improve the conduction of the sound waves, and makes sure there’s no air between the wand and your skin.)

Since they are dodging your bones and your lungs, the wand can wind up feeling like it’s trying to dig under your ribs as the technician attempts to get the clearest image, which can be a bit uncomfortable.  It’s not really painful, just a bit…insistent.  This is another time when the breathing exercises can come in handy.  Although it was rather uncomfortable a few times, I didn’t have any bruising afterward.

The technician takes a series of images from multiple angles, so they move the wand around and dig it in to new uncomfortable places to get the various images.  This may cause them to re-apply more gel as well.  My technician also asked me to take a deep breath, hold it, and exhale at various points in the procedure.  (She only forgot to tell me to resume breathing once.)

I appreciated that the technician explained to me what she was doing as she was doing it, and didn’t mind me watching the monitor as she was working.  An echocardiogram allows you to see the heart beating, and the heart valves opening and closing, and it’s fascinating to watch.

I particularly enjoyed watching the Doppler portion of the procedure:

The first part of the procedure took about 20-25 minutes, and then it was time for the Bubble Study (a.k.a. saline contrast study).  My PCM ordered a bubble study because she wanted to determine if there was a hole in my heart.

In a normal heart, the bubbles that are injected for the test enter the right side of the heart through the vein and then go through to the lungs and are removed from the bloodstream before the blood circulates to the left side of the heart.  If there is a hole between the right and left sides of the heart, the technician can see the bubbles flow through the hole to the left side, where they don’t belong.

Don’t Panic!  The bubble study is less freaky than it sounds.  Nothing is injected directly into your heart.  (Also, if you do have a hole in your heart, and the bubbles leak though to the left side, it’s ok.  Your body will still process the bubbles safely.)

A second technician came into the room, we had the conversation about bubbles and why they aren’t dangerous, and she inserted an IV line into my right arm (since I still needed to lie on my left side for the procedure). The IV line had a valve, so that the tech could start and stop the flow of the saline contrast solution.

The second tech told me that at several points during the bubble study, I would need to do a valsalva maneuver, but she described it as “the way you would bear down during a bowel movement”.  Well, that’s not the way I learned to do a valsalva maneuver during aerospace physiology, so we had a conversation until I figured out that what they *really* wanted was an anti-G straining maneuver (except they wanted me to hold my breath during the maneuver, and not exhale in a big gust when they told me I could exhale).

With that cleared up, we proceeded with the bubble study.  The first technician would signal that she was ready, the second technician would release a stream of bubbles into the vein near my elbow, and they would tell me when they wanted me to do the straining maneuver.

Then we would watch the stream of bubbles rush into my heart.  The bubbles appear white on the monitor, and they are very obvious.  Sometimes the second tech would massage my arm a bit to help the bubbles flow faster or something.

The saline bubble solution felt a little bit weird when it first went into my arm, but then I didn’t feel it anymore.  The first batch of bubbles felt weird when it entered my heart – my heart seemed to flutter a little bit.  But it didn’t hurt, and I didn’t feel it with the subsequent bubble batches.

We repeated the sequence four or five times, until there was no more saline solution, and the first tech was satisfied that she had all the images she needed.  They were both very impressed with my straining technique. 🙂

Then the second tech removed the IV line, the first tech removed the electrode sticky pads, and they left me to wipe the gel off my chest and get dressed.

The whole procedure took about an hour, and I had no residual effects.  Turns out, the bubble study really *was* no big deal.

Also, since having a hole between the two sides is congenital (something you’re born with), I’ll never have to have this procedure again.  Once they’ve determined whether the hole is there or not, that doesn’t change and you never need to check again.

TL;DR:

Tired to the Bone

Tired Dog

I try to be optimistic and proactive about my health.  But some days I’m just tired to the bone.

Last week I had three medical procedures.  One was a new treatment, and two were diagnostic.  It may take days, weeks, or months before we know if the new treatment is having an effect.  So I wait…

Meanwhile,

The diagnostic procedures revealed that I have been correct for the past 2+ years that there is something wrong with my wrist.

More than two years ago I fell violently on a wet ceramic tile floor.  Ever since, I have been telling doctors and therapists that I have pain and malfunction in four areas: my scapula, my shoulder, my elbow, and my wrist.

Although my doctor ordered x-rays immediately after the fall, once those came back negative for broken bones she refused to send me for additional imaging (MRI/arthrogram).  Nearly one year later, after I had “failed to progress” in physical therapy, my doctor finally sent me for a shoulder MRI/arthrogram, which revealed that my labrum was severely torn and would not heal without surgery.

By that point, nearly one full year after the injury, I was in severe pain and could barely do my job.  Some days I left work early due to the pain, and I wasn’t getting much sleep either.  I could sleep in one position on the couch, surrounded by pillows that held my shoulder in the least-painful position, but if I shifted in my sleep the pain would wake me up.

I was taking a strong NSAID and a narcotic, but that wasn’t enough to control the pain.  I was getting pretty desperate for relief.  For months I requested that my doctor refer me for pain management, but she refused.

Fortunately, once I received the diagnosis of the torn labrum (a.k.a. SLAP tear/SLAP lesion) things happened a little more quickly.

The story of how I selected my orthopedic shoulder surgeon is a saga for another post.  But once I had authorization to receive care from him, I was able to see him a few days later (one month after the MRI).

At this point, I was desperate for relief, and I didn’t care if it cost me my job.  I told the nurse I would take the first available surgery slot, and asked her to look for cancellations.  She found a cancellation for the following week, which gave me just enough time to stop taking all medications, vitamins, and supplements and get them out of my system so they didn’t interfere with the surgery or the recovery.

I told my boss that I was having surgery the next week, and would probably be out for at least 6 weeks since I couldn’t drive with my arm in a sling.  Although I was an hourly worker, and would not get paid while I wasn’t working, they didn’t fire me.  They told me to get the help I needed and come back when I was better.

I had the surgery, and it was successful.  The surgeon discovered that my labrum was completely severed, and he had to trim it, re-attach it, and anchor it to the bone.  However, the biceps tendon was not torn, and the rotator cuff was not damaged either.

Even immediately post-surgery, the pain level was so much lower than before the surgery.  I was able to stop taking narcotics after about two days.

I started physical therapy seven weeks after surgery.  My surgeon wanted to give the labrum plenty of time to reattach to the bone and form a strong connection.

We noticed in physical therapy that I was still having pain and malfunction in the scapula, elbow, and wrist.  My doctor and physical therapist wanted to give it some time, to see whether this would shake out as physical therapy re-trained the muscles to function as they had before the fall.

My surgeon said that if the pain and swelling in my hand and wrist had not gone down in three months, I should probably see an orthopedic wrist surgeon, as I might have a tear in my triangular fibrocartilage complex (TFCC).

Then a whole lot of life happened.  Moved twice.  Different states. New PCM.  New PCM refused to refer me for MRI/arthrogram of wrist, which was still discolored, swollen, weak, and painful, but did refer me to a new physical therapist.  Physical therapist wanted to try treatment first, but after I “failed to progress” with elbow and wrist function, PT agreed it was time to get diagnostics and see an orthopedic specialist.

Meanwhile, I had finally gotten my VA disability claim processed, and after a seven month wait for an appointment had finally seen a VA PCM.  Since I had not been able to get my Tricare PCM to follow-up on the wrist, I asked my VA PCM to treat it.  She sent me for x-rays immediately following our appointment.  The x-rays showed my ulna was mis-aligned.

Less than two weeks after I saw my VA PCM for the first time, I had EMG and CNS procedures to determine if there was permanent nerve damage in my left arm/hand, and to determine whether the problem was due to a pinched nerve in my neck.

A few days later, I had an appointment at the VA hand clinic.  The x-rays had indicated a problem in my wrist, and the examination at the hand clinic confirmed it, so the hand clinic referred me for a wrist MRI/arthrogram.  FINALLY!

Three weeks later I had the MRI and arthrogram (post pending).  It was more than two years since I had been injured, and more than a year since the shoulder surgery.

The arthrogram revealed not only that I have a TFCC tear, but also that I have a scapholunate (S-L) tear – two torn ligaments in my wrist.

Initially, I was happy to finally have diagnostic evidence to support the injury claims I have been making for the last two-plus years.  And I was excited by the possibility that I could get the ligaments repaired and finally begin to heal.

But today I am just tired to the bone.  I have to find a new orthopedic surgeon in the state where I now live.  Someone I can trust to work on my wrist – a very delicate and complex part of the human body.  Someone in either the Tricare or the VA system.  And I have to get authorization 1) to consult with them and 2) to have surgery, if necessary.

Plus, I still don’t know whether I have a torn ligament or ligaments in my elbow.  My physical therapist thinks that I do.  But I haven’t been able to get Tricare or the VA to send me for diagnostics of my elbow yet.

On a better day, I will conduct more research on orthopedic wrist surgeons, and I will fight to get the referrals and the treatment that I need.  On a better day, I will take positive action to resolve this injury.

But today I am tired.  Today I will rest and regroup, so that I can resume battle recharged and equipped with knowledge.

Bottom Line:  It’s ok to be tired.  We all need rest.  We all need self-care.  Resting does not mean we are weak.

Lessons Learned:

  1. Keep fighting until you get the care you need.  There will be good days and there will be bad days, but you deserve to be heard and to be treated.
  2. You don’t have to go it alone.  Get a Patient Advocate, Case Manager, or lawyer to assist you.
  3. “If you haven’t got your health, you haven’t got anything.”  I delayed my first round of physical therapy because I was busy with work and school.  If I had “failed” PT sooner, I probably would have gotten my shoulder MRI sooner and my shoulder surgery sooner.  I wish I had made my health more of a priority sooner.  Problems don’t go away when you ignore them.
  4. Learn the administrative procedures.  HMOs typically have set procedures for dealing with illness, injury, etc.  PCMs have to follow the sequence when treating patients.  Even though I knew I needed shoulder surgery, I had to “fail” PT first.  It will do you no good to try to pre-empt procedures – you won’t get authorization to do things out of sequence.  So find out the sequence and get it done so you can get to the end-state you need.
  5. Trust your gut.  Various healthcare providers gave me various ideas on what might be causing my symptoms – only one of them was (partially) correct.  I knew from the beginning that something was wrong with my wrist and that I needed imaging to find out what it was.  You know your body better than anyone else.  If you know something is wrong, keep demanding treatment until it’s fixed to your satisfaction.
  6. Watch out for wet freaking ceramic tile floors!  Or any other slip, trip, or fall hazard – you don’t want to jack yourself up like I did.

Indoor Air Quality – How I Made the Air I Breathe Healthier By Using NASA Research

Some of you may be wondering why I said in my first post that I’d rather have house plants than an air purifier.  I chose house plants because they do not use any energy other than sunlight, and because my research did not convince me that air purifiers were significantly better than houseplants.  Thus, I preferred the cheaper, more natural option.

What I said in the previous post:

To me, [naturopathic self-healing] means utilizing evidence-based natural solutions when possible, such as using house plants to improve the quality of the air in my house, rather than buying an air purifier.

The Spousal Unit and I had talked for years about getting an air purifier.  We thought that putting an air purifier in the bedroom would help us get better sleep.  I had read blogs and websites written by asthmatics and allergy sufferers who highly recommended air purifiers with HEPA filters, and they were pretty persuasive.  The only thing holding me back was the price – $500+ for a one-room HEPA filter air purifier.

“Maybe I could start with something less expensive,” I thought.  “What about those Himalayan salt lamps?”  According to the advertisements, a Himalayan salt lamp “works as an air purifier by emitting negative ions into the air.”  And they retail for $25-$30 for a smaller lamp.  So I did some research.  Unfortunately, I found that Himalayan salt lamps do not emit negative ions in a large enough quantity to have an actual effect on your indoor environment.  For a thorough examination of Himalayan salt lamps, I recommend this post over at A Breath of Reason blog.  Bottom line: they don’t improve air quality.

Ok, what about beeswax candles?  They are also touted as being good for air quality because they release negative ions.  Nope, Skepticcystic over at A Breath of Reason debunked beeswax candles too.  (See this post.)  According to her research, not only do beeswax candles not release stable negative ions, but there is no scientific evidence that beeswax is healthier to burn than other types of wax.  So, although some would argue that you should avoid the phthalates in artificially scented candles, the type of wax  a candle is made of doesn’t appear to make a difference to indoor air quality.  Bottom line: Regardless of what they are made of, burning candles does not improve indoor air quality.

So back to air purifying machines…

For a practical overview of air purifiers, check out this article from ConsumerReports.  For example, ConsumerReports suggests:

“Before you buy an air purifier, try some simple, common-sense steps to reduce indoor air pollution. Begin by vacuuming often, banning smoking indoors, minimizing use of candles and wood fires, and using exhaust fans in kitchen, bath, and laundry areas.”

As the article continues, various claims made by air purifier companies are tested.  ConsumerReports cautions that ozone-producing air purifiers are actually harmful to your health and should be avoided, particularly if you have allergies or breathing problems.  This is confirmed by the American Academy of Asthma Allergy & Immunology:

“There is no debate about the negative effect of ozone…with the FDA concluding there is no place for ozone in medical treatment.” (See article here.)

For more information on the pros and cons of air purifiers, read this article from the New York Times, in which Steven Kurutz, an allergy sufferer, tested six popular air purifiers.  Here are a few excerpts from his article:

“For all their high-tech wizardry (some claim to be able to eliminate particles 0.3 microns in size and smaller), air purifiers occupy the same category as faith-based wellness products like nutritional supplements.”

And,

“Over the years, the Federal Trade Commission has taken action against several makers of air purifiers, including brands like Honeywell and Oreck, for unsubstantiated allergy-relief claims or for advertising that their devices removed virtually all impurities from the indoor air people breathed.”

According to ConsumerReports’ deputy home editor, Celia Kuperszmid Lehrman, whom Kurutz interviewed for the article,

“The first thing you need to know about an air purifier is that most people don’t need one.”

However, some doctors do recommend air purifiers for their patients, particularly children who suffer from asthma.  So, if you have asthma or allergies (or both), talk to your doctor about whether an air purifier would be beneficial for you.

According to the American Academy of Allergy Asthma & Immunology:

“There is no definite evidence of filtration clinically benefiting patients with allergic disease, but this may be the result of the studies being of insufficient durations to prove benefit.   The best review of the topic is by Sublett et al in 2010, a report of the Indoor Allergen Committee of the American Academy of Allergy Asthma and Immunology.” (See AAAAI article here.)

The Bottom Line for Air Purifiers: The different things you may be allergic to (dog allergens, cat allergens, mite allergens, mold, pollen, etc.) have different-sized particles.  You will see the most benefit if you select an air purifier that is designed to filter the particle size of the allergen that most affects you.

Conclusion from the Sublett et al report:

“As far as optimal choice of cleaning devices, initial cost and ease of regular maintenance should be considered. Portable room air cleaners with HEPA filters, especially those that filter the breathing zone during sleep, appear to be beneficial.

For the millions of households with forced air HVAC systems, regular maintenance schedules and the use of high-efficiency disposable filters appear to be the best choices.

However, further studies and research in this area are desirable to make more definitive recommendations in the role of air filtration on improving disease outcomes.”

Ok, so I could buy an expensive HEPA filter air purifier for my bedroom, which might help us sleep a bit better.  Are there any other options?

That’s when I remembered that house plants help improve indoor air quality.

Most of us learned in school that plants breathe in carbon dioxide and breathe out oxygen (roughly speaking), which is great for humans because we breathe in oxygen and breathe out carbon dioxide.  So having plants in the house helps increase the oxygen level in the air and decrease the carbon dioxide level.  But indoor plants can do more than just produce oxygen.

NASA published research in 1989 which demonstrated that house plants help reduce indoor air pollution.  Due to the energy crunch in the 70’s, buildings became more air-tight to reduce energy costs associated with escaping heated or cooled air.  But then occupants began developing health problems, and researchers determined that decreased air flow in buildings led to higher concentrations of carbon dioxide and volatile organic compounds (VOCs) in the indoor air.

Three of the VOCs NASA focused upon in its research were benzene, tricloroethylene, and formaldehyde.  These chemicals pose various health hazards that range from skin and eye irritation to headaches, asthma, and cancer (pp. 3-5).  Assuming we’d like to avoid these health hazards, what can we do to reduce the levels of these chemicals in our homes?

As NASA points out, “The first and most obvious step in reducing indoor air pollution is to reduce off-gassing from building materials and furnishings before they are allowed to be installed.” (p.2)

The best way to reduce chemical indoor air pollution is to choose lower-VOC or zero-VOC options for furnishings, floorings, and other elements inside your home (wall paint, flooring glues, shower curtains, etc).  That way, you’re bringing less VOCs into your house to begin with.  (There are lots of good articles about this on the web; I encourage you to Google-Fu them.)

In addition to reducing VOCs by using less-toxic cleaning supplies, lower-VOC paint, etc., we figured “If it’s good enough for NASA, it’s good enough for us,” and bought houseplants – lots of houseplants.

Before I bought the plants, I did an online search and found many helpful articles.  This article at Lifehacker.com has a graphic of various houseplants and the chemicals they filter best.  And since houseplants have not fared well at my house in the past, I also read articles, including this one, on low-maintenance, hardy houseplants.  See this article for a good overview of the benefits of houseplants, including how many you need per room/ per square foot.

In the end, I decided to buy plants that didn’t have runners that would wind up all over the house (I’m looking at you, golden pothos).  I found a local nursery and selected plants for various rooms based on the available sunlight in those rooms, the amount of available space, and what looked good to me.  Be sure to check how big each plant typically grows, so you don’t buy ones that will outgrow the space you bought them for.

For the bedroom, I selected a snake plant (a.k.a. mother-in-law’s-tongue; see picture at top of post) because they are one of the only plants that continue to take in carbon dioxide and give out oxygen at night.

So far, it’s been about six months and none of the houseplants has died.  In fact, nearly all of them are thriving.  It’s hard to say whether our indoor air quality has improved, since we don’t have a way to test it.  But at least we know that science is on our side, and we didn’t waste our money on air purification myths like beeswax candles or salt crystal lamps.

CAUTION: Many low-maintenance houseplants are toxic to dogs, cats, and sometimes children if they chew on the plants.  If this is likely to happen in your home, make sure you know which plants are toxic, and put them where pets or children cannot reach them.

 

 

Health Hack: Morning Checklist

The military loves checklists.  For some career fields, it feels like there’s a checklist for every action except going to the can/head/toilet. (Number 1 – check.  Number 2 – check.)

For many of us veterans, using checklists has become a deeply ingrained habit pattern.  So why not harness the checklist habit pattern and utilize the checklist tool to create a healthier lifestyle?

Particularly if you have a health condition that affects your memory, thought-process, or motivation, a checklist can be a very helpful aid.  Why not use  checklists as a health life hack? (“Life hacking refers to any trick, shortcut, skill, or novelty method that increases productivity and efficiency, in all walks of life.”)

Research indicates that it is often beneficial to take positive actions whether or not we “feel like it”.  Since I frequently wake up feeling crappy and either forget to accomplish some or most of my morning routine or just don’t feel like doing it – but I know that my morning routine is good for my health & wellbeing – I have decided to implement a morning checklist.  While it’s easy to destroy my morning routine by gradually skipping more and more days, it’s much more difficult for me to intentionally not accomplish the checklist.  So, for me, routine checklists are an effective life hack.

This is my Morning Checklist:

Morning Health Checklist – One Sick Vet

(Feel free to print it out and use it, or create your own.)

You could also use a daily health journal, a spread sheet, or a chart (like a kid’s chore chart) on the wall or refrigerator or bathroom mirror.  Whatever works for you.  (Anyone know of an app for that?)  The key is to find a way to get yourself to consistently make healthy choices and take healthy actions whether or not you feel like it, or to find a method that helps you remember when you are having difficulty remembering.

What will you do to hack your health today?

Medical Procedures: What It’s Like To Get An EMG (Electromyography)

Raise your hand if you’ve got a bad shoulder (badum ching!).  Yup, me too.  Although I had surgery to repair it a year ago, I’ve had some lingering problems.

Since physical therapy (PT) hasn’t resolved the functionality problems with that arm, my primary care manager (PCM) ordered some diagnostic medical procedures to try to determine what’s causing the problems.  One of the procedures that was ordered was an electromyography.

Electromyography (EMG) is a diagnostic procedure that assesses the health of muscles and the nerve cells that control them (motor neurons).  According to the Mayo Clinic,

“Motor neurons transmit electrical signals that cause muscles to contract. An EMG translates these signals into graphs, sounds or numerical values that a specialist interprets…EMG results can reveal nerve dysfunction, muscle dysfunction or problems with nerve-to-muscle signal transmission.”

In my case, they were trying to determine whether a pinched nerve in my neck was causing the problems with my arm.

Electromyography is an outpatient procedure that typically takes about an hour.  EMG is often done in conjunction with a nerve conduction study (NCS), which I also had.  NCS is the measurement of “the speed of conduction of an electrical impulse through a nerve. NCS can determine nerve damage and destruction” (Johns Hopkins).

According to WebMD,

“Nerve conduction studies are done before an EMG if both tests are being done. Nerve conduction tests may take from 15 minutes to 1 hour or more, depending on how many nerves and muscles are studied.”

Since they were going to need access to my arm and shoulder (and trapezius, as it turned out), I wore a track suit with a tank top underneath. They asked me to take off the track suit jacket and lie down on an examining table.

To prepare for the NCS, the person administering the torture procedure asked me to move my fingers, hand, and arm in several different directions so she could determine her targets.  These she marked on my arm with a marking pen.  She fastened several electrodes to my hand and fingers with tape (see picture below), and proceeded to zap me with a machine that looked like a taser (but used less voltage, obviously).

 

This is not a pleasant sensation.  It typically wasn’t too painful, except when she applied multiple shocks in the same location.  The second or third consecutive shock in the same spot became more and more painful.  For the most part, she told me what she was going to do before she did it, which helped me prepare.  When she told me she needed to do 10 shocks in the same place, I knew two things: 1) It was going to hurt like hell, and 2) I’d better do the stress management/relaxation breathing techniques I learned at the base Wellness Center.

Breathing techniques, whether learned through biofeedback training or as part of yoga or meditation can be very helpful for managing pain or stress.  I use them whenever I am having an uncomfortable/painful/stressful medical procedure.  Of course, in this case, relaxing was a bit more challenging, since my body was also jerking from the shocks.  For some of the shocks, only my hand/wrist twitched.  But for some of them, my opposite leg jumped.  Several times I got a cramp in my arm muscles, and toward the end, I got a cramp in the muscles in my lower back.

That was part one.  Part two was the EMG.  “During a needle EMG, a needle electrode inserted directly into a muscle records the electrical activity in that muscle” (Mayo Clinic).

The needle is inserted into various muscles.  It didn’t hurt most of the times it was inserted, since it is a very fine needle.  It did hurt when it was inserted into the trapezius muscle.  Once it is inserted, the doctor taps on the needle, and sometimes moves it around inside the muscle as she listens to the signal.  As you can imagine, this doesn’t feel very good.  Then she asks you to engage the muscle.  You can hear an increase in signal noise while you are engaging the muscle.  This also doesn’t feel very good, as the needle feels like it is stabbing you more.

These tests may be done only on one side of your body (one arm, one leg, etc.), or they may be done on both sides of your body in order to compare results.  In this case, they only tested the problematic arm, not both, and the doctors were able to give me my results at the end of the procedures.

The good news is they didn’t see any evidence that I have a pinched nerve in my neck.  The bad news is that these diagnostic procedures didn’t help determine the cause of the problems with my arm.

After the tests: I had one righteous bruise, and I was tired for the rest of the day.

According to WebMD:

“After the [EMG], you may be sore and have a tingling feeling in your muscles for up to 2 days. If your pain gets worse or you have swelling, tenderness, or pus at any of the needle sites, call your doctor.”

“If you still have pain after the [NCS]:

  • Put ice or a cold pack on the sore area for 10 to 20 minutes at a time. Put a thin cloth between the ice and your skin.
  • Take an over-the-counter pain medicine, such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), or naproxen (Aleve). Be safe with medicines. Read and follow all instructions on the label.”

How NOT to Do It: Applying for VA Disability Years After Military Separation

Something slightly different today: I had the opportunity to write a guest post for The Military Guide.  Started by a Navy veteran who transitioned to an early retirement lifestyle after 20 years of military service, The Military Guide covers subjects such as financial independence and early retirement from a military perspective.  If you’re interested in ways to parlay military pay and benefits into savings, investments, and possibly a side hustle or two so that you, too, can avoid working or can work on your own terms after you separate from the military, head on over there and check it out.  Doug Nordman, the founder of The Military Guide, retired in his early forties and now surfs and supports veterans causes.  With some hard work and careful planning, that could be you!

The post I wrote for The Military Guide covers my experience of filing for VA disability well *after* I separated from the military.  Hopefully it will be a cautionary tale of what NOT to do, if you are still on active duty. Or, perhaps, it will give you the motivation to go ahead and apply for VA disability benefits, even if it’s been *years* since you separated from the military.  Check it out and let me know what you think.