Category — medical world

Friday, February 26th – Can you say epithelialization?

Let’s try it in syllables. Ep-i-thee-lee-ul-i-zay-shun.
And what in the world might this tongue-twister mean?

Epithelial tissue is the membranous tissue that covers many body organs and lines many body cavities. When you’re talking about a wound, epithelial tissue is what forms across the top of the wound when it’s almost healed. The next and final step in wound healing is the formation of epidermal tissue, or the epidermis — or just plain skin.

So epithelialization is the formation of epithelial tissue across the surface of a wound. And that, dear readers, whoever and wherever you may be, is what is happening to me — after almost a year of dealing with varying degrees of Wound Agony and Horror.

Yup, it’s getting smaller, all right, and it’s moving right along. What was once the size of a closed cell phone is now about as long as the short side of a credit card, and about as wide — at the widest part – as a dime. It’s shaped weirdly like the State of California, except that the outlines are not ruler-straight, but kind of jagged.

And all but the very bottom of the Shape of California is now covered by epithelial tissue! Yes, epithelialization is indeed taking place. Maybe my goal of having it fully closed by the Vernal Equinox – that’d be March 21st – is not unrealistic after all! (If it isn’t completely epithelialized by then, I’ll shoot for the Summer Solstice – June 21st.)

Now you know what my Word of the Week is. Please feel free to use it at will… but I hope you don’t have to apply it to a personal condition.

Thanks for reading — Betsy

Friday, January 1, 2010 — I’m back! 2009 is over, and Two Thousand Ten, or Twenty-Ten — whichever you prefer — has begun. Unfortunately, I committed a blogger’s worst sin between September and now, in that I disappeared off the face of the earth and failed to tell you all why. So please take it that I apologize profusely, abase myself, grovel at your feet…  and let’s move on.

Words About Wounds

Well, you wouldn’t think it possible, but I did it AGAIN. The same damn thing, the same damn slip-in-the-shower — except that this time there were two rubber mats there that were supposed to keep me from slipping. Go figure! This was in mid-October, two months to the day after I had been discharged from the Mercy Hospital Rehab Department’s Wound Care division.

There was no chance for infection this time, though, thank goodness. I had actually popped 2000 mg of Amoxicillin just before stepping into the shower, in preparation for a dental appointment mid-morning  (because of all the joint replacements, I take antibiotics before dental work, and will for the rest of my life, it appears). The wound was about an inch northeast of the previous site; much shallower, a lot longer, with only about 1.5 inches at the top that was of any concern.  Unfortunately, the fragile top skin of the original wound was damaged, so I now had TWO sites. I saw the doctor within two hours, and was back at Mercy the next morning, looking and feeling very shamefaced and embarrassed.

Emily said, “Wouldn’t it just have been easier for us to go out to lunch together?? Did you have to come back as a patient?”

Long story short: the new one is totally healed; the original one probably has another six weeks to go. I do the dressings myself, daily, and go to Mercy twice a week. That’ll be once a week very soon. I have become fairly knowledgeable about wound care, believe me, and have decided it’s not a field I’d like to go into permanently. At least, there was no discussion of MAGGOTS this time.

Chiropractically Speaking

Slowly, slowly… twice a week with Dr. Klein… the graph is creeping upwards again and I am beginning to feel that my body is getting back to where it ought to be.

We are working toward the goal of getting my lower back a bit more limber, so that I can bend over from a sitting position on my raised toilet seat and fasten the infamous Velcro Circ-Aid by myself. As it is, I have to depend on my Beloved Spouse to do it for me. This, for me, is anathema: Fiercely Independent, that’s me, and I can hardly stand having to ask for help every day! Also, it’s impractical, because I get up long before the Spouse does; so there are often long periods when I am Circ-Aidless.

But by working “more aggressively” — his words — with CAM, the magical robotic tool, on the lumbar region, David Klein says he thinks there’s a good chance we might achieve this goal at some point.

What all this has shown me is that, no matter what else is going on with my body, I do want to continue regular chiropractic sessions. Forever, if I can manage that. The difference in how I feel when I go regularly, and how I feel when I don’t, is BIG.

I am pleased to report that my raving about the wonders of chiropractic convinced my daughter, who lives in Massachusetts, and her husband, both to find an excellent chiropractor near them to work on Sarah’s bad back and Chris’s feet! And they are both happy as can be. I was a bit surprised to hear that Chris’s bunion improved, but hey, who knows what-all chiropractic can do!

Sad Cat Stuff

My wonderful thirty-year-old cat, Amy, is dying. According to the Mobile Vet, Dr. Doss, she would be 134 in human years, and is something of a phenomenon in that she hasn’t had any of the usual elderly-cat illnesses. Till now. She has a tumor in the nasal cavity, he believes, which is pressing on the optic nerve and causing the third eyelid (nictitating membrane) to push up over her eyeball on one side. It’s also causing congestion, loss of the olfactory sense (tremendously important to cats), and sneezing.

This has been going on, and getting worse, since the Thanksgiving weekend in November. We treated the upper respiratory infection with antibiotics and megavitamins, and it got somewhat better. But then that eyelid came up, and she stopped eating about ten days ago. She keeps herself going on lots of water and maybe half a cup of light cream, over a 24-hour period.

We talked about euthanasia. But this incredible cat is determined to keep living her life as much as she can, as long as she can. She is just skin and bones now — such a little animal, when you get down to it; and I’d always thought she was a medium-sized cat! — but she continues to make choices and decisions for herself. For example, just like always, she decides each night whether she’s sleeping with me or with the Beloved Spouse. Now, when I’m the lucky one, she plasters herself to me like a little limpet; draped across my neck or lying on my arm with her head on my shoulder, she pushes her face into my neck and purrs herself to sleep. Her purr is pretty raspy now, but I love it.

She also takes herself out the cat-flap in the kitchen window to relieve herself; having lived on her own outdoors for 15 or more years, she has nothing but scorn for the litterbox that Chloe uses happily enough. And she spends much of each day, now that it’s a little warmer, napping under her favorite bush, getting some sun on her tummy.

So our choice is to let her keep getting what she can out of every day, as long as she isn’t in pain. Discomfort she can handle: she is a tough old lady. And we will enjoy and cherish every moment we have with her, even though we know time is running out.

Happy Family Stuff

I had a wonderful week in Toronto in early November, for my grandson William’s Bar Mitzvah. All three of my kids were there, all four of the grandchildren, and assorted other family members as well. It was gorgeous!

Besides the really beautiful service and William’s lovely, right-on-tune chanting of a very long Torah portion in Hebrew, another musical event got me right in the heart.  One evening, when all of us were gathered in Danny and Jackie’s kitchen and dining room, eating up all the leftover food and having a drink or two, my daughter Sarah and my 16-year-old granddaughter Heather (Will’s sister), announced that they had a song they wanted to sing — for ME! Whereupon they sang, touchingly and melodically, the song “For Good,” from the musical “Wicked”. It’s all about how “people come into our lives/for a reason, bringing that which we must learn…”, and ends up with, “Because I knew you/I have been changed for good.”

You can imagine, I was weeping like a waterfall from about the first note. Both Sarah and Heather have lovely voices, and part of it was in harmony. I loved it. My daughter-in-law Jackie videotaped their rehearsal of the song that afternoon, so I can replay it and cry some more any time I want.

Starting Over

So that’s about it, in a nutshell…good stuff, not-so-good stuff… and now we’re moving along into January. My Beloved Spouse and I will celebrate 14 years of marriage this coming Tuesday. (Amy, our cat, has been with us for 11 of those years.) And shortly thereafter, I will become even older… I cannot believe it’ll be 72 years. Yikes! How can this BE?

I don’t make New Year’s Resolutions. I think they are self-defeating. But I do think about what I might like to do differently in the new year. One of those things is, I’m hoping I won’t let myself get sidetracked again, but will continue blogging more regularly. I guess it doesn’t have to be as dramatic as MAGGOTS to be a certifiable blog — right?

I wish each of you a beautiful year. May 2010 bring all of us some of what we dream about…  Thanks for reading — Betsy

Monday, July 14th – Today I had an appointment with my terrific Primary Care Physician at Scripps Clinic, Dr. Sanjeev Shah. And, just as with Dr. William Bugbee in June and Dr. H. Arthur Silverman in April, I was looking forward to seeing Dr. Shah with a certain amount of trepidation. I never know how MDs are going to react to hearing that I have been receiving chiropractic adjustments three or four times a week for more than four months now. Twice now I’ve been more than pleasantly surprised — I would say instead, I’ve been astonished — by the positive and encouraging attitude my doctors have shown. Since I previously had only my late OB/GYN father’s long-standing and negative opinion of chiropractic to go by, it has been nothing short of a revelation to see how open these MDs are to chiropractic, and to “alternative medicine” in general. Scripps Clinic actually has a Department of Alternative Medicine. And, as I mentioned in an earlier post, the University of California San Diego Medical School is now sending its Fellows seeking Board certification in Pain Management to Seaside Chiropractic, for a certain number of hours learning from Dr. David Klein how chiropractic can be efficacious in managing pain.

Dr.Sanjeev Shah commented on how good my blood pressure looked, and how great I  looked, having lost a fair bit of weight since I last saw him in February. He also mentioned that I seemed to be walking better than I had been. So then I told him the story of my Skeptic’s Journey with Chiropractic. I showed him how I can now move the right foot, that had been “like a block of wood attached to the leg,” to quote Dr. Klein; I showed him how I can wiggle the toes, which a few months ago just sat there, immobile, no matter what I did. (Still can’t quite pick up marbles with them, but that will happen soon.) I showed him how I can now reach both arms behind my back — also new in the last couple of months.   I told him how much better I feel, overall. I reported Dr. Bugbee’s remark about “keeping me out of the hands of the surgeons,” and awaited his comments.

Dr. Sanjeev Shah did not disappoint me. He said: “That’s quite a statement, coming from a surgeon! I would say, it’s obviously working for you — keep at it. And I’ll see you in six months!”

I told him I hoped to be walking without the cane at that appointment in January!

So three out of my three regular MDs have unequivocally given me the thumbs-up I guess I was hoping for!  Cheers to Dr. Sanjeev Shah and his two colleagues, who are to be congratulated for their open-mindedness to chiropractic in the face of the evidence:  ME!

Thanks for reading — Betsy

Saturday, April 16th — I had a visit with my rheumatologist, Dr. H. Arthur Silverman, at Scripps Clinic, on Thursday, having not seen him since December, before my journey with chiropractic began. I needed a new prescription from him for Norco (yes, I am still taking opioid painkillers, although not nearly so many as I did a couple of months ago), so I made sure I got the prescription before I told him I was going to a chiropractor. I suppose I thought he might fling open the door of the examining room and tell me never to darken it again, or something like that. I was actually surprised at how receptive he was.  He sat down and said, “Tell me about it,” and I did. When I finished, Dr. H. Arthur Silverman said, “Well, you’re looking terrific; whatever is happening, it’s all good if you’re feeling so much better. Just keep it up, and I’ll see you in six months!”

It was sort of anticlimactic, actually.  Yesterday, I had said to David Klein, “Wonder what I can say to my rheumatologist tomorrow.” And David said, “How about bye-bye?” No, not just yet; but I’m keeping an open mind.  Maybe someday.  I figure, if I can be comfortable at some point without taking any pain medication, I will be ready to say bye-bye to my  rheumatologist, who has been really helpful to me up to now. Dr. H. Arthur Silverman couldn’t have been kinder or more supportive to me over the past few difficult years, and I appreciate all he’s done for me.

Not just yet, as I said.  Here it is almost midnight on a Saturday night, and I’m in the middle of one of my Midnight Perambulations. That’s what I call it when the peripheral neuropathies in my feet (caused, I suppose, by nerve damage during the last two hip revisions) start giving me electric shocks and long, deep aches. I can’t lie down quietly, and now I can’t really even sit comfortably because there are those toes, twingling away. “Dem toes, dem toes, dem daaam toes…”  Now, I take Lyrica for the neuropathies (thank you, Dr. Silverman!); and it helps, in that I only have to Perambulate about twice a week now instead of every night, as I did last fall. And I don’t have to cry about the pain any more. But I am hoping that the chiropractic adjustments will eventually free some poor little nerves that have been SUBLUXATED — love that word! — trapped between the vertebrae, and maybe the toes won’t twingle any more.  Here I was, all happy because I have gotten back some of the sensation in the sole of my right foot.  I should have kept quiet about that, maybe I jinxed myself.

So, right at this point in time, I guess I have a foot in both camps, as they say.  I’m not giving up the drugs, but I’m getting as much chiropractic treatment as I can. Let’s see what happens.  It’ll be a surprise.

Tuesday, March 25th –  Well, I apparently got it a bit wrong. The musical sound actually emanated from the robot, but was triggered by the resonating frequency of the bone.

I believe I would still rather think of it as “singing bones.”  I love the thought of that.

But the best thing is, the sound is perceptible to someone OUTSIDE my body. Dr. Klein could hear it perfectly well.  That is so neat!

When I got home after my adjustment today, I was feeling pretty stretchy and limber… not a usual feeling for me. And I suddenly thought:  “I have to fill out a form each time I go to see Dr. Klein, with a drawing of a human figure. I shade in the places where I feel pain, and assign each place a number on the pain scale from 1 to 10. When I started seeing him just under a month ago, I was giving each area a 4 or a5; and the past week, I’ve been giving every area a 3.  But hey, I can hardly believe it — if I had to fill out that form right now, I’d put a 2 on every single pain area!”

This may not seem very significant to you, but to me, it’s almost miraculous. I haven’t been down to 2 for at least three years. I mentioned at the beginning of this blog that in the past two and a half years I’ve had three revisions of earlier bilateral total hip replacements. The second one turned out to require rebuilding of the whole left side of the pelvic bone with a special porous metal, into which new bone would grow and fuse. This was due to the fact that the polymer coating on the original implant had eaten away a big hole in the bone, which had to be cleared of necrotic tissue and then covered with metal plates so there would be something that could hold the screws of the new implant.  (No wonder I was having a lot, A LOT, of pain!)

That revision dislocated within ten days, but I didn’t realize it (and neither did anyone at the rehab facility) because I was on such a high level of opiates for pain management. The surgery had to be redone two months later. My surgeon said the pelvic bone couldn’t be rebuilt a third time. If this went wrong for any reason, I would be in a wheelchair the rest of my life. I spent a total of four months in a skilled nursing facility, with two months of placing no weight on the operated side. The only time I could get out of bed was to lurch to the bathroom on my walker: hop with all my weight on the right foot, then a tippy-toe touchdown on the left, just for a second. The rest of the time I spent with physical therapy and learning to walk again. When I came home from rehab in March 2007, I then had the task of coming off a strong dependency on Fentanyl — not at all fun, in fact, pretty awful. I was on the walker through August 2007, in fact, and have been walking with a cane ever since. On good days my pain level was 3; on many days it was 5.  I thought it would be that way permanently, and so I learned to live with it and got on with my life.

I don’t suppose it is realistic to expect that 2 will be repeated every day from now on. But I do, now, have a reasonable hope that my regular adjustments will really get rid of my pain eventually. I cannot thank David Klein enough! It’s so exciting to see how quickly I’m making progress under his care. In addition, his wonderful staff — Roseanna and Emily and Cheng Cheng — are so supportive and cheerful, so happy to witness my improvement:  I love coming to this office. (Oh, and it doesn’t hurt to mention that there is always a basket of chocolate-covered peppermint patties on the front desk, and a daily plateful of some kind of sinful cookie or little pastry.  No wonder my diet has ground to a halt…)

Chiropractic is a journey I never thought I’d be making, and I am inexpressibly grateful to all the folks at Seaside Chiropractic.

Wednesday, March 19th — Today, after Dr. Klein used the robot on my feet, I noticed little indentations in the skin and underlying flesh. I commented on the edema, wondering if it would go away eventually. He gave me a brief mini-lecture on how fluids like blood travel through the body, via the circulatory system — a closed system with the heart as the central pump. In other words, blood is pumped to all parts of the body by means of the arteries, and returns to the heart through the veins. Lymph is a clear fluid that is squeezed from blood plasma — basically, it’s blood that has no red cells.  The lymphatic system is a one-way system rather than a circulatory system. Lymph collects in many little sacs throughout the body, often near the joints, and drains out through little one-way valves.  That’s what is causing the edema in my feet — an over-collection of lymph, made worse by gravity. (This is massively oversimplified, by the way. If you’re interested in more about lymph and the lymphatic system, go to Google.  It’ll give you several websites of varying complexity that will tell you more than you ever wanted to know about lymph.)

Dr. Klein suggested that my physical therapist might perform a lymphatic massage to help drain the excess lymph out of my feet.  It’s a simple massage using a “milking” movement of the hands, from the feet back toward the legs.  If my artificial hips permitted me to reach my feet, which they do not, I could easily do it myself.  Maybe I could do it by doing my regular PT leg-lifts, then bending the knees back.  I’ll try that and report back to Dr. Klein.

He has worked on my shoulders with the robot three times now, and that feels very good too. I notice that I’m able to tolerate higher levels of pressure from the robot than I was at the beginning. At first, it was 10 pounds of pressure at the neck, and 15 pounds at shoulder level. Farther down the back, where the vertebrae are larger, he used 20 pounds.  Now Dr. Klein starts at 15 pounds on the neck, moves to 20 around the shoulders, and 25 lower down the back. Nothing has ever been painful! The worst it’s been during an adjustment, I would say, is the feeling that my teeth are chattering when he starts on the neck. I guess this must be how the pavement feels when the workmen start jackhammering! And even that isn’t really very bad at all. I do feel pretty stiff and sore the next morning, briefly; but then, it’s hard to tell how much of that pain is caused by the adjustments and how much is just the regular garden-variety stiffness and soreness I’ve been living with for years.