Elbow Update: I am hardware free!

I went to a massage appointment today, mostly to get the crud out of my muscles. I picked up a bug recently, and was left pretty sore everywhere by it. But I had the CMT work on my left arm as well (not around the elbow, but all the muscles around it), and my shoulder. By the time she was done, I had more comfortable movement in my arm in a long time.

So, I fired off an email to my orthopedist, letting him know that I had really good range-of-motion, and that the massage really opened it up. I also asked if I could start going without the brace, as I didn't think it was making much of a difference right now. About 30 minutes later... I got his blessing to remove it.


Yep! I am hardware-free! While I have it if needed, I am working slowly to get my arm back to its norm, and hope to never wear it again. I still need to wait on major strength work until I get cleared on the 11th, but this is a significant step forward for me. My mobility is really good. With increased range-of-motion, I started feeding myself with my left arm again this week (Thankfully! Try using chopsticks with your non-dominant hand!), which has improved my muscle tone a bit, and my arm is no longer shaky when I hold something.The back of my arm is still tight near the elbow, but I suspect that will improve as well. Muscle-mass... um, yeah... there isn't any right now. Once given permission, I will be doing some serious strength training again, to get that back. My poor right arm has been a victim of overuse syndrome, so I am sure that will improve as well.

Marching onward! I will be back on my bike soon! And working more hands-on in EMS again. :-)

Back in School

On January 25, 2010, I became a student again.

No, I didn't quit my day job; I am still working for the State of CA. What I did do was to sign up for two classes at a local community college this semester. The first is Introduction to Investigations. I have had an interest in criminalistics and forensics since before "CSI: Crime Scene Investigation" debuted on television. After all, I am a microbiologist by training. I've been thinking about incorporating criminal investigation into my CV, so I figured this was as good a time as any.

The second is one that is the real love... it is a pre-paramedic class. Basically, this class gives students a "leg up" with paramedic training, something that I am absolutely going to get. The program is totally different than when I got my EMT-II back in the early 1980's... I am effectively starting over. We didn't have 12-lead EKG. We didn't have the autonomy that paramedics now have. We didn't have most of the drugs that are now in the arsenal (And some of the ones we used are no longer there, or are not frontline meds.). We weren't allowed some of the advanced airway techniques that are now in use. Yes, we did endotracheal intubation, and we had esophageal airways (Those were actually in the EMT-I scope of practice at the time).

Twice now, the part-time program I wanted to take was canceled. One way or another, this WILL happen. I will find a program. Somewhere.

I don't normally share other blog's posts here, but this one deserves a special place:

http://6yearmed.blogspot.com/2009/05/quiet-place.html

She gets it. She REALLY gets it.

An MRI... and good news

Last Friday, I contacted my orthopedist, because I was concerned about some things with my elbow. These were:

• Could not bend my elbow more than 90 degrees without pain (I have been doing exercises per my orthopedist for mobility, not strength). I wasn't sure if the pain was due to the tendon tear, or due to it needing to be stretched.
• An odd "ache" that had started, with no known reason
• No major improvement since I saw him on January 11th.

 During my last visit, he offered the opportunity to MRI my elbow if I had increased pain, or no major improvement within a few weeks. So, after sending my email to him on Friday morning, I was surprised to get a phone call from him in the afternoon.He decided it was a good time to get that MRI done. He sent off the request, and gave me the number to call to followup ASAP. So, after getting off the phone with him, I did just that. I left a message for the MRI scheduler, figuring I'd hear something in a week. I did mention in the message that my doc had just put the request in for an ASAP MRI.

Surprise! I got a call 20 minutes later. And an even bigger surprise... an appointment at 5:30pm that night. I took it.

I showed up, and was taken to the MRI trailer. I've had 3 other MRI's, so this one wasn't a concern. Some people have real issues with the noise and the claustrophobic feeling the tube can cause. I've actually found the sound almost soothing. I know... I'm wierd. You can't have magnetic metal at all in the MRI tube. I removed my glasses, elbow brace, put my keys and ID on the counter next to my brace and glasses. Hearing protection was given to me, and I was placed in a modified "Superman" pose, prone (on my stomach), with my left arm straight out past my head, my arm locked into a tube with wedges placed inside (stuffing material) for the machine to do its magic on and scan my arm. My head was cocked to the right a bit, with my right arm bent and under my head. I had a pillow also. The scan was expected to take 30-40 minutes.

Initially, it wasn't a problem. About 20 minutes in, my deltoid and biceps muscles (shoulder and upper arm) began to cramp and spasm. I tried to not move, and succeeded for a while, but after 10 minutes, the pain from the spasms was too great, and I couldn't help it. MRI's are very sensitive to movement. So the last 2 scans didn't come out. They needed to be repeated. I mentioned to the tech what was going on, and I had two choices... hold still no matter what, or come back another day after taking a prescribed muscle relaxer. I thought about it for a minute, and decided to just get through it. I did a little repositioning of my head, and rubbed the muscles for a second, then tucked my head down and went somewhere else for the next 10 minutes. Where did I go? I went to the beach; walking on the wet sand at the water's edge in Huntington Beach in my mind. Great trick I learned years ago when dealing with pain. Doesn't always work, but most of the time. But the pain was mounting...

I was just about to say I couldn't do it any longer, when the tech announced he was done, and he got the last two scans. Whew! He pulled me out of the tube, and initially I couldn't make my left arm work. It was like a limp noodle. Started wriggling my fingers, then wrist, and finally could get my shoulder to cooperate enough that I sat up. It still didn't want to move much. And a good part of my shoulder had actually gone numb. Got my brace back on after a few minutes, and then was escorted back into the medical center, where I then left to go home.

I sat in my car for several minutes before leaving. My shoulder was twitching and cramping constantly. It plain HURT. But, the scan was done, and I hoped it would tell what the orthopedist and I wanted to know: How bad was the carnage in my elbow?

When I got home, I emailed my orthopedist to let him know the scan was done. He emailed back to me that he would check on it first thing Monday morning. I took some pain meds and went to bed.

Sure enough, on Monday, I got an email from him around 8:40am.The MRI confirmed the fracture in the bone spur, and I have a helluva contusion (bad bruise) on the triceps tendon, BUT THERE IS NOT A TENDON TEAR! WOO HOO! YEE HAW!!! We emailed back and forth a bit, with him warning me to "behave myself" (in other words, don't be working EMS directly - still supervisory only). Of course! I want this to heal NOW.

So, I can deal with a fracture. Bones heal eventually (usually). This is a bone spur, so it might not behave. If it doesn't there are options. So, I am still allowed out of the brace for minor range-of-motion exercises, and to shower. That's it. No lifting, tugging, or pulling on the arm (Not that I have anyway... I've been good.). My next appointment is on 2/11/10. Here's hoping it is healed by then.

An exercise in patience, as healing continues

Just a quick update.

I am continuing to do what my orthopedist has told me to do, including brief forays out of the brace while at home to reduce stiffness. Mild movement only. But I am able to get my arm to bend to 90 degrees now without pain. Anything further, and it hurts. I have to remind myself that it was just 3 weeks ago that I got hurt, and that I really need to be patient with my healing. 3 weeks to go...

Disasters and Individual Readiness

January happens to be one of the "on-call" months for my DMAT. About a week before each on-call month, I go through my 72 hour pack and my main gear bag, making sure that anything I "borrowed" from it was put back in, any foods that need to be replaced are, and that everything is in good shape. I potentially have to live out of my 72 hour bag. It has food, my medical gear, first aid kit, change of clothes, stuff to keep me busy, some survival gear, etc. And my gear bag is replacement clothing, sleeping bag, sleeping pad, pillow, spare bag (Things expand while on deployment! I swear!), MREs, and more.

I had begun this process, then got hurt. On December 31, I called my unit commander to advise him I would not be deployable for 6 weeks. I think that hurt worse than the injury. I joined DMAT to provide medical care during disasters. I made the decision to join the team right after 9/11 (I had heard about them during my EMT recert class), and I've been with them ever since. I've deployed since in 2004, and 2008, with wildland fire medical and CalMAT thrown in in-between. Even when the orthopedist told me the news, I had not immediately thought it would take me out of deployment availabiltiy, but that realization hit a few moments later.

This week, as hopefully all of you are aware, a 7.0 earthquake hit in Haiti, a few miles from Port-Au-Prince. Casualty estimates are 50,000 to possibly 500,000. That's just the dead. Injured? Try 4 or 5 times that. Illness, infection, rescue/recovery/rebuilding injuries will increase that. And the hospitals and clinics are destroyed. This is a first for DMATs. We have historically worked US missions, although some teams have gone to US territories, such as Guam, and American Samoa. Teams landed in Port-Au-Prince today, along with DMORT (Disaster Mortuary Response Team), IMSuRT (International Medical Surgical Response Team), and more. My team is on standby, although not first out the door for this mission. The medical response for this mission will be prolonged. The magnitude of this disaster is almost surreal. 3 million people are homeless. Malaria, Dengue, HIV/AIDS, Hepatitis B, and TB are endemic in Haiti.

I was asked last night "how broken I was", by one of my teammates. A few want me to deploy with the team, but I can't. Part of my readiness is assessing my capability. I am an EMT. Yes, I am also the Electronic Medical Record expert on the team, but I am first and foremost an EMT. I can't do that work right now. And I need to let my elbow heal, so that I can continue to be a responder, for the team, for my company, and for my employer. This is my livelihood at stake right now. Back in July, I had to make the same decision when I had my knee worked on. Each of us has a responsibility to ensure that we are capable of performing our work. And to assess ourselves and determine that we are not putting our team or partners at risk due to illness or injury. I don't want to do something that will make my arm worse, and potentially send me to the O.R., when I can potentially avoid it by allowing my arm to heal. And I don't want to risk the safety of my team.

Besides, there will always be more deployments. And I suspect multiple deployments to Haiti.

Elbow update

I went back in this afternoon for another round of x-rays, and time to chat with the orthopedist. Although he requested an "in-splint" x-ray, the brace covered the area to be seen, so I needed to remove it for a good shot.

This is a print of the x-ray (I need to remember to bring my camera with me next time), cropped:

The text was added by me. You can see where the bone spur I have tore away from the bone (That was the initial injury on 12/28/09). Additionally, if you look at that bone spur, you can see a break in it. That was what happened 24 hours after the initial injury at the gym, when I slung my backpack on my back. Worse injury, in other words. This shot was actually taken on 12/31/09.

So, today's film shows that the bone spur hasn't moved. Which means it is still a partial tear only, and should heal on its own. But, with my propensity to shred things really well, cautious optimism is the term of the day. No surgery now, thankfully! Hopefully never. When the doc checked it out, and had me pull up with my forearm against his hand with my arm bent at about 90 degrees, it still hurt like hell. Extension is good, though, which bodes well also that it isn't torn horribly.

At this point, I am still to keep it in the brace, but I can remove it for very passive exercises when I am at home (and still for showering, thankfully). Otherwise, it stays braced. Even while sleeping. No lifting with my left arm at all. This will continue for another 5 weeks. Any increase in pain, "pop", or no improvement over the next few weeks will send me to have an MRI. But not for now. And yes, I am still banned off my bike.

Thank you to everyone for all your well wishes while I deal with this injury. Your thoughts and prayers are very appreciated.

Las Vegas Trip

Last Wednesday, I took off for Las Vegas, to attend the 2010 Consumer Electronics Show. Aside from the show, my family lives there, so it affords me the opportunity to visit them as well, which I always love. The drive out there was actually quite nice. I didn't see the sun until I got onto highway 58 and up the hill a bit. As many in California know, in winter, northern and central CA are either fogged in, or it is rainy. Once up the hill, the sun was out and the temperature jumped from 44 to 60 degrees. It was comfortable.

I got there in about 10 hours, taking a few breaks along the way to rest my arm a bit. I was pretty sore when I got to the RV that I stay in. Typically, I bring the SUV for around town transportation, and my father brings his RV for the show. This year, he also brought his own truck. His RV is really comfortable. I happened to arrive near sunset, and fired off a few shots:

The show itself was fun. I wasn't very impressed my first day there, but Friday and Saturday, I got to play with a lot of cool stuff. And Thursday night, I attended a fun party, that also had a lot of great stuff to see. Some of this years swag was fun, but less companies were offering it. I didn't win anything (that I know of at this point), but I still entered the freebie contests as I found them. I reviewed a few items for publication, and will be doing more soon, including some headphones that are semi-custom in fit. And inexpensive!

Thursday night, I happened to witness a medical issue that occurred in a casino. I watched it from start to finish, since they had EMTs there. I was walking by as the casino EMTs arrived. It was interesting to watch how they handled a patient having a stroke while playing blackjack. They provided excellent care for the patient, who was tranferred over to Clark County fire paramedics, and transported to a local hospital for further treatment.

Friday after the show, I needed to rest. I did gamble a little (Hey, I have to pay my Vegas visitor's fee, right?), but got some dinner and went back to the RV. My arm was pretty sore after being down by my side most of Thursday and Friday, and being protective of it, so people didn't smack into it (The show floor was VERY busy). Some booths are extremely popular, and resemble mosh pits for the freebies given out.

Saturday evening, I got to spend time with my family, enjoying a really good dinner that was cooked by my sister-in-law, Paula (I want that recipe for the rice!). It didn't last nearly long enough, and soon I had to head back to the RV to get some sleep before leaving the next morning.

Yesterday's trip went quickly. I basically drove straight through, stopping only to get food and for some "brief relief". Took today off, just to kick back, but also because I have a doctor's appointment this afternoon to get more x-rays on my elbow, and chat with the orthopedist to make sure that my injury is stable and doesn't need surgery. I will let everyone know later today...