Time And Materials

By another name, it's Parts and Labor.

But not included in that paradigm is talent.

It was the learned talent of my neurosurgeon that has left my arm virtually pain-free - virtually, since all that is now left, pain-wise, is typical old-age meltdown.

Parts? My titanium plate and four titanium screws in my neck comes to a staggering four grand. That's $4,000 for you mathemeticians. That was included in the $17,000-plus hospital bill.

But wait, there's more...

Got the bill from the neurosurgeon the other day. For his part. For his talent.

So not counting the other four doctors I saw during the initial phase of quackery, before someone was willing - and able - to pick up a scalpel and FIX THE DAMN THING, just the doctor's fee was eighteen grand. Math types: $18,000.

And if you take a stab at an estimate for all things considered - time off work (FMLA did help), pain, suffering, and the whatnot not itemized, my neck is now worth about $40,000.

Funny, there's no mention of what room service cost.

Not kidding. Meals are ordered on the phone. And yes, they call it room service.

I'm Not A Monster

Marilee has a new term for me.

She just said "I've created a monster."

I was just commenting on a peculiar abnormality that occurred after my spinal surgery - I've been having trouble swallowing, a condition known as dysphagia. Not during the healing process, but afterwards, as this snippet from a health journal in Ireland explains (the italics are my emphasis):

"Dysphagia is a common complication of anterior cervical surgery, with potentially serious respiratory complications. The available literature suggests that symptoms may be prolonged for several weeks or more in a substantial number of patients. This report suggests that the initial post operative dysfunction resolves as early as ten days post operatively and that following this, a different pattern develops related to the position of the neck. Flexion of the neck at this stage will reduce the pressure on crico-pharyngeus and also facilitates swallowing by improving aryepiglottic closure and tongue base retraction."

I'm not having difficulty breathing, just swallowing. Feels like there's something there, but I just can't pinpoint it.

As far as diagnosis, x-rays and MRI's aren't conclusive in finding the problem, but esophageal manometry will be used for the testing.

So I'd just explained all of that to Marilee, and as I'd turned away to do something else, she made that monster comment. Rather than attack the subject directly, I commenced the above monograph.

Just a moment - I'll ask her now what she meant by that quip:

Says she: "I'M the medical person."

"And in that fantasy world, what does that make me?"

"You're the computer person. Stick to what you know best."

Hm.

You know, she's right. In THIS fantasy world, I know to keep my big mouth shut.

Back To Work

Trepidation included at no extra charge.

In other news, hopefully Jenn and Chris won't have to deal with a law that's been on the books for centuries:

A little-known law dating to Elizabethan England is suddenly being enforced with gusto in Pennsylvania. The law can force adult children to pay their parents' health-care costs.

From the Philadelphia Enquirer.

Schematics For The Human Body

In my chosen profession, wiring diagrams are what I live for. Seeing an overview of how things are put together is paramount in understanding how everything works. So, too, the human body. Muscles, ligaments, bones, you name it. All are put together in such a way that boggles the mind.

Not being one to self-diagnose, I never would have imagined prior to my spinal surgery just how much goes on in ones' spinal cord. Admittedly, I never even knew how the spine works. As an example, I had always believed the spinal cord traveled through the discs, leading to herniated discs. That's not the case. Rather, the spinal cord travels through the vertebrae, and the discs are located behind the spinal cord:
In the image above, the spinal cord passes through the "Vertebral foramen", while the disc is located in the oval shaped depression at the top of the image. The nerve bundle attached to the spinal cord passes through the transverse foramen.¹

In my case, enough degeneration had occurred in the disc between my C6 and C7 vertebrae (C7 is shown above) such that the disc had herniated and was pressing against the right-hand nerve bundle.

So far so good, but just how does one know - from a layperson's perspective - where that nerve bundle goes? And how does it affect the body?

I knew what my symptoms were, and was a bit surprised that the doctor knew exactly what the problem was without seeing my MRI. After meeting him and again explaining what my symptoms were, he stopped me before I got too far ahead of myself, and basically explained "I know how you're wired and you don't."

At that point, I put my neck - literally - in his hands.

In my exile these past months (I return to work the 13th), I frequently wondered about the wiring diagram; surely this information would be available somewhere. Not to self-diagnose myself, since I'd already had my surgery, but just to see if I could find that elusive wiring diagram. And finally found the term that I'd been searching for. As is often the case, you know what you're looking for, you just don't know what it's called.

Friends, it's called a dermatome (click the image for a larger view):

From Wikipedia: "Dermatomes are useful in neurology for finding the site of damage to the spine."

I only wish I'd known about dermatomes long ago; I'd had a dull pain in my hand for several years, and the whole time it had been a herniating disc, exacerbated by the events of a couple months ago.

And now you, too, have a reference point for finding out how you are wired.


¹ Disclaimer: I am NOT a physician. Nor will I ever be. This information is not to be construed as legitimate medical information. The opinions presented here are my own. If you are experiencing life-threatening symptoms, don't contact me - call a doctor. Really. If you're having a major problem, getting on the internet isn't in your best interest.

A Picture Is Worth A Thousand Words

Indeed:

The x-ray image above was taken yesterday afternoon. Yes, that's MY neck. And MY titanium plate. Replete with screws. I was able to keep the x-ray - a souvenir of sorts.

Maybe I'll have it printed and carry it around in my wallet.

Proof I'm not carrying contraband in my neck for screeners.

Recovery Update

Stopped by the "office" today to drop off my truck, phone, access card, and laptop. It's an asset management thing.

Enough about that - at least it got me out of the house for awhile.

Took my Steri-Strips off last night - the scar isn't bad at all, since there were no stitches. Looks like (and Marilee concurs) that no one will be the wiser that I even had spinal surgery. Which could be a bad thing...

"So you've been off for how long, you say you had surgery, yet there's no surgical scar?"

[crickets]

"Yeah, riiiight."

On My Healing Process

Overall, doing well. At least I think so from my vantage point. I've been able to (mostly) stay off the Lortab, though there's been a few evening muscle spasms and I take Carisoprodol for that.

No pain, though I get pins and needles in my fingertips from time to time. At least I'm not as bad off as this guy.

Just have to lean my neck to the left to make mine go away, probably still some irritation in that C6-C7 bundle. But not as bad as it once was.

I have a follow-up scheduled for next Wednesday and an X-ray an hour beforehand which sort of surprised me, but this is a new experience for me.

Maybe the X-ray is to make sure my screws aren't loose.

Though that's a whole 'nother branch of medicine.

The Respiration Technician

I'd like this guy's job. I met him if only for a brief moment a couple hours before I checked out of the hospital last Wednesday.

He goes around to every patients' room and checks their blood oxygen levels. The device he used was a "finger pulse oximeter", and I want one. No, really.

Bulky it's not. In fact, he was carrying it in the palm of his hand - but it was even smaller than that.

Similar in function to the stethoscope-less clip-on-your-finger device many care facilities use nowadays, this thing also clips onto your finger and measures not only your oxygen level but your pulse as well. Even had a damn EKG-like display. Had a bright OLED display and can be read in just about any ambient light.The one he had was rather spendy - he said the hospital got them for about 200 bucks a pop, but there are less-fancy ones available without the EKG function. Some even have a USB port for long-term diagnoses.

One rather minimalistic model just has large characters a la old-school LED's and can be had for about $50.

No, I don't want one for Father's Day.

Just sayin'.

About Post-Op Meds

This is more of a "Words to the wise" than about specifics.

Specifically, watch what you read when you're on your post-operative medications.

As said previously, a book I'd heard about but put aside for another time to read has been getting my attention late at night in my dreams.

I've never had problems dreaming and/or getting into REM sleep. In this particular case, though, the subject matter can give you the heebie-jeebies if put in the wrong context, that context being under the influence.

Of what? The mere fact that - in Utah at least - that one needs to show ID when picking up one's meds from the local apothecary if said meds are a narcotic, then all you need do is think Timothy Leary. For my generation, that gets the point across pretty easily.

I've already written about some of the travels I've done (read trips) about other meds I've taken and what the thankfully non-negative outcomes were. But those were conscious travels; rather these past few have been in my sub-conscious. Not sure that since I was in deep sleep I was therefore unconscious.

The book, by A. J. Jacobs, is titled "The Year of Living Biblically". The subject matter wouldn't otherwise have got my attention if not for a report done by the Bryant Park Project on NPR in late 2007. It sounded interesting, if only that the question comes up occasionally whether the the Bible should be taken literally, or as literature?^1,2

I imagine that since none of the Bible should be considered as fantasy (I suppose it depends on who you talk to, or even if your beliefs are of the Creationist/Evolutionist/Flying Spaghetti Monster variety), but since my mind lately is muddied a bit by my prescribed narcotics, bits of reality have been interspersed with that of the book.

Listen to the piece at NPR about the book, then imagine what your mind might do with it.

Yes, I'll probably finish reading the book, but I'm not one to comment on it in part or in full.

Particularly if I'm under the influence.


¹ OK, I admit I had to look up the word literal: Pertaining to a letter of the alphabet. More typically, it means “based on what is actually written or expressed.” A literal interpretation gives an exact rendering—word for word— taking words in their usual or primary sense. It is also used to describe thinking which is unimaginative or matter of fact.http://www.enotes.com/literary-terms/literal
² There was even a class in high school called "Bible as Lit". Thirty-four years ago. Imagine how far we've come.

No Where Near Normalcy Yet

It occurred to me this morning that I'm not feeling at all "normal". Not particularly because someone last week was digging around in my neck with sharp instruments and a SCREWDRIVER, but because my routine has been altered in ways too numerous to mention.

And trying to get back to something approaching normal has been a real challenge.

Yesterday, for example, though my blog post had to do with sleeping, and the challenges involved with that, I had actually written most of that on Thursday with my manual Bob's BS.

Yesterday, I couldn't come up with anything new to write about - I was in pain most of the day, couldn't find a comfortable position to sleep in, there were constant dog interruptions, couldn't "get into" any of the movies I tried to watch, et cetera.

And as far as pain, no combination of my meds seemed to do the trick.

I awoke this morning at 4:15am and could not get back to sleep. Came downstairs, watched a bit of TV, and still had pain¹ I could not control.

Marilee was up at about 5am - which surprised me for a Saturday. I was having a "constitutional" out on the porch, and she startled me as I rose so as to go back into the house. Turned and ran smack dab into the post on the porch, leading with my arm. Yes, THAT arm.

After stumbling back inside and meandering around the kitchen and family room and trying to decide whether to go back upstairs and trying to sleep some more, somewhere in the back of my drug-muddled mind I began to wonder just what the hell was going on: Thursday had been so much more "normal", but Friday everything turned to crap. I even had headaches that hadn't been present in the last two days, even with all the dru...

Then it hit me, as if headlong into a brick wall.

Thus this blog post.

Normalcy - or something approaching it - is achieved with a drug I had none of on Friday.

It's more commonly referred to by its non-generic name: COFFEE.

¹ I suppose I should mention just what pain means in my current post-op state. Pain is a shooting pain more so from my right shoulder through the elbow into my hand. Yes, the same damn pain that I had the surgery for in the first place. But since all those nerve routes have now been relieved of herniation or whatever, it will just take time for those routes to heal.

Taking Things For Granted

Something as simple as sleeping.

Sleeping has become an interesting experience all on its own. After sleeping just one night at LDS Hospital on the standard-issue hospital bed - no doubt designed by the same guy as the medieval "rack" - and having to sleep at an exact 30-degree angle as decreed by my neurosurgeon, I have found that position to be nearly impossible to maintain.

Being a left- or right-side sleeper all my life, adapting to anything other than a 90- or 270-degree attitude (pitch, yaw, whatever), is quite challenging. And for me to keep in that position requires a foam cervical collar, also likely designed by someone in the dark ages.

The "log-roll" is the accepted method for getting into the left- or right- axes described above, provided that there's a flat spot.

This log has no flat spot.

[In hindsight, it appears that Marilee's decision to purchase a two-ended recliner for the two of us has become a Godsend. With Lexie as a counterweight at 2am, I was able to sleep quite comfortable at an approximate 30-degree-ish angle. Or was it foresight?]

Free Time

I seem to have an over-abundance of free time - I'm only at my first full day of post-op and I'm just a bit stir crazy. Call it cabin fever if you'd like. I could drive if need be, but Marilee would rather I didn't. But considering all the neat-o meds still coursing through my system, maybe I'll just stay put.

Sitting here with not much else to do but heal, it occurred to me that it would be a great time to catch up on some long-put-off reading. Having just picked up a few tomes from my basement library, and realizing that "The Word Museum" and "Casual Lex" aren't exactly War and Peace - the Salt Lake Valley white pages would be just as riveting - I grabbed a tome I'd heard about last year on NPR called "The Year of Living Biblically" by A. J. Jacobs.

I had just gotten to page 9 of the hard cover edition when I was overcome by the urge to grab my Bob's BS journal and make a few notes and quickly ran out of room on a full page.

Having just reached that point and realizing that all this time I have on my hands that I can garner quite a bit of useful stuff or worthless crap.

Or pure BS.

Thus the grabbing of my BS book.

It had me remember that in my hospital room, there was not only nothing to write ON, but nothing to write WITH. It took my nurse-on-duty a bit of time to track down some paper, once she inadvertently left a pen in the room with me. Just a simple Bic stick pen, it had me wanting to write something. Anything.

If only to make note of things to write about in the coming days and weeks of myself nursing my sore neck.

Interestingly enough, when I was making those notes earlier in my manual notebook, my arm was not hurting one bit. Now, typing on the notebook, the pins and needles are starting to remind me they've not entirely left my system. Yeah, I know, give it time.

So using a simple PENCIL in my BS journal, I was able to stop a pain from occurring.

And what does that mean to you? You wouldn't have been able to read this until MUCH later.

But do YOU need a Bob's BS book? Why not? Manual notebooks work just as well as their electronic counterparts, and don't crash.

Tempting, isn't it?

Post-Op

I'm home from the hospital for some much-needed recuperation.

And now pain free, at least the pain for which I went in for. Now the pain to get rid of is from the surgery.

I want to thank the staff at LDS Hospital for taking such good care of me, specifically Rochelle, Jeff, Angie, Tiva, Laura, Maria, Elizabeth, Ondira, and Breanne. Through the haze of anesthesia, I might have missed a few names; for those I missed, I thank you, too.

And thanks particularly to Dr. Robert G. Peterson, my neurosurgeon.

And in case you're wondering, his middle name is Gordon.

I'll have more in the next few days but for now I'm exhausted.

Incommunicado

I'm actually writing this post Monday at about 3:30pm, but having it post at Tuesday, 9:15am.

The reason? At that particular time Tuesday I'll be checking into LDS Hospital for my surgery.

So although there won't be any "real-time" blog post on Tuesday, I'll be taking my cell phone with me so as to "Tweet" once I'm coherent enough to do so.

How will you know I've "tweeted"? It'll be over there in the right-hand sidebar under "@bobsbs", which is oddly enough my Twitter username.

My surgery dictates I'll be spending the night at LDS, so nothing much will be forthcoming Tuesday evening, either. Again, look for a tweet or three.

All for now - I'm going to go nap some more before tonight - tomorrow's going to be a loooong day...

Type to you all soon!

Gravity Sucks

Be it known that in my current physical state that gravity sucks. Not the other way 'round.

In a sequence of events that can only be described as miraculous, Marilee called for me for an appointment with a neurosurgeon Wednesday, he saw me yesterday, and my surgery is scheduled for this coming Tuesday.

Yes, surgery. And, yes, a scalpel will be involved.

THANK GOD.

As far as gravity is concerned, if I lay completely motionless with my right arm straight out from my torso at a 90-degree angle, I can sleep rather well. And when not sleeping, and gravity being what it is, it's all meds. Thank God for meds. Even now, as I type, with my arm(s) at awkward angles, I can only tap-tap-tap for only a few minutes at a time. But even with the pain, I felt I needed to get this post off before I must lay down and get gravity off my mind. And arms.

So far this morning, I've had a Valium, two extra-strength Tylenols, and a Lortab. And while my mind might be a bit foggy, I can type.

And after Tuesday, I'll be able to type without that cocktail. I'll probably have a different cocktail, but they'll be part of the road to recovery rather than numerous stop-gaps, which has been the case with the other top-notch¹ physicians I've seen to date for this same affliction.

If you've noticed a particular thread these last few posts, you'll realize I'm not one to believe any one physician and what they may have to say at any one given examination. Marilee is a fan of "Mystery Diagnosis" type programs; she TiVo's every one she can find. They're all about people who have seen infinite numbers of MD's (and quacks) for months and years and never find a diagnosis until ONE caring MD finds some obscure non-textbook case or other in a similarly-obscure text. And even while some of those cases are so rare there aren't any set cures, at least they have a name.

I got along rather well in the hour or so we spent with my neurosurgeon, Dr. Robert G. Peterson. The mere fact his first name is Robert made me acutely aware he had a bit of credence. That he's also an Aquarius (January 28 vs. my January 31) made him even more so credible - a fact that Marilee realized all too well - he's a bit of an ass in the way he speaks and acts. I did not ask what his middle name is - mine also starts with a G - that would be too freaky, and I decided to leave it alone.

So anyway, that's what's going on in my pain, meds, and "My Spinal Surgery" posts for now. I'll try to post again before the procedure, but don't ecpect too much for a few days or even a week afterwards; but my mind will be active and will come up with some choice subjects afterwards.

You can bet on that.

¹ That comment is very tongue-in-cheek. MD#1: Here's some meds, you'll be fine again in a week or so. MD#2: Here's some more meds, and a list of orthopedists. MD#3: Go to this other MD(#4), he'll poke some needles in your back, oh, and here's some more meds. Which brings us to MD#5, the surgeon.

Prince Valium

If you've come here looking for a reference to the movie SpaceBalls, you'll be disappointed. Prince Valium is how my friend Dave refers to me since I've been having my neck/back/arm pains.

And Prince Valium has just entered my star system; it's the only thing that keeps the pain at bay.

I have that appointment with the orthopedic surgeon today at 1pm. While I'm not worried about what he might suggest as a treatment regimen, it was after a short comment Marilee made last evening that made me realize what else he might suggest - for the better, of course.

She (Marilee) has a friend who had to undergo some neurological surgery a year or so ago, but the surgeon would not do the surgery unless the friend quit doing something for a period of six weeks prior to the procedure.

Marilee reminded me of that, and to not be surprised if this surgeon suggested the same thing.

So while my pain in the neck may subside, the pain of quitting smoking will make up for the pain in my arm.

There's No Instruction Manual For Life

Let alone trying to navigate the mess the health care system has become.

I should know. Or rather, my wife knows.

If it weren't for my dear wife of three years - actually, we've done away with the whole "when we met" anniversary and just lumped that in with our wedding anniversary, thus making yesterday's date of May26th our five year anniversary - the whole mess of figuring out insurance documentation is her job. Because it really is her job.

I was off work last week, since the meds I've been taking make me dangerous on the road. Dizzy enough from the meds to trip over the coffee table in the family room, God forbid what I might trip over driving a 3/4 ton truck during work.

After my X-ray and consultation sent me in the direction of an MRI and subsequent consultation, I had my "operation" last Friday - laying motionless, face down on a table similar to a massage table while a physiatrist (that's not a typo) deftly injected cortisone into my spinal cavity. The initial consultation with him did say that the effects could take "a week or two", but not what to do in the meantime.

In that meantime, the pain has not subsided; it's actually gotten worse. As it had been in my last week's off time. So I continue to take my pain meds, and still am not driving.

To make matters worse if not already so, having already run out of sick time, and after a much-needed vacation earlier this year, I'm getting rather low on vacation time. Which means, of course, that in a few days I won't be getting compensation of any kind.

Enter FMLA - the Family Leave Medical Act. But not having the prowess in such things as my wife does, I figured it would just kick in automatically.

NO, I DID NOT KNOW THIS, so don't bother with your "What you should have done" comments.

To get things rolling on that note, I've got another appointment with another physician - that will make FIVE for this particular affliction I've been living with for about five weeks now - tomorrow at 1pm. This guy's an orthopedic surgeon. An actual, live, breathing dude that actually uses a scalpel in his job. So far it's been a pen, pencil, or keyboard. And just a bit of needle.

What the HELL ever happened to the doctors who did everything themselves?

Anyway, more to come tomorrow after THAT appointment, I'm sure.

Modern Medicine

Though I fully expected a witch doctor a la ooo eee ooo aaa aaa bing bang walla walla bing bang to come dancing through the door yesterday afternoon, it wouldn't have mattered much since I was face-down on an operating room table with instruments poking into my spine.

I had my epidural yesterday afternoon.

After the insertion of an IV tube in my left arm - which interestingly enough didn't hurt as much as the one for my gall bladder surgery a couple years ago, I was off to the operating room which consisted of something akin to a massage table next to a mini MRI machine.

I had expected to have been knocked out for the procedure, but was fully awake, and while the pin-like pricks in my back weren't painful, they didn't last but a minute.

I was in and out of "surgery" for not much longer than fifteen minutes.

Of course, I also expected my arm pain to cease immediately, but was told it might take a week or two.

Lovely. Two more weeks of agonizing arm pain, making it downright impossible to type, let along drive due to the cocktail of Diazepam and Lortab. And this morning, I awoke with not a pain in my arm, but Princess barking at the closed bedroom door "asking" to be let out.

Stumbling towards the door, tripping over Marilee's recliner, and an awkwardly-placed pillow, thus began the three-dog-one-human march down the stairs.

THAT was more stumble than march since the lovely drugs intended to calm me a bit apparently haven't left my body yet.

Dogs have now been let out, and thought I'd blog a bit before returning to bed.

And have just remembered one of the "possible" side effects of the procedure - blurred vision, and my hunting and pecking is a bit offf.

HAVING TROUBLE TYPING. Not that I ever learned, mind you; I don't know a home row from a throw rug, and those little nubbins on the 'F' and 'J' leys get in the way. Not to mention the eraser-stick smack dab in the middle of the two.

Have had to re-read everything I've typed thus far, and it's taking far longer to type this than usual, and am adding extra characters all over the place.

And just glanced at the clock - it's taken me a full forty-five minutes to type this little enrty.

Methinks I need to get back to peaceful slumber to sleep off what the hell ever it is that's still in my veins.

Except for the cortisone - THAT can stay for a while.

Taking A Break

I'm off work this week, but I'd rather it would be for more pleasurable pursuits.

My prescriptive cocktail currently consists of Ibuprofen, Diazepam, and Lortab; individually, they do nothing for the pain in my arm, but combined, they do wonders for the pain caused by a multitude of pinched nerves in my neck.

As such, I cannot drive and thus do my daily work routine.

And so as to not exacerbate anything that may b e going on in my arm as a result, I'm taking a break from blogging as it is too painful to sit with my arms extended,

Prepare for a barrage of topics in the next week or so...

♫ Make The Pain Go Away ♫

Hopefully, the little musical notes will translate well into the title of this post.

Had my MRI done last Wednesday. While the procedure itself wasn't painful, the laying motionless for twenty-five minutes was excruciating.

And Friday was the the follow-up consultation.

I'd type more just now, but it is far too painful to type.

More later.