I woke up with a shart.
Not exactly woke up with, but soon after.
…In the middle of the first cup of coffee I’ve had in days.
Lying in bed, dallying with my 35 year old, much loved, many times broken and repaired porcelain coffee cup, made special for me by my dear departed daddy-o, sipping strong Cafe Bustelo made in my simple Melita single cup red plastic drip cone. Very strong.
It began the way most farts begin. But it didn’t stop there.
Fortunate that I had my favorite lounge pants on, and that they are black, and that I have a handy clothes pole in my rig where they now hang, dripping dry after a wash-out in the bathroom sink.
I am disappointed. This morning bulges with plans unfulfilled. It was to be the second in a series of unparalleled good days.
Yesterday, I wasted about two weeks worth of energy that I didn’t have, but took a mortgage on my future and went ahead with something wasteful in every way.
I have held off writing about this whole balagan (Hebrew for “wretched mess”) with the cardiologist, simply because it’s too boring to think about, and certainly too boring to write about. I’m feeling sleepy.
B’kitsur (in short): I have been experiencing episodes of inflammation in my veins, on and off for a year. Since I must have the torn cartilage in my left wrist surgically repaired, it is now relevant to discover whether this vein issue presents any additional surgical risk. I was sent to a cardiologist who supposedly specializes in veins, to find out.
This cardiologist did not seem at all interested in my veins or anything else. Oh yes: he is interested in tests. Every kind of test that is high tech and expensive, he is interested in. I believe he might be a little bit interested in money, too.
Last week I endured three kinds of cardiac echo tests, performed by a male technologist whose pinky finger seemed to be using my bare left nipple as a place marker as he worked the echo probe on my heart; at least I hope that is what he was doing. It hugely triggered my rape survivor PTSD, and I dissociated, leaving him alone with my left nipple.
The next part of the balagan was a stress echo, where they do a regular echocardiogram, then hook you up to a 12-lead EKG (they hook you up real good: instead of merely slapping the sticky EKG leads on, they first scrub you down with alcohol and then sandpaper your skin without asking first whether it’s OK or whether you have any skin conditions, then they stick the leads on your abraded skin without looking to see whether you’re already bleeding) and put you on a treadmill. You take two or three steps at a normal pace, then suddenly and without warning, they turn up both the pace and the angle, so that you have to trot to keep up; and suddenly your legs feel like they’re going to fall right off and you tell them that; so instead of simply slowing the treadmill down, they stop it suddenly, so you DO fall down. Then they drag you bodily onto the echo table and do the “post exercise” scan, which of course is invalid because your heart rate didn’t reach the target 85% of maximum. Shit, I could have told them that.
Now, you must understand that this represents all of what I hate in modern medicine. Not all. That comes later. Most.
Thing One: This test should have been scuttled. Medicare should never have been billed for an inadequate exam. It’s like billing for a blood test where the quantity was not sufficient to test. And yet it was billed. Is this fraud, or merely bad practice? I’m thinking.
Thing two: When I saw the cardiologist in follow-up for this inadequate test, he never really questioned why I was unable to exercise, even though I have been complaining and complaining and complaining of exercise intolerance to anyone and EVERYONE, including himself.
Instead of talking this through with me, he went ahead and ordered a NUCLEAR stress test. NUCLEAR!
How effing much are they billing Medicare for that one? Cheeziz K. Reist** on a bicycle, I can’t even imagine. 4K? At least. With whipped cream and a cherry on top. No nuts, thank you, they get in my teeth.
The nuclear balagan began yesterday afternoon, following the first decent morning I’ve had in weeks. The heat has killed my already overheated constitution. My weight is plummeting, since anything heavier than clear liquids leads to hours of belly pain and retching.
So it stands to reason that on the first morning that I pop out of bed at 0630 feeling rested and ready to engage with the world, I must fast, because fast I must if I am to get this nuclear test behind me.
So I fritter the day away drinking sugary liquids so I won’t get any more hypoglycemic than I already am. I check my pup into an air conditioned kennel at the vet for the afternoon, and check myself into the diagnostic cardiology lab again.
I am relieved to find that the tech with the heat-seeking pinky has been replaced with a robot who scores very high on the Spectrum, but behaves well and doesn’t give me any shit about using the special tape I brought to secure the IV: special tape that does not rip my skin off. He gets the IV in on the first try, painlessly, in my only good vein. I love him.
I’m injected with Technetium 99, the radioactive isotope that the gamma camera will read, to make pictures of my heart at rest. I’m given my first Chinese Water Torture huge cup of water to gulp, which expands my circulating blood volume. They want to get the isotope into my heart muscle and cardiac vessels.
The gamma camera scanner is claustrophobic and cold. I dissociate.
Next thing is the injection through the IV of some stuff that dilates all of my blood vessels very suddenly. It’s a good thing I’m lying down already, since my blood pressure plummets from 130/85 to 90/60, which is officially the territory of circulatory shock. It felt very weird. I decided not to dissociate for a bit, knowing that I could at any time. I kind of dug feeling how it felt, the weirdness of it all. I stayed present for it.
Now they wanted me to eat a high fat snack, to help open up my circulation and get things running. Fortunately I had just such a thing in my backpack. They did have snacks there, but all of them contained gluten. That’s why I always bring my own food, anywhere and everywhere. You can never tell.
After another giant cup of water and two radioactive trips to the bathroom, I went back into the scanner, this time with leads on. The EKG would coordinate the camera to pick up on the various phases of contraction and relaxation of my heart. Cool.
So that’s done. Very nice. Except for the couple of PVC’s (Premature Ventricular Contractions) that I had, which are nonspecific and most likely benign, I am sure that this will be a normal study.
And I think I remember signing a “Medicare balance billing” agreement, which means that anything Medicare doesn’t pay for, I get to pay for.
Worse, this whole balagan has snowballed from: why does this person have recurrent vein inflammation? into a whole high tech cardiac workup.
Medicine has got itself into a very sad situation.
I’m crushed to see my formerly noble profession sink so low.
I remember babbling to the tech who did the vasodilating torture test (they swapped him out for the robot for this part), about how any doctor who knew her salt could do everything she needed with a stethoscope, an otoscope, ophthalmoscope, tuning fork, some straight pins, and a few basic lab tests, five working senses, and a working sixth sense. Your basic Black Bag.
He said yeah, I know, right? That’s what they do in the third world.
I’m like, yeah, right? What are you gonna do when the grid goes down?
Meanwhile back at the low tech ranch, I’ve been forcing myself to stay inside my body when I’m out walking The Doggess. It’s been worthwhile.
I notice that while I do get out of breath, the limiting factor is that after a few minutes both my thighs and my calves start to feel like wood. If I don’t slow down or stop for a few minutes, my legs just absolutely stop me. I just can’t go no further. Nothing doing.
And so [n.b., one is never to begin a sentence with “and so”], what is your diagnosis, Doctor? (Physician, heal thyself…if you can tell me who said that, you get a prize!)
Hie thee to the medical literature. Ah, there ’tis! What ill manner of bodily curse is’t? Fie, Doctor! Take it off me now! What, cans’t? Nay.
It is: Neural claudication.
“Claudication” happens when, for one reason or another, arteries experience spasms in response to increased oxygen demands, such as exercise or digestion. When this affects the heart, we use the term angina. When speaking of arteries downstream from the heart, such as the legs or abdominal arteries, we say claudication.
The most common cause of claudication is atherosclerosis, and the most common cause of atherosclerosis is smoking. Second most common, diabetes. I don’t smoke and I’m not diabetic.
Move down one notch on the algorithm.
Next cause: neurogenic. Degenerative Disc Disease, long-standing. Yup, got that. Description. Yup, got that. What to do about it: um, let’s see. Whole spine decompression and fixation? Hmmm, let me think about that for a while.
In the meantime, I have my explanation for the most recent annoying symptom on the list: my right thigh goes into a cramp when driving in traffic, or anytime I can’t use the cruise control. Claudication! And it didn’t cost Medicare a thing!
Dammit, is there a doctor in the house?!
Getting back to the shart thing:
Last evening, having completed all of the cardiac testing I intend to have in this life, I collected my ebullient pup from the vet and returned to my tiny-but-it’s-got-a-plugin camping spot. Had a few larfs with a kindred soul at the far end of the campground, went to bed with high hopes for today. Woke up feeling pretty good, made coffee and a gluten free muffin…whoops, the Crohn’s monster swooped in and snatched another day. Oh well, let it go, let it go, let it go. What’s the hurry? Where’s the fire?
In my guts, is where the fire is.
**Dear R. Crumb, thank you for bringing Cheeses K. Reist into the world. Cheeziz is his great-grand-nephew, seven times removed.