Ever since my orthopedist told me to ditch the Xarelto, and I decided to ignore him, I've been meaning to schedule an actual follow-up appointment with my husband's PCP to, I don't know, discuss a plan? Although I informally consulted several other medical professionals regarding their thoughts on continuing Xarelto despite improvement in my DVT, and all agreed on a minimum of three months, I never got a formal opinion. I figured that at the very least, I would need my husband's doctor to write a script for my Xarelto, since I could hardly ask my orthopedist to renew it after he told me to stop taking it. I just hadn't gotten around to it yet, mostly because I'm not out of Xarelto yet. (Thank you, drug reps, for free samples. :))
However, I saw my husband's doctor this morning, because I have been hideously sick for 10 days now and finally realized that I was getting worse, not better. On Monday, after a week of constant nose blowing + the Xarelto, the blood vessels in my nose finally rebelled, causing The Mother Of All Nosebleeds, at least in my adult life. (I've had worse as a child; one time the bleeding required having all the blood sucked out of my nose and then having my nostril cauterized.) Anyway, my husband texted Dr. A last night to see if he was seeing patients today, and if so, if he could squeeze me in. Since my husband took the day off and the kids don't have school, we
slept in this morning (although, due to my coughing, I'm not sure either
one of us has actually slept for real in several days). We both 'woke
up' around 7:30, at which point my husband checked his phone and told me
Dr. A would see me 8:30. It turns out that Dr. A was not actually seeing patients today, but agreed to squeeze me in between paperwork. I only later found out that my husband's text was: My wife has a marriage-ending cough. Is there any way you can see her tomorrow? LOL.
Since Dr. A was doing me a huuuuuuge favor, I decided it would not be an appropriate time to bring up the blood clot. However, he brought it up on his own. (I used to see his PA, who has now moved, so he has all my records.) After diagnosing me with having 'The Crap,' he asked how my right leg was doing. I launched into an abridged version of the saga, and he reiterated that while he did not want to insult anyone, according to his training, I should be on Xarelto for six months, at which point we should do another ultrasound. He also thought that it might not be a bad idea to have a lab workup of my blood done, just to make sure I don't have any clotting disorders or anything funky, and we can also check cholesterol and all that fun stuff. Since I can't have that done while on Xarelto, we should schedule that for approximately two weeks after I stop taking it. That means sometime in February. He asked me if my orthopedist had told me why he thought it was a good idea for me to stop taking Xarelto and I told him I got the feeling my orthopedist just wanted me to go away already.
Finally, he asked me how my hip was, and I told him it felt pretty much the same as it did before the surgery, and added that I thought I might need a new orthopedist. He said labrums were notoriously finicky, then asked if I'd had an arthrogram of my hip, with contrast dye. I told him I hadn't, and he said in his experience, straight up MRIs weren't that useful for hips - and added, 'I don't mean any offense to anyone.' The funny thing is that it is his former PA, Sarah, who ordered the MRI, which I told him. I didn't say it in an obnoxious way, just an FYI way. He semi-frowned, then flipped through my records, and pulled up a page with a sticky note on it, and said, 'Yup, here it is.' Then he read the sticky note out loud to me - apparently a note he had written: Sarah - an MRI for a hip is of limited usefulness without contrast dye. LOL. OOPS. I do miss Sarah, though, even if she didn't order the dye.
At any rate, he was very prompt and very thorough, and spent about 20 minutes with me, which I really appreciate considering he was seeing me on a day when he wasn't even seeing patients, and I'm not even really his patient. I finally understood why my husband likes this guy so much. Yesterday, when I was at the pediatrician's with my daughter for her annual checkup, I was thinking how funny it is that almost all of our primary care providers are old-school doctors - as I've told my husband before, old white men. Ha. These are usually solo practitioners who still do things like give out their home phone numbers and do house calls. They don't have fancy patient portals, and when you pay them, you actually write a check out to them and send it to their physical address, and not some place in Phoenix or Chicago. I've calculated that our pediatrician must be almost the same age as my long-dead grandparents, and I dread the day when he retires (or dies), because he is just fabulous, and I love him. (The pediatrician we had before him was the same way, and he did retire.) I think part of why it's so hard for me to deal with orthopedists is because they are, like, the opposite of the old-school style I'm drawn to. It is the huge corporation versus the mom and pop corner store. Interestingly, our old pediatrician once saw me limping when I brought my daughter in and wanted to know what was wrong. At the time, I was having a lot knee pain, so he referred me to one of his orthopedist friends, a solo practitioner orthopedist. (You just don't see many of those anymore.) I remember being shocked when the orthopedist himself came out into the waiting room to get me - no nurse or MA, just him. He was fabulous, but unfortunately, like most other doctors of this type, he is retired. Now, don't get me wrong, I appreciate the modern techniques and know-how of the orthopedists in the Gigantic Orthopedic Conglomerates, and I understand that no one hopes for a long-term relationship with an orthopedist the way they might hope for a long-term relationship with a primary care provider. At the same time, I could not help but note the stark contrast between my time spent with Dr. A and the time spent with my orthopedist. While modern orthopedic techniques are indeed amazing, it seems like throwing in a little bit of old-fashioned medicine might go a long way.
Wednesday, November 26, 2014
Sunday, November 16, 2014
Food for Thought (18 Weeks + 6 Days)
Like most of the country, we have been in a cold snap for the past week. And not just cold, but really cold, for here anyway. I've been worried about walking around on slippery sidewalks and just the cold weather in general. But... oddly enough, my hips seem to enjoy the cold weather. Maybe it's like they are being constantly iced, LOL. At any rate, they've actually been feeling quite good since I last wrote. Weird. But weird in a good way, right?
In other news, due to the cold weather, I've been spending more time on the Internet than usual, trolling random blogs related to random (and sometimes not so random) topics that are of interest to me. I'm in the midst of having what may or may not be an 'aha' moment, but is interesting to note regardless of whether it's relevant or not. In reading other hip blogs, I've noticed that several of them are by people who have hip problems due to Ehlers-Danlos syndrome (EDS), which is a connective tissue/collagen disorder. There are several types of EDS, of which the mildest is Type III - hypermobility syndrome. The reason this sticks in my mind is because my daughter has actually been diagnosed with EDS - Type III. It was a long time ago, and at the time, we had so many other things going on with her that I never really thought twice about it. In fact, I went back and read my journal from the visit that we had with the geneticist who diagnosed her, and I didn't even write about that diagnosis. And apparently we even had a follow-up with the doctor that I didn't even find worthy of a journal entry. However, a few days ago, I was cleaning out my file cabinet and came across a folder full of medical reports from when my daughter was young. The doctor wrote: Given N's personal and family history of hypermobility, I diagnosed her with Ehlers-Danlos syndrome type III, otherwise known as benign hypermobility syndrome. I believe this to be the cause of a significant portion of her motor development delay... I would like N to be seen by a pediatric neurologist to try to differentiate any hypotonia from her extreme joint hypermobility.
There are a couple reasons I didn't think much of the EDS diagnosis, one of those being that the doctor didn't make a big deal about it. The other reason is because I'm not sure I really believed her. EDS - Type III is inherited in an autosomal dominant manner, which means that either I or my husband would have to have it to pass it down. And since the question of whether either I or my husband had EDS didn't come up, I guess I just figured the doctor was just sort of making stuff up, ha ha. Now, I guess on some level I realize that you don't get to be a pediatric geneticist at a reputable research hospital if you are in the habit of making stuff up, but at the same time, there were many other concerns on the table at the time, obviously the least of which was EDS. At the same time, it's not as if I've had such awesome experiences with doctors that I believe everything they tell me, and in my experience, most people's understanding of basic science is so limited, it has made a lot of health care providers lazy about their medical knowledge, or at least how they convey that knowledge. Another consideration is that mutations can arise de novo (meaning neither my husband nor I would have to have the condition), and in fact my daughter does have a de novo chromosomal duplication. So that is always a possibility.
On the other hand, now that I think about it, it is absolutely not out of the question that I might also this condition. What actually got me thinking about it was the fact the one of the blogs I stumbled across was a teenage girl with hip pain. She had a couple of failed hip surgeries, which is what actually led to the diagnosis of EDS; because of EDS, her tendons and ligaments were too lax to keep the joint in place after surgery. It is also worth noting that because EDS is due to a collagen defect, and collagen is present throughout the body, EDS is associated with other issues, notably with the heart and the GI tract. My daughter does have some heart issues (which actually baffled the pediatric cardiologist we saw) and GI issues (which a pediatric gastroenterologist said 'to keep an eye on'), and I also have heart and GI issues I have never really pursued, just because these are hard things to pursue when you barely ever go to the doctor. LOL.
At any rate, it is some interesting food for thought.
* * * * *
FYI, here were my impressions after our first visit to the pediatric geneticist:
April 14, 2007
Our meeting with the pediatric geneticist was mostly, as I suspected it would be, uninformative. However, it was much less torturous than I expected it to be, which was a pleasant surprise. I've never been to a research hospital before, which I realize is a good thing, because most of the people there are in a sorry condition. (...)
I have to admit it was really nice, though. The waiting room was like no other waiting room I've ever been in. It was enormous, with lovely toys for kids of all ages. The only other people in the room were two grad students (I presume) trying to recruit children for a study on memory. Our appointment was at 1:00, and when the clock ticked past 1:00 and we still hadn't been called in, I was annoyed considering they had emphasized the importance of us getting there early. However, we got in around 1:10, which I suppose isn't too bad. (Our ped's view on making people wait for appointments is that it is a form of 'medical arrogance.')
At 1:10, a girl wearing jeans and a t-shirt took N in and did all the standard poking, prodding, and measuring, then we went and waited for Dr. K for another five minutes. I had no image in my mind of what a pediatric geneticist MD would be like, but I was still definitely surprised when the doctor came in. First of all, Dr. K was, like, my age (literally, as it turns out), and secondly, she was wearing a fancy Chinese-ish looking shirt and nice slacks.
And sandals. Which I wouldn't have noticed, because, after all, who notices a man's shoes? (from 'The Shawshank Redemption') But the first thing she did was apologize, saying she was feeling very self-conscious today. She went on to explain that she liked these sandals so much she bought them in both black and brown. It was dark when she got dressed, and she ended up with one black and one brown. Then she sat down on the examining table with her legs crossed, rummaged through a fancy, Chinese-ish looking handbag (she was not Chinese, but a white farm girl), and pulled out a piece of paper.
Then she commenced taking a family history, first from me, then from E. Mine took all of one minute. I told her I was healthy and had no problems other than having hemoglobin E. Then she asked about my family and I told her I had two brothers, but that we were not genetically related. And that was the end of that. Then it was E's turn. The abridged version of the medical problems in E's family took about 30 minutes. N was tearing around the room the whole time, going back and forth from me to E to me, climbing on the chairs, pulling at the blinds, playing with the sink, and pushing the doctor's chair all over. Finally she demanded to be picked up by Dr. K, which is completely different from how she is with [our normal ped] (screaming hysterically and clinging to me from the minute he walks in the door). Dr. K decided this would be a good time to start her examination.
The very first thing she noticed was her ears, which is funny because we've always joked about how her ears stick out, never realizing that there could be a medical significance. But apparently sticking out ears can be a sign of muscle weakness. Obviously some people's ears just stick out, but since neither mine nor E's do, N's ears are suspect. In fact, Dr. K said her ears are classic 'Charcot' ears, which I recognized as being 'Charcot-Marie-Tooth' disease, although I couldn't remember what it was. However, she didn't seem too concerned because apparently the rest of her did not look 'Charcot.' (Although, I have to say, once I got home and Googled Charcot-Marie-Tooth, I started to wonder.)
After further examination, she exclaimed that N was the most flexible human she had ever seen, which isn't surprising, because she's been practicing for, what, six months? LOL. We've always thought it's logical that N is flexible, because both E and I are extremely flexible, and so N is Ridiculously Flexible. Dr. K said the delays in her gross motor development could definitely be due to the extreme laxity in her joints, especially since her fine motor skills were on par with what they should be for an almost 17-month-old. She also said that her muscle tone was good, which it wouldn't be if she were hypotonic, noting that flexibility concerns the connective tissue, whereas hypotonia concerns the muscles. However, she couldn't rule out that there was something wrong with her muscularly because of her ears and her problems swallowing.
She said that N needed to be evaluated by a speech and swallowing specialist before she could make any decisions about what sort of testing, if any, we should have done. She said it could be that her swallowing problems were unrelated to the gross motor development delays; maybe they were neurological. She also said that even if she had no muscular problems, she could still benefit from physical therapy, so we should have a physical therapist work with her, too.
(...)
Overall it was a good appointment, even though it just confirmed some of the things that we've thought all along. We're going to get a PT referral from [our ped], then go back to see Dr. K in two months. At that point she'll decide if there any genetic tests we should have done. She said if she was going to have N poked, she wanted to make sure she got all the tests done that she wanted, and she didn't want to do tests just to do them, which I appreciate.
Mostly it's a relief, because I was kind of worried that a specialist might take one look at N and say, 'Oh yes, it's obviously such and such' (kind of like the Charcot ears, which would have never occurred to me). But she didn't. She didn't seem overly concerned, which is logical because I'm sure that she sees many kids in much worse shape than N, but still. She didn't seem to think she had any sort of alarming condition and didn't even bring up muscular dystrophy or spinal muscular atrophy, which are the things we were initially concerned about. In fact, she didn't even bat an eye at N's above normal CPK levels.
I'm sitting in a café right now; I'm supposed to be working on a take-home exam, but instead I just spent an hour writing this entry. Ironically, a woman who just had a baby came in. I heard her telling the girl behind the counter that the labor had been very difficult, she had ended up having an emergency hysterectomy, and her daughter (now seven weeks) was still in the hospital. However, she seemed so upbeat and factual about it as she recounted the story. Oh the trials of parenthood. You don't stay strong by choice, you stay strong because you have to.
In other news, due to the cold weather, I've been spending more time on the Internet than usual, trolling random blogs related to random (and sometimes not so random) topics that are of interest to me. I'm in the midst of having what may or may not be an 'aha' moment, but is interesting to note regardless of whether it's relevant or not. In reading other hip blogs, I've noticed that several of them are by people who have hip problems due to Ehlers-Danlos syndrome (EDS), which is a connective tissue/collagen disorder. There are several types of EDS, of which the mildest is Type III - hypermobility syndrome. The reason this sticks in my mind is because my daughter has actually been diagnosed with EDS - Type III. It was a long time ago, and at the time, we had so many other things going on with her that I never really thought twice about it. In fact, I went back and read my journal from the visit that we had with the geneticist who diagnosed her, and I didn't even write about that diagnosis. And apparently we even had a follow-up with the doctor that I didn't even find worthy of a journal entry. However, a few days ago, I was cleaning out my file cabinet and came across a folder full of medical reports from when my daughter was young. The doctor wrote: Given N's personal and family history of hypermobility, I diagnosed her with Ehlers-Danlos syndrome type III, otherwise known as benign hypermobility syndrome. I believe this to be the cause of a significant portion of her motor development delay... I would like N to be seen by a pediatric neurologist to try to differentiate any hypotonia from her extreme joint hypermobility.
There are a couple reasons I didn't think much of the EDS diagnosis, one of those being that the doctor didn't make a big deal about it. The other reason is because I'm not sure I really believed her. EDS - Type III is inherited in an autosomal dominant manner, which means that either I or my husband would have to have it to pass it down. And since the question of whether either I or my husband had EDS didn't come up, I guess I just figured the doctor was just sort of making stuff up, ha ha. Now, I guess on some level I realize that you don't get to be a pediatric geneticist at a reputable research hospital if you are in the habit of making stuff up, but at the same time, there were many other concerns on the table at the time, obviously the least of which was EDS. At the same time, it's not as if I've had such awesome experiences with doctors that I believe everything they tell me, and in my experience, most people's understanding of basic science is so limited, it has made a lot of health care providers lazy about their medical knowledge, or at least how they convey that knowledge. Another consideration is that mutations can arise de novo (meaning neither my husband nor I would have to have the condition), and in fact my daughter does have a de novo chromosomal duplication. So that is always a possibility.
On the other hand, now that I think about it, it is absolutely not out of the question that I might also this condition. What actually got me thinking about it was the fact the one of the blogs I stumbled across was a teenage girl with hip pain. She had a couple of failed hip surgeries, which is what actually led to the diagnosis of EDS; because of EDS, her tendons and ligaments were too lax to keep the joint in place after surgery. It is also worth noting that because EDS is due to a collagen defect, and collagen is present throughout the body, EDS is associated with other issues, notably with the heart and the GI tract. My daughter does have some heart issues (which actually baffled the pediatric cardiologist we saw) and GI issues (which a pediatric gastroenterologist said 'to keep an eye on'), and I also have heart and GI issues I have never really pursued, just because these are hard things to pursue when you barely ever go to the doctor. LOL.
At any rate, it is some interesting food for thought.
* * * * *
FYI, here were my impressions after our first visit to the pediatric geneticist:
April 14, 2007
Our meeting with the pediatric geneticist was mostly, as I suspected it would be, uninformative. However, it was much less torturous than I expected it to be, which was a pleasant surprise. I've never been to a research hospital before, which I realize is a good thing, because most of the people there are in a sorry condition. (...)
I have to admit it was really nice, though. The waiting room was like no other waiting room I've ever been in. It was enormous, with lovely toys for kids of all ages. The only other people in the room were two grad students (I presume) trying to recruit children for a study on memory. Our appointment was at 1:00, and when the clock ticked past 1:00 and we still hadn't been called in, I was annoyed considering they had emphasized the importance of us getting there early. However, we got in around 1:10, which I suppose isn't too bad. (Our ped's view on making people wait for appointments is that it is a form of 'medical arrogance.')
At 1:10, a girl wearing jeans and a t-shirt took N in and did all the standard poking, prodding, and measuring, then we went and waited for Dr. K for another five minutes. I had no image in my mind of what a pediatric geneticist MD would be like, but I was still definitely surprised when the doctor came in. First of all, Dr. K was, like, my age (literally, as it turns out), and secondly, she was wearing a fancy Chinese-ish looking shirt and nice slacks.
And sandals. Which I wouldn't have noticed, because, after all, who notices a man's shoes? (from 'The Shawshank Redemption') But the first thing she did was apologize, saying she was feeling very self-conscious today. She went on to explain that she liked these sandals so much she bought them in both black and brown. It was dark when she got dressed, and she ended up with one black and one brown. Then she sat down on the examining table with her legs crossed, rummaged through a fancy, Chinese-ish looking handbag (she was not Chinese, but a white farm girl), and pulled out a piece of paper.
Then she commenced taking a family history, first from me, then from E. Mine took all of one minute. I told her I was healthy and had no problems other than having hemoglobin E. Then she asked about my family and I told her I had two brothers, but that we were not genetically related. And that was the end of that. Then it was E's turn. The abridged version of the medical problems in E's family took about 30 minutes. N was tearing around the room the whole time, going back and forth from me to E to me, climbing on the chairs, pulling at the blinds, playing with the sink, and pushing the doctor's chair all over. Finally she demanded to be picked up by Dr. K, which is completely different from how she is with [our normal ped] (screaming hysterically and clinging to me from the minute he walks in the door). Dr. K decided this would be a good time to start her examination.
The very first thing she noticed was her ears, which is funny because we've always joked about how her ears stick out, never realizing that there could be a medical significance. But apparently sticking out ears can be a sign of muscle weakness. Obviously some people's ears just stick out, but since neither mine nor E's do, N's ears are suspect. In fact, Dr. K said her ears are classic 'Charcot' ears, which I recognized as being 'Charcot-Marie-Tooth' disease, although I couldn't remember what it was. However, she didn't seem too concerned because apparently the rest of her did not look 'Charcot.' (Although, I have to say, once I got home and Googled Charcot-Marie-Tooth, I started to wonder.)
After further examination, she exclaimed that N was the most flexible human she had ever seen, which isn't surprising, because she's been practicing for, what, six months? LOL. We've always thought it's logical that N is flexible, because both E and I are extremely flexible, and so N is Ridiculously Flexible. Dr. K said the delays in her gross motor development could definitely be due to the extreme laxity in her joints, especially since her fine motor skills were on par with what they should be for an almost 17-month-old. She also said that her muscle tone was good, which it wouldn't be if she were hypotonic, noting that flexibility concerns the connective tissue, whereas hypotonia concerns the muscles. However, she couldn't rule out that there was something wrong with her muscularly because of her ears and her problems swallowing.
She said that N needed to be evaluated by a speech and swallowing specialist before she could make any decisions about what sort of testing, if any, we should have done. She said it could be that her swallowing problems were unrelated to the gross motor development delays; maybe they were neurological. She also said that even if she had no muscular problems, she could still benefit from physical therapy, so we should have a physical therapist work with her, too.
(...)
Overall it was a good appointment, even though it just confirmed some of the things that we've thought all along. We're going to get a PT referral from [our ped], then go back to see Dr. K in two months. At that point she'll decide if there any genetic tests we should have done. She said if she was going to have N poked, she wanted to make sure she got all the tests done that she wanted, and she didn't want to do tests just to do them, which I appreciate.
Mostly it's a relief, because I was kind of worried that a specialist might take one look at N and say, 'Oh yes, it's obviously such and such' (kind of like the Charcot ears, which would have never occurred to me). But she didn't. She didn't seem overly concerned, which is logical because I'm sure that she sees many kids in much worse shape than N, but still. She didn't seem to think she had any sort of alarming condition and didn't even bring up muscular dystrophy or spinal muscular atrophy, which are the things we were initially concerned about. In fact, she didn't even bat an eye at N's above normal CPK levels.
I'm sitting in a café right now; I'm supposed to be working on a take-home exam, but instead I just spent an hour writing this entry. Ironically, a woman who just had a baby came in. I heard her telling the girl behind the counter that the labor had been very difficult, she had ended up having an emergency hysterectomy, and her daughter (now seven weeks) was still in the hospital. However, she seemed so upbeat and factual about it as she recounted the story. Oh the trials of parenthood. You don't stay strong by choice, you stay strong because you have to.
Tuesday, November 11, 2014
The Weather Outside is Frightful (18 Weeks + 1 Day)
Just some facts, mostly for my own record:
- On Saturday, I rode my bike for the first time in over four months. It has been so long that I forgot which side the chain was on and rolled up my pant leg on the wrong side. I only rode about two miles total and walked about one mile total. My hip felt fine - or as fine as it ever feels.
- On Sunday, my hip started killing me - my muscles were super tight despite incessant stretching, and I also felt pain in the hip joint itself, especially when I made a concerted effort to stand with my weight distributed equally between both legs. I'm not sure if this was due to the bike riding (I can't think of why it would be) or just coincidence.
- This pain has not gone away.
- My back also hurts. A lot. I'm super bummed about this because one thing I noticed almost immediately after surgery was that my back felt really good. Of course, I wasn't walking at the time, but before surgery, as well as now, my back hurts even when I am just sitting or lying down.
- I started taking meloxicam again on Friday. I don't think it's helping. My orthopedist also gave me a script for naproxen along with the meloxicam. He said if the meloxicam didn't work then I should try the naproxen. Maybe I will.
- In trying to come up with explanations for why I suddenly feel so much worse, I've only come up with stopping the meloxicam and possibly the cortisone injection wearing off? Granted, I don't feel like the second cortisone injection actually helped, but maybe it did. Maybe I would have felt way worse without it, and now it's wearing off and I'm feeling, well, way worse.
- I fell down the stairs a few weeks ago. I mentioned that I have a fear of falling down stairs that isn't totally irrational, because I have actually fallen down stairs a few times, as have my kids. It was a pretty minor fall (hence why I never even wrote out it) - just the last two steps and I think I fell backwards. My quadriceps and my back were what hurt the next day, and the day after that, if I recall correctly. I sort of blew if off because I was actually on my way to my parents' house, and I was rushing - hence the fall. I didn't say anything to my mom about it because she is super annoying about how much she dislikes our house and how scary she thinks our stairs are, and I just didn't feel like listening to her go on and on about our stairs (not that I even disagree, but at a certain point you have to get over it). Anyway, I suppose it's possible the fall did some damage, although I doubt it. I feel like my hip should have started hurting sooner if that were the cause of my current pain, but what do I know.
- It is snowing out. The sidewalks are very slippery. This is a little scary.
Friday, November 7, 2014
Book Club on Thursday, Orthopedist on Friday (17 Weeks + 4 Days)
Exactly four months post-surgery
As has become the norm for the past three months, I had book club on Thursday followed by an appointment with my orthopedist on Friday. I wasn't looking forward to the appointment after my display of jerkiness a few weeks ago, plus I knew that nothing would come of the appointment, so I should have just canceled it. But... I didn't. I could have just said I was sorry for the nastygram, but I just couldn't bring myself to apologize because I'm not exactly sorry. I sent multiple polite e-mails requesting follow up communication, and that didn't work, so I felt like I had no choice, other than to just sit around for months with no follow up, which IMHO is Not Okay. I guess I have pretty high expectations when it comes to communication. I spend a few hours a day responding to e-mails, mostly from students, which is important when face-to-face time is limited. Sometimes they don't like my response to them, but... I do always respond, usually within a few hours, and with very few exceptions, almost always within 24 hours.
Anyway, no one said anything about my nastygram, and everyone was very pleasant and cordial. The orthopedist's MA seemed to be trying extra hard to be friendly. When we were walking back to the room, she started off by saying, 'I just have to warn you...' and I immediately thought Uh oh, then anticipated her saying something like, The doctor hates you. However, she was just warning me that she was super busy and hadn't cleaned the room yet, so she was going to need to clean it while I was sitting in there, which she thought would be better than keeping me out in the waiting room. Fortunately, 'cleaning' in an orthopedist's office consists of throwing away the paper that covers the examination table and pulling out more. LOL. She asked me how I was feeling, and I told her I was feeling much better. Then she sort of surprised me and asked if I thought I was actually feeling better or if I was just getting used to the pain, ha ha. I admitted there might be some of that, but that I did think I was genuinely feeling better. I said I had a period of a few weeks when I felt awesome, and I really thought this was finally OVER, but that over the past couple of weeks I've felt the pain creeping back. Nevertheless, I was pretty sure that I still felt better than I did at the last visit.
The MA apparently relayed this information to the orthopedist because when he came in he cheerfully declared, 'Rumor has it you're getting better!' I repeated the information to him, including the pain creeping back, to which he replied, 'No. No creeping is allowed.' LOL. Seriously, I love this guy's personality. It's hard to explain, but on some fundamental level, we really click, which is probably why I was stupid enough to let him operate on me. Even when I want to be really angry with him for being a douchebag of a doctor, I just can't stay mad. Plus, he never keeps me waiting, either, which is always a plus, and a very rare quality among orthopedists (in my experience). He then went through his usual spiel of most people feeling back to normal after three months, but for some people it's six months and others nine months, then just as I was telling him not to even mention the nine-month category to me, he added that hopefully I was in the six month category.
Then I got up onto the examination table so he could do his useless set of 'tests' on me. The MA had told me to put on a pair of those hideous exam shorts in case the doctor wanted to do some manipulations or whatever. I smiled and nodded my head and didn't bother changing, because I didn't feel like it and knew the doctor wasn't going to look that closely. (He has never even looked to see how the incisions healed except when he took the stitches out two weeks post-surgery.) However, he did comment on my shoes, asking me if they were Danskos. I said they were. Then he said he wore Danskos when he operated, and I replied that I didn't know they made Danskos for men. He said somewhat sheepishly that he definitely only wore them during surgery, otherwise he got weird looks. LOL. I told him I had started wearing them when I started teaching back-to-back anatomy labs for six hours straight and needed comfortable, closed-toe shoes. They are the shoes teachers and nurses, and apparently even male orthopedic surgeons, swear by.
Other than the shoe conversation - shoes must be his thing, as I remember him having a conversation about my mom's shoes prior to surgery - highlights include the following:
On my way out, I stopped by the PT room to say hello to my therapist. He said he had recently done a music gig (he is a professional musician by night) at the university. Interestingly, I attended an evening event at the university tonight and chatted with one of the music professors about my therapist. The professor mentioned that AJ was one of just three 'professional level' bass players in town and was sort of a 'go to' guy for jazz musicians. He seemed surprised that a professional musician could have such a respectable day job, much in the same way that my students seem surprised when they realize that a lot of university faculty have talents outside their narrow fields of study. It's all rather amusing when you think about it.
Also at the function tonight, I spent some time with a colleague/friend who had the same surgery I did, but two months after I did. She is now about two months post-surgery and told me that she basically doesn't have any pain at all, except on rare occasions when 'I do something stupid.' She really felt there must be something wrong for me to be having so much pain four months later. Hmmmmm.
And finally, I turn 40 on Sunday. I have so many mixed feelings about that. I feel like my 30s brought so many great things to my life, but I've heard that the 40s can be even better. So here is to what is likely to be my last post here as a 39-year-old. Cheers!
As has become the norm for the past three months, I had book club on Thursday followed by an appointment with my orthopedist on Friday. I wasn't looking forward to the appointment after my display of jerkiness a few weeks ago, plus I knew that nothing would come of the appointment, so I should have just canceled it. But... I didn't. I could have just said I was sorry for the nastygram, but I just couldn't bring myself to apologize because I'm not exactly sorry. I sent multiple polite e-mails requesting follow up communication, and that didn't work, so I felt like I had no choice, other than to just sit around for months with no follow up, which IMHO is Not Okay. I guess I have pretty high expectations when it comes to communication. I spend a few hours a day responding to e-mails, mostly from students, which is important when face-to-face time is limited. Sometimes they don't like my response to them, but... I do always respond, usually within a few hours, and with very few exceptions, almost always within 24 hours.
Anyway, no one said anything about my nastygram, and everyone was very pleasant and cordial. The orthopedist's MA seemed to be trying extra hard to be friendly. When we were walking back to the room, she started off by saying, 'I just have to warn you...' and I immediately thought Uh oh, then anticipated her saying something like, The doctor hates you. However, she was just warning me that she was super busy and hadn't cleaned the room yet, so she was going to need to clean it while I was sitting in there, which she thought would be better than keeping me out in the waiting room. Fortunately, 'cleaning' in an orthopedist's office consists of throwing away the paper that covers the examination table and pulling out more. LOL. She asked me how I was feeling, and I told her I was feeling much better. Then she sort of surprised me and asked if I thought I was actually feeling better or if I was just getting used to the pain, ha ha. I admitted there might be some of that, but that I did think I was genuinely feeling better. I said I had a period of a few weeks when I felt awesome, and I really thought this was finally OVER, but that over the past couple of weeks I've felt the pain creeping back. Nevertheless, I was pretty sure that I still felt better than I did at the last visit.
The MA apparently relayed this information to the orthopedist because when he came in he cheerfully declared, 'Rumor has it you're getting better!' I repeated the information to him, including the pain creeping back, to which he replied, 'No. No creeping is allowed.' LOL. Seriously, I love this guy's personality. It's hard to explain, but on some fundamental level, we really click, which is probably why I was stupid enough to let him operate on me. Even when I want to be really angry with him for being a douchebag of a doctor, I just can't stay mad. Plus, he never keeps me waiting, either, which is always a plus, and a very rare quality among orthopedists (in my experience). He then went through his usual spiel of most people feeling back to normal after three months, but for some people it's six months and others nine months, then just as I was telling him not to even mention the nine-month category to me, he added that hopefully I was in the six month category.
Then I got up onto the examination table so he could do his useless set of 'tests' on me. The MA had told me to put on a pair of those hideous exam shorts in case the doctor wanted to do some manipulations or whatever. I smiled and nodded my head and didn't bother changing, because I didn't feel like it and knew the doctor wasn't going to look that closely. (He has never even looked to see how the incisions healed except when he took the stitches out two weeks post-surgery.) However, he did comment on my shoes, asking me if they were Danskos. I said they were. Then he said he wore Danskos when he operated, and I replied that I didn't know they made Danskos for men. He said somewhat sheepishly that he definitely only wore them during surgery, otherwise he got weird looks. LOL. I told him I had started wearing them when I started teaching back-to-back anatomy labs for six hours straight and needed comfortable, closed-toe shoes. They are the shoes teachers and nurses, and apparently even male orthopedic surgeons, swear by.
Other than the shoe conversation - shoes must be his thing, as I remember him having a conversation about my mom's shoes prior to surgery - highlights include the following:
- My blood clot is much improved. My doctor apologized for taking a while to get back to me about it (which I appreciated), and then gave me a copy of the report from the radiologist. (He is getting to know me!) He said there was some residual clotting that might never go away (??) but that wasn't enough to keep me on the Xarelto (??) I sort of smiled and nodded my head and didn't mention I had gotten a second and third and fourth opinion about this.
FINDINGS: The common femoral vein and proximal and mid portions of the superficial femoral vein are normally compressible. In the distal SFV and extending through the popliteal vein, there is chronic thrombus, which causes the vein to be incompletely compressible. This is significantly improved compared to the previous exam. The calf veins are compressible, with no DVT present.
IMPRESSION: There is residual chronic thrombus in the distal superficial femoral vein and popliteal vein. There has been improvement compared to the previous venous ultrasound study from 8/8/2014.
- I have trochanteric bursitis in both hips, which I knew. Fortunately, it's not hurting terribly, and according to my doctor, it will magically and spontaneously resolve itself at some undisclosed date in the future. He did mention that we could do cortisone injections to help speed up the healing and when I vigorously shook my head no, he agreed that, 'Yeah, you've already had so many shots.' We also both agreed that going back to PT would not be helpful, as it's actually PT that caused the bursitis in my left hip in the first place, and it's actually feeling much better since I stopped PT. So, I'll just wait it out.
- When I go from sitting to standing, it hurts, just like it did before surgery (which is what worries me). Supposedly this will also magically and spontaneously resolve itself at some undisclosed date in the future.
- It still hurts when I flex my hip, although mostly only when I go up stairs, whereas before it hurt when I went down stairs as well. At least the sharp pains I used to have are gone, so that is a happy thing. My doctor said I have some tendonitis, but it seems to be in my sartorius, which is more lateral than the major hip flexors. Not that it really matters, because this too will magically and spontaneously resolve itself at some undisclosed date in the future.
- I will follow up in two months, at which point hopefully my pain will have magically and spontaneously resolved itself.
- There is so much to look forward to in the future. :)
- In writing this, I was trying to think of reasons that my pain seems to be returning, and it dawned on me that I stopped taking the meloxicam a while back because I was having GI issues. Since my GI issues seem to have at least gone dormant, I think I'm going to try taking the meloxicam again.
On my way out, I stopped by the PT room to say hello to my therapist. He said he had recently done a music gig (he is a professional musician by night) at the university. Interestingly, I attended an evening event at the university tonight and chatted with one of the music professors about my therapist. The professor mentioned that AJ was one of just three 'professional level' bass players in town and was sort of a 'go to' guy for jazz musicians. He seemed surprised that a professional musician could have such a respectable day job, much in the same way that my students seem surprised when they realize that a lot of university faculty have talents outside their narrow fields of study. It's all rather amusing when you think about it.
Also at the function tonight, I spent some time with a colleague/friend who had the same surgery I did, but two months after I did. She is now about two months post-surgery and told me that she basically doesn't have any pain at all, except on rare occasions when 'I do something stupid.' She really felt there must be something wrong for me to be having so much pain four months later. Hmmmmm.
And finally, I turn 40 on Sunday. I have so many mixed feelings about that. I feel like my 30s brought so many great things to my life, but I've heard that the 40s can be even better. So here is to what is likely to be my last post here as a 39-year-old. Cheers!
Tuesday, October 28, 2014
No News is Good News (16 Weeks + 1 Day)
I don't have a lot to say, and that is a GOOD thing. Very good!
- My hip still feels good! Given that I was feeling good the last time I saw my orthopedist, and that I'm still feeling good, I must be going on almost four weeks of feeling good. I still have low-level pain, and pain when I get up after sitting for a while (déjà vu all over again), but it is so much better than it has been, and even better than it was before surgery (um, finally). It seems sort of ridiculous to be excited over the fact that almost four months after surgery, I feel better than before the surgery, but, hey, whatever.
- Of all the things I've tried post-surgery, it seems like the best thing I've done for my hips is to stop physical therapy. (LOL - What's wrong with this picture?)
- My surgeon's MA called me last week, on Friday. My cell phone told me it was from ABC Orthopedics, which immediately made me nervous. It was my orthopedist's MA, who seems like a super sweet woman. I don't know if it's because she really cares a lot or if it's because it's her job to clean up after unresponsive orthopedists and she's just really good at her job, but either way, she's always super nice and seems extremely competent as well. I was relieved it was her and not my orthopedist (although who are we kidding - why would it be him?). She said she had gotten 'another e-mail' from me and went on to say that she was sorry my doctor hadn't responded to me, that she had given him my results, and said that she would have stayed on him if she knew he hadn't gotten back to me. Eventually I figured out that she was talking about the nastygram I sent on Tuesday, and I told her that my doctor had in fact gotten back to me. She seemed relieved, and when I told her, 'Yes, I finally worked a response out of him,' she laughed somewhat knowingly and said apologetically, 'I'm sorry you feel like we aren't taking care of you.' She actually sounded very sincere and not snarky or anything. Since I was at work and didn't really want to get into it with her (it's not her fault), plus I was shocked by her apology and didn't know how to respond, I just said, 'Oh, well, thank you for that,' and confirmed that I would see them on November 7th. And that was that.
- In other other news, I've been having some GI issues. I'll spare you the details. LOL. They started about two weeks ago after having sushi, which can always be a cause for concern - though I've never gotten sick from sushi, even sushi that I've eaten in a strip mall in Nevada. (I can't say the same for McDonald's.) However, since no one else in my family got sick, I ruled out the sushi. Of course my next concern was that it is the medication I'm on, as both the Xarelto and the meloxicam are causes for concern. And then there is always the concern that I'm just a hypochondriac, and the anxiety I cause myself by being a hypochondriac either causes or exacerbates symptoms I already have (which may be due to anxiety from hypochondria or 'real' reasons). I do have some experience with GI stuff, and GI stuff is tricky. Eventually I concluded that anxiety and hypochondria alone were unlikely to produce such nasty symptoms for so long. (In my experience, anxiety can produce pain, but not usually bleeding.) So, I stopped taking meloxicam on Friday because of concern over my GI tract, plus the fact that my hip is still feeling pretty good. I figured it would be a good test for my hip, and not taking meloxicam hasn't had any effect on my hip. Granted, it has also not had much of an effect on my GI tract, but I have to figure if it's having zero effect, good or bad, I might as well not take it.
- I've been feeling sort of crappy overall, so I added Vitamin D back in to my pill-taking regimen. So now instead of taking Xarelto + meloxicam in the morning, I take Xarelto + Vitamin D. So far it doesn't seem to be helping, when I subtract out the possible placebo effect. Which leads me back to my original diagnosis of anxiety and hypochondria. HA!
Wednesday, October 22, 2014
And the verdict is... (15 Weeks + 2 Days)
Okay, so 'verdict' is probably too strong of a word, but I did get an 'emergency' second opinion today (via husband via his doctor, who saw me for my DVT after I was treated in the ER). He and my husband actually have a text-each-other-regularly type of relationship. My husband recently had some routine lab work done as part of his annual physical, and he told me Dr. A just texted him the results telling him he was fine. Oh I'm so jealous.
Anyway. Dr. A stuck by his original suggestion, which was to take the Xarelto for six months. He hadn't looked at the report (because I'm not even his patient), but said that he would, but that it basically didn't matter. Six months, and he was going to stick with that. Add into that the fact that the clot isn't even gone - it's just 'better' (supposedly?) And even if it were gone, you continue taking the medication for a period after it's gone to make sure it stays gone.
And then he asked my husband, 'How do you hide a dollar from a surgeon?' (See answer below.)
On a related note, I was talking to a friend today who also has hip pain and has been taking meloxicam as well. I asked her if she was still taking it and she said no, her doctor told her she shouldn't take it for more than a month because it can cause heart problems if you take it for too long. WTF? I've now been taking it for two months. This made me seriously wonder if my orthopedist flunked pharmacology in med school! However, when I got home, I consulted Dr. Google, who didn't say anything about adverse long-term effects. In fact, Dr. Google told me that meloxicam is indicated to treat pain for rheumatoid and osteoarthritis, which makes me think it must be (relatively) safe long-term, given that these are permanent conditions. (???) Maybe this means my doctor isn't the only doctor out there who failed pharmacology in med school. LOL.
And by the way, the answer to my Dr. A's riddle: You put it in the patient's chart.
Anyway. Dr. A stuck by his original suggestion, which was to take the Xarelto for six months. He hadn't looked at the report (because I'm not even his patient), but said that he would, but that it basically didn't matter. Six months, and he was going to stick with that. Add into that the fact that the clot isn't even gone - it's just 'better' (supposedly?) And even if it were gone, you continue taking the medication for a period after it's gone to make sure it stays gone.
And then he asked my husband, 'How do you hide a dollar from a surgeon?' (See answer below.)
On a related note, I was talking to a friend today who also has hip pain and has been taking meloxicam as well. I asked her if she was still taking it and she said no, her doctor told her she shouldn't take it for more than a month because it can cause heart problems if you take it for too long. WTF? I've now been taking it for two months. This made me seriously wonder if my orthopedist flunked pharmacology in med school! However, when I got home, I consulted Dr. Google, who didn't say anything about adverse long-term effects. In fact, Dr. Google told me that meloxicam is indicated to treat pain for rheumatoid and osteoarthritis, which makes me think it must be (relatively) safe long-term, given that these are permanent conditions. (???) Maybe this means my doctor isn't the only doctor out there who failed pharmacology in med school. LOL.
And by the way, the answer to my Dr. A's riddle: You put it in the patient's chart.
A Ship without a Sail (15 Weeks + 1 Day)
This is not my proudest moment. But... sometimes you have to do what you have to do.
I feel like all I've done lately is bitch and bitch and bitch and piss and moan and bitch some more. Since I feel so overly negative, I've been trying to leave out a few details about my orthopedist that have been reallyfrustrating me pissing me off. Honestly, I try pretty hard to give people the benefit of the doubt, especially medical professionals. I can get along with most people, at least on a superficial level. And I've tried reeaaaaally hard to be positive about my orthopedist, who is a super nice guy, and who I really want to like. However, I've had a few concerns about him. Specifically, I don't have any confidence he knows how to handle DVT appropriately. Not that I know how, either, but based on everything that I've read and opinions from other medical professionals, I'm... unsure. And this is sort of a big deal - it's not like getting a bad opinion about a sore wrist; this is acute and extensive DVT, which can be really serious. I know that orthopedists don't really 'do' blood clots, but shouldn't they at least be... I dunno... proficient? Maybe he is and maybe I read too much shit on the Internet, but I do have my doubts.
Also, it's not just my lack of confidence in him, although that is obviously the biggest and most pressing issue. However, I'm also less than thrilled with his lack of responsiveness to the questions I've sent him via the patient portal, which claims that you will receive a response within two working days. Of course, he was extremely responsive to me pre-surgery and his medical assistant was very responsive for the first week post-surgery and then post-blood clot. But lately... no responses. And it's not as if I'm constantly sending him e-mails with huge demands or anything. After my September appointment, when he said that my labrum had not healed yet, I got to wondering if it was okay for me to be, like, doing stuff, if he thought my labrum was still torn. I mean, that's why he said I had to be on crutches for a freaking month - to let the labrum heal. I sent him a quick e-mail asking what type of activity level he would recommend. He never responded. After my last visit, I mentioned that he had only ordered an ultrasound on my calf and the back of my knee (which to be honest didn't give me much confidence that he's even paying any attention to what's going on). I sent him an e-mail making sure the ultrasound would be of my entire leg. (Hello! It is the clot in the femoral vein that has been the most distressing from the start!) I wasn't sure if it was necessary for the order to explicitly state this, especially since I was having the repeat ultrasound at the same location, but I didn't want to take any chances. He never responded. I took care of it myself. After my ultrasound a week ago, the tech told me that my orthopedist would have the report by the end of the day. My orthopedist had told me he would follow up once he had the results of the ultrasound. I had talked briefly to the tech, who knows stuff, but said that a radiologist would read the images and send an official report to my doctor. I gave my orthopedist a few days, then on Friday sent an e-mail asking if he could let me know the official results - i.e., prognosis? recommendations? He didn't respond. Not that I expected a response on Friday, but I gave him two business days before unleashing my fury on him today (Tuesday).
And unleash I did. As I said, I'm not proud of it, but man. Seriously? The title of my message was 'Can you please respond?' LOL. Given that the only time he has ever personally responded to any of my inquiries was pre-surgery (i.e., in the wooing phase), I was doubtful he even gets the e-mails. Or if he does get them, it seems doubtful he actually reads them, given his lack of response. I figured if anything, his MA reads them, and he only responds to the ones his worker bee can't handle. Perhaps when I composed my pissy e-mail I had it in my mind that no one was actually going to read it, given that there is no evidence that anyone does. I mean, I GET that orthopedists are busy. I GET being busy. I, too, am a busy lady. But, if you are that busy, then the patient portal should not be programmed to send an automated response that someone will get back to you within two business days if no one is actually going to (which I wrote in my pissy e-mail). Maybe I am a problem patient, but I really don't feel like I'm being that high maintenance with a few basic questions + one refill request for Xarelto within the past two months ( = four e-mails total - including the refill request and and my repeat request for my ultrasound results). It's not like I'm a Patient Portal Abuser. And the alternative to the patient portal is calling the office, waiting on hold for 10-15 minutes, getting the runaround, then being routed to an MA's voice mail (which I also wrote in my pissy e-mail). Who has time for that?
I know reports and e-mail are a huge time suck for health care providers, and trust me, I understand the time it takes to answer e-mails. I get (and respond to) many, many e-mails a day from students, and I'm aware that writing a report takes a lot of time. E-mail and reports do not seem to be my doctor's strong suit. Not that the latter really matters - after all, the whole idea of the patient having access to her/his reports is something that comes along with the patient portal, which as far as I know is a fairly recent invention. (For routine health care matters, we always seem to go for the solo practitioners, none of whom can afford this.) At any rate, since the patient portal seems to be mandatory for being a patient at this particular practice, it has been interesting for me to read the 'care summaries' the doctors write. Notably, my doctor never writes anything, except All of the patient's questions were answered and they state they understand and agree with the discussed treatment plan. They will follow up as planned, sooner if any problems. This must be some default option in the report-writing software. Interestingly, the only time my doctor has ever written anything other than this was after I had my second cortisone injection. The doctor who gave me the injection asked me what my doctor thought of my ongoing pain and I said I didn't have any idea what he was thinking. I noticed the report after that actually contained information. Word-for-word:
September 5, 2014: still having some sharp pains in her right hip. She has been going to physical therapy. She is still taking her Xarelto for her blood clot a 39-year-old female 2 months status post right hip arthroscopy with labral repair. At this time her hip has flared up and she states she would like to proceed with a intra-articular corticosteroid injection into her hip at this time. She states the Voltaren were not working for thus I will switch her over to meloxicam 15 mg once daily. She'll continue doing the physical therapy to help decrease her pain and improve her function. She'll continue taking her Xarelto also for one more month and we'll check an ultrasound of her right calf at that time I will see her back in 4 weeks' time to see how she is progressing. I do go she is frustrated with her progression but I did reassure I think that she will continue to improve we'll continue doing her physical therapy and try to improve her function and decrease her pain September 10, 2014: Patient here for right hip injection. she underwent a hip arthroscopy by Dr. Z. She says her pain now is worse than before the surgery. She is here for a repeat injection of her right hip joint.
(I'm so glad English composition is a requirement for most med schools!)
Anyway. Apparently my doctor does receive the e-mails through the patient portal, which actually makes it more unforgivable that he hasn't responded in the past. I sent my pissy e-mail close to 6:00 tonight. After putting the kids to bed and taking a shower, I came back downstairs and saw there was a message on our answering machine. The only people who call me after 8:00 PM are my mom, and lately, political campaigns, so I pressed the 'play' button on the answering machine while debating whether or not I had the energy to call my mom back at 8:30 on Tuesday night. I was shocked to discover that the message was from my orthopedist. WTF? I guess my pissy e-mail got through to him. I sort of feel bad about it, but sort of don't. For one, if he had just responded in a timely manner, there wouldn't have been a pissy e-mail in the first place. Also, as someone who works aaaaaalllll hours of the nights answering e-mails and grading, I'm hardly going to cry a river for someone making ten times more than I do who has to work outside the standard 8-5 business day.
(On a side note, I totally freaked a student out one time. I was up late grading assignments, which my students submit online, and I received a 'panicked' e-mail from a student claiming that she had submitted her assignment on time, but for some reason Blackboard was telling her that her assignment was late, and this was obviously a glitch on Blackboard, and she just wanted to make sure she wasn't penalized for this. I immediately shot her an e-mail back - around 1:30 AM - assuring her that I had been on Blackboard ALL NIGHT, for the past six hours, and her assignment was definitely not submitted before the deadline. Just like my orthopedist, the student never responded.)
But back to my original point. My orthopedist seemed super pissy on the phone, and to be honest, I don't blame him. The last thing you want when you finish a long day of work is a pissy e-mail from a patient you're obviously sick of. I know the feeling; I get lots of pissy e-mails from students and respond (semi) pissily. Here is a transcript of his message, plus imagine this in fast-forward mode; he was definitely talking ridiculously fast, as if to make the point that I don't have time for this shit.
Hey Mrs. Moon how're you this is Dr. Z giving you a call sorry to call so late just got done operating. It is... Tuesday night got the results of your ultrasound um they look good so I'll be able to get you off that um blood clot um blood clotting medication um looks good there's still a little... a small clot in there but it looks greatly improved from your last study so we can go ahead and get you off the Xarelto at this time and I think you should be doing just fine any questions feel free to give us a call back at the office tomorrow otherwise I'll talk to you soon thanks bye.
On the one hand, I don't feel like I should complain. This is what I wanted, isn't it? On the other hand, I don't trust this. So I'm supposed to stop taking Xarelto just like that, based on a seven-second message from my orthopedist? As much as I'd love for this to be the case, I can't find any evidence to indicate this is the right thing to do. I get that my doctor is probably super annoyed with me right now and probably just wants me to Go Away Already, but is this grounds for giving bad advice? Is he so pissed he wants me dead? LOL.
Additional concerns:
And now... I feel like a ship without a sail, desperately in need of some guidance. (Any thoughts? Please share... here or on LJ...)
P.S. A few days ago, I wrote that I saw an anti-Xarelto ad on TV. While I was writing this entry, a similar ambulance chaser ad came on for anyone who has Smith & Nephew implants (which I do). So now I have two things working against me. Awesome!
I feel like all I've done lately is bitch and bitch and bitch and piss and moan and bitch some more. Since I feel so overly negative, I've been trying to leave out a few details about my orthopedist that have been really
Also, it's not just my lack of confidence in him, although that is obviously the biggest and most pressing issue. However, I'm also less than thrilled with his lack of responsiveness to the questions I've sent him via the patient portal, which claims that you will receive a response within two working days. Of course, he was extremely responsive to me pre-surgery and his medical assistant was very responsive for the first week post-surgery and then post-blood clot. But lately... no responses. And it's not as if I'm constantly sending him e-mails with huge demands or anything. After my September appointment, when he said that my labrum had not healed yet, I got to wondering if it was okay for me to be, like, doing stuff, if he thought my labrum was still torn. I mean, that's why he said I had to be on crutches for a freaking month - to let the labrum heal. I sent him a quick e-mail asking what type of activity level he would recommend. He never responded. After my last visit, I mentioned that he had only ordered an ultrasound on my calf and the back of my knee (which to be honest didn't give me much confidence that he's even paying any attention to what's going on). I sent him an e-mail making sure the ultrasound would be of my entire leg. (Hello! It is the clot in the femoral vein that has been the most distressing from the start!) I wasn't sure if it was necessary for the order to explicitly state this, especially since I was having the repeat ultrasound at the same location, but I didn't want to take any chances. He never responded. I took care of it myself. After my ultrasound a week ago, the tech told me that my orthopedist would have the report by the end of the day. My orthopedist had told me he would follow up once he had the results of the ultrasound. I had talked briefly to the tech, who knows stuff, but said that a radiologist would read the images and send an official report to my doctor. I gave my orthopedist a few days, then on Friday sent an e-mail asking if he could let me know the official results - i.e., prognosis? recommendations? He didn't respond. Not that I expected a response on Friday, but I gave him two business days before unleashing my fury on him today (Tuesday).
And unleash I did. As I said, I'm not proud of it, but man. Seriously? The title of my message was 'Can you please respond?' LOL. Given that the only time he has ever personally responded to any of my inquiries was pre-surgery (i.e., in the wooing phase), I was doubtful he even gets the e-mails. Or if he does get them, it seems doubtful he actually reads them, given his lack of response. I figured if anything, his MA reads them, and he only responds to the ones his worker bee can't handle. Perhaps when I composed my pissy e-mail I had it in my mind that no one was actually going to read it, given that there is no evidence that anyone does. I mean, I GET that orthopedists are busy. I GET being busy. I, too, am a busy lady. But, if you are that busy, then the patient portal should not be programmed to send an automated response that someone will get back to you within two business days if no one is actually going to (which I wrote in my pissy e-mail). Maybe I am a problem patient, but I really don't feel like I'm being that high maintenance with a few basic questions + one refill request for Xarelto within the past two months ( = four e-mails total - including the refill request and and my repeat request for my ultrasound results). It's not like I'm a Patient Portal Abuser. And the alternative to the patient portal is calling the office, waiting on hold for 10-15 minutes, getting the runaround, then being routed to an MA's voice mail (which I also wrote in my pissy e-mail). Who has time for that?
I know reports and e-mail are a huge time suck for health care providers, and trust me, I understand the time it takes to answer e-mails. I get (and respond to) many, many e-mails a day from students, and I'm aware that writing a report takes a lot of time. E-mail and reports do not seem to be my doctor's strong suit. Not that the latter really matters - after all, the whole idea of the patient having access to her/his reports is something that comes along with the patient portal, which as far as I know is a fairly recent invention. (For routine health care matters, we always seem to go for the solo practitioners, none of whom can afford this.) At any rate, since the patient portal seems to be mandatory for being a patient at this particular practice, it has been interesting for me to read the 'care summaries' the doctors write. Notably, my doctor never writes anything, except All of the patient's questions were answered and they state they understand and agree with the discussed treatment plan. They will follow up as planned, sooner if any problems. This must be some default option in the report-writing software. Interestingly, the only time my doctor has ever written anything other than this was after I had my second cortisone injection. The doctor who gave me the injection asked me what my doctor thought of my ongoing pain and I said I didn't have any idea what he was thinking. I noticed the report after that actually contained information. Word-for-word:
September 5, 2014: still having some sharp pains in her right hip. She has been going to physical therapy. She is still taking her Xarelto for her blood clot a 39-year-old female 2 months status post right hip arthroscopy with labral repair. At this time her hip has flared up and she states she would like to proceed with a intra-articular corticosteroid injection into her hip at this time. She states the Voltaren were not working for thus I will switch her over to meloxicam 15 mg once daily. She'll continue doing the physical therapy to help decrease her pain and improve her function. She'll continue taking her Xarelto also for one more month and we'll check an ultrasound of her right calf at that time I will see her back in 4 weeks' time to see how she is progressing. I do go she is frustrated with her progression but I did reassure I think that she will continue to improve we'll continue doing her physical therapy and try to improve her function and decrease her pain September 10, 2014: Patient here for right hip injection. she underwent a hip arthroscopy by Dr. Z. She says her pain now is worse than before the surgery. She is here for a repeat injection of her right hip joint.
(I'm so glad English composition is a requirement for most med schools!)
Anyway. Apparently my doctor does receive the e-mails through the patient portal, which actually makes it more unforgivable that he hasn't responded in the past. I sent my pissy e-mail close to 6:00 tonight. After putting the kids to bed and taking a shower, I came back downstairs and saw there was a message on our answering machine. The only people who call me after 8:00 PM are my mom, and lately, political campaigns, so I pressed the 'play' button on the answering machine while debating whether or not I had the energy to call my mom back at 8:30 on Tuesday night. I was shocked to discover that the message was from my orthopedist. WTF? I guess my pissy e-mail got through to him. I sort of feel bad about it, but sort of don't. For one, if he had just responded in a timely manner, there wouldn't have been a pissy e-mail in the first place. Also, as someone who works aaaaaalllll hours of the nights answering e-mails and grading, I'm hardly going to cry a river for someone making ten times more than I do who has to work outside the standard 8-5 business day.
(On a side note, I totally freaked a student out one time. I was up late grading assignments, which my students submit online, and I received a 'panicked' e-mail from a student claiming that she had submitted her assignment on time, but for some reason Blackboard was telling her that her assignment was late, and this was obviously a glitch on Blackboard, and she just wanted to make sure she wasn't penalized for this. I immediately shot her an e-mail back - around 1:30 AM - assuring her that I had been on Blackboard ALL NIGHT, for the past six hours, and her assignment was definitely not submitted before the deadline. Just like my orthopedist, the student never responded.)
But back to my original point. My orthopedist seemed super pissy on the phone, and to be honest, I don't blame him. The last thing you want when you finish a long day of work is a pissy e-mail from a patient you're obviously sick of. I know the feeling; I get lots of pissy e-mails from students and respond (semi) pissily. Here is a transcript of his message, plus imagine this in fast-forward mode; he was definitely talking ridiculously fast, as if to make the point that I don't have time for this shit.
Hey Mrs. Moon how're you this is Dr. Z giving you a call sorry to call so late just got done operating. It is... Tuesday night got the results of your ultrasound um they look good so I'll be able to get you off that um blood clot um blood clotting medication um looks good there's still a little... a small clot in there but it looks greatly improved from your last study so we can go ahead and get you off the Xarelto at this time and I think you should be doing just fine any questions feel free to give us a call back at the office tomorrow otherwise I'll talk to you soon thanks bye.
On the one hand, I don't feel like I should complain. This is what I wanted, isn't it? On the other hand, I don't trust this. So I'm supposed to stop taking Xarelto just like that, based on a seven-second message from my orthopedist? As much as I'd love for this to be the case, I can't find any evidence to indicate this is the right thing to do. I get that my doctor is probably super annoyed with me right now and probably just wants me to Go Away Already, but is this grounds for giving bad advice? Is he so pissed he wants me dead? LOL.
Additional concerns:
- This does not seem consistent with what the ultrasound tech told me. When I expressed my disappointment to the tech, she said it wasn't really realistic for such an extensive clot to resolve that quickly; it often took six months or even a year (and she should know). I realize this is ultrasound tech vs. orthopedic surgeon (via radiologist) but for some reason I'm feeling more confidence in the tech. Considering the whole reason my blood clot was even diagnosed and promptly treated was due to a PT assistant and ultrasound tech, I'm not feeling huge love toward the more highly educated.
- Following an episode of acute DVT, especially extensive DVT, it seems pretty standard to be on Xarelto for at least three months, more likely six months, and possibly even a year. I mentioned that I saw my husband's PCP the Monday after being treated in the ER, and he said that I would need to be on Xarelto for six months minimum. I realize that family practitioners don't necessarily 'do' blood clots any more than orthopedists, but considering my orthopedist doesn't even realize the clot was in my thigh, I'm... nervous. Fortunately, I asked the imaging place to have the results sent to this family practitioner as well, and I am considering consulting him as a second opinion.
- Also, I've been communicating with my former PA for reasons unrelated to my hip. However, my hip did come up, and she said, (S)o sorry you ended up with those complications! DVT's are both scary and annoying. Will it be 3 months on the Xarelto? What did Dr A say? When I replied that Dr. A had said I needed to be on Xarelto for SIX months because the DVT was so extensive, she replied, 6 months sounds right for such a big event. So.... what to think? Again, I'm putting more confidence in my former PA than my surgeon, but... my PA is a really smart woman who knew/knows me so much better than my orthopedist.
- So basically I don't know what to do. As much as I'd love to stop taking the Xarelto, I'm REALLY wary of just ditching it willy-nilly, and as far as I can tell, my orthopedist is the only person who is okay with this. And... I don't trust him. At the same time, after my pissy e-mail and his pissy call to me, I don't feel comfortable trying to facilitate any further communication with him.
- I realize it might be a good thing for me to find a new doctor, especially given that none of this even addresses my ongoing hip issues (remember those?), but a.) I'm starting to think all orthopedists are the same and b.) I'm feeling impatient at this point. Even if there is a better orthopedist out there, it's unlikely s/he could help me in the time period within which I am hoping to be helped ( = ASAP).
And now... I feel like a ship without a sail, desperately in need of some guidance. (Any thoughts? Please share... here or on LJ...)
P.S. A few days ago, I wrote that I saw an anti-Xarelto ad on TV. While I was writing this entry, a similar ambulance chaser ad came on for anyone who has Smith & Nephew implants (which I do). So now I have two things working against me. Awesome!
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