I miswrote some things, I meant to say that I almost used my right foot to remove the strap from the left foot that was forcing the internal rotation. The reason I would refuse pain meds when I'm at home is that I can control the position of the leg and avoid pain that way and I figure the pain is telling me the position is causing damage to tissue, so I think the pain in that situation is useful because it prevents me from further damaging tissue.
They could just give me a TENS unit, or just give me one pill at the imaging place without giving me a prescription, have me wait an hour, then do it. Or, they could just let me out of the machine when it starts to hurt and then continue when the pain lessens. I don't usually take narcotics. I didn't finish the whole prescription when I had the surgery 7 years ago because the pain went away and I didn't need them. The problem is, though, that they don't know me, so they don't know I'm on the straight and narrow.
I'm considering refusing any additional imaging unless there is some plan for pain control during the procedure.
I tried the best I could to hold still so they could get the image, but I doubt it was good enough.
The resident also put on the PT referral for me to lose to weight. I eat a good diet, I usually exercise (can't right now due to the hip). I just have to take frequent bursts of prednisone. It didn't make sense to me since you're fighting up against prednisone, but again she didn't have the time to get to know me and so she had no way of knowing I'm an "raw, organic, fruit, nuts" type of health freak.
Anyway, they are really good in terms of trying to help, they called me back for a second MRI when they needed to look more closely at something and in fact didn't charge anything for the second one. I am thankful they were honest enough and caring enough to look after me that way. I just get cranky when I'm in pain.View Thread
My granddad was an engineer, my dad was an engineer, my sister is an engineer, I think you're right, in general, about the interpersonal stuff, but most I've met have good intentions.
There are some engineer patients I've had who aren't so stuck in strictly either/or thinking, so I was making a gross generalizations, not necessarily true of each individual engineer. Your in a related field, but I don't think it would be true of you, for instance.
My dad recently fell. He has one weak leg and was going down a step. I asked him if he went down with his bad leg to the lower step and then brought the good leg to the same step, and he said "no, that wouldn't make any difference". I then explained that going down with the bad leg means the good leg is the one controlling the lowering of the body and so he would be less likely to fall. He said, "yeah, LESS LIKELY, what good is that?" I said, "dad, there are no guarantees and you can't remove all risk". He says, "even if I go down with my weak leg first, eventually I have to put all my weight on it because I have to pick up my good leg." I said, "yes, I know that, dad....but you're not having to put all your weight on it and at the same time have it control lowering the weight of your entire body. It just has to stay straight and support all your weight, which is easier and so you're not as likely to fall."
A physical therapist I work with had similar issues with a patient that was a physicist. The PT kept telling him, "move to the edge of your chair, move your feet close to the chair, separate your feet so you have a wide base of support, and then move you nose over your toes and that will make it easier to stand." The physicist argued left and right that his instructions would cause him to fall. Then, the PT explained, "no, it won't because you have a force of pull from various muscles, including the hamstrings. You are not accounting for the muscles and their optimum position for strength and contraction." Then, finally, the physicist agreed to try it and was pleasantly surprised at how much easier it made standing.
Still, as you point out, not every engineer is like that, but in my experience, it is common.
The resident was actually a woman, but I'm sure you are right about the drug seeking. She works at a university medical center were they see all types, and in fact in my work I've faced it as well. When she heard I was vomiting with ibuprofen, she asked if drank a lot. I said, "well, I drink alcohol at communion and then I occasionally have a glass of wine at special occasions...like graduations/weddings/etc. All in all, I have about 4 ounces of alcohol a year, I don't think that would be enough to cause stomach bleeding. Initially, I had to take a bunch of ibuprofen, and my stomach after a month said, "enough is enough". I'm not asking for pain medicines to go home with and take on a daily basis, in fact I would probably refuse that because I need to feel pain to know I'm hurting the tissue. I left a message with the attending's administrative assistant, and was asking to be covered for pain for the period of the procedure - maybe a 2 hour duration. I don't care if it's narcotic or not, they had to redo the image to get a good one and I'm almost in tears and trying to not move and have normal breathing. I was almost going to just take the damn strap that holding my leg in that position with my right foot and refuse the imaging. I don't think it's humane to do that to someone, but I do understand the concern with drug seeking, but then the attending or the resident would need to spend time to talk with me to learn I'm not asking for a large amount of narcotics...I'm just asking for something to cover me for 2 hours. If they can't get the image because I'm almost in tears from pain and can't hold still enough, then it affects my care. It's also complicated because due to health care changes I'm new to them.View Thread
Today I went in for the second MRI and learned that this other machine is the same magnet strength as the old. Evidently, the first MRI pictures just weren't the best.
It's been windy around here lately, so in these last few days the asthma has been dipping a bit. I was coughing earlier today, so took the rescue and it lessened the cough. While in the machine, I was coughing due to asthma, and the person doing the MRI said, "try not to cough, you need to stay still". I thought of saying, "well, then let me out and I can take more rescue meds", but the cough wasn't that bad and I could suppress it.
They positioned me the same as before. I tried to take one ibuprofen yesterday, but ended up vomiting with a bit of red stuff coming up...so I couldn't take any because that sounds like a possible GI bleed to me. So, I bought Tylenol today. However, I didn't want to take any and then have to vomit while in the MRI machine. So, again, I had no predmedication for pain. Then, he asked me, "how are you?" I said, "the left hip hurts like hell". He said, "I have to redo the picture, remember to stay still." I wasn't moving the hips around, but maybe my breathing rate was increased due to pain. I was almost crying at the end because of the pain. I don't think they got the picture they needed.
When I got home, I called the orthopedic doctor's administrative assistant and left him a message so he would know the lack of pain control was making it hard to get an MRI image. I asked the resident if I could have something else for pain since my stomach doesn't tolerate the ibuprofen right now. She asked if I drink alcohol, and I don't, except some wine coolers I had about 20 years ago. My stomach just isn't tolerating the naproxen or the ibuprofen right now. The resident said I couldn't have any pain control. I don't understand why they don't give me something to lessen the pain before the MRI so I can have more even breathing and therefore less movement.
Yes, you did answer my MRI question. I had also been reading WebMD's articles on MRI, which said that some magnets are stronger and some are standard. I'm too lazy to quote the article. I figured from that maybe the next MRI machine had a stronger magnet than the one they used with me about a week ago. You basically verified my suspicion. I guess it's a bit like telescopes, they get a blurry image of outer space sometimes then they have to increase the power to get a better image. They told me they wouldn't "run it through", which I guess means they won't recharge insurance. They also told me the next MRI machine is in demand. So, I have to go in at an odd hour so they can get the image since they said they recommended getting it soon.
On of the disadvantages of knowing medical stuff is people can't comfort you as easily. One of my friends said, "don't worry, whatever they find they will be able to fix." I said, "you can't know that without knowing what they will find. I would there's a 99% chance it's a muscle or tendon tear or some type of soft tissue or connective tissue damage. But I did have a case where a woman kept complaining of pain in her hip, and it turned out to be cancer. You can't know if it can be fixed until you know what it is. Thanks anyway for the encouragement."
Internships are required and you don't get paid in my field. In fact, you have to pay the school in order to do them. This is a real bummer because I had various things happen with my internships, like the company close 2 weeks into the internship, but I still had to pay the school the full amount. It increases your student loans. Normally, level 2 fieldwork students (internship folks) get the easier to treat diagnosis...hip replacement, knee replacement, etc with a smaller portion of harder to treat diagnosis like stroke, spinal cord injury, etc because they are just learning and there's so much thinking on your feet that happens (ie, patient is in the shower and is a heavy transfer, I can't find anyone to help me and I want help, what do I do?). I would either just wait for someone and get behind in my schedule or I would modify the transfer if I thought I could do the modified version safety. Normally, you remove the armrest, position the wheelchair very close to the tub bench, and do a scoot transfer or a squat pivot transfer. If there's a sliding board available, all the better.
There I go with medical jargon again....feel free to look things up or you can always ask me what I mean and I'll try to explain. Like you said, a word is worth a 1000 words, much easier for me to say the one word I know, but not so good for communication.
I think there is a different type of reasoning between things like computer science or engineering and physical medicine and rehabilitation. Usually it takes awhile for the engineer patients to change. Typically, they'll think in black or white terms, whereas rehabilitation wise there is often risk at either extreme and you have to balance between the extremes. For instance, after joint surgery, if you don't get up at all you can get bed sores and pneumonia, not to mention deconditioning. If you get up immediately and run a marathon, then you damage the newly the operated joint. The best course is somewhere in between. A lot of the engineer folks will typically choose one extreme or the other figuring one is right and one is wrong....kind of like binary....0 or 1, but never both. An old friend of mine is a computer scientist, and he told me they were making them take a course in Systems, which addresses the various ways of looking at things, and recently they were considering analytical versus holistic models to explain reality. I thought it was a good course.
Specifically regarding medical ethics, any medical provider is legally required to report and suspicions (they don't have to know for sure it's happening) or abuse or neglect...forgot to mention that before.View Thread
In my field, the internships are required for the license and graduation. Most places are fine with working with fieldwork students because it's free labor and they get to market their organization to a soon to be new grad (translation...cheap labor).
Sorry about that with the terminology, I tend to forget when I'm using medical jargon because I'm around it all the time so its regular English to me. I think when the orthopedic doctor or resident mentioned "trauma" they were specifically referring to a fall or a bicycle accident or something like that. When I say there was no trauma, I mean I didn't fall on it, I didn't fall off my bike, I wasn't in a car accident, etc. All I know is the PT 8 years ago told me the sacroiliac joint pops in and out. Late Dec, it felt like it was out of place. I walked on it 8 or 9 hours a day for 3 or 4 days in a row as work was busy. When work slowed down, I did things to help it pop back into place. I heard it pop, then no pain over the sacral area, which is typical, then a few later, there was pain in the left hip. I took ibuprofen and avoided any activity that made the hip be in really bad pain, but this meant I continued to work, to walk on it, to occasionally do heavy lifting, and continued riding my bike. Then, I had to take some Levaquin. Things were going well pain wise with the hip, so on day 5 of Levaquin I tried to get off the ibuprofen, then the night of day 8 of Levaquin, I woke up screaming with pain in the left hip, then next day I went to urgent care....etc.
So, there's no obvious explanation for it, I mean it's common for me to pop the sacrum back into alignment for 8 years now. Nothing like this has ever happened, so the etiology (sorry, the cause of the pain) is unclear. I honestly don't know. It's not like I feel down the stairs and then it hurt.
By the way, I'm being a bit lazy here, but are there different magnets in different MRIs? The radiology department called me today and said that the orthopedic radiologist saw something and needed more clear MRI images and so had to use a different MRI machine to get them and they told me come back in a few days to use a different MRI machine. I thought one MRI was the same as another, but apparently I'm wrong. I don't work with MRIs or MRI images at all since I'm mostly inpatient. Do different machines have different types of magnetics?
"I'm glad I don't have to make such personal decisions at work." It is one of the most stressful elements of my job. Most people who go into the field really want to help at some level. I end up feeling responsible for another person's life, and I hope I make the right decisions. It's stressful knowing another person's life, to some degree, is your hands because you feel responsible and you don't want to hurt them or make the wrong decision and you want to benefit them as much as possible. You run into situations in which the answer is not clear, which is why its usually a good idea to discuss with the whole team as they may be able to help.
For instance, take Jehovah's Witnesses and blood transfusions. It is clear that if an adult refuses a blood transfusion for themselves saying "it's against my religion" then the medical team must respected their right to refuse treatment....but what if they are refusing for their child? That situation went to the courts because some medical teams considered it child abuse/neglect. It's not clear cut....the courts decided the medical teams involved had in fact infringed on religious freedom of the parents and found the medical teams to be wrong. There's all these grey areas.View Thread
Sorry I couldn't be of more help. It's a difficult situation. My state has a vocational rehab department that knows all the applicable laws. The two I know are the American with Disabilities Act and disability information. In my state, the vocational rehab department does the first two decisions in case of disabilities, then it goes to the administrative law judge if the person continues to appeal the decision. In any case, in my state the vocational rehab department really knows the applicable employment laws and has information on retraining into a different career. Maybe your state has something similar.View Thread
You have a very impressive educational background.
In healthcare, jobs are much more available. Usually, internships are required for your license. Most physically healthy people in my field should be able to get a job initially, but it may be in an area of practice or with an employer that no one else wants. So, they do that for a few years to get the experience, then move on to what they want to do.
In the situation I described, I would go to my manager and discuss it in team meeting, with the administrator involved. Discussing with those also involved in the care is important because no one knows everything and they may have had experiences that could help guide actions in the present. I'm assuming here that the 98 year old lady is still present in her second admit to the inpatient rehab facility. It's also important to work as a team because sometimes the power of attorney will try to pit one member against the other, so the team communication has to be good. Usually, the team will report to adult protective services because you don't have to have proof of financial exploitation, you only have to suspect it. The balancing act, though, is how to handle it in such a way so the medical power of attorney won't remove the 98 year old lady against medical advice from the facility. The team will usually appoint one person to discuss the situation with the power of attorney if there are any problems, most likely either the director of rehab or the administrator of the rehab facility. Once the team reports to adult protective services, it is their responsibility to follow up and determine if the situation represents elder abuse or if it's a situation of right to refuse medical treatment. Some rehab teams I've been a part of will in fact report to adult protective services before the first discharge.
What's difficult with my diagnosis is that it's not just the greater trochanter area, it's also the ischial tuberosity and the area around the anterior interior iliac spine. I honestly don't know what caused it all, but I'm assuming it's the case that several of the muscles, or tendons, or what have you joined the party.View Thread
Thanks for the information on career changes. The main benefit of working at home for me would be its sedentary, I'm at a decreased risk of upper respiratory infections, and I can control triggers. So, there would be less disruption in income and maybe I could even manage full time work if I can do it during an exacerbation. I may also be able to do it to an older age, but in the short term I would expect a drop in income, which also means a drop in retirement savings in the years when I really should be stuffing it away.
Thanks for the information on orthopedic implants. As I work in physical medicine and rehabilitation and not in radiology, I honestly don't know the details of that. I do know they asked a lot about brain implants, etc. I've also been out of school for 14 years, so what I don't use is forgotten. On the other hand, for the settings I work in I'm good at what I need to know for those settings and at making moment to moment decisions based on changing circumstances that are clinically relevant. That's something you normally get from experience, and it's probably why employers tend to value on the job experience. It's hard to teach that "decision making in a unique circumstance" in a text book.
For instance, let's say from a rehabilitation perspective the recommendation is for a 98 year old lady to go to assistive living. She has the assets for it. The power of attorney, who is also the beneficiary in the will, refuses, instead sending the 98 year old lady home, stating "she needs to preserve her money in case she needs it later". As predicted by various rehabilitation tests, she falls shortly after going home and is readmitted to the inpatient rehab unit. She suffers physical damage from the fall that is sufficient to now require a long term care (nursing home) discharge. Is this financial exploitation of the elderly and should a referral be made to adult protective services, or does it fall under right to refuse recommendations? So, what should be done? That kind of stuff you run across all the time in physical medicine and rehabilitation, but you can't really learn it from a textbook. So, I can see why employers would want experience.
I'm not a vegan, but I try to eat a portion of the fruits and veggies.
The MRI went okay, but they used a strap to force internal rotation so they could get a good image of the area around the left great trochanter. The right side didn't hurt, but this position really made the left side hurt like hell, especially after the 30 minutes or so. I thought getting the image was worth whatever risk to tendons/muscles/or what have you. Still, if I could do it over again, I would have pre medicated with pain meds.View Thread
I realized my prior responses were poorly worded. What I was trying to say is that yes, social security is taken out of the paycheck, and yes, it is a federal program. However, in New Mexico, the state agency is the one who makes the final determination of whether to approve or deny benefits and sometimes it goes to an administrative law judge. After that, it goes to the Appeal Council, then to the US District Court. I know the federal laws guide determinations to a degree, what I don't know is how much leeway the state level has in implementing it and interpreting it. My impression from informal conversations with friends is that the state has a degree of leeway in how it interprets and implements the federal guidelines. For instance, the disability attorney I spoke with in my state gave me literature which says, "State agency decision-makers also tend to apply specific formulas found in state agency manuals to determine residual functional capacity (RFC) for certain medical impairments, thus treating all claimants with similar medical findings the same. Few of the state agency formulas in these manuals indicate that a claimant cannot do sedentary work. On the other hand, the administrative law judges (ALJs) who handle hearings tend to view their role as evaluating the entire case-including the claimant's credibility-to determine capacity for work. ALJs find claimants under age 50 disabled because of inability to do sedentary work much more often than state agency decision-makers do." That's what I'm unclear about and what I've been trying to learn over the last hour...there are for sure federal regulations on disability definitions and determinations, but do the individual states have some leeway on how they interpret and implement those federal guidelines? From talking to folks I know who've gone through the process, my impression is that the states have some leeway on that. However, I don't know for sure and I can't find a specific website the addresses that. I'm a particularly poor writer, so please bear with me .View Thread