Samantha Warwick

Ultrasound Room 12, Please

Posted Saturday, January 10th, 2015

Medical research and studies

This story was originally posted on July 10, 2014 before I decided to pull it.  However, in light of the upcoming thematic shift of my blog, I am reposting this to illustrate my interest in the themes of medicine – though my interest in health, medicine, healing and literature reaches well beyond my own personal experiences.  Here, I accounted for one day of 605 living with a chronic daily headache.

It’s hard to know exactly what my doctors think when they see my name on their next patient chart:

a)      I wonder what she’s read on the internet this time
b)      I wonder how many questions she’ll have today
c)      …if she’ll have any highlighted diagrams
d)      I need a drink
e)        All of the above

I’ve had a headache for 422 days.  Of these 422 days, only about 15 of them would be considered debilitating.  Usually the ache is a steady 4/10 which allows me to carry on with my job and various activities—excluding late nights with friends—which have suffered and waned this past year.

Two weeks ago was my fourth appointment with a musculoskeletal specialist—Dr. Z—for ultrasound-guided diagnostic (and possibly therapeutic) trigger point injections into my neck muscles.  I have a lot of questions when I’m around doctors.  My mind is a reasonably quiet anthill outside of health and medicine, but as soon as a doctor or massage/physio therapist enters my exam room, pointed curiosity kicks the anthill into a chaos of thoughts and questions:

Why do no drugs touch this headache?  Why does my headache go away when I’m exercising?   Why does it go away when I’m in the steam room?  Why does it go away when I’m in the process of eating?  Why does it ALWAYS come back?  Can a trigger point in the neck cause tension and pain in the jaw?  But HOW are they connected?  What muscles are those?  No—this one—what’s it called?  Will a problem there refer the headache to here (touch top of head)?  Can you see the trigger points on the ultrasound?  What do they look like?  Like the size of a pea?  At the insertion or in the muscle belly?  Can we use the thinner needle?  How many gauges is it—22 or 25?  Can you check the muscle insertion of the splenii and semispinalis capitis?  That’s here, right? 

The week before we’d injected my sternocleidomastoid, and as he left the room at the end of the appointment he said, “Next time, a dollar a question!”

So two weeks ago—day 406—was uncharacteristically hot in Calgary.  Thirty-three Steigle Radlerdegrees, and I decided to bring him and the ultrasound technician a beer.  I’ve decided to introduce my doctors and health peeps to the Stiegl Radler.  But dudes generally like regular (not grapefruit) beer, and I’d heard the normal Stiegl is good, so I selected two regular Stiegls and one Grapefruit Radler.  I wanted to be prepared for a thirsty resident hovering like a ghost in the corner of the room as there had been before.

I arrived at the procedure clinic early to rate my pain out of 10 and wait.  I rated 4 as I always do.  I stared out the big windows and wished I was tubing down the Elbow River.  “Samantha,” a young woman eventually called, and I followed her to the waiting cubicles where she handed me a gown, “Undress from waist up,” she said.
“Can I have Ultrasound Room #12 please?”
She glanced both ways down the hall, brow crinkled.
“The one just around the corner to the left.”
It was clear people didn’t typically ask for ultrasound rooms the way you ask for a favourite restaurant table near the windows.
“T is working that room today.”
“Perfect!  I have something for T—so that would be great.”
“I’ll check,” she said.

I’d been given a different room a few weeks before, and I did not like it.  Ultrasound rooms have dimmers, and the switch was not within my reach, and I did not enjoy the ultrasound tech as much.  Everything matters.

I waited in my cubicle, checking the beer was still cold, fidgeting with the ties at the back of my gown and catching a short nap while sitting upright against the wall.

“Samantha,” the woman’s voice carried into the cubicles, and I opened my eyes against the room, gathered my stuff.  “I can take you to room twelve,” she said.
“Thanks again,” I said.  “Twelve is the best.”
She left and I played with the dimmer until the light was just so.  I examined the MSK poster on the wall revealing the insides of a shoulder (or maybe it was a knee) wishing it was a neck.  I spread my notes and muscle diagrams on the exam table.

T entered the room, “Hi,” she said cheerfully.
“Hey!”
“How are you doing?”
“About the same.”
She gave my papers the sideways eyeball and asked when I’d had my last period.
“I brought you a beer,” I said.  “The Radler.  Have you tried the Stiegl Radler?  It’s the only beer I’ll drink.”
“Really?” she said, “thank you.  It’s so hot out today.”
“So hot.”
She did some stuff at the ultrasound machine, “Let me go get the doctor.”

She left.  I touched my documents and glanced at my Post-it-Note of questions.  It had taken serious effort to reduce my questions to the size of a Post-it, but I had big news to tell Dr. Z and I needed to focus: a skilled myofascial and trigger point therapist had finally located and confirmed a stubborn trigger point in my upper neck that re-created my headache exactly.

T returned with Dr. Z.
“Hi, Samantha,” he said (exhaling or was that just my imagination?) and sat in a chair opposite me.  The exam table and my papers rested between us.  He glanced at the portfolio I’d brought with me.
“I have news,” I said.
“Yes?”
“I saw C at PT—you know—who works with B?  She’s amazing.  She found this crazy trigger point in my splenius capitis!”
He seemed to take interest in my laminated images of the human musculoskeletal system.
“Someone gave me that,” I said.  “Cool, yes?”
I lifted the second diagram I’d brought of a head where the splenius capitis trigger point was marked with a star and its “classic” referral pattern highlighted.
“This,” I traced the referral pattern to the vertex of the head, “is so much like my headache.”  I bent my head sideways to move my ponytail.  “And she drew an X on the spot.”
“Well, well,” he said—or something like this—something hard to interpret.
“There’s something there,” I said.  “I want to know what you think.”
I don’t remember the dialogue that followed well enough to include it here, but he agreed to re-target the area.  Worth a shot, I should have said—ha ha!

“Did T tell you I brought you a beer?”
“You didn’t have to do that,” he said.  “I was only teasing you about the questions.”
“Don’t other people ask questions?”
“Yeah,” T said, “but they don’t usually have pictures with them.”
“But they’re so useful…” I said, an affectionate nod to my work.
Dr. Z seemed to struggle with whether he should accept the beer I had brought.
“…Well I suppose I’ve accepted wine before…” he said to the laminate.
“They’re on ice in my bag.”
“You have them on ice?”
I lifted my bag to show him the beers and the ice pack.
Silence.
“And I’m your last patient,” I grinned.
I looked at T.  I looked at Dr. Z.
“Listen guys—I’m going to FORGET my three cans of beer on the exam table at the end of this appointment, all right?”

I cleared my stuff from the table and Dr. Z patted the surface, “Okay, let’s take a look at this X.”
I lay on my front in a prone position, propped up by a pillow under my chest so he could feel the back of my neck.
“I’m surprised it’s still so well-marked,” he said.
“Yes,” I said.  “I had my husband re-mark it.”
Silence.
He palpated the X and proceeded with the injection with T at the ultrasound.

InjectionInjections of anesthetic into the muscles at the back of my neck have usually reduced the headache to some degree for a few hours—but my diagnostics have not been slam dunks.  The injections are unpleasant, especially up into the intracranial insertion points.  While he injected I stopped talking for 30 seconds.
“Are you okay?” Dr. Z asked.
30 seconds of silence and he thought I’d passed out.
After the procedure he toweled off the ultrasound goop from the back of my neck and we agreed to stop the diagnostic injections for a while, see how I feel.

“Thanks,” I said.
“Always a pleasure.”
I widened my eyes at him.
“What is it?”
“I don’t have any more questions right now.”
“Not possible.”
“Bye,” I said.
“Bye,” he said.
T laughed.
She stayed and I placed the cans of beer on the exam table.
“So I can request you, right?” I asked.  “You’re soothing.”
“Sure,” she said.  “I’ll watch for your name.”  As she headed toward the door she turned around before leaving. “I’ll definitely remember your name.”

Note: The dialogue in this piece is as I remember it, however—without a dictaphone, some creative license had to be taken.  Names of involved parties have been changed to random letters to protect the innocent.  I intend to continue blogging about my adventures in trigger point therapy.

 


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