A place where I can share interesting ideas and maybe get a few things off my chest

Archive for the ‘MRI’ Category

My Shoulders Hurt.

About a year-and-a-half ago, I noticed my right shoulder hurt a little. It didn’t really get any worse for a long time and I mostly ignored it, but last December, I decided I didn’t want it to hurt anymore. So, I went to see an orthopedist. He diagnosed me with rotator cuff tendonitis and said, “Here’s some Naprosyn (essentially script strength Aleve). Take this twice a day and come back in a month.”

A month later, no improvement, Doc said, “Let’s try a cortisone shot.” I revealed myself as the major needle-phobic weenie that I am and said, “Let’s not. How about another 30 days of Naprosyn?”

“It probably won’t help if it hasn’t helped so far, but there’s no harm in trying it.”

In late January, I tried out for a play. The appointment I had made ended up being the afternoon of opening night. I cancelled with the intention of (since he was right and the 2nd month of Naprosen hadn’t helped) coordinating the next appointment with my husband so he could hold my hand while the GIANT needle was administered. (“It’s not the length of the needle that matters, it’s the gauge,” said Doc. HA!)

The following week, Mother fell on the sidewalk while going out to get the mail. Twenty-four stitches, five days in hospital, four weeks in a rehab facility, and four weeks of various therapies (during which I could only work half-time) later, BOTH shoulders hurt.

Then our dog got sick and had to be put down.

It was not a great spring. If I weren’t so stubborn and so Southern, I might begin to lose faith in black-eyed peas. But I digress.

I finally made an appointment in June to face the needles (yes, now multiple needles because multiple shoulders were in pain.) My wonderful husband went with me, held my hand, and I was mostly OK, not getting fainty until after the second injection. In an effort at levity, DH made a joke about the size of the needle. I did not laugh.

All the stories I’d heard about how miraculous a cortisone injection can be couldn’t even produce a placebo effect for me. My shoulders still hurt. At my follow-up, Doc said something to the effect of: “Well the next step is an MRI to see how what we need to do for surgery.” I said, “What about another set of cortisone shots?”

“The efficacy rate for a second round of shots after the first round didn’t help is only about 40%, but it’s certainly worth a try if that’s what you want to do.” Without anyone there to hold my hand, I bravely submitted myself to two more injections with GIANT NEEDLES INTO MY SHOULDERS! (I really was very brave. I would have given myself a sucker, had I had one.)

And…they didn’t help. At all.

After much internal debate, I made an appointment with my friendly, neighborhood acupuncturist. My husband said, “You know what acupuncturists do, right?” With great bravado, I told him that after facing two rounds of giant needles, I should be able to handle a few little ones.

It turns out that sometimes, when energy whats-its aren’t flowing properly, those little tiny needles can really sting! After my prescribed number of sessions with little improvement, the acupuncturist told me that I should have seen a marked reduction in pain and she felt it would be prudent to refer me to an orthopedist.

*whimper*

I’m scheduled for a double-MRI next week. I’ll let y’all know how it goes.

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Mother and the Dementia Paradigm Shift

(Please note: this is a lecture slide, not Mom’s scan.)



This past Tuesday, Mother and I headed over to USF for her first-ever MRI.  She did wonderfully, and they got very good images, which they then handed to us on a CD to carry to our later appointment at the Byrd Alzheimer’s Institute. After a nice lunch at Panera, we were able to make our noon appointment with Dr. Fargher with 10 minutes to spare.

While I waited in the lobby, Dr. Fargher escorted Mother back for an MMSE and evaluation. Afterward, it was my turn in the doctor’s office to talk about the results. Mother scored higher on the MMSE this time than she did when we visited two years ago. This does not usually happen. What made the biggest difference was one item that last time Mother didn’t even try, saying “I can’t”, that this time she attempted and got 4 out of 5 points for. I told Dr. Fargher that when we had visited before, Mother had only just started going to the Neighborly Care Network senior center, and for the past 1.5 years or so, she has been attending three days per week.

With the report Dr. Fargher had received from the imaging lab, and the CD I had in hand, we looked at the brain images together which showed some overall shrinkage (not uncommon given Mom’s age), very little shrinkage in the areas of the brain normally connected with Alzheimer’s, and a couple of spots indicating small strokes (ischemic incidents, for you medically-oriented family members). This indicates that most of Mother’s dementia is actually vascular in origin.

We also talked about Mom’s hearing loss, and the doctor mentioned that she had to resort to using a pen and paper to clarify some of the questions, and Mother was able to easily understand and answer, even doing fairly well on remembering a set of three words, after they were written down. The doctor suggested we keep a whiteboard handy at home for times when Steve or I didn’t feel like we were getting an idea across. We decided that Mother’s current meds were all good, and that there was no reason to set up regular appointments, but to call if any additional problems arose.

This really changes everything! 

The length of time from diagnosis of Alzheimer’s to death is usually 3-7 years, depending on what stage the person is when evaluated. Since Mom’s initial diagnosis for Alzheimer’s-type Dementia back in 2007 (no MRI done at that time), I’ve been worrying about how I would handle her inevitable decline, starting with having to work part-time so I’d be home with her anytime she wasn’t at the senior center, and of not being able to leave her alone even for short periods of time. I’ve been waiting for the horrible eventuality of Mom deteriorating into some mere shell of herself, not remembering anything or recognizing anyone.  

For vascular dementia, if the stroke risk is addressed, then relatively normal functioning can be maintained indefinitely. All this time, I just thought that her meds were working really well, as the decline we’ve seen is really minimal, and the memory loss patchy and not interfering that much with her daily functioning. (You don’t really need to remember what a hush puppy is in order to fix yourself a sandwich for lunch.)

With the realization that a lot of Mom’s seeming inability to grasp what we’re telling her is probably directly linked to her hearing loss, my falling-off-to-sleep self wondered last night about the possibility of us all learning some basic sign language. I already know how to sign “thank you” and “good morning” – maybe Mom and I will start working on that today.

 

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