I'm reading this New Yorker piece right now. Atul Gawatabe is a doctor and writer - I read one of his books and it changed the way I understood pain, or began to change it. This essay is a commencement speech to the new doctors graduating Harvard Medical School and outlines the changing world they will practice in and the challenges of reorganizing our national treatment system to reflect economic reality and the changed boundaries of medical practice.
He talks about the move "toward generating treatments and diagnostics that do not stand in isolation" and that made me stop. I've been thinking a lot this past week about the stand alone nature of medical services and how that's not necesarily a good thing.
I hurt my hip a few weeks ago, a old pain that suddenly blossomed and blossomed again - I triggered it in November and noticed that I was having muscle spasms in conjunction with family visits and laughed at myself, and stretched and mostly got better and then hurt it again in February again in conjunction with a family visit, and then hurt it again, 3fold, in April around some family stress. Since mid-April I've mostly been sitting.
I saw a massage therapist and a chiropractor and read books on trigger points. It never occurred to me to go to a doctor because it was a soft tissue injury and in the past I've been told the pain was probably arthritis and offered an xray which I didn't want. I don't think it's arthritis and I didn't want to have it pigeonholed due to any deterioration that might show up ( I'm 42, I'm over six feet tall, and not slender. I am SURE I have joint degeneration). This thing I have - I can feel the trigger points all over my hip and leg, both the massage therapist and the chiropractor say the joints feel un-arthritic and mostly, I was tired of mentioning it to medical people and getting a quick off the cuff - arthritis. degenerative hip disease. Which may have been based in training and experience but felt like both dismissal and a blind alley.
But I was also not pushing. I was rejecting the attitude I perceived but not attempting to change or challenge it. This is a hard one. Because if you don't ask a question - challenge your OWN assumptions about what's being said to you until you really understand, at the very least - you'll never have a complete answer.
Here's the thing.
We have this cultural narrative that things fail as you age. You turn forty and shit goes south. Over 40 eyes. Strength. Immunity. Speed of healing. Physical integrity.
A couple of years ago I had a lot of trouble with bleeding gums - dentist checked everything, sent me for blood work, nothing turned up or helped.
In 2008 I was tired. I felt old, I didn't like walking, I stopped going to the gym for 6 months and bickered with a friend who seemed to think there was something (morally, not physically) wrong with me for not getting around more or better. My feet hurt. My legs fell asleep a lot when I sat cross legged. I had a couple of UTIs that turned out to be precurors to a kidney stone, after which I felt a lot better.
So much better that I didn't question any further why I'd been so tired in the first place
So much better I started yoga in 2009, which was life changing.
At least until the fall when I had episodes of exhaustion, shaking hands, weak arms and dizziness that ended up in a diagnosis of iron deficiency. The symptoms got better with a supplement, and then came back last spring: this time the tests came back Vitamin D deficient. Again supplements helped but I came back less strong (my gums got a lot better though).
Somehow I failed to notice that "better" was not the same as "as well as before." It's so hard to hold onto the emotional memory of before, the phsyical memory of wellness.
I was dizzy all last summer in yoga when it got hot (which was pretty much every day, oh summer of 2010, you steamy minx), blamed the D deficiency, struggled to regain strength in my arm and have been struggling for months for focus, or desire or passion or SOMETHING that would help me focus on the future and what I need to change in my life. I cry a LOT in therapy these days.
I have muscle spasms in my leg/hip and neck/shoulder that have nagged and lingered for years. I haven't spun much for the last 2 years because my neck freezes up. Yoga helped a lot, but I've been plateaued in yoga due to what seemed like the limitations of my strength and fitness and an unwillingness to engage with pushing past that. Because I lacked will. Or something.
I developed allergies for the first time 18 months ago, and ached in my knees and hands all winter. And let us just say that digestively, things have not been good for a good year and a half. The hand tremor came back a few weeks ago - it does when I skip vitamins for a few days. My feet started to fall asleep when I sit cross legged again too. And my little toe started to hurt randomly and sharply.
I'm writing this all down because it's so absurd. I went for a physical last week and I told my Doc I felt great. I wasn't lying. I'm IN good shape (well except for having to sit on my ass for the last 6 weeks while my hip slowly mended) and it feels good to be physically coherent, but I've also...persuaded myself that none of this is oh, large enough to matter. I'm just getting older and well, this is part of it right?
Um. No. What I am is nutritionally deficient.
Not all the tests are back yet, it could be a lot of things (I'm betting on celiac disease) but I am low enough on B12 that my doctor was surprised I was not showing neurological symptoms.
I think I was. My vision is better since I started getting injections last week - no more '40-year-old-eyes' focus problems or dry eyes - I've got better concentration and reading comprehension, better thinking, better memory for details. I didn't realize I was foggy until I wasn't anymore, I didn't realize I'd become a pessimist until it started to lift, I thought my recent lack of follow through and motivation was a character flaw, until I found myself fitting thought to deed all last weekend instead of looking around wondering where the two days went (sleep mostly). The degree to which my hip began to work again as soon as the b12 hit my system tells me a LOT of that is probably related too. Toe pain and feet falling asleep? Also gone.
I'm LUCKY. I'm middle class with health coverage, I can GO to the doctor. And yet I've been walking around for 4 years at least, starving my system of essential components - because I never mentioned my bleeding gums to my GP, and and went to the Gyn not the GP for excessive abdominal/hormonal bloating and talked about vitamins with HIM, but not the bloating with HER and downplayed my loss of vigour to myself so deeply that I could look my doctor in the face and tell her I felt great when I was starting each day so bleak in my heart I had to force myself out of bed.
I'm pretty sure from the questions she asked me that she didn't believe me, which I appreciate very much. But I wish I'd known 4 years ago that bleeding gums might be a sign of vitamin deficiency not just gum disease - or that vitamin deficiency was actually, you know, SERIOUS - and had enough of a sense of the interconnectedness of all things to mention it during a physical. Because the information I bring, the assumptions I make and the questions I ask as the owner/occupant of this body are the connective tissue between all the disparate parts of our medical and mental health systems.
I've decided that this summer is going to be GOOD. Because I haven't had the energy for optimism since 2008 and that's just way too long. And if you have any niggling little things you aren't taking seriously? Do me a favor: write them all down and go to the doctor.