Sometimes Things Can be a Real Pain in the Neck

While my boyfriend and I were waiting for authorization from his insurance company, he and to a lesser extent, I were continuing to treat his wounds with the Iodosorb and a foam dressing. Although, I want to be more involved than I have been, his schedule has required him to take more of the responsibility for his usual dressing changes. At his recent wound care appointment, his doctor explained that she felt the wound on the lateral (outside) part of his foot was doing so well and had become so superficial that she felt she would be able to glue it closed and then apply steri-strips to secure the edges of it. My boyfriend and I were pleased that at least one of his wounds was beginning to come along so the doctor applied medical grade superglue. His medial (inside) wound was also looking very good and the doctor told us to continue using the Iodosorb and the foam dressing. She then asked how the progress was with his new braces, which he then explained that he had received authorization and was just waiting to make the appointment. Although, I did not say anything at that point, I did feel somewhat blindsided by the information because I had repeatedly asked him if he had heard anything and was consistently told, “no”. To say that I was peeved, is an understatement, but I tried to take a step back and understand that all of this really was his responsibility and I should perhaps try to take more of a hands-off approach, especially because I had a lot of my own stuff to deal with as far as my shoulder was concerned.


By this point, I have seen three; orthopedists for my shoulder injury. The first orthopedist disagreed with the MRI report, based on her viewing the images personally, and also on the physical exam she performed on my arm. She said that in her opinion, I had not torn anything and what I had was a case of bursitis, and some early arthritis in the top of my shoulder but that ultimately, one of my muscles was just not as built up as she would have liked. She then recommended a cortisone shot to try to help my pain. I had had one previously, in my hip and I knew that cortisone shots were painful but that it had helped my hip so I agreed. I also agreed, because I had done some prior research and knew that getting one shot in my shoulder would be okay but that getting too many, could lead to any surgical repair being more difficult. I had originally, gone into the appointment, thinking that I would just hear her out and wouldn’t make any actual decisions but all of that seemed to go out the window. I think what happened was, I was thrown for a loop when she said that I did not have tendon damage and so I may have somewhat let my guard down. My initial thought was that I of course would not have gone ahead and scheduled any type of repair of the shoulder until I had at least gotten a second orthopedic opinion but maybe I felt that, that wouldn’t be needed so I went ahead with the shot. After I got the shot I went home and applied ice to my shoulder to try to minimize the pain and swelling and took it easy for the rest of the day.


I decided to get a second orthopedic opinion on my shoulder situation prior to beginning any physical therapy as a “tie-breaker” of sorts because the MRI report had said one thing and the orthopedist’s opinion was different. I went to the second orthopedist with copies of all the imaging that I had done of my shoulder and also the patient portal app that I had on my phone that documented everything from my initial orthopedist appointment. That orthopedist viewed the images and also agreed that it didn’t look like I had torn anything. He then did an exam of my shoulder, during which he asked me to move in all sorts of painful positions. At the end of all of this he explained the diagnoses he had come up with. According to him, I had Bursitis, a contusion of the shoulder, impingement syndrome and a neck strain. After hearing all of this I asked what my options are and was told that he could give me another cortisone shot but that at this time all he would recommend would be physical therapy. I accepted the cortisone shot because by that point I was more confident that I would not need surgery. I received the shot and left with the instruction to start physical therapy in about a week.

Of course while I was trying to handle all of the pain and inconvenience of having a shoulder injury, I was also continuing to assist my boyfriend with his wound care. His wounds in my opinion were beginning to stall in the healing process which somewhat bothered me but they weren’t really looking worse at that point so we continued to treat his wounds as directed, until I noticed something different. All of a sudden, when I was changing the dressings on his wounds, I noticed that some undermining was developing on one of them. I looked into the small opening as closely as I could, with the flashlight of my cell-phone and I realized that the undermining area looked to be very dry. Of course, I had learned all about moist wound healing so my first instinct was that something should be done so that the area could gain a bit more moisture. I explained to my boyfriend what I saw and what my thought process was and asked him if it would be okay if I called the wound care center and got some input on the situation.


When I called I spoke with the nurse that I communicate with very well and explained to her what I felt was going on. She then asked me what I wanted to do based on the supplies I had available. I told her that I would like to use Hydrogel in the new area and she said that if I felt it was too dry to go ahead and stop using the Iodosorb and to apply the Hydrogel. When I hung-up with the nurse I explained to my boyfriend what she had said and he said to go ahead with the new plan. I then had to figure out a way to apply the Hydrogel, which comes in a tube similar to a toothpaste tube, into a very small opening. After thinking it over for a minute, I decided that I could probably put some of the gel into a syringe and push it in that way. I was unsure if it would work completely as the diameter of the syringe was slightly larger than the opening I needed to squirt the gel into. I gave it a try and although I wasn’t sure if the gel went down as far as was necessary I knew that what I was able to get into it, would most likely help. Afterward, my boyfriend went home and I wasn’t going to see him or his wounds for a few more days. It ended up that I didn’t even get to see his wounds until the following wound care appointment. When we got there I was happy that we got the nurse that I had spoken to on the phone so I wouldn’t have to explain to a different nurse why we weren’t following the written orders. The doctor came in and told me that she had heard all about what was going on and what I had done. When she examined him she saw the part I was talking about and because the Hydrogel that I applied had done it’s job she told us to discontinue that and to go back to the Iodosorb, she also took a culture of his wounds because it had been awhile since one had been taken and she wanted to make sure that the new undermining area wasn’t caused by an infection.


The doctor called me a couple of days later and told me that some infection had shown up in the culture and she was considering putting my boyfriend on a topical antibiotic ointment. I said that it was probably a good idea based on what I had been seeing and gave the information for the pharmacy my boyfriend uses. I then called my boyfriend and explained to him what the doctor and I had discussed. He then told me that if we needed to do daily dressing changes while using the antibiotic, new supplies would need to be ordered because as it was he barely had enough to get him through until his scheduled visit to the wound care center. I was slightly peeved that he had forgotten to mention it at the appointment and though I voiced this annoyance to him, I also called the wound care center and asked that new supplies be ordered. It took several days for the pharmacy to get his antibiotic in stock so while we waited we stuck to the dressings schedule that we had been using.


By this point I had been going to physical therapy to try to decrease my neck and shoulder pain and to increase my range of motion. After a few sessions that consisted mostly of stretching, my physical therapist determined that in her opinion my first rib was slightly out of whack and she wanted to adjust it. Without entirely thinking it through, I allowed her to manipulate me so that my rib would go back into place. I went home afterward and actually felt somewhat better, almost like she had loosened something and although moving was still painful, I felt like I was able to move slightly farther. All of this continued for several weeks when I noticed that I wasn’t really getting any more improvement or pain relief. I had a follow-up appointment with the orthopedist after seeing my therapist for approximately seven weeks. During the appointment, we discussed that my shoulder pain was improved slightly but that my neck was still really bothering me, I also asked him if he thought my rib had been out of place and explained that my physical therapist had been doing some adjustments to it. He said that he didn’t feel that my rib was out of place at all but he recommended that we take a neck x-ray to determine a cause of my neck pain. When my orthopedist pulled-up the x-ray images on the computer, I myself was able to see that something didn’t look quite right. The orthopedist explained that I had a slipped disc in my neck. I was somewhat relieved that I had a real reason for being in so much pain and yet I was concerned because a slipped disc didn’t sound like a minor diagnosis. When I asked what should be done about it, I was told to continue therapy and that he would see me again if I felt I was still not improving after awhile. I continued physical therapy for about another week when I decided perhaps it was time for yet a third opinion. I called the orthopedist that my wound care surgeon had recommended and was able to get an appointment relatively quickly.

I am Sick of Being Confused and Frustrated

It was approximately, two weeks later when finally the day of my shoulder MRI arrived. I went to the MRI a whole lot calmer than I usually am, due to a mild sedative that I had asked my primary doctor to prescribe. Ordinarily, I do not take any medication prior to an MRI but this time I decided that it was a good idea because I had been told that I had moved during the one I had on my wrist and I did not want any potential movement to distort the images. After the test I tried to relax for a few days and focus on celebrating the holidays with my friends and family. When my primary doctor’s office got in touch with me to discuss the findings of my MRI, I was told by my doctor’s Physicians Assistant (PA) that one of the tendons in my shoulder was partially torn and another was completely torn and that a third may have been involved. As such it was my doctor’s recommendation that I be evaluated by an orthopedist. My initial reaction to hearing that I had torn tendons was unfit for print but let’s just say it was rather loud and colorful.


It was a couple of days after speaking with my doctor’s office, when I was finally able to think clearly enough to process what the PA had told me, when suddenly, what she had said didn’t seem to make sense. I contacted my doctor’s office via the patient portal and asked that my physician call me so that I could speak to her directly for clarification. When she called me back, my primary question, was how the method of injury corresponded with my diagnoses; because to me it didn’t seem like banging the back of my shoulder would have actually torn a tendon, let alone two and potentially three. My doctor, told me that I was asking a very good question and the only thing she could come up with was that I had slightly and only momentarily dislocated my shoulder, which had damaged the tendons, but that I should ask the orthopedist that question. I made an appointment with the orthopedist that my doctor recommended for the following week. While I was waiting for the day of my appointment to arrive, it occurred to me that if I had actually torn tendons that the usual treatment is surgery. I have finally learned though that second opinions are useful and so I reached out to my former wound care surgeon to see if he would be willing to recommend an orthopedist. It may seem strange that I contacted my wound care surgeon for an issue with my shoulder and maybe it is, it’s just that I have such a level of trust with him and obviously, he knows surgeons that have other specialties, my theory, was really, what did I have to loose?


During this time, boyfriend and I have continued to use the Iodosorb to treat his wounds and although they are not healed yet, his cultures haven’t shown any infection that needs to be treated. While this is clearly, good news, the doctor has suggested that he get evaluated for new braces because perhaps the fit is contributing to his wounds. While my boyfriend agreed that the evaluation seemed like a good idea, he kept putting off being evaluated. By then of course I was frustrated that my boyfriend’s wounds were not closed but I was more frustrated by his failure to be evaluated for new braces. My thought process was, if there is something that could potentially help his wounds heal and also prevent more from forming in the future, why the heck isn’t he getting it done? During his wound care appointment a few weeks ago, my boyfriend’s doctor, asked him both what was stopping him from having his braces evaluated and what they could do in order to help facilitate it. My boyfriend said that making an appointment that corresponded with his work schedule was a challenge but that he didn’t really need anyone at the wound care center to do anything to make getting the evaluation any easier. The doctor, told us to continue treating the wounds as we had been but that she really wanted his braces evaluated. She also turned to me and I think half-jokingly told me to make it happen. While she may or may not have been half joking, I took her seriously, because I understood where she was coming from in explaining that nothing she could do would help him if he didn’t take care of the root cause of the problem.


I let all of this go for a couple of days, hoping that my boyfriend would step up and do what everyone felt needed to be done. While I was waiting, I was also stewing to myself and talking to the therapist that I have been seeing for approximately a year and a half. After hearing her out and really considering all that she had said about my boyfriend and I each having different “roles” in our relationship that we tend to excel at, I decided on a plan. I determined that pleading with him to make his own appointment hadn’t been successful, which in my view left me with two options. I could both sit and do nothing about it and potentially, “let him fall on his ass” metaphorically speaking, Or I could offer help. I chose the latter, which I am pleased to report that he took me up on. Knowing, his schedule and all of our commitments for the near future, I was able to call and make him an appointment so that his braces could be evaluated. My boyfriend also allowed me to speak with his wound care doctor to request that she call the place where he gets his braces adjusted so she could give her medical opinion on his wounds and what adjustments may potentially help.


My boyfriend and I went to his braces evaluation together approximately one and a half weeks ago during which he and I did our typical “dance” of him explaining what is happening and me sitting silently and just observing. I think this tends to be my modus operandi because I have very strong boundaries when it comes to people speaking up for me and therefore am hesitant to do it for others, yet in this instance I do not think it was a wise decision. What ended up happening was little more than a colossal waste of time. Two things were done during this appointment, one of which was for a portion of his brace to be smoothed out so that it didn’t cut into his skin anymore. Of course that was a wise decision because his skin under that area of the brace is starting to wear down but it is not on his feet where his actual wounds are, although I do realize that smoothing that portion may help prevent his skin from breaking down further. The only other thing that happened was that my boyfriend was told that the company needed to contact his insurance company so that they could obtain authorization for new braces. It is my belief that this could have been done prior to his appointment because now he will have to go back at some point after insurance approves new braces so that he can be measured and casted for them. We are now waiting to hear back from either the braces company or his insurance company with either an approval or a denial of his new braces. Personally, I am not worried about his insurance company denying his request because he hasn’t gotten a new brace in several years and this one is clearly not fitting properly, I am just frustrated by yet another delay.

Why Can’t I Just Be Pain-Free and Healthy? Dealing with Several Issues (PART 2)

After soaking my toe in warm water daily, with absolutely no improvement, I followed up with the podiatrist’s partner one week later at the wound care center. When I got there, the nurse that I had always been most comfortable with saw me. She examined my toe, and said that it looked really healthy; that she didn’t see any signs of infection and that it seemed to be healing well. I told her that I agreed it did not seem to be infected but that my pain has not changed at all. At that point I attempted to pick her brain to see what she could come up with for possible causes of my discomfort and what solutions she may have. She was completely stumped and said we would have to ask the podiatrist. When the podiatrist examined my toe he was thrilled with how it looked, I explained that I was still experiencing pain and nothing I was doing was relieving it.


His only suggestion was to cut the toe off of an old pair of sneakers so that it wouldn’t have any pressure on it. I am not sure why I didn’t press further, but the fact is, aside from that appointment I hadn’t really been wearing shoes at all and was still in pain so I did not really think that destroying a pair of sneakers was going to help. The podiatrist sent me home with instructions to cover the toenail area with Silver Gel and to cover it with a band aid and a very small dressing that is the equivalent of a compression stocking, to help the swelling. He also recommended that I return the following week so that my original podiatrist could see me. After that, the nurse came in to apply the dressing to my toe. While she was doing that, she explained that Silver Gel is basically Bacitracin that has silver in it, which as I know by now, has antimicrobial properties. I left confident that I would be able to adequately care for my toe until I could be seen again.


During the time I was waiting for my appointment with the podiatrist, several other health issues needed to be addressed. Firstly, I had two appointments with the orthopedist regarding the pain in my wrist that was not decreasing, though I was on the prescription dosage of Ibuprofen and had been using the splint regularly. During the first appointment he had told me to just wait it out a few more weeks, unfortunately, waiting it out did not seem to be helping. When I went back to the orthopedist he examined my wrist and then left the decision as to the next step up to me. He said that it was certainly reasonable to wait it out a little longer yet he also explained that getting an MRI scheduled was absolutely warranted. I decided to schedule the MRI firstly, because I really did want answers and secondly, I figured with scheduling the way it usually is, my wrist would have time to feel better prior to getting it, which would enable me to cancel the test.

Awhile back, my urologist ordered a routine urinalysis because I am still looking for a cause of my lingering back pain. A few days later I called the urologist’s office, after receiving my lab results via the Patient Portal that my local hospital has. While I as a patient, do like that I personally get to see my results, along, with a chart that gives the normal ranges of numbers. The lab results from the patient portal of course do not erase the need for a physician, both to explain things to me in plain English and also to call in medication if necessary. When I spoke with the nurse, she said that my urologist was wondering if I was experiencing any other symptoms that would indicate a Urinary Tract Infection (UTI). I then explained to her that the only symptom was the back pain but no new symptoms had developed. She then explained to me that the reason she was asking was because my urologist was wondering how I felt about Not treating the infection if I was asymptomatic. The doctor’s concern with treating my infection was that I was becoming resistant to antibiotics that he was able to prescribe and so treating the resistant bacteria would be the job of the infection disease doctors. I explained, to the nurse that I felt like not treating it was the wiser decision at that point and that I would call the office if any symptoms developed.


All the while, my boyfriend informed me that he had wounds on his foot. Seriously, how much more medical drama could I be expected to handle? I admittedly, ignored my boyfriend’s wounds for a couple of weeks, because I was dealing with my own stuff. I also know that my boyfriend, while stubborn at times, was not going to let a wound get out of control so a part of me didn’t feel all that bad for somewhat ignoring his needs. When I did get asked to look at them, I did and saw two wounds, both of which were caused by his ill-fitting braces. I knew that my boyfriend had already gotten his braces adjusted so that they would hopefully no longer add to the problem. I then examined the wounds; the first one was open but had very little depth and to the best knowledge was not showing signs of being infected. The second wound, looked like a very small puncture in the center of a large callous. While the second wound appeared smaller than the other wound, it actually worried me more. I was concerned because I could see that it had some depth but due to its size I was not able to visualize exactly how much depth it had. I then covered both of his wounds with Bacitracin and put one of the only dressings I had on them. At that point we decided to call and schedule an appointment at the wound care center so that my boyfriend could be evaluated and we could be given some appropriate dressings. When I called to try to get an appointment for my boyfriend, we hoped that one would be able to be scheduled with the same wound care surgeon that we had both grown so comfortable with. We were pleased to hear that the surgeon was scheduled to be at the wound care center the following week so an appointment was scheduled. It seemed to me that we were going to be spending the day at the hospital because that day was when I was also scheduled to see the podiatrist.


The day before my boyfriend and I had our appointments at the wound care center was the day that I had the MRI of my wrist scheduled for. I went to the MRI appointment not at all worried about the test, mostly because I had certainly had MRI’s before but also because I had several other concerning things on my mind.


That week, I had noticed that I was starting to develop signs of a UTI; of course I had already been warned that the cultures had come back indicating that I had one so I was not surprised when suddenly I noticed that my urine was cloudy and had an odor to it, what did surprise me and temporarily scare me however, was when I noticed small amounts of blood in my urine. Of all the UTI symptoms the blood was of course the most concerning, until I remembered that with all of the Ibuprofen I had been taking, it was possible that the medication itself was causing that particular symptom. I mentioned all of this to the nurse at my urologist’s office and she agreed that it was possible that the Ibuprofen was causing the small amount of blood and as such she suggested I try to ease up on the dosage if it was at all comfortable. She also recommended that I have a consultation with an Infectious Disease doctor at my local hospital because, the previous bacteria was resistant. I did ease up on the medication and the blood in my urine eased to exist, at least to the naked eye. I also called and made an appointment with Infectious Disease, just to cover my bases.


In addition to the kidney pain and my painful wrist, I was of course following up with the podiatrist for my painful and still swollen toe. When I got there I casually mentioned all of the other health issues that were going on. When the podiatrist looked at my toe she was incredibly pleased with how it looked. The hematoma was gone and the nail was beginning to grow in nicely and I showed no obvious signs of infection. I then asked her why she thought I might still be in pain and she was somewhat unsure. It was then that she asked me if I had any other symptoms that might seem unrelated, that she would be able to use. After thinking for a minute I told her that I had been having some muscle spasms in the calf of the leg that was having the toe issue. At that point she excused herself to go talk to the other podiatrist, when she came back, she had a business card with her. She suggested that I see a vascular surgeon just to rule out anything that could be fixed. She also said that if the vascular surgeon was unable to help that I should seriously consider going to a pain specialist. Clearly, I had some things to think about and maybe even some doctor’s appointments to make, that would have to wait though, because an hour later, my boyfriend had his appointment with the wound care surgeon.


During his appointment we both explained what had caused his wounds, what we had been doing to treat them and that the issue with his brace, which caused them had been fixed. During the evaluation, the wound care surgeon voiced his concern that the situation was not entirely fixed because the callous was still present. The small wound that was on the callous was considered closed, too the wound care surgeon. I am currently slightly worried that it has more just formed a scab but that the puncture depth may still be a problem. The only reason I can come up with for not voicing my concern was that I somewhat felt like it wasn’t any of my business. If my boyfriend wasn’t worried, then why should I be? The wound care surgeon told my boyfriend and I that we were to put Iodosorb in the wound and then cover it with Aquacel Foam. Iodosorb is a brown paste, the purpose of which is to absorb fluid, and remove any fluid or debris that the wound may have. As the Iodosorb absorbs the drainage from the wound, iodine is released from the paste, which helps to kill bacteria. Aquacel Foam works, by gelling on contact with the wound’s drainage and then pulling the majority of the moisture away from the wound so that maceration does not occur, yet it also, allows for an appropriately moist environment for optimal healing. We were then told, to use foam dressing on top of the callous, not so much for absorption but to provide some protection from his brace. After we were both clear on the instructions to take care of his wounds we were told to schedule a follow-up appointment a few weeks later.