Ultrasound Room 12, Please

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.
“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.
“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.
“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.”
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.


Happy Birthday, Ryan Lochte (Oh, right—wrong country. This entry is dedicated to CT, you know who you are)

BCN Competition Pool
BCN Competition Pool

My swimming friends will notice that I have not been writing about the performances at the World Aquatic Championships that I’ve been attending since July 20.  Given that I’m staying at the same hotel as the Canadian (and Samoan!) athletes, this may seem like a mysterious omission.  Originally I thought I might accost the Canadian swimmers in the elevator and ask what music they listen to in the call room, or if they feel their chi is aligned, but I have ultimately chosen to leave them alone.  I won’t write about what I may (or may not) have overheard X and X discussing in the hotel’s rooftop hot tub.  Lurking writers, we’re the worst.

A quick recap for my water buddies: I followed the Canadian open water swimmers closely—literally followed them on foot—along the pedestrian seawall beside the course last week.  A belated shout-out to Olympic bronze medalist, Richard Weinberger (5th place in the 10K, 1:49:19), Eric Hedlin (silver medal for 5K, 53:49.3), Zsofia Balazs (10K, 1:58:28), Philippe Guertin (9th in the 25K, 4:48:46), and Nadine Williams (who swam both the 10 + 25K).  I was in the hotel lobby when Nadine—our only female to take part in the 25K—was escorted back with the assistance of her teammate Zsofia.  Our Chef de Mission immediately asked if there was anything she needed.  “Club sandwich?” Zsophia answered for Nadine, as they hobbled back to their room where I imagine Nadine must have face-planted into her bed and slept for ten hours.

Men's 10K open water race as they pass a feeding station
Men’s 10K open water race as they pass a feeding station

So: Ryan Lochte.  I know, I know, he is an American swimmer with a bazillion fans, and I am here in support of the Canadian team.  But I can’t help myself.  Besides, today is his birthday.  He is 29.  A Leo.  For those of you who don’t know who I’m talking about, visit this page.

I started following Lochte’s career two years ago at World’s in Shanghai with my friend, CT.  We sat together in the stands fiddling with the zoom features on our cameras whenever he appeared on deck.  “What are you two looking at?” my husband Dave and his colleague joked from their seats behind us.  “Nothing,” we sang in schoolgirl unison.

Last night, the pre-finals buzz was electric.  Over 10,000 spectators filled the stadium at Palau Sant Jordi overlooking the 50m swimming pool.  Coldplay’s Fix You blasted from the speakers in a gut-churning crescendo as video footage of the swimming thus far was displayed on giant screens.

Coldplay and the swimming footage came to a close, and the officials marched on deck.  The first event was men’s 200 back.  Eight backstrokers were introduced to the blocks.  Lane five: US superstar, Ryan Lochte.  What colour would his shoes be this evening?  His shoes are always changing.  Orange, I thought at first glance.  No.  Pink?  Orange-pink.  He was wearing his big headphones.  What was he listening to?  Techo-dance?  Arcade Fire?  Bob Marley?  All eight swimmers had a moment to take off their jackets, track pants and shoes.  Swing their arms or dowse their faces with water.  They were given the signal to hop into the pool and grip the bars.  6:09pm.  Take your marks.  And they were off.  Four lengths of the pool and Lochte took the gold in a time of 1:53.79.  This is only the beginning.

At 7:08, Lochte—having already fit in the 200 back medal ceremonies—took to the blocks again to swim the semi-final 100 fly (a newer event for him) and won the race in 51.48.  Barely forty-five minutes later he swam a third event—the second leg of the US men’s gold medal 4X200m freestyle relay with a split of 1:44.98.

Photo of a press TV showing Lochte mid-interview in Shanghai 2011
Photo of a press TV showing Lochte mid-interview in Shanghai 2011

After finals, Dave suggested we exit via the athlete’s entrance, a few levels below the stands.  “You might be able to see Lochte,” he smiled indulgently.  “Sure,” I shrugged, inwardly elated.  We made our way to the hallway beneath the stage, where swimmers were drying off and collecting themselves before the award presentations.  We saw Sun Yang, Chinese distance freestyle champion and then…the US men’s relay team.  There he was.  He was not dressed yet.  Water ran down the length of his arms… Would it be inappropriate to ask him to sign my shirt?  I was approximately one foot away from him as we made our way toward the exit between the relay team and the fruit table.   “So?” Dave said once we were outside.  “Now you’ve seen him.”  Unable to wipe the preposterous smile off my face, I slid on my sunglasses, “Okay.  That was cool.”

This morning I learned that Lochte’s middle name is Steven, that he is a middle child of five, and that his mother is Cuban.  His nicknames are Reezy and The Lochtenator.  He weighs 194 pounds.

This meet did not start off so well for him in the 200 freestyle a few days ago.  An interview via Sports Live discusses his performance transformation: “I was not the real Ryan Lochte,” he is quoted.  “I suddenly worried about how I was going to swim, whether I was going to win and with what time.”  He decided to bring back the old Ryan Lochte.  “The one who does not care.  The one who just gets on the blocks and takes on the guys next to him.  I am a racer and that is what I do best.”

He is right.  There is a danger in caring too much.  When we care too much, we can get tied-up without even realizing what is happening.  The distinction between focus and over-focus is precarious.  I’ve had my own bun fights with this lesson in various forms over the years.

Well, happy birthday Ryan Lochte.  I *liked* your Facebook page today, joining your 483 THOUSAND other fans.  PS, Carli Tyson—I wish you were here!

August & Everything After (Nostalgic at Hotel Barcelona Centre, Eixample District)

Technical difficulty loading old scans. Here is a more recent pic of us together.
Technical difficulty loading old scans. Here is a more recent pic of us together.

Yep, this post is named after the debut (1993) studio album by the Counting Crows, released as I was spray painting a 1976 Ford Pinto orange and green with my best friend Barb.  Grade 10, when driving from Vancouver to Grand Forks to sit on the hood of the car and eat pizza was a fantastic way to spend a Sunday.

Two years later we upgraded to a Ford Ranger pick-up (complete with white canopy), so we could drive from Vancouver to Prince Edward Island and sleep in the truck.  We set out on this trip after high school graduation with virtually no money in the bank (gas was cheap on the prairies, we announced with confidence), prepared to live off the canned tuna and peas we’d taken from our respective parents’ houses and piled in a laundry basket.  We discovered early into the venture that the best place to park for the night was unused elementary/high school parking lots.  Each night, we ferreted out the best lot in whatever town we’d found ourselves, where we ‘secured’ ourselves under the canopy by tying the back shut with a rope (not possible to lock from the inside back then), and squishing beside each other on a single mattress.  I remember waking up in the middle of the night to Barb clutching one of my arms.  I uncurled her fingers that were gripping my bicep and forearm.  “Hey, whoa,” she said blearily.  “I was dreaming about baseball.”

There was no song on the Counting Crows album called August & Everything After.  I wondered why as we played the cassette over and over again crossing into Alberta.  Our ghetto blaster kept running out of battery power, so we stopped at a Radio Shack in Lethbridge to buy a plug for the cigarette lighter.  “There!”  We high-fived as music crackled out of the world’s worst speakers.

I kept a journal on this month-long adventure across the country and back.  However, in a fit of stupidity a few years later, I decided to destroy all of my high school journals by lighting them on fire in a garbage can.  I regret this now.

Something else I remember: when the clock struck August 1st on this voyage, I scrolled the words August & Everything After on the cover of my cork-brown notebook.  Every single August 1 since 1995, these words run through my head, as though this date is my new beginning ever year, a start-over, a clean slate.

The songs on this album still have a nostalgic power over me.  “Perfect Blue Buildings,” for instance, always made me imagine a dreaded conformist future where I lived in a tall building of identical apartments, worked a job I didn’t love, disconnected from nature, trapped in an insular, suffocating urbanity.  No!  Barb and I shook our fists out the pick-up truck windows, we will never conform!  Barb had real dreads.  I wore army boots with everything including my bathing suit.  We would be horse trainers for the circus!  Live off canned peaches!  Swim with dolphins in Hawaii!

photoClearly, this post is not about Barcelona.  Funny how being away from home can make you think about your own country, memories of other summers.  Once I’m home, I will think about Spain and Catalonia country—about the incredible heat, Modernista architecture, the narrow Gothic alleys of the Old Town and hole-in-the-wall bars, the July full moon hanging over Platja Sant Sebastià, marinated anchovies and refreshing lemon beer, the view of Barcelona from atop the hill of Montjuïc.

In the meantime, I raise my glass to August 1, welcome another year, a clean slate.  Barb remembers this road trip as clearly as I do.  “Can you believe we really did that?” we say to each other now and then.  The only book we had on board was some kind of sex guide with ridiculous photos.  We pulled the book out occasionally as entertainment, “I don’t get this one,” I’d say, holding the book upside down.  She’d laugh:  “Yeah, that looks dumb.”
Then we’d sidle up beside a Great Lake to take a bath.
To August 1. To Barb.  Salud!