Wednesday, October 26, 2016

Torn (Not Torn)

“Strip down to your underwear,” the technician said, “and put these on over them.” She handed me a pair of baggy blue paper boxers. I changed as directed, pulled on a hospital gown, and locked my stuff in a locker.

Just a week earlier my insurance company declined to pay for the MRI I now prepared for. Insurance companies are sometimes called providers, but in my mind, I see old white guys who say no; who understand the bottom line and little else.

My doctor wanted me scanned so she could see what was probably a torn left shoulder rotator cuff. After the insurance company said no, she referred me to an orthopedic surgeon. He too wanted that MRI. This time, the old white guy said yes.

“It will take about half an hour,” the MRI tech told me, once I came into the exam room. “Some people try taking a nap in there.” A nap, in that forbidding MRI tunnel?

I gave her the locker key and she hung it on a hook. At her bidding I lay back on a kind of runway that would deliver me into the apparatus (3.0 Testa Magnetic Technology). She girded my left shoulder in something not unlike a football player’s shoulder pad, and tucked a thick cushion under my knees.

“If you need something, squeeze this,” the tech said, handing me a bulbous object about the size of a chicken egg. She did not instruct me to lay still, but the message was clear.

At last she slid me into that big magnetic thing, like a cake into an Easy Bake Oven. And with alarming rattles and clangs and beeps, the enormous machine came to life. It buzzed noisily, like the deep buzzing of an airport luggage carousel, but in short staccato blasts. Superior imaging resolution. State of the Art technology. Thirty minutes of it.

I closed my eyes. Some patients experience claustrophobia. Not me – but I didnt nap, either. No; more like sensory deprivation, almost an out of body experience. Images: a woman in silhouette at the top of the stairs. Children taking cannonball plunges in deep clear water. Dancers, flocks of birds, masses of humanity. Shoulders. Soft tissue damage.

And suddenly ... it ended. Done so soon? I asked. Half an hour, the tech said. It seemed like less. She burned the MRI images onto a CD. Take this with you to the doctor. Virtually one hundred precent detection of rotator cuff tears.

Two days later I huddled with the orthopedic surgeon, who told me that I did not, in fact, have a rotator cuff tear. Subscapularis and teres minor are intact,” he said. “Evidence of tendinosis and peritendinosis through the rotator interval…there is a linear tear of the superior labrum extending from the biceps anchor anteriorly to the 2 o’clock position...” and so on and so forth.

So there is a tear – a fray, the doctor also called it. Very minor. Go get yourself some physical therapy, he said. No need to cut you open. But he understood there still was pain.

In my previous blog post, I expressed doubts about Western medicine. But a drowning person grabs the blade of a sword – or in this case, a steroid injection. “Yes, please,” I said, when the doctor offered, and I sat willingly as he shot me up. Within minutes the pain was cut in half, maybe even a bit more than that. There was an accompanying giddiness, an elation, which the doctor said was common. And I realized how beautiful everything is.

Friday, October 21, 2016


“Rotator cuff” is a familiar phrase, often heard in the context of a sports injury. I never even knew what a rotator cuff was until recently: a group of muscles and tendons that connect the shoulder blade to the humerus, where they form a sort of cuff. You use them to move your shoulder, and rotate it.

I know now because I tore my rotator cuff last May. I didn't know it at the time; it seemed an insignificant bike mishap, more embarrassing than anything else.

I had just emerged from a guitar store with a new set of strings tucked into my backpack. Wore new road bike shoes. Unlocked the bike, clicked my left foot into the pedal, placed my right foot on the ground. Rolled forward toward the street. Hit a bump. Toppled slowly to my left, unable to extract foot from pedal to catch myself. Hit the ground.

It’s my left shoulder. I may not know much about rotator cuffs, or which part of mine is torn. But I do know there’s a long list of ordinary things I am, at present, unable to do without serious pain. I can’t put on a shirt, or tuck it in; can’t put on a jacket or a backpack; can’t stretch and yawn; can’t extend my left arm above my head – can't do any of it pain free. There’s a bunch of other stuff, too. I do these things anyway, but if I’m not careful, it hurts like hell.

At first I thought: give it a week or two and it will heal. But before May was out, I accepted that a trip to the doctor was in order. I’ve seen this doctor before and like him, though I do not entirely trust Western medicine. He ruled out any broken bones but did not detect the rotator cuff tear. His prescribed treatment? Handfuls of Advil.

In spite of intermittent, stabbing shoulder pain, I enjoyed an ordinary summer. Kept riding my bike. Never did try the Advil cure, but it wouldn’t have helped. Finally, on the last day of September, I saw a second doctor. She diagnosed the tear and wanted me to have an MRI, but the insurance company said no. So she handed me off to a third doctor, an orthopedic surgeon.

This doctor also diagnosed a torn rotator cuff. An MRI, he said, would confirm it, and pinpoint the affected area. What about the insurance company? I asked. Worry not, the doc replied. Shoulders are my specialty. My word carries great weight.

That was Tuesday afternoon, 10-18. On Wednesday morning I received a phone call from Boulder MRI to set up the procedure: the following Monday afternoon, contingent on insurance company approval.

In between these May and September doctor visits I began seeing a massage therapist – chair massages at a local natural foods store. She's helped a lot, working out various knots and giving plenty of attention to my shoulder. It's chased away some of the pain, but wasn’t the magic bullet I thought it might be. Torn is torn. I believe in massage therapy, though, and still see her once a week.

Treatment for a rotator cuff tear is either physical therapy, or surgery.

I’m counting down to Monday.