Chronicles of Chronic Pain Part 2

My current physician is Dr. B., and he has been fantastic. I cannot recall when I've had a doctor who is more thorough. When I initially came to see him about the pain in my left arm, he had me take in-office X-rays that day! I was floored. He also suggested getting an EMG, but he was cognizant enough to realize that perhaps my HMO would not cover the test if it were done in-house, so he had me check. He told me that if they did it in-house, it'd be a lot less painful for me than if I'd have to see a specialist, since he uses electrodes and the specialist would use needles. Of course, my HMO would not cover the in-house treatment. I guess you can't win them all.

At any rate, he has performed an X-ray of my neck, blood work (I have a family history of Lupus, but am negative for that so far) and an EKG. When the pain in my chest persisted and became a bit more severe, he had me get a chest X-Ray. When the pain migrated to my right arm, Dr. B. decided to have me go ahead and have the EMG. For those of you who may not know, an EMG is a test used to measure electrical activity in the nerves and muscles. The specialist I was sent to checked for nerve damage and any pinched nerves, but found none. The EMG was as painful as Dr. B. promised; it was even more painful knowing that it may have been unnecessary. After the prong jabs and needle pokes, the specialist took my pulse in three positions - sitting, sitting with my left arm up halfway, and sitting with my arm up and my head turned to the right.

"Hmmm", said the specialist, as he lifted my arm. "Hmmm", he said again, as he had me turn my head. I stare at him in wonder, and he finally says, "I think you may have Thoracic Outlet Syndrome." He went on to explain that TOS is a congenital disorder in which those afflicted were born with an extra rib in their neck. The rib places pressure on a nerve, causing restricted circulation and pain. His cue was the fact that when he took my pulse with my arm raised, it weakened, and when I turned my head, it disappeared completely (this is called Adson's sign). I asked him if it was a congenital condition, why was it just now appearing? He said my recent weight gain most likely played a factor. Still, I could not help but wonder why I had to go through that tremendous amount of pain for such a simple test to point us in the right direction.

Despite the unnecessary pain, I could not help but feel a glimmer of hope now that I had a possible answer. Sure it was a condition that I had not ever heard of, but it was something - surely if the condition is recognized, it also had a treatment. I was anxious to see Dr. B. so that we could discuss this new finding. When I did see him, he did not seem convinced that it could actually be TOS (considering the previous neck X-ray), but recommended that I have a CT scan of the area to make sure.

The CT scan was a harrowing experience. If Dr. B. is incredibly adept at the level of care he provides, the specialists and other health care service providers he has to send me to for tests and treatment seem to be equally inept. I am literally working through my pain - I have not yet taken a medical leave at my job. As such, time off for all of these tests is precious. Imagine my dismay, then, when I show up for my CT scan and am told that due to my seafood (read: iodine) allergy, I could not take the test that day as the scan used a contrast dye, and I had not taken the necessary anti-allergy medicine.

Why had I failed to do so? It may have something to do with the fact that no one neither informed me of nor provided me with this important medication. Considering the fact that I took a day off of work for this procedure, the sympathetic triage nurse did what she could (there was a discrepancy between my doctor's written order and what the CT tech had regarding the dye), but ultimately I could not get the test done that day. We worked it out so that I could return on an upcoming scheduled day off that wasn't too far into the future, and I was handed my medication then. I was also promised that I would not have to re-register; I would be able to come right to the Imaging desk and get my test done. I was frustrated, but I'd rather be safe than sorry. Besides, this was one of those rare off days hospitals have from time to time, right?