Whenever the rainbow appears in the clouds, I will see it and remember the everlasting covenant between God and all living creatures of every kind on the earth." Genesis 9:13

Sunday, August 08, 2010

My plans for this week

1)  Work my butt off.
2)  Scary Dr.Body appointment.  Complete with another urine culture because I still have UTI symptoms and the last culture was negative but I'd also had several doses of antibiotic.  So, this time a culture not involving masking.  Unless the symptoms are totally gone by then, of course.  Which is possible.

The reason this appointment is scary is that he doesn't know some things he needs to know.  Things like I have a really hard time with pain and that I will lie, even mid-exam, if I think something shouldn't hurt that does.  When I was there a few weeks ago with the possible kidney stone one of the things he did was push hard into the middle of my back.  It hurt, quite a bit, but I thought "that's stupid, there's no way he's really checking anything except whether I'll say anything hurt".  And it turns out that my lying then indicated one of the symptoms I did have wasn't there.  Genius.  Did this ultimately affect anything?  Probably not, other than I might have qualified for pain meds or a more serious search into what pain meds I could have if I'd told the truth.  But he hasn't dealt with me and pain quite so much and he needs to know that 1) my admitting something hurts badly means that I'm in a LOT of pain and 2) I lie about it.  The dentist has made it known that I am not to be trusted as so he does things like if I says a tooth is sore he tests every single tooth around it because once I said a tooth was sore and he did what he typically does, which is test the one behind the sore one to compare the reactions and I about hit the ceiling.  That led to the discovery of a deep cavity in the tooth I said hurt and a big crack in the one behind it.  The filling of that crack had a 50-50 chance of needing a root canal/crown, and so I left knowing it would ache.  I put up with it for several weeks before going back.  The exam made me say ouch, but not in such a painful way that he thought it was anything at all.  However, given the option of the root canal I'd more than likely need based on the ongoing achiness I went for it and it was so extremely infected that my dentist had to flush it with lidocaine solution to fully numb it and then sort of deep clean it.  He said it was about 24 hours from sepsis.  That resulted in a few things:  1) My dentist no longer believes me about pain.  If I say something is sore he suspects "about to explode".  My exams are done very carefully because he doesn't trust me. 2)  I was given hefty doses of pain meds and antibiotics are ordered to bed for the day.  3)  He confirmed what I had observed a long time ago with an independent observation that anti-psychotics (or the need to be treated with them) seem to dull pain awareness.  4)When combined with my experience with my ankle shredding last winter I finally came to understand how little i understand pain.

When talking to Dr. Mind about this a few weeks ago I said something about knowing that my lack of appropriately admitting pain probably led to some of the damage to my ankle.  I hurt my ankle going to see Dr. Mind and so he was the one who was there when I bandaged my skinned knee and then pulled off my sock and shoe and saw the damage:  a huge, purple lump surrounded by my whole foot swelling within minutes of the injury.  I needed the session so we still talked as much as I could and watched in awe as the swelling got worse.  By the end I couldn't put a shoe on, so Dr. Mind carries my shoes, coat and purse down the stairs and got me to the car.  I drove to urgent care, hobbled in, accepted an ice pack, and was taken back quickly, meaning I triaged in rapidly.  I proceeded to insist on walking and adamantly refused a wheelchair.  When I mentioned this to Dr. Mind recently he was horrified.  Apparently logic would say if it looks like that DON'T WALK ON IT".  Again, I thought I was overreacting, and I think that was precisely what led to my leaving urgent care with no pain meds and then led to nobody really seeing how badly injured it was until I finally saw the podiatrist feeling absolutely stupid but unable to tolerate any more soreness in my other foot from limping.  He saw the injury immediately upon having me stand in my bare feet so he could see how I stood on the sore foot.  Even then I thought he was making the sprain into a big deal when it wasn't until he showed me xrays with angles drawn to show where my ankle should be and where it was.  I feel fairly sure that there was a sequence of events that went like this:  I insisted it didn't hurt.  But then I refused the simple pain meds (motrin, tylenol 3) that urgent care offered and wanted something stronger (they didn't belive me about allergies and interactions) and so looked like I was drug-seeking.  I was then up all night and so Dr. Body gave me pain meds from a fax requesting them since he knows this happens frequently.  When I saw Dr. Body I remember him commenting about the severe bruising and that it was pretty bad if it went around my heel as it did, but he didn't have xrays and at most had the urgent care doctor's report and in it would be mainly freatured that I walked in, had no fracture, and refused tetanus shots and had some big huge story about needing emergency care, IVs, and specific meds available if given one.  The urgent care doctor thought this was all drama, probably psychiatrically related, but in fact it is what Dr. Brain has said needs done if I have to have a tetansus shot because I am anaphylactically allergic and the meds needed to treat anaphylaxis are contraindicated with the MAOI and can kill me by causing a stroke.  Therefore I would need the shot while hooked to an IV so if I had to have epinephrine they then could give meds to control my blood pressure rapidly.  Urgent care doctor thought I was trying to avoid the shot.  So anyway, Dr. Body was working from those notes and to my knowledge was not even made aware of the xray showing a previous fracture.  So he too under-treated and didn't send me to a specialist.  I think I fooled the PT as well, although there were weird things involved there so who knows.  I know they thought it curious that I complained of pain in a 2nd area that hurt because of how badly things were torn, but they did not realize this.

So, anyway, essentially I have an appointment which I am paying out of pocket for so my insurance doesn't find another way to deny my psych visits in which I have to reveal that first, I am a liar, and second, that I have no idea how to tell when something really hurts or doesn't, that I never trust myself, and that if I am to function I need to know specifically how to know that something is wrong and that I need checked out, because if I am left with the impression that there isn't really anything wrong I will make myself crazy and I may need specific paramters that say "problem" versus "no big deal" I will turn that into echoes of my past.

This is not an easy discussion and I am not looking forward to it.  Ugh.

No comments: