Back From the Icky Place

Yup.

It happened again.

This time when I went to the ER, they grabbed me and held me. Ha! Frisked me all over and cuffed me up and said, --You carrying anything we should know about, anything dangerous?

I went there Saturday night. Because, of course, stuff like this only happens on the weekends.

I had been working steadily in the yard, vigorously enough - but not TOO hard - and trying to ignore this new pain I'd felt for the last couple of weeks. It hurt off and on in my lower left rib cage.

My lungs were hurting too, enough that I'd gone to an acupuncturist last Tuesday. I saw her a few times a couple years back, but I couldn't afford even the discount $50 fee any more. I did notice that one of my billions of pain areas improved dramatically after just the first visit. That pain was from pleurisy, an autoimmune inflammatory disorder. It attacks the membrane lining surrounding your lungs. Then, when that's supposed to smoothly slide against the membrane lining your chest as you breathe, as you inhale - still with me here? - the two linings kind of stick together instead of sliding. Hurts like hell. Makes it very hard to breathe. Every breath is like a knife in your chest.

So that still felt much better on Saturday, only a few days after the acupuncture visit. But the other inflammatory-type pain, the rib cage one, plagued me again. It'd get so painful it would make it hard to breathe, too. Like trying to breathe with a broken rib.

Rheumatoid arthritis, that classic autoimmune disorder, was my first chronic illness. I got it at age 8, in the ball joints of my big toes. Since then it's migrated all over my body. There are more than 100 types; the one I have, like some others, doesn't just attack joints. RA will attack your collagen or, like mine, your connective tissue. Every tendon attaching bone to bone, every ligament attaching muscle to bone, every silvery membrane surrounding muscle, is its game. Joints? Sure. Yum! Plus everything else it can find. Organs too. Ouch.

In the interest of fighting back using humor, I make jokes out of it. Most of my jokes are 50% fact and 50% silliness. So I'm only half-kidding - or half-serious - when I say, *I have arthritis in my eyes, I have arthritis in my teeth...*

It's true. It makes my eyeballs hurt: it attacks the eye-moving muscles where they attach to your eyeballs, among other places. Our teeth are held in place not just by our gums, but by the ligament attaching the gum and the tooth. That ligament is largely connective tissue, and in me, it gets inflamed from the same autoimmune RA that eats my joints.

So I've had arthritis in my ribs before. Luckily, not very often, and after a time it goes away.

They have special names for all these. Even the arthritis that attacks the connective tissue holding your ribs onto your sternum has a name all its own. I get that one too. That's where my curiosity to understand all the Things Gone Wrong kind of hits the limit. I just don't care to remember the name and personal details of the Rib/Sternum Attachment Arthritis. Yeah, falling down on the job, I am.

This rib thing going on right now? It feels like RA inflammation. But you can't always tell. There are other things it could be. Things that need a Real Medical Pro to check out: a heart attack, a big internal MRSA or HSV-1 abscess or infection, a pulmonary embolism. I ignored it for 2 weeks, hoping it'd go away on its own.

But suddenly on Saturday at 4:00, I couldn't move. I was working in the back yard, clearing out some branches and leaves, and found I couldn't bend down to my rake. I couldn't twist from side to side. And really really really had trouble breathing.

Crap.

I went into *hurricane prep* mode. Went to Sam's and picked up a few prescriptions that were hanging around. Went to Walmart too, made sure I was all stocked up. Swept the floor, took my bath, packed a few things, gave the neighbors across the street a house key. Ate my last supper. At 1 am I finally went to the ER.

It was fairly quiet by then. They triaged me as a priority because of the chest pain. Shot me full of morphine, thank God, though not nearly enough. It took the edge off so I could breathe a little bit more, and I was glad of that much.

I was running a fever, although they didn't know it, because it was 98.2. I told them my norm is around 97, but I suspect they didn't believe me. They didn't much buy the blood pressure thing either: I explained I had nice low BP, but they saw 150/110. Pain. Pain racks it up on me.

So they assumed: Maybe a heart attack. The doc palpated and said, hmmm, it's actually in the vicinity of your stomach not your heart. I had felt a little better after I ate my dinner, but that didn't seem to matter to the guy when I told him.

By 4am I was drifting in and out of consciousness. I heard quite a commotion at one point - an Almost Dead person came in, I think maybe a crime or accident victim. That's a rare occurrence where I was, because it's not a Level 1 Trauma Center. I think the paramedics brought him there because it was the closest hospital, and they'd already revived the guy from death one time, and had no more time to lose.

I asked later if he made it. It kind of sounded like they brought him back again and then lost him. But they wouldn't tell me. Privacy laws. I was embarrassed and said, oh of course. Well...I hope he made it. That's all.

The whole place was full of Code Blues all night. Heard it on the intercom 4 or 5 times. Code Blue ER. Code Blue ICU. Code Blue...

They did bloods and a chest xray. Great bloods except for one that might indicate a pulmonary embolism (PE), a blood clot in the lungs that can kill you quick. So they checked me in.

Argh. I hate the Icky Place.

But I'm back home now. Not much wiser except for this: it wasn't a heart attack, or a PE, or a big MRSA abscess, or a perforated stomach ulcer. They said the chest xray and ultrasound were clear for a PE or ulcer, and the heart was normal, and the white blood cell count was good.

They did find some lung problems on the chest ultrasound. The doc said he couldn't tell if it was old or new or both. I said, --Probably both-- and then I told him a brief version of this:

Used to be, you could hear me breathing from two blocks away. I have pneumonia scars in both lungs. I have asthma, though it's well controlled now. I had chronic asthmatic bronchitis and recurring acute bronchitis, both, for many years. I was even diagnosed with COPD (chronic obstructive pulmonary disease, from emphysema or chronic bronchitis) in 1993.

COPD is a bad thing to have. It's not curable. It doesn't go away. You die from it, very slowly and painfully, losing more and more function over the years, with no hope of a cure.

But I no longer get that diagnosis.

I completely retrained my lungs, I made them as healthy as can be again. I quit smoking. I got my allergies under better control. I threw away all the drapes and carpet and upholstery in my new house in 1996. I use HEPA air filter machines in every room of my house. I did yoga lung exercises and can expand my lungs to the greatest capacity some x-ray techs have ever seen - so they tell me, all shocked, looking at my lung pix, knowing my lungs' sorry history.

I relearned how to breathe again. This was long hard work; it took several years. But I wanted to live, you see. At the time I started the effort, there was a real and immediate danger of my lung disease killing me. Oh, I fought such a battle.

I still get pleurisy sometimes, always after breathing too many particulates. That's why when I do my bricklaying, it's only dry paving now. I don't use mortar any more because I really can't. When I mix the dry mortar with water to make *mud,* I inhale some particulates, even if I'm wearing a really good mask. Mortar is caustic, and it brings on the pleurisy just terribly.

So.

This morning they decided to discharge me. The doc wanted to put me on antibiotics, thinking I have pneumonia, and when I told him I'm on permanent Cipro and minocycline he was surprised. He said, --Okay, that'lI do.--

I got sent home with firm instructions to get a thorough bronchoscopy done. --Why not here?-- I asked. --Well, because it's an outpatient procedure, and if it's not heart disease and not a PE we don't do it here.

That was a silly reason. This doc is thinking pneumonia and/or COPD. Those are both serious enough to check out right away. Certainly the heart sonogram was outpatient too, and they were still pushing it on me till the last minute, even after all their other heart tests were normal, and I explained I'd had a big bunch of studies done on my heart within the year. My heart hurts, yes, but probably from RA inflammation. Otherwise it's in exceptionally good shape. Even the mitral valve prolapse I was diagnosed with years back may not be accurate - my latest heart ultrasound, with a greatly improved imaging capacity, actually showed the mitral valve as it worked, and it was normal. Beautiful, in fact.

So. --Why not do the bronchoscopy there at the hospital,-- k asks kdad the MD?

--Cost, probably.

Oh.

Makes sense.

I've learned that only a few doctors can do that procedure, and I bet it's seriously expensive. EKGs and chest xrays and cat scans and ultrasounds, they're all just done by technicians. And readily reimbursed by Medicare et al. Probably those tests are much more profitable than a bronchoscopy.

So...maybe I have pneumonia, maybe another lung problem like emphysema (though I don't think so), maybe something else.

Maybe just a really bad arthritis attack in the ribs.

Cause, hey. Why be normal?

Anyway, I'm home. My great pulmonary doc, the one that finally did my sleep study and cracked up at how bad my sleep apnea is, is qualified to do the bronchoscopy. And - to my joy - he's on my new no-copay insurance now, yay! I can't get in to see him until the 9th. That's the day before I leave for the Fossil Farm, and I bet he won't do the bronchoscopy the same day. But I'll work on him, just in case.

Well. Please forgive my dumping all these Icky Place details on you all at once. I'm a little wired and fevery and way sick and extremely happy to be home and back on the net, me. Maybe tomorrow I'll regale you with the lighter side of the Icky Place experience. Like, the food.

I mean, it was Really Scary Food.

What the heck are folks EATING out there?

Sheesh. The things one sees when one leaves the Accidental Hermitage and steps out into the Real World for a bit.

*Liquid Eggs?!?*

REALLY Scary.