Tuesday, October 06, 2009

a MS caregivng whatdunit

Mix intermittent pain with Multiple Sclerosis related memory loss and mental confusion and you get a genuine whodunit or better yet, whatdunit.

Two weekends ago, a week in the life of caregiving, I mentioned intermittent pain in Patti’s left arm.

Examination of the arm by nursing staff and physical therapist found no range of motion problems nor did Patti report any pain.

As an advocate you must do more than monitor a ‘whatdunit’. You must inject yourself IN the mystery.

Whenever I put her jacket on or off, I did so at the nurses’ station so any and all ‘intermittent’ incidents of pain were witnessed and logged.

When Patti’s physician visited she attempted to replicate the problem with no success. Fortunately, there was a file of witnessed episodes, and X-rays were ordered.

No fractures were found, though the x-ray analysis somewhat distractingly reported evidence of osteoporosis.

When a patient is unable to direct their own medical care the ‘advocate’ must help keep the focus.

Patti was next referred to an orthopedic specialist.

To ensure communication I transported and accompanied Patti to her appointment. Her examination revealed nothing nor did Patti complain of any pain.

Before tearing my hair out, I suggested a demonstration … Patti yelped and grabbed her arm as soon as I slid on the left arm of her jacket.

Re-focusing his examination on where she grabbed her arm …

Ortho: “Patti, let me know if this hurts?”
Patti: (yelp) “If you do that again, I am going to kick your f#@king ass!”
Ortho: “in other words, yes”
… he found a tender “extension mass” in her left elbow.

Diagnosis = tendonitis.

Extension injuries, we learned, are not uncommon to elbows and wrists for people in wheelchairs.

1) tennis elbow strap
2) intermittent analgesics
3) physical therapy

As for osteoporosis, he did NOT agree with the portable x-ray analysis.

As for Patti all she wanted after that appointment was a ciggie, ‘analgesics’, and a mid-day nap.

Caregivingly Yours, Patrick Leer
web site: http://caregivinglyyours.com/
videos: http://www.youtube.com/daddyleer
musings: Patrick Ponders ...


  1. it must be like diagnosing by exclusion; this doesn't hurt, so it must be this, and so on especially if it is hard to get a "reliable" history from the patient. So glad you thought to "reconstruct the crime" so to speak and show what motion/activity caused the discomfort. I'm glad Patti, in the choicest of words, was able to get the message across that that indeed was where the pain was. Now hoping the prescribed analgesics, PT, and strap will help her feel better soon.

    hoping you are enjoying fall Patrick :)


  2. I am glad you finally found the cause. I can imagine, very clearly lately how painful that must be for her.


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