My blog is turning into a journal of medical horrors. But that's the only really interesting thing going on right now, so here we go.

Yesterday, I went in for the MR-Arthrogram. It wasn't as bad as I made it sound in my previous post. It was worse.

The first worse part? The cost. My Orthopaedic Surgeon's office estimated that it would cost about $600 or $700. They were wrong. The estimated portion of the procedure not covered by my insurance is just under $1150. *ouch!* Right in the wallet! But what can I do? I need to be able to sleep through the night again. I need to be able to get life back to normal again.

The other worse part? It was surprisingly painful. Again, if you're squeamish, you might not want to read on.

After arriving at the Imaging Center and filling out a bunch of paperwork, they had me change into scrub pants and a gown and I was asked to lay down on a table with a fluoroscope. A fluoroscope is basically a lower-dose x-ray machine that provides live images. The radiologist came in to fill my shoulder joint with contrast medium. The local anesthetic was a piece of cake--a little pinch and a little stinging for a few seconds. No big deal. But the other needle? *ouch*

In order to place the needle in the proper position, the radiologist has to push the needle in until it hits the bone, then pull it back a little bit. When that needle hit the bone, it HURT. Instant tears springing into my eyes, and a big wince. Yeah. It was bad. Then I felt strange pressure/pain as he injected a LOT of fluid into my shoulder joint. That fluid has nowhere to go, so it slightly expands the entire joint, and yes, that is a painful process. Worse than I thought it was going to be. *ouch again* When the contrast medium was in, he quickly pulled the large needle out, which was just as painful as when the needle hit the bone, but because he did it quickly, the pain was over before it really registered, thank goodness. And with that, the hard part of the procedure was done.

The radiologist then proceeded to position my arm in different positions and told the radiology tech to take different pictures (basically screen captures from the fluoroscope) of my shoulder joint. That was kind of fun to see. I watched the bones in my shoulder moving about as the radiologist positioned my shoulder.

The next hour was spent in a "high field open MRI" machine. They took several pictures of my shoulder. The MRI made a lot of loud buzzing and banging sounds as it made high-resolution images of the inside of my shoulder. The time to take each picture ranged from 4 1/2 to 15 minutes.

My shoulder remained VERY sore for the rest of the day, and I ended up taking Lortab last night so I could sleep. Fortunately, I'm feeling a lot better this morning. It feels as if a lot of the fluid in my shoulder has been absorbed and a lot of the pain I was feeling yesterday is gone. Because of the Lortab, I think I slept better last night than I have since July. That was nice too.

The result of all of this?

Labral tear extending from the posterior superior labrum posteriorly just past 3 oclock

Now I have a diagnosis.

This particular tear is called a SLAP tear. This web page explains all about it. The most interesting bit to me was the part about causes:

The cause of a SLAP tear can generally be divided into acute traumatic events or chronic repetitive injuries that lead to failure. An example of an acute traumatic event would be a fall onto an outstretched arm, which may result in SLAP lesion secondary to abnormal contact between the humeral head and the superior labrum/biceps anchor. One of the most chronic repetitive injuries that leads to a SLAP tear is overhead throwing. Overhead athletes, especially baseball pitchers, place huge amounts of stress on the shoulder with every throw. The position of external rotation just before ball release can overstress the attachment of the biceps tendon and can lead to a SLAP tear.

Although my shoulder was sore from playing racquetball left-handed, racquetball is not an overhead motion. However, my natural reaction to being pulled backward off of the raft was to extend my arm to stop myself from falling. My right hand was busy with a paddle. My left hand took the brunt of it, and the result was the tear that I'm dealing with. I am 100% certain that this tear happened that day on the river. I felt the pop. I felt the sickening clicking in my joint immediately after. This diagnosis confirms what I had already thought.

The next step comes tomorrow. I am meeting with my Orthopaedic Surgeon to determine the severity of the tear and to decide on a course of treatment. From everything that I've read, this is going to mean surgical repair followed by a bunch of physical therapy. Wonderful.

The nice thing about this diagnosis, though, is that certainty that my shoulder was injured on the river trip. Because of this, I emailed my bishop yesterday and started the process of filing a claim with the church's supplemental insurance program. Costs not covered by my insurance (which will be significant--I chose the high deductible insurance plan this year, not anticipating a shoulder injury) will hopefully be covered by this supplemental insurance.

The other nice thing is simply that there IS a diagnosis. I don't have to continue wondering what's going on in there. With a diagnosis, the surgeon can recommend a definitive treatment plan and give me a prognosis for future recovery. There can be a light at the end of this tunnel of sleep deprivation, even if that light may be a few more months down the road.

I'm tired.  I'm really REALLY tired.  Every afternoon I start falling asleep at my desk.  I'm having trouble concentrating.  The reason that I'm so tired?  I haven't had an uninterrupted night's sleep since JULY.  Every night I wake up multiple times because of shoulder pain.

I'm tired of being tired.

I'm tired enough that I don't care any more how much this is going to cost.  I want to get my shoulder diagnosed and fixed.

Tuesday, I'm going to have a MR-Arthrogram done.  It's a two-step procedure.  The first involved needles.  If you're squeamish about such things, stop reading now.

As I said, the first step involves needles.  Big needles.  Long needles.  They use one needle to inject a local anesthetic into my shoulder.  Then they use a fluoroscope (basically, a live-view x-ray) to guide another larger-bore and much longer needle into my shoulder joint.  They then fill my shoulder joint with a "contrast medium" and remove the big, long needle.

After I move my shoulder in about every possible direction to make sure that the contrast medium is fully distributed everywhere in my shoulder joint, they will use Magnetic Resonance Imaging (MRI) to get a detailed look at my shoulder so that they can find out exactly what is going on in there.

I'm also tired of not knowing what is going on.  MR-Arthrography is used to locate problems with the glenoid labrum (the cartilage ring around the shoulder socket) or tears in the rotator cuff.  Either of these might cause the type of pain that I am experiencing.

The anti-inflammatory meds don't seem to have done much, but I'm still going to be taking them--just in case nothing is found.

After the MR-Arthrogram, I get to wait.  And wait.  And wait until my Orthopaedic Surgeon has an opening.  Right now, it doesn't look like I'll get in to see him until the 26th of September or so.

I don't care what happens next if it leads to me being able to sleep through the night again.

My shoulder still hurts.

A lot.

Enough to go see a doctor about it today.  They took x-rays, and everything appears to be looking pretty normal.  There is a little thickening of the acromion.  The acromion/clavicle joint might be a little tiny bit wide.  There are some tiny bone spurs, but nothing that should be causing problems.

This means that my shoulder still has swelling inside (which my doctor thought was less likely with the "medical history" that I gave him) or there is soft tissue damage to either the labrum (cartilage that surrounds the "socket" part of the shoulder joint) or the rotator cuff (a system of muscles and tendons that make the shoulder work).

My choices:

• Strong anti-inflammatory medication
• Cortisone injection
• MRI

I'm starting with the least expensive option first.  I'm going to be taking anti-inflammatories for the next month or so.  It takes 7-10 days for this particular drug to reach "clinical effective strength" in my system.  So after a couple of weeks, if it's not getting any better, then I'll probably jump to the third (and most expensive) option.  It would end up costing somewhere in the neighborhood of $600-$700.  And since I'm on a high-deductible insurance plan this year, all of that cost (plus the cost of today's doctor visit and the medication) will all be coming out of my pocket.  That hurts, but not as much as my shoulder hurts.

I thought about going with an MRI right away, because that's the easiest way for the doctors to see whether or not there is soft tissue damage and I could get a much quicker, more definitive diagnosis.  But another part of me thinks that even if there IS soft tissue damage, if I can just hold out until January before needing surgery (and the anti-inflammatory meds might help there), I might end up paying less out of pocket.

And that's the update.  I'm sure you wanted to know.

Last week, I was able to spend a few days at Flaming Gorge with both of my sons.  It was the only "high adventure" camp that I was able to attend with both of my sons.  We had a really good time.  We floated a bit of the Green River on rubber rafts.  We toured the Flaming Gorge dam.  I was able to cook some amazingly awesome dutch oven food for the group.  It was generally a really good time.

It was also a learning experience for me.  I don't really like what I learned.

Since I had volunteered to help with the food for this campout, I accompanied my son's (only one son is a scout now--the other is an adult) leaders to the grocery store to pick up some food.  The Varsity Coach (whom I shall refer to as B.B.) said that the had a confession--that he had not completed the required BSA medical form.  The Venturing Advisor (whom I shall refer to as C.B.) said that he hadn't done it either.  There was no reason given, but it was made pretty clear by their comments that they didn't feel as if it were important enough.  C.B. said that he might be leaving early, and that he wouldn't be on the activity for 72 hours.  I reminded him of BSA policy that it doesn't matter how long any individual attendee would be at the activity.  If the activity itself is longer than 72 hours, then all participants, youth and adult, would be required to have a completed BSA medical form.

This "do as I say, not as I do" attitude displayed to me by my son's current and future scout leaders upset me a little bit.  It made me feel as if, for them, convenience trumped obedience to BSA guidelines designed for the safety and protection of both youth and adults participating in a high adventure camp.

The evening that we arrived at camp, the leaders mentioned some of the activities that we would be doing at this camp.  One of the activities mentioned was cliff jumping.  I mentioned that I didn't believe that cliff jumping was an approved BSA activity.  My comment was completely ignored.  After we returned home, I read the following in the Guide to Safe Scouting:

Diving and Elevated Entry: Diving is permitted only into clear, unobstructed water from heights no greater than 40 inches. Water depth must be at least 7 feet. Bottom depth contours below diving boards and elevated surfaces require greater water depths and must conform to state regulations. Persons should not jump into water from heights greater than they are tall, and should jump only into water chest deep or greater with minimal risk from contact with the bottom. No elevated entry is permitted where the person must clear any obstacle, including land.

Scouts were jumping into the water from heights much greater than they are tall.  One leader jumped from a cliff estimated to be about 90 feet above the water.  This is obviously contrary to the guide to safe scouting.  This point is also emphasized in the safe swim training that B.B. said he completed just before we left on this trip.

I don't expect that leaders to completely know every regulation and guideline in the Guide to Safe Scouting.  However, I doubt that either B.B. or C.B. has read the Guide to Safe Scouting or they would have questioned the wisdom of cliff jumping.  Additionally, the scouting unit is required to file a Tour Plan with the district BSA office before a campout like the one at Flaming Gorge.  The Tour Plan application says the following:

We certify that appropriate planning has been conducted using the Sweet 16 of BSA Safety, qualified and trained supervision is in place, permissions are secured, health records have been reviewed, and adult leaders have read and are in possession of a current copy of  Guide to Safe Scouting and other appropriate resources.

If these leaders had read the Guide to Safe Scouting and if they had a copy of the Guide to Safe Scouting in their possession (which I am 100% sure they did not), we could have consulted the guide about the wisdom of cliff jumping during this activity.  In this case, even with someone (me) questioning the appropriateness of this activity, fun seemed to me to trump safety.

As we floated the Green River, the leaders emphasized the importance of wearing life jackets (thank heavens) during the entire float trip.  However, at one point on this float trip, I was sitting on the back of my raft next to another gentleman.  C.B. and one of the other adult leaders (J.L.) came up with the idea that it would be funny to have one of the youth jump from their raft, grab the back of the life jackets of the two of us on the back of the raft, and pull us into the river.  This is obviously not something anyone would consider safe--think of a horse collar tackle in Football.  It's a penalty because of a safety issue of being dragged down from behind.  C.B. offered the young man $20 if he would do it, and both C.B. and J.L. continued to egg him on until he did so.  It tweaked my left shoulder (which has been hurting for a couple of weeks now) pretty badly, and now when I move it, there's a sickening clicking inside my shoulder that I hope won't require surgery.  But the leaders again showed me that fun (or funny) trumps safety.

Incidentally, J.L. apologized profusely when he heard that this had tweaked my shoulder.  The young man apologized profusely.  The young man's father apologized.  C.B., who had egged the young man on--even offering him $20--never said a word.  I know it's petty of me to expect something, and I'm still pretty ticked off at C.B.  I'm working on learning to forgive right now.  I'm not learning that lesson very quickly.

So what did I learn from this?  I can't trust my son to go on activities with his scout leaders.  Even when I go along, I can't let my sons out of my sight.  My older son jumped from a 12-ish foot cliff since I wasn't there at the moment to yet again question the wisdom of cliff jumping.  I learned that convenience trumps obedience; that fun trumps safety.  I learned that these leaders have a "do as I say, not as I do" attitude about rules or guidelines that seem inconvenient.

Fortunately, my younger son now has enough camping nights to earn his camping merit badge, because I can't send him camping with these leaders ever again, and I certainly don't want to go along on campouts with these leaders any more.

In the end, there really is no excuse.  The rules that were broken, regardless of importance, are spelled out in black and white.  There is nothing ambiguous about these rules.  This is why the scouting leaders in my unit have lost my trust and will no longer have my support (or my son) on outdoor activities.

They have lost my trust and I don't know how or if they can gain it back again.

Yesterday afternoon, things started getting warm at my house.

I thought it might have been an afternoon of baking.  I made a couple of loaves of French bread and a pan of lasagna.  I even used the broiler in my oven to make some of the French bread into garlic bread.  So I thought that maybe the overuse of my oven might have been overpowering the air conditioning a little.  A little later, my wife was doing dishes and noticed that the vent by her feet (the one that usually feels so good on the feet on a hot day) wasn't blowing air that was very cold.

I went out and noticed that the fan on the A/C unit outside wasn't moving.  It was making a bit of a buzzing noise, but there was no movement.  I fiddled about with it a little bit, but didn't really know what to do.

I called the company that fixed our furnace a few months ago and left a message.  This morning, I made an appointment for a technician to come out and fix whatever was wrong.  We needed it fixed quickly because the weather forecast for the next four days predicted temperatures just north of 100 degrees.  Yuck.

I also posted something on Facebook about our air conditioning woes.  Fortunately, one of the guys in my neighborhood had a similar problem and he told me how he fixed it for only the price of a part.

So I decided to check it out.  Air conditioners have a big compressor, heat exchange unit (like a radiator on a car) and a large fan in the outdoors part of the system.  Both the compressor and the fan rely on a capacitor (kind of like a mini battery) to get them started.  I took the capacitor off and realized right away that it was bad.  It had bulges on the top and bottom and a little yellowish oil had leaked out.  I used my multimeter to measure the capacitance across both capacitors (it's a dual capacitor) and both readings were zero.  That was definitely the problem.

It took a little while to track down a part, but once I had the part, I installed it and started up the system and the cold air started pouring out of the vents.  SUCCESS!

It was a little bit of a gamble, because I had already called the HVAC company and told them I didn't need the technician to come out after all.  If I had been wrong, we would have spent a rather warm night tonight.  But the gamble paid off.  For just over $30 and a couple of hours of running around, I was able to fix the problem.  The HVAC company would have charged me a LOT more than that.

It feels good to fix something myself.

This morning, as I drove in to work, I heard another radio advertisement for a local spa/hot tub company.  They recently had a huge "Memorial Day Sell" and talked about how much money one might save "...after mell-in rebate."

I don't think lazy/mispronounced vowels bothered me as much before I learned to speak Dutch.  After all, a small change in the way a vowel is pronounced is all it takes to change paying one's rent into paying one's prostitute.  That's especially troublesome when it's an LDS missionary that is speaking.

It's just lazy speech that causes people to go to the mellbox to get their mell, drink a glass of melk, and lay down for the night on their pellow.  There are two types of people in the world: mell and femell.  And when picking up a hammer, don't forget the nells.

Small pet peeve, I know, but I would have thought that someone that gets PAID to do a radio commercial would be able to properly pronounce the words "sale" and "mail"

It certainly doesn't make me want to buy a spa from this company, even if it is on sell.

During the planning phases of a trip, I was in the process of reserving a rental car.  We recently had some repairs done to our Subaru Outback, and the only company in town that had an economy car available was Hertz.

At the end of that rental, we had a "scratch-off" card that was supposed to give us a great discount on a future rental.  I scratched off the card and it said that with the included promotional code, we could save up to $25 on a week-long or weekend car rental.  Perfect!  I was planning on a weekend rental for the upcoming trip.

I went to the Hertz web site to reserve the vehicle.  Before adding in the coupon code, the entire rental was just under $90.  After adding in the coupon code, the entire rental was just under $250.  WHAT??

Strangely enough, I figured that saving $25 would cause the price to decrease by $25, but no.  Not using Hertz math.  You see, the $25 savings only applied to a daily rate that was more than double the daily rate of the price I was originally given online.

So we're going with a different company.  Hertz' math hurts my brain too much.

On Sunday night, I flew to San Francisco to attend a technical conference.  I arrived rather late and rode BART into the downtown area.  From there, I had a 10-ish minute walk to my hotel.

Maybe I just haven't been in the right (or wrong?) parts of Salt Lake late at night, but it's pretty clear that Salt Lake City and San Francisco are not even in the same league when it comes to being a big city.  Utah doesn't really have a big city.  Salt Lake is large-ish, but it's nothing like San Francisco.

As I walked to the hotel (first walking a block in the wrong direction), I noticed that pretty much every business that was closed for the night had someone (or two or three someones) sleeping in the doorway.  Most of them had a few belongings--a sleeping bag and a small bag of stuff--with them.  I've never even been close to living on the street.  I can't imagine what that would be like.  Now, as the weather gets warmer, it would be more bearable.  How do they survive during the winter?

There are a lot of panhandlers around too.  I saw a couple of veterans with missing limbs, sitting in wheelchairs or on standing with crutches.  At the BART station, when the AirBART bus pulled in, there were several people either asking for money or offering to help people purchase tickets for BART, afterwards asking for a buck or two for their trouble.

One of the guys traveling with us said he got in about the same time that the prostitutes were out in significant numbers.  After checking into the hotel, he heard a couple of them arguing at the top of their lungs. (Downtown isn't always the best place to stay.)

Some of these street people we're quite a bit more humorous than others.  For example, on the way back to our hotel from Pier 39, we walked by a park where a man was adamantly (and loudly) proclaiming "This is MY bench!!  I live here!!!" to someone who stopped to sit and watch his dog in the park.  He then proceeded to meow loudly at the dog, just to annoy the owner who tried to sit in his "home." A block or two later, a panhandler was holding a sign that said "Why lie?  I want beer."

The thing that haunts me, though, is the lady that I passed on the way back to the convention after lunch.  She was sitting on a street corner with the familiar cardboard sign, asking for any help of any kind.  She looked completely defeated as she sat there on the street corner by an orange construction barrier, sobbing.

What haunts me is that I really have no way of knowing the "why" behind her tears.  Is she really destitute and devastated?  Probably.  I doubt that sitting on a street corner begging is someone's first choice of making a living.  But were those tears real or were they manufactured by someone that knows that she "earns" more money if she looks more forlorn?  I'll never know.

But whether the tears were real or not, that face and the anguish I saw, real or not, will probably stick in my mind for some time.

I'm still here...but barely.

It's been a crazy few weeks.  Why?

Older son graduates High School in a couple of weeks.  He also turns 18 around that same time.  So we have been working on getting his Eagle Scout Rank application done.  He finished all of the requirements.  The paperwork associated with the Eagle Scout Rank is kind of crazy.

Older son also has been finishing up his last requirements for Duty to God, which also must be completed before he turns 18.

Older son got a job at Seven Peaks, then decided not to keep it.  Why?  Because they pay less than minimum wage, offering a bonus if you work through the whole summer.  Stupid. But he also was made a Flight Director at the Christa McAuliffe Space Education Center, which is a paid position that he can hang onto while at college.

Speaking of college, we've also jumped through several hoops getting older son registered at Utah Valley University for the fall.  Next step?  Pay a lot of money for tuition.

Older son also had his final High School orchestra concert.

Younger son is driving.  Younger son got backed into by a neighbor, who did everything in his power to try to avoid responsibility for said accident.  We got the check from the guy's insurance company yesterday.  Between the accident on 18 April and yesterday, I've spent way too much time on the phone with insurance companies.

Younger son is also volunteering a LOT at the Christa McAuliffe Space Education Center, and since he only has a learner's permit, we've been ferrying him back and forth.

Younger son's final Junior High orchestra concert was last night.

Thank heavens I didn't teach the summer term course I was offered at UVU.  Teaching on top of all of this would have been WAY too much.

Life is crazy busy.  It probably won't get much better very soon.

A friend that I grew up with--a rather squirrely young man at the time--has grown up to be a loving, kind father of six children.

On Friday, his 12-year-old daughter, through a terrible accident, was deprived of oxygen for a time and was being cared for in a pediatric ICU.  Early the following morning, his daughter passed away.

On Friday, this friend's plea was for everyone to pray for an Easter miracle.  Yesterday, when he informed everyone of the passing of his daughter, he said the following:

For all who prayed for an Easter Miracle we wanted to let you know there have been four marvelous Easter Miracles. Because of Elizabeth, 2 people will receive sight, a young man will walk again, and a baby will receive a new heart valve. We prayed for an Easter Miracle, and were blessed with 4. We love you all. Thank for your love, support, and prayers.

My heart aches for this friend and his entire family.  They are taking comfort in the message of Easter--that Christ was resurrected, and that through Him, this same miracle will be given to Elizabeth.  Their faith that there is life after death is sustaining the family during this very difficult time.

It's amazing to me to see a father who has just lost his daughter turn away from anger and despair and instead see the miracles wrought by his daughter's life and death.