Wednesday, August 30, 2017

DX Severe Osteoporosis: Part III -- Looking to the "Whole" for Answers

"It is not by sending his awareness out beyond the natural world that the shaman makes contact with the purveyors of life and health, nor by journeying into his personal psyche; rather, it is by propelling his awareness laterally, outward into the depths of a landscape at once both sensuous and psychological, the living dream that we share with the soaring hawk, the spider, and the stone silently sprouting lichens on its coarse surface."

     David Abram, 

     author of The Spell of the Sensuous

This is Part III of a multi-part essay telling you about my own personal experience with osteoporosis.

Part III :  The "Whole"

I knew from the start that I wanted to be informed about, and involved in, every aspect of testing, diagnosis, and the development of a treatment plan for my osteoporosis. Anyone can choose to do this, if she or he is willing and able to put in the time and attention. It was somewhat easier for me because of my medical training but I still struggled and I knew it was important to get the expert help of specialists. The specialists were allies in unknown territory for me. I rounded up the best I could find. I put together my own team to go up against this disease that was my new adversary.

The fourth endocrinologist that I contacted (I found out later) was the "Godfather" of osteoporosis. A doctor world renown for his expertise in osteoporosis and who ended up being not just an amazing doctor to me but also my mentor. I also saw several additional orthopedists because I not only had osteoporosis but my hip pain persisted beyond the time when the micro-fractures should have healed.

While the specialists gave me useful information (especially the endocrinologist) it could be frustrating to try to communicate with them. The very focus that made them experts in their fields seemed to give them a kind of blindness. It was as if they could only see from one point of view, the view given them by their specialty. To me it made sense not to confine my vision to one viewpoint, but to consider my body as a whole. After having been active all my life, I was not used to being shut down physically. Now I had two chronic disorders at once, the hip pain and the bone loss. This got me thinking--could there be a connection between the two? Not that one was necessarily causing the other--the micro-fractures and osteoporosis, yes, but the persistent hip inflammation and severe bone loss?...well...could THEY be from the same underlying mechanism? Could these two entities be caused by the same "poison in the water"?

I put this question to the different specialists I was seeing: a new orthopedist and his in-residency assistant at Boston General Hospital, and also to the endocrinologist at UConn Center for Osteoporosis. But each of them just looked through the eyes of his own specialty. The two orthopedists thought only in terms of bones and joints, focusing totally on the hip inflammation. They ruled out arthritis and Lyme disease, and never once mentioned the word osteoporosis and certainly didn't consider the possibility that there could be a deeper connection between the two entities on the biochemical or body systems level. The endocrinologist thought only about hormonal and metabolic disease processes within the organs that can cause a loss of bone density. He never thought to look at the persistent inflammation in the hip for any clues that might help him find the reason for the osteoporosis.

Like race horses wearing blinkers, if it wasn't right in front of them, if it wasn't in their specialty, then it didn't exist. My suggestion of a possible underlying condition contributing both to the lingering inflammation in the hip and the systemic osteoporosis would have involved crossing lines between specialties. Their minds just could not do that. Modern Western medicine is so bound up in its own laws of associating particular symptoms with particular disease conditions and commonly associated causal factors, that physicians often resist considering any alternate possibilities of connection.

The problem with how the specialists looked at things seemed to be a case of hyper-focus. But when you are looking at your own predicament and trying to find answers, immediate answers, it goes beyond hyper-focus, it goes into desperation. Having that feeling of desperation and focusing too intensely in your effort to find an answer can, and usually does, interfere with your ability to see something that is right in front of you.

Caught in a crisis, desperate for solutions -- solutions now--
it is hard for the mind to let go of the sharp focus. We feel that that intensity of focus is the only way to solve the problem. But in truth, we need to widen our view. We need to stand back--decipher the significant reality that may be cluttered, camouflaged, distorted by dogma and our own hyper-reactive emotions, and take in the "whole" view. In my own practice as a chiropractic physician, I have seen that pushing to make a diagnosis too soon can lead to error. Simply holding the pieces of the puzzle for a few hours or days can help to make the connections between patients' symptoms and my examination findings become clearer. Forcing puzzle pieces together doesn't work. By holding single threads of information, such as the appearance of an x-ray or various results from the lab, and then allowing your focus to widen--to let connections between threads or dangling pieces become clearer--the connections will eventually evolve and become locking pieces to the puzzle. It is by gong back and forth between sharp focus--wide focus--sharp focus, that you allow the diagnosis to develop. It takes time and patience to let the pervasive pattern of energy that runs through each person's system help in connecting the pieces into a whole. All my experience told me that I needed to bring a different kind of vision to the problem of my osteoporosis than that one on which the specialists relied.

I began to see that the trail to recovery would be long. That those moments when I had stood with the two initial orthopedic surgeons looking at the dark x-ray of my hip, that I was standing at the beginning of a long trail through difficult terrain that might (and did) extend for years. Academically speaking, the trail was choked with a tangle of medical information that was hard to decipher. But even more difficult was the psychological challenge of this boulder strewn trail; one where I would stumble and curse through multiple fragility fractures--twelve over the next five years. be continued...

"The effects of any serious disease ripple throughout our bodies, throughout our lives--throughout everything we think of as the self."
Crucibles of Will

Wednesday, August 23, 2017

DX Severe Osteoporosis: Part II -- A Burning

"Our lives are a burning. The physical processes that fuel and sustain us--breathing and eating--are kinds of burning. Our passion also is a kind of fire. When our lives are lit by our passions, they give off light and heat. In the end our bodies are consumed, and only the gold is left."
                                                                                                  R. Keith McCormick, DC

This is Part II of a multi-part essay telling you about my own personal experience with osteoporosis.

Part II A Burning

My first reaction was embarrassment. How could I have this? I'd eaten well all my life: or at least I thought I had. I'd always drunk a lot of milk. I'd never done anything "wrong." I'd always done everything "right" to be healthy. It just didn't make any sense. Osteoporosis--a disease associated with frailty--was the antithesis of who I thought I was. From early on, the foundation of my life centered on developing the strongest, fastest, healthiest body I could. I had always wanted to be an Olympian and it seemed that from day one my attitude had been one of wanting to improve--to be the best, strongest, toughest competitor out there. My body was the vessel by which to achieve this, and I had fueled it with those goals in mind.

I didn't tell anyone of my condition. I was too embarrassed--ashamed of what I had become--a broken-down old man in what I had thought was the prime of my life.

Initially, I struggled, not knowing how I was going to get out of this crumbling skeletal mess. Before I was diagnosed, I felt that I was almost unstoppable and certainly unbreakable. Osteoporosis did not fit with my unbreakable self-image. Now I was afraid I would fracture my spine if I opened the garage door or bent down to pick up something, and certainly shatter if I fell off my bike. Always one to help out at my son's school, moving benches, lifting boxes, building sheds, I began to hide or made excuses. I was supposed to be strong, an Ironman (triathlete), an ex-Olympian no less. And now, just like that, I couldn't move a table. Everyone would surely think I was a wimp!

The voice of the orthopedist, "You should go on disability" and "Now promise me that you'll walk with a cane," made me want to throw up. When I stood before a mirror, no matter how long I searched for that person I used to be, all I saw was emptiness. My self-confidence, as well as my inner structural core, had withered away.

The first endocrinologist I saw read down a list of about twenty diseases and risk factors that can cause severe bone loss, asking me questions after each item. When he got to the bottom of the list, he diagnosed me with "primary osteoporosis" and handed me two prescriptions. One was for a thiazide diuretic to help reduce the calcium loss in my urine, and the other for alendronate (Fosamax), a bisphosphonate to harden my bones. I told him that I wasn't there for prescriptions--I was there to find out why I had osteoporosis--and to fix it.

After calls and e-mails to three more endocrinologists, one of whom wrote back asking for the date of my last menstrual period, I finally made an appointment with one who specialized in the treatment of osteoporosis. The day of my appointment came and, as I opened the door to his waiting room, I stepped into a world that made me shudder. Trying to look invisible, I walked slowly to a chair and sat down. There were three other patients: all older women, all in wheelchairs, each with a dowager's hump indicating spinal degeneration from a series of compression fractures. All three women looked downward. The did not speak. They did not make eye contact with me or each other. Each was withdrawn as though she were collapsing inward. And then it dawned on me. These women were now my peers.

When I left that office, I never looked back. I was on a mission--a mission not only to find out everything I could about my osteoporosis and fix it, but also to gain back my lost self-confidence.

"Frailty has a way of sneaking up on a person. It's like the wear of your running shoes. Everything seems to be going along fine and then you pull up lame because your shoes have worn out -- as if the innersole somehow broke down overnight while you were sleeping."

Monday, August 14, 2017

DX Severe Osteoporosis: Part I -- The Day That Changed My Life Forever

"Glimmering on the edge of death, sweeping in to overwhelm us, is the larger sense of who we are."

   Paul Rezendes
   author of The Wild Within

This is Part I of a multi-part essay telling you about my own personal experience with osteoporosis. I'll try not to be too windy but I will take you through some of the diagnostic and treatment phases of my care. I will offer LOTS of information to help you gain a better understanding of osteoporosis in general, and hopefully even some specifics into your own bone health. 

Part I :  The Day that Changed My Life Forever

I remember the day like it was yesterday...

The doctor put the x-ray up on the view-box...the bones were not white: they were gray--like ashes.

The x-ray of my pelvis didn't light up with the brightness of hard, opaque tissue characteristic of healthy bone. It was dull, and the light that filtered through it, drained the room of substance. There had been barely enough room for an exam table and an old chair, and now it felt claustrophobic. I stood wedged between the two orthopedic surgeons, faces pale and gray in the dim, florescent, hospital light as we stared at the film showing the first hard evidence that something was seriously wrong. "The hip joint itself looks good," the senior orthopedist said, "but the bone looks rare--not much density."

It had been the pain that finally forced me to the doctor's office; the pain that had stopped my running. As an athlete who had trained intensely for over 25 years, running road races, and competing in the sports of modern pentathlon and triathlon, I was used to discomfort and nagging injuries. But this time the pain persisted in a way it never had before. It was in my hip, and at first I thought it was just another over-use injury from running.

But the severity of this injury was more than I could figure out myself...I needed some help.

One look at the x-ray showed an obvious lack of overall bone density. Where there should have been the whiteness of bone, there were the dark grays typical of softer, less-dense tissues. Later an MRI, bone scan, and two bone density exams revealed capsular synovitis with micro-fracturing of the femoral head, and severe osteoporosis of the spine and both hips. Like a ton of bricks, I was totally floored as the bone density technician unprofessionally blurted out, "you have worse bone density than a 100-year-old woman!"

How could I have osteoporosis? I was a 46-year-old man, I had been active all my life, and I had always tried to live a healthy life-style. It seemed to me that nothing I had done had invited this disease, and that I had done a lot that should have prevented it. But here it was. It was too late to shut the door in its face. It had already moved in and was making itself at home. Now I had to figure out how to live with it, how to limit the damage, and how to stop it if I could. And I had to figure it out fast--before it ate away my bones.

(to be continued)
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