impinged diligence.

(a contribution to meltdowns)
over a month ago i began experiencing pain in my left shoulder. it came on gradually and as i entered the third or so week of discomfort i could hardly lift my arm out to the side, behind me or across my front without an alarming breath-taking pinch inside my shoulder that would radiate towards the upper third part of my arm. so, finally, i decided to look for an orthopedic specialist. it seems whenever i am bothered with some new, foreign physical discomfort i get annoyingly burdened with a disposition owned and operated by vulnerability and thus, cranky. this state really pisses me off. so i researched and found a couple of orthopedic doctors within my insurance network and set their numbers aside to call in a day or so. you know- to just give it a couple more days to see if the discomfort would go away on it's own. in the meantime it was also time to schedule a couple of appointments that are due- the breast mri and the "how many times can i cancel this one" colonoscopy (i'd like to know the statistics on how many times this procedure is cancelled and re-scheduled). having to tend to any procedure puts way more attention on my physicality than i care to offer. it's disruptive at best. that's why i put off the shoulder thing. and i have yet to schedule the colonoscopy. anyway, in the meantime, even though i'm mystified about my shoulder because i don't recall an "event" that would have caused injury to it and despite the fact that i'm getting a little worried about it i decide to give it a little more time. and besides i've heard folks around me complain of joint aches and pains so i figure "how bad could it be?". "it's probably nothing serious" they say. i am 43- doesn't joint pain come with the territory?

it was during this time that i came across some information that puts me in a tailspin. my friend posted information on her blog about a certain kind of lymphedema and my mind immediately went wandering. i self diagnosed myself, of course. i was now considering the possibility of truncal lymphedema. i had complained twice to my doctor about pain in my under arm area and this mere fact didn't help: lymphedema is an ongoing concern for anyone that has had a mastectomy for it can come on at anytime, even years, after surgery. i freaked out and called my friend right away. after she calmed me down with her rational, peaceful wisdom she asked me if, besides the pain and discomfort in my shoulder, "do you have any swelling?". "um, no" i replied. considering that the swelling is THE main symptom of truncal lymphedema my diagnosis seemed inappropriate. she then guided the conversation to the recent announcement of the metastatic Stage 4 bone cancer diagnoses of Elizabeth Edwards just that day. at the time i thought my friend was changing the topic to get my mind off my shoulder "worries". it wasn't until after i saw a doctor that i realized that, perhaps, she was thinking i should be taking the pain a little more seriously. especially after she learned that i had been dealing with it for weeks and it came on gradually with no specific cause. prior to our conversation i was wondering if i should see my surgeon or an orthopedic specialist. after evaluating my condition we agreed that i'd see a joint doctor first- that i would benefit from an x-ray.

so i make the appointment with an orthopedic specialist and actually go to it. i fill out the usual forms and health/history questionaire and by the time i get in to see the doctor he knows just about everything about me. he's a genuinely nice person with a good direct, matter-of-fact delivery. his first question out of the gate is "how long have you been experiencing this discomfort?" "almost a month" i answer. i am then asked to display examples of what movements my shoulder can tolerate or should i say CAN'T tolerate following the commanded questions "can you do this? and how about this? and this? and how about this? and how far?" "geeze!!! did i mention my shoulder HURTS when i move it?" i wanted ask. but didn't. finally he say's we need an x-ray. so i comply.

i'm sitting in the exam room upon the exam table waiting for the results when the doc returns. instead of heading over to computer to immediately review the x-ray images he sits next to me, sighs, and says "why did you wait so long to come in?" "i thought i'd wait and see if it would go away" i replied with a sort of question mark pitch- feeling like i just answered a trick question- knowing my answer was wrong. and then he continued to slather on a bountiful load of reality. "you're not like most people who can sort of dismiss or tolerate joint pain. an ache here. an ache there. typical of getting older or being athletic... and people around you might think it's helpful to say that everyone experiences some joint pain..." where the hell is this going, i wonder. and no sooner had i asked myself that question he laid out the answer. "you've had breast cancer. twice. the common place for metastatic cancer to occur is in the bones. any joint or bone pain should be taken seriously and immediately checked out. ok?"..."of course" i responded- as if i'd thought about this already and added it to the load of worries and possibilities and suddenly resenting "most" people with an embarrassing passion. with that he stood and invited me over to the computer. the moment the image came up he exclaims "there's no sign of cancer or bone abnormalities". relieved of a worry that i originally wasn't worrying about i half jokingly added "that's great, i guess i'll go now" implying that now, since it wasn't cancer i really didn't give a shit what was going on with my shoulder. and stupidly, i meant it.

what i do have is impingement syndrome in my left shoulder and i'm OVER the idea of comparing the degree of seriousness of any common ailment to cancer. i can't afford to be careless with recovery- i'm already in the early stages of "frozen shoulder" caused by limited mobility. this damn condition is painful and debilitating and gets worse before it gets better, apparently. of course i'm a truck load of grateful because i don't have bone metastasis. but should i be grateful for my shoulder impingement? i am partaking in physical therapy, chiropractic services and, for the first time, acupuncture. the condition was most likely brought on by an act of over exertion and bad posture (rounded shoulder) causing poor bone alignment.

some advice for "most people": not only is my body and it's history different from yours, so are my fears. your attempts to comfort me by minimizing or simplifying my physical complaints and concerns only makes me feel like a hypochondriac and this causes me to pretend to be one of you. the truth is- if i'm expressing discomfort or "complaining" out loud- most likely i am reaching out to you in an effort to share or expose my fears. please help me move past the fear and embrace rational action, to move forward with appropriate diligence to take care of my body without judgment or dangerous comforting.

diligence and fear are companions that live within my inner dialogue. after my first breast cancer diagnoses in 2000 i reached out to a friend by expressing fear of my first mammogram following my lumpectomy. i'm not sure if she was just trying to comfort me or she believed this to be true but she said "cancer rarely comes back. don't worry!" i'm not sure how i responded. it was the last time for a long time that i outwardly expressed fear. you see, my reality was different. i had spent hours reading about cancer cells and their growth rates. my friend apparently hadn't seen the bold graphic titled "cancer cell growth rate 100 days to 11 years (age of average palpable tumor)" on page 265 of Dr. Susan Love's Breast Book. and she obviously wasn't aware of the dueling "theories on the natural history of breast cancer". little did my friend know that too much information opens the minds door to a vast landscape of possibilities. i understood reality differently to say the least. but my expectations for her to grasp my needs were unfair.

it's hard to level the rocky landscape of worry. and even more difficult is understanding the necessary comradeship between diligence and fear. it's an ongoing process as i'll dutifully tend to annual appointments that require me to maneuver skillfully through each of them. but in between those appointments i can only remind myself that there’s no such thing as ‘an installment plan...’.