Thursday, April 24, 2014

the 1% and a shot in the ass

I think I understand why the local clinic prescribes such limited amounts of medicine: it's a way to make sure you stay in close dialogue with your doctor. Every five days, I run out of meds and tell the lady at the clinic's front desk that I've come for both physiotherapy and a prescription renewal. I wait a bit, then I get to sit with the doctor, like a penitent at confession.

Today, the doc looked at me and said I didn't look as if I'd improved. We perused my pedometer again; he saw that I'd averaged about 8,000 steps per day since Monday, but fewer than 2,000 steps per day over the weekend. He jabbed his finger at the weekend numbers on my phone and said, "That's how little you should be walking!" I told him that that was impossible, given the fact that I walk among several buildings on campus, especially every Monday, Tuesday, and Wednesday—the days on which I teach Korean. I also mentioned that, in my opinion, the meds had lost their effect. This proved worrisome for the doc, and he put me on his table to do some range-of-motion exercises. After we finished, we went back to his desk and sat down.

Looking glum, the doc said that, in his estimation, the probability of necrosis had jumped. "Tissue necrosis?" I asked in English, not having memorized the Korean term. He shook his head: "Avascular necrosis. Bone." He showed me his little plastic model of a hip, spine, and legs. Continuing in Korean, with a few English words sprinkled in at key points, the doctor said that osteonecrosis (also called AVN, or avascular necrosis) happens when bone isn't supplied with blood. It gets brittle, and in the case of the hip's ball-and-socket joint, the "ball" part of the joint can eventually even collapse. Very painful. The doc told me to look up "avascular necrosis" online, which I of course did while I was getting my "therapy." (More on that in a bit.) He also told me the Korean term: 무혈성괴사, muhyeolseong-gwoesa.

The doctor still wasn't totally sure what was going on, but he said that, if we were looking at the onset of osteonecrosis, such a thing wouldn't show up on an X-ray. Not at first, anyway. So he said the next step most likely would have to involve something that could scan more deeply and in more detail, which brought our conversation back around to MRIs. I told the doc again that I wouldn't be able to afford an MRI (I also recently learned, from a supervisor, that our campus insurance doesn't cover MRIs), despite how cheap MRIs are here in Korea, compared to MRIs in the States. The doctor still felt that I should visit another center; I told him that my boss at DCU had already recommended a place or two, and the doc nodded at the names I gave him. I'll be making an appointment to visit the Keimyung University Dongsan International Clinic next week. I'm hoping the scans they do won't be MRI-scale, such that the cost of a visit won't be prohibitively high.

With all of that settled, the doc asked me again, as he did on my first visit, whether I wanted a shot to help me through the pain. This time around I said yes, despite not knowing the cost or knowing how long the evil needle was going to be. I was told to go to the forbiddingly named Injection Room (jusa-shil), where I was tucked into a tiny corner space and hidden behind a curtain; this made me feel as if I were a neophyte stand-up comedian. A nurse poked her head in, told me to loosen and lower my pants, and bade me expose a meaty Kevin-buttock. I was surprised: I had thought that the injection would be right into the pain site, inside the fold of my hip. I was mistaken. The nurse mimed the posture I needed to assume: fists on the waist-high bed in front of me, leaving me slightly bent over and presenting my ass as a hefty bovine sacrifice to the god of science. I kept waiting for the shot to happen...but felt almost nothing except the faint echo of a slight sting. The nurse told me to keep pressing a small wad of gauze against my ass, and that was it: we were done. Totally painless.

I was reminded of a blogger named Jelly, of the blog I Got Two Shoes, who used to describe her regular doctor visits and the "ass injections" she would always end up getting—injections whose effects seemed, to me at least, questionable at best, despite their frequency. Today, I had my own taste of those "ass injections" and, depending on how well the shot seems to work, I may go back for more. The cost of the shot? Only W600, or about 50 cents, US.

Necrosis had been presented to me as a "1%" option when I had my initial consultation with the doctor. While I was right that tissue necrosis would likely have been visible on those X-rays, osteonecrosis would not have been. At this point, the doc is assigning a much higher probability to the chance of osteonecrosis, hence his urgency in getting me to a facility that can scan me and treat me more deeply. I admire his modesty: he could have done the money-grubbing thing and fought to keep me under his care. Instead, he's done the ethical, sensible thing by preparing to send me on my way.

So when I left the doc's office and went upstairs for therapy, I used my phone to look up AVN. Sure enough: AVN is not visible in X-ray at the outset; it usually strikes men aged 30-60; deterioration leads to eventual bone collapse (again, this sounds amazingly painful); AVN's causes are currently unknown, although AVN is associated with several preexistent conditions, including hypertension (i.e., high blood pressure, which I have). At this point, I'm not ready to give up and say Folks, I have AVN, mainly because the pain's sudden appearance remains unexplained. I haven't read enough to know whether AVN symptoms can appear so suddenly, but I do know that AVN sufferers can be asymptomatic long before the first perceptible signs appear. That doesn't bode well for my case, but I'll withhold judgment until I know more.

The prognosis for younger patients with AVN isn't great. For older patients (in their 60s), hip replacement is generally the solution. That sounds like major surgery to me, and there's no way in hell I'm undergoing that. For younger patients, a more modest replacement of the femoral head is possible, although this procedure is still experimental in the States despite being more widespread in Britain. I'm not sure whether it's even done in Korea, and I'd be deathly afraid to go under the knife here.

But that sort of speculation is about events still far, far in the future. For now, I take things a day at a time. First order of business: go to a bigger facility and get checked out there. And if that facility also demands that I get an MRI, I'll look into whether I can get on some sort of payment plan so that I don't have to pay a lump sum and end up poor. Either that, or I'll have to wait until I'm in a much higher-paying job before I can think about undergoing more involved medical procedures—scans, surgery, whatever.

Options and gambles. Life is a series of walls, each wall with several doors. We contemplate the doors, not always knowing what lies behind each of them, and we make our choices.


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