Pain Relief (or so I thought)

Thursday arrived. I was excited for the beginning to the end of my daily pain.

I had a 2:15 PM appt with Dr. Richman. My sister, through the efforts of her daughters hand issues, told my of a special parking garage for HSS patients and staff. I borrowed my mothers car (much smaller than an Excursion), grabbed the ever present wife and started for the city. Came down the FDR Drive, exited at 71st street and immediately made a right turn into...the wrong garage. There's a pay-garage right smack dab next to the staff and patient garage on 71st street. By the time you realize you're in the wrong place, you've passed the HSS garage and are dedicated to the private one. (HSS patients and doctors can park in the HSS garage for free. Just get your parking ticket validated at any doctors office in the Hospital and you're good to go.

I arrived at the Dr.'s office about 25 minutes early. As a new patient there are tons and tons of forms to fill out. In this case, no less than 10 sheets of paper. Upon concluding writing my diatribe, I sat there waiting. About 2:45 I was taken into one of the examining rooms, given a smock and told to strip. The Dr. would be in shortly.

Having been trained in emergency medicine I always enjoyed down time in a medical facility. It allowed me to explore new equipment, new medical books, static body part models, charts, cupboards, drawers and sometimes play with topical medications. In this case the models were very good, of the lumbar spine with little rubber 'tendons' (which represented the nerve bundles) were out. I picked up the model and proceeded to manipulate it. I then looked at a very nice pole mounted diagnostic system which monitored no less than 5 life signs. I played with it for a few minutes then left it be when I couldn't erase new settings I placed in it and then realized the system was networked and probably visible on a staff station outside. I also found some syringes and drapes, a medical marking pen (which I evenly swapped with the Dr. for my liquigel pen) and some ethyl chloride (I needed to play with this freeze compound.)

About 3:25 the Dr. Richman arrived. We had a lengthy conversation about my case, a full examination, a look-see of the prescription issued by Dr. Feinberg. He then called said he needed to use the rail hung PC to bring up my MRi images from the hospital database (he stated his wireless laptop was presently charging.) On a larger 22" monitor up popped my recent MRi. He looked at the images and made a pssh sound. He stated the images were not of the quality he'd like to see. He asked if there was any issue with the people in the radiology office and I said no. He then noted the images came off an open MRi machine they had. He then asked if I was claustrophobic, to which I stated no, its just that the other machine wasn't available. He then brought up the radiologists report and read through it. He finally stated that he had two issues for being able to conduct blocks today. 1st he didn't have the necessary imaging he would wish, so I needed another MRi. Next he stated that the blocks would be done by CT guided technique and that would be done in their CT Pain lab, which would require out-patient scheduling.

So, he was going to schedule another MRi and speak with the radiologist to make sure I got the real deal. (This leads me to wonder why HSS does not have the best of the best machines out there to provide their doctors with the best information and testing possible. Oh, nay-sayers I understand, it comes down to money, but still. HSS keeps many doctors gainfully employed who charge premium rates to their patients. Typically HSS Dr.'s do not participate in the most available health insurance.) At this point I began asking him about recent research I'd done on imaging, testing processes and the like, including MRN. He stated that he'd read some papers on MRN and was intrigued by the findings and ability, but he had not yet come in contact with the technology. He then picked up the phone and tried to find the head of radiology to speak with her about it. He tried no less than 10 extensions to find her, but it was nearing the end of the day and things around the hospital were hectic with a good deal of patients. He then told me he would speak with the Radiologist to get the departments impression of MRN and get back to me to arrange further testing. He also indicated that he was leaving for vacation the following week and would return on the 25th, but would no less call me later. (never did). I asked him in the interim, how I should approach pain resolution. He stated he'd increase my Neurontin 1200mg t.i.d. and gave me 2 scripts for a ketofen/ketomine/lidocaine/amitryptoline compound. The compound I should rub into the anorectal area 3-5x per day.

My wife, who has been ever so kind throughout all, ran down the prescriptions the following day. A pharmacy listed on the prescription sheet in lower NY was contacted. They didn't have an immediate answer whether they'd be able to build the compound immediately or not. They'd get back to us. We contacted our regular pharmacy, who also didn't know if they could build the compound through their traditional suppliers. Thankfully we were pointed to a pharmacy in East Meadow, NY called Prescription Headquarters. These people had immediate answers. They'd have the compound available for pickup the next day, Friday. They are exceptional people and truly care about patients and their needs. Certainly in my case they understood that pain is a terrible thing and they expeditiously worked to assist in my case.

The next day I called the Dr.'s office to see what he had found out from the Radiologist. I got his PA. The Dr. was now on vacation. Huh? He said he'd get back to me. He hadn't. This is not turning out to be an HSS experience like I'd had or my family had experienced in the past. Was I sliding into a venerable black-hole of medical diagnostics? Was my condition not pretty or easy enough? Ugh. I began to see the writing on the wall. I needed to press the issue and press hard. Time for self-realization. I asked the PA (Mila) about 2 things. First, imaging. Thankfully, the doctor appears to be extremely adept and more long-winded than most doctors in writing notes. He's able to type and typed the notes into his now charged laptop. She read them on the phone with me. He noted MRN and the need to speak with radiology. She asked if I would call on Tuesday so she had time to seek out the radiologist and speak with him. Fine.

I called on Tuesday. She'd spoken with the Radiologist and he didn't know anything about MRN. I asked if she wished me to send over some info on it, and she said by all means. I sent it over to her and she immediately took it to the radiologist. They got on a conference call with the vacationing doctor and discussed the matter. They concluded that HSS couldn't assist me with the specific test, but they would seek out a partner hospital in NY that had one. She called several hospitals to find out no one had the test equipment or protocols. She then said the radiologist would issue the order to have the testing done. (Yeah.) I also stated that I was blowing through all of my Neurontin the other Dr has prescribed and needed a new order. She immediately called the pharmacy and had them fill the new script. I have to say, Mila is an exceptional PA who is detail oriented and accommodating and has the ability to think on her feet.