28 March 2009

The Hell That is Frozen Shoulder

I have Frozen Shoulder. Again. I had a it a few years ago, before I started blogging. Never heard of it? Neither had I. It's officially called Adhesive Capsulitis. See, your tissues freak the hell out and form bands of tight, inflamed adhesions throughout the capsule surrounding your glenohumeral joint. This scarred and inflamed capsule constricts the joint, locking it into its own private hell. Range of motion is severely restricted, pain is basically comparable to having your shin broken with an axe, and duration can range from a few months to two years or more.

This shit hurts, people. It has three stages:
  • FREEZING: this is when you're basically wracked in pain. All the fucking time. Two kinds of pain, actually: chronic pain that is worse at night, and acute just-kill-me-now pain when you accidentally move past your ever-decreasing range of motion. This is where I am now.
  • FROZEN: this is when the pain supposedly starts to fade, but the capsule has basically locked your arm into a very limited range. Good luck wiping your ass. This is the time to introduce excruciating physical therapy, in order to try and coax your shoulder into moving again.
  • THAWING: this is where your motion is supposed to gradually come back. It's not very common to regain your full range of motion. The agonizing PT is continued through this phase.
So yeah, I had this three or four years back. Took over a year and a half to run its course. I remember when I was diagnosed. I thought Frozen Shoulder sounded stupid. Like some wimp-ass diagnosis for big crybabies or hypochondriacs. Adhesive Capsulitis sounded better, but still. Didn't sound like a "real" condition, like torn rotator cuff, or bone spur, or something badass like that. I soon found out different.

Frozen Shoulder is not for pussies, people.

Put it this way; I had three babies with no drugs. Two of the offspring were just under nine pounds, one was just over nine pounds. No drugs. I made it through shin splints in basic training with only Ben-Gay for relief. Hell, I made it through basic training, period.  I had two wisdom teeth pulled with only local anesthetic. I can do pain. I'm a woman. But dealing with that Frozen Shoulder wore me down. It was rough.

And it's back.

The other night my shoulder suddenly seized up in a cramp. (This would be the aforementioned "acute pain".) I screamed like a girl and cried. Literally. Screamed and cried. Male Offspring was about to take me to the emergency room. Of course, he probably just wanted to drive, but still. He gave me what he called hug therapy afterward. This is from a teenage boy, folks. If I had to deal with that pain for the length of a labor ... I couldn't do it. I'd be screaming for the drugs in five minutes.

When my shoulder started hurting a few months back, I figured I had wrenched it somehow, you know, with my active lifestyle and all, and didn't think much of it. But as time went on, I had to face the fact that I was having a relapse. According to the literature, relapses are extremely rare. Surprise, I'm one of the lucky few who get to experience that rare treat.


This time is worse. Worse because I know what I'm in for. The first time, I could trick myself. You know, say things like, "Maybe I'll be one of those people who heal in a few months." or "The physical therapy will speed up the process." Complete bullshit, but it had a psychological placebo effect. This time, I know what's up. I don't think I can do this again, people. It's like getting scared of childbirth once you're already pregnant. Ain't no getting out of it now - you're in it for the duration.

And my neck's not long enough to gnaw my arm off.

I can't tuck in a shirt, let alone reach in a back pocket. I can't hook my bra. I can't reach across to wash my other shoulder. Shaving under that arm? Please. Deodorant is spotty at best. Taking a coat off sucks.

Washing, drying, and styling my hair mostly one-handed is frustrating, painful, and makes me mad as hell. It also renders me unable to let go of my anger and resentment toward Laura, the heifer who butchered my hair. Every day I hate her more, and I'm not generally into hate, except for George Bush. I'm telling you, every day it festers, and that shit's not healthy. Catching her in an alley while armed with a pair of pinking shears has replaced winning the lottery as my main fantasy.

Showering has become a dreaded ordeal and leaves me feeling like a big crybaby. I've considered going to work in pajamas rather than face getting dressed. And my pajamas aren't pretty, people. Sleep is difficult. That's an understatement. I'm ODing on Valerian and Unisom. I don't want to go on prescription pain relievers or sleep aids, because of the length of time involved with this thing. I mean, popping hard drugs for a couple of weeks or even a month is one thing, but when you're talking upwards of a year, that's something else. Who wants to end up like Rush Limbaugh?

The worst is making involuntary movements - like if you stumble and try to catch yourself, or automatically reach out to catch something, or if something startles you and makes you jump. Agony. There's a fraction of a second between the time you make the movement and the time that agony slams you like a rabid water buffalo on crystal meth, when you realize what you've done. That's the fraction of a second you consider bashing your head on concrete to knock yourself out. But there's not enough time.

To add to the fun, it's my right shoulder. I'm right-handed. I already mouse left-handed at work, so that's okay, but I'm starting to do other things left-handed. I'll be ambidextrous by the time this shit's over.

I've heard of some people who get bilateral FS. That's right, both arms at once! How the hell do those guys wipe their asses? Or drive? Or eat? Or do anything? Holy hell. If that happens, you'd better hope you have a partner or a live-in aide, because I don't see how you'd manage. It sucks having FS as a single person, even with only one arm affected. Basically, I can reach forward, to a certain height, with no problem. Any other direction is a definite no-go. At least I can type. Good thing -- that's pretty important for my job, hello. Like anyone needs a reason to stand out in this economy.

There is a surgical treatment option, but my HMO wouldn't go for it. Likewise the cortisone injections I've heard some patients get. The only treatment my HMO approves is physical therapy. Cheapass bastards. Last time, they did a few initial sessions with me, but basically handed me some papers with instructions and cartoon illustrations and told me to do it on my own at home. Then they collected their copay. But hey, we've got to guard against the evils of "socialized medicine" because US medical care is the best in the world!

Actually, maybe I was better off doing it at home. Check out this poor bastard. I can't even imagine being able to move my arm up that high, so he must be coming along nicely. Pay no attention to the screams. It's all about progress in physical therapy. No pain, no gain.

Brutal. My former drill sergeant is probably a physical therapist now. The one who got kicked out for trainee abuse. Anyway, this whole thing is making me really pissy.

I mean more than usual.

23 March 2009

Xylitol: Sugarless Gum Can Kill Your Dog

Last week Batman ate some Orbit Sweet Mint sugarless gum. The rogue canine taught himself how to pull open the junk drawer.  The top drawer. He pulled out a box of gum from Costco, along with a bag of hinges, instructions for the thermostat, a couple of magic markers, and some pizza coupons. I don't know how many packs of gum were left in the box, but in hindsight, I don't think it could have been many.

Oh. No wonder you look so guilty. Foolish Labradog, how much gum did you eat? Did you learn nothing from that emergency surgery situation? Yeah, that's right, hang your head, I'm talking about the Great Tampon Escapade, not to mention the Toothpick Incident. You'd think that would've cured you from indiscriminately snarfing down whatever you come across.

Well, when you're blowing bubbles out your ass, don't come whining to me.

But then, I thought, I'd better look this up. Just in case. And I was stunned. Orbit has an ingredient called Xylitol, a natural sugar alcohol, first harvested from the bark of birch trees in Finland and found in various fruits, vegetables, berries, even mushrooms. Xylitol has been used in Europe for some time now, but didn't find its way to the US market until about 2003. It's used in sugarless gums, candies, and in some baked goods.

Xylitol is great for humans: it's natural, has no aftertaste, is as sweet as sugar with only 40% of the calories, and studies have proven it actually reduces cavities. Something about the way it interacts with bacteria in the mouth. It's a godsend for diabetics, as it does not require insulin to metabolize, therefore does not impact blood sugar levels. And it tastes great. There are even studies suggesting a possible use in fighting osteoporosis! Great stuff, right? So what's the catch?

The catch, for dog owners, is that it can kill your dog. And it doesn't take much. I was lucky I didn't come home to a dead dog last week, people.

Dogs metabolize Xylitol much differently than we humans do. We process the stuff slowly. Dogs' bodies metabolize it all once. Xylitol tricks the dog's body into dumping massive amounts of insulin into the system, but guess what, there's no actual sugar there for the insulin to act on. The dog's blood sugar levels plummet, and acute hypoglycemia sets in.

Within 30 to 60 minutes, a dog can present with lethargy, ataxia, seizures, and even unconsciousness. Basically a diabetic coma. If it is not addressed quickly, the dog can die.

The other problem dogs face, in addition to the hypoglycemia, is liver failure. This can be accompanied by internal bleeding, due to clotting abnormalities. Even a dog exhibiting few hypoglycemic symptoms can end up with liver damage, or even acute hepatic failure. The liver damage may not manifest until 12 - 48 hours after ingestion, and it can be permanent.

There is no antidote for canine Xylitol poisoning. The acute hypoglycemia can be countered by inducing vomiting if the ingestion is discovered quickly, and/or by administering a dextrose IV solution. However, if the hypoglycemia is not treated quickly, liver damage or failure can follow, and vets are not able to do as much for that.

If you see any of these symptoms in your dog, especially if you suspect your dog may have had access to sugarless gum, candy, or sweets, get your dog to the vet immediately:
  • Weakness or lethargy
  • Pale gums
  • Ataxia (uncoordinated movements)
  • Depression
  • Vomiting or diarrhea
  • Hypokalemia (decreased potassium)
  • Seizures
  • Collapse
  • Unconsciousness
  • Liver dysfunction and/or failure

If discovered quickly, and you're sure about what your dog has ingested, you can induce vomiting using fresh hydrogen peroxide, 1tsp (5cc or 5ml) for each 10 lbs of body weight. (I've done this with Batman before, and it took 4 or 5 tsp. He weighs nearly 70 lbs. I did it with Mason once, it only took 1 tsp.) CALL YOUR VET FIRST: depending on your dog's symptoms, s/he may advise against inducing vomiting to avoid possible aspiration into the lungs, or if more than two hours has passed since the ingestion. Activated charcoal does not effectively absorb Xylitol in the stomach.

After hours, you can call the ASPCA 24-hour emergency poison hotline directly at 1-888-426-4435. They may apply a $60 charge, but you don't have time to waste if your dog has eaten this stuff. If this happens after hours, take your dog to a 24-hour emergency animal hospital. You guys know I don't say that lightly -- I know how much that shit costs.

What happened to Batman? He showed few symptoms, but that is apparently NOT typical. He was lethargic, but not terribly. I paid $160 to have the vet run complete blood work and liver enzymes on him, and tell me he was going to be fine. My vet said a few dogs seem to react more mildly to Xylitol than most. Apparently Batman is one of those few. I feel like he cheated death. I swear that dog has nine lives.

Let me stress, that is not the norm. I read story after story on the Internets about people coming home to dead, unconscious, or seizing dogs. Dogs DIE from this. Not just a few here and there, either. Others are euthanized because the damage to the liver is too severe in the end. Some dogs are under critical care treatment for days or even a week. This is nothing to mess around with, folks. It happens fast, and it doesn't take much. A couple of sticks of some gums can kill a smaller dog. Batman is the exception - extreme illness or death are the normal results. Or maybe he just didn't eat that much? I read about a dog named Copper who died from eating the exact same gum that Batman ate.

By all rights, Batman should've been dead by the time I got home.

Most Americans don't know about Xylitol. Many vets are still unaware of the dangers. The number of cases is rising quickly, as more and more products use Xylitol. If the owner is unaware that Rover got some Tic Tacs from the car, or snatched some gum from an open purse, those incidents get chalked up to an unknown cause, so the number of deaths is probably higher than reported.

For the record, other sweeteners like sorbitol and mannitol are not harmful to dogs. The gum Batman ate had Xylitol listed as "less than 2%", with sorbitol as the first ingredient, and mannitol also listed. Other gums, like Trident, have higher amounts. Orbit made a new line called Orbit Complete, in which the main draw is the high levels of Xylitol. Like I said, it's great for human teeth.

There is pressure on the FDA and manufacturers to use warning labels. The FDA says they're in the business of people, not animals. The manufacturers are afraid people will think the product itself is bad, when actually it's just the way dogs process it. So, no labels yet. Greedyass corporate bastards. Capitalism at its best.

So no cookies, gummy bites, muffins, mints, or gum for Fido. I'm glad we still have Batman. I read a lot of heartbreaking stories about people who lost their animals. Be careful with your canine friends, people.

02 March 2009

Stalking Anthony Bourdain

I'm home with a roiling gut today. This is what it takes for me to get time on Male Offspring's computer.  I'm on the couch, hanging with my man, Anthony Bourdain. Yes, the Travel Channel. I know, right? Trust, this guy is no Rick Steves or Samantha Brown. No offense to Rick or Sam. Just not my thing.

I watched Samantha once. Destination Ireland. The whole time, I was like, okay, is she really trying to do a fake Irish accent? It was intermittent, but definitely there. Weird! And what's with the cheery, eager-beaver act? Girl would be perfect working the Starbucks drive-thru speaker at 5am. That brand of perky just pisses me off. But guess what came on right afterward? Anthony Bourdain's Ireland show! I know, too good, right? I don't know what those folks at the Travel Channel were thinking, unless they're going for a mass exodus of SamFans over to Anthony's side of the pub. Basically here's the difference: kissing the blarney stone with an affected faux-Irish accent complete with cheesy soundtrack, versus quaffing Guinness in a smoky bar after a walk through Belfast, Northern Ireland, touching on the not-so-cheery history between the Protestants and Catholics.

Yeah, pour me the Guinness.

Most travel shows work my last nerve with their exoticism and touristy bullshit. I will actually set a reminder for Tony's show. There I said it. I'm addicted to a travel/foodie show.

He's so goddamn appealing.

This guy is the only smoker and pork eater worshipper that I could consider dating. Or marrying. Or stalking. Whatever. Those of you who know how extremely anti-cigi I am, in addition to my vegetarian status, will appreciate the depth of my obsession, here.

Anthony's show, No Reservations, comes with a parental warning. A deliciously sardonic New Yorker, the FCC's obscenity rules are clearly not foremost in his mind. He tends to drink a lot. I don't mean like sampling a good Cabernet with dinner. I mean like slamming it back and dealing with the hangover later. He also says "fuck" a lot and is basically irreverent, caustic, and sexy in a tall, slightly bowlegged, boots-and-leather-jacket kind of way. He's likely to bust out with a "holy shit!" while masticating a juicy mouthful of meat, and you'll never catch him with an umbrella in his drink. And yes, he can occasionally slide toward disdainful when it comes to his travel and food compatriots:

I think the Travel Channel knows it's not getting Jamie Oliver or Rachel Ray when they throw their lot in with me.

Even Samantha Brown would have a hard time summoning a "wow" for this.

He eschews the tourist traps and five-star restaurants, heading instead for street vendors, family meals, and, as a self-described aficionado of the dive bar, any place where local home brew and home cooking can be found.

He will eat any local specialty, from seal eyes to chicken anus to still-squirming octopus tentacles. What's cool about that though, is that he doesn't do it in that "Ohmygod this is so exotic and freakish, watch me gross you out!" kind of way. (Looking at you, Andrew Zimmern.) No, rather than playing the obnoxious dude-check-this-out American, Tony, for all his general snarkiness, is all about genuine learning, about respecting and honoring the people, cultures and traditions of the countries he visits. He uses his show as a vehicle to challenge assumptions and stereotypes. You can see he is honored that people would invite him to their tables, share their food and their stories.

So yeah, I'm smitten with a travel show foodie. I was considering becoming a full time groupie, when my stalking turned up the inconvenient fact that he's now married, and has a little girl. He's apparently a very proud parent:

...she goes absolutely bat shit over risotto made with wild nettles. And when her Mom dips a finger in the local red wine, she greatly prefers it to juice. This makes me very proud.

Damn. I missed my window. Word on the street is, he even gave up the smoking in the interest of extended parenthood. Cruel irony. Stay sweet, Tony.

Okay, stay snarky. Whatever.