The diagnosis from the doctor is that I have a sprain, not a separation. I guess technically that’s a Type 1 separation (nondisplaced sprain of the AC ligament). This is good news, because it means that ordinary activity, while painful, is not going to tear anything loose.


This is where I get angry.

It’s PROBABLY a sprain, not a separation. How does the doctor tell the difference? There are two methods:
1) speed of recovery
2) MRI

If I had this to do over, I would have demanded an MRI. This is my livelihood we’re talking about. Had I been a Major League Baseball player, the initial exam would have included X-rays and an MRI. I just got X-rays. Apparently my doctor doesn’t believe me when I tell him that my right arm feeds my family.

So yeah, I’m a little upset right now. I agree, it’s probably just a sprain, and I’m going to act that way. But the four days I spent convalescing so that the initial diagnosis could be refined could have been much, MUCH more productive (better convalescence, more peace of mind) if I’d had more information up front. The next time (knock on wood) something happens to my right arm, the doctor is going to get a left-handed death-grip on his short and curlies, to be released only when I’ve had every test he can imagine necessary for full diagnosis.

Anyway, here’s the deal: I start physical therapy on Friday, and I start drawing again as soon as I’m done writing this. I’ll have to back off on the Lortab and the Soma anytime I plan to draw, and I’m not good to drive stick for a few days. I have a prescription for 800mg dosages of ibuprofen and for 50mg of something called Ultram, of which the doctor gave me a glowing recommendation, but was unable to supply sufficient detail. I’ll go get a second opinion from Doctor Google before I eat any of that crap.

I appreciate all of your “you’ll be fine, take it easy, don’t try to draw” votes. I’m exercising the executive veto here. I hope you don’t take it personally.


9 thoughts on “Diagnosis”

  1. What’s to take personally? NOW, we all know you’re not going to risk tearing your shoulder up worse just by using it. In your place I’d be doing the same thing.

  2. When I broke my arm about a year and a half ago, my doctor recommended 4 advils (ibuprofen) and 4 tylenols (acetaminophen) every 4-6 hours, because apparently they can be taken together. It actually worked really well, and there weren’t really any side effects, either. Just a thought. Get better, Howard!

  3. Ultram

    Tramidol is generic ultram. FWIW, I was given a ‘script for Tramidol. Being one of ‘those people’ who are very tolerant of narcotics on other pain relievers, it was next to useless. You being rather easy to knock over with pain meds, may get more mileage from it. To put things in perspective, my normal prescription now is Stadol Nasal Spray http://www.drugs.com/PDR/Stadol_NS_Nasal_Spray.html . 2mg followed in 1 hour by 2 more mg. “The following doses were found to have approximately equivalent analgesic effect: 2 mg butorphanol (Stadol), 10 mg morphine, 40 mg pentazocine (Talwin) and 80 mg meperidine.” The 4mg of Stadol ‘takes the edge’ off enough for me to function.

    Hope you get better relief than I did,

  4. I suspect that there are two reasons for nopt doing the MRI. I’m told that they are *expensive*, and more than a bit stressful for many people (loud enough that they issue you earplugs, and having you have to remain motionless in a small space).

    Second, MRI units tend to be a bit backed up on scheduling…

    So if you’ve got an HMO, it’ll take *quite* a fight to get an MRI.

  5. You seem kinda concerned about the Ultram. so I looked it up in my drug guide for you.

    It’s a centrally acting analgesic (so not a narcotic)

    it’s for moderate to moderately severe pain.

    it binds to your mu-opioid receptors, inhibiting the reuptake of serotonin and norepinephrin in the CNS (so it’ll probably make you happy too because that’s what anti-depressants do as well) The therapeutic effect is decreased pain.

    it’s 75% absorbed by oral (pill form) administration and is mostly metabolised by your liver, but 30% is secreted in your urine.

    the half-life is 5-9 hours.

    it’s contraindicated in: acute alcohol intoxication (i think you’re safe from that), physical dependency on opioids (can cause withdrawal), and isn’t recommended for use during pregnancy or lactation (again, i think you’re safe)

    it’s to be used cautiously in geriatrics, epileptics, renal impairment, hepatic impairment, if you are also receiving MAO inhibitors (a type of antidepressant) or CNS depressants, head trauma, and children.

    adverse reactions (side effects) include:
    •somnolence (drowsiness)

    it can cause siezure, but it’s rare.

    those are the common ones. There are others, but after studying pharmacology all year, I’ve cone to realize there’s a lot of CYA being done in pharmaceutical side effects.

    you have an increased risk of CNS depression (which will affect breathing, heart rate – vital signs) if you take it with other CNS depressants – including opioid analgesics (like tylenol with codiene.) also with natural stuff like Kava, valerian and chamomile (incidentally, chamomile is bad for asthmatics)

    my nursing assessment section says:
    assess pain before and at 2-3 hours after administration
    assess BP and respiratory rate before and periodically after administration (you could get Sandra to do your respiratory rate, but you should have it done when you aren’t aware she’s doing it. like… when she talks to you)
    prolonged use *can* lead to dependency and tolerance, although this effect is milder than with opioids – most patients do not develop dependency

    some other handy info:
    tramadol is considered to provide more analgesia than codiene 60mg but less than combined aspirin/codeine in post -op pain.
    for chronic pain, daily doses of 250mg provide pain rleief similar to that of 5 doses/day of tylenol 300mg/codiene 30mg
    regularly administered doeses are more effective than dosing PRN (when needed) analgesia is more effective if given before pain becomes severe.

    may cause dizziness/drowsiness – avoud driving and other activities requiring alertness until your response to the med is known.
    change positions slowly to minimize dizziness caused by positional changes
    if you’re planning on being on ‘bedrest’ and on this drug, ensure you turn, cough and breathe deeply every 2 hours. 🙂

    I don’t know if I’ve provided any more info than you already had, but I hope that helps – Heal soon!

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