Man with clipboard next to air conditioning unit

If Somatization Disorders Existed Outside of Medicine

Like many couples, my husband and I have different ideas about what constitutes an optimal household temperature. I’ve gotten through entire summers without using the air conditioner more than a handful of times. My husband Alec, on the other hand, becomes very uncomfortable at any temperature above arctic blast.

Lately we’ve been having temps in the high 80s Fahrenheit, with humidity ranging between 70% – 90%. I still sit happily without A/C. When my husband comes home from work, he’s near the point of drawing an ice bath to avoid bursting into flames.

Saturday, after he got home from his second job, he opened the front door and dragged his partially liquified body directly to the thermostat. He punched down the dial and air started to blow. He waited impatiently. His pained expression said that segments of his very soul were being boiled from his body by the Kansas heat. The A/C unit turned on, and air started to blow through the vents.

He sighed with gratitude and headed upstairs to change clothes. A few minutes later I was startled by his shouting.

“This damned air isn’t even blowing cold!” he exclaimed.

Thank goodness! I thought. Usually when he turned the air on my skin turned blue and my fingers stopped working. I forced a troubled look instead. “Oh no. I guess we’ll have to call the service people,” I said.

I could see that the heat had permeated the essence of his civility. Action had to be taken before he was completely devastated by his sweltering surroundings. Unfortunately, a holiday weekend intervened and the heat continued unabated. My miserable, melting husband was surely on the brink of death! He somehow survived the ordeal and made it back to the air conditioned haven of his cubicle on Tuesday morning.

I met the A/C repairman, Eric, at the door this morning. Eric introduced himself cordially. He wore neat little booties to protect my not so meticulously swept floor from dirt and footprints. He inspected the air conditioning unit, twiddled with the thermostat, flipped things in the furnace room and reset breakers.

He pronounced his findings with confidence. “I’ve checked everything. I don’t see any problems. You have to keep it on during the day to keep the humidity low,” he said. “How cold were you trying to set it?”

“Um, I think my husband was trying to set it around 65,” I guessed.

“Oh, well, it can’t do that. It isn’t meant to go that low. It could burn out,” he told me. “But it’s working fine. Just keep it on. If there are any issues within 30 days, give us a call and we won’t charge for another service visit.”

“Okay,” I agreed. Sounded reasonable to me. I paid the service fee and Eric drove off in his bright yellow van.

I read the medical record — I mean job order, that Eric had created.

System is working properly at this time. Capacities are within tolerance. Refrigerant level is ok. Recommend setting t-stat at 70 or above.

He had put it so kindly, but it was clear what had happened.

My air conditioner had Conversion disorder.

I dug through the previous diagnoses given to my unit by other providers.

Unit functioning, but has exterior damage caused by lawn equipment. Also, disconnect has broken leg – had to use plyer’s (sic) to kill power.

Surely Eric had seen these things. He must have been too sensitive and considerate to mention them. He was truly a compassionate serviceman.

About five years ago, something had happened to my A/C unit that would change its life forever. While trimming the edges of my yard, I’d accidentally sliced into the casing of my A/C’s exterior. I was horrified by what I had done. The weed eater slipped from my hands as I considered the scene of the crime.

Had I broken it? Didn’t they cost thousands to replace? How should I tell my husband?

I didn’t even consider the emotional toll that kind of trauma must have taken on the air conditioner itself. But clearly it had suffered in silence. After all of these years, it continued to live in the yard, uncomforted, and with its wounds untreated. Until this fateful spring, when the burden of cooling the home of its abuser simply became too much. Its deep seating feelings of inadequacy and self doubt had affected its ability to simply sit back and chill. Eric had used the words burn out. Surely my unit was doing just that.

Thankfully Eric had done what had needed to be done. While he stated he couldn’t find a physical reason for my unit to be non-functioning, he’d spent a good deal of time at the side of the house with it. I had assumed he was inspecting parts, but I know now he was engaging in Dialectical Dehumidification Therapy with my traumatized unit.

I appreciate how he didn’t confront me about my unit’s trauma. My guilt was already profound. I’d thought I had gotten away with it.

What happens in the side yard stays in the side yard.

Or so I’d hoped. Eric wrote up the ticket in a way that assigned no blame. Right now my A/C is quietly purring, and I feel the cool air puffing from the vent across the room. I know now that all appliances can heal. They just need the right encouragement.

Update: The A/C experienced complete mechanical failure a few weeks later because Conversion disorder is very rarely the real problem, it’s merely a strategy employed by incompetent service people or physicians to blame the victim for diagnostic shortcomings.

The Real Cost of Healthcare Pt 2

Our friends Dana and Andrew followed up with Dr. Boneanmussle, to find out if anything could be done for Andrew’s neck and shoulder pain.

Dr. Boneanmussle strode confidently into the room. He was a stocky man who looked like he had spent a lot of time in the gym when he was younger. He cordially introduced himself to our couple and launched into his presentation.

“I looked at your bone scan,” he said. “Now keep in mind bone scans are virtually useless studies. I think Dr. Neurosurgeon ordered it to politely make you go away. I do see an area of some density on the scan, but it tells me nothing. You need to have a shoulder MRI.”

He went on.

“I’ll look at the MRI myself, because let me tell you something,” he continued. “Fifty percent of radiology reports are wrong. That is they miss things. Lots of doctors rely on the opinions of radiologists who do a half assed job and then end up sending their patients away telling them it is all in their heads. I’m not that kind of doctor.” [I ask you reader, to contrast this with Dr. Jape’s statement about trusting radiologists in a previous post].

Now I believe that when Dr. Boneanmussle said 50% of radiology reports are wrong, he wasn’t drawing from any legitimate statistic, but rather using a number that he thought reflected his experience as a shoulder specialist reviewing x-rays and MRIs. Whether this statistic applies more broadly isn’t really important here. Dr. Boneanmussle’s perception is important.

So Andrew went for an MRI.

Andrew and Dana returned, and Dr. Boneanmussle invited them to look at the MRI images with him. Boneanmussle was good, because despite the poor resolution on his Dell laptop, he identified problems with Andrew’s shoulder. He recognized some bone spurs, which he said may or may not play a role in the pain Andrew was experiencing. He also identified significant inflammation that may have resulted from past trauma Andrew had experienced in that area following both a car accident and athletic injuries. He offered Andrew treatment options: steroid injections into the site of inflammation, physical therapy, surgery to open the site and get a better look at what was going on, or to take no action and be referred to pain management for more drugs.

Andrew opted for the injections. Dr. Boneanmussle performed them right then and there. Andrew now reports about a 40% reduction in pain and a significant increase in mobility in the weeks following the injections.

This is all very interesting because Andrew had been complaining of neck pain for about a decade. He primary care doctor simply ordered neck MRIs that came back negative, and gave him pain meds. After about 8 years of pain meds, Andrew was done taking pills. He got two opinions from neurosurgeons. One visit is recounted in http://www.athinkingpatient.com/commentary/the-real-cost-of-healthcare/. His other visit to a neurosurgeon consisted of the doctor first telling him there was nothing visible in the MRI of his neck and then immediately inquiring about Andrew’s stress level. Because instead of considering the possibility of referred pain from a mechanical shoulder problem, the neurosurgeon went straight to at the possibility of psychological causation.

Dr. Boneanmussle ended up spending about 15 minutes reviewing the images with Andrew and Dana and counseling Andrew on his options. He spent about 8 minutes injecting the methylprednisolone into two sites in Andrew’s shoulder and inspecting the results. Andrew’s insurance was billed $135 for the 15 minute counsel, $213.00 for performing the injection, and $40.00 for the cost of the methylprednisolone from the pharmacy. This totaled $388.00. His insurance negotiated payment to $153.25.

From arrival to checkout, Andrew had spent about 30 minutes in the office. He had a 40 minute round trip drive to the office. So his net income loss for the visit was around $44.00. Andrew was given information and treatment options. He was given treatment at the time of his visit that proved to be effective over the following weeks. Andrew has no complaints about the cost of the solution to his shoulder problem. Even if Dr. Boneanmussle had not been able to treat the problem on the spot, Andrew would have been content with paying for the amount of insight he had been given into the problem.

This, my friends, is how doctoring should be done.

Language, Sound, and Silent Language

Yesterday I had my second session of auditory processing disorder therapy with Dr. Katz. A very pleasant colleague of his from New Zealand sat in on the session.

When I first started working with Dr. Katz this year, he evaluated my processing by playing words and sounds to me and asking me to repeat what I heard. My biggest challenge was to repeat the sounds I heard to him as I actually heard them, rather than repeat them as I knew I was supposed to have heard them. For instance, yesterday he played a word. I explained that it sounded to me like “wu-wuhl” but that I knew it should be “wall” as I didn’t know of any English word “wu-wuhl.” When he played the sound, the first thing I did was spell w-u-w-u-h-l in my head. I immediately recognized that it is not a real word and decided I must had heard “wall” instead.

That is why it takes me so long to respond to people at times. It takes me even longer to respond when I hear a word like “sent” because I am busy spelling s-c-e-n-t, s-e-n-t and c-e-n-t, while evaluating the context to figure out which one I should have heard. It gets even worse with words like “see” because I have to go through s-e-a, s-e-e, and also s-i, because I’ve been around lots of Spanish speaking people my whole life. Then, for instance, if I’m in Colorado I have to wonder if I was supposed to have heard “ski,” rather than any version of “see”.

This is a strategy I refer to as my “internal closed captioning system”. It is a habit I’ve had for as long as I can remember. Turns out I was wrong about “wall” when Dr. Katz played the word. The word he had played was “wool”. I would never have guessed “wool” unless it was part of a conversation about sheep, yarn, or sweaters. It is a word I hear far less often than “wall”. I work with averages and probability when I’m talking to people. It really drove home how reliant I have been on context and spelling for understanding speech throughout my entire life. It also explained why I had experienced such a hard time in classrooms and lectures throughout my educational career.

I get really fatigued after my sessions with Dr. Katz. I still experience profound exhaustion after being exposed to sound from which I am expected to extract meaning. But despite this I will continue because the sessions are incredibly eye opening and informative. I’m slowly learning to differentiate sounds based on their own merit, rather than based on context.

Today I had another variety of language lesson. I had a one on one tutoring session in American Sign Language or ASL. My tutor is super cool and I feel like I have learned a lot already. What I find interesting about my ASL class is that unlike anything else I’ve ever been expected to learn, I’m not expected to learn with my ears. My tutor uses her voice some, but like many Deaf people, her enunciation is different from that of hearing people. With my APD I don’t stand a chance of figuring out what she says. Which is fine, because as it turns out I’m learning content at a faster pace because of the visual nature of the subject matter. I have never learned this quickly through spoken communication. It is almost like discovering an ancestral homeland. The language just feels right to me.

I am very excited about what the future may hold. I finally have a firm grasp of my strengths and limitations. I know what I can do and I know how I can do it. I hope my journey can be of benefit to others.