Anatomy of a knee

My husband has been having pain in his right knee, the result of a fall while playing racquetball back in February. (He also pulled the hamstring group of muscles in his left leg, and the pain from that was so bad that he did not notice the problem with his right knee for some weeks.) The doctor tentatively diagnosed a torn meniscus, which was confirmed last week by an MRI.

I remembered from ninth grade science that a meniscus was the curve at the top of liquid in a cylinder (such as a test tube). Obviously the term means something else in relation to a knee, but I figured (correctly) that it probably had to do with the shape. It comes from the Greek word for “crescent.”

Despite having injured my own knee back when I was 22, I never had any clear idea just what the inside of a knee looks like. After all, back in 1984 we didn’t have wikipedia, and I wasn’t interested enough to go to the library and find a book about knees. Now I can see just how complex the knee is, and I’m not surprised that the doctor who treated me was never able to determine exactly what was wrong with my knee.

A look inside the larynx

As the doctor explained to me yesterday how my vocal cords were inflamed because of the constant postnasal drip (which could be due to either a virus or allergies, he couldn’t say which was more likely), I had a mental picture of my larynx with two thick white cords covered in mucus. Something like this, but with more realistic flesh color and oozy mucus.

Then I remembered the pictures we had been shown in a class in Voice and Diction that I took in college. At the time, I was amazed that it was possible to take pictures of the larynx – in color, no less! Somewhat to my disappointment, there were no “cords” as I had always imagined them. (Our professor told us it is more accurate to call them vocal folds – but if even my doctor calls them vocal cords, I guess the change is unlikely to catch on.)

Some of the pictures showed a larynx that was inflamed, and I tried to imagine my larynx looking that way, as it no doubt had on a number of occasions when I had laryngitis. Our professor emphasized how important it was to take good care of our vocal cords, by not straining them (e.g. from too much yelling at sports events) and not smoking. I’ve never smoked, and I’m not the sort who tends to yell, at sporting events or anywhere else. But I probably don’t rest my voice enough when I get laryngitis, which is at least once a year.

I decided to look on the Web to see if I could find pictures of the larynx like those I had seen in that class over thirty years ago. There are lots available, including videos. This one shows a healthy larynx, and you even get to watch the tiny camera snaked through the person’s nose and down her throat (a procedure I had to have done before my sleep study, to see if the opening in my throat was small enough that apnea was a reasonable diagnosis). You’ll have to wait until about the one-minute mark to see the larynx clearly.

Here is a (much shorter) video (scroll down to Example 5) showing someone with laryngitis caused by a virus. (You’ll have to have QuickTime installed in order to watch it.) I’m guessing that’s about how my larynx looks right now. And according to the doctor, it will probably keep looking – and sounding – that way until I give it enough rest so it can get better. (The laryngitis often lasts quite a while after the virus itself is gone, probably because once people feel better they want to talk again.)

An example to follow

Yesterday’s Wall Street Journal has a very interesting article in the on the choices physicians make when it comes to their own end-of-life decisions. In some ways the comments on the article are even more interesting.

What Ken Murray writes simply confirms my own thinking on the topic. But the comments present a wide variety of views, and bring up some of the practical difficulties in making appropriate end-of-life decisions for ourselves or our loved ones.

One thing that surprised me in the comments was the level of cynicism regarding the motives of the medical establishment. Some people accuse doctors of recommending and performing procedures that cost a lot but do little to improve or extend life, simply to make more money. The more reasonable (IMO) comments point out that doctors feel obliged to provide what amounts to futile care, simply to minimize the possibility of ruinously expensive lawsuits.

The health benefits of radiation?

I remember being surprised when I read, several years ago, that cigarettes were once thought to promote health. (I was, if anything, more surprised when I read that there actually are some possible health benefits from smoking. For most people, the risks far outweigh the benefits, however.)

I was even more surprised, reading this evening about the 144th birthday of Marie Curie (recognized by today’s Google Doodle), to find out that radiation was once considered beneficial. Can you imagine wanting to brush your teeth with radioactive toothpaste?

There are times that the benefits outweigh the risks. A few months after giving birth in 1992, I was tested for low thyroid levels. The test required use of some kind of radioactive dye, and I had to stop nursing my son for a week. Rather than pump and throw out milk for a week, I decided to just wean him a month earlier than I had planned (he was about five months old). It presumably had little if any effect on my health or his, and it enabled the doctor to prescribe the medication I needed (and have been taking ever since).

Most of the time, though, radiation kills. That’s precisely its purpose when used on cancer patients – to kill the cancer cells. (And it’s an unavoidable effect that a lot of healthy cells get killed too.) It’s hard to imagine now, in a day when anyone working with radioactive materials in a lab has to wear a radiation monitoring badge, that people once thought it was a good idea to line a ceramic drinking cup with uranium. (It’s even harder for me to imagine how they thought that would reduce flatulence.)

CPR in the 21st century

I first had CPR training almost twenty-five years ago, when the company I worked for asked for volunteers to learn the technique. I remember little about it except having to say loudly “Lady, lady! Are you OK?” I rarely say anything very loudly, and I felt very awkward having to say it to the plastic mannequin lying on a table in the company lunchroom. (One thing I don’t remember is what we were supposed to say if the victim was male.)

I also remember that it was much harder to compress the mannequin’s chest than I had expected, and I wondered if I could do it effectively on a real person. They told us that sometimes the technique could result in broken bones. They also told us that while we didn’t have to perform CPR, once we started we were obligated to continue until medical personnel arrived.

I was very glad that I never found myself in a situation where CPR was needed. We did once have a man in the plant have a heart attack while at work, but I was in another part of the building, and only learned about it later in the day. No one trained in CPR was nearby when it happened, and people who witnessed it were very upset that no one had been able to help. Even hearing that the doctor had said that the heart attack was so massive that Roy was probably dead before he hit the floor, and that CPR would not have made a difference, didn’t make them feel much better.

A few years ago, I read somewhere that studies had shown that CPR was generally pretty ineffective. I don’t remember whether the article I read also said that people were no longer urged to perform CPR, but my overall impression was relief – if I found myself in a situation where someone was in cardiac arrest, I needn’t agonize over whether to try to do CPR or not if it wasn’t really going to make much difference.

Then a couple of weeks ago I was asked to join my department’s safety committee, to take the place of someone who had recently left for another job. I needed to check a certain area of the department to make sure everyone was out when the fire or severe weather warning sounded. Sure, no problem, I could do that. Having already agreed to that, I also agreed when I was told I needed to have current CPR certification.

Breathing through a mask

Last night I had my not-so-eagerly anticipated second sleep study, in which I had to use a CPAP machine and decide which style of mask I preferred. For the first sleep study, I found it uncomfortable enough having so many wires attached to me that I was afraid to move around very much. Add to that a mask over my face, connected to a machine on a table by a flexible hose – how was I ever going to get to sleep?

A few years ago my husband had persuaded me to try his CPAP machine, as he suspected I also had sleep apnea, but I found I simply could not sleep with that thing over my face. I told myself I could breathe just fine, but there was something about having my mouth and nose covered that made me very nervous. The longer I lay there trying to relax, the more wide awake and irrationally frightened I felt, until finally I pulled it off. I might not sleep deeply, due to the apnea, but at least with my face open to the air I could get to sleep.

I’ve never had a problem with claustrophobia, so my reaction surprised me. When I went on a business trip to St. Louis some fifteen years ago, I went up to the top of the Gateway Arch, and you sit in a pod that people have compared to a large clothes dryer. It didn’t faze me in the least. Nor did I have any trouble being inside an MRI machine (though, to my disappointment, the MRI didn’t show why my knee bothered me the way it did).

When I read Amanda Ripley’s The Unthinkable recently, I found another explanation for my problem with the mask on my face. In her chapter about panic, she recounts the drowning death of a scuba diver who pulled out his air regulator and refused to put it back in. The conscious mind knows that this thing in the mouth is the source of life-giving air. But the instinct of a land-dwelling creature is to leave the mouth clear in order to breathe. In a panic, instinct takes over.

No more “Robot Lady”

I just read, with great interest, about the successful larynx transplant that has enable a woman to talk again, after more than a decade of being unable to speak except using an electronic device that generates mechanical speech. I have encountered a few people with such devices in my life, and I admit that it has always made me uncomfortable.

I would never make fun of such people, as teenage pranksters who made fun of Brenda Jensen and called her “robot lady.” But I could never act quite naturally with them – I’d keep from staring but I couldn’t ignore the strangeness of the sounds coming from them. I’ve read about how people with visible disabilities greatly appreciate those rare people who neither stare at their physical deformity nor pointedly avoid looking at it, and I would like to be that way but I don’t manage it.

My first thought when reading the article was that losing my voice wouldn’t be as big a deal for me as for someone as sociable as Jensen. I was just reflecting today on how much more comfortable I am with written communication, because it lets me edit myself before other people learn what I have to say. When I am speaking, I have to be able to come up with words to say what I want faster than I can really formulate them. So either I don’t say what I want to, or I say something that doesn’t come out the way I would like it to.

Writing isn’t practical for every circumstance, though. Imagine going to the store and having to write out your question when you can’t find something. Or wanting to make a doctor’s appointment without being able to just call his office. And how would you greet people at work or at church?

I imagine if I ever had to use one of those electronic devices to “speak,” most people would be very understanding and caring. But I would think about how I always felt uncomfortable around people with “robot” voices, and wonder how many people around me felt that way.

Right now, larynx transplants are very rare (this was the second in the U.S., and the only one to involve transplanting a part of the windpipe also), both because of the difficulty of the operation, and because the recipient has to take drugs for the rest of his life to avoid the transplant being rejected. But I seem to remember reading something somewhere recently (perhaps this article) that held out hope of developments that would reduce or remove the need for such drugs.

Books: Next

Usually I do not enjoy books in which there is not a likeable protagonist, but Michael Crichton’s Next is an exception. I picked it up at a yard sale some time ago but only picked it up to read this week – spurred in part by my older son having been reading several of Crichton’s books for a freshman English class in college (though I don’t know if he read this one).

I took a break from it for a couple days, first to read Alcatraz Versus the Shattered Lens, the fourth and apparently final book in Brandon Sanderson’s hilarious (and sometimes thoughtful) series about Alcatraz Smedry, then to work on puzzles in my new National Observer crossword book (WalMart was out of the Herald Tribune crossword books I usually buy). I was somewhat reluctant to pick up Crichton’s novel again, not having yet found any very likable characters in it.

But I noticed, with some surprise, that I had already read more than halfway through the book, largely without stopping (mandatory time off work gives me lots of time to read). I must have found it pretty engrossing. So I picked it up again, intending to read for half an hour or so, so that it would be late enough to take my Synthroid before I went to bed (among my reading this week was an article about a study showing that Synthroid was more effective on an empty stomach at bedtime).

I finished the novel and headed to bed nearly three hours later, having stayed up almost (but not quite) late enough to see the new year in. My mind was full of the thought-provoking scenarios Crichton had included in his novel, and the recommendations he makes in an Author’s Note regarding the legal environment for genetic research.

Wired for sleep

The sleep technician told me that by the time she was done hooking me up for the sleep study, I would look like a suicide bomber. Do I? (I imagine they avoid putting wires on their faces; it would call way too much attention to them.)

She took the picture for me on my cell phone, and it didn’t come out very clearly, but you can see the multitude of wires that she had connected to my head, chest, and legs. You don’t actually wear that box during the night, but it has to be portable like that (it’s hanging on a loop around my neck) so that you can get up during the night to go to the bathroom, as I had to.

Not surprisingly, it took a while to get to sleep, between being in an unfamiliar bed and having all that stuff connected to me. (At one point I did manage to dislodge the wire under my nose that was supposed to monitor if I stopped breathing.) But by morning I was surprisingly comfortable and felt reasonably well-rested.

The doctor will have to review the report, but the technician said I would probably be diagnosed with sleep apnea. I remember waking up twice, but she said I woke up quite a few times. My oxygen saturation level, which is supposed to be at least 95%, dipped to 86% once, and more often to 90%. For a couple hours I had few “incidents” (I’m not sure exactly what defines an incident), but at other times I had one after another.

I didn’t read up about sleep studies ahead of time, since I wasn’t worried about what it would be like. But now that it’s done (for now – there will likely be a follow-up study using a CPAP machine), I find it very interesting to find out what all those wires were doing.

The electrodes on my head measured brain waves. Electrodes around my eyes recorded eye movements. Electrodes around my chin measured muscle tone. And the ones on my torso measured my heart rate. The straps around my chest and abdomen monitored muscle movement during breathing. The sensors on my legs detected leg movements.

The one that surprised me was the sensor on my finger. I had assumed it was measuring my pulse, but now I read that it is what measured my blood oxygen level. I had noticed the red light in the sensor, but I had thought of it as being similar to the indicator lights on my computer. Apparently, however, it is an infrared device, measuring the color of the blood through the fingernail (more blue = less oxygen).

But as interesting as it was, I’m looking forward to spending tonight in my own bed.

A view through the nose

Last month, my husband told me to talk to my doctor and request a sleep study, because I stopped breathing so often while I slept. The first step toward getting a sleep study, I soon learned, was to visit the otolaryngologist, commonly known as an ENT (ear, nose, and throat) doctor.

The main part of the exam was a nasopharyngoscopy, which involves using a flexible fiberoptic scope that is snaked through one nostril to get a look at the nasal passages and the throat. It’s not the most pleasant procedure, but compared to procedures putting flexible scopes through other parts of the body, it’s not too bad.

They numb the nasal passages first by spraying an anesthetic up the nose, as well as spraying a decongestant to shrink the tissues (I suppose to allow more room for the scope). The doctor warned me that these medicines would taste awful, but after the initial grimace at the nasty taste, I found it really wasn’t more than somewhat unpleasant, and only lasted a few minutes.

My nose apparently looks just fine (unlike my husband’s, who turned out to have a deviated septum when they did this exam on him a number of years ago). But the opening in my throat through which the air must pass was narrow enough that the doctor said obstructive sleep apnea was very likely the cause of my excessive tiredness.

I left the office feeling pretty good. Partly because I now have a sleep study scheduled for December 3, which may lead to treatment to help me sleep better. But also because that decongestant and anesthetic had temporarily removed the low-level discomfort in my sinuses and throat that I’ve become so accustomed to that I barely notice it any more until it gets worse.

In the meantime, I intend to adopt one of the suggestions the doctor had for getting to sleep more easily. I had already resolved to cut back on my late evening snacks, after this morning’s open enrollment meeting at work, where they talked about how important it is to make behavioral changes to improve our health and reduce our health care costs. But I want something that helps me sleep, and a cup of warm Ovaltine every night sounds like a pretty good idea.