When a respected East coast University Medical department starts acting like a Medicare Mill

My Accidental Right Wrist Fusion

After a my disabling ischemic stroke, in December 11 2003, I agreed to a surgical procedure to relieve my right fingers curl. And also a separate procedure to straighten my `locked’ right arm. After my stroke my right wrist and hand was involuntarily (by the resultant brain damage) forced to point in an upward direction towards my left unaffected side. This made basic functioning such as dressing and walking quite difficult. My balance was affected as well as my pronounced exaggerated right leg curl (my right heel turns toward my unaffected side).

Unfortunately no printed review/summery by the University of Pennsylvania medical team was offered as to the operations I believed I and the surgeon had agreed upon. Perhaps that would have prevented the incomplete discussion and resulting continued discomfort from the second group of surgery procedures.

The first procedure went without a hitch. It corrected my `locked’ elbow and allowed my right arm to hang loosely at my side (so much so that now it gets caught in my sleeping position– and drags on the floor when I stoop to pick up something).

However the second set of procedures were unfortunately also not discussed correctly:
It was explained to me (and one of my adult nieces who was present with me in the doctors examining room).
The briefing stated that my right hand finger tendons would be extended. Also in order to perform this extension the nerves of the fingers would need to be severed. It was clearly stated that no increased function would result, nor was I under the illusion that the hand would ever function usefully again.

No mention of my wrist being fused!

After a lifetime of questioning Doctors and following my own mature health choices. I actually found the Doctor reassuring, apparently thorough, as befits her stature in a major teaching medical institution. Unfortunately, hindsight has provided an tragic explanation for the gross oversight of Dr Keenan. She was preparing to retire in a great hurry and I got lost in the shuffle. I did not realize it then but there was actually No One in charge of explaining to me what the operation that Dr Keenan had planned for me.
Her nurse on her staff was supposed to update me and also promised me some printed documentation. Nothing was provided me.

However the lack of full discussion or supplied documentation as to the two scheduled operations on my arm and hand was quite unfortunate. I believe most of these problems could easily be avoided by documentation or full disclosure of what the surgery entailed.

In fact there was documentation for a surgery on a planned leg procedure, and much of the single meeting discussion was concerning this possible future correction.

The first I heard of the wrist fusion was in the hospital room when the surgeon visited my the day after the operation and I was just conscious enough to say “What did you do.” It was then the surgeon stated that my wrist was fused.

To this day it remains swollen and often aches and the wrist is often uncomfortable and with pain. I seem to have traded one type of discomfort for another. My fingers are in a state I have termed “permanent boxtox extension.”
Note: I did try botox injections after my stroke and found that lengthening was not to my liking. I told that to Dr. Keenan well before the surgery.

From the recent surgery my right pinky gets caught on fabrics in sweaters and shirt arms, coat sleeves etc. This pinky finger seems to jut out quite annoyingly and unnaturally.

After my stroke I had pursued on the web to see if there was any possible help for my affliction, and I came across a news report on a discussion by the a surgeon in Philadelphia on a series of operations on stroke affected limbs. Unfortunately in regard to the arm correction only the finger tendons extensions was named in the news report.

The Physiatrist in NYC I was seeing at the time had noted my difficulties with my locked in place right arm and the resultant skin irritation under my right armpit.
My internist at this time misdiagnosed it as a fungous, and sent me home with a script for an anti-fungous cream which (of course) did nothing.

A year later with a different internist, I diagnosed myself and told him that the itching was due to the weight of my upper arm pressing against my torso. He agreed to refer me to a dermatologist. This specialist wrote me a script for a steroid which relieved my immediate discomfort. However the problem has re-occurred with discouraging frequency. In fact the soreness and itching persists to this day in a different form; and also affect my right breast area — i can only assume that my shoulder sublimation and weight of the inert arm adds to the problem.

The amount of cramped muscles on my right side I assume is certainly related to my post paralysis attempts to walk and exercise. I stretch as much as my spaticity and tightness allow me. My main stretching is cross leg on my bed in a “pseudo yoga position.” I now do this twice a day since the first arm operation. I have yet to find an affective release for my neck cramps and right shoulder pain.

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Robert Gellman

In the early days, before I established a positive identity as a disabled person. Robert was tremendously helpful to me.
He was similarly disabled, and he was also highly intelligent and competent.
He became disabled at a young age, I believe around 40 years old.

Actually it’s hard to imagine what he really experienced. His stroke and resultant hemiparisis was a result of an operation that a doctor recommended. My stroke was quite dissimilar and I lived until 53 years old before my right sided paralysis. Thus I had a really good run before I had to stop playing guitar.

Robert taught me many ways of coping with my walking difficulties. He once remarked that he went to physical therapy in the early day of his stroke but found it was not very helpful. I had a similar experience. I often had to teach the therapist myself, as opposed to the other way around. What a drag!

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Albert Polon

My dad was a tremendous positive influence on me.
He was quite aware and an excellent teacher.
Compassionate, creative, he helped me create and grow a strong moral core.

The Polon family was always concerned with the contradictions inherent in living in an imperfect society. We were culturally Jewish, yet we were atheists. Solidly left of center, however open to other values. We were also willing to examine our own inconsistencies.

My parent’s house was filled with The New York Times,  books by Carl Sandburg, and I recall the Golden Bough by Sir James Frazier (all the volumes!). Norman Mailer’s The Naked and The Dead. The Fifty Minute Hour (which started my successful lifelong use of psychotherapy to move past emotional roadblocks). My mother introduced me to The Golden Notebook, and movies by Satyajit Ray.  They both loved Steve Allen and Ernie Kovacs. Of course Jackie Gleason was on each Saturday night. They appreciated Johnny Carson and Jack Paar.

Al, as we called him,  was fascinated by intelligent games of Chance. He loved Bridge, and other card games. He also had a passion for spectator sports, especially horse racing both Trotters and Straight Up. He introduced me Dashiell Hammett and film noir before it was called that.  We lived quite close to The New Yorker Theater, the premier revival film house of the 1950s and 60s. [I believe the owner was Daniel Talbot,  however this is a digression.]

In 1953 My Dad received some devastating news. Previously he underwent a surgical procedure — a sympathectomy, just after I was born This was supposed to lower his blood pressure. It did for a while but not for long. 7 years is hardly an acceptable bargain for all the pain and suffering from the removal of his nerves of his middle torso.  Especially since the expectation was for a permanent improvement.
He realized that he could not go through another round of failed experimentation. He decided to take the family to Europe for an extended stay. It was an incredible adventure. Al bought a Citroen, and we drove around the continent and saw the clash of cultures first hand.

The cultures, and the view while driving were more than I (as a five-years-old) were open to experience. However many memories are retained, all of them good.  I recall the beach at Cannes, and a certain Austrian (I believe) funhouse, and the many great meals in unusual places and restaurants.

However his mother Rose died suddenly  however and Al flew back to the States in  a rush without us. When he got back to NYC his doctors started him on a new blood pressure lowering drug (surpersill ?spell).

It worked fairly well. He still had tremendous difficulty standing up since his nervous system  was surgically compromised.  But he lived for 20+ years. Unfortunately at the age of 54 he came down with colon cancer,  and the Barium test was unhelpful (it missed the growth). Remember this was 1970s. He died in the early 1970s.
During my youth, and especially as I became of college age I grew more rebellious. This was the late 1960s, and I was looking for a fight, so I fought with all authority figures.  A  problem I retained for many years. I fought with him often, but my household could accept conflict. We were all quite strong willed.

I remember when the Kubrick film  2001 came out. We saw it as a family. And we also saw Mike Todd Jr.’s Smellovision film about China (boy did my mom freeze, since it used the AC system to distribute the aroma). Such was life with an extraordinary man, my Dad.

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Love is anything But

When you fall in love you’re able to take a welcome
Brief pause in the chaos of life
A safe island where you can catch your breath.

We grasp for happiness and feel it slip away
How to slow down the cruel clock, is to ask the impossible.
It can be an agony to discover (know what)?
That it’s all so Temporary.

Now a giant gap parts us.
The brief moment of Oneness ended while I was unaware.
We have lost again, and no one is left for the better

I was clueless that a change was about to occur.
I suppose I was unaware,  how unhappy You Must have been.

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I Thought I Knew Love

The worst of it I was convinced that we were of a same desire and mind         to make it work.
The pull to each other I believed was unstoppable. 
I felt that we could work any tensions out because I was so in love.
I must be the densest person on Earth. Could I missed many signs?
I miss not waking up with her and seeing her at my breakfast table.
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Frank Deford commentary on NPR’s Morning Edition in 2008

February 6, 2008

I was quite enthralled by Frank De Ford’s comments as to the state of the NBA today. I could not help noticing the similarities to the “Super Tuesday” that just occurred.

American culture probably always been obsessed with the “Star Search / American Idol” approach.. Nowhere is this weakness in our culture more devastating as in our political process. As entertainment becomes the centerpiece of the the media’s assault on our daily life. We base our judgments on who runs our world in terms of the best quotes or who appears sincere.

Look at the prolongation of the nominating process. The seasons of sport are blissfully timed. What we are experiencing is an endless bad (or good) playoff run. It certainly leaves substance behind.

 As a long suffering New York City sport fan, I have watch the poorly run corporations who own and mis-manage our teams. Couldn’t we say the same thing about our government and private industry?

 It is good to notice the evolution of Mr. DeFord’ s comments over the years I have heard him on NPR. He has ceased his sarcastic tone and now contributes stronger criticisms. His new contributions are appreciated.

September 10. 2012

It’s seems to me that the political process in the world’s largest democracy is unfix-able. The quantities of money that are dedicated to electing and retaining power are so vast and seemingly uncontrollable. What hope do we have to oppose those who do not let their moral view of the consequences of their actions to achieve a more inclusive discussion to find some solutions to our massive American problems.

Like many I tune out all political advertisements, and seek my own facts as I perceive them as flawed as that might be.

 The invasion of Iraq and the badly thought out “rebuilding” of it seem to be symptomatic of America’s inability to to manage itself.

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Señor Bolero

Happy Valentine’s Day
I first heard Jose Feliciano in 1962 or 1963 at the Newport Folk Festival.  I was a small teenager trying to figure out too many puzzles in my confused life.  I was struggling with mastering the guitar: a challenge that can take a lifetime, and  deservedly so.

Needless to say Jose was great and a inspiration. At that point I was fixated on black guitarists of an earlier era such as Reverend Gary Davis and Big Bill Broonzy (and still am to some extent). But here was a man slightly older than me who played the hell out of whatever musical style he tried that day, some Latin songs and some familiar ballads. As I continued to study the guitar  and started performing in Manhattan I caught an occasional  set or  performance by Jose. Since his career blasted off around then the venue were no longer intimate. He played at the Central Park Skating Rink  in the summer  of probably 65 or 64, it was a double bill I recall he was opening for a more famous act.  And he dared to play one number on electric guitar which was a traditional mambo that became famous at that time via another act. But  his skill on the classical guitar was just inspirational.  His riffs were like precise layers of melodious sounds in the  hot summer ether around us.

At this point in my life I can no longer play my beloved guitar but I still am captivated by great guitar players and complete musicians as I strived to become.  Before my stroke, I finally allowed myself to accept that I was a good player and enjoyed the sounds that my technique spun.– an issue that haunted me most of my life.

What sparked this recollection? I just heard a cut from “Jose Feliciano – Señor Bolero” on NPR and today picked up the CD. It is everything I love about this player and artist. He is still powerful as always to me, and speaks from the universal corazon.
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