My Short-lived One-Armed Bandit Existence

"How did that happen?” “What did you do?”

I was met with these queries when I showed up in an international meeting with my arm in a sling. Okay, the sling was not the heavy-duty type – my arm was neither in a cast nor mummy-wrapped in several meters of bandage. I was wearing a very simple belt-like contraption, intended to keep my bent arm in place and prevent the inflamed area from being further strained.

Flashback. A few days before I was set to travel, my left arm was feeling a little sore. I didn’t pay much attention to it and in fact, went to the gym twice that week. I was however, very cautious and conscious to not lift weights, although I did a few machine exercises. A day before traveling, my arm was positively hurting. I was a little anxious, given that it showed the same symptoms of a condition I had several years ago. Back then, I literally couldn’t move my left arm – couldn’t twist, raise or bend it. Making a fist hurt and I learned to do basic functions like eating, taking a shower, and dressing up with just one hand. Thankfully, it was my right. “Calcified tendinitis”, the doctor told me then, a condition which refers to the build-up of calcium salts in a tendon, usually as a result of an injury, trauma or stress, leading to inflammation. Apart from taking medication for it (Bextra, which is no longer available), I had to go through two weeks of daily physical therapy, which included having electric current run through the affected area for about 20 minutes.

I did not see a doctor, which was quite stupid, actually. I figured, I’ll just take painkillers to ease the pain. The flight (13 hours to Amsterdam and another hour to Geneva, with two hours of layover time in Schipol airport) was uncomfortable, to say the least. I tried to distract myself from the pain by reading Norman Lebrecht’s, “The Life and Death of Classical Music”, while listening to Gautier Capuçon’s recording of Rachmaninoff and Prokofiev’s cello sonatas. The book is a fascinating read – it takes you to the innards of the classical recording industry, from the early 1900s up to contemporary times – but that’s another blog – if I get to it.

By the time I got to Geneva, which was at 10 in the evening, the pain signals from my brain went full throttle. I managed to sleep, albeit uncomfortably, but resolved that I had to get medical care the next morning. Just as well, because when I woke up, my left arm had gone on strike. By mid-morning, I texted my friend, Hendrik, who’s with the Philippine mission in Geneva assigned to the UN Human Rights Council. Hendrik belonged to Batch 12 of the Cadetship Programme for foreign service officers – the first batch for which ACHIEVE conducted a two-day HIV and Migration seminar-workshop.

Hendrik took me to the clinic, which was just a couple of blocks from my hotel. In all the years I’ve traveled outside the Philippines (since 1993), I’ve only been to a foreign clinic once (this was in the UN headquarters in Bangkok when I had tummy upset during a workshop – which I surmised later – was caused by indiscriminate popping of ibuprofen). ACHIEVE’s work on migration and health issues resonated so distinctly, especially with regards to access to health care of migrants and mobile populations. I single-handedly (no pun intended) validated some of the findings in our research, especially with regards to barriers in accessing health care/services. One is that many migrants don’t seek health care because of language/communication barriers. It was a good thing that the doctor could speak in English, and even though he was not very fluent, his diagnosis of my condition was comprehensible. Second major barrier is economic. Our NGO partner in Malaysia, Tenaganita, has said that migrants often have to pay first-class cost for third-class medical service.

The doctor who attended to me was quite helpful. The first thing he asked me was if I had health insurance. He examined my arm and said it was already inflamed. He then informed me that he would prescribe medication to ease the pain and stop the inflammation. Since I would be going home in five day’s time, he suggested that I should just do the proper medical tests and treatment in the Philippines, i.e., X-ray and blood test (to check for possible infection or uric acid build-up), as it would be very expensive to have it there. He did warn that if my condition did not improve within 24 hours, I should go back to the clinic. For that consultation, I paid 120 Swiss francs (US$114.00 or PhP 5,400.00), which I hope my travel insurance would cover. Having the lab tests would have cost me an additional 300-400 Swiss francs (US $280-US $380 or PhP 13,500-18,000)! 

The next two days, my arm was nestled comfortably in that sling. I must say, many of my colleagues in that meeting were impressed with its unobtrusiveness. And it perfectly matched the color of my clothes. My condition did improve because by the third day I could dress up using both hands (although still slightly pained). By mid-day, I was able to do without the sling; it was getting a tad inconvenient to move around with it. Yet, my arm was not completely functional. When Hendrik, I and our friend P.A. went out to have fondue for dinner that evening, I had to ask P.A to break my bread into pieces and cut the steak in small slices. On the fourth day, I could already clean my left ear using my left hand. I still couldn’t tie my shoelaces, though, so I had to forego using my sneakers, and consequently ended up buying a couple of black socks for my other shoe.

That didn’t deter me from shopping though – I got the three C’s: chocolates, cheese, and classical music CDs. It goes without saying that I got owls too (one was a Swiss-made locket – something similar to what I got in Kobe many years ago).  Speaking of CDs, there’s a tiny shop under the Gare Cornavin train station which has a very extensive stock of classical and jazz music CDs. And some come as low as 4.90-9.90 Swiss francs (US$4.65-9.40 or PhP 220.00-420.00). Not bad at all! To think that classical CDs sold commercially in the Philippines is as common as seeing a barn owl in one’s backyard. Don’t ask me how many CDs I ended up hauling – all I can I say is that the inflammation in my left arm was not a major deterrent at all.

I am writing this blog on the flight back and oh, it’s great to be able to type with both hands again. Tomorrow, I shall see the doctor and will subserviently succumb to whatever treatment he/she prescribes. In the meantime, let me listen to a scratchy Al Jolson recording.

P.S. I went to the doctor today. He asked me to get an X-ray of my left shoulder/arm and a uric acid exam (although my blood chem test results last April showed normal uric acid levels). So I did both. He told me to continue taking the anti-inflammatory medicine and see him next week (which might be a little problematic as I am going up to Baguio for a vacay with my office, yey!).  Only then will I know if I have to go through physical therapy for it. Best thing about the check-up today -- my HMO covered everything. My uric acid result was normal (in fact, low-normal) but the impression in my Roentgenological findings (okay, that’s the X-ray report) read: Peritendinitis calcarea.

There’s still one pleasure I’m deprived of: being able to scratch my back with unbridled abandon.

 

From: http://www.ajronline.org/cgi/reprint/133/6/1139.pdf

Calcific tendinitis of the flexor carpi ulnaris presents a characteristic radiographic appearance of amorphous calcification near the pisiform. This calcification frequently is associated with acute symptoms and may be related to certain occupations and hobbies.

There are several synonyms for this inflammatory condition. They include penitendinitis calcarea, peniarthnitis calcarea, calcific tendinitis, calcific bursitis, and calcareous tendinitis and bursitis. The exact etiology of these calcifications is uncertain. They may actually represent a common soft tissue response to a variety of insults. While clinical symptoms occasionally date back to a specific event, a definite history of trauma usually is not elicited. Calcific tendinitis does seem to be related to certain types of activity, such as sudden repeated motions, and it may be associated with certain occupations and hobbies such as typing, golfing, or violin playing.

Clinically, this inflammatory reaction causes severe localized pain, tenderness to palpation, limited motion, swelling, redness, and increased warmth. There may be proximal extension of redness and swelling, but usually there is no local adenopathy, toxemia, or fever. Treatment is the same as for any calcific tendinitis or bursitis and includes analgesics, anti-inflammatory agents, heat, local anesthetic and/or steroid injection, mechanical disruption or aspiration of the calcification with a needle tip and (rarely) surgical excision. The relief afforded by these measures is thought to be due in great part to the release of tension within the area of calcium deposition with subsequent dissemination and absorption of the calcium salts.