Thursday, June 21, 2007

It's been a While

First off, let me declare, for the world to know, that rumors of my death have been grossly exadurated.

I'm alive, though I'd like surgery.

When last we left our hero, I had returned from America. Most international planes fly into Manila, and it was in Manila I became trapped by medical issues. It's a long, and not particularly interesting story, so I'll make it succinct.

I stopped into the peace corps office. If you'll be in Manila it's really just polite to see the staff that devote all their time to you, even if you rarely get to actually see them. While I was there, I mentioned to my medical officer that my migraine meds weren't being effective. Since I've arrive here, they've shifted meds on me a few times, hoping something will stick, so I thought they might have something new I could try. Eventually, something has to be effective, right?

Well they wanted me to see a dr about the issue while I was there. I did, and the dr told me to have an MRI. There's another few days in Manila. The MRI (thankfully) showed a completely normal brain, utterly devoid of tumors or other nasty business. But what it did show was a serious sinus infection. Now, this was hardly a surprise at this point. Anytime my sinuses have been examined they have been seriously infected, as far back as I can recall. This was allegedly due to my deviated septum for which I had surgery a few years back.

Well they sent me next to an ENT specialist, who was in the middle of a long rant about how these things are completely normal, when he stopped mid-lecture and looked intently at my scan. "But... this is different" he said.

He examined my nose and told me that my previous surgery for a deviated septum had been a failure, and my septum was deviated again. Then he went on to say I might have another, unrelated, sinus issue. He wasn't sure, and he wanted a CAT scan. But first, he wanted me to take 10 days of antibiotics to clear out my infection.

So I got my meds, and they sent me back to Guimaras (where I hadn't been for roughly a month at this point, since I'd just come back from America). However, my cheerful reunion was only about 10 days long before I hopped a plane back to Manila for a CAT scan. This made the Big 3 for me: I've had a CAT Scan, an EEG, and an MRI since I got here.

The CAT scan showed roughly what I think my dr had expected it to. For one thing, it showed that sinus problems are basically built into my nose at this point. My sinuses can't drain, bacteria feeds off of the stuff thats in them, and BAM you've got a bad infection. In fact, I took my CAT scan just a few days after I ended my antibiotic treatment, and it was already infected again. We're talking about a constant, predictable, unavoidable sinus infection that I've probably had... well... forever I guess.

As I'd been told before, sinus infections are linked to migraines. I just happen to have perpetual severe sinus infections, and perpetual, severe migraines. Could be a coincidence, and doctors can't promise that getting rid of one will rid me of the other. But it seems to me that it would be quite a coincidence if the 2 severe problems, known to often be related, just happened to be unrelated in my case. Also, when I was taking those antibiotics to kill the infection, it definitely had an effect on my migraines, in some interesting ways that I won't get into.

The doctor has recommended surgery for me, Endoscopic Sinus Surgery, basically creating a hole in the structure of the nose through which my sinuses could drain. My previous ENT, in America, villianized my deviated septum, while my secondary problem, a subtle structural abnormality in my nose, went un-noticed and un-treated. And of course my septum surgery didn't succeed, it seems.

So now I've entered into a whole new arena. It's hard to take when a doctor tells you that you need surgery. And for about a day, before I was able to discuss this with Peace Corps, I was a little bit intimidated. Now that I've discussed it, that feeling has passed. If I want this surgery, I may need to take some great pains to pursue it before Peace Corps will approve it.

Peace Corps doesn't authorize many surgeries inside your country. I suspect this is because, as our medical care provider, they would be liable if someone flung an accusation that they were subjecting you to untrustworthy medical care. Therefore, if I have this surgery it's likely to be in DC. But of course that brings in a dozen other complications - cost of the plane ticket, significantly longer disruptions from our work at site, jet lag, and of course the significant possibility for many surgeries: that the patient won't return to his job at all.

For these reasons (and this is only to the best of my understanding, not from official sources) Peace Corps is reluctant to do any surgery that might be considered "un-necessary". This is my worry. However, it takes a while for them to make a decision. I returned home from America almost a month ago, and I think I've spent more time in Manila than at my job. But as of yesterday, I'm back on Guimaras. They sent me here to wait for an official response from Peace Corps. Ultimately, the man who will decide whether i need this surgery is an expert who will never examine or talk to me. This makes me uncomfortable.

But I'm resolute. Since returning I've had a renewed sense of determination, and I've divided it two subjects: First and most obvious (as the subject of most of this writing) I'll get that surgery. I've lived with these migraines far too long, and my sinus troubles as well. If they can't cure it through medicine, than they will find another solution. I'm fairly certain this is a requirement of denying my surgery. Short of putting me on antibiotics all the time (which I'm certain is not an actual option), I don't see what alternative treatment they can offer.

Second: My work. Coming home was depressing. I've accomplished markedly little in my year on the job. Mostly because no one seems to know what to do with me, I suspect. But I've used my time in Manila to have long discussions with Peace Corps staff, who are now planning a rather serious intervention. I like my center, it's an interesting place to work. I like my co-workers, they're good, intelligent people who know what they're doing for the most part. The only thing I lack is a particularly useful function there. That will be solved. Unfortunately my first issue distracts me from the second by no small measure.

In any case, that's where I am now. That's my life. I'm waiting to hear back and find out how easy it will be for me to get my surgery, and planning out some change (still vague for the moment) at my center. Hope everyone out these has had a pleasurable, if not easy, time since I left. I know it's been difficult for some, but hang in there.

Long days and pleasant nights all,

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