THE ELBOW THAT CONTROLLED A LIFE

I looked at the chief complaint of a 47-year-old female named Becky in the family practice office. It read, “Sore elbow not getting better.” Looking back at previous charting I noticed Becky had been in the office two weeks before with the same complaint. At that visit she was prescribed Motrin, told to wear a brace, elbow rest for several weeks, and to follow-up if not better. I lightly knocked on the examination room door and walked inside. There I saw a fairly attractive woman sitting on the examination table wearing a mini skirt, tight sweater, shoulder length curled black hair, 3 inch high heels, a strong smell of perfume, and wearing a lot of make-up. Although attractive I sensed she was having a difficult time with the aging process. I could relate to her on that one. I introduced myself as the nurse practitioner student and she smiled to greet me. I sat down on the roller stool to get her history.

“It says here your elbow still hurts. You were seen here two weeks ago and it has not gotten better? ” I asked.

“Yes. It still hurts. It is not getting any better,” said Becky as she grabbed her right elbow. I knew she thought that gesture would make her history even more convincing about her pain.

“Did you take the Motrin as prescribed?” I asked.

“Yes. I ran out several days ago. I think it helped a little,” said Becky. I began writing my subjective part of the medical history.

“Did you continue to take the Motrin?” I asked. Becky looked at me funny.

“No. My prescription ran out,” she said slightly abruptly. I looked at her.

“You can buy Motrin over-the-counter,” I responded. She did not say anything and crossed her legs. I left that topic alone for the time being.

“Have you been wearing your brace?” I asked.

“I wore it for a couple of days. I can’t wear it that much because it interferes with my life,” said Becky. I wrote that down in quotes.

“Did it seem to help when you did wear it?” I asked.

“Yes. I guess so,” replied Becky.

“What do you do for a living?” I asked.

“I am a secretary. I type a lot on the computer. Wearing that brace only makes it more difficult,” she said.

“Did your elbow begin to hurt more after doing anything in particular?” I asked. She once again looked at me.

“I was playing golf. And during my swing I noticed it still hurt,” she said. I wrote that one down too.

“How many times have you played golf since coming into the office a couple of weeks ago?” I asked.

“I guess about three. Is there something that could be done to get rid of the pain? It interferes with my golf game!” said Becky in a firm voice.

“Did you wear the brace playing golf?” I asked.

“No. Why would I do that?” she responded.

“Alrighty then,” I thought to myself. One diagnosis I had already come up with was brain damageous perfumious. I got up from the stool to wash my hands to begin my exam. I started by assessing her right elbow to see if there were any deformities, bruising, swelling…etc. I saw none. I then began palpating her elbow. I began at the lateral epicondyle of the humerus. She told me it hurt when I touched it. I then proceeded to the medial side. She told me it did not hurt when I touched it. I then palpated down her forearm to her fingertips. I did range of motion of her elbow and asked her to rotate her forearm and dorsiflex and supinate her wrist. That produced pain. I concluded the exam by listening to her heart and lungs. Then I sat down to chart my findings. Before getting everything charted Becky was eager for an explanation of why her elbow continued to hurt after two weeks. Her right leg re-crossed her left and began to bounce back and forth.

“So. Is there anything else that can be done to help with the pain?” asked Becky.

“Becky. Pain is a way our body tells us something is wrong and/or needs to heal. This is what they call tennis elbow. Probably from playing golf you aggravated your elbow from the repetitious movement of swinging the golf clubs. The only thing that can be done at this point is for you to stop playing golf for several weeks, wear your elbow brace, and take Motrin. It will take time to heal. It will only become more aggravated and painful if you don’t allow it to heal." I sat there and watched the expression on her face. She looked like she was almost getting angry.  

“I will not allow this to control my life!” responded Becky in a firm voice.

“This is something that will go away if given enough time. You just need to rest your elbow for several weeks and you will be able to play golf again,” I said.

“Unfortunately you are getting older and sometimes our bodies tend to hurt and injure themselves more quickly than they did when we were younger,” I said. I tried to fluff that up as much as I could because I had been going through the same problems in life. The look on Becky’s face was anger. Then I knew she did not want to see the nurse practitioner student any longer.

“No. It will not control my life. There has to be something else that can be done!” she said. I sensed I was not making the situation any better.

“Oh I know. What was I thinking? Let me get out my Star Trek medical equipment to heal you right here and now. One swipe of the scanner and everything will be like when you were…say…FOUR!!” I thought to myself.

“Okay. I will go get my preceptor and we will be back in the room in a few minutes,” I said as I gave her one of my programmed smiles.

I talked with my preceptor and she agreed with everything I said. She went into the room and repeated everything I told Becky. Becky still did not want to hear anything about giving up golf for any length of time. My preceptor also repeated the aging speech. That was not well received even when she did it. Becky wanted to be cured today and now. She did not want to wait and did not want her golf game to be disrupted anymore than it already had been.

She was given another prescription for Motrin and the directions of elbow rest and wearing her brace. She was told if it did not get any better with this treatment plan then we would consider injecting the elbow. Becky left not hearing what she wanted to hear. I watched her as she walked down the hallway out to the check-out.

“Getting old sucks huh?” I thought to myself as I noticed my right knee was hurting from standing most of the day. Maybe I should get my Star Trek medical scanner out to do something about that. Love that modern space technology! I knew she would be back in a week or less or find another provider who would give her the answer she seeked.