City Carrier Assistant (CCA) Mailman Maladies - Charley Horse, Kidney Stones and Inguinal Hernia
Mel Goes Medical
Although I am a mailman and not a doctor, I have enough medical knowledge to make overly broad assumptions based on very limited evidence. As a frequently injured letter carrier, I've been to enough real doctors to redraw from memory the anatomical charts on the consulting room wall, but that certainly doesn't qualify me to give medical advice to you, the aspiring City Carrier Assistant (CCA) or Rural Carrier Associate. Therefore, if you're sick or injured, see a real doctor, don't try to self medicate based on what I'm sharing with you here. All I'm doing in this article is sharing some of my own mail-related injuries, so that you can recognize them when they happen or, better yet, avoid them completely.
I could write my own medical encyclopedia based on injuries that happen specifically to letter carriers, but space is limited. A lot of you reading this are going to say but what about this? - or you left out that. I'm sure you have your own stories to tell and we'd love to hear them, but you'll have to either get your own website, or tell us about them in the comments section below. In the meantime, be prepared to suffer through the three main medical maladies that this mailman has met, these being the Charley Horse, the Kidney Stone, and the Inguinal Hernia.
A Charley Horse won't get you into the winner's circle at Churchill Downs, it won't have you vaulting obstacles in the equestrian phase of the Olympic Games, and if Ben Hur would have included this worn out nag in his team in the famous chariot race to the death, it would have been him being trampled to death, instead of the evil Roman Messala. A Charley Horse is a tired old workhorse that only leads to getting shipped off to the Postal glue factory early, if you don't take precautions.
Charley Horse is a colloquial term used to describe painful muscle spasms in the legs. The name may come from Charles "Old Hoss" Radbourn, a hall of fame baseball pitcher of the late 19th century who suffered from painful leg cramps on the mound. In other regions of the world, however, there also seems to be an equine association with these cramps. In parts of Italy, for example, they are known as Donkey Bites. The Germans are apparently much more fond of the excruciating spasms, affectionately referring to them as a Pferdekuss (horse kiss). The Swedes, who must have a cultural sadomasochist streak, call them a Thigh Cookie.
Although I inherited my tendency toward Charley Horses from my mother, suggesting there might be a genetic component, they strike me most often, without warning, in the least desirable places, when I have had a particularly dehydrating day delivering your mail in the relentless Southern California sun. Occasionally they wake me up screaming in the middle of the night. They attack me when I am sitting at the computer writing about them, as if they are trying to suppress the dissemination of information about their nefarious activities. The Charley Horse also has a sadistic sense of humor, because on several occasions one has kicked me hard while stuck in a freeway traffic jam. In these circumstances I have no other choice but to tough out the intense pain, there being no easily accessible spot to pull over to walk off the cramp. Recently, during our February heat wave, I had one strike me in the thigh and calf of the same leg, on the same day. For some reason they favor my right leg.
Very important from a letter carrier's perspective, Charley Horses have been linked to low levels of magnesium, sodium, potassium, or calcium, all minerals found caked on our dainty Postal undergarments after a particularly scorching day. To alleviate this mineral loss, doctors recommend drinking water throughout the day to avoid dehydration, and also advise the consumption of sports drinks containing high levels of electrolytes, such as Gatorade. From my experience, however, on a really hot day you can do all of these things, eat more bananas then the Silverback Gorilla in the enclosure at the San Diego Zoo, and still get booted by a particularly ornery Charley Horse. If dehydration, intense exercise, restricted blood flow to a leg (caused perhaps by sitting in front of your computer), or pregnancy do not explain your little uncorraled herd of Charley Horses, then you need to consult a doctor for possible nerve compression issues.
To relieve Charley Horses in the calf or back of the thigh, real medical doctors, not mailmen pretending to know what they are talking about, recommend putting weight on the affected leg and then bending the knee. For Charley Horses in the front of the thigh, the suggested method is to hold onto a chair for support, then lift your foot toward the buttocks. I have instinctively tried the first technique, with mixed results, but not the latter, although I do suffer from Charley Horses in all three places.
Of course, if you are stuck in your car in rush hour traffic, none of these techniques are appropriate, unless you have a sun roof or convertible, I suppose - although the Highway Patrol may take issue with you standing up while operating a motor vehicle. One pain-relieving method for these situations, which I discovered out of sheer desperation, is to relax and take deep and heavy breaths. You really have to focus and concentrate for this to work. A slight deviation back to normal breathing and the Charley Horse will come back kicking and screaming.
The Inguinal Hernia is an affliction of those two little rabbit holes, possessed by us boys, where our family jewels go to run and hide in when they are cold or scared. Every man knows about his secret rabbit holes, but what I didn't know before I started researching this is that women also have an inguinal canal, although it is less prominent than in men.
To use more specific medical terminology than "rabbit holes," and "family jewels," the inguinal hernia strikes in the inguinal canal, a small passage through the lower abdominal wall. The aperture carries the spermatic cord in males, and the round ligament of the uterus in women. The inguinal canal is only four centimeters in length, but being a weak spot in the abdominal cavity it represents a frequent source of herniation. .
A hernia, in general, is an opening in the abdominal cavity through which an organ, frequently a section of intestine, sometimes even part of the liver, can potentially protrude. The danger of hernias comes from strangulation, a process in which the blood supply in these dislocated organs is blocked. Organs protruding through herniated areas of the body cavity result in pain, tenderness, and sometimes a visible lump.
My own experience with the inguinal hernia began in 1998. I had just passed a painful kidney stone, which you will learn about in the next section. Although I was certainly relieved to be rid of that particular mailman malady, I continued to feel pain in approximately the same region for months afterward, and assumed that I was forming more stones. I went to the doctor on a number of occasions for this, but wasn't given any help besides prescriptions for pain pills.
One day I discovered a disturbing lump in my lower abdomen. Never having a hernia before, I assumed it must be a particularly large kidney stone working its way downward. I went back to the doctor, and this time was correctly diagnosed with a hernia, for which I was put on light duty for a couple of weeks while waiting for my paperwork to be processed by the department of labor. During my sabbatical from street delivery, my unforgiving Postal Supervisor would ask me to perform impossible tasks, like moving heavy trays of mail between vehicles. With an inguinal hernia, it is practically impossible to lift even a light tray of letters from the floor. It is a daunting task just to pick up a gum wrapper. Anyhow, I suffered along in this fashion, avoiding his sadistic requests for the most part, with gradually increasing pain. Finally my doctor said "screw the paperwork, we have to operate."
While performing the subsequent laparoscopic procedure, the surgeon actually found two hernias, one each in the left and right inguinal canals, which he repaired with a synthetic mesh. Although I was told there was a potential for mesh breakage and a return of the hernia, 18 years later the repairs have held up nicely and my family jewels still feel very snug and unthreatened in their patched up man caves.
Although there is a genetic predisposition for hernias, and many inguinal hernias may be congenital, meaning that the individual is born with small weaknesses in the inguinal walls, these defects that are present from the time of birth can be aggravated by strain upon the inguinal canal. This is caused by actions such as coughing, heavy lifting, and pregnancy. Hernias that are not aggravated in this fashion may exist for years in silence, without any protrusion, strangulation or need for repair.
Without anything other than anecdotal evidence to base this upon, I am unilaterally declaring the "inguinal hernia" to be the official "Mailman's hernia," because I have known at least two other mailmen like me who have suffered from this particular Mailman's Malady. Coincidence or not, both of them were on the tall side, such as I am. In those days when I was afflicted with this hernia, the Postal Service did not supply us with the nifty ergonomic poles that we have now. As a result, we had to do a lot of package rearranging by physically climbing into the back of the Long Life Vehicle (LLV), something we are not supposed to do but still have to if we want to get the job done. Tall people such as myself, of course, had to stoop over more to arrange mail, and we felt the strain right in the old rabbit holes.
As a Postal City Carrier Assistant (CCA) you are probably young now and in good health, but if you don't do things right, frequent repetitions of non-ergonomic motions will give you the internal anatomy of an 80 year old by the time you are 30. Use the poles provided for arranging parcels as much as possible. Also, if you have already been diagnosed with an inguinal hernia, a hernia truss can help keep your innards intact while awaiting surgery.
Protect Your Family Jewels!
Although the Inguinal Hernia can be a real ball buster, and the Charley Horse breaks out of the barn at inconvenient times, the mother of all Mailman Maladies may be the Kidney Stone. With this affliction we can basically classify two types of letter carriers; those who have had a kidney stone and those who will get a kidney stone.
Some time in late 1997, or early 1998, I woke up in the middle of the night with some sort of non-specific discomfort in the lower back that had me rolling around in bed, unable to fall asleep again. It was not the usual muscle ache associated with mail delivery, because taking a couple of Tylenol didn't help any. At one point I went to the bathroom, saw blood in my urine, and knew right then that something was horribly amiss in the plumbing.
The next day I went to the emergency room, certain I was going to die soon, because my internal medical encyclopedia told me that people who bleed when they pee just don't make it to old age. Because there had been no pre-cleansing process, the x-rays didn't show anything other than fuzzy blotches representing my internal waste products, but the medical consensus was that I had a kidney stone.
Eventually I was referred to a specialist, but in the meantime I had to suffer through a lot of asinine conclusions from general practitioners, many of whom know appallingly little about the subject. One doctor told me that all kidney stones pass within 24 hours. He was full of the same stuff that had prevented my x-ray from being successful.
As it turned out, I carried my "baby" around for approximately a month. After one more frantic rush to the emergency room that resolved nothing, I eventually learned to coexist with the spiky intruder living in my ureter. When the rock moved I would suffer pain, and take a couple pills. When the stone took a rest I was still in discomfort, like having somebody's thumb constantly jabbed in my lower back, but I was able to function.
My specialist finally managed to get a good picture of the kidney stone, saying "cheese" from deep down in my renal system, taunting the camera. The doctor looked at me, sitting there in relative calm, then looked at the x-ray again. "Dang, you're one tough hombre," he concluded. "I get people all the time with much less than this who roll around in agony on my floor."
The doctor examined the x-ray for a few more moments, then turned to me with a decidedly grave aspect. "Well, I'm afraid we're going to have to go in there and dig this sucker out," he said. He then went on to describe the process by which some kind of rigid instrument would be inserted via the tiny hole in the end of my reproductive organ, from where it would be wormed in much deeper to go fishing for the stone.
My tough hombre look suddenly faded. I blanched, as they say in literary circles. I must have gone a whiter shade of pale in the consulting room, because the doctor suddenly relented. With a smile and a reassuring pat on the back he said "Okay, we'll give it a couple more days and see what happens."
That very evening, through an unprecedented act of cooperation between my kidney stone and the muscles of my ureter, both of whom protested the proposed invasion and the loss of territorial integrity it would mean for all parties, I finally passed my kidney stone. It fell into the toilet with the most satisfying clink I have ever heard in my life. Naturally I scooped the 8mm, jagged edged stone out of the water and saved it, sometimes bringing it out for visitors to gawk at when they would drop by, Before I could have it set into a ring, however, my little stone vanished. Certainly my wife had something to do with that.
All lighthearted banter aside, kidney stones are a serious affliction for letter carriers, and for folks in all occupations. Although there are other factors involved, dehydration certainly is a fundamental cause. God provided human beings with two excellent filters, known as kidneys. If we don't keep those suckers moist and in constant, happy, homeostasis, they develop hard water deposits, just like the plumbing in your house. These hard water minerals are the substance from which the stones form. My particular rock was made of calcium oxalate, the most common type of kidney stone.
From the letter carrier's perspective, winter dehydration is much more serious than summer. In summertime we tend to drink plenty of fluids on the job, simply because we feel thirsty. Much of this water is sweated out in hot weather, meaning we don't have to make very many restroom stops.
In the winter, however, letter carriers don't feel as thirsty, even though we really are, and we don't sweat much. For the most part, we tend to neglect our fluid levels. Because we are not sweating, maintaining a healthy fluid intake means that we will have to make many more unplanned pit stops than we think we have time for. For this reason our kidneys are not kept moist like they should be, and the resulting gunky buildup in the bottom of our renal filters results in painful stones, sooner or later.
The bottom line for you, the CCA, is that you have to keep drinking water even if you don't feel thirsty, or you are not sweating. Would you prefer rolling off for a simple side trip to the bathroom, or rolling around on some sadistic urologist's examining table as he "goes fishing" with a catheter stuck up your tiny urethral opening?
I was going to end this article with a snooty Latin phrase meaning "In Conclusion," in order to conform to the medical motif, but it turns out my Latin is as rusty as my medical verbiage.
Therefore, in conclusion, this article was intended only to warn you, the fledgling City Carrier Assistant, about a few medical complications you will be up against delivering mail for the United States Postal Service, so you can spread your wings before they get clipped. It was certainly not intended to be an all-inclusive list, nor a substitute for real medical advice. Please don't go to your physician complaining "but Dr. Mel said this or that." In spite of having extensive training on the surgery simulator you see in the top of the article, I am only a Mailman. I do not practice medicine.