Welcome to the current newsletter issue of
Advances in Medicine (AIM) - Take AIM against pain.
Feel free to send me an e-mail with your own thoughts
and experiences. Email: timsams@mypainreliefdoc.com.
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OLD DOGS; NEW TRICKS
Bill came to see me again after having not come into the office
in a year and a half. He had been complaining of severe back
pain radiating down his left leg, and left leg weakness, treated
through worker's compensation. He had some other pain
complaints, but they weren't addressed because they weren't
being treated through work comp. Several orthopedic surgeons had
determined that his symptoms were probably caused by a
nonsurgically correctible problem in his thoracic area.
I, too, believed his problem was nonsurgical and did not support
additional searching for a surgical answer. I thought he was
doctor shopping and acute medically seeking, not accepting the
reality of his situation. In spite of negative feedback from
virtually all his providers, and with my very reluctant,
halfhearted support, he decided to go outside the work comp
system and pursue some additional testing through non-work comp
providers. He continually complained that his pain was too
severe for him to tolerate for life. Naturally, I recommended an
antidepressant.
Long story as short as possible. His nonwork comp neurosurgeon
determined that he had several herniated discs in his neck that
were compressing his spinal cord-a triple cervical fusion
followed on a nearly emergent basis. He had less pain and more
function afterward. Another lumbar MRI revealed herniated discs
encroaching on two nerve roots vs. the previous MRI that had
been essentially normal. A double fusion followed with improved
pain relief and function.
Neither of these problems explained the severe burning in his
mid-back. Another thoracic MRI revealed bone spurs encroaching
on another nerve root. Removal of the bone spur and laminectomy
followed with improved pain and function. Still, he reported
pain in his left leg that was better but still severe and
didn't seem like classic radiculopathy. An EMG/NCS suggested a
peripheral nerve problem in the leg and exploratory surgery
revealed scar tissue severely pressing on the peroneal nerve in
his thigh. Following removal of the scar tissue, he had
dramatically improved pain and function.
His neurosurgeon was not bound by the work comp requirements to
treat only the accepted injury and body parts. He was relentless
in evaluating each problem independently, yet appreciating that
they were interdependent problems and assessing the whole
person. With each of four surgeries, Bill got better and better.
When he came to my office, he looked like a different person. He
brought his wife with him who attested to the gloriously
positive changes in her husband.
What can people in pain learn from this? Bill was honest and
trusted himself and his knowledge of his own body to drive some
of his decisions. He demonstrated courage in the face of
differing authoritative opinions and multiple surgeries. He was
independent in doing his own research and making his own
decisions. He was creative in his problem solving and
information gathering. He planned his pain paradigm thoroughly.
He demonstrated initiative in finding doctors and treatments. He
was relentless and persevering in pursuing as close to certainty
as he could get in terms of diagnosis. Finally, he decided to
trust this one neurosurgeon based upon his instincts and the
neurosurgeon's accurate diagnosis of the initial, life
threatening cervical problem.
Honesty, courage, independence, creativity, planning,
initiative, and perseverance are the hallmarks of a
pain-resistant personality and Bill demonstrated these big time.
He refused to give up. He seized control of his own health, and
refused to be deterred. He is a hero and a brilliant example of
self-management.
What can we as providers learn from this? First, I must
acknowledge that for every patient who has an outcome from
multiple surgeries like Bill's, there are a hundred who were
made worse by multiple surgeries. The statistics were not in
Bill's favor, and thank God, Bill didn't listen to the
statistics. Second, it is absolutely critical to treat the whole
person and not the body part. Even in a medical legal or
insurance system that demands focusing on the body part, we must
resist doing this. We must always listen to our patients. At some
point, even I stopped "hearing" Bill's unique complaints
and saw him as a "nonsurgical low back with radicular
symptoms," like thousands of patients before him. The subtle
variation in his story-I either didn't listen to or didn't
ask about. That didn't happen until he saw a totally different
provider, completely outside the "system," who had a fresh
perspective. The rest of us would have continued in our subtly
condescending belief that he was not adjusting properly to his
chronic problem. Shame on us and on me. I guess that's why
they call it clinical practice.
Bill knows he is probably going to have some pain for the rest
of his life. But he can proceed knowing that he has done
everything he could medically to have less pain. Now it's up
to him to get in the best mental and physical shape he can. He
taught a bunch of old dogs a few new tricks. I am one of those
old dogs. Woof.
Comments?
Good light,
Dr. Tim Sams
My Pain Relief Doc
www.mypainreliefdoc.com
Copyright 2007. Dr. Tim Sams and My Pain Relief Doc.
All rights reserved. www.mypainreliefdoc.com
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include the entire article, along with the web links
and copyright information. Thanks, Dr. Tim
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