Wednesday, January 23, 2019

Mind Over Matter

“Friends are as companions on a journey, who ought to aid each other to persevere in the road to a happier life.” ~Pythagoras

I have found friendship in this remarkable woman. I think, by reading her story, you too will be compelled by her. 

I give to you, Stumped Mom.

A note to readers: This post deals with opioid use, chemical dependency, depression, and suicidal thoughts.

“Mind over Matter,” those were the actual words spoken to me in my doctor’s office two weeks ago, as I limped out of the room, in so much pain that my 5’10” frame was listing to one side. Nevermind that my physical therapist, whom I saw later that day, thought that advice was negligent at best. In his opinion, I have been exhibiting the symptoms and patterns of a severe disk herniation or rupture and I need to proceed with extreme caution in all of my activities. Unfortunately this casual disregard for my pain even the worst thing that has been done to me in my long two-part journey in back pain.

In order to understand our present, we must first understand our past. This story, dear reader, is a story of two eras; the era before opioid epidemic awareness and the era after. Four years ago at the mature age of some twenty plus thirteen or so years, give or take, I hurt my back.  At the time of my injury, I was literally in the best shape of my life, I was learning Olympic lifting in my dojo with friends, doing intense crossfit workouts and training hard in a mixed martial art. I was keeping up with some of the men my size in my martial art. Some-time in the summer of 2014, my back started to hurt. I added new stretches to my routine and kept on going. In October of that year I fell down some stairs while I was carrying my two year old. My back and hip took the brunt of the fall.

I have seen and experienced conventional western medicine at its worst and least effective. So when the pain started, I saw the chiropractor that put me back together after my baby, and got myself a tens unit. When that didn’t work, I went to my primary care doctor, she ordered x-rays and found evidence of mid-spine arthritis and prescribed physical therapy. I decided, just to be on the safe, thorough and healthy side, to see a naturopath; under her instruction, I got myself onto a super restrictive and expensive anti-inflammatory diet. I put my martial arts training on a pause so that I could recover.

Things got worse and soon I was barely able to walk, sitting down and standing up caused blinding pain, shooting down my right leg, and then one day when I was driving home from work I felt my foot go heavy and numb. So, I called the doctor again. This time, she got out her Rx pad and ordered a round of oral corto-steroids, Tramadol and Gabapentin, and some Vicodin for bedtime for good measure.

I was meant to continue physical therapy.  Some of my memories from this period are patchy because pain does a funny thing where if it’s severe enough the brain tries not to remember for long periods of time. What I do remember is that I was prescribed copious amounts of painkillers for months on end, while doctors thumbed around with injections and therapies. All the while, I continued working and mothering and wifing through the whole thing. I was frequently given prescriptions for Tramadol, Percocet, and Vicodin, even when I was nowhere near running out of medication and displayed a reluctance to take them.

Eventually, a proper MRI was ordered and based on the reading, I was recommended as a good candidate for micro-laminectomy. In layman's terms, the bottom disk in my spine was jacked up and it was pressing on the nerve roots that branch off of the spine and control the right quarter of my body. My physical therapy team expressed guilt and remorse, they told me that the kind of herniation I had was only aggravated by the exercises that they were prescribing

My surgery was an unqualified success. I woke up and the pain was almost instantly better. I recovered faster than expected and quickly got off the pain medication. Gradually, I worked my way back into my martial arts training regimen. I had leftover medication and slowly used it for flare-ups, over the course of my recovery. I never developed a chemical dependency or addiction, I credit this, not to my medical team who prescribed with cavalier casualness, but to a good support network, and an apparent individual lack of predisposition toward addiction or chemical dependency. I maintained, prior to my injury during and after the opinion that chemical addiction is to our generation what cancer was to our grandparents; a killer that medicine doesn’t really understand that is made more lethal through stigma.

If this were a Hollywood film we would move through the last four years of my life with a montage of opioid crisis headlines, as well as medical literature snippets reporting that painkillers make back pain worse in the long run, that most back surgeries are unnecessary. These news stories would be interspersed with inspirational clips of me getting my strength back, slowly returning to the dojo and the gym and putting my life together after a divorce. Our montage closes in December of 2018 with me feeling a twinge in my lower back as I pry the old office microwave out of the trunk of my passenger car, in the parking lot of a local, appliance recycling center.

I strained my back on a Sunday and I rested that day and on Monday. On Tuesday, the twinge got worse after I tried to exercise. I went to see my Chiropractor. After a week, the pain kept getting worse and the Chiropractor said he could feel my disk bulging and he wanted me to see my primary doctor. This time, I didn’t mess around. When the pain continued to increase, I called and asked to see my regular doctor but because I got hurt at work, my HMO insisted I be seen through their occupational health team. So shattered was my trust from my previous experiences and so scared was I that they wouldn’t let me see a doctor that knows me, I cried in the waiting room. The occupational health team has yet to prove my fears unjustified.

I have seen two doctors with this occupational health group, the one who told me, “Mind over matter,” is actually the better one. She at the very least addressed pain management in some form. The other doctor, I saw through this department, told me that it wasn’t possible for physical therapy to make back pain worse and he didn’t even talk to me about how to manage my pain in any way whatsoever, he also refused to order the MRI, that was supposed to be part of my treatment plan per the first doctor I saw. He referred me to a spine care nurse who talked to me on the phone ordered the MRI (after cursing him under her breath) and sent me the link to  gaslighting production []  that told me what I was experiencing was perfectly normal and all I really needed to do was get the right exercises, start walking and maintain a positive attitude. The video seemed to assume that I was older and less active than I am. Anyway, Fuck that mansplaining doctor and his spine care team, that has never seen me in person, I hope he gets nasty, recurrent hemorrhoids.

Meanwhile, my pain has progressed in much the same fashion that it did in 2014-2015, the only difference being that this time it's on the opposite side of my body. I started to get better after the first few physical therapy visits, and the introduction of the nerve medicine Gabapentin. I was walking well, able to make slight bends and I was optimistic for a full three days! Then, a week ago my pain got worse, so bad that the things that previously brought relief, walking and standing, increased my pain. During the weekends, I had been treating pain with edible medical cannabis (legal on the entire west coast of the United States) but my usual dose didn’t touch the pain; rather it made me paranoid that it would never stop. I tried resting and I tried walking through the pain and I ended up trudging a half a mile through tears in freezing wind.  Right now my pain plan consists of Gabapentin, Tylenol and what I will call a small stipend of Vicodin. I was given 30 pain pills on my initial visit and I wasn’t prescribed more until I came into the office 25 days later, with my pain so bad that my blood pressure was near crisis level (190/100).

All of the literature and advice for back-pain sufferers seems to assume that the audience is an aging population with inactive lifestyles and bad habits. I won’t say that I’m a model of health but I’m a hell of a lot younger than the typical pain patient, my symptoms are severe and I have an actual history of being cured by actual surgery. None of this seems to matter to the doctors, they keep treating me like I couldn’t possibly be as hurt as I think I am and sending me home with platitudes instead of help. My physical therapy team is stymied, everything they have tried has either failed or made me worse. Right now I am cutting pain meds in half and rationing them for the worst times. As my pain has spiraled out of control and my activity had ground to a halt my mental state has deteriorated. I have long relied on exercise and martial arts to manage periodic depression. I have started having suicidal thoughts, I am terrified of the pain continuing to worsen, and the doctors continuing to refuse to offer any sort of adequate form of treatment.

So what am I asking for? I dare not ask for pain medication for fear of being cut off completely. I have no illusions about the dangers of opioids and I am absolutely sickened by the way that our medical system fails its drug addiction patients. All I want is timely, compassionate and effective treatment. I am hopeful this will come with the MRI results later this week.

My experience indicates big problems with our medical establishment treated pain before they were forced to acknowledge the opioid crisis and how they are treating it now. How is it that doctors can prescribe a drug that they know causes dependency and give the patients nothing but a stern warning not to abuse it? Why don’t they talk with patients about the warning signs of addiction and talk to them about who to call if they start to notice them? Why don’t doctors work with them on a plan to get off the medication that looks at the whole patient?  I have my theories about the reasons why this isn’t happening and they have nothing to do with patient or public health outcomes.

In my perfect world patients like me who are in pain and patients who develop dependence or addiction would be treated with equal respect and dignity. As it stands now, neither group is getting what they need. Pain patients are being given “stiff upper lip” pep talks and slow rolling diagnosis while addicts are being treated like criminals and degenerates. I have experienced the treatment of severe and chronic pain, both pre-and post opioid crisis awareness and my conclusion both approaches suck and so does the American medical system.

Finally, please, unless you have experienced an actual L5 disk rupture that required surgery before the age of 40 do not leave pain treatment advice in the comments.

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  1. 38, going thru the same exact thing! I accidentally stumbled upon this blog. It's been 6 months out of work and after my x-ray showed degenerative disc disease, I'm being referred to physical therapy and aqua therapy and an orthopedic. After reading thru the info on the disability application, I cried knowing it could be another 6 I months to see what happens during these Dr visits I have no money to pay for up to two days a week. On top of that I was diagnosed with sciatica over a year ago. Chiropractor visit resulted in the pain moving to the other side as well. Periods of depression leave me in bed and at home daily thinking therest no help insight and I to was prescribed tramadol which I try to only take when so severe I can't sleep. Household chores like reaching in the washer and standing over the stove put me back in bed. Driving is done, I can't sit on my tailbone as I also have sacrum/lumbar degeneration. I would love to become pen pals. I don't know a single person that knows what I'm going through. Email, text, instaInst, Snapchat....

  2. Also, after my job for 20 years sitting behind a desk made my pain constant, I decided to get my CNA then my LPN so I could be more active vs sitting for 8-10 hrs. This has only made it worse, severe actually.

    1. Walking long hallways and lifting patients and changing their beds and diapers (40 residents 2-3 times in an 8 hour shift). Made it so severe.