(Non-political posts occasionally appear on weekends. This isn't the weekend. I don't care.)
Why are doctors so loathe to prescribe pain medications these days?
Twelve years ago, after a molar flare-up, I had to wait two days for oral surgery. The dentist gave me a prescrition for some codeine. A very similar situation occurred a year or so ago -- but this time, the dentist told me to take acetaminophin.
For some time now, a bout of sciatica has kept me away from the computer -- away, in fact, from any activity requiring me to maintain a non-horizontal position for more than ten minutes. This fact has somewhat soured my famously sweet disposition. (So has sparring with stubborn folk who pretend to be experts on a law they refuse to read. But that’s an issue for another time.)
Sciatica occurs when a herniated disk pinches the main nerve running through the leg. The resultant sensation feels as though one has thousands of tiny goblins lodged inside the thigh and calf muscles, using knives to stab their way out.
My mother had the same affliction. In her case, it signaled the presence of the lung cancer which killed her little more than a year later. (The cancer had metastasized to her vertebrae.) Trannies and Dem-haters will be sorry to learn that I do not smoke, and will therefore probably remain around to annoy people for some years to come.
Normally, nothing short of alien abduction could ever get me to enter a doctor’s office, but when sitting down becomes impossible, earning money becomes impossible. The doctor did all the usual unnecessary things -- checking blood pressure, measuring height -- then shot an unnamed “pain reliever” into my butt. She also gave me a bottle of the same pain reliever.
After hobbling home, I read the label and discovered that this “pain reliever” was Naproxin -- sold over the counter as Alleve. Infuriated, I called the doctor.
“You charged me $210 for that visit,” I reminded her in an other-than-sweet tone of voice. “And all I got was the same stuff I bought at the pharmacy two days ago for $3.99. It doesn’t work.”
“This is a stronger dose,” she explained.
“It’s equivalent to two pills of the $3.99 stuff!” I answered. “So what’s the difference?” Actually, I already knew the difference: $206.01. “Look, did you honestly think I was malingering?”
“Oh no,” she answered. “I’m sure you have sciatica. It can be very painful.”
“So how painful does it have to be before you give me some real pain relief?”
“Like what?”
Like what? I was ready to drop-kick the phone. She’s the doctor, and I have to tell her?
Imagine the following words delivered in a note-perfect imitation of John Cleese returning the dead parrot:
“Like CODEINE! Vicodin! Morphine! Demarol! Tylenol 3! I don’t care if you give me Bin Laden-brand smack smuggled in from the back streets of Kandahar. Next time I place a pill down my throat, I want to know that a poppy was involved in its manufacture!”
After another few minutes of high-decibel “sweet talking,” I finally convinced her that the Norwegian Blue had gone to join the choir invisible. In other words, she filled out the damned scrip.
For chrissakes, I don’t take pills to get goofy. This ain’t about fun. All I want is to be able to sit down to earn money to pay rent.
Doctors used to be in business of pain relief. What changed?
On the other hand:
A small taste of chronic pain has many virtues.
Pain allows one to see through new eyes. Look over here: The earthquake victims in Peru. Look over there: The massacre of the Yezidis. Look at the suffering masses in Darfur and Palestine and a hundred other places -- not to mention the cancer ward or emergency room at your local hospital.
Right now, American soldiers labor under a blazingly hot Iraqi sun, undergoing unimaginable stresses as they do their duty in this obscene, misbegotten war. Too many of those soldiers will come home with spinal cord injuries or missing limbs.
America’s best are dealing with problems worse than I’ve ever had to face, and too many of them will confront their challenges for the rest of their lives. My sciatica will clear up within a month, probably sooner. A temporary loss of mobility, however inconvenient, has taught me a lesson I hope never to forget.
I’m one lucky son of a bitch.
14 comments:
Joe, I work in an ER, and I assure you that it had less to do with you than with the doc. Some docs adopt strict rules - i.e., no narcotics for migraines - and don't deviate from them. Others judge the patient according to his pain and history of visits. And some hand the stuff out somewhat indiscriminately to make their lives easier. I recently had my doctor at the student health center refuse to write me a scrip for a psoriasis cream. I mildly pointed out that there was not a lot of abuse potential, but she insisted that she did not write scrips for psoriasis meds - she could only refer me to a dermatologist to do so. In essence, her function was to diagnose a condition I have had for 15 years, and refer me to a dermatologist, but not to treat my illness. She might as well have been a liaison for an insurance company.
I've been an RN a long time and say ,,, you have back pain... go to a chiropractor! Joseph, I never believed in chiropractic until I had a bad knee and went through two hundred bottles of aspirin without effect. The Chiropractor fixed the problem and no more of that. I believe we all must find treatments outside of western medicine right now. Western medicine has been taken over to control the population.
It's not about money or laws that you cannot get medication Joseph. All our meds are going to third world countries now. That's why we pay so much and cannot get prescriptions for things that are available say, to a Congressman or Senator.
Nothing was more sickening to me than Romney saying he had ten dollar copays...... One of my prescriptions is over seven hundred a month and nope, insurance does not cover it. GO FIGURE>
Drop western medicine and get well Joseph
Is a herniated disk the same as a swollen disk? Usually immediately icing the insult or injury will arrest the swelling -- it's the swelling of a disk or muscle (from a sprain or odd twisting) that impinges on the nerves and causes the severe pain, so you want to halt the damage asap (for future reference). Therapies: hanging by your arms (in a pull-up, rather than a chin-up orientation) for a few minutes will stretch the back muscles and relieve some pain, often allowing you to stand and walk. A chin-up bar is best, but if you have an open stairway, you can try to hang from the back side of the stairway (like a fire escape or basement stairs). If you have stairs indoors with an upper landing, you can lie on your stomach with your legs draped over the top step, with the step's edge just above your knee so that your legs hang over the stairs. The weight of your legs will pull them down (gradually) and stretch the lower back. It takes about ten minutes. Also, a friend can pull on your legs while you're lying down on your back, which will stretch the lower back muscles. Long-term therapies include losing weight if there's some to lose, walking to strengthen your mushy quadriceps, keeping your chin up (chin-on-chest = very bad) whenever you bend, and having friends in the medical profession.
Ditto on the chiropractor. A good one will teach you a series of stretching excercises which you can do yourself to keep the pain at bay.
I agree with Anon 3:45 that western medicine is really bad at solving these kinds of problems. My girlfriend had the same problem and osteopathy (Chiropractors are a specialized branch of osteopathy) saved her! Pills will only solve the symptoms (the pain) and not the source of the problem (even if pills are necessary when a "crisis" occurs).
Finding a good "alternative medicine" provider is the difficult part, there's a lot of "snake oil" vendors out there.
Was the doctor wearing any Naproxin clothing? If you want the hard stuff why not join the marines and ask to be stationed in Afghanistan?
My life changed after herniating four lumbar discs. I assume that you're placing a pillow behind your lower back when sitting. Your chair back should provide support at least up to your shoulder blades. Like aitchd above, brachiating (hanging by the arms like an ape)is really the best thing for me. The ideal height is to find a rafter, porch header, tree branch, or hang a chinning bar (from a chain allows easy adjustment, link by link) where I can stand on tiptoe, reach the bar, then level my feet until they lift off the floor. Consciously relax the lower back and try to lengthen the lumbar spine. This works as well for me as chiropractic adjustments, and I can do them any time. Get an adjustable orthopedic chair that truly supports your back,$$$$$$. "Relax the Back" stores are a good place for this stuff.
As for chiropractors, I never had neck problems until my chiropractor gave me a complimentary neck adjustment. Now to do any artwork I have to sit in an orthopedic chair with head support and draw on a slantboard to avoid lowering my chin and stressing the cervical spine. When it was at its worst I had to lie flat on my stomach on the bed (hard on the lumbar) and have the paper on a low table I built that fit around the corner of the foot of the bed. Your computer monitor should be centered at eye level so that you don't have to tilt your head forward. Good luck.
joseph,
you know you've got alot of inflammation and puffiness (aka "swelling")around the lowback area so in addition to any pain medicine you need to take something to reduce the swelling.
I find that taking 800mg of ibuprofin every eight hours (you need to take it with something to eat like a snack or meal) really helped. sometimes I take a 800mg of ibuprofin (tylenol) just to help sleep better and help me relax (which it also does). and yes, of course it also is a pain reliever. ibuprofin works wonders--discovered it when I had gum graft surgery in my mouth due to receding gum.
a regular doctor won't do ANYTHING to help you pain condition except recommend you to an orthopedic surgeon who will of course tell you that you need SURGERY to fix your back which is generally the worst thing you can do, akin to permanently ruining your back in many cases. If you can get one to prescribe physical therapy that would be great but it is so damn expensive and in LA what a nightmare it is to have to spend 30 minutes (if you're lucky the office is close) driving and fighting for a parking space in order to get a 40 minute appointment--you'll be stressed out just getting to/from the appointment.
I have been going to a chiropractor on and off (different ones as I have moved) for many years and it does provide relief and really does help.
I recommend doing 800mg ibuprofin and going to a good chiropractor in the valley--sorry I don't live in LA purgatory so can't recommend anyone--but find one that is recommended by more than one person.
good luck ,sorry to hear you've been hurting
Just a correction for Anon 3:29 : ibuprofen brand name is not Tynelol, it's Advil. It has a similar structure to Aspirin, so it can be hard on the stomach. 800mg is a mega dose that dentist will prescribe for major pain. For my headaches, often 200mg is enough and it's the only thing that works for me.
Thanks much to everyone.
Before I went to see the doc, I was taking 800 mgs or therabouts of ibuprofin and naproxin, enough to make the stomach do flip-flops. Didn't really help the sciatica.
There are times when the Poppy is Our Friend.
I've heard varying things about chiropractic practices, but I'm willing to try anything once. If I have the money. Which I don't.
Ah, but you know what the most comforting words are? "This too shall pass." As I said, I'm a lucky bastard. Think of the folks who have to deal with -- say -- phantom limb pain. I'm luckier than I have any right to be.
Joseph,
My wife has a compressed verterba, two unstable ones anda lack of cartiledge between three. The only surgical solution would be to bolt 4 vertebra together, and if the allignment is not perfect, pinched nerves forever.
She has ben going to a Radiologist for four years to receive epidural cortiZone injectiona about every three months, 2hixh have kept her pretty much pain free. Different times have yeilded different results, some wonderful, some still leaving some pain, but better.
Your sciatica is causes by only one nerve. I would look for a radiologist who performs th3se treatments.
They use a flouroscope so they can direct the needle to the exact nerve causing the problem.
Here surgery would be massive and "iffy," which the surgeon admits.
The radiologist told her, "I can't fix your problem, but I can keep you walking, mostly pain free." And he has eone that. Her has been a savior, and hopefully you can find one.
My sympathies, Joseph. An alternative cause to an origin in the spine is a spasm in the piri formis muscle which is deep in your butt. The sciatic nerve runs next to it (or surrounds it for some people). This was the cause for me. Stretching and OTC analgesics were adequate, over time.
I am suspicious of chiropractic. Soon after the sciatica I had a rather large L4-L5 disk herniation on the other side. I would not want anyone moving things around there. A neurosurgeon fixed it.
I am sorry you are in pain. God knows I know exactly how you feel. Sometimes the only thing that works is to knock yourself out and try to sleep through it. Nyquil will do the trick.
I had a sciatica attack once where I couldn't sit, lay down or stand. I managed to drive myself to an Urgent Care facility, where the doc prescribed Moutrin. I also visited holistic practioners and an DO who showed me some stretches (which I still do every day)and sold me a "natural", drug free remedy which included tumeric, which is a natural anti-inflammatory (you can get tumeric in a health food store). What triggered my attack was extreme stress in my personal and professional life. I also recommend chriropractors. I found one who doesn't twist or tork (that causes me to tense my muschles) but uses a computer called "Proactivator", which has been very helpful. Joseph, do you have insurance? If you do, some policies do cover chiropracty. But I can emphathize. That pain is horrible. I took Moutrin and slept about 2 days after that attack. Try ice also.
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