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Doctor, Am I Crazy

SPINAL EDUCATION

Doctor, Am I Crazy?

Spinal related disorders are not only the most common ailments affecting our society, they are among the most painful and most misunderstood by the medical profession. An example of this is patient Ron Miles. Six months after an emergency disc surgery Ron was in so much pain he seriously contemplated suicide. His doctor prescribed pain medication but his condition continued to deteriorate. Ron consulted with his doctor but the response he received made Ron more despondent. “My doctor thought I was crazy, that my pain simply couldn’t be that bad, he didn’t believe me!”

Many orthopedic and neurosurgeons are uncomfortable at the thought of seeing back pain patients. Doctors sometimes display frustration by acting aloof, conveying to the patient that their problem does not warrant their skill, or denying that the patient they performed a perfectly good operation on still has pain. The problem is that doctors cannot agree on the diagnosis. Does a patient have a bulging disc, a herniated disc, or a degenerative disc? Does a patient need surgery or can he/she be treated conservatively? If a patient needs surgery doctors cannot agree on what is the most successful operation and if the patient has pain afterwards, they cannot agree on the potential cause of the problem and what should be done to correct it.

The confusion among the medical specialties manifests itself as frustration and even despair in our patients. Many of my patients search for years, travel from doctor to doctor, hoping someone will believe that their problem is real, that they are not confabulating a “tall tale” just to obtain narcotics or swindle a fortune out of the worker’s compensation system. Doctors who suggest to their patients that “it’s all in their mind” further contribute to their medical problem, not solve it. The fact is many doctors are inexperienced at evaluating and treating patients who have had prior surgery. We must be reminded what we learned early on in medical school, listen to the patient!

When I first saw Ron Miles I felt that his condition was serious and needed immediate attention. I reviewed his test, which showed only a very small problem. The test however did not correspond to his complaint and his pain was out of proportion to his myelogram. I believed him. Due to his young age of 32, we decided to repeat the test with a technique that relies on the radiologist injecting dye into the disc and into the dural sac. Performing this test sometimes allows the doctor to differentiate scar tissue from disc tissue. Sometimes it can even separate a malingerer from a patient telling the truth. The next day I received a phone call from the radiologist confirming the fact that Ron Miles had one of the largest herniated discs he had ever seen, proving the patient’s level of discomfort had been warranted. I asked Ron to return to my office with his family to discuss the potential risks and benefits of the proposed corrective surgery. His decision was to have the operation, which consisted of a repeat laminectomy, a discectomy, posterial lateral fusion with pedicle screws and rods and a repair of the pelvis using iliac allograft.

On his fifth hospital day, the day of discharge, he was out of pain, the surgical procedure was successful. He recounted how he had spent one year trying to get someone to listen to him. This 250 pound fully bearded man walked up to me, put his arms around me and said, “Dr. Light, thank you for giving me my life back.”

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