Final day of confinement? Hardly!

Greetings again dear reader.  When last we left we were discussing the rights of the patient in the hospital and rehashing my "whoa is me" tale.  Now we are at day three and the final day before discharge.  On this day I got to work with the orthotist.  An orthotist is a specialist who hand crafts a specialized supportive or artificial orthopedic device.  In my case, I was given a four point restraint which involves a chest plate with shoulder supports and four poles that stick into a chin support in front and an occipital support for the back of the head.  In this way you are locked into an immobilized and stable position. I was instructed to wear this device 23 hours per day for the next six weeks.  I will remind you dear readers that this was the 1990's and such measures would NEVER be used today.  If you are going through a similar experience and are wondering why you only received a soft collar to wear for two weeks, it is because that is the correct application of the support for most neck surgeries.

Being immobilized is sickeningly restrictive and incredibly uncomfortable.  The full effect of this comes when you take the brace off after 23 hours and your joints receive the load weight of your head and the nerves spring into action and start telling your brain- all at once- about your orientation in space.  It causes immense and immediate nausea and dizziness.  Depriving the joints of their normal load does not allow them to sense where they are in space.  Reloading the joint after a long period creates a massive cascade of neural information that the brain simply can not process all at once hence this leads to the nausea and dizziness.  The muscles too go through a negative transformation.  No load on the muscles permits them to adaptively waste away.  For anyone who has ever worn a cast; you know what I mean.  My head felt like a giant boulder whenever the neck brace was off.  This positive feedback cycle was perpetuated for a total of six weeks!

During this entire time I had to use opioids to control the pain but this did nothing for the nausea and dizziness.  Blissfully, I was sent home with a cane for the botched donor site in my hip, and a wedge shaped pillow which I was to sleep on for the next two months.  What can we learn from my experience and how can we avoid some of the pitfalls?

It is always necessary to have your doctor provide a rational for what he or she is prescribing.  If something does not feel right to you, you should question it.  If the results are not coming within the time frame anticipated a second opinion may be warranted.  In my case, that second opinion would be coming shortly and would be followed another 12 times after that!  For now, the release from the hospital to another sort of confinement was at hand.

The first thing I did after struggling up the stairs to my bedroom was to call my chiropractor.  Luckily for me that was as easy as yelling; "Honey, could you come on up here please?"  Yes, you have it right dear reader.  My wife is a chiropractor.  Her names is Dr. Maureen M. Hayes and she is my personal physician.  Three days of laying in bed had put me in a bad way with my lower and middle back so the first therapy I received was a chiropractic adjustment.  OMG what a relief... but then I was remanded to bed in my restrictive immobilizer jacket.  I did get a big new TV out of it and I caught up on all my shows watching the likes of Justin Wilson the Cajun Cook and all manner of other mind numbing pabulum.

Alas dear reader the story continues as did the neck pain.  When we return we shall begin the long journey of opinions.  Until we speak again, I remain yours in optimism and good health.

Sincerely,

Dr. Steven M. Green

Hospital Hijinks and the rights of the patient- Day Two of Confinement

Well dear reader I have stopped shaking from the memory of that first day and I am now ready to address day two of a three day hospital stay.  Both urine and morphine are flowing freely and so, though I remain uncomfortable, I am really now feeling more sorry for myself than anything else.  When you come down from a previously active lifestyle; one which you love, and are forced into confinement, your attitude has a tendency to deteriorate rapidly.  Now, in my practice I was heretofore nicknamed by my patient's as "High Voltage".  They named me this because I had a hard and fast rule in my office that there would be no new magazines ever in my waiting room because I was absolutely determined to remain on schedule.  I specifically made my waiting area the size of a postage stamp and stocked it with magazines only once- on the day I opened the doors in 1985.  The staff were under strict orders never to keep a patient waiting.  Should an emergency intervene in this carefully orchestrated ballet, I would present myself to those in the waiting room, profusely apologize, inform the waiting patient's that there was an emergency that I needed to dedicate my time too, estimate their waiting time to the best of my ability and offer them a reschedule.  All other patient's on the schedule were called and apprised of the delay so that they could adjust their schedules or re-schedule as necessary.  The hospital system was not quite as strict in this regard and, as you are their captive, you remain on their schedule!

Perhaps this wouldn't be so bad if I were not remanded to bed and thus at the total mercy of a benevolent staff.  I quickly learned who I could speak to and who would be my ally.  I give a great big shout out to Kevin who was my sincere savior.  He saw my distress at not having been able to shower and offered to help me with this task.  As humbling as this experience was, the sensation of cleanliness is truly a religious experience and one that brings a fuller sense of dignity.  As a patient in the hospital you are entitled to this and I would urge that if you take anything away from this entry dear reader it is that you have rights as a patient.

In the hospital you have the right to adequate pain medication.  Pain is real, difficult to qualify and quantify except by the person who is wearing it, and it can be a terrific source of stress.  Whilst under the care and treatment of medical personnel in the hospital you MUST speak up if you are uncomfortable and in pain.  The next thing that is of importance is that you have a right to know what the game plan is and you should be actively engaged in the thought process and the decision making.  I know it sounds simple on its face but being a patient in the hospital reduces a person to an almost infantile sense of insecurity and you begin to feel a sense of inadequacy.  This should be cast aside and your personality should shine through along with your participation in the process.  Last but not least, you have the right to be clean and comfortable.  You should never lie in your own filth for any length of time.  You are in the hospital to recuperate and recover.  This requires your comfort and your comfort is predicated upon your hygiene and your state of mind  amongst other things.  Most hospital personnel I have been involved with deserve angel wings.  There were only a few folks who made my time uncomfortable and I fired them as you should.  Brook no personality conflict.  You are paying for this treatment!

And so, day two was a procession of visitors, get well cards, bouquets and balloons.  Thanks to all of my patient's who sent them!  A special thanks goes out to Chris- a particular patient who thought it would be great to send a stripper to my room.  Of course, the full force and effect of this little show was completely up-ended by the presence of my wife who was actively gauging my interest in said stripper to the never ending amusement of the hospital staff who saw her coming a mile away.  Well, I guess its the thought that counts, right?  It certainly lightened the mood anyway... for everyone but me, the red-faced captive who had to pretend not to look because my wife was there to the sheer delight of the bemused staff!  Great. 

My pains were under control with the IV morphine and day slowly turned to night when the floor fell silent and the visitors- including my wife- slipped away.  Being left by yourself- for someone who has abandonment issues- is not a fun thing to experience and I quickly set myself up a master pity party of "Whoa is me".  Instead of proactively planning my recovery, I was festering in my own broth.  A tidbit here is to never ever let yourself get up in your head!  There is no room at the inn for negativism when you are attempting to recover.  Find a diversion.  Mine was to offer all hospital personnel candy.  That way I had a pretty active audience and as long as I could keep interviewing them and ask them abouth their own health issues, and not think about my own problems, I was fine.  Sleep came slowly but at last I was at rest and waiting impatiently for the next and final day of incarceration, um, I mean hospitalization.

Until then dear reader, please remember when going into the hospital that you have rights, be an active participant in your care even if your bum is hanging out of your hospital gown and you feel small in your bed.  Its your body and it will be your ultimate decision that will take precedence.  If there is a complicated task ahead for your surgery, make sure to mark your body with indelible ink marker as to the side or spot that will be worked on.  Its not funny and its not a joke.  Sometimes mistakes are made.  Making a couple of doodles on your body can save you a lot of agony later. 

Until next we speak dear reader, I remain yours in perfect health.

Dr. Steven M. Green

The Day After Surgery

The day after surgery proved to be a memorable one for all the wrong reasons but primarily because instead of fixing my problem I had merely made a trade! That is not what I had in mind when I signed on for surgery and if there is anything redeeming one can take away from my experience it is to do your research on your surgical team as soon as you are contemplating elective surgery. As I previously shared with you dear reader, I knew well the neurosurgeon I had engaged. I did not know the orthopedic surgeon and was unaware that he was responsible for a certain critical part of my procedure. It is important for the consumer to take the time to troll the Internet or to engage a family member or friend to do this for you. One of the best places to look is your state's board of licensure for the health practitioner of your choosing. That might be the board of medicine or the board of chiropractic or even some other board. Regardless, these boards which are maintained by the state, are packed with critical information about your practitioner particularly their malpractice records and this information is free and available to the public.

Now, please don't get me wrong when I say this but keep in mind that we do have a litigious society and doctors are humans too. They did not spend their youth inside classrooms just to make mistakes. And yes, I know that we can be very arrogant at times. It sort of comes with territory you know? I mean really, should I go to work thinking "well, I'm pretty good at what I do." Hell no! You want a person who thinks they are the best and has spent their time making sure that they are, in fact, the best. That said, even the best of us do make mistakes and for that we are sued and these suits appear on our public records. As a practitioner I feel fortunate to have spent my time wisely with my craft and my patient's and I have a ZERO claims record. I confess it is something that I am quite proud of. But, do not disqualify a physician if he has had one or two suits over a decade or two of practice. What you do want to be on the lookout for is PATTERN and REPETITION. Those two together spell disaster and indicate that it is wise for you to move on and for your state board to police and discipline its ranks more thoroughly.

There are also pay sites, blogs, and opinion polls as well as public sites such as Yahoo, Google, and Kudzu where people will leave commentary on their experiences.  Be apprised that negative encounters get 10 times the press that positive encounters do.  That said, all good with zero bad should raise your hackles as if there might be some stuffing of the ballot box.  If, after a thorough search, you have come up empty handed then some of the pay sites such as healthgrades might be useful to you.  I have a tendency to stay away from those sites as I find that they typically offer you what you can get for free.  By all means, check your circle of friends, family and coworkers first.  Occasionally, there will be magazine articles in your area where "top doctors" will be rated.  This is usually a polling of physicians asking who they would go to if they had a specific problem with (fill in problem area).  This can be helpful as long as the quid pro quo is kept to a minimum.  A good search will probably require a day or two but in the absence of direct referral by your circle of known people it will be the next best thing.

In my case, I knew the capabilities and expertise of my neurosurgeon.  I did not know the same for the orthopedist.   I did feel that it was the orthopedic surgeon's responsibility to call in a substitute if he were too ill to continue with my case. I was unconscious at the time so I can not speak definitively about the circumstances at that moment and I did NOT legally pursue the orthopedist for this matter. Many have suggested that I should have and for the record, the pain I have endured surely made me wish I had. At the same time, I would not be the person I am today if not for the experiences I have just had. So there you have it.

My dilemma was just beginning and I questioned my neurosurgeon about the mirror image pain. He assured me that this was only because of the manipulation of the neural tissues at the site of incision and that all would be well within a two week time span. I impatiently waited and medicated. For me, percodan (now Percocet) and Darvon were my physicians first lines of analgesic defense. They proved less than adequate and quite frankly made me severely ill. Morphine was introduced IV for the next three days whilst in hospital confinement. This worked wonders and was by far superior to all other forms of medicaments to date. In the arms of Morpheus I rested comfortably.

Well, that was all well and good until it was found I was retaining urine! Uh-Oh! Out came the Foley Catheter. For those unfamiliar with this particularly odious and Draconian torture instrument, it is a hose about the diameter of a large Bic Pen (actually a bit larger) that is inserted up the penile urethra and into the bladder. This allows urine to pass freely and involuntarily into a collection bag strapped to the side of your hospital bed. The muscles of my bladder were in spasm and in sequence, a cadre of hospital personnel were called to my room to try their hand (and muscle) at ramming this thing up into me. After many unsuccessful attempts by all in attendance, the on-call urologist was awakened. He begged us to use the pediatric diameter pipe which was more akin to a knitting needle. Still, no luck but by this time my patience had worn thin and the urge to pee or go mad was to a raging head. I ordered all personnel out of my room in a very unkindly and rude manner and, against physician orders, I demanded that my wife assist me to the bedside in a standing posture. There upon with a mighty yell I let loose what felt like a stream of searingly hot  razor blades. The vision I have is out of body with me in a three point stance and my wife firmly planting my hips to her gut to keep me from collapsing. My head swam in pain and relief at the same time! MORE MORPHINE!!!!

The morphine, fed intravenously though a pain pump, swept up my veins like a white heat and continued up the back of my neck and to the top of my head in a rapid rush. It crescendoed in minutes to what I can only describe as a warm, full bodied, embrace. It felt like putting on your favorite sweatshirt as soon as it comes out of the dryer after you have shoveled snow during a blizzard and you are still cold and drenched to the skin. The relief brought tears of thanks to my eyes and a gentle rest to my body.

How was I going to bear more of this? What would I do if they  took away the pain pump? How long did I have to lie here like this? Not so fast dear reader. Let me catch my own breath from reliving that nightmarish day. The hospitalization will end soon enough. We will save the rest for the coming entry.

Until I speak to you again; keep the faith, stay strong, and never, never, never, give up!

Dr. Steven M. Green

Victory over Chronic Pain

If any of you out there in the blogosphere are suffering from chronic pain you have my sympathies but more importantly, you will have my encouragement and support. As a chronic pain patient myself I have endeavored to find solutions to my own issues and in so doing have been blessed with a body of knowledge and experience not otherwise available to non-sufferers or those new to the vagaries of chronic pain. Obviously, solutions will vary from patient to patient and the causes of chronic pain are innumerable so some of this will apply to you and other aspects will not. It is your job to pick and choose. Perhaps the best way to start is to begin with my own story.

I am a chiropractor by profession and thoroughly enjoyed the interaction with my patients on a daily basis for over a decade when I was suddenly struck with an injury that resulted in the herniation and fragmentation of a disc in my neck at the C5/6 level. The intensity of the pain and the complexity of the injury manifested itself quickly and within three weeks of the date of the injury I had lost the bulk of the muscles in my shoulder and arm and the bone was readily visible under the skin while my ability to use my left arm had been reduced to zero- also known as flaccid paralysis. Despite the best chiropractic services, this had progressed to a surgical emergency!

Using my contacts in the field I was able to secure the services of an imminently qualified neurosurgeon in whom I placed my full faith and confidence. As a matter of protocol, I was asked to seek a second opinion and was referred to a local orthopedist. He quickly seconded the motion of the neurosurgeon and surgery was scheduled post haste. The state of the art techniques of the day were utilized (1993) and things progressed slowly in the operatory. What was unknown to me at the time was that the local orthopedist who I had seen as a "second opinion" had actually become the "second chair" in the operation. I never would have knowingly approved this particular surgeon but things quickly went from bad to worse when it was revealed that this particular surgeon was suffering from his own chronic pain issue! My surgery was complex and it took three hours until the orthopedist was able to do his part. He was in agony by this time and he was in no condition to operate at that point. Instead of calling a surrogate or substitute, he did in fact operate and instead of using calipers and careful measurements to place a perfectly shaped graft into the neck he instead took a chisel, whacked off a reasonably sized chunk of bone and hammered it home! The results were quickly realized when I awoke from the anesthesia to mirror image pain! What was once left arm pain and dysfunction had now turned into right arm pain! And thus began a saga that was to last me a full 17 years!

During this time I have used traditional and non traditional avenues of health care. I have scoured the United States as well as Thailand, Singapore, India, and Malaysia. I have used supplements, vitamins, physical therapy, lasers, hypnotherapy, counseling, meditation, and yet more surgery. This has been a long and often frustrating process. By blogging I hope to bring to you dear reader some sense of hope and optimism. I hope that I can be a resource for you and a sounding board for your ruminations or frustrations on the subject. Ultimately, I hope to expedite your search for relief. As we go along, I will try and explore each avenue I took and the level of success that I achieved with that particular effort. In the end, I will share with you what keeps me going now and how I feel you can apply these same principles to allow you too to function more fully and enjoy life more completely. Stay tuned for periodic updates and feel free to chime in at any time with comments or questions.

Until we speak again, I remain sincerely yours in the hopes for a pain free existence...

Dr. Steven M. Green, DC