Comments on life, the universe and everything from an aging Sixties survivor.

Location: Massachusetts, United States

Ummm, isn't "about me" part of the point of the blog?

Friday, November 22, 2013

Chronic geezerism

These days, I make my living as a medical coder. Whilst most coders work for healthcare providers, trying to come up with the most accurate possible description of diagnoses and procedures, in order to earn the provider the most money, I do the opposite: read their claims and pick them apart, in order to save the payer the most money possible.

All that is back story. The result is that I see a good many treatments in an average week, some again and again. At 60-something, I figure I've earned the privilege of offering unsolicited advice, especially to younger people.

Today's unsolicited advice, based on my work, is: take care of your back. This is especially true if you have a physically demanding occupation. Why? Because regardless of what anyone tells you, once you've sustained a serious neck or spine injury, you'll never be the same again.

Brain injuries get the headlines, and with good reason. However, it takes much less to damage that slim line of bone and neural tissue that connects your brain to your pelvic girdle. Despite  more, and more costly, measures to repair damage along that line, few of those measures have lasting benefits. Your spine has a lot of parts and it carries an enormous amount of neural traffic. That means that no matter how skilful your surgeons, no matter how sophisticated the parts implanted in there, things can go wrong. And they do: more often than not.

When they do, spinal injury patients are quick to fall into the worst trap of modern medicine. Physicians and surgeons exist to heal, to cure, but they are mortal and fallible. One of their fallibilities is a resentment when they are unable to heal their  patients. Those who cannot be healed can be seen as a rebuke to the entire  profession, and it is very difficult to educate that attitude out of medicine.

There are now specialists in the management of pain. Many are dedicated and sincere. Others are simply making a living out of people with chronic pain; a living that depends on dependency. Oddly enough, sullen surgeons angry that their treatments haven't cured a patient, and the less ethical sort of pain management specialist, have one thing in common. Both will happily pump the patient full of opioids, convincing themselves and the patient that there has been a cure.And the curve of the patient's dependency goes up, and up, and up.

We get a few of that sort in the TN world, but I prefer the approach I've gotten. (It's one I've probably elicited by showing clinical knowledge.) Opioids, as I've pointed out before, are useless for TN; the physician can't hide behind that screen. I'd rather hear that what I've got can be managed, but not cured, at this stage of things. I'd rather be reminded that abusing the drugs that can help me will compromise the management of my pain, and that the list of drugs that can help me is disturbingly short. I'd rather be encouraged with the knowledge that what I have won't kill me, unless I do it myself.

All too often, people with chronic pain from orthopaedic trauma don't get this treatment. Opioids work, then it takes more to work. Often, it isn't until the patient  is clinically addicted that the physician tries to put the brakes on the habit they have helped to enable. Grumble grumble damn grumble. The blandishments of marginally acceptable therapies and outright woo are better only because they don't make the patient clinically addicted.

Respecting your spine is a small price to pay for missing out on this part of the adventures of clinical pain. If I've missed your piece of the party, don't worry: we'll get there sooner or later. Ramble done.

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