Archive for December 30th, 2012

The Thinker

Sometimes you have to be your own doctor

2012 ends for me with some positive health news. Problems I have been chasing for years appear to be on their way to resolution, or are at least in remission. The bad news is that despite the many physicians and specialists I have seen, overall I have had to become my own doctor. Such is the world of chasing annoying medical problems for middle-aged people like me in the 21st century.

The one physician I cannot complain about is my primary care physician, who is on the ball, at least about problems he can easily figure out, like my high cholesterol. I have been on a variety of statins, first Lipitor before it went generic, then Simvastatin because it was generic. My physician was on the ball enough to order me to get regular blood work after I switched drugs. It detected that the Simvastatin was causing muscle deterioration, so much so that if it had gone on much longer I would have ended up in the hospital. He saved my insurance company and me thousands of dollars and me from a potentially life threatening condition. So now I am back on Lipitor, which is now generic, with the only yellow flag being an increase in a liver enzyme, something that can happen when you are on Lipitor.

I have also been chasing my painful sciatica. Sciatica is a particularly baffling condition since there are so many possibilities for its root cause. Having it meant that sitting was painful and brought burning sensations down the back of my thighs. I’ve been dealing with it for years and have gone so far as to consider solutions like standing desks. Pretty much everything I have tried brought no permanent relief. When no relief was in sight despite seeing orthopedic surgeons and chiropractors, I ended up on the Internet. It seemed there were two possibilities: a herniated disk or piriformis syndrome. The latter seemed more likely and it occurs when the piriformis muscles in the leg constrict nerves exiting the spinal column. After a lot of traction at my chiropractor’s office and releasing pressure on the piriformis muscle it seemed to go away. Then like a doofus I thought it was gone for good, and stopped getting traction, only to have it come back with a vengeance. What works now is more traction, but this time getting it regularly so my L5 joint does slide back into a position so that it presses against the spinal nerve again. I am getting traction every three weeks now. I also have a special ergonomic chair at work that does not put pressure on L5, like many supposedly ergonomic chairs too, including Aeron chairs due to the drop at the back of the seat. The sciatica is not completely gone but most days I don’t notice it. Moreover, it looks like regular traction will keep it in remission and the key is to keep coming back for more traction at regular intervals.

I also have large feet and consequently a lot of foot related issues. These were originally numbness in the feet. My foot issues got more acute with a recent recurrence of plantar fasciitis on the left foot. Plantar fasciitis typically manifests it out as a burning feeling on the souls of your feet, although this time it was at the heel of the foot. This is a condition occurs when tendons are torn in the feet and it takes months to heal. So I have been wearing running shoes with lots of cushion in the heels. Four months later it is not quite gone, but it is nearly gone.

What to do about all the numbness in my feet? I had seen neurologists and confirmed neuropathies. My podiatrist speculated that my varicose veins might cause them. I had the veins removed on the right leg, where the problem was more acute, but it did not solve the problem. At one point I spent four weeks in a boot that immobilized my foot because the joint pain became excruciating. I was beginning to wonder if I would be better off without my feet. The metatarsal bones in my feet felt like they were not where they should be. Had something broken and moved out of alignment? Eventually my podiatrist agreed to have an MRI done of my foot. Everything was exactly where it should be, which would be good news except for the occasional excruciating pain. One thing that was noticed: muscle atrophy in the feet. So I was sent to a physical therapist and spent weeks trying to regain my balance and strengthening the muscles in my feet. With more muscle mass in my feet, my condition began to clear. It appears if I had done this to start with, I would have avoided years of pain and consultations. No one had the ability to figure it out, and it never occurred to my podiatrist to test the strength of the muscles in my feet. Moreover, the sciatic nerve cascades down into the feet. It is likely that sciatica contributed to the problem.

It seems like an informed and inquisitive patient is the key to solving these chronic problems, because our physicians for the most part can’t seem to properly diagnose these more complex issues. I found that pain is a pretty good motivator for action, but I feel frustrated because I had to piece it altogether, as well as prompt my physicians to get tests that I thought I needed.

Obviously, it shouldn’t be this way. However, I am at a loss on how to improve our health care system so that these probably typical experiences that I had are faster to get properly diagnosed. Whatever medical training our medical specialists are getting, it seems insufficient. They are good at seeing trees, but not so much the forest.

 

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