A day without pain

The Thinker by Rodin

Daily pain is a fact of life for many of us, particularly as we age. Pain can range from acute (migraines) to the intangible but devastating (depression). Regardless of the kind of pain, pain is a warning that something with us is not right and needs fixing.

I have been dealing with the pain of sciatica for years. At least now I have a name for what I have been going through. It started many years ago with numbness in my toes, escalated into general foot pain, particularly when standing, then slowly migrated toward my spinal cord. For the last few years the sciatica was most painful on the backs of my thighs. As the day progressed, and particularly when I was sitting most of the day, the pain radiated from a slow burning sensation to an acute burning sensation. At its worst, it is sort of like sitting on burning matches. I did not like it, but I got used to it. It helped that in the morning I was pain free and it wasn’t until I engaged in more sedentary tasks that the condition progressed.

Regular readers may recall that I consulted various specialists. I endured shoe inserts, surface vein removal surgery, tarsal tunnel surgery, as well as other invasive and non-invasive tests. It was all for naught. Part of my problem was that sciatica is a syndrome. This is a fancy way of saying it was caused by lots of multiple factors, none of which could necessarily be pinned down. Trying to cure sciatica is thus a lot like trying to shoot a bull’s-eye while wearing a mask. It also means that physicians are of little use because they are as baffled as you are, just not honest enough to tell you.

Ibuprofen offered no relief. Physical therapy offered some relief, but could consume up to an hour a day. The best relief was to not sit, which was hard to do and stay employed. Doctors were willing to do deep tissue steroid injections at the base of my spine that might reduce the pain or make it go away for a while, but would not cure the problem. My spine was not damaged so spinal surgery would have been useless. I was driven to the mighty search engine Google to try to figure out what I had. The only thing that came up was a condition called piriformis syndrome. My prognosis for a full recovery: not great.

Today, while the pain of sciatica is still not completely gone, it is nearly gone. A few weeks back the chiropractor I see examined the soles of my feet when I complained that it felt like I had a flat stone under my feet after using the elliptical machine in the gym. He pressed certain spots and had me yelping in pain. “You need metatarsal pads in your shoes,” he told me. It took me about a week to see the podiatrist who said, “they will help but what you really need are custom foot orthotics”. The orthotics are on order but in the meantime I have metatarsal pads glued to my Superfeet shoe inserts. Those three-dollar pads have done more to reduce my sciatica than all the other treatment combined. I am hopeful that when the orthotics arrive the pain, which is now a very mild burning sensation that appears from time to time, will vanish altogether.

Yet I doubt custom foot orthotics alone is curing my condition. If I have piriformis syndrome then compression of the sciatic nerve near my piriformis joints (the joints that connect the hips with the legs) is part of my condition. How did this happen? According to Wikipedia many of us have a congenital condition wherein the sciatic nerve goes through the piriformis muscle, which can then compress the nerve. Exercise, particularly the weight lifting I was doing at the gym likely contributed to this problem. This weight also contributed to something akin to the collapse of the bones in my feet, making certain bones lower than they should be. This put more stress on certain parts of my feet, triggering pain. The custom foot orthotics should even out the foot pressure.

In addition, my chiropractor has been aligning my spine and loosening joints. My spine was bent a few degrees toward my right side, not that I never noticed. After three months of chiropractic therapy and a lot of traction, my spine is now straight, meaning that my body mass is now aligned evenly and symmetrical. Nerves that were stretched because my spine was not straight are no longer artificially stressed. It is hard to say for sure but these are also likely contributing toward my recovery. Body symmetry, in addition to helping people attract mates, is good for the body in general. Your body wants to be symmetrical. Over fifty-plus years my body symmetry changed. Regular jostling of my piriformis joints by my chiropractor have opened up those joints as well. Whether it will relieve pressure on the sciatic nerve remains to be seen, but it appears that enough pressure is being released. And by solving the pressure problems in my feet, pain signals are not regularly going back to the brain. All these are likely contributing to relief.

I feel tangibly close to going a whole day without pain. I cannot remember how long it has been since I have had a pain free day. My guess is that it has been at least five years. I remain frustrated by how incompetent our medical establishment proved to be to diagnose and treat my condition. However, I have a lot more respect for chiropractors now than I used to have. I know the medical establishment tends to look down on chiropractors with their fussy insistence on holistic medicine. For me, a competent chiropractor and lots of traction over many months seems to be solving my very complex problem that the medical establishment simply could not solve, and at a fraction of their hefty fees.

I am fortunate to be well insured. I know that there are millions of other Americans who are uninsured, and many of them are as old or older than me and dealing with chronic pain as bad, if not worse, than what I have been dealing with. For the most part, we cannot be bothered to insure them. If they cannot afford medical care on their Wal-Mart wages then to hell with them. It is more important to be principled than to collectively organize so all of us can get relief from needless pain and suffering. At some level, we appear to be a country for whom “personal responsibility” is effectively enshrining sadism toward the less moneyed among us. Having gone through years of often disabling pain, the only ones I feel a lack of compassion for are for those whose ideology keeps them inured from doing something to address  so much pointless suffering. Shame on them.

Chiropractors are a bit of a stretch

The Thinker by Rodin

I am not feeling too happy with physicians these days. Most specialists cannot see outside their own specialties. As for our general practitioners, they excel at treating the ordinary but often find themselves baffled by the mysterious, wherein they reach for their referral forms. This leaves us patients with more complicated medical problems often feeling desperate and depending on web sites for dubious guidance.

In 2004, I developed numbness and pain in my foot, which eventually spread to both feet. It was later followed by persistent tingling and burning on the back of my thighs when sitting. Since it started in my foot, I saw a podiatrist who stuck a needle full of steroids into my foot. When that did not work, he sent me to a neurologist and a vein specialist. The neurologist verified neuropathies. The vein specialist noticed my varicose veins and talked me into having the surface veins on my right leg removed. It was supposed to relieve the pressure on the nerves of the foot. Eventually I had tarsal tunnel surgery to treat a condition that apparently I never had. Thousands of dollars in co-pays alone were wasted. It looks like the real problems were upstream, but no one bothered to raise this is a possibility. I sure didn’t have a clue.

My primary care physician was baffled when I last saw him but when I told him I thought I had sciatica he gave me a list of referrals to more specialists. I haven’t reached the bottom of his list yet, which includes pain management specialists. I did see the orthopedist, who verified something I already knew from a previous MRI: my spine was fine. When I said I thought I had sciatica, he sent me to a chiropractor. There you can find me two to three mornings at week, generally at 7:30 AM getting traction on one of their VAX-D machines in my latest attempt to live something resembling a pain free life.

No pain, no gain. Traction is not necessarily painful, but it can be. However, it is uncomfortable. It has quickly risen on the list of things I would really prefer not to do. I would not be doing it at all if I did not feel desperate. Traction involves mounting a tight harness around my waist, lying down on the traction machine and letting the machine methodically pull me at sixty to eighty pounds, for ten cycles, while I hold on with my hands. I need to create space between my bones so things down there can move around. For a while, it made my breastbone hurt. It definitely makes my shoulder muscles hurt.

I have no idea whether this will work or not, but the chiropractor’s approach at least sounds logical. They took X-rays of my waist standing up and bending. When I bend, a space near my hipbone where the nerve to my right leg traverses is noticeably smaller than the one on the left side. The premise is that this is where my nerve impingement is occurring and is the root of my problem. Traction, ultrasound, low level electrical shocks to my lower back and right leg should allow my nerve to transmit data freely, making it go away in a couple of months. It’s like taking your foot off a hose. Or so they say.

It’s just a matter of getting a proper skeletal alignment, my chiropractors Dr. F. and Dr. R. assure me. They show me on my X-rays how one hipbone is slightly below the other. Get it and my spine in alignment so everything is aligned naturally again and I should get real relief. Alas, it’s not a simple thing to get your spine realigned. It means you have to become good friends with your chiropractors, a VAX-D machine, the youthful woman behind their counter and the women in the therapy rooms because you will be seeing all of them regularly. In fact, they may get more intimate with you than your spouse, as their soft hands slip ultrasound pads under your briefs and onto your buttocks. This part of the therapy happens after the traction when I am still trying to walk normally. I am still frequently moaning and feeling like a bat in sunshine because my head had been pushed inside the darkness of a U shaped pillow for twenty minutes. Otherwise, their hands might feel sensual. The electrical sparkly set of pads definitely gives you a tingly feeling; it needs to be “strong but comfortable” they tell me. I think I have some inkling of what it feels to be electrocuted. It would not be my preferred method of execution.

After all this therapy, you finally get to see the chiropractor. Typically, the most intimate I get with my doctor is when he puts his finger where the sun doesn’t shine during a physical. If you feel you are not getting intimate enough with your doctor, you definitely need to see your chiropractor. If they are not repeatedly violating your physical space, they are doing something wrong. Sometimes I figure I should be wrestling with them. Invariably you end up in some unnatural position with their breath close to your face, they push you sharply and some bone on your spine or hips cracks or shifts.

When I think of people with back problems, I think of obese people. Oddly, I have noticed few obese people at this chiropractic center. It’s full of very healthy looking people. Perhaps like me they ended up here in part by doing things “right”. I have been getting regular exercise for more than thirty years. I have run thousands of miles altogether, and pushed or pulled on innumerable weight machines. All of this was to stay healthy, but all that exercise turned out to have some unwelcome side effects on my body by perturbing my natural shape. It seems if you believe in exercise, you need to keep your chiropractor on your speed dial.

Yet I like my chiropractors perhaps because they are so un-physician like. So maybe this means I am starting to groove with the whole holistic medicine thing. Go see a physician and they will order tests and write prescriptions. It seems they cannot wait to get rid of you. Both my chiropractors are personable and don’t seem to be inordinately worried if you keep them a few extra minutes. They care about my problems and since you see them regularly they know you by name. Dr. R. can relate to my sciatica. He gave me his experience. “The pain was so bad I was screaming. I was living on Percocet.” Solution: months of traction and chiropractic care and it went away. “I am very hopeful for you”, he says as he had a 99.7% success rate when he worked for the military’s version of socialized medicine: Tri-care. He gave me his business card and wrote his cell phone number on it. “Call me anytime with any questions,” he says. I am not used to positive attention from doctors. Is he trying to help me, or pick me up, or both?

This is my first venture into holistic medicine. “Chiropractic first, drugs second, surgery last,” their sign says. I need to temporarily turn my spine into something more like jelly than a spine, and let things resettle into a more natural shape. To facilitate this, I must also take calcium supplements. Most importantly, I have to keep coming back, get more traction, have more sparkly things done on my spine, make more small talk with the Swedish therapist and give them a twenty-dollar co-pay. Then I stagger off to work where I periodically place ice bags under my thighs and in the small of my back to dull the chronic pain.

I obviously am not sure this chiropractor thing is going to work out, but I am hopeful. However many visits it takes, it will likely be a fraction of the cost of my two surgeries or the other specialists I saw who largely wasted my money and are causing our health insurance premiums to go through the roof. Time will tell, but I just wish I had been smart enough to start with the chiropractor. I might have removed years of pointless misery from my life.