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.

A day without pain

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.