Under the Knife, Part 2
// January 16th, 2011 // 2 Comments » // Life-n-Times, Opinion
Some of you may know that I’ve been having some issues with my back recently. For the past three months, I’ve had increasingly painful issues with my lower back. For three months, I sought help from a remarkable number of neurologists, neurosurgeons, physical therapists…I even had my back MRI’d no less than four times in three months. Finally, I found an orthopaedic surgeon who actually took the time out to show me what he saw, and why he was “astonished” that the neurosurgeons didn’t catch this three months ago…
On Tuesday, Jan. 18th, at High Noon, I’ll be going under the knife again for the second time in two years: this time, I’m going to have a procedure to remove a disc bulge that is, literally, pressing my spinal cord up against the back of my spine, causing me extraordinary pain, as well as weakness in the mid-section, legs, and feet. The most disconcerting part of it all: when I have a bowel movement, it feels like a wave of weakness and pain washes over my midsection. Talk about weird sensations.
What’s amazing to me is that I had not one, but two, neurosurgeons who said that they couldn’t find “anything in your MRIs that could explain your symptoms.” Nothing in my MRIs? Really? I’ll let you be the judge…
This is the sideview MRI image of my spine. Notice anything odd?
Something jumped out at me immediately: take a look at the space between the vertebrae three up from the bottom. See how the area to the right of the vertebrae is black? The orthopaedic surgeon who finally said (and I quote “no shit”) that I was not insane, and that I did, indeed have a back problem that could be addressed by surgery, pointed this out to me:
Basically you can see how the bulging disc has cut my spine into two discrete sections: the part above the L3/L4 disc, and the part below it. He even noted the nerves radiating out of the compressed area…the white being my spinal fluid. His conclusion: “this isn’t a minor case of a disc bulge…this is significant and and extreme stenosis of your spine at L3/L4″. He then showed me a top-down view, to make his point even clearer. Here’s the top-down version of the vertebrae/disc one level above the trouble spot–at L2/L3:
Now compare that to one level down, at L3/L4 (where the disc is bulging)…specifically compare the white space on the previous image to this image:
Note how there is zero white space around the nerves in the second image? Note the blue area that is the shape/size of the previous disc…and how the disc actually seems to extend into the spinal cord on the second image? To make things clear, I’ve highlighted the disc bulge in the second image here:
Pretty clear, no? So, why is it that not one, but two neurosurgeons missed this? As the orthopaedic surgeon (whom I strongly recommend–Dr. Leonard Nelson of Raleigh Orthopaedics…thanks to Peter Haggar for recommending him to me) noted: “it’s as if they never bothered to look at the actual MRI images.” And, in fact, that seems to be a distinct possibility. The reasoning? When visiting the neurosurgeons, I was specifically asked to also bring the radiologist reports. Those reports, noted Dr. Nelson, downplayed the severity of the disc bulge at L3-L4. So much so that Dr. Nelson considered picking up the phone, calling the radiologist to express his concerns about the tone of the report. In Dr. Nelson’s opinion: “the radiologist did you no favors…they simply missed just how severe this stenosis is, and in doing so, caused you to suffer for months for no real reason.”
The bottom line is that two neurosurgeons (one of which is pretty highly regarded in the community–he even performed a similar operation on Dr. Nelson, himself), seem to have missed something that even to an untrained eye seems pretty obvious…and given my advanced symptoms, was dangerous to miss since weakness is a pretty advanced symptom of stenosis. How serious? Left untreated this condition could have resulted in the death of the nerves servicing the legs, calves, and feet. And all of this because the neurosurgeons could not be bothered to look at the actual images. Amazing.
The lesson of all of this is: persist. If you think there’s something wrong, don’t listen to the “professionals”. Get multiple opinions. The answer is NOT (as the neurosurgeons and neurologists attempted to push) pain killers. Those do not address the root cause, but only mask the symptoms.
What amazes me is that one of the neurosurgeons over-ruled my General Practitioner doctor–who saw the MRI images, and thought that it was a pretty clear-cut case of stenosis. He insisted that the MRI did not explain my symptoms. In fact, I received a letter from that neurosurgeon that simply added insult to injury:
“I will also mention that you do have some findings in your low back between the third and forth vertebrae, but those findings are certainly not able to explain your complaints and findings on physical examination.”
Really? Take a look at those images again. What do you think? Is the complete blocking of the spinal column due to a bulging disc, the pressing of the nerves against boney protrusions on the back, and the complete lack of spinal fluid due to the disc blockage not indicative of potential issues with the nerves? Dr. Nelson seems to think they at least are contributory to my current ailments. This Tuesday, we’ll see if he’s right. I can only hope that he is.
Healthcare is broke, and gutting healthcare reform is NOT the answer.
This all made me think of the ridiculous arguments put forth by my friends on the Republican/Tea Party side of the political spectrum: the concept that we have the world’s best medical system. Sorry, but that assertion is simply asinine. We. Do. Not. In fact, numerous studies put our health and medical system far behind other first world nations–which, of course, have been attacked by the right as being “distortions”. Sorry, but I’ll trust the New England Journal of Medicine, which has far more weight to me than some partisan group sponsored and paid for by the medical insurance lobby to gut current healthcare reform efforts by the current administration. Let me state this as clearly as I can:
We do NOT have the world’s best healthcare system. Period.
Why do I say this? Simple: I have one of the best healthcare policies in the nation, from the world’s largest IT company. I have also received consistently subpar care–even from one of the nation’s most renown medical providers–a provider which specifically failed me in so many ways, I can’t even count them any more.
Bottom line: if our healthcare system is broke for someone like me, god knows what it’s like for someone who doesn’t have the resources or insurance plans that I am fortunate enough to have. All of which pales in comparison to the healthcare that my friends in Europe and Japan enjoy. So we have the best healthcare system in the world? Hogwash, lies, and purposeful misrepresentations.
Healthcare is broke. And suggesting “free market” forces can provide a better system is also bunk: think about it for a moment. The free market is driven by one thing, and one thing only–maximization of profit for the shareholder.
So I posit this question to you: should our healthcare system be driven by profit? Do you think it’s correct that someone profit off another’s health misfortunes? If so, frankly, I’d question whether you, or someone you love, has had to suffer through our existing system, and whether such a person morally understands that somethings must necessarily go beyond profit–because, let’s be honest here: if anything should be beyond the realm of market economics, shouldn’t that be the care we provide for our loved ones through our healthcare system? If you don’t agree with that, honestly, you scare me, and you embody many of the worst traits of those things which concern me about our current economic model.
Lastly, I’ll go back to something which medical providers have subscribed to for centuries: read, for a moment, the hippocratic oath, which I quote here in it’s modern version:
I swear to fulfill, to the best of my ability and judgment, this covenant:
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.
I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.
I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given to me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure.
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.”
Note that no where in that oath is a mention of profit for the provider–in fact, quite the opposite…the oath requires healthcare providers to consider economic consequences of their actions and the impact on their families for those they care for. Greed should have no place in healthcare. And that’s just something you either agree or disagree on. It is curious to me that typically those who don’t agree with that assertion have rarely suffered a significant health issue. Go figure.
So, that’s my rant. And what’s going on with me.
Expect another post here, er, post surgery. 
Surgery is scheduled for 12PM on Tuesday, and should be done by 2PM. If all goes well, I’ll be back at the homestead on Wednesday…and will have someone at the house waiting for me when I do get home (thanks SpenceWatch friends!).
For those of you who have passed along your best wishes, thanks. For those of you who didn’t even know about it, well, don’t feel bad–I just don’t like to complain about health issues–even though this posting would seem to be counter-evidence of that. I just figured it was time to let folks know what was going on… 
