Medical Articles - Your Doctor and You
FAULTY WIRING MYSTIFIES MECHANICS AND DOCTORS ALIKE
The Boston Globe - December 17, 2007
Doctor Anne Louise Oaklander
I was confident at the inspection station. My trusty '96 Mazda Protege was driving fine. But I got a shock that day: a black rejection sticker for emissions. "Get a tune up," I was urged. Somewhere during the garage visits, bills, and phone calls, it occurred to me that my car had the same problem as my patients with neuralgia, a type of chronic pain caused by nerve damage. They are laid low by pain in various locations, but medical exams and tests often show no cause. Their problem is not actually where their pain is felt, but in the nerves that carry pain messages to the brain. Normally, pain neurons only fire briefly during injury or illness to signal a problem, but short-circuits can make them fire continually, just like my engine warning light that stayed lit for months. Some neuralgia patients, whose symptoms are often triggered by common conditions such as shingles, diabetes, and osteoarthritis of the spine, are prescribed effective medications and may get pain relief. More often their "mystery pain" goes untreated as doctors fail to recognize and treat its neurological causes. And physicians, no matter how caring, must also weigh the chances of federal scrutiny when prescribing strong pain medicines for patients without sufficient explanation for their pain.
Many neuralgia patients undergo unnecessary repairs just like my Protege. These include local-anesthetic injections that help only briefly while the area is numbed. I remember the woman whose dentist tried to treat her neurological jaw pain by doggedly extracting one innocent molar after another, leaving her toothless and impoverished, and no better. Most surgeries do not help neuralgia, and surgery causes or worsens many cases. In addition to living with chronic pain, my patients have to cope with an unforgiving medical and disability system with little tolerance for elusive problems. My fruitless phone calls to the Registry of Motor Vehicles pale next to my patients' efforts to seek insurance coverage, disability benefits, worker's compensation, or simply to get a doctor to listen and help. Medical tests aren't sensitive enough to detect subtle electrical problems, just as my mechanic's tests couldn't find the fault that was causing loss of my car's emission's data. Lack of evidence is interpreted as evidence of lack of a problem, and my patient's symptoms are attributed to psychological causes, character flaws, or to just plain lying to con a doctor into writing a narcotics prescription.
With each new agency, each new doctor, my patients need to retell their complicated histories to convince yet another skeptical listener. Most feel vaguely guilty for having such a difficult problem, and many wonder at some point if indeed they might be crazy. Some cry with relief when I tell them that I have seen their kind of problem before and it is caused by neurological damage, not neurosis. Some eventually give up, traumatized twice - once by their illness and once by our system. I am haunted by the memory of a woman who killed herself last year, believing this the only way to end her suffering. Last month, my story took a turn for the better: On a whim, Eddie, the mechanic who has worked doggedly to fix my Protege's problem, plugged it into the inspection computer. By some miracle, at that moment it held enough data for me to PASS! We shared a giddy moment. But my lawfulness is temporary. My car's nerves are still fickle and my check engine light still goes on and off at will. I must expect rejection at my next emissions test. I've heard that Motor Vehicles is ending tailpipe-emissions testing altogether, which will leave no option for cars like mine to pass. Will we have to junk otherwise well-running cars that can't meet the new rules? Given the complexity of our own neurological wiring, perhaps physicians, medical insurers, and disability boards should also make provisions, so that patients with chronic pain from wiring problems can still get the care and compassion they need.
Link to original article
The Boston Globe - December 17, 2007
Doctor Anne Louise Oaklander
I was confident at the inspection station. My trusty '96 Mazda Protege was driving fine. But I got a shock that day: a black rejection sticker for emissions. "Get a tune up," I was urged. Somewhere during the garage visits, bills, and phone calls, it occurred to me that my car had the same problem as my patients with neuralgia, a type of chronic pain caused by nerve damage. They are laid low by pain in various locations, but medical exams and tests often show no cause. Their problem is not actually where their pain is felt, but in the nerves that carry pain messages to the brain. Normally, pain neurons only fire briefly during injury or illness to signal a problem, but short-circuits can make them fire continually, just like my engine warning light that stayed lit for months. Some neuralgia patients, whose symptoms are often triggered by common conditions such as shingles, diabetes, and osteoarthritis of the spine, are prescribed effective medications and may get pain relief. More often their "mystery pain" goes untreated as doctors fail to recognize and treat its neurological causes. And physicians, no matter how caring, must also weigh the chances of federal scrutiny when prescribing strong pain medicines for patients without sufficient explanation for their pain.
Many neuralgia patients undergo unnecessary repairs just like my Protege. These include local-anesthetic injections that help only briefly while the area is numbed. I remember the woman whose dentist tried to treat her neurological jaw pain by doggedly extracting one innocent molar after another, leaving her toothless and impoverished, and no better. Most surgeries do not help neuralgia, and surgery causes or worsens many cases. In addition to living with chronic pain, my patients have to cope with an unforgiving medical and disability system with little tolerance for elusive problems. My fruitless phone calls to the Registry of Motor Vehicles pale next to my patients' efforts to seek insurance coverage, disability benefits, worker's compensation, or simply to get a doctor to listen and help. Medical tests aren't sensitive enough to detect subtle electrical problems, just as my mechanic's tests couldn't find the fault that was causing loss of my car's emission's data. Lack of evidence is interpreted as evidence of lack of a problem, and my patient's symptoms are attributed to psychological causes, character flaws, or to just plain lying to con a doctor into writing a narcotics prescription.
With each new agency, each new doctor, my patients need to retell their complicated histories to convince yet another skeptical listener. Most feel vaguely guilty for having such a difficult problem, and many wonder at some point if indeed they might be crazy. Some cry with relief when I tell them that I have seen their kind of problem before and it is caused by neurological damage, not neurosis. Some eventually give up, traumatized twice - once by their illness and once by our system. I am haunted by the memory of a woman who killed herself last year, believing this the only way to end her suffering. Last month, my story took a turn for the better: On a whim, Eddie, the mechanic who has worked doggedly to fix my Protege's problem, plugged it into the inspection computer. By some miracle, at that moment it held enough data for me to PASS! We shared a giddy moment. But my lawfulness is temporary. My car's nerves are still fickle and my check engine light still goes on and off at will. I must expect rejection at my next emissions test. I've heard that Motor Vehicles is ending tailpipe-emissions testing altogether, which will leave no option for cars like mine to pass. Will we have to junk otherwise well-running cars that can't meet the new rules? Given the complexity of our own neurological wiring, perhaps physicians, medical insurers, and disability boards should also make provisions, so that patients with chronic pain from wiring problems can still get the care and compassion they need.
Link to original article
WHAT TYPE OF DOCTOR TREATS PAIN?
Doctors who manage pain are frequently anesthesiologists. Anesthesiologists are doctors of medicine (M.D.) or osteopathy (D.O.) who make sure that you are safe, pain-free and comfortable during and following surgery. They also provide their services in other areas of the hospital - especially in the labor and delivery area - or in doctors' offices where painful medical tests or procedures are performed. But not everyone realizes that decades of research and work done by anesthesiologists have led to the development of newer, more effective treatments for patients who have pain unrelated to surgery. Many techniques used to make surgery and childbirth virtually painless are now being used to relieve other types of pain. In fact, the work pioneered by anesthesiologists that led to these new medications and treatments also has created a new category of medicine called pain medicine. Frequently the anesthesiologist heads a team of other specialists and doctors who work together to help you manage your pain. The anesthesiologist or other pain medicine doctors (such as neurologists, oncologists, orthopedists, physiatrists and psychiatrists) and nonphysician specialists (such as nurses, nurse practitioners, physician assistants, physical or rehabilitation therapists and psychologists) all work together to evaluate your condition. Then this "team" of specialists will develop a treatment plan designed just for you.
What type of training does a pain medicine doctor have?
Like other physicians, anesthesiologists earned a college degree and then completed four years of medical school. They spent four more years learning the medical specialty of anesthesiology and pain medicine during residency training. Many anesthesiologists who specialize in pain medicine receive an additional year of fellowship training to become a "subspecialist," or an expert in treating pain. Some also have done research, and many have special certification in pain medicine through the American Board of Anesthesiology (ABA). The ABA is the only organization recognized by the American Board of Medical Specialties to offer special credentials in pain medicine.
What does a pain medicine doctor do? Can these doctors find out why I hurt?
Pain medicine doctors are experts at diagnosing why you are having pain as well as treating the pain itself. Some of the more common pain problems they manage include: arthritis, back and neck pain, cancer pain, nerve pain, migraine headaches, shingles, phantom limb pain for amputees and pain caused by AIDS. They also manage acute pain caused by surgery, a debilitating illness or a serious injury. Examples include: pain after a knee-joint replacement, pain during recovery from a car accident, pain following stomach or chest surgery, or pain associated with sickle cell disease. You may be treated in the hospital or in an outpatient clinic.
Doctors who manage pain are frequently anesthesiologists. Anesthesiologists are doctors of medicine (M.D.) or osteopathy (D.O.) who make sure that you are safe, pain-free and comfortable during and following surgery. They also provide their services in other areas of the hospital - especially in the labor and delivery area - or in doctors' offices where painful medical tests or procedures are performed. But not everyone realizes that decades of research and work done by anesthesiologists have led to the development of newer, more effective treatments for patients who have pain unrelated to surgery. Many techniques used to make surgery and childbirth virtually painless are now being used to relieve other types of pain. In fact, the work pioneered by anesthesiologists that led to these new medications and treatments also has created a new category of medicine called pain medicine. Frequently the anesthesiologist heads a team of other specialists and doctors who work together to help you manage your pain. The anesthesiologist or other pain medicine doctors (such as neurologists, oncologists, orthopedists, physiatrists and psychiatrists) and nonphysician specialists (such as nurses, nurse practitioners, physician assistants, physical or rehabilitation therapists and psychologists) all work together to evaluate your condition. Then this "team" of specialists will develop a treatment plan designed just for you.
What type of training does a pain medicine doctor have?
Like other physicians, anesthesiologists earned a college degree and then completed four years of medical school. They spent four more years learning the medical specialty of anesthesiology and pain medicine during residency training. Many anesthesiologists who specialize in pain medicine receive an additional year of fellowship training to become a "subspecialist," or an expert in treating pain. Some also have done research, and many have special certification in pain medicine through the American Board of Anesthesiology (ABA). The ABA is the only organization recognized by the American Board of Medical Specialties to offer special credentials in pain medicine.
What does a pain medicine doctor do? Can these doctors find out why I hurt?
Pain medicine doctors are experts at diagnosing why you are having pain as well as treating the pain itself. Some of the more common pain problems they manage include: arthritis, back and neck pain, cancer pain, nerve pain, migraine headaches, shingles, phantom limb pain for amputees and pain caused by AIDS. They also manage acute pain caused by surgery, a debilitating illness or a serious injury. Examples include: pain after a knee-joint replacement, pain during recovery from a car accident, pain following stomach or chest surgery, or pain associated with sickle cell disease. You may be treated in the hospital or in an outpatient clinic.
- The pain medicine doctor will work closely with your primary care doctor.
- Pain medicine doctors will review your medical records and X-rays as needed.
- They will ask you to describe your pain in detail, such as where it hurts, for how long, what makes the pain worse or what makes it feel better.
- They may ask you to fill out a detailed questionnaire that helps them to assess the impact that your pain is having on your lifestyle and if it is interfering with your daily activities.
- They also will do a complete physical examination on you.
- They may need to order other tests and will then review all of their findings to determine what is causing your pain and how the problem can be corrected.
WHAT CAN YOU DO TO BE A SMARTER PATIENT?
THESE ARE QUESTIONS WE ALL NEED THE ANSWERS TO!
Tips for How to Be a Smart Patient
THESE ARE QUESTIONS WE ALL NEED THE ANSWERS TO!
Tips for How to Be a Smart Patient
YOUR NEXT DOCTOR'S VISIT, MAKE THE MOST OF IT
By Kathleen Doheny
HealthDay Reporter
SUNDAY, Jan. 29 (HealthDay News) -- A visit to the doctor's office sometimes seems like it's over in a flash, and by the time you get to your car you've thought of six things you forgot to ask. But if you follow some simple suggestions before your next visit, you'll become a more educated health-care consumer -- and quite possibly improve your medical care and your relationship with your doctor. For starters, "make a list of what you want to discuss," said Dr. Jim King, a family physician in Selmer, Tenn., and a member of the American Academy of Family Physicians' board of directors. Also, be clear on the purpose of the appointment -- for instance, is it to check on your recovery from a sprained ankle, or is it to review treatments for high blood pressure.
Dr. Virgilio Licona, a family physician in Brighton, Colo., and also a member of the American Academy of Family Physicians' board of directors, suggests you jot down any symptoms you might be experiencing. "Write down any questions you have, no matter how silly they may sound to you," he said. Before the appointment, be sure to check if you need to fast for certain lab tests, King said, or whether you need to skip regular medication. He said he's had patients skip medications before a visit, thinking that was what they were supposed to do, only to learn he wanted to check the patient's blood level of a medication to see if it was working properly. Also, bring along any medicines you may be taking -- and be sure they're in their original bottles. "You can go over them with your doctor," Licona said, to be certain you're taking the proper dose at the right time. This is also a good time to tell your doctor what herbs or other supplements you might be taking, as well as over-the-counter medications. During the visit, King suggests that you "write down what your doctor says about your problem or condition. Ask for handouts on the condition," he said, adding they are readily available in most offices.
Another suggestion: Take along a spouse, a family member or a friend to help you understand what the doctor has to say, especially if you're newly diagnosed with a condition. The family member or friend may think of questions that don't occur to you. But if you are alone, and have trouble remembering things, you might ask the doctor if you can tape-record the conversation. Also, turn off your cell phone. "When you are in the middle of an exam, having that go off can be counterproductive," said Licona. "Turning it off is not only a courtesy but makes sure you maximize your time with your doctor." Ask when the next visit should be, and, if you have lab work ordered, when you need to have it done. And be sure to follow up with the doctor if you need to. It's always OK to call back your doctor if you don't understand the instructions, or if new questions pop up. If you've had tests done, such as lab blood work, don't assume "no news is good news" unless your doctor has told you that. Be sure to call for results if you don't receive them after the visit.
SOURCES: Virgilio Licona, M.D., family physician, Brighton, Colo., and board of directors, American Academy of Family Physicians; Jim King, M.D., family physician, Selmer, Tenn., and board of directors, American Academy of Family Physicians
By Kathleen Doheny
HealthDay Reporter
SUNDAY, Jan. 29 (HealthDay News) -- A visit to the doctor's office sometimes seems like it's over in a flash, and by the time you get to your car you've thought of six things you forgot to ask. But if you follow some simple suggestions before your next visit, you'll become a more educated health-care consumer -- and quite possibly improve your medical care and your relationship with your doctor. For starters, "make a list of what you want to discuss," said Dr. Jim King, a family physician in Selmer, Tenn., and a member of the American Academy of Family Physicians' board of directors. Also, be clear on the purpose of the appointment -- for instance, is it to check on your recovery from a sprained ankle, or is it to review treatments for high blood pressure.
Dr. Virgilio Licona, a family physician in Brighton, Colo., and also a member of the American Academy of Family Physicians' board of directors, suggests you jot down any symptoms you might be experiencing. "Write down any questions you have, no matter how silly they may sound to you," he said. Before the appointment, be sure to check if you need to fast for certain lab tests, King said, or whether you need to skip regular medication. He said he's had patients skip medications before a visit, thinking that was what they were supposed to do, only to learn he wanted to check the patient's blood level of a medication to see if it was working properly. Also, bring along any medicines you may be taking -- and be sure they're in their original bottles. "You can go over them with your doctor," Licona said, to be certain you're taking the proper dose at the right time. This is also a good time to tell your doctor what herbs or other supplements you might be taking, as well as over-the-counter medications. During the visit, King suggests that you "write down what your doctor says about your problem or condition. Ask for handouts on the condition," he said, adding they are readily available in most offices.
Another suggestion: Take along a spouse, a family member or a friend to help you understand what the doctor has to say, especially if you're newly diagnosed with a condition. The family member or friend may think of questions that don't occur to you. But if you are alone, and have trouble remembering things, you might ask the doctor if you can tape-record the conversation. Also, turn off your cell phone. "When you are in the middle of an exam, having that go off can be counterproductive," said Licona. "Turning it off is not only a courtesy but makes sure you maximize your time with your doctor." Ask when the next visit should be, and, if you have lab work ordered, when you need to have it done. And be sure to follow up with the doctor if you need to. It's always OK to call back your doctor if you don't understand the instructions, or if new questions pop up. If you've had tests done, such as lab blood work, don't assume "no news is good news" unless your doctor has told you that. Be sure to call for results if you don't receive them after the visit.
SOURCES: Virgilio Licona, M.D., family physician, Brighton, Colo., and board of directors, American Academy of Family Physicians; Jim King, M.D., family physician, Selmer, Tenn., and board of directors, American Academy of Family Physicians
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