Wednesday, March 21, 2007

Oh my aching back

OK, so I said I felt all-around good after my slow and easy run at Chuckanut. And I also mentioned that I had some back pain, something with which I am unfortunately quite familiar. I expected a day or two of discomfort and then complete resolution, which is usually the case. I even went out and walked 4 miles - interspersed with a little bit of "jogging" - on Sunday. I felt better while I was moving, but afterwards had pain even just sitting in my car driving home. Boy, this is worse than my "usual" tweaks.

Well, work certainly has not helped the healing process. The physical exams I do are a bit physical in the sense that I am ranging hips and backs and frequently bending and twisting, and EMG's also require the same. All these things hurt my achy breaky back. But then again, even sitting does. It has indeed gotten much better, but no where near as quickly as I want it to nor as quickly as it NEEDS to. I've got the Mad City 100k in 2 weeks!

So, I finally found a break in my work schedule on Tuesday and I went to a GOOD chiropractor I know. I don't often use or refer to chiropractors. [No offense to anyone who may be a chiropractor, but I have just found that SOME chiros do spinal adjustments for every complaint. There certainly are others that actually examine and treat accordingly, but I have remained somewhat skeptical based on past experience. Again, I mean no offense and if you are taking offense, please remember that DOCTORS get bad raps ALL THE TIME. I hear over and over and over again how people don't like their rushed and uninterested, medication-prescribing, non-examining doctors. I understand the complaints and the skepticism. There are good and bad healthcare providers all over the place. In fact the whole healthcare system sits on a failing foundation. ...but that's a topic for an entirely different blog.]

So, anyway, that rant expressed, I went to a good chiropractor that I know. Her and I have shared many patients and have spoken on the phone but have never personally met. Well, it was an absolute delight to meet her, and in the end, I was so thoroughly impressed with her assessment and treatment. She actually focussed the bulk of the treatment on my gimpy ankle. She showed me how much motion I lacked in the subtalar and cuboid joints. There certainly was a marked difference and I have known all along that I lack motion in the ankle, e.g., I know I can't squat into full dorsiflexion on that right ankle like I can on the left. So, anyway, she mobilized those joints and then worked on my back too. She did NO spinal adjustments and yet I walked away feeling straighter and taller and had less pain.

After work, I then went to my fave strain-counterstrain therapist Larry Ham and he worked on my spastic QL muscle. (You'll be introduced to Larry again soon.) I felt so much better after those two treatments Tuesday and slept better that night, though I still took some muscle relaxers and another dose of prednisone. Shh, don't tell!

Today was tough though. While I am much better, I am certainly still injured. I cannot tolerate any position for longer than 15 minutes, so I'm constantly fidgeting to get comfortable. I desperately wanted a good back massage but didn't even leave work today until 9 pm. That's 13 hours of work for the day. Gee! I wonder why my back hurts??

So, a patient cancelled for my 4 pm slot tomorrow and I didn't have it filled. Instead, I made an appointment for massage and I am already looking forward to it. I have to get better! I will see the chiropractor again on Friday, and then Friday afternoon I'm headed back to Seattle, this time for what promises to be an excellent work conference called "Running Medicine: From Biomechanics to the Prevention & Management of Overuse Injuries." I'm really looking forward to it. Hmm, maybe they could use me as the poster child...

Anyway, I was I a better doctor for having had back pain or do patients think I am somehow "weaker," less effective? I mean, if I can't even keep myself from having back pain, how can I possibly help them? Do you think they think that? Or do they think, she understands because she's been there? I wonder. I never compare myself to my patients. Everybody is so unique when it comes to injury and pain and how they function and cope that no comparisons among people or injuries could ever be made. And yet, I see myself in almost all my patients. But then again, I see myself in almost all people too. It's just the way I connect with the world. I don't mention my own back pain, though some of my patients have asked me these past couple of days if I hurt my back. [Hmm, the stiff rise from my chair and flexed posture is that obvious?] I get a sense of empathy from my patients and also that they know I can empathize with them...since I treat an awful lot of back pain. I only wonder if they would "prefer" a doctor who is altogether healthy and injury free or one who they know has some real idea about some of what they may be experiencing.

I have thought good and hard about this before, but that was about smoking. I counsel every one of my smoking patients that they should quit and I offer my support. I acknowledge that I know that they know that they should quit, and I tell them gently but firmly that I want them to quit, and I explain why, and I offer support and ways to help with quitting, and I tell them that I will ask about the smoking at every follow-up visit...just so they know. And I say it with a smile and not in a condescending manner. And then I let them know that I know it is not easy to quit, that I've been there, that I used to smoke 2 packs a day, and I did that for nearly 10 years. I quit the day before medical school because I did not want to be a hypocritical doctor. I also saw in my medical school Anatomy class what smoking REALLY does to your lungs. My cadaver was a smoker. His lungs were literally caked with tar and they were black and fantastically disgusting. It left an impression on my mind that I will never forget. I thank my cadaver for that!

In any case, I have always felt that my patients felt like I understood their smoking addiction and I think they believed me when I said I would support them in their quitting just because I offered that I have been there too. In fact, I have had many patients quit, and many successfully. Some quit cold turkey and some quit with the help of new medications.

It is one of the most exciting and rewarding parts of my practice when someone comes back and says with a smile, "Guess what, doc?" And I'll guess - sometimes wrong, sometimes right. And the "Yes, I quit smoking and haven't smoked since ___!" are some of the sweetest words a doc could hear. And then we cheer and do the little "quit smoking" jig and high five and express our joy however we want. It's wonderful and I know how hard it is, so I feel the strength of my patients and I am overjoyed. I truly am.

So, back to backs. I don't feel the same way with backs. Maybe it's because I quit smoking a long time ago and it's no longer a "weakness" for me. But the back pain is present now, an obvious "weakness" that can be seen. I wish it weren't so. It's different from when I had my ankle surgery and I was on crutches at work. That was elective surgery. To the contrary, I feel more like a victim of my back.

So, I really hope this gets better soon. I must say that even after typing this, I am ready to get up and stretch and move about. I know it will heal up and I know I will avoid any trails for a least 31 mile trail runs in the mud! I just hope I can do a little running before the Mad City 100k on 4/7.

OK, must sleep. Got another long day tomorrow! I must say though, long days or not, I really enjoy my practice. People are genuinely good, just about every single one of them. I really dig people. :)


Bob Gentile said...

backkkkkkkkkkkkkkkkkkk OFF !!!!

hmmm well I have been fortunate so far to not have any back pain and I have never smoked before so I can't relate to this post-- what else do you have for me--haha

My Dad stopped smoking last year after 30 years---Yikes! wasn't any major reason why but he knew he had to and FINALLY did, so that was awesome!

If my Doctor had back pain and was treating me for a back pain, It wouldn't bother me as long as I felt he/she was sincere in helping me... Now if they told me to quit smoking and as he said that blew a puff of smoke in my face that would be a whole other issue--lol

I hope you Get Better SOON Lisa

Anonymous said...

You know Dr. A and you know how much I respect and love her. There's no doubt in my mind that your patients feel the same way about you. You're one of the good ones who does care and who does spend time and who instills hope. So what if you get injured...I'd prefer a dr. who lives and experiences life as you do rather than some couch potato dr. who only has text book experience.

Sending healing vibes your way...G

olga said...

Lisa, I am with Mr. G (hey, darling!). You are a GREAT doctor, one who thinks through and has a knowledge (because most of us learn by own mistakes, I think what you're going and gone through is a learning experience), and because you possess love for your patients and friends.
Now to your back. Any chance you can elaborate on when it started, what cuased it and what has been done in terms of tests and treatments before? MRI (bulging/herniating disk)? Muscle spasm due to something (what)? Nerve damage? Oh, how I know the back pain - was on my way to surgery only less than 7 years ago! Did everything that was out there! Can tell more when we meet again.
Speaking of - I just printed your schedule for the weekend, you are free after 5 pm. I am free after 4:30 pm in Seattle. I plan to meet with Kendra for little something - it could be a hike/run near by (although the wetaher promises to suck, so if it is - how about dinner?) Can I email both of you at the same time and we would get to spend some time bragging about our injuries and re-living our past primes, as well as share our ways to get to a new ones?

Lisa B said...

Thanks so much you guys! I appreciate your kind words. And yes, Dr. A is awesome... worth flying to Seattle for!

I hope to see you, Olga. I'll email you.

Leaving work now...

Backofpack said...

Came by from Olga's blog. I have to say I'd much rather have an active and vibrant doc with an injury rather than a couch-potato doc. I've had an overweight cardiologist tell me to quit running and found it very hard to take him seriously. I found one who plays tennis (couldn't find a runner/cardiologist in my insurance plan) and feel like he at least has more ideas about what it means to be active. Just the idea that you think about it and wonder about it says a lot!

Hope you had fun with Olga in Seattle!

Lisa B said...

Hi BOP -
Thanks for stopping by and for your post. I too once saw a very overweight and out of shape doc for my back. He hardly even examined me and instead just said, "You need more meat on your bones...that's probably why your back hurts." Like you, I found it difficult to take him seriously.
Anyway, thanks for the note. And yes, us girlies had a good time in Seattle! See pic, more later.