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 wondering....am 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 while...at 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. :)