Sunday, August 13, 2006

Comment on one of my posts......

Some time back, I wrote a post on my BLOG pertaining to the chronic pain my husband has dealt with for the past 10 years or so and our difficulty finding someone willing to treat it enough to even bother.

Recently, a doctor blogger commented on my site that he had posted his response to my post, “Drug Seeker…Maybe, Maybe Not” on his site because it turned into such a long comment. Below was the response he posted in reference to my post. His words are in BLUE. My response is in PEACH (and if that has not completely and utterly confused you, you’re one step ahead of me!).


Pain Management
I view it as a duty and privilege to adequately control pain in my patients. It is imperative that the patients take an active role in their health as well, however. Just writing a prescription is not sufficient therapy for many chronically painful conditions. If back or leg pain is present in the setting of obesity
, (Obesity remark number 1 – no where on my BLOG have I ever said my husband is obese, but this was automatically assumed.) then weight loss is just as important as pharmaceuticals. Physical therapy and exercise, in most cases, are essential. (Everyone cannot afford physical therapy. He does exercise as much as is possible and in different ways that a healthy person could given his health conditions.) Maintaining functionality, including continuing employment when at all possible, is important not only for psychosocial and financial reasons but to promote structure and a positive self-image. (Exactly! Hence the need for pain medication that will enable him to try again. He has worked a full time job since he was fifteen years old. He worked full time while in college getting his engineering degree because his dad was dying and HE had to work to pay off the mortgage on his folks’ home. He is definitely not afraid of work.) The natural release of endorphins one achieves with a satisfactory family/job/exercise situation is more effective long-term than just narcing someone up and letting them get fatter, (Second reference to obesity with insinuation that he is already that way and is continuing to grow.) lazier,(Whoever once said he is lazy!?! He is a very artistic and creative man and our yard could compete with the best of them and we won’t even talk about how well he can cook and make our meals healthy yet still have plenty of flavor. Lazier!?!) and more withdrawn from society. Depression is frequently present and must be treated as well. (Yep – certainly agree with this one.)

Opioids are important, but they need to be used wisely...with the goal of maximizing potential. Pain relief should be an intermediate goal, not the ultimate goal. (NOT THE ULTIMATE GOAL !?!? If this goal is reached, that IS what will help him to reach his potential. All I can say here is I would be willing to bet the person making this comment has never lived with unrelenting pain.) The ultimate goal is return to function. Anyone can be made comfortable with medication, but if they are just a comfortable blob (Obesity reference #3…I mean when the term BLOB is used in the context of everything else that has been said in this post, I think I am pretty safe to assume using the term blob as a term of endearment for the obese.) nodding off on the couch, why bother? (Why bother? Ummmm, maybe because for that few minutes he has some relief from the pain? Is that a good enough reason for ya?)

Pain management needs to be directed by one physician, but in certain cases a multispecialty approach can be helpful (Ortho/Neuro/Psych, for example). (Yep, we’re thinking alike on this point. He does see several specialists about his health issues including the pain.) A carefully worded pain management contract, where the patient agrees to be honest about his compliance with therapy and the medications he obtains, is mandatory. (We have paid so far this year, $900 just for drug testing that the pain management office requires for anyone they are treating with the drug he is on.) Visits to the ER for breakthrough pain should be rare, not routine. (The only two times he has used an emergency room in his life were when he was 12 and was hit by a car and 4 years ago when he broke his elbow. No ER for pain relief so I hope that calms everyone with the concern of him wasting valuable time and space for “no good reason”.) It must be made clear that lost or stolen prescriptions will not be replaced, and that changes in the amounts of medications taken must be approved by the managing physician. (Goes without saying. So far he has never lost his medication.) The patient therefore is involved with the plan, and shares some responsibility for getting better. (Not losing his medication and not being robbed means he has gotten involved with the plan? Great! He is doing well then.)

The goal should be to get better, not just to feel better. (Gee! Why didn’t we think of that???? "Hey Honey, quit worrying about feeling better - just get better!!!"

What if this is a disease process that will not get better? What if it is not a back strain or leg pain or some other type of pain that can be blown off as being caused by his lazy “slobby” obese self??? By the way, without a miracle he will NOT get better. His pain is not caused by obesity or laziness or being a slob!)

As you can tell, I am very upset by that response to my post about my dear husband. I normally do not get confrontational, it goes against my nature and my personality, and even now by blogging it is not really confronting anyone, but I had to point out some things this doctor said.

I read all the whining and ugliness that went on, on another blog this week where doctors and other health care professionals (not all but most) were taking “pot shots” at fat people. I don’t take things like that very seriously because blogging is an anonymous way to vent and give our opinions on things and see how other people think.

Being the eternal peacemaker that I am, I even wrote a comment on that situation and how we can’t take things like that very seriously. This response however makes me rethink how I was viewing the hostility I read in those comments. This response leads me to believe, the doctor who wrote it automatically assumed several things about my husband…that he is obese, that he is a slob, that he is lazy. How could one make that assumption? How can he assume that he does not take an active role in his own health situations?

Until you have lived this life where pain is a 24/7 companion, you just can’t truly know what it is like. They cannot teach this in a textbook and it come with the true understanding of what it does to your life and the people closest to you.

I just could not keep my mouth shut on this one.

While we are on the subject of my husband, I will let you know he did go back to work last week. It is not exactly what he wanted and was accustomed to financially, but it is less stress and it is something not terribly physically demanding. I appreciate the kind words from those of you who have written about him.

UPDATE!!!! I appreciate the posts I have had on this particular post, but as of this moment I am not allowing posts on this subject, and I am removing the ones already there since there has been such provaction. I had some very angry responses and some which were barely veiled threats against another poster and I just cannot let my BLOG be used for hostility against ANYONE.

I have no problem with discussing a subject and in the real world I know I cannot force anyone to "play nice", but here on my little BLOG I can stop the insanity.

Suffice to say, this is a "hot bed" topic to all who are close to the situation and tempers can run high when people feel they are not being listened to or that they feel that are being talked down to.

S.I.M.D.

4 comments:

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scalpel said...
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Camilo said...

The facts of pain
People spent too much time thinking that pain was just the brain reaction to a single situation (a fall, some hit, a punch) but Scientifics have discover that pain is much more complex than that, and can reflect to parts in your body that have nothing to with it and can make it to difficult for you to stand other problems
For a lot of years now people had lived with pain accepting it as a part of their life but some changes in this attitude have to made because pain is not that easy to stand and in too many cases it makes another health problem worse .
Pain is Prevalent
• More than 50 million Americans people live with severe pain caused by several illness or disorders, and every year nearly 25 million people suffer with acute pain as a result of injury or surgery.
• Nine in ten Americans suffered from regular pain (89% said they have some kind of pain on a monthly or more often basis).
• Although the medical knowledge and technology is now available to relieve or greatly ease most pain, most pain goes untreated, under treated, or improperly treated.
• People don’t realize that pain is not something they "just have to live with," even though treatments are available to solve most types of pain. And, in fact, if not treated, pain can make other health issue worse.
• Four in five Americans believed aches and pains were a part of being older and 64 percent would only see a doctor when they could not stand the pain any more. Sixty percent said that pain was something you just have to live with, and 55% told they were uncomfortable taking medications.
• Pain causes the majority of pain sufferers (68%) to feel anxious, irritable, or depressed.
• Most of the people with pain say that their pain interferes with their ability to sleep.
• The 40% of those with pain say that their pain interferes with their productivity and ability to work.

Source: The American Pain oundation
Pain relief