Incapacitation

[SDQDI]

I had my L5-S1 disc replaced in my early twenties, it is surprising how much pain you can get used to when it comes gradually.

 

My pain started before I was 20 but was tolerable and just gradually got worse, at twenty I saw a surgeon who said he could fuse the vertebrae together which would remove some of my flexibility but he said it was unlikely to help the pain! I basically said thanks but no thanks and with the thought that surgery couldn't help I put up with it as it got worse and worse. (I wasn't overweight at that time) I eventually got to the stage where it really affected everything I did, I couldn't walk far, driving was a nightmare and if I sat down at lunch time I couldn't get back up and had to roll across the floor to get to bed. I knew I had to get something done but was still holding off because of a lack of confidence of a good result.

 

Then I had a friend who had a disc replacement (all the surgeons I had talked to said there was no such thing as a disc or vertebrae replacement and said fusing was the only thing that could be done) and he was back to pain free life almost immediately post op and he gave me his Dr's name. It all went well from there, a phone call later and I organised a copy of my X-rays to be sent to him which was followed by a call back with a fairly prompt appointment time.

 

At my appointment was told very confidently "yes it can be fixed by replacing the dodgy disc, I can fit you in tomorrow afternoon seeing as you have travelled a fair way. You will just have to organise to stay up here (Gold Coast) for two weeks post op, you can have a little time to decide if you like" I looked at my wife and she looked at me and I said yep lets do it.

 

One night in hospital and I can still remember my first walk post op, the physio led me straight to the stairs and helped me down, I automatically favoured my bad side due to habit and she scolded me and made me descend one foot after the other and I was absolutely gob smacked that I could do it with no pain whatsoever! After my two week check up I drove from the Gold Coast back to hillston Nsw and after another few days I was back on a motorbike mustering.

 

It is absolutely amazing what can be done, having said that I am extremely glad I had kept my private health insurance up to date, it still costed enough but is the best money I have ever spent.

 

Your back is extremely important, don't let any sugeon fuse you up without a second opinion!

 

And a shameless plug for Dr Matthew Scott-Young of Gold Coast spine! 07 5528 6477

 

Just looked at my card, that was in 2008 so 8 years on and no pain.

 

 

[Old Koreelah]

...driving was a nightmare and if I sat down at lunch time I couldn't get back up...

No plurry doubt about you, SD. Now I know why you like to get the drive over so quickly.

(You never tried the back pain excuse to get let off all those speeding fines?)

 

 

[dutchroll]

Your back is extremely important, don't let any surgeon fuse you up without a second opinion!

Talking to mine he said fusion still has its place, but only when you've totally run out of options and need to relieve severe pain. He said disc surgery is much more conservative these days compared to many years ago when they'd fuse you without even giving it a second thought.

I actually had a very new procedure which, after the portion of diseased and protruding disc is nibbled away to release the pressure on the nerve roots which is causing all the symptoms, involves putting in a small titanium anchored poly flap which reduces the probability of a relapse of the remaining disc in that same space.

 

I was hoping he'd actually implanted Adamantium in my spine, but alas it wasn't to be and I cannot become Wolverine.

 

 

[facthunter]

I've seen some terrible results of disc fusion.(back a while. People walking bent over). I'm fortunate. The surgeons I visit don't use me to pay off their Maserati, and also seem very impressed how I've managed to "Fix" (ameliorate,) some threatening conditions we have been monitoring by exercise, (Movement rather than strength) Vitamin D and good diet. Small doses of sunshine. Don't lose weight quickly or you may lose muscle mass, and you won't replace it easily if at all. I gave up smoking years ago, (wish I'd never done it ever) and have cut the alcohol and may give it up.

 

Use your body's own healing power, and minimum drugs and antibiotics. Get the immune system working properly. (That's a big study in itself). Nev

 

 

[dutchroll]

I'm fortunate. The surgeons I visit don't use me to pay off their Maserati......

The majority of surgeons don't actually use patients to pay off their Maserati. You are "normal". A minority of patients are "unfortunate".

Mrs Dutch has occasionally (she would argue "continuously") run afoul of hospital management for actually caring about her patients' welfare, rather than just shovelling numbers through the operating theatre as quick as she can to reduce the waiting list so the management can crawl up the Health Minister's backside and tell them how spiffingly well everything is going. The management of public hospitals and the politicians who control them live in a bubble which is absolutely impenetrable by reality. Sorry.....I digress!

 

 

[johnm]

seems airlines and health agencies have the same strategies DR ? ................. always enjoy your dissection of the 2

 

 

[Old Koreelah]

...Use you body's own healing power, and minimum drugs and antibiotics. Get the immune system working properly. (That's a big study in itself). Nev

The best advice anyone could follow. Even as a kid I was aware of the importance of giving my immune system plenty of exercise. Running around barefoot on the farm sure gave it a workout.

 

 

[Jaba-who]

Yes. Back pain is also frequently associated with poor circulation... can be a sign of atherosclerosis. Both are related to poor (eg western) diet and lack of exercise.

Mmmm .... Sorry But No.

 

cos .....This is not a cause of back pain - In terms of common back pains, it has nothing to do with it.

 

In fact probably the only cause of atherosclerosis being a cause of back pain is when an aortic aneurysm in the chest dissects (tears open or between layers) and can cause sharp pain referred to the interscapular area. (Middle of the back between the shoulder blades and that's rare these days and portends a very high risk of rolling and dying there and then. )

 

There is a very rare syndrome called Leriche's syndrome which can give buttock pain with exercise ( as well as impotence ) that is from atherosclerosis but that's not back pain.

 

For the record

 

In western societies causes of low back pain (Majority of cases of back pain)

 

Way most common - Musculo-skeletal causes (Including Osteo-arthritis, poor muscle tone and function and lots of others (includes the disc pathology Dutch mentioned)

 

Then - True nerve entrapments and nerve injury (surprising low incidence really) - despite everyone thinking they have "pinched nerves" . (Dutch's Disc can make a crossed over appearance here too!)

 

Followed by - Uncommon Auto-immune Diseases (Ankylosing Spondylitis in males, Rheumatoid Arthritis in females etc )

 

Secondary malignancies (esp. prostate cancer in the case of readers of this forum)

 

Rare infections

 

Small number of even rarer causes

 

(with exception of malignancy and some rare infections....)

 

All are made worse by obesity

 

All can be affected by posture

 

Most can be ameliorated by exercise

 

Treatment involving these modalities now forms mainstay of treatment for most back pain.

 

Only a small number need surgery. Current commonly quoted benchmark is that if as an orthopaedic surgeon you are operating on more than 10% of the patients you see for back pain you are operating too much. (But this is variable because if you have a highly knowledgeable GP referral base then they may do a lot of filtering and appropriate treatment so their referrals are more likely to be people who really could benefit from surgery. If your referral base is 24 hr medical centers and high-turn-over, churn 'em-through and refer-em' centres etc then it could be even lower than 10%.

 

I have never heard of any study looking at enhancing immunity suggesting it can make any difference. In fact the causes that are known to be associated with immunity are ALL related to excessive immune responses (Rhuematoid, Ank. Spondylitis) causing the immune system to attack the linings around the joints. The treatment in those is to suppress the immune system.

 

Have to be very careful when anyone tells you that something "enhances immunity" - mostly they have no idea what immunity is, what cells, substances, factors or pathways are involved.

 

Often it's something like primary school logic - "There are cells in the immune pathway, cells need protein, vitamins or some substance to function.

 

Therefore if I sell you something that contains that something it will "enhance your immunity". "

 

They have no idea whether it ever gets to the specific cell involved - often these things don't - they are metabolized and used for something else. Nor whether if it gets to the cell whether it actually even gets used by the cell.

 

Mostly the claims are never the result of testing for either increased end cell activity or any evidence that immunity was ever changed or that test subjects ever actually had any clinical benefit from the taking of the original substance.

 

 

[Gnarly Gnu]

.....This is not a cause of back pain - In terms of common back pains, it has nothing to do with it.

You are right, it was badly worded. Poor circulation does not in itself create the pain; according to the experts over time it can lead to degeneration which in turn gives the pain.

 

Most can be ameliorated by exercise

 

This is good advice. Too often one hears the opposite (don't bend, lift nothing etc)

 

 

[facthunter]

A system of "fee for service" is rife for exploitation and it is. Unnecessary operations are very common. I would estimate as high as 25% in some areas. Nev

 

 

[dutchroll]

I don't think there's any data to support 1 in every 4 being unnecessary Nev, but yes we do know that happens unfortunately.

 

Proving it is a problem. There are certain conditions which will often get better naturally. My prolapsed disc had something like a 90% chance of resolving naturally within about 8 weeks with rest and physio. We waited (on the surgeon's recommendation), and it didn't. I was in the 10% club, and as an added bonus I ended up being in the other club for which a cortisone injection does nothing at all after a further 3 weeks. Lucky me - sat (well lay down mostly) around in substantial discomfort and unable to work for 3 months watching nature abysmally fail to take its course (in fact it got progressively worse), plus the time to recover after the operation!

 

So even though you have a condition which might commonly resolve naturally with time, who is to say that you'll be in that group? And how long are you prepared to tolerate the pain and disability to find out? You'd also be surprised at how many patients walk in and demand an operation, rather than talk about alternatives. This is how the lines get blurred in determining what was necessary and what wasn't. However as I said, I'm not denying it doesn't deliberately occur. We know it does.

 

 

[johnm]

(the non medical viewpoint) there seems to be a growing opinion that there is so much technology available that some / many prescribed procedures and prescriptions may be unnecessary or harmful

 

its true, I watched an ABC program on it

 

the cure might be more harmful than the ailment (I now expect all trained medical persons to defend their position !)

 

................... or is this just a popular misconception ?

 

 

[Nobody]

We can't get agreement on the causes (or frequency) of jabiru engine failures, a topic a group of flyers would have some knowledge of. Do you really expect the members of this site to form an informed position about the efficacy of a complex medical procedure?

 

 

[facthunter]

If the surgeon explains truthfully the risks and the extended recovery often associated with these things, and the real likely outcomes, it would be better. AS Dutch says a lot of people expect miracles and demand a treatment or prescription every time they go near a specialist. "Take this and it will be better" (fixed) is expected to be available. I don't profess to be a doctor but anything I write here has come from one. Generally they are very intelligent people whose company I enjoy. The younger ones could do with a lesson in handling humans occasionally. Their "bedside" manner is non existent sometimes. The nurses know which doctors are UP themselves. Nev

 

 

[Jaba-who]

(the non medical viewpoint) there seems to be a growing opinion that there is so much technology available that some / many prescribed procedures and prescriptions may be unnecessary or harmfulits true, I watched an ABC program on it

 

the cure might be more harmful than the ailment (I now expect all trained medical persons to defend their position !)

 

................... or is this just a popular misconception ?

As a general principle its probably somewhat right.

 

Except you need to be very wary of docos - they present the bits that make a good story and forget to tell the real world other bits.

 

A great example is the principle that we do "too many caesareans". (But you can cut and paste just about any operation into that.)

 

The general belief is we do too many. The often quoted standard is about 20 % of births as caesars is acceptable. 1:5 births

 

That's a general statistic. It gives no indication to a O & G standing in front of a patient in labour on what to do.

 

We know that some signs and findings are associated with bad outcomes.

 

But all of those signs etc can be seen in some women and they still go on to deliver normally and have a healthy baby.

 

Now transplant yourself into the situation.

 

You have a woman in labour in front of you.

 

She displays some signs that sometimes seen in bad outcomes.

 

You can caesar her - have a healthy out come - mother and baby. (By far the statistically most likely outcome )

 

You can Caesar and have a complication of the surgery - compared to good outcomes, rare these days.

 

You can not caesar and still have a healthy outcome

 

You can not do a caesar and have a bad outcome - baby with lifelong birth defect and all the horrible stuff it causes.

 

- dead baby

 

- dead mother

 

- spend years going through court battles over it

 

- lose your medical career, your own marriage and own own future

 

There is absolutely one thing you will NEVER do. And that's say to the mother "I have done 5 caesars already this week. So even though I think it will be best for you, I have to keep the averages within the state limits so I can't do a caesarian for you. "

 

But that's what the arm chair experts have no concept of. They never have to actually make the decision.

 

With regard most medical procedures - you only know which outcome you're gonna get - after you've done it.

 

 

[dutchroll]

the cure might be more harmful than the ailment (I now expect all trained medical persons to defend their position !) ................... or is this just a popular misconception ?

It is true that there is very little that a doctor can prescribe or surgical procedure that they can perform which doesn't have the potential to harm you more than it fixes you. Even if that potential is extraordinarily low. However it is all about balancing risk (isn't life in general?). You are required to be informed of those risks and it becomes your decision as to whether the good outweighs the bad.

The pivotal court case in Australia was as recent as 1992, Rogers v Whitaker, which lead to a big upheaval regarding "informed consent" and pretty much changed the face of how that was done in this country. You can look it up online, but essentially an ophthalmologist was successfully sued by a patient for failing to inform her of a 1 in 14,000 chance of a particular serious complication, which of course she got (it was not the fault of the doctor). The upshot of it all was that risks have to be disclosed no matter how small, if they could have a material effect on the outcome, or the patient is deemed to not have given informed consent.

 

It doesn't have to be entirely verbal though. It could be by giving the patient a pamphlet to read (and actually this is often recommended as a backup to a discussion with the patient). You're also supposed to be given the opportunity to ask questions.

 

Nev you're right about bedside manner, though regrettably it is not related to surgical skills so sometimes you just have to wear it. All professions have issues with how some individuals communicate.

 

 

[Old Koreelah]

...The younger ones could do with a lesson in handling humans occasionally. Their "bedside" manner is non existent sometimes. The nurses know which doctors are UP themselves. Nev

One my sisters is a highly qualified nurse. I once commented on her years of extra training and asked why she just didn't become a doctor. She just looked at me and said "but I want to help people!"

 

 

[Jaba-who]

The pivotal court case in Australia was as recent as 1992, Rogers v Whitaker, which lead to a big upheaval regarding "informed consent" and pretty much changed the face of how that was done in this country. You can look it up online, but essentially an ophthalmologist was successfully sued by a patient.

..........snipped ...........

 

Nev you're right about bedside manner, though regrettably it is not related to surgical skills so sometimes you just have to wear it. All professions have issues with how some individuals communicate.

Rogers and Whittaker has been modified since then as well. Very complex but one of the problems early after that was a surge in people who sued because they got complications. Not that they were avoidable just that they claimed (or were not ) they were not told about them. No need to prove they would not have taken the risk anyway, if they had been told. Resulted in huge payouts for totally obvious things -I have a friend who got sued and found against because he didn't tell a patient that cutting into and draining a huge abscess that was making him sick would leave a scar. Absolutely no way he would have refused to have the life saving surgery to drain the infection but he just wasn't told he'd have a scar. That was one of the cases that was cited to change Rogers vs Whittaker.

 

Now you also have to convince a judge you would not have gone ahead with the operation if you had been told about the risk.

 

As for good bedside manor, Dutch is right. As a general principle yep good bedside manner is great and desirable but .......... There's always a hidden problem.

 

Good bedside manner is sometimes a front for being a crap doctor.

 

We have an elderly surgeon in my town who is the smarmiest little weasel. Has the gift of the gab with patients. I've heard patients say how caring and wonderful he is and no-one seems to ever complain. But he's a complete idiot, and is technically a deplorable surgeon. He is so bad only one anaesthetist in a town with about 30 anaesthetists will work with him. Another surgeon sees about 3 patients a week who need fixing up after the first guy has trashed them. weve tried to have him deregistered but patients won't complain and there's only so much you can do when patients who have incured problems think he's wonderful.

 

 

[dutchroll]

The other type is the one who "talks the talk" and impresses, but can't actually operate to save themselves.

 

Weird how medicine sometimes parallels aviation!

 

 

[Jaba-who]

The other type is the one who "talks the talk" and impresses, but can't actually operate to save themselves.Weird how medicine sometimes parallels aviation!

Yep. They are so much alike. One difference though is that we don't come with a manuaL. It's a bit like what would happen if an A380 was magically plonked in front of us and with no manuals we are expected to write our own.

 

And we can all write our own manual which may or may not align with someone else's manual. The manual builds up according to who stumbles upon what issues when and if they decide to tell the rest of the world about it.

 

And Anaesthesia is the area of medicine that most parallels aviation

 

Planning = pre-op assessment

 

Take off = induction

 

Cruise = maintenance phase

 

Landing = emergence

 

Post flight putting away, addressing issues = recovery

 

In the event of bad events - reports, debriefs etc

 

Next flight ( patient) - same steps but completely different

 

 

[Guest SrPilot]

For some people the painkillers don't work. I'm one of them. Anyhow it's a blessing in disguise. Painkillers have serious side effects. Operations on your back aren't a permanent fix either. Usually works for a couple of years if that. The best long term is to find movement exercises that suit you, that keep the discs in your back moving. Don't have weight on them when you move and don't lift spare wheels out of car boots or lift stuff the wrong way. Lift and twist is real bad. It's your back and it's the only one you are likely to have, ever. Nev

Back when -- for years -- I had back trouble, one of my physicians made 4 suggestions. 1. Never, never lock your knees when bending over a sink to wash your face or hair. It puts too much stress on the lower back and associated muscles and yet many men do so regularly according to a couple of doctors with whom I've chatted. 2. Never pick up heavy objects by bending over. Actually, if I'm thinking I do not bend over to pick up something as light as an objecting weighing in at 6.2 attograms.** Squat instead and lift by straightening your legs. 3. Check your mattress and springs. Sagging, soft beds sometimes cause back problems. 4. When your back goes out, sleep on your back on a quilt on the floor, perhaps with a pillow under your knees. I had recurring back trouble from a young age up to maybe 40. I started concentrating on walking upright, watching my weight, never bending over with knees locked, and - as needed - sleeping on the floor with a pillow under my legs. These suggestions will not help with every back problem, but I have had only one or two bouts of back trouble in the past 10 years or so, whereas I used to have several events every year sometimes for weeks at a time. Just some ideas that served me well.

 

** Scientists at Cornell University have physically detected a mass of just 6.3 attograms. The work was carried out by Professor Harold Craighead and Rob Ilic (both USA). An attogram is a billionth of a billionth of a gram, which is too heavy to lift by bending over, knees locked.

 

 

[spacesailor]

And that was the attogram that broke the camels back!

 

spacesailor

 

 

[red750]

You're right there OK. I don't know where they got the name Emergency Response. There's never any sign of response, let alone urgency.

Case in point.

 

Last night my son had a very painful ankle which made walking very difficult. In fact he has had to use a walking stick. Decided he should have it checked out, so I took him to the ER at Box Hill Hospital, arriving at about 10.50pm. Brand new Emergency Dept, opened less than 2 years ago. Only 3 people in the waiting area. Went through Triage, then took a seat.

 

The ubiquitous cleaners came through and scrubbed the floor, telling an orderly where he could and could not take a wheelchair patient. About an hour and a quarter later, we were told "You should be in the Fast Track waiting area", and were taken down a corridor and told "Sit here, we will be with you shortly."

 

Forty minutes later, at about 1.45, the nurse came back and said "This section is closing down. You'll have to go back to the main waiting area. It won't be long now." After about half an hour, with staff wandering around behind the triage counter, I asked what was taking them two and a half hours and they said they had a lot of patients in the examination area before us, a couple of intensive care patients, and most of the doctors had gone home at midnight. "You'll be next."

 

A few minutes later, a young lady and her boyfriend came in. She was limping, and said she had fallen up the stairs. Out came a wheelchair, and 10 minutes later she was called for attention. Eventually we got to see a young doctor who checked my son's ankle and asked a lot of questions, suggested they may need to keep him in till morning to do an ultrasound. Then said he had to discuss it with his boss and would be back in 10 minutes. When he came back, he took a blood sample to test for DVT, and said the test would take half an hour. Eventually came back and said "No indication of DVT, we think it's Archilles Tendonitis. Go home and treat it with Nurofen. Here's a note for your GP." Finally limped out of the EMERGENCY Dept at 3.30am. Great health system. Feeling a little tired this morning.

 

 

[dutchroll]

Unfortunately the perspective that all the doctors and nurses are sitting around on their arses after hours doing nothing is often born from ignorance (not deliberate - just ignorance of how the emergency/casualty system works).

 

Urgent casualties which are not triaged in the waiting room are usually admitted from ambulances via the emergency entrance which is not visible to patients in the waiting area.

 

Doctors can be absolutely flat out behind the scenes with patients in theatres or treatment rooms while the waiting room has the casual appearance of nothing happening at all.

 

When my wife did her 36 hour shift non-stop (actually she had a one or two hour break where she fell asleep in the tea room I think from memory) in Canberra hospital a few years back, she didn't visit the hospital waiting room once. So while the long suffering waiting room patients probably would've thought she was just bone lazy and couldn't care less about their sprained ankles or cuts and bruises, the reality was that she was sent home utterly exhausted after nearly falling asleep in the operating theatre (with still a long list of patients waiting for treatment).

 

 

[red750]

Which indicates that we need more doctors available to handle the demand.