Back Pain: Pillbillies, Drugstore Cowboys & Epidural Steroids; A Short Story of Medical Woe part … 2

It’s early Halloween; maybe that’s what’s going on. I debated leaving my doctor’s appointment after the weird intake experience. Once the nurse left the room, I pulled out my notebook and wrote why I was at the John Muir Orthopedic Center. “I don’t want to make things worst. I had persistent back pain about 15 years ago. When I mentioned it, a chiropractor, matter of factly said, don’t sit with your  legs crossed. That did it. Pain gone. I started to pay attention to my work outs and I discovered using the elliptical machines throws my right knee and lower back out of alignment. Shoulder bags and back packs slide off me; my shoulders slope down instead of out, so I stick with cross body bags. I am here because of an Ehlers-Danlos diagnosis and the recommendation I see a doctor with this specialty1. I figured there would be an examination of my hyper-mobility followed by do this, not that.“

Knock, knock; the doctor enters. “Hi, I am Dr N and I specialize in spines. what brings you in?” He takes a seat. “Hi, I’m Sheila, I have been diagnosed with Ehlers Danlos and the recommendations it I see a cardiologist and someone with your specialty”  I try to hand him my diagnosis, and he puts his hands in his lap, looks  at the wall behind me, not at me. This is insane. I lay the report on the examination table. Is he a jerk or did I violate some covid protocol? He proceeds to repeat what any google search would tell you. “There are some things you shouldn’t do, you will get worse with age and there is no cure. You need to see a cardiologist and get an echocardiogram.”  He continues to not look at me and says, “You have to manage your weight. Some physical therapy may help. You need to do strength training and do low impact things  like the elliptical machines and swimming”

I’m almost underweight, the elliptical machines mess me up, why does he not even look at me, is there a hidden camera somewhere? I jump up from my chair and go into infomercial mode, “ I am 5’6” and weigh 118 pounds, I don’t have a weight issue.” Pulling up my sleeve, and making a muscle, I continue. “I’m 18% body fat, I am pretty lean and muscular. My issue is the I can bend completely backward and touch the floor.” I demonstrated by doing a backbend. “I am 63 years old, I can do what I just did and yet pulled my shoulder out when I got here just taking my coat off. I hurt all over and it was recommended that I see you. You don’t have anything to say?” I asked returning to my seat. “No,” he says standing “see a cardiologist” and he leaves.  

What in the name of medical dysfunction just happened? Was Josh Whedon secretly filming a second season to Dr Horrible? There were 3 opportunities to stop this madness before this waste of 5 minutes with Dr. N since he does “spines only and apparently but he never said it, does not work with Ehlers Danlos.  I noted this condition when I made the appointment and asked that it be validated that I was seeing the right doctor. I said that when I checked in with the receptionist and I said it with intake zombie.2 They all could have said Dr. N does spines only. Nah, I believe myself to be a “filler patient.“  I was someone the doctor could be done with in less than 5 minutes.  People like me give him room in a schedule that has patients stacked 15 minutes apart. The official rationale of why none of those 3 interactions ended with Dr N does spines only is those three  are health care workers not medical professionals and therefore unable to render anything that could be construed as a diagnosis. Am I making excuses for mediocracy? But then, it started to make sense.

The Orthopedic doctors were on the third floor. I was told suite 300 (third floor) when I made he appointment.  But Dr N was on the first floor in urgent care. I recalled a news report from spring. Shots given in urgent care cost more; there is a facility usage fee. In the case I heard about on NPR, a copay of  $30 for a  shot in the doctor’s office increased to a copay of $364.58 when not given in a doctor’s office because of the facility usage fee. 3 Hmmm, the plot thickens. Physicians with a specialty like Dr N give epidural steroid shots for pain. Now I understood why I was asked my pain on a scale of 1-10 without any reference with intake zombie2. Report pain, get a shot, doctor gets paid…a lot.

I am part of the problem. With only a $25 copay, will I even remember to look at the total cost of  a less than 5 minute visit with a doctor who would not even look at me? Will the bill even arrive in 2021? The language and behavior I found to be odd and frustrating was to keep the facility and doctor from any medical liability. Neither intake or the doctor would even touch the expert opinion I arrived with let alone read it or discuss.  The Yelp reviews for Dr N were polarized. Those thankful for an injection to stop pain and the others who sounded like a variation of my experience for an average of 3.5 out of 5.

For as much as we know about the dangers of OxyContin, doctors are still prescribing twice as many opioids for pain. From July 2020,

“We’re 5% of the world’s population, but we consume 80% of the world’s prescription opioids,” said Dr. Jonathan Chen, a physician and researcher at Stanford University Medical Center who studies prescribing patterns. 

Doctors And Dentists Still Flooding U.S. With Opioid Prescriptions

The federal government has passed opioid legislation to deal with this “drug”problem. But reading the legislation from this bipartisan solution, does not give me hope. The highlights are people who were legally prescribed opioids now fall under the American’s with Disabilities Act and are entitled to all provisions granted. There is continuing education required for doctors, clinical guidelines, best practices and prescribing limits and funding for alternative non addictive treatments. Aha. Follow the money and this is where Dr. N aka Dr “I do spines” comes in.

Dr “I do spines” specializes in spinal injections, When he said, “I do spines” I now realize it was code, an invitation to have a different conversation. Saddle up you pillbillies4 and drugstore cowboys5, drag your wounded arses into orthopedic urgent care and get an epidural spine injection. You won’t get that opioid hit and you might not even get pain relief, but Big Pharma reigns. Yee Haaa. This quote is from October 2012 – 9 years ago and he practice is even more common now.

The use of spinal injections, which have been around for 50 years, has been growing rapidly with one study reporting a 629 percent increase in Medicare expenditures for epidural steroid injections over the last decade.

Back pain injections can cost as much as $600 per shot. Insurance will pay much of the cost and there are often a lot of shots given. Sadly, there are lots of programs all over America that advise you on the Internet and in newspaper ads to come in and get a shot for back pain before trying anything else – that’s just lousy medicine.

Many needlessly getting steroid injections for back pain, bioethicist says

Halloween trick or treat came early for me. The trick was my medical tale of woe. The treat, two weeks of content for a blog post. Insert big smile here. Time to be no tricks and all treats. Enjoy your week and do something that brings you joy.

1Physiatrists specialize in a wide variety of treatments for the musculoskeletal system – the muscles, bones, and associated nerves, ligaments, tendons, and other structures – and the musculoskeletal disorders that cause pain and/or difficulty with functioning. 

2 See last week’s post: Contraindicated: Should I Stay or Should Go; a Short Story of Medical Woe…part 1

3Her Doctor’s Office Moved 1 Floor Up. Why Did Her Treatment Cost 10 Times More?

4a person who gets their high by way of prescription drugs

5Someone who is addicted to pills, prescription pills. 

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