Fads in Fashion Are Fine, but in Medicine?

If you've had chronic pain for the last decade, as I have, you know exactly what the title refers to. If you haven't, you probably think that fads are limited to fashion, music and social networking, but medicine is ruled by science.

Yeah, not so much.

Medicine is ruled by fads, and no, that's not good for the patient. Yesterday, I left my doctor's office with a prescription for Sevella. I've never heard of it, so I looked it up.

Milnacipran is not used to treat depression, but it belongs to the same class of medications as many antidepressants.

Sevella is an SSRI/SNRI, putting it in the same group as Prozac and Wellbutrin (Zyban if you're quitting smoking). When my pain first sent me to doctors for relief, tricyclic antidepressants were the fad, so I took Elavil. Fifteen days after starting Elavil, I tried to kill myself. After that came the first wave of the fad of treating chronic pain with SSRI/SNRIs. "But I'm not depressed," I protested and was assured that these new antidepressants had no effect besides pain relief if you weren't depressed. I can only assume my doctor got that line from the drug rep, because it's not true. My reaction was not unique. Prozac left me despondent, crying until I literally ran out of tears. Wellbutrin turned me into an avatar of rage and I found myself screaming obscenities at some poor guy named Tim when my cable went out. (Sorry, Tim.)

My doctor knows this, I've told him these stories in great detail. My file should have "NO ANTIDEPRESSANTS" written on it in red pen.

After that was the fad for Neurontin, an anticonvulsant. The drug reps were pushing it hard for disorders other than epilepsy, and doctors treating pain patients were delighted to play along, even though there was no evidence that Neurontin did anything for chronic pain. It didn't do anything for me, and my doctor at the time told me that Neurontin was the gold standard for chronic pain and if it didn't work for me, maybe I just liked narcotics too much.

Not one fucking study, no science at all, just a drug rep's assurances, and I was a junkie.

After that came Lyrica. It was a miracle! We would all be saved! I got so dizzy I couldn't stand up. "Wait for it to pass," my doctor said, "This stuff is worth it." I did eventually learn to walk somewhat straight, but my pain didn't go away. After six months, I gave up, but to this day, I still have balance problems, and if I turn my head too fast, I fall over.

Last year, right before my doctor's visit, I saw an ad for Cymbalta. "Here we go again," I said. "He's not going to give you that," my husband said, "He knows what happens to you on antidepressants."

As soon as he walked into the exam room, my doctor was singing the praises of Cymbalta. "Angels deliver it directly from heaven!" I'm paraphrasing, but he was pushing this stuff like the manufacturer had sent an assassin to his house and was holding his family hostage until he prescribed enough of it.

I'd had enough. I refused. He threatened to stop my pain meds unless I tried it. I took the sample pack- and then went home and threw it away. I told him it didn't work, but I had tried.

This year, it's Sevella and everyone's getting a scrip! Pink is the new black, belts are the new gloves and Sevella is the new Cymbalta. Here's a look at the side effects:

Milnacipran may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• nausea

• vomiting

• constipation

• stomach pain

• weight loss

• dry mouth

• feeling of extreme facial warmth and/or redness

• increased sweating

• headache

• dizziness

• blurred vision

• difficulty falling or staying asleep

• decreased sexual desire or ability

• pain or swelling of the testicles

• difficulty urinating

• rash

• itching

Would you prescribe that to someone who just got done telling you that they can't sleep and their gallbladder is sending them to the ER every three weeks? If so, you have what it takes to be a pain doctor- a fantastic commitment to fads and a sociopathic unconcern for the wellbeing of other people!

I can't wait for next year.

Some People Are Lucky I'm Not the Incredible Hulk

I had a doctor's appointment today with the doctor who treats my disintegrating joints. In order to attend this appointment, I woke up my mother-in-law at 8am (she doesn't get home from work until midnight), I lied to work about oversleeping (because we're not allowed to take time off for doctor's appointments), and I failed to fully pay the PP&L (electric) all of what I owed so I could come up with the $50 copay. I fucking worked to be able to see this doctor.

Which is why I was especially enraged when, about two minutes into the appointment, another doctor opens the door without knocking- I could have been undressed, mind you- and starts talking to my doctor about a patient with Crohns Disease and a fulminating knee.

Does my doctor say, "Hey, I'm with a patient here, you'll have to wait"? No, he does not. He explains that the fulminating knee thing is a symptom of active Crohns and the other doctor needs to get that under control. They then proceed to debate just how fulminating the knee needs to be before simply addressing the Crohns isn't enough.

IN THE MIDDLE OF MY FUCKING APPOINTMENT.

But wait, there's more. With absolutely no apology, we return to my appointment only to be interrupted again by a nurse with a picture of a stomach polyp*. They proceed to debate whether or not some medication can be given to the owner of the polyp.

IN THE MIDDLE OF MY FUCKING APPOINTMENT.

Look, I'm sympathetic to people with Crohns Disease and polyps. They certainly deserve every effort on the part of their doctors. Just not IN THE MIDDLE OF MY FUCKING APPOINTMENT.

I felt like asking for a reimbursement on my copay based on the percentage of the appointment that was devoted to other patients. And beating a few people with a chair. Also.

*On her iPhone. There really is an app for everything.

Do Doctors Realize How Stupid They Sound?

Me being still obsessed with my complete inability to eat anything, I'd like to share two conversations I had in the ER early Tuesday morning. Both of these happened while I was on a lot of dilaudid, mind you, so I was a bit more, um, direct than I usually am.

Conversation 1:

Dr: We need to test the function of your gallbladder.

Me: Okay.

Dr.: We can't do it right now, you'll have to schedule it later.

Me: Okay. So what does that involve?

Dr.: They'll inject a nuclear dye into your gallbladder to make it spasm-

Me: Wait, wait, wait. Isn't spasming what's going on right now? That's what's causing the pain, right?

Dr.: Well, yes, but we need to see-

Me: So you expect me to walk into a room knowing that I'm going to leave feeling like this, only without the dilaudid and the toridol?

Dr.: Well, yes, but in order to-

Me: Just how many different kinds of crazy do you think I am?

Seriously, how do you say that to someone? "Hey, I've got a great opportunity for you to deliberately feel the sort of pain that makes you beg for death! Sign up now!" Um, no, I'd rather not.

Conversation 2 (after 4 shots of dilaudid and 2 of toridol):

Dr.: If we can't get your pain under control, we'll have to admit you.

Me: And do what?

Dr.: What?

Me: What are you going to do on the 8th floor that you aren't doing here?

Dr.: Um, well, we can work on controlling the pain.

Me: You just gave me enough dilaudid to knock out an elephant, does the dilaudid work better the higher up you are?

Dr.: No.

Me: I can't sleep on dilaudid. I can't stop grinding my teeth on dilaudid. I'd like to go home, wait for the dilaudid to wear off and sleep in my comfortable bed with my pillow that smells like me. I don't see how being in some overly bright room with some roommate who wants to watch Fox News at top volume would be any better.

Dr.: I can't release you with uncontrolled pain. It's against hospital regulations and it's unethical.

Me: and I have insurance, so those things matter, I suppose. My pain's all gone now, get this IV out and send me home.

Really, pain? Don't make me laugh. Me and pain are old friends, the kind that can't stand each other anymore, but we've been together so long we don't know what else to do. Ethics? Every doctor I've ever seen undertreats my pain deliberately because they're scared of the DEA or they think I'm lying, but all of a sudden undertreating pain is unethical? Like you'd care if I didn't have insurance? Fuck off.

This Really Cannot Be Said Enough

(I won't link to the blog post that sparked this, but suffice it to say that yet another person finds mental illness shameful and doesn't want to seek treatment.)

When I first met my SIL, she had been diagnosed with bipolar disorder for several years and had been struggling with it for years before that. It took a long time to get the right medications in the right doses. She, in and of herself, was eye opening to me, in that she was the first person I'd ever met with a mental illness who discussed it as openly and unashamedly as one would discuss a physical illness*.

The same way I would say, without shame or reserve, that my hips are painful and stiff today, she would say that she found herself considering an affair during a manic state. The same way I would say that I couldn't keep up with housework, she would say that she demanded hospitalization because she couldn't appropriately mother her children.

That amazed me, and it shouldn't. It really cannot be said enough: illness is illness. You have no more control over your brain than you do over your pancreas or your bone marrow. So, unless you would be deeply ashamed of and not seek treatment for diabetes and leukemia, go to a doctor. If you are desperate and in constant agony, you need help. It doesn't matter whether that agony is . . . well, I was going to say in your body or in your brain, but pain is in your brain. Without my brain to react to it, my foot can't hurt.

Pain is pain, illness is illness and nobody needs to suffer. And nobody needs to be ashamed of falling ill. Diabetes is not evidence of weakness, kidney stones are not evidence of laziness, and obsessive compulsive disorder is not evidence of either. By the way, if you could wish yourself better, you'd have done that by now, so get to a doctor, okay?

*I'm using the distinction for conversational purposes, but really it drives me nuts. The brain is physical. Mental illnesses are the result of abnormalities in the functioning of the brain, and are therefore physical in nature. The distinction we make between mental and physical illness is meaningless and dangerous besides.

The Problem is Bigger Than That

[trigger warning: explicit descriptions of medical procedures and childbirth. If this will upset you, please visit the otter instead.]

There's been a lot of talk lately about trauma women in labor experience at the hands of medical professionals, a/k/a "birth rape"* The stories are horrific, but, in my opinion, developed after ten long years at the mercy of medical professionals, this ruckus totally misses the point.

The problem isn't that women in labor are uniquely in a position to be victimized by medical professionals. The victims of such medical professionals are not uniquely women in labor. In other words, you don't have to be a woman in labor to be victimized by a medical professional. You simply have to be in a room with certain medical professionals.

Case in point: a friend of mine needed a lumbar puncture (spinal tap) in order to tell if he had Multiple Sclerosis or Lyme Disease. These two diseases can cause similar symptoms and similar MRI results, but have vastly different treatments, so distinguishing between the two is necessary. My friend is a large man, so he needed to have the lumbar puncture done at the hospital by a doctor.

Before the procedure began, the nurse told the doctor that the needle they had was too large, they needed to get another. "Too bad," snapped the doctor. He had a schedule to keep, he had a golf game to get to. Waiting for someone to get the correct needle would take too long, so, before my friend could object, doctor forced the needle into my friend's spine. When I say "forced", I mean forced.

I could hear him scream from down the hall.

Then, to add insult to injury, the doctor refused to draw enough cerebral spinal fluid to allow for

two tests. "We've got enough to test for MS, what more do we need?" he said.

That's right. This doctor tortured a man so as not delay a golf game and didn't even get the damn test done.

My friend still doesn't know what is wrong with him and he's likely to die without knowing, because he's not going back for another lumbar puncture.

That is exactly the same arrogance that leads to this:

The quickest example I can come up with is the time a doula friend of mine heard the OB say while a VBAC mom was pushing (pretty much under his breath, I don’t even think the mom heard this): “It’s the LEAST you can do for your VBAC” and he put one end of the scissors in her vagina and one in her anus and cut her a 4th degree episiotomy. No fetal distress, no reason beyond what I guess was his irritation at not just doing a repeat cesarean?

The problem isn't women and it isn't birth. It's doctors. It's doctors who think that eight years of medical school and a fancy title give them rights over other people's bodies.

I have had many, many tests and procedures performed on me in the last ten years. Every time the test was done by a technician, I received a description of the test beforehand, was told what level of discomfort or pain to expect and invited to speak up if I needed to during the test. The man who gave me my first nerve conduction study had done it to himself twice just to see what his patients would be experiencing. (NCS involves repeated electric shocks to test how the nerves conduct electricity.)

Teh Hubby once took three hours to complete an MRI because the technician allowed him to stop and calm down in between cycles. MRIs should take 40 minutes or so, but she was unfailingly kind the entire time. Not once did she display the slightest irritation.

Every test or procedure performed by a doctor came with exactly the same concern I feel for the potato I slice for dinner. Once, I demanded that a doctor stop a test (that can be stopped at any time, which I know because a technician had allowed me to stop the test the previous time I had it done) and he laughed at me.

What needs to be done is not tell women what they can do to stop abuses during labor. We need to talk to the doctors, before they ever see a patient. We need to remind them that it's not their body, it's not their choice, and they won't have to live with it afterwards. We need to remind them that abuse is abuse is abuse, and we need to start prosecuting accordingly.

For everyone.

*NOT my term. I think it's inappropriate at best to use the word "rape" that way.

Depression Rating Scales and Chronic Pain Patients

I, as a person with chronic pain, frequently get accused of being depressed, by family, friends and medical professionals. I wouldn't mind it if this were genuine concern, which sometimes it is, but in the case of medical professionals, it's generally a brush off. "You're crazy, I don't have to deal with your medical issues." It's a lot easier, and safer, for a doctor to refer me to a psychiatrist, than to prescribe me painkillers in a strength and dosage that actually works.

Consider this: five years ago, I was on (DUMDUMDUM!) 20 mg Oxycontin with Percoset for breakthrough pain. Yes, the evil, dreaded hillbilly heroin- or, as I called it, 12 hours of effective pain relief that allowed me to live my life. I took this medication exactly as prescribed. I never "lost" my medication or took too much or anything else, so I was a little surprised to be downgraded to Vicodin, with nothing else. And then be accused of being depressed. By the same doctor that had previously had no trouble prescribing me Oxycontin in the first place.

I was surprised, that is, until I saw a local doctor sent to prison for "overprescribing". Then it all made sense. The DEA wanted to make some kind of point, so I got screwed. And my doctor couldn't tell me that, so he used depression as an excuse.

What's even worse about that is that chronic pain patients will score as being depressed using depression scales. Why is that? Well, let's look at the symptoms of depression:

Feelings of: Sadness, hopeless, helpless, worthless. Well, sure, I'm sad that I'm in pain. I have no hope of it getting better, and I am helpless to do anything about it.

Feelings of guilt. Yeah, I do feel guilty about all the stuff I used to be able to do and can't keep up with anymore. It's not my fault, it's the pain, but guilt isn't entirely rational.

Insomnia. Break your leg. Now go to bed. Oh, you can't sleep? How odd.

Loss of appetite. Break your leg. Now try to eat a nice, steak dinner. What's that? You don't want to eat? That's weird.

Difficulty keeping up with work and other activities. Break your leg. What? You can't go to work? You can't mop the floor? I wonder why.

Loss of libido. Break your leg. Wanna fuck? No? Freak.

General somatic symptoms. Heaviness in limbs, back or head. Backaches,

headaches, muscle aches. Loss of energy and

fatigability. Well, yeah, that's my entire problem. Oh, it's all in my head. C'mere, I need to break your leg.

slowness of thought and speech, impaired ability to concentrate, decreased motor activity. Break your leg. Now recite the Quadratic Equation. No, that's not it, you must be depressed.

Agitation, including fidgeting, playing with hands, hair, etc., moving about, can't sit still, biting hands, nails, etc. Break your leg. Now why can't you sit still?

Hypochondriasis (and this one's especially offensive) self absorption, preoccupation with health, frequently asks for help. Break your leg. Why are you so obsessed with this leg? Why do you keep bothering me about it? Why are you so self absorbed, I have feelings, too, you know.

Now, imagine being a chronic pain patient and being asked to fill out that depression assessment. Imagine being a chronic pain patient, begging your doctor for help with the pain that is destroying your life, and having him suggest to you that your real problem is that you're depressed, not that you're in pain. Imagine being told that repeatedly by people who haven't spent 5 minutes in your body and are really just trying to get out of dealing with you.

Yeah, I'm a little bitter.

All I Know About Science

gene therapy, disabled, abortion, christian, atheism, doctors, science,
I learned from Jurassic Park.

That was the shortest shorter Ken Connor of The Christian Post.

Recent reports of an unprecedented development in gene therapy indicate that humility before the mysterious and awesome power of nature is a lesson mankind has yet to learn. Like Crichton's Hammond, the scientific community seems unable to resist the Siren song of "discovery," even when the future of humanity may well be at stake.

shorter Ken: I know fuck all about gene therapy, but it scares me. All science does.

The field of genetics has been viewed as the last frontier of biological science, and with good reason. Unlike other forms of medicine that are applied at the individual level-e.g., mending an artery, fashioning a skin graft, or removing a tumor-genetics involves manipulation of the very building blocks of life. Manipulation of genetic material can affect not only individuals, but generations yet to come. That's why some scientists are celebrating after successfully replacing "faulty" genetic material of one female monkey with genetic material from another female monkey to produce several apparently healthy offspring from the genetically altered eggs. Many in the field are excited at the prospect of using this technology to help women with genetic maladies produce healthy children-despite "a host of safety, legal, ethical and social questions" that should give them pause.

I still don't know anything about gene therapy, but if women, even monkey women, are benefitting from it, I'm against it. And I like to put quotes around random assortments of words for no apparent reason.

It is easy to understand the altruistic impulse that drives many scientists to push the limits in pursuit of eradicating diseases and disabilities; but, as they say, the road to hell is paved with good intentions. Scientists and society must weigh the potential benefits of any given scientific "advance" against the costs of any unintended consequences. If we allow ourselves to be guided solely by our passion to break barriers and our irrepressible desire to play God, we could end up the authors of immeasurable damage to the whole human race.

Those scientists, always showing off and trying to disprove god. They couldn't possibly be motivated by a desire to help people by permanently curing such horrific maladies as Tay-Sachs or hemophilia. (Hey, if god wants you to watch your baby bleed to death from a scratch, that's what you should do. He's love, you know.)

Thousands of years of knowledge and discovery have illuminated much, but when push comes to shove doctors and scientists still wonder at the miraculous poetry and precision on display in the workings of life on earth. Of course, things sometimes go wrong. Nature does not always work the way we would like; but considering the vast complexity of the natural world, it is amazing that nature malfunctions as infrequently as it does.

It's not like scientists know everything, and until they do, they shouldn't do anything. Except give me antibiotics when I'm sick and chemo when I have cancer. But other than that, they need to stop playing god. As for the "infrequency of malfunctions"? Wow, really, cuz this is a long list.

True to our nature, however, mostly good is not good enough. Human beings desire perfection on this earth. We reject the Christian understanding of sin and fallenness as inescapable features of the human condition (manifested in part by our physical imperfection and frailty) and resort to the use of science as our instrument of omnipotence. Following Margaret Sanger in the early 20th century, for a time we believed that we could breed imperfection out of the human race by controlling who could and could not procreate. Adolf Hitler extended the theory of eugenics to its atrocious conclusion with his holocaust of 11 million Jews, Poles, Catholics, Christians, gypsies, the mentally and physically disabled, homosexuals, Communists, and others. In the early to mid-20th century, patients with psychological and mental disorders became experimental fodder for doctors convinced that lobotomy was the solution for ailments now treatable through therapy and medication.

atheists like to kill people, doctors and scientists have been wrong in the past, and sure, i'll pass on a bypass and let my heart explode rather than mess with god's perfect creation. right.

Today our methods of playing God are more subtle, but no less inhumane. With our righteous defense of a woman's "right to choose" and an individual's "right to die," we assume the divine mantle of Creation and Destruction. With our embrace of bioethicists like Peter Singer-who defines personhood according to a utilitarian "quality-of-life" criteria that does not recognize the humanity of the unborn, the disabled, the diseased, or the infirm-we endeavor to remake nature in our own vain image.

wouldn't gene therapy prevent abortions related to such disorders as Down's, etc? so, less abortions is bad? oh, i get it, Tay-Sachs is good? no, i don't get it.

So it is with genetic technology. When wielded proudly, unconstrained by humility and a sense of our place in the natural order, it represents a grave danger. Whether you call it the Law of Unintended Consequences or Murphy's Law, experience demonstrates that if something can go wrong it usually will-despite the best laid plans and the best of intentions. This may be of little consequence when applied to the mundane decisions of daily life, but when we are talking about the use of a technology that could irrevocably alter the human species, shouldn't we ask whether some risks are worth taking?

so, gene therapy done whilst praying to the lord would be okay? and, yes, i think we should ask parents whose children have died of these sorts of diseases if some risks are worth taking.

look, there are legitimate questions about this sort of thing, but "why aren't they consulting the bible before making medical/scientific breakthroughs" is not one of them. asshat.