Sandy Brown, MD

Disclosures

January 25, 2007

It started as a pain by my left scapula, which I wrote off as a muscle spasm. But, despite heat, rest, and tincture of time, it didn't go away. Instead, it spread down my left shoulder and into both my arm and hand. Eventually, it caused my first 3 fingers to tingle. After it persisted for several weeks without letup, I realized that this was not a mere muscle injury; this was full-on radiculitis. Somehow, calling it a "pinched nerve," as my patients did, did not do it any justice. This was really painful. . . and worrisome.

As I only had major medical health insurance, I groveled before Michelle, the MRI tech, to ask for a cervical MRI on the q.t. She was happy to oblige. "Those MRs are too darn expensive anyhow!" she exclaimed.

The study revealed some foraminal narrowing at the C5-6 level and some osteophytes, but little else in the way of pathology. "Hey," I said to Russ, the radiologist, "Little old ladies have worse spines than mine and they don't have my symptoms." "I know," Russ said. "Sometimes, the x-rays don't explain the whole clinical picture. But these are definitely not normal. At least there aren't any bulging or herniated disks. Why don't you let another clinician see the x-rays and give you an exam?"

That was an excellent idea. I emailed Richard, our local neurologist, and told him about my symptoms. I was slightly apprehensive, as Richard was usually somewhat dogmatic in his approach and liked things done his way, but why not get his opinion? This was within his bailiwick, wasn't it? He called me in, examined me, and concluded that I had C5-C6 radiculitis. "So how do I get better?" I asked. Richard's regimen was to wear a rigid cervical collar 24/7 and do halter traction for 4 hours a day -- an hour on, an hour off. "Wow, that's pretty radical, isn't it," I said. "That's what you have to do to avoid surgery," he explained. "Plus, it may not even work. Let's give it a month".

I lasted a day. Besides being extreme, it just wasn't doable for me, with my schedule of going to work and seeing patients. And, like a proactive patient, I was asking other doctors what I should do -- neurologists, orthopaedists, neurosurgeons -- whoever would listen. No one else told me to do what Richard had prescribed. In fact, everyone's advice was so completely different, I could only surmise that there was no true standard of care for my condition. Between intermittent hangings and keeping my neck in a brace when it ached, I tried massage, heat, ice, Yoga, physical therapy, acupuncture, and chiropractic manipulation. I also took many drugs: NSAIDs [nonsteroidal anti-inflammatory drugs], Neurontin, Flexeril, and an occasional Vicodin. Nothing helped, although I sensed things were improving. I wasn't sure what to ascribe it to, but I knew it wasn't from overusing the collar or excessive traction.

Two weeks later, Richard called to see how I was doing. "Pretty good," I said. "It doesn't hurt to move my head from side to side anymore." As soon as I said it, I regretted it. "Why are you moving your head?" Richard asked. "You're supposed to be in the collar." It took a bit of quick thinking to qualify that I meant when I moved my head while showering. Somehow, I couldn't summon up the courage to tell Richard his treatment was medieval, and not supported in any literature I could find. "Keep it up, Sandy, and you'll be back on your dirt bike soon." He laughed. "Yeah, right," I thought. "It'll take me a month to get back the muscle tone in my neck when I take off this collar I'm using for a crutch."

A week later, while going to the hospital mail room and minus my collar, I caught sight of Richard heading my way. He hadn't seen me yet, so this was my opportunity to tell him that I had failed his treatment plan or. . . dart into the bathroom. When I got to the office I told Dalia, my office manager, what had happened. She laughed. "You didn't want to get a lecture from your doctor, so you hid from him rather than get busted. That's pretty funny, Dr. Brown." "Yeah", I admitted, "I'm a real wuss. Now I know how my patients feel when I catch them smoking cigarettes -- unless they see me first!"

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