Thursday, December 23, 2004

Ex animo; ex nihillo nihil fit

From the font of medical wisdom have streamed soothing pearls of compassion and insightful gems of moral vision. But from that same river cesspools have formed, and out of those stench-blanketed cauldrons have crawled some of the lowest vermin that walk the Earth!

These are doctors who talk a good game; who talk about a patient's well-being with well-practiced sincerity but say the words with one eye fixed on their bank accounts and the other eye fixed on their insurance premiums. Scumbags, in other words, because the patient to this bunch of cretins is nothing more than a coded file, neatly alphabetized and summarized.

What the hell is he talking about? you may wonder. Well, I'm talking about charlatans who represent themselves as angels of mercy but who, in fact, are demons from hell with no higher wish than to fill their lives with bigger and better toys, homes, cars, yachts, etcetera, ad infinitum.

These trumped up little demigods demand absolute surrender in order to feel like they're important, though their knowledge is nothing more than technical data about the human body. Of course, when applied with a modicum of humanity and care, that knowledge can be highly efficacious, often resulting in seeming miracles (though I would submit only one Being produces true miracles).

On the other hand, the lowlifes to whom I refer when I slap physicians with criticism and, yes, revulsion, are plentiful and are undermining medicine irretrievably. Patients die everyday because some doctor screwed up, either by neglect — willful or otherwise — by ignorance, by carelessness or by sheer lunacy!

The number of physicians who actually practice medicine ethically, heroically and selflessly are few indeed, though some do exist, I'll grant you that.

But more often than not, the doctor you wind up with, no matter your condition, will have dozens of priorities that outweigh patient care.

I give you a real example: A patient who received facet numbing (it's a procedure involving injecting steroids and anesthesia into specific spinal points; who then moved on to nerve ablation (actual burning of nerve endings so as to damage them, thereby obliterating pain signals that normally would emit from same; and on to catheter implantation whereby a surgeon opens a hole in the spine, inserts a temporary catheter through which steroids and anesthesia are injected — usually for three days but sometimes for up to 10 days in a row; and onward to the morphine pump implant, whereby a little impeller machine (a pump) is implanted under the skin near the abdomen and a port is left open at the exterior of the skin. The pump is then programmed by computer formulas that deliver set amounts of medication on a schedule determined by the physician; and these are just the early stages of "pain management." Cocaine is used frequently — literally hammered into the sinus cavity with brutal force so that the cocaine is hard-packed and dissolves slowly over a period of days. The idea, of course, is to deliver pain relief to specific brain sites. Needles are inserted into the cranium through the temples, usually just above and forward of the ears, and specific never endings are fried with electric current or laser light. On and on it goes, and if the patient remains in agony, somehow it's the patient's fault and they are summarily branded "noncompliant." Now remember, the word "noncomplaint" when it comes to pain management is code for drug abuser - though nothing could be further from the truth in this actual case. But legally and medical speaking, the word does the trick, allowing the frustrated physician to dump the patient and retrain his/her pristine reputation (if such is the case).

Now we've all heard of people who've been framed and who paid dearly for crimes they didn't commit. But pain physicians condemn patients everyday for no better reason than that they find themselves unable to produce a "miracle" cure and, therefore, face the possibility of having that patient's file sully their golden reputation, which is of course based on their "success" rate.

A lot of pain specialists talk about improving the patient's "quality of life." I've even had one world-renowned pain specialist tell me that he's never concerned about the type or amount of medication he has to prescribe so long as the medication is beneficial and, on balance, less harmful than the pain when it comes to "quality of life." This lovely phrase is empty rhetoric in the mouths of MOST pain specialists and the proof of that is evident in the way patients who don't respond to invasive procedures are treated once they reach a breaking point and prefer to live their lives dependent on medication. Hell, the video they show patients who're considering morphine pump implantation raves about the marvelous change in the quality of life after having the pump placed. Testimonials sing the praises of how much freedom and mobility pump-patients regained and how, despite the physical dependence created by long-term morphine use, their lives are relatively normal again.

But the reality for more than one of these morphine-pump patients is that doctors refuse to increase the dosage or sequence of dosages based solely on their subjective determination that the patient SHOULD BE FEELING MUCH BETTER NOW based on his/her computations. They always tell you that they'll work with you once the pump is installed and raise the level of medication until a balance is found; a balance between pain subsidence and befuddlement. Some patients need large amounts of opiate medication to receive relief, some require less. But all are different and none can be treated beneficially by sticking strictly to formulas provided by the pump manufacturers. But that's exactly what happens in most cases I've encountered. The doctor makes an adjustment on the second or maybe even the third visit. But after that he/she grow impatient and adamant about regulating the amounts of morphine (or whatever) delivered to the patient, and the frequency with which those doses are delivered. Too bad if the patient complains that he/she is still feeling excruciating pain — it simply must be psychosomatic far as these medical pundits are concerned.

How would you feel if someone lopped of your thumb, tied off the wound with a string and applied some benzocaine at the site, then told you that's adequate to treat your PAIN? Well, if it did reduce the pain to a tolerable level you'd feel OK, right? But if it didn't begin to touch the pain and your pleas for mercy fell on deaf ears or worse, if your pleas were treated as a sign of manipulation on your part rather than the truth of your pain, how then would you feel?

This is what happens in the world of pain management all too often. And it's disgusting, immoral, outrageous and unethical! These physicians ought to be banned from practicing medicine or relegated to doing research on dogs and mice, since those critters can't complain too loudly or with any rational clarity.

To ALL you pain docs who've dumped patients because you: A. Didn't want to deal with a difficult case (meaning you'd have to adjust that patient's meds for years to come; B. Were frustrated with your lack of success after all the cutting, burning and probing with needles and, therefore, decided to discontinue the patient's care; C. Decided you didn't want to expose yourself to questions from the state Board of Public Safety, the DEA or any government agency that might question your treatment (this is common with pain meds and yet, you're the professionals who prescribed these meds in the first place and, in most cases, upped the dosages and maintained the patients' regimen for months or years; or for those of you who've simply informed a patient that they would no longer receive your ministrations and would no longer prescribe the powerful, physically addictive medications that you've prescribed for many months with no explanation at all other than a four-paragraph letter leading with that most powerful word "noncompliance," as in "as you know, you have violated our clinics policy and are noncompliant." Never mind that the patient "as you know" is clueless as to the reason why he or she is being summarily dumped on the street with a physical drug dependence problem on top of a chronic pain problem; I say to you, I hope you get yours in triplicate!

If there is a God who balances the scales of injustice, you will suffer the pain and indignity you inflict on your patients in copious doses. I'm sure one of the worst things that could happen to you unscrupulous, arrogant pricks is to lose your Swiss chalets, your new Lexis and Mercedes and your trophy wives, but I pray that's only the beginning for you!

Sneer, as I'm sure you will, but you know in your black heart that you've done wrong, WRONG, and you deserve punishment commensurate to your misdeed!

For you patients who've had to suffer through the cycles of circus-like acts such physicians demand of you, my heart bleeds compassion for you and I send you prayers for deliverance from your pain — little respite in that, I know.

So if you find yourself in chronic pain and at that point of desperation that you're willing to subject yourself to ANY medical invasion, know that you'll be giving up your freedom to choose, your ability to live as you like. Your lives will be enslaved by a physician who may or may not give a damn about you as a person. Really, you'll be turning your well-being over to someone who may have as much conscience as the corner smack dealer, perhaps even less. So open your eyes before you take that step. It may lead to a long drop from high cliff!
Happy New Year!

Tuesday, December 21, 2004

The sad fact is, ignorant dilettantes crafted the war on drugs — what a waste!

Thinking about the experiences several friends and acquaintances have relayed to me concerning their experience with physicians, specifically so-called "pain specialists," who've created more pain and added to their unendurable lives a load of emotional confusion and fear unlike any they'd known before trusting their bodies care to these cowardly specialists, I am angry and frustrated at the callous disregard for the patients' needs these charlatans consistently (almost) apply when ministering to their "needs."

I put needs in quotes because it seems that the physicians who've set themselves up as arbiters of pain amelioration are, from the start, phonies at best; at worst, egomaniacal freaks who want to control their patients' lives, or at least that's how it appears.

In more than a few cases here in lil' old Lubbock, I've talked with pain patients who've had doctors who refused to listen to their complaints about lack of efficacy, choosing rather to tell the patients how they "should" feel after taking the prescribed medication and submitting to the surgery du jour. As a result, the physicians create groups of morphine- oxycontin- methadone-addicted folks who MUST consent to any indignity to get their medication, up to and including dangerous surgical procedures that may or may not produce beneficial results. The issue here is, is the patients' needs paramount, is the pain these doctors are supposed to be addressing in their practices really what they're trying to ameliorate? Or is it the doctors own careers that are at the heart of every medical record installed in their voluminous filing systems?

Many, many times pain patients are ousted from clinics or private practices without explanation or reason. All the physician has to do is scribble one word on a piece of paper and he or she is immediately free — legally and medically speaking — to blithely dump a patient on the street, sick, in withdrawal from taking opiate-medications for, in most cases, months or even years, as prescribed by these same doctors. The one word, by the way, is "noncompliant." That word alone describes to the medical world a plethora of possible actions or inactions on the patients' part that COMPELS the doctor to dump the bewildered patient. But what does it mean, really? In the murky world of pain management, noncompliance can mean anything from refusal to accept the next surgical procedure the doctor(s) would like to try, to outright abusive use of the prescribed medications.

In any case, that single buzzword gets the physician off the hook with his/her peers for any questions related to medical necessity or medical ethics that might arise if a patient squawks about being summarily dismissed by said physician(s).

What is happening, in many, many cases, is that pain specialists — an already marginalized, suspect group among mainstream physicians because they deal in (gasp) opiates and other addictive medications, sometimes prescribed for, as mentioned, years, are running scared from the DEA and, more often, their state boards of medicine enforcers - in Texas, the minions of the attorney general's office.

Because many times these "specialists" attack the pain on the front end with large doses of strong medicine while coaxing the patient into accepting more and more radical surgical procedures - procedures, I believe, that are often utilized to both try and alleviate the patients' pain and cover the physicians' collective asses (pain is such a subjective condition and so little is truly known about its pathology - is it emotional or physical? is it damaged nerve endings or gross injury that precipitates the condition? - that these "pioneers" who try and treat the suffering patient must keep one eye on the DEA and one eye on the patient. This situation inevitably, it seems to me, except in the cases where surgical outcomes are successful, lead to the patients' dependency on one or more pain-relieving medication and puts the doctor squarely under the spotlight of suspicious anti-drug agents, be they federal or state or both - create a conflict between medicine and law enforcement. And law enforcement, without a doubt, will out in ALL cases.

Hence, if a physician is challenged, say, by some youthful, energetic Department of Public Safety agent tasked with nailing drug-seekers and plain old addicts (all in the best interest of society, of course), the physician will, more often than not, err on the side of covering one's ass and immediately dump that patient - for cause or not. Forget that the physician has been prescribing the medications, doing the surgical procedures, etcetera. The premise is that the poor physician has been duped all along; that all those sophisticated tests, MRI imagery and X-rays lied, as did the patient, and the real issue is simply one of a drug addict trying to get a legal fix. Am I wrong? I think not!

Too much evidence leans in the direction of condemning these so-called pain specialists for being cowardly, unfeeling, unethical boobs if they're ever questioned by a legal authority, never mind that the legal entity has no standing in medical circles. Never mind that the patient, in most cases, has no record of drug abuse or arrests for drug use. All it takes for the the physician to duck his/her head into the proverbial sand is a visit from one of the state or federal drug lords' minions, and voila! Another one bites the dust!

The patient is then faced with the prospect of having been branded a "noncompliant," which in medical-speak means "drug-seeker," make no mistake about it. And this moniker, of course, makes it almost impossible for the patient to find another "pain specialist" who'll take responsibility for treating the patient, despite the fact that he or she may still be suffering miserably - in fact, suffering more so since they are, of course, drug-dependent after being prescribed strong opiates (or other physically addictive medications) and will inevitably feel the pain of withdrawal.

More on this later (I've got to run an emergency errand).

But to digress slightly from the path of this tirade - though not too far - I give you a link to check out, if only for its interesting reading.

The War On Drugs: The beginning ...Really, it's just food for thought.

Back soon. Merry Christmas and Happy New Year (if that's your thing)!