Ahmed Raslan

Fifteen months ago, I fell off a ladder and crushed my first lumbar vertebra. My internist sent me to Chris Noonan, a back surgeon. Noonan put me in a metal brace for six weeks and suggested a surgery called a kyphoplasty in which he would inject cement into the broken vertebra. I read up on kyphoplasty and found that it is of no longterm benefit, and that the cement sometimes escapes and breaks surrounding vertebra. Noonan became angry when I mentioned these things, and his anger, alongside his usual callousness and arrogance, inspired me to go to another surgeon, Jonathan Sherman. Sherman agreed with me about the kyphoplasty, and instead suggested monitoring the vertebra for further collapse. On my third visit, he announced that it had gone from 20 to 24-degrees in three months, and that a surgery called a pedicle subtraction osteotomy with thoracolumbar fusion would be necessary if it got beyond 30-degrees (in plain English, he would re-break my back and fuse four vertebra, two above the break and two below it). When I asked for further details, he refused to answer, saying that they would only upset me!

I went home and Googled the surgery and learned the following: he would cut through my belly to reach my backbone; the surgery has a 50% risk of serious complications; it would leave my entire body severely weakened; it has a very long recovery period; and it wouldn’t restore me to anything approaching normal. I also noted that it’s mostly done on people with severe scoliosis, so I questioned his competence in recommending it for a broken vertebra, and, if the surgery proved necessary, I had no thought of having it in Eugene. I then went back to my internist and asked for a referral to a surgeon in Portland at Oregon Health Sciences University (OHSU doctors see the worst of the worst). He said he would have recommended it if I hadn’t, so I started the four month wait to see Dr. Ahmed Raslan (pictured) in a sixteen story medical building that is just one of OHSU’s many facilities. My appointment was yesterday.

After an office exam, Raslan sent me downstairs for two X-Rays and two CAT-scans. Less than an hour later, I was back in his office. The first thing he said was that I didn’t need surgery. He then showed me how the angle of collapse is measured and said that Sherman measured it entirely wrong, but that even if he had gotten it right, I wouldn’t need such a surgery at 40-degrees much less 30, that is unless my back was so out of alignment that my head no longer rested above my hips, and even then, a lesser surgery should suffice. This was the best possible news.

I then told him that, between the pain in my back and the pain in both shoulders, I found it extremely difficult to sleep even with all the pills I take. He said he would send me to a pain specialist here in Eugene with a recommendation for pain-killing injections. I know what to anticipate because I’ve had fluoroscopically-guided injections into my neck vertebra, and they’re scary, but happy drugs make them downright enjoyable. I really like happy drugs.

When I write about my medical adventures, it is with the hope that those who are as naive as I once was will take note of the following: (a) the letters MD don’t, of themselves, mean squat, (b) half of all doctors are callous, arrogant, and incompetent, and (c) it is a serious mistake for the patient to simply sit back and trust that everything that should be done will be done, and that it will be done right. Even if your doctor is the best, many other “caregivers” will have an opportunity to maim or kill you (400,000 Americans a year die of medical errors, making it the third leading cause of death behind heart disease and cancer).

Two of the few things that are more stressful than medical problems are medical care and, in America, the resultant insurance hassles. The more I am exposed to these things, the more I approach them with an adversarial attitude. On the downside, this sometimes makes it hard for me to hide my hostility when dealing with greed and incompetence, but on the upside, I’ve completely lost my adolescent notion that doctors are demigods. I have also learned that it’s good to have Peggy go to doctors’ appointments with me for moral support, to ask additional questions, and to remember what was said. We all like to believe that we’re strong enough to go it alone, but the truth is that having backup helps us get better care, and the stakes are too high to settle for anything less.

Peggy (who worked as an RN for three decades) says that she needs this support more than I because doctors don’t treat women, including women who are nurses, with the same respect that they treat men, so having me there makes it more likely that her thoughts, questions, and concerns will be taken seriously. There was a time when it was widely believed that the influx of women into medicine would humanize it, but it has been my experience that women doctors are as bad if not worse than men. It’s as if they had to renounce the virtues of womanhood (empathy and attentiveness) while taking on and exaggerating the weaknesses of manhood (haste, cockiness, and a contempt for weakness) in order to complete their training. 

I came away yesterday feeling that, although the pain is as bad ever,  the road has become a lot smoother. Now, I’m just mad at that Sherman idiot for causing me so much unnecessarily anxiety.


kylie said...

thats wonderful news for you! i'm so pleased you got a second opinion.

as a group, i dont trust doctors at all and i think most of us struggle to ask the right questions so we are never quite sure whether we are getting appropriate care or not.

Snowbrush said...

I've had a few doctors that I very much trusted, but, as they say, 50% of the people in ANY given occupation are by definition below average. I think of doctors as being like car wrecks in it only takes a second for one to screw you up for life.

Charles Gramlich said...

Lana is going through many similar experiences right now. It is very tough. I hope there will be some improvement.

Elephant's Child said...

Wonderful news. I am thrilled to hear that surgery isn't in your immediate future.
After more than our share of medical mayhem I view most medicos with a degree of suspicion. And, sadly, Peggy is right. One of my neurologists ignored my talk of pain completely visit after visit. When the smaller portion came with me and agreed that it was severe the neurologist finally made (some) attempt to treat it. Hiss and spit.

lotta joy said...

If your doctor would have recommended OHSU to begin with, why were you sent to Noonan then the other idiot first. I guess I'm confusing your doctor with your internist. My beloved friend that passed last week had the cement procedure as I told you, and hers leaked, causing excruciating pain. HER pain caused the demigod to throw his hands in the air and pronounce "I am done here."

Today, after going to my doctor and telling him my pain is escalating and spreading, he said "I don't want to hear that". Joe was with me and said "This is IMPORTANT." Or I wouldn't have even been given a moment of acknowledgement. Which was ALL I got.

I ended up doing as you did: researching Google for some answers. (try telling the demigod that you have replaced him with the internet) But I still need the medication and I wish Google had an answer for that.

kj said...

after several years of intermittent back pain, my Mother had a kyphoplasty, performed by a physiatrist, and the result was nothing short of amazing. she never again complained of pain in the same way or at the same level.

you are probably going to see a physiatrist for your injection(s) and that person likely knows about the non-narcotic options for management of chronic pain. just saying, just in case.

i can't think of anything more important than refusing to settle on an experienced physician who knows how to listen and who is affiliated with with a good university or medical center.

best of luck, snow.

PhilipH said...

Absolute joy to read this post Snowy. And I'm pretty sure that most men would applaud you too.

I know only too well that there are thousands of deaths in our hospitals in the UK which are described as "avoidable", a nice euphemistic word of course.

Estimated 1000 'avoidable' deaths every MONTH in hospitals over here and probably hundreds of 'avoidable' operations, such as cutting off the left leg instead of the right! Yes, that has happened in the past.

I know that there are times when one is hospitalised owning to an accident, car crash etc. Many lives have been saved by these emergency departments who operate under great stress and pressure, BUT when it comes to seeking a medical opinion, as in your case, then you are perfectly right in saying BEWARE. Watch out, there's a Quack about! Money is of course one of the reasons that complex and dangerous operations are opined as necessary. Caveat emptor! Get a second and third opinion is the best advice, precisely as outlined in your forthright posting.

Snowbrush said...

“If your doctor would have recommended OHSU to begin with, why were you sent to Noonan then the other idiot first.”

I needed to see someone right away, Eugene was in the midst of a rare winter storm that made it difficult to even get across town without a four-wheel drive, and I was in no condition to make the 115 mile trip to Portland anyway. Also, there was some hope that the pain wouldn’t get this bad. The treatment that I was initially given here was appropriate. Even the kyphoplasty is still a common recommendation. When it first came out some years ago, doctors had high hopes for it, but the fact is that those hopes simply haven’t been realized. I don’t know if they still do it because it’s a money-maker or because they don’t have any other options and feel pressured to do something, but the fact is that it doesn’t prevent further vertebral collapse, and it doesn’t help the pain unless it’s done within a couple of weeks after the break (my recommendation came two months after the break), and even then, when you look at the patient’s pain level several months out, it’s no better with kyphoplasty than without. In other words, you might get some temporary relief, but you run a risk in doing it, and there was no way I was going to run that risk.

“you are probably going to see a physiatrist for your injection(s) and that person likely knows about the non-narcotic options for management of chronic pain.”

You’re not confusing injections of pain-killing drugs with kyphoplasty, are you? I would anticipate a neurologist/pain specialist doing them simply because that’s who did them before. I’ve been to two pain specialists long enough to get their recommendations and, in one case, a false diagnosis, so I can rattle off the options for the treatment of my shoulder pain, at least, as well as anyone. It comes down to surgery (I’ve had three of those) physical therapy, TENS, Neurontin, steroid injections, narcotics, and Cymbalta. I don’t use my TENS unit, but I take all of the recommended pills. I’m still new to the treatment of my back pain, but I’m no stranger to vertebral injections for pain because I have an osteonecrotic (i.e. dead) cervical vertebra.

“I know only too well that there are thousands of deaths in our hospitals in the UK…”

That 400,000 is a recent update that much higher than previous estimates, yet even it might be low because everyone involved in patient care has a motive for covering up caregiver caused deaths.

“Get a second and third opinion is the best advice, precisely as outlined in your forthright posting.”

I grew up thinking of doctors as if they were gods and, before she became a nurse, Peggy did too. For instance, back in the seventies, she had a growth of some kind removed from her forearm. The doctor did it in his office, put a bandage over the incision, and told her not to change the bandage before her next visit with him a week later. This was in summer in hot and humid Mississippi, and both of us thought it a very odd recommendation, but, by god, he was a doctor, so we figured he must know what he was doing. Well, predictably, the wound became infected. When you see one fuck-up after another after another, you stop trusting these people any further than you absolutely have to because despite all those years of intensive training, they still do things that are so stupid that anyone with a brain would know that they’re wrong unless that person simply wasn’t thinking. And, as you pointed out, the greed factor can’t be discounted. For instance, the more money that doctors in a given area can make from doing a particular surgery on a particular group of people (people with really good insurance, for example), the more they perform that surgery.

kj said...

Snow, usually a physiatrist (specialty in physical medicine and rehab) who does pain mgt and cortisone injections.

No I wasn't confusing one treatment with another

All Consuming said...

Well this is marvellous news!! I'm feeling a huge amount of relief for you, not just for the present news, but for the fact that you didn't have any surgery previous to finding this out, which would have been devastating. People do trust doctors too much, as I recently said in my comments to rhymes, the patient needs to take control themselves sometimes and find out on the web all the information the docs won't tell you, for whatever reason that may be. Your tenacity has saved you some unnecessary and horrible surgery, though its a shame the process has taken so long before finding the organ grinder, what with all those bloody monkeys fannying about in your path. *hugs him very pleased indeed* x

G. B. Miller said...

Gotta love doctors who are so caught up in their sense of worth/importance that they throw hissy fits whenever someone has the gall to ask them a question about something they recommended.

Good luck on the upcoming procedure and here's to living a somewhat pain free existence.

possum said...

A sad truth is, half of any graduating class is below average. That includes doctors.
Every class has someone at the bottom of the class. That includes doctors. Every graduating class probably includes someone who has a parent with enough money or influence to get the kid thru graduation. That includes doctors.

If you are lucky - and I hope Dr Raslan is the answer - you will get someone who is both brilliant and compassionate, and you will be as fine as possible given all your circumstances.

You might want to edit this out - and I do not mean it to take anything away from your experience, but it made me think of John McCain who flunked out of his military training numerous times, but was an admiral's son... He smashed a couple training jets here on the Shore, for a total of 5 planes smashed and was involved in, if not instrumental to, the worst accident ever onboard a US Navy aircraft carrier -- the USS Forrestal fire.
A doctor can destroy quite a few lives, but idiots like McPain can destroy the world. ("Bomb, bomb, bomb Iran!")

Maybe we need an honesty in advertising on grade averages (tho they can be bought) or at the very least, class rank for those who hold our lives in their hands.

As someone who was told years ago I would never walk again... I, too, have struggled with pain, avoided surgeries, and have spent most of the last 41 years with my wheelchair parked in my barn. OK, it comes out from time to time and I keep one at the Train Station and one in my van now... but I am still mostly on my feet from ignoring several doctors.
Actually, I have a chiropractor who keeps me out of that chair and has done so for over 25 years. An amazing woman. Gentle stretching, not the wham, wham stuff.
I wish you well, snowy!

Snowbrush said...

“usually a physiatrist (specialty in physical medicine and rehab) who does pain mgt and cortisone injections.”

Maybe it’s just a coincidence that all the pain specialists I know of started out as neurologists, but that’s the way it seems to be here. After all, there’s no law that says you have to be physiatrist to work in the field. As for your mother’s reaction, I suspect she had osteoporosis because that’s about the only thing this surgery is good for. Statistically, in my case, had it been done within the first few weeks, at most, after my accident, it might have led to short-term pain relief, but after several months, I would have been no better off than if I hadn’t had it done, and I would have. Sometimes, it takes new people going into medicine before worthless surgeries are finally abandoned.

“you didn't have any surgery previous to finding this out, which would have been devastating.”

I’ve had three shoulder surgeries. Two took the better part of a year to recover from, and the third took an entire year. With all three, my recovery was painful, involved sleeping for months in a recliner, using ice every night/all night, and left me unable to use the arm that was operated on for quite awhile. What I know of back surgeries is that they’re often unnecessary, unsuccessful, sometimes leave the patient in a lot more pain, and often lead to further back surgeries. This one sounded even worse than most and certainly worse than the shoulder surgeries I’ve had, so there was no way I was going to submit to that simply based upon a number. I had much rather live in quite a bit of pain than to go through such a surgery. After all, part of what got me through so shoulder surgeries was telling myself that, at least it wasn’t a serious back surgery.

“Gotta love doctors who are so caught up in their sense of worth/importance that they throw hissy fits whenever someone has the gall to ask them a question about something they recommended.”

There are some doctors who seem to hate above all things the words, “I Googled what you said and…” Right there, the doctor can either go a long way toward winning my trust, or he can lose it completely. Something else that I’ve given a lot of thought too is that I think arrogance and incompetence go hand-in-hand. The best surgeons I’ve had were confident but also humble enough to listen to my thoughts and to explain the reasoning behind their recommendations. The doc I saw last week did that.

Snowbrush said...

“You might want to edit this out”

I can’t even see everything you wrote prior to approving it, and I don’t have the option to edit anything out. However, you didn’t say anything that I would even want to edit out. McCain is an unapologetic militant, and those who like him, like that about him.

“Every class has someone at the bottom of the class.”

I’ll tell you about an experience I had. I had a good primary care doc, but he left, so I had to find another one. I didn’t have anybody in mind, and this woman named Emma Lou Junior had some openings, so I went to her. It turned out that she was black, but I just got a kick out that. Like when she did my prostate exam, and I thought it funny that a Mississippi white boy was standing in Eugene, Oregon, with a black woman’s fingers up his ass. Anyway, I didn’t initially have either a good or a bad impression of her, but it wasn’t long before I started questioning her competence. Then, Peggy went for her first visit, which was also a physical, and when she started telling Emma Lou about some problems she was having, Emma Lou said that she would have to come back to talk about problems because this was just a physical. Well, every doctor we’ve ever been too wanted to talk about our problems during our physicals, so this pissed Peggy off royally. Then, the sneaky suspicion entered my mind that Emma Lou was a complete idiot who only got through school because of affirmative action. It occurred to me that this was a serious failing of affirmative action, that is that all blacks who were less than stellar performers would be suspected of being less competent than whites because they even might have gotten through school because of affirmative action. I also had the thought that no one in his right mind would want to put his life in the hands of someone who might have been held to less stringent standards because his or her teachers were afraid of being called racist. This thought was the final straw for me regarding Emma Lou.

Sparkling Red said...

If you will excuse the expression, you are preaching to the choir on this one! ;-) I have many years of experience working with doctors, and while there are some wonderful people among them, some of them are just awful jerks. You definitely have to double-check their recommendations. Even the best doctors can and do make mistakes. Good for you for taking responsibility for your health care.

BBC said...

I've been very lucky, in almost 72 years I've had very few problems and no pains I can't deal with.

I did have a hernia repaired last year but it wasn't any big deal and I didn't take any pain meds after the operation, just bit the bullet.

Linda said...

Good humblebrag. Oh, and your point was??