Tuesday, March 02, 2010

Rheumatoid arthritis, disability, and dismay

One of my favorite patients struggles mightily with the pain and disability of rheumatoid arthritis. Unfortunately, she got hooked on Oxycontin that she started taking for the pain of infected foot ulcers brought on by the immune-suppressive drugs she takes to control her disease.

Each time I see her, I'm dismayed with 1) how quickly life can unravel due to disease and disability, and 2) how difficult it is to be taken seriously when you take too many pain meds no matter how legitimate your need for same. I spent over an hour on the phone today with the patient and a pain specialist she consulted last month. The latter never even examined her when she came to his office seeking help with pain control and narcotics withdrawal. "I could have you committed," he told her, "for your illegal use of drugs. What on earth did he think he'd accomplish with nonsense like that except to drive her to tears (which he did).

So now she's fallen and sustained four compression fractures of vertebrae made thin from steroid use. The orthopedist she sees for degenerative disk disease never mentioned to her that her new, dreadful pain was due to fractures. I have no idea what my colleagues think they're doing here. But I do know if you're malnourished, angry, and you look older than you are due to the ravages of pain and illness, it's extraordinarily hard to be taken seriously.

6 comments:

Ruth said...

So sad, but I see this all the time too. I am glad I work on a unit where the root causes of pain are investigated rather than treating symptoms only. The elderly are more vulnerable to nondiagnosis. But I think the boomers may be more proactive and informed as they age.

G. Out said...

Our body is a very sensitive organ and instantly sends out alarm signals to indicate faults. We need to be on the lookout for these signals to take timely action. Pain is one such signal that our body sends for us to act on a particular area. When our body is injured or hurt, the nerves in the affected area release chemical signals. Other nerves send these signals to the brain, where they are recognized as pain.

Anonymous said...

This story makes me very sad. Hugs to your patient.

femail doc said...

Ruth, G Out, Anon,
Thanks for your comments. She makes me sad too. She is currently undergoing evaluation for a vertebroplasty in hopes that we can diminish her pain sources by one big step.

Anonymous said...

she's lucky to have a doctor like you, who continues to search out solutions to her difficulties.

Medtipster said...

This story is indeed rather touching. I really like your caring approach. The world needs more health care providers like you.