Saturday, April 28, 2007

The Tale of the Floppy Eared Bunny

"(The Saga of Chymopapain)
As the laboratory staff watched in awe the rabbit's ears began to wilt following the intravenous injection of the enzyme chymopapain. It remained for orthopedic surgeon Lyman Smith to turn this observation into a new therapy for the treatment of herniated discs. Why, he reasoned couldn't chymopapain also dissolve the collagen in a herniated disc? From this basic observation the saga of chemonucleolysis (enzymatic dissolution of disc collagen) with chymopapain (the active ingredient in Adolf's meat tenderizer) was born. It turned out to be a textbook example of how not to do things in medicine including high grade marketing blitz (the " M2H" factor). This resulted in a patient stampede to have chemonucleolysis.
There can be no question but that the M2H factor for chymopapain was one of highest ever recorded. Because it wasn't released by the United States Food and Drug Administration until November 10, 1983 a large cottage industry had been created in Canada starting in the 1970s. This was a modern version of the "underground railroad" where lines of U.S. clients were often passed through enzymatic assembly lines (a process which has become reversed in recent years). The good news was that only a small number of Canadian Orthopedists and Neurosurgeons practiced chemonucleolysis and they were expert at it. But even the doctors became caught up in the hype. One prominent Canadian orthopedic chymopapain advocate stated at a medical meeting that all he required was a "few cc's of chymopapain" to take care of all of his spine patients! The widespread Canadian expertise was unfortunately not also reflected in the United States where approximately 7,000 orthopedic and neurosurgeons took a one day "training" course in this needle technique and pronounced themselves fully qualified to perform chemonucleolysis at their local hospitals (whose credentialing committees nodded in assent) after Food and Drug Association approval. Those few hospitals who believed that some degree of apprenticeship was required by these neo-procedurists typically gave in to the argument that since other institutions weren't requiring such that their physicians would become non-competitive and thus loose patients. Their credentialing committees then rubber stamped this example of poor medical practice and hospital self-interest.
While some of the 7,000 American trainees actually had some prior experience with needling techniques and fluoroscopic imaging many did not. The sad part of this tale is that the inadvertent deposition of chymopapain into nerve tissue as well as the sub-arachnoid space created some horrendous problems (including stroke, paraplegia, and death) for a significant number of patients. Even though injecting chymopapain simply required placing the tip of a needle in the nucleus pulposus of a disc many practitioners learned that this was not as simple as it seemed. These needles often ended up in other locations as shown below.

The incidence and prevalence of unnecessary, but serious, complications with the use of chymopapain gave it such a bad name that it soon fell into disuse in the United States. Now, one might think that this is was the end of this tale, but it isn't. Chemonucleolysis with chymopapain (or other enzymes such as collagenase) really weren't a bad idea if qualified people were involved in injecting them. The real problem was the high M2H factor which created a feeding frenzy for patients as well as their physicians.
As it turned out, even when chymopapain was injected into the right location there were important associated liabilities. A major example of this was replacing leg pain (by dissolving the disc) with incapacitating back pain caused by the sudden collapse of the disc interspace producing pressure on the facet joints. Another problem was the high level of allergenicity of the drug itself.
Unfortunately the use of chymopapain created new problems for patients. Could the resulting back pain have been addressed?. The answer is yes, by the use of anti-gravitational traction (but it wasn't). After a respectful period of time chemonucleolysis with chymopapain began to re-emerge in Europe in a lower dose application....where it remains today. In the United States it continues to remain unused and shunned. Despite the tale of chymopapain and its unfortunate demise the M2H phenomenon is still alive and well in the over-promoting of medical devices and techniques even today. "

The above article is the property of and used with the permission of Dr. Charles V. Burton

It is with the discovery of his website and the study of his vast knowledge and material that has helped me endure and understand the truth of the first of many procedures, that would take me down my 25 year (so far) path to devastating Chronic Pain.

Wednesday, April 18, 2007

The more Doctors I see the more frustrated I get

This is a photo of me and my little Bichon Frise, Aaron. I don't know what I would do without him, and I don't know what I will do when he is gone. Remember I said earlier that when you live a life of Chronic pain, the first to go are your friends, then your family, but he is always

there, no matter what.
I saw a new Doctor today and got the usual, we can do an epidural shot to which I replied NO! Then the next thing is the no I can't prescribe anything for pain or at least anything that will help.
I look at my little dog that I love so much, the one that is always there for me, yet if I knew that he was in the kind of pain that I am in, that he was suffering like I am, I would take him and have him put to sleep because I couldn't stand to see him suffer. It would be one of the hardest things that I have ever done in my life, yet I would do it out of love for him.
But what do we do in our so-called civilized society for people in unbearable pain. Nothing!! Oh they will do surgery on you just as long as you will let them. More surgery is not going to help someone like me. The damage has already been done. Nerves in your central nervous system don't regenerate themselves. I am not saying that there aren't any good and ethical physicians out there because there are. But I am saying that has not been my experience. I don't entirely blame the medical profession either. Much of it has to do with politics.
The Bush Administrations war on drugs has scared many physicians from prescribing opiods because they are afraid of the DEA. I am no drug addict and neither are the millions of people like me who have to depend on powerful pain medication just to exist, forget about having any kind of meaninful life. Just to exist. So where does that leave us? I'll tell you where it leaves us. Suffering!!! Maybe they should pass a law to make it legal to do what I would have to do to my little dog, Aaron. Just put us to sleep!!

Saturday, April 14, 2007

How do we make our voices heard

Sometimes I really want to give up. But then I ask myself-What does that mean, Kill myself. I really don't want to die. I know that is not the answer. Life is short enough if you have a relatively painless life and besides I love my family, I want to watch my little grand daughters grow up. You can't run away from Chronic Pain. Its always there 24/7. I love this beautiful earth and marvel at "Gods Creation". The government, the physicians and the DEA are so caught up in as they put it "drug abuse" especially the opiods and to a lesser degree the CNS drugs they don't understand that people who are truly in Chronic Pain hate taking drugs, I know I do. For one thing you are always fighting the "side effects" of powerful pain medications. I have a hard time taking anything, even anti-inflamatory, antibiotics and especially opiods. I will never understand how any person who has a love of life as I do, would want to take any type mind altering drug. I guess that is why most people who suffer as I do don't become addicted. They don't even want to take them in the first place. They just want a life. And to their credit, the DEA has issued guidelines and as long as the Practicioner and the patient follow those rules they have stated that they want bother the doctor or the patient. All of the state medical boards have agreed upon the same frame work, but still finding a doctor to help you, unless you have a long term relationship with them is almost impossible. I am sorry to pick on the pain management doctors, but it is the truth. Injecting shots into the Epidural area of your spine rarely helps, they are extremely expensive and they are dangerous. Injecting contrast materials into my spine that have been proven to be toxic is exactly what I suffer from today.
It is called Adhesive Arocnoditis, which is burned nerves in your spinal cord. In spite of that I still have to have two fusions in the lumbar region just for stability. Not only will it not help the main source of my pain, there is a good chance it will make it worse. My wife called my surgeon's nurse over a week ago to set up the surgery and we still have not received a phone call from their office. This is insane!! Why do they do this? I guess, just because they can.

Monday, April 9, 2007

Who is supposed to look out for us?

All over this country people are suffering. Old people are laying in "Old age homes and hospitals being undertreated for their pain". People from all walks of life are having to endure levels of pain that is an absolute violation of "human rights". The very profession that we are supposed to look to to help us when we are in pain has stigmatized us. Just walk into a doctors office and mention "chronic pain" and you have immediately entered into a "hostile relationship" with the very person that is supposed to help you. They will however, take your money. What is the first thing they ask you for if you are a new patient? Where are you hurting? NO! What is your problem? NO! Do you have insurance coverage? YES, that is the first thing you hear. The healthcare system in this country is an absolute disaster. I know there are many people in this that do not have health insurance, but I have the best insurance money can buy and it has not helped me. Something has to be done to hold the medical profession accountable for not doing what they are supposed to do.

I have suffered 23 years from unimaginable Chronic Pain, not as a result of the original injury I sustained, but because of the medical procedures done to me. But if I try to get a doctor to help with controlling my pain I am looked at with suspicion. Their excuse is I am afraid you will become addicted. This is ridiculous, yet it happens every day in this country and I will fight it as long as I live.

Friday, April 6, 2007

"There are many minimally invasive spine procedures being performed today. Some, such as epidural steroid injections are often used with little appreciation or understanding of the patient's real diagnosis ("shotgun therapy") and sometimes with no understanding that the patient does not even have an anatomic epidural space (i.e. obliterated by prior spine surgery). Most certainly, in the "physician do no harm" department ill-advised and ill-performed epidural steroid injections have created devastating lifelong problems for significant numbers of unsuspecting patients.

Other minimally invasive procedures such as percutaneous radio-frequency facet blocks (PRFFNB) which have benefited many over many decades are therapeutic, but destructive, in that they cauterize normal nerves to achieve their effect. The value of such a procedure is that the benefit to the patient outweighs the minimal risk."

Source: Dr। Charles Burton, M.D. read more at,Min-Invasive.htm

If there is one person in this country that I consider an expert on the spine, it is Dr. Burton. I thank him for giving me permission to use some of his information.

As I may have said before, the procedures performed on me in the early 1980s have destroyed my life, yet the very surgeon that I am presently seeing wants to do fusions on the affected discs. But when I try to talk to him about the present condition of the nerves in my spinal cord he want even talk about it. It is like he don't believe there is a condition called "Adhesive Arocnoditis." Evidently they aren't taught the failures in medical school. This much I do know. I will be staying up until 4:00 A.M. in the morning. Why? I am in to much pain to sleep. Try living like that for a few weeks much less years like I have done.