My experiences following a recent back injury I sustained have caused me to realize some very troubling commonalities between the practice of medicine and the practice of law.
On July 10, 2016, I herniated at least one disc in my lower back while working out at the gym. Almost immediately following the injury, I began sweating profusely, lost my hearing, and my vision became very blurry and spotty just before I literally fainted from the pain. Unfortunately, I experienced similar symptoms over the following couple of weeks and nearly fainted from the pain on each of those occasions.
While I wouldn’t wish such an injury on anyone, the lessons I’ve learned through my ordeal have been eye-opening.
I initially went to my chiropractor, who took several X-rays of my back. Based upon my symptoms and his review of the X-rays, he believed that I had herniated the disc between the L4 and L5 of my lumbar spine. Because of the extent of my pain and other symptoms, he referred me to a board certified orthopedic surgeon. In fact, his office actually scheduled that appointment for me.
The orthopedic surgeon immediately sent me for an MRI scan of my lower back. In order to try and address my symptoms, the doctor prescribed an anti-inflammatory, a pain killer, and a muscle relaxer. I also purchased a cane and rented a wheelchair because I could hardly move and even the slightest movement caused me excruciating pain.
The following day, I returned to the doctor’s office to learn the results of the MRI. Neither the radiologist nor the orthopedic surgeon saw any disc herniation, so the doctor recommended that I take it easy and continue taking the medications he had prescribed. The doctor believed that I had merely strained and possibly torn a muscle in my back and was treating the injury as such. He also scheduled me for a CAT scan the following day, but learned nothing new from the results. In order to prepare me for the CAT scan, they gave me sedation for the procedure through an IV, among other things. To my surprise, the pain was so extreme that morphine itself wasn’t able to relieve it. They then added some other pain sedative to the IV and were able to finally break the pain, at least for a short period of time.
Meanwhile, a couple of days later, in the middle of the night, I had my spouse call the paramedics because the pain was so severe that I needed to be taken to the Emergency Room and I couldn’t even get out of bed and into the wheelchair.
The paramedics placed me into a stretcher to take me to the emergency room. Even though I had already been treated at Methodist Hospital in Arcadia for the injury, when I received the CAT scan, the paramedics refused to take me there. They told me that the CAT scan at that facility wasn’t functioning and took me instead to Huntington Hospital in Pasadena. It didn’t matter that they were already familiar with my injury at Methodist Hospital and that a CAT scan had been taken there only a couple of days earlier.
The trip to the emergency room was absolutely excruciating because of the manner in which the paramedics had strapped me onto the gurney. However, that was nothing compared to what was about to come. When we arrived at the emergency room, I was told that there were no available beds and the paramedics literally forced me into a chair in the waiting room. The pain they caused me was absolutely unbearable. I was screaming from pain for at least an hour before they moved me into a bed.
Unfortunately, I was then ignored by everyone at the facility for quite a number of hours, other than having been placed on a bed behind some curtains. When the emergency room doctor finally saw me, she gave me an IV with some morphine to cut the pain. She completely disregarded my comment that the morphine alone didn’t relieve the pain only days earlier at Methodist Hospital. She added nothing to it and I just remained there in terrible pain for several hours before they released me. The extremely poor treatment I received at the emergency room caused my spouse to register a complaint against the doctor.
Two days later, I returned to the orthopedic surgeon’s office and he couldn’t figure out why I was experiencing symptoms related to a herniated disc, when neither he nor the radiologist had been able to find any evidence of such. He therefore referred me to a board certified neurologist.
Interestingly enough, the neurologist found evidence of a herniated disc in my MRI scan. He then prescribed a stronger anti-inflammatory, pain killer, muscle relaxer, and an anti-epileptic medication that is used to treat nerve pain. He also referred me to a board certified orthopedic surgeon who specializes in back injuries at the exact same facility that had referred me to him, so that I could be scheduled to receive a lumbar epidural steroid injection for my low back pain and sciatica.
The following day, I began receiving acupuncture treatment five days a week for a couple of weeks. Following several of those treatments, I noticed a significant reduction in my pain. However, I wasn’t sure whether it was due to the medication, the acupuncture or a combination of the two.
A week later, I started physical therapy, learned some exercises to improve my condition, and was advised that I was using the cane improperly. I was using it with my left hand because because I have experiencing pain and weakness in my left leg. I learned that I was supposed to hold the cane with my right hand for balance and support because of the pain and weakness I was experiencing in my left leg. That explained why I had been having such difficulty walking even with the cane and fell at home a few days earlier, while walking with it.
Three days later, I received the lumbar epidural steroid injection from my new orthopedic surgeon. While it really didn’t really relieve any of my symptoms, my condition had improved enough for us to take our long planned cruise to Alaska with dear friends of ours and I was able to enjoy the cruise and get around with the aid of my cane.
Almost immediately upon my return, the neurologist had me stop taking the anti-inflammatory, pain killer, and muscle relaxer. The only medication he wanted me taking at that point was the anti-epileptic medication that is used to treat nerve pain.
Unfortunately, once off those medications, I was unable to sleep more than 1 1/2 to 2 hours a night due to my sciatica pain. A week later, I advanced my upcoming appointment with the neurologist and began treating with a different acupuncturist to deal with my symptoms.
When I returned to the neurologist and explained that I had hardly slept since he took me off of three of my medications, he told me that I could start taking the muscle relaxer and pain medication before bed. Immediately upon resuming those medications, I was able to sleep through the night.
On August 16th, I posted the following comment on my personal Facebook page:
“I’m so pleased with the professionals helping me with my back injury. They all tend to follow up with me and see how I’m doing. In fact, my neurologist’s office just called to see how I slept last night after advising me to take the pain medication and muscle relaxer again, just before bed. I’m scheduled to see them tomorrow morning (of which they were aware) and they called to check up on me today, instead of just waiting to hear from me tomorrow. They wanted to make sure that if I still had sleeping problems, that they would be addressed today, so that I didn’t have yet another night with little sleep.”
On my first visit with the new acupuncturist he visually inspected my body from the waist up and asked me a great many questions regarding the injury and my symptoms. Just by looking at me, he was able to determine my sleeping position. By listening carefully to my answers to his questions, he opined that I had ruptured discs in both the L4 and L5 region of my lumbar spine. Based upon his assessment, he treated me primarily in the L4 region of my spine and told me that he believed I would have received better results from the lumbar epidural steroid injection, had it been to the L4, rather than the L5 region.
He then did things which he said would relieve my most severe pain, which was around the left inside ankle and surrounding area. He also advised me to start sleeping on my back instead of on my side.
When I attempted to alter my sleeping position, I found that I couldn’t fall asleep until I turned to my side. Since I was exhausted from little sleep for a week, I stopped trying to change sleeping positions for the time being.
Surprisingly, when I woke up the following morning, I noticed that the pain I had been experiencing in the inside of my left ankle area had significantly dissipated for the first time since the July 10th injury.
Meanwhile, on August 17th, my neurologist scheduled me for an electromyography (EMG), “a diagnostic procedure to assess the health of muscles and the nerve cells that control them (motor neurons).” He also prescribed an additional anti-epileptic medication that is used to treat nerve pain. Irrespective, from my description, the neurologist opined that my damaged nerves are regenerating.
Two days later, the neurologist did the electromyogram (EMG) and nerve conduction study. During the test, he told me that he noticed significant muscle loss in my entire left leg, which he opined was the result of the nerves not functioning properly or at all in certain parts of my left leg. He also noted that certain muscles in a number of areas were constantly agitated as a result of nerve damage from my injury. Based upon his assessment, he opined that I would require spinal fusion surgery. This was the same neurologist who had been very supportive about acupuncture and non-surgical approaches to my back injury, until the results of my EMG.
I told the doctor that my new acupuncturist believed that I had ruptured discs in both the L4 and L5 region of my lumbar spine. I also told him how certain of my symptoms were relieved to a good degree, after he treated me for an L4 disc injury. The neurologist listened and explained that the injury was limited to the L5 region and why that was also causing me to experience symptoms from an L4 disc herniation.
In any event, the neurologist referred me back to the same board certified orthopedic surgeon who gave me the lumbar epidural steroid injection. I then requested names of several other surgeons, so that I could obtain a few “second opinions.” He provided me this a list of recommended surgeons. The first surgeon on the list had an asterisk by his name and others listed on the bottom of the list had their names crossed-off after written, so that I would know to stay far away from them.
After receiving the list, I started doing my research on each of the doctors. Since I was still hoping to avoid back surgery, I only scheduled consultations with those surgeons who not only had excellent reviews, but when some of those reviews reflected the fact that non-surgical options were given when such options were equally or more appropriate for their particular situation.
In fact, one such surgeon had a review which indicated that of three surgeons consulted, he was the only one to recommend a non-surgical option and that option was extremely successful. Interestingly enough, while the surgeon with the asterisk by his name had wonderful reviews, none of them mentioned anything about non-surgical options being given. I decided that while I may well consult with that surgeon if I learned that surgery was my only option, it was still premature for me to limit myself in such a way.
While I was ready, willing and able to subject myself to back surgery if absolutely necessary, I viewed that option as an absolute last resort. To me, back surgery was the equivalent of engaging in litigation to address a conflict and/or dispute, particularly when interpersonal relationships are involved. I felt that if I didn’t very carefully screen the surgeons in such a manner, I might find myself undergoing back surgery unnecessarily because I didn’t know any better. From my perspective, it was the same as if I only consulted with attorneys who only litigate and engage in litigated negotiation to assist their clients in addressing their conflicts and disputes. After all, you can only give what you have and teach what you know. And, outcomes are typically determined by the way in which the “game” is designed. I wasn’t inclined to design the “game” for back surgery, if other options might be more appropriate for my situation.
Between April 27, 2015 and June 26, 2016, Huffington Post published my seven part series titled “How Family Law Attorneys Tend to Think.” I wasn’t about to allow surgeons force me into surgery the same way my series described how so many family law attorneys essentially force their clients into litigation.
In any event, after completing my research, I scheduled “second opinions” with three of the surgeons, including the one who had given me the lumbar epidural steroid injection.
On August 29th, the day before my first consultation for a “second opinion”, I unfortunately had a huge setback from which I learned a great deal. Sometime around 7:00 a.m., I fainted at the bathroom counter as I was just about to brush my teeth. I did not faint from pain and I had absolutely no advance notice. I don’t recall having fainted, except that I awoke on the ground with my tooth brush on one side of me and the tube of tooth paste on the other side. I couldn’t figure out why I had gritty material in my mouth when I awoke, until I started rubbing my tongue along my front teeth.
It turned out that I broke the veneers on my four front teeth that my grandfather had installed in the mid 1980’s. Just the prior week, my dental hygienist mentioned that she was amazed at how well my veneers had held up over the years and still looked great. She said they typically don’t last longer than approximately seventeen to twenty years.
When I got up and looked at myself in the mirror, I noticed a deep cut below my chin, and a cut below my lip. I felt pain in my head, jaw and back and in the inside of my lower lip, among other things. I collapsed so fast and with such force that my front teeth made a relatively deep indentation in the concrete bathroom counter.
As soon as I put myself together, I drove to the Emergency Room at Huntington Hospital., where I remained from 7:30 a.m. to 12:30 p.m. They asked me what had happened, took plenty of X-rays, and ran an ambit of tests. Because I had fainted, they took my blood pressure while I was lying down, sitting up and standing up. They also gave me four stitches for the gash under my chin and informed me that my front teeth had actually impaled my lower lip before the veneers crumbled. They glued the exterior of that wound and prescribed an antibiotic. The doctor said that was the more serious of my wounds and that he was certain that it would become infected.
They weren’t certain as to the cause of my fainting and insisted that I make an appointment with my primary physician. However, they did find that my potassium level was dangerously low. They were so concerned with my low potassium level that they gave me potassium in both liquid and solid form. The doctor told me that my low potassium level could have caused me to faint. They also diagnosed me with “orthostatic hypotension — also called postural hypotension — is a form of low blood pressure that happens when you stand up from sitting or lying down. Orthostatic hypotension can make you feel dizzy or lightheaded, and maybe even faint.
I told the doctor that my board certified otolaryngologist prescribed Hydrochlorothiazide several years ago to try and limit further hearing loss from my Meniere’s Disease. Since that medication depletes a person’s potassium level, she had also prescribed potassium supplements, which I have been taking three times a day since I began taking the Hydrochlorothiazide. To say that I was surprised to hear that my potassium level was so low would be an understatement. However, I certainly hadn’t taken the supplement since going to bed the night before.
Believe it or not, but I rushed them to get me out of the Emergency Room by around 12:30 p.m. because I was scheduled to have a pre-mediation caucusing session with a party prior to their upcoming mediation and didn’t want that meeting rescheduled.
At the conclusion of that caucusing session, I immediately called my dentist, who was able to fit me in immediately. They sanded down the bottoms and backs of my veneers to make them less uncomfortable while I waited to have them replaced at a cost of almost $10,000.00.
The following morning, I had an appointment with my neurologist. He advised me that each of the four medications he had prescribed and which I was currently taking was independently able to cause such fainting and immediately took me off all of those medications.
Later that day, I went to the first of my “second opinion” consultations. That appointment was with a doctor board certified in Neurological Surgery. The doctor spent a good amount of time with me and asked me a great many questions. After carefully listening to me, reviewing my file and my MRI, he told me that he did not recommend that I undergo surgery for my injury. He told me that I was clearly improving and that I would most likely fully recover by continuing with my physical therapy, home exercises and other such things.
He told me that I had actually ruptured discs in both the L4 and L5 region of my lumbar spine and showed me the two ruptured discs on the MRI. He did, however, recommend that I allow him to give me a periradicular injection in both the L4 and L5 regions of my spine to relieve my symptoms in the meantime. He explained to me that it was more specific to the specific nerves at issue and that he’s found it far more effective than epidural injections for treating injuries such as mine.
He also took the time to explain why such an option had not been recommended by the orthopedic surgeon and made the distinction between an orthopedic surgeon and a neurosurgeon very clear. He also made sure that I was scheduled to see my primary physician because a health man my age should not be fainting for no reason.
Interestingly enough, my second acupuncturist was the only other person to assess that I had ruptured discs in both the L4 and L5 region of my lumbar spine, and he never saw any of my medical records. For what it’s worth, several people who had undergone back surgery had told me that I should have it performed by a neurosurgeon rather than an orthopedic surgeon. Based upon my experience, I would have to agree. Needless to say, I cancelled the other two “second opinions.”
On September 1st, I had my appointment with my primary physician. I learned that there was zero doubt that my fainting spell was caused by prescription medication. Not only were each of the four drugs I was prescribed by my neurologist independently able to have caused me to faint, but the medication I was prescribed to address my hearing loss was as well. In addition to it depleting my potassium (a possible cause), it further lowered my blood pressure that was naturally on the low side of normal, thereby causing orthostatic hypotension (another possible cause of my fainting spell). My primary doctor asked me if I was aware whether or not the Hydrochlorothiazide had made any difference in my hearing. I told him that I was unaware that it was having any impact and he immediately took me off that medication.
These doctors pump us full of drugs with all these possible side effects, even when they aren’t shown to be addressing the symptoms for which they were prescribed. It reminds me of lawyers unnecessarily subjecting us to litigation and all the ensuing consequences. The failings within both the medical and legal fields have a great deal to do with a lack of ample emotional intelligence by doctors and lawyers, in my opinion. This includes a lack of empathy, although they may have sincere concern, and poor active listening skills.
Through this unbelievable and horrible ordeal, I have come to learn that the medical profession is just as screwed up as the legal profession. I have also experienced the difference between medical professionals expressing concern and the immense benefits of emotional intelligence. I’m convinced that among other things, my second acupuncturist has a very high level of emotional intelligence. I am absolutely amazed at what he was able to assess what all of the doctors missed, with the exception of the neurosurgeon.
It also became abundantly clear that doctors tend to refer their patients back and forth to each other, and not necessarily because the referring doctor is the most appropriate choice. It appeared to me to be an act of self-interest because of the business they receive from those doctors. I’ve noticed the exact same thing in the legal field.
I also learned that holistic healers such as chiropractors refer business to medical doctors when they deem appropriate and those same doctors bad mouth such fields and wouldn’t refer business to them, if their life depended upon it. Interestingly enough, the same behavior occurs between “lawyers as peacemakers, practicing holistic, problem-solving law”, including acting as facilitative and transformative mediators, and traditional litigators.
I have also gained immense empathy for elderly and disabled people. Since I’m a glass half full kind of guy, I’d say that the new perspective alone is invaluable. However, I wouldn’t wish this on anyone.
I’m also incredibly grateful that I have such a wonderful spouse and that most of this ordeal took place while school was on summer break, since my spouse happens to be a grade school teacher. I could not have asked for more attention, care and concern than I received at home.