Anybody know a GOOD Doctor?

I'm looking for a miracle worker!

I enjoy reading Sydney Smith (not her real name) over at Medpundit, and I visit the "Grand Rounds" now and then. There's another great doctor online at The Doctor is In. Both sites link to other online doctors, some of whom I read regularly, even though I don't link to them. In all that reading, however, I haven't found a clue about my own medical problems, other than the FDA is making it harder and harder for me to have a pain-free day.

I have a half-dozen semi-related problems. All of them are directly attributable to my 26 years of military service in one way or another. My problems include damage to the vertebrae in my neck that has caused calcium deposits to grow on the inside of the spinal column to the point where they're beginning to push the spinal chord out of center. I've had two spots where this has been fixed - at the vertebral joints at C4-5 and C5-6 (C4-5 means the joint between the fourth and fifth cervical vertebra, two of the seven vertebrae in the neck). The disk between the two vertebrae was removed, the calcium scraped out, and the two vertebrae fused together. There's another joint, C7-T1 (first thoracic vertebra) that has one of these calcium deposits (called an annulus) growing. There are some osteoarthritic changes (arthritis caused by damage to the joint) taking place from C3 through T1. Some of these osteophytes (calcium deposits) are putting pressure on nerves that come out between the joints.

I also have damage and mild degeneration of several facet joints (the part of the vertebra that stick out in the back to hold the joint in alignment). This causes a problem called Myofascial Pain Syndrome, where, when the joints aren't in proper alignment, they pinch or rub the nerve roots to the back muscles, and produce tight or "locked" muscles and pain. There are about a dozen places in my entire spine where this happens, but the worst place is in the T6-7 and T7-8 areas - about midway down the thoracic (middle) spine.

To cap it off, I have mild degenerative disk disease that begins about C3 and runs all the way down my spine, at least two compressed disks (L3-4, L4-5 - three of the five lumbar or lowere back vertebrae), and a small tear in a disk (L5-S1) in my lower back. These problems here sometimes put pressure on the nerves that run down my legs (sciatic nerve), and cause pain from the low back all the way to the toes (called sciatica). There are also several areas of osteoarthritis between the neck and my lower back, but these aren't as serious as the problems in my neck. They do sometimes cause pain, but not very often.

These problems aren't caused by any major injury. I have never had a MAJOR injury in my life. What caused these problems were more than two dozen minor problems over much of a 40-year period. I did the back exercises, I kept in pretty good shape, and I don't consider myself overweight (although the government, in its infinite desire to make everyone exactly the same, does). How many people have slipped on ice and fallen on their backs? I've done it two or three times. I've helped move military office furniture and "sprained" or "strained" my back a half-dozen times (when your work includes classified information, moving it can be a pain - those four-drawer file safes are HEAVY!). I've been hit in the back by stray pieces of equipment, had heavy objects fall on me, and generally been banged up and bruised a number of different times in a number of different - and frequently unusual - ways. It all adds up after awhile, and you end up being in a lot of pain.

In addition to my back problems, I've been diagnosed as having ulnar/median nerve entrapment (the ulnar nerve and median nerve are the two major nerves that run from the neck, across the top of the shoulder, and down to the fingertips), and bilateral (on both sides) carpal tunnel syndrome. Lately, I've also developed a bursitis problem in both shoulders that hasn't responded well to treatment. Just to confuse the medical people more, and to make it harder for them to diagnose and treat my problems, my body is one of the 6% that have the ulnar and median nerves inverted, one of the 14% that have a "cervical rib" (extensions on either side of the C-7 vertebra that stick out an inch or more farther than in most people), and a "cap" on the shoulder joint. It took my doctor three "sticks" to get the needle in for a cortisone shot last week. I've been diagnosed with "several" kinds of sleep apnea, I have a reactive hypoglycemia problem, and knees and ankles that have been grossly mistreated (I had to have surgery on the right knee, and really need it on the left one).

I also have a tinnitus problem. Tinnitus is a phantom ringing in the ears caused by damage to the nerve cells in the inner ear. Tinnitus is usually a temporary phenomena, and can be caused by taking too much of an anti-inflammatory drug like aspirin or ibuprofen, by a hard blow to the head, or by exposure to prolonged or very loud noises. I've experienced more than my share of all three! My tinnitus is bilateral (in both ears), LOUD (it takes a sound of 60dB or more to cover the ringing), and persistent (there all the time). It's also mostly the same frequency (around 6000 hz), but has frequent "overtones" ranging from very low to very high pitches. One of the problems with tinnitus is that it frequently "sensitizes" your ears to sound. Outside sounds can cause anything from an earache to the equivalent of the worst migraine on record. Many people who have severe tinnitus don't want to be around noise. I don't watch television, I don't listen to radio, and I don't spend much time outside my basement office, because doing so causes me pain. For someone who's traipsed over much of the world, and who enjoys travel and new things, being "locked" in an 11x13 foot room is quite a change - and not satisfactory at all!

Tinnitus can also trigger another unusual problem - timbromandibular joint syndrome. This is a problem with the hinge of the lower jaw. The problem is caused by clenching or grinding teeth. In my case, it's triggered by pain elsewhere. The jaw joint "snaps" and "pops" like a trick knee, and feels worse! It's like the pain you get from chewing three pieces of bubblegum at the same time for about six hours.

Thank GOD! for military doctors. Most of the time, they're willing to listen, understand what I've been through, and are willing to help in any way they can. Unfortunately, short of a whole-spine transplant (which isn't currently available) or some pretty nasty drugs, there's not much they can do but treat the symptoms and wait until things get so bad surgery's the only answer. That's ALWAYS the last resort when you're working that close to nerves, and where the slightest miscue can result in full or partial paralysis for the rest of your life. One of the big problems with most medication, however, is that it's usually good only against one particular type of pain, and doesn't touch other types of pain.

I've been taking COX-2 inhibitors for pain for about five years now. I started out using Vioxx, and switched last year to Bextra when the Air Force pharmacies quit stocking Vioxx. The good news is, they work. The bad news is, some (maybe all?) COX-2 inhibitors can increase the risk of heart problems in some people. I take these drugs once a day, usually at bedtime. They DO work, and I know it if I accidentally miss a night. I also take a drug called Ultram for as-needed pain relief, with or without flexeril (a muscle relaxer). Ultram primarily works to relieve "nerve pain", while the flexeril helps relax tight muscles from the tension the pain causes. I've found I can alternate this with acetaminophen to relieve headaches and muscle aches, and get even better relief. There are a number of drugs I can't take, from aspirin and ibuprofen to Celebrex (another COX-2 inhibitor) and Darvon, because it makes the tinnitus worse, thins my blood to the point I bruise easily, and just cause a number of other unneeded complications. It's taken me twenty years to find a suite of medications that can work together and do a fairly decent job of regulating my pain - about 75% of the time.

The pain medication can usually handle the back pain and the neck pain. The sciatica is best treated by pain medication, muscle relaxers, ice, heat, and bedrest, followed later by mild exercise. I take the acetaminophen for headaches, and about half the time, it works. I haven't found ANYTHING that can help with the tinnitus, and I've tried all the "normal" treatments - acclimation, 'white' noise, background sounds, biofeedback - none of it's done any good. (I've been prescribed hearing aids, and we'll see if those work or not very soon.) I've given up coffee for a month (no change, except I became the world's biggest grouch!), tried a half-dozen herbal treatments, and anything else I could find. I've had the carpal tunnel surgery on the left wrist, but it's the one that I have the hardest time with now, and which the nerve conduction tests are the most "positive" for carpal tunnel. I've tried epidural injections in both the neck and the midback. They last three to five weeks in the neck, and six to ten weeks in the midback. I've done the bursitis exercises my doctor prescribed and had the cortisone shots. Relief lasted less than ten days.

My body's in bad shape because I believed that I should do everything possible to accomplish the tasks I'd been assigned, even when there was no earthly way one person (or even a team) could accomplish every one, every time. I gave the proverbial 110%. I also wasn't always careful. Sometimes, even when I was careful, others weren't, and I ended up hurting myself trying to prevent a disaster from occurring, or got caught in the disaster others created. Yet I never felt "sorry" for myself when these things happened, and my only concern now is that I wasn't as careful as I could have been. Most of the things that happened to me also happened to others, just not in quite the number. Some of the things I did, or was involved in, had never been done before, and there was no "known danger signs" to be aware of. I would do nothing to change the circumstances, but the 'cost' has proven to be rather high - not as high as for a few, but definitely more than I expected. I'm the person I am today because of those circumstances, and I can accept the current state of my body as being the consequences of "living in interesting times (and places)".

Of course, I wouldn't turn down a miracle cure, medical or otherwise!

I'd be happy to discuss any of this with anyone, and also to listen to others tell their stories. I don't doubt there are people out there that can top mine, but it would be interesting swapping yarns...