Wednesday, September 02, 2009

Health Care, How Care: Part 1


With our governor just subject to scalpel (and drill and hammer), I shall personalize the health care topic a bit here, with cross-posting at Harrumph!

We could note in passing that this is not a very scientific presentation, much open to the criticism of bloggers as opiners without checkable facts. Yet, blending facts with illustrations from experience is pretty much what you get from a visit to your typical primary-care physician or even specialist. More not that later and here.

Let's consider a few aspects of Gov. Deval Patrick's hip replacement. First and most obviously, he's covered. He has the excellent insurance from the state and he and wife Diane are quite wealthy on their own. They don't have concerns of getting the best care, paying for it or losing his job while he recovers.

Second, he has the great advantage of getting a mechanical repair. Like work from skilled cabinet makers or auto mechanics, a hip replacement is an eye-guided, hands-on job. Surgeons do a lot of these and the vendors have fine-tuned the gouge-out and pound-in joints for decades. They can see what they're doing and be sure all is well before sending him back to bed.

Contrast that with the far less precise visit to your family physician. Whether you come in for a checkup or with a particular complaint, you rely on the doc's art and even mood. There's a lot less medical science in an office visit than we think and hope.

Sure FPs (what we used to call GPs) read medical journals and attend training to keep up on studies and developments. Unfortunately, the findings often contradict previous and current studies. That understandably leads to doctors' faddishness, of waving a single study as now-we-know proof of how to proceed. Far too often as well, studies funded directly or indirectly by drug companies prove, kind of, that doctors should treat this or that symptom with drugs.

Only a few of us are demented in ways that we enjoy pain or seek being incapacitated. When docs say they'll alleviate our symptoms, it sounds sweet and, well, necessary.

On the other hand, I have a base contention that this illustrates a fundamental failing of U.S. health care. If rather than treating symptoms with drugs our docs analyzed, diagnosed and cured underlying causes of patients' problems, we would be much healthier, I hold.

Many doctors and surely all pharmaceutical giants would quickly and loudly squeal that there is no scientific evidence of a causal relationship between treating symptoms with drugs first or exclusively and our pathetic national longevity. (We're like 17th on the list of long-living nations.) Pardon my snickers as I note that drug-company funded research does not study outcomes associated with drug-for-symptoms v. underlying-cause treatments. The best outcome for patient has not been on the table.

Every medical college and research university should have such a study in the works. This goes to the core of our national health as well as our medical practice and procedure. More on this in future posts.

Today, I'll tell you about my hip operation. There are stories about my shoulder repair, testicular agony and leg surgery pending. Each contains lessons of health care.

Over at Left Ahead!, we've been asking for our promised podcast with Gov. Patrick. Former chief of staff Doug Rubin was setting this up before he went to the re-elect campaign. Three different staffers since say it's in the works. However, the subtext included a personal health question — is he a big consumer of diet sodas?

Thus, you can open the lid to the box of my own hip-surgery tale. Rather, peek at how and why I ended up not getting both hips replaced a decade ago.

Our governor had long-term hip pain. His doctors attributed that to a combination of an auto accident and arthritis, reasonable factors that may well account for his troubles.

In my case, various FPs and orthopedic surgeons likewise had good explanations of why I was crippled. They also projected numerous x-ray and CAT views before me that showed plain striations on my hip-socket balls. They had me heading for a double hip replacement.

I don't get emotionally invested in pain. I am well aware of it and dislike it, but I can go about my business without whining and without drugs. I headed for the doctors and endured the tests because I couldn't walk. My hips hurt to the point that I needed a walking staff to make it the 20 feet from bed to toilet.

Noting my personal history, the various doctors had a pretty good idea that it was arthritis. I was about the age Patrick is now, early 50s. That's typical for the onset of symptoms. More to the point, I had been an athlete. As a team swimmer, I figure I had done well over a million whip kicks in practice and competition. Plus, I was a regular cyclist as an adult. My hips had taken their share of abuse.

Sure enough, the internal images showed what the surgeons predicted. Their solution was new hip joints. Ta da.

At a very different corporal locale, I had very different symptoms. For example, when I'd shower and close my eyes, I saw an intense light show. That concerned me more. I had had a gruesome injury at 19 when I was hit as a pedestrian and thrown head-first through a windshield. Then recently, I got a strong concussion when an inattentive driver broadsided me on my cycle as she turned and floored her car without looking.

So, I was a mess top and bottom. My brain might be imploding and I couldn't walk right or without agony.
Complicating this was that I still had my tonsils, or put another way, I had never had surgery of any type and didn't want any.

Yet, I had physical, visual, quasi-scientific proof that arthritis crippled me. The fix was plain and inevitable and the surgeons were positive of cause and cure.

Well, I never had the replacement surgery. I was cured without cutting. It was not through prayers to a saint or other such miracle.

Instead a friend pointed me to what sounded like a serious crackpot, one with the unlikely name of Betty Martini. Someone with my last name of Ball, surely the most risible in the language, should never goof on another's name, but really, Betty Martini?

She is a relentless foe of aspartame, a.k.a. by brand name NutraSweet®. Our FDA approves the sweetener and the company carrying the name cites many studies alleging its safety. However, at her Mission Possible group, Martini piles on studies, news and personal reports that say otherwise. She led me to try my own personal (universe of one) quasi-scientific study.

Relevant details in my instance included:
  • History of head injuries.
  • Two key symptoms, according to Martini's work, of aspartame reactions —hip pain and brain electrical anomalies.
  • Heavy use of aspartame (one to two two-liter bottles a day, in lieu of water or juice).
The short of it is that after years of increasing hip pain, I was free of even discomfort within three weeks of stopping the Diet Pepsi. Likewise, the light shows totally disappeared after more than a year of daily occurrence.

Being hardheaded, masochistic or scientific, depending on how you look at it, I had to know. I reintroduced aspartame by my liquid of choice three times. I had the same effects each time. Within two days, the hip pain and flashes returned and then went away a few days after stopping. That's not pure science, but I remain convinced.

A mess top and bottom


I confess now as then, I was highly skeptical of Martini's assertions. Not only did she seem New Age and even crackpot, but real surgeons had waved x-rays and aired solid reasoning at me. I had to prove or disprove this in my own little and very personal experiments.

I won't debate the NutraSweet folk or any aspartame vendor. That's Martini's business. It's quite likely that sensitivity to the substance varies considerably and just as likely from my perspective that many have symptoms they attribute to other causes. I certainly understand why the vendors pretend their chemical limo is very safe to ride every day everywhere.

For my part, I do tell people my story. Non-surgical, non-drug solutions to chronic pain and other symptoms seem to intrigue us all.

Moreover, I have no way of knowing whether Gov. Patrick fit my mold at all in this. He and I both had doctors positive that our hip pain required metal replacing bone. Mine were wrong, but his may well have been right.

In my deepest heart, I would like to return to my childhood belief that doctors truly know causes and cures. Alas, I have had too many experiences contradicting that. I'll share a few more in future parts and link to them here as they post.

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2 comments:

massmarrier said...

Betty Martini of the Mission Possible organization and I swapped email after I posted this. Her reply included:
Here's a post that will give you information for your blog post since it tells the whole story of how aspartame got approved. http://www.mpwhi.com/letter_to_cynthia_oshita.htm

Uncle said...

Another WABAC moment. Sherlock Holmes quoted Thoreau thus: "Circumstantial evidence is occasionally very convincing...as when you find a trout in the milk." I had early-onset hip pain in my 30s. In the fullness of time I wound up in a part-time job in a health food store to support my writing habit. There, I read and heard a great deal of this discussion, enough to get largely off the aspartame. Pain goes away; circumstantial evidence triumphs.

The odd thing about the whole discussion re Gov. Patrick is how reluctant my shoulder surgeon was to attribute trauma as the underlying cause. There was Ca in the MRI, ergo, there was arthritis. Not until he got in there and could see the physical damage was he satisfied of a traumatic component.

Whilst this is often annoying, I would rather have a physician make a conservative initial diagnosis and revise it on evidence than otherwise. It *is* an inexact science; indeed it is often an art, not a science. This doesn't invite excess intuition.

The same conservatism bedevils advances in diagnosis again and again, but it does force those who advance a circumstantial cause-effect to strengthen their arguments. Where aspartame is concerned, I expect that to happen, and fairly soon.

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