I’ve had many injuries in my time; pulled muscles, torn muscles, sprains, and strains; it’s what you’d expect from an ageing bloke keen on sport. In the past, whenever I injured myself, I dealt with it by resting the afflicted area for a few days, taking a few painkillers and adding a bit of heat treatment.
After rest, I’d regain my strength and mobility with gentle activity; slowly building myself back up to normality. This has served me well so far. So much so that I can pretty much deal with most soft tissues injuries that come along without involving medical professionals.
I wrote a blog post a while ago: Many years ago I was involved in a car accident. One of my many injuries was a broken vertebrae on the left side of my lumbar — accompanied by damage to the soft tissue that surrounds the vertebrae i.e. disc and nerves.
After that accident I was confined to a hospital bed for a while before I was encouraged to undertake mild physiotherapy; slowly building my activities towards getting back to normal. It’s just what I’d expected; symptomatic recovery: a more intense version of the treatment I gave myself when I dealt with minor sprains and strains. It made perfect sense.
More than 25 years have passed since that particular accident; since then I’ve been dogged by chronic lower back pain which I’ve dealt with in the usual way: periods of rest, over the counter anti-inflammatory medication, supplemented by occasional prescription painkillers and self administered physiotherapy. Up to now I’ve managed the situation satisfactorily; I’ve continued to work, earn a living and even run a business.
Nobody Wants Wet Feet
The situation changed eight weeks ago: One morning, after showering, I bent down to dry my feet. Suddenly, there was what sounded like a twang or a snap on the left side of my lower back. Within seconds I was in agony; I couldn’t straighten up. It was equally painful to stand; and even more painful to attempt to sit. All I could do was collapse onto the nearby bed and just lie there helpless.
After a short while the intense pain levelled itself out; it reduced from torturous agony to extreme debilitating pain. But, when I tried to move, my muscles went into severe spasm. As luck would have it I’d stashed a box of codeine in my bedside draw.
I took the maximum dose of codeine and lay on the bed for the next hour. My rational mind told me that I’d probably just strained a muscle, but in the deeper recesses of my mind I couldn’t help but think I’d done something more serious. In fact the last time I’d been in this much pain with my back was the day they cut me out of my car wreck 25 years ago.
After a couple of hours, thanks to the large dose of opiates, the pain eased enough for me to hobble around the place, trying to go about my business as usual. The next day the pain was worse and my movement became more and more restricted. I felt it was more than a back strain. It felt different to the chronic episodes of back pain I’d suffered over the years. I was suffering severe pain, spasms, and nerve pain that radiated from my lumbar down my left leg and into my foot.
My GP has Retired
The thing is I’m self employed and run a business; if I don’t work I don’t get paid and if I don’t get paid, well…you know where I’m going with this. I tried to make an appointment with my GP, but I could only get seen by him after a two-week wait. That’s unusual, normally I would get an appointment much quicker than that. When I queried it with the receptionist she told me that the usual GPs had retired and the practice had been taken over by new doctors; the appointment system had changed — for the worse as far as I was concerned.
The best she could offer me was a telephone consultation with the GP. I was stunned by this; but I’ve since found out that this is common practice amongst GP surgeries these days. Two hours later the GP duly rang me and we discussed the problem. Although he did not offer a diagnosis or even an opinion of what injury I’d caused to my back he did advise me to keep taking the codeine, along with paracetamol, and he wrote me a prescription for Amitriptyline to be taken at night.
The GP also advised me to go about my business as usual as best as possible otherwise my back would freeze up and I would end up in more pain. He then told me he would see me in two weeks time if I still felt it was necessary. Despite me querying it, the GP was adamant that rest was not necessary. It seemed to me, although he didn’t say it, he was treating me for a back strain — a pulled muscle.
It’s Not Like It Used To Be
I found the GP to be a nice man, very personable in his approach. That said, call me old fashioned but I was a little stunned; this whole process was done over the phone without any physical examination, X-ray or MRI scan being undertaken. How can you possibly treat someone for acute lower back trauma without confirming exactly what the damage is? Especially knowing I have a lengthy history of chronic back pain; suffered as the result of a traumatic bone injury, sustained in a high-speed car collision.
I don’t live in a cocoon, I’m aware of the issues being reported about changes in the NHS, but I was still shocked that things had
changed deteriorated so much. Nevertheless, I decided: it is what it is, I would just have to get on with it. I understand now why so many people just turn up at the local A&E department for treatment.
During my two-week wait to see the doctor, a friend loaned me a walking stick which was a big help; taking some pressure off the affected area. I also read a huge amount about the treatment of lower back pain to see if I could solve the problem myself. Everything about the problem pointed toward me probably having ‘slipped’ a disc.
The information I could glean from research, was to take medication to manage the pain and then keep mobile. There appeared to be little reference to rest and recuperation. This surprised me. But it did concur with the advice I’d been given over the ‘phone by the GP, as well as that given by well-meaning friends.
But, the reality is, none of us, including a medical professional, knew what damage I’d done to my back; therefore, for all we knew, by soldiering on, trying to carry out my normal tasks, I could’ve just been making my injury worse — edging my way closer to paralysis, or at the very least, irreparable damage and permanent disability. I know that sounds melodramatic but it certainly felt that way to me because the pain seemed to be getting worse rather than better.
A Welcome Second Opinion
My two-week wait to see the doctor was over: I hobbled into the surgery complete with walking stick in one hand and my wife supporting me by my other arm. It was a different doctor this time. I could see he’d prepared himself, he had my medical notes open on his computer and was therefore well aware of my history. This coupled with my dramatic entrance into his office, reminiscent of a scene from the hunchback of Notre Dame, left him in no doubt that, despite being doped to the hilt on Opiates, I was still in severe pain when I tried to move.
He explained to me that it was his opinion that I had a prolapsed or herniated disc in my lumbar (for us non medics, that’s a slipped disc). The GP stressed that an X-ray would not show the damage, as discs are actually soft tissue. The only way to confirm his diagnosis was with and MRI scan. That said, he maintained there was no point in an MRI; he was treating me for the worst-case scenario — a herniated disc — so having an MRI would not change the treatment he was about to suggest.
He advised that I should initially rest in bed for five days: no housework, no cooking, no sitting at a computer; in fact, no work at all over that period. He also prescribed Tramadol to replace the Codeine, he said it was a stronger and more effective opiate; he also prescribed Diazepam to relax me during the daytime to minimise spasms. At night I had to continue with Amitriptyline which, along with it’s pain killing properties would help me sleep.
Rest & Recuperation is the way forward
The initial advice of soldiering on did nothing but make the situation worse. The second GP’s advice had me feeling better after five days. The pain had reduced significantly and the meds were helping. It’s now two weeks since I had the consultation with the second GP and I’m working again; almost pain free and able to move much better.
After eight weeks of pain, I feel relieved; my gut had been telling me to rest while it seemed everyone else — including a doctor — was telling me to soldier on through the pain. I should’ve listened to my gut. Why was I given such bad advice almost everywhere I turned? What has changed in our society to make people no longer believe in the therapeutic effect of rest and recuperation?
I’m still having a tough time getting my head around it all.