August 3rd, 2009

Chronic pain, health insurance, and me

Almost twenty years ago I hurt my back and sustained injuries to both arms that left me with what’s known as neuropathic pain.

We all know what pain from an injury feels like. But if you’re fortunate, you don’t know—and will never have to learn from personal experience—what neuropathic pain is like.

Nerves ordinarily conduct pain impulses when tissues are damaged, but that sort of pain corresponds to the degree of injury and is time-limited. Once healing occurs, the pain (or almost all of it) goes away. Neuropathic pain is different; it arises from injury to the nerves themselves. They become disordered in a host of ways, and the quality of the pain impulses is quite different from that of the more familiar types of pain, and has a marked tendency to become chronic:

Neuropathic pain, in contrast to nociceptive pain, is described as “burning”, “electric”, “tingling”, and “shooting” in nature. It can be continuous or paroxysmal in presentation.

Not that much is known about nerve pain today, and it remains exceedingly difficult to treat. But about twenty years ago, when I began to deal with it myself, it was the relative Dark Ages of pain control.

When I hurt my arms it was terrifying; the pain felt like nothing I’d ever had before, and it was with me 24/7. The best I can do to describe it is to say that among its many horrific qualities was the feeling of having sustained a severe sunburn on the entire surface of both arms. But with a real sunburn, there are salves and ointments to apply, you know why you’re hurting, and you know that in a few days the pain will go away.

This pain was different. It waxed and waned in odd and erratic fashion, although it tended to be at its worst at night, which made sleep nearly impossible and the nights a long drawn-out torment. It wasn’t just the burning, either. There was also tingling and stabbing pain and severe achiness and exquisite sensitivity and weakness and pressure and all sorts of odd sensations that gave me the feeling that my body had become a sadistic trickster bent on driving me mad.

I’m grateful that no doctor ever suggested my pain was imaginary or psychogenic in nature. It was clear to them from my history and findings that I had sustained nerve injuries in both arms. Several nerves were affected, but by far the most severe symptoms were in the ulnar nerves:

ulnar.jpg

The first doctor I saw was an arm specialist, and he sent me to a neurologist for tests called EMGs that measure nerve conductivity and attempt to pinpoint the site and extent of the damage. My results were ambiguous: conductivity was slowed, especially across the elbow, but not enough to indicate a need for surgery, and not enough to show which of several different types of surgery I should have (if you look at the diagram above you’ll see that there are a number of possible areas for compression of the ulnar nerve, and the site determines the type of surgery indicated).

When my doctor told me the news, he sent me home after saying that he could do nothing for me. I still remember his chilling words, “Even morphine won’t touch this sort of pain.”

It turned out he was wrong about that; morphine will touch it, but only a little. In fact, methadone tends to touch it a lot more firmly. But I wasn’t seeking drugs, especially opioids, which have a host of dangerous side effects; I was seeking a way to heal.

Over the years I tried many things, to little or no lasting effect. Several types of non-opioid medication. Many different sorts of physical therapy, too numerous to count. Cortisone. Experimental MRIs that were supposed to image damaged nerves. I also sunk many thousands of dollars into the alternative medicine industry. Acupuncture. Osteopathy. Homeopathy. Naturopathy. Reiki. Magnets. And more. Along the way I met many good people and many charlatans, the kind and the cruel, the caring and the indifferent.

And after a while I went to the experts. Since my case was somewhat unusual and some of the various syndromes under consideration somewhat rare, there weren’t a lot of knowledgeable people and the ones who did exist were spread out around the country. I don’t remember exactly how many I consulted—quite a few in Boston, for example—but to find the most expert of experts I had to do a lot of research and travel quite a distance.

My insurance covered much of this, except for the alternative practitioners. I had always had a horror of not having medical choices, so for years my husband and I had paid extra to have the freedom to go to other states, and not to be bound by a primary care physician’s recommendations and restrictions.

It was money well spent. But I soon discovered that even the experts disagreed as to what the best treatment would be. One wanted me to have a very invasive and dangerous surgery to remove my first rib through my armpit. One thought I should have a scalene muscle in my neck removed as well. Each thought the surgery would probably help somewhat, but they told me the risk of complications and permanent damage was high, and the chances of marked improvement not good.

There was a also a somewhat less risky (although still chancy) elbow surgery I could have (actually, I had a choice among at least three types of elbow surgery). But the doctors in Boston and the East refused to perform it on me because, although my symptoms pointed to ulnar nerve entrapment at the elbow, the findings on my EMG tests (which had been repeated about five times over the years) remained ambiguous.

Finally, nine years into this, facing continual debilitating and demoralizing pain, and having exhausted all the non-surgical remedies I could find, I went with my gut and made my decision. My perception was that the bulk of my pain originated in the elbow area. If doctors in the East wouldn’t operate on my elbow (the right, which was worse than the left), there was a famous doctor in the West who would. He was one of the world’s experts in elbows and had done more surgery of this type than almost any other surgeon in the world. He took a careful history, looked at all my tests, and examined me thoroughly. He announced himself willing to perform the surgery to release my ulnar nerve from the elbow and move it to a new place under a muscle in my forearm.

Before the surgery I was given a sheet full of dire warnings for me to sign. I knew that most other doctors would have disagreed with this man’s decision. I had no idea whether I was doing the right thing, and he gave me no guarantees whatsoever, except that he would do his best. But I knew I had run out of alternatives and that I could not live with myself if I didn’t try for what now appeared to be my best (and perhaps only) hope of getting better. I also knew I would probably never be normal, but I’d almost forgotten what that was; I’d settle for “improved.” So I was at peace with my decision.

I remained at peace with it throughout my lengthy and extremely difficult recuperation, lasting about two years.

In the recovery room right after the surgery, the two doctors who’d operated on me had a fascinating but sobering tale to tell: they were surprised at the amount of damage they’d found in my elbow, much worse than expected. My ulnar nerve itself was red and swollen. There was at least an inch of thick scar tissue pinning it down completely within the cubital tunnel, the passageway in the elbow through which the ulnar nerve normally runs, so that in my case the nerve was unable to move freely. This is what had caused at least some of the terrible pressure and pain; every time I’d moved my arm I was stretching and injuring the nerve.

The doctors added that the surgery had taken twice as long as normal, and had traumatized the nerve much more than usual. They also had noticed that other smaller nerves had gotten tangled up in the mess of scar tissue, and they’d had no recourse but to cut those nerves as well. They could not predict what the effects of that severing would be.

The doctors made it clear that they did not know how well I’d recover, or how long it would take. We were in uncharted waters. But I knew I’d gone to the best people possible. And they told me something else that I took to heart during the many dark hours that followed: it seemed I’d had the correct surgery, after all. Although they could not guarantee that I would improve, the damage they had viewed when they had opened up my arm was so bad that they could not see how I ever could have improved without an operation.

Now I’m grateful every day that I had that surgery. Although it took a couple of years to recover, I would say I’ve improved about 75% as a result of the operation. That means, quite simply, that I got my life back. Not a completely normal life—but I wasn’t really expecting that. It’s a life that, although I still have to be protective and careful, allows me to do so many things I couldn’t do before, and to do them without significant pain or the need to take powerful medications.

Why am I telling this long and tedious and rather personal tale? Although all these years have passed, I’ve thought of it recently in connection with the health care reforms being discussed in Washington. The flexibility of my insurance coverage was one of the main reasons I was able to go so far in seeking relief; without it I have little doubt that I’d still be be in terrible trouble.

It was actually my injuries that first propelled me online over ten years ago, looking for information to help me with my decisions, and to read about the experiences of other people who suffered from similar problems. One of the things I found at that time that made a deep impression on me were the stories told by patients in Canada and Britain. Although they didn’t have to worry about insurance coverage, they were uniformly the most miserable of all the chronic pain patients on several message boards I frequented. They had to wait forever for tests. There were far fewer specialists in Canada and Britain who knew anything about their injuries or how to treat them either surgically or medically. The problems of these patients were generally considered unimportant and they were given low priority.

Until that time, if I’d thought about the health care system in those countries at all, I had assumed it was a great thing that there was universal coverage. But during this experience I learned that, at least for nerve injuries and chronic pain of the sort I had, the care here was far better. In fact, many of these people dreamed of saving up enough money to come to the US to some of the surgeons I’d been able to see. But they could not afford it, and they continued to suffer.

I’m not a rich person. But ever since then I’ve continued to pay extra for the medical insurance most likely to preserve my freedom to choose. If I hadn’t been able to have surgery on the west coast, I believe that even now, ten years later, I would probably be suffering from pain at or above the level of those early years. The prospect is so dreadful that I shudder to even think about it. I’m just grateful that wasn’t the case.

My back injury had a different course. I still have some pain and vulnerability there but I’ve never had surgery, because I got major relief from an epidural steroid injection I received about fifteen years ago. That’s probably why this article about a newly-announced British policy towards those very same injections caught my eye:

The Government’s drug rationing watchdog says “therapeutic” injections of steroids, such as cortisone, which are used to reduce inflammation, should no longer be offered to patients suffering from persistent lower back pain when the cause is not known.

Instead the National Institute of Health and Clinical Excellence (NICE) is ordering doctors to offer patients remedies like acupuncture and osteopathy…

The NHS currently issues more than 60,000 treatments of steroid injections every year. NICE said in its guidance it wants to cut this to just 3,000 treatments a year, a move which would save the NHS £33 million.

That’s a proposed 95% reduction in the number of these injections, which are an invaluable aid to the treatment of back injury—which, by the way, is an area of medicine for which “the cause” is rarely known. As the article goes on to point out, such treatments are a relatively simple and less risky way of saving many people from being on opioids for the rest of their lives, or having much more expensive and risky surgery in the future. Penny wise and pound foolish.

And perhaps a portent of things to come here.

55 Responses to “Chronic pain, health insurance, and me”

  1. Baklava Says:

    You are an incredible woman.

    If there was only a way to make a million people read this.

    The reality is – Liberals/Democrats believe they “CARE” and therefore they are make changes for the good.

    They do not believe you care and therefore they do not ‘care’ to hear you.

    We need to administer some sort of treatment for their character weakness.

  2. Lucius Says:

    Baklava, how about administering a caning to liberals. They will be more concerned with their own pain than “caring” about ours.

  3. Megaera Says:

    10 years ago, at 48, I had to have both hips replaced. I had reasonably flexible insurance and I found an extremely helpful website for hip surgery candidates around the world and spent hours studying their posts and reading up on the alternative therapies, all time well spent. 10 years ago Canadians (and Brits with no access to private medical care) were uniformly reporting 6- to 12-month and greater waits for hip surgeries, since they were considered “elective”, even though for many patients the operation meant the difference between walking and not walking and surcease from crippling pain. Me, I made my appointments, had my surgeries, did my recoveries, and (D.G.) haven’t looked back.

    10 years later, the situation in Canada and Britain has only degenerated, and the “free” care promised isn’t even a mockery of care for someone in constant pain and unable to move normally, who could be helped by a relatively simple simple, straightforward, well-understood procedure which isn’t available because either there aren’t enough surgeons, or surgical beds, anesthesiologists, or nurses, or implants — in short, rationing, because that’s how government-run systems save money. In fact, the ONLY way they can save money.

    It is a matter of concern for me and for every hip-replacement patient in this country, because the implants don’t last forever, and usually need to be replaced (called a revision) within 12 to 20 years after the first surgery, depending on a lot of variables. So for me (and the rest of us), Obamacare means a double whammy: around the time I most probably will need revision surgery my insurance options will have evaporated and I’ll have been forced onto the “public option”, but by then I’ll also be too old and valueless, and will be told that the revision procedure is too costly to be wasted on me, and the new implants aren’t available — I should just take some pain pills and buy a wheelchair. Cheaper, and more convenient for the state. The future is not a pleasant vision.

  4. dane Says:

    First of all, I am glad you were able to get some relief and had the ability to get the treatment YOU decided on. If Obama keeps going and I get something like that I probably won’t even be able to buy a gun to put myself out of my misery – but then again there will probably be licensed clinics more than happy to help in that respect – that will be covered under the Kevorkian clause of the public option.

    I had a friend who recently had a liver transplant – in his mid 60’s he had to have extensive tests done on several possible donors over a period of a couple of years. I have no doubt Obamacare would have told him to be thankful he had time to get his affairs in order as they patted his hand and gave him some pills to help with the pain in his waning days.

  5. Baklava Says:

    Lucius,

    How about Canada care for liberals and the market for everyone else.

    They want it? They can have it ! 😉

  6. Bill West Says:

    Coincidence: I found your site just today and you’ve written on a topic that has affected my family since my wife and I first met. She had spine surgery in 1988 to correct a curvature (scoliosis). She has had four spine surgeries since that time, one to remove the rods inserted in the first surgery, which had become infected. Each of the subsequent surgeries were intended to relieve pain, and each resulted in increased pain.

    Your description of neuropathic pain is as she describes it. She is an energetic person by nature, and most people don’t realize the pain she is suffereing all of the time. Most people think the answer is to ‘suck it up’ and take a pain pill.

    She is under the treatment of a wonderful doctor who doesn’t take insurance, but our plan allows us to submit for reimbursements. She has struggled to have her current thereapeutic regimen authorized for partial reimbursement, after numerous letters and angry phone calls. We also put $4,500 each year into a 125 plan, and that evaporates by August. With all of this, we have reached an equalibrium in a steadily declining situation, if that’s possible.

    Under ObamaCare our current arrangements would go away. My wife would be classified as expendible. Quality of life would rapidly deteriorate to the point of unbearable. Before long assisted suicide will have become a healthcare option. She wouldn’t survive a cost/benefit analysis.

    Bill West
    Los Angeles

  7. Tatyana Says:

    Baklava, you reminded me of all those liberals’ cries, in 2004, intending to move to Canada due to incomprehensible Bush win in elections.

    Ah, if only they knew how to keep their word! Double benefit…They by now would have learned what state-backed medicine means and We would have got rid of them and their folly.

    Neo: I can’t say I feel your pain (as a fellow lower back sufferer I know it’s impossible), but I can imagine what those years of health concerns meant, in practical terms.

    Please accept my sympathy.

  8. Oh, bother Says:

    When I read the Telegraph article on reducing access to steroid injections I was reduced to sputtering fury. Is NICE setting out to be stupid as well as vicious? 95% reduction in steroid injections means substantially reduced productivity for those chronic-pain patients who have been denied. I would have thought the UK could use all the tax income they could get, but maybe not.

    Neo didn’t touch upon this part of the chronic pain game, but the first time chronic pain sidelined me my productivity, expressed in income, was reduced by 75%. Reduced productivity, reduced income, reduced tax revenues to pay for the vast bureaucracy that will scrutinize every aspect of our healthcare. In order to pay those bureaucrats, something will have to give. Identifying that, is an exercise for the reader. Anecdotal hint: my most important doctors say they will quit the practice of medicine, and I believe them.

    Whatever method of rationing, will suit them.

  9. Hong Says:

    Wonderfully detailed as usual. I won’t bore anyone with my spinal issues but needless to say, Obamacare has me in a fright. My best hope is that any bill passed by these liberals will do nothing worse. Instead of creating an expensive and inefficient govt health insurance, why not offer something like vouchers to every American citizen to pay for a private plan? Wouldn’t that quiet the criticism while providing the universal coverage at a more affordable budget? Oh I forgot, we’re not dealing with sober players in Congress or the White House. It’s the Chicago thugocracy in charge. God help us.

  10. Will Says:

    Wow, thanks for the perspective. I am an anesthesiologist. Although my practice is limited to pediatrics, I had enough exposure to chronic pain and neuropathic pain to give me some insight. You just gave me more.

    As a healthcare provider (and regular reader) I am truly in fear of the changes on the table. I fear for my future as a practitioner, but more importantly, I fear for all of my fellow citizens and patients. Whats coming isn’t good at all and I fear choice is the target more than anything else.

    While health care is the topic, control is the real issue. The people in government want control of us, our health and our pocketbooks. They want to make the choices not leave them to me or you. Very scary.

    Now is the time to rally and for us to educate our fellows and make ourselves heard. As I have written my representatives, if its not good enough for you, its not good enough for me or my family either….

  11. Baklava Says:

    Do you know what is really unfair?

    The unequal access to computers.

    As somebody who has worked in the computer field for 20+ years, I think the government needs to provide all people computers.

    🙂 He he

  12. gcotharn Says:

    My sister in law has a story of American health care and American health insurance:

    She had two rare and difficult to diagnose (and undiagnosed) infections inside her organs and digestive tract. Over a couple of years, she was constantly sick, had no energy (she looked, to me, like she was slowly dying), and definitely was miserable. She went to doctor after doctor. No one could find the problem. Luckily, she had good health insurance, and was able to doggedly continue her quest to find what was wrong with her. Finally, after approx 2 years of searching, she landed with a disease specialist – a self styled medical Sherlock Holmes – in New Orleans. After extensive (and expensive) testing, he discovered her problems, set her courses of medication, and in only a few weeks she was dramatically strengthened and back to normal. I saw her before and after: the change in her health was dramatic. She is not a wealthy woman. IMO, her health insurance likely saved her life.

  13. Baklava Says:

    Who has better care? America

    http://www.hoover.org/publications/digest/49525427.html

    I love her

  14. James Says:

    If you have anything that is not life threatening in Canada you have to wait. I have had recurring and debilitating “dizzy spells” lasting 3-4 days about once a year for the last 6 years. Waited 6 months on a waiting list to see an ear nose and throat specialist. On the day I was finally scheduled to see the doctor, she rushed out to the hospital to operate on a guy who shot himself in the face with a nail gun.

  15. Mr. Frank Says:

    One thing the Canadians and Brits have is the U.S. as an escape hatch. If we go the government route, there will be no escape.

    Drudge has some links today to videos of angry voters confronting politicians. Maybe people are waking up.

  16. Vieux Charles Says:

    Neo,
    To heal your affirmity you heroicly demonstrated, accountability, self-reliance, determination and resolve. These are qualities absolutely necessary for survival, and qualities completely alien to the despondent minions that have allowed themselves to be swallowed up by the Obama Borg.

    Thanks for sharing 🙂

  17. saveliberty Says:

    I am very glad that you had this surgery and that you have your life back.

    I would also like to thank you for sharing such a powerful, personal story as to why we would be at a loss if the government were to close off doors for healing in the name of “reform”.

  18. ELC Says:

    Yes, thanks for sharing that intimate and powerful story.

    But ever since then I’ve continued to pay extra for the medical insurance most likely to preserve my freedom to choose. You are in luck! Democrats are all for keeping a woman’s freedom to choose!

    Oh. What’s that? That’s not what they mean by choice? Never mind.

    That points out an irony, though, doesn’t it? As I understand things, Democrats say the “right” to “choose” abortion should be a decision made between a woman and her doctor, but it looks like every other medical choice is going to become, if they get their way, eventually, a decision made by one’s loving, caring federal bureaucrat.

  19. Oblio Says:

    Neo, I admire your moral courage, and your patience and courage in the face of terrible pain is part and parcel of what makes you so admirable. Mrs. Oblio is sort of the same way. You and she deal with what is.

    On the Obamacare front, Wretchard has posted something of unusual brilliance, even for him. http://pajamasmedia.com/richardfernandez/2009/08/03/we-have-to-make-judgments-very-fast/#more-5355

    Wow.

  20. MikeLL Says:

    Fascinating story. Thank you for sharing, Neo. This is, I think, what is frightening a lot of people.

    Some interesing comments at the NHS article link. One of my favorites:

    “So compassionate…this Nationalized Healthcare that covers everyone and treats no one.
    P. Aaron
    on August 03, 2009
    at 12:00 PM”

  21. MikeLL Says:

    Oblio,

    WOW. I had not seen that video.

    Arlen Specter: “Every bill is read and understood by me before I vote.”

    LIAR! So crazy what these people are doing.

  22. jon baker Says:

    I believe shingles must be a form of neuropathic pain, albeit usually milder than what you experienced. My father has been suffering for months with them, though they are getting better.

  23. The Anchoress — A First Things Blog Says:

    […] goes deeply personal to chronicle a horrendous-sounding injury, years of pain, and how this is relevant to what may be in our own future. It’s long, but […]

  24. Jim G. Says:

    There are so many stories such as yours, Neo, that illustrate how a market system of healthcare allows us to get better treatment for really difficult cases.

    Single payer healthcare sounds good to those who cannot or will not see how much better the system works when doctors and patients are allowed to work together. When a medical standards board sets the rules for treatment, anything unusual like
    Neo’s problem is just left untreated or under treated only with cheap pain meds. Adam Smith first recognized how many thousands of decisions by the individuals involved did a better job of making the best decisons and achieving the best outcomes. The Obama crew just do not recognize the genius of that. Somehow to them it seems so chaotic and………UNFAIR.

    This debate over healthcare reform is, in fact, a debate over whether we are going to be a free market, small government nation or become a nation of sheep herded into pens by central planning. I am writing and calling my Congress critters every other day. I’m attending two Tea Party demonstrations against healthcare reform this month. If you are frightened by the ideas that the dems want to institute, you should make your views known to your representatives. They work (supposedly) for us. That video of the crowd at Specter’s meeting – those are taking place all over the country. Make your voices heard. It is the only hope we have.

  25. E Says:

    Note to self: when in need of immediate attention under our future Obamacare system, shoot self in face with nail gun.

    Neo, you’re a woman of rare courage. I know you didn’t share your story to earn accolades – but please accept our admiration and respect. I’m glad you didn’t have to go the nail gun route.

  26. Deborah Says:

    I am so grateful that you were able to find some relief for your pain.

    I believe that the proposed heath care “reforms” will kill us all.

  27. Rose Says:

    I never cease to be amazed and impressed when I come here. Thank you, Neo. As always, I leave with my heart warmed, knowing there are good people out there.

  28. Robohobo Says:

    I also am a sufferer from chronic pain. In my late twenties I injured a disk @ L4-L5 as a herniation. That resolved itself over about 3 years to just occasional bouts of spasms. Then 4 years ago at age 53 I injured L3-L4 as another herniation. BTW, L5-S is naturally fused.

    The resulting pain from the L3-L4 injury was too much. It involved shooting pain from the right hip to the middle of my shin. It was so severe, I could only sleep for a few hours and I could only walk with a cane for 25 feet or so then have to stop and gasp until the burn subsided. I tried several non-invasive things to try and get better:
    1. Therapy with no improvement. Just the opposite.
    2. Facet point injections (3 each) of cortico-steroids and time release pain killers to try and alleviate the nerve irritation. These had no lasting success. After 3 to 4 weeks I was back where I started. You can only take so many at one site as they tend to strip the calcium out of the bone.

    Then we went to surgical consultation. A more detailed MRI was done and all the damage came to light. Degenerative spinal stenosis due to osteo-arthritis and age. It is called skiers back due to repeated impacts from the sport in my youth.

    I had the surgery to reduce the herniations and clean out the bome channels and spurs – discectomy at both sites. They also did nerve conduction tests during surgery and found diminished function. It helped some but I now find myself with reduced circulation in both legs, the right side (L3-L4) injury is coming back, severe pain in soles of my feet as a side effect of the facet point injections (they don’t spell out that possible side effect) and limited mobility from the constant pain. I take the opioids and gabapentin to treat the pain. But they only help so much.

    Because of all of this and other medical history, I now find myself uninsurable. It sucks but I still do not want the public option to be put in place. It will bankrupt the nation. I imagine I will be one of those who is found to be not treatable and asked to consider ‘other’ options.

    Screw the fascists. Never give in.

  29. Perfected democrat Says:

    “But ever since then I’ve continued to pay extra for the medical insurance most likely to preserve my freedom to choose.”

    When you lose your freedom to choose, your life isn’t worth the proverbial “plug nickel” once essentially dishonest, incompetent, shallow left-wing blowhard bureaucrats are in sole control. The Democrat’s agenda, across the board, is so incredibly sinister it boggles the imagination. But only with the healthcare reform issue does it become upfront and personal in the most intimate and compelling way. I’m often in awe of your ability to pump out these articles faster than I can think about them and respond thoughtfully, and here again you have outdone yourself with your best article yet Neo. When everyday is even a little bit of a pain filled physical hell, arrogance becomes so incredibly annoying…

  30. Mrs Whatsit Says:

    I know you wrote about your ordeal to illuminate issues of choice and access, but I came away from reading your history struck by your resolve, resourcefulness and plain old courage. Many people afflicted by chronic pain are destroyed by its relentlessness. You, by contrast, seem to have been steeled. I wonder if you’ve ever thought about whether there is a connection between what it took you to get through your pain — what Oblio called dealing with what is — and what it took to make your political change. Both are acts of dealing with what is, and also acts of courage. Did one help you find strength for the other, or are they chicken and egg?

  31. fraydna52 Says:

    RE jon baker:
    Yes, shingles does cause neuropathic pain. I thought of that when reading this post, since I had shingles on my leg last year. Some unfortunate people end up with a condition called post-herpetic neuralgia, which is a challenge to treat. (Thankfully, I was spared that complication.)

    I can identify a bit with neo’s description. It is a very unique pain that is hard to imagine if you’ve not experienced it. In fact, my case of shingles began with neuropathic pain before the blisters appeared.

    Neo, your story is both an uplifting testament to persistence and a cautionary tale regarding the impending changes to personal choice and health care. Thanks for sharing it.

  32. bill Says:

    I would not wish that experience on anyone, of my political stripe or not. Certainly, this qualifies you to participate strongly in the discussion, and I hope that you do.

  33. Oblio Says:

    bill, I disagree. neo does not qualify to “participate strongly in the discussion” because of her suffering; everyone is qualified. If neo had never suffered, she would still be qualified.

    neo deserves to be listened to because of her clarity of mind and strength of character.

  34. Baklava Says:

    Neo is

    1. Qualified
    2. Well spoken
    3. Commands respect
    4. Is persuasive

    Certainly everybody can write. What Neo brings is an ability, a set of experiences, and a higher possibility of the listener giving an ear to what she is saying.

    It’s like Kelly King speaking saying she will not vote for Obama again.

    It has more impact than the 39 year old white guy (me) who has no health problems and some ability to write but nowhere near Neo’s. 😉

    It’s an unfortunate thing that liberals focus less on substance of the words and more on who is speaking and style……

  35. goesh Says:

    Systemic /proteolytic enzymes, pharmaceutical grade
    Germanium but do your research before buying
    – very potent analgesics minus harmful side affects

  36. Baklava Says:

    Chilling

    http://wizbangblog.com/content/2009/08/04/oregon-health-plan-has-already-weighed-the-cost-of-life-1.php

  37. J.L. Says:

    Neo, first, Your account was articulate and vivid. I wish you well in your continued recovery. I hope any and all remaining pain that you may have will be taken care of and no longer cause you trouble.

    As for Obamacare… as I’ve noted in previous postings. It’s as if these leftists are wedded to their precious theories. If they really believe that such centralized health care is the answer, then they have their heads so stuck in their theory books that they dont look at reality. If, as some have stated, they don’t care about reality and cling to theory as a means to expand their power, then what they are doing is immoral. So, they are either stupid or despicable.

    I’m not all the way to the right politically, but I know enough not to trust the same government that concocted the so-called stimulus package (a hapharzardly put together collection of pork pieces parts with the word “stimulus” attached), and which enacted and administered the laughable “cash for clunkers” plan, to take hold of our health care system.

  38. J.L. Says:

    At the risk of being redundant, I have to quote Jim G.’s posting, above, which stated so well WHY I dont trust the govenment, and prefer a free market system. Reality refutes the theories that the ledt concocts. The free market, though chaotic, takes better account of the chaos that is reality.


    Jim G. Says:

    There are so many stories such as yours, Neo, that illustrate how a market system of healthcare allows us to get better treatment for really difficult cases.

    Single payer healthcare sounds good to those who cannot or will not see how much better the system works when doctors and patients are allowed to work together. When a medical standards board sets the rules for treatment, anything unusual like
    Neo’s problem is just left untreated or under treated only with cheap pain meds. Adam Smith first recognized how many thousands of decisions by the individuals involved did a better job of making the best decisons and achieving the best outcomes. The Obama crew just do not recognize the genius of that. Somehow to them it seems so chaotic and………UNFAIR.

    Well stated Jim. G.

  39. J.L. Says:

    Coorection:

    “the ledt concocts”

    the left concocts

  40. RWB Says:

    A very moving post and perhaps the most important argument against nationalized healthcare.

    I have link to you in my own humble post.

  41. DavidW Says:

    Hi Neo,
    cross-posted your story (as a link) at
    http://blog.acton.org/archives/11521-healthcare-dont-forget-the-morality-of-it.html#comment-6224
    (see DavidW). Asked there, after Uninsurable gave his account:
    But some are simply left out. A market-compatible solution? (deflating the government’s argument for interference?)

    What would be your angle on that one?

  42. Fred2 Says:

    Thank goodness you are still able to type!

  43. grackle Says:

    My own attitude toward the healthcare debate is still undergoing an evolution.

    Here’s some interesting thoughts I’ve come across, mainly at Kausfiles.com:

    Right now healthcare is 17% of the GDP. People talk about the high cost of healthcare(“sky-rocketing!”) but considered as an average 17% doesn’t seem all that high to me. Sure, it used to be lower but we have better medical technology and procedures today than in years past. Not that I don’t think it couldn’t be lower, or shouldn’t be lower. We are much better at prolonging life and treating certain diseases and that has a tendency to be more expensive.

    I came across the economic concept of superior goods and inferior goods.

    Inferior goods are those things that we don’t buy more of if our income rises. If I win the Lotto I won’t be buying more magazines or more jalapenos.

    Superior goods are those things we buy more of as our income rises. If I come into a windfall I would probably buy a better abode, an automobile – perhaps 2 or 3, take a long tour of Europe, etc.

    Healthcare is definitely superior goods. Since America has over the years become richer it is only natural, in economic terms, that more is spent on healthcare. A nation has a tendency to spend more on superior goods as it becomes wealthier. There’s not much spent on big screen TVs or healthcare now in Sudan but that will probably go up if Sudan becomes a richer nation.

    I think the debate on healthcare is somewhat misplaced on both sides. While keeping healthcare costs down is a worthwhile goal, cost containment should not be the primary goal and cost considerations should not be the primary driver of policy.

  44. Dr Bob Says:

    Neo,

    Your story illustrates another very important aspect of the health care debate: the the issue of outcomes research, and best practices.

    Of course, it’s hard to argue with “experts” getting together and deciding what’s the best approach to various health care problems. But many, many areas of medicine are not at all black and white — multiple treatments exist for a condition which is recalcitrant (like chronic pain syndromes) because no one treatment is helpful in everybody. This ambiguity actually promotes medical advances by allowing “off-label” treatments & medications to help these difficult patients.

    Bottom line is that under the new federal bureaucracy & single-payor government plan, your elbow surgery would never have been approved.

  45. Baklava Says:

    grackle wrote, “I think the debate on healthcare is somewhat misplaced on both sides.

    It probably depends on who you are reading and what their arguments are on each side.

    I believe our GOOD MINDS are not misplaced with this debate.

    Consider…..
    Everybody’s health for the most part is in their own power to control. Their diet and exercise are crucial to this. Health simply isn’t injected into your body with money or government. Health is a series of individual decisions. Health costs have gone up because of our collective unhealthy decisions, advancements in technology and GOVERNMENT which has helped INFLATE prices.

    Now, for those people who have health issues that are not due to their own decisions (like Neo or a baby with a disease or cancer, etc) there is NOBODY who goes without care. It is and has been illegal for a hospital to turn down caring for a patient.

    Thus the red ink that many hospitals incur whose location is bad.

    How do we solve the ‘access’ and ‘cost’ issues?

    The leftist/Democrat/liberal solutions actually would take away ‘access’ (see Canada, British health care anecodetes).

    The left approach would increase ‘cost’.

    Our smart minds on this topic do have solutions that will reduce costs and improve access.

    Will. reduce. costs. will. improve. access.

    Do you recognize this?

  46. Barb the Evil Genius Says:

    I can think of lots of counter-examples off the top of my head. I am bi-polar. It’s mostly controllable as long as I take my very expensive meds. I also have a counselor and a psychiatrist I can see regularly.

    My husband has Crohn’s disease and Hashimoto’s disease. He did nothing to acquire those, but he needs a specialist for each, and again, more meds. Crohn’s meds are especially expensive.

    My sister-in-law also has Crohn’s. Hers has required surgery as well as specialist visits and lots of meds.

    I don’t believe Neo’s injuries were within her power to control.

    Not to mention I don’t believe things like cancer or heart disease are as cut-and-dried linked to certain factors as many believe. In any case, all of us would probably get short shrift under nationalized health care, and none of us have done anything “wrong”.

  47. Health Care Critics: An “Angry Mob” or “Expressing Their Concerns”? « Minnesota Free Market Institute Says:

    […] A blogger with chronic pain considers how her choices for treatment will be curtailed […]

  48. blert Says:

    I’m having chronic burning sinusitus that is affecting my sleep very much in the manner of yours.

    I’m still fighting my HMO. They’d rather give me opioids as against a cure.

    There is a consistent theme with all but one of my physicians: they always contradict me. Twenty-one years have passed. It’s a shame.

    When a physician cannot accept the falsity of his diagnosis his emotions turn to anger, resentment and hostility. When he gets it wrong, then the patient is being ‘difficult.’

    I rather suspect that I’ll have to visit the Mayo Clinic. (They saved my sister’s life for which her children are truly grateful. )

  49. grackle Says:

    Our smart minds on this topic do have solutions that will reduce costs and improve access.

    I’m NOT against reducing costs. What I’m doubtful about is using cost reduction as the primary concern when making policy.

    I’m not sure what is meant by the term, “improving access,” so I am not sure how to respond. In general it seems to me that everyone has some access to healthcare – even those who cannot pay. Our emergency rooms are not allowed to turn people away. I guess the issue is what kind of access and under what circumstances.

    Will. reduce. costs. will. improve. access.

    Do you recognize this?

    Well, I’m not for anything floated by Congress at this time. It seems to me that we would be better off leaving the system alone.

    I’m not against some reform of the insurance industry. It seems to me that there are things that could be changed to benefit both the consumers and the doctors that deal with the insurance companies.

    I like the idea of abolishing requirements that consumers buy insurance only from companies in the state in which they live. What the present system amounts to is an absence of competition.

    Standardizing the administrative transactions of the insurance companies would also simplify things for both doctor and patient.

    In short, I would like the insurance companies to be made to honestly compete with each other instead of merely divvying up the consumer pie as they do now. Real competition would probably result in a reduction in cost.

    But I don’t want draconian reform that would have the effect of eventually driving the insurance industry into bankruptcy. Eliminating all “preexisting conditions” seems to me to be a recipe for eventual bankruptcy of the insurance industry.

    We can’t have folks deciding to buy insurance only after they come into a catastrophic medical condition. On the other hand, refusing to insure someone because they take high blood pressure medication seems unfair.

    Stopping the practice of conditioning promotions, raises and bonuses on insurance adjusters’ rate of refusing claims is another step I favor.

    I am emphatically NOT for any kind of single payer system.

    I would be in favor of relieving the doctors of the onerous malpractice insurance fees they pay now, perhaps with a mandatory ceiling on jury awards and a downward limit on legal fees going to the lawyers. The lawyers are in business just like anyone else but we make it too tempting for them to try to hit the jackpot through frivolous litigation.

    But as I’ve said before, my attitude in this area is undergoing evolution. I’m open to arguments for particular viewpoints. Fire away but please be specific.

  50. Artfldgr Says:

    i am very sorry to hear of your pain…

    though some may find this interesting:

    Neuropathic pain: The sea provides a new hope of relief

    A compound initially isolated from a soft coral (Capnella imbricata) collected at Green Island off Taiwan, could lead scientists to develop a new set of treatments for neuropathic pain – chronic pain that sometimes follows damage to the nervous system. Currently this form of pain is very poorly controlled by the usual analgesics (aspirin like drugs (NSAIDS) or even opioids like morphine) and novel treatments are urgently required. The conclusion of a paper published today in the British Journal of Pharmacology is that this new compound could be a candidate.

    http://www.physorg.com/news168674447.html

  51. Mike Says:

    “Right now healthcare is 17% of the GDP. People talk about the high cost of healthcare(‘sky-rocketing!’) but considered as an average 17% doesn’t seem all that high to me.”

    It’s not the macro that matters. It’s the micro.

    I’m no fan of gov’t healthcare. But I’m no fan of insurer-driven “exponential cost curve” either…ie. healthcare cost as percentage of wages. (and diminishing wages at that..)

    So yes, cost containment does need to be a goal, of WHATEVER we do to address healthcare, public or private.

    Since suggestions are seldom offered as to how we bend that curve down, and how on earth Americans will continue to absorb the Y-over-Y increases, I’ll offer my 2 cents:
    – immigration reform
    – computerization (and standardized records access)… every step of every process, cradle to grave.

  52. Sidney Says:

    I don’t understand why a public option is necessary in order to negotiate lower prices with drug companies to bring costs down. We have free trade for nearly all other products coupled with quality control regulations. How fast would drug prices drop if we could buy high quality drugs from abroad 10 times cheaper?

    The two big issues are making health insurance mandatory for all employed citizens, and also making sure no one is excluded for pre-existing conditions. It’s ridiculous that insurance companies are allowed to do that. Are bad drivers denied car insurance? No. It simply costs more.

    No one likes to pay for expensive health treatments. And some folks have bad health problems requiring expensive treatment through no fault of their own. It is more than possible for the rest of America to chip in to help those people. Thank God we already do through taxpayer-backed emergency room care for the uninsured/charity hospitals, etc., even though we draw the line at preventative care.

    This is all simply about who pays for an incredibly expensive service that we ALL require. Thank God we don’t live in a nation that denies immediate healthcare to anyone. Figuring out how to pay for it all is no easy task. The liabilities increased by $8 trillion when Bush added prescription drug coverage to Medicare for the elderly. And that’s JUST for the elderly.

    The benefits of private medicine are undeniable, and free choice of doctor is important. I certainly hope ObamaCare does not mess with that. Government control is very scary. At the same time, private insurance and drug companies are REAPING profits while squeezing doctors and patients. And no one has the guts, or the money, to take them down.

    1) Limit insurance companies ability to make profits at the expense of our lives and our health. There should be no billionaire insurance company executives.

    2) Allow free trade for drug imports, with careful quality control and regulation. This will help the rest of the world as much as it will help us, and it will flush out inefficiency and price distortion in the American drug market.

    3) Make sure all employees are required to purchase health insurers, same as all drivers being forced to buy car insurance. Make this automatic and streamlined— take it straight from their paycheck but still give them the option to pick the insurance, AND the doctor they want.

    4) Tort reform for doctors so they no longer have to practice expensive, defensive medicine to avoid lawsuits

  53. sm Says:

    Well put. Let’s remember please that there are MANY US citizens unable to obtain ANY sort of health care. That is who this plan is about. I understand the nit-picking of the privileged, but it’s best viewed from a micro standpoint.

    Yes, you are privileged if you have a computer, are reading this, and have any sort of health care.

  54. karen Says:

    Hi, I had the exact same problem with my ulnar nerve fingers and arm/elbow. Had the exact operation about a year ago. It is not better but the surgeon says to give it a little time. Nerve pain is debilitating. I use my tens unit a lot. Some days are difficult to get through. The surgeon found a lot of scar tissue and my ulnar nerve tethered to my elbow bone. Your story made me hopeful. I too pay a lot for supplemental health insurance with medicare and appreciate the freedom I have in choice.

  55. Wry Mouth Says:

    thanks for relinking to this essay. it provides some clarity and hope for a member of my family.

Leave a Reply

XHTML: You can use these tags: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>



About Me

Previously a lifelong Democrat, born in New York and living in New England, surrounded by liberals on all sides, I've found myself slowly but surely leaving the fold and becoming that dread thing: a neocon.
Read More >>






Monthly Archives



Blogroll

Ace (bold)
AmericanDigest (writer’s digest)
AmericanThinker (thought full)
Anchoress (first things first)
AnnAlthouse (more than law)
AtlasShrugs (fearless)
AugeanStables (historian’s task)
Baldilocks (outspoken)
Barcepundit (theBrainInSpain)
Beldar (Texas lawman)
BelmontClub (deep thoughts)
Betsy’sPage (teach)
Bookworm (writingReader)
Breitbart (big)
ChicagoBoyz (boyz will be)
Contentions (CommentaryBlog)
DanielInVenezuela (against tyranny)
DeanEsmay (conservative liberal)
Donklephant (political chimera)
Dr.Helen (rights of man)
Dr.Sanity (thinking shrink)
DreamsToLightening (Asher)
EdDriscoll (market liberal)
Fausta’sBlog (opinionated)
GayPatriot (self-explanatory)
HadEnoughTherapy? (yep)
HotAir (a roomful)
InFromTheCold (once a spook)
InstaPundit (the hub)
JawaReport (the doctor is Rusty)
LegalInsurrection (law prof)
RedState (conservative)
Maggie’sFarm (centrist commune)
MelaniePhillips (formidable)
MerylYourish (centrist)
MichaelTotten (globetrotter)
MichaelYon (War Zones)
Michelle Malkin (clarion pen)
Michelle Obama's Mirror (reflections)
MudvilleGazette (milblog central)
NoPasaran! (behind French facade)
NormanGeras (principled leftist)
OneCosmos (Gagdad Bob’s blog)
PJMedia (comprehensive)
PointOfNoReturn (Jewish refugees)
Powerline (foursight)
ProteinWisdom (wiseguy)
QandO (neolibertarian)
RachelLucas (in Italy)
RogerL.Simon (PJ guy)
SecondDraft (be the judge)
SeekerBlog (inquiring minds)
SisterToldjah (she said)
Sisu (commentary plus cats)
Spengler (Goldman)
TheDoctorIsIn (indeed)
Tigerhawk (eclectic talk)
VictorDavisHanson (prof)
Vodkapundit (drinker-thinker)
Volokh (lawblog)
Zombie (alive)

Regent Badge