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A wretched back

These letters exemplify many that I have received, and duplicate the complaints of many of my patients over the years.

Professor Driver Jowitt, I have found your info by accident and what I have read has confirmed some suspicions I have had about my own care for some time.

About 30 years ago I had a Takata type disc extrusion which led to laminectomy discectomy including a dural tear and weeks on my back in hospital. It was not enjoyable.

I have just had a fusion to help with awful foot and leg pain due to instability and bilateral foraminal stenosis.

I still have pain in both legs and feet and my low back feels no more stable than before. I have suspected for a long time that I have not been fully informed on my true condition-based simply on how bad I often feel- and I know that my GP is taking his lead from the latest ‘expert’ and my outpourings are largely dismissed.

After all I have been ‘fixed’ now… so what is the problem???

My insurer is taking an increasingly hard line lately on folks like me. I am about to be sent for assessment by an independent contractor to determine if I can return to my trade as a carpenter. I fully expect this to be found to be true and my exit (from benefits) put into motion. I have not worked full time since 2002 – in great pain and discomfort – and lost my latest (light)job when I agreed to the fusion. I feel let down by my health services.

Dear Patient, I have the greatest sympathy for you. Medical investigatory techniques (including the most recently developed “scans”) are relatively crude. Therefore a meticulously accurate diagnosis is often lacking. At times the view is taken that “nothing shows, therefore nothing is wrong”. This is an inferior conclusion, which I often have to counter in Court. My argument is that “absence of evidence is not evidence of absence”.

By the same token, such an absence of an anatomical diagnosis defeats accurate treatment design.

However empirically and over a lifetime of involvement in vertebral management [both surgical and (mostly) non-surgical] the least dangerous and most effective form of management is in water, as described in my website.

I imagine you are seeking responses to those who might deem you “fit to work” and so cut your grants. If I can help further, please let me know.

Dear Doctor Driver-Jowitt, I have read some of your articles on spine surgery and tried, elsewhere, to contact you.

I am doing some research on my own situation post discectomy/laminectomy for Takata type extrusion (20mm) in 1989 and L5/S1 fusion recently. I have significant ongoing issues. I am a 52 year old ex tradesman.

Can you tell me how I can establish the current status of my ligamentum flavum? After reading what you have written I think I may have instability and weakness due to its removal in 1989. But how on earth would I know??

Dear Patient, As a beginning, it is not likely to be productive to return to the past in terms of unpicking previous events. What counts is to get going on a process of improving what you have at present.

However, having said that, it might also be important to provide your source of social benefits with some reasons why you may never have been truly “cured” following the original disc prolapse.

At the date of your original surgery it was widespread practice to excise the ligamentum flavum, and to strip away the inter-spinous/supra-spinous ligaments, as well as to elevate (and so inadvertently de-nervate) the mutifidus muscles. The last mentioned is an often unrecognised cause of “instability” as well as “transfer pathology” to segments above and below the segment of primary pathology.

Therefore those who might take the stance “you have been correctly treated, nothing can be found by experts now, and therefore you are fit to work as a carpenter” might well be wrong. Add the impairments at the disc level to other (unrelated and often subliminal) changes of age, and you could well have good reasons not to be able to return to work as a carpenter. Indeed if you are expected to build and mount trusses, or work on scaffolds and ladders, you should be prevented from those activities.

Have your hips been checked? An arthritis, at times not appreciated, can often exacerbate vertebral problems.

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2 Responses

  1. i clicked on a wrenched back and to my surprize i thought i was reading my surgeries, i had surgery which was a fusion dec171997 it took me nearly three years to feel some what normal there was no feeling in the right foot at times and they would draw so bad i walked half the time on the sides which did nothing to help , then 2 neck surgeries 98 and 99 then 2008 nine screws i recovred i thought with alot of ok feeling like normal but the last 5 months all hell has broke loose i feel someing is terrible wrong sceduled for Mri and a soon return to the Docs office which hes the best in the world he has injected me so much hes actually bent and broke needles..i was told by my orthopedic from my hometown i would be in a wheel chair by the time i was 50 im now 53..I see it coming now 6 abdomen surgeries and the core being weak..do you know if i take a deep breathe it hurts like hell. Meds are Hydrocodne take when pain , relfan, flexrill. meydrol pak every other month and and the anasethia puts me in the hospital…Depression , Manic Biopolar cymbalta and respridol and kolopin , 22 ECT i just wished i could communicate better with the doctors, but they treat me differnt i feel casue i wig out so bad after 27 surgeries the anstheia ia demon all in itself it million times worse than the surgeroy

    • Your letter illustrates the sad tricks of life which fall onto some. Readers will have great sympathy with you, and some might reflect on their own relative good fortune. This might be one benefit of this website.
      By extension, another perspective arises. I don’t want you to think that this applies to you, but your letter prompts my wider thoughts.
      Against a background of familiarity with repairable mechanical devices, consumer “power” and “guarantees”, the spreading of a (essentially politically driven) concept that humans have “rights” and in particular the “right to health and healthcare” has occurred.
      We have created around us an age of demand. One result is the demand for immediate attention from health carers, sometimes for trivial “inconveniences”. These are temporary and self limiting health problems, which common experience and common sense should put into perspective. When people do not apply this perspective to themselves, and a demand is made for an “instant cure”, matters start to go wrong.
      Health carers can only assume that their patients have self-assessed themselves, and are presenting major intrusions into their lives. Only the patient knows how much pain or disability they are suffering. If the patient overplays, then overtreatment is a danger. Not only does this absorb the healthcare dollar, but the dangers inherent in all powerful interferences with natural biology (another term for treatment) occur. Examples are the increasing impotence of antibiotics, unwarranted surgery, plus many other endangering “medical” events.

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