White Coat Underground

Some things I just don’t understand

I gotta admit that I just don’t get it. Perhaps it’s my overly narrow world-view, or perhaps it’s my lack of imagination, but I really don’t get it. Let me explain.

I’ve got this horrid pain in my back and leg. It’s searing, aching, gnawing. My foot is numb, but still hurts. It tingles, feels heavy, and it’s weak. Sometimes it feels like electricity is jumping through it, sometimes like little worms are crawling in it. Being a curious person, I look for ways to explain this.

I’m sure this horrid crawling feeling could be explained thusly:

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Perhaps there are actual worms crawling beneath my skin. Other people have that:

I can see a black minature snake like creature swimming in my bath with red fibers, blue fibers, black hairs, brown small insects, black specs and white crustations/twirled up fibers,lice looking larvae that I can see literally come out of my arms, legs, etc., without permanent exit damage to my skin.

Or maybe it’s something more complex, like a disturbance in the flow of Qi:

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The most common imbalance in acute sciatica is qi and blood stagnation in the back channels. But it is also important to treat the underlying imbalance, which may be causing the qi and blood to stagnate.

Or could it be a subluxation, you know, “the silent killer”? According to chriropractic philosophy:

When subluxations occur, chiropractors use specific techniques to return the vertebrae into their proper positions or mobilize them so they can move freely. These techniques are called spinal manipulations or adjustments. During an adjustment, the vertebra is freed from the misaligned position and returned to the proper position in the spinal column. Once performed, the adjustment allows the body to heal and maintain homeostasis.

Hmmm…I suppose I’ll find out if I really have a subluxation when I have my MRI on Tuesday.

This is my problem. It seems everyone has a theory as to what causes back and leg pain, whether it be disturbed Qi, Morgellons syndrome, or vertebral subluxation complexes. Of course there is another theory as well. According to “real” doctors, there is a nerve that exits my spine between the L5 and S1 vertebral bodies, and sometimes an intervertebral disc can rupture,

i-38317a0840ef4a035d77e642651aae09-LumbarDiscHerniation.jpg

exerting pressure on the nerve, causing symptoms in the specific areas innervated by that nerve. And the real doctors don’t think that it’s just the physical pressure:

Pain is also believed to be mediated by inflammatory mechanisms that involve substances such as phospholipase A2, nitric oxide, and prostaglandin E. These mediators are all found in the nucleus pulposus itself. Phospholipase A2 has been found in high concentrations in herniated lumbar discs; this substance acts on cell membranes to release arachidonic acid, a precursor to other prostaglandins and leukotrienes that further advance the inflammatory cascade. Additionally, leukotriene B4 and the substance thromboxane B2 have been found to have direct nociceptive stimulatory roles.

How am I to know who is right?

Here we have several competing theories to explain my back pain. Some would say only one could be correct. Others might say that each is a different way of correctly explaining the same thing. Let’s examine common arguments for these explanations.

The worms: sure, it sounds crazy to me, but who am I to diminish someone else’s subjective experience? The answer is quite simple. Subjective experience helps to describe the subjective feelings, such as pain, fear, and anxiety. It doesn’t help explain cause. It seems rather implausible, based on my knowledge of the real world, that parasites are crawling under my skin, despite the fact that it feels that way. Also, I’ve seen a lot of back and leg pain, and not once has it been caused by parasites. When patients are imaged in the MRI or CT, or go to the operating room, worms isn’t what we find.

The Qi: This sounds like a good explanation. The idea is thousands of years old, and apparently quite popular. Unfortunately, age and popularity are not valid criteria for judging medical ideas. Yes, the idea of “qi” is thousands of years old, but a thousand years ago, people didn’t live very long. A thousand years ago, our understanding of the human body and its diseases was limited to vague ideas of spirits, curses, gods, and other superstitions that did not rely on any understanding of anatomy or physiology. People didn’t know causes, and couldn’t prevent or cure disease (but some physicians had made inroads into properly describing diseases). In fact, these ideas have been largely abandoned in their countries of origin. People in China who have access to proper health care choose the same “western” medicine that we use here in the States every day. A study of the history of medicine really helps here. Vesalius the anatomist, who sketched pictures of what really exists inside people; William Harvey, who described the circulation of blood, a real, tangible substance that performs a real, measurable function. A history of Qi will be much less interesting, since it is invisible and unmeasurable, two qualities it shares with other non-existent substances.

Suluxation: I do not think it means what you think it mean. Chiropractors subscribe to the theory of “vertebral subluxation”. This differs from the medical definition considerably. An orthopaedic (real) subluxation is a painful partial dislocation of a vertebral body. A “chiropractic subluxation” is an asymptomatic misalignment or a “vertebral subluxation complex” thought to be a cause of disease. The mechanism posited is usually the blocking of nerve impulses from spinal roots, or some such nonsense. Such a subluxation has never been proven to exist. When I have my MRI tomorrow, we may or may not find a prolapsed disc (I think we will) but we certainly won’t find a vertebral subluxation, which is what a chiropractor would likely treat in me.

When different theories are in competition to explain an phenomenon, we should probably judge them by their plausibility and by their ability to properly describe the real world and to make predictions. Since there are no actual worms in my skin (which the MRI will confirm) that’s off the table. Since no one can measure Qi prove that it even exists, or even show that it is manipulable, that’s out. Since subluxations, in the chiropractic sense, don’t exist, that’s out.

I guess I’m stuck with my disc bulge. That’s a drag. Nerve compression due to a prolapsed disc is painful, and is treated with physical therapy, which is time consuming and sometimes painful. It also isn’t always successful. But it has the benefit of relying on our best knowledge of reality, medical and otherwise. It doesn’t require us to make up unmeasurable energy fields, invisible parasites, or non-existent anatomic abnormalities.

Reality is hard. Science is hard. And my back hurts. Still, I’ll take reality, thanks.

Comments

  1. #1 muttpupdad
    February 2, 2009

    You left out Satan and his demons sticking you with their pitchforks for questioning the Power of Dog in your rantings about the power of prayer as the only True Medicine!

  2. #2 Braxton Thomason
    February 2, 2009

    Hey, PAL, I’ve also got an L5-S1 herniation and DDD there leading to not just leg pain but frequent serious episodes. I’m planning on getting an artificial disc this week since physical therapy and cortisone shots have failed to improve me over the past 4 years I’ve had the condition (in fact it’s gotten progressively worse).

    Any thoughts? I know that the long term results of ADR aren’t much better than fusion, but the short term seems much better, and I might get what’s left of my youth back.

  3. #3 Dianne
    February 2, 2009

    Given your symptoms, I’m starting to worry about cord compression. Hope it’s nothing so nasty. (And shouldn’t you be taking some anti-inflammatories or something?)

    BTW: Are you violating HIPAA by discussing your own case on the blog? I would think not, since you clearly have your own permission to be discussing it, but the law is a strange thing at times…

  4. #4 Bob O'H
    February 2, 2009

    Pain is also believed to be mediated by inflammatory mechanisms that involve substances such as phospholipase A2, nitric oxide, and prostaglandin E.

    NO? That must be it – it causes everything, doesn’t it?

  5. #5 D. C. Sessions
    February 2, 2009

    Others have advice. I only have wishes: “Hope you’re feeling better, Dude.”

    Now, about something distracting to discuss …

  6. #6 The Perky Skeptic
    February 2, 2009

    This sounds really awful. I hope you feel better soon. :(

  7. #7 Strider
    February 2, 2009

    I don’t know why but the descriptions of Morgellons syndrome always strike me as funny; probably because they’re SO crazy sounding.

  8. #8 Bill
    February 2, 2009

    Thank you so much for helping to spread awareness of Morgellons disease and posting such a good piece on the matter. If your readers would like more info on Morgellons, they can check out morgellons

  9. #9 PalMD
    February 2, 2009

    @Bill:

    HAHAHAHAHAHA

  10. #10 leigh
    February 2, 2009

    hope it’s apparent on the MRI, discograms suck.

  11. #11 PalMD
    February 2, 2009

    I’ll post my relevant images when they are available.

  12. #12 Isis the Scientist
    February 2, 2009

    Pal, I feel really guilty for laughing at your pain, but this post was hilarious. I am a very sensual person (not in the dirty way) and am very easily skeeved out by certain physical sensations. The worms was enough to put poor Isis over the edge.

  13. #13 eddie
    February 3, 2009

    Of course, there was that time it turned out to be guinea worms. But you’d have to have been in the tropics.
    I misread a part of the morgellons page and thought; The Neanderthals. Isn’t that another name for Holland?
    Maybe I’ve got Freudian Dyslexia.

  14. #14 Strider
    February 3, 2009

    @Bill
    And always with the fibers! What’s with the fibers?

  15. #15 J Vohs
    February 3, 2009

    Condolences on the back stuff. I think the rays and magnetic fields of the MRI cured my back issues. Then again perhaps it was the four years of PT recommended exercises and ongoing caution when lifting heavy things.

  16. #16 visible
    February 4, 2009
  17. #17 SAC
    February 5, 2009

    PAL, loved the post… I, too, am guilty of enjoying your dissection of this painful event.

    So, I have dreamed of worms in my body. They are usually under my skin though. I have dreamed of forces of energy pulling me to perform strange acts. I have also dreamed to be returned to my right position so that I may move freely but I am unlikely to be crowned Queen of Sheba in this lifetime. Unfortunately, I dream the imaginative but live in reality. Look forward to your MRI results… Hope you feel better.

  18. #18 Doug K
    February 6, 2009

    mere anecdote: I too have the l5-s1 bulge/herniation/whatever. My PT gave me a large range of exercises, and recommended both Pilates and yoga as maintenance in the long term. I had about four months off running, with weekly PT sessions. I now have only mild pain, very little as long as I keep up with the core exercises and stretching. So there is hope..

    Three years ago the back pain morphed into sciatica, which gradually yielded to a different set of core exercises and stretching.

    What’s really boring is my limited run training time now has to include a couple hours a week of core. I don’t enjoy core exercises. But I’ll take them over getting my back cracked.. this is scary,
    http://www.wikihow.com/Crack-Your-Back

  19. #19 Lance
    July 3, 2009

    What does scientology banner do on a scientific blog? :)
    Antiques Collecting

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