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Approaching The Problem Systematically

The second of these articles taught us more about Aida’s history of pain. She counted several episodes where severe pain resulted in emergency room visits and subsequent X-rays. Each primary care physician follow-up visit discouraged Aida. She began to question whether her PCP believed her stories. Perhaps at wit’s end, her PCP sought a mental health referral. Aida doubted his compassion. She finished her second session by questioning my position. Did I believe her? It was imperative to her that I believed her. What do we do now? How do we proceed?

Steven, Aida’s husband and other main support, (he had witnessed one episode) arrived with Aida. She walked assiduously to my office. She was in obvious pain. Steven and I shared greetings and he demonstrated no signs of timidity. “Marshall, I’m really worried about my wife. Her functioning is being compromised. She awoke this morning stiff and in pain. She took a Tylenol. It really doesn’t alleviate her pain. I’m scared that I’m losing my wife. Her PCP doesn’t believe her. He sees no classical signs of pain. X-rays and an MRI proved nothing. How can she experience pain and it not show up in tests?” He had his arm around her shoulders and was lightly massaging her. She didn’t resist. “She can’t work and her leave of absence may be close to running out of time. They generously pay her, given years of excellent service. Something has got to give, Marshall. Do you have any suggestions?” Yes, Steve, I do.

I took a deep breath. You know, doctors are discovering new things medically. Our age and lifestyle, I believe, occasions pain that is real to its owner, yet not seen in clinical testing. I wonder if your PCP sent you to me because he couldn’t figure out something he hadn’t seen before. In all due respect, I want to hear medical providers partner with their patients who present with new and different problems. Someone out there may be familiar with your problem, your pain, and be able to be helpful. Some doctors have a problem justifying continued treatment, especially pain medicine when all else comes up short. Patients need to feel hopeful. Doctors need to partner, also, with other practitioners. A team approach might be the current favorable approach to managing a problem such as yours, Aida.

“Thank-you, Marshall. I’m starting to feel good about a solution. What do you suggest?” “Well, I’d like you to consider a referral to a Physical Therapist. A seasoned PT might approach your problem systematically of a thorough exam, tests on exercise, and other equipment and conditioning. A rule out of diet may lean towards a referral to a Nutritionist. Perhaps a dietary plan is part of a plan for holistic health. Additionally, a Message Therapist may be suitable. She or he can also detect tightness and be able to offer approaches to loosen your tight muscles. Some folks opt for yoga for stretching and strengthening. These practitioners can also advise you on other treatments for consideration. I have a story to tell you.

Many years ago, a woman came to talk about some situational depression/anxiety. She was experiencing facial pain that tests could not detect for a medical diagnosis. Her PCP and other specialists ran tests without results. Long story short, she got the message that it was all in her head. She was retired and living with her spouse. They were at wit’s end. Her pain was real to her and to no one else. She presented with no psychiatric history. She was a healthy woman who was in pain.

She was computer literate. I encouraged her to put out an APB (all points bulletin) internationally to the global medical providers. Someone out there knows. Several months later, she went to the Cleveland Clinic and had her case reviewed by a group. All were mystified. One doctor said that she knew what was happening. Soon after, the problem was treated and controlled. What do you say, folks?

“Sounds good to me.” I would continue seeing Aida, if she wanted after seeing a PT, et al.

Let there be peace on earth and let it begin with me.

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