Now, we know better.

This is a tale of my mom, and of advances in research and medical treatment.

know better do better quote

Maya Angelou famously said, “Do the best you can until you know better.  Then when you know better, do better.”  This statement can be readily applied to scientific advances in patient care, and in the case of my mother, low back pain.

In the 1980s, when my brother and I were very young, my mom suffered from chronic low back pain.  There was no incident that started her pain, per se, but it was a dull ache that developed into chronic pain over the years.  She was diagnosed with “degenerative disc disease,” and in 1988 had aggressive back surgery, whereby the surgeon fused four of her five lumbar vertebrae together via screws and an eight-inch metal rod.  I have vague memories of visiting her in recovery in an Edmonton hospital, a few hour’s drive from our tiny prairie town of Hughenden, Alberta.  My nine-year-old brain didn’t hold on to many of the details, just that she was in a hospital bed, and I’d never seen my invincible mother, well, not invincible.

She recovered well, and her low back pain was a thing of the past through my ego-centric teenage and young adult years.  And while her history of back pain and surgery didn’t play a conscious role in my decision to become a chiropractor, the irony is not lost on me that I treat patients like her pre-surgical self every day.  I could have helped her, and let me boldly state that she might have avoided back surgery.  You see, she had no radiculopathy (pain down the leg due to pressure on a lumbar spinal nerve), no indicators of disc bulges or herniations, and she was only 38 years old, coincidentally the exact same age that I am now.

However, her back pain is back with a vengeance now, thirty years later.  It’s worsened over the last several years, and she now has trouble being on her feet or sitting for prolonged periods of time, and struggles to lift much more than her youngest 21-lb granddaughter. It’s affecting her quality of life, despite regular rehab exercises guided by yours truly, ergonomic modifications, and other conservative treatment measures.  The thing is, for the last thirty years, her body has compensated for the lack of movement through her lumbar spine, and the segments above and below her fusion now show advanced degeneration.  Her movement patterns have changed, her core muscles have changed, her biomechanics have changed.  Her spine does not move well, and as a cumulative result, she is in pain much of the time.

She’ll tell you she feels lucky.  Lucky that her pain was mostly gone for the last thirty years.  Lucky that the post-surgical ramifications haven’t affected her much until now.  But I’ll tell you that I wish she didn’t have chronic low back pain in the 1980s, because the conservative management today would be far different.

Why do I tell you this?  Because now, we know better.  Now, we do better.  And we are really good at treating low back pain.

lumbar fusion

This is similar to my mom’s spinal surgery in 1988, although four of her five lumbar vertebrae are involved.

*** As an aside, I never use the term “Degenerative Disc Disease” as a diagnosis because I think the term creates fear-mongering and patient helplessness.  Words spoken by a medical professional carry power, a power that I do not take lightly.  Improved semantics = improved patient outcomes.  And might I remind you that there is not always a correlation between clinic imaging results and a patient’s symptomatology…..

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