Truth - an excerpt of 'Take Charge of Your Chronic Pain'

As is the case with many of my peers, my interest in becoming a
pain doctor grew out of my background in anesthesiology. During
my anesthesia residency at the University of Southern California, one
of my teachers issued this challenge: See to it that our patients wake
up after surgery without any pain. If you’ve ever walked through a
post-anesthesia recovery room in a teaching hospital and heard all the
moans and groans, you know that is not an easy task. It requires giving
people enough strong, intravenous pain medication so they will
feel comfortable, but not so much that they won’t wake up. I got to be
pretty good at that game, and by the time I became chief resident during
my last year I had perfected it. And when I did my senior elective
in pain medicine, I learned that there were special procedures that I
could perform as an anesthesiologist that could make people feel better
instantly. I couldn’t think of a cooler career choice.

Shortly after graduating, I decided to open my own practice.
Most of my peers looked for secure jobs with established medical
groups or joined large institutions where they received a salary and
a steady supply of patients. I heard over and over again from older
physicians about how difficult things had become in private practice,
but what the heck did I know?

I soon learned how difficult it was to start an independent practice.
Fully loaded with high hopes and plenty of type A habits, I left
the house at 6:00 a.m. each day to get a jump on my work. There
was no time to “waste” on breakfast, so I often grabbed a cappuccino
and a scone from one of the local coffee spots. By noon I would
be starving and often indulged in whatever I could lay my hands on,
like take-out Chinese or, better yet, hospital food. I was so busy I
usually spent most of the weekend at my office dictating reports and
doing other catch-up work. Family time was extremely limited, and
it hurt me when my five-year-old son drew a picture of his family
and I wasn’t in it. But his teacher assured me that this was common
for kids his age. Getting in enough exercise was also tough. I usually
tried to cram a whole week’s worth in at once by playing basketball
for a few hours on Saturday morning, running as hard as possible.
I had been a lifelong soccer player, so my knees had suffered
through the usual wear and tear. Everything was all right, however,
until I suffered my first anterior cruciate ligament (ACL) tear when
I was in my late twenties. ACL tears are common in pivoting sports
like skiing, soccer, and football. I was playing in a league of mostly
immigrants who spoke little English in an economically challenged
part of Los Angeles. They were great guys, but dedicated to the
sport; so dedicated, in fact, that when I tore my ACL, one of my
teammates, who worked at the hospital where I was training, pulled
off my shorts and gave them to someone else so he could take my
place (The game must go on!). My right knee was too swollen and
painful to walk on, so I had to roll my body to the sidelines, in my
underwear, until one of my colleagues came to help me get home.
Despite the injury I hobbled through my duties as chief resident
without missing any time and, with a little surgery and rehabilitation,
I eventually felt pretty good.

As I reached my thirties, I noticed I was becoming less coordinated
when playing sports and was adding inches around my waist.
It was during one of those Saturday morning basketball games,
while I was running, that my right knee seemed to explode. As I
lay on the court, pounding the floor with my fist in frustration and
anger, I was thinking: “What did I do to deserve this? I was just running
down the court, for heaven’s sake!” Then I realized what had
happened. I had already torn my ACL during that soccer game years
before—this time I managed to tear just about everything I possibly
could in that same knee. I thought it had hurt a lot the time before,
but this time it was much worse. Some of the guys helped me up
(with my shorts on, this time) and I eventually drove the two miles
home, using only my left foot.

Surgery repaired the damage to my knee, but the pain was
intense, especially at night. I could barely sleep for the next three or
four months. Medications didn’t seem to help much, and the nausea
and constipation weren’t fun either. About a week after the surgery,
I went back to a full work schedule; being self-employed, I had no
choice.

Each night I went home in agony, with my entire right leg swollen
even though I was wearing a compression stocking. My armpits
were sore from bounding around on crutches all day, and I started
to notice that I was having a real hard time remembering things.
People would tell me something, and fifteen minutes later I would
struggle to recall what they had said. Experiencing that forgetfulness
reminded me that many of my patients had told me, fearfully, that
their minds did not seem to work nearly as well as they once did
when their pain problems started. Although I was always at a loss
to explain this phenomenon, I had consoled them with the news
that they were not alone in their complaints. Now I was joining the
ranks of the forgetful.

I was flat-out depressed. Many of my patients had told me
they, too, became depressed once their pain had settled in. They
described it as “feeling hopeless,” “feeling helpless,” “having a lot of
dark thoughts,” and “questioning the worth of living.”
Getting from place to place was a struggle; I felt trapped in my
body. Climbing up and down the stairs in my home exacerbated my
pain. It was an ordeal! Even simply watching the nightly news, listening
to the parade of terrible events and dire predictions, seemed
to make my knee hurt more. I could feel the bad news go from the
newscasters’ lips right into my knee.

Yet little had changed. My wife still loved me, my kids were
still adorable, and my job was still clicking. The only difference was
a knee injury. Yes, it was severe, but millions of people had recovered
from similar injuries—I felt like my entire life was unraveling.
I’d been hearing stories like this from my chronic pain patients
for years, stories of how a single injury destroyed their lives. I had
always sympathized, but felt it couldn’t happen to me. Now it was
happening to me.

It was as if I was looking in the mirror and seeing not the
“healthy” me but someone who very much resembled the unfortunate
people my patients had been telling me about. I asked myself
the same questions they had asked me so many times: Why had I
not made a full recovery? Why did a physical injury make me feel
so miserable inside? What did my future look like? As a doctor I
always try to lend an empathetic ear and really understand what
my patients are going through, but this was a lot more than I had
ever bargained for. I hadn’t planned on learning how to be a good
doctor by being a patient and having all these problems dumped on
my head!

The rest of my body wasn’t faring too well, either. My weight
had edged higher thanks to the inactivity; my total cholesterol had
skyrocketed to 250-plus. My LDL (“bad cholesterol”) was way too
high, while my HDL (“good cholesterol”) was way too low. When
a nutritionist told me I might be developing metabolic syndrome—
a precursor to diabetes and coronary artery disease—I thought:
“Lovely, just lovely. Not only am I hobbling around and feeling like
crap, but now the crystal ball in the nutritionist’s office has me getting
my first heart attack at age fifty!”

I knew I had to make some major changes, so I did. They didn’t
happen overnight like in the movies. It was more of an evolution
over time, with lots of input from a variety of sources.
A few months after my surgery, when it was still very painful
for me to do much of anything, my wife suggested that I look into
Pilates. “Pee-what?” I thought. Feeling desperate, I decided to give
it a go. The next thing I knew, I was working with funky equipment
made of springs and bars. I was amazed to discover how my injury
had affected not just my right leg but my entire body, including
my stomach muscles. My instructor taught me the Pilates way to
breath, and before I knew it, my body was starting to move again.
Finally! And I learned slow, steady ways to get those tight, painful
spasming muscles to work again. I was gradually getting stronger
and more flexible. In addition to discovering how an injury to one
body part affects the whole body and being introduced to new ways
of breathing, I also learned exercises that helped me work through
those affected areas when I was stuck, when I didn’t know what to
do.

I didn’t lose any weight during the first post-injury year, but I
didn’t give up. During the first year, I began to learn about things
I hadn’t been taught in medical school, things like inherited body
type, antioxidants, and the glycemic index. I substituted green
tea for my morning dose of cappuccino and took time to prepare
healthy breakfasts and lunches. I still left the house at 6:00 a.m.
every day, but I went to the gym first and then to work. Because
I was unable to run, I started cycling to get some aerobic exercise
and enjoy the outdoors. I also stopped spending weekends at the
office, devoting the time to my family instead. After about three
years of consciously managing my health, I was back down to my
high school body weight.

I was becoming increasingly intrigued by some of the Eastern
practices, such as yoga. Too chicken to walk into a yoga studio and
dive into a class, I jumped when I came across an opportunity to
take some private lessons from an instructor. The physical postures
were very helpful, but what I learned about myself was amazing. For
example, I discovered there was a very tight area in the middle of my
back that kept me from assuming certain positions. I learned that
the spot seemed to be filled with sadness and other intense emotions
that seeped out when I did back bends or other exercises that took a
lot of energy. Opening up about my emotions was never a strength
of mine. Reliving negative experiences only seemed to make me feel
worse, so I tended to avoid doing that. But I came to realize that
I “hid” negative energy in parts of my body and later channeled it
into injured parts, like my knee, when under stress.

Both yoga and Pilates taught me about fear. I’m really uncomfortable
with being upside down; I like the control I have when my
feet are on the ground. Fortunately one of my yoga instructors was
hell-bent on teaching me how to do headstands and handstands
despite the angst I felt about doing so, which was clearly reflected
in my body language. It took me many months to get to the point
where I could do a handstand next to a wall, but all that work—and
failure—taught me a lot about balance and movement and how to
work through fear without giving up.

Along the way I learned other valuable lessons about how to
live with balance and harmony among family, work, and self. One
summer I discovered a charming resort and fishing town along the
Mediterranean, which has since become a refuge for my family and
me. My time there is really very simple. I watch the people, take
photographs, and chat with the local shop owners. I walk a lot,
mostly up and down hills. My lunches with my family are slow and
can last for hours. I’ve found that if I eat slowly, walk often and far,
breathe fresh air, and smile at others, my batteries can be recharged
in a week or less.

I bet you’re thinking that with yoga and Pilates, a good diet and
exercise, and lots of time and fun with my family, my knee must
be as good as new and my life rosier than ever. Well, guess again. I
still have chronic pain, and my knee crackles like ground glass every
time I bend it. There was no magical cure, but I learned how to take
care of my knee so that I can limit my discomfort while leading a
very active life. As a whole I’m much healthier now, physically and
mentally, than I have been at any point in my life, and it has helped
me become a wiser and more effective physician. For all that I am
grateful.