Saturday, April 23, 2016

Training the New Guy

Breaking in a new doctor is a complicated process.  For a long time I wouldn't go back to someone if I didn't like them at the first appointment.  Then I found that it takes a while to build trust and for them to get to know and trust me as much as for me to know and trust them.  The neck issue makes it much more difficult.  When I started seeing my first chronic pain doctor, I was going through these stages at the same time.  I wanted to be "fixed" and I went with him along the crazy path of trying to find the cure.  Now I tend to observe and try to reign in the efforts of each new doctor, because I've already been where they're at and I'm just waiting for them to join me in acceptance-land, where the real work begins.

These are the stages that I go through with most of my doctors and medical professionals.  They generally take about six months, depending on how often I'm seeing them.

1)  Denial

They start out very optimistic.  They are sure that my previous doctors had it all wrong.  I either do not have the injury I think I have, or it will be much easier to treat because they do things better.  They may roll their eyes when I mention previous treatments, they may openly criticize the people I've seen before, or they may just quietly decide to try something new.  They are confident that they can do better, and we start our treatment with clear goals and a timeline for improvement.

2)  Blame

This one is the hardest to take.  There comes a time, usually a few weeks into treatment, when things aren't working the way we thought they would.  The exercises they gave me make things worse, the massages sometimes irritate my neck and I have increased pain.  It's easy to blame the doctor.  They sometimes blame me.  I'm not working hard enough, or I'm working too hard, I have poor posture, I'm being too picky.  Depending on how all of this goes, we sometimes don't make it past this stage.

3)  Searching

This happens a few months in.  They decide that there must be some system-wide reason that treatment isn't working.  They order blood tests, and suggest dietary changes, and send me for diagnostic procedures.  We check sugar, thyroid, magnesium, iron, vitamin d, and sodium.  We look for fibromyalgia, diabetes, brain tumors, sleep apnea, anemia, and acid reflux.  I stop eating sugar, grains, dairy, fruit, sweet vegetables, salt, nuts, and caffeine.  And they never find anything.  I've stopped going on the search with them.  Now I tend to just tell them that it's been tried, unless they suggest something new and interesting.

4)  Giving Up

So they get a bit depressed.  Somewhere around six months in, they ask me if what they're doing is even helping me.  This is when I have to reassure my massage therapist that I never thought massage was going to cure me.  I came here because without a weekly massage I quickly go downhill.  This keeps me functional.  Ditto for chiropractic.  Sometimes this stage is good because this is when they refer me to a specialist, where I start over again, and maybe get some better answers.

5)  Acceptance

There's a day when I come in for treatment and they say something like "disc issues are such a pain, they get aggravated so easily" or "hey maybe this other treatment might get you some pain relief" or "you might want to think about getting another injection, that really seemed to help for a while last time."  This is when I know that we've made it.  We are now on the same page with my treatment.  It absolutely does suck that it takes this long for the new doctor to believe me, but I respect their need to go through the process.  They need to KNOW, not just take my word for it.  This is the point where I can come in one day and grumble about how everything went to hell over the weekend, lay down, and let them fix it.  This is when we can talk about the merits of injections vs pain meds vs surgery.  Mostly this is where we adjust our treatment plan and expectations.  We work towards pain management rather than a cure.

Starting Over

I hate finding new doctors, mostly because of this lengthy process.  But I've found some really great people by sticking it out.  Once we get to the final "reality" stage, we know each other pretty well, we communicate better than we did, and we trust each other.  It's a good place to be.

I recently switched physical therapists.  I'd been going to one for about six weeks and I felt miserable.  Every appointment was agony and, despite me telling him that, it didn't get better.  The exercises were aggravating my nerves to the point that I temporarily lost a good portion of my arm strength.  The arm exercises actually got harder every time I did them, not easier (that's bad!) and I kept getting hurt because they were simply too busy to make sure I was doing things correctly.  I started looking for someone new when I left there one day and was barely able to drive home.

The new guy also aggravated everything at the first appointment.  But at the second appointment, when I told him that, he backed WAY off.  We're going very slowly now, which is what I need.  He still has me do a lot of hard exercises, but he doesn't make me feel like a wimp when I tell him I can't do any more.  We're still going to have to go through all of the stages together, I can tell.  I wish there was a way to skip it.  But in the meantime, I think what we're doing might be helping just a smidge.

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