Chronic Pain

Genevieve's congenitally curved spine wasn't helped at all by the 1974 occupational injury that left her on workers' compensation for the rest of her life. The older she got, the more pronounced the curvature became, the more her herniated disc was subjected to pressure, and the more pain she experienced.

A herniated discEarly on in the injury's progression to degenerative disc disease, Gen was treated for simple sciatica. She practiced the core-strengthening exercises until one of two things happened: Either the pain lessened considerably or she lost interest in the exercises. Besides, on the market was a non-steroidal anti-inflammatory medication called Vioxx. It worked well enough that Gen's pain was not just tolerable--the pain disappeared completely, at least until the Vioxx wore off.

So why bother with core strength when you can just take Vioxx?

Gen's rolling walker chairAlthough Gen couldn't stand on her own, she could move just fine if she was supported by her rolling walker or a shopping cart. She could get in and out of her car and take care of her own business. She was adhering to a regular cardio-vascular exercise program--pushing her walker around her neighborhood and sitting on its seat when she needed to rest. Even before Vioxx was withdrawn from the market out of concerns over its contribution to stroke and heart attack, the doses at which Gen was taking it caused GI bleeding. I took Gen to her physician's office one afternoon for a routine INR--a measurement she had regularly because she was taking a blood thinner. The first thing we noticed was that her blood pressure was 100/60. Gen's blood pressure was well-managed by medication, but this particular reading didn't feel right. The aide said cheerfully "Well your blood pressure certainly is just fine."

I begged to differ with her and told the aide that the reading was well below normal for Gen and it was not necessarily a good sign. The aide nodded and shuffled us into the room where the INR was taken. Gen's INR came back elevated. The nurse practitioner came in looking alarmed. She examined Gen for rectal bleeding and told us "You have a GI bleed going on and I'm going to admit you immediately. Do you want me to call an ambulance to transport you or can your daughter take you over?"

Gen looked at me. "How do you want to do this?" she asked. I knew that the rescue squad across the street wouldn't be able to get a crew out for at least an hour, if it could get one out at all. The EMS community often joked about the squad's response time--like the one where the squad was called for a patient at the eye clinic across the street from the squad's station, but by the time the squad arrived, the patient had trained a seeing eye dog so she could walk to the hospital.