The Broken Soldier

Got a call yesterday from Knox.  The phone was upstairs or something.  I missed it.  I listened to the message this morning.  The doctor handling my case wants to discuss my referral, mentioned something about reading this site, and wanting to “clear the air.”  I called back right away.  It’s Saturday, and no one was there.   I left a brief message.  Now that Knox is ‘on to me,’ this is as good a place as any to discuss this matter.

There is no air to clear.  My position is straightforward, and I won’t be distracted by ironing out possibly false impressions, on minutia and matters not central to the medical and legal necessities of treating me.  I was injured on active duty.  The Army is required to treat me.  Period.  This injury is fairly common and there are conventional methods of treating it. Typically one to four months of conservative treatment - bed rest, anti-inflammatory medication, pain management, physical therapy, epidural steroid injections, etc.  If symptoms don’t get better, or get worse, as in my case, neurosurgical intervention becomes part of a conservative approach.  In instances in which bowel and urinary incontinence are observed, emergency surgical intervention is the conventional approach, as the presence of these symptoms are indicative of Cauda Equina Syndrome (my symptoms making more sense now that I know L3-L5 are degenerating too).  It’s been 15 months.  I’ve not responded to over a year of conservative treatment.  Surgical intervention is about a year overdue.  Surgery is not an unreasonable request.  It isn’t expecting to receive medical care “carte blanche.”

Dr. Toon, of whom you are all familiar, was handling my case.  Let’s review.  Dr. Toon was almost an hour late to our first appointment.  He rudely threw my wife out of the exam room.  He looked to confirm the MRI report of right side broad-based lateral disc herniation at L5-S1 on a sagittal image.  For those of you unfamiliar with reading MRIs or elementary geometry, follow me.  Perform an Atlanta Braves chop with the hand of your choosing, and keep your hand in that position.  Make a fist.  Bend your wrist so that the fingers of your balled fist are facing you.  Stick your thumb through your fingers - like “I got your nose.”  There’s a representation of an intervertebral disc herniation in three dimensional space.  Imagine, if you will, trying to find that herniation on a two-dimensional image - noting well that 2D provides length and width, but no depth.  See the problem?  Me too.  I asked him to look again.  He did, but on the sagittal image.  I asked him what accounted for such a radical difference of opinion, to which he responded, “It’s a judgement call.”  I asked if the first judgement matched my symptoms?  He said, “Yes, but that’s not what you have.  Civilian doctors tend to overcall.”

He then went on, after finding an L5-S1 disc herniation on the sagittal image, re-diagnosing it as a central focal disc herniation, to perform a series of physical exams.  He performed Waddle’s Signs - a test used, though not by anyone practicing medicine I know, other than Army doctors and docs working for Workers’ Comp Insurance companies, to identify potential malingering in the absence of a reasonable organic cause for pain and other symptoms.  Any herniation can cause nerve compression.  Even disc desiccation can cause nerve compression.  In other words, he performed this test after finding a perfectly reasonable organic cause for pain and symptoms.  In his report he mentioned I had two (2) of these signs.  For those who use this method, three or more are considered suggestive of malingering or a psychologic cause.  He didn’t bother mentioning which signs I had, if any.  Given that I knew what he was doing when he did it, and that I don’t recall any positive signs, I suspect he fudged the results.  But to perform this test in the first place given a reasonable organic cause, as well as an 8 hour car ride the previous day and walking around the hospital aggravating it, is questionable.  Failing to name the signs present even more so.

Dr. Toon then did a brief neurological exam.  He tested my patellar reflexes.  Note well that patellar reflexes are spared with nerve root compression at L5, S1, or both.  In other words, the test was meaningless given the results of the MRI.  Though he made quite a big deal about this reflex being spared.  He claimed the strength in my right leg and foot were normal.  This in spite of not being able to dorsiflex the lateral toes on my right foot, my right foot, or fully use my right calf.  Later EMG confirmed motor impairment at L5 - chronic L5 radiculopathy.

He then asked me to walk around the exam room.  I was already in pain from the ride to Knox and walking around the hospital.  Pain close to 10 out of 10.  He confused sweating and rapid heart beat and deep exhalation without deep inhalation as signs of de-conditioning rather than signs of extreme pain, claiming, “Look at you.  Sweating from walking around the exam room.  You’re really out of shape.”

He then sent my wife and I on a wild goose chase through Ireland Community.  Lab, X-ray, Physical Therapy for one appointment, an appointment I couldn’t keep by the way, and for another MRI.  I was suspicious given what had happened during the exam, but I did it anyway.

He sent me to the pharmacy for a script of OTC NSAIDs.  I grabbed his report, read it, and was so pissed off that I left without filling the script.  Claiming over an hour of face time when it was more like 20-30 minutes.  No mention of symptoms I had other than pain.  Claims to having performed certain examination techniques he hadn’t performed.  Blaming my weight gain for symptoms.  Getting my personal, educational and professional information wrong.

That was just the first meeting.  The second he forced me to go to Knox, 480 miles each way, to get an MRI.  Both technicians were aghast when we told them where we were from and why we were there.  The trip had aggravated my injury to such an extent that my legs were trembling and my back was spasming uncontrollably.  Both said they’d do what they could, but that the MRI would likely be unusable.  One of the techs angrily said, “If he had to have you down here, which I don’t know why he would, he should have at least given you muscle relaxers.  This trip is going to be pointless for you.”  From this likely unusable image, Dr. Toon found that my lumbar spine “appeared normal.”  This after finding a herniation on the first, along with signs of Intervertebral Disc Disease, the veterinary term for Degenerative Disc Disease, which, by the way, has no cure and doesn’t repair itself.  If he saw it on the first, it would be there on the second too, save for some miracle.  Given that I’m still symptomatic, I seriously doubt that a miracle took place.

I complained a bit, specifically about the bowel and urinary incontinence, something he failed to mention in his first report.  He mentioned it in the second, but did nothing about it (c.f. above standard approaches given these symptoms). My suspicion grew.  I filed a complaint with ICE.  They got back to me once.  I outlined my complaints and they never contacted me again.  It wasn’t until Bruce contacted the commander of Ireland with threat of naming her as co-defendent on a writ of mandate that I heard from them again.

I know my critics get tired of reading this, but I don’t really care.  I’m a U of M grad.  I have degrees in Physical Anthro and Behav. Neuro, among other things.  I was a combat medic.  I worked at the U of M Med Cntr as a clinical researcher in the Neuro Dept/Neuropsych Div.  Not as a coffee-maker.  Proficient use of SPSS Syntax is a handy talent.  I’m not grotesquely stupid.  I’m not ignorant of the applied/medical science relating to my injury, or of standard treatments.  And I’m not completely ignorant of the law either.  Time for patiently waiting is at an end.  Time for dialoging is at an end.  It’s time to treat me.  I alerted Bruce, and he and my attorney buddy will be filing the writ regardless of referral status.

No amount of talking could undo the pain and harm the Army have caused me.  Nothing could dispel the negative emotions I feel towards them.  I am broken, depressed and anxious - common in folks with chronic pain and likely to stay with me for the rest of my life, drug addicted, and financially ruined.  And I’m this way because of others’ bad decisions.  What is there to talk about?