Human Medicine: A Pain In The Neck

About fifteen very serious humans in long white lab coats entered the room with the only one familiar to me speaking:

"The good news is, we have identified the cause of your neck pain. The bad news is, no one in this hospital has ever seen this before."

Spontaneous Bilateral Vertebral Artery Dissection are words you likely have never heard but I will never forget.

The two vertebral arteries that run along the backside of your neck are responsible for carrying blood to the brain and spinal cord. Both of mine spontaneously tore along the inside wall.

This almost always occurs in people who have been in car accidents or situations where the head is violently separated from the body.

I was just an ordinary, low key, everyday, young mom who had experienced none of those things. I was an active long distance runner but apart from that had not participated in combat/contact sports, ridden any roller coasters or horses, or had my neck/anything adjusted by a chiropractor.

It's a freak thing when one vertebral artery spontaneously dissects. Bilateral means both. By the time the image in this article was taken, one of the dissections had completely occluded the artery, the other was something like 60% blocked. Due to the presence of unexpected nearby vessels, they suspected both were total occlusions at possibly different times.

At least two takeaways:

1. The human body is a remarkable thing! I didn't stroke out or die because my body just created alternate pathways to keep pumping blood to my brain. It's not known if I was born with those collateral blood vessels or if they were also spontaneously created to support the failing ones. How freaking cool is that!?

2. Doctors know a lot about human bodies and diseases. But the patient is the exclusive expert, manager and advocate of and for their own body and diseases.

Two weeks before that frightening sea of white coats entered my hospital room, I presented to a Fast Track department with neck pain. The doctor there suggested I had slept wrong, or maybe had used a new pillow that I somehow forgot about. He gave me some muscle relaxers and sent me on my way.

One week before the SBVAD diagnosis, I had presented to an Urgent Care with persisting neck pain. The doctor there concluded that I had some sort of temporary musculoskeletal imbalance, gave me a cortisone shot and sent me on my way.

The day I presented to the Emergency Room I had the neck pain plus a headache that presented like a lightning bolt had struck me from the top of my head. I waited three very long, very excruciating hours in the waiting room.

I was given enough drugs to make me no longer coherent, X-rays and CT scans were inconclusive and they almost sent me home.

Dr. Stephen Burton, the Neurology consult, admitted me for further imaging. It is likely that his decision to listen to the patient who while still coherent said, "I have had muscle pain. I have had headaches. This is different." - saved that patient's life.

I don't fault the doctors who assessed me and sent me on my way.

Over the last three decades, doctors spend an average of 17 minutes with patients, and they have patients stacked up in waiting rooms.

Within that 17 minutes, they have to complete a full assessment including medical history and physical exam. You may present with neck pain but diseases in the human body can present issues in one area that is totally unrelated to the actual affected areas. Only assessing the neck can result in overlooking other potential diagnoses.

After all is said and done, including documenting each of the areas of assessment (which has not improved with the advent of electronic medical records btw), this leaves the human in charge with about 3-6 minutes to triangulate what has been presented against all of their known and unknown medical knowledge to make a decision, formulate a plan of attack and present it to the patient.

...and then rinse and repeat 20-60 times every day!

I'm burned out from just the thought of that.

Unscientific opinion: Physicians didn't spend four years of undergrad study, four years of medical school, three years in medical residency, countless hours studying and stressing over board exams and hundreds of thousands of dollars of debt to spend three to six minutes actually caring for patients.

While so much needs to be repaired in the healthcare system, there are a few things that in addition to being a patient patient, humans can do to help increase the time that other humans are spending on their care plan:

1?? Subject Matter Expert: No one understands you better than you. Well, maybe your mom. But you know your medical history and current medications.

If you haven't already, write it down, keep it updated and print copies. If you present this document at the start of any visit, you'll skip the hassle of trying to remember it all on the spot and the risk of forgetting something important. Win!

2?? Care Manager: You are ultimately responsible for your own care. This includes being on time for scheduled events (15 minutes early to complete paperwork), following instructions given, taking medications as prescribed, taking care of yourself by making good food decisions, eating healthy foods, exercising 30 minutes a day at least five days a week.

You know, all that stuff you blow off because every doctor (and your mom) says so. You must manage and take control of your own care!

3?? Advocate: Bring your mom. No, seriously. Patients are often their own worst advocates. Bring a trusted family member or friend with you to appointments where decisions are being made.

Especially if you are already in a vulnerable position like in pain or dealing with a debilitating disease. Doctors are humans too! Remember, their brains are busy triangulating the best care plan and are more likely to miss empathy cues because they are in their head - exactly where you want them to be!

Though often assumed to be entirely comprised of clinical staff, the "Care Team" includes the patient, their care plan and their trusted family member and/or friends.

Empowered, educated, well supported patients have better outcomes.

And that, in my unscientific opinion, is the intended result of the herculean struggles that physicians went through to become physicians and continue to go through Every. Single. Day.