Spinal Decompression Therapy

The following is my personal opinion of Spinal Decompression, based on my experiences in the fall of 2012 at a Toronto back clinic.

I am a male, age 65, and have suffered from lower back pain (L5,S1) for more than half of my life. All back pain sufferers have different symptoms - for me, I was generally fine for most of the year, however every few months I would be the victim of seemingly random attacks, which would leave me completely debilitated and confined to bed unable to move for a week to 10 days. Despite the pain, recovery was usually quite sudden and complete, often finding me back to my normal routine within two or three weeks. During the period of the attacks, the pain was excruciating, often locking up my whole mid-section.

Over the years, I have tried virtually everything to free myself of these sudden and painful attacks - chiro, physio, acupuncture, yoga, steroid injections, etc. Nothing worked. I was adamant that I would not go under the knife - I had heard that for many who chose surgery, their back pain returned again after a number of years.

Then I heard about a particular back clinic in my area that was advertising heavily on the radio stations here in Toronto - glowing testimonials from previous patients. I decided to pay them a visit - it is unfortunate that I did not do my due diligence and research before my appointment; otherwise I would have probably made a different decision.

I met with the Director of this particular clinic (for the sake of this article, I will call him Robert). I mentioned that I was not currently in any pain, but that in my case, I get attacks every few months. As such, I stated that it would be difficult to gauge the success of any treatment, other than waiting 6 months to a year to see if the attacks returned.

Robert asked if I had any X-rays or MRI scans done recently. I mentioned I had an MRI done a few years ago, and he asked to see it. I obliged by getting a copy from the hospital and bringing it in for him to review. He examined the images, and stated that I had severe degradation of the lumbar disc at L5,S1. I already knew this; also, my last scan had indicated that my complete spine had degenerative disc disease, and the diagnosis was that there was nothing really that could be done for this.

However, Robert was quite emphatic that he could fix my condition with his combined treatment of spinal decompression, laser therapy, and supplements. This is where the high-pressure sales pitch came in. He claimed a 95% success rate with over 13,000 patients. Wanted me to sign up right away, as my condition was quite severe and he did not want me to waste any time before starting his program.

The cost?  It was quite high.. he offered several plans. Pay as you go: which would end up costing over $10,000 for 20 spinal decompression and laser therapy sessions. Alternatively, I could pay in 3 payments, and the cost would be reduced slightly. Or pay it all up front and save about $3,000. Despite this high cost, my wife and I agreed it was worth a try. But when we tried to defer our payment by a few weeks so as to have the payment appear on the next month's Visa bill, he would not allow it. He insisted on payment up front, despite the fact I was going on vacation and would not be able to start treatment for several weeks. That should have been a warning flag to me, but I missed it. I paid the $7,000+ dollars and left for my vacation.

When I returned and started treatment, I was surprised to see a new receptionist at the desk - the first of many staff changes yet to come. She provided me with a back support belt, which she seemed to have difficulty adjusting and fitting on me. No specific instructions were given as to the use of this belt. She also gave be a large jar of supplements that I was to take each day. When I got home, I found these supplements consisted of 3 large capsules of fish oil (Omega-3), 3 large capsules of Glucosamine, and 3 capsules of some herbal remedy. (I had already been taking Omega 3 fish oil and Glucosamine daily on my own, and mentioned this to Robert. He asked me to stop taking these, and use his own brands of these.)

The treatments consisted of:
  1. sitting with a heating pad on my back for 10 to 15 minutes
  2. then onto the rack (DRX9000 spinal decompression bed) for 25 minutes
  3. then lying down with an ice pack on my back for 10-15 minutes
  4. then having laser therapy (class IV K-laser) for about 8 minutes
This process was repeated for each session, usually 3 or 4 times a week.

Half way through the treatments, I had a 10 minute evaluation by Robert, who examined me with some high-tech monitoring device on my back that graphed out my areas of pain/inflammation. He claimed it had been reduced significantly - I said I did not feel any differently. He gave me a series of stretch exercises to perform each day.

After 20 sessions were complete, I had another short evaluation with Robert, where he said I had significant improvement, and gave me a few more stretch exercises to do each day. Robert also gave me an 'adjustment' to my spine - the typical back twist and cracking used by all chiropractors. I was to return the following week for another 'adjustment' and for orthotics fitting. These were included in the cost of the program. Oddly, the fitting was done by the receptionist - not a trained technician, chiropractor, or doctor.

I was to return the following week to pick up my orthotics, but as fate would have it, I had another back attack which left me confined to bed for a week, so I had to cancel my appointment. So much for the great success claims of this back clinic!

When I did return for my orthotics, I found them somewhat uncomfortable - the left one seemed to have a bump pushing up on the ball of my foot, just above the arch. The receptionist said this was normal, and would take some time to get used to.. she did not offer to check them or that they were correctly fit to my feet. Robert then came in for 5 minutes and gave me another 'adjustment' – he did not check the orthotics.

My final session was basically an exit interview with Robert, and a sales pitch for ongoing adjustments and a monthly or semi-monthly session on the rack and laser therapy. With my severe disc degradation problem, he suggested that actually a weekly visit would be best. I told him that I felt the therapy did not help me - I informed him of my back attack after the last session, and he was quite surprised and asked why I had not mentioned it. I said I had told his staff.  (I was surprised they had not informed him). Based on that, I felt it would not be in my best interest to continue therapy with him and his clinic. I asked if he offered a money back guarantee, and he told me that all patients are different and react differently to treatments, and therefore he could not make any such guarantees. Instead, he offered to give me 10 more treatments free of charge - I declined the offer.

Overall, I was disappointed with the whole experience. I kick myself for not doing due diligence - there are many non-success stories on the net. Unfortunately, the cost of this program was not covered by my company medical insurance.

I found the staff at this back clinic to be rather unprofessional. On several days I was left waiting 30 to 40 minutes for my laser treatment, only to be told (after I finally asked) that the laser technician was off sick that day. There were several other instances where I was left waiting for long periods - all that was needed was a brief explanation for the delay, but this was never forthcoming. Other days, I would observe staff laughing out loud and giggling uncontrollably like little girls - in front of patients. In another case, I was being attended to on the rack by Robert, all the while with his cellphone in his ear carrying on a conversation with someone else while treating me - very unprofessional.

During my treatment, I saw a very high staff turn-over - not once, but several times - to the point that when I left the clinic after 2 months, none of the original staff, other than Robert, had remained. This changeover of staff had an impact on my treatment as I found the new staff were being trained and learning on the job, with me as the guinea pig. I found myself being strapped onto the rack in different techniques, some of which I felt were wrong, as I did not have the same feelings and sensations as in previous appointments. Same for the laser treatments.. different from person to person.

Spinal decompression may not be for you. If you are considering this treatment, think twice and do due diligence. Search the web for information on spinal decompression. While there are many spinal decompression success stories, there are also some bad experiences. Try to get references from former patients of the clinic you are considering; try to speak to former patients who have had the treatments several years ago to see if there was a relapse. Many back clinics have websites. Check out the staffs' credentials, and check it out again in a month or two to see if there is frequent staff turnover – a red flag in my opinion. And do not rush into treatment – if you have been suffering from back pain for many years, you probably can wait a few more months while you check out the clinic.

 

As a long time back pain sufferer, I am of the firm belief that TIME HEALS. During peak pain attacks, I have often thought I was going to be left permanently disabled in some way. However, given time, the back will heal itself. In my personal case, I have found that severe back pain will usually leave me disabled for a week to 10 days (i.e., confined to bed, unable to move). Then, almost like magic, I can move with relatively little pain, and after 4 to 6 weeks, completely back to normal. That is, until I do something stupid like twisting, bending or lifting improperly. The key is knowing your limits and recognizing what causes the attacks.

CBC's Marketplace did a program on spinal decompression back in 2010.  I believe only Canadian residents can view this online. Well worth watching before you commit.  Here is a link to that show:
Stretching the Truth - http://www.cbc.ca/marketplace/2010/stretching_the_truth/main.html

Another good resource is Donald S. Corenman’s website: www.neckandback.com. Dr. Corenman is an Orthopedic Spine Surgeon who has been working for the past 12 years at the Steadman Clinic in Vail, Colorado. One good aspect of this site is his forum, where he is said to personally answer all questions related to back pain.

Here are some quotes from Dr. Corenman, who was initially trained as a chiropractor before becoming an orthopedic spine surgeon:

 

“The decompression (traction) table typically used by chiropractors (DMX 9000 and others) I am generally not a fan of. The two problems are the costs and utilization. Generally, there is a "program" you have to sign up for. This programs consists of 20 visits regardless of the success of traction and traction can aggravate symptoms in some patients. The charges of using the machine are also very high. Now I am not against traction, but to state that this modality "decompresses" the disc is not valid or accurate. If traction is to be effective, you should know in 2-3 visits and if the initial treatment aggravates symptoms, do not continue.”

            “The "spinal decompression" machine is simply a traction machine. It does not put anything "back into place". I have no specific objection to these spinal decompression machines like the DMX 9000 except the "sales programs" associated with them. You do not need more than two "treatments" to find if they are effective for you personally. I personally think these machines are not that effective.”

Hemorrhoids or Anusitis?

So I was chatting with my family doctor a few months ago, and said I really wanted a second opinion regarding my ongoing problem of hemorrhoids. I said I had been seeing a doctor who specializes in colonoscopies and he had told me that there was nothing he could do about my hemorrhoids.

I had been seeing this specialist for about 10 years now, and he has been doing my colonoscopies every two or three years. Why so frequently, when everyone else has them every 5 years? Well, the first time he found a polyp several cm in diameter; he removed it and found it was benign, but it seems when they find something, they opt to be on the safe side and do them more frequently. Believe me - if you ever had a colonoscopy, you really don't want to have them too frequently; the actual procedure itself is not so bad, since the patient is sedated and often does not feel anything. However, the prep the two days before is a killer - you spend nearly all the time on the porcelain throne and by the time you have pretty well purged yourself, the bum is raw and sore.

Anyway, I digress. My family doctor suggested I go to the Rudd Clinic in downtown Toronto. Apparently, they are the authority on all things bum and bowel related. I had to wait about a month or so to get in, but considering their reputation and specialization, that was really not that bad a wait. When I got there, I was surprised that I was seen by Dr. Warren Rudd himself.

I went into the exam room and he asked what the problem was. I said I had really bad hemorrhoids that hurt like hell and burned like hell. In fact, I had even taken a picture of them with my iPhone and took it out to show him. He did not seem surprised that I had a photo of my hemorrhoids, but after taking a look, he immediately said, "That's not hemorrhoids." I said, "What do you mean? Look at all those bulging bubbles there." At that point, he asked me to drop my pants so he could have a better look. Once again, he said it was not hemorrhoids. He said it is a condition called Anusitis, sometimes called Anal Itch, which is often caused by diet, and cured by changing diet. He asked if I drank coffee, and I said just decaf. He said it did not matter - caffeinated or decaf - I had to immediately stop drinking coffee and colas, as well as chocolate, and anything hot or spicy. He then asked if I read while on the toilet, and I said of course, whereupon he said I have to break that habit: never sit on the toilet more than 2 minutes!

He then asked if I read his book. What book? Knew nothing about it. I asked if he had one there, and he popped into his office and returned with a copy. I asked how much, and he said $20 - no tax. "Read chapter six", he said. Actually, he said read the whole book and especially chapter six, which deals with my specific condition of Anusitis.He then told me to go downstairs to the drugstore and buy a device called Anurex. He said it is small device, about 3 inches long and about half an inch in diameter, with a knob about an inch in diameter at the top. He said to put it into the freezer for about 2 hours and then insert it into my anus. It works like a cold compress that you would put onto your arm or leg if you sprained it. Only, this works 'internally' in the anal canal. The device is reusable - just wash it thoroughly afterwards, and put it back into its container and return it to the freezer. It comes with a small container of aloe lubricant, but that is a very small container, and he said I could get a tube of KY lubricant instead.Quite frankly, I think I still have hemorrhoids, but he claims differently, and he is the expert. What bothers me is that my colonoscopy doctor, and family doctor, both mis-diagnosed this problem, and I have been living in pain for over 15 years.

I have been using the Anurex device for several weeks now, and have also changed my diet to mostly bland foods. And, oh yes, I have a high fibre cereal (Fibre 1) each morning. He insisted on this - said this is the only cereal with 15 grams of fibre per serving, and that I needed this each day. For the first week I did not notice any difference, in fact, it seemed to make my more constipated, which aggravated the problem down below because it made me force each bowel movement. I called him up about this, saying it sort of negated the effect of the Annurx device if I had to exert so much force for a bowel movement. He asked if I was drinking water with the cereal - I said no. He then said that eating fibre is useless unless it is accompanied by a bottle of water. Apparently, water is the catalyst that makes the fibre work in the bowels. So, I started drinking water each morning with the cereal, and actually taking a bottle with each meal, and I can't believe the difference. I now have the recommended 2 to 3 firm, but not hard, bowel movements each day.

However, the 'hemorrhoids' are still there, and still as sore as ever. I have a followup appointment with him this Friday. I am not expecting miracles, but he did say it may take 3 to 4 months till the anusitis goes away.

OHIP

In Ontario, most people are covered by OHIP, which is the Ontario Health Insurance Program. Basically, when you see a Doctor or other health care professional, you present your OHIP card, and the service provider bills OHIP for their services - you don't pay anything. Well, that is the way it works in most cases - there are some services that are not covered by OHIP.

Anyway, the other day I got to wondering if there was any way to reconcile what OHIP is being billed vs what services I actually got. I wanted to see if the health care practioners were being honest, and not billing for services I never got. I also wanted to see exactly how much they were charging OHIP for their services. For example, how much if any, is my doctor billing OHIP for prescription refills made over the phone by my drugist.

After searching the various OHIP website pages, I could not find anything. So, I sent off a note to the main contact listed for OHIP explaining that I wanted to see my OHIP records for 2009 and 2010 year-to-date. To my surprise, I got a reply which detailed the process:

Dear Sir/Madam,

Thank you for your e-mail sent to ServiceOntario for the Ministry of Health and Long-Term Care.

A Personal Claim History (PCH) is a summary or listing of all services received under a person's Ontario Health Insurance Plan (OHIP) health card number. It is not an individual's personal medical record history, but rather, a payment record of medical claims submitted by health care providers against a specific health number.

A PCH may include details such as: date service was received, fee paid to the health service provider, health number, patient's name, fee schedule code, health care provider's name, date the claim was approved for payment by the ministry, etc.

The ministry's databases keep fee for service records for seven years, plus the current year.

This signed request must be made in writing (no special form is required) and include the following information:

• health card number
  
• date of birth
  
• time frame of history
  
• mailing and physical address (if different)
  
• signature and date
  

The request can be sent to:

Ministry of Health and Long-Term Care
Personal Health Information Office
Corporate Administration Services
49 Place d'Armes, 4th Floor
P.O. Box 48
Kingston ON K7L 5J3

There is no fee for this service when the request is performed by the original cardholder.

Thank you again for your inquiry.

Regards,
M. Steinbok
Customer Service Agent
ServiceOntario -- making it easier
Visit us at: www.ServiceOntario.ca

So, I sent off a letter today, requesting my history of OHIP billings for the past year and a half. Now I wait for the reply.

I post this here for all people of Ontario: you should be requesting a similar history and comparing it to your actual medical services that were rendered to you. No one else is going to audit your records.

Dupuytren's Contracture, Redux

Back in October, I blogged about my problem with Dupuytren's Contracture in my right hand.

On Dec. 18th, 2007, I had surgery to repair this. It was done by a leading plastic surgeon, Dr Paul Binhammer, here at Sunnybrook Health Sciences Centre in Toronto. He did the procedure right in his office. The procedure, called Needle Aponeurotomy, or NA for short, did not take long, probably about 15 to 20 minutes. The worst, or most painful part of the whole procedure was the local freezing, in which he had to inject a needle in my finger in several places. Once it was frozen, the actual surgery was completely painless.

He made very small needle point incisions, and with a small needle-like scalpel, he cut the cords just under the skin which were causing the finger to contract. The finger almost immediately straightened out. After a light bandaging, he sent me over to have a custom split made. The cost of this was around $25 – this was the only cost incurred for the entire procedure, since the actual surgery was covered by our provincial medical insurance, OHIP. I am supposed to only wear the split at night when sleeping, and leave it off during normal daily activities.

The next day, I removed the bandages, and there were only a few small scab spots where he had done the surgery. There was virtually no pain, and the use of my finger was pretty much back to normal; there was no discomfort, and it did not hamper any activities in any way.

Dr. Binhammer asked me if I would like to participate in a controlled study, to "Study the Effects of Steroid Injection With Percutaneous Needle Aponeurotomy in Patients with Dupuytren's Contracture". The complete text ( 5 pages ) of this study can be found here. Approximately 44 people are in the test, where triamcinolone acetonide is injected into the finger after the surgery. Follow up visits are scheduled to track progress, and to get further injections. I have already been back once, around mid-January for a second injection. And, like the needle for the anesthetic, these steroid needles also hurt. My next appointment is in March.

Today, my finger is almost completely straight – with maybe a 5-degree bend. There is still slight pain on the inside of the joint where he stuck the needles in. It is only painful to touch, or when pressure is put on it. It feels like nerve damage. Hopefully, this will fade with time. And the top of my knuckle seems to have a bit of a callus lump, which is a bit red and sore. I am quite sure this is caused by the splint, and for the past few days, I have been sleeping without it to allow it to heal a bit.

The following photo is of my hand a few days after the surgery:


The next two photos are what my hand looks like today:



The next two photos show the splint that was made for me to wear each night; it is made of a hard plastic that thay moulded to fit my hand, and is held in place with velro straps (I added some felt pads inside for comfort):



And finally, a couple of photos of my hand in the splint. Basically, it holds my ring and small finger straight; I also use a small glove to make it a bit more comfortable:

Dupuytren's Contracture

About 4 or 5 years ago, I developed a condition whereby my small finger on my right hand would not straighten out completely. I visited my doctor and he diagnosed it as a condition called Dupuytren's Contracture (pronounced "doo-PAY-trens"), also called Dupuytren's Disease. He referred me to a plastic surgeon in our area. The photo to the right is of my right hand, palm up, showing the small finger.

The surgeon said it could be fixed with surgery, but the surgery was not without risk – in fact, he said there was a 15% possibility of permanent nerve damage. I did not like the odds, and since the condition was not painful, I chose to not have surgery and live with it. For the most part, it did not impact my day to day life in any way.

However, earlier this year, it began to bother me somewhat. Not so much pain, although it did hurt a bit if pressure was put on it in the area of my palm just behind the finger, but not on the finger itself. No, it was more a nuisance. Because of the continued curvature of the finger, it tended to get caught on things like when I put my hand into my pocket, or when washing my face it snagged on my nose (I know, sounds gross, but on several occasions I ended up with a bleeding nose because of it.)

So I started doing some research on the net. I found that there was a relatively new procedure called Needle Aponevrotomy, or NA for short, that was much less invasive than major surgery. Developed in Paris, very few doctors in North America were practicing it. I found a Dr. David Kline in Oregon that had a clinic to do the procedure and was seriously considering going down there to have it done.

Then, after doing some more research, I found a Dr. Paul Binhammer right here in Toronto that also was doing NA at the Sunnybrook Health Sciences Centre, about a 20 drive from my home. I immediately contacted my doctor to have him arrange an appointment for me. That was back around February.

I finally got to see Dr. Binhammer yesterday, and it looks very promising. He said that he could do the NA procedure in his office and it would take about 20 minutes. Then, I would need to go down to the splint department, where they would make a custom splint for my hand. This splint is to be worn each night when I sleep for the next 3 months. It is not needed during the day, and supposedly I will have full mobility in the hand immediately after the procedure. The cost of the entire procedure is covered by OHIP (the Ontario Medicare program); the only thing that is not covered is the cost of the materials required to make the splint.

He pointed out that the NA procedure does not remove the diseased tissue, but cuts the fibers allowing the finger to straighten. There is possibility the condition will return a few years down the road, in which case, he could perform an operation to remove the diseased tissue. He said he could do this operation now instead of NA, but left it up to me to make the decision. I said I thought the NA procedure would be the best choice first, and if needed, I could come back for the operation.

He said I can expect a call from his secretary to set up an appointment for the NA procedure, which I am hoping will be soon, and I will not have to wait another 8 or 9 months.

Lost in Transition

Perhaps the name of this blog should have been "Lost in Transition"!

All my life, I worked for a large multi-national computer company. In the beginning, it was fine.. in fact, I actually liked my work. I was one of those guys that could not wait until the weekend was over so I could get back to work.

The company was famous for putting its employees first. And for a time, they acted like they really meant it. There were all kinds of programs for the benefit of the employees. When the employees voiced a concern, the company listened, usually, and often acted.

But over the years, things gradually changed - especially, in the late 80s and early 90s. This was a time of turmoil not only in the computer industry, but also for many companies and businesses. Many shut their doors. Many employees were cut. There was fierce competition, and margins were getting smaller and smaller.

Our company had an unwritten policy of never firing anyone. Well, you had to be pretty bad to actually get fired. More often than not, a poorly performing employee was simply moved to another area and given another chance at a different job, but still within the same company. It was almost like working for the government, where no one ever got fired. All that changed in the late 80s and early 90s - when the focus changed from keeping an employee happy, to keeping the company alive. Indeed, there were many soothsayers that predicted the company would not last - but somehow it did.

This was an almost live or die situation for the company, and while many others were folding, we were struggling to stay alive. Layoffs, for the first time in the company's history, had started - but they were never called layoffs. Many were forced retirements, or early retirements. Whole departments were made redundant - the employees of which were sometimes given a few weeks or months to find work elsewhere within the company, or face termination. This is where good contacts and networking skills became extremely useful!

In the beginning, those that took the early retirement packages made off like bandits. Often, they would get a severance package of 18 to 24 months salary. The problem was, that this initial package was voluntary, and those that volunteered were the most skilled in the company, so when they left, not only could they easily get work elsewhere, but they left a serious hole in the company's workforce. To make matters worse, many often came back to the company as contractors at double their original salary! (We needed the contractors to help fill the void after all the skilled labour left!). Needless to say, this angered a lot of the remaining workforce, and soon a new policy was put in force the prohibited anyone who took early retirement, from working as a contractor.

Often, we did not have a choice. We would come into work one day, and be told our unit was being sold off, or merged with another. The word 'transition' became the word of the day. Our company was famous for creating new words and acronyms (we even made acronyms out of acronyms!), but the one I really hated the most was transition - used as a verb! As in, "you are being transitioned to this department". There is no such verb! Arrrgh! It made me angry to hear supposedly educated upper management using that expression. But they were like lemmings.. once it started, everyone was using it.

Needless to say, I was 'transitioned' many times, against my will, during those turbulent times. But times were tough everywhere, and I guess I was thankful to still have a job. I had many friends in the company that were forced into early retirement, and were still out of work several years later.

Lost in Lost in Translation

Watched Lost in Translation again last week. L watched it with me, but she just does not get it. She prefers a movie with some sort of action plot that reaches a climax and has a good or happy ending. Lost is not like that.. it is a story of a moment in time, and of some people in that time and place. It does not have a beginning or ending. It is a story of life, or a part of life.

Really not sure why I like it so much. I like Bill Murray, and find his performance in this movie very good. He does not even need dialog - the expressions on his face do the speaking. Another reason might be that I have been in Tokyo, and al lot of what I saw in the movie, brought back memories of my trip there.

Anyway, I picked up a copy cheap on eBay. I don't normally buy DVDs or VHS movies, because I rarely watch the same movie more than once. But I wanted to see the out-takes, the interviews, all the little extras they bundle into a DVD offering. Plus of course, I want to watch it again.. and again.