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A dislocated bone and why health care is so expensive.

A few years ago I was involved in a car accident. Not my fault, I got rear ended and my car totaled.  For over a year I suffered from severe back pain. My orthopedic surgeon and back specialist looked at the X-rays, the ordered MRIs. The back pain was getting worse and at times it was excruciating. All I got was a prescription to Hydro-codone, the generic of the Vicodin.

Last year I decided to take advantage of the time between jobs to concentrate on getting healthy again. Throughout the pain, I had kept working because I couldn't afford to leave work and the pain was intermittent, so some days, it was not too terrible. I only used the (sixty pill!) bottle of Vicodin I got for emergencies, or plane trips, were sitting in a chair in pain was just too much. But since Vicodin is so powerful (it puts me in a daze) I could not use it for work, so I managed work in pain, sitting for long hours in front of a monitor doing work.

The pain had not only reduced the quality of life, which mostly consisted of finding ways of getting through work and collapsing afterwards, had me max-out my sick days at work and forced me to dig into vacations; it had also been incredibly expensive. I tried pretty much everything. A consult with a different doctor, acupuncture, and physical therapy. Some had palliative effects but none had long lasting effect.

A physical therapist told me on a visit to Puerto Rico that physical therapy depended greatly on the therapist and since my result with physical therapy sessions had varied from pain reducing massage, to being in so much pain after the session I could not make it to my car walking and had to lie on my back on the sidewalk, I decided to take the advice to heart and look at my medical providers again. I looked for a new chiropractor.

My new chiropractor was more into holistic treatment and quickly figured out that I had done some damage to my digestive system with the amount of pain pills I was regularly taking. She cajoled me into going into a restrictive diet: no dairy, no eggs, no wheat, no soy. I never did eliminate soy completely, but the rest I did and started to feel better and loose weight (both of which I'm sure helped the back). I had not realized how much the pain medication was driving my diet. Not wanting to take them on an empty stomach I was eating a lot during the day and some not so good stuff.

But the main reason I went on this crazy diet was that I felt very comfortable talking to my chiropractor. She took time to listen and investigate. Her restrictive diet was a way of figuring out if I had a food allergy or possibly was becoming lactose intolerant and I was on board for that. But these conversations led to us catching something that had eluded my doctors. Even though I had pointed it out, no one had noticed I had a dislocated coccyx until one day when talking to my chiropractor. I asked her about her some of her best successes. She told me that she'd had a patient that was going for surgery for the coccyx. She'd proposed to the patient the they try to adjust it first and see if surgery could be avoided. The patient recovered with the adjustments alone and didn't need surgery. It struck me that I might have that too. I had been going through the embarrassment of showing everyone that treated me where it hurt the most (which, trust me, is not easy to explain) no one had  caught it. My chiropractor said that we could adjust the bones there and see what happens.

I likely had a dislocated coccyx that was caused by the accident. Easy to miss on a quick look or a quick examination since most people my age have their coccyx bones fused, but mine articulate ever so slightly, enough to get dislocated and made way worse by the extensive sitting I did in my work. The adjustments have done great things for my back. Once that area of the back was not as painful as it was, I was able to lower my drug intake to just occasional flare ups and have been able to sit for longer and longer periods of time pain free.

Arriving at this 'diagnosis' was a process. It involved both me and the medical professional, and it required time. A lot of time in discussion, and investigation. And here we come to why health care is so expensive.

All the tests, X-rays, MRIs, doctor visits, physical therapy, drugs, lost productivity and frankly despair I went through stem from a desire to save money in medical costs. All of this is to save the cost of spending time with the doctor, the teasing out, the figuring out the problem and how to best treat it.

This is the paradox of health care costs. To save money overall, they cost money -- by not valuing the most important part of the process: the patient-doctor time and interaction. While now many problems and diseases are quick to diagnose and treat; many are not. I always felt the pressure of time when talking to doctors. Quick! Tell me your problem so I can assign a diagnosis and send you home with a legal drug prescription. We now have the tyranny of the 15 minute doctor visit, and the terrible cost it incurs.

Contrast this with my chiropractor. Most visits are in-fact only 15 minutes since it's only maintenance (what in a doctor's office would be a follow-up appointment). But some are way longer, and that's were evaluation and teasing of the problem actually occurs, and where over a year of pain, pain killers and mental anguish can turn the tide toward healing and hope.

We have to cut "treating the disease/syndrome/problem/back/whatever" mentality and start treating the patient as a whole or holistically as they say. Otherwise health care will continue to be a pain in the butt.

[Extensive Editing on March 16, 2011.]

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