Too smart for his own good
Not long ago, I was, as usual, struggling with chronic pain, trying to come up with a new subject for a blog, and decided to ask Mel for input about pain. He’s a very intelligent man who has about double the brain capacity and vocabulary that I have. He also tends to get on a roll about his work, and it’s difficult to stop his momentum. I should have known better, of course, since the first six medical novels we wrote together had given me an inkling of what to expect. When he has a patient in his clinic, he is wonderful about explaining, thorough in his approach, and has a terrific bedside manner, but I’m not a patient, I’m his wife, and I think he thinks I somehow automatically picked up his vocabulary by osmosis when we got married–also that I can type a thousand words a minute. Didn’t happen. You can tell this by the following exchange:
“I’d love to help, sweetheart,” he said.”Make it simple for me, okay?” I asked.
“Okay, simply put, pain is usually a reflex arc,” he said. “Every part of a pain response is in two-parts. There is the afferent and there is efferent. Afferent is affect, and efferent is effect and–”
“Wait! Honey? What was it you just said?”
“The classic is you put your hand on a hot stove. Pain is the afferent response, as in, it affects you. As a result of the brain feeling pain, it triggers you to pull your hand back, therefore it’s efferent–or the effect. It’s what the muscles do in response. So a reflex arc doesn’t require a higher brain function.”
“Um, honey? Simple words, please. Honey! Wait, I can’t keep up. I can’t type that fast–“”–so treating pain is a process of cause and effect. You just have to remove what’s causing the pain. It isn’t usually as simple as taking a hand off the hot stove.”
“I’m talking about other kinds of pain.”
“Getting to that, sweetheart. The cause of most pain is not nearly as obvious. The best thing is to figure out what’s causing the pain.”
“That’s the catch, isn’t it?”
“If you take away the cause, you take away the pain. While you’re trying ot figure it out, you give pain blockers, which are narcotics–not something the doctor will willingly give you since so many people abuse them. Ultram is a newer pain med that works pretty well–“”Mel? Mel! Slow down! I’m tying as fast as I can–”
“If you can’t adequately block the pain, then you distract. Take a tens unit, for instance. TENS comes from the term trans cutaneous electrical nerve stimulation. It substitutes one pain for another, but the electrical stimulation distracts them from the old pain.”
“Hold it. Wait. Trans cute-what?”
“Lidocaine, on the other hand, kills pain as an anesthetic. It doesn’t block nerve endings, but it numbs them. It doesn’t last long, so it doesn’t work well for long-standing pain, although Marcaine with steroids in an injection can last longer.”
“Okay, lidocaine. Is that spelled with an e at the end, or–“
“General anesthesia puts the brain to sleep–another way of killing pain for surgery, though of course you can’t use that for chronic pain. Epidurals are versions of lidocaine, going for bigger nerves to anesthetize, so it’s a regional anesthesia.”
“There! That’s the word I want. Chronic pain. I need to know how to treat chronic pa–“
“For chronic pain, if you have a TENS unit and use it daily, that could help distract from the pain. Capzacin has a distracting agent in it that burns the skin, but the burn tends to go away if you can stand it long enough.”
“All right! Now we’re on a roll!”
“Benzocaine is a topical lidocaine, so that’s used for sunburns or toothache. Ambesol and Orajel are toothache benzocaines.”
“How can that help with chronic pain?”
“A classic example for fixing pain is to liken it to a broken bone–not to gross anyone out– that’s out of place, when you reset it, lining the bone up is probably as good at pain control as blasting the patient with pain medi–“
“No, honey, please go back to the chronic pain treat–“
“It’s the same with dislocations. It hurts when something is dislocated, and it hurts getting it back into place, but the body wants you to know about the problem with a lot of pain. You fix it, you’re better. Like a thorn in the foot. You don’t take pain meds for the thorn in the foot, you remove the thorn.”
“Okay, honey.” Sigh. “Got it. Remove whatever’s causing the chronic pain. Thanks for helping. See you soon! Remember, I have an appointment for you to adjust my back today.”
“Oh. Okay, sweetheart. Is that all you needed?”
“Yeah, once I get it sorted out.”
I no longer write the fast-paced medical novels set in emergency departments, because my brain can’t handle that much information and my fingers can’t type that quickly. I think from now on I’m going to email Mel my interview questions.
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