Friday, December 26, 2014
YOLO COUNTY NEWS
99 CENTS

Pain management is the doctor’s job, not the desk monkey’s

DebraDeAngeloW

By
From page A13 | January 13, 2013 |

Let’s talk about pain.

There are three subcategories: Those who cause it, those who endure it, and those who can’t take it. Although I’ve fallen into all three at some point or another (and everyone who knows me is pointing wildly at the first one), it’s number three that I’m concerned about today.

On the pain tolerance scale, from zero to 10, I’m a zero’s zero. The absolute alpha of the pain spectrum. Somebody has to be the beginning of every spectrum, and when it comes to pain, that somebody would be me.

I’m lucky to have led a relatively pain-free life — just the usual bumps and bruises of childhood. I used to get migraines, which were like an ax in the skull, but compared to childbirth? Childbirth trumps migraines.

I took those Lamaze classes, and learned to breathe through the “discomfort” of contractions. Discomfort? Would they call shoving a grapefruit through your nostril “discomfort”? Oh, what a sad, cruel joke all that heeh-heeh-heeh nonsense is. You don’t need to pant heeh-heeh-heeh when in labor. You need to know how to grab the gurney and say — growl actually — “So help me God, I will drop this kid on the floor if I don’t feel a needle in my butt right now!” It’s amazing how fast the nurse appears with the Demerol when you create a public disturbance.

Yes, I was a lot wiser the second time around.

My other significant brush with pain was when my appendix was leaking and ready to burst. Through the mist of agony, I experienced that eerie premonition that I needed to get to the hospital right now or I would die. Turns out, I was right. I was on the operating table in no time.

And then there’s vein ablation, a process to treat varicose veins, which are on the surface, and peripheral vein disease (PVD), which is deeper inside the leg. In both cases, the vein valves collapse and just flutter uselessly in the bloodstream, leaving the heart to do all the work of returning the blood. Lucky me, I have both conditions, but the PVD was the most concerning. It made my ankles and feet swell because the vascular system backs up all the way down to the capillaries, and I felt like I was wearing lead stockings all the time. Left untreated, PVD will ulcerate right through the skin and destroy the flesh on the surface.

Yeah, it’s bloody gross. Why do you think I endured this procedure six times already?

Well, last week, I endured my seventh. There I was, face down on the procedure table, the vascular surgeon on his third attempt to close a particularly large and unruly vein — a perforator, they call it — that runs horizontally at the top of the inside of my calf, and had opened to about the size and length of a hot dog. The ablation process begins with a series of rattlesnake bite injections that ostensibly numb the area (ha ha). Then they make an incision, thread a wire through the vein and zap it with lasers at intervals, fusing the vein walls and essentially creating a blood clot sausage that eventually hardens and is absorbed by the body.

Squirming yet? Suck it up, buttercup. It’s way less painful to read than endure it.

And here’s the kicker: no anesthesia. No pain killers. Just two lousy little Valium that are about as effective as Tic-Tacs when you are seized with anxiety-fueled adrenaline because you know what’s about to go down.

All you get to help you cope with the pain is a pair of grips on the table to grab onto, and I’m amazed that I didn’t twist them right off.

I begged for mild IV sedation this time, as it had helped in the past, but the medical assistant refused. The reason: The insurance company won’t pay for it. The insurance company decided it’s unnecessary.

Really.

I say we slap a few insurance CEOs face down and tell them to hold on tight while we jam some acid-filled needles into their veins and then fry them from the inside. How unnecessary is that sedation now, Mr. CEO? Wipe your nose before you answer. I can’t understand you while you’re sniveling.

The most exasperating detail of this story is that my vascular surgeon agrees that I’m at the extreme weenie end of the pain scale. He knows that what feels like a pin prick to another patient feels like being stabbed with an ice pick to me. Maybe I simply have more nerve endings per square inch than other people. Or maybe my nerve endings are a thousand times more sensitive than other people’s, picking up on pain frequencies that other people don’t, just like dogs hear things that people can’t. Maybe it’s some variation on fibromyalgia, where my pain receptors are incorrectly interpreting pain signals.

Whatever it is, my experience with pain is wildly amplified. And it’s real. I’m not wired like other people. I know it. My doctor knows it. But he can’t do anything to alleviate it, because the insurance company holds veto power over his medical decisions, and employs legions of flunky clerks to screen the “Mother May I” preauthorization papers doctors must submit before doing anything. Talk about the tail wagging the dog. When did a medical degree become a prerequisite for rubber-stamp clerical jobs? Do you even need a high school diploma for that? Why are white-collar desk monkeys calling the shots on medical decisions?

This is insanity. It must change. The only role an insurance company should play in medical decisions is to shut up and pay the bill. My insurance company has no right to decide how much pain I can withstand. I’m the only one who knows that, and my doctor is the only one with the expertise and medical judgment to decide how to deal with it — not some desk monkey with a rubber stamp and a GED.

— Email Debra DeAngelo at debra@wintersexpress.com; read more of her work at www.wintersexpress.com and www.edebra.com

Comments

comments

Debra DeAngelo

  • Recent Posts

  • Enter your email address to subscribe to this newspaper and receive notifications of new articles by email.

  • .

    News

    Exchange students bring the world to Davis

    By Anne Ternus-Bellamy | From Page: A1 | Gallery

     
    Pastor has many plans for CA House

    By Jeff Hudson | From Page: A1 | Gallery

     
    Transit survey: 47 percent ride bikes to UCD campus

    By Special to The Enterprise | From Page: A1 | Gallery

    Playing Santa

    By Enterprise staff | From Page: A2 | Gallery

     
    Goats help recycle Christmas trees

    By The Associated Press | From Page: A2 | Gallery

     
    Learn fruit tree tips at free class

    By Enterprise staff | From Page: A3

    Davis Bike Club hears about British cycling tour

    By Enterprise staff | From Page: A3

     
    Pick up a Davis map at Chamber office

    By Enterprise staff | From Page: A3

    Sierra Club calendars on sale Saturday

    By Enterprise staff | From Page: A3

     
    Special holiday gifts

    By Sue Cockrell | From Page: A3

    Woodland-Davis commute bus service expands

    By Enterprise staff | From Page: A3

     
    Explorit: Get a rise out of science

    By Lisa Justice | From Page: A4

    NAMI meeting offers family support

    By Special to The Enterprise | From Page: A6

     
    Yoga, chanting intro offered

    By Enterprise staff | From Page: A8

    .

    Forum

    Blamed for her sister’s rage

    By Creators Syndicate | From Page: B5

     
    How much for the calling birds?

    By Creators Syndicate | From Page: B5

    Many ensured a successful parade

    By Letters to the Editor | From Page: A10

     
    Thanks for putting food on the table

    By Letters to the Editor | From Page: A10

     
    Steve Sack cartoon

    By Debbie Davis | From Page: A10

     
    .

    Sports

    Two more for the road for 9-1 Aggie men

    By Bruce Gallaudet | From Page: B1 | Gallery

     
    Patterson is college football’s top coach

    By The Associated Press | From Page: B1 | Gallery

    Clippers get a win over Golden State

    By The Associated Press | From Page: B1 | Gallery

     
    NBA roundup: Heat beat Cavs in LeBron’s return to Miami

    By The Associated Press | From Page: B10 | Gallery

     
    .

    Features

    .

    Arts

    ‘Unbroken': A bit underwhelming

    By Derrick Bang | From Page: A11 | Gallery

     
    Folk musicians will jam on Jan. 2

    By Enterprise staff | From Page: A11

    .

    Business

    Passat: Roomy, affordable sedan with German engineering

    By Ann M. Job | From Page: B3 | Gallery

     
    .

    Obituaries

    James J. Dunning Jr.

    By Special to The Enterprise | From Page: A4

     
    Floyd W. Fenocchio

    By Special to The Enterprise | From Page: A4

    .

    Comics

    Comics: Friday, December 26, 2014 (set 2)

    By Creator | From Page: B7

     
    Comics: Thursday, December 26, 2014 (set 1)

    By Creator | From Page: A9