Listen to your patients!

Here’s a lesson for patients and health care providers. I recently evaluated a patient who was suffering from carpal tunnel syndrome. He had lived with pain and numbness in one hand that began a little over a year ago.

These symptoms were treated with cortisone injections, which temporarily relieved the symptoms. After a few rounds of cortisone, he finally relented and underwent a carpal ligament release. And: problem solved. No more pain in that hand.

Then a few months ago he felt the same symptoms of pain and numbness in the OTHER hand. Not wanting to go through injections and surgery, he sought more conservative care first. Twelve visits to a physical therapist did not help. Six more visits to a chiropractor who is an Active Release Technique provider also did not help.

So in front of me sat a man who was running out of patience and hope. Carpal tunnel syndrome does tend to be a “mechanical” problem---something occupies the space of the tunnel and presses on the median nerve. If you remove or reduce that occupying “mass”, the symptoms go away. Very often, the “mass” is somewhere else along the path of the median nerve (pronator teres, antecubital fossa, medial intermuscular septum, etc.).

What was odd was the success, albeit temporary, of the cortisone injection coupled with the absolute failure of the other approaches (which included ART, stretching, strength training, ultrasound, electrical stimulation and ice).

Chiropractors are not experts in pharmacology. That stated, most chiropractors (and physical therapists) become very familiar with the 40 or 50 most commonly prescribed medications. This patient was taking a heart medication that was NOT familiar to me. A quick search through the PDR (Physician’s Desk Reference) followed by a phone call to my favorite pharmacist (thanks for taking my call so quickly, Dave) confirmed my suspicions.

This patient seemed to be suffering from a side-effect of a medication he was taking. When I asked the patient if he had spoken to this cardiologist (who prescribed the drug) about his carpal tunnel syndrome symptoms, he said “no”. He did not think a heart doctor would know or care about hand problems. Similarly, his general practitioner was unaware of his heart medication (same logic employed here, too). And finally, on his initial patient paper work, he failed to include this drug as something he currently takes. I had to ask him in order to learn about it. I made him phone his cardiologist from my office to set up an appointment for later that day.

When I spoke to the patient recently, his cardiologist had altered the medication about a month earlier. His pain and numbness were completely gone. I wish I could say it is because I treated him so well—all I did was talk to and examine him!

The lesson—patients: tell your health care provider EVERYTHING. Let him/her decide if it is germane to your condition. And doctors: if you’re not helping within the first 2 weeks, you’re not going to help. At that point, change your course of treatment or find someone with a different perspective.