Like many middle-agers, my list of complaints is long. Life often goes too fast for one to address the multiple nagging aches that seem to cling to you over the years. I have suffered from frequent headaches since I was a child. I remember the headaches starting when I was in middle school playing pee-wee football. The headaches become more frequent and severe during my residency. I was fortunate to rotate through a headache clinic as part of my internal medicine training. Here, I diagnosed myself with a combination of tension and non-classical migraine headaches. As doctors are prone to do, I began treating myself... unsuccessfully. I had little relief with over-the-counter medications such as Tylenol, ibuprofen, and naprosyn. I had a friend prescribe me an antidepressant called amitriptyline for headache prevention. It didn’t seem to have any impact on my headaches, but I did sleep well while taking it and I had a very dry mouth. Taking a mere 25 mg dose, about ¼ the normal dose I have often prescribed to little old ladies, I was dead to the world. Normally a light sleeper, I could now sleep through a fire alarm and when I did awaken I felt groggy until noon, which is not a good state for a busy 3rd year medical resident to be in! I sought guidance from an ophthalmologist, but my eyes were normal. I tried allergy meds, thinking maybe I had sinus allergies, all to no avail.
Fortunately, the frequency of my headaches usually wanes after a month or so of increased frequency and I would forget about them being an issue. This changed a few years back when I was nearing the end of my infectious diseases fellowship and I developed daily crushing headaches the centered behind my right eye. These headaches woke me from my sleep and were associated with nasal stuffiness and tearing in my eye. Aha, I had a new diagnosis… cluster headaches. At some point in the intervening years between childhood and fellowship, I had started taking Maxalt a few times a month for my headaches with some benefit. Now I was taking it 2-3 times a day with minimal relief. Finally, I could stand it no longer and I went to the emergency room seeking relief. I had a CT scan of my head which was essentially normal, and my diagnosis of cluster headaches was confirmed. I spent 6 hours in the emergency room and I was given no acute therapy for my headache. I merely received a referral to a neurologist, and a prescription for prednisone and verapamil (both meds thought to help cluster headaches, that I suggested to the ER doctor) for a few weeks down the line! Maybe I can see why persons might be looking for alternatives to “modern” medicine.
I saw the neurologist a few weeks later who added little to my therapy, but did excise a $40 co-pay for his efforts. I half-heartedly took the prednisone and verapamil for the next few months and eventually tapered off these meds. Ultimately, my headaches returned to their normal pattern.
My other maladies include bilateral heel pain diagnosed as plantar fasciitis by a podiatrist. After playing basketball, I would hobble around for several days walking like a gorilla on the outsides of my feet. I tried icing my feet, ibuprofen in mega doses, rest, and every brand of over the counter orthotic insert available, all without relief. In desperation, I even allowed fresh faced podiatry students to inject my heels with steroids hoping for improvement. Finally, I resorted to pricey, tailor-made orthotic inserts which I have worn religiously for the past 5 years. The inserts, made of hard plastic with a small amount of rubber cushioning over them, were made based on a mold of my feet designed to keep my feet in the “neutral position” according to the podiatrist. It sounded a bit hokey to me, but I have largely been able to return to my normal activities with the exception of running. Despite the success of the orthotics, I still have an element of heel pain that persists and basically rules out ever walking barefoot. Also, the inserts guarantee that no shoe will truly feel comfortable again. Imagine buying a nice cushioned pair of running shoes and then throwing in a couple of rocks before placing them on your feet!
My third chronic complaint is my lower back. I know this is extremely common, largely because almost half my patients have the same complaint. My lower back is stiff in the morning when I get up and aches throughout the day. Having 3 young children doesn’t help. In fact, I can clearly appreciate my back aches worsening over the course of a long family vacation and improving when I return to work. I rarely have radiation of pain into my legs, but at times the back pain is quite limiting. I have resorted to stretching, something I despise. I have prided myself on being the least limber person in the world. I don’t think I have touched my toes since I was in utero! I live on anti-inflammatories. It is a wonder I haven’t bled to death from stomach ulcers. I wear a back brace when I play basketball and a sleep with a board under my mattress.
[tomorrow, am I losing my mind?]
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