Exceptional Care – Avoiding Bad Care: Pelvic Pain, Part 1

By | June 24, 2011

 

Well meaning physicians embarked on therapy after therapy, that produced more side effects than relief.

In this and the next several blogs I would like to return to a topic that we began over a month ago, the question of Exceptional Care, and by that I mean exceptionally good care. This may sound obvious, but the first and most important step in getting exceptionally good is avoiding exceptionally bad care and here I believe that one example will speak volumes.

 

E. A. is a 26-year-old woman who has suffered from lower abdominal pain since puberty. The pelvic pain was so severe that she underwent 3 surgical procedures. Laparoscopy showed endometriosis and scarring, which were treated with resection, fulguration and coils, all without lasting effect. She was also started on potent chronic narcotic therapy, which also didn’t really relieve her pain, but nevertheless when first she saw me, she had developed narcotic dependence to Methadone and Dilaudid. Finally she was started on high doses of corticosteroids, which again did not help her chronic pain, but had resulted in massive weight gain such that she was now 3 times her normal size.

 

Of note E. A. also suffered from upper abdominal pain and acid reflux. She has a sister with odd periodic headaches and a mother with migraines. Therapies that have produced temporary relief are acupuncture and TENS therapy. One particularly distressing thing about this case is that I personally know all of the doctors who have treated this woman and they are all excellent and caring physicians who produced more in the way of side effects and complications than pain relief. The problem is that they were dealing with a condition that they rarely treat and which is effectively treated by only a hand full of physicians across the country.

 


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