Rude Health
A new paper from a spinal specialist suggests back pain has been neglected, writes Maurice Gueret, as he pays tribute to Sligo’s greatest family doctor
Dr Maurice Gueret on the neglect of back pain
Frequent flyers
Though surgery premises are eerily quiet, human life and other illnesses go on in spite of our pandemic. Dublin-based spinal surgeon Derek Cawley has written a thought-provoking paper on back pain in the 21st Century, asking if the condition is still as painful as it was. The first two decades of this century have seen a steady increase in ‘non-specific low back pain’, and in about a quarter of these patients, discomfort persists beyond three months. He believes that these chronic low back pain patients are often misdiagnosed, or underdiagnosed. Quite often, they are not new patients, but are what he terms ‘frequent flyers’. Disc degeneration, alignment of the spine, hypermobility of spaces between vertebrae, dysfunction of muscles and the degree of spinal curve need to be assessed in these chronic cases. Depression, loss of employment, failure of close relationships, addiction to analgesic medicines and an inability to access appropriate expertise are common experiences. Mr Cawley is right to point out that the ailment in question has not been the focus for State investment or political pressure. My experience of healthcare politics over 30 years suggests that lobbying and scandals have joined unions and tradition as the major forces exerting pressure on where resources go in Ireland. Back pain doesn’t have a foundation the way hearts do, or a society like cancer does, to lobby on its behalf. And if you don’t lobby Irish power-brokers, then Ireland doesn’t seem to care.
Still standing
Surgeon Cawley also asks why humans are so susceptible to low back pain. He says that one ability we take for granted, namely to walk on two feet, is a relatively new one, and dates back only seven million years. He contrasts this with our ability to form blood clots when faced with a cut, which is at least 50 million years old. Therefore, he describes the ability to stand up straight as a genetically fragile function. The most vulnerable spot in the spine is the junction between the mobile fifth lumbar vertebra and the more secure sacrum below it. He mentions new research that discerns between ‘hip walkers’ and ‘spine walkers’ — some sway when walking, while others glide. Mr Cawley’s new paper is a fascinating read. Back pain deserves to be much higher up the healthcare agenda than it is. Patients with health insurance can now access some really top-class multi-disciplinary spinal services. Next time your politicians deem it safe to return to your doorstep, ask them why we cannot have health insurance for everyone.
Pandemic lingo
Congratulations to the
National Adult Literacy Agency at nala.ie for producing a guide to the words that this coronavirus has thrown up. Everything from ‘pandemic’ to ‘super spreader’,
‘epidemic’ to ‘cluster’, and ‘PPE’ is perfectly explained in understandable English. I couldn’t find the word ‘Covidiot’, but then we’ve all probably heard quite enough at this stage from President Trump.
Doctor Paddy
Sligo lost a great servant this month. Dr Patrick J Henry of Rosses Point passed away in a Dublin nursing home. He practised in the county for no less than 62 years, and wrote a number of books on his life as a GP, the history of medicine in Sligo, and the healing power of humour. He was greatly loved by patients and colleagues alike, and had a wonderful philosophy of practice. Nobody was ever turned away. He or his surgery partner would see them on the day. He also had unwritten rules. The first job of each consultation was to put the patient at ease. He or she would be listened to and not interrupted. Eye contact was to be maintained. Peering at a computer screen was kept to a bare minimum. And he rarely forgot to ask the all-important question: what really brought you here today?
On one surgery visit, he told a man that his blood pressure was up. The patient got upset, and asked Dr Paddy to tell him a joke and retake it. He did as was requested, and lo and behold, the man’s blood pressure had returned to normal. On another occasion, he had a worrier in who was always asking how his heart was. Dr Paddy told him that it was so perfect it would last him as long as he would live! One of his books included a little Senility Prayer at the end: “God grant me the senility to avoid those I couldn’t stand, and the good fortune to meet those who mean a lot to me, and the eyesight to know the difference.”
May he rest in well-deserved peace.
Dr Maurice Gueret is editor of the ‘Irish Medical Directory’ drmauricegueret.com