Good Article From WSJ Including Dr. Sarno

http://www.wsj.com/articles/SB970798347921216775

How many doctors does it take to cure a common ailment?

By
LISA GUBERNICK Staff Reporter of The Wall Street Journal
Updated Oct. 6, 2000 12:05 a.m. ET

M y back aches. Never enough to miss a day of work, though sufficient to interrupt a night's sleep, make long flights miserable and cause me to think twice about lifting my six-year-old. But recently I thought I finally might be able to find a cure.

At a time when patients, politicians and doctors everywhere are complaining about restrictions on health coverage, my boss offered me what seemed like an extraordinary luxury: She would pick up the tab for as many specialists as necessary to nail down a diagnosis and, with any luck, a remedy. In all, I went to eight specialists of all stripes, including some of the best in their fields, from a psychoanalyst to the celebrity doctor that shock-radio host Howard Stern swears by.

So how many different answers did we get? You guessed it: Eight. "You're way past the point of saying, 'Let's do something conservative,' " said one physician, before sending me (to the tune of $1,108) into one of those coffin-like MRI machines. Another doctor gave me essentially a $275 bone massage. And one told me it was all in my head. But more on that later.

Our mission here was to find out how much this era of increased medical expertise is really helping. The number of M.D.'s who have become certified specialists has risen about 20% to nearly 90% of all doctors during the past two decades. But new scientific advances and alternative therapies have left many Americans confused about the options, and dazed by bills that come with finding the right one. Indeed, Americans who share my pain spend an estimated $25 billion on back trouble alone.

During the past several months, I've made a healthy contribution to that tab. And I've learned a thing or two. This specialist syndrome that so many of us face has taken on a life of its own. In one major study, more than 1,000 physicians were asked to recommend treatments and tests for three patients with back trouble, based on descriptions of their problems. The responses reflected each doctor's specialty. "Who you see is what you get," says the University of Washington's Dr. Richard Deyo, an author of the study.

It's a recipe for frustration for anyone who shares my pain. "I'm determined to get at a cure," says Patrick McAuliffe, a 41-year-old banking consultant, who has blown $5,000 seeing seven different medical professionals in the past year -- and still has no cure for his excruciating back pain.

For my part, I found that I often had as much confidence in my own instincts as those of the specialists. (While I liked osteopathic manipulation, I got almost as much relief sitting in a massaging chair during a recent pedicure.) One other lesson: I realized that I'd rather endure a little pain than needles and medicines with uncertain results.

So let's begin my multi-month saga as a professional whiner. (I told each doctor that I was a writer for The Wall Street Journal, but didn't tell them until after all my appointments that I was writing a story.)

The Osteopath
Osteopaths are doctors of osteopathic medicine (D.O.) instead of medical doctors (M.D.). But they have the same privileges, including the right to perform surgery and prescribe medicine, and they are growing in popularity. One reason: "osteopathic manipulation" -- a sort of bone massage that relies on physical touch, which appeals to patients with back pain.

I could see why. While the questions Dr. Gary Inwald asked about my back seemed typical (how long had it hurt, where was the pain), the exam wasn't. He had me walk across the floor, first on my toes and then on my heels. He pressed his finger into my back, kneading it just above my hip. I grimaced. He told me I had a strained ligament near my sacroiliac, the joint linking the bottom of the spine and pelvis, and had me lie on the examining table.

Then, the osteopathic manipulation: Dr. Inwald pulled my right knee to my chest, then over the side of the table. He asked if it helped; it did. He gave me a prescription for Naprosyn, an anti-inflammatory, and another for a so-called sacral belt to support my back. He also suggested special exercises and ultrasound heat, both offered by his practice.

The Chiropractor
TV producer Randy Robinson won't go near a medical doctor for his lower-back problems, which have kept him from work twice during the past two years. "Almost everyone I know that has had surgery tells me they regret it," he says. He gave up on yoga and acupuncture, but found relief in a five-minute "vertebral adjustment" and deep-tissue massage he gets twice a month from his chiropractor. Such testimonials are one reason visits to chiropractors have quintupled during the past five years, according to the American Chiropractic Association. (Chiropractors are trained in aligning the bones of the spine.)

Chiropractor Douglas Seckendorf was confident his therapy could help relieve my pain. His first question: Had I been to see anyone else? "Did he take X-rays?" When I told him I had seen an osteopath who didn't take X-rays, he ordered up a set. In the meantime, he did an initial exam and disagreed strongly with the osteopath's diagnosis. "Treating that will have the same effect as eating ice cream," he said.

The formal diagnosis, after my X-rays came back: facet impingement -- irritation of the joints at the bottom of the spine. The treatment: eight physical-therapy sessions, at $110 a pop, to correct my posture.

The Acupuncturist
Once regarded as a fringe treatment, the practice of inserting thin needles into the body to relieve pain now has support from no less than the National Institutes of Health. One recent convert: Design consultant Grace Jeffers, who has suffered both lower-back and stomach pain for years. After going to a gastroenterologist, an orthopedist, a neurologist and a chiropractor with no luck, she tried acupuncture. She now goes twice weekly, getting as many as a dozen needles inserted from head to toe. "The acupuncturist was the first one to see the correlation between my back and stomach pain," she says. "I cannot believe the difference."

My experience, with Dr. Soon Jack Leung, wasn't quite so sanguine. In the exam room, sandwiched between a fabric shop and a 25-cent store, Dr. Leung brought out something called an acupunctoscope, an instrument with a metal wand that he ran up and down my back. As it hit the small of my back, the machine's hum became a loud squeal. It grew quieter as it went down toward my thigh, then squealed again just below the hip. "It detects an electric current," he said, "which is stronger where the nerve is pinched." The diagnosis: a pinched left sciatic nerve. The treatment: eight to 10 sessions of acupuncture.

I endured a single session. The doctor inserted six needles for 25 minutes. It didn't hurt until he inserted the last needle. Pain shot from my calf down through my instep. "That's good," he said. "It's a helpful sign." When I left, my back felt fine; my foot was another story.

The Psychiatrist
Many doctors believe back pain is the result of unexpressed anger. So I went to see Wayne Myers, a psychoanalyst. He asked about the stresses in my life. With a demanding job, getting my young child admitted to a local private school ("Is it as bad as I've heard?" the doctor asked) and a helpful but equally hard-working spouse, I explained that there simply weren't enough hours in the day. Forty-five minutes later, it was over. He didn't think he had much to offer me, he said, but gave me a prescription for Valium should my back keep interrupting my sleep.

I walked out of the doctor's office and started heading back to work. A couple of blocks away, I passed a nail salon. It was my birthday -- and I stopped for a pedicure. There was a massage button on the chair I sat in while my toes were painted pink. My back felt almost as good as it did after my osteopathic manipulation.

The Homeopath
A poster in the entryway for William Bergman, who has a family medical practice with a specialty in homeopathy and clinical nutrition, shows famous homeopathic patients: among them, Washington Irving. Above the receptionists' desk is a photo of a famous patient of more recent vintage: Marla Maples, ex-wife of Donald Trump. The doctor said that I might benefit from homeopathic treatments coupled with physical therapy. He offered Traumeel, which he described as an herb-based substitute for Naprosyn, but without the gastro-intestinal side-effects.

He also recommended a stress-management program he ran called "HeartMath." I skipped the math but tried the pills, which tasted a bit like schoolboard chalk. With no effect after a couple of days, I quit. (The doctor said I would need to take three pills a day for a month to see results.)

Plenty of other people, though, swear by this stuff -- enough to rack up more than $400 million in sales of homeopathic medicines last year. Executive recruiter Jenny Baldwin tried it to treat a muscle inflammation that caused agonizing pain in her foot. After an orthopedic surgeon diagnosed her, Ms. Baldwin called her sister, a homeopathic enthusiast, for a recommendation and wound up taking three different pills twice a day. Each had magnesium as primary ingredient. "They didn't even taste weird, and they worked," she says.

The Physiatrist
Vijay Vad's office was like a sports hall of fame, plastered with signed posters of ballerinas and hockey players. I had been referred to him after being turned away by two orthopedic surgeons. (Some orthopedic surgeons consider themselves one of the last stops on the backache odyssey. Both surgeons whose offices I called sent me to other specialists.)

After hearing about my symptoms, Dr. Vad spent about five minutes looking over my back. He had me sit down, pressed down on one leg, then the other, checking my resistance. "You have a classic disk problem," he said. "You're way past the point of saying 'Let's do something conservative.' I want to inject a small amount of Cortisone and Lidocaine to neutralize the toxic spill from the disk."

First, though, he wanted me to get an MRI, one of those devices that picks up images X-rays can't see. If the MRI showed disk problems, as he expected, he wanted me to get a nerve test to identify the precise location of damage, to be followed by the shots. "You're still at risk for re-herniating," he said, and gave me a cryotherm back wrap he wanted me to wear, complete with ice packs, for 15 minutes a night. It felt like wearing a girdle packed with an ice-cube tray -- and made me nearly as uncomfortable as my backache.

The Neurologist
The second orthopedic surgeon I called, who had performed near-miraculous surgery on New York Jets Dennis Byrd's broken neck in the early '90s, sent me off to Gerald Smallberg, a neurologist.

Dr. Smallberg asked how much I exercise and whether it causes any discomfort. "The good news is it's not serious," he said after hearing my answer. (I run a couple of miles most days with little or no pain.) "The bad news is it's chronic. You'll probably just have to live with it until it gets worse." Still, he suggested an MRI to pin the problem down.

Back pain may be bad, but there was plenty of reason to think an MRI could be worse. After all, how many times does a medical technician offer up a blindfold before the procedure takes place? The blindfold's purpose: eliminate the sense of claustrophobia induced by the long metal tube in which the MRI takes place.

Along with the blindfold, the technician offered me a set of earphones and my choice of radio stations. Why he bothered, I don't know. By the time I was inside the tube, the grinding sound of the MRI made me feel like I was trapped in a Pac-Man game.

I emerged from the tube after 20 minutes. In the tone usually reserved for soldiers returning from the battlefront, the technician told me I had done well. "One out of 10 can't take it," he told me.

Despite one or two suggestions to the contrary, the MRI showed some mild disk bulging but nothing at all serious. After seeing the results, Dr. Vad downgraded his initial treatment suggestion to ibuprofen and an ice wrap on the back, though he said I might still benefit from Cortisone injections if that didn't work.

Celebrity Doctor
My final visit was to Dr. John Sarno, professor of Clinical Rehabilitation Medicine at New York University. His book "The Mindbody Prescription" boasts a testimonial from talk radio's Mr. Stern, who dedicated his own book, "Private Parts," to Dr. Sarno "for ridding me of back pain and obsessive-compulsive disorder."

Trained as a physiatrist, Dr. Sarno eschews traditional treatments. He believes virtually all back problems come from what he calls tension myositis syndrome, the result of a mild reduction in oxygen to the muscles, tendons or nerves. The trigger for TMS, he says, is a "mindbody" problem, caused by unexpressed emotions.

Dr. Sarno's secretary asked about my medical history -- and whether I had read the doctor's book. I answered yes. When the doctor himself called later, he, too, wanted to know if I had read his book -- and about the nature of my pain. "I'm almost certain you have TMS, which is what I describe in my book," he said. "This is psychologically induced. You must accept that diagnosis in order to get better." He added that by coming to see him, I was committing to going to his seminars and teaching sessions. (It's all included in a single $800 fee.)"

I set up an appointment, where he asked about my family history and the sources of stress in my life. During the physical exam, he put pressure on the side of my thigh. I yelped with pain. "That tenderness is typical," the doctor said. "There is nothing structurally wrong with you."

Treatment began with two lectures, followed by six weeks of 45-minute homework sessions. His pitch: how specious many diagnoses and treatments of back pain were. In one study, 98 people who had never had back pain were given MRIs; more than half had structural abnormalities involving their disks.

"It all makes sense," said a tall man with a grizzled beard as we walked out. "I just wish I could say I felt better." I couldn't have agreed with him more.

My Final Answer
Did any of this actually help? I felt a little better after the osteopathic manipulation. I hated the acupuncture, and passed on the Cortisone shots, which seemed a bit extreme, as well as Dr. Sarno's six weeks of "homework."

For now, I'm trying to do a little more stretching each day, and I'm still popping some Advil. I might even try to squeeze in a few more pedicures.

Write to Lisa Gubernick at lisa.gubernick@wsj.com

THE DOW JONES 'WHINE' INDEX
I went to eight different medical specialists to deal with my backache. Here's what they said I had -- and how much it would cost to fix it. (Each doctor was given a chance to comment on his diagnosis or treatment before the story went to press.)

Osteopath Gary Inwald
Diagnosis: Sacroiliacitis (translation: inflammation of the joint that links the spine and pelvis).

Treatment: Naprosyn; ultrasound heat treatment and physical therapy ($105 per session).

Cost of Visit: $200 for visit, plus $75 for "osteopathic manipulation"

Comments: In praise of bone massage: $75 to pull my right knee to my chest seemed like a lot, but it actually made my back feel better. Of course, so did the massaging chair I sat in a few weeks later while getting a pedicure.

Chiropractor Douglas Seckendorf
Diagnosis: Possible facet impingement (translation: I have bad posture, which ends up pinching the nerve in my lower spine).

Treatment: Physical therapy ($110 per session).

Cost of Visit: $195, plus $75 for X-rays

Comments: He rejected the osteopath's diagnosis: "Treating that will have the same effect as eating ice cream."

Acupuncturist Soon Jack Leung
Diagnosis: Pinched left sciatic nerve.

Treatment: Eight acupuncture sessions ($70 a session).

Cost of Visit: $70

Comments: I lasted just one session. When I left, my back felt fine. Not so for my foot, which throbbed after he inserted the last of six needles.

Psychiatrist Wayne Myers
Diagnosis: No formal diagnosis, though he noted that back pain is often stress-related.

Treatment: Valium.

Cost of Visit: $250

Comments: Just the frankness you'd hope for in a psychiatrist: He said he didn't think psychotherapy would help my back. Offered Valium, a muscle relaxant, to help me sleep.

Homeopath William Bergman
Diagnosis: No formal diagnosis, but said stress could be contributing to my pain.

Treatment: Chalky-tasting pills derived from an herb ($15) ; "HeartMath" stress-management sessions ($125).

Cost of Visit: $250

Comments: Gave me an herbal substitute for Naprosyn. Also suggested an appointment with his partner, a naturopathic doctor, to discuss my diet. The idea: "to achieve deeper benefits to address the body's systems as an integrated whole."

Physiatrist Vijay Vad
Diagnosis: Nerve radiculitis (an inflammation of the nerve in the spine caused by material that spills from a damaged disk).

Treatment: Iced back brace, exercises and Cortisone/Lidocaine injections directly into the spine. ($1,108 for the MRI)

Cost of Visit: $375

Comments: High medical drama. Initially, he said I was "way past" conservative therapy and suggested Cortisone injections, pending the results of an MRI. When "nothing horrible" showed up on the MRI, he downgraded me to ibuprofen and a (very uncomfortable) ice wrap on my back.

Neurologist Gerald Smallberg
Diagnosis: Mild disk bulging (pressure on the disk causes it to bulge, pinching a nerve).

Treatment: Physical therapy (also suggested an MRI).

Cost of Visit: $400

Comments: Low medical drama. He said the problem isn't serious and doesn't need to be dealt with urgently: "At your age, it's impossible not to have something," he offered.

Celebrity Doctor John Sarno
Diagnosis: Tension myositis syndrome (very common, according to Dr. Sarno, a psychosomatic condition in which a mild reduction of oxygen to muscles, nerves or tendons triggers pain).

Treatment: Two lectures, six weeks of daily 45-minute homework sessions linked to Dr. Sarno's book, "The Mindbody Prescription."

Cost of Visit: $800 (includes initial consult, lectures, follow-up teaching sessions)

Comments: Howard Stern swears by him. After two lectures and a consultation, I'm somewhat agnostic. "I want people who are receptive to my diagnosis," Dr. Sarno says. (He and his secretary both asked, prior to my appointment, if I had read his book.)

 

Lisa Gubernick; Author and Reporter, 48
Published: March 17, 2004
Lisa Gubernick, an author and reporter who wrote about the entertainment industry for The Wall Street Journal and as the Hollywood correspondent for Forbes magazine, died yesterday at St. Luke's-Roosevelt Hospital Center in Manhattan. She was 48 and lived in Manhattan.

The cause was colon cancer, said Laurie Cohen, a family friend.

Ms. Gubernick began her career writing about finance. She became a senior writer at The American Lawyer in 1984 and started its spinoff newsletter Takeover Control Alert. She joined Forbes in July 1984, was its Hollywood correspondent from 1987 to 1990, and became a senior editor in 1990. She joined The Journal in 1998, covering entertainment for its Weekend Journal section.

She wrote ''Squandered Fortune: The Life and Times of Huntington Hartford'' (Putnam, 1991) and ''Get Hot or Go Home: Trisha Yearwood, The Making of a Nashville Star'' (Morrow, 1993).

Ms. Gubernick was a graduate of Bryn Mawr College.

She is survived by her mother, Grace, of Manhattan; her husband, Paul Fishleder, an editor at The New York Times; and her daughter, Lily.

 

A very fascinating post TT, a demanding lifestyle, whether it's professional or social can have a huge impact on ones physiology.

 

Okay, this just SPIKE my hypochondria up sooooooooooo bad.....

Kalo

 

It's a great that she was versed with Dr Sarnos work for the article, but a shame didn't explore it to it's fullest, nor explore the work of other mind body authors such as Dr Gabor Mate. It's just enforces the view that people who develop life threatening illnesses usually have a life long history of mind body disorders. So it's hugely important to resolve the inner conflict asap.

 

What if you can't resolve them....This is so contradictory...Sarno says you don't have to resolve them...Just to believe in a mind syndrome...

In a nutshell what does Garbor Mate say with regards to how to resolve deep hidden emotions?

The TMS shrinks on this board say, you don't have to resolve them...Just know that anxiety and fear keep the symptons alive.

How many people on this board go around and around in cirlces trying to figure out via journaling what is ailing them....

Kalo

 

When I say resolve, it means to be aware of, but not pass judgement on a thought. The more often one does this, the less of a "hold" that habitual thought or behaviour has on us. The key is to create a space between us and that very emotion that triggers a response.

 

mike2o14...What do you mean not pass judgement on a thought? I am just trying to understand...I want to get well..

Kalo

 

Hi Kalo, have you read any posts about the benefits of practing mindfulness meditation and being mindful? It's a topic which has been discussed heavily on the forum lately.

In short, when we are being mindful, we learn to be aware of our thoughts without passing judgement. Quite often we get lost within our thinking, whether that is fear, being negative, worry, anxiety etc. Mindfulness allows us to be conciously aware without reacting.

 

Ah, I get it...THANKS FOR EXPLAINING!!!! I haven't been on the forum for a while...TMS is really bad...I put a lot of judgement on my thoughts....I guess I should be more mindful...

THANKS,

Kalo

 

From the Greg Gutfeld article:

"... Sarno is an MD who spent his life working with patients. His conclusions are revolutionary, but not necessary to accept, to reap their benefits. That the pain might be due to repressed anger is secondary, and to me, meaningless. The primary key was his solution: Do not adjust your life to the pain, but instead return to full activity. Because there is no reason to think you are making matters worse when living your life. MOVE ON. This is key: we stop doing things because we think we ARE making things worse. By erasing that option, it creates freedom. By refusing to surrender to the spasm, the spasm retreats ."

Stop all psychobabbling, just do it! Find something in life you want to pursue with ENTHUSIASM. Get a divorce from your mind.

 

Unfortunately the point of the article is moot for Lisa Gubernick, since she died so relatively young. My point in posting it was that it had a laundry list of "healing" specialists, from traditional doctors to new-agey complementary types. I've tried most of them and so have many who have stumbled across TMS--nobody finds TMS first. The reporter wrote for a well respected newspaper the WSJ, and by profession needs to be a skeptic. Some of the "cures" worked for the believers, undoubtedly due to the placebo effect. I was amused by the accu, and his magic wand that would buzz when it found the "source" of the problem--I wondered if the accu had a button he pressed to make the alarm go off and what percentage of his customers bought the ten session plan after due to the Pavlovian effect. I had probably close to 200 accu sessions and in hindsight the relief I gained was due to the hour of relaxation which soon wore off after returning to life's highway.

It's unfortunate Lisa Gubernick didn't follow through with the Good Doctor's program. She was probably completely skeptical of all back cures by then, and also couldn't make the time commitment for the lectures with her busy lifestyle and a young child to raise. It was interesting that perhaps she saved the best for last and stopped seeking out more healing modalities. Would she maybe not have gotten colon cancer if she'd bought into Dr. Sarno's theory, become more introspective, slowed down a bit, and reduced the stress in her life?

 

I agree completely with your post, it's easy for people to become discouraged when they have exhausted all means and find no relief. The fact we have so much on offer also makes it hard for some to sift through and establish what is credible especially if they are facing a life threatening illnesses. Having so much choice also makes it harder for one to activate the placebo effect, more choice equates uncertainty, doubt etc. IMO less choice sometimes brings about heightened belief and certainty.