9.01.06, Deciding on Next Procedure

This is all boring material but needs to be passed on. It's all about my Wednesday doctor's appointment with Dr. Saunders to discuss a possible procedure I might undergo for pain reduction. (below)

Today has been quiet and bookish, I've been holed up trying to finish some writing. For Franky Scale everything is fine, no incident...what's the number for that? If I stick with trying to rate it based on lack of pain or other problems, which I probably should, then 7 today. Despite my use of narcotics. (below)

The Celiac Plexus: This endoscopic procedure involves the standard EUS (endoscopic ultrasound, or garden hose down the throat with a camera and a needle or two on it, shoved down into the gut or “belly” as the first doctor liked to call it) and then the injection of alcohol into the celiac plexus in order to numb or kill the related nerves. The goal is to reduce abdominal pain, and a side effect/bonus is the likelihood that I’ll be able to reduce the amount of “narcotics” I take. Less constipation results too, we hope. This was the gist of my Wednesday appointment with Dr. Saunders, although most of my time was spent with a Dr. Scanga because the former was stuck with a patient for about 45 minutes.

Curious, there was a distinctly judgmental or moralistic tone I caught during this appointment: “You’re taking a HUNDRED mg of oxycontin every day?”, bushy eyebrows raised, and you could just hear the suggestion in his voice. This was Scanga. I got the sense of being looked at askew like (a) I shouldn’t need that much medication for pain, (b) I should tough it out for odd puritanical reasons, (c) I might be faking it to try and overly enjoy the meds, or (d) who knows. I said nothing then, except when later in our consult I told them that pain management is the single key to improving the quality of my life, which is short, and something they need to consider. Don’t know why but I could only say anything indirectly at the time. The whole issue of terminal-ity hadn’t been brought up and I feel they were more uncomfortable talking about it than I. The difference between these two GI fellows and Dr. Whiting and EVERYONE at the SCCA is like night and day. The former group just doesn’t seem to get it, the latter is entirely sympathetic and would never criticize what you're doing or how you’re doing it to relieve your pain, or manage it. Why should they, you're fucking dying?

Wednesday’s boys were a little lacking, then, in their terminal bedside manner. And I learned a new angle on the use of euphemism. So many times they use is to protect the patient or themselves, to make the world sound softer, more fuzzy, to hide a procedure or fact from immediate understanding. Non-resectable, for example, means “we can’t operate”; ablation, killing some nerves and possibly reduce pain; apoptosis, the dying off of cells; etc. What I found on Wednesday was the reverse use of euphemism, that is, the deliberate non-use of a more euphemistic term to make it all sound more coarse.

At SCCA my pain meds are usual referred to by drug name, as opiates, or even opioids. The term “narcotics,” with is its potentially flashy and negative connotations we get from the news and drug wars, is rarely used. At this appointment, however, the word narcotic was used regularly. Call me paranoid, if you will, but the term was used to a specific non-euphemistic end, that’s what I sensed. You tell someone they’re using quite a lot of narcotics as opposed to quite a lot of opioids and I think a different message is conveyed.

Otherwise they seemed fine, competent (to the degree I can judge this), and possibly skilled. Risk involved is loss of feeling in the lower body, something very, very unlikely they assure me as they stress how routine this 15-minute procedure really is. In very rare cases paralysis might occur, but they dodged this question, which I asked because Whiting told me about it. (He’s far more straightforward.) Doctor #1, Scanga, was the fill-in-while-real-doctor-is-late guy who had to gather general info about me and press on my stomach while the primary GI guy or EUS specialist was busy with another patient. Doctor #2 came in only to give me a little sales pitch of why I might do the procedure; and to tell me he thinks I’m a likely candidate for it given my pain situation. It works, he says, in 70-80 percent of the patients, who will feel significant pain reduction; however, they might have to have the thing redone in three to six months time.

Time to do more homework on doctor #2 (Dr. Saunders), on the procedure, and then decide whether to do it.