The Good Doctors – Part Two

The Good Doctors – Part Two

by Cynthia Toussaint

Cynthia Toussaint

Cynthia Toussaint

Despite my self-management rule to stay away from Western healthcare professionals, I recently sang their praises. Six weeks later, not so much.

As you may recall, I had a severe, scary bout of bursitis that landed me in the ER for a night. A week later, at the strong advice of my pain doctor and physical therapist who I trust emphatically, I had six cortisone injections. And I remain pain free.

Problem is I’m not convinced it was the cortisone that gave me relief. When I think back, I’d been pain free for almost a week from rest and NSAIDs when I finally got in to see my needle doctor. In fact I’d just returned from my mother’s home (a six hour trip each way) with no pain. I think the rest and NSAIDs did the trick. But, again, I put my trust in my healthcare professionals to know best – especially since I was about to leave for a business trip to Europe.

Sadly, the cortisone continues to give me horrific side effects, most of which I was not warned about. They started in Europe. I had insomnia (I mean I didn’t get a wink of shut-eye) for two nights. I also had intense anxiety that made me feel like my body was going to jump out of its skin!

When I returned to the US I was stunned to see that I’d lost five pounds. I’m slender with the metabolism of a hummingbird – and I struggle to keep my weight on. I was eating three times my normal amount and still losing up to four pounds a night. REALLY scary! I also had to pee like crazy. That urge broke up my sleep and swimming routines. I was extremely irritable and waking through the night with “cotton mouth.”

After John googled my symptoms and learned they’re all common steroid side-effects, I emailed my doctor. I was pretty devastated when he informed me that the drug had most-likely sparked diabetes. He told me to get an emergency appointment with my internist – and that I should never have another cortisone injection.

When I saw my internist for blood and urine analysis, she was alarmed by my weight loss. Dr. Carmen advised me that while a cortisone-induced diabetes flare is common, the drug also may have awakened a dormant cancer. SERIOUSLY???

I’m still anxiously awaiting my diagnosis.

In the meantime, my blood pressure is high for the first time in my life – yes, another cortisone side-effect. I’m still dealing with the anxiety, irritability, cotton mouth and frequent urination though these side-effects are lessening. And for the first time this morning, I’d finally gained my weight back. But at the cost of being so stuffed it’s uncomfortable for my life partner John to put his arm around me when we cuddle at night.

In the end this was just another episode of western medicine making me sicker. My mistake was taking the advice of the healthcare professionals I trusted rather than listening to my gut.

Don’t get me wrong. I’m certain these healers were doing the best they could to help me. But I wonder why they didn’t tell me to keep using NSAIDs and rest since this regimen had already provided total pain relief. I wonder why they didn’t disclose these common, scary cortisone side-effects. And mostly I wonder why they didn’t consider this powerful drug only as a last treatment option. Why wasn’t I given the sage advice to “watch and wait”?

We all (including yours truly!) need to remember the extraordinary healing powers our bodies possess. As my fellow sister-in-pain Mindy recently reminded me, “Like a flower opens to the sun, our bodies turn toward healing.”

We women in pain are our own best doctors. I’ll let you know what happens…

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There are 16 comments for this article
  1. Maureen at 5:55 am

    Dr. Quintner, Again, I thank you for your reply. I get it now 🙂 and yes, you are correct~
    I live with the repetitive thoughts of ‘had I known then what I know now’!
    The permanent effects of my surgeries (many BLE parasthesia’s, painful RSD right foot and left hip/thigh areas, incredible muscle tightness/stiffness, scar tissue effects, lumbar pressure, other ‘nerve damage effects etc etc) are all a constant reminder of ‘perhaps I really didn’t need any of my 4 surgeries, let alone another recommended one now!
    I remember (like a bad dream) how my surgeon was so very mad at me because of my ongoing post-op c/o pain and my request 2yrs later to have all of my painful hardware removed. Obviously I bruised his young ego. His anger caused me to be afraid of him.
    The bottom line is…my surgeries messed me up and changed my life.
    I’ve recently put myself on a new path with a 25 yrs. experienced therapeutic deep tissue type massage therapist now and WOW…what a ‘good’ difference in the deep muscle/soft tissue pain.
    Oh, I could go on and on with it all…as many of us could!
    So, I will stop here and wish you and yours a Very Merry Christmas,
    as well as to all of my fellow Pain Warriors and may we all be blessed from above with many reasons to smile in the New Year!

  2. John Quintner at 10:08 am

    Maureen, I did mean to say “uncommon”. There are far to many people to whom the label “failed back surgery syndrome” is applied. Might I suggest that the failure is on the part of the surgeon who performed the procedure(s) in the first place?

  3. Maureen at 8:14 am

    Dr. Quintner,
    You hit the nail on the head! once again! Thank you for your post to me.
    Although, I am a bit confused by what you said in your last sentence ‘uncommon…’
    I keep reading that over and over and am just not getting it.
    Did you mean ‘common’?
    As a long time ‘spine patient’ I’ve been through it all and have gotten to know my body well. And, my doc has told me that I have a lot of lumbo-sacral arthritis and scar tissue. I can feel it on days when my pain escalates due to over activity and/or weather.
    So would I benefit from any of the Neuro’s suggestions which are:
    Facet blocks L4,5-S1. Then discography (ouch!!), then facet fusions bilaterally and if need be down the road… transforaminal interbody fusion.
    I’m already fused at L4,5. My gut says to stay far away from anymore surgery!!!

    Therefore, I do know better than to even bother with the injections and/or further surgery. From experiences…the fear of both are immense anyway.
    But, the Neuro would not allow me to tell him ‘anything’ about my past history!

    For now, I am booked for injections in late Jan. because I need time to make my solid decision.
    Bottom line, it’s about having self confidence in my decision. And your post confirmed what my gut tells me and helped me feel ‘more confident’ in knowing what
    I know! Thank you.
    If I wasn’t on meds..I believe this confidence would be more solid.
    I’m hanging by a thread with my Pain doctor whom I just found out yesterday is leaving the group he’s with, next month.
    And now… I have to start with yet another one…my 6th in 2 yrs!!
    Its not like it used to be when I was safely well cared for, that’s for sure!
    Thank you for listening and caring. Maureen

  4. John Quintner, Physician in Rheumatology and Pain Medicine at 12:44 am

    Maureen, you might like to know that facet joint arthritis causes about 10% of all low back pain. Further to this, facet joint steroid injections provide relief of pain for a short period of time in only one of every 10 people who undergo this procedure. If a facet joint has been shown to be the cause of back pain (i.e. a positive local anaesthetic block), facet joint neurotomy (rhizotomy) will help only one in 4 of these people, with pain relief lasting for a matter of months. An epidural spinal injection performed for radiating leg pain (“sciatica”) has much the same outcome, benefitting one in 4 people. There is no rational scientific reason for recommending a lumbar epidural steroid injection to treat a person with low back pain. Finally, it is uncommon for people presenting with low back pain to derive much if any benefit from spinal surgery.

    If your physician does not provide you with this sort of information before offering you invasive treatment, you would be best advised to seek help elsewhere.

  5. Maureen at 8:07 am

    Cynthia, oh my my! I had commented on your part 1 post. I believe I may have said something like ‘no wonder you were able to travel after that, 6 injections is way too much for hip pain.’. One injection at that site would be more than enough, in my opinion. Therefore, no wonder you had such awful side effects!
    I agree with Dr. Quintner’s post.

    I have had many many sets of painful lumbar facet joint and transforaminal injections over the years, more than you can shake a stick at!
    Every time I had side effects. I was pretty ignorant over those years.
    One doctor ‘over injected’ me (12 lumbar injections at once! without sedation. I felt like I was being tortured and had to be held down as I screamed! He was a monster) and I became paralyzed from the waist down until the next morning.
    He didn’t seem to care at all when he saw me for a split second in recovery.
    The surgi center had to stay open 2 hours past closing time just for me.
    My blood pressure went sky high. And yet, they ‘had to go home’ so they discharged me in that condition.
    My daughter had to carry me in her arms to get me into the car and then into the house, when they discharged me to go home.
    Needless to say, I changed doctors after that and felt that I then had an awesome new pain mgmt. doc whom I trusted.
    And at least then…he sedated me for my painful injections.
    And, we did many over those next 5 years, generally every 3-4mths.
    Each time I suffered for a whole week with insomnia for at least 2 nights, constant headache, bloating, ‘palpitations galore’ that would take my breath away all day/night!, increased constipation and lumbar burning for a few days.
    I stupidly thought that this was par for the course!
    Until I got a CLUE and began researching and speaking up for myself and finally stopped all injections about 4 yrs ago. They never really helped me anyway!!!

    Now…fast forward…4-5 years later, I’ve moved to a different state and here I am again now…up against going through it ‘again’ (or not), especially after reading your post!, per my recent consult with a Neurosurgeon.
    I’ve declined greatly in the past 2 years with my spine/pain issues.
    My new Pain Management here is not the swiftest.
    But, due to my complaints, I was ordered an MRI in May and then ,per the result,
    to the Neuro. for an opinion.
    He ordered xrays and a CT scan and came up with a plan… facet joint block injections, then possibly facet joint fusion yada yada yada.
    I’ve had 4 spine surgeries, spinal stimulator, tons of therapies, the works etc etc
    in the past.
    I booked the injections for the end of Jan. to give me more time to get through the holidays, and to think about it, knowing all that I would have to endure for a week if I have them. I’m very confused.

    Meanwhile, I work weekly with a ‘Yoga Therapist for Chronic Pain’ and we are trying to get ‘deeper’ into the issues in my low back/sacral pain that prevents me from prolonged sitting/standing etc.. I’m learning more about meditation and breathing.

    And then came your post! A big fat reminder of the awful side effects of steroids.
    Even when I just get an injection into my shoulder or knee once a year or so, I have slighter side effects before I even leave the doctor’s office (my primary does them).
    Oooooh, what do I do? follow my gut and cancel the procedure? or go with the flow and suffer to keep connected to this apparently well renowned Neuro. for better care here in Fla.???!! I know that that may even sound insane huh?!
    I will say this…since the humidity here in Fla. has died down… I’m having less nerve burning, a bit less pain and am able to tolerate a bit more activity around my home and can get out for short walks.
    I was mostly bedridden and had to use a back brace and a cane all summer long!
    Hmmmm?! What is that all about??
    It all could be worse, but I’d give anything to not have to deal with any of this….

  6. Anne Fuqua at 10:52 pm

    I get wanting to feel well for a big trip, but the Dr shouldn’t have done steroid a injection, much less six of them if you were already doing better. That just doesn’t make sense to me. Neither does the logic of six injections. The only thing I could possibly imagine was that one dose was divided over six areas, but that doesn’t make a ton of sense either. I could see splitting a dose between two joints but not six. It didn’t sound like your pain was that spread out either.

  7. Dooney at 6:23 pm

    Sorry you had such a rough time with this. I know we all want what we think will help us feel better. It’s so easy to say yes especially when you have “experts” telling you it will help. I think those of us with medical issues/chronic pain have all tried multiple things that didn’t make a difference or made us worse. No one should ever feel bad for wanting to just feel normal and trying whatever it takes. Hope you feel better soon.

  8. sara patterson at 2:24 pm

    “Costs of US prescription opioid epidemic estimated at $78. 5 billion”

    Please check on this statement i see going around . How much is the DEA spending on harassing doctors instead of going after real criminals that shoot back.

  9. Mark Ibsen at 1:56 pm

    Yep.
    “Don’t just DO something, sit there”
    Is a good policy.
    Keep asking the question:
    Are you working for ME?
    That should help.
    And this:
    “If your only tool is a hammer
    Everything looks like a nail”

  10. John Quintner, Physician in Rheumatology and Pain Medicine at 1:43 pm

    The fact that you allegedly underwent six cortisone injections (at the one sitting?) suggests to me that whoever performed them was in sore need of some education. Further to this, your trust in this health professional was indeed badly placed.

  11. Bob Schubring at 12:55 pm

    The severe anxiety Cynthia discusses, is a common result of the Inverse Placebo Effect.

    Whenever we humans are forced by other humans, to do something, we.guess that what we were forced to do, was good for the person who forced us but was bad for us. We make that guess, because it seems easier to explain why a good choice is good, and then let the other person make the good choice, than to go to the trouble of compelling the other person to make the good choice, by force.

    Western medicine became an instrument of the State and statism, during the 20th Century. In America during the 1920’s, Western medicine decided, with the force of law, when alcohol or opioid use was for medicinal purposes and when it was used for the prohibited purposes of inducing pleasure. By 1934, alcohol had become lawful again and cannabis had become prohibited. Some practitioners of Western medicine were taken by shock, that their pediatric patients’ parents could not fill prescriptions for cannabis any more. Cannabis had been the favored treatment for childhood colic. Tylenol added to bismuth sub-salicylate just wasn’t as effective, even though legislators had prohibited US cannabis cultivation and commanded doctors to switch meds.

    This entire history of command-and-control in Western medicine is deeply disturbing to the rational mind. The drug that worked in 1933, did not suddenly stop working in 1934. Nutritious butter did not suddenly become harmful, when some physicians began telling people to switch to margarine, and the gastric discomfort people felt from eating margarine did not persuade them that margarine was a healthful choice.

    By repeatedly seeking to impose choices upon us, rather than teach us why a choice is good, Western medicine has undermined it’s branding, here in the West. Impoverished people in Africa, the Indian subcontinent, and rural China still think of Western medicine as scientific, because the breakthroughs it has brought them, all based on science, are impressive. Here in the West, we see the unscientific and anti-rational influences at work, that turn doctors into political propagandists, and we respond to Western medicine with anxiety over what it might do to us.

    To my mind, that makes it difficult to tell how much of Cynthia’s anxiety response was due to the cortisone shocking her liver and dysregulating her blood sugar, and how much was plain worry that the doctors might have given her something that would make her sicker. It’s the kind of question we shouldn’t need to ask, because doctors should not lie to patients and make us feel afraid of them.

    Meanwhile, my curiosity is aroused. Since cortisone is a naturally-occurring substance that’s in our bodies already, is Cynthia’s cortisone intolerance causing her body to starve her muscles and joints of cortisone, to protect her liver, and is the cortisone starvation in her muscles and joints, related to why she feels exhausted all the time and hurts constantly?

    Given that Western medicine made all of its’ advances by asking wild scientific questions like that, why aren’t Cynthia and people like her, ever put in contact with medical researchers who want to devise cutting-edge treatments for such conditions?

    It would certainly make anxiety easier to manage, if doctors and patients actually communicated about what was important.

  12. JoDawn at 11:15 am

    Always a good reminder to listen to your own body. Our drs & other practioners can’t feel what we are feeling.
    We have to be sure to tell them & be ready to find someone else if they won’t pay attention…
    A very scary thought for many pain patients.

    Merry Christmas, Happy Holidays to you all! & may we all have less pain next year!

  13. Kathy C at 9:26 am

    Oh Dear!
    This pain stuff is the long haul. When anyone sings the praises of anything, we have to learn to put it in perspective. Unfortunately the Medical Community does not. The use of Steroids is fraught with problems, yet they have not come up with anything better. They also have not studied them or put out any real guidelines for their use. There is not even much information for conscientious Doctors, to decide if one is more useful of less dangerous than the other.
    It is very likely you physician, relied on the latest big Pharma Advertising rather than his own observations or anything Scientific.
    The search for relief from pain makes us rather desperate. The self reporting of improvement always needs to be taken carefully. There is no one keeping track of thing like this. The Side effects won’t be recorded somewhere, and reporting them to the Physician will not improve the care for the next patient.
    Big Pharma will come out with another reformulated Steroid, under Patent, and they will promote as if it is something “New.” They really don’t keep track of any of this. If someone were to die, due to these medications, it would not be reported anywhere. It would be attributed to an underlying cause. They have decided that one way to promote these medications is to avoid Data collection. We do not have care based on Science anymore. The “Science” conflicted with their profit making abilities. Steroid “treatments” are just more profitable.
    Some people have know for decades that Steroids are problematic, but in the current climate of Medical Care, the Marketing and Public Relations, rather than Scientific evidence is relied on by Physicians. The current narrative about Opiates, helps them to justify the use of steroids. They just don’t count the side effects. The clever Marketing Strategies, promote new variations as “better” or they imply progress. They might even include the anecdotal stories of patients who like yourself saw relief. Since it is all Advertising and marketing, they won’t mention the duration, or the side effects. We are in a Post Science Era. The Corporations have won.
    I remember reading one of my dad’s Sports Magazines back in the mid Seventies, about a famous Football Player who blew out a knee due to Steroids. Ever since I read that seemingly unrelated Article, I have been skeptical. In seeking relief at any cost I subjected myself to Steroid Injections. The more targeted ones offered a little relief, they were done carefully by my Pain Management Physician.
    Our local Hospital opened a so called “Pain Clinic” 20 years ago, to cash in the Steroid Business. They shut it down when it appeared their might be a Litigation. This “Clinic” was run like an assembly line, because it was a money maker. They ran just about everybody through it. They sicked their Lawyers on anyone who made a complaint. They did not believe in using Imaging for the Procedures, it was cutting into their Profits. Since thy were the only Hospital in the area they were able to avoid acknowledging any damage they did. Of course there is no way of knowing how many adverse events there were.
    They recently re-opened offering a “Cure” for pain. We have an “opiood Epidemic, so they have cashed in on that. There will be a new batch of patients who have nothing to compare it to, so if they manage to avoid paralyzing anyone, or too many people. They will be raking in the Profit. They are a monopoly around here, so they will have an unlimited supply of customers. Their Doctor who did an injection in my Thoracic spine and nearly paralyzed me, quietly quit his job. Apparently they “lost” my Imaging. Their ‘Nurse” who is supposed to be on call for problems after the Injection was most likely instructed to Gas Light anybody who called with a problem.
    This is a business, nothing more. expecting any kind of basic common sense is not productive. They have trained Lawyers who are very good at deflecting problems and intimidating anyone who has an adverse event. The Physicians are trained to avoid any kind of Liability Issues. They can’t even nod the affirmative if a patient reports anything. They have been brainwashed into believing each Patient is out to get them. This coupled with their Employment Contract Gag Orders, and Confidentiality agreements have created a culture of secrecy, which is very convenient for the Corporations.

    Of course people with certain Injuries will report relief. The Sprained ankle or sports type injury. The rest who have nothing to compare it to, so they will feel they were given care, after all they avoided taking pain meds. Suffering through these injections and the after effects is better than being a “Drug Addict.” Remember there is no one

  14. HAYDEN at 8:34 am

    It sounds like the writer is healthy enough to maintain exercise. That is great! I am sorry that a shot for bursitis seems to be having some negative side effects. I hope she recovers and has learned that she should not, eveidently, have any further cortisone shots. It is also great that everyone does not have such negative side effects. I am 58 years old and have been an active builder for 40 years. Needless to say joints wear out…….sort of like a mecahnical car part. I have had cortisone shots for which I am ghrateful to not have had any negative side effects. Peoples metabolism, their tolerances to medication, their ability to exercise to stay strong change with age. My point, we can’t discard conventional physicians and medication. Sometimes the conventional treatment actually helps! Everyone has to along lifes way arrive at the best treatment, individually. Sort of like those that damn some of us for using strong conventional medication in pain control. I believe we all want to feel as “normal” as possible and if it takes say an opioid medicine to treat and I mean treat beacuse for most chronic pain there is only treatment, no cure. Chronic pain is physiologically disabling, mentally distressing, and costly. The alternative is a painful vegetative state. We all reresponsible in finding the help that helps our condition we can accept whether it be conventional medicine or an alternative way. I hope for the best for the writer of the story I am comenting on, as well as those who find conventional works best for them. Alternative or conventional medicine, there is not a cureall way to treat our individual health conditions.

  15. Michael G Langley, MD at 6:48 am

    I, also, forgot to mention my biggest fear with these medications. They can suppress the adrenal gland to the point that a patient becomes Addisonian. That is the number one reason that “cortisone” treatment is limited. Iatrogenic Addison’s disease is not acceptable! In the absence of elevated blood sugar levels, the increase in sodium in the blood stream (increases the blood pressure) can also remove fluid from the free space, in the tissues, to equalize the electrolyte level. This result in weight loss. When the sodium decreases back to normal, the interstitial fluid are replaced by osmosis. That results in weight gain. This is part of why women have weight gain during certain parts of their menstrual cycle. They produce sex steroids every month during the luteal stage of the menstrual cycle. I submit that they are the cause of mental changes seen with women’s monthly cycle

  16. Michael G Langley, MD at 6:33 am

    Treating non-existent pain with a “cortisone” injection seems to be very negligent, to me! Cortisone has always been a reason to be cautious. It is a drug that should never be taken lightly. Along with the symptoms noted above, patients can also suffer from depression and other changes in the mental state. They can be miracle drugs in relieving pain and should always be in the armamentarium of a doctor treating inflammatory pain. They should not be the first line of treatment. Someone who has relief from the NSAID-s should never need a shot or prescription of “cortisone”!

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