Practicing What You Preach

Dr. CohnThere is an old adage that suggests a person should be wary to trust a skinny chef, and a similar principle can be applied to the medical world. Would you trust a doctor who is obese, waddles into the room, and smells of smoke to advise you on diet, exercise, and healthy living? Probably not, because they are not following their own advice.

At some level, the medical practitioner must be able to communicate and relate to their patients. Sometimes, it is their level of knowledge and experience that is obviously superior that helps invoke trust. At another level, sometimes it is the personal experience that may make an added difference.

As a Physical Medicine physician specializing in pain medicine, I have spent years studying and providing care to thousands of patients. I try to keep up with new research and treatments, reading journals and even attending conferences. During the course of countless evaluations, a doctor learns how to address a problem and that there may be many different treatment approaches to the same problem. One thing I didn’t expect to learn was that I would have to apply my knowledge to my own problems.

Back pain affects about 85% of the population at some point in their lives. My first bout occurred during my second year of medical school. I was lifting free weights with the bar at an awkward angle, and the next thing I knew my back had given out. Since I had no weakness, just pain, the physician treated it conservatively with ice, heat, physical therapy and anti-inflammatories. It took months to resolve, but as long as I was careful about using proper body mechanics when lifting, I was fine.

Years later, when I was in my late forties, I started noticing my back more regularly, and it occasionally flared with bouts of pain down my legs. This was when I underwent my first MRI – 25 years after my back was first injured. The scan showed a significant L5/S1 spondylolisthesis with narrowing where the nerve roots exit. A radiologist friend who read the scan asked me which colleague I planned to see for surgery. I tried injections, massage, exercise and anti-inflammatory medications to control pain at times, but they only stifled the pain, they didn’t resolve it. Aerobic conditioning was probably the most helpful, but I still dealt with pain from time to time.

Unfortunately, a couple of years ago it flared worse, brought on by no special aggravating factor. A new MRI showed severe narrowing where the nerves exit at the L5/S1 level. A couple of injections calmed my spine down, and I again was given a lesson in the importance of exercise. Regular exercise has been essential to control symptoms. If I do not exercise, my back begins to ache. Stretching and loosening up the back muscles is necessary multiple times a day, and anti-inflammatories help control stiffness. I also use a neuropathic medication to keep some of the sensitivity of the nerves down.

Despite back pain, life can still go on and be pretty normal. I do most everything I want to do, but running and jogging is off my list. I still exercise, but strengthening my core is not optional any longer. Core strengthening is definitely boring, but it helps immensely. I prefer aerobic activities like biking, using an elliptical or walking long distances. Long walks usually require stretching breaks, but as my dog gets her exercise, so do I.

So far, I have no absolute loss of muscle function in my legs and no trouble controlling my bladder or bowel related to my back. Still the most important aspect of treatment is taking care of myself and exercising. To get that done, I have to wake up very early each day and make it a priority. If a doctor does not take care of himself, it is not possible to take care of others. At this time, listening to my own advice of exercise, take your medications, don’t complain and stick with the routine are working for me. For me, I must practice what I preach.

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Thomas Cohn, MD

Interventional pain doctor helping Minnesotans manage back, neck, foot, and other pain. Board-certified in physical medicine and rehabilitation with additional board-certification in pain management from the American Board of Anesthesiology (ABA), the American Board of Interventional Pain Physicians (ABIPP) and the American Board of Pain Medicine (ABPM).

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