Posts Tagged ‘orthopedics’

Medical Sigh Science

July 16th, 2012

My comminuted (multiple breaks and pieces) collarbone got the latest treatment or non-treatment. As an example of how medicine changes and maybe or maybe not advances, conventional orthopedic wisdom has again shifted.

Pic note: Click for a somewhat larger view.

Where a badly broken clavicle used to require holding the big pieces together with a plate and screws (pins, in surgeon lingo), recent trends favor non-surgical benign neglect. This surgical info page describes the options.

Previously, the idea and ideal were to stabilize the whole bone and keep the pieces together to promote faster, stronger bonding healing. Now, according to both my ortho surgeon and physical therapist, the new wisdom is that outcomes are no better with plates/screws than letting the components find each other and form enough bone to made a renewed clavicle.

I’ve only had surgery once in my life, three-plus years ago for a badly broken leg. I shall permanently wear a titanium rod inside my left tibia from my knee to ankle. I’m not eager for more cutting, drilling, pounding, and other internal carpentry.  Yet, I already have a tangerine-sized lump above my left pec. Chums who had broken their collarbones as teens or 20-somethings have insisted I feel their residual bumps, which are much smaller. They said they had simple, single breaks, which may account for the difference.

Several other folk with related knowledge, including Uncle whose daughter is in the PT/rehab biz, concur on the shift from plates/screws. While plain old logic suggests that bones that fuse into their original alignment will be much stronger than those that lump up more randomly, the surgeons say their studies don’t support that. Hard to believe, but in my case it’s a bit late to speculate.

What’s amusing to me, even being an non-controlling participant in this current treatment scheme, is knowing that the science in medical science is mostly not linear. Unlike the concept we grew up hearing, treatments don’t inch or leap ahead to better and better outcomes. Instead, they mostly seem to move in and out like the tides.

I recall my first awareness of that when I was in elementary to middle schools. My mother ran Red Cross chapters, which included planning for and overseeing such courses as first aid and home nursing. She was really annoyed to have to replace those texts and see her instructors were tweaked as the AMA and similar bodies changed their minds with new research truths. I think of covering wounds, particularly burns. Yes bandage; no, open air; no, salve; and on and on, somethings changing with each new major study more than once a year.

Truth be told, docs and medial societies can be incredible faddists. Studies can contradict each other, despite following precise and detailed methods and even being replicated by others. The science can be approximate or fungible, which leads to funky doc punditry. It’s the now-we-know syndrome that comes with the fad of the latest findings. Generally no one dies from the sudden shifts, but I long ago lost faith in the concept of inexorable medical advances.

Certainly even worse than shifts in perceived surgical best practices is drug pushing. So many adults end up with one to a dozen or even more prescriptions. I think of my late in-laws who’d each fill a window sill with their daily meds when they visited. My wife remarked to her mother that those were a lot of different drugs. Her mother agreed and said she asked her doctor if they were all necessary. She reported that he asked her which she’d like to stop, and when she picked one said if she stopped taking it, she’d die.

More commonly, docs find it far easier to treat symptoms with drugs than actually to diagnose the cause of the symptom and, to think back to the ideal of the profession, cure the patient with the like of nutrition, behavior modification and such. So, the docs are more likely to say that taking this or that drug will add two or five or more years to the patients’ lives.

These pharmaceutical company promises may or may not have validity per patient, but we can be sure the benefits don’t compound. That is if you have six prescriptions for drugs your doc says will add those years to your life, you can’t expect the benefits to add up. If it did, we might all expect to live to 150 or longer.

I hark back to childhood when I was never seriously sick, but a pediatrician seemed magic. Swollen tonsils got a single penicillin shot in the butt and cleared up quickly. Nowadays, I”m aware people past their 20s or 30s tend to end up with chronic conditions or ambiguous symptoms. Very much unlike the mystery disease article in the Sunday New York Times Magazine or an episode of House,  we don’t get a team of dedicated, resource (including time) rich doctors who do what is necessary to diagnose and cure us. In fact, we can be pretty sure, our nurses and doctors won’t have the time and inclination to listen to our symptoms and consider our self-diagnosis.

Back to my increasingly lumpy formerly unified collarbone, I didn’t have a lot of options. In the ER and next week followup, the orthopedic surgeons said the muscles would likely keep the bones close enough. I could have insisted on a plate at the time or when I saw the big gap at five weeks, could have pushed to the then big deal of opening me up, re-breaking the bones as needed and then using the plate. So, really, no choice by that time.

Now if I don’t have another trauma to that collarbone and if normal activity including free weights doesn’t snap the new version, the outcome will be acceptable. I won’t project or anticipate. I’ll just go with the idea that the current treatment trend is OK.