Peering Into The Crystal Ball: When Will The Podiatry Profession Shake Free Of Dogma When It Comes To Nerves?

Stephen Barrett DPM FACFAS

I will admit I was a little spooked when I entered this place. With the parting of the heavy hanging beads bejeweling the doorway of the fortune-teller’s “office,” the hairs on the back of my neck had reached full piloerection.

My uneasiness increased as the “hippie like” beads uncomfortably scraped against the side of my face, giving me enough neurosensory distraction to briefly make me ask myself what the hell I was doing. Why was I here? This place reminded me of an experience I had years back when I had the good fortune to go to Marrakesh and experience the exotic Moroccan culture. That involved cobras and I hate snakes. Except this wasn’t Morocco, this was that mystical, voodoo laden crescent city — New Orleans — and this place was not in the best of neighborhoods.

I had been invited to participate in the Graham International Implant Institute’s sixth annual meeting and getting to hear Michael Graham, DPM, speak again compelled me to head to this very reputable fortune-teller’s emporium. (I knew it was reputable by the classy, albeit coffee-stained business card handed to me by the hawker at the street corner just on the edge of the French Quarter. It had to be an omen from the surgery gods that this messenger was right there at the same time I walked by. Not to mention the fact that I rarely, if ever, take something from a street huckster.)

Now why, you may ask, did I have to go there? Good question.

As I wrote about a few blogs ago dealing with all the incredible and high-level research that Dr. Graham’s team has done, you always learn more when you hear things again. You also learn more when you have had time to mentally digest some concepts and try them in clinic with great results, but are still not necessarily in the comfort zone with your reluctant cortex. I knew this time was a little different but the same message resonated. The hindfoot is much of the time the center of the root of all evil pedal pathology, especially when it is connected to a tight triceps surae.

Sitting there in the meeting, I realized I needed to look into the future because we have the ability to shape it, change it and accelerate its presence more quickly to the “now.” This will do some incredible things that will greatly help people. The worst possible thing we can do as a profession is plod along in the quagmire of the status quo, which is really doing nothing. Medicine in general does “nothing” very well, does it for long periods of time and with the greatest of pomposity, even when the evidence is beating us in the face like Smokin’ Joe Frasier did in the first round of his first fight against Muhammad Ali.

Take for example the great H. pylori story. Robin Warren, AC, and Barry Marshall, AC, FRACP, two Australian physicians, won the 2005 Nobel Prize in Medicine for their discovery that gastritis and ulcers (and many stomach cancers) were the result of bacterial infection from Helicobacter and not from the stress of daily life as medical dogma had so staunchly defended.

So here we go: two guys make the discovery and no one accepts them as any more than quacks and lunatics. Finally, to prove it, Marshall drank a broth of the bacteria and had become violently sick within days. He then treated and cured himself with bismuth and metronidazole. By 1985, it was well established in the world of microbiology but it took another 10 years for gastroenterologists to begin acceptance.

I must ask: how many of their colleagues’ patients died during those 10 years? They had the treatment right there in their prescription pads available to them but they were so sure they were right that they did nothing but give Tagamet and other ineffective drugs. It is hard to fight billion dollar babies.

Gazing Into The Crystal Ball On Medical Dogma

“Sit down on the pillow,” the fortune-teller commanded in her husky voice. Looking down at the pillow, I wondered how many truly pathetic saps had postured their sad derrieres upon this worn and tattered satin to try and see into their future. Evidently quite a few, based on the wear and tear of this wretched perch.

“Visa or MasterCard? she whispered from behind the large glass sphere. (Spirits need money too. Maybe the surgical gods do not as they have been used to getting stiffed by the third party administrators for so long.) “What is it you want to know, sir?” she inquired while fondling the crystal ball in front of her.

Clearing my throat and shifting my ischial tuberosities on the dilapidated pillow, I was able to squeak out, “I want to know how long it will take for our profession to understand and adopt some very understood and completely documented concepts. Essentially, why are we still using outdated, dogmatic approaches to treatments when we know better?”

She arched her back like a cobra getting ready to strike and lowered her head into a position so she was looking at me through the crystal ball. It made her otherwise attractive face appear grotesque and deformed like those mirrors in the circus funhouse. “Uncle Morton is talking to me. Give me some time,” she said in an almost imperceptible whisper.

There were a few awkward minutes of trying to sit perfectly still on the uncomfortable “pillow for saps” and trying not to laugh out loud as I watched the facial gyrations emanating from the glass sphere of our future from her contorted face during her silent conversation with Uncle Morton. Then she straightened out her spine and said: “Uncle Morton is telling me there are multiple reasons holding the average podiatric surgeon from instantly adopting these universal truths known in the surgical ether but not appreciated yet here on planet Earth. He conveyed this obscure number 5.07 to me.”

There was silence for a while as I was contemplating Morton’s conveyance. I knew instantly what the significance of the number was but didn’t want to say anything that would give this soothsayer any information to further my sap status. “Go ahead. Tell me more,” I said.

The “teller” went on about Morton’s secrets to her. “He said that people are suffering in their middle and late ages because there is a reluctance … he called it an instinctual fear of doing something before a symptom arises. In the other world, Morton can easily see that this has got to change but the only way is for a few brave warriors of your profession to fight a major battle to change this paradigm of status quo, and that’s not so easy to do.”

The mental torrents swirling around my muddled mind about that time were so intense that I thought my gray matter had been placed in the Cuisinart. “Is there anything else mystical Morton conveyed?” I asked.

“Just three things,” she replied instantaneously. “First, something about a stent, then decompress early and drink the alcohol and stop injecting it. I don’t really know what that means.”

“I do,” I said, and jumped up quickly. “What is the total?”

“Five hundred dollars.”

“You want $500 for that?”

Without any facial expression, she countered, “Spirituality is expensive, my dear friend.” Think of the amount of beads I could have purchased with 500 bucks. Wow.

Final Words Of Wisdom

It had started to rain as I made my exit back into the street and the remorse of just being extricated of a significant amount of money waned quickly. I smiled to myself, getting the message loud and clear without the slightest filament of doubt. If it is not loud and clear to you, here are the intellectual clues (I will call it a bludgeoning for you slow ones).

1. Stop cutting out the nerve, injecting it with alcohol and/or freezing it if it is just entrapped.
2. If there is a biomechanical fault, treat it as early as possible, even if there are no demonstrable symptoms, knowing that there will be is enough (the science is compelling).
3. If the patients have diabetes, decompress their peripheral nerves before they get a hole in their foot and end up losing their leg, even if they can feel the 5.07 monofilament.

Next time you are thinking about going to a fortune-teller, don’t do it. Just read all the compelling literature out there and you will truly see into the future.

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