| T O P I C R E V I E W |
| marytabby |
Posted - 07/08/2005 : 10:04:00
Just a little story I wanted to share about my TMS experience and my primary care doc.
When I was REALLY bad with my back in January, and I was seeing my doctor and EVERY specialist out there, had every blood test done, every xray, MRI done, l was looking for answers. I had NO knowledge of TMS or Sarno at this time. I did what every person does who only knows about structural problems, etc. Why should I know any different, right? I mean I found about TMS on my own on a local TV program. So cut to the chase, 6 months after I start feeling better with my back, I email my doc and I say, "doc, I'm feeling so much better, thanks to this new program by a Dr. John Sarno. Please, if you've never heard of him, do some reading and you may just save future patients from running around from one specialist to another, and you'll probably save our health insurance plan millions of dollars in unnecesarry tests, diagnostic films, etc.
He wrote back:"I know about Sarno and his work, but remember, it was YOU who kept insisting you wanted all those tests."
My point here is how on earth could he let me go from doc to doc if he had known about Sarno/TMS? Of course I was asking for every test. No one told me any different. So my hunch is that he did not share his Sarno knowledge with me due to the psychological stigma that some patients probably shy away from (the "all in your head answer). I am furious that my doc never once even mildly suggested TMS, or "hey, patient, ever heard of this guy Sarno? Just for giggles, humor me and read this book." He could have saved me thousands of dollars and spinning wheels with office visits all over the city of Boston if he had the guts to be a good doctor and find a way to suggest it to me. I would have gladly read the books. Who knows why he didn't point me that way, but I am giving him the benefit of doubt by saying maybe it's the stigma thing, or maybe he's just an inbecile.
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| Jim1999 |
Posted - 07/17/2005 : 22:13:51
quote:
Originally posted by Dr. Fatteh
Tom,
I think the idea of a TMS conference is an EXCELLENT one. Perhaps there are only 20 or so listed TMS docs in the country right now, but there may also be more where Dr. Ziggles came from, so you never know what the turnout might be. While Maui would be great, perhaps as an homage to Dr. Sarno NYC would be appropriate. Perhaps I'll send out some emails to Dr.Schechter and others. And, I think there should be a way to make TMS sufferers a part of the conference as well. It could bring a boatload of exposure to the field.
Parvez Fatteh, M.D.
There's been a lot of really good discussion in this thread! I particularly like the idea of a TMS conference. I agree that NYC would be very appropriate. In addition to honoring Dr. Sarno, there are many former TMS sufferers in the area, so many more such people should be able to attend. Maybe John Stossel could make it.
Dr. Fatteh, please keep us posted about whether there's any progress towards having such a conference.
Jim |
| drziggles |
Posted - 07/16/2005 : 20:12:42
Thanks for your nice words, Marg. I fully agree that postconcussion syndrome, as well as "whiplash", are both forms of TMS. However, I think that patients would not be amenable to the TMS diagnosis, because they often have secondary gain issues such as lawsuits and disability--in those people, there's little one can do to help them...
And yes, Sarno is a TOTAL pariah at NYU. He says that no one at the whole center refers patients to him, and that if he didn't already have tenure prior to his coming up with the TMS concept, he would not still be there...
The US mentality of quick fixes and expectations of omnipotence from doctors/surgeons is a huge obstacle to the acceptance of TMS. Even if insurance companies could benefit from TMS, they'd never push the idea because most patients/physicians would find it offensive and ridiculous given the current paradigm of structural causes of back pain... |
| johnnyg |
Posted - 07/15/2005 : 08:26:20
There is a large segment in the U.S. interested in cutting costs too, the HMO's. They're getting bigger on preventative medicine, maybe TMS should be categorized as preventative--even Dr. Sarno mentions in his books that the idea is to prevent accute attacks from occuring or reoccuring(in addition to a cure from pain.) HMO's would certaintly save bundles on useless treatements. But then again the back pain industry would fight this tooth and nail.
Since insurance is different everywhere, it seems that some creative thinking is needed. Just as an example,when I did VAX-D therapy, the ins. co's don't pay for VAX-D because they consider it experimental. So the DR.s (chiropractor's office) provides some PT and they charged for the PT, thus essentially making the VAX-D therapy "free."
Maybe there would be a way to recharacterize TMS therapy. for example, implement a more formal program of treatment that involves more than a quick physical check up and a psychological lecture. It seems that we want to change the culture from thinking physically to thinking psychologically, but to get started, mabe we have to fool 'em into thinking it is a physical treatment by stressing the fact that it is a physical disorder. With enough support, there also could be a way to create a tax-exempt org like a 501(c)(3) (charitable org) with a membership to fund TMS-related doctor visits. Unfortunately, in the US you need employers to fund health trusts such as Voluntary Employees Beneficiary Associations for the purpose of paying health benefits. I don't know I'm not a health care expert, just brainstorming a little. I have some experience with employee benefits welfare trusts, any ideas? |
| n/a |
Posted - 07/15/2005 : 01:32:46
OK, this does not address the problems for doctors in the United States - that of broaching the subject of psychological links to physical symptoms. Maybe another country where most medical care is funded from national taxes and therefore it is the interest of the state to keep costs down would prove more receptive to these ideas - enough to create interest internationally?
Like here in the UK for example.
There is not the same pressure over here for doctors to make money for the practice. If they can find ways that cut the costs of treating patients it is in all their interests to do so.
I realise that it's not practical for TMS doctors from America to uproot themselves and their families over here, not to mention the fact that the opportunities to make money are more limited in the UK, but maybe there could be a way of targeting the medical profession over here and in certain other European countries with good socialised medical systems - the Scandinavian countries for example.
Any research and findings would soon bounce bounce back to the US and might be taken seriously.
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| Marg |
Posted - 07/15/2005 : 00:17:50
Dr Ziggles, Pity I did not see you last year. When a patient suffers concussion which goes on to being Post Concussion Syndrome surely this is really TMS. Being triggered big time by an injury to the brain. These patients already know what there brain is going through, in my case I wrote in my diary "This concussion stuff is really wacky, it is all mind games," the massive headaches they suffer and the confusion. The not knowing yourself anymore, the pain that hits anywhere in the body as long as you have pain somewhere it does not matter where. The incredible lack of sleep, then when a physio tells you the pain is coming from the back, in brilliant McKenzie Method fashion the pain is centred in the back. Miraculous, McKenzie understood about how pain can be centred in one area, all you have to do is focus on that one area. Nobody get me wrong, I know physios are a bad word, but my one did his best, he gave it his all. Maybe Dr Ziggles, easy patients are the brain injury patients, as they already know they have a problem in the brain department. Marg |
| tennis tom |
Posted - 07/14/2005 : 15:21:47
quote:
Originally posted by johnnyg
This is why I went to a TMS doctor. Problem is, these people will have to have the money to pay the cost out of pocket cuz insurance ain't gonna cover the time and expense involved.
I have had several TMS doctor visits and my Blue Cross paid for large parts of the expense. If the insurance companies were smart they would encourage or require patients to be evaluated for TMS FIRST. This would IMHO lower costs greatly, especially on surgeries, PT and years of failed diagnoses searching for non-existent structural causes for chronic pain. |
| johnnyg |
Posted - 07/14/2005 : 12:56:59
"TMS doctors will have to go it alone and be viewed as mavericks, loners or odd-balls."
I think this is already happening.
"As a TMS doctor, perhaps you can create a practice from a niche of patients who have discovered TMS and are seeking out an OBJECTIVE medical diagnsosis and those patients that your fellow doctors have given up on."
This is why I went to a TMS doctor. Problem is, these people will have to have the money to pay the cost out of pocket cuz insurance ain't gonna cover the time and expense involved.
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| tennis tom |
Posted - 07/14/2005 : 09:51:26
quote:
Originally posted by Dr. Fatteh
Art,
We as physicians ABSOLUTELY have tons to learn from the TMS patients out there and in this forum. This is a grassroots movement, with doctors and patients side by side, shoulder to shoulder. Don't give up on us!
Thanks for that thought Dr. Fatteh. Communications between the physician and the patient have become almost extinct under the current system, it would slow down the assembly line. When I see my family doctor, the conversation is limited to answering facts about my symptoms.
Having a TMS conference in NYC would be a good idea since it would give the good Doctor an opportunity to hopefully attend.
To drziggles, I can see your predicament. Being new to the practice (corporation), and on probation for several years, your having to prove your aility to produce revenues for the partnership and fitting in with your colleagues. I've heard that Dr. Sarno is rather isolated from his "colleagues" at NYU. Perhaps this will have to be the state of the TMS doctor at this stage in the evolution of medicine.
TMS doctors will have to go it alone and be viewed as mavericks, loners or odd-balls. This has always been the path that innovators and explorers of new territory have had to endure.
As a TMS doctor, perhaps you can create a practice from a niche of patients who have discovered TMS and are seeking out an OBJECTIVE medical diagnsosis and those patients that your fellow doctors have given up on.
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| Marg |
Posted - 07/13/2005 : 22:51:48
These TMS doctors would have loved me walk into their office. When I was seen, for the first time, by a neuro-psychologist in Sept 2004, my shoulder was swollen and pain into the left arm and I had terrible upper back pain. I looked my neuro- in the eye and said, "I did not hurt my back when that thoroughbred horse planted me into the ground." I told her firmly I thought the head was playing games with me. (I had suffered a mild brain injury) Regardless, I was sent off to see the physio. I need tell no-one what happened after that. Things could have been so different if my neuro-psychologist had been aware of TMS. I would have been an easy patient instead a terrible challenge. |
| JoeC |
Posted - 07/13/2005 : 21:21:57
Breaking the ice to patients about TMS:
1) This is just speculation, but I think it is easier to introduce Sarno to people who have been exposed to and understand Freud.
2) You should probably introduce it only after certain things fail, either with you or previous doctors.
3) Tell patiets how you found out about it. Maybe tell them about the celebrities who have discovered this new treatment theory as well.
I guess in the end you have to screen your patients like JS.
Joe |
| drziggles |
Posted - 07/13/2005 : 20:59:48
First off, I would like to thank everyone for their warm welcome and their words of encouragement and advice. I would be quite interested to attend a conference on TMS with doctors and patients--sharing tips on exactly the sorts of things you have been discussing could be quite helpful.
Regarding adding my name to the TMS doctors list, I will plan on doing so in the future. Part of my trepidation about using this approach in general is that I am a new physician in a large group of neurologists (and an employee until partnership, after three years). Besides worrying how my patients respond, I am also concerned about how my colleagues would feel about my approach, since it is certainly not "standard" neurologic care. If I have patients calling the front desk and asking about TMS, no one will know what the hell they are talking about!
I have spoken about the concepts with a nurse practioner in the group, as well as with one of our neuropsychologist, who is very interested in TMS. Baby steps, I figure! I will certainly contact the doc you mention for tips on how to integrate TMS into practice. I had emailed Marc Sopher several months ago, but we never really got into contact.
I also will check out the Spinal Stabilization book. As everyone realizes, there are plenty of people who just cannot accept the TMS concept. For them, I would certainly try any other modalities that are not harmful.
I have been surprised, though, how little initiative some take in their own care. In my limited experience, I've found that people are not willing to put much effort into making themselves better beyond pills or injections. It's amazing that despite how disabling pain can be, many still just want a quick fix...that's modern medicine for you, and the expectations of we Americans with our increasingly short attention spans.. |
| Allan |
Posted - 07/13/2005 : 19:39:26
drziggles
Regarding your earlier posting relative to communicating the possibility of TMS to your patients.
May I suggest that you contact Dr. Eugene Martinez of the New England Baptist Hospital in Boston and ask how he does it.
It is my understanding from various postings on this forum that several members have seen him and have reported that he is discussing TMS with his patients and handing out the book, Healing Back Pain.
He is also listed as a TMS physician in the directory.
Maybe some members reading this posting can add their comments from personal experience.
Allan. |
| Dr. Fatteh |
Posted - 07/13/2005 : 17:57:08
Art,
We as physicians ABSOLUTELY have tons to learn from the TMS patients out there and in this forum. This is a grassroots movement, with doctors and patients side by side, shoulder to shoulder. Don't give up on us! |
| art |
Posted - 07/13/2005 : 16:07:08
I think the conference is a great idea. How about Vegas?  Half kidding I suppose, but only half. Maybe this wouldn't be the most "respectable" kind of place for such a gathering, but on the other hand there's no law against having a good time either.
Too bad there's no way(that I can think of) for us patients to write off such a trip like you docs get to do. Any accountants or tax attorneys out there?
edit: just wanted to add that I find it very exciting to have some TMS physicians joining the forum, especially newly minted ones. It feels to me that we patients have something to offer you guys by virtue of our experience. I hope so anyway. |
| PeterW |
Posted - 07/13/2005 : 15:06:09
Drziggles, I'm another first time poster and have resolved my own back problems through another approach, but still am intrigued by TMS theory and am personally finding application for it.
I agree with Art's suggestion to 'feel out' the patients' receptivity to the psychological. I would also point out that for patients not open to the Sarno approach there is another innovative and clinically proven option for those with low back pain. It actually works too. This is the 'Spinal Stabilization' approach to spinal rehab developed in Australia, best summarized by Rick Jemmett's book "Spinal Stabilization - the new Science of Back Pain". This approach has worked wonders for me and has an excellent clinical track record and is soundly reseached and proven. Though like anything else new and innovative, it's taking time to 'catch on'.
Before everyone starts screaming at this 'physical' approach', please bear with me . . .
In a simplified nutshell, it focusses on the 'rewiring' of the nervous system to allow correct activation the inner spinal support muscles (multifidus and pelvic floor) which have been found by researchers to be not activating properly in people with chronic low back pain. This problem leads to instablility, stiffness and pain as all the surrounding supporting muscles have to compensate.
Having been successfully treated with this and more recently reading about the TMS approach, I also cant help wondering if there is some overlap. It's possible this nervous system glitch could be an alternative (and better) explanation to Sarno's 'low blood flow' theory for the physical end of TMS back pain.
Also, could psychological factors play a role in causing these nervous system and muscle control faults that have been clearly documented? I dont see why not. I was treated successfully with the stabilization protocol (and it wasn't placebo, believe me). But I read Sarno after the fact and strike a bingo on the TMS personality profile.
In essence the 'Stabilization' theory agrees with the Sarno model in the premise that structural injuries (disk etc) heal and are not the cause of ongoing long term pain. Sarno works by 'rewiring' the patient's emotional awareness, allowing physical healing from a psychological perspective, and the Stability model 'rewires' from a neurological/muscle activation perspective, with gentle muscle isolation exercises totally unlike anything previously used in back rehab. Both approaches clearly bring excellent results for patients who are willing to commit, and were developed as a result of someone actually paying attention to the fact that the old standard approaches just weren't working.
This is pretty cutting edge stuff and not yet the standard rehab approach. You have to hunt to find professionals familiar with it. Again, like TMS. But for the first time I see emerging a possible hint of overlap between the polarized 'physical' and 'psychological' schools of effective back pain treatment.
But yes, I am mentioning physical approach, and I'll take the knocks if anyone wants to take me to task for this posting. I have nothing to gain personally and I'm not a health care worker, just WAS a long term back sufferer. I'm not trying to dis Sarno. I've read two of his books and finding some of his approaches applicable to myself even after my back problems have largely been resolved. But since we have doctors contributing to these threads who want to help their patients, I just feel compelled to tell them and any other interested parties that the 'not open to Sarno' subgroup can indeed be helped as well.
Peter Watson |
| Dr. Fatteh |
Posted - 07/13/2005 : 15:00:04
Tom,
I think the idea of a TMS conference is an EXCELLENT one. Perhaps there are only 20 or so listed TMS docs in the country right now, but there may also be more where Dr. Ziggles came from, so you never know what the turnout might be. While Maui would be great, perhaps as an homage to Dr. Sarno NYC would be appropriate. Perhaps I'll send out some emails to Dr.Schechter and others. And, I think there should be a way to make TMS sufferers a part of the conference as well. It could bring a boatload of exposure to the field.
Parvez Fatteh, M.D. |
| tennis tom |
Posted - 07/13/2005 : 14:50:02
Dear drziggles,
Thank you for posting at this board as well as Dr. Fatteh, it's always nice to hear from you. May I suggest that one of the first things any TMS doctor should do is add their name and contact information to the "links" on this site's home page http://tmshelp.com/links.htm and also at the http://www.tarpityoga.com/directory.html
For the TMS sufferer, the problem is usually one of not being able to find a TMS doctor. You may also want to set up your own web site as some other TMS doctors have. Perhaps consulting with a marketing person would also help. I think there is a big enough niche of patients, looking for alternatives to surgery, to keep the few TMS doctors on the planet busy, once the word gets out.
Maybe talk to some of your fellow TMS doctors to learn how they handle broaching the subject of TMS to new patients who have never heard of it. How about a conference of TMS doctors and maybe patients too, somewhere nice like Maui. |
| johnnyg |
Posted - 07/13/2005 : 11:58:51
Docs:
The TMS doctor I saw has the same problems you are describing. In fact he is leary of accepting new TMS patients for a variety of reasons, usually the time factor. He mentioned to me the difficulty in broaching the subject to people who don't know about TMS. But he trained with Sarno and is dedicated to it. In my first visit to him, he mentioned situations where a patient that doesn't know about TMS comes in and mentions a back ache. If he suspects it might be TMS, he makes the big decision--do I mention TMS or not. He didn't tell me the exact words he uses, but he broaches the subject very carefully to see it they are receptive. Like starting off with a dicussion of the patients stress level etc., and then try to get to a point where he can can gauge whether or not the person will understand or accept the connection between the stress and the pain. It would also be a good idea to prepare a brochure to let them read and see if the patient "sees" himself there.
If the doc doesn't get anywhere with TMS, he'll do the conventional thing or even send them to a chiropractor. He recognizes that even placebos do work permanently sometimes and if the person simply won't buy into a psychogenic cause, then maybe they will have enough faith in that chiropractor or PT.
Unfortunately, the reason TMS is a last resort is due in large part to the fact that the public is, like most doctors, conditioned to look for physical causes first (I did it and I bet everyone here did that too). But this is also a positive, because then they run the gamut of conventional treatments and eventually find out they don't work; and that process is often necessary in order for them to accept the TMS diagnosis themselves. The good thing is that, and Dr Sarno has said this, the public is more receptive to the TMS diagnosis than rigidly trained doctors. So we can be deconditioned easier and faster. |
| Fredarm57 |
Posted - 07/13/2005 : 07:41:38
drziggles: I second Art's recommendation. To use an analogy, you wouldn't use a treatment on a patient that might cause an adverse reaction or be ineffective due to an underlying condition. For example, you wouldn't use penicillin on a patient that is allergic to it. In this case, the knowledge is the "penicillin", as Dr. Sarno has commented. If the patient is not receptive to the TMS concept, the TMS approach won't work. In effect, the patient is "allergic" to the treatment. So you use another treatment, the conventional PT approach. But maybe, by at least planting the seed, if the conventional approach doesn't work, the patient may become receptive to TMS more quickly than if you hadn't at least mentioned it as an option. Fred
Fred |
| Dr. Fatteh |
Posted - 07/13/2005 : 02:12:19
Dear Friends,
I am a pain medicine practitioner and believer in TMS theory. I can understand the anger on this board regarding the rigidity, stubbornness, and downright disingenuousness of the medical profession. However, I feel that a little perspective is needed on the case of the primary care doc in question.
Even as a pain specialist and TMS believer, it is EXTREMELY DIFFICULT to even broach the topic of psychosomatic illness in over 95% of cases that I see. And the reason is, alluded to insightfully by Baseball65, that there is indeed DUAL CONDITIONING going on. We as the medical profession have conditioned patients to focus STRICTLY on the structural, while patients have taken the lesson and DEMANDED that tangible intervention be provided in order to "fix" them. It is therefore an unfortunate fact that bringing up TMS WOULD poison the doctor-patient relationship and trust that we as physicians work towards. I have two general categories of patients, those who have learned about TMS and then got my name and came in for education and re-assurance, and everyone else. And within the "everyone else" category a great number of severely disabled people have at least crossed through the worker's compenstion system, which has left them highly anxious and downright paranoid about the intentions of insurance adjustors, lawyers, and yes doctors.
I don't believe that the doctor in question should automatically be labelled as greedy, or as a co-conspirater, or even arrogant. Perhaps he should not have been defensive upon learning about your exposure to TMS. And, perhaps if you were truly at the end of your rope then the idea could have been presented as a "last resort." But, you see, right now TMS theory has only achieved "last resort" status in mainstream medicine. This is something that I and other TMS physicians struggle with every day, and admittedly it is something I could stand to improve upon within myself as a physician. I share the neurologists call to all of you to assist us in the medical profession in finding the ideal formula for introducing TMS early on in a case and not just as a last resort. Because as it stands now, the introduction of the idea of psychosomatic illness early on in a treatment course usually results not only in distrust, but usually a change of doctors.
Finally, remember this. Dr. Sarno himself heavily screens his patients by phone. And, if a patient is not open to the idea of psychological causes of his/her pain, then that patient is not seen. So, it is very likely, Maryalma8, that you and most pain sufferers in your situation would never be allowed through Dr. Sarno's door unless you happened to be at the right stage of desperation. If a pioneer such as Dr.Sarno would be unlikely to treat the "average" pain patient, then how could such expectations be placed on a regular old doc like the PCP mentioned. Right now our goal should be to educate doctors, especially the young ones who are a little more open to new ideas. This doc at least took the time to learn and understand the TMS. Right now this makes him one of the good guys, in need of encouragement, not scorn. What I would recommend, Maryalma, for the greater good, would be to see him again to share the experiences of your recovery to provide him with the positive feedback needed to encourage him to introduce TMS treatment earlier and earlier with his other patients. Remember, everyone, it takes a village at time... Best wishes. |
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