There was a front-page story in the NY Times about the shooting of the CEO of United Healthcare. The suspect came from privilege and had a bright future. Unfortunately, he suffered from chronic LBP and did not improve with a surgical fusion of his lower back for a purported spondylolisthesis. A surgical fusion to solve chronic low back pain, whether it is done for this lesion or “degenerative disc disease,” should rarely be performed unless there is gross movement between the vertebrae of more than three to four millimeters. Additionally, surgery performed in any part of the body has a significant chance of making the pain worse when a person has ongoing chronic pain. You are stressing an already “fired up” nervous system.1
Here is one article reporting on the tragedy: https://www.cbsnews.com/news/luigi-mangione-healthcare-ceo-shooting-what-we-know/
I will present various aspects of it and begin with the story of a young gentleman of the same age and a spondylolisthesis I met about ten years ago. This is part of the foreword to my book, Do You Really Need Spine Surgery? His name is Sachit Eagan, and we are still in touch.
Foreword to Do You Really Need Spine Surgery?
The story you are about to read is the first of three histories I presented. It illustrates why I wrote my book on making the correct decision regarding spine surgery.
Sachit Egan
“You can choose to leave my office today without scheduling your surgery, but you will regret it. Patients with your spinal anatomy have backs that will inevitably break down, and the pain will be debilitating. I guarantee that you’ll come back to me within three years, and you’ll beg me for surgery.” I stared at the doctor, totally dumbfounded. I’d spent the past eighteen months exploring options for relieving the intense back pain that had erupted in my early twenties. After the typical non-invasive treatments (epidural injections, physical therapy, chiropractic care) hadn’t produced lasting results, I’d decided that surgery was the next logical step. In many ways, it also felt like my last hope.
I had grown up a bookworm, spending much of my childhood indoors and pouring myself into books and video games. I remember complaining endlessly one middle school day when my family dragged me off the couch for a trip to Muir Woods. However, my outlook changed following an overnight hike of Yosemite’s Half Dome during my first year of college. As I watched the sun rise over the distant peaks, I refocused my life on spending time outdoors.
I quickly picked up rock climbing, trail running, and backpacking and started an outdoor recreation program at my university. I maintained an intense exercise regimen designed to build strength and endurance for these activities, and I took this training as seriously as I did my studies. After graduating, I moved to Alaska, leading river rafting and backpacking trips near Denali National Park. Indeed, I came to view being an outdoorsman as a key component of my identity.
Sadly, things soon changed again—this time for the worse. One afternoon, I felt a snap in my lower back while picking up a heavy equipment box. Shortly afterward, I was hunched over with nerve-wrenching pain in my back and right leg. Days later, on my twenty-third birthday, I could not walk to a restaurant two blocks from my car. As I sat on the sidewalk that afternoon, I distinctly remember thinking, “Will I ever be able to climb Half Dome again?”
I spent the next year and a half pursuing non-invasive treatments, yielding one positive result. A skilled chiropractor was able to resolve my leg pain fully. However, the crippling back pain remained. At that point, I felt the hopelessness that is all too common among those afflicted with chronic back pain. Desperate to return to my previous form, I felt surgery looming as the only remaining option.
Within weeks, I had appointments with three top spine surgeons in the Bay Area. To my surprise, their advice was identical. “Have surgery now. Do not pass GO, do not collect $200… have surgery as soon as possible.”
Given the magnitude of their proposed procedures (multilevel fusions, potentially with artificial disc replacements), I’m amazed that these surgeons didn’t encourage me to reflect on my options. One of them (the chief of spine surgery at a name-brand hospital) even pushed me to schedule surgery for the following week. In hindsight, I’m amazed that I agreed to this proposal—we discussed a wholly life-altering procedure and didn’t even allow for research or preparation time.
With surgery scheduled just days away, I received a tremendous stroke of good fortune. A trusted friend recommended Dr. Hanscom’s first book (Back in Control). I picked it up and pored over it throughout the weekend. With newfound hope, I cancelled my surgery and opted to call Dr. Hanscom’s office in Washington. I flew from the Bay Area to Seattle to visit him in person a few weeks later.
I’ll never forget his first words upon entering the examination room, “You shouldn’t even be considering surgery. Based on your anatomy, you’re simply not a candidate. It’s a failure of our medical system that anyone would even recommend surgery to you.”
After Dr. Hanscom convinced me to rule out surgery, I admit it took some time to discern my next steps. Dr. Hanscom had assured me that my pain wasn’t related to anatomy or injuries in my spine. As such, I felt I had nothing to lose by carefully attempting to reintroduce my old hobbies into my life. I began with light weightlifting and aerobic exercise, which I ramped up gradually. Eventually, I added hiking, backpacking, and rock climbing.
Six years later, I’m in the best shape of my life. I make an annual trip to Yosemite and Half Dome, and I’m happy to say I’ve never reconsidered surgery. I’ll always be grateful that I met Dr. Hanscom during a scary time in my life and that I didn’t follow through with spine surgery.
—Sachit Egan, 2019
Sachit Ivanhoe video
I worked with him to create a video for Ivanhoe a few years ago. I am still in touch with him.
What happened?
Why would a 26 y/o young man with a promising future commit such a crime? It is a terrible story, and there are no excuses. However, there are clear explanations. At the core of the deed is being trapped by mental and/or mental pain. Trapped by any situation, from finances to relationships, fires up your fight-or-flight response. Humans call this anger. Dr. John Sarno describes how it feels to be trapped by pain as “rage.” Unfortunately, the metabolism (function) of the thinking brain is compromised, and actions are often irrational.
The answers lie in learning skills to regulate your physiology from threat to safety, where your body can rest, regenerate, and heal. Additionally, you re-engage your neocortex (thinking/ rational brain). Although we learned these concepts in medical school, we were not taught these concepts in our practical medical training. A term I use is “Dynamic Healing.”
He tried
He read several books on chronic pain, including the 2012 edition of my book, Back in Control.
Early in my practice, I learned that reading a book alone is of limited benefit. “Dr. Hanscom, I read your book and still hurt.” Nothing happens until you learn skills to calm and re-route your nervous system. It is why we keep working on evolving ways to teach people how to heal. The DOC Journey course and app are the latest tools, and I am working on making them more transparent and easier to navigate.
Why I quit my practice
One of my former surgical colleagues was killed in Tulsa, OK. I also had one serious death threat with a gun early in my practice. Thankfully, he never showed up at my clinic that day.
Seeing three to five patients every week badly damaged from unnecessary spine surgery was disturbing. Simultaneously, I was witnessing many people escaping from chronic pain with minimal resources and no risk. As I gained more insights, even patients with surgical problems would cancel surgery because their pain resolved. It was gratifying and also surprising. From a practice perspective, it was challenging to generate revenue.
In 2018, I encountered a patient who was in his early 30’s with a spondylolisthesis, which is a bony defect in the back of the vertebrae that does not cause chronic lower back pain if it is stable. He had no leg pain, and the vertebrae were bone-on-bone. In this scenario, the spine is very stable. It has somewhat fused itself. However, a complex procedure was performed that paralyzed him. He would have done well with a structured rehab program. It was a tipping point for me, and I decided to quit my practice at that moment and pursue these efforts to educate clinicians and patients about the basic science and clinical approaches to healing chronic pain.
I wrote a book about how to make the best surgical decision, and this section of my website adds more dimensions to it. If you decide to pursue surgery, this protocol will optimize your odds of success.
Please don’t take a casual approach to spine surgery. It is a definitive answer only if there is a surgical lesion. Just experiencing unrelenting pain is not an indication. The downside of failed spine surgery is often catastrophic, especially given the many other effective solutions.
References
- Perkins FM and Henrik Kehlet. Chronic Pain as an Outcome of Surgery. Anesthesiology (2000); 93: 1123-1133