My Painful Story
Growing up as an athlete through my teenage and college years I had suffered from typical strains and sprains which most of us have dealt with. None of which took me out of a sport for more than a few weeks. I felt I was pretty indestructible all the way into my mid-twenties. After college most weekends, if I wasn't creating some rock climbing adventure in the Smoky Mountains I would probably be dodging branches and trees while riding my mountain bike full speed through the Carolina forests. I had and still do have a sense of adventure. But now in my 30s I have a completely different perspective with certain activities and how to preserve my body while participating in them. Some of this is due to the people I see on a daily basis in my practice, who have had life altering injuries. But a vast majority is influenced by an event which lasted almost 3 years for me. I had become an MAT practitioner back in 2009, I felt I always had a mechanical mind, coupled with a previous degree in Architecture which allowed me to help the people who landed in my office by looking at the human body through a biomechanical lens. As I felt I could find solutions to their dysfunctions, I truly had NO IDEA what debilitating pain was like, nor could I actually empathize with them. It wasn't until November 20th of 2013 when everything changed for me. In my practice I perform multiple positional manual muscle tests on clients daily, in a typical day I could perform several hundred manual tests. These tests range from simple hand and wrist tests which require very little physical effort by me, to incredibly difficult spinal muscle tests, especially when I had a football lineman on the table. This job would usually leave me physically spent by the end of the day. One evening I was finishing the last session of a day's work with a client. I was performing a positional muscle test on his hip when all of a sudden I felt a an incredible sharp stab to my lower right abdomen. I have a pretty high tolerance for pain, many years of martial arts are probably attributed to that, but this pain was like nothing I had experienced before, it was exquisite. I winced. I finished the session pretending that I was ok, but clearly that was a lie, and I had no idea what I was in for. This was the beginning of a long arduous journey which would change many aspects of my life and allowed me to mature as a person in ways I had no idea were possible. That evening I hadn’t thought much of it, I was a little sore in the gut but I thought it was nothing unusual after a minor strain. It wasn’t until I woke in the middle of the night with an intense pain in my lower right abdomen. The pain was as if I had a knife lodged into my side, it was the type of pain which causes your mouth to go watery and your vision to narrow. If any of you have had intense pain you know what I’m talking about. We had thought it may be appendicitis, and rushed down to the ER.
At the hospital they scanned me for all sorts of visceral problems, CT scan for appendicitis, ultrasound for kidney and gallbladder issues, blood and stool samples etc. Ultimately, they found nothing. I was sent home barely walking with a prescription for pain medication. The next few days I rested and iced still with no idea what was causing the pain. After a few visits with my primary care physician it was concluded that I was having muscular problems, possibly a side strain oblique injury and I just needed some time to rest. Rest is what I did, I spent many of the days from bed barely able to move without any sort of stabbing sensation. After a month I was feeling somewhat better and decided to begin work again. Big mistake, that night it all happened again, I went back to the ER hoping they would finally see what was causing my pain. We went through the same procedures and tests all with the same negative findings. I went home with another bottle of pills and was beginning to really worry what was ailing me. The next day I met with a local sports injury Physician. She was very understanding of my dilemma but couldn’t offer any insights other than to try physical therapy. After a few practitioners and three months of physical therapy with dry needling there was zero change. If anything, it was getting worse, I was beginning to have pain on my opposite side. At this point I was slipping into depression. I began to search for help from other MAT specialists who were friends of mine. Over the next few months I had flown out to get numerous treatments with minimal relief and a growing knife in both of my sides. The depression deepened, the next frantic step was to throw everything and the kitchen sink at the problem, I tried acupuncture, Chiropractic, multiple massage therapists and numerous physical therapists, all failing miserably. My symptoms on a regular day included, painful abdominal muscle spasms like concrete, burning through into my groin, sharp stabbing sensations when coughing, laughing, sneezing and walking. The pain kept me up most nights. At this point I had been doing a lot of research and was wondering if I had undiagnosed hernias, it was a long shot because nothing was visible. I went to another sports injury physician, he ultrasounded me for them with negative results. The conundrum was, although I was happy I didn’t have hernias, I was disappointed because I was still without answers. A few more months of Drs, barely walking and working in incredible pain, usually in the evening you would find me on my carpeted bedroom floor in the fetal position with wet eyes staring blankly at the beige coloured wall. I was giving out on hope in the medical system. One of the hardest parts was the lack of empathy from many of Physicians I met with. None of them had answers, but the ones who at least could show empathy made the expensive bills seem more digestible.
In my research I had learned that in order to find certain types of hernias, ‘sports hernias’ and some inguinal hernias I would need to see a surgeon who specifically dealt with sports hernias. Unfortunately, there are only 5 in the entire United States who deal with them. I made an appointment with the top Hernia Specialist in the Southeast over at Emory University Hospital in Atlanta. I was excited that I finally felt I was homing in on the diagnosis, even though many other doctors had ruled out hernias and everything else from gallstones to cancer. There I was waiting in the examination room and in comes “Head Honcho Super Surgeon” He gave me 5 minutes to explain my situation. He slapped on his blue nitrile gloves and decided to do the typical turn and cough test. A few seconds later he stood up, then he said something which I will never forget, “Hey bud, I don’t see anything wrong with you, give it another year”. My heart sank, at the same time I was screaming on the inside. I was thinking, “Hey Doc, you know that I may chew on a muzzle of a gun by then, right?” I left the office furious and with $500 less in my pocket. I began the 4 hour drive home. At this point I was in tears, this was nothing new for me lately as my tear ducts had been getting some regular use over the past 12 months.
On my way home I was brainstorming everything I currently knew about anatomy and physiology. Using quantitative reasoning there was nothing adding up, because everything had been tested for. Then I began to think about the reliability of the certain tests I was given and came to the conclusion that there must be some sort of muscular tear which is not being found. I was at the end of my rope physically and emotionally but I wasn’t ready to throw in the towel just yet. In my research I had found online that there was one other Surgeon I could visit who is unanimously considered the absolute best in the world in regards to anything related to abdominal musculature. There was just one problem, she was located in Munich, Germany. After already visiting 15 Physicians what’s one more, right? At this point I had nowhere else to turn, I had tried every non-invasive technique under the sun, I was out of options. The way I saw it I had two options left, get checked out by her or prepare for checking out from this life. Many of you who have not gone through tremendous physical pain wouldn’t understand, however the few of you who have, know that when pain is high, relentless and given zero diagnoses your mind goes to place where the body wants to check out and you become willing to end pain with any means possible...if you know what I mean. To some they may not agree, but if you haven’t been in similar shoes, please hold judgment.
Two weeks later in early December, just over 12 incredibly long months I found myself on an overnight Lufthansa flight to Munich, I will add that Lufthansa is the absolute best airline I have ever flown. The following morning I was sitting in yet another examination room waiting for the Doctor. Her name was Dr. Ulrike Muschaweck and her assistant was Dr. Sandra. They both came in, I told them of my story, they then proceeded to the examination, the first was with an ultrasound, I began to lose hope as in the past this diagnostic procedure was always negative. I lowered my pants and began to lay back on the examination table. This is when Dr. M said she would prefer that I stand for the examination rather than being supine. I agreed, while standing it had dawned on me…”DUH! How could have the US Doctors not known this?” It’s all about gravity folks, when one is supine any visceral contents move posterior to the spine. If there was any abdominal tear it would be very hard to find. While she was moving the wand over my inguinal ligament she had me tense up my abdominal wall, I still remember it as clear as day, I could see with my very own eyes a protrusion on the grainy black and white ultrasound monitor. She said in a beautiful southern German accent, “there it is! a decent sized inguinal hernia, let’s check the left side now, yes we have another one, it looks a little bigger.” At this point I was at the most vulnerable state I can think I have ever been in. “Pants down in a foreign country, in front of two woman and tears began to stream down my face” lol. A few minutes later they finished the exam and brought me into the surgical consult room. At this point they scheduled me into surgery for the very next day. This is a huge convenience they do for international patients, usually it would be several weeks before surgery. The next morning after being prepped for surgery Dr. Sandra and Dr. M came in and encouraged me that everything was going to be just fine. You know, there is something about female surgeons that I have to admire, they seem to have this innate way to give maternal compassion to their patients, you can really sense their empathy which seems most males do not always possess. I felt perfectly at ease that they were going to do a fantastic job. I was rolled into the most beautiful ER I have ever seen, it was circular in shape with light blue glass walls and pristine white and stainless steel equipment. I was in for what was scheduled as a quick 1.5hr procedure. They moved me from the gurney to the table, at this point they gently strapped my arms and legs to the table and prepared to begin. Most of the time I am a smart ass and usually when I am nervous I resort to comedy to help ease the nerves. So there I was laying on a table wearing not much more than my birthday suit once my gown was removed, the blanket came later. It wasn’t until that moment I realised I was the only dude in the room and blindingly naked, I’m English(English accent), It was an all woman surgical team! That’s when I said, “You know ladies, USUALLY when a group of women strap me down to a table butt naked they at least have the courtesy to buy me a damn glass of wine first.” They all began to laugh through their face masks as you could see their eyes and noses scrunch up, which was when the anesthesiologist looked at me, she didn’t miss a beat and said, “I have something much better than wine for you Mr. Wicks” She pushed the syringe and the IV began to drip, my eyes closed.
The surgery was a success, however, it took almost four hours to complete. The next thing I remember was being pushed out of the OR on a gurney and hearing the words “we fixed your hernias Mr. Wicks”. I was barely conscious but in my best German accent I told the nurses “Tausend Dank”, which in German means ‘I thank you a thousand times’. I was truly grateful. I overnighted in the private recovery room, which by the way looked more like a posh boutique hotel room rather than a surgical ward. They ordered amazing German food from the cafe across the street and brought it straight to my bedside, mmmmmm apple strudel!,. I thought, “what an amazing practice Dr. Muschaweck has, she really has pulled out the red carpet for her patients”. The next morning I met with Dr. M and she debriefed me. The surgery was more complicated than expected which is why it took so long. It turned out I did indeed have large bilateral inguinal hernias measuring 4.5cm x 3 .5cm on the left side and 4cm x 5cm on the right side. She also showed me photos of a large 7 cm lipoma she removed from my right side inguinal ligament. She told me that my Ilio-inguinal nerve which is very large was being completely squashed between the lipoma and the abdominal contents. At this point it made perfect sense why I was in so much pain for what seemed like and eternity. I thought, “Holy crap! I had a tumor growing in my inguinal canal and tears the size of softballs, I’m not crazy after all.” I flew home a few days later. Again, Lufthansa impressed me by reserving an entire center row at the back of the plane knowing that it would make me more comfortable for the 13 hr flight across the pond. I will forever be grateful to Lufthansa. My road to recovery wasn’t easy, I was in a good deal of pain for a several weeks and it took me almost a year to be completely symptom free, standing up straight, exercising and jogging without pain. I would like to give a very special thanks to the entire staff at UM Hernienzentrum and a very special thank you to Nurse Edith, Dr. Sandra and most importantly Dr. Ulrike Muschaweck. You three Ladies will always be hero’s to me, there are no words in the English language which can express my gratitude to you, so I will have to say “tausend dank”.
To the ones who have been shown that pain can arise from zero current pathologies. I don’t argue with that. However, I will caution that if one is in pain, one shouldn’t ever speak in absolutes regarding non-pathological pain, this occurs when one is told there is nothing wrong. At this point one is left trying to deal with the pain. The problem with speaking in absolutes is that it inhibits all conscious thought and discoveries of things which one is currently unaware of. If one hasn’t received a diagnosis, that doesn’t mean there is nothing physically abnormal, it only means that a true dysfunction may not have been discovered yet. Remember, in general our medical system is only as good as its diagnostic capabilities and there is much more to be discovered about the human body.
Pictured above is Dr.Ulrike Muschaweck