The Semi-annual VA Doc Check-up

I went to a VA appointment two days ago, because what better way to celebrate Veteran’s Day than to spend the entire next day at the VA? My PCM asked me a few questions when I sat down. Pertinent ones like “Are you new?” So many answers to that question. “No, I’m almost 49 years old with high-mileage.” “Why? Do I have that new Veteran smell?” “No, but Voc Rehab says I’m refurbished and certified for employment.” Or the one I really had to fight back: “No, you’ve been my PCM since my last visit in May… are YOU new?”

In other news, my Primary Care doc was very concerned about my self-medication to cope with chronic pain as a result of multiple surgeries, including botched surgeries, while I was under military care for 28 years. She was aghast at the types and quantities of medication I was taking and clearly disapproved of the fact that I took myself off of Gabapentin without a medical consult. Am I abusing OPIOIDS? No. Do I drink alcohol in excess to drown the pain? No. Do I use marijuana? No. What was it she was aghast about then? Simple, I take maximum strength Tylenol 1000mg about three times a day (arthritis delayed-release) and some days I supplement or replace that with ibuprofen or naproxen during the daytime (600mg dose). At night I often take 5mg or 10mg of Flexeril to prevent spasms in my sleep. Those amounts caused her to become very agitated and I was informed that I am overmedicating myself at dangerous levels.

Hmmm. Okay. The Army told me that for my age, size, etc my toxicity level for Tylenol was about 4G (4000mg) per day. According to her, that level is actually 3.6G (3600mg) per day and she doesn’t like me being so close to the limit. Admittedly, that doesn’t give me much room for increase to deal with acute pain or injury, but I don’t take narcotics at all, so I think I could probably take a narcotic pain killer for a short period if I had acute pain or injury. Additionally, she was very concerned about the effects of such “large” doses of NSAIDs and feels muscle relaxants are not a good long-term management plan for my spasms.

I’m really starting to think she is “new”. Yes, I’m on the upper end of where you should be with Tylenol. Yes, NSAIDs can cause GI problems, destroy stomach lining, and causes ulcers. Anyone with a PDR (Physician’s Desk Reference), a tendency to read the fine print on medicine bottles while on the crapper, or an internet bookmark for WebMD knows the downsides of NSAID use; but we have a different name for them in the Army. They are called “Infantry Candy” and they are issued in 800mg horse tablets to be consumed orally 3x a day (2400mg daily) until you get tired of choking yourself or your inflammation subsides. Somehow my consumption of one-fourth of that dose is incredibly risky though.

I had to learn to do math just to take civilian Motrin. How many of these little pills is a horse pill? They are easier to swallow than the military ones, but they are almost too small. They jump out of your hand onto the floor very easily. They fail to let go of your hand when you try to pop a handful of them in your mouth all at one time. They also like to leave a rear guard perched precariously at the back of your throat refusing to clear out, not unlike a paratrooper frozen in the door until a jumpmaster ass-ists their exit with a boot to the fourth point of contact.

I will agree that the ideal pain management situation should include something less glass of water chasing floaty pills and more deep-tissue massage/spa day every day. Maybe a little Tai Chi and Chill (more on that in a later blog post) could be a good substitute. I’m almost willing to try one of those “Teeter Inversion Tables” (recommended for use only on an empty stomach), because who doesn’t want to be able to do a weird jump and say “I feel great!” every day? On a more serious note, what precisely does the good doctor consider an adequate replacement for a well-tolerated CNS/muscle relaxant like Flexeril? That question was answered with *crickets*.

VA Docs may mean well, but it’s like talking to a family practitioner who deals with generic sniffles, colds, allergies, and sinus infections every day and then you try to get them to understand that your entire adult life has simply been a never-ending episode of M.A.S.H. Or for the Millennial generation that may have never seen a single episode of M.A.S.H., think Chicago Med and ER with random interjections of the variety seen in House. Put some military uniforms in the mix, dial up the number of GSW’s, explosive force trauma and blunt trauma cases, and sprinkle lightly with altered mental status. Then you will have a much more accurate picture of life with military medicine.

Regardless, I’m not addicted to opioids, I don’t drink myself into a stupor or sit around stoned all day as a form of self-medication (CBD only, no THC), and I’ve been managing on levels of OTC medications that are easily 1/4th the amount I was given constantly as an active duty Soldier. Honestly, I find it surprising that such low levels of medication even have an impact on my pain at all. I also fall out of bed laughing when I see a commercial where some construction worker with back pain claims that a single 200mg tablet of Aleve keeps him functioning all day long. What planet is this on?

Please understand that I have received good care and bad care from the VA depending on the doctor, location, and injury or illness. It’s a crap shoot whether you get good care, indifferent care, or bad care in my experience. I don’t speak for all veterans regarding VA care. I’m not attempting to paint the VA with a broad brush. I’m just chronicling my “adventures” in the world of socialized medicine and sharing for your information or amusement. Stay Shiny folks!