Wednesday, 11 July 2012

Health: Pascal's Wager and Desperation

The 17th century French philosopher and mathematician Blaise Pascal argued that there was more to be gained by believing in God than not. Even if the truth can't be known, a rational person should live as if God exists. (This kind of reminds me of the joke about sinning like crazy then repenting on your deathbed in order to get the best of both worlds. Hmmm, hasn't somebody written a story with humorous overtones about the sinner who unexpectedly gets killed in a freak accident and doesn't get a chance to repent? Ha ha, off to hell with you for eternity!)

If you have an injury, is it better to believe in a remedy than not? Is there more to be gained by trying a supplement, a new diet, or an exercise then by not trying it? Whether it works or not remains to be seen but like Pascal with his wager, if you don't place a bet you can't win?

Have a health issue and everybody you know will chime in with their own stories of health issues, whether related or not, and what they have done to supposedly assist in returning themselves to resplendent good health. Doctors, neurologists, and sports medicine specialists plus physiotherapists, chiropractors, naturopaths, acupuncturists, and massage therapists along with dietary supplements, vitamins, minerals, and herbal teas represent the tip of the iceberg in advice I've gotten from family, colleagues, business acquaintances, and the lady serving croissants at the counter of Starbucks. It seems like everyone has had at one time or another something go wrong and they are more than willing to pass along a summation of their escape from hell. Having lived a life up until this point in what now seems in comparison to be near-perfect health, I appear to have saved up all my potential bad luck for one over the top accident of earth-shattering proportions and am now faced with the daunting task of sorting out the wheat from the chaff, of determining out of this avalanche of unsolicited advice what is legitimate and what is hogwash.

To recap: On April 7, 2012, I suffered the worst sports injury of my life. I completely traumatized the upper left quadrant of my body, left shoulder, arm and hand, although I stopped just short of tearing my rotator cuff. While this would seem to require six months to a year to properly heal and return to full form, my injury has also left me with 2 partially herniated cervical discs, the C6 and the C7. While some on-line articles say that anywhere from 40% to 90% of the time herniated discs heal themselves, I can find nothing definitive which would lead me to believe that if I hang in there long enough, my body will "do its stuff" and return me to my former glory. The only other option is surgery which entails removing the herniated disc and fusing the two surrounding vertebrae together. This is considered the very last resort and some stories paint anything but a rosy picture of the outcome of such a procedure.

I point out the herniated discs as they are a source of on-going problems. The bulging discs push against my C6 and C7 nerves causing referred pain in my upper left quadrant. I pretty much feel constant shooting pain in my forearm and the back of my hand, tingling and numbness in my hand and a various aches in my shoulder. While I know that my body is trying to heal from the trauma, I know that I am also feeling referred pain from the pinched nerve in my neck. Is the pain real pain from my injury or is it "fake" pain from the pressure on the C6 nerve? Then again, does it matter? Referred pain certainly feels real enough, believe me!

In a nutshell, life sucks right now. It sucks a lot. While I am not expecting anybody to hand me the brass ring of healing, I realise that I am pretty much relying on my own body to heal itself. I have 2 questions. Question number one is how long does this injury take to heal and what if anything can I do to assist? Secondly, referring specifically to the herniated discs, will they eventually heal or not? I think I now know the answer to question number one but I don't know the answer to question number two. Not only do I not know how long a herniated disc takes to heal, I don't know if it is even possible. Okay, possible in my case. I have read accounts of people seeing improvements in the condition of their herniated discs so there is hope, no specific empirical evidence, just hope. And is hope (or is possibly desperation) going to push me to do such and such an exercise or follow a certain diet or take vitamin and mineral supplements with the objective of speeding up maybe guaranteeing my recovery?

Glucosamine Chondroitin
Do I feel a little foolish admitting to this? I research herniated cervical discs through Google and run across a number of comments written by people with similar problems. One guy says he heard about glucosamine chondroitin, started taking it and although he can't say for certain whether it has contributed to the healing of his herniated disc, he is better now after a few months. On this basis and this basis alone I went out and bought a bottle of the stuff and have now been taking the recommended dosage of two pills three times a day for the past two weeks. The bottle says you need to do this for at least four weeks before seeing any results.

Okay, supposedly this substance isn't harmful but on the other hand, there are conflicting reports as to whether or not the stuff does any good. I suppose there's an argument that if you're trying to recover from an injury you may need more of something than you normally do, but when scientific double blind testing can't reproduce conclusive proof that something is in fact doing something beneficial, you wonder what all the hubbub is about.

Peanut Butter and Jelly
I have people telling me left, right and center what they have eaten, taken or drank to assist their healing. What's true and what's bogus? I couldn't help thinking of peanut butter and jelly sandwiches.

Let's say that one year from now, I will be better. (Heck, I better be better! Hell, I hope slash pray I'm better!! Ha ha.) Today, right now, I start eating peanut butter and jelly sandwiches everyday for lunch. At the end of the year can I tell everybody what I've been eating? Am I or somebody else for that matter going to start speculating out loud about how the salubrious nature of the strawberry combined with the protein of peanuts assists the body in repairing itself?

My point is that correlation doesn't mean causation. You're going to think of me trying to be funny but I see this as a problem everywhere sometimes on a grand scale.

In a widely studied example, numerous epidemiological studies showed that women who were taking combined hormone replacement therapy (HRT) also had a lower-than-average incidence of coronary heart disease (CHD), leading doctors to propose that HRT was protective against CHD. But randomized controlled trials showed that HRT caused a small but statistically significant increase in risk of CHD. Re-analysis of the data from the epidemiological studies showed that women undertaking HRT were more likely to be from higher socio-economic groups (ABC1), with better than average diet and exercise regimens. The use of HRT and decreased incidence of coronary heart disease were coincident effects of a common cause (i.e. the benefits associated with a higher socioeconomic status), rather than cause and effect as had been supposed. (Wikipedia: Correlation does not imply causation)

How many times do we do things just because somebody said to do it? How many times we do things without checking whether those things are true or false? How many times do we do things just because we see other people doing it? Did you know that putting oil and salt in water to boil spaghetti noodles is a bunch of bulls**t? (see my blog: Boiling spaghetti: to salt or not to salt)

Andy Kaufman
This gentleman (1949-1984) was an American comedian although performance artist may be a more fitting term. What's pertinent in his story is that he was diagnosed with a rare form of lung cancer. He had no chance of recovery.

Out of desperation (or maybe it was merely a question of what's the harm in trying) he went through a number of alternative cures. Obviously none of them succeeded but at the time, when I first heard the stories of natural medicine, an all-fruit-and-vegetables diet and even "psychic surgery", I couldn't help thinking it all sounded pretty strange if not downright cuckoo.

Curiously enough, I find myself in similar circumstances. Am I yet desperate enough that if somebody told me to stand on my head and spit wooden nickels, would I do it? I have tried a chiropractor, a massage therapist and an acupuncturist but not more than once each. I didn't feel that what they were offering matched my problem. I am sticking with a kinesiologist because he has been the only one so far who demonstrated any immediate and positive results. But in saying that, I have come to recognise that I have a long row to hoe. I have also come to recognise that the healing of my herniated discs is more than likely beyond his help, in fact beyond the help of anyone. If my discs heal, it is going to be because of my body, not necessarily because of a drug, a vitamin supplement, or physiotherapy.

Final Word
Six months to a year. That is the amount of time I have come to understand as being the minimum necessary before I declare my healing a success or a failure. As of this writing, I am three days away from the 14th week anniversary of my accident, just three and a half months. Family and colleagues ask me the same question, "Are you getting better?" I would say the correct answer may involve taking the improvement scale down to four decimal points. In other words, from one day to the next, from one week to the next, I can't say that I am making remarkable strides. While I walk to work and the grocery store, I do so gritting my teeth. Walking puts stress on my upper body which stresses my neck causing my herniated disc to push against my C6 nerve causing referred pain in my left forearm and hand. The experience is so unpleasant; I can't go for a leisurely stroll around the block. In fact, I spend a great deal of time holding my left arm on top of my head. (This position reduces how much the vertebrae push on the discs.) I am typing this article only with my right hand as I hold my left arm on my head. Weird but it does provide some albeit small relief. Another eight months of this? Life really sucks right now.

Lasciate ogne speranza, voi ch'intrate.


Wikipedia: Pascal's Wager
Pascal’s Wager (also known as Pascal’s Gambit) is an argument in apologetic philosophy which was devised by the seventeenth-century French philosopher, mathematician, and physicist, Blaise Pascal. It posits that there's more to be gained from wagering on the existence of God than from atheism, and that a rational person should live as though God exists, even though the truth of the matter can't actually be known.

Wikipedia: Glucosamine
Oral glucosamine is a dietary supplement... marketed to support the structure and function of joints and the marketing is targeted to people suffering from osteoarthritis.

Since glucosamine is a precursor for glycosaminoglycans, and glycosaminoglycans are a major component of joint cartilage, supplemental glucosamine may help to prevent cartilage degeneration and treat arthritis. Its use as a therapy for osteoarthritis appears safe, but there is conflicting evidence as to its effectiveness. A systematic review found that effect sizes from glucosamine supplementation were highest in industry-funded studies and lowest in independent studies.

Wikipedia: Chondroitin sulfate
Chondroitin sulfate is an important structural component of cartilage and provides much of its resistance to compression. Along with glucosamine, chondroitin sulfate has become a widely used dietary supplement for treatment of osteoarthritis.

Nutrition Diva - July 26/2010
Do Glucosamine Supplements Work? by Monica Reinagel, M.S., L.D./N.
[The] official take on glucosamine and chondroitin supplements is that they are a waste of money. But I’m not quite ready to throw in the towel on these. The fact is that many people do report substantial improvement in their joint pain when they take these supplements. And I’m not sure that it’s entirely due to a placebo effect. In fact, the authors of the 2006 study hinted that certain people seem to get more benefit than others.

The problem is that the only way to know whether you’re one of those people is to try it yourself. And if you do notice some improvement, there’d be no way to guarantee that you weren’t imagining it. But, hey, feeling better is feeling better! And, unlike arthritis drugs, glucosamine supplements appear to be exceedingly safe and well-tolerated.

Wikipedia: Correlation does not imply causation
"Correlation does not imply causation" (related to "ignoring a common cause" and questionable cause) is a phrase used in science and statistics to emphasize that correlation between two variables does not automatically imply that one causes the other (though correlation is necessary for linear causation in the absence of any third and countervailing causative variable, and can indicate possible causes or areas for further investigation; in other words, correlation is a hint).

Wikipedia: Andy Kaufman
Andrew Geoffrey "Andy" Kaufman (January 17, 1949 – May 16, 1984) was an American entertainer, actor and performance artist. While often referred to as a comedian, Kaufman did not consider himself to be one. He disdained telling jokes and engaging in comedy as it was traditionally understood, referring to himself instead as a "song-and-dance man." Elaborate hoaxes and pranks were major elements of his career. His act maintains a cult following and he continues to be respected among comedians for his original material, performance style, and unflinching commitment to character.

Wikipedia: Inferno (Dante)
Inferno (Italian for "Hell") is the first part of Dante Alighieri's 14th-century epic poem Divine Comedy. It is followed by Purgatorio and Paradiso. It is an allegory telling of the journey of Dante through Hell, guided by the Roman poet Virgil. In the poem, Hell is depicted as nine circles of suffering located within the Earth. Allegorically, the Divine Comedy represents the journey of the soul towards God, with the Inferno describing the recognition and rejection of sin.
Dante passes through the gate of Hell, which bears an inscription, the ninth (and final) line of which is the famous phrase "Lasciate ogne speranza, voi ch'intrate", or "Abandon all hope, ye who enter here".


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