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BIAS AGAINST PATIENTS WITH PAIN Sandra’s experience — multiple specialists, no answers, worsening pain and frustration—are all too common, research shows. Misdiagnosis, lack of pain

knowledge by health care practitioners and downplaying people’s pain are just part of the problem, a 2023 survey of pain specialists in Greece found. There’s also a lack of clear steps for

making a diagnosis. Too often, chronic pain patients are seen as trouble. The U.S. Pain Foundation’s 2022 survey of 2,275 adults with chronic pain found that 63 percent felt their health

care practitioners had a bias against them because of their pain. For the rest of 2022, Carlson left the house only for physical therapy, the occasional medical appointment and trips to a

local hospital emergency room for two milder stroke-like episodes. _I’m not a quitter. I kept trying until I got beat so low to the ground that I couldn’t get back up. I didn’t tell my

husband, but I gave up. Every place we went, the answer was not there. I could see the stress in my husband’s eyes. I said, “If it kills me, it will kill me.” I just gave up. My husband saw

it. He kept doing research. He reached his hand out and said, “We’re going to keep going.” How he did it, I don’t know, but he did._ Travis never gave up. He searched the internet and phoned

medical centers across the U.S. at night, on weekends and during scraps of time at work. “I had to really think harder now,” he says. Sandra now suspected all her symptoms pointed to a

nerve problem. She suggested he look there. “I just kept on trying,” Travis says. “We just had to tough it out before goodness would come.” At times it seemed hopeless. But Travis, a loving

husband with no medical education, had faith. He didn’t know it yet, but he was on the verge of a discovery that would change everything in their lives. ‘PRESS HERE’ One of Travis’ searches

had led him to Anthony Echo, M.D., a plastic surgeon at Houston Methodist Hospital who specializes in peripheral nerve surgery. Travis had emailed an emotional letter to Echo about his

wife’s condition. After reading the letter, Echo thought he could help. He agreed to do a teleconference with the couple in January 2023. But on that critical day, they were unable to log in

from their computer. So they had to use Sandra’s cellphone. She sat in her wheelchair, with Travis beside her on the living room couch. The technical snafu underscored her sense that this

was another in an endless line of disappointments. Through his search, Travis finally found the right doctor. Owen Freeman _When my husband found Dr. Echo, I didn’t think he would be able to

help me. There was no way to get my hopes up because there was no hope, absolutely none! I was just existing in a body that was no good for me, just buying time, and I knew my time was

running out._ In fact, in the unlikeliest of ways, the moment had come that would give Sandra Carlson back her life. Over the phone, Echo began a series of questions about Sandra’s symptoms,

then asked her to press on her left hip and at her left groin crease. Every touch was painful. The simple test, combined with Carlson’s symptoms, made Echo suspect that the lateral femoral

cutaneous nerve and the lateral femoral nerve that help control muscles and provide sensation in the hip and leg might have been compressed on Carlson’s left side. But he couldn’t make a

diagnosis without an exam. He told the couple he thought he knew the cause. Could Carlson come to Houston for an exam? _I couldn’t believe what I was hearing. My knee-jerk reaction was, “Did

he just say that?” Doctors had been sending me home with nothing, and here he is telling me that he thinks he knows what it is. It was like God shining a light down on me. Travis set up the

appointment and got plane tickets right away._ In February 2023, the couple flew to Houston. Physical exams and tests ruled out other causes of her pain such as muscle, tendon or joint

problems. A consultation with a Houston Methodist specialist confirmed that the source of Carlson’s symptoms was not her spine. Echo was sure Carlson’s nerves were getting squeezed at points

where they pass through narrow openings surrounded by large muscles and thick connective tissue. When nerves, which he describes as soft and squishy “like gummy worms,” are compressed, it

can reduce blood flow and even damage the nerve fibers, hindering the flow of signals between the brain and body. “I use the analogy of a garden hose,” Echo says. “Water is going through the

hose, but if you step on it, only a limited amount will go through. When you take your foot off the hose, the flow returns. From a rudimentary standpoint, it’s like nerves when they’re

kinked because of pressure from fascia or surrounding tissues or scar tissue, then the signals are not going to go back and forth as they should, and it will manifest as weakness, pain or

paralysis.” Sandra’s pain diminished significantly. Owen Freeman THE ROAD BACK In April 2023, Echo operated to decompress her lateral femoral cutaneous and lateral femoral nerves. “My goal

was to improve her pain,” he says. “I had no expectations of her being able to move her leg and walk again.” Carlson says immediately afterward her leg felt warm, instead of icy cold. Her

pain diminished. In August 2023, Echo operated again, to decompress Carlson’s sciatic and common peroneal nerves. Carlson began to feel creepy-crawly sensations down her leg as the nerve

began conducting signals again. “She started getting muscle function back,” Echo says. “That was the surprising part.” The transformation was rapid and amazing. Carlson stopped taking

Dilaudid two weeks later. She was out of her wheelchair in October. By December she was no longer incontinent. The journey wasn’t over by any means, however. Her left knee was “frozen” and

unbendable due to arthrofibrosis, the build-up of scar tissue in the joint from disuse. But she could walk, with crutches. Carlson returned to Houston Methodist for knee surgery in April

2024 to remove scar tissue and restore her range of motion. _I can move fairly normally. I don’t use a wheelchair. I don’t use crutches. I was praying for a miracle every day of my life. God

was tired of hearing from me. I just wanted this one miracle, and he gave it to me through Dr. Echo. I just had to keep my faith. It was hard, but God gave me a test, and I passed it

through Dr. Echo. I am a nonquitter._ In late September of 2024, she underwent another surgery to address lingering nerve pain in her knee and ankle. Throughout this time, she has continued

physical therapy in Savannah and for a while in Houston, after her knee procedure. She exercises several times a day at home. By last spring, Sandra could walk unaided. Owen Freeman HAPPY

TEARS “She’s conquered so much,” says physical therapy assistant Jennifer Poston, who has worked one-on-one with Carlson at Fife Therapy in Savannah since 2020. “Her pain was so bad. When

she walked into physical therapy after her surgeries, not in a wheelchair, we all cried. It’s been a powerful, emotional journey.” Echo says he sees many patients like Carlson who’ve

consulted many specialists for unexplained pain and loss of muscle function before finding out the cause is nerve compression. The condition, also called pinched nerve or nerve entrapment

syndrome, can happen to nerves throughout the body. An estimated 10 percent of adults experience some type of neuropathic pain. The most widely recognized type is carpal tunnel syndrome, in

which the median nerve to the hand gets squeezed in a bony passageway between the wrist and palm. “Many of my patients have seen 10 to 20 different specialists by the time they are diagnosed

with a peripheral nerve problem,” he says. There are few nerve compression surgeons practicing in the U.S., he notes, and there has been low awareness of nerve compression in the medical

community. “A lot of very good doctors in their own specialties may overlook the peripheral nervous system as a source of chronic pain. Neurosurgeons look at the brain and the spinal cord.

Others, such as orthopedists, look to find out if there is a musculoskeletal problem.” Nerve compression can be difficult to diagnose. “There are no numerical tests that can measure the

amount of pain that a patient is having,” says Tung, the Washington University School of Medicine plastic surgeon. He specializes in peripheral nerve compression. “Electrical studies [of

nerves and muscles] are part of it, but a big part also is examining the patient, and it relies a lot more on the physician’s physical and clinical diagnostic skills.” As a result,

compressed nerves may be misdiagnosed or overlooked, according to a 2021 textbook on the subject. Various types of painful nerve compression have been misdiagnosed as a psychological

problem, infections, an inflamed prostate, failed back surgery, or foot problems like plantar fasciitis and heel spurs. Searching for answers can take time and determination, Echo says.

Carlson “was trying hard to get better, looking at all the options. Seeing her walk when she assumed that she would never walk again and be in a wheelchair for the rest of her life was

amazing.” For Sandra and Travis Carlson, it was a miracle.