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Why I left my tech job to work on chronic pain

(sailhealth.substack.com)
330 points glasscannon | 4 comments | 04 Jul 25 12:50 UTC | HN request time: 2.465s | source
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mattgreenrocks ◴[04 Jul 25 13:53 UTC] No.44464592[source]▶
I’ve been dealing with chronic reflux for about 8 mos now. On PPIs and they don’t seem to do much. But once I get away from my typical routine of work/dadding then all the symptoms vanish, even to the point of being able to eat foods that are not good for reflux: spicy things, tomatoes, a bit of coffee. In my case, this is absolutely a downstream symptom of something mind-body. Already been scoped and got a diagnosis of visceral hypersensitivity, which is medical speak for “nerves in esophagus are too sensitive.”

The question of why is out of scope.

In this case, docs just don’t know why. (I think it kinda pisses them off not know, tbh). And finding out is not really in their wheelhouse.

I’ve made some life changes (new job) to see what happens here. But I also have to be prepared for the possibility that it doesn’t fix it. Been working through The Body Keeps The Score as well.

Looking forward to seeing what the author discusses here.

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eddythompson80 ◴[04 Jul 25 14:22 UTC] No.44464819[source]▶
> In this case, docs just don’t know why. (I think it kinda pisses them off not know, tbh). And finding out is not really in their wheelhouse.

Chronic reflux as a symptom is almost always initially treated by PPIs because the cause among white collar workers is assumed to be chronic stress[1]. Since doctors can't "treat stress" only its symptoms, they will just tell you to try and manage stressors in your life yourself. Maybe suggest counseling but in general they are limited in what they can do. What they can do, if you are persistent in the complaint, is to just run through all the other less likely causes of it.

I was lucky omeprazole worked for me the first time. I knew exactly what was stressing me out 24/7 and the acid reflux and frequent belching combined with the "pit in my stomach" feeling was all too common and connected around my main stressor. In my case, it started 8 months after accepting a role shift from engineering into management. I was cautiously excited initially, but it just soured very quickly. I would feel physical angst parking at work every morning trying to remind myself of all the web of political infighting "what our team is hiding from this other team", "who we can discuss what with", "how that other team is actively undermining us and their other downstream partners, but how we are circumventing that" how to 4d chess maneuver yourself in the most counterproductive ways possible. It was illuminating on where a lot of those special "business requirements" come from sometimes, but it just wasn't for me. Cutting that out was a massive relief

[1]: Stress and glucocorticoids have well documented effects on the digestive system. I recommend the "Why Zebras Don't Get Ulcers" book chapter on stress and the digestive system.

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1. qzw ◴[04 Jul 25 14:43 UTC] No.44465008[source]▶
Western medicine “can’t treat stress” but Eastern medicine definitely claims to be able to. But then so do various nebulous “alternative medicines”. Another comment mentioned deep meditation as being effective, and I believe there are a number of studies that have shown it to have actual effect. I’ll add another tried and true stress cure but with a twist. Exercise has consistently been shown to help reduce stress, but I find that you have to pick an activity that’s different than what you normally do, e.g. if you’re a runner, try swimming or tennis. The goal is to actually raise the stress level while exercising by doing something unfamiliar and therefore more challenging. In my experience, if the exercise is too relaxed or routine, it doesn’t allow your mind to disengage from the other stressors that are causing symptoms. Of course, all this is pure anecdata from an internet rando.
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2. Aurornis ◴[04 Jul 25 14:51 UTC] No.44465073[source]▶
> Western medicine “can’t treat stress”

This is false. Therapy is designed to do just this and it’s readily available in different modalities that have been trialed and studied. You can book an appointment with a therapist today and start working on techniques to build stress resilience and stress handling techniques

> but Eastern medicine definitely claims to be able to. But then so do various nebulous “alternative medicines”.

Much of the allure of so-called Eastern medicines is the feeling that it’s ancient, semi-secret knowledge that is mysteriously superior to modern medicine. There are a lot of herbal medicines that kind of do something, but the effects are small and often prone to rapid tolerance build up and side effects. A large part of the efficacy is getting the patient to believe that the medicine and/or practices are a cure for their ills. Feeling like you’re tapping in to a mysterious ancient solution to stress will encourage a very strong placebo effect, which can actually reduce the stress.

Similarly, when we do randomized trials of medicines for depressive disorder it’s incredible how much the placebo group improves. When people have been told they’re receiving a treatment, it usually helps to some extent even if the treatment does nothing at all!

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3. sampullman ◴[04 Jul 25 15:26 UTC] No.44465348[source]▶
I don't think the allure of Eastern medicine has much to do with a feeling that it's ancient or secret. It's pretty normal here in Taiwan to go to a TCM clinic here in Taiwan for various treatments, including stress. The practitioners have degrees and certifications for it.

I can't say how much is placebo, but there isn't really anything mysterious about it.

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4. Aurornis ◴[04 Jul 25 15:41 UTC] No.44465494{3}[source]▶
The ancient and mysterious part is the idea that it’s based on wisdom passed down through generations and herbal concoctions, as opposed to synthetic medicines tested in RCTs. This is precisely what draws a lot of people to it, and why it falls in the category of alternative medicine.

It’s actually very interesting that many of the herbal compounds they use do have some quantifiable biological activities. So it’s not all placebo, but you’ll also discover that many of the herbs being sold don’t contain the ingredients they claim, don’t contain enough active ingredients to do anything, or might even be contaminated.

I once asked some doctor friends what things they’ll never do after seeing the consequences in their patients. One of the most surprising answers, to me, was that they avoided TCM and Avurvedic medicines. Apparently they see a lot of people come in with elevated liver enzymes or signs of kidney problems and discover that some TCM or Ayurvedic herbal remedy is causing the damage. Discontinuing the supplement can stop the damage. This happens with megadoses of other supplements too, especially some of the things peddled to gym bros. However, TCM and Ayurvedic supplements seem to catch people by surprise because they assume it’s safer.