The Road to Recovery with Norman Marcus, M.D.

New York, N.Y.  “Jim” is a Marine who is currently being treated for chronic pain by Norman Marcus, MD. With an effective and innovative treatment intervention, Jim avoided spinal surgery and most of his pain is gone.

I served in Iraq and Afghanistan. I was deployed three times. My first tour was in Iraq for eight and a half months. My second time, I was in Iraq for 11 months and my third deployment was cut short when I was in an IED explosion in Afghanistan on ground patrol in a 50 caliber Machine Gunner driving along. It was a 50-60lb charge. I had on knee and elbow pads, hard hat, but sustained multiple injuries.” —Jim

Can you describe your injuries?

The IED explosion cost me a fractured hip, two cracked knees, holes in my left arm, broken right and left ankles, and three herniated disks in my spine (upper and lower back). Also, after the explosion, I was deaf for a couple of weeks. They sent me to a camp where they try to “heal” you up and then sent me back stateside. I had severe black spots in my eyes, severe arthritis, a cracked femur, broken pelvis and it took a year and a half for me to go through major recovery. I have pain all over my body. I thought I’d have to live with this pain for the rest of my life. I also suffer from typical symptoms of PTSD, which include nightmares, sleep disorders, trouble with keeping my cool, and anxiety.

How did you find your way to Norman Marcus, M.D.?

I found him through TRICARE management doctors. I was looking for a good pain doctor. One person told me he knew a guy that knew a guy. Norman came highly recommended. He under-stands me and is very empathic. I can relate to him about things. He’s not only my doctor—who’s made an amazing difference—but also a good man and father figure.

What was different about this new treatment?

First of all, he looked at the areas where I was complaining of pain to see if the muscles there might be involved. This was different because up until then most of my doctors were looking at my spine and thought that unless I had sur-gery on the spine I couldn’t get better. He found a load of muscles that were tender with an instrument that he uses and he told me that this is where most of my pain came from. But, he also saw how tense I was and said he couldn’t do anything before I first did his exercises to help me relax and start to stretch the muscles which had become very tight. It took me more than a month to learn and do the exercises and it did help some but I still had serious pain. That’s when he started his injection treatment of the muscles and it has really worked.

Norman Marcus’ procedure made all the difference. That’s why I am happy to speak about his treatment to bring it to others’ attention.

It is wonderful for you to spread the word to your comrades who might also suffer from chronic pain due to war injuries. Back pain is the number one injury reported by returning veterans. Is there anything you would like people to understand from your time in combat?

Marines are different. We lead the way. We are the first ones in and last ones out in any conflict. The Marine Corp mindset is it’s all or nothing. One hundred percent is given to accomplish a mission. There is no room for error. We have a saying, “Check, Preparedness, Improvise.” If I’m told I have to go through a wall, I have to find a way to do it. There’s no “I can’t.” The job of a warrior is to kill the enemy. It is not something we enjoy doing. It is not for money. It has to be done to protect the people of our nation and it is my job to do it for you.

When you take another man’s life, it is a big responsibility. When a life is gone, that person is erased like a line on a piece of paper. I have to face the fact that I killed someone. I have to face the fact that I’d do it again in a heartbeat if our way of life is threatened or endangered. Freedom is not free. There’s a price for freedom. The question should be, “Was progress made through the actions that were taken in Iraq and Afghanistan?” Most people’s eye is on the action instead of the goal. The goal is to have a democracy. In some of these countries, they have no state, no government. There’s manipulation to the fullest. Once you see these things you realize that America is the most incredible nation in the world. I believe as an American and a Marine I was defending and upholding democracy.

“I have pain all over my body. I thought I’d have to live with this pain for the rest of my life.”

Treating a Hero

Jim’s pain was the result of many things. His physical pain stemmed predominately from muscles and once they were properly identified and treated, he began to experience relief for the first time. Back pain leads to many unsuccessful spine surgeries because muscle, the major reason for back pain, is overlooked. Jim was spared from back surgery, but this was only part of the story.

Often, returning military members need pain medication and misuse them by taking more than the prescribed dosage. In certain cases, as with our injured Marine, addiction occurs. We had plans to meet for our final interview for this article and he arrived looking disheveled with slurred speech, “high” on his medication and possibly alcohol as well. Dr. Marcus told him firmly but gently that he had disrespected himself arriving in this condition, making it impossible to conduct the interview. He was visibly embarrassed . Marcus said, “How many relationships has this problem cost you?” The Marine answered “Three.” Norman said, “If you think three, it’s a lot more. I can’t continue to treat you if you are not in a 12-step program and seeing a therapist at the VA. I will have to get a call from your sponsor that you are attending daily meetings for me to continue treating you.” Marcus explained, “I can’t risk giving him injections when I don’t know what other chemicals are in his body. He has to be clean and sober to be treated.” There are drug interactions and Dr. Marcus couldn’t be sure if Jim was being honest about what he was taking before or after their visits. In this case, this young man was self-medicating not only his physical pain, but his emotional pain as well.

Pain medications will address both physical and emotional pain. Pain killers are more effective for longer periods of time in altering mood than they are for reducing pain. This is the foundation for the problem of abuse in soldiers who are also struggling with painful emotions. Eventually, as they are taking medication for physical pain they stop differentiating their physical from their emotional pain. Any pain or discomfort comes under the umbrella of “pain” and then any discomfort can be an excuse to grab their pain killers. The relief from these medications is temporary at best. What is left when the medications wear off are the feelings they’ve been trying to avoid: pain, sadness, and ultimately fear. These are not easy emotions for anyone, even a soldier, to confront.

One of the problems is that young soldiers may not be ready to handle the level of stress associated with actual or anticipated battle. Better screening could possibly identify who will be at higher risk. These young men, for the most part, are running on adrenaline and testosterone. What happens to all of those other feelings, such as, loneliness, sadness and fear? Do they have the ability to cope with them without adopting maladaptive behavior? Those who come from healthy, stable families might do better than those who do not. Training of these young men should take into account their emotional needs. We have to find a way to decrease the incidence of post-traumatic stress, substance abuse, and associated chronic pain syndromes.

Given the military credo is to be tough and not show fear or pain, getting soldiers to reveal themselves is a challenge. Treating returning veterans who suffer with complex pain problems is difficult. No one specialist can take on all the work necessary to help these men and women reintegrate into civilian life. What is needed is an interdisciplinary approach with staff skilled in pain management, physical rehabilitation, addiction, psychiatric medication, and psychological interventions to give them all the help they may need.

It is so apparent how extreme war is as you say this. I can understand how so many return-ing military members suffer from post-traumatic stress. You have experienced things no one should. There is an emotional cost in having made the sacrifice that you have for our country. We must remember that.

You are right about there being a cost. My family has participated in war since the before this country was born. My ancestors have fought in every conflict since 1775. Back 15 generations. One of the greatest Marines was Chesty Puller. He received 7 Navy Crosses, which is the highest honor except the Medal of Honor. I feel honored to have followed in such great men’s footsteps. Once a Marine, always a Marine. Endurance is the Marine’s Creed. I have endured through all that I have experienced and I find strength in that.

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About Lorraine Cancro, MSW: Eye on Humanity

View all posts by Lorraine Cancro, MSW: Eye on Humanity
Lorraine Cancro, MSW: Eye on Humanity
Lorraine Cancro, MSW is a Clinical Social Worker and Executive Director of the Global Stress Initiative (GSI) a program focused on early detection and prevention of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) among returning military members, their families, and civilian survivors of trauma. She also serves on the Medical Advisory Board for Stand for the Troops which spearheads research on TBI and PTSD among returning military members and is Global Adviser to the Luce Foundation. She is an active advocate raising awareness of the growing numbers of people impacted by TBI and PTSD for several publications addressing mental health issues.