Like many pain management specialists, Dr. McKenna began his practice as an anesthesiologist. The Saratoga, California, native got his medical degree from Harvard University and moved here to join Anesthesiology Consultants Inc. in 1988, when he was 30 years old. Here are the highlights from his recent interview with Heidi Kyser:
Anybody in the medical field was revered by my family. I remember if a nurse or doctor said something, it was like God speaking.
I dislocated my shoulder several times playing football and ended up having to have an operation. I was very intrigued by the orthopedic surgeon and the fact that he made me better.
I just knocked door to door at Stanford Medical Center, and the doctor who ran the pathology laboratory, Howard Sussman, hired me as a lab assistant. I did things the average undergraduate doesn’t do. I had to harvest enzymes from different body structures, I had to go to the pathology lab, and if I needed bone, I had to extract it. It was really cool. I learned that I loved biology.
My junior year I did my surgical clinical rotation at Mass General. I thought it was really rewarding to take care of super-sick, critically ill patients, so I ended up spending a lot of time in the ICU, and the guys running it were the anesthesiologists, so I met a lot of them. I thought what they did was really neat, because it’s so scientific.
There’s lots of pain management in the Yellow Pages, but the American Board of Medical Specialties has designated only three bodies [the American Board of Anesthesiology, the American Board of Physical Medicine and Rehabilitation and the American Board of Neurology and Psychiatry] that can provide board-certification status. That’s a pretty rigorous system that you have to go through. So, the first thing to do is ask, “Are these people really subspecialized and board-certified?” Only a handful have that certification.
Pain is a perception, so there can be a significant psychological component, but typically there is some sort of underlying physiological cause. We ask patients questions that give us an idea of their functional status, and then we measure their perceived pain. Obviously, you’re measuring that against the same person, so if it’s a 10 in your mind, and the next time I see you it’s only an eight, that would still tell me that what I’m doing is working—even if a 10 in your mind is only a two in someone else’s.
Our goal is to intervene in a way that diagnoses the source of somebody’s pain and then provides a treatment that either eliminates or significantly diminishes the pain. Then we treat the residual pain with other means, whether that be exercise, physical therapy or medications.
Bottom line is, after surgery, pain control is critical, because it allows the patient to get up and move, which prevents deep-venous thrombosis, pneumonia and other complications.
One of my first patients in private practice was a gentleman with a malignant renal-cell cancer. I surgically implanted a pump in him, and we managed his pain. He ended up going out of town for several months, and when he came back he was admitted to the hospital. It was obvious he was going to pass away in the next several days. I went to see him, and he looked at me and said, “You allowed me to get to know my grandkids.”