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First PM Appointment...Big Disappointment!
I just came back from my pm appointment. I am surprised and amazed that I spent 200.00 for him to tell me that I have chronic low back pain, that I will have for the rest of my life..I'm 43, that he didn't think surgery would be an option because of the risk of scar tissue would make it worst...and that he would only prescribe what my pcp (a physicians assistant) is giving me which is flexeril and ultram, both of which are absolutely not helping whatsoever. He wants to give me epidural injections, three in a row, a week apart, at 600.00 each....with no guarantee that it would be beneficial.
I left there trying to hold back tears....Because the future looks so dismal.....I don't want to live the rest of my life like this....The only thing I'm accomplishing is getting to work, as a one person barbershop owner, and trying to get into the car at the end of the day. Once I'm at home, all I can do is try to rest and hope to feel better for the next work day. The weekends are purely nothing but recovering from the previous week....I have no idea what type of work I could do, or learn to do at this point...I've been barbering for 18 years.....
I have a disc that is pressing on a nerve root, causing severe pain in my lower back and hip and thigh.
I just don't know what to do....
I left there trying to hold back tears....Because the future looks so dismal.....I don't want to live the rest of my life like this....The only thing I'm accomplishing is getting to work, as a one person barbershop owner, and trying to get into the car at the end of the day. Once I'm at home, all I can do is try to rest and hope to feel better for the next work day. The weekends are purely nothing but recovering from the previous week....I have no idea what type of work I could do, or learn to do at this point...I've been barbering for 18 years.....
I have a disc that is pressing on a nerve root, causing severe pain in my lower back and hip and thigh.
I just don't know what to do....
With an MRI report like that, you certainly need a neurosurgeon. There is a fairly new surgery that involves the implanting of a device called the X-stop. Rather than the old way of removing the offending disc, fusing vertebrae and maybe even using metal plates to hold the mess together, these little spacers are used to take the pressure off the nerve. Since you also have scoliosis, the X-stop could be invaluable to you both now and in the future.
The procedure is fast and very minimally invasive so it's done on an outpatient basis. Since it's fairly new, not every neurosurgeon is even aware of the product or thesurgical process of installing it. This spacer was developed primarily for older patients with spinal stenosis that causes discs to rupture. You may, or may not be a candidate for it but it certainly won't hurt to ask.
Not all pain docs are created equally. Some are "shot jockeys" and refuse to prescribe narcotic meds. That's their right as physicians. There are pros and cons to narcotic therapy so I can't say that I blame docs who choose not to use that therapy in their practice. Epidural injections can help a great deal; and sometimes not. You don't know until you give it a try. Some pain docs will consider narcotic therapy but only after everything else like physical therapy and injections have been tried.
There is no magic cure for chronic pain, and nerve pain is notoriously difficult to treat. The goal isn't to cure your pain, but to lessen your pain to a manageable level that you can live with. Keep on searching for solutions, and try to keep the lines of communication open with your doctors. Do your own research too so you can have a conversation with the docs in their own language. If you tend to forget questions during appointments, write them down. Above all, never give up. :-)
The procedure is fast and very minimally invasive so it's done on an outpatient basis. Since it's fairly new, not every neurosurgeon is even aware of the product or thesurgical process of installing it. This spacer was developed primarily for older patients with spinal stenosis that causes discs to rupture. You may, or may not be a candidate for it but it certainly won't hurt to ask.
Not all pain docs are created equally. Some are "shot jockeys" and refuse to prescribe narcotic meds. That's their right as physicians. There are pros and cons to narcotic therapy so I can't say that I blame docs who choose not to use that therapy in their practice. Epidural injections can help a great deal; and sometimes not. You don't know until you give it a try. Some pain docs will consider narcotic therapy but only after everything else like physical therapy and injections have been tried.
There is no magic cure for chronic pain, and nerve pain is notoriously difficult to treat. The goal isn't to cure your pain, but to lessen your pain to a manageable level that you can live with. Keep on searching for solutions, and try to keep the lines of communication open with your doctors. Do your own research too so you can have a conversation with the docs in their own language. If you tend to forget questions during appointments, write them down. Above all, never give up. :-)
I am so grateful and thankful for your replies. I don't feel so all alone dealing with this...8)
So, what I was hoping for was to be prescribed medication that would enable me to function and do everyday tasks, like of course - working, bathing the dog, mopping the floors etc. I would like for my level of pain to allow me to walk daily, like I used to before the pain got this bad.
I've always had pain, due to a car accident when I was 11, a fall at work when I was 17 - both of which I had physical therapy for, a rollerblading fall when I was about 34 (the end of my roller blading career). I just used to have flare-ups lasting about a week to ten days, generally. and a lower level of pain all the time. It's gradually gotten worse the past few years. This past October, I had what I thought was one of my normal flare-ups, but it didn't get better. I have some days better than others, and certain times of the day where it's more bearable. But pretty much, everyday I have severe debilitating pain, especially when I am working.
The impression from my MRI is this.....
1. scoliosis of the lumbar spine with a convexity to the right.
2. Loss of lumbar lordisis.
3. Mild retrolisthesis of L5 over S1. Moderate diffuse annular bulge with medium sized central, right paracentral and lateral extrusion of intervening disc intenting the thecal sac and compressing the right exiting L5 nerve root. Partial obliteration of the foraminal fat is identified by this diffuse bulge more so on the right. Extruded disc fratment measures 7.93 x 4.61 mm.
4. Mild diffuse annular bulge of L4 disc intenting the thecal sac. Mild bilateral facet osteoarthropathy at this level.
5. Large uterus with fibroids
So the doctor today saw this, and also an xray from 2002...with the findings regarding my spine....
PLAIN FILMS CERVICAL SPINE: The odontoid is incompletely seen on open-mouth odontoid view but appears grossly intact on the lateral view. Some straightening of cervical spine is evident which may be related to muscle spasm. Cervical disc spaces and vertebral body heights appear reasonably well maintained with otherwise good alignment seen. Neural foramina appear patent. No prevertebral soft tissue swelling is evident. Pre dens space is within normal limits.
PLAIN FILMS THORACIC SPINE: Twelve rib pairs are evident. Pedicles appear intact. Mild levoscoliosis is evident. Osteophytic spurring is evident multifocally. Thoracic disc spaces and vertebral body heights appear reasonably well maintained with otherwise good alignment seen.
PLAIN FILMS LUBAR SPINE: Lumbar dextroscoliosis is evident with pedicles intact. Slight disc space narrowing is evident at lower three lumbar levels. Vertebral body heights appear reasonably well mainained. Mild multifocal osteophytic spurring is seen. Probable pelvic phleboliths are evident.
Also, in the past year, the pain is now in my right hip and front of my right thigh. It seems like when my back pain is better, the hip and thigh is worse...that pain is more of a burning sensation verses the back which feels like a knife in my back with alot of pressure. At times my knees just give and I feel like I'm going to fall unless I grab onto something. Or if I sit, I sometimes can't get back up or have to use my arms to pull myself up.
I know that my pain is not as bad as some people's pain, but my life now revolves around it.
I don't have health insurance. And haven't had any since my divorce in January of 05. I've barely been able to keep myself and two children afloat since then, as they have turned 18 and their father no longer contributes, however they still live with me and both are going to the local communtiy college, which their father doesn't help with. Added to the fact that my pre-existing condition is documented, I haven't even tried to get insurance for myself. I was dealing with it by walking, which I am not doing any more, ice, hot baths, tons of ibuprophin and a couple of glasses of red wine at the end of the day.
All of the advice you guys have given me has been very helpful. I am thinking I will write an email to my pcp, because I seem to forget to mention things to him when I'm there and let him know how things went today. And as far as the "Best of", I'm in the Central Florida area, and there's a magazine that publishes an annual "Best Doctor" thing that is voted on by peers. And you are probably right that a neuro doctor would be the best for me to try.
Thanks again, and I'm so glad I found this forum.
So, what I was hoping for was to be prescribed medication that would enable me to function and do everyday tasks, like of course - working, bathing the dog, mopping the floors etc. I would like for my level of pain to allow me to walk daily, like I used to before the pain got this bad.
I've always had pain, due to a car accident when I was 11, a fall at work when I was 17 - both of which I had physical therapy for, a rollerblading fall when I was about 34 (the end of my roller blading career). I just used to have flare-ups lasting about a week to ten days, generally. and a lower level of pain all the time. It's gradually gotten worse the past few years. This past October, I had what I thought was one of my normal flare-ups, but it didn't get better. I have some days better than others, and certain times of the day where it's more bearable. But pretty much, everyday I have severe debilitating pain, especially when I am working.
The impression from my MRI is this.....
1. scoliosis of the lumbar spine with a convexity to the right.
2. Loss of lumbar lordisis.
3. Mild retrolisthesis of L5 over S1. Moderate diffuse annular bulge with medium sized central, right paracentral and lateral extrusion of intervening disc intenting the thecal sac and compressing the right exiting L5 nerve root. Partial obliteration of the foraminal fat is identified by this diffuse bulge more so on the right. Extruded disc fratment measures 7.93 x 4.61 mm.
4. Mild diffuse annular bulge of L4 disc intenting the thecal sac. Mild bilateral facet osteoarthropathy at this level.
5. Large uterus with fibroids
So the doctor today saw this, and also an xray from 2002...with the findings regarding my spine....
PLAIN FILMS CERVICAL SPINE: The odontoid is incompletely seen on open-mouth odontoid view but appears grossly intact on the lateral view. Some straightening of cervical spine is evident which may be related to muscle spasm. Cervical disc spaces and vertebral body heights appear reasonably well maintained with otherwise good alignment seen. Neural foramina appear patent. No prevertebral soft tissue swelling is evident. Pre dens space is within normal limits.
PLAIN FILMS THORACIC SPINE: Twelve rib pairs are evident. Pedicles appear intact. Mild levoscoliosis is evident. Osteophytic spurring is evident multifocally. Thoracic disc spaces and vertebral body heights appear reasonably well maintained with otherwise good alignment seen.
PLAIN FILMS LUBAR SPINE: Lumbar dextroscoliosis is evident with pedicles intact. Slight disc space narrowing is evident at lower three lumbar levels. Vertebral body heights appear reasonably well mainained. Mild multifocal osteophytic spurring is seen. Probable pelvic phleboliths are evident.
Also, in the past year, the pain is now in my right hip and front of my right thigh. It seems like when my back pain is better, the hip and thigh is worse...that pain is more of a burning sensation verses the back which feels like a knife in my back with alot of pressure. At times my knees just give and I feel like I'm going to fall unless I grab onto something. Or if I sit, I sometimes can't get back up or have to use my arms to pull myself up.
I know that my pain is not as bad as some people's pain, but my life now revolves around it.
I don't have health insurance. And haven't had any since my divorce in January of 05. I've barely been able to keep myself and two children afloat since then, as they have turned 18 and their father no longer contributes, however they still live with me and both are going to the local communtiy college, which their father doesn't help with. Added to the fact that my pre-existing condition is documented, I haven't even tried to get insurance for myself. I was dealing with it by walking, which I am not doing any more, ice, hot baths, tons of ibuprophin and a couple of glasses of red wine at the end of the day.
All of the advice you guys have given me has been very helpful. I am thinking I will write an email to my pcp, because I seem to forget to mention things to him when I'm there and let him know how things went today. And as far as the "Best of", I'm in the Central Florida area, and there's a magazine that publishes an annual "Best Doctor" thing that is voted on by peers. And you are probably right that a neuro doctor would be the best for me to try.
Thanks again, and I'm so glad I found this forum.
Tough situation, no doubt. However there are routes to take. Helpless or hopeless, you are not. First things first. I assume your pcp, referred this last appt for you. If they did, they too are probabley taking a more conservative route with your treatment as can be seen with the meds you are on and the action as to diagnosis and treatment performed thus far. Have you had an MRI or CAT scan. If so , what was the impression? Which disc level is at question? How long has this been of issue?
Short of having these and answers to other questions, I would first look at finding a spinal surgeon to speak to evaluate your condition. Orthos are OK, but you want a, SPECIALIST. A neurosurgical Surgeon. Now, some people will say these Doctors are cut happy, however when we speak of Neurospecialist, they are truly the best to ascertain not only the point(s) of issue, but also the best way to resolve it. This is not always by surgical intervention. Depending where you live, there are great ways to find the best, of the best. Here in RI, we have a state magazine who publishes each year, an issue called, "Top Doctors". These are Doctors that are voted on by, other doctors. a, who would you as a Doctor, see yourself. These are no doubt the best. Check your area. Also, word of mouth is indeed the oldest and one of the forth telling, if enough people are asked. The law of averages apply there. Depending on your insurance coverage, you can seek out your Doctor, and not need a referral by your Doctor. As I read your post, it looks as though you are paying out of pocket. Make your money counts. As to injections, they are subjective. They are however, one of the beginning routes taken when a conservative route is elected, or the Doctor can find no hard evidence of nerve intrapment or disc deteroration. So make sure your next Doctor of choice will enlighten your actual underlying condition, not just a mask of injection(s) to cover over the problem. There are many new advances in Neuro-Spinal techniques and procedures, so get ALL the facts first, and then proceed in your best interest. Non-Invasive is now the norm. I realize you are on your feet all day, and was in construction myself, so I absolutely know what your day and worse yet, your late afternoon and evenings are like. The numb, aching fire like pain that interchanges with a different seating position or roll over, just to have it creap back in 2-3 minutes. I know the feeling. I've battle back pain for 20 years. Had about every test performed. Had 3 surgeries and still have to take the medicinal equivalent of an "end Stage" Cancer Patient. On good days, I get 70% relief, on bad days I get 50, and thats with meds that make anything else for that day, impossible. For you, medicine today gives much much better hope. Act one stage at a time. Do research on the options. Get advice from people on sites like here, to help explain the turns and bumps along the way. Good luck !
Short of having these and answers to other questions, I would first look at finding a spinal surgeon to speak to evaluate your condition. Orthos are OK, but you want a, SPECIALIST. A neurosurgical Surgeon. Now, some people will say these Doctors are cut happy, however when we speak of Neurospecialist, they are truly the best to ascertain not only the point(s) of issue, but also the best way to resolve it. This is not always by surgical intervention. Depending where you live, there are great ways to find the best, of the best. Here in RI, we have a state magazine who publishes each year, an issue called, "Top Doctors". These are Doctors that are voted on by, other doctors. a, who would you as a Doctor, see yourself. These are no doubt the best. Check your area. Also, word of mouth is indeed the oldest and one of the forth telling, if enough people are asked. The law of averages apply there. Depending on your insurance coverage, you can seek out your Doctor, and not need a referral by your Doctor. As I read your post, it looks as though you are paying out of pocket. Make your money counts. As to injections, they are subjective. They are however, one of the beginning routes taken when a conservative route is elected, or the Doctor can find no hard evidence of nerve intrapment or disc deteroration. So make sure your next Doctor of choice will enlighten your actual underlying condition, not just a mask of injection(s) to cover over the problem. There are many new advances in Neuro-Spinal techniques and procedures, so get ALL the facts first, and then proceed in your best interest. Non-Invasive is now the norm. I realize you are on your feet all day, and was in construction myself, so I absolutely know what your day and worse yet, your late afternoon and evenings are like. The numb, aching fire like pain that interchanges with a different seating position or roll over, just to have it creap back in 2-3 minutes. I know the feeling. I've battle back pain for 20 years. Had about every test performed. Had 3 surgeries and still have to take the medicinal equivalent of an "end Stage" Cancer Patient. On good days, I get 70% relief, on bad days I get 50, and thats with meds that make anything else for that day, impossible. For you, medicine today gives much much better hope. Act one stage at a time. Do research on the options. Get advice from people on sites like here, to help explain the turns and bumps along the way. Good luck !
That is the question all PM doctors ask you.
What are your goals and expectations from pain management?
this will allow them to see what you want out of your treatment so they will know what approaches to look at as far as options.
I am assuming your number one goal is to be able to manage your pain. That is a good one to start with. As far as expectations goes mine were to be able to have a pain level at which I could function as live my life as normal as possible. I expect my doctor to listen to me as far as what I want to try and be able to dismiss what I do not from the options the doctor is offering.
You are hiring a PM doctor to level out your pain and give you a quality of life you would not have without pain management.
Explain to your PCP that this doctor was not willing to listen to you and wishes to push you into procedures your not willing to try at this point.
You have to be your own advocate and express your concerns and make known that you are willing to listen to what the doctor is offering but be able to speak out when that option isn't right for you.
There are some hoops you will have to jump through , we all have but do not be pushed into something you do not want.
There are very controversial views on these blocks. Some doctors are all for them and other's who see them as being more harmful.
You have spent alot of money to be told what you already knew and given medications know does not work. Call your PCP and
explain that your appointment did not go well and ask can he/she refer you elsewhere. Also tell the doctor the medications are not controlling your pain and see what other options they can offer you until you get into see another PM doctor.
Finding the right PM doctor is very important. You may see two three or even more before finding the right one for you. We have all been there. Do not give up as there are some
really great ones out there.
It is so frustrating I know believe me. I had to see several before finding mt first great PM doctor but when I finally did it was worth the time aggravation and money spent.
I wish you the best, keep us updated and we will help any way we can:)
What are your goals and expectations from pain management?
this will allow them to see what you want out of your treatment so they will know what approaches to look at as far as options.
I am assuming your number one goal is to be able to manage your pain. That is a good one to start with. As far as expectations goes mine were to be able to have a pain level at which I could function as live my life as normal as possible. I expect my doctor to listen to me as far as what I want to try and be able to dismiss what I do not from the options the doctor is offering.
You are hiring a PM doctor to level out your pain and give you a quality of life you would not have without pain management.
Explain to your PCP that this doctor was not willing to listen to you and wishes to push you into procedures your not willing to try at this point.
You have to be your own advocate and express your concerns and make known that you are willing to listen to what the doctor is offering but be able to speak out when that option isn't right for you.
There are some hoops you will have to jump through , we all have but do not be pushed into something you do not want.
There are very controversial views on these blocks. Some doctors are all for them and other's who see them as being more harmful.
You have spent alot of money to be told what you already knew and given medications know does not work. Call your PCP and
explain that your appointment did not go well and ask can he/she refer you elsewhere. Also tell the doctor the medications are not controlling your pain and see what other options they can offer you until you get into see another PM doctor.
Finding the right PM doctor is very important. You may see two three or even more before finding the right one for you. We have all been there. Do not give up as there are some
really great ones out there.
It is so frustrating I know believe me. I had to see several before finding mt first great PM doctor but when I finally did it was worth the time aggravation and money spent.
I wish you the best, keep us updated and we will help any way we can:)
From my experience when you start out a new PM doctor you have to follow their treatment suggestions until you have worked your way up and through the treatments. In fact, when I first saw my PM he had me scheduled back the next Monday for an injection. They will exhaust all alternatives before placing you on medication.
What were you hoping for, what were you expecting from the visit? Have you had a MRI to determine you exact diagnosis? Maybe that would provide the PM more information about your situation that would be helpful. I would make sure the PM has all your history too... so you don't have to start from square one. I am sure you are frustrated b/c $200 is alot of money to be tossing to the wind... I wouldn't give up yet. Good luck!
What were you hoping for, what were you expecting from the visit? Have you had a MRI to determine you exact diagnosis? Maybe that would provide the PM more information about your situation that would be helpful. I would make sure the PM has all your history too... so you don't have to start from square one. I am sure you are frustrated b/c $200 is alot of money to be tossing to the wind... I wouldn't give up yet. Good luck!
It's amazing the money we spend for a Pain Specialist to tell you what you already knew. You really need to move on and find another provider. As your looking, inquire about the treatment options for pain. Tell them that your not interested in nerve blocks as I don't think that they work any way and your not interested in Meds that can be prescribed by your PCP. Be totally frank with them.
I know this approach sounds very forward but it works. You need to tell them that you're not new to pain management and NOT going to spend 200.00 for treatment you can get at your PCP office, that your there for real pain management.
Make sure to take all documentation with you.
Sorry that you're so upset. I would be too.
Well wishes,
Mollyrae
I know this approach sounds very forward but it works. You need to tell them that you're not new to pain management and NOT going to spend 200.00 for treatment you can get at your PCP office, that your there for real pain management.
Make sure to take all documentation with you.
Sorry that you're so upset. I would be too.
Well wishes,
Mollyrae
I'm sorry this went so badly for you. I'd go back to the doctor who referred me to this doctor. I'd ask for a referral for a second opinion. Perhaps a referral to another orthopedic surgeon and get an opinion on the surgery.
Scar tissue is an issue. But not everyone gets enough of it to cause a problem. I don't know your history and I don't know if you do.
The injections could help. Some people they do and others they don't. They didn't help my husband and he did the surgery. He's doing much better. But that's not to say it would help you.
I wouldn't give up. Just because this doctor didn't help you doesn't mean there isn't help out there for you. Don't give up.
Good luck.
Scar tissue is an issue. But not everyone gets enough of it to cause a problem. I don't know your history and I don't know if you do.
The injections could help. Some people they do and others they don't. They didn't help my husband and he did the surgery. He's doing much better. But that's not to say it would help you.
I wouldn't give up. Just because this doctor didn't help you doesn't mean there isn't help out there for you. Don't give up.
Good luck.
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