hortonhears1
11-10-2004, 10:30 PM
I have 2 herniated disc in my neck and 1 lumbar. Neuro. doc said no need for surgery. I'm a 43 yr old male who has always worked physical jobs and have been out going on 7 weeks.I have alot of pain in my neck,down arms ,numb hands'lower back pain, butt pain, leg pian and tingling feet. I'm on vicidin 7.5-750 and valuim for spasm's along with nuerotin napraxon and welbutrin xl. sometimes the pain is so bad i almost start to cry. I already sence the relucancy of my w/c doctor to prescribe pain meds. I'm scared that this pain clinic I going to will make me feel the same way.I'm not a junkie, I don't even drink or smoke can someone please let me know what to expect. I don't want to end up buying drugs on the street. thanks in advance :confused:
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kisa
11-11-2004, 04:47 PM
how did PM go?, I have found that they have been very supportive & the only place that did not make me feel like a "Addict". I do hope you had a positive experiance, & they they helped you in some degree. Please let us know, Peace & pain free days sent in your direction :)
hortonhears1
11-12-2004, 11:32 PM
It was probably the worst experence I've ever had with a Dr. No communiction at all . Would only look at my lumbar not my cervical . Took next to no case history and took me into a treatment room and numbed my butt and gave me 5 injections that i still don't know what they were and said see you in a month. Refused to even consider any pain meds because in her veiw my injury did'nt warrant any. and this was not taking in anything to do wth my cervical problems. Unfortunatly this is a work/comp case and I don't have much choice. Thank god I have a caring GP I've been using for years who will give me my meds when I need them. Of course w/c comp won't pay but thats ok.I've been working physical jobs for over 20 years and I never thought I would end up feeling like a criminal just to get relief from pain. Thanks for letting me vent it's been a rough few days. Art
lllblessedlll
11-20-2004, 06:28 AM
It was probably the worst experence I've ever had with a Dr. No communiction at all . Would only look at my lumbar not my cervical . Took next to no case history and took me into a treatment room and numbed my butt and gave me 5 injections that i still don't know what they were and said see you in a month. Refused to even consider any pain meds because in her veiw my injury did'nt warrant any. and this was not taking in anything to do wth my cervical problems. Unfortunatly this is a work/comp case and I don't have much choice. Thank god I have a caring GP I've been using for years who will give me my meds when I need them. Of course w/c comp won't pay but thats ok.I've been working physical jobs for over 20 years and I never thought I would end up feeling like a criminal just to get relief from pain. Thanks for letting me vent it's been a rough few days. Art
Wow, I hope I have better luck when I go next month to pain management. Hi, You sound kinda like me. I have a herniated C 5 and 6 (cervical) and am going next month for my first epidural. I finally got my GP to give me enough pain meds to get me through till I go for the epidurals. You said that they worked with your lumbar area, Did the treatment give you any pain relief? I'm like you, I don't understand these doctors thinking everyone is a drug addict. I mean they see the x-rays and mri's so they should understand that we are in alot of pain. Well I hope you get the relief that your searching for. Take care.
Wow, I hope I have better luck when I go next month to pain management. Hi, You sound kinda like me. I have a herniated C 5 and 6 (cervical) and am going next month for my first epidural. I finally got my GP to give me enough pain meds to get me through till I go for the epidurals. You said that they worked with your lumbar area, Did the treatment give you any pain relief? I'm like you, I don't understand these doctors thinking everyone is a drug addict. I mean they see the x-rays and mri's so they should understand that we are in alot of pain. Well I hope you get the relief that your searching for. Take care.
Shoreline
11-20-2004, 04:36 PM
Hey Horton, I can empathatize with being stuck in the comp system. The doctors are contracted by the insurance carrreer and are insurance friendly. If their return to work rate is too low or or they spend too much on diagnostics like doing a fresh MRI, CT, Meylogram or discogram, the comp carrier frowns upon it and if they don't have a high enough return to work rate with denial of legitimate claims they loose their lucrative comp contracts. Comp will pay for some things such as the type of pain management you recieved, which was either trigger point injections which are a numbing agent and an anti inflamatory or you had SI joint injections with a numbing agent and steroids or a non steroidal anti inflamatory.
I went through the same crud, it's all in your head, your just a drug seeker, pain management boot camp, 7 hours a day 5 days a week for a month in which every single patent was cured and returned to work, some with minmimum restrictions some with none. I thought it was pretty amazing that any doc or clinic had a 100% success rate. Hmmm Statistically impossible. :rolleyes:
You either go with the flow, or fight it and risk losing your salary benefits, it's there little way to enforce compliance when they say your ready to return to work, If you don't they just cut off the checks. They will continue the medical but it becomes a waiting game to see who's going to go BK first, and I'm pretty sure they can outlast you when it comes to income .
After 9 months, It's even hard to be treated as an acute patient if you go through your own insurance or pay cash. They can do lots of TP injections, epidural steroid injections and nerve blocks but if you have a nerve compression, all the injections will do is numb you and give temporary relief.
The way I got comp to move was to get my own independent medical eval. IT cost about $350 10 years ago, but worth every penny. I traveled 3 hours to Duke university and saw the chief NS . He spent about 3 hours doing a complete exam, and showing me everything that was wrong. Without the IME, I would still be loosing bowel function when I go over a speed bump and still feel like I'm standing in either ice water or boiling water and comp would be telling me I'm fine.
The IME surgeon drew all over my MRI's, CT's and meylo outlining and showing every problem which made it very dffficult for the local docs to say there was nothing wrong. I've seen comp set up IME's for people but if comp is paying they are sending you to another one of there docs which will not disagree with anythig another comp doc says, so it's not exactly an independent eval.
It's the dfference between employer friendly or patient friendly when it comes to their diagnostic abilities. Back and neck pain are one thing but radiculopothy, loss of reflexes, atrophy and muscle wasting caused by a nerve impingement and foot drop is something completely different from a muscle strain. The sad thing is , you could have been their best and most productve employee, but when faced with a 80k surgery and months of rehab, all the good stuff is forgotten and you are now looked at as a liability.
Once you hire an attorney, the relationship between you and your company and their comp carrier becomes advisarial. With an attorney, the insurance company can't/won't even speak to you about the simplest thing. If they cut your pay off, you have to have your attorney fight for reistatement.
You do have the Industrial commsion on your side or whatever your states version of the industrial commision is, They become the mediator between your attorney and the company and their carrier. The commision can and will reinstate your pay if they find you have been unfairly denied your benefits. However your are still stuck with their surgeons if you need surgery. You do have the right to another opinion, hopefully somebody that's not a golfing bud of the first doc that claims there is nothing wrong and you will never need surgery.
It's a nightmare sytem but better than no system you find in other countries.
My advice is try to cooperate with comp the best you can and get your own surgical opinion outside their loop of docs. Then present them with the findings and ask how can you not see a problem when anyone not paid by the comp carrier can. It borders on neglagence and mal practice to completely ignore something any other doc can easily see.
If you have a nerve compression, which can usually be found by one of several diagnostic tests, the likleyhood of succesfully relieving the impingement is better than the likely hood of the surgery relieving back or neck pain, But the nerve pain is much harder to manage and doesn't respond as well to conventional therapy. Basically because there is a mechanical problem that needs to be adressed so you can only numb it or mask it for so long.
The problem with long drawn out cases if you do need surgery, is the longer you wait, the less likely you are to have a positive outcome from surgery. There are many new methods to correct a disc bulge or nerve impingement that were not available 12 years ago. Micro discectomies and endoscopic surgery aren't as invasive as open surgery wth a laminectomy to remove the spinous process to get to the problem.
The most important thing at this point is to find out what is really wrong. If a disc was going to receed and relieve an impingement, the therapies and modalities tried would show some sign of improvement, if your getting worse, what occurs is engraining of the pain signal into nerve pathwatys, the change from acute pain to chronic pain which is controlled by a different part of your brain and different nerve pathways and different neurtransmitters that aren't involved in acute pain.
The changes that occur are part of the gateway theory of pain. basically you have pain, it's transmitted through neuro transmitters in one direction, to a specific apart of your brain, interpreted and your body starts a cascade of response to the injured area, like muscle spasm to brace the injured area, a flood of natural antiinflamaotires and some other physical and biochemical responses.
With acute pain, pain that goes beyond 4-6 months, the gate basically stays open, neurtransmitters no longer only flow in one direction to the same part of the brain. Transmission occurs in both directions leaving the gate open and engraining the pain signal into nerve tissue. Even different neuro transmitters deveolop and start activating which actually makes things worse.
At this point, I would get another surgical opinion, use their doc, and if he comes up with the same low back pain DX with no exam of your neck and no complete neuro exam, withut additional diagnostics. It's time to spend your own money to find out what's going on and find someone well outside the comp loop of docs and get an IME from a doc you chose and you pay for.
If thier docs dispute the results, then you will have to hire an attorney, take the evidence of injury and the IME and that docs recomendations to the industrial comission and get the problem fixed if you have a doc willing, that thinks it's possible and that uses the least invasive method you can find. If endo and micro surgery doesn't work, they can always slice through every back muscle and clip away bone to get to he problem. But with the newer less invasive techniques, recovery time is quicker and hoptaliazation is often a simple 24 hour stay, verses days of IV opiates to manage invasive surgery and months of rehab to strengthen and release the scar tissue caused by open surgery.
The neurologic symptoms are the more important symptoms and can be documented in several ways, first simple neuro evaluation, then an EMG which measures conductivity of specific nerves, If you have an impingement, it shows a difference in the number of mili seceonds it takes for a small amount of electricity to travel from ponint A to point B and back to A again, then they compare the time it took for curent to travel comparing one side to the other. IT's really not a terrible test but can be useful to know the results.
There is no easy solution to comp. After one surgery that I waited 8 months for and a year of rehab and PM bootcamp where you wouldn't get a tylenol 3 on your worst day I was so sick of dealing with docs that lied and said you willnever need another surgery again and yoit's all in yourhead and you have a drug problem. I thought settling would eleviate so much anxiety and stress That I did settle.
continued
I went through the same crud, it's all in your head, your just a drug seeker, pain management boot camp, 7 hours a day 5 days a week for a month in which every single patent was cured and returned to work, some with minmimum restrictions some with none. I thought it was pretty amazing that any doc or clinic had a 100% success rate. Hmmm Statistically impossible. :rolleyes:
You either go with the flow, or fight it and risk losing your salary benefits, it's there little way to enforce compliance when they say your ready to return to work, If you don't they just cut off the checks. They will continue the medical but it becomes a waiting game to see who's going to go BK first, and I'm pretty sure they can outlast you when it comes to income .
After 9 months, It's even hard to be treated as an acute patient if you go through your own insurance or pay cash. They can do lots of TP injections, epidural steroid injections and nerve blocks but if you have a nerve compression, all the injections will do is numb you and give temporary relief.
The way I got comp to move was to get my own independent medical eval. IT cost about $350 10 years ago, but worth every penny. I traveled 3 hours to Duke university and saw the chief NS . He spent about 3 hours doing a complete exam, and showing me everything that was wrong. Without the IME, I would still be loosing bowel function when I go over a speed bump and still feel like I'm standing in either ice water or boiling water and comp would be telling me I'm fine.
The IME surgeon drew all over my MRI's, CT's and meylo outlining and showing every problem which made it very dffficult for the local docs to say there was nothing wrong. I've seen comp set up IME's for people but if comp is paying they are sending you to another one of there docs which will not disagree with anythig another comp doc says, so it's not exactly an independent eval.
It's the dfference between employer friendly or patient friendly when it comes to their diagnostic abilities. Back and neck pain are one thing but radiculopothy, loss of reflexes, atrophy and muscle wasting caused by a nerve impingement and foot drop is something completely different from a muscle strain. The sad thing is , you could have been their best and most productve employee, but when faced with a 80k surgery and months of rehab, all the good stuff is forgotten and you are now looked at as a liability.
Once you hire an attorney, the relationship between you and your company and their comp carrier becomes advisarial. With an attorney, the insurance company can't/won't even speak to you about the simplest thing. If they cut your pay off, you have to have your attorney fight for reistatement.
You do have the Industrial commsion on your side or whatever your states version of the industrial commision is, They become the mediator between your attorney and the company and their carrier. The commision can and will reinstate your pay if they find you have been unfairly denied your benefits. However your are still stuck with their surgeons if you need surgery. You do have the right to another opinion, hopefully somebody that's not a golfing bud of the first doc that claims there is nothing wrong and you will never need surgery.
It's a nightmare sytem but better than no system you find in other countries.
My advice is try to cooperate with comp the best you can and get your own surgical opinion outside their loop of docs. Then present them with the findings and ask how can you not see a problem when anyone not paid by the comp carrier can. It borders on neglagence and mal practice to completely ignore something any other doc can easily see.
If you have a nerve compression, which can usually be found by one of several diagnostic tests, the likleyhood of succesfully relieving the impingement is better than the likely hood of the surgery relieving back or neck pain, But the nerve pain is much harder to manage and doesn't respond as well to conventional therapy. Basically because there is a mechanical problem that needs to be adressed so you can only numb it or mask it for so long.
The problem with long drawn out cases if you do need surgery, is the longer you wait, the less likely you are to have a positive outcome from surgery. There are many new methods to correct a disc bulge or nerve impingement that were not available 12 years ago. Micro discectomies and endoscopic surgery aren't as invasive as open surgery wth a laminectomy to remove the spinous process to get to the problem.
The most important thing at this point is to find out what is really wrong. If a disc was going to receed and relieve an impingement, the therapies and modalities tried would show some sign of improvement, if your getting worse, what occurs is engraining of the pain signal into nerve pathwatys, the change from acute pain to chronic pain which is controlled by a different part of your brain and different nerve pathways and different neurtransmitters that aren't involved in acute pain.
The changes that occur are part of the gateway theory of pain. basically you have pain, it's transmitted through neuro transmitters in one direction, to a specific apart of your brain, interpreted and your body starts a cascade of response to the injured area, like muscle spasm to brace the injured area, a flood of natural antiinflamaotires and some other physical and biochemical responses.
With acute pain, pain that goes beyond 4-6 months, the gate basically stays open, neurtransmitters no longer only flow in one direction to the same part of the brain. Transmission occurs in both directions leaving the gate open and engraining the pain signal into nerve tissue. Even different neuro transmitters deveolop and start activating which actually makes things worse.
At this point, I would get another surgical opinion, use their doc, and if he comes up with the same low back pain DX with no exam of your neck and no complete neuro exam, withut additional diagnostics. It's time to spend your own money to find out what's going on and find someone well outside the comp loop of docs and get an IME from a doc you chose and you pay for.
If thier docs dispute the results, then you will have to hire an attorney, take the evidence of injury and the IME and that docs recomendations to the industrial comission and get the problem fixed if you have a doc willing, that thinks it's possible and that uses the least invasive method you can find. If endo and micro surgery doesn't work, they can always slice through every back muscle and clip away bone to get to he problem. But with the newer less invasive techniques, recovery time is quicker and hoptaliazation is often a simple 24 hour stay, verses days of IV opiates to manage invasive surgery and months of rehab to strengthen and release the scar tissue caused by open surgery.
The neurologic symptoms are the more important symptoms and can be documented in several ways, first simple neuro evaluation, then an EMG which measures conductivity of specific nerves, If you have an impingement, it shows a difference in the number of mili seceonds it takes for a small amount of electricity to travel from ponint A to point B and back to A again, then they compare the time it took for curent to travel comparing one side to the other. IT's really not a terrible test but can be useful to know the results.
There is no easy solution to comp. After one surgery that I waited 8 months for and a year of rehab and PM bootcamp where you wouldn't get a tylenol 3 on your worst day I was so sick of dealing with docs that lied and said you willnever need another surgery again and yoit's all in yourhead and you have a drug problem. I thought settling would eleviate so much anxiety and stress That I did settle.
continued
Shoreline
11-20-2004, 04:40 PM
Hind sight is definitely 20/20, since settling, I've incurred over 500k in medical bills from surgery, PT, PM, PM procedures, diagnostics and medications. I just had an Intrathecal morphine pump implanted in June. The last attempted fusion was almost 12 hours long and used 40k just in hardware.
Nobody gets rich on comp. There is no such thing as pain and suffering unless you were injured by some type of neglegence. But in my case, I settled for a chunk of cash and 1 year of continued medical benefits with docs I wouldn't see if I was being paid. Almost 1 month to the day after my medical beni expired I had my first fusion, the doc claimed that was a success and any request for pain meds afterthe first 6 weeks post op was met with the same rediculous answers, like drug seeker, you need rehab and detox etc because it followed me from the comp docs file. Anything they can do to discredtit you or deminish your problem is right in line for comp.
It wasn't untill the hardware snapped that they were convinced the fusion had failed. I can't blame them completely for not identifying a failed fusion because there is no test to determne if donar bone is alive and thriving or dead and just sitting there. When they went back in to revize the 3 level fueion, everything had shifted, blew the disc above and below and they flaked the old donor bone out like dried fish. My 3 level with 6 screws and 2 rods turned into a 6 level with 12 screws and 8 rods. Both harrigton "verticle rods" and hrorizontal rods to prevent twisting.
That fusion never grew either although the doc called it a success right up untill that set of hardware started snapping. hardware wouldn't snap if the bone grew and was bearing the weight, but hardware in fusions isn't designed to bear the weight for a lifetime. So now I have screw tips embeded in vertabrea from the first fusion, 2 broken screws in L5 and the screws in my sacrum toggle back and forth as if you stock a nail in drywall and yanked it back and forth untill the hole was twice the size of the nail. At this point there isn't a reasonable way to fix it or a doc willing to take a chance on a 4th surgery that would run from T10-S1.
I guess my point is, even if you have succesful surgery and your recovery goes well, you can reinjure the same site and end up going down the same path I did. Looking back I was foolish to trade lifetime medical benis for cash. The last year I had script insurance through my wifes company, which was only 10 months, they paid out over 23 k in prescription beni's just to manage the pain. I've been disabled since the last surgery, It took 2 years to be awarded social security disability, I lost the house, went BK and still struggle, just because I wanted out of that screwed up system.
I saw a dozen different PM docs, went though 3 different clinics and a work hardening program before a PM clinic actually presribed a pain med when I had been bed ridden for 9 months since the last attempt to fuse me.
I'm pretty much worst case scenario, but the longer you put off something that can be fixed, and the more invasive the procedure, the less likely you are to have a positive outcome. GO to the most reputable med school in your area and get an IME and start disputing their findings. They will either admit there is a problem and perform surgery or make you an offer to dissapear. At that point you have to get an attorney.
Anyway, I can empethize, I'm glad your family doc isn't letting you suffer to much. PM docs that don't use pain meds are more common than PM docs that do. The way I went through PM and every possible modaility and procedure and surgery, pain meds were only offered only as a last resort. Things aren't quite that bad now but comp is still bad and putting off something that needs to be corected only harms you, not them.
So you may have to pay for a few things yourself to get some real answers and then confront them and bring in a comp attorney if they play games like cutting off your pay if you refuse to return to work no better than you are today.
I wish I had a better outlook on comp, but who you work for makes a difference. There are 5 comp systems in my state. Interstate comerce, government employeee, state employeee, longshoreman, and the Jones act for injury on comercial vessals at sea. Obviously the govt is the better system, the Jones act has better beni's and longshorman have decent beni's. I happened to fall under the system with the least amount of beni's, the shortest perrod of coverage add no disability or retirement programs. So I'm a bit jaded towards comp scum.LOL
Good luck and you really do have to take things into your own hands and get your own eval and see a surgeon that's not afiliated with your comp system to really get to the truth. It's comps job to tell you your fine and return you to work, or offer you a crap settlement and no option to return to work and no unemployment beni's.
Good luck, Dave
Nobody gets rich on comp. There is no such thing as pain and suffering unless you were injured by some type of neglegence. But in my case, I settled for a chunk of cash and 1 year of continued medical benefits with docs I wouldn't see if I was being paid. Almost 1 month to the day after my medical beni expired I had my first fusion, the doc claimed that was a success and any request for pain meds afterthe first 6 weeks post op was met with the same rediculous answers, like drug seeker, you need rehab and detox etc because it followed me from the comp docs file. Anything they can do to discredtit you or deminish your problem is right in line for comp.
It wasn't untill the hardware snapped that they were convinced the fusion had failed. I can't blame them completely for not identifying a failed fusion because there is no test to determne if donar bone is alive and thriving or dead and just sitting there. When they went back in to revize the 3 level fueion, everything had shifted, blew the disc above and below and they flaked the old donor bone out like dried fish. My 3 level with 6 screws and 2 rods turned into a 6 level with 12 screws and 8 rods. Both harrigton "verticle rods" and hrorizontal rods to prevent twisting.
That fusion never grew either although the doc called it a success right up untill that set of hardware started snapping. hardware wouldn't snap if the bone grew and was bearing the weight, but hardware in fusions isn't designed to bear the weight for a lifetime. So now I have screw tips embeded in vertabrea from the first fusion, 2 broken screws in L5 and the screws in my sacrum toggle back and forth as if you stock a nail in drywall and yanked it back and forth untill the hole was twice the size of the nail. At this point there isn't a reasonable way to fix it or a doc willing to take a chance on a 4th surgery that would run from T10-S1.
I guess my point is, even if you have succesful surgery and your recovery goes well, you can reinjure the same site and end up going down the same path I did. Looking back I was foolish to trade lifetime medical benis for cash. The last year I had script insurance through my wifes company, which was only 10 months, they paid out over 23 k in prescription beni's just to manage the pain. I've been disabled since the last surgery, It took 2 years to be awarded social security disability, I lost the house, went BK and still struggle, just because I wanted out of that screwed up system.
I saw a dozen different PM docs, went though 3 different clinics and a work hardening program before a PM clinic actually presribed a pain med when I had been bed ridden for 9 months since the last attempt to fuse me.
I'm pretty much worst case scenario, but the longer you put off something that can be fixed, and the more invasive the procedure, the less likely you are to have a positive outcome. GO to the most reputable med school in your area and get an IME and start disputing their findings. They will either admit there is a problem and perform surgery or make you an offer to dissapear. At that point you have to get an attorney.
Anyway, I can empethize, I'm glad your family doc isn't letting you suffer to much. PM docs that don't use pain meds are more common than PM docs that do. The way I went through PM and every possible modaility and procedure and surgery, pain meds were only offered only as a last resort. Things aren't quite that bad now but comp is still bad and putting off something that needs to be corected only harms you, not them.
So you may have to pay for a few things yourself to get some real answers and then confront them and bring in a comp attorney if they play games like cutting off your pay if you refuse to return to work no better than you are today.
I wish I had a better outlook on comp, but who you work for makes a difference. There are 5 comp systems in my state. Interstate comerce, government employeee, state employeee, longshoreman, and the Jones act for injury on comercial vessals at sea. Obviously the govt is the better system, the Jones act has better beni's and longshorman have decent beni's. I happened to fall under the system with the least amount of beni's, the shortest perrod of coverage add no disability or retirement programs. So I'm a bit jaded towards comp scum.LOL
Good luck and you really do have to take things into your own hands and get your own eval and see a surgeon that's not afiliated with your comp system to really get to the truth. It's comps job to tell you your fine and return you to work, or offer you a crap settlement and no option to return to work and no unemployment beni's.
Good luck, Dave