I thought of this after I posted below about SI vs. facet joint dysfunction. I need to find another doc. Who normally does injections, just a pain management doc (physiatrist)? Do ortho surgeons ever do this?
Some ortho doc's utilize their hospital's anethesia department for testing and injections, while other's will only do their own. My first doc utilized the hospitals department for a disogram and injections and I wound up temporarily paralyzed with loss of all lower body functions.
I know there are always risks but what surprised me was that he told me I'd have feeling back in a couple of hours and helped the nurse pile me into a wheelchair and deliver me to the parking garage for my friend to drive me home. Five hours later still no change and it took a number of phone calls, help from the local police to load me back into my car and then hospitalized for more than a week until I started getting some functions back. I was able to stand with the aid of a walker a month later. BTW, the guy doing the test and injections was way behind schedule, being more than 2 hrs late getting to me. Later learned that in his rush, he injected quickly and the quick pressure from the quick injection bruised the spinal cord. Thankfully no permanent damage and I didn't sue, but the ortho in his attempt to protect this guy tried to convince me it was a hysterical paralyzation. HAH! I would have never been able to be in the field of work I was in and get the security clearances required if I were prone to that. In all of the aircraft crashes and mutilations I witnessed in 28 years, I know this was not so. I still had total confidence that the good Lord and my doc would do what was meant to be. The doc wasn't as confident as I, so I changed doc's.
Now, I know that some doctors are more skilled than others and that there are ortho doc's I might not want giving me any kind of injection, but after all I've been through with 8 spine surgeries and 4 fusion surgeries with 10 levels this last time, I absolutely would not want anyone other than an ortho or neuro spine specialist doing anything invasive on my spine.
Pretty much any doctor can do them, you must be asking who to trust. I would make sure that I got someone who uses a flourascope. At the spine clinics here, we refer to them as back factories, each doctor specializes, PM, neuro, surgeon, ortho, rehab, and shots. So, one guy does shots all day long.
Last edited by injured betty; 03-18-2005 at 08:16 PM.
Actually My Pain Management Doctor is the one that did my injections, all he does all day is perform ESI's.... Nerve Blocks.....Performs procedures....thats it......He uses the flourascope xray as well.....only time I have actually ever physically seen him is on the days of my ESI's... on my monthly visits every month for pain med refills... and followups I see his P.A.
I was also told that most usually Anestesiologists are the ones that perform these types of these procedures....
Quietcook, it sounds like an awful experience!!! It goes to show you just have to be so careful about who does these procedures. I had epidurals when I had my three kids, and they had a highly experience anethesiologist (sp) do those. It's so frustrating b/c I know the only way to truly dx SI joint dysfunction is to do an injection of the steriod/pain medication. Just the thought of a needle back there is scary enough!
I think I was too confident for my PM doc today. First visit, sent from the ortho doc to help my SI joint problem. Unbelievable how this guy could discount everything told to me from the PT, ortho doc, and MRI. I felt like I was the doctor, telling him what my report said, asking him to show me why he was right and the other assessments are wrong. What a quack.
Betty and Wild Rose, this doc does not do shots all day long, only on Mondays. The clinic I went to doesn't having anyone else but him doing shots. There is only one good doc there who specializes in knees, shoulders, arms, etc. I went to him for my wrist five years ago, and he took care of my problem first time. I had iontophorsesis done for four weeks, problem cured. I wish I could go to him, but he doesn't do backs. I am soooo disappointed in my treatment thus far.
I also got the feeling they thought I was making the pain up. Since nothing showed up on the MRI but the arthritis (and of course that wasn't causing my pain), I shouldn't have pain. I am worried b/c I'm afraid if there is something really wrong (like cancer) I'll find out too late. I have a relative who hurt her knee years ago, and it ended up being bone cancer...she was only 15 at dx, and she died 6 weeks later.
The other's have more than answered your originial ? - just be sure that WHOMEVER does your injections, does so using flouroscope. NEVER let anyone do any procedures like this without it. Most reputable docs would never consider attempting this "blind" but I KNOW FROM EXPERIENCE some do.
You deserve a standing ovation for being more knowledgeable of your condition than your PM good for you!!
Knowledge is power and the more you know the more you can better help yourself make wiser decisions and help ensure yourself the best possible outcome!
I can certainly see why you would be somewhat anxious about bone ca - perhaps you could get a bone scan - if for no other reason to lessen your worry?
Thank you, BionicWitch. I can't imagine a doc doing an injection w/o knowing where the needle is going! I certainly got alot of great information here on how to deal with these doctors. Knowledge is certainly power....I have a son with a disability, and the schools blew me off until I found out our legal rights. Once they saw I knew my stuff, I got what I wanted for my son. I've been down that path for docs for him....this goes on all the time. I don't get too intimidated anymore by doctors, but once I find one I like, I will stick with them forever. We have the same pediatrician for 18 years!!
I always try to remain polite when I'm asking questions, but they know they can't just sell me a bill of goods.
It sounds like your experience was pretty bad. I bet it was awful having that injection done blind.
Thanks again for the info on the flouroscope. You can bet I will be asking about that when I go the next doc.
[COLOR=Magenta]It's so frustrating b/c I know the only way to truly dx SI joint dysfunction is to do an injection of the steriod/pain medication. Just the thought of a needle back there is scary enough! [/COLOR]
I was diagnosed with SI dysfunction w/o the use of any needles. I had the leg raise test, which showed that I had ***extreme*** pain in the SI joint. I had an MRI which showed the arthritis that was caused by the laxisity of the SI ligament and a CT scan, which showed the inflammation around the SI area.
I had read a lot of information in regards to the shots and decided against them. They wouldn't have cured my pain and I weighed the pros and cons. Now, from there, what to do...... There are only two options to cure SI dysfunction. Surgery and Prolotherapy. You can help the pain through other methods, but to cure it is another story. The ligaments, if they are stretched out, aren't like muscles, the ligament stays stretched. This in turn causes slop in the joint, which causes slop in the spine and arthritis. The facet joints start moving about and you get arthritis in the facets. It is a tumble down, domino effect.
I did the Prolo, but by no means am I advocating it. It seems that I did not do enough sessions and am back to square one. No matter how much I exercise, how many miles I walk, the ligament is still stretched.
As for who can do the shots? I had a primary take out a needle and want to do the shots. He does them all of the time. In fact, he had the needles ready to go.
Just be really careful who does them for you and ask about the bone scan to check for inflammation and you may not need any shots.
Betty, thank you very much for the great info. I am a little confused....what exactly is the leg raise test for SI joint? He did several leg raises (laying on my back, raising straight up, then turning leg side to side). I also laid on my stomach and he raised my bent leg toward my back. I had alot of pain just moving from my back to stomach and vice versa, more than just raising my leg up in the air. The test he did not do, but the PT did was have me lay on the table with my leg hanging off the side and he maneuvered it a bit. That hurt. The PT had no problem dx me with SI disorder. He said I passed the test for it.
What you said makes total sense to me. I need to ask about more non invasive testing....but, it was almost impossible to get insurance to approve my MRI!!! I hope to find another doc soon that will listen to me and be open to these things. I'm a little nervous about seeing the chiro. on Monday....I can't wait to hear what he has to say. I feel the pain all over the left lower back and into the buttocks, not just in my facet joint area. I don't care if they think it's a *little* bit of arthritis...it's there, and I have pain.
My PT also copied for me pictures of the tests he did to dx my problem. The PM doc didn't even do half of them. I also plan to talk to my PT again on Monday.
What is prolotherapy? What do you think about traction as a treatment for the arthritis?
jdlfmc- I totally agree with you. It's so hard to find those docs...takes time. I have a few we use for other things we've had for years, it's so nice when they know you well.
It is so hard to get through the insurance maze. I got a bill for my MRI today, $5000 and they sent it to the wrong place, three months ago. I kept waiting for a phone call for an appointment to go over the new results. Idiots!!!
The leg raise test that they did on me was as follows:
I had to lay on my back, legs straight out. The Osteopath came to the side of the table, the side that I hurt on, and had me lift my leg while he kept his fingers on the SI joint. He used the other hand and shoulder to support my leg. Ouch!!! I had a lot of slop in my ligament and knew it. He did the manipulation where you hang your leg over the side and manuvered my joints back in place. He then had me do the cobra position, which is on your chest, come up on your elbows. I could not walk when I left there last time. It was a ten on the pain scale. But, I got better. My problem is that the ligament is stretched out, again. I need more Prolo. I think that I would have been fine but I injured myself again.
Sometimes, you have to put health in front of insurance. I had to. I couldn't really afford it, but I couldn't really afford not to. I am paying for most of my health care out of my own pocket. This last MRI floored me when the bill came. There goes any hope of a vacation this year and I will be eating pb&j for awhile.
PMs treat all kinds of ailments. PT's are more specialized. I would trust a PT before I trusted a PM and most of all, I would trust a DO, and not a Chiro. Chiros are in it for the money, just like the PMs. Of all of the docs that I have talked to in my area, they shared with me that the PMs are usually doctors whose licenses to perform surgery has been pulled or hospital privledges yanked. If you have a bit of money, it is worth it to investigate the doctor before continuing to see them. It costs us $15 to check out my husband's surgeon. Good investment.
Do not, under any circumstances, let them put you on a traction table without specific instructions. The Chiro that I went to put me on a McKenzie table, against my presription order, and whacked my back. If you see a table, where you stand on it and then the pelvis is snapped, using it, run!!!! The table will be the stand up kind. They strap you in. It is medevil. It is torture. Also, if you do see a Chiro and they try to set up numerous visits, run. Also, make sure that a Chiro follows the script to a T. When I went back and told the doctor what the Chiro had done, he said that it was not part of the script. This doctor ended up leaving town. He had sent too many patients there and had too many problems. The Chiro was a whack job.
I hope that you find answers. Prolo is not covered by insurance. It is about $500 per session. They stick needles filled with sugar water into your injured area to try to re-injure you. You are inflammed and can't take anything for the inflammation. They give you pain meds if you need them. Three to six sessions are the norm. I had mine done by a spine surgeon. I felt that he was on the shady side, in fact, he bilked my insurance company but it was between him or another doc who is a confirmed rip off. We live in a rural area and have to do what we can with who we have. Our insurance sucks.
Betty, thank you again for taking the time to respond. You have given great information! The PM did not do the test the way you describe, but the PT did. That's how he dx me with SI joint disorder. The ortho doc did not do the test, either. He sent me to the PT, and agreed with whatever he said. While he was rather useless other than to order my needed tests, he didn't explain anything to me. The PT has been the only one I trust. He's the guy who spent 12 sessions with me, many days I came in there when all I could do was pain mgmt modalities. I've been to another ortho in that practice before for a hip and wrist injury, and he was great. That's why I was so surprised at how awful this experience was.
I have the app't with the chiro tomorrow afternoon, and don't feel good about it. My thought is to go and talk with him w/o allowing any treatment and just see what gut feeling I have. I am also going to call my PT tomorrow to let him know what the PM said. I still have two approved visits left. My PT had discussed the traction option with me, but didn't want to do it w/o a script. The PM wrote a script for the chiro to do only facet joint mobilization, not SI. I don't even feel comfortable with the script b/c he is so much in disagreement with the PT after only seeing me for 15 minutes, and not even believing my MRI was accurate.
Everything you describe about your SI joint pain is what I have. It makes so much sense!! I know my SI joint is the cause of the arthritis in the facet joints. Perhaps I had some there before I fell as I've had symptoms of stiffness before my injury. It has been progressively worse since then. I also think the arthritis could be in the SI joint, if that's possible.
AJD...The pain in that joint feels as if someone is taking a knife and turning it around. It's sharp, stabbing, and happens depending on how I move. Sometimes, I could just reach a little bit to pick up my drink when I am sitting at the table, and I get the pain, or when I'm reaching out my car door window at the bank drive thru. Or, when I'm turning around to look out my window when driving. It happens during the night when I change positions in my bed. Sometimes, it wakes me up. I feel relief when I'm walking, but later on, the stiffness and pain returns.
How interesting about the PM's having their privileges yanked. It doesn't surprise me at all!! I have read some about the DO's, and they sound like doctors I would like to see. I am going to find one instead of a PM.
I agree with you on the insurance issue. Been there before some years ago for my son's illness (another story for another board Had to pay alot of uncovered bills. Convinced the hospital to write off 80% of one hospital stay, and convinced DH's employer to cover another time. Spent alot of time fighting for our rights. Still have one doc we pay most out of pocket, it's worth it b/c he's good.
Prolo sounds pretty painful!! Do you think it was worth it? I'm sorry it's been so difficult for you to find what you need, it seems it's become the norm these days to get help for any kind of illness. Insurance continues to get more and more expensive for less coverage.
Where I live, I am able to find out info about doctors online. We have a county website where you can look up anyone, and if they have ever been in our court system, it will show up. I found out my dentist is a convicted multiple DUI offender, I've found other ones who have been sued for all kinds of things. They even publish PDF files of actual court documents (complaints, summons, etc). Our state also has a license lookup for everyone who needs a license to work...right down to barbers and hairdressers. You can find out if the docs have pending actions, when their licenses expire, when they were born, what school they went to, what certifications they have. It gives you a good idea, but docs can still be whack jobs.
Again, thank you for all the great info. I'm sure you are helping alot of people besides me. It's so nice to know people who understand. I've been pretty upset this weekend over my recent experiences with these docs. Just have to keep looking for the right one.