Hi Coal Train, Fortunately you are allowed to post the name of your doc and I'm curious as to who you saw.
The first thing you have to do is take docs off the pedestal. Once you see them more eye to eye, you won't drive 3 hours spend a couple hundred bucks and walk out without an answer. Sorry if that sounds blunt, but I was your age once too, and I that's pretty much what weare tought or lead to believe, Docs have the answers and and we shouldn't question them. I'm sure that works just fine in the narcecistic world of medecine where a docs ego thrives when he doesn't have to explain his opinion and that's all your getting, one docs opinion.
However the bottom line is, medecine is called a practice for a reason, because they don't know the answer, They know what to look for, they will certainly have their opinion, they can use a medical model for months and months of treatment but it doesn't make them right. If a doc orders an Epidural, ask how is this going to help, if he gives you a a vauge answer like it will reduce swelling and make you feel better, ask him what is so swollen you need to stick steroids into my spinal cord. There isn't an answer, they shouldn't be willing to share unles they simply don't know.
Despite age differences betwen you and a 50 year old doc, you still know when someone is BSing you and isn't giving you an answer either for some reaon or because they don't know. You really have to change the way you see docs and demand answers to all your questions. It helps to write them down as I'm sure you came up with at east 20 legit questions that you want the answer to on the way home.
Docs work off a medical model. A medical model predicts and sugests a course of action when a patient present X, Y and Z complaints. 80% OF patients that go to the doc complaining of low back pain will get better without any major intervention. Epidurals and PT are pretty standard, so are anti inflamatories, muscle reaxers and mild pain meds, and it works for 80% of the people, so 100% get to try them.
Don't take offense that the docs doesn't seem to understand the severity of things. If an MRI showed a shreaded discs leaking blobs of disc goo up and down the spinal canal I think the doc would have been a little more agressive as far as further testing. Even if it apreared you need surgery by an MRI, Without the neuro deficiencies, like foot drop,loss of reflexes, loss of muscle mass, bowel or bladder control. They aren't going to treat this like an emergency untill you have symptoms taside frompain that seem to a doc like something needs to be done before a window of opportunityty closes to make a surgeical corection. A surgeon can handle getting your through the basic medical model just as easily as a PM doc, In fact before the days of PM docs, that was the surgeons job. Now he can focus only on those that need surgery thanks to PM. Sometimes it's a good thing, sometimes PM's actuyally prevent a possible cure by doping people up past the point of being able to corect a problem. There is no one size fits all answer..
It is a trial and error process bu the further away you get from the point of injury, the less you start fitting into that medical model they rely so heavily on the closer your getting to an actual answer. There is no way to avoid those hoops everyone jumps through. If your don't do the PT or epidurals, the doc won't take your pain seruiously. Personally if someone said to stick a Banana in my ars and hop on one leg for 72 seconds every 1/2 hour while singing the star spamgled banner, I would have done it if there was the slightest chance of relieving pain and avoiding surgery.
To give you an idea of how they rely on medical models to map and plan treatment. Simply knowing it, allows me to treat 80% of those patients that present low back pain to their doc. It's pretty scarry I'm capable of treating 80% of the patients that report low backpain to their doc, but they are simply using a tried and true tested method of getting you passed this flair and over the hump. Surgery is something you do when nothing else workls, when everything else fails. Perhaps I differ from others in that I think a potential cure from surgery outweighs the negative aspects of being dependnet on a doc and opiates the rest of my life, but at least I know I tried everything ever asked.
I think surgery is worth a shot if you have neuro defects they think they can fix before a patient is sent off to PM to be put on opiates the rest of their life. Fortunately not all PM docs use opiates and there are dozens of techniques you can try and use and I still use the ones that worked even after 14 years and 3 failed fusions later.
Some things you learn or try won't work, some things you learn and try have the potential to work given the right circumstances,,but everything you try is just a docs opinion of what he thinks will work. It does take you step by step away from the medical model where docs actually have to use their brain and start using less common diagnostics, like meylograms, discograms, emg's and other tests more specific to finding nerve/cord compressions rather than wide angle views like Xrays and MRI's. Not that any show pain. But the more you try, the the more serious they will take you.
Someone desperate for pain relief will do a discogram or meylogram. Someone that just wants pain meds will shop PM docs untill they find one that shares the same opinion they believe. Why bother with a discogram if a patient has already decided they want meds instead of surgery. A cure is a cure, I don't vcare how big the bottle of meds is, there isn't a cure at the bottom. The miconception that opiates are virtually harmless as long as you only take them for pain makes excepting someone has developed a problem when they are only taking what their doc prescribed. People do forget about the first 10 docs they sayw that said opiates would be a terrible way to go, but rely on that one docs opinion that sayid opiates are OK as long as the pain is real.
I would hardly call opiates harmeless, but they are a tool available and when the benefit outweighs the negative aspects and you can live with knowing this is your only option, it's a much easier pill to swallow , so to speak.
Anyway, It's 5am, I just got back from the second sleep study where I used a CPAP machine. It's been 8 years since I slept more than 3 hours straight and last night was even worse. I may have to except that with 12 screws, 8 rods and 3 failed back surgeries, I should be greatful for 3 hours of escape in the form of sleep.
I'll write more when I'm not whacky from another night in a sleep lab but I would like to know what other symptoms besides back pain you have. When did this start, accident injury, etc. 6 weeks into a flair and not getting relief, idoesn't really through the model out the window to the docs, your just taking a little longer than normal. It's actually impressive you had an MRI in the first few months of an injury uless you were brought by ambulance following an MVA and had no feeling or sensation from the waste down. I know nobody wants to be compared to anyone else, but it's human nature. The doc sees you, listens to you complain, and thinks about the guy he saw that day that will never walk again and can't help but realize how lucky you are and how likely stats are that you will be fine. The neuro symptoms are the ones that make the doc pay attn and think your not one of the 80% that are part of the medical model. Leg pain? Foot drop? Sexual dysfunction, loss of reflexes, bowel and bladder cntrol, etc. All those are the symptoms that inmdicate your not one of the 80% that will get better regardless of the treatment they offer. Regardless of what's happened so far, here is no reason to think you will be in pain the rest of your life and need pain meds the rest f your life. They make things more tolerable, but doping up so you don't have to take time off work isn't the best course of action and one that few docs will share that opinion.
Try not to catastophize and think worst case scenario. You may be fine after a few weeks of PT and learning exactly what muscles you need to strengthen to suport a healthy spine. Have you heard of Pilates, people in hollywood are paying hundreds of bucks an hour to have a pilates trainer come to their house and teach them some excercises. Pilates is simply core strengthening and balance, the acxact sam thing that everyone with a bad back goes through at PT. But you can't charge quite as muich if it doesn't have a trendy and fashionable name aside from excercise.
Just some general advice, don't ever walk out of a docs office not understanding what he believes is wrong and how anything he recomends is going to help. It is his job to explain himslef although docs got away with not explaining their methods and motives for decades. The net levels the playing fieled. He can't through a DX at you that you can't look up and then question how he came up with that. Don't be arrogant or denmanding, but anyone that claims to be in enough pain to need prescription pain meds, should want some answers, not just a script. Those happy to stay ignorant as long as they get a script, aren't behaving the way someone with pain they describe as life altering, a 10+ and effecting the quality of their life, are setting off red flags in the docs mind and that ends up in your permanant record and follows you for every other doc to see that one docs doubts regarding the severity of your condition or injury.
Good luck, Dave