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Old 05-18-2011, 01:07 PM   #1
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Doctor question - please help

I posted this in the Back Problems forum but they're not as active there. I'd appreciate any help (this rainy/cold weather is making me miserable).

What kind of doctor should I see?

I could really use some help deciding on what type of doctor I should go to. I've already been to a lot of different ones but I'm in pain and nobody has helped much. I have Osteoarthritis of the spine. My MRI reports say -

Central herniated disc with moderate spinal cord compression at C5/C6.

Minimal disc bulge at L3/L4

Ridiging at: T6/T7, T7/T8, C4/C5

Foraminal Stenosis at: C4/C5 (left only), C5/C6 (bilateral), L3/L4 - L4/L5 - L5/S1 (bilateral significant).

Neurosurgeon sent me to Rheumatologist. Was on Humira for a while with little relief. Went back to Neuro.

Neuro then sent me to Pain Management. I had a few series of epidural steriod injections (ESIs) and they helped. I went back every 6 months for the past few years to get ESIs (could only get either neck or back - had to choose). Self medicated with Tylenol and Advil for pain.

Last set of ESIs, Pain Management Dr sent me for another MRI of my neck. It was the same and he told me I needed to see an Ortho doctor.

Went to the Orthos dr. What a joke he was. He told me he KNEW I had nerve damage (even though I know I don't) and sent me for a nerve study. When the results came back normal, the doctor said that I must have stress at home and I should relax. HUH?!?! I fired him.

Now I don't have any doctor. I'm due for another ESI and my body is hurting both neck and back. The Tylenol and Advil aren't cutting it. Where do I go now? Surgeon? Rheumatologist? Pain Management Dr? Ortho Dr? I'm so lost and have pain. Help please.

Last edited by carscheles; 05-18-2011 at 01:08 PM.

 
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Old 05-18-2011, 03:47 PM   #2
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Re: Doctor question - please help

I know it's hard going from Dr. to Dr....

The good part so far is that you have had an MRI done...and have those results...and the wonderful part is that you DON'T have any nerve damage...that is fantastic!! That means that the herniation at the C levels is not too bad to cause any nerve issues...this is something to celebrate

I would be careful with taking too much ibuprohpen and acetaminophen....these can cause a whole host of issues...some irreversible in your stomach, intestine and kindey's....

I would go one more time to a Board Certified Neurosurgeon...(don't let the surgeon part scare you...most good one's don't jump to surgery and use all sorts of things to help diagnose and treat and offer suggestions..)...But to me...they are the best of the best at looking at your MRI results...A regular Orthopedic Surgeon specializes more in lower back...but a Neuro works with the spine and head...This is who handled my 3 Cervical fusions..

Not sure when the MRI was done...but if older than a few years...they will want to do another...but again...since you don't have any nerve issues...surgery shouldn't be on the table...

Once seen by them to verify and offer treatment...most likely you will then be sent to a Pain Management Dr. to help deal with the chronic pain...they can do the ESI's if those helped...as well as do or recommend acupuncture, cognitive behavioral therapy, physical therapy and/or traction which can help with the discs and possibly move them back in..they can offer a muscle relaxer which sounds like it would help you greatly...there is Robaxin, Baclofen, Flexeril...lots of choices....as well as a mild narcotic to be taken as needed....

They are there to not just give medicine...A good PM should help you in all aspects of your life with the pain...If you find a Dr. that just hands you a narcotic...run in the other direction as they will probably be shut down by the DEA soon!! LOL..

And yes...stress and depression is very common with those that have chronic pain...Lots of people find therapy as a part of there treatment...as well as being on an antidepressant...

These are just some examples of things a good PM will offer for treatment..

I still think you need to find a good Neurosurgeon first and go from there...

I wish you well!!!

 
Old 05-19-2011, 04:29 AM   #3
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Re: Doctor question - please help

Quote:
Originally Posted by Ilovemycutedog View Post
IThe good part so far is that you have had an MRI done...and have those results...and the wonderful part is that you DON'T have any nerve damage...that is fantastic!! That means that the herniation at the C levels is not too bad to cause any nerve issues...this is something to celebrate
I know I'm lucky. The doctor's are really surprised that I don't have nerve damage.

Quote:
Originally Posted by Ilovemycutedog View Post
I would be careful with taking too much ibuprohpen and acetaminophen....these can cause a whole host of issues...some irreversible in your stomach, intestine and kindey's....
I know and hate the risks but I couldn't survive without it. I take them together 4 Adivl and 2 Tylenol twice a day. I HAVE to have pain relief (I'm sure you can understand that).

Quote:
Originally Posted by Ilovemycutedog View Post
I would go one more time to a Board Certified Neurosurgeon...(don't let the surgeon part scare you...most good one's don't jump to surgery and use all sorts of things to help diagnose and treat and offer suggestions..)...But to me...they are the best of the best at looking at your MRI results...A regular Orthopedic Surgeon specializes more in lower back...but a Neuro works with the spine and head...This is who handled my 3 Cervical fusions..
My fear is that they'll say multilevel sugeries and two of them. One for lumbar and one for cervical. I'm sure they wouldn't do both on the same day.

Quote:
Originally Posted by Ilovemycutedog View Post
Not sure when the MRI was done...but if older than a few years...they will want to do another...but again...since you don't have any nerve issues...surgery shouldn't be on the table...
My last cervical MRI was around 7 months ago. My last lumbar was around 4 years ago.

Quote:
Originally Posted by Ilovemycutedog View Post
They are there to not just give medicine...A good PM should help you in all aspects of your life with the pain...If you find a Dr. that just hands you a narcotic...run in the other direction as they will probably be shut down by the DEA soon!! LOL..
My last PM was an ESI pusher. He did them in his office and it was an assembly line of ESIs all day. I'm sure that's where the $$ came from so that's what he wanted to do. And his office would only accept cash as an insurance co-pay so you get the idea of where his mind was.

Quote:
Originally Posted by Ilovemycutedog View Post
And yes...stress and depression is very common with those that have chronic pain...Lots of people find therapy as a part of there treatment...as well as being on an antidepressant...
I'm on Prozac (which is great). The ortho doctor was a strange bird - he thought that because I don't have nerve damage, that I don't have any issues. He felt how tight my shoulders were and declared that I must have stress at home (besides my pain, my life is going well). Wouldn't tight shoulders be a sign of muscle spasms too? I'm not a doctor but that seems pretty logical.

Quote:
Originally Posted by Ilovemycutedog View Post
I wish you well!!!
Thank you so very much. I really, really, appreciate the advice!

 
Old 05-19-2011, 08:02 AM   #4
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Re: Doctor question - please help

Now..I am certainly not a Dr. as no one is on here...but I can't imagine any Dr. that would operate right now on you without any nerve damage...Surgery should be the absolute last resort...and for me....was only done when the choice was either permanent nerve damage or paralysis...

Surgery is NOT for pain relief as most people hope for...it's to alleviate the disc from compressing on the spine...unfortunately...lots people still have pain after surgeries...

So if you see someone and they say you need surgery based on those findings from the MRI..I would be running the other direction...and of course..it's best to get 2 or 3 opinions before ever doing this..again...I only did them when it was SEVERE herniation into the cord space...

But I don't think you are even close to that right now so I wouldn't worry at all...

After you see a Neuro Dr...then they can send you to a PM who should be able to help more with your pain with all the things I mentioned above instead of having to take so much otc meds...

Believe me....a good muscle relaxer for you would do absolute wonders compared to what you are taking now!!!...and would really help those spasms!!...And I know it's hard when you are hurting...but doing yoga/stretching is really helpful to try and stay loose..

I truly hope you can get those appts soon...even the Neuro may just prescribe a muscle relaxer for you and not even have to go to a PM Dr...

Good luck

 
Old 05-19-2011, 10:32 AM   #5
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Re: Doctor question - please help

you have gotten some really really great advice and some i was going to mention too. the one thing here that seriously bothers me is that after four years of what you had going on, it states NO changes? do you have BOTH of your MRI reports just to compare findings at particular levels? some of what you just already had was/is degenerative in nature and would also be more ongoing/deteriorating whether it is OA or DDD, i have very heavy DDD esp in c spine, and it shows. just that alone in and of itself would continue, so really am wondering here how MUCH change, or advancement has taken place overall over four more years of moving that neck(even just basic flexion and extension that we all do ALLL day long), lifting, twiting and tourque and just the normal 'daily' activities you do that does also add to this too.

have they actually definitively confirmed this IS OA or DDD? do you know for sure? how did they actually tell you they confirmed the OA Dx? OA is a deteriorating joint condition to my understanding(my dad had this horribly bad in both knees then ankles) while DDD is more within the discs themselves deteriorationg, and can also weaken vertebrae too. i just do not see even ONE of what are many many actual facet joints (two at each level) even being deteriorated or holding fluid as in facet edema? nothing appears to be impacting joints yet you have a joint deteriorating condition/disease process, ya know what i mean? just wondering since the humera did not appear to work well? (tell me if i am wrong here, but isn't humera SUPPOSED to help STOP the actual deterioration/progression in joints, and help the pain? did THAT do that for you) but that too could be becasue your pain just can be more radiculopathic in nature too which it realistically would NOT help so much in THAT area, esp if your pain is not within joints. while the many different types of anti siezure meds usually have the best track record with calming the firing signals from inflammed spinal areas that create radiculopathic types of pain/symptoms. lyrica is a good one to try for pain if you do not get side effects. but you most definitely DO need a GOOD pain clinic here that is not afraid to simply treat pain 'appropriately". there IS a huge difference betweeen PMs that do NOT use any levels of narcotics to ease suffering and the ones who will 'only' give injections, big difference. and that IS the type you just need desperately esp since alot of the OTCs taken for way too long in way too high amts will damage not only ones liver, but also the kidneys too. this does unfortuently happen to way too many people out there who usually have a pretty good high level of pain, but have opiate phobic docs, or they are too flippin lazy to do the documentation for need to even Rx them to any given patient. and that partient not only suffers with pain, but organ function loss ONLY becasue OF their own doc who is 'supposed to be' actually helping them and also advocating for them too. that one just makes me ill. too many people are simply suffering and feel soo flippin helpless. its finding that GOOD solid pain clinic carsch that will really help YOU to deal with the pain aspect while you seeking consults/evals from other neurosurgeons, or a good accredited spinal surgeon whos been trained specifically in c spines and has the higher level of training to even enter that spinal canal. some do, same with some neurosurgeons too, and some do not. and of course it goes without saying to stay the heck away from the OTHER ones you have seen who sound like total idiots considering what you just have going on there that DOES need some attention soon.

was that cord contact finding present on your four years ago MRI at all? that question i really need answered, just knowing if this HAS been recently found or was there four years ago too. that one finding is what would really concern me moreso than others since it states CORD contact caused by herniation and not simply "thecal sac or dura effacement" or compression(its way beyond THAT at this point)? those are the outter 'cushion' surrounding and protecting your actual spinal cord as kind of the 'shock absorber" between the backs of the vertebrae/discs area and the cord itself. anytime you just have direct contact(even with only 'mild' it is simply NOT supposed to even BE that far into the canal, ever) with the spinal cord in the c spine esp, it CAN turn into a serious issue with even one lil fender bender type accident with an airbag deploying into your face or into the neck, among many other things we just can 'do" moving our own necks too? this is MY bigger fear with the mess i also have again in my c spine(initial round for me stared in 02). i too have an area at C 3-4 that has very direct cord contact at this point and this automatically also impairs the overall ability of your CSF fluid to do what IT just does all day long too, going back and forth from the brain(where it gets replenished every so many seconds) then flows down one side of our spinal cords to sacral just keeping it fully bathed and hydrated, then right back up into the brain again and once again gets replenished. any changes in that CSF pressure or impairment of that CSF will create a flow issue and congestion within that specific area as well. you can actually see that impairment upon my last MRI done in aug, that shows the contact, but is still allowing at least 'some' CSF to flow thru that area too, which is what you simply NEED to have or that contacted area if this goes further into the cord, will eventually dessicate/dry out then the spinal cord tissue will die off too with no good reptitive recyling hydration present. then that part of the cord is no longer just 'good healthy neual tissue and any functions it once performed are also not there anymore either.

if i were you, i would really seek out a good surgeon, neurosurgeons personally i have had the best luck with in these types of situations(c spine and spinal cord surgery) since they are usually better trained going into or relieving pressure off of the c spinal cord levels(make darn certain that the NS you choose ALSO uses whats called 'intraoperative monitoring" that monitors your motor and sensory functions when there just is any possibility of collateral neural damage BY the surgeon.esp when relieving cord compression too. it really IS more of an early warning/safety precaution for the surgeon and for you). but it will ALWAYS, with no matter what 'type' of actual surgeon you are seeking out, experiece, knowledge and years of hands on experience too just really matter. word of mouth from someone who you probably do already know who has had an ACDF done(this just sounds like what would have to be done at your c 5-6 at the very least) is one of the best ways to find the 'good ones' out there. but you do need to tackle this more important c spine issue before doing anything with that lumbar based upon what i have seen here.

if there is ANY way that you could actually first, type out word for word how that interpretting rad first initially saw your c spine four years ago in THAT report, then type out the same word for word way he is seeing it now, it seriously would help to answer some other questions too(i personally just do not understand having an actual deteriorating joint condition and yet not one single of the many facet joints within the spinal appear to even be impacted at all). its all in how a particular finding gets worded and the specific wording/language used to describe too that helps to really get the best underlying idea of how the finding is actually showing at least to him or her upon seeing it on hardfilm. it could be very helpful, esp the two together.

but DO start trying to find a really ghood PM while also nailing d0own a 'good' neurosurgeon to try and tackle that c 5-6 issue. for anything below the c spine, an ortho really would not be a problem for me, but up in that very highly vascular and innervated and with junctions area of the c spine, i would personally not settle for anything less than a very highly experienced NS. good luck with this, and please DO keep us posted, marcia
__________________
3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

 
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