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  • Lumbar MRI – Problems with Radiology Reports

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    Old 08-30-2017, 07:02 AM   #1
    wt2
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    Unhappy Lumbar MRI – Problems with Radiology Reports

    Hi,
    I have some questions that I hope some of you can help me with. Because of problems with past Radiology reports of my MRIs, I am trying to think of how I can avoid that with a new MRI I have scheduled for next week. I am thinking of telling the imaging company that I don’t want any Radiology report done and just want it sent to my Spine Surgery Doctor. But also thinking of telling them that if they do put a Radiology report in my records, which doesn’t match the findings of my Spine Surgery doctor, that I will then sue them. I am afraid that even if they agree not to do one, that someone there will follow their normal procedures and do it anyway. And that will cause me bad problems with my pain management. Below are more details on my predicament.

    I have had chronic pain and chronic fatigue for more than a decade, mainly from problems in my lower back. I have also been on opioid medications for these problems for more than a decade, including being on the exact same opioid medications and levels of medications for the past 6 years. As many others have faced, my doctors have been telling me that they are going to cut back these medications because of their fears of the government (CDC so-called guidelines, which they are paranoid about). From the past, I know that if they cut my pain medications, that my chronic fatigue issues will then probably make me bedridden. My pain management doctors have changed many times and the new one I was just assigned to focused specifically on the Radiologist report from my MRI a couple years ago, and said he can’t continue my pain medications given what it says. He also didn’t want to spend more than 5 minutes with me, and obviously didn’t look at all my records there. Instead all I hear lately is “the CDC says”, over and over again.

    My family doctor, as well as other spine surgery doctors have told me that I am not on a larger than normal amount of pain medications and tell me to fight the pain management doctors on reducing it. In doing so, I got new X-Rays, and am getting a new MRI, of my lower back. With the MRI I had about 2 ½ years ago, the Radiologist report summed up my back with “No acute pathology. Minimal disc desiccation throughout lumbar region but no disc herniations”. Many doctors don’t look through all my records to see the diagnoses from expert Spine Surgeons, who list the following problems that they see in this same MRI: Lumbar Radiculopathy, Lumbar Spinal Stenosis, Spondylolisthesis degenerative, DDD Lumbar, Lumbar Spondylosis, Arthritis throughout your spine, and “Schmorl’s Nodes at many of your disc levels.” I have had two top 100 Spine Surgeon doctors review my problems and they have concluded in general that surgery won’t fix my pain issues. I have tried to go to other pain management clinics, which resulted in horrible problems for me.

    So how do I get the MRI and stop some Radiologist from putting in my records a report saying basically no trouble found? Has anyone faced this same issue and dealt with it in a good way? The Spine Surgeon says that Radiologists are just generalists and they don’t have the expertise to see many of the issues that they can see in my MRI. I also wonder if MRI’s done while I am laying down don’t show the problems as well as they would if I was standing (or sitting) up—since that is when I have problems. That raises a secondary question of should I not let them put a pillow under my legs during the MRI, to make me more comfortable? Maybe that will make the images of things more clear, even though it is very uncomfortable for me to lay flat? I have had about 5 MRIs in the past and they always seem to put something under my legs for my comfort. Any thoughts on all this would be appreciated.

     
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    Old 08-30-2017, 09:01 PM   #2
    teteri66
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    Re: Lumbar MRI – Problems with Radiology Reports

    As a general rule, standing MRIs are not as clear as the standard prone ones. Some spine surgeons will not even bother looking at them. Putting a pillow under your knees during the MRI is not affecting the quality of the imaging. If anything, it helps as you should be a little more comfortable which should help you to lie still.

    I don't understand why you don't have more freedom over who gives you the medication. I would think you could get a letter from a spine surgeon stating that you are not a candidate for surgery and therefore your options are limited to pain control.

    Have you explored the possibility of having a neurostimulator implanted or perhaps a pain pump?

    I don't think threatening a law suit will accomplish anything positive. Their policy regarding procedure is what it is. It doesn't make sense to me that anyone would take the opinion of the radiologist who scans hundreds of images a day to a spine specialist with his/her specialized expertise.

    Why can't your family doctor prescribe your medications?

    Also, are you convinced surgery would not help your situation? Have you seen a number of different spine surgeons?

     
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    Old 08-31-2017, 06:00 PM   #3
    wt2
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    Re: Lumbar MRI – Problems with Radiology Reports

    Teteri66,

    Thank you very much for responding to my questions.

    After reviewing more some of the radiology reports that others have posted here, maybe I need to look more at where I am getting the MRIs. I explained my concerns more to my spine surgeon and he said that if I get an MRI at their place (which I was told initially wasn't an option), that he will then speak to the radiologist if he doesn't agree with their report findings. So I am very hopeful that this will address my concerns.
    I still think there has to be something to how they do almost all MRI's laying down, that doesn't expose some things for some patients. Just as how my spondylolisthesis isn't found except for me standing and bending in an X-Ray. But I appreciate your comments on pillows.

    My doctors in the past have discouraged pain pumps, saying that they are very problematic. It is only now, since there is such a push to limit Opioid medications that some providers are now talking to me about them. However, I am dealing mostly with PA's or other non-doctors that I don't believe have a good enough education to recommend them. They have asked me to consider Spinal Cord Simulators (SCS- or the neurostimulators you mention), which I am looking at. In general, I have had such bad experiences with surgeries in the past, that I am very reluctant to do anything major. With the SCS, I am concerned mostly about them being able to place the many receptors in my back because they have a terrible time now just trying to do injections in my lower back. Do you have any experience with SCS? I also have other questions on it, and am researching it more. Something that did cut my pain in half though would definitely be great.

    From your responses, I am wondering if you have had to deal with pain management clinics? In my experience, most family doctors won’t prescribe pain medications. And that is the big focus on the CDC’s guidelines, to get these doctors to cut way back on any opioid medications. Going to a pain management clinic is somewhat like being an inmate, rather than a patient. In the past six months or so, I haven’t been even asked by the practitioners there how I am doing or what things are causing my pain. Instead the focus is on reducing my medications to some magical MME number that they say the CDC has concluded is what is best for me! So the government from thousands of miles away, without looking at my files, knows what is best for me? In that time they have changed my doctor twice, and both of the new ones keep going over the CDC guidelines and how they need to somehow conform to them—even though these guidelines are officially just that, are meant specifically for family practitioners, and in my opinion shouldn’t even pertain to me because I have been getting a form of Palliative care for almost a decade—surgery won’t help me and I have three doctors that I work with on a regular basis to just make things bearable.

    Yes I have seen several spine surgeons, including two top 100 surgeons, that insurance paid for through Grand Rounds, that basically concluded that surgery won’t fix my pain problems. One of them suggested surgery, but admits that it won’t likely fix my pain issues, and that my prospects are not as good as some other patients. Maybe they would write a statement on that, but if my current doctors won't read the many things already in my file, I'm not sure they would care about that either—he wasn’t happy that I wanted him to spend more than five minutes with him the last appointment!

    One other option is to go to another pain management clinic. Most of them seem all the same in how they treat patients--especially now because of this clampdown on pain medications. Despite the fact that they are great money makers for those running them, they seem to have a hard time keeping help. However, the last time I tried to change clinics, the doctor wanted to start over with everything I have done in the past fourteen years, and then when I didn’t like that wrote up in my records that I was just looking for drugs. This is despite the facts that I told my existing pain management clinic exactly what I was doing--looking for another clinic that was in-network to my insurance. That was a horrible experience! All this is nothing like the doctor patient relationship that is supposed to exist, and something that others who haven’t experienced it don’t understand what it is like.

    Thanks again for your words and advice.

     
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    Old 09-01-2017, 06:57 AM   #4
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    Re: Lumbar MRI – Problems with Radiology Reports

    Getting the MRI where the current spine surgeon has some control is a great idea. There is a great deal of variance from place to place. Some radiologists write very brief reports while some go into great detail. That just might be the best thing for you to do at this point.

    Luckily I do not have experience with a pain clinic such as you describe. The interventional pain management doctors I have seen were associated with a medical clinic where my spine surgeon and my neurologist also work. Also pain medication didn't work for my issues so I never had to deal with trying to obtain opioids beyond what my spine surgeon prescribed. I have heard many horror stories from others, so you aren't the only one with chronic pain who has problems. From articles I have recently read, some doctors are becoming aware that these top down regulations do not work for people dealing with chronic pain and realize there needs to be another approach. But this won't turn around right away, so doesn't help you now.

    I had surgery for a spondylolisthesis at L4-5 back in 2008. Even though the surgery was medically successful, it did not resolve my issues with pain, numbness and tingling. Initially no one could find a reason for my nerve pain and A neurostimulator was suggested. I refused because I felt there was still something mechanically wrong with my spine that might be fixable. I spent the next two years going from one specialist to another. I went out of state to have a standing/sitting MRI...which a spine surgeon in a third state wouldn't even look at. It did confirm what one of my therapists had been speculating on about what was causing my pain when standing. Then we were able to convince a surgeon and he added on to my original fusion. We all thought my issues were coming from L5-S1 but when the surgeon opened me up, it turned out my facet joints had worn down to tiny nubs and my spine was very unstable at L3-4.

    My surgeon had given me low expectations for how much of my pain would be resolved as the nerves had been compressed for a long time. However, other than some numbness in my feet, I am doing very well.

    Your spondylolisthesis must not be your primary problem /issue if your surgeons don't feel surgery would address your pain issues.

     
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    Old 09-02-2017, 01:36 PM   #5
    wt2
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    Re: Lumbar MRI – Problems with Radiology Reports

    Hi teteri66,

    Thanks again for your responses! What you went through is very interesting to me, especially the part about the sitting MRIs. Something is wrong with how they figure that they can tell everything from MRIs done while a person is laying down. My surgeon did say to avoid Open MRI’s, and that they get clearer pictures from the closed ones. Maybe others know that, but that is the first time I had heard it.

    So if I understand correctly, they fused further up your spine? It sounds like that has now been many years ago, which if true is very good. As I have heard other horror stories of fusions causing instability in surrounding areas over time, causing further need for additional fusions. I do also have degeneration of my lower spine disks, and problems with the facet joints (can’t remember the diagnosis terms right now), and arthritis and bone spurs throughout my lower back. At some point in my mid 40s I lost about 3 inches in height over about a two year period, which I attribute to the degenerative disease in my back.
    In any case it is good to hear that you got those things figured out and that they were able to help you quite a bit.

     
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    Old 09-03-2017, 09:37 AM   #6
    teteri66
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    Re: Lumbar MRI – Problems with Radiology Reports

    From my experience, I think the problem with MRIs that are not done in the tube while prone is that there is much greater likelihood that the patient will move around. When you are in pain, it is very difficult to stand completely still for two or three minutes at a time.

    I had a similar experience to yours with the MRI report. My daughter was living in Minneapolis at the time, so I had an "upright" MRI while visiting her. The images and report were sent to my doctor and to me. When I got it, it made no sense. It reported a bulging disc at L4-5 when in reality I had no disc there and was fused at that segment. I think they sent me the wrong report. The records were supposed to be removed from my file, but when I was scheduled for surgery about a year later, it caused my insurance carrier to reject paying for my surgery, calling it "medically unnecessary." My surgery had to be rescheduled while I went through the appeal process.

    Regarding what is called "adjacent disc disease"...whenever there is an immobilized segment in the spine, the next segment up or down takes the brunt of the stress from movement. So yes, depending on how the person moves, and uses the spine, the next segment can wear out more quickly. Statistically it only happens in about 17% of cases. However, it is often the case that the next segment was already a bit problematic but the surgeon decided not to include it in the original surgery. It was already showing signs of degeneration at the time surgery was done.

    For my original surgery, I had opinions ranging from fusing one segment to fusing four or five. I lee ted to go with the one as I figured it could always be added on to at a later date. In hindsight, if I had three done originally, I could have avoided two more surgeries!

     
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