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General Practicioneer or neurosurgeon

AnonymousUserAAnonymousUser Posts: 49,622
My wife has a herniated l5s1. She has had some numbness in her toes and cannot do a toe lift. Her GP sent her to a neurosurgeon and he said that he didn't think she needed surgery at that point but to comeback if needed. Flash forward a month and my wife is doing better, but has the numbness and tingling. Her GP told her he believed she was having damage to her nerve and that she had a window of 2 to 3 weeks to have surgery otherwise she would end up losing feeling in her leg permantly and not be able to walk.He set up a consult quickly for the same neurosurgeon as before. My wife was shaken by this.She saw the NS 4 days later. He said he was 100% certain what the GP said wasn't true. No danger of losing the ability to use her leg.He thought my wife was actually improving!So the question is this. Who should she believe? The GP whom she has trusted for years? Or the NS who obviously has more experience with this stuff? I'm looking forward to some opinions. Thanks
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Comments

  • I agree with Paul, definitely get a second opinion from a different surgeon. That's something I would do regardless of what the first surgeon says. I would also ask my GP about seeing a physiatrist or pain management doctor, they would have alternatives to surgery that are more conservative and may alleviate her symptoms. There are many injections and tests, such as the EMG, that can provide a lot of direction in the best manner of treatment.
    Good luck, I hope your wife can get some relief and welcome to Spine-Health!
    Jay
  • Maybe in the past doctors thought that if I nerve was compressed, you needed to alleviate the compression right away or the nerve would be damaged. Now that mostly is not the case.

    By a "toe lift" do you mean she cannot go up on her toes or walk on her toes? Can she walk on her heels? Does she have any other numbness or tingling going down her leg? It is odd to only have it in her toe....

    I would suggest getting a second opinion from a fellowship-trained orthopedic spinal surgeon. This would be an ortho who devotes his practice to the back and spine (nothing else like joint replacement, setting bones, sports medicine, etc.). This specialty has similar training as a neurosurgeon but I feel offers a slightly different perspective.

    They are usually working with the patient to find the source of the problem and then offer conservative treatments...probably having a pain management doc or a physiatrist do the injections, nerve blocks, or whatever might be required. But I think it is better to start out here and be referred because of the following reasons.
    1) I feel the ortho with perhaps be better at making the original diagnosis since spinal issues are the only thing s/he deals with

    2) and most important: I feel you should have a surgeon lined up in the event that your wife would need emergency surgery. Especially with a problem at L5-S1 there is a possibility of developing "cauda equina" syndrome, which means the nerve compression is causing bowel or bladder problems, which is considered a medical emergency. If you don't have a surgeon of your choice, you will end up with whoever is on call at the hospital. Also, you know how long you have to wait to get into a specialist as a new patient. If you have an established relationship, you will be able to get in right away.

    There are other reasons, but those are the most important, in my layman's humble opinion!!

    I would tend to side with the NS's opinion. Tingling does not necessarily indicate nerve damage. It depends what else is going on. I had numbness and tingling in both feet for more than three years and do not have permanent nerve damage. But, it varies from case to case, person to person. I would get another opinion so you feel better about waiting.

    Good luck.
    xx Gwennie
  • dilaurodilauro ConnecticutPosts: 10,065
    Especially if the diagnosis you have received does not make sense to you or there are other problems.
    You do not want to fool around with spinal disc problems and more importantly, you never want to fool around with a disc that is impinging a nerve root and causing nerve pain.
    Its important to go with a doctor that you trust and like, but sometimes, even the worst bed side manners can result in the best doctors.
    You want someone who will be willing to not give up until they have fully diagnosed your wife and have come up with an action plan. There are so many diagnostic tests today, one or more should prove the point and then there are so many conservative treatments that always needs to be considered before the topic of surgery is even thought of.
    Ron DiLauro Veritas-Health Forums Manager
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • djembe44,
    You may find my history very helpful. It appears to have some distinct similarities

    http://www.spine-health.com/forum/sciatica-leg-pain-radiculopathy/weak-calf-muscle-0.


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