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New Physiatrist

sleeprgirlssleeprgirl Posts: 695
edited 06/11/2012 - 8:49 AM in Chronic Pain
Went to new pm doctor yesterday, after having increased and severe back and leg pain and increased numbness in legs/feet after having three neurolysis procedures in Sept/Oct for scar tissue around my fusion site.

First off, he was very kind. Will have to say that this has been lacking in my very fragmented care over the last year. He was trained in India and the US. Secondly, he does not prescribe meds, which is great since my preious pm doc made some accusations that I did not appreciate. I had never seen or needed a pm doctor before September, and this issues that I had have been a huge lesson learned. I consider myself new in this chronic pain arena.

At any rate, I was so happy to see a pm doctor who would concentrate on a diagnosis and plan of care. He does not like RFA or lysis of adhesions, but uses blocks, PT, some chiropratic tx when indicated, and then finally surgery when indicated. He does feel that meds are appropriate for chronic pain as well, he just doesn't personally prescribe.

My fusion is L4-5, but I had degenerative changes on L5-S1 facets even before my fusion, which my original surgeon did not want to address. I also have SI joint instatibility causing the greatest severity of pain that I have. I have also had thoracic pain since April. My NS got xrays in June, but did not address them at the time. The xray mentioned some scoliosis, and narrowing at T7, and kyphosis is pronounced, and that radionuclide bone scan may be helpful. Not addressed.

Yesterday it was interesting to note that my upper body reflexes were normal, but my lower body reflexes were exaggerated.

My new pm doc is getting a thoracic and lumbar MRI, with and without contrast on Wednesday, then I see him that afternoon.

He did say that he could not comment on the status of my fusion (I have delayed fusion at one year out). I asked if I should get a second surgical opinion. He said yes and no.
We will wait to see the results of the MRI. I am going to see a fellow trained orthopedic surgeon that actually is in the office of my pm doc. He probably has one of the best resumes in my state. How bad could that be?? (taking words from my favorite cook-barefoot contessa).

In anesthesia, we see the problem, react to the problem, fix the problem...not so in the spinal community. For every symptom, there are 500 causes, and then a variety of solutions. I'm accustomed to getting quick results. This year has been a steep learning curve. My brain is saturated with information. Very confusing.

I just read about the reflexes, but for the life of my I can't remember what I read (those darn meds causing memory issues again), so if anyone can point me to some information, I would greatly appreciate it. I do have a few ideas that come to mind, which I'm not to keen about.

Thus I continue with this spinal journey....just seems like yesterday I had a wonderful career, walking 25 miles a week, playing Rachmaninoff on the piano, scuba diving...would just like a little sliver of this back. I'm determined...I just need really good clinicians around me to help me through it.

Sorry for the long post!




  • *HUGZ* to ya woman!! As discussed in PM's, I am so glad that you are finally with a doctor that has a heart and a brain! :)

    Thinking back on it, I learned similar as you have, that with spine issues, there are no "instant diagnosis" issues for the most part. Your appendix goes bad, bing diagnosed, out it comes, problem solved. Neck, back pain, radiates out - tests might not rule in or out the true issues - frustrating for sure!

    Reflexes (how I remember with mine). When my issues were radicular, the reflexes were slow to respond. With the neuropathy, they 'hyper' responded, as with neuropathy vs radicular..the nerves are not responding appropriately or correctly. Lisa, do a Google for "Nerve reflex responses", and that should help. Again, so glad you are moving into the "win-win" circle doctor wise! *HUGZ*

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Lisa,

    First off is all of your symptoms related to the lumbar spine? If so your upper body reflexes should be good to go unless you have some issues with your neck. This is what I was told about reflexes to not pay to much attention to them till it happens on a consistent basis. So if you have some older medical reports and reflex exams were done you might want to look at those and see where you were.

    From the cervical spine there are a few of us with myelopathy and we have very hyper reflexes to actually clonus. There are varying degrees of clonus meaning some have sustained clonus. Now myelopathy can happen in the lumbar region but isn't seen very often. Did he rate the reflex on a scale 1-5? There is some great information just by googling it under nuero exams.

    I am glad you found a good pm, although I have to say I took the non med route for a very long time, and I think it actually did more damage than good. For instance I was trying to do therapy well the pain was so bad I had no success in it whatsoever. With some meds on board I was finally able to get through some therapy. I might add meds and injections was a entire approach. But if the injections help enough and you could get going in some therapy maybe that is the ticket to put you on the right track.

    Keep in mind the world of chronic pain there seems to be that blend of what will work. The great thing about you is your game to try it all and have your eyes wide open to all types of treatment. One thing we all know is that the more tools we put in our tool box the better we are at the end of the day dealing with pain.

    Keep in mind you might have some set backs with pain with the new treatments. But, you sound like your up for the challenge and willing to work with it. I hope this is the answer and maybe you won't be a chronic pain patient, now wouldn't that be great
  • Brenda, I will do that google search. I've spent today reading MRI interpretations, so that I can better understand my doctor on Wednesday after I finish with the MRI.

    Tamtam, funny that you mention myleopathy, because my NS's PA had tested only my lower reflexes back in August, and I had hyperreflexia. He said no myleopathy noted. Another thing on my list to understand more thoroughly.

    My new doctor did say that normal-upper, exagerated-lower means that it is not cervical. The thoracic issues are post-fusion, and I have waist and rib tenderness, hence the thoracic MRI.

    I have back, hip and intense aching groin pain/pressure. Looking at the dermatome level that is L2. However, I read that you can have issues at L5 and it can travel up to L2 and appear like L2 when it is really L5. I have L5-S1 facet degeneratie changes, so that was interesting to read.

    My appreciation for the difficulties for the clinician continue to grow as I become more informed myself.

    Oh..tamtam...my new pm doctor believes that meds are useful, but just doesn't prescribe. He is going to send me to someone who will prescribes all meds needed. Not sure who this person will be, but his assistant told me that he can do that. I'm on the trilogy for pain, plus lidoderm patches. My NS is prescribing my meds at this time.

    As FROG said to me...Will definitely maybe get there...probably :-)

  • I forgot about the clonus aspect of nerve actions. I have it in my left foot, and allegedly as my Neurologist put it (my toes curl up instead of down?) when they run their probe thing along my feet, it helped validate the EMG diagnosis of upper motor neuron lesions. Sigh..Still don't know why if they're there, how I got them.

    For my back my nerves affected are the L2 and L3, and as such "back, outer hips, front of thighs to the inner knees." On a bad day, it extends to the top of my calf's - none below. I think that's why I thought the feet reaction was weird. Does any of your leg issues match L2/3 or is that portion match the L5?

    Have you asked your doctors more about what reflexes they are testing and why? E.g., what they're looking for specifically? Like Tamtam said, baseline and comparison. I'm expecting my Neurologist will do a full workup to see where I am now vs 6 months ago, and now a year ago + for the MRI's last taken.

    Make sure to keep "their" feet to the fire woman, and get answers. You're a nurse, you know better than a lot of us non medical types how doctors are. :)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • If you map it out, I have many L1-S1 symptoms. I'm certain that I will have more questions by Wednesday after the MRI. Thanks for the input.
  • Lisa,

    You know the drill. Please DO write down your questions. Even in the medical field, when you are in "patient" mode, I am sure there is a wee bit of the ole "white coat syndrome" even with RN's? I am still so happy that things are finally turning around for you for the better woman. *HUGZ* :)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
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