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What doc do I ask to see a specialist???

MelWMMelW Posts: 427
edited 06/11/2012 - 9:02 AM in Chronic Pain
For me to see a specialist (spine, neuro, or ortho?), to have them take a look at my MRI, who would I have to get the referral from? I have my general doc, who I just saw about a fall I took in the garage and anything new that pops up and then my PM doc for my chronic pain.

I am already on several pain medications, have tried injections several times over the past few months, do all the stretches I have been shown, but nothing seems to be helping. Last time I was at my pain doc, he said he will not raise my meds because he thinks I am on enough already and that if I am still having that much pain then he doesn't want to mask it, he wants to figure out why. This is the first MRI I have had since December 2009, so he is basing his decision to not raise meds on an MRI that's several years old, so I understand his decision on meds. So I guess with me just having an MRI, do I call the PM doc and have him look over it and see what he wants to do? Or do I ask my PM or family doc to refer me to a specialist, that knows what they are looking for on an MRI? I know this should be simple, but I just am not sure how to go about it.

Any advice will be greatly appreciated!


  • Who ever ordered your mri can review it and then can give you a referal to a specialist,
    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
  • Thanks for the quick response! I am calling them now to see if they will get me a referal.
  • I just called and left a message for the nurse. I pray they give me this referal so I can figure out what, if anything, can be done. I can't take much more. I feel like this pain is ruining my life.

    I am going to school for nursing, still taking pre-req courses, but I seriously question how in gods name I will be able to care for others, as a nurse, with the pain I am in. I have always wanted a career where I can help others. Ever since I was little I wanted to be a police officer. It was my dream! Since having cervical surgery, and still having so many pain/degenerative issues, my doctors have told me that there is no way I can become a police officer because of the physical demands of the job, as well as the medications I am taking. Next on my list was a nurse, most everyone in my family is either a pilot or a nurse or doctor, so I figure I would love to follow in my familys footsteps. If I cannot get my pain "in check," I will not be able to meet the demands of being a nurse either. As of this moment, my doctor doesn't want me to even lift anything over ten pounds! I am just depressed right now and feeling extremely inadequate as a human being.

    About a year ago I was finally getting to that place of "acceptance." Now I am back in a place I hoped I would never be again, anger, depression, and feeling worthless. I just want to go back to being able to ride dirt bikes with my boys, not worrying about everything I do because I fear "paying" for it for days to come. I just want to be able to do things and not question whether I should or shouldn't.

    I am done whining/rambling now. Thanks to everyone here on SH for being here for me, and everyone else. You all seem to be the only ones who understand.
  • When pain comes on we all fall back and realise oops yes i still hurt and i am paying for simply geting a litle active when thats not normal at all,

    Your body will tell you what it can and what it cant do, Not much can be done about it,
    Soon as we get a slight releif we try to get back to normal day to day activity and almost always pay for it,

    We just push on and even if we have to pay for it later we do it to keep our sanity,
    I myself got somewhat active over the weekend working around the house and now feel like i was hit by 67 chevy impala and i hurt from head to toe,

    Who would of ever known anyone can have such skeletal muscle and joint pain in there body after surgery,

    Best of luck just hang in there,
    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
  • Thanks! They actually got me in to see an ortho doc at 4pm today. Right after I got off of the phone with scheduling, I got a call frm their PT department wanting to schedule my physical therapy, before I've even seen the doc... Is that normal? I've don PT, its been about two years, but I got ZERO relief, if anything, it really aggravated things. I've had two sets of injections, no help either. I still do stretching so things don't get to tight, so I'm not sure what PT will accomplish.

    Do I go ahead and do the PT? Or push for answers. I feel like PT and injections are thwir first answer to everything, even when we have been that route with no success.

    I was expecting it to take a bit linger to see a doctor, so I feel unprepared on how to approach it. If I don't have things written down, I go in and forget everything I wanted to say and just end up doing whatever they suggest....
  • I am so darn confused and pissed! So I get to the doctors office, finally get back to see him and find out he is a sports medicine doctor that specializes in bones and joints in the arms and legs (extremities). Shouldn't I have seen a spine specialist? I asked over the phone, when she said he was an orthopedic doctor, if he specialized in spines, and she said yes. He was as nice as could be, but made it sound like none of this was even spine related, even though I've already had spine surgery and my MRI shows, and I have been told by my doctor, that a lot of my pain is stemming from stress above and below my fusion, among a few other factors. He didn't even look at my MRI, he just read part of the report.

    I don't know what to do... Should I call my doctors office back and tell them I want to see an actual "spine" specialist? Or should I be going back to the neuro that did my surgery? I don't know why this is turning into a mess. They know I have ongoing spinal issues, so why in gods name did they send me to a doctor that doesn't even specialize in spines?!?!?!?! :'-(
  • They scheduled PT asap as this is the normal course of action that an Ortho or Neuro is going to suggest most likely and it's usually so hard to get on the schedule.

    If you haven't done PT in two years...I would certainly go and see what it can do now.

    All the things I use are exercise, regular therapy, aqua therapy, massage, yoga/stretching, acupuncture, steroid injections, TENS unit, muscle relaxer, sleep med, counseling, and eating all Organic and anti-inflammatory foods.

    I do all of these things daily/weekly/monthly in addition to the opiates I am prescribed. Each one of these lowers my pain level a tiny bit.

    One of them on their own, just like an opiate, does not do the trick.

    So it's not about one and done with other modalities. It's keeping them all in our toolbox and using them all the time.

    With chronic spine issues...it's imperative that we keep our core strengthened, and keep all our other back, shoulder, arms and legs strong to take the pressure off our spine.

    Same thing with keeping a healthy weight...(not knowing what yours is...but just a general statement)...

    So...that is just me....I keep everything on the table to help keep my pain at a 5 to 7 on the pain scale daily...

    This is unfortunately what it's like with chronic pain.

    The decision about your career is something you will have to work with your Dr. to see if it's possible. It's very difficult and many of us have had to stop our career path and either change it or give it up completely.

    Unless there is something that can be "fixed" permanently.....then it's working with our Drs. to live the best possible life we can with our chronic pain...

    I am certainly wishing you the best....

  • I totally see going to PT to see what kind of relief I can get, but right now I just feel like I should have seen a different kind of specalist. Maybe I am crazy, but it seems to me I should have someone that specializes in spinal issues. A spine specialist may have me doing the same thing, but I think I would feel much more comfortable having a spine doc overseeing this.

    This doctor also said that if I do not get relief from the PT he may suggest botox injections... I have heard of this, but I do not know a lot about it.

    I think I am just really frustrated with everything. I have been in pain since soon after my ACDF (in 2009) and have been seeing a pain doc ever since. My pain doctor and my surgeon, who did the ACDF, both told me my pain is coming from above and below my fusion, as well as stenosis and a few other things that I can't remember at the moment, but this doctor did not even seem to take any of my spine issues into consideration. I told him I am experiencing shooting pain down my arm, with a lot of weakness and some tingling/numbness, which is mimicing the issues I had prior to the ACDF and what led me into surgery to begin with. I can't sit for very long periods of time because of the pain and it has gotten worse over time.

    I do understand that there are steps that need to be taken. I would much rather be able to get relief from conservative treatment than invasive. I just do not feel comfortable with the fact that he didn't even look at my MRI, but is giving me a treatment plan.
  • I thought that you were getting an appt. with an Orthopedic Surgeon to go over the MRI result and speak with them about your pain...So you met with him and he didn't have the MRI results? Did you give them to him? Or call the radiologist and have them send it over to him?

    I thought you meant they went ahead and ALSO scheduled PT for you but you are still meeting with the Ortho....He is a spine Dr....

    You can certainly get a referral to a Neurosurgeon if you choose if you are not happy with the Ortho...

    Sorry for being a bit confused here.....This is a new MRI since your surgery....correct? The Ortho should be looking at both your MRI before the surgery and the one that is most recent..

    Unfortunately as I mentioned....after a fusion surgery....some people end up with chronic pain. And the biggest downfall of fusions are that they cause pressure on the discs above/below the fusion.

    90% of all spine issues resolve themselves with conservative treatments...

    The other 10% like us need surgery and that is only to take the pressure off the spine....not guaranteed to take away all the pain...

    I am doing everything in my power to not need another surgery..

    Botox injections are becoming more popular in treating pain both for migraines and nerve pain in the neck/back...If your insurance covers this....it's absolutely worth trying. As I mentioned...everything is worth doing to have it put even the tiniest dent in our pain..

    There just isn't a magic fix or magic pill...We have to keep using as many things as possible to help besides opiates...

    And again...sorry for the memory here...but are you on a muscle relaxant and nerve pain medication? How about an antidepressant?

    I know you are hurting and frustrating....the only thing you can do is take it one day at a time and ask that the Ortho look over the MRI and give his opinion...and if you don't care for him..then find another Dr....They also need to be working with your PM Dr.....

    keep us posted...

  • "I thought that you were getting an appt. with an Orthopedic Surgeon to go over the MRI result and speak with them about your pain...So you met with him and he didn't have the MRI results? Did you give them to him? Or call the radiologist and have them send it over to him?"

    I thought I was meeting with an orthopedic surgeon as well. After meeting with him I was really confused so I asked what kind of doctor he is and they said he is not a surgeon, that he is an orthopedic sports med doc... Very confused??? He had my MRI CD and report, but said he glanced at my report and didn't see anything that would put me in pain???

    "Sorry for being a bit confused here.....This is a new MRI since your surgery....correct? The Ortho should be looking at both your MRI before the surgery and the one that is most recent.."

    Yes, it is a new MRI, which is what has me upset and so confused. I asked if they had my past MRI, and they don't, but then they told me that I have nothing new going on. How can they know that if they did not have my past MRI to compare it to. When I got home I found my old MRI and compared it to the new one and they have quite a few differences. I have always been really good about keeping all of my doctors informed, as far as what doctors I see, meds I am taking, tests/MRIs/x-rays I have had done, etc. They have copies of everything I have ever had done. I always ask that he be copied on stuff, or I give him copies of my stuff.

    "And again...sorry for the memory here...but are you on a muscle relaxant and nerve pain medication? How about an antidepressant?"

    Yes, I am on a muscle relaxer (Flexeril, 10mg, 2xdaily), an anti-inflammatory (Meloxicam, 15mg daily), anti-depressant (Celexa, 20mg), and pain meds are oxycodone (5mg, 3xdaily), and Fentynal, 25mcg.

    "I know you are hurting and frustrating....the only thing you can do is take it one day at a time and ask that the Ortho look over the MRI and give his opinion...and if you don't care for him..then find another Dr....They also need to be working with your PM Dr....."

    I feel like there's been a lot of miscommunication on both my end and the doctors. I really didn't know how to go about all of this, so when I called my family doctor this morning to get a referral to an ortho or neuro, I assumed he knows the drill and he would get me on the right path, but I do not feel like that is what happened. I would feel a lot more comfortable if I would have seen a doctor that specializes in spinal issues.

    And I am not looking for a mircle, I know things take time and effort on my part. I just feel like I have been doing everything in my power to help myself and not doing a darn thing. I eat healthy, I rarely ever have a drink, and I do as much exercise as my body will allow, up until lately.
  • Well, I just called my docs office and left a message for the nurse. I told them that since I've already had cervical spine surgery that I would feel much more comfortable if I was being treated by a spine specialist, and not a orthopedic sports medicine doctor that specializes in sports injuries. Makes sense to me! Not sure why they didn't think of that when they scheduled me with him.....

    Hopefully this doesn't turn into a bigger mess!
  • While you rely on Primary doctors for referrals, its good to check his responses. When talking refferals, ask your referring doctors the specifics of who he is referring you to and if your not satisfied with it, ask if you have other options for specialist doctors. The best way to do this is to schedule an appointment with your primary doctor so you can be sure he has the time to realize your requests and actually talk about it before sending you away with a referral. Otherwise he's likely sending out a referral to the first place he thinks of, while he's rushing between appointments.

    Also, doing your own research on the internet always helps. You can easily find orthos, spine specialists in your area through google, compare and contrast them and contact these specialists yourself. Sometimes they require no prior refferal and if they do you, can ask them to request a fax referral from your primary, this way YOUR the one in charge and you only need your primary to sign the papers:)

    I find a mix of both ways usually gets me what I need. good luck!
  • Thanks for the advice! I called my docs office today and asked specifically if he'd refer me to the neuro that did my first surgery. I will call tomorrow and ask my neuro if they require a referral. I didn't even think of that! I got so flustered, and was in pain that I wasn't thinking straight.

    Thanks again! I'll let yall know what I hear.
  • My family docs office is so awesome! I just spoke to the nurse and they totally understand my reasoning for wanting to see my neuro surgeon. The nurse I talked to said she has scoliosis and understands 100%, she said she would feel the same way and my doctor was happy I called and voiced my opinion on wanting to see a spine specialist. He just didn't know exactly who to send me to until I left my message. It was a miscommunication on my part, should've been more specific when I called and asked the first time.

    She said my neuro should be calling today or tomorrow to get me scheduled. I am hoping it doesn't take too long to get in since I have been to them before and he did my original surgery. I hope it is quick so we can get this figured out before I lose my sanity!
  • Glad it all resolved well! Usually I will call the doctor's office if they havent called me by 4pm to schedule an appointment.
    Good Luck and let us know what the NeuroDoc says:)

    I walked outside for two seconds and the neuro called and I missed the call!!!! I called right back and the scheduler was on the phone with another patient... I left another message.

    I will update after I talk to her. I am keeping my phone strapped to me!!!!!
  • I had similar thing hapen when i wanted a 2 nd opinion before my scs implant,

    I wanted to see a new spine specialist neuro who was up north of here and called there office and i was clear it has to be a spine soecialist neuro,

    They set me up a date and we drove up there to see the neuro, Turns out the neuro only treat brain and such dissorders,

    I was pissed when she recomended i come back and see the other dr who treats spine,

    I never went back and got a 2 nd opinion from a neuro near my home,

    This is why i always post about make sure you see a spine specialist neuro or ortho bacause they dont all deal with spine,

    And of course they charge for the visit even when they make a mistake seting you up with the wrong specialist,
    Flexicore ADR 2004 resulting nerve damage l4l5 Fusion 2006 same level, 2009 hardware removal with lami !
    2012 scs implant ,
  • Oh man, I hate to hear that. You sit in pain, can't wait to see a doc so you can figure out what's wrong and see what your options are, then show up to find out it's not even the right kind of doc... It is a big downer. Not to mention it sometimes takes weeks, if not months to get in and see a neuro. UGH!

    Well, I finally did get a date for an appointment with my neuro.... June 15th!!! I know I should be positive and be happy that I got an appointment, but I really just want to cry. I feel like it is a life time away.

    It wouldn't be so bad that its a month away if it wasn't for the fact that I finally called the admin for my surgeon directly (because their scheduling office kept bsing), she remembered me (after three years, pretty impressive), anyhow, she said no one had even sent over my mri, nor any paperwork, which I was told was done last week. She had no idea I was even trying to get in!!!!!! Add to that, no one has been coordinating with all of my docs either (PM, primary, injection doc), which I was told was being done also. She got it straightened out and got me scheduled and told me exactly what the doc needs from all of my docs (notes from PM, injections doc, and primary doc).

    Now I am even more stressed because I am in college for my nursing degree (better late than never! :-))) and I decided to take this summer off because of all the neck issues. I was really hoping to get in sooner so that if I have to have something more major done, then I have the summer off and should be able to start classes the end of August (I am taking a really light load, 6 credit hours).

    I am just pissed, and stressed! I hate all the formalities of trying to see a doc!! I know it is a necessary evil, but damn!

    LOL, well I guess that's enough of my rant/venting/ for today... Stay tuned for tomorrow as I have just finished cleaning my kitchen from top to bottom and plan to start paying for it by tomorrow, possibly this eve :-(
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