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Seeking Advice

Hello there! I have suffered with mid-back issues since 2007 and I am a fairly young (27) male who got a progressive injury while working for the Post Office. Long story short, it took years to identify my injury and begin any form of treatment. I have an open Workers Compensation case and continue to battle on a regular basis.

I have been diagnosed (via MRI) with three herniated discs with nerve impingement at each level at T6-7, T7-8, T8-T9, as well as Thoracic Facet Syndrome, Degenerative Disc Disease, Chronic Pain Syndrome, and Depression with Anxiety (which I feel is understandable given my situation).

I have seen quite a few doctors about my back. My GP doctor has run out of treatment options (although she did her best and I appreciate her effort) and she said I should speak to my Pain Management doctors. One of my PM doctors is an anesthesiologist who specializes in injections and similar procedures. We had done several epidurals and facet injects with little impact. He referred me to a colleague to get a rhizotomy at each level both sides. This only relieved pressure on the facet joints... no real pain relief- which I feel it matters. But took over 8 months to get done. Not to mention Workers Comp is not paying for this procedure for an unknown reason... I have to pay out of my pocket. After this procedure not doing what they said it would I felt VERY depressed for a month and decided something HAD to be done. So I scheduled a new meeting.

So I had a meeting with this doctor to ask about ANY possible treatment solutions. After waiting over an hour and a half to see him (after waiting such a long time, I hurt. A lot.) but I understand he is busy, but he came in for a VERY brief (under five minute meeting). He entered and acted as if I was wasting his time. He was very rude and abrupt, he barely let me speak. He said my ONLY options are to do nothing or join another Pain Doctors group therapy sessions. This other doctor was in charge of my pain for about a year a couple of years ago. This doctor only wanted to shove high dose morphine and muscle relaxers down my throat. I have always said I am wary of such drugs as my family has a serious history with alcoholism and drug abuse (NOT myself personally... but immediate family). Still I listen to this other doctor for the full year I was with him. That year was the hardest of my life. I felt little relief and fell deeper into depression. Eventually I said enough is enough and went to a new doctor (my current GP doctor).

I told this story to my doctor and he seemed not to care. Maybe I offended him because they are colleagues, I am unsure. I apologized if I did in fact offend him. He acted as if I want to do nothing. I have repeatedly stressed the fact I want to get better and I make a clear effort to make a positive impact on my life (example: I started dieting to lose some weight to relieve pressure on my back. I have lost 35 lbs in the past 6 months). And he acted like I just want to roll over and give up. I also feel I should mention the program he suggested is VERY expensive and I have a hard time getting Workers Comp to cover anything, let alone something as expensive as this program. And I feel it is somewhat of a conflict of interest since they share offices and most likely share some of the profits.

I am not sure why he was so rude and abrupt, this is unlike my previous visits. I have recently filed for disability since I have not worked since my initial injury. I have waited so long to file because I wanted to get better, but at this point I feel I have exhausted my treatment options and for the foreseeable future I am going to be in intolerable pain. When we were leaving the office the doctor said something that shocked me because of his clear anger over the subject. He stated that not a single individual can be disabled. Before I could respond he barked, "Even Quadriplegics can work." And he left with that. I was stunned. Although I understand that some people can work around their disabilities, I disagree and think some are too hard to overcome. I respect his perspective but I feel he was overly aggressive, rude and abrupt. Also, I did NOT ask him to file a report saying I am disabled. My disability lawyer did ask him a few basic questions, but nothing that has not already been established in my Workers Comp case. We did not talk about disability during the brief encounter until we left... and he brought it up.

Now I need advice. What should I do? I honestly do not want to return to this doctors supervision, as I do not trust him. And I feel sort of abandoned by my other doctor. All I want is to get better, but I suppose if there are no more treatments there are no more treatments. Should I find another Pain Doctor? Should I just do what I have been doing and improve my life on my own? I need advice from people who have had similar situations or understand my situation.

I almost forgot, I have had more treatments than what I listed, I have done plenty of PT and Aquatic PT and plenty of pills (although I shy away from them). Any advice would be appreciated. I have spoken with two surgeons about surgery but neither think surgery is viable since there are three discs that are herniated and they are unsure which one to operate on. Not only that but the location is very tricky and they reserve surgery only when you are in a critical situation. I understand that they are unwillingly, at this time, to do surgery.

And a brief description of my pain: I have a 6 inch by 6 inch square on my back that is in constant pain. The area is always achy accompanied with sharp pain that comes out of the spine. When the pain gets very bad it can turn into a burning pain. When this happens I feel sick to my stomach and can barely think. I am terrified to go out in public or into situations where I can get sudden onset extreme pain. I have a hard time doing anything for more than twenty minutes (typing this in one go has been very painful). This pain has been constant since my initial injury in 2007.

Anyway, I am sorry for such a long post but I need advice. If I seem like I am complaining, I apologize. I just want to report my issues and figure out what to do. I have tried to include everything I could... but I am sure I left something out. Thank you for reading and thank you for your advice in advance!


  • LizLiz Posts: 7,832
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    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • jlrfryejjlrfrye ohioPosts: 1,110
    Explain everything that you just said to him or her and ask for your Dr of record to be changed along with a referral to another DR. Even if there is nothing more that can be done it is important to have a good relationship with your Dr. If the Dr you have now, you do not trust, then he is not the one for you. The medications that you do not like taking is understandable but there are many medications out there that have a low addiction factor. Ive had Drs that I personally thought were rude and do not want my long term care under their supervision. It is important that you trust your Dr.
  • I appreciate the response. I agree, I should be able to trust my doctors. This was the first time I felt anything like that from him and it seemed out of the blue. I guess I should start looking on Monday at where to go next. I appreciate the input :D
  • sandisandi Posts: 6,343
    edited 06/08/2013 - 10:14 AM
    you are seeing the wrong doctor for the wrong condition. Your GP is not the doctor to treat your back condition. Your GP is there to treat your overall health picture and if your insurance requires it, refer you to other specialists as your medical condition warrants it.
    You should either be consulting with either a board certified orthopedic or neurosurgeon , and in your case specifically a thoracic surgeon since the area of the spine problems are in that area. You may need to find out where the largest city near you is, and then check their registry for a board certified thoracic ortho or neurosurgeon. Most spine surgeons will not touch a patient in the thoracic area unless there is a risk of paralysis, so you really need to find the biggest city hospital near you and start your search there.
    A radio frequency ablation is done to burn the nerve fibers in the facet joints of the spine. It does not relieve pressure. However, it can be a failure if there are not test injections done first to confirm that the area is the cause of the pain, and if the burning of the nerves is not done properly. Most patients who undergo RFA have excellent pain relief when the cause of the pain is coming from the facets and not some other area. It would be worthwhile undergoing it again, but this time , under the care of a board certfied Interventional Pain management doctor. These doctors specifically use various injections , nerve ablation procedures and medical devices to help reduce pain .
    While I can understand your fears regarding the use of opiates to treat the pain, and it is something that ALL pain patients must keep in mind, used properly, under the guidance of a properly trained physician, they are one small part of the overall treatment of chronic pain.
    Anesthesiologists do also treat pain but they are not always the best choice when it comes to getting specialized procedures such as RFA, spinal cord stimulators and other modalities performed since their primary speciality is one of anesthesia.
  • Many surgeons shy away from thoracic surgery, and for good reason. However, there are those spinal surgeons that specialize in thoracic surgery and are comfortable and highly experienced repairing/fusing multiple discs areas. I have no idea where you live, and again, there aren't many that do specialize in this specific type of surgery (as in general its more rare to have problems here and it is a more dangers procedure compared to neck and lumbar). You will probably have to travel to see one. I still think it would be worth the travel to consult with one of these surgeons. I'd think your workers comp lawyer could help you with this search.
    33yo mom of two. My surgical history...preadolescence scoliosis, kyphosis, and a hot mess.... 5 spine surgeries and lots of items added I wasn't born with (titanium, peek, surgical steel). Guess cremation is out. TSA loves me.
  • Thanks for responding guys! First off, I went to my GP just for a fresh start. And I totally understand I have complicated back issue that she is not quite qualified to deal with (thus why I am looking into options).

    I had numerous injections in the facet area by the anesthesiologist and I had some relief. He referred me to someone who was very skilled with the RFA. After a month or so the relief I felt was in the facets, but it was just minor pressure like relief. I was led to believe that I would have much more pain relief, thus my disappointment.

    I am aware that surgery is dangerous in the location, which is a bummer because I am in constant pain. The nearest 'major city' would be Boston. I will do some digging and give my Workers Comp lawyer a call and see what she thinks.

    Thank you very much for your help!
  • I would find a complete new healthcare team. Get a new PCP that you like, and trust first, as they coordinate all of your care. your new PCP can most likely refer you to a pain specialist that you might like. The trick is to keep trying until you find the right doctor. Usually they are the ones that you like, and feel comfortable talking with. I would ask to be referred to a physiatrist by your PCP first. the physiatrist is a medical doctor that went to school for 2 extra years studying the muscoskeletal system in depth. They are trained to treat the "whole person', and i think will be "right up your alley". Don't be afraid of becoming addicted to painkillers, if you need them, then you need them. No sense in suffering if they might help you. I have heard horror stories regarding workers compensation claims, and never filed one myself. I'm so glad I didn't. I filed for SSI instead, at age 28, and am so glad I went that route. good luck.
  • I just realized your near Boston. The best place for you to go is New England Baptist Hospital. It's also where all the professional sports players go for any type of joint surgery, and treatment. I would ask your doctor if you can be referred to a doctor that's affiliated with them. I'm serious. I have had 9 lower back surgeries in 4 different hospitals. Baptist was the last one, and saved my life! They are great there.
  • terror8396tterror8396 Posts: 1,832
    edited 06/09/2013 - 4:54 AM
    just one comment about seeing quite a few doctors for your pain. i think that doctors have negative reactions to people who see a lot of doctors. i don't know how many you have seen but there are records, especially with workman's comp that show who you saw and for what reason. this might be the reason for the hostility with doctors. i believe with workman's comp. you are to see a doctor and become established with them. i also think that one must get permission to see other doctors. when you were injured, your work should have sent you to a work comp clinic to check you out. they set up appointments to come in an also set up a doctor to see you. i am not sure with respect to workman's comp why you saw a lot of doctors. my friend at work is on workman's comp and he sees one doctor that he was referred to. i believe you can see your own if they handle workman comp but if not your case manager will set you up with one. i don't think going to different doctors is the way it is handled. my guess is that is why the doctors acted rude and dismissive towards you. see one doctor and stick with them especially if your case manager has set you up with one. i believe if you are not happy, then you should tell your case manager to get you a new one. i also think that most workman comp doctors feel that their job is to get you back to work asap and not be off for a long time. this is the talk to that my friend got when he went on workman's comp. he has a case that is outstanding but he is working. this might be another reason for the attitude of your doctors
    I have 4 fusions from L5-3, the latest last May '12 where they fixed my disc that broke.They went through my side this time. I take 40 mg of oxycontin 4x a day and 4 fenatyl lollipops 300 micro gms 4x a day.
  • I will check out the New England Baptist Hospital and see what programs they have! I appreciate it! I just hate the feeling where they act like I wasting their time. I saw one of the better surgeons in my area and he said that no one should do my surgery and even if I found someone to do it, it might not be in my best interest. Which was a total bummer- I just want relief! But they sound pretty awesome so I will definitely look into them!

    And in regards to Workers Compensation... I worked for the Federal Government when I got hurt and the rules with the Federal Workers Comp and State Workers Comp are entirely different (the Federal Government Comp is much harder to deal with). I am able to choose my own doctors and when the Workers Comp want a different opinion I go to their "doctor" (who is generally in some sketchy location a ways out of the way). And seeing multiple doctors shouldn't be a problem... as I was referred to all of them except my PCP. I am sure they could think I am "doctor shopping" but anyone with sense could argue that I am trying to get treatment. I haven't seen any new doctors in about a year, so I don't think his recent hostility is that. Thanks for thinking though!
  • srahimissrahimi Posts: 1
    edited 06/13/2013 - 2:07 PM
    Being proactive about finding good doctors is important and everyone here is has given good advice. Having said that I've found that doctors (busy as they typically are) can only put so much energy into delivering consistent help with your pain. I've written a few of things that helped me a great deal while I was at the peak of dealing with my disc herniation issues a few years back (coincidentally also due to a progressive work-related injury at three points along my spine.)

    -Eating very spicy food if you can manage (the endorphin rush from the capsacin helps. I'm pretty much addicted to Thai pepper at this point.)
    -Stretching/mobility exercises performed daily (guided by a professional physical therapist.) Especially for progressive injuries you have to strengthen the weaker parts of your back.
    -Meditation (calms the mental components of pain, though maybe not practical when you are in bad pain)
    -Moist Heat (A hot rubber water bottle on my neck every night when I slept for one month helped get rid of 30% of my neck pain)
    -TENS devices (They sell them online. I was given a TENS device by a chiropractor after two years of visiting doctors and cycling through solutions. It changed my life, basically giving me a knob to control my pain level. I like the TENS 3000 version best, which I think is on Amazon.)

    Be as firm with your worker's compensation counterparts as you can, you deserve whatever care you need especially as a government worker.
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