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Tips for Discussing DDD With my DR

I am a 28 year old male. I recently had a Lumber and Cervical X-Ray along with a Lumbar MRI. Now the X-rays were discussed with my nurse practitioner, and he said the cervical x-ray was fine but did show some DDD. The lumbar x-ray showed some DDD. The MRI showed slight bulging of the discs and DDD, but no significant nerve issue according to the rude phone nurse who tried to tell me going to the ER for my back pain was like going to the ER for a hangnail. I told her a hangnail does not cause you to be curled up in a ball nearly in tears. She asked why I thought I hurt so bad and tried to elude to a number of things like physical dependence on pain killers(previous NP had gradually increased dosage and added medications to the point I was on 2x50 MG Tramadol every 6 hours, 1x Lortab 10/500 twice a day, and Soma(I pretty much took one at night, and occasionally one during the day)), my weight(even though I was exercising at one point, and managed to maintain my weight for about a year), and other reasons that I can;t even be bothered to remember. She actually rattled the MRI results off to me on the phone saying "but you already knew that." I knew about the cervical DDD, but the Lumbar X-Ray looked fine. I go in Friday to discuss the MRI results with my NP. I am rolling with the DDD diagnosis for now, but believe this could actually be Fibro. I was injured in an MVA 3+ years ago and been on a down hill decline, with 2 spurts of improved health, and I have neck pain, with tingling in my arms and base of my neck. I have pain in the lower back that predates the MVA for years and would flair up making it hard to work as it was. The back pain has been known to cause my legs to buckle enough that I had no choice but to go down on my own or go down the hard way. It also causes tingling in my legs. Latley it has even been a bit of vertical pain along the spine where as in the past it was horizontal across my low back. I have pain in both knees. I had ortho knee surgery(R Knee) that predates the MVA and grinding in the R Knee when going up and down stairs. Oh and my shoulders are sensitive to. They grind and pop when they move. Even holding my baby nephew caused me extreme pain last time I held him. So I made this far longer then I wanted, but my reading says DDD does fit my symptoms(other then the fatigue and shoulders). Can any one suggest some bullet points to hit with the NP in regards to DDD?


  • dilaurodilauro ConnecticutPosts: 9,848
    Ron DiLauro Spine-Health System Administrator
    I am not a medical professional. I comment on personal experiences
    You can email me at: rdilauro@veritashealth.com
  • I can certainty see how DDD fits but it does not explain the fatigue or restless leg syndrome(unless that is a DDD symptom and I am getting it crossed). By fatigue I mean that no matter how much sleep I get, I don't wake feeling rested. Although some times it is because I don't sleep good at night because of the pain. I feel tired during the day which would certainly contribute to a fibro diagnosis as would the RLS.

    FWIW, I did fracture L3, L4, and L4 when I was in 8th grade(so about 14). Since then no imaging has showed anything worth mentioning until now. Although even now, the nurse seemed to highly down play the bulging of the discs as insignificant(it was worth mentioning on the x-ray report wasn't it?). I saw many specialist about 7 years ago, and they all said muscle spasms. They treated it with TENs unit, epidural injections, trigger points injections, lumbar nerve blocks, Vax-D, PT, massage therapy, heat, ice, and possibly other things I have forgotten. After a year or so of various treatments, I resumed a mostly normal life but did have a hard time staying at a job due to occasional flair ups and missing to much time off. Fast forward to 3 years ago and my girlfriend and I were in an MVA. The impact spun my vehicle 90* and drug it at least 8 feet. It pushed the other vehicle sideways about 6 feet. It also cracked the frame of the vehicle. My girlfriend did not suffer any injuries other then a bruise. However, since then my health has been almost completely down hill relying on long term opiate therapy for most of those 3 years. I say almost completely because I have had 2 periods of improvement. The first was probably medicine related, and I was exercising 2-3 times a week, if not more. I was taking 20 min walks at least twice a day. This lasted for like 3 months starting around January following the accident(which was in late June 2010). Again this year I saw an improvement period. I was able to exercise more then I had for about 2 years(since Jan 2011). However, the stress of finding a new physician due to problems with my old nurse practitioner earlier this year brought my health back down and I was unable to discus the unexplained improvement with her due to the discharge.

    The NP I am seeing now has been very good about getting diagnostics done rather then just medicating me. Now there is not much he can do cost wise but medicate me but at least we have imaging now. The new clinic is non-narcotic so I have been placed on Lyrica. Lyrica has helped some with the back pain but I feel it has done nothing noteworthy for my neck and knee pains. However, I am only on 150MG while Phizer says 400 MG is the min therapeutic dose for fibro. However, there doesnt seem to be any clinical data, that neither I nor my fibro suffering buddy, could find relating to lyrica for DDD treatment.

    I was also curious if any one has advice on the NSAID front? I was on Ibpruofen 800MG x 3 a day, but never found it effective. I tried Naperson as well with no luck. A convenient care doc I saw between physicians was quick to give me Keterolac but my NP does not like it due to the harshness on the liver. Plus it seems this should only be taken short term. He put me on 15MG Mobic x1 a day. Mobic is a CO2 inhibitor like Celbrex. It seemed worthless though. I went back to Keterolac but again, this is a drug that looks to me like it should only be used short term.

    Sorry for the length. Just trying to be detailed. Thanks again for the response. I will double check that URL and see if it is info I have already read or not.
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