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Today's PM visit

I'm new here and wrote a long post in the Sciatica forum. Long history of back pain with sciatica. This is a WC injury so treatment has been almost non-existent. Today was my 2nd. Pm visit. I've had MRI's which were inconclusive and did have an NCS/EMG in 2013 that stated although not seen on MRI and diagnosed as muscoskeletal he found abnormal results that show neurological changes so may perhaps be intermittent. He stated an L4 radiculopathy on left side. He never did the EMG on my right leg although I am one of those exceptions that has dual sciatica. Funny thing is is that I am unable to walk as of 10 days ago due to severe right leg weakness. I had my first PM visit last month. His report stated no true leg weakness and was diagnosed as facet arthritis and wanted to do facet injections at 3 sites. I asked if this would help with my leg symptoms and his response was your problem is in your back. About 10 days ago with increasing pain I experienced a complete loss of function in my right leg. I couldn't stand or walk and went into ED. He diagnosed a R L3,L4,L5 compression with decreased reflexes in my leg and CT scan only showed mild degenerative change with numerous small disc bulges. I was given pain relief shots and 3 RX's when I left and told to follow up with Dr. One of them was 2mg. dilaudid. Fast forward to today's PM visit. Of note here is my Occ. doc has prescribed Norco 5's for a while as needed 2X per day. (60 per mth) I have talked with her before that on some days I need none others more so she is aware of this and this amount has worked OK for me for some time. If I run out I go without but normally don't unless my next appt. is delayed for an extended time for some reason. If I have extra I delay refill and she is given this info by pharmacy. It angers me even explaining this but I just feel the need to vent about today's visit. I was not prescribed anything by PM doctor at my first visit, You may sense that I distrusted his diagnosis and was hoping with new info maybe he would explore further as I have to get back to work (not getting paid) and am too hyper of a person to deal with this inability to walk. He seemed very angry that I was given meds in ED and even more so a RX. I was honest and told him I took it once and was so nauseated I didn't take anymore and have gone back to the Norcos. I also told him I had been taking it 3-4X per day. He flipped out about me taking more than the 2 per day noted on the rx bottle I had been routinely taking. I told him after reading it was important to tell them about anything you had taken, He asked me where the dilaudid was and I told him at home. He asked me if I had any intention of taking it and I said if the pain ever gets that excruciating that I would do anything to relieve it, possibly. He was very nasty the whole visit and prescribed me Lyrica. He asked me about gabapentin and I told him I tried it a couple years ago and thought I was going beserk. I actually got shingles last year and my FP insisted I take it but I was too terrified and I wouldn't. Luckily I have no lingering side effects from those. I also have a history of panic attacks and odd personality changes from a trial with Celexa. Hence I have a fear of new meds. It's silly but I feel the need to express that I have taken Norco so many times for numerous things over the years that I am able to work and think normally. At least with my perception. Anyway I expressed a fear about the lyrica as a co-worker said she felt like she was drunk all the time on it. This further angered him and he stated the Norco had far more side effects and that's what I needed to stop taking. Maybe a little sympathy. reassurance and a low starting point? Nope! I don't know why I feel guilty right now like some kind of addict. I never asked him for anything at either visit and kept reiterating to him my #1 concern is not pain right now it's my inability to walk. I've read a few posts on here about people being treated like this but feel maybe PM is not a good field for this guy. Am I wrong in my thoughts here or would you run from this office. He's still pursuing the facet injections only. I'm so frustrated right now I could scream.


  • SavageSavage United StatesPosts: 5,476
    Hi limpy1 ! From my experience with doctors, including PM docs...they do not like others to prescribe or change their orders.
    That is not our fault..not your fault..especially when it is an emergency. We do what doctors tell us.
    You also said doctor flipped out when you said you took more medication than was prescribed on bottle. Yes it is good to be honest as doc needs to know to effectively care for you. But that..kind of rightfully would aggravate him.

    I'm not sure if you told him how well you are able to tolerate the med.. But that could have been a red flag to doctor and that is why he wants you on another med. also, it is quite normal to change up the meds after a time or so they told me. Like a year or two OxyContin then back to fentanyl patch.

    Lastly, I noticed you expressed about your friend's reaction to a med so you afraid to take it. Nothing wrong with letting doc know of your anxieties, but they don't want to talk about your friends. It's kind of irrelevant but also doctor needs to feel you have some trust going on especially when he may have felt he lost a little trust in you...as previously said. When you told doc you would do whatever needed to be done to relieve your pain...he might have thought you are too comfortable with that pain med. Doctor probably was waiting for " I would call your office when out of control or if after hours whar do you suggest? Should I go to the ER?"
    I don't really see anything here that can't be fixed. Just getting off on wrong foot. I would go to next visit and give doc and myself another chance. At better communication.
    That just my opinion and I'm sure others will come your way!
    Good luck to you!
    Spine-Health Moderator
    Please read my medical history at: Medical History

  • First off I want to thank you so much for responding. I've ranted so much to my poor (adult thankfully) daughter since this started that I feel so bad for her. I've posted twice and admit I check numerous times to see if anyone replied but no prior luck. Sometimes just talking to others who understand how frustrating an ordeal we have is, albeit at different levels can be very therapeutic. As far as the PM guy he is actually an anesthesiologist and his specialty is managing pain before surgery. As stated this is WC so I've never seen any spinal specialists. I had 1 visit prior with him and the only reference to medication we had was what I was taking at the time. As stated my Occupational Dr. (NP actually) prescribes the 60 Norco a month for me. PM(?) doc noted the advil, tylenol. prilosec (nisad damage) and the norcos on my chart. He asked me if they work and I said they take the edge off. Due to the reflux and a reactive sun allergy I was switched to Norco about 2 years ago or so. I can take ibuprofin in the winter and I do although if I take more than 1 I have pretty bad stomach pains. It does seem to be less with the Norco but obviously it's not perfect either. But regardless I really didn't think it was such a problem till this last visit. MY number 1 prob. with this guy and I talked to my Occ. doc at my last visit was that I told her he didn't listen to me. He completely dismissed my leg weakness and I'm probably going to have 1 more thing to fight with comp about as he wrote in the facet approval request no true leg weakness. He stated I have facet arthritis. I would have to make this a mile long to really understand why I felt this way but as stated above even if he didn't believe it was genuine my prior EMG showed otherwise. I told my daughter with the new CT and him seeing the recent increase in nerve damage in my leg perhaps he would at least suggest the epidural. No...I was right he was so nasty the whole visit and asked me when the sciatica symptoms started. Um...I discussed this with you last visit and you said my back arthritis was my problem, remember? I had no contract or any agreement or anything with this guy. Nor did he even discuss medication other than what I said above. He didn't nor as far as I could tell have any intentions of taking over that part of my care. In fact on my way out the door I thought I'd give him the heads up that I have a severe allergy to contrast dye as he never asked about allergies either. I have to continue reporting to my Occ. Doc for my work restrictions anyway. I knew before I went he wasn't the Doc for me when he didn't listen, has never explained at all about what the injections he wanted to do would entail, effects or anything. Just strictly said he was recommending facet injections. Maybe he's angry my Ct scan said nothing about facets? I will say that I tried to make it clear that I didn't go into ED because of the pain. My leg was not responding to my brain. It was very scary to me. I'm used to weakness, shocks etc. but I literally couldn't move my leg or flex my foot at all. I was afraid of it being permanent but apparently I should have ignored this and waited a few more months for the facet injections like a good little patient. Yes, they gave me something for pain because that's what they do there and it did hurt. But my worst fear was permanent nerve damage. Thank God it has slowly got better over the last 2 weeks but I am still dragging my foot and can't do the toe or heel stand thing. (He at least did check that at my last visit) As I write this I knew it was unlikely when I went a few days ago that I would be going back but it is impossible to find anyone that will accept my ins. I admit this leg thing is scary to me and the ED doc said I needed follow up care for it. I reported to the Occ. NP I see after the ED visit but she admits she doesn't have the skill to treat me and suggested nothing but patiently waiting for the injection approval saying it could be months and merely agreeing that I was unable to work right now and out I went. I guess I was hoping if it was serious the pm guy would see it at this last visit? I changed my mind on that one as he still is only pursuing facet injections and what's even funnier is I've had stones in both my kidneys for years. As seen on my CT result he was holding he asked me if I knew that and I said yes. He then asked me if they pursued that that might be what my problem was. For anyone that has never passed any they only cause pain when they are moving. An xray or CT scan would show them doing so and they could make that diagnosis. Such as the one in his hand. And as I've passed numerous ones I can honestly say I've never lost the ability to move my leg! And this reflex weakness was noted by the Doc in ED! Too funny! To anyone that has read this far I'm so sorry for being so lengthy on every response but this lack of proper care and diagnosis for so many years has me right over the edge so even just writing this is therapeutic.
  • PlumbTuckeredOutPlumbTuckeredOut Philadelphia, PAPosts: 325
    I don't want to sound like a bus advertisement (I don't watch TV!) but with a work related injury you need a LAWYER! The insurance that your employer has covers your employer and not you! I had a bad injury 15 years ago and I got a lawyer as soon as a friend encouraged me. Pretty soon I was getting the tests I needed within a week and I was getting paid by the insurance company for the money I was out because of the injury. (Different states have different laws though!)

    Additionally, you keep mentioning your leg pain. I remember this so well before my first back surgery in 1998. I thought my leg was injured and then it always felt like a small dog was peeing on it.... it's all referred pain from your back injury. It definitely hurts like hell but the correction to that pain will be found in your back.

    I'm definitely not a doctor nor a lawyer but it seems like you're being tossed around and you need someone advocating for you.
    Good Luck!

    Two roads diverged in a wood, and I took the one less traveled by...... (Robert Frost)
    I still don't know if I should have taken the one that said, "Caution! Dead End" (Me)
  • Motor1MMotor1 Pittsburgh, PaPosts: 556
    edited 03/09/2015 - 11:04 AM
    I was injured at work also. I worked for a small company. I found out the hard way, that they really didn't care about my wellbeing. I was venting to my physical therapist one day about how I wasn't being paid properly while I was on light duty & going to doctor appointments & therapy. My therapist handed me a card from an attorney that has helped many of her patients. I was very reserved at first to call him. My thoughts were, I'm not looking for a huge settlement of money out of this, I just want paid properly & get the tests & treatment that I deserve, so that I can get better & go back to work. He has actually been a blessing to me! I no longer have to deal with the insurance company on my own! He makes any phone calls that needs made. I live in Pennsylvania & the law here states that I had to use the work comp doctors for 90 days, then I was permitted to go to any doctor I wanted to. It was hard to see their doctors. I had so many injections into my neck & none of them worked at all. Unfortunately, I was required to keep getting them if the doctor recommended them. Please get some names of attorneys & get a consultation. I wish you luck in your journey. I hope you get answers & treatment soon.
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