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When to call or not?

When you first start to have some type of back problem, a big question always comes up

When do I call a doctor and which doctor do I call?

This can be a very tough question to answer. It would be so much easier if we could see each other face to face. Instead, we can only gauge things on what is being said online.

I have a couple of my standards. But, please this is not any formal medical advice or is it something that you need to follow. It is based on my own personal experiences.

The first 24-48 hours
This is the time period after you first felt a back problem. It is also the time that you should use Ice and
Heat I always like to start with ice for at least the first 24 hours after you first had the problem. It could be the result of a fall, an accident, getting out of bed the wrong way, etc. The ice can have a calming effect on the subject area. Then after that , I would start to apply heat. The heat would generally smooth things over.

First week
I tend to give things at least one week before I make any big move. Depending on where the problem is, I would try to rest that area, perhaps lying down some more (but not a lot). Not doing anything very strenuous.

Second week
Ok, when the problem continues into the second week and without much change, I start to put together a plan. If every day after this, there is no change or worsens, I jump to the next plan, if things remain the same or start to feel better, I will tend to ride it out.

Third week
When you hit this period and its the same or worse, its time to start to call the doctor. The first call, I would generally make would be to my primary care physician. They are the generalist and can pretty much size up your situation. That could mean some low dosage pain medications, a script for a couple of weeks of physical therapy, perhaps scheduling a mri, etc.

From that point on, the primary care physician can make recommendations to continue as is, seek a spinal specialist, etc

So, for me, its the 3 week time frame that I use to evaluate a given situation and then decide on what to do. As I started out with this thread, these are my views only. Each of us need to evaluate ourselves to determine what the situation is. Everyone has a different pain threshold, so that comes into play. Based on what caused the problem (ie Car accident vs picking up something wrong) plays a key role.

Listen to your body, dont jump to any conclusions. I can not tell you how many threads I have read over the years here when a member talks about their new back pain, what to do, who to call, etc, when after a few days, the problem goes away.

But I will stress this. IF you feel that something is really wrong, do not wait any time period to call your doctor. Its much safer to see the doctor and have them tell you it is basically a strain vs not seeing a doctor only to have a very bad disc herniation and nerve impingement.

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


  • Betty65BBetty65 FloridaPosts: 83
    In your opinion, when should a person call after they've been in pain management for some time? For example, I've had DDD, facet joint issues, and bulging discs for several years. Things seems to be degenerating (no pun intended) a little and I'm wondering if I should re-visit my primary doc for new x-rays.

    The PM doc is inclined to continue treating new pain symptoms with different methods such as nerve blocks and medicines. No problem there because the treatments are helping. In your experience, when have you re-done diagnostic tests?

  • itsautonomicitsautonomic LouisianaPosts: 1,801
    edited 07/07/2015 - 2:11 PM
    I would just add if there was an injury and then any loss of motor function, loss of feeling in extremeties or issues with bladder that is cause for immediate doctor visit just to be safe.

    These are very valid statements and important.... Aaron, thank you for posting this Ron DiLauro
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
  • Hey Betty! Doesn't your PM do X-rays & organize scans, MRI's etc for you? I have an MRI about once a year but my back isn't stable, things change frequently. I can tell when something big has changed & sometimes I have 2 MRIs a year. I know I'm not an average case. I've had several different insurance plans & they've never questioned my diagnostics.

    How old are your images?

    If it really feels like something's changed in your spine I'd ask for new tests. I went a long time (years) without a new MRI. My PM at the time kept telling me that he was buying machines (he owns most of the clinics in my area) & I should wait. When I finally got new images my spine had started to fuse & ever since I've been told by surgeons "You've waited too long! Surgery would be too risky!". Ugh! (I have other complications too)
    If it feels like nerves are more compressed or numbness increases, bladder issues, etc it could become an emergency. I've got permanent nerve damage that could of been avoided. Ugh!
    Osteoarthritis & DDD.
  • Itsautonomic. Yes!! Accidents resulting in injury are different. Even if you've had back pain for years you should be aware of nerve impingement risks.

    CES symptoms are considered a 'Red Flag' emergency in England. NHS docs are supposed to get you face-to-face with a surgeon within ONE work week!!

    Spineys should keep that in mind. Any numbness & issues in the 'Saddle' area (the bits of you that would touch a horses saddle if riding), loss of bladder control etc are an EMERGENCY!
    Osteoarthritis & DDD.
  • itsautonomicitsautonomic LouisianaPosts: 1,801
    Yea one of my personal biggest mistakes was canceling the ambulance that we had called after my injury when i was paralyzed in the arms. I had school test the next day and my arms started to work again and it was my senior year last semester etc etc. I should have went and what the doctors tell me now is they would have most likely put me on steroid infusion because of loss of arm function and suspicion of cord impact. That might have really helped, but I didnt want to go to ER for pain/back issues from past bad exp. Put yourself first.
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
  • Betty65BBetty65 FloridaPosts: 83
    It's been over a year since my last MRI. Since I have a personal friendship with my primary care doc, I think I will ask her to repeat the MRI when I see her this month. I would at least like to see if things have remained the same. Your advice as well as itsautonomic's "Put yourself first" give me the courage I need to speak up!

  • Advocate for yourself! Great advise. It's amazing how fast my spine has changed in the past. Really scary. Different spine problems need a different approach sometimes. It's best to keep on-top of things. I also have (at least) yearly medical tests to make sure my liver is doing ok. Chronic pain can cause deficiencies & hormonal changes (As can meds) That can make you feel terrible! It's important to have regular checks. It amazes me that a lot of docs don't recommend them.
    The other thing I keep reading is mouth/teeth problems after years of dry mouth caused by meds & pain. I know I get a very dry mouth at times. I'm going to start using products etc to deal with that now before it becomes an issue.
    Osteoarthritis & DDD.
  • Betty65BBetty65 FloridaPosts: 83
    I may be veering off topic, but it's interesting that you mentioned the dry mouth/teeth problems! Just yesterday I was searching WalMart for something to help my dry mouth and eyes! I've tried Biotin mouthwash, which was DISGUSTING, the Biotin toothpaste, which was ok, but yesterday I found a new product made by ACT. It's lozenges made specifically for dry mouth. They taste nice and the relief lasts for awhile. I also purchased some lubricating eye drops.

    I think I've said it before, but chronic pain can be a part-time (if not full-time) job! Hugs!
  • Pain makes me nauseas so I chew/suck ginger gum & sweets a lot. Now I'm going to add dry mouth products! I'm going to look like Brittany Spears constantly chewing on something! Hahaha ;-)

    Osteoarthritis & DDD.
  • dilaurodilauro ConnecticutPosts: 9,832
    may not be directly related to the subject I started, but still they are worth saying and responding to.

    Nausea has become my way of life as I have lived with chronic pain and all types of medications. I've had many GI tests to find out WHY my stomach gets the way it is. Bottom line, I was told as long as I continue with my medications, especially, the narcotics, there is really no sense in looking into the problem.

    Part of my problems resulted in some very violent vomiting that would last an hour or so. That would totally drain me and I was spent for a day (quick method to lose a pound or so)

    To offset some of this, I use Zofan. Same medication that they prescribe for chemo therapy patients. It really works fast. I use 4mg tablets, but when things are rougher, I go for 8mg. My script is written for 3 per day, but there are days I dont use it at all.

    I have also find fresh ginger to be another great Please, calm my stomach! method. Its natural, and if you love ginger, thats an extra. So, we also have several nodules of fresh ginger in the house. I can use if for my stomach (raw), cook with it, or use it in some alcoholic and non-alcoholic drinks.

    We all need to be creative when it comes to handling stomach issues. For a while, I was taking aka seltzer 3 or 4 times a day.
    My friend, who is a doctor told me to STOP that.... It works, but I need to limit how many times I would take it
    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
  • Thank you Ron. I have prescription meds too but I already take more pills than I'd like. I know for sure than my sickness is part of my bodies reaction to pain. I gave up having the tests after they ruled out anything scary. They make lots of ginger products for chemo therapy & pregnancy nausea. Nice & natural. I like the candies best. All of the big store pharmacies around here sell them but they're often hidden on a low shelf. Health shops have a nice selection too. Ginger is one of the best natural 'tricks' I've ever been taught.

    I've started taking Tumeric Curcumin C3 complex for inflammation. That's one you have to run by your doc because it can be too much with certain antiinflammatories. I'm already eating lots of Antiinflammatory foods. I love to cook & eat Indian food. That's another good way of getting the ginger, garlic & tumeric into your system.

    Other than drinking lots of water does anyone know any natural remedies for dry mouth? I'm going to make a list of all the possible effects of chronic pain & long term narcotic therapy & the little natural/medical ways we can avoid them. I'm tired of fire fighting my health. I already control my diet as much as possible. Only look laxatives twice last year despite being on morphine ER which has always been the most binding of the meds for me! In the past my pharmacist put the fear of god into me about the long term effects of narcotic constipation! I do a liver cleanse diet a couple of times a year. I'm young & hopefully I have many years to go. This is always going to be part of my life now. I don't want the rest of me falling apart. Spine & joints are more than enough!!
    Osteoarthritis & DDD.
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