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What kind of Dr should I see?

AnonymousUserAAnonymousUser Posts: 49,671
edited 06/11/2012 - 8:19 AM in Back Surgery and Neck Surgery
I have been in treatment with a pm doc for the last 4 or 5 years. My pain has gotten progressively worse to the point where it is very difficult for me to sit here at my computer because of the excruciating pain (my bum, hips, knees, legs, feet, lower back, mid- upper- back, shoulders, neck, after about 15 or 20 minutes I get a furious headache which is relieved when I lay back down) .It effects pretty much my entire back at this point. I have not slept in a real bed for 3 years. I have to sleep on my sofa. It is becoming very difficult to find a comfortable position. Standing for more that a few minutes exacerbates the pain, too. Sometimes I am unable to stand up straight and have to walk very slowly bent over at an angle. I have had injections of one sort or another every week for the last three weeks and have appts for the next two.

I asked my pm doc a while back if there was anything else that could be done and she said there was nothing I could do. A couple of weeks ago she told me that I needed a three level fusion. I don't know which parts of my back she was referring to since there are so many problems there. She also said that they are learning that people who had fusions five years ago are starting to have trouble with those fusions and seemed to be discouraging me against this option.

I love my pm because she has kept me going for a long time. With the government breathing down their back about opiate rx's, sometimes I feel like she wants to keep me and others around who are willing to take these procedures so that she can document that she uses lots of things to control pain and not just meds. Does that make sense.

The injections are painful as many of you know and give temporary relief. They are helping less and less. The pain is currently ruling my life. I find that I am lying down the majority of the time. I am constantly driving back and forth to my pain doc.

There is a spine clinic that my insurance covers, should I try them to discuss options? What kind of doctor do I need to see?

I have been looking at the forums here and surgery sounds awful. I am 50 "ish" and have not much of a quality of life at this point.

Well, thank you for reading this if you made it this far and I welcome any suggestions regarding what sort of doctor I should be discussing these things with.


  • You have ALOT going on! Bless your heart!
    I think yes you may want to just get a doc's opinion if you haven't yet besides or before the pain doctor. With all you have going on a 3 level fusion would be very difficult however if your quality of life has gotten to where you cannot bear to do anything it's worth getting some other input to see if you can get some help!

    An EXPERIENCED spine specialist, an ortho with at least a year fellow in spine sugery,or an experienced neurosurgeon are all options and who/what your comfortable with. I went to one of each, I was too complicated for a neurosurgeon and after all 3 opinions made my decision.

    When you call to get info about a doc and possibly to make an appt it is accectable to ask about a docs credentials or you may be familiar with someone either way one big question if they recommend surgery is "are you going to stick with me no matter what?" Alot of patients get "dropped" after being labeled "failed back"

    Good luck and take care of yourself!
  • Skippy,

    First of all, let me tell you that I had a very uneventful three-level fusion with instrumentation just over 11 weeks ago. I am tempted to say it was successful, but the reason I hesitate is because it is still too early to tell that. But what I can tell, that unlike many on this forum who had very painful and difficult surgeries, mine went like a charm, with no postoperative pain whatsoever. after the morphine pump was removed (in two days) I did not even need a Tylenol. All my previous leg pain and numbness is gone. So I could not been happier.

    Having said that, I will still caution you against jumping into surgery. You see you are younger than I and maybe you have other alternatives to try before electing surgery. And surgery in most cases is elective, except when your quality of life is is so bad that anything else would be an improvement.
    Another emergency reason for surgery is loss of bladder and bowel control. Furthermore, if your problem is mostly leg pain and numbness (sciatic) your
    chances for success are much higher than if you have a lot of lover back and other problems.

    Now it is always a good idea to consult with several specialists. They could be neurosurgeons or orthopedic surgeons, providing they qualify as spinal surgeons and they do a lot of similar surgeries than you are considering.

    Talk to several people and ask what are your options and if you have any alternatives to surgery. This way, you may be able to avoid or at least postpone one. If surgery is necessary, at least you will be convinced that you did your homework and you did not decide on one prematurely.

    Good luck making this very important decision.


  • both for your thoughtful input. My pcp sent me straight to pm doc 4 or 5 yrs ago and I have been with her since. I haven't had any other opinions. I have thought a lot about my quality of life. I know that it could be worse. But it is fairly bad now, though I do keep a good outlook I think.

    I have read stories here about surgeons dropping their patients and that's a good point to think about.

    I think I will at least get a couple of opinions. I don't want to end up in worse condition but it doesn't sound like there is really any way of knowing.

  • I had a three level fusion at the same area, L-2,3,4 and work done on S-1 (bone spurs and calcium build-up due to hairline fracture not taken care of when injury happened) First I hold a high faith in my Neurosurgeon. I beleive people do better with Neurosurgeons rather tha Orthopedic. Neuro's just know your nerve endings better, and they don't start you with physical therapy until your almost fully fused, which I think is incredibly smart. Made sense.. I wasn't allowed to start PT until I was at 20 weeks post-op. (I am now at 23 weeks).

    And not all fusion stories turn out bad. There are, and have been a lot of people who have been on this web-site that we don't even hear from anymore, due to their doing GREAT!! Go to the "success stories" forum. Then there are some that are not doing so good.

    I beleive it is due to starting physical therapy way too soon, or just plain pushing yourself too hard. Overdoing it!! This is a very very slow re-cooperation process, to the point of being very frustrating. They tear up an awful lot when they go in there, that takes a lot of time to heal. Longer than what your surgeon will tell you, that's for sure!!! My NS took clipped bone from the "pointy" tips of my upper vertebra for my fusion, instead of my hip. So not only am I healing from the fusion itself, I've got those tips trying to grow back. So it basically feels like a broken bone.

    But I'm only at 23 weeks, not 5 years. I know of one gentleman that had my very same surgery about 8 years ago, and he couldn't be happier. It's a lot of your inner faith and strength, and CONVINCING yourself, fighting for yourself, praying that YOU WILL FIGHT THIS AND GET BETTER!!! Life will never be the same as it was before, and thats a hard one to swallow. But I know in my heart, that this was the best thing I could of done. Life is just different.

    You really have to fight the urge to do things. I'm 52 but the mind of a 25 year old. I'm ALWAYS stopping myself.

    Take care, and go to that forum. I got to ride my ATV two weeks ago, so it does get better!!! :)
  • Hey Lynnsy,

    I don't mean to be argumentative but I have to tell you that my OS (spinal specialist) must have handled my nerves during my decompression and L3-S1 fusion with kid gloves because I have not experienced any of the excruciating pain or even normal pain many people described on this site. Zilch! Nada! Not when I woke up from surgery nor ever since. No pain meds for me (except for my migraine).

    He told me from the beginning that no PT for at least 6 months. So after 11 weeks I am still just walking - a lot! He said after three months I will be able to swim.

    No I don't doubt, that there are OS who would push people into PT. So my belief is that what is most important is not whether it is a NS or a OS, but the doctor's training, experience, and most of all his reputation. When I consulted my PCP after I saw both a NS and an OS and asked her which one would she select, she said the only one she would consider is that particular OS. Later at the rehab, the OT told me, she can always tell this surgeon's patients because the are doing so much better that other after similar surgeries.

    I am sorry for the long winded response, but I am just so darn pleased with this OS I had to stand up for him and not only because he so cute (which he is!) but at my age I can say things like that if I want to. }:) }:) }:)

    Cheers to all,

    Kin :) :) :)
  • to ask for a referral to the spine clinic today.
    I appreciate all of the information and encouragement.

  • Skippy, many people here know exactly what you mean in "no quality of life". I have been there in the past, and I feel I am there once again. Its so hard. People that haven't experienced this themselves, even those that love you and care deeply for you, just can't understand the way some of us here do. Hang in there, you are not alone.

    For me, when I really hit this point, was when I sought the surgical opinions. If there is a surgical option for you, you need to seriously consider it, you sound like you "are there". There's a point when you realize "What do you have to lose at this point? How much worse can this get"? Just be sure they treat the source of the pain. If you take a surgical option, follow post-op your instructions to a "T". Be prepared for things to get a little worse before they get better, and accept their is a very real risk you might end up worse after surgery, even in the most skilled surgical hands. Stuff does happens. But alot of time everything goes great - that's why people are still having surgery to alleviate back pain!! And yes, some patients do go through the surgery, have dramatic immediate improvement, a great quality of life for a couple years, and then need another surgery. So weren't the couple years in between of good life worth going through the surgery instead of a guarantee of "no quality of life"?

    My PM didn't suggest surgery to me at anytime - I went for the surgical opinions when I was ready after well over a year of failed "conservative" therapy trying to "avoid back surgery". I doubt my PM's motive in not pushing me to surgery was for his financial gain and "keeping me" (God knows he has enough patients), I think it was honestly because he/(they) see the surgical failures in their office(patient bias - the patients that don't do well after surgery are the ones that go back to them), and are acting in the patients best interest. They don't want patients that can "live" and be "functional" through effective pain management to risk getting worse or being disabled by those surgeries gone bad. PM's are a very special group of docs, and God bless them for what they do. I do have issue, however, that your PM told you a surgery would guarantee you future problems. You will find plenty of testimonials here where that is just not the case!
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