Injured 09/07. Brief round of PT (no more than a few sessions), sent back to work, and a second, more decisive injury in low back (collapsed to floor, couldn't move). MRI ordered, L1/L2 herniation with extrusion into thecal sac. Radiation into right thigh, feeling like a severe groin pull medially and into anterior thigh. Some paresthesia (pins and needles) in bilateral feet, bottom, more to medial.
Original doc diagnosed L5/S1 facet syndrome, despite my complaint of pain higher up, and MRI showing L1/L2 herniation. She injected at L5/S1, bilaterally, not epidural. Ordered PT. No improvement, second set of injection at L1/L2, minor and temporary improvement, more PT, and a final set of bilateral spine injections. I believed they were epidurals, but was told by the IME below that they were, in fact, not epidurals.
IME confirmed herniation, with treatment alternatives to include surgery, eventually, in the absence of any improvement with epidural injections. (IME is surgeon). Reports no "non-organic reporting of symptoms") (Negative Waddell's).
Original doc orders FCE. 20 minutes into FCE, BP spiked to 170/110, diaphoresis, vertigo due to extreme outbreak of severe pain. Sent to the ER on doc's order, and FCE terminated. FCE reports that though terminated, subjective reports of pain completely supported by objective findings (full and consistent effort, etc.).
Doctor orders second MRI, shows L1/L2 herniation largely resolved/resorbed. Closes file shortly after, no pain management plan, no further diagnostics, returning to full duty without restrictions (including a weight limit higher than I came in to begin with), despite continuing complaints of severe pain - night wakings, can't move/immobilized/severe pain, can't tolerate sitting, walking or standing for more than 15-20 minutes. She ascribed it to my low pain tolerance, and closed care.
I moved to the IME doctor, who is a surgeon. On viewing second MRI, surgeon sends to practice's physiatrist.
Physiatrist examines, tells me, in so many words, "odd, given MRI, but no Waddell's, so I'm not going to drop you." I ask for further diagnostics, as I cannot understand why I have the same symptoms as I always had, with nothing coming up in imaging. Orders bone scan, CT myelogram, though he literally told me "they're not going to show anything never seen an MRI negative with a myelogram positive. You're going to get fired, go through hell for about 6 months, and move on with your life." (I am not playing for effect here - this is literally what he told me this at our first visit ).
Bone scan neg., myelogram positive for right-sided nerve root impingement at L2/L3.
Sent back by physiatrist to IME/surgeon. Surgeon orders NCV, EMG.
Neurologist reports normal NCV, although tibial F-Wave is above upper limit. He ascribes the above-limit (59.0 ms) to my height - 6' 2", rather than any pathology. F-Wave peroneal is 53.9 ms.
EMG is normal except for lower lumbar 1+ fibs, 1+ waves.
Neurologist's Interpretation: NCV normal, except for the aforementioned tibial F-wave, explained away by my height; mild denervation in right lumbar paraspinal muscle.
Concludes (1) "No electrophysiologic evidence of focal or diffuse peripheral neuropathy affecting the right leg;" and (2) right lumbar radiculopathy, not otherwise localizable on the above data."
One is that during the EMG, the first needle insertion caused a surprising zinger - spasm in the thigh, sent through to back, and my back injury area - always a tightly defined locus - zinged as well. In this spasm, tried to relax, my impression is that he wasn't getting a good reading as he tried 3x, then he moved on. I offered to return to it, he said it wasn't needed. Since this right thigh - where he had it placed was in a good locus for the pain I feel - a definite poin medially/groin, to a band anterior thigh - seems important, I am concerned this was a poor marker/data.
I am most concerned that as with my first doctor, who simply closed care without considering more, I am faced with an injury that is debilitating and ongoing, but these objective findings are not supporting anything - symptoms include the night pain, a band of moderate paresthesia on the anterior of my right thing if I sit for any length of time (feels like lidocaine to the touch), the "groin pull" sensation, and my back pain. The intensity isn't constant, but when it hits hard, hard is hard.
The whiff of suspicion has weighed on me heavily - from my original "own" doctor's first ordering the FCE "for the purpose of finding out whether patient's subjective reports of symptoms are consistent with objective findings," to the phyiatrist's repeated statements to me at each of the two visits to his office that "you're not getting any money out of this - you're screwed," it gets old, when I am just dealing with what I am dealing with. It seems to me that it should be evident that if I was seeking a windfall, I wouldn't have chosen the insurance carrier's own practice group to render my care. I want to return to health.
At any rate, based on the above, if any have any thoughts as to what I can reasonably expect to be facing in terms of care, and alternatives to seek given that the back pain/radiculopathy has been with me the entire time, as well as the right side "lame leg" symptoms, I'd be deeply appreciative.