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PM Doc

tammypttammyp Posts: 49
edited 06/11/2012 - 8:41 AM in Back Surgery and Neck Surgery
Hi everyone
I have not been here for some time.
I had TLIF done in March of 09.
I was having some sucess about 5 months post op but started having nerve symptoms and muscle spasms again.
Basically all the same sypmtoms I had pre surgery that had been eliminated by surgery.
So I had a follow up with him on Jan 6th and told him about my symptoms with a new problem with minor bladder leaking and occasional numbness in my personel area.
He got the MRI and had his Sec call to set up an appt to review it with him.
And he did not see anything to warrent surgery at this time
.
I do have a mild disc bulge at l4 and severe foraminal narrowing at the level l5 he did surgery on.
Any way the last time I was there he said he did not want to do another surgery on me so soon and wanted to try other things and is referring me to a PM Dr.
Does this mean he is done with me and doesnt think there is credibility in my symptoms or is this him trying to treat me with an alternative to surgery.
I dont know what a PM does so i'm just wondering whats going on.
I was off all pain meds after 5 months other than ultracet which I only take when my RLS aggravates me at night.
So I know its not a drug addiction issue.
Sorry I'm just scared hes trying to blow me off and I'm scared because I know something is wrong and I dont want my nerves to get permanently damaged exspecially the one that contols my bladder.
No need to reply to my rambling just want some insight on what to expect from a PM.
Thanks for reading!
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Comments

  • PM Doc

    Hi everyone
    I have not been here for some time.
    I had TLIF done in March of 09.
    I was having some sucess about 5 months post op but started having nerve symptoms and muscle spasms again.
    Basically all the same sypmtoms I had pre surgery that had been eliminated by surgery.
    So I had a follow up with him on Jan 6th and told him about my symptoms with a new problem with minor bladder leaking and occasional numbness in my personel area.
    He got the MRI and had his Sec call to set up an appt to review it with him.
    And he did not see anything to warrent surgery at this time
    .
    I do have a mild disc bulge at l4 and severe foraminal narrowing at the level l5 he did surgery on.
    Any way the last time I was there he said he did not want to do another surgery on me so soon and wanted to try other things and is referring me to a PM Dr.
    Does this mean he is done with me and doesnt think there is credibility in my symptoms or is this him trying to treat me with an alternative to surgery.
    I dont know what a PM does so i'm just wondering whats going on.
    I was off all pain meds after 5 months other than ultracet which I only take when my RLS aggravates me at night.
    So I know its not a drug addiction issue.
    Sorry I'm just scared hes trying to blow me off and I'm scared because I know something is wrong and I dont want my nerves to get permanently damaged exspecially the one that contols my bladder.
    No need to reply to my rambling just want some insight on what to expect from a PM.
    Thanks for reading!
  • Hi Tammy! Have you thought about seeing your gynocologist or a urologist?
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  • So does anyone have any thoughts on what to expect at a PM Dr?
  • When I went to a PM Dr. he did injections cortisone Epidurals to take the swelling down. I had trigger point injections for the tight muscles and facet joint injections all to help with the pain and to get a better range of motion. A PM Dr. can also order pain medications and tests to find the cause of your pain. You could also get a second opinion Neurosurgeon to assess you also. Take care. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • If your surgeon is sending you to a PM doc for saddle anesthesia and urinary incontinence, I would be running(well, OK, I don't run, I'd limp fast) to another surgeon for another opinion. The only good thing about a PM doc is that maybe he/she would be open to actually listening to what you have to say. Maybe the PM doc could help you get referral to another surgeon for a consult.

    Did you have RLS before or after your surgery? Make sure you mention that to the PM doc.

    Surgeons do surgery. He did surgery and he prob thinks his job is done. So, he sends you off to PM when you have symptoms he doesn't want to address(just my personal opinion.) An MRI is not the be all and end all of tests, especially when you have hardware that interferes with a good view. After fusion surgery, docs often order an MRI to look at soft tissue and then a CT scan to look at bony structures. Both have limitations due to the titanium creating artifact, like bad reception on the TV.

    Maybe this PM will listen and get you on the right track. Just as a possibility(and I am not a doc), it could be some sort of cauda equina syndrome, which can be chronic or acute. I hope your PM appt is soon and the PM takes charge and helps you.
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  • Does the new MRI show "severe foraminal narrowing at L5"? If so, when you put that with the symptoms you mentioned, I would think your surgeon would want to do a bit of investigating. Is he sending you to a PM with instructions as to what he wants the PM to do?

    Often after surgery, when the patient still has symptoms of nerve pain, the surgeon will suggest some investigative nerve blocks, done by the PM or physiatrist, to determine the source of the pain. Or he might order a steroid injection to try to settle down a nerve that he feels is causing the pain.

    Is the foraminal stenosis on the opposite side from where he operated? I don't know why he didn't take care of this problem while he was in there. Oh, I guess I don't know at what level you had your surgery....

    Basically, interventional pain medicine is a relatively new specialty, at least in the US. It became an independent specialty about fifteen years ago. A PM doctor is equipped to evaluate, rehabilitate and treat patients who are in pain. For a back patient, it means they may take over the management of a patient's case after the surgeon has discharged the patient (or given up?).

    The PM doctor can prescribe medications, and perform various injections, nerve and facet blocks, ablations, etc....all the treatments except for surgery (in most cases). Sometimes PM docs staff the endoscopic disc decompression clinics, laser spine clinics, etc, but usually the PM doctor will work to lessen the patient's pain.

    Ideally they work in a clinic that also includes other ways to approach pain such as through nutrition, alternative treatments, psychiatry, counseling, etc.

    Whenever there are bladder or bowel problems and the patient also has lower lumbar or sacral problems, one must consider the possibility of cauda equina syndrome. You can read about it here:

    http://www.spine-health.com/information/cauda-equina
  • Thank you enurse!
    I had RLS here and there a few months before surgery, after surgery it went away for about 5 months and is now happening several nights a week.
    I can undrstand him not wanting to do surgery again only 9 months since the last but like you said I dont know how he could ignore saddle and bladder issues. I had great faith in him and am really deflated and concerned that he might be kicking me to the curb now that his great work is done.
    I had spina bifida occulta(39 years with the l5 s1 nerve area exsposed) which was not realized until he got in there. He said I had alot of scar tissue and said that one particular nerve was in bad shape..maybe this was the cauda equina and he thinks that there was permanent damage. The bladder issues only happen a few times a month but the saddle numbness is new.
    I will be seeing him in a week to go over my plans and get set up with the PM.
    I'm not covinced that this is nerve damage from before since I was getting better at the 5 month point.
    I want someone to do adequate testing to make sure that this isnt something new before sending me to get my symptoms covered up with drugs and shots.
    I will keep in mind a second opinion if it looks like I'm getting thrown into the chronic pain section.
    Cheers
  • For what it worth
    L4-5 there is sisc desiccation and mild disc bulge space narrowing with mild circumferential spondylotic bulge. there is a small posterocentral and right central focal disc bulge which appears smaller than on prior exam. No prominent central canal stenosis or neural narrowing is noted.

    L5 S1
    More prominent disc desiccation and disc space narrowing ar e noted wwith grade 1 anterolisthesis, measuring 8mm.
    There is moderate circumferential spondylotic bulge.
    associated disc uncovering is noted. there has been interval post sugical changes with transperdicular fixation screws and rods. There is circumferential spondylotic bulge with posterolateral spondylotic ridging producing severe bilateral neural foraminal narrowing without disc protusion or central canal stenosis.
    This is unchanged from the prior exam. the conus appear normal at the L1 level.
    That last part is confusing me most about it being unchanged from the prior exam.
    He said he cleaned out the nerve canal enough to run a bus through.
    Did he not clean it up or could it have reherniated?
    Im so confused now I really need some valium.
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