jritchie82
Stranger
Reged: 12/05/02
Posts: 10
Loc: Southwest TN
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Ouch so I've been suffering from back pain for awhile now, I've been on this board quite awhile, but just renewed my subscrition (hence the stranger status or whatever.)
Anyway, back to the problem at hand... Been having back pain in between my shoulder blades which is sometimes dull that wraps around my chest/abdomen, but most of the time it's like someone has taken an electric cord and zapped me.
Went to my PCP, who said "Why didn't you go to your neuro for this?" I then told him that I since I need a refferal (stupid insurance), that he could help me get in to see my neuro quicker (usually a 3 month wait, I kid you not).. So anyway.. go see the neuro and he is perplexed.. Does a full neuro exam, almost 30 minutes of various neuro type tests.. Seems concerned, and sends me off for an MRI... He gave me his cell phone number to call him everyday w/ updates (how cool I thought)... Well the pain was and is getting worse by each passing week so I called him up, and explained the pain again, and how it's getting worse.. He told me to take 1gram of tylenol and call him back if it's not any better the next day.. Of course, it's not. So I called him the next day... And guess what he tells me to take another gram of tylenol! I explain to him that it doesn't help, and that I'm worried about my liver.. He then proceeds to tell me that I need to see a "Specialist" for anything stronger. Well got my MRI (results below). And I'm off to see him today to show him the films, and for him to "Explore my options with me"... I'm kinda scared he will suggest surgery. Which would be painfull for the problem lies in the thoracic spine.. They would have to cut me from the FRONT, and break ribs and stuff.. Now onto the MRI.. What do you all think? And do you think it's wrong for him not to prescribe me anything for the pain? I've got no long standing drug history what-so-ever, and I'm 21!
Clinical information:
Back Pain, Positive Lhermitees Sign
Technique:
This study was performed using a 1.5 Tesla Phillips MRI Scanner. Images of the thoracic spine were obtained in the sagittal and axial planes using standard and fast spin echo technique. T1 axial and sagittal images were obtained following IV contrast administration.
Findings:
Small Schmorl's nodes are noted at multiple levels involving the end plates. The vertebral bodies are otherwise well maintained with satisfactory alignment. No significant disc space narrowing is seen at any level. No evidence of significant canal stenosis or neural foraminal narrowing at any level. At the T11-12 level there is a left paracentral disc protrusion which exerts some mass effect on the spinal cord. No other abnormalities are seen at this level. At the T7-8 level there is a disc bulge without other significant finding. At the T4-5 level there is a small left sided disc protrusion without mass effect on the spinal cord.
Opinion:
1. Left Paracentral disc protrusion at the T11-12 level.
2. Central Disc Bulge at the T7-8 level.
3. Small left-sided disc protrusion at the T4-5 level.
4. Small Schmorl's nodes involving end plates at multiple disc levels.
Date of dictation: 3/13/04
-JR
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Common Sense over common thought - Me
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dhc_60
Member
Reged: 01/31/04
Posts: 177
Loc: mo.
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im not realy sure what you want to know. of course it is not acceptable for your dr. not to give you something for the pain. welcome to the brave new world of pain care hysteria.
the mri would seem to be sufficient for an OP. but i cant gaurantee anything. you will just have to try.
i think youronlinedoctor offers your consult fee back if the dr. wont prescribe meds. but im not sure. check the FAQ section. ephy had the same agreement. so they were the first OP i used just in case records werent enough for dr. to prescribe meds, but all went well. they may have changed rules. so check FAQ.
hope this helps.
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everything is going according to plan... its just not my plan.
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mermaid72000
Member
Reged: 01/19/04
Posts: 125
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i have a friend who had a broken neck and the pcp gives her a whopping 30 hydros a month!! she can barely move around and still works full time. she is a total chronic pain patient who has never been addicted to painkillers, grits her teeth most of the time. they give her plenty of 800mg motrin. in this town for real it takes a act of god to get anything. they want to refer you and refer you and put the pain script on another dr. its really sickening. my mom had her chest opened and she is 76 and they gave her one script of hydro and said we dont want you getting addicted, your chest is ripped open but take one hydro a day. in my experience its the younger dr's that are paranoid. they are so afraid of addiction they undermedicate and cause needless agony. just my experience
carol
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jritchie82
Stranger
Reged: 12/05/02
Posts: 10
Loc: Southwest TN
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Ok.. Went to the neuro today (actually just an hour ago) to review my films... He told me nothing short of a "Narcotic" would ease my pain.. So i'm thinking to myself in my head "that's what i've been trying to tell you"........ So he then goes and gives me NEURONTIN.. Which I already take for a seizure disorder.. He had my chart right in front of him. And he could have seen that.. I "reminded him" that I already take it... He then says to double my doses 3X a day.. So instead of 400mg 3X a day he wants me to take 800mg 3x a day..
So I dropped the bomb on him.. I told him I appreciate his "Professionalism" (ha ha) so far.. But that I have read various publications on the "Off label" uses of neurontin and how it hasn't been proven..He turned ghostly white and started giving me a lecture on how "this will stop the pain before it starts" (BS) and other scenerios where drugs are used in an off label fashion. I basically told him I didn't buy it, and took my neurontin samples and left. So now I don't know what to do. I'm stil in pain, no relief what-so-ever
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tb1218
Member
Reged: 09/19/02
Posts: 171
Loc: indiana
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I have a friend on Nuerontin for Diabetic nuerophathy (she loses feeling in her hands) and the nuerontin is suppose to help, but I dont see it as a pain reliever. I believe it probably is your age. My daughter (20 yrs. old) has a very bad back, disc problems, fibromyalgia, myofacial pain syndrom, etc. Anyway when she goes into spasms, she is in extruciating pain and our family doc says take 4 advil. I take her to the ER and she received darvocet and flexeril. In combination they help a little, but she only got a small script with no refills and no doctor gives her anything stronger. I would suggest to you to do some research on your condition and read the boards and ASK for something the next time you go. (When my daughter goes to the doctor, I go with and ask for the flexeril) Be specific and have facts. Its sad to see pain in peoples faces and I just dont see how doctors can say "take tylenol" If it doesnt work research doctors who would be more inclined to give you something to make you more comfortable. Good luck to you!
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joyous
Newbie
Reged: 01/16/04
Posts: 48
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What did the neurologist say about the MRI?
Did he diagnose you with a specific condition?
I believe you said you have health insurance, do you have the option of using 'out of network' doctors? I was having similar problems....misdiagnosis (or no diagnosis for that matter), and under treatment of pain.
I would ask for a second opinion. PM me if you like and I can give you more information on how I finally got an adequate diagnosis and am finally being treated for several conditions (from a few car accidents), including chronic pain. The trick is finding the right doctor who understands CP and is not afraid to treat it. I found mine through my physical therapist. I hope this helps.
Oh yeah, believe it or not, taking a parent with you to these appointments might help. Apparently a patient appears more 'credible' with a parent or spouse in the room. There are a few threads about this.
I hope you can get some pain relief soon, and like I said if you need anything, feel free to PM me.
Best,
Joy
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night_shade
Threadhead
Reged: 08/26/03
Posts: 907
Loc: The State of Hockey
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My MRI results are somewhat similar, but more extensive than yours. All my back pain is thoracic and I was told by my PM doc that surgery of the thoracic spine is a huge undertaking with only marginal results.
I have 2 fractures (both of T7--which is now classed as "unstable",) multiple "bulging" disks, degenerative disk disease, minor scoliosis (primarily in the lumbar and lower thoracic spine) and nerve root pain which, as you describe in your post, carries around to the front of the chest (I actually thought my chest pain was heart-related because of the referred pain...had no idea it came from back problems!)
After 12 years of hundreds of medical visits mostly PT, chiro, neuro and PCP and being told it was just "muscle spasms"...someone FINALLY suggested an MRI. I found out at my 1st PM appointment that the original radiologist who interpreted the results missed several things--including the non-healed fracture! I think you said you brought the films (or had them sent to the doctor you saw) so I imagine that doc actually viewed the films and didn't just rely on the radiologist's interpretation? Anyway, I'd also had dozens of other treatments and diagnostic tests such as an EMG, thoracic nerve root block, epidural steroid injections, multiple prescription NSAIDs and steroids, trigger point injections of lidocaine, ad nauseum...
My PM doc was VERY compassionate and was nearly offended that I hadn't been medicated prior to that appointment. I am now treated with methadone for pain and receive appropriate care for my condition.
Perhaps an appointment to a pain clinic would be appropriate for your case? I know my PM clinic only takes patients on referral, so perhaps you could ask your PCP for a referral?
Best of luck!
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jritchie82
Stranger
Reged: 12/05/02
Posts: 10
Loc: Southwest TN
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Quote:
What did the neurologist say about the MRI?
Did he diagnose you with a specific condition?
I believe you said you have health insurance, do you have the option of using 'out of network' doctors? I was having similar problems....misdiagnosis (or no diagnosis for that matter), and under treatment of pain.
I would ask for a second opinion. PM me if you like and I can give you more information on how I finally got an adequate diagnosis and am finally being treated for several conditions (from a few car accidents), including chronic pain. The trick is finding the right doctor who understands CP and is not afraid to treat it. I found mine through my physical therapist. I hope this helps.
Oh yeah, believe it or not, taking a parent with you to these appointments might help. Apparently a patient appears more 'credible' with a parent or spouse in the room. There are a few threads about this.
I hope you can get some pain relief soon, and like I said if you need anything, feel free to PM me.
Best,
Joy
Hi Joy..And everyone for their reply....
He looked at the film and said "Oh yeah, there IS a protrusion pressing on your spinal cord"... Like he didn't believe the MRI report or something.
Didn't give me a diagnosis, or anything! Said I'd have to see an orthopaedist, and physical therapy possibly.
I took my mother to the visit who also told the Dr. how I get when I'm in excuciating pain.. Didn't seem to help much.
I just hope that I find some pain relief soon, because this REALLY hurts.
-JR
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joyous
Newbie
Reged: 01/16/04
Posts: 48
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JR,
I would just keep trying. See if you can get a second opinion about your MRI (that's what I did) and get in to see the Orthopedist as soon as possible. Physical Therapy can work wonders, but it takes time. Try to relax as much as you can because stress will only exacerbate the pain. I would definitely pursue this until you find someone who can get you out of pain first and then figure out how to solve the problem. Keep us posted.
Hang in there!
Joy 
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redhill
Banned. Flames, offending others
Reged: 06/02/03
Posts: 278
Loc: Hell on Earth, for now
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Quote:
My MRI results are somewhat similar, but more extensive than yours. All my back pain is thoracic and I was told by my PM doc that surgery of the thoracic spine is a huge undertaking with only marginal results.
I seem to have a very similar set of problems, where a 'bulge' is causing the most protrusion in my thoracic area.
My doctor constantly reminds me he has never heard of pain originating from there, and insists my back pain is caused by something else (even though the MRI clearly shows the 'bulge'.) In fact, to him, my back pain can be caused by anything else, except what is plain to see on the MRI.
Sometimes doctors themselves don't seem to understand the notion of Occam's razor.
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johng
Board Addict
Reged: 02/13/03
Posts: 358
Loc: great lakes
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surgons can be simple minded.
I had a ortho MD look at my MRI say all my pain was muscular sent a letter do my PMD saying I was 'seeking' pain meds sent me home over Xmas with nothing I went back to the rehab doctor who almost went through the roof about (appoligized that I had no pain meds over xmas) sent me to another surgon and was given surgery which helped. So i went from one doctor to another doctor in 2 weeks My 'muscle pain' went to needed sugery.
you good one and bad ones it seems I have more than my share of bad ones
john
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LumbarSpasm
Silent Chaos
Reged: 05/07/02
Posts: 1538
Loc: USA
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A bulge is often considered normal in an aging spine and may be a symptom of degenerative disk disease.
A protrusion is a type of herniation, the term having something to do with the severeness of the degree that the disk is out of place. A protrusion sticks out less than an extrusion.
Is there an annular tear in your disk?
Depends on what type of doc you are seeing as is mentioned above, on how MRI results are interpreted. However the MRI is a tool for diagnosis along with a physical exam and patient symptom reporting, an MRI alone is not enough to diagnosis back pain etiology.
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jritchie82
Stranger
Reged: 12/05/02
Posts: 10
Loc: Southwest TN
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Well folks, there is a light at the end of the tunnell. I went to see the Neurosurgeon my neurologist reccomended yesterday and he was a real (insert cuss word here)  . He pressed on my spine where the problem is --- repeatedly, asking if it hurt. It hurt me so bad that I could hardly say yes .. So he proceeded to jam his fist into my back again and told me to "Speak Up" if it was hurting me! I said yes.. And he repeated the procedure again and again for about five minutes. Putting me through some of the worst pain I've ever had in my life. This made my back pain even worse. After all of this he told me that I wouldn't be a surgical candidate. And left the room, with me completely flabbergasted. The nurse reenetered the room and told me that I could leave now. I asked to speak to the doctor again, and pretty much begged for mercy. And to get anything even ultram for the pain. His response was "we only write prescriptions for our surgical candidates" .. So by now you must be asking yourself "What's so good about this, and how is he "Free at last". First of all the neurosurgeon reffered me to a pain clinic for "Further management" .. But couldn't get me an appointment in the near future. So I left by telling the nurse "I guess I'll go back home and suffer now".... 
Fast forward to tonight at three am. I work in our major E.R./trauma center.. And I was doing some lifting (a big no no). And really REALLY aggravated the situation to the point where I couldn't funtion as my job description see's fit. So I checked into the E.R. which was slammed. So I thought to myself that I was going to be there for at least 6 hours, AT LEAST..
Well, I guess since being a employee they called me back right away (all of my nurse friends where yelling out in mock fun "Here comes a Drug seeker" and laughing. But I couldn't as I was in pain. To my surprise the doctor came in, saw me and could tell right away the pain I was in and Gave me 4mg Dilaudid/12.5 phenergan IV, which I've never had before - And sent me home with a presciption for percocet....!
So now I feel that I've:
A. Accomplished my short term pain relief goal,  
B. Recieved a consult for a pain clinic. 
I was in so much pain, for so long, and was getting ping-ponged between doctors so much , I was finally determined to get relief no matter what the hurdle. And I feel very good that I've finally accomplished this.
I'm sorry If I've rambled on and On, but I'm told Dilaudid will do this to you. 
Thank you everyone for your support  . I finally feel that this great hurdle is now over with, and even more-so, since this was an "On the Job" injury (or rather a severe excasterbation) that I would be covered by workmans comp for any time off, and for the ER visit even though I have a very good insurance plan. So finally after the "System" had been screwing with me for so long.....
Again thanks to everyone of their kind words of support.
Sincerely,
JR :woohoo:
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mermaid72000
Member
Reged: 01/19/04
Posts: 125
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i am sorry to hear about this idiot surgeon, but very happy you finally got some pain relief. the thought of sitting in er chills my soul and there is never a guarantee the docs will give you anything in that situation. i am just happy you got pain relief.
take care
carol
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