I AM A 40 YEAR OLD MARRIED MOTHER OF TWO BOYS, AGES 12 & 16.

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I AM A 40 YEAR OLD MARRIED MOTHER OF TWO BOYS, AGES 12 & 16. I HAVE HAD SCOLIOSIS ALL MY LIKE. NEVER REALLY ANY PROBLEMS ALTHOUGH I'VE ALWAYS HAD SOME SLIGHT BACK PAIN. IN THE FALL I MOVED A PLANTER ON MY DECK AND VIRTUALLY COULD NOT STAND UP. MY PCP SAID IT WAS MUSCLE SPASMS AND GAVE ME MEDICATION. IN APRIL, THE MONTH OF MY FORTIETH BIRTHDAY, I HAD EXTREME LOW BACK PAIN THAT TURNED INTO PAIN IN MY RIGHT THIGH DOWN TO MY KNEE. I STARTED BY GOING TO THE OTHROPEDIC DR WHO HAD DONE MY ORTHOSCOPIC KNEE SURGERY 3 YEARS AGO. HE SAID IT COULD BE THE KNEE, BUT THOUGHT IT WAS PROBABLY A BACK PROBLEM. XRAY OF THE RIGHT KNEE SHOWED SOME ARTHRITIS AND BONE SPURS. HE SENT ME TO THE "BACK DR" IN HIS PRACTICE. HE IMMEDIATELY FELT IT WAS A TEAR IN A DISC AND SCHEDULED ME FOR 2 EPIDURAL STEROID INJECTIONS TWO WEEKS APART. NEITHER ONE GAVE ME ANY RELIEF. HE PRESCRIBED ONE MONTH OF VICODIN, WHICH HELPED WITH THE PAIN. HE ORDERED AN MRI ON 7/11/06 WHICH SHOWED L1-L2 DESICCATION & NARROWING OF THE DISC SPACE & MILD BULGING OF THE DISC. L2-L3 PARTIAL DESICCATION AND MILD BULGING, NO SIGNIFICANT SPINAL STENOSIS. L3-L4 PARTIAL DESICCATION OF THE DISC, NO SIGNIFICANT SPINAL STENOSIS. L4-L5 PARTIAL DESICCATION AND MILD BULGING OF THE DISC, NO SIGNIFICANT SPINAL STENOSIS. L5-S1 NOTHING NOTED. SCHMORL'S NODES ARE NOTED WITHIN THE ENDPLATES OF THE L1,L2 & L4 VERTEBRAL BODIES. LEVOSCOLIOSIS OF THE LUMBAR SPINE IS NOTED. NO EVIDENCE TO SUGGEST DISC HERNIATION, NERVE ROOT COMPRESSION OR SPINAL STENOSIS. MY ORTHOPEDIC DR DID NOT DISCUSS THE RESULTS WITH ME, BUT SAID HE STILL FELT IT WAS A LUMBAR DISC INJURY, ANNULUS TEAR. HE WANTED ME TO TRY A FEW WEEKS OF PT BEFORE DOING A DISCOGRAM AND TOLD ME TO RISKS OF INFECTION. MY PCP SAID THE REPORT LOOKED "GREAT" AND THAT I SHOULD TRY PT IF I COULD TOLERATE IT. I HAVE NOW HAD 3 FULL WEEKS OF PT. I LOVE MY DOCTOR. HE FOUND THAT DUE TO MY SCOLIOSIS MY BODY IS ALL OUT OF WACK. MY RIGHT SHOULDER IS LOWER THAN MY LEFT, AND MY LEFT LEG IS ALMOST 1/2 INCH SHORTER THAN THE RIGHT. HE PUT A WEDGE IN MY SHOE, DOES MINOR CHIROPRACTIC ADJUSTMENTS, GIVES ME EXERCISES, AND USES MOIST HEAT. HE SAYS MY HIPS ARE MORE IN LINE, BUT MY PAIN CONTINUES AND IS GETTING WORSE. MY NECK IS NEW VERY PAINFUL, MY RIGHT AND LEFT KNEES ARE GIVING WAY AT TIMES, I HAVE A HARD TIME STANDING UP FROM A SITTING POSITION AND CANNOT WALK FOR LONG PERIODS OF TIME. I CANNOT SLEEP AT NIGHT AND IT'S ALL IF CAN TO MAKE IT TO WORK HALF A DAY. MY PT DOCTOR BELIEVES THAT NOT ALL OF MY PAIN IS COMING FROM THE MIS-ALIGNMENT. I HAVE A TOTAL SENSE OF NOT FEELING WELL AND I AM BECOMING UNFUNCTIONAL. MY ENTIRE BACK IS EXCRUCIATING MOST OF THE TIME AND I THINK I AM GETTING DEPRESSED. MY PT DOCTOR SAYS THAT BY LOOKING AT MY MRI REPORT IT DOESN'T LOOK THAT BAD, BUT SINCE EXAMINING ME AND SEEING MY PAIN, IT'S NOT VERY GOOD EITHER. HE WILL EVALUATE ME NEXT WEEK TO SEE WHERE TO GO FROM HERE. IF HE IS NOT HELPING ME MUCH, HE WILL SEND ME BACK TO THE ORTHOPEDIC DR. I DON'T KNOW WHAT TO DO. I SEE SO MANY THINGS IT COULD BE. SHOULD I GO THROUGH WITH THE DISCOGRAM? WHAT HAPPENS IF A TEAR IS FOUND? THANK YOU SO MUCH FOR YOUR ASSISTANCE. I GUESS I'M JUST LOOKING FOR A GOOD SECOND OPINION. SINCERELY, CYNTHIA E. PITTMAN, MIDLOTHIAN, VIRGINIA EMAIL: XXXXX@XXXXXX.XXX

Customer (name blocked for privacy)

Status: Closed Value: $8

Dear Cynthia,

I will do what I can to advise you.

In order to do so, I may have to ask personal questions and/or discuss your problem with my colleagues. I will need your permission to do so.

I'll begin by thanking you for a far better problem summary report than I am accustomed to seeing on JA.

I must first ask if you have been seen by a neurologist. Next, are any of your doctors asociated with the Virginia Commonwealth University School of Medicine.

We'll get to the discogram tomorrow.

I must tell you that my primary actvity is teaching medicine. I do check this site at least twice a day as my duties permit, so you may find some delays in my responding to you.

Teaching Doc

What I tell you is what I teach. I'm here to help improve your quality of life, and I'll work with you as long as necessary to help you.

Reply to Teaching Doc's Post: THANK YOU FOR RESPONDING SO QUICKLY! YOU DO HAVE MY PERMISSION TO DISCUSS THIS WITH YOUR COLLEAGUES. I HAVE NOT SEEN A NEUROLOGIST NOR HAS IT BEEN SUGGESTED THAT I SHOULD. I HAVE CONSTANT HEADACHES, EVERY DAY, BUT MY PT DOCTOR BELIEVES THAT IS FROM MY NECK BEING OUT OF LINE. I HAVE NOTICED JUST THIS WEEKEND A SHARP, SHORT PAIN ON MY RIGHT HIP/UPPER THIGH AREA, THAT CATCHES ME AND KEEPS ME AWAKE MOST NIGHTS. AS I SAID BEFORE, THE PAIN IS IN BOTH KNEES NOW, AND THE AREA JUST BELOW MY RIGHT KNEE, THE FRONT OF THE CALF AREA ACHES CONSTANTLY AND SWELLS BY THE END OF THE DAY. I HAVE THOUGHT OF GOING TO A CHIROPRACTOR, BUT MY PT DOCTOR IS BASICALLY DOING SOME OF THAT NOW. HE POPS MY RIGHT HIP AND ADJUSTS MY NECK. THIS PAST THURSDAY, WHILE LYING ON MY STOMACH, HE PRESSED ON MY LOWER BACK AND I CAME OFF THE TABLE. WHEN I ASKED HIM WHAT THAT WAS HE SAID IT WAS THE AREA AROUND MY L5 VERTEBRE. IT IS SO TENDER. JUST A NOTE: I WAS BORN BREECH AND AT 6 WEEKS WAS PUT INTO A BODY CAST UNTIL I WAS 6 MONTHS OLD. I WAS TOLD MY HIP SOCKET WAS NOT FORMED CORRECTLY AND THAT ONE LEG WAS SHORTER THAN THE OTHER. MY MOTHER CANNOT REMEMBER WHICH LEG! THANK YOU SO MUCH FOR ANY ANSWERS/ADVICE YOU ARE ABLE TO GIVE ME. I AM AT MY WITS END! CYNTHIA E. PITTMAN

P.S. AS FAR AS I KNOW THEY ARE JUST AFFLIATED WITH BON SECOURS ST FRANCIS MEDICAL CENTER AND POSSIBLY JOHNSTON-WILLIS HOSPITAL IN RICHMOND, VA

Edited by Customer (name blocked for privacy) on August 5 2006 at 8:07 PM

I'm just checking in today.

The additional information is very helpful. The happenings in your first year set you up for a lot of your current problem(s), and without that information, I would be wandering in a maze of now unimportant considerations.

Tell me about your "PT doctor." Is he/she a physiatrist (physical medicine and rehabilitation specialist)? Is he/she and MD or, by chance, a DO (osteopathic physician)?

Now, I'll ask you a personal favor. Messages in all upper-case print are dificult to read; we are "trained" to read sentence case and lower case, as in newspapers. I know using all upper case is easier than popping the shift key, but I'll aprciate yourr using it in our correspondance.

I may not be back until tomorrow, so there's no rush to answer today's questions.

TD

What I tell you is what I teach. I'm here to help improve your quality of life, and I'll work with you as long as necessary to help you.

Reply to Teaching Doc's Post: Dear Doc,

My PT doctor has MS,PT,OCS after his name. I hope this is helpful! I forgot to tell you that I have pain in my tailbone area when sitting and then upon standing up. My PT doctor has commented that I seem compressed, like at times I feel my neck is being compressed into my body. I have to try really hard to straighten up and watch my posture. They are working on strengthening my abdominal muscles as well. I am going back to work tomorrow after being off for a week, and I am very nervous about it. I have to climb two flights of stairs to my office, and have almost fallen down the stairs on several occasions. You would think after vitually doing nothing all week I would feel rested. I am trying to continue with my PT exercises at least once a day. Thank you again. Please feel free to ask any questions you feel are relevant. I have to admit to you that I am a smoker, for over 20 years. I smoke 1/2 pack to 1 pack per day. I do not smoke in my home, in my vehicle, or at work, only outside. You can let me have it on your next post!

Edited by Customer (name blocked for privacy) on August 6 2006 at 9:30 AM

Dear Cynthia,

The people who have been caring for you will not be happy with my advice.

My PT doctor has MS,PT,OCS after his name.

Your "PT doctor" is not a physician and does not have a doctoral degree. He should not tell/allow people to call him "doctor." If he encourages people to refer to him as "dcotor," he is guilty of misrepresentation and/or, in some states, a fraudulent act.

MS, Master of Science, this degree can be obtained with one year (some require two) study after the AB or BS.

PT, Physical Therapist, a certification, can be in conjuction with other study and degree.

OCS, I'm not certain, but it is not a doctoral degree and may be a certificate rather than a degree.

Rate me as an academic snob if you will. When a problem is as complex as yours, it requires a team approach, contributions from various specialists accustomed to working together, all coordinated by one of them.

There are two avenues for obtaining such service(s). First, at an academic medical school center, and second, at a major multi-specialty clinic that may or may not have an academic affiliation.

When unusual and complex situations arise, the solo practitioner, or one in a single-specialty praactice, usually does not have the experience and/or tools to do more than scratch his/her head. The really good ones refer their patients to a center where the knowledge and practice is at the cutting edge of the art and science.

You are not far from the very excellent VCU Medical Center. Prior to my retirement from actual patient care at the Indiana University School of medicine and Medical Center, I knew their nephrologists through the literature and personal contact at meetings.

I do not know their referral/admitting procedures. I suggest you ask your PCP to arrange a visit there for you. He should know the setup, so leave it to him/her to chose the clinic/department.

If there are problems with the referral, let me know. I know people who know people.

You may keep this thread open if you wish; I'm not here for any payments. If you want to close this, you can reach me at wisenash@mac.com. (The user name is not a brag. Wise is my partner and I'm Nash.)

Finally, feel free to print our exchange and show it to your PCP. If it upsets him/her, so be it. You came to me for advice, and I have no choice but to treat you as if you were in my office.

TD

Edited by wisenash on August 6 2006 at 11:16 AM

What I tell you is what I teach. I'm here to help improve your quality of life, and I'll work with you as long as necessary to help you.

Reply to Teaching Doc's Post: Dear Doc,
Thank you so much for the information. I do feel that I have been tossed around like a ragdoll from doctor to doctor and none of them are communicating with each other. I dropped the MRI report my PCP's office, I took the report to PT with me. Although the "back doctor" and the "knee doctor" are in the same practice, I don't know whether they've talked about me and my situation. I don't know who the back doctor has consulted with. It's West End Orthopedic Clinic. Fifteen years ago I had a boating accident in which the top of my left foot was lacerated to the bone by a boat prop. After the local hospital had sewn me up, I started having severe problems. I was sent to MCV and saw the head of neurosurgery there, a Dr. Harold Young, who sent me to his nerve specialist at MCV who treated me for Reflex Sympathic Dystrophy, did surgery to repair nerves in the foot by taking nerves from my leg. I was also seeing the Pain Management Clinic there twice a week and getting cortisone shots directly into the foot. Although I was not completely cured, the pain was managed and they tried to fix me. It seems as though you are saying I should pursue this type of route again. Thank you for that. But I would also like to know your feelings on my condition. I know that without seeing me and my reports, but I have given you as much information as I have. I would be truly grateful for your medical opinion. And I would like to continue this correspondence with you. I will let my husband, Richard, read this, and will print it out as well. I hope I'm not bothering you too much!

Dear Cynthia,

Dr. Young is now Professor and Head of Neurosurgery. Some might say that's coincidental, I'd say it's providential. You already know how to make the contact, and they have some records of you. (Sorry you've had the experience with RSD.)

I just don't have either the data base or the combined expertise to offer you an educated opinion. Among the things I emphsize to my students is the fact that in addition to knowing what they do know, they must also know what they don't know. If a doctor knows when and to whom to refer, he won't do harm to his patient.

We certainly can continue "talking." I've already become informal; see the use of contractions.

This old grandfather is off to bed. I'll be on the watch for messages from you.

Frank Nash

What I tell you is what I teach. I'm here to help improve your quality of life, and I'll work with you as long as necessary to help you.

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