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Arguing about diagnosis? [UPDATE: 1-3-13]

eadubyeeaduby Posts: 100
edited 01/03/2013 - 9:37 AM in Neck Pain: Cervical
So over the past couple of days I've been researching like crazy and reviewing my MRI images because my diagnosis from pain management of Myofascial Pain Syndrome doesn't really line up well with everything I'm experiencing, and the therapist who did my recent PT eval strongly disagreed with it and called it a "we don't know what it is so we'll call it this" diagnosis.

Well I think I've found the answer. Cervical foraminal stenosis. All of the information I have uncovered about this diagnosis lines up well with what I am experiencing. When I went over my MRIs I found imaging supporting this being the case and affecting the C7 nerve root, which would also line up with my symptoms.

My question is, what is the best way to bring this up to the doctors? I want to be heard. I know that there is a chance I may not be right but I am quite confident in my findings and definitely think that it is worth looking into. Do I bring it up to pain management? My primary care? Go back to the orthopedic spine doctor that referred me to pain management after my MRI was normal? Any advice is appreciated!

1-13-13 UPDATE:
I had my pain management appointment at eleven this morning. The way my PM clinic works is for regular appointments you see PAs and NPs and then you see the MDs for your procedures and testing. So the NP (the same one I always see) comes in and I tell her how the aquatic therapy has aggravated my pain drastically and how I'm upset and angry that they are diagnosing it as a muscular problem but both the physical therapist and the er physician disagreed. Then I tell her how I did some research and took a look at my MRIs and start to tell her about how I believe that at the C6-7 there is narrowing in the neuro-- and she interrupts me right there and starts talking about how my films were read by a radiologist and I am not one. I interrupt and ask her to at least look at the images I have brought, she refuses and I push and she says she will have it reread by a radiologist.

Then she starts to act like she is going to end the appointment and I am *not* okay with this since at this point with my condition I am in such a bad state my quality of life is down the tube and my career is starting to go down the drain. I tell her as such and she says "I can't give you narcotics without a reason." Never once did I ask for narcotics, suggest them, anything of that sort.... I am incredibly upset and I explode crying and yammering on about the pain and this and that I can't do and how my life is. She kind of freaks, says "I'm going to go get a doctor", and leaves the room.

She returns with one of the MDs that I haven't met before and I tell her right away that I don't care whether they give me narcotics or not I just want help. She asks some questions about my pain, and with my answers she each time confirms that they are related to the C7 nerve root... Then she says that we can up my nerve pain medication (Topamax) and that I can have a diagnostic nerve block to see if the C6-7 is causing the problem. So on Tuesday I am going to get the nerve block! Quite happy about that. If nothing is found from the nerve block or the reevaluation of the MRI then the doctor said I will be getting a bone scan as the next diagnostic step.


Microlaminectomy and discectomy at C7-T1 on April 26th.
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Comments


  • Have you got, or could you get a copy of the MRI report?
    That would probably mention C7 nerve root compression or something about stenosis of the foramen.
  • eaduby said:
    When I went over my MRIs I found imaging supporting this being the case and affecting the C7 nerve root, which would also line up with my symptoms.
    The report does not state finding any "significant" narrowing. Otherwise I probably wouldn't have to fight this diagnosis, but I'm not an idiot, and while I am saying there is a chance I could be misled... I know how to find out how the condition looks on an MRI and then I know how to go through my films to see if I find any comparable images. Which I did.
    Microlaminectomy and discectomy at C7-T1 on April 26th.
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  • edited 12/31/2012 - 9:59 AM
    The user and all related content has been deleted.
    C3-C7
    Severe DDD, Severe neural foraminal stenosis at 2 levels, moderate canal stenosis at 2 levels, significantly impaired left shoulder & arm function. Chronic moderate compression fracture at C6.
  • eadubyeeaduby Posts: 100
    edited 01/01/2013 - 2:55 AM
    Thanks for sharing Daffydolphin. A lot of what I've been reading in my research says the same thing that a CTM is more likely to catch the foraminal stenosis than MRI. I'm just praying that everything will go well at my appointment with PM on Thursday and they'll pursue this testing.

    What are they doing now for treatment of your condition?
    Microlaminectomy and discectomy at C7-T1 on April 26th.
  • edited 01/01/2013 - 6:03 AM
    The user and all related content has been deleted.
    C3-C7
    Severe DDD, Severe neural foraminal stenosis at 2 levels, moderate canal stenosis at 2 levels, significantly impaired left shoulder & arm function. Chronic moderate compression fracture at C6.
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  • eadubyeeaduby Posts: 100
    edited 01/01/2013 - 10:05 AM
    I can not sleep in bed either, but I am considering getting a sleep number bed soon because I really miss sleeping next to my husband. I currently have to sleep on the couch to avoid waking up in significant pain.

    When my first physical therapist tried traction it did help a bit, and when I had my eval with my new physical therapist it was obvious that stretching my neck in that manner relieved some of the pain. I am on the highest dose of tramadol plus flexeril, cymbalta, meloxicam, lidoderm patches, and topamax and am still in considerable pain a lot of the time. I ended up going to the ER on Saturday because it was unmanageable and all of the doctor offices were closed. They gave me percocet which actually helps and brings the pain down to a dull ache and mild pinching/shooting pains, but everyone I'm seeing (PCP & PM) wants to refuse to give me these kinds of medications since there's no abnormalities in my MRI report.
    Microlaminectomy and discectomy at C7-T1 on April 26th.
  • The user and all related content has been deleted.
    C3-C7
    Severe DDD, Severe neural foraminal stenosis at 2 levels, moderate canal stenosis at 2 levels, significantly impaired left shoulder & arm function. Chronic moderate compression fracture at C6.
  • Daffydolphin said:
    In answer to your original question at the start of this thread, most PMs don't diagnose. If an orthopedic spine doctor is not helpful, look for a neurological spine specialist/surgeon.
    That is interesting because they are the ones who decided to give my problem the MPS names. I am definitely planning to ask PCP about seeing a neurosurgeon when I see her next week, I think that would be my best bet.

    Thank you for the advice on the medications, that is a concern that I will have to bring up. And lastly I did have an EMG and it was normal so I'm assuming there is no permanent damage yet, the pain hasn't been severe for too long, and the tingling/numbness does come and go so it makes sense.
    Microlaminectomy and discectomy at C7-T1 on April 26th.
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