Why do doctors lie? A plea for advice.

[spotbird]

I have had chronic back pain which is sometimes quite severe so my GP referred me to a rheumatologist . The rheumatologist was abrupt and didn't listen, repeated questions, made no eye contact, just your average asshole doctor, so I didn't think much about it. He ordered a bunch of tests and xrays.

At the follow-up he went over the x-rays with me and described anomalies vertebrae by vertebrae. He suggested I have an epidural of steroids by a different doctor in our small town. Desperate for relief, but realizing that someone skilled should do the procedure, I researched and found a spinal pain specialist in a city an hour and a half away.

The spinal doctor required a referral, which the original rheumatologist provided. Later rheumatologist's medical assistant called to say she was having difficulty faxing the report to the spinal doctor and suggested I pick it up, which I did. (She may have wanted me to see it?)

Naturally I read the report, and it contains nothing of what the rheumatologist told me in person. In fact, it doesn't even mention the second visit where he explained my pain to me. It contains reports from the radiologists which are quite different from what I was told.

I have already visited the spine specialist (he had a cancellation)because the report hadn't arrived from the first doctor I explained what that doctor had told me. The problem now is now the report contradicts everything I thought I knew.

The rheumatologist must have been offended by the fact that I sought consult elsewhere, but what do I do now?

[judge_smales]

1. The Dr. didn't lie

s/he probably got the wrong results and presented them to you at the second appt.

[spotbird]

4. The second appointment is where he went over the results

of the blood tests and the x-ray films. It was the more important of the two appointments, IMO. Certainly those observations should be included, right?

[BiggJawn]

2. The spine specialist SHOULD form his own opinion.

Based on HIS observations. I know *I* would if I was one!

This is medicine, not auto repair, where the car comes into the garage with a form from the "Service Writer" in the windshield telling the mechanic to fix what the computer said to fix and ONLY what the computer said to fix, i.e., repalce $2500 of engine parts to "fix" poor economy, never mind the 1/2-flat tyres....

Be blunt. Tell the specialist that you read the report, and it seems to contradict what you were told by the first MD. Base what you do next on his response and attitude.

As for why doctors lie, I wish the hell I knew. "Jehovah Complex" can't be the only reason....

[spotbird]

3. Do you think it would be useful to get the x-rays and MRI films

and bring them with the original doctors report? Is that done?

[silverlib]

5. This is good advice

If you don't take the films with you, the new doctor will ask you to get them (requiring another delay), as (if you have insurance) the insurance company won't pay for a new set of studies.

It is also correct that the new doctor won't rely heavily on what the previous doctor told you. I would only tell him if he asks.

Back problems are intricate. Something that could show up in one study might not show up at all in another.

Spine doctors are good and another newer field is Physical Medicine - these doctors are great at digging and finding the things other doctors don't find. They are also great at conservative management and will only refer to surgeons when all else has failed or there is no conservative treatment available for the diagnosis.

[spotbird]

6. I guess the fact that the old doctor makes no mention of what he told

me directly is what was so frustrating.

Why would that happen?

[silverlib]

9. the doctor was definitely not up front with you...

there are good ones, not so good ones and bad ones. You are a dissatisfied customer and have every right to be upset with this doctor. The post following this one is also correct. Only an MRI or myelogram can diagnose certain musculoskeletal irregularities and problems. Even X-rays with flexion and extension can show something more than standard X-rays.

Doctors are like churches, bars and AA meetings, etc. If you don't like one, there is another one down the street. There is nothing wrong with getting other opinions and doctors understand this and are happy to help you out. You are not shopping for drugs, you are looking for a diagnosis. They may not bad mouth another in their profession and this is often shown by them not wanting to know what another doctor has told you. This protects them. I was told recently that I had carpal tunnel syndrome by a family practitioner and a neurologist (which is scary), but the Physical Medicine doctor is the one that diagnosed ulnar entrapment or cubicle tunnel syndrome, which is not even close.

[spotbird]

13. You're right, I know.

The first doctor gave me bad vibes from the very first moment. If he had been selling me a car I would have made my excuses and left. There is no reason to think that medicine doesn't have its fair share of jerks. The good thing is that I got out early.

With the actual films the spinal doctor should be able to judge for himself what the problem is. The only problem is the procedure is my next appointment with him, even still he can look at the x-rays and decide for himself whether that treatment is necessary.

Thank you so much.

[silverlib]

18. In the meantime..

on edit - most have been typing when you posted that you were already taking glucosamine - sorry.

check out glucosamine with condroitin - over the counter. Orthopedic surgeons that I transcribe recommend it over and over. It's in the vitamins and minerals section and is shown to help rebuild bone, which counters the cause of most degenerative bone disorders. The cheapest I have found is at Sam's or Cosco's. This also helps with the pain, although it is not an anti-inflammatory.

you should know within two weeks whether it is helping you or not. There is nothing in it that can hurt you and it is not a drug that should not be used with other medication.

if you don't opt to try it, at least ask your doctor about it. the physical medicine doctor I went to works with and refers to physical therapists, acupuncturists, occupational therapist, osteopaths, chiropractors, pain management doctors, and surgeons, as well as being certified to perform epidural steroid injection.

I feel for you. My husband has had his stomach eaten up with years of using Lodine, Celebrex and Bextra trying to help his back. (although Celebrex is the least likely to do this)

I promise to be quiet now. You are getting a lot of advice and your condition can be really overwhelming when presented with a doctor you do not trust.

[OneBlueSky]

7. have you had an mri? . . .

x-rays don't show soft tissue, so if your problem is disk-related, they're pretty useless for diagnostic purposes . . . just as a precaution, check out the following website to learn what can happen if disk problems go undetected and untreated . . . not trying to be an alarmist or anything, but I too suffered from chronic back pain, and by the time the proper diagnosis was made, it was too late to prevent permanent nerve damage . . . good luck . . .

http://www.caudaequina.org/

[spotbird]

11. I have had an MRI of the lower back and hip.

That showed four mildly herniated disks without nerve involvement. Since that MRI was done, however, the most severe pain has moved up my back. On x-ray only, that area showed (according to what the rheumatologist told me) me after viewing the x-rays scoliosis, arthritis or bone spurs in almost every disk as well as narrowing of the space between many of the vertebrae. The radiologists report is far more benign, not noting anywhere close to what the doctor said he saw.

I already called the hospital where all the x-rays were done and they will give me them to take with me to the next appointment, which is the procedure.

[nothingshocksmeanymore]

19. A spine specialist can perform what is known as a discogram

SOme people actually have BACK PAIN originating from the disc itself..not the nerve roots.

[spotbird]

20. Would that change the treatment?

Would an epidural of steroids still be helpful?

[nothingshocksmeanymore]

21. Epidurals are more helpful for sciatic pain (i.e. nerve tissue)

than for back pain and are NOT without risk. They are also usually temporary in benefit.

If your leg pain is worse than your back pain, yes.

BTW, WALKING is the best thing in the world for back pain provided you have good shoes.

Walking and exercise increase endorphins which are your body's own guard to pain receptors.

[spotbird]

22. What is the risk of an epidural?

I asked both doctors and neither explained a risk. When I said to the first one, "what are the downsides", he answered, "there is no downside."

[silverlib]

23. there are risks..

they are rare and I am not real familiar with them. When I transcribe for a doctor who uses this, there is a standard paragraph I type "risks, alternatives and benefits were discussed with the patient in detail." Like you said previously, pretend the doctor is a car salesman and if you do not like the product, leave. A good doctor will be very open and answer your questions. Prolotherapy is another new treatment that also involves injections.

Gee, I'm sorry - I said I would stop.

[spotbird]

24. Please don't stop, you are very educational!

I appreciate your input!

[silverlib]

33. Okay - one more thing

I've been offline for a while - working (thank God).

It's been mentioned before, pertaining to sciatica, but epidural shots are (according to my physical medicine doctor) only effective with a radiculopathy, which means that the back pain w/or w/o numbness and tingling radiates into either or both hips, legs, feet, or all. A good doctor will first diagnose and test. An open-minded doctor will suggest physical therapy, injections, a home exercise program, further testing if the diagnosis needs to be substantiated, surgery or alternative choices, such as chiropractic, osteopathic, acupuncturist, massage therapist, etc. If you first go to a spine specialist, their specialty is spinal surgery, which of course is sometimes the best option. My primary care physician first refers to a physical medicine specialist, who will diagnose and test and refer to a spinal surgeon only if the patient chooses this as one of the options for treating his/her diagnosis or when other conservative treatments fail to give the patient relief. I reiterate - there is nothing wrong with back surgery and sometimes it is the only way.

Please keep us posted as to what works for you. I hope you are pain free soon.

[nothingshocksmeanymore]

26. Answers to both :

Prolotherapy is relatively new and the jury isn't in yet on whether it is any more efficient than traditional treatment.

The specific risks of epidurals are as follows:

The needle can puncture both the dural sac and the spinal cord area, releasing spinal fluid which can cause severe headaches. Epidurals should ALWAYS be done within extremely close proximity to a hospital.

Since it IS a steroid, all risks concerning steroids such as blood sugar increase etc are included.

The main issue is the anesthesiologist puncturing the dura. Only get the shots by a board certified doctor and these risks diminish considerably.

Still..they are often only temporary.

[spotbird]

27. I did understand their temporary nature, but not the risk.

But even a month will less pain would be a real luxury. Also, if I get to a normal level of pain it will be easier to get back to the gym, I can start physical therapy etc.

The spine doctor is a board certified neurologist who does 50+ of these a week, is that better or worse than an anesthesiologist?

I still walk, today I took a three mile walk with a friend (at a brisk pace).

Thanks for your advice, I guess I need to ask more questions about the procedure.

[nothingshocksmeanymore]

29. The doc sounds competent

Check him out with your state medical quality assurance board (that is what it is called in California...don't know what they call it by you, but they should advise as to whether he has any restrictions on his license.) He SOUNDS exactly like a doc who can and should do these.

[Heddi]

31. One downside that I know of

(because I experienced it personally) is a....gah! What's the name---Spinal Headache, or Nerve Headache or something. When you get the epidural, there's a slight chance that you could get a really really bad headache--like, migrane headache. Like, i can't look at light or move my head without wanting to vomit headache.

But I had 3 epidurals, and only had the headache once. It lasted about 24 hours, I laid in the bedroom with the lights off and a cool towel on my head. It went away, and was very minimal compared to the utter relief I got with the epidural, which cured my pain instantly and allowed me to MOVE without....dying :)

Do a google on "epidural" and you should get some good information

[populistmom]

34. I had a terrible side effect from an epidural

With my last baby, I labored at home for three days (yes three days) all trying to avoid another c-section in part due to not reacting to anesthesia well. Well, after the 9th or 10th hour of transition stuck between 7 and 8cm, I couldn't take it anymore and went in for the epidural. They went in just a micrometer too far and bam!- I had a spinal headache for a week (on top of ultimately recovery from another f*cking c-section and trying to care for and nurse a baby).

A spinal headache is the most painful headache you can imagine (and I've had migraines a handful of times). I had to lie flat for a week and every time I had to get up to go to the bathroom, it took about 45 minutes to recover again. Once I did lay down, the pain would temporarily subside until I had to get up.

Anyhow, I don't know if the epidural they would give for you is any different than the ones they give to laboring women, but if they say there is no risk, it's simply not true.

[radwriter0555]

8. Go to a chiropractor.

End of story.

These people will do NOTHING to solve your problem, they'll merely give you pills and drugs to temporarily ease the pain as you've already found.

Your spine needs to be re-aligned with therapy and manipulation. Then you need to exercize properly to strengthen the back to continue the re-alignment which will ease the pain.

I suggest you find someone in your area who treats using the "Activator' method which has far better results for the long term, than the twisty stuff.

I've been riding the "back pain horse" for 25 years. I have arthritis, spurs, anomolies, compression, herniated discs, the whole works. All the pain is alleviated with chiropractic therapy.

[Bridget Burke]

10. Get the best REAL medical opinion you can before seeing....

a Chiropracter.

A friend of mine had progressively worsening pain centered in the back. A chiropracter worked on him for more than a year, promising relief and getting paid. The pain got worse. My friend then consulted an acupuncturist who, after a quick exam, told him to see an M.D.

He had pancreatic cancer. An earlier diagnosis probably wouldn't have helped in the final outcome--not with THAT malignancy. But he finally got the opiates that offered relief from intractible pain in the brief time remaining.

[ursacorwin]

12. try this as well

my mom is a physician and she deals with chronic pain all the time...but without the drugs and surgery.

http://www.upledger.com/home.htm

It is estimated by the National Institutes of Health that more than 48 million people suffer from chronic pain and that the low back is one of the most affected areas.

In 2002, the Multidisciplinary Approaches conference addressed this timely subject before an eager audience in Seattle. Now, in response to requests for this information from practitioners on the East Coast, we’re pleased to bring this important topic to Tampa Bay, Florida, in 2004.

The Multidisciplinary Approaches to Low Back and Pelvic Pain conference delivers an in-depth examination of therapeutic advances that are improving patient outcomes in this body area. Each presenter is a leader in pain management who brings a unique perspective to the conference. The result is a comprehensive analysis of effective and practical solutions you can apply to even the most difficult cases.

[spotbird]

15. Thanks, that is exactly what I'd like to find.

I'll call and get the booklet.

[Heddi]

16. I had a severely herniated disc a year ago

that caused such severe sciatiaca in my right leg that I was unable to get more than 2 hours sleep a night.

I couldn't walk, I couldn't sit, I couldn't stand, I coudldn't lie down...couldn't do anything without this pain that felt like a red-hot knife was being run down the back of my leg.

I went to my Dr and at first was given physical therapy for a few months, then was given an MRI which detected the herniated disc. I was scheduled for laproscopic discectomy a month and a half later.

In the interim, I went to a Chriropractor. Many people on this board reccomended it to me.

In fact, I went to three chiropractors.

All of them---ALL OF THEM---did nothing but ascerbate the pain.

They told me (in kinder words) that I was a pawn of the medical system by taking pain meds that actually allowed me to sleep, for having physical therapy that actually allowed me to move, and taking anti-inflamatory medicines that allowed me to function, and the STUPIDEST thing I ever decided to do (according to them) was to agree to (in one Chiro's words) "Get TOTALLY unnecessary surgery that will do nothing but line the pockets of my incompetent doctors."

??

The first chiro I saw wanted me in to be adjusted every day for a month. I only saw him for a week and had to stop because I was in such pain afterwards that I would leave the office in tears. I had to call out of work several days because I couldn't get out of bed because of the pain.

I stopped seeing him, because at the advice of people on DU, that was a bad chiropractor, and GOOD chiropractors can solve any problem that is spine related, blah blah blah.

So I went to a second one. Same condesending attitude, same pain after 'adjustment'.

went to a third and final one. Not so condesending attitude about my doctors and their care, but a holier-than-thou attitude where he informed me that most ailments, even when not related to the spine, are actually related to the spine, and that he was able to cure anyone of anything.

Same pain afterwards. Actually, during one visit, I was in such pain that I vomited.

A few weeks later, I got my God-Forbid back surgery. Was in and out of the OR in less than 5 hours.

That day, I took mild anti-inflamatory meds, but no pain meds. First time w/o pain meds in over 6 months.

That was the first night in nearly a year that I was able to get a full night's sleep.

The next day, every bit of sciatic pain was gone. I could sit in a chair w/o biting my lips from intense pain. I could lay in bed, flat on my back, without crying out in agony. I didn't have to sleep with a gaggle of pillows stacked under my back and leg and everywhere in between. I was able to walk for more than 3 minutes without having to stop, sit down for 30 minutes to aleviate the pain.

If I didn't have back surgery when I did, I would be totally disabled now, I'm sure of it. The pain was of a magnitude that I never hope to experience again.

The moral of the story--not EVERYONE can be cured by Chiropractors.

I went to their offices with an open mind. I wanted to try ANYTHING that would allow me to live a full life without chronic pain.

I didn't get it.

Many people do, but alternately, many people don't.

I would NEVER tell someone that because a Chiro worked for me, then it WILL DEFINITELY Work for them. Also, I would never say that because I got no results (or totally negative results) from a Chiro, then it will NEVER work for anyone else.

if the OP decides to go to a Chiropractor, she should do so WHILE SEEING HER SPECIALIST. Don't rule out one or the other. One may give her relief while the other doesn't. One may be effective while the other isn't.

But I'd never say that Chiro's are better at solving ALL spinal problems in ways that conventional medical doctors can't.

[spotbird]

28. What an awful ordeal.

I'm sorry that you had to go through all that. I'll be careful.

[Heddi]

30. Well what I'm saying

is don't put all your eggs in one basket. Try different options, because in medicine, there's not a one-size-fits-all approach to ANY medical condition.

Try a chiropractor, but stay in touch with your specialist. Try accupuncture as well if you feel that may benefit from you.

I knew people I worked with who had herniated discs who got no relief from surgery, but got lotsa releif from getting epidural steroid injections once a month, and others who swore by chiros and accupuncture. Some tried yoga, stretching, pilates, exercise, losing weight, etc.

Everyone responds to treatment differently. Try different things (as you can afford them) and see what you respond to best, and go with that :)

I hope you feel better soon. There's nothing worse than being sick (injured/in pain/etc) and feeling that there's nothing that can be done for you.

[spotbird]

17. Physical therapy is on the horizon to show me the safest way to

exercises. I'm also trying other natural remedies like MSM, glucosamine and chondroitin, so far with no noticeable results.

If things don't work out with the spinal doctor I guess more aggressive alternatives may be in order.

[OneBlueSky]

35. that is a WRONG answer . . .

I have a chiropractor to thank for my permanent nerve damage and resulting disability . . . wouldn't go near one with the proverbial ten-foot pole . . .

[PVnRT]

14. I don't if it's lying or just plain incompetence

I would personally vote for the latter in this case.

[bigwillq]

25. the lie b/c they have the money

to get a better lawyer if one sues them for being wrong

[Sir_Shrek]

32. Is this supposed to be a slam...

...on Howard Dean? :D