mmglobal
03-29-2006, 02:27 AM
I’m in Germany now with a client who had a 3-level cervical
ADR procedure done today. While she is not someone who posts, she has been
reading the forums voraciously for years and has given me the OK to share her
story.
I’m not really posting about her surgery. I’ll leave that for her in the days to come. The purpose of this post is to tell about the difficulty in getting a good diagnosis and how the tests that we rely so heavily on can fail us.
Her symptoms include various numbness and weakness in her upper extremities, shooting pains in shoulders and upper arms, pains shooting up into head and behind one eye. These symptoms can be exacerbated by specific movements. Also experienced are intermittent occasional wobbly legs, gait problem and inability to hold her urine. It should be noted that these intermittent problems clearly coincide with worsening of other symptoms.
Her case was presented to many local (deep south) spine surgeons, neurologists and pain management specialists. All were unable to correlate problems between her cervical spine and these issues. While her imaging does show some pathology in her c-spine, it is all viewed to be too minor to be causing the symptoms described.
When I presented her case to some of the top spine surgeons including Dr. Bertagnoli, I received similar responses, but instead of a dismissal, we received instructions to rule-out other causes… brain MRI, thoracic MRI. After ruling out other obvious causes, he (Dr. B) would consider her case again. After further review, she was scheduled for a likely 2-level (possibly more) cervical ADR.
Upon arriving in Munich, we went to a Neurologist that I particularly like for a comprehensive neuro review (something that she had not gotten in spite having paid for three with neurologists who dismissed her before fully evaluating her.) As I watch test after test demonstrate lack of proper function in certain muscle groups, inability to walk properly, severe pain generated with certain movements, etc…. I kept looking at her mother and asking if anyone had done that???? Has anyone done that??? The answer was usually, ‘no’. It was so frustrating knowing that this poor woman had been dismissed… the doctors label her as a doctor shopper, never give a complete evaluation or offer any help. They wonder why we wind up going to doctor after doctor as if we are simply seeking attention, meds, etc… I’ve experienced this first hand as a patient myself, and now several times with clients as well.
It was quite confounding for the doctors looking at the films that showed so very little. She had full sets of flexion / extension xrays that showed no instability. She even had a functional MRI with series in flexion and extension…. showing NO instability. Fortunately for her, there was one CT scan that showed minor instability at a level that had never been considered. If this film was not present, or if this CT was done in such a way that is showed the instability to be less or none, as had the other imaging that normally shows instability; we would still not know about a serious pain generator. Because of the single image and because of the comprehensive neuro review, it was decided to discogram that level, even though the disc looked healthy. In all the prior treatment, this level was never even discussed. In addition to a traditional cervical discogram (if there is such a thing), Dr. B also did a functional discogram… putting the segment in question in flexion and extension, while under flouroscopy, after the contrast was injected. This clearly demonstrated the instability. Injection of the contrast at this level also recreated some of her symptoms in a big way.
The fact that many of our doctors dismiss us inappropriately because they can’t figure it out… it must be our fault…. we are drug seekers… we are malingerers… we are doctor shoppers…. THIS IS NOT NEWS TO US. I’ve just never seen it demonstrated so clearly. The neuro who did the wonderful workup was not taken aback by the lack of dispositive imaging. He says that it is not uncommon for surgeons to discover pathology that does not show on the imaging. The neuro workup clearly demonstrated cervical myelopathy and radiculopathy, consistent with complaints of the patient, consistent with the location where pathology shows (even though it is not thought to be severe enough to be responsible for the symptoms), consistent with patterns expected for the type of injury she sustained. Imaging is not the be all, end all of the diagnosis; it is just another one of the tools used. Doctors who label their patients early and close their mind to a complete diagnosis will fail to do their job in cases such as these. Sadly, they ‘rat out’ the patient to the next doctor… sending an intro letter that clearly states, “here comes a doctor shopper”. This intro causes the next doctor in line to close his mind and label the patient before he or she even gets started. And they wonder why some people keep going to doctor after doctor.
Mark
I’m not really posting about her surgery. I’ll leave that for her in the days to come. The purpose of this post is to tell about the difficulty in getting a good diagnosis and how the tests that we rely so heavily on can fail us.
Her symptoms include various numbness and weakness in her upper extremities, shooting pains in shoulders and upper arms, pains shooting up into head and behind one eye. These symptoms can be exacerbated by specific movements. Also experienced are intermittent occasional wobbly legs, gait problem and inability to hold her urine. It should be noted that these intermittent problems clearly coincide with worsening of other symptoms.
Her case was presented to many local (deep south) spine surgeons, neurologists and pain management specialists. All were unable to correlate problems between her cervical spine and these issues. While her imaging does show some pathology in her c-spine, it is all viewed to be too minor to be causing the symptoms described.
When I presented her case to some of the top spine surgeons including Dr. Bertagnoli, I received similar responses, but instead of a dismissal, we received instructions to rule-out other causes… brain MRI, thoracic MRI. After ruling out other obvious causes, he (Dr. B) would consider her case again. After further review, she was scheduled for a likely 2-level (possibly more) cervical ADR.
Upon arriving in Munich, we went to a Neurologist that I particularly like for a comprehensive neuro review (something that she had not gotten in spite having paid for three with neurologists who dismissed her before fully evaluating her.) As I watch test after test demonstrate lack of proper function in certain muscle groups, inability to walk properly, severe pain generated with certain movements, etc…. I kept looking at her mother and asking if anyone had done that???? Has anyone done that??? The answer was usually, ‘no’. It was so frustrating knowing that this poor woman had been dismissed… the doctors label her as a doctor shopper, never give a complete evaluation or offer any help. They wonder why we wind up going to doctor after doctor as if we are simply seeking attention, meds, etc… I’ve experienced this first hand as a patient myself, and now several times with clients as well.
It was quite confounding for the doctors looking at the films that showed so very little. She had full sets of flexion / extension xrays that showed no instability. She even had a functional MRI with series in flexion and extension…. showing NO instability. Fortunately for her, there was one CT scan that showed minor instability at a level that had never been considered. If this film was not present, or if this CT was done in such a way that is showed the instability to be less or none, as had the other imaging that normally shows instability; we would still not know about a serious pain generator. Because of the single image and because of the comprehensive neuro review, it was decided to discogram that level, even though the disc looked healthy. In all the prior treatment, this level was never even discussed. In addition to a traditional cervical discogram (if there is such a thing), Dr. B also did a functional discogram… putting the segment in question in flexion and extension, while under flouroscopy, after the contrast was injected. This clearly demonstrated the instability. Injection of the contrast at this level also recreated some of her symptoms in a big way.
The fact that many of our doctors dismiss us inappropriately because they can’t figure it out… it must be our fault…. we are drug seekers… we are malingerers… we are doctor shoppers…. THIS IS NOT NEWS TO US. I’ve just never seen it demonstrated so clearly. The neuro who did the wonderful workup was not taken aback by the lack of dispositive imaging. He says that it is not uncommon for surgeons to discover pathology that does not show on the imaging. The neuro workup clearly demonstrated cervical myelopathy and radiculopathy, consistent with complaints of the patient, consistent with the location where pathology shows (even though it is not thought to be severe enough to be responsible for the symptoms), consistent with patterns expected for the type of injury she sustained. Imaging is not the be all, end all of the diagnosis; it is just another one of the tools used. Doctors who label their patients early and close their mind to a complete diagnosis will fail to do their job in cases such as these. Sadly, they ‘rat out’ the patient to the next doctor… sending an intro letter that clearly states, “here comes a doctor shopper”. This intro causes the next doctor in line to close his mind and label the patient before he or she even gets started. And they wonder why some people keep going to doctor after doctor.
Mark