Doctors...cant live with and cant live without them (sigh)
 

Hi all!! Sorry I havent been around lately, things have been upside down at my house now for over 3 months. It all started when the hot water line broke under the house, and boy has it been a roller coaster ride with all the different contractors, insurance adjuster, and inconvenience of it all.

Hopefully today will be the last of it after the painter leaves this afternoon :yahoo:

Today I had a run in with another doctor....jeesh! I have been going everyday for a stretch on the IDD therapy machine, and it has been making my hip hurt. It occurred to me that it could be hurting me more than I know because I have osteopenia in that hip, and RSD in the hip and leg.

So I asked the good doctor if this machine could be dangerous for me to use. When I said I have osteopenia he looked at me in disbelief, and asked "how do you know you have osteopenia?". What a stupid question, and I wanted to give him a sarcastic answer, but told him that the scan I had showed it. Then he says "how do you know it was the right test?" So then he makes me explain every detail so he will believe I am not fabricating the whole thing. I get so tired of these doctors acting like im some kind of nincompoop.

Then he says after I finish the 10 more treatments he will have another scan done. I kinda got short with him and said that would be a little late to find out of these treatments are doing damage, and why dont you believe me when I say it is hurting me???

Then he goes into a lecture on reducing the pain meds because I have had 10 treatments so far, and should be getting better not worse. Then I tell him I would like to know what damage has been done if any before I go for more of these spine stretching treatments, and what in the world does reducing the pain meds have to do with this conversation? He isnt even the doctor that is prescribing my meds anyways :rolleyes:

That is when he started insinuating that im a drug seeking addict. :mad:
I mentioned that the back isnt the only thing I have wrong, I also have RSD and that is what caused the osteopenia. Then he says "who says you have RSD?". That is when I about lost it, wanted to bang my cane across his thick skull. But instead just thanked him and left.

My back is jacked up pretty bad, and this treatment is the option I took instead of back surgery. In my mind the injured back is enough of a problem for anything he might prescribe never mind the RSD. If your bad enough for surgery it should say something to this moron about any pain I might be in.

Now I am in a quandry in what direction to go in, and am leaning towards never steppiing foot in that office again. :(

On a lighter note, I found a power chair lift that mounts inside of my van. It is wonderful!! The only draw back is that I lose the 3rd row seating, but I can live with that because of the freedom this lift is giving me. I am sooo stoked im ready for a road trip LOL.

Hope everyone is doing well, and now that my house is almost put back together I should be able to check in more often. :grouphug:

Hi Allen,
 

I'm glad to see you back.

As far as that Dr., I wouldn't step foot in his office again. If you know he is making you worse then it's so.

My PT tells me if I come home hurting from him working on me then we know not to do what he did to make it worse again. What he is doing is trying to figure out exactly is going on with me. He thinks my neck and thoracic spine is messed up but he's trying to work on everything else to calm down what he can to seperate the problems. It's working too.

As far as the back, could you look for a good Physical Therapist that will try and help with it?

Glad you are back.

Ada

Allen,
Glad your house is back together!
(I'm a Master plumber, so I know what that can be, Seeing it so many times).

But, I'm glad that you're close to deciding not to go back there, because, a third into your note, I came to that conclusion!
I hope you don't.

The silly fool, didn't even look at your records enough to see your total dx, and then, he's asking you? It sounded to me as if he's afraid of liability. I'm sure that's not what you're after, just some pain relief.
But, to insinuate you are drug seeking is LOW!

Who sent you to this fool?
If it was your doctor, I'd be on the phone with him/her!

After ten more treatments he'll have another scan done? I'd have said, "No ya won't!"
Seriously, who'd be the fool if you did go back there? You were a Gentleman, with the way you left. But now, you're "leaning" the right way, imho.

There are too many good PT's around. Caring people.
Obviously, this man is not one of those.

Maybe find a good Chiropractor!

I wish you the best!

Pete
Asb

Just my opinion but...... if you get the wrong "vibe" from this particular dr, then don't go back. Personally, from what you've told me about him/her I would not step foot in his/her office again. If you can, I'd find someone else.....

Hang in there !
L2L

hi there...
 

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Congrats on your power chair lift:)
Congrats on getting your home back in order:)

I am sorry that you had that experience with the "lost" doctor. You know what the answer to your question is..look at your post. The answer is screaming at you.

Good to see ya again Allen!

I vote with everyone else for not going within 10 miles of that "doctor" again!! What an (insert some bad words here)!! LOL

Glad your house is finally getting back to/is now normal again. What a thing to have happen. Hopefully nothing that bad will happen ever again. :-)

Hugs,

Karen

Didn't he ask before you started this spinal work what was wrong and why you had the cane? Maybe that's why he became difficult as these are probably things he needed to know beforehand, like the RSD and the osteopenia.

I am sorry I know how bad doctor apts are in addition to being in pain. From the million docs I have seen what I feel is key and hard is to have open communication and a game plan with options. I know it can be hard to start over but if I were you since you are not happy I would for sure go for another opinion. This doctor does not sound like he has a lot of knowledge with what is going on with you and I wonder if that is why he questioned. Sometimes I think if a doc does not know instead of saying that he turns it around on the patient. Hang in there and I hope you feel better. On a side note I would encourage you to keep up with your bone density tests. I had osteopenia to start and now have osteoporosis.

hey allen glad to see you around again.

on the back surgery note my husband had to have fusion of L5-s1 in oct o7 and since then he has had horrible pain .. if you can believe this he is having to go to my pain management doc in july because his neurosurgeon told him what do you want me to do !! and no other spine specialist here in town would see him because there wasnt anything surgeical that they could do they said. never mind you that they havent seen him.. as he says if he didnt have to of had it he never would of!!


im glad that the house is getting back together ..

im sorry that the doc was a you know what . !! ihate those docs they think they know it all and they dont know diddly

hang in there buddy

carrie

With his attitude, I am sure he will be a top advisor for Obama-care...

So as universal health care approaches, let's here it for Medicare fee schedule...$.20 on the dollar for the docs; only the bad will hang....the rest of the experienced docs will retire or do something else. We will be left with the bad and the ugly and docs whose names we cannot pronounce.

And strike up a victory for evidenced based medicine. Since there are no EBM studies on RSD/CRPS, no treatment will therefore be recommended as it will not be paid for and docs will be sanctioned for off-labeling scripts and treatment. There are NO EBM recommendations for us; we have been sold down the river.

Really, it's coming...

First of all, we don't know yet what (if anything) will come out of Congress this summer. But even assuming that some form of EBM (evidenced based medicine?) studies are required for coverage, I can't agree that no EBM studies currently exist for CRPS.

Consider, "Evidence of focal small-fiber axonal degeneration in complex regional pain syndrome-I (reflex sympathetic dystrophy)," Oaklander AL, Rissmiller JG, Gelman LB, Zheng L, Chang Y, Gott R, Pain, 2006; 120: 235-243, free full text at http://www.rsds.org/2/library/articl..._pain_2006.pdf, the abstract of which follows:

CRPS-I consists of post-traumatic limb pain and autonomic abnormalities that continue despite apparent healing of inciting injuries. The cause of symptoms is unknown and objective findings are few, making diagnosis and treatment controversial, and research difficult. We tested the hypotheses that CRPS-I is caused by persistent minimal distal nerve injury (MDNI), specifically distal degeneration of small-diameter axons. These subserve pain and autonomic function. We studied 18 adults with IASP-defined CRPS-I affecting their arms or legs. We studied three sites on subjects’ CRPS-affected and matching contralateral limb; the CRPS-affected site, and nearby unaffected ipsilateral and matching contralateral control sites. We performed quantitative mechanical and thermal sensory testing (QST) followed by quantitation of epidermal neurite densities within PGP9.5-immunolabeled skin biopsies. Seven adults with chronic leg pain, edema, disuse, and prior surgeries from trauma or osteoarthritis provided symptom-matched controls. CRPS-I subjects had representative histories and symptoms. Medical procedures were unexpectedly frequently associated with CRPS onset. QST revealed mechanical allodynia (P < 0.03) and heat-pain hyperalgesia (P < 0.04) at the CRPS-affected site. Axonal densities were highly correlated between subjects’ ipsilateral and contralateral control sites (r = 0.97), but were diminished at the CRPS-affected sites of 17/18 subjects, on average by 29% (P < 0.001). Overall, control subjects had no painful-site neurite reductions (P = 1.00), suggesting that pain, disuse, or prior surgeries alone do not explain CRPS-associated neurite losses. These results support the hypothesis that CRPS-I is specifically associated with post-traumatic focal MDNI affecting nociceptive small-fibers. This type of nerve injury will remain undetected in most clinical settings. [Emphasis added.]

OR

"The Brain in Chronic CRPS Pain: Abnormal Gray-White Matter Interactions in Emotional and Autonomic Regions," Paul Y. Geha, Marwan N. Baliki, R. Norman Harden, William R. Bauer, Todd B. Parrish, and A. Vania Apkarian, Neuron 60, 570–581, November 26, 2008, free full text at http://www.apkarianlab.northwestern....S_Neuron08.pdf and in particular, the first two paragraphs of the "discussion" portion of the article at pp. 574-575:

DISCUSSION

The main outcome of the current study is the observation that CRPS patients exhibit regional gray matter atrophy in a single cluster encompassing right VMPFC [ventromedial prefrontal cortex], AI [anterior insula], and NAc [nucleus accumbens], localized decreased white matter anisotropy, and changes in branching and connectivity of white matter tracts linked to these site-specific gray and white matter abnormalities. Unlike results from chronic back pain and fibromyalgia (Apkarian et al., 2004b; Kuchinad et al., 2007), whole-brain gray matter and ventricular size were similar between CRPS and control subjects. Aging effects on whole-brain gray matter volume were similar but smaller than those seen in fibromyalgia (Kuchinad et al., 2007), suggesting a smaller impact of the condition on whole-brain gray matter parameters. Notably, the relationship between brain white matter skeletal FA and brain gray matter volume seems completely disrupted in CRPS, implying reorganization of white matter tracks in a manner that no longer conforms to the relationship seen in healthy subjects. Because this is a disruption at the whole-brain level, it entails either diffuse disruption of gray to white matter relationships or multiple distinct abnormalities with compensatory remodeling of the brain in CRPS.

Role of Right AI in CRPS Symptoms

Regional gray matter density comparison indicated atrophy within a single cluster for the whole group of CRPS. The same brain region or portions of the same cluster exhibited atrophy even after subdividing the group by age or by laterality of CRPS pain. Hence, the atrophy spanning AI, VMPFC, and NAc seems a robust result in CRPS and is right hemisphere dominant. Moreover, this atrophy was related to the two fundamental clinical characteristics of CRPS, duration and intensity, which impacted the density of this cluster above and beyond normal aging. When the cluster was subdivided into separate anatomical regions, the right AI correlated with duration of CRPS pain. The insula is the brain structure most often observed activated in acute pain tasks (Apkarian et al., 2005). In CRPS patients, bilateral AI activity correlates with ratings of touch-induced pain (allodynia) and pin-prick hyperalgesia (Maihofner et al., 2005, 2006). Moreover, recent human brain imaging studies, consistent with the older literature regarding the role of the insula as a viscerosensory cortex (Craig, 2002; Saper, 2002), highlight the role of the right AI in the representation of autonomic and visceral responses Critchley, 2005). Patients with pure autonomic failure due to peripheral disruption of autonomic responses exhibit reduced right AI activity (Critchley et al., 2001) and atrophy in right AI (Critchley et al., 2003a). In healthy subjects, neural activity in right AI predicts subjects’ accuracy in heartbeat detection, while local gray matter volume, at coordinates closely approximating the center of the cluster we observed atrophied in our CRPS patients, correlates with subjective ratings of visceral awareness (Critchley et al., 2004). Furthermore, by comparing brain activity and autonomic responses in a fear conditioning task between healthy subjects and pure autonomic failure patients, Critchley and colleagues conclude that the right AI is involved in emotional representations, ‘‘wherein ‘feelings’ are the integration of both the mapping of internal arousal and conscious awareness of emotional stimuli’’ (Critchley et al., 2002). Given that CRPS patients are presumed to be in a constant negative emotional state and exhibit multiple signs of abnormal autonomic function, atrophy of right AI in CRPS corroborates the above studies and suggests that central anatomical abnormalities may explain fundamental symptoms of CRPS. [Emphasis added.]

Call me crazy, but I think these qualify as Evidence Based Medicine, albeit medicine requiring the backup of a tertiary medical center. But if that's what's required to make a firm diagnosis, then treating CRPS will require more and not less expensive medicine, if EBM standards are to be employed, because, after a long, long time they now exist. Put another way, it may be time to drop the "Syndrome" from CRPS.

Mike

a clarification on my last (with apologies to Allen)
 

Folks,

I got carried away with all of the "Evidenced Based Medicine" in the post that preceded mine, without appreciating just how far from the theme of the thread the post really was. As in, "so you don't like doctors now . . . ."

While a discussion of whether CRPS now meets whatever the standards of EBM may be appropriate, Allen's thread was not the place for it. That said, with the issue raised - in what spirit I cannot judge - I believe a response to have been appropriate. I am sorry, however, for whatever role I played in the digression.

Mike

Question: What do you call someone who graduates from medical school last in his/her class?

Answer: "Doctor."

Sounds like you found one fitting that description.

Mike