As I have mentioned in the past, I have debilitating leg pain, but only in my lower legs. I also have some back problems. My doctor referred me to see a certain orthopedist for the problem. My health insurance sent me to a different orthopedist.
After 2 months, the spine specialist that my insurance sent me to announced “It’s a vascular problem.” Then washed his hands of my case. My only solution was to return to my family physician and ask for a referral to a vascular specialist… Which my family physician denied whilst exclaiming “fucking idiot.”
Those two little words sum up my GP’s feelings about the spine specialist I was sent to in lieu of the one I was referred to. It also summed up my case. I don’t think the specialist was intentionally trying to be a fucking idiot, but in hindsight, I have questions about how much he actually listened to me.
For starters, my health insurance denied paying for physical therapy because it was “medically unnecessary” but did pay for bilateral SI joint injections because they were deemed “medically necessary.” When it happened, I figured it was just my health insurance being a pain in the ass. It’s happened before. I would find out today that physical therapy was denied because it wouldn’t even provide short term relief of my symptoms.
Today, I saw a different doctor… one that my GP actually referred me to that specializes in pain management. He spent 45 minutes listening to my symptoms and timeline of problems. Then he hung his head and said “Dr. X is known for ignoring things if they don’t fit his theory of the problem.”
That’s when he gave me the tutorial of what’s actually wrong with my back and lower legs. Spoiler Alert: They are related, not vascular, and been diagnosed previously.
I’ve had a disk in my lumbar region go bad. It’s the very bottom disk and it has degenerated. As a result, my spine doesn’t flex and bend when I move, it slides. This has caused a problem with the facet joints, which are the joints that exist where the nerves come out of the spine. The disk that went bad is the disk connected to the facet joints that truncate in my lower legs. To picture this, imagine an upside down tree with the trunk extending from my spine, into my thighs, and then branches appearing only in my lower legs. They stop above the ankles.
Dr. X even sent me to have a nerve conductivity test, which I did, but did not request the results. Last week, while I was at my neurologist’s office, I decided to mention to him that the nerve conductivity test was really weird. My right leg, I felt it and I twitched, but it didn’t hurt. My left leg – Holy Rusted Metal, Batman! I nearly jumped off the table from the electric jolt. It wasn’t uncomfortable, it actually hurt and I hadn’t expected it because my right leg hadn’t hurt. He offered to redo the nerve conductivity test on the spot because in his words I “should have wanted to jump off the table regardless of which leg was being tested because to get a real reading the stimulation has to be very high and it is very painful.”
The pain management doctor told me to hope that a few more injections will help calm the nerve down. But it isn’t something that is ever going to go away. I will always have issues with aggravation of those facet joints because the disk has degenerated to that point. Unfortunately, the problem has existed for 15 months now and the nerve damage may be permanent. I’ll know more Friday…
However, I’m beginning to agree with my GP. It appears that Dr. X does not believe people as young as 36 can damage their spines or even have arthritis (which I have in both hips and my SI joints, fun stuff). He decided early on that the problem was poor muscle development in my back and the legs were unrelated. Which is why I did physical therapy and why physical therapy didn’t actually stop the pain. His own notes though say he suspected I had nerve damage and problems with the facet joint, specifically on the right side. He even mentions that at several of my appointments, I specifically pointed to a spot just to the right of my spine above my SI Joints and he could press on it and cause me pain, indicating that the facet joint and nerve root on that side were damaged. Then there was a side note: patient indicates that she experiences pain during intimate activities that was relieved with the SI joint injections, which is unlikely and she is therefore imagining the injections were effective. Conclusion: leg pain is caused by vascular problem and pelvic pain is caused by age. No mention of the arthritis in my SI joints which is clearly visible on a freakin’ X-Ray and never once mentioned to me, but would in fact be helped by steroid injections into my SI Joints and could indeed cause pain during intimate physical activities.
So I spent a couple of weeks convincing myself that I was crazy and the pain in my back and legs are unrelated and possibly imaginary. Thankfully, my GP doesn’t believe I’m crazy and looked at my X-Rays. He’s the one that informed me I had arthritis in them. He then asked me if I had told Dr. X that I was born with both hips out of socket and it wasn’t discovered until I was six weeks old. I had and he told me I wouldn’t suffer any ill effects from it. However, my GP said this is actually considered a “trauma incident” especially at that age. My hips being out of socket, even though I wasn’t walking or even crawling yet, would put pressure on my still forming pelvis and specifically on the SI joints. And where Dr. X said he saw no indication of a “traumatic effects” from it. The arthritis specialist that consulted with my GP before he decided to send me to a pain management doctor said he say blatant evidence of “trauma” to both my hips and SI joints that he would attribute to having hip dislocation, especially at a physical development stage like the first year of my life.
Great. Conflicting opinions. Just what I need.
But the pain management doctor cleared it all up for me. It seems that he is also an orthopedic spinal specialist who went into chronic pain management because most orthopedists are trained to believe that physical therapy is almost always the answer. What he did was confirm I wasn’t crazy and I wasn’t imagining it. He agreed with the arthritis consultant and my GP that my X-Rays indicated I had moderate arthritis in my right hip and right SI joint and minor arthritis in my left hip and left SI joint. He also pointed out to me the areas on the X-Rays that he said indicated trauma to both my hips and pelvis. Even though they healed fine, they left pitting on the bone, which has led to arthritis. Then he did the one thing I could never get Dr. X to do… He had me walk and as I did, he placed a stethoscope on my back where I indicated I could feel it pop and grind. I took just three steps before it happened. The look on his face when he heard it was kind of alarming. The pop and grind I feel is my spine moving bone against bone. It doesn’t matter how much I develop the muscles in my back, it is not going to keep bone from hitting bone.
Friday I go for injections into the facet joints, the SI joints, and possibly get an epidural. We will have to see how I react to those injections before we can make any decisions about the extent of damage. It will also require another nerve conductivity test. Worst case, they don’t work all that well and I have to have ablation done on those nerves. But that is something that only time can determine.
And because my GP is in his 70s and doesn’t care anymore what people think, he followed the “fucking idiot” comment with “this is an absolute clusterfuck.” This was while he was staring at the X-Ray that clearly indicated I had moderate arthritis that had been labelled as minor and a “non-factor for pain.” That sentiment, I agree with completely… It has been an absolute clusterfuck. Best part, the pain management doctor put me on “rest” for the remained of the week. Obviously he doesn’t understand the needs of Lola the Destroyer, my clothes to get washed, or the fact that if I don’t at least show up to darts, we probably won’t have a full team this week and we really need one. Yep, clusterfuck is a great word for it.