Is it normal for a doctor not do a discogram?

[fireyangel76]

Maria,
You have a great point! It is really hard to be on your toes and ask all the right questions, comprehend the answers, and formulate any follow up questions when you are in pain and in a fog from meds, infomation ect. As is always said hind sight is 20/20!

Think that the only option may be taking Mark to an Appt! Even with all my reading and research it cant replace the "hands on type" experience he has gained. Just need my lotto winnings and to get out of the HMO nightmare!
How are you feeling?

[Maria]

Mark accompanied me to one of my most important surgical opinions/visits/consultations as it was a 2nd surgical opinion to decide whether surgery would be authorized by WC for the 2nd time (meaning WC verbally authorized two level ADR surgery in 03 for me but then rescinded this authorization when CA WC legislation was changing in 05). It took till '06 to get authorization again (now written authorization documented) and Mark went with me to that visit and I felt his expertise was beneficial in terms of communicating with the Neurosurgeon and how the outcome of my case turned out. Actually without him I'm sure I would not have even made it as the time of the appt. was changed by several hours because of an emergency the Neuro had to attend. By the time of the appt. I was completely exhausted and not even able to think straight let alone speak clearly for myself without groaning (thanks infinity Mark).

Ok, anyway, I do know HMOs are a pain in terms of authorizing and esp. if out of network (worked for managed care/HMOs the last 14 years of employment) so I do wish you all the best~ please keep us posted!

[Cheryl]

Well after that last horrific appt this doctors nurse actually took it upon herself to schedule me an appointment with another doctor. She ran it by my doctor so as to be politically correct but I believe this says alot about what she witnessed. In addition, my general practicitioner is copied on all my visits with spine doctors. He read the report and called to tell me to seek another opinion (in his politically correct terms). At least I know I'm not the crazy one here.

So, I am going to yet another doctor on Monday and I have a great girlfriend coming with me who definately will hear what I don't. Because my husband is going to be living it up in Vegas. He's gotta have some fun after the year we've been through.

Of course I would prefer Mark to come but the different coasts causes a problem. I'm going to have him consult with the doctors after I get the reports.

Thanks for all the support.

[fireyangel76]

Cheryl,
Good luck Monday. I hope you get some answers and viable options.

[Maria]

Cheryl,
Good luck with next visit and hope you'll have your questions ready yet be ready for something unexpected should the next consulting surgeon make some point/suggestion/observation the last didn't. Perhaps your friend can be taking down what the doc says or have a small recorder in her pocket (hmmm.. did I suggest that/no)...

Glad you'll have Mark getting some other opinions for you and hope soon you'll feel confident with a diagnosis no matter what you do about it.

take care~ Maria

[mmglobal]

Cheryl,

Greetings from Straubing! I'm so sorry that you are having such a difficult time getting to someone who can help you.

It's interesting that while lumbar discography is becoming a more accepted norm, cervical discography is still lagging behind. I'm in the process of arranging cervical discography for several people in the US and I've discovered that a couple of places I've had it done have stopped doing them. It's relatively uncommon and not a huge part of their practice, so it it's controversial, they are demotivated and don't want to bother.

I believe that it is controversial BECAUSE it is rare and can be done improperly and can generate ambiguous or incorrect results. Those with little practice or experience with it will make mistakes and generate negative experiences and data. As with so many things, in the proper hands, it is a most useful tool. Done improperly or even interpreted improperly, it is problematic.

With the larger discs, larger canal area and more durable nerve structures in the lumbar spine; lumbar discography is less of a problem than cervical discography. With the smaller discs / smaller volumes in the cervical spine, I think it's easier to generate false positives. I have not heard of problems caused by cervical discography, but I'd be surprised if there aren't serious potential complications.

I look forward to hearing positive news about your appt. on Monday.
______________

Regarding my sitting in on Dr.'s appts: Thanks for all the kind words from everyone. I'm very proud of what I'm able to do. I've done this many dozens of times with clients from all over the world. It's been great to see when patients who've been dismissed by doctor after doctor and have not been able to get a serious look, actually are listened to and get their problems addressed appropriately. It is not normally needed (but can still make an important difference) in straight forward cases. In complex cases where there are multi-focal problems, patients are too often dismissed based on their demographic. Assumptions are made about secondary gain, drug issues, psych issues or other medical problems that overshadow new or previously undiagnosed issues.

"Your films don't look bad enough to cause the problems you are reporting."

I hear this too often in cases when the patient has additional spine problems or other health problems. If the patient was a 50 year-old CEO with no other health issues, the problem would be pursued aggressively. If the problem is in a 40 year old woman with prior spine surgeries, prior chronic pain issues, and who knows what else... the new problem is completely overshadowed and they never even get a fair look (by SOME doctors.)

In the past weeks and next few weeks, I have clients from Alaska, Utah, Georgia, Canada, New Jersey and No. Cal. coming to So. Cal. to see 5 different spine surgeons, 2 neurologists and a pain management specialist - simply because they are going to doctor after doctor and unable to get any help. I wish I could easily get all around the country to help folks like Cheryl, but it's not practical. (That's why my system of remote diagnosis is so useful! Usually, by the time the patient is seeing the doctor, there has been a review and a dialog, so the doctor is already engaged in the case and has been brought past the 'demographic dismissal'.)

I have to run... Bertagnoli will perform multi-level lumbar surgery on a client in couple of hours... next week brings a very interesting revision surgery with a completely new system to stabilize a tilted lumbar ADR. (Jeff - are you reading?) I'll write more when I get some time... this whole summer has been a sprint... I hope to get some time to relax and catch up soon.

All the best,

Mark

[Cheryl]

Just got back from the new doc. After going into all of the politics of his office and he himself called it a soap opera , He is “willing” to treat me. He’s a physiatrist though so he’s just doing injections and diagnostic tests. I will be getting another facet block injection with a different medication on c5- c7 next week. Next he’ll order EMG and CT myleography. Apparantly I live in the wrong city for a cervical discogram because he said no doctor in Charlotte will do them since someone was paralyzed and here is a quadripalegic who is suing the radiologist.
He used the exact quote that Mark mentioned above about my films not justifying my pain.

I am so sick of the doctor politics and egos I could scream. Luckily I did work in corportate america and I know how to "play the game" so I held myself together today with my friend by my side and at least we are moving forward now.