"You don't need to see a surgeon, you're just depressed!"

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I can't tell you how many of my clients have told me that this is what they are hearing from their doctors. This is even true for many patients who have such profound pathology that you can see in on their imaging from across the room... or on people with multiple surgeries and a ton of hardware in their spines.

Men get it too, but I think it's more common for women: When I first discovered the online patient community and read about these problem, I first thought that the patients were somehow defective... how is it possible that they can't communicate effectively with their doctors? I find it so easy. Then, my pain management doctor called me and said, "I can't help you anymore. You are way too mobile to be experiencing the kind of pain you are reporting. You need to see a psychiatrist, not a pain management doctor."

I had been complaining of advancing S1 radiculopathy for months and my imaging did not support my complaints. (2 months later, my left foot went numb and I had a 15mm protrusion at L5-S1.) He was a good guy who had been doing his best to help me. They have to make judgments based on very imperfect information and they will most certainly make mistakes. They will give heavy meds to those who shouldn't have them and they will withhold meds to those who should. They cannot be right all the time and are just doing the best they can. (The rotten SOB!)

I'm in Straubing, Germany now with a client who had surgery a couple of days ago. She was getting the "you are just depressed" crap from her doctors in spite of the obvious pathology. "It doesn't look bad enough to be causing the level of symptoms you are reporting." She had had a 2-level fusion years before and both the disc above and below were now suspect and verified to be pain generators by prior discography. (How doctors can see the data and still give the "you are just depressed" nonsense is beyond me!)

There were several things that were remarkable about her surgery. First, when the anterior ligament was exposed, it looked very inflamed. This is somewhat rare and I've only seen it 3 other times although I've seen well over 100 ADR surgeries. Many surgeons don't believe that anterior disc problems can be painful, but in the cases I've seen this, the surgeon has remarked that this is definitely a big pain generator. The ligament does not normally have vessels in it.. it's normally white and glistening.. not all pink and swollen. Later, when the surgeon did interoperative discography the contrast media IMMEDIATELY extravasated out the back of the disc into the canal area. I've seen this many times, but never so fast and complete. The posterior annulus and ligament were not intact. The epidurography provided by the contrast (that is why he uses interoperative discography) showed that the spinal cord was more profoundly deformed by the disc bulge than what appeared on the imaging.

It's nice to have findings like these during surgery because it gives more confidence that pain generators are being addressed. We don't know how good she'll get, but we expect her to be much better because the serious problems have been addressed. Once the ADR was in place, we could see from the remaining contrast that the depression in the spinal cord was gone as the disc space was restored and the decompression was complete.

Just a few hours after the surgery, the patient was saying.... "My elbows don't hurt like they used to! Left side pain is gone.. right side pain is still there, but substantially reduced." As the days wear on, we'll know more about early relief. We don't know how complete it will be. We don't know if she'll have the onset of additional symptoms. Only time will tell the results of the surgery and I've seen too much to encourage counting chickens before they hatch. However, based on what we've seen, we are very hopeful and we could not be happier with where she is so soon after her surgery.

This is such a far cry from "you are just depressed." I still don't understand how so many in the medical community can be so far off base.

Sorry for the long rant... all the best,

Mark