… or an explanation of why I was so torqued after my visit to Dr. Donaldson today.
Clarification
First, I would like to clarify that Dr. Donaldson and his staff were very knowledgeable and friendly. When the time comes for my back surgery, whether it is now or later sometime, he will definitely be the one I look to do the cutting. That being said, I feel an explanation for my anger is required.
It Starts Here
Last week, I had an MRI on my back to determine what is causing the pain radiating down my right leg and across my lower back. I already knew what it was because I’ve been dealing with it for the last 11 years. The flare up this time is much different. There are no spasms down my leg… just raw pain clear to my toes. So much so, that I can’t sleep at night. Monday night I had an appointment with my family doctor to review the MRI results. This is where my aggravation with today starts.
You may or may not know that family medicine doctors are not always trained to read tests directly from their original media (ie: X-rays, EKG’s, MRI Images, CAT scans etc). What they get is a summary report written by a doctor who is trained to read the media. On Monday, my family doctor pulled up this summary report to review it with me. I could see it on the screen and read it. Its no secret, after all, they are my MRI results. The first few lines made mention of severe deterioration of all disks below T11. There was some medical terminology that lead my doc to believe that T11/12 disk was protruding into the spinal column. I could see a measurement listed but I’m not familiar with the scaling of the disks to know what it should be in relation to normal.
He noted several symptoms that are caused by this kind of injury. I had all of them. He then went to say that this type of injury could lead to paralysis if I twisted wrong or fell. He commented that he didn’t think I golfed or road motorcycles because those would be very dangerous things for me to do. I told him I did own a motorcycle and ride quite frequently. He told me that I should not be doing anything more than going to work and coming home to rest. Work would even be out of the question if my job required lifting or climbing. He said that it looked to him like it was time to see a Spinal Surgeon. Not just any orthopedic surgeon, this had to be a specialist because of the nature of the damage at T11/12.
I asked him about L4/5 and L5/S1 because that is where the pain was generating from that was keeping me from sleeping. He told me that he didn’t think that the surgeon would consider L4/L5 until he looked at T11/12. Maybe the surgeon might do both areas since he was already in the back working but T11/12 was definitely the priority right now. I asked about the epidural that was scheduled for Thursday. He told me we should leave that on the table as an option right now but he didn’t feel it would buy me anything at this time. I left the office dejected and extremely concerned. If my pain at L4/5 was this bad and he’s now telling me T11/12 is critical and could cause paralysis, things must be really a mess at T11/12.
The Surgeon
I was surprised when I got a call from my family doctor’s office on Tuesday morning stating they already had me an appointment with Dr. Donaldson. I had been reading up on Dr. D.’s credentials and reviews on the internet. He came well regarded and had some really good medical background in my untrained opinion. I talked to my neighbor Tuesday night. Dr. D had done his back surgery and was well liked. Throughout the day Wednesday, I received many comments from friends that they had used or had loved ones who had used Dr. D. as well. All agreed that he was the man for the job. This belayed some of my concerns. I was pretty sure I was going to the right place.
I arrived at Dr. D.’s office ready to hear the worst. I talked with a couple other patients while I waited to be called in. They were very pleased with the office staff and other doctors in general. The lovely rainy weather had my back throbbing the whole trip down. I also knew that there would be some manipulation of my legs and back to help diagnose the level of pain I was in. I was ready for that as well.
I finally was taken to an exam room and told the Dr. D. would be in shortly. It took about 15 minutes for him to walk through the door. I was just starting a game of Solitaire on my iPhone as he walked in. We joked about that for a second. He introduced himself and set straight to work. He asked me multiple questions regarding how long I’ve had back pain, accidents, etc… He then began the expected manipulation. Levels of strength and pain were judge as well as my reflex reactions. He stated that I definitely had problems in L4/5 and L5/S1 before ever even pulling up the MRI images.
The Rage Begins
He then pulled up the MRI and slid the monitor over so I could easily see it. He had the full images up, not the summary report my family doc had shown me. High definition images filled the screen. The left side of the screen showed a vertical side view of my spine while the right showed cut away views from the top of the disk. Dr. D. scrolled down the left side image selecting L4/5. He then stopped and selected a better disk to show me what each part of the structure was. “The black mass is the disk. These little black hairs are nerves. This white space is the spinal cavity and that circle there is actually the spinal cord itself.” he noted, as he moved the cursor to the corresponding area of the screen. He then returned to L4/5, showing me how the disk had pushed itself out and around the spinal cord into the spinal cavity. The same could be seen in L3/4 and L5/S1.
He noted that he would like to try the epidural to reduce the inflammation. He commented on the fact that I had made it this far with this kind of damage was pretty extraordinary. Most people can’t tolerate it that long. He isn’t the first to mention my high tolerance for pain. Several doctors have told me that I tend to withstand more than most individuals. Hence when they give me pain meds, they are not given lightly because by the time I need them, I am really hurting. He feels that if the epidural(s) work, it could buy me another two or three years before surgery. I am now getting a little grumpy (internally). I hope he didn’t notice. I have taken a day off work and driven to Pittsburgh, only to be told what I felt I should have been told by my family doctor first.
I told Dr. D. that the reason this appointment was made so urgently was because of the notation the T11/12 could cause paralysis if it wasn’t fixed. He said “Let’s take a look, but I didn’t see anything offhand to worry about.” My internal temperature went from grumpy to angry. He scrolled up the screen to T11/12. Clicking on it revealed the top cutaway view. He drug the cursor over a small bulge in what would be the right side of the spinal cavity. “Not worried about that at all.” He said. “You have much more damage down here. Look… You can see it even in the side view here.” Now my fuse is ready to sizzle. I am fighting to remain professional with him. I am not angry with him. He is showing me exactly what/where the problems are. There can be no question he is right. Any one that can look at a picture and see the difference between a rose and a Pitbull could tell that L4/5 was much much worse than T11/12.
I asked him what would happen if the epidural doesn’t help. How will the surgery be done. He took the time to show me where they would trim out the failed disk and how they would clean out the ‘Spinal Stenosis’ otherwise known as narrowing of the spinal cavity. He felt this would give me major relief without having to fuse any bones. Insert sigh of relief here. The anger is still growing at this point because I keep thinking “What was on that summary report that led my doc to think T11/12 was so critical? This is my back and my life we’re talking about here!”
He sent me home with his card and direct number. My only restrictions. No repetitive twisting, lifting or yard work until the epidural has time to take hold, which is mostly common sense. You can’t tell if something works if you are doing things that defeat its purpose. He wants an update on what the epidural does. Very nice man. Very good training and bedside manner.
Troubleshooting 101 – Why I was stewing to a boiling point on the way home.
I have been trained in troubleshooting. It is a vast part of what I have done every day for the last 20+ years of my life. Troubleshooting consists of two main parts: Knowing the basic operation and having the tools knowledge to determine what needs to be done to fix the problem.
Knowing the basic operation of something is the simplest part of troubleshooting. Once you know the basics, you can apply those to just about anything that is similar. The basics are things like knowing where the power cord plugs in, where is the “ON” button, what does this part or that part look like. You don’t need to know the fine detail at this point, just roughly what to look for. This is often referred to as “Common Sense”.
Having the tools/knowledge to determine what needs to be done to fix the issue is the next level. This is where you go to school to get certified or you spend time in the industry to be familiar with the finer details of how things work. In the case of this blog, this would be where a physician spends years in medical school and residency to learn how the body functions.
Here’s how troubleshooting applies to my visit to the surgeon today. First, you have to remember what I mentioned earlier, not every doctor is trained to read test results right from their original media. Second, You need to remember, I am not a doctor nor did I stay at a Holiday Inn Express last night or play one on TV.
As the MRI images displayed on the screen in front of me, several bits of information are available to my eye. General pictures that allow me to compare one disk to the next one above or below it. This is just like looking at your photos from Disney World from this year in comparison to those from the last trip. You can see the changes. “OH LOOK! Cinderella’s Castle had Christmas lights on it last year! This year it was decorated like a cake!” There was also medical data that I could only guess at what it meant because I am not trained in the field of medicine.
I could see that T11/12 had much less damage than L4/5. I didn’t need to be a doctor. It was like looking at a red rose on the left and a yellow rose on the right. The comparison was unmistakable. That’s the “Common Sense” or basic element.
The second element comes from 11 years of dealing with this condition. This is my training, however informal it may be. I have learned to deal with this injury as time has gone by. I know from past diagnosis and treatment that when I get this pain going down my right leg, It is associated with disks L4/5 and L5/S1. To add to this knowledge, I have done research myself in preparation for the day surgery might come. I have seen spinal mock ups with the vertebrae and disks labeled. I have noted the ones that the docs tell me are causing my pain.
I can draw my own non-medically trained conclusion that: 1) The pain going down my leg comes from the L4/5 area and not T11/12. 2) It is this pain that is keeping me awake at night not the minor (in comparison) pain that is in my mid back at the T11/12 area. 3) Someone has misinterpreted the data along the way to indicate that T11/12 is critically damaged and I am more at risk from that than from the disks at L4/5 that I can see on the actual image are much more distorted and damaged. 4) I am fortunate to be sent to a specialist who recognizes the medical implications versus the physical implications. Yes, more dangerous circumstances can occur (paralysis) if T11/12 push on the spine BUT that injury has probably been there for a while based on its location and the deterioration around it. The problem that must be dealt with first and foremost is the pain that is affecting my life right here and now, not the possible problems that could happen if I’m in an accident in the future.
I don’t hold any ill will toward Dr. D. I even have thought about how much responsibility my family doc had in the T11/12 scare… And I will tell you, I WAS scared. I won’t even put the blame on him because he was looking at a document that someone else had written. Someone, who doesn’t have a clue who I am or what the history of my injury is.
I had someone tell me that this happens. The person who reads the scans doesn’t necessarily read the patient as well. As a matter of fact, he or she has probably never even seen me walking down the hall, let alone examined me to find the extent of my injuries. He or she is just someone flipping through a photo album laying on the coffee table at some hall or venue. There are no links for them to see that I can hardly stand up straight or have trouble walking. The blame lies in the system that does not allow the person documenting the test to be the examiner.
All this being said, my anger and disappointment this afternoon was pointless. I did find out what will happen if I do have to have surgery and I am much less worried about having it than I was this morning before I left for Pittsburgh. My friends are right. They told me, that even though I didn’t get the outcome I expected, the trip was not a waste. I also got an unexpected benefit from my self induced internal rage. My adrenaline was up the whole way home. The leg/back that had been hurting the whole way down was now cloaked from my mind. I actually had some temporary relief. I even got a nice nap when I got home before the pain became noticeable again.
That’s the story of the day. (Judging by the word count maybe its a book report of the day or the start of a thesis).
I’m off to bed.
~Cappy