I need a cynical mind to help me figure out the agenda of my father's primary care physician.

[EmilyAnne]

My dad has had a slipped disc diagnosed over 20 years ago. He was riding his bike, swerved out of the path of a driver, flew through the air and landed on a raised manhole cover.
Ouch.
Since then, he has not been very active, has gained weight which puts more pressure on his disc.
He has episode of intense pain from time to time.

Recently, it got so bad that he stayed in bed all weekend and couldn't walk more than a few steps at a time.
He also has some nerve damage because he can't feel one of his legs.

My mother has been wanting him to get an MRI and see a specialist for almost a year, but the PCP says "no."
He claims that since my father already knows what is wrong from that 20 year old diagnosis, there is no reason for the MRI other than to more towards back surgery. He says that back surgery is the absolute worst thing that anyone can go through, that it never helps, it only makes everything worse, and therefore getting an MRI is pointless.
My father is, of course, terrified of having back surgery so he has just sat back and gone along with the PCP.

After the last weekend, my mother went to the PCP with my dad and insisted, over and over again and very loudly, that my father have an MRI.
The doctor actually raised his voice at my mother, told her she was being "hard nosed," even rolled his eyes at her.
All the while insisting that he has my father's best interests in mind and that the moment a specialist gets a look at the MRI, he will push for surgery and my dad's life will be ruined.
He told my mother that there hasn't been a single improvement in technology related to back surgery in the 20 years since my dad's accident.

Can any of you with more experience with this kind of thing tell me the angle here?
Why would he be so against the MRI?
Is it true that doctor's get bonuses for keeping referrals down?
I would assume that is the case here, but he has given both parents referrals to other types of specialists in the past.
Seems like he would want a patient to receive other opinions, just for liability issues alone.

[Duer 157099]

1. Incredible. That's almost exactly opposite my situation

I've held the position that your father's PCP does - I'm very opposed to surgery for all the reasons he seems to put forth. I've had MRIs and discograms and everything else, and nearly had the surgery, but didn't.

I was just thinking about looking into it again, to see if anything has changed in the past decade wrt to techniques etc.

I don't know what to tell you. It's really hard to guess the PCP's motivation in this.

[EmilyAnne]

18. Have you experienced any relief or do you feel like you are in the same place?

Thanks for your response!

[CaliforniaPeggy]

2. I think you're on the right track here.

And is there any way your dad can get a new doctor?

This one sounds like a real hard-ass, to be blunt.

He certainly needs surgery.

Good grief.

My sympathies to all of you, esp. your long-suffering dad.

He thinks your dad's life will be ruined? It sounds like that's already happened!

:hug:

[EmilyAnne]

19. That's the way I see it! For years now, my father has not enjoyed life as he could.

When I was living in Spain years ago, he didn't visit me because of the long plane ride and the constant walking that was a part of my lifestyle there.
My mother came alone.
We went to a beautiful medieval town called Segovia and climbed the tiniest set of spiral stairs until we reached the top of a castle.
It was so beautiful and I remember thinking that, unless something changes, my father will never be able to do anything like this.
That was ten years ago and its getting worse!

The decision to get surgery will be up to my father, but I just don't understand why the doctor wants to deny him access to information that can help him make this decision.

He will definitely get a new doctor if I have anything to do with it!
I talked to mom tonight, but dad will get a piece of my mind tomorrow.
I love him, damn it, and if there is something that can be done to relieve his pain and increase the quality of his life, then he should at least hear about it!

[WannaJumpMyScooter]

3. there have been tremendous advances

in treating backs surgically, certainly in the past 20, but really in the last 5 years

he needs to dump this moron, soon.

[EmilyAnne]

20. He sounds like a moron. The extreme comment about no improvements in the field in 20 years

really convinced me off it.

What a stupid, absolutist thing to say!
Its impossible that 20 years have brought not a single improvement in the field.

It seems that the doctor has a personal problem with back surgeons.

[Manifestor_of_Light]

4. There are two different issues here.

One is the MRI.
The second one is the implication the dr. is making, that IF a specialist sees an MRI he will order back surgery.

The conclusion of back surgery is NOT hard and fast.

I wonder why the dr. is convinced that IF a specialist saw the MRI, he would order back surgery.

That's what I don't get.

I would insist on the MRI and tell the doctor that back surgery is NOT inevitable. Not if the patient doesn't sign a permission. Ask the doctor WHY he thinks an MRI in the hands of a specialist will lead to back surgery?

From what I've heard from taking depositions of neurologists and orthopods, back surgery does NOT make things better. So your conclusion of not wanting back surgery may well be right.

[EmilyAnne]

21. Interesting. Thanks for your insight about the depositions.

I guess the doctor thinks my parents are just brainless fools who will be led down an inevitable path to surgery as soon as the MRI is administered.
I always think the more information, the better.

[TexasObserver]

5. First, put everything in writing, in letter form, mail it, certified.

Second, demand a new primary care physician, and state that you unhappy with the current PCP because he is insensitive to his patient's complaints and pain.

[EmilyAnne]

22. And that will save him from getting grief from his insurance provider? I'll tell him to do it!

Thanks!

[TexasObserver]

30. I don't know if it will save him from grief.

It will leave a traceable paper trail of his demand, and it will lay the groundwork for future complaints if he remains the PCP. If you don't put it in writing and document its delivery to the company, you won't likely get anywhere on changing the PCP.

Of course, there may be a risk they will try to cancel his coverage and make him go elsewhere. You have to weigh that, too.

[Lugnut]

6. I'd get a new PCP.

While it's true that there are no guarantees with back surgery I think your dad deserves to be better informed about his options. My sister had a good result from her surgery but her situation may not be similar to that of your dad.

[EmilyAnne]

23. That's great about your sister.

I don't "get" the doctor wanting to deprive my father of information about just what is going on with his body.
He sounds like a control freak.
He may still think he has my father's best interests in heart, but he should trust that my parents can make informed decisions rather than viewing them as mindless idiots who need to be protected from MRI results and second opinions from experts.
Jeez.

[Lugnut]

55. Honestly, I'd be insulted.

I'd resent being treated so disrespectfully. I'm fortunate to have a PCP who is honest and open to discussion about treatment options. Best wishes to your dad.

[pnwmom]

7. Is your father in a managed care plan? n/t

[EmilyAnne]

24. An HMO.

An HMO that's grown crappier and more difficult to use over the years, but at least he has coverage.
His company is laying people off every month and they offered my father a shockingly low severance package in exchange for his voluntary retirement. He declined.
Now we are worried about him losing his job and losing insurance in the midst of this whole episode.

Sad thing is I know he is feeling the full weight of all of this job related stress, along with an unsupportive doctor who is using scare tactics, kids who suspect that he will neglect his health (we kids do worry about you parents), my mother's attempts to take on the doctor, his fears about the possibility of having back surgery and being in pain!
He's the one who should get to decide.
He wants an MRI.
That should be enough for a decent PCP.
This doctor stinks and is treating my father like an idiot.

[pnwmom]

35. If he's in an HMO, yes, there's a possibility that this doctor is under pressure

to limit referrals. You should see what appeal rights there are when the doctor denies a request like this.

[Love Bug]

48. MRIs are expensive tests and the HMO probably requires their

providers to use any means possible to deny expensive tests. Your father needs another PCP right away. He should also be seeing an orthopedic specialist, too, but the HMO may require the PCP to "sign off" on sending him to a specialist.

How, exactly, has the PCP been treating your father? Pain meds only? His attitude and actions border on the unethical, imo. However, the current PCP may have so programmed your father against surgery that even going to a specialist and having the appropriate tests may not result in surgery. But, your father is not being served well by this PCP and HMO. He needs to be able to make an informed decision.

[Love Bug]

49. MRIs are expensive tests and the HMO probably requires their

providers to use any means possible to deny expensive tests. Your father needs another PCP right away. He should also be seeing an orthopedic specialist, too, but the HMO may require the PCP to "sign off" on sending him to a specialist.

How, exactly, has the PCP been treating your father? Pain meds only? His attitude and actions border on the unethical, imo. However, the current PCP may have so programmed your father against surgery that even going to a specialist and having the appropriate tests may not result in surgery. But, your father is not being served well by this PCP and HMO. He needs to be able to make an informed decision.

[CoffeeCat]

8. This doctor sounds like a sick sadist!!

I'm not kidding. Something is wrong with this guy. He sounds like one of those jerk doctors who is
high on his own power as a physician, and uses that power to give horrible, awful advice!

I am stunned at your post. Simply stunned.

I had back surgery for a slipped disk about 8 years ago. Not everyone benefits from back surgery, but many do! I
sure did. I was in such intense pain before I went into surgery, and when I woke up--I felt like a new person. I
gained a new life.

So, your father had an initial diagnosis of a slipped disc, but has been in pain since then? And did he have the
one surgery after the bike accident? ...just trying to understand this.

If your father's leg is numb, chances are he has sciatica. I had that with my slipped disc too. The disc protrudes
and juts up against the sciatic nerve and causes leg pain. I do know that pain comes first, then numbness is a progression
of sciatic nerve deterioration. I don't know why this doctor won't at least get an MRI, because it sounds like there
is some progressive damage there. The damage could be from surrounding discs...and an MRI would give a clear answer.

I know that when you have one slipped disc, the surrounding disc sometimes can deteriorate faster, due to the damaged
disc weakening. So, it would make sense to give your dad the MRI to see what is going on.

This really isn't something to fool around with. This is not about toughing it out or enduring the pain. Untreated bulging
discs can cause many other problems. Sciatica (as you know) is one. So is blurred vision and incontinence as well as loss
of balance, etc. The pain can really be debilitating, leaving the person with depression and a low quality of life.

I can't say this loud enough...your father needs a second opinion. Another doctor would have no problem suggesting an MRI.

I mentioned my first surgery, which was 8 years ago. I had back pain last year and my doctor ordered an MRI right away! My
previous back problems made an MRI mandatory--in my doctor's eyes.

There is such a thing as degenerative disc disease. And discs do age and show some damage--as we all age (just like our teeth).
Your father could have some of that going on. An MRI could give the answers.

When someone presents with back pain--you don't mess around. This is your spine! It's not like he has a headache. This is serious
and this doctor is not a serious person. This is beyond the pale.


Geez, this makes me so angry! This doctor is a quack! I guess I'm the cynic you were looking for! :)

[EmilyAnne]

25. Thanks so much! This is very encouraging.

Where did you have your surgery, by the way?
My parents are in Houston, so they are very lucky to be so near an excellent medical center.

You are so right about the depression. My dad is a depressive eater, too, so the extra weight he carries related to his overeating also makes the back pain worse.
And not being able to exercise means that his weight loss is all about his diet.
Plus, his quality of life has decreased.
My dad was a runner, a cyclist and a hiker. Weekends were always some kind of free, out door activity like a game in a park or a picnic.
That all changed after his accident.
He tries, but he just can't walk too far.
If something can be done to help, why shouldn't he at least be armed with the information?
The doctor stinks.

[CoffeeCat]

51. So, your father has endured this pain for 20 years?

He's never had surgery at all?

When I had that back pain, it was one of the most difficult times of my life. Chronic pain robs a person of everything
that makes us human. The pain is there all of the time, and there is never any peace. I can't believe this stupid
doctor!

Your father is probably self medicating with food. That's understandable. It's amazing he doesn't have a drinking
problem or other addictions. I'm happy that he's not addicted to pain killers, but again--hasn't this doctor ever
given him meds to alleviate the pain? Has he ever suggested anything (even Advil, etc) to help quell the pain???

I hope you will keep us informed, because there is so much hope for your father. He just needs to see a doctor who
isn't a complete failure.

In my opinion, this doctor has violated the Hippocratic Oath.

[EmilyAnne]

56. He had a back brace about fifteen years ago. It was a very complicated thing that looked like a

medieval girdle. I don't remember if there was much relief, but he hasn't worn it in at least ten years so I guess that means he didn't.

He is prescribed 800 mg of ibuprofen.
He doesn't drink, quit smoking 25 years ago, doesn't take any pain medications other than the ibuprofen, so he has no other vices but FOOD, glorious food.

But, aside from the stupid back brace and the ibuprofen, I really don't think anything else has been suggested by this or any other doctor.
My dad has one thought that has been drilled into his brain and that is "no surgery, no surgery, no surgery."
So, with this in mind, I have a feeling that he has been keeping the severity of the pain to himself most of the time to avoid the suggestion of surgery.
He definitely hasn't been pushing for the MRI because he's scared (thanks to the doctor, in my opinion), but now that he finally asks for one, the doctor won't get on board.

And, yes, its been at at least 20 years since his bike accident. I don't know if the accident caused the disc to slip or if it worsened an emerging condition, but that accident changed lifestyle.
No more recreation or exercise after that.
His belly looks like Buddha's.
And he doesn't drink alcohol!
Its all food!

Thanks so much for your words of encouragement.
I will keep you updated!

[TorchTheWitch]

38. Agreed! 2 people I know benefitted greatly from back surgery

One of my brothers is one. He had the same sort of symptoms with the numbness down the leg and a lot of great pain. Eventually he got the back surgery and was like a new person. The other is a woman I worked with for years. All those years she suffered, got hooked on narcotics because of her pain, she was always grouchy and difficult to get along with, she drank too much as a secondary way to aleviate the pain, etc. She finally had the surgery and she's completely different! She smiles and laughs all the time (something I NEVER witnessed her doing before), she got off all those narcotics, her marriage is so much better now (she was close to getting divorced because her constant pain made her unbarable as a person and I have no idea how her husband put up with her like that for so long), she can work more than two days a week with no problems at all... finally getting the surgery was the smartest thing she ever did.

I totally agree that this doctor is a quack and a dangerous one. It is a doctor's job to explore ALL the options. His claiming that nothing has changed in the improvement of the field is ABSURD, and claiming they never work is flat out BS. Back surgeries don't always work out well, but every case is different, and the majority of them DO work out well... maybe not "cured" or "as good as new" but certainly a vast improvement. I think it's far better to go through the surgery and if it works, fabulous, and if it doesn't he'd be no worse off than he was before. Everyone reacts differently to back surgery depending on all sorts of factors and what exactly the injury is... for my brother he was practically as good as new very soon after the surgery, but for the woman I used to work with it took several months (but through those months it was constant improvement).

[HamdenRice]

42. I had that kind of miraculous effect also. When I woke up, the sciatica was gone

and the feeling had come back to my arms.

The whole ordeal was at least the source of plenty of "Doc, will I ever play the piano again" jokes with my surgeon.

[SPedigrees]

9. As one who also has disc problems

I agree with the assessment of your dad's doc. Every study ever done points to low benefits from most back surgeries and no better outcomes than less invasive measures.

For what it's worth (everyone is different) the things which help me most with pain episodes are:

Decompression achieved by hanging from a bar mounted high up in a doorway. Hanging by one's hands in a relaxed position for a minute or two is therapeutic and opens up the vertebrae allowing the disc(s) to slide back into place.

Muscle relaxants (flexeril) have helped me a lot because they undo the cycle of muscle spasms. When the muscles tense up it becomes a chain reaction and the tightening muscles pull the disc out of alignment. I've tried steroids and narcotic pain pills but neither of these is as effective as flexeril for me.

Relaxing and swinging one's arms back and forth (in windmill fashion) seems to help provided that you relax your body while doing this.

Soaking in a hot bath with epsom salts.

Probably not applicable for a man, but for me hormone replacement therapy including androgens has diminished my episodes by about 1/2 in both severity and frequency.

Hope your dad improves. I feel his pain. I don't think his doctor is a quack; I think his assessment is valid and true.

[CoffeeCat]

12. I had a bulging disc at L4-L5, and surgery was the only option...

The disc had progressively protruded and the pain was intolerable.

I had back and leg pain for weeks, but I wasn't given anything but Tylenol--because I was pregnant through
all of this.

The back kept getting worse, which was my disc bulging further and further. Finally, it just blew. I
was in such horrible pain, I couldn't sit or stand. When I put a blanket on my legs, it hurt--that's how
bad it was.

I was rushed to the ER, and put on morphine. I had surgery the next day--when I was five months pregnant (and
still breastfeeding a 10 month old!).

I woke up a new person and I was pain free for about 7 years. I had some back pain again, the dr ordered an MRI.
I was ok, and the pain worked itself out and I've been fine since.

Surgery was life-saving in my case.

[EmilyAnne]

29. Wow! You are one tough mama! nt

[Holly_Hobby]

10. Get your dad to a neurosurgeon......X-Stop works!

This is something new, works 100% of the time and it's....out patient!

I have 3 of these and NO. MORE. LEG. PAIN.

http://www.spine-dr.com/site/surgery/surgery_xstop_ipd.html

[EmilyAnne]

27. Amazing! Thanks! I am forwarding this whole thread to my dad.

Its so great to hear that you are no longer in pain.

And, as far as the doctor's claim that there haven't been any technological improvements in this field in 20 years, I would bet that X-stop came to be in the last 20 years.

[Holly_Hobby]

59. The procedure is a few years old......since 2002

My PCP told me about it, he had a visit from the salesman that day, I was there for another reason.

I went to a neurosurgeon a few weeks later, a few weeks after that I was in surgery and home the same day! No pain upon getting off the gurney. The only problem is that the can't be done more than one at a time if you need more than one. Mine were spaced out every 8 weeks.

I couldn't be happier, it also helped my bone-on-bone pain in my lower back.

It was developed for people who aren't good surgery candidates, i.e., elderly, etc. It worked so well, they're using it on anyone who wants to try it.

Good luck to your dad and tell him to print off the link in my first post and shove it in his PCP's face and demand a referral to a neurosurgeon immediately.

[rucky]

46. WOW

why isn't this all over the news?

[Holly_Hobby]

60. It's been used since 2002

I can't answer that. All I know is that it works and works well. Mine are about 2 years old and I haven't had any more leg pain.

Spine collapse runs in my family, so I'll probably have a few more done in time.

[MiniMe]

11. My answer would be that I would want to see if the condition has changed

in the last 20 years. Some PCPs get "punished" by the managed health care company for ordering tests or sending people to specialists. Getting an MRI does not automatically mean that he has to see a specialist, the radiologist will read the x-ray and prepare a report. What if there is a new injury there? Or the original injury has deteriorated? I agree with the others, he needs to change PCPs. Perhaps this one has had a bad experience with a specialist himself.

[EmilyAnne]

31. The punishments are the first thing that popped into my mind when I talked to my mom, but she

insists that it can't be the case because he has sent them to other specialists for "other things" (things that she didn't elaborate on because they are always guarded about any health concerns because they know that their kids will "nag" just as I am going to do tomorrow when I talk to my dad about this doctor.)

Anyway, I agree that getting an MRI will not force my dad to get surgery. Its such a weird assumption. Either the doctor thinks my dad is a moron who can't be trusted to make decisions about his own body, or, as you said, the doctor has had some kind of bad experience with a specialist and its personal.

[pnwmom]

36. MRI's are expensive, and so is back surgery. Just because he's been sent for

other tests doesn't mean the doctor doesn't try to limit them, especially the expensive ones.

[HillbillyBob]

13. INSIST on the MRI, that was how they found that my Grammas

'arthritic hip' was actually Multiple Myoloma..tho of course by then it was too late. If something keeps hurting insist they look closer, as things turned out my Gramma should have had hip replacement when I insisted that she have an MRI. My family talked her out of it. I am a long term aids patient and have had many friends that had similar problems and had to have hip replacment.
Get the MRI and go from there.

[sandnsea]

14. My sister's shoulder as well

A tumor, Non-Hodgkins Lymphoma. You're right, it could be something worse.

[EmilyAnne]

17. Ironically enough, my father-in-law died of Multiple Myeloma two years ago.

And it presented with lower back pain.
His doctor did not take it seriously until he was literally bed ridden.
He died within two months of diagnosis.
Its such a horrible disease.

I am so sorry about your grandmother.

I agree that my father should be armed with information from different sources.
The PCP acts as if my parents are so stupid that the minute a specialist gets a look at that MRI, they will be putty in his hands.
I think people are capable of making decisions about these things for themselves.
Regardless, he IS getting a new PCP.
Its one thing to advise. Its another thing to command.

Thanks for your input and good luck with your health!

[old mark]

15. To have surgery or not will depend on the injury. I have disc problems

for over 20 years, saw a surgeon who recommended surgery, but I went with physical therapy, and have never had surgery yet. I know many people who have had disc surgery and have been made worse - some have had multiple surgeries to correct the damage done by previous surgeries.
There are two different questions here - I recommend an MRI, but I would never recommend back surgery except as a last resort, and I really mean last - there are too many incompetent surgeons and unnecessary surgeries, with terrible results.

mark

[EmilyAnne]

32. I don't even think my father has been referred to a physical therapist! You would think that if his

doctor is so fearful about surgery, he would at least promote alternatives such as the one you chose.
Either way, like you, my father should get to make the best decisions based on current information.
He shouldn't be bullied by a doctor.

Thanks for your informative post, by the way.
I hope the physical therapy helped!

[McCamy Taylor]

16. Surgery for herniated lumbar disc causes more problems than it corrects in most cases...

If it really is a simple herniated lumbar disc and if there is no nerve involvement. If he has numbness or weakness of a leg (or any change of bowel or bladder function), there is a possibility that he has spinal stenosis. This problem does get better with surgery. Spinal stenosis causes referred pain that is worse with walking, better when sitting down (not be confused with claudication of the legs caused by clogged arteries).

A nerve conduction study will evaluate for nerve damage but he needs an imaging study of the back to tell what the anatomical problem is.

Many doctors have seen people have such bad results from lumbar disc surgery that they are hesitant to suggest it and feel like they are protecting their patients when they keep them away from the surgeon.

[CoffeeCat]

52. I agree that back surgery is not for everyone...

...and in many cases it is not the answer. We seem to be learning-as-we-go when it comes
to back pain. I do understand what you are saying--and I had back surgery for a ruptured disc and
the surgery was a miracle for me.

What I don't get---is why this doctor won't even give this man an MRI. That just flabbergasts me.

Maybe this doctor is against surgery--and feels that too many surgeries are done, etc. Fine. However,
to deny this man a basic MRI--to assess the problem--is negligent, in my opinion. Especially when this
man has been in horrible pain for many years, and is showing signs of nerve damage--with the sciatica
and leg numbness.

Why no MRI? Why no physical therapy? This just doesn't make sense to me, regardless of his feelings
about back surgery.

Anyway--he's not a neurosurgeon. Shouldn't that determination be left up to the specialist? Isn't that
why we have specialists?

Just asking questions here...

[truedelphi]

26. Yes doctors get bonuses for keeping MRI requests down. More importantly

An MRI is a valuable tool to assess what is going on with his back today.

I have had several friends, and myself too, in a similar situation to the MRI request.

Here's the thing - it might not be that your dad needs surgery. Sometimes an injury like the one that he has suffered can allow for a cyst or other problem to occur.

A cyst can be eliminated by a minor procedure. But if that is what is now adding to his misery, the fact that this doctor is denying him the MRI is only withholding information and treatment from your dad.

Keep advocating for your dad. ALso, some HMO's have in the fine print of the original contract the fact that if you are totally frustrated by what they are doing or not doing, you can request a specialist. One from outside their purview of bonuses being withheld etc.

[EmilyAnne]

33. Interesting. Thanks! nt

[quiller4]

28. Your Dad needs a second opinion. Start with that.

Surgical techniques have improved. You have less likelihood of developing complications from surgery but the improvements in technology have not greatly improved the outcomes. My husband has suffered for years. His symptoms are very similar to your father's. Losing weight, practicing some back exercises and periodic dosing with anti-inflammatory medication and pain medication during flare-ups following strain all provide some relief.

He always has some pain. He has grown used to the numbness and tingling in his left leg. There are always ice packs ready in our refrigerator and the heating pad is never far from my husband's chair.

My spouse's PCP strongly recommended against surgery but still orders tests periodically (my husband suffered the first injury 30+ years ago)to monitor the situation. One of the injured discs ruptured 12 years ago. After the last specialist's exam my husband was told that his damage is sufficient that our insurance would consider surgery justified. However, surgery would further restrict movement and would not necessarily lessen pain.

[radfringe]

34. Insist on seeing another Doctor

a number of years ago my mom fell down the stairs and hurt her back. After a couple of days of hobbling around the house she went to the doctor - he told her she just "wrenched her back", i.e probably a pulled muscle.

Told her to lose weight, exercise more. He didn't order any x-rays/MRI etc.

A year later my dad changed jobs, and with it new health insurance/doctors. She went to new doctor for check-up, mentioned her back pain. He ordered MRI.

Turns out she had cracked a disc. It had healed since then, but not all that "neatly". Doc told her if she had treatment at the time of the injury they could have done something. He ordered physical therapy, and said eventually she may need surgery. So far, she hasn't needed surgery, although her back does act up from time to time, and her current doc has her go for a MRI every 2-3 years just to keep an eye on it.

For the past 7-8 months a friend of ours has been having bouts of pain and nausea. Comes and go. Her doctor told her it was probably the flu, indigestion and other "diagnosis". She asked her doctor if it could be her gall bladder - he pooh-poohed it, wouldn't order tests. Symptoms continued, last week after an especially painful bout, she went back to doctor's office. Her PCP wasn't available, she saw a different doc, she again asked about possible gall bladder problem. This doc ordered tests - and guess what - it is her gall bladder and she needs surgery.

GET YOUR DAD TO A DIFFERENT DOCTOR. EVEN WITH AN HMO - you have the right to insist on a 2nd opinion

[OKNancy]

37. FWIW - I had a very sucessful back surgery

Now, I will say I had one of the best surgeons there is and it was 25 years ago. The doc cleaned out the ruptured disc
( lumbar laminectomy ) and it was instant relief. Even with the cut open back it was heaven not feeling the pain in my back and leg. I had some nerve damage too, but for these past 25 years, I've still taught ballet and other dance forms.

So, as far as " the worst thing someone can go through"... it wasn't in my case at all. It was the best thing I ever did.

[Turbineguy]

39. It's why they have

second opinions.

But it all sounds a bit strange with this Doctor and all.

[LeftishBrit]

40. This is plain wrong..

there have been a LOT of improvements in the last 20 years. My mother benefitted enormously from having decompression surgery.

It's true that doctors generally recommend against using surgery as the first resort for a back problem - often physiotherapy can prevent the need, or the problem simply improves with time. But the objection to even getting an MRI is bizarre.

'Is it true that doctor's get bonuses for keeping referrals down?'

I have no idea about America; but in some regional health authorities in the UK - yes.

[HamdenRice]

41. I've had a successful fusion of 3 cervical vertabrae -- my take is

It's a confusing situation you face. My diagnosis and prognosis were grim--that I had compression of the spinal cord itself, not a root nerve -- and would be paralyzed from the neck down.

Even scarier, I had an older friend at the time who had had exactly the same condition many years prior, didn't know about it, and while playing baseball the condition caused damage to his spinal cord and caused him partial paralysis. So I knew the threat was serious -- beyond the pain.

I saw several neuro surgeons and had a family/friend doctor advise me with current research.

It is true that there was at the time a high rate of failure to improve symptoms through back surgery. But this seems to be more from bad choices of surgery by surgeons and lack of studies about what works, than the absolute inability of surgery to help drastically.

It turned out that studies showed that the first surgeon's recommended surgery had little effect on my condition. The second surgeon's recommended surgery had a very good track record. The second surgeon was based in a large teaching and research hospital. I had the surgery 10 years ago and I'm fine -- in fact better than I was for years before the surgery.

The idea of just not knowing what's going on as your father deteriorates seems completely wrong. Nerves could be deteriorating. You should get around this road block and get an MRI and diagnosis -- then you can decide if surgery would help.

I would say though from what I read about my condition is that being overweight and inactive creates a very bad prognosis. If there's anyway to get your father to lose weight and regain some activity through nonsurgical interventions, that would be important.

Good luck and good health to your Dad.

[JoDog]

43. I have family with severe back problems

and they have heard what your dad's doctor said: even with advancements made in recent years, back surgery can be a zero sum thing.

That being said, you dad should still have an MRI and get evaluated. It's very likely that other conditions connected to or even independent of the disc could be contributing to his pain. It's also possible that treatments short of heavy-duty surgery (chiropractor) could help him. But he won't know if he doesn't have a complete picture.

Also, your dad sounds like a candidate for pain management. If his problem cannot be relived by surgery, then he should be on some kind of pain meds, stronger than Tylenol. Getting his pain under control could be a good first step to managing his depression and eating better, which would in turn help the back pain even more.

[graywarrior]

44. Second opinion.

[LeftHander]

45. Some PCP docs are just gatekeepers for HMOs

They keep costs down by not treating patients and are rewarded by employers for doing so.

"take two aspirin and don't call me."

[Marrah_G]

47. You need to get him a different doctor

Spinal Surgery is not what it once was.

I've had it. I walked out of the hospital the very same day. I was walking through home depot in two days.

Before that I couldn't move due to the pain.

Please get your father a new PCP

[Bluenorthwest]

50. He should be fully informed of options

But I do heartily recommend losing weight as step one...I speak from experience...and also when looking at the surgery option, look very closely at not just the result figures, but the breakdown of those figures by age, gender and other factors. I was offered a surgery that had 'great results' but when I looked closer, the great results were largely among younger people, and women. In my actual group, the sucess rate was far lower, and the rate of 'no change' or 'worse' far higher. Also far higher in my group was the death rate. 3 out of 100 died, and all 3 were men like unto me.
So look at detailed information. Select surgery very carefully. Surgeons believe in surgery.

[Mopar151]

53. Mean and stupid works for me - 2 stories

I had a triple lumbar diskectomy (L3, L4, L5) on Aug.11, 1991, By Dr. Barton Sachs in Concord NH. I had had conservatively managed back pain for 10 years before that, but it worsened significantly that spring, and went over the top a couple weeks before (my physical therapist had to walk me to my car).
I am not perfect, but I am largely pain-free and quite capable physically. I'll also tell you that it's the rehab after the surgery that makes the big difference, and that is true for a lot of modern orthapaedic surgery. 5 weeks after surgery, I was up to walking 4 miles a day as part of my postop, and started the big rehab. By December, I was back at work full-time, with a floor-to table lift rating of 75# (the weight of a machine vise on a Bridgeport).Shortly therafter, Dr. Sachs moved on to teach back surgery at Tufts.,
2 other guys I know had similar surgery around that time, and spent their rehab time drinkin' beer and ridin' around - today they're junk.
When my wife-to-be first moved here with me, she got stuck with a lousy doctor with a bad attitude about obesity. She was diagnosed with arthritc hips by this Dr, and her pal the rheaumatoligist down the hall. She was told to lose weight - no way she could have surgery - given a prescription for Klonopin (the stuff makes you so stupid OZZY Osborne sued his doctor for putting him on it!) - and told to see a pain specialist. She being a smart lady,:loveya: :grouphug: she chose a young agressive PHYSIATRIST. This dude rocked!:yourock: 1st visit, he checked things out, and said he needed a bone scan:wtf: and wrote up the order for it (about 10 min. - I went with Michelle 'cuz). She had the scan, back we go. He told us both hips were junk with avascular necrosis. She said "But I've been told I can't have surgery" I'll never forget his words then "Don't even worry about it - we fix people bigger'n you all the time!" I expressed my opinion of her former docs - he kinda harrumphed, but she had a new PCP (the hip surgeon's wife) in about a week!
Get your Dad a new PCP NOW (and get his records!) - He should walk out of his inital visit with a physiatrist referral, prefrebaly with an MRI date all set up. If surgery is the option, be picky about the surgeon and the rehab team. You say Dad is active and outdoorsy - his first week of postop will be like getting out of jail! Do it soon, before the Huston humidity makes walking a chore!
Best of luck to you all - and if I can help talk Dad into this - contact me. If the HMO makes a fuss, make malpractice noises at them and let them know you have the records.:grr:

[crispini]

54. Actually, he's quite right about back surgery

http://www.mayoclinic.com/health/back-surgery/HQ00305

That said, there's no reason not to have the MRI.

But what OTHER treatments is he giving your dad to help?

[EmilyAnne]

57. NONE, as far as I can see. 800 mg ibuprofen. A prescription dose, but he could just as easily

take 4 over-the-counter advil, it seems.
And he is still in major pain.

No suggestion that he go to a physical therapist.
He had a horrible back brace about 15 years ago that looked like a torture-girdle.
And that is all, as far as I know.

In fairness, I think my dad has been going along with his doctor because he really doesn't want to even consider surgery.
Its only in the last week that he has decided to ask for the MRI.

Thanks for that link!

[crispini]

58. Well, poop. There are all kinds of other things you can do for back pain.

PT
Acupuncture.
heat and cold therapy
decompression
yoga and other stretches

Get out the google and go for it... back pain is a bugger, but there are non-invasive techniques that can help.

[Mopar151]

67. And if you look at my earlier post - It takes a village....

You need to take a "systems approach" to the whole thing. I have a short leg, and I'm 6'7, so a realtively small percentage of leg length adds up to an inch - a wedge lift inside my shoe helped my back issues then, and got rid of ankle pain that had plauged me since childhood.
Strong anti-inflammatories can really help, too - on the 3-4 years I was on Feldene (IIRC), I had a markedly improved quality of life. Subsequent wear, tear, and injuries led to the surgery.
And stretching/yoga should be taught to every child in school - a far better use of gym class than dodgeball!

[DeepBlueC]

61. An MRI can goive misleading results

http://www.spine-health.com/conditions/herniated-disc/pinched-nerve-versus-disc-pain-and-proper-treatment

I concur with most of the people her who say that his PCP is absolutely right about back surgery.

Look for books by back specialist Hamilton Hall. Your father is more likely to get relief from exercise and strengthening than surgery. The weight gain does not help either.

[H2O Man]

62. I had extensive back surgery.

I was in a serious auto accident; a fellow chatting on a cell phone didn't notice two stop signs and a red light. He T-boned me at 55 mph, knocking my vehicle into a third one. No fun at all. It did a lot of damage to my lower back, and some damage to other parts of me.

The human spine is not built for walking up-right for a lifetime. Just everyday life puts some wear-and-tear on it. Hence, if one has an injury, it will deteriorate over time at a faster rate than for others.

There have been improvements in a couple of types of back surgery. However, none are "100%" successful, no matter what anyone says. In fact, even with the two most advanced types, it is important to understand what "success" means -- because only about 20% of people have actual improvement. "Success" means that the surgery stops or significantly reduces the rate that one's back deteriorates.

If, for example, we think of the "cage" as replacing a couple of links on an old chain with new, strong links, one can understand that it will be a matter of time until the old links closest to the new ones wear out, actually at a quicker rate.

After lots of surgery and years of PT, I'm glad that I did. I have some okay days, and some terrible days. If I didn't have the work done, I don't think I'd have the okay days. But even at my best, I'm limited, and my life was absolutely changed by a guy on a cell phone.

Your father should request a second opinion. If he isn't satisfied, ask for a third opinion.

[ohheckyeah]

63. n/t

[moondust]

64. It's valid.

It often happens that if a patient has an established diagnosis and the treatment will be the same with or without the additional testing, the physician will not recommend the additional testing especially if it is an expensive exam like an MRI.

I have personally been through something very similar at a VA hospital. I have a chronically painful shoulder that has been injured a couple times in the past. They took x-rays and said they didn't find anything significant. The pain has persisted for years but they will not do an MRI unless it is agreed by all that I am on the path to shoulder surgery. I'm not interested in surgery and the "unremarkable" x-ray is probably more than enough to convince them that I don't need surgery. I'd just like to know exactly what is wrong with it and if it could be fixed with surgery or some other more focused treatment.

Get a second opinion if you want but be wary of anybody who seems eager to push him into surgery.

[riderinthestorm]

65. Get a second opinion. And keep an open mind.

Last year I had a friend who tore her rotator cuff. I was shocked to learn they were going to treat it with steroid injections, PT, and massage (she supplemented the physician prescribed therapies with chiropractic work and acupuncture). I thought that surgery was the only fix but she was assured that doctors were discovering that the surgery was less effective than these treatments.

Your dad has a lot of other options besides surgery. I'm pretty surprised they haven't been using some of these with him these past few years as they have become much more mainstream.

I would imagine however, that an MRI wouldn't be out of consideration at this point however, and it doesn't seem like an unreasonable request to get one as a baseline. Your dad's PCP would be the one initially seeing the MRI results so I'm not sure why the PCP thinks your dad would have no other input from anyone other than the specialist.

[RB TexLa]

66. I don't even have to read to know. The agenda of the physician is to remove money from your father

and or his insurance company.

[yy4me]

68. Sometimes we all endure pain thinking that it will eventually get

better or that if we complain we will be seen as hypochondriacs.Your dad has a right to see any physician on the list offered by your insurance company. There is no need to be stubborn or complacent in this matter. Get a second opinion. Better than that, get a new doctor. You need to confirm what is being told to you and find out other options.

I would be through the roof by now with my PCP if this happened to me. All it takes is a call to a physicians referral service or check your list to see who is near enough to see. Call to explain your situation and the fact that your Dad is in real pain and you need to find out what is going on.
Good luck.

PS Angie's List now does reviews of Physicians. http://www.angieslist.com/Angieslist/