Just saw the physiatrist/pain management doc, and it was possibly one of the least helpful and most condescending doctors appointments I've had. My husband, who works in the medical field, accompanied me, and was kind of shocked by his 'bedside' manner. As in, I wasn't even all that surprised by it, although I was annoyed/sad/mad coming away, but my husband seemed astounded.
The doc had said to come back if six weeks of PT didn't help. I told him I was pretty much the same, though the diclofenac helped (I even told him I have tried taking it consistently/as often as possible, then going without, to test this). He looked at my pain diagram and said it looked exactly the same. But he ended up just reiterating that I have degenerating discs in my lower back (which I actually think is not what the MRI report said... it said "mildly bulging disc" -- not desiccated, not herniated, and only mildly bulging) which causes inflammation, that the NSAID helps with this, and that we need to strengthen the area to support it and improve flexibility. He said he could give me cortisone shots if I am uncomfortable enough, but I kind of want to hold out on that as long as I can. Other than that he didn't have anything to offer me. He asked if I was still doing PT, I said the PT said I had completed the course and that if I wasn't improved she thought there was probably either more going on or we were targeting the wrong areas. He said I should keep doing exercises at home. He asked if I had tried chiropractic -- I have told him previously and reiterated that I have been seeing a chiropractor regularly for two and a half going on three years. He said I should see them twice or up to three times a month. And maybe consider trying acupuncture.
My husband asked about a disc in the lower back causing pain in my upper back and ribs, and the doc (sounding very annoyed at the question) said that if one thing is off in the spine the muscles all over try to compensate. I understand that reasoning, but it still seems improbable that a lower back mild disc issue would cause upper back pain first, then rib pain, then low back pain. And all that my husband and I have been able to find has indicated that discs tend to cause only local inflammation, not widespread inflammation. So why would I have inflammatory pain in my upper back and ribs? And it really has never seemed muscular -- it aches on the spine itself, and when I press on that area it aches on the spine itself. I guess if the muscles are all tight they would pull on the spine and make that area unhappy? But my muscles have loosened up considerably in the area -- my chiro over the last year and my PT over the last two months have noticed marked improvement. And honestly, we need to strengthen the area and improve flexibility? Does he want a demonstration?
By the the time he asked if I had any more questions, I was mostly just ready to get out of there as quickly as possible. He did at least change the diclofenac formulation for me so I can take it twice a day instead of three times -- I like attempting to sleep longer than 8 hours when I can so I don't like having to wake up/stay up late for that. And if I'm going to continue the pain management route with or without an answer for what's going on, I'm leaning towards finding a different doctor for that. His tone and manner was awful, not necessarily what he said exactly. Maybe he was just having a bad day, but his manner previously hasn't exactly been great anyway.
So... I guess I'm on to a second opinion from a different rheumatologist in a different network. Hopefully they're at least less dismissive than I feel like I've gotten so far. The only ones who have felt helpful, even if they haven't had answers, have been my PCP and PT. Even if they don't know what's wrong having someone say "yeah, seems weird, let's see if we can figure it out" would be nice.
Last edited by Nicole_B; 06/05/17 09:49 PM.