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Serious pain, a cancelled job interview, crappy doctor. Help.
October 30, 2013 4:22 PM   Subscribe

Posting for boyfriend. He's in serious pain and had to cancel a majorly major job interview. His doctor is useless right now. Boyfriend has a very high co-pay/co-insurance plan and is looking for an affordable way to get a diagnosis + treatment started ASAP...and perhaps some tips on salvaging the job prospect.

Part I. The Pain and Maddening Doctors.

About a 10 days ago my boyfriend hurt his back in a yoga class. It started in the lower right just above the hips, from the spine radiating outward. He figured it was a pulled muscle. After a few days most of his back was knotted up pretty badly. When he started having sharp pain with deep breaths he called his doctor again....who can't see him until next Wednesday. Not sure why he didn't give a referral to another doctor.

Yesterday his feet started getting numb and tingly. Called doctor again, still can't squeeze him in early. I'll worry about hexing the mofo later. Doctor said to go to the ER for x-rays and an MRI. At the ER, the doctor said they can't do any imaging if it's not a life threatening emergency. Huh? Is this what we can expect from other ER's or Urgent Care centers? ER sent him off with a prescription for Norco and some muscle relaxants. Why his primary care doctor can't/won't call in orders to an imaging facility/hospital is beyond me.

So. We need an affordable plan B as soon as possible. He was laid off from his job about 2 1/2 months ago and bought a meh high co-insurance, high-copay plan and is already on the hook for $500 + 20% for the ER visit that resulted in nothing more than the most expensive round of painkillers ever.

Any suggestions? We live in Portland Or. He's hesitant to go to a chiropractor, but is willing to give it a shot if we can find one who can give an accurate diagnosis. Massage therapy is an option, but we're concerned about further damage without knowing precisely what's going on.

Part II. Majorly Major Interviews, Damage Control.

He had a job interview scheduled this week and had to cancel when the feet numbness set in. It was a pretty big deal...senior level position, well regarded firm blah blah blah. They had put a lot of effort into coordinating several hours of meetings and interviews with their other senior mucks.

Is there anything he can do to try to salvage the job prospect? He's 50 and is really concerned that his age + this mess will be a huge red flag for the firm.

By the by, the sense of urgency here is A. excruciating pain and B. another majorly major, several hours long interview process Monday. He's going to do it...no matter what I say or how much I fret.

Thanks All.
posted by space_cookie to Health & Fitness (27 answers total) 1 user marked this as a favorite
 
Where I live, The Netherlands, we can call our GP on an emergency as well, without making an appointment. This can really happen any time, including Sundays, and is usually always stated on their websites or something. I'm sure you have some emergency GPs who can have a look.

If you didn't get referred, ask for it! Sounds painful!

About the second thing. These things happen. It's embarrassing and annoying for both parties, but people usually have some understanding. He should just give a call to the key person and insist on a second interview, along with an explanation (the yoga thing might be embarrassing, but I don't know what you boyfriend is like, it could be a silly story to tell also, I'd risk using it; these annoying things happen to me all the time too, and I tell them to clients. The annoyance usually becomes "charming".).

Good luck, you'll get through!
posted by ahtlast93 at 4:47 PM on October 30, 2013


Whatever on earth you do, please do not go to a chiropracter. There is *zero* scientific evidence of the value of chiropractic for acute back injuries (or really for about anything else, it's pretty much 95% quackery and 5% massage therapy). You will certainly not be insured for that if you aren't insured for the ER, and the chiro will, I predict, require a series of visits to "treat" whatever this is.

Unless you went to an incompetent ER, the fact that they ruled out doing imaging means they ruled out anything that is progressive. You can never be to sure and numb extremities is a bit concerning, but it sure sounds like an acute strain injury of some kind and pain killers, muscle relaxants, heat/ice, etc. is all they can do for you anyway. I have to believe that's what the ER docs told you and it didn't register because . . . .bad pain.




Not a doctor. Etc.
posted by spitbull at 4:47 PM on October 30, 2013 [8 favorites]


I am not a doctor, but it sounds like a pinched sciatic nerve to me. Commence googling for symptom matching. I had a similar issue in college after a fall and a combination of visits to a chiropractor and an acupuncturist worked for me. You might want to check out the National College of Naturopathic Medicine- in town, and should have walk-in hours. I've also heard that people can benefit greatly from a steroid injection for the quickest fix, but this would obviously involve seeing an MD/using your pricey insurance.

As for the interview process, honesty is your best policy. It's also a bit about spin. Something like, "I care about health and wellness, therefore yoga, but (self-deprecating jokeish) I'm also an unflexible dude and threw out my back". They don't need to know the whole story.

Don't bring up age, they can't speak to it in any way; HR red flag. So long as you keep it light, apologize a lot, and offer to come in again whenever it's convenient for the bigwigs I think it'll go well- (especially if he is extra-sweet to the actual EA who is likely coordinating all this- their opinion on whether or not he is genuine and apologetic will matter if this company is any good).

Best of luck!
posted by Lilbetty19 at 4:54 PM on October 30, 2013 [2 favorites]


1) Can you get in with another doctor sooner? Does it have to be THIS doctor?

OR: Can you call ahead to a walk-in and see if they can refer you to any sort of imaging?

Also, what explanation did the doctor's give that gave him pain pills/muscle relaxants?

I had a horribly painful neck muscle thing and it came down to muscles spasms and they gave me muscle relaxants and anti-inflammatories. And trust me it HURT! But the explanation was that "these things happen when your muscles tighten and spasm for various reasons, and if the muscle relaxants and anti-inflammatories don't do the trick we can try steroids." It went away within two weeks total.

So Im kind of on the side with spitbull that it may be something that you can't do much else other than what the prescribed. (I am also not a doctor.. etc.)

However if you feel there is something very wrong, then fight for a second opinion and imaging.

2) Get through the interview. Apologize for the cancelation but there was a last minute emergency. If it were me, right up front I would say "Sorry if I sit funny, I pulled my back out!" and move on.

He's going to be sitting in pain doing something if he's not at the interview right? At least this way he might get a job during that time.
posted by Crystalinne at 4:55 PM on October 30, 2013 [1 favorite]


While normally I would disagree with the predictable anti-chiropractor rhetoric, in this case there's no point in seeing a chiro if you're not already a patient, because just like an MD, a chiro won't treat you without intake, assessment, and probably at least xrays, MRI preferred. Don't put this on a massage therapist, this is a medical issue with nerve entrapment at least, and the kind of massage that can help is the kind of massage that can exacerbate the issue if not done under PT/MD/DC orders.

He needs to call his doc and insist on being seen that day, docs keep space on their schedules for emergencies like this.

And yes, if he's ambulatory he's unlikely to get a spinal xray at the ER.
posted by headnsouth at 4:59 PM on October 30, 2013 [1 favorite]


Ugh, this sucks. Can you try taking magnesium sulfate supplements and baths with Epsom salt while he waits? They helped me tremendously with my sciatic nerve pain. Massage with a tennis ball also helped.
posted by snickerdoodle at 5:04 PM on October 30, 2013


Ask your friends for a rec to a good orthopedist. You can even post on Facebook and someone you know is bound to have one. Or go to one at whatever is the major medical center/hospital in Portland. Personally I would not waste time or money on something alternative for major back pain as it sounds like some of the worst pain there is. Just look on health grades or google "best orthopedist Portland" and make an appointment stat.
posted by wildflower at 5:05 PM on October 30, 2013


OHSU looks to be a good fit. Or google 'pain clinic Portland', and research via yelp/google/friends to find out which private clinic is most recommended. Lots of pain clinics are spine problem specialists. Besides the awfulness of acute back pain, it stinks about the timing of this for his deductible!
posted by txtwinkletoes at 5:06 PM on October 30, 2013


IANAD, but I'll second that it sounds like a sciatic nerve pinch. I'm getting over one now. It just sort of happened as I was getting up from my desk and got worse through the week (aggravated by a series of long driving trips I had to make). Didn't hurt when I stood or walked, but got stiff as hell if I sat for too long. Like Quasimodo, bent-over stiff. Jolty-feelings radiating down one leg from inside my, uh, right cheek. More on it here.

I've had decent luck with a chiropractor and back pain, but asked around for recommendations for the least-woo person I could find. Ended up picking someone recommended by a friend of ours who is a PT. The chiropractor, for what it's worth, was relatively inexpensive. X-rays and the initial assessment was ~$50, treatments have been ~$30 each since then. I'll probably top out at 6-8 visits max.

I switched to a standing desk, used a lumbar support when I drove and tried to be as kind as possible to my back while moving around. The chiropractor seemed to help, and the guy I'm seeing isn't interested in umpteen visits forever or trying to sell me vitamins I don't need.
posted by jquinby at 5:06 PM on October 30, 2013


Re: the job interview, I'd use phrases like "sports injury."
posted by salvia at 5:11 PM on October 30, 2013 [11 favorites]


In emergency situations where I needed to see an MD, I've used ZocDoc to find an immediate appointment. It lets you put in your insurance, location and what specialty you need and gives you a list of people with appointment times. It works in major metropolitan areas in the US.

This might be a way for him to see someone who will assess his problem. Good luck on getting this resolved and for his interview.
posted by sciencegeek at 5:20 PM on October 30, 2013


It does sound like sciatic pain. I had excellent luck with a physical therapist: they were able to assess me without expensive tests, just by doing hands-on examination. They were then able to relieve a large part of my pain almost instantly with a deep tissue massage. I entered the office limping and whimpering, and I left with no limp and just lingering stiffness. Went back several times, much better very quickly.
posted by clone boulevard at 5:32 PM on October 30, 2013


You need a family medicine clinic (family medicine is basically general practice), not the ER. ERs are for life-threatening emergencies, which is why this injury isn't getting what he needs - if you can survive with it for 10 days, the ER is the wrong place to go, and you might not even get much attention at Urgent Care (which is intended for emergent, unstable problems that aren't life-threatening.)
OHSU's Family Medicine Clinics at Richmond and Gabriel Parkare accepting new patients. The Richmond Clinic provides same-day clinic access. It will still cost money, but not nearly as much as the ER, and OHSU generally works with most major insurers.
posted by gingerest at 5:34 PM on October 30, 2013


gingerest, he's already seen a doctor, who can't get him in until wednesday. OHSU may be accepting new patients, but that's no guarantee that they have a new patient appointment inside of a week.
posted by KathrynT at 5:36 PM on October 30, 2013


Just my two cents.....I was in exactly the same situation (pain wise, dr wise, not job wise) desperate for relief, vehemently anti chiro but went as an absolute last resort and walked out of the office (after literally crawling in still in my PJ's I had worn for almost a week) cautious but completely pain free. It was an absolutely miracle if there ever was one. I had a severely knotted up lower back that was pinching a nerve...to be honest, I was in so much pain, I don't remember what all he said that was wrong. The point is, with a few adjustments, my pain did a complete 180. Honest. I'm in the US, I wasn't a previous patient, he took me right in , did only one x-ray (I fainted when he tried to get me to stand to do another) and I paid $40. He did make me wait on the table for a while after the adjustment and drink some juice (due to the fainting) and wanted me to go see my regular dr to check my blood sugar but I didn't since they couldn't get me in for the back pain, why could they get me in for fainting? Also, I often faint when in distress, so it didn't bother me as much as it did the chiro. So, don't write a chiro completely off. A good one can really help the right kind of injury. I wish you both the best...
posted by pearlybob at 5:53 PM on October 30, 2013 [4 favorites]


I went through something like this 18 months ago. Basically immobilizing sciatica. Severe pain, numbness and twitching muscles in both legs. In my case it was a combination of a small herniation and an arthritic L4/L5 (an old folks problem that may not apply). Unfortunately the solution (sorta, kinda, half-assedly) was a $25K surgery. And apparently the only way it can be properly diagnosed is with an MRI, not cheap in itself. I use a large regional clinic so there was little delay in seeing me quickly and directing me to the proper specialists. Wishing for good luck with him getting past this and back to good health...
posted by jim in austin at 6:11 PM on October 30, 2013


I broke my tailbone last year, and was in an excruciating amount of pain. I also could not get an appointment to see my orthopedic surgeon until a few days later. Fortunately, I live within walking distance of an urgent care facility. The doctor and staff had weak reviews on Yelp for being rude and poor bedside manner, but I was in so much pain, I didn't care. I called to confirm availability, walked over, and within 30 minutes had a prescription for vicodin. I was able to calm down and fall asleep, which helped immensely in my recovery. The urgent care facility was in my Blue Cross network, so the cost was not prohibitive, especially given the circumstances.
posted by invisible ink at 6:20 PM on October 30, 2013


If it were me in similar circumstances, I would just show up at my doctor's office first thing in the morning and asked to be fit in. Tell them you will wait, it is important.
posted by JohnnyGunn at 7:13 PM on October 30, 2013 [1 favorite]


KathrynT- yes, that's why I specified that Richmond provides same-day access. I think that it's even possible to get same-day access with Gabriel Park but they don't guarantee it on the website. Since OPBoyfriend already has opiates from the expensive and otherwise unhelpful ER visit, the problem is getting imaging and diagnosis.
posted by gingerest at 7:17 PM on October 30, 2013


Seconding JohnnyGunn.
posted by Dansaman at 9:58 PM on October 30, 2013


Zoc doc is good for finding another doc with immediate availability. Maybe even agree to see a resident supervised by a doc - that could get you in faster to see someone at least. I feel for you. The medical and insurance system can be just as frustrating as the pain and injury itself.
posted by mike_bling at 4:08 AM on October 31, 2013


Your regular doctor is probably not going to be able to help you very much, aside from giving pain medication and referring you to a specialist. If you want to skip that step, go to www.apta.org, go to "Find a PT," and find a physical therapist in your area that is an Orthopedic Certified Specialist (has the letters OCS after their name). Get an appointment with them. If you can't get in with them, get them on the phone and ask them what next steps should be.

Or go to an orthopedist. Ortho Portland is wonderful.

Sudden onset of leg numbness is a serious issue, and he should get seen by somebody who knows what they're talking about (I'm gonna open myself up to criticism here and say NOT a chiropractor) ASAP.
posted by jennyjenny at 7:20 AM on October 31, 2013


I'm going to go ahead and out myself here... I am a Doctor of Chiropractic, but I am not your Chiropractor and this is not chiropractic/medical advice.

I see patients with descriptions of pain and mechanisms of injury such as this regularly. A good chiropractor can do a history and exam and will be able to tell you if you need an MRI or not. Pain, numbness, and tingling into the legs can be the result of many causes, but the most common ones I see are disc injuries and sciatic irritation. If it is a disc injury an MRI should be performed. If the orthopedic and neurological tests do not indicate a disc injury then chiropractic manipulation may be beneficial (and save you a significant amount of money.)

To find a good chiropractor I recommend the American Chiropractic Association's Find a Doc website: American Chiropractic Association

In my experience, doctors who are members of their state or national associations are more likely to follow the standard of care and are more up-to-date on the latest research.

If you have any progressive neurological symptoms (urinary or fecal incontinence, foot drop...) then I would recommend you go back to the ER. The ER should be able to order an orthopedic consult. And that Orthopedist can order an MRI if warranted.

As to the comment that there is *zero* scientific evidence of the value of chiropractic care for acute back injuries... I'll just leave these links here:

National Institutes of Health

WebMD
posted by Broken Ankle at 7:38 AM on October 31, 2013 [2 favorites]


Seconding pearlybob -- I'm just about as non-woo as they get, but my chiro is my go-to guy for non-internal stuff, whether it's back, joint, muscle or otherwise. Ask around for a recommendation, and try a session -- it'll likely be faster and cost less than the other route, and it might just help.

There are good and bad chiropractors, as there are good and bad doctors, mechanics, etc., etc. Finding a good one was a frakking godsend for me, naysayers be damned.
posted by liquado at 8:01 AM on October 31, 2013


I have been to Pearl Health Ctr Chiropractic, which also has in-house MDs. I am a scientist have a very low threshold for 'quackery', and I didn't find anything 'woo woo' at all about the assessment, or treatment. I also was wary of pressure to purchase things, creating an 'addiction cycle' to 'getting adjusted'- but that didn't occur at all. Intake was thorough, treatment was gentle. I got a great physiological explanation, which was very consistent with the explanation/exercises from my physical therapist. I'd seen my regular doctor, had been going to a PT for 10 visits prior, and saw the chiropractor because I was exasperated with my slow progress. I made huge improvements after only 2 visits to the chiropractor, which allowed me to continue my home exercises and stretching and now I'm back to my normal exercise routine. I felt those leaps helped me save money and time, overall.

On a separate occasion, I was stuck in bed for 3 days with a lower back spasm (no numb/tingling however). I saw a Dr. who (I rejected heavier meds) prescribed alternating ice and heat at 15 min intervals, elevating my knees and lower legs with a pillow to maintain a neutral lower back position in bed, and 4 ibuprofen taken at 4-6 bour intervals (for 3 days only due to impact on liver). I also saw a chiropractor on that occasion, and walked out of the office with MUCH less pain than when I went in. In that instance, I saw the chiropractor 4 times total, with a marked improvement in pain after each visit, and I worked my way back into my own regimen. This is not medical advice- obvs, just my experience.
posted by iiniisfree at 8:12 AM on October 31, 2013 [1 favorite]


Thank you all so much...ya'll pretty much wrote the plan...He finally got in to see his doctor. He didn't seem to think there were enough symptoms present for sciatic nerve pinch to warrant an MRI, doc. gave him a prescription for oral steroids and refills for flexeril, hydrocodone. He's still in quite a lot of pain, but the levels are now tolerable. Hopefully this will get him through the Monday interview. If things don't improve or get worse over the next several days, he'll go to either OHSU or Portland Ortho.

Thanks again!

PS. Sports injury! Brilliant.
PPS. gingerest, thanks for the heads up about Richmond and Gabriel Park, I used to refer my OHP clients there all the time, but got so habituated to hearing about longish waits for appointments that I didn't think to check.
posted by space_cookie at 12:54 PM on November 1, 2013 [1 favorite]


I've written before about how I came across the Egoscue Method of physical therapy after 15 years of recurrent back pain (which every few years would get to the cane+back brace+opiate painkiller level) and haven't had an episode since. They have a clinic in Portland.
posted by Lexica at 7:33 PM on November 1, 2013


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