waiting is the hardest part
May 22, 2014 4:55 AM   Subscribe

Is two weeks too long to wait to see a neurosurgeon for a vertebral fracture?

So while on vacation in Mexico last week on Thursday I had a low-speed scooter accident and landed flat on my ass, fracturing my L-2. I think it's a bit worse than a typical compression fracture, crushing about 40% on one side. My uncle is a radiologist and looked at my images while I was in Mexico to see if it seemed safe to travel; while he really eschews much of anything but interpreting images he thought that while I could probably travel (and did), I needed to see a neurosurgeon as soon as I was back and that they may want to do something rather than just leave it alone. I went to the ER the day I got back (Sunday), and they just gave me pain meds and referred me to a neuro place; however, the first opening with a PA is a week from tomorrow, which will be just over two weeks after the accident. I can't seem to swing getting in any earlier. I don't know if a radiologist at the ER or just the ER doctor looked at my films, I was kind of out of it and at this point I'd have to go back in person to talk to medical records to see who did look at them, and I don't know if it would have made a difference.
My question— as best as I can tell— is should I be really just fighting for any other way to see someone sooner? This is a small city and there aren't a lot of practices, if you search online pretty much all of them in the area are at this practice. I told them to let me know of any cancellations and I would drop whatever to get there.
Of course you are not my doctor, but is this a ridiculously long time to wait, or is it not that uncommon? It kind of freaks me out to be hanging around like this. I'm trying to go very easy in the meantime.
posted by Red Loop to Health & Fitness (10 answers total) 1 user marked this as a favorite
I got my hardware installed two days after my fall, and I spent those two days having surgery on my foot and under observation in the icu.

Vertebral fractures are classified as stable or unstable. Which is yours? At 40 percent compression, though - I'd be fighting to be seen or at least have an answer as to what they plan is (not just 'we're booked until then'). Do you have a brace?
posted by Dashy at 5:23 AM on May 22, 2014

Have you sent your film to the neuro place and asked them if they can ask the consulting doctor if it can wait? That would be my first step. Makes them accountable before the consultation.

If it can't wait they need to tell you so you can get an appointment elsewhere if they're that busy. I doubt they're too busy to slot in an urgent case. But it needs to be classified that way by the neuro doc if it is.
posted by taff at 5:56 AM on May 22, 2014

You say you're in a small town. I would consider calling practices in the big town near you. I also fell off a scooter (but broke my leg, in a pretty complicated way) and joined an online recovery group for people with the same kind of fracture I had. I can say, fairly broadly, that after a person's severity of injury and age, the biggest factor in how well they recovered was if they were in a small town, or big city. Big city hospitals and surgeons are better skilled, are more up to date on current practices and techniques.

Plus, you'll have more options, and hopefully more availability. After the consult, it could take a week or two to get on the surgery schedule, if you do need surgery. And if you're looking at 4 weeks post fracture? You'll have a fair amount of bone already setting, not to mention thats just an extra month of down time, before you even get the surgery.

Of course, you'll want to confirm that they are in-network for your insurance.

Oh, and I don't know if anyone has told you this yet, but opiate painkillers are pretty notoriously constipating. You'll probably be on the hard stuff for 4-6 weeks, and well. Lets just say, take a daily stool softener and drink lots of water.
posted by fontophilic at 6:07 AM on May 22, 2014

You're in Asheville? Can someone take you to Charlotte, Raleigh, or Durham? Do you have a primary care physician and if so can she or he help you to get an appointment sooner?
posted by mareli at 6:11 AM on May 22, 2014

They gave me a weird brace in Mexico for travel that the ER doctor here said to forget about. I assume it's somewhat stable because the insurance company felt after consulting that I should be able to travel, but I know it wasn't clear cut. I'm in Asheville, I could possibly get in to someone in a larger city, yeah. Charlotte is the closest. I don't really want to drive 3 hours but I could probably do it after traveling all the way back from Mexico.
I contacted them today to see if anyone can look at my films, but no one has called back yet (they never actually answer, just return messages). I just found out that a co-worker's landlord is one of the main PAs there, so he's asking her for me.
I saw my primary physician yesterday just to check out a few other ancillary problems but he couldn't help. My fingers are crossed for my co-worker's in, because yeah besides the fear of making it worse I worry about the bones setting funky.
posted by Red Loop at 8:25 AM on May 22, 2014

You should have a new CT and see if things are worse. I am surprised they did not do this in the ER and they relied on someone else's week old images.

You need a teaching hospital with associated spine clinic. I am unsure on recommendation for neurosurgeon for the lumbar spine - that seems awful far away from the brain for a neurosurgeon unless you fear nerve damage. I personally would worry about mobility.

I looked at the Carolina spine and surgery center (is this where you were referred?) and they don't list compression fracture as something they treat.

If I were you I would seriously consider going to the ER at UNC Chapel Hill, explain symptoms (especially if getting worse) and see if you can get immediate evaluation by orthopedic or neurosurgeon as necessary. They can give consult in the ER and they should do proper imaging.

Please go to a real hospital and get this treated.
posted by crazycanuck at 9:25 AM on May 22, 2014 [1 favorite]

Btw your guys in Asheville will just refer you to the city anyway if something is really wrong so might as well go now. They might admit you from the ER. with an unstable fracture, admission with inpatient phyio/occupational therapy before surgery is what you really want.
posted by crazycanuck at 9:29 AM on May 22, 2014

Seconding the crazy northern neighbor's advice - please go. Please update, too, as a fellow broken back you're in my thoughts, and I'm worried about you slipping through the cracks, medically speaking.
posted by Dashy at 3:32 PM on May 22, 2014

UNC Chapel Hill is a 4-hour drive, or I could go to Vanderbilt in Nashville where I have family. I heard back from my primary about the dizzyness and stomach pain I saw him for, it seems my liver enzymes are a little out of whack and my potassium is a little high. He thinks it's probably from being jarred, and if it doesn't improve soon to check again.
I talked with someone from Carolina Spine a few hours ago; she said that the Dr from there had consulted with the ER doctor when I was in the ER, but couldn't tell me if he had looked at the films or just talked about the brace (I heard her end of the conversation about the brace, and at that point anyway it was all they talked about), she said she would find out and call me back, but now it's after 5:30. I'll wait and see what they say, hopefully in the morning.

I will say my pain levels aren't terrible, and I don't seem to be having any nerve symptoms except the very occasional and slight tingles that are barely noticeable. I don't seem to be getting worse. It'll be exactly a week since the injury in an hour or so, so maybe that's good.
posted by Red Loop at 4:36 PM on May 22, 2014

OK Vanderbilt, but go to a real hospital.

You should be on IV fluids for the potassium until they ultrasound or CT your abdomen to assess the scope of damage from the blunt trauma. Probably would fix the dizziness. While you're in the imaging machine they can take a look-see at your spine and whatever else the Mexican doctors and the people without imaging missed.

Tingling is a bad sign. Dizziness, stomach pain, and bad Labs are bad signs. It is in your best interest to go to a hospital with good surgeons just in case.

Geez I can't believe they let you out of the ER without fluids!
posted by crazycanuck at 10:40 PM on May 22, 2014 [1 favorite]

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