MRI/Spine finding, now what doctor do I talk to?

September 9, 2015 11:39 PM

I am so utterly confused over what to do with my most recent medical news. I had an MRI about a week and a half ago. The results came back to indicate I had a thoracic disc issue. I need to talk to someone about what this means and don't know who. The doctors and assistants are moving along to get me pain relief, but no one is actually telling me what I should expect with the findings and who I even talk to. I feel really lost in the system.

I'm normally a proactive patient, but I have to throw my hands up and say I'm out of my depth. For years now we've been trying to figure out what is causing my chronic and increasing pain. I was diagnosed with Fibromyalgia because the docs couldn't find anything else wrong.

Eventually the pain progressed to a significant and debilitating band of pain around my rib cage. It hurt so much and became the most limiting of all my pains. My pain management doctor sent me to the pain management clinic at the local hospital for and evaluation for a nerve block. I didn't see the doctor, just the Physicians Assistant. She ordered and an MRI, which they said they needed to do to see where they are injecting and to rule out problems coming from the spine. They were pretty sure nothing would show up.

A few days after the MRI, I get a call and telling me they found a small protrusion at my t7-8 disc, and because it has no where to go in that part of the spine, it goes in. And they're pretty sure that's what's causing the rib pain, so they can do an epidural which has a good chance of helping.

Yay! That one thing might get better. I had long abandoned hope of finding a cause to my pain symptoms. EXCEPT now there appears there might be for at least some of it. I only spoke to the physician;s assistant with the MRI results, and that conversation was more like "We found something, it's a small protrusion and it's probably causing your rib pain. And then we spoke about the specifics of the procedure, the risks, etc...

Here is the thing, I really feel like I need to talk to someone about the specific findings from the MRI and what it means for me. I got a copy of the report myself, and I want to know if this is at all related to my other "Fibromyalgia" symptoms. My diagnosis of fibro came from doctors being unable to diagnose my pain. They told me it was a diagnosis of exclusion, and I was missing key features of the old fibro diagnostic criteria. And now with this, I don't know if it's just a confounding factor or if this is the smoking gun I've known was out there.

I did some internet searching and a lot of my symptoms can be symptoms of thoracic spine problems. Some surprising like nausea and frequent urination, both of which I chalked up to just being generally fragile and the meds I'm on. One symptom that is apparently missed is weakness in the legs and fatigue, and that was a presenting symptom! I also have mild hyperreflexia in my knees - noted by a couple doctors and physical therapists, but more as an "huh, that's interesting." It's not bad, it's just a tad more than normal. But I see that can go hand and hand with thoracic disc issues.

I haven't spoken to the doctor who I was referred to for the injection, only her PA. The doctor will be doing the injection, but I don't know if I'll ever speak to hear. The referring doc looked at the MRI report, and didn't have much to say other than being happy that I might get some relief from the steroid injection. Admittedly, he just saw the report a few minutes after I did, and I didn't have a lot of questions to ask yet.

So do I:
- Go back to my pain doctor and ask him what it means?
- Try to get an appointment with the doctor who ordered the MRI and is doing the injections so she can talk to it about what symptoms I might have
- Talk to the Physician's Assistant again.
- Find a spine doctor to look at my MRI and discuss?
- Other?

posted by [insert clever name here] to Health & Fitness (7 answers total)

I'd say go back to your original pain doctor. At least in the UK, the injection would be done by an anaesthetist or radiologist so they more than likely would be able to answer your questions, but they're likely to be busy during the procedure and you already have a pre-existing relationship with your pain doctor (presumably they know all your symptoms already). You'll probably be seeing your pain doctor in a few weeks anyway to judge the success of the injection?
posted by tinkletown at 1:05 AM on September 10, 2015

Talk to an orthopedist who specializes in the spine.
posted by amro at 5:09 AM on September 10, 2015 [5 favorites]

I've had bilateral steroid injections into my SI joints. Not fun. Mine were CT-guided, although there are a variety of techniques. We knew it was a long shot to help with some debilitations, but at the time it made sense to try and it was fully covered under the Australian system.

I'd start with whichever doctor you're working with to manage your fibromyalgia. And by manage, I mean the primary prescribing doctor for your main medications and the one that's been following your history for the longest. If it's the pain management dude, ok. If it's your GP, ok. Rheumatologist? Ok. I wouldn't worry too much about talking to the doctor performing the procedure itself. In this context, they are a technician. I'm away from the US system, but I'd also advise that the Physician Assistant isn't the right person, no matter how well intended they might be.

Make sure the office knows you need enough time to review a potential procedure that's being recommended in the context of your current treatment plan. The important questions for me would be: Is the MRI finding compelling; What kind of relief might it provide and for how long; If it really helps, what next?

Good luck.
posted by michswiss at 5:15 AM on September 10, 2015 [1 favorite]

Wait until after the injection to schedule your follow up appointment. At your appointment, you can discuss with your doctor what symptoms the injection helped with. You can ask how often people with your condition generally need injections. Don't look for definite answers. Back pain symptoms vary from patient to patient. It will take time to learn the rules of your specific issue.

On a side note, when dealing with back pain, if you consult with a surgeon, they will recommend surgery and if you consult with a pain management doctor, they will recommend pain management. Ask if you are a candidate for physical therapy. And then ask again. And again. Until one of them says yes.
posted by myselfasme at 6:13 AM on September 10, 2015 [1 favorite]

this is just from general knowledge picked up from having ms: once the problem is "something is damaging your nerves" then you can get all kinds of symptoms (pain around the ribs is a classic). nerves are responsible for running your body, right? and the signals are getting "messed up". so "random" bad things happen.

so, in my experience, what doctors do, is try hunt for the cause. which is typically using MRI. and that is what they've done in your case. now they've found a cause, they have something to "fix" and so are going to be happy doctors on much more concrete ground. (oh, boy, the machine is broken, we can fix it..)

but the flip side of that is that really, your symptoms matter a lot more to you than to them. they can help you manage them (pain meds for example), but they don't find them that "interesting" because they're not that new: "well, that could be caused by what we see".

so what i'm saying really is you need to follow up on the clear, physical problem you have, and get that fixed. but don't be too phased if they don't seem to care much about all the other "weird" symptoms. they are more likely to care post op (assuming there's an op), if that should "fix" things and they're still there.

(not sure if this helps, i kind of read into your question that you're concerned about the symptoms...)
posted by andrewcooke at 7:14 AM on September 10, 2015 [2 favorites]

Neurological surgeon.
posted by Oyéah at 9:01 AM on September 10, 2015

Your pain management doctor isn't 1) a spine specialist and 2) is equipped to help you only with the symptoms, not the cause of the symptoms.

So you need to see someone who specializes in the spine. That could be an orthopedist (they are surgeons), a neurosurgeon (they are surgeons too), a physiatrist (they specialize in physical rehab and work with physical therapists), or someone else. You need help deciding which one, it sounds like.

If I were you, I'd call the Physician Assistant and ask who you should see. That person might want to see you him/herself, if that's the intake point at that practice. PAs are not just executive admins; they are clinicians themselves. Or they might refer you to a doctor in their group or in another group to talk about next steps, if any. You might be referred to PT or to be evaluated by a surgeon. But you need to start with someone who specializes in the spine.

I have spine problems. I would only see a pain specialist for these problems if a I had a chronic/untreatable condition and knew that managing the pain of my symptoms was my only hope.
posted by ImproviseOrDie at 10:33 AM on September 10, 2015 [2 favorites]