Good visit with PM doc

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BrentE1961
Regular Member


Date Joined Jan 2009
Total Posts : 47
   Posted 3/4/2009 11:08 AM (GMT -7)   
I saw my PM doc yesterday. I was kind of reluctant to discuss a certain event with him (description to follow), but reading on here that we should always be 100% honest reinforced my decision to do so and just let the chips fall where they may.

The issue was this: a little over a month ago I had an appointment with the physical therapist at the facility that my PM is associated with. I was in the middle of a flare-up, and had an epidural injection scheduled a few days later. Anyway, when I saw the PT, he "measured" my range of motion and saw that it had decreased from earlier visits. He acted like I had not been trying to do my exercises, and told me that if I had been doing them that I would have improved. I told him that I had in fact been doing what I could to the limit of my pain tolerance. He responded with more of the same, and insinuated that I didn't want to get better. Now I know they are supposed to challenge us, but this guy was out of line. I asked him what he wanted of me, and explained what it was like living with constant pain, the loss of things we experience, etc. He then asked me when my last MRI was. When I told him about a year, he said that I needed a new one. He told me that I needed to see a neurosurgeon because if "his" exercises didn't "remodel" my back, that only surgery would be appropriate. He said that if I continued to see my PM and get pain medicine and a few epidurals a year when I flare up, I would never get any better, I was wasting my time, etc. He then told me that he wouldn't see me as a PT patient - I was not, in his mind, a good "candidate" for PT (even though I had an order from my doc for a few more visits).

I was afraid to tell my doc, to be honest. I was afraid he would think that the PT was right, that I was a bad patient, noncompliant, a drug seeker, whatever.

Anyway, I told him everything, as accurately and completely truthful as I could be.

He reminded me that we had discussed my surgical options more than once, and that my only option covered by insurance was a multi-level fusion, which he said didn't have a good enough outcome rate to risk at this time, since I am still working and enjoy a decent, if not perfect, life. He told me to continue my exercises at home (which I am diligent about, BTW, along with using my PM-approved inversion table). He said if I need further PT, he will send me to someone else.

He then told me that the PT had been extremely inappropriate, and that he would take care of that "situation". He said that the PT should never have "diagnosed" me or told me to have surgery, and that refusing to treat me under his orders was "reprehensible".

It just felt good to be believed by a health professional when one of his own had treated me like a liar, a lazy patient, or a drug seeker. I have been seeing the same PM for years, and never ask for early refills, "lose" my prescriptions, etc. - never. To know that he can see that I deserve to be treated as a patient and not a criminal was very reassuring.
47 YO Male, chronic back pain. Herniated disc L5/S1 2003. Discectomy with partial laminectomy 2004. Now told I have Failed Back Syndrome with discogenic pain.


Pain level varies from disturbing to nearly intolerable.


straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 13473
   Posted 3/4/2009 11:42 AM (GMT -7)   
Brent,
 
How unfortunate you ended under the care of a physical therapist of that caliber. However, over the years I have seen many of them act that very way, diagnosing people and telling them the opposite of what the dr says, trying to intimidate the patient, oh the list goes on. I don't know why they do this, if they wantd to be drs they should have continued their education.
 
I am really glad you leveled with your dr and was up front with him. I am sure after being his patient for so long, he knows what kind of a person you are. You have been what mine called me a model patient. I sure hope he rips the therapist a new one,lol. He deserves it and I am sure he just lost some potential business too. Gets what he deserves.
 
My good friend recently had hip replacement done. His dr gave him home exercises to do when he was released from the hospital and he did them diligently. He was just great and walking right for the first time in years and out of horrible pain. The dr could not believe how bad his hip was till he went in, he said it looked like a piece of cauliflower. Anyway, 6 weeks post op he goes in and asks the dr if he needed to go to PT. The dr said are you hurting, he said no, he said well you are walking with a normal gait. He said I can send you therapy if you want them to pull, yank and twist on that hip and make you hurt like you did before surgery!!! He said continue your exercises I know you are doing them, you don't need any PT!!! So, you see its not always the answer.
 
Great post and hope you will keep letting us know how you are doing....Susie
 
 


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 3/4/2009 12:32 PM (GMT -7)   
Brent,
Like Susie and many others here, I've been through a ton of PT's in my life. Have a wonderful one now, but have been to some that have ended up hurting me even more. I'm very careful now about who I choose, and who I let touch me. That PT was technically practicing beyond the scope of his license. He's licensed to do PT, not diagnose whether you need surgery. I'm glad you're getting away from him.

There are good PT's out there, but sometimes you have to learn the hard way what to look for. Unfortunately, I don't think the doctors know much about guiding us in that arena.

Good for you for being honest and I hope that PT get at least a reprimand.

PaLady

BrentE1961
Regular Member


Date Joined Jan 2009
Total Posts : 47
   Posted 3/4/2009 1:04 PM (GMT -7)   
PaLady, Susie, thanks for the reply. I understand that there is a lot of prescription forgery, drug seekers, and all that. If I go to a pharmacy and see a pharmacist I don't know, I could even see why they may be questioning of prescriptions for narcotics - after all, they are the guardians of the warehouse of drugs they have, and they are supposed to sniff out the forged prescriptions and all that. However, they do sometimes take it too far. Once they have verified the prescription, they should quit acting suspicious. For a PT to act that way, well, I just don't get it. He has no role in preventing diversion or anything related. Does the guy actually believe that I would have had surgery, and then have a guy jab a big needle next to my spinal cord every so often just as a ruse to get drugs? Does he think I want to live a limited life? This PT in particular has struck me as arrogant when I have seen him in the past (we have never had a confrontation of any type, and even on this last visit I didn't get angry or anything, I just politely told him what I previously mentioned). I guess he is a frustrated wannabe physician or something. I don't really want the guy to get in a great deal of trouble or anything, but I do hope my PM doc tells him to stick to what he is supposed to do - follow the doctor's orders to give patients PT to the best of his ability, and let the physicians do the diagnosis and medical treatments. I mean really, who in the world would let a surgeon cut them open, do epidurals, etc. if they didn't really hurt? It makes no sense.
47 YO Male, chronic back pain. Herniated disc L5/S1 2003. Discectomy with partial laminectomy 2004. Now told I have Failed Back Syndrome with discogenic pain.


Pain level varies from disturbing to nearly intolerable.


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 3/4/2009 1:35 PM (GMT -7)   
Brent,
There's another piece to this we don't often think of, and it's especially true for PT. It's important we can relax when doing PT. What's the point of all that heat and stim and ultrasound, etc. Some of iti is to relax the muscles so they can be stretched. If we're tense, scared, angry, whatever that means we'll be "holding" our musculature, even if we don't realize it. When we hold back on emotions, they get held in the body. So it's actually counter to our own therapy and well being, especially in that instance. You want a PT you can trust and relax with.

PaLady

BrentE1961
Regular Member


Date Joined Jan 2009
Total Posts : 47
   Posted 3/4/2009 2:51 PM (GMT -7)   
PALady - excellent point. After the way the guy treated me, I was tense, and that surely isn't conducive to therapy. I didn't think of that, but it seems like a PT ought to.

This guy was too busy feeding his own ego by playing doctor to care about me, I am afraid.

What really is strange to me is to hear you and Susie mention that the "PT playing doctor" isn't all that uncommon. I would think that the physicians would be furious when they hear about stuff like this.
47 YO Male, chronic back pain. Herniated disc L5/S1 2003. Discectomy with partial laminectomy 2004. Now told I have Failed Back Syndrome with discogenic pain.


Pain level varies from disturbing to nearly intolerable.


PAlady
Veteran Member


Date Joined Nov 2007
Total Posts : 6795
   Posted 3/4/2009 6:22 PM (GMT -7)   
Brent,
I'm not sure - at least in my experience - that most PT's try to practice beyond the scope of their license. But I have experienced my share of lousy PT's over the years. The good ones, however, have helped me immensely and i'm a huge believer in what a good PT can teach and do, even if it doesn't cure all the pain.

PaLady

edt
Veteran Member


Date Joined Dec 2008
Total Posts : 773
   Posted 3/4/2009 7:12 PM (GMT -7)   
I totally agree with all thats been said!  Right after the fusion surgery, I had a PT that didn't push me if I said I was hurting she stuck me on a table with ice or heat.  Come to find out later that if she had done it right, I would probably have better ROM. 
Years later I found a wonderful PT, made a huge difference!
So glad you let your Dr. know!
Patti

skeye
Veteran Member


Date Joined Mar 2008
Total Posts : 2976
   Posted 3/4/2009 11:00 PM (GMT -7)   
Hi Brent,

I'm sure that there are some really excellent PT's out there, but most of the ones I have come across have had (major) God complexes.

One of them was even almost completely & directly responsible for one of my shoulder surgeries because she decided she knew more than my doc (one of the best shoulder surgeons in the country) & went against my doc's instructions at approximately only one week post op & did something with my shoulder that I was not allowed to do for at least six months, if not longer! I had been pain-free after surgery & from then on out was in excruciating pain & my shoulder became extremely loose. The pain decreased in intensity over the period of a year & a half, but never went away for several years, until after my second surgery. It turns out my ligaments had been pretty severely damaged. Some of it was from returning to the pool, but I believe that the majority of it was caused by that PT, as my ligaments were fine when they looked at them during the first surgery & I was not racing or practice at anywhere near the level that I was pre-op & the beginning of my severe subluxation problems can be traced back to that event. That was my first experience with PT & also when I lost all my trust of PT's. Unfortunately, I have found my distrust of PT's to be warranted; that was just one of my awful PT stories, I have many more.

I'm sorry you had to go through a bad PT experience as well. I'm glad your doc is taking care of the situation!

Skeye

Post Edited (skeye) : 3/4/2009 11:04:45 PM (GMT-7)


straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 13473
   Posted 3/5/2009 12:32 AM (GMT -7)   
Hey Brent, whether or not you were wanting to get this guy in trouble is really nothing to consider or think about. I think its a patients duty to report to a physician as you did when a therapist starts his/her own dx'ing. I have just seen this happen too many times. If a dr is not made aware of these sort of things, then he will continue to send patients to this person. He could very easily injure someone by trying to play dr. I also do not believe in the ones that have the motto no pain no gain, thats BS. We know about different types of pain from dealing with CP. The pain should be minimal not excruciating like so many will do from being too aggressive. The ones I have seen play doctor or as someone else said have the God syndrome are as arraogant as the day is long.
 
Susie


BrentE1961
Regular Member


Date Joined Jan 2009
Total Posts : 47
   Posted 3/5/2009 9:23 AM (GMT -7)   
Thanks everyone! I feel lucky to have found this group. It feels good to finally have some people to "talk" to that understand what I (and all of you) go through just as a part of our daily lives. The non-CP people out there just cannot comprehend what it is like to have pain at a very high level for days, weeks, months, years at a time, with little hope of ever being pain-free again. The best I hope for on a day-to-day basis is that I won't hurt too much that day as I get up in the AM. I still hold out long-term hope that maybe they will perfect an artificial disc that my insurance will cover, and that I will be more normal someday, but that isn't part of my daily life. I also feel blessed to have a good PM doc that listens. He doesn't hand out pain medicine like candy or anything, but he does address my flare-ups with compassion and prompt treatment (usually an epidural if enough time has passed - those work well for me most of the time). I also feel blessed to have insurance to pay for most of it.

One thing I forgot to mention - when we were discussing the surgical option that the PT had "prescribed", the PM told me that he would want me to try a neurostimulator before any fusion surgery was considered. I asked him about lead migration, and he claimed that he has a very low rate of that happening, and that his happened early in his experience with using them in his practice. He said the skill of the person doing the lead implant can make a huge difference in the incidence of lead migration as well as the percentage relief that a patient can achieve with the device. He said that he implants more of the devices than any other doc in So Cal, and that I could verify that with a manufacturer's rep if I wish. He claimed that some PM's in the area who are uncomfortable implanting the devices refer their patients to him for the procedure.

Does that sound realistic to anybody out there who has had an implanted neurostimulator?

Again, thank you to everyone. It feels good to talk about this stuff.
47 YO Male, chronic back pain. Herniated disc L5/S1 2003. Discectomy with partial laminectomy 2004. Now told I have Failed Back Syndrome with discogenic pain.


Pain level varies from disturbing to nearly intolerable.


straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 13473
   Posted 3/5/2009 8:55 PM (GMT -7)   
Brent your pain dr actually does the inplant? The question you asked him was very good, because there are some on here tht had problems with the leads migrating. So, yes it really does happen. So, I take it your dr is he a neurosurgeron or what? My pump dr is a neurosurgeon but she retired from surgery totally and decided to maintain pain pump patients only. Most of the pain drs here in Ft Worth have ref their pump patients to her after surgery. Which is great for us patients cause this dr knows her business on these pumps. Most of our pain drs were anesthesiologists before going into pain mgt. Thats just not enough education I don't think to handle a CP person. Thats why they are often so under treated in their pain lack of knowledge.....Susie


BrentE1961
Regular Member


Date Joined Jan 2009
Total Posts : 47
   Posted 3/6/2009 12:56 PM (GMT -7)   
straydog said...
Brent your pain dr actually does the inplant? The question you asked him was very good, because there are some on here tht had problems with the leads migrating. So, yes it really does happen. So, I take it your dr is he a neurosurgeron or what? My pump dr is a neurosurgeon but she retired from surgery totally and decided to maintain pain pump patients only. Most of the pain drs here in Ft Worth have ref their pump patients to her after surgery. Which is great for us patients cause this dr knows her business on these pumps. Most of our pain drs were anesthesiologists before going into pain mgt. Thats just not enough education I don't think to handle a CP person. Thats why they are often so under treated in their pain lack of knowledge.....Susie


Susie: Yes, the PM doc does the implant himself, unless the paddle leads are required. Those he turns over to a neuro, but he assists.
47 YO Male, chronic back pain. Herniated disc L5/S1 2003. Discectomy with partial laminectomy 2004. Now told I have Failed Back Syndrome with discogenic pain.


Pain level varies from disturbing to nearly intolerable.


straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 13473
   Posted 3/6/2009 7:39 PM (GMT -7)   
My former pain mgt dr was not a surgeon, he was an anesthesiologist before pain mgt. When I had my pain pump put in he was there, along with a surgeon he brought in and a lady from Medtronic that brought my pump.

Susie

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