Good visit with PM doc

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.

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

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

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

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)

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.

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.