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My PCP won't refer me for specialist or authorize MRI
First I had surgery for severe nerve compression in 2021 at L4-L5.
I've been suffering from neck and shoulder pain for the last ten years or so. I've had 2 cervical epidurals and 2 facet RFAs by pain management without much relief. I was told they couldn't do anything else and might be muscle related. I've been getting botox injections in my neck without much relief.
My latest setback was about 2 weeks ago when my lower back and legs started to hurt very badly and I couldn't walk so I went to the ER. They did a CT and gave pain meds and a walker. I also had neck and shoulder pain that increased this day. I also had numbness and tingling in my feet, arm and hand.
My impression for the CT is below...
IMPRESSION:
1. BULGING DISC WITH DISC PROTRUSION AT L2-L3, MODERATELY
COMPRESSING THE THECAL SAC
2. BULGING DISC AT L4-L5, MILDLY COMPRESSING THE THECAL SAC AND
CAUSING BILATERAL SUBARTICULAR RECESS STENOSIS
3. MILD BULGING DISC AT L5-S1
My last cervical MRI was done in 2022 and these are the impressions below...
C1-C2: Normally aligned, without stenosis.
C2-C3: Partial disc desiccation, without loss of disc height, disc
herniation or spinal stenosis.
C3-C4: Partial disc desiccation, mild diffuse disc space narrowing,
and small left uncovertebral spur contributing to mild left neural
foraminal encroachment. No sign of residual posterior disc bulge.
C4-C5: Partial disc desiccation, mild diffuse disc space narrowing
and small left uncovertebral spur contributing to mild left neural
foraminal encroachment. Previously seen small central disc protrusion
is no longer seen.
C5-C6: Partial disc desiccation with interval mild diffuse disc space
narrowing and small interval central posterior disc protrusion
partially effacing the ventral subarachnoid space, without cord
compression or significant neural foraminal stenosis.
C6-C7: Partial disc desiccation with mild disc space narrowing
interval small central posterior disc protrusion partially effacing
the ventral subarachnoid space, without cord compression or neural
foraminal encroachment.
C7-T1: Partial disc desiccation, without significant loss of disc
height, disc herniation or spinal stenosis.
I was given a steroid dose pack which has helped but I'm still in pain and doing anything just makes the pain flare up. I was given a catheter by my PCP because it was extremely difficult to pee but that passed a day later thankfully.
So I currently have moderate pain in my neck, shoulders, lower back and mild pain in my legs. I have off and on headaches with sudden aches that radiate from the lower back left of my head and ear and up, partial numbness in my right hand, sharp stabbing pain on the left side of my chest, sharp pain and tingling down my left arm, sharp and dull pains off and on in my lower back and legs and tingling in my right foot.
Even with all this she won't prescribe pain meds, she won't order further testing (MRI or newer cervical MRI) or refer me to a pain doctor or to a spine surgeon (as the ER doc strongly urged). She says if I have a flareup I can see her to get a toradol injection or get it at an urgent care center if her office is closed or go to the ER if it's severe enough.
I'm at my wits end and don't know what I can do about this. I can change PCP docs but it won't go into effect until May 1st because I have to see her in early April to get my last authorization for another treatment which is very expensive.
Sorry for being so long on this post and am hoping for any advice.
Thanks!
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In reply to @johnnyspine I am sorry for your pain and difficulty you are having presently. I had to learn to be a strong advocate for myself as a result of the changes we face today in the medical system, and while it took a long time, it has helped me to receive nearly all of the labs, drugs and procedures that I need and ask for of my PCP. It is a process.
I had a full back MRI several months ago and the results are somewhat similar to yours. I am not a medical professional, but my former job allowed me to have more than a layman's knowledge of spinal injuries, head trauma, etc.
I recently confessed to my doctor that I am having increased low back pain accompanied by weakness in my legs, so he has ordered another lumbar MRI for next week. I would encourage you to have a frank discussion with your PCP about how all of your symptoms are impacting your quality of life, and perhaps she will show some mercy and provide you with either meds or referrals to the appropriate specialists. Think: "the squeaky wheel gets the grease." It is not easy, but patient being their own advocate has become the norm in today's medical world. I was usually hesitant to ask my clinicians for what I needed, but have learned that we as patients now must be their own best advocate in terms of getting quality care. Can you call your insurance company and explain your dilemma; I have found this to be of great help, and recently received permission to go "out of network" for some of my specialty care. Don't be afraid. It does take practice.
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6 ReactionsHave you been tested for arthritis and evaluated for
autoimmune inflammatory causes for your pain.?
Does your insurance and financial status prevent you
from getting another opinion or self referrals?
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1 ReactionMay is right around the corner (time wise, not pain wise). You need to have your final appointment and change providers. This situation is unacceptable. This isn't patient care - you are a hostage. I'd report this.
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5 ReactionsAre you in managed care or Medicare Advantage.?Many issues with
prior authorization and network hospital access in the works.
@johnnyspine - Some good advice above. The two medical reports you included seem to indicate some degradation from the first to the second tests. That suggests your pain and increased symptoms need to be seriously considered as fairly swift degradation needs to be addressed. Sooner than later...
You describe some serious issues with walking and now you have some arm/leg/feet numbness which can be an indication of stenosis and/or spondy progression. I tolerated neck and back discomfort for decades. But when my legs started becoming numb multiple times a day - the docs sat up and took immediate notice. Those symptoms are nothing to ignore.
Does your insurance require a PCP referral? If yes and your PCP still refuses - consider other ways to get in front of a specialist - preferably a neurosurgeon or highly qualified physiatrist.
Please keep us informed as to what's happening. Thinking about you...
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3 ReactionsI know GPs don’t like to prescribe pain meds. In my state they are only allowed to prescribe a 10 day supply anyway. I was on opiates from my GP for chronic pain, when he referred all his patients to a pain clinic. That’s where I go now.
Why in earth wouldn’t your doctor refer you to one?!
I understand your insurance dilemma, but you need to find a new doctor!
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2 Reactionsmild osteoartritis in hips excellerated for age. ive been tested for nearly all autoimmune inflammation causes due to ibs and sibo. i went out of pocket to another gi doc who dxed me with sibo and gave xifaxan. my pcp refused to do anything else because the first gi doc said the biopsy didnt account for my symptoms. my pathology report listed sibo as an option in the differential and said it would need clinical correlation.
i'm very tight on money right now.
medicare advantage chronic special needs plan. every er visit costs me a $150 copay.
I'm trying to get her to let me see my prior neurosurgeon who is in network still.
Can you call your past neurosurgeon directly? Give it a shot!
You have some good advice from others who know the system.
Charge on!
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