Lower Back help needed

[Jason Hyatt]

I gotta say guys, I'm with the doc on this one. While I'm no osteopath or chiropractor, my 16 years as a paramedic and another 10 as a respiratory therapist have at least enabled me to spot bullshit when it comes to medicine. Everything I've read from him is consistent with the chronic-phase treatment I've seen in HUNDREDS (maybe thousands) of orthopedic patients (and in the treatment my own chiropractor uses for me.). The fact that he asked EXACTLY the right questions was my first clue. The history is an immensely important part of the diagnostic process; in some cases even more so than the physical exam. There is a reason medical students spend a ridiculous amount of time learning to take a history properly. Physical symptoms are often vague and/or applicable to a wide range of problems. The history narrows the differential considerably. He's limited by the inability to perform the physical exam and said as much. I can't diagnose lung disease from a history alone but I can narrow it WAAAAY down -- much more so than someone without the education and clinical experience I have. I can also dispel a lot of misinformation about your lung disease and its treatment just by listening and talking to you. That's all he did. He also offered to work with Andy to find a chiropractor who CAN perform a physical exam and who is also going to ask those same questions (for the same reasons).

My second clue to him being legit was the consideration of contraindications to treatment. Bullshitters rarely if ever acknowledge that their advice or treatment have limitations. Every therapy has indications, contraindications, methods/techniques, and treatment goals. You have to use the right method, for the right reason, to achieve the right outcome.

- He considered the indications for heat vs cold therapy (acute phase vs chronic-phase -- incidentally, the pain that comes on top of an existing injury that you get after training is called acute-on-chronic. The acute inflammation caused by AGGRAVATING the injury responds to ice and anti-inflammatories. The chronic condition does not. That has to do with the cellular process of disease and the way the body repairs damage.).
- He considered the contraindications to therapy (diabetes, clotting disorders, etc.).
- He described the method in detail (wet vs dry, time of application, etc).
- He considered the goal of treatment (optimize circulation to the area to relax muscle spasms and speed healing).
- And he considered the limitations of therapy by noting that he could not offer a more complete diagnosis without an exam but, again, offered to find someone near Andy who could.

Additionally, his plan of care did not stop at "slap a hot pack on there and stretch"; he offered to help Andy find a practitioner near him that can help him establish a more precise diagnosis and provide a long-term treatment plan and do so within his means. That's what the profession of medicine is SUPPOSED to be about! Sorry fellas, but the doc is right.

[Jason Hyatt]

Sidebar: Our obsession with imaging studies has caused two very serious problems in medicine:

1) The belief that imaging studies are definitive. This is a problem for both patients and students. Students fail to spend enough time thinking anatomically and developmentally when examining a patient because "we'll just get a CT." They don't spend enough time developing their history and exam skills because they use imaging as a crutch. Every surgeon I have worked with has lambasted more than one student or resident for missing a diagnosis because they relied too heavily on the imaging. You wanna know how to diagnose an abdomen? Read "Copes Early Diagnosis of the Acute Abdomen", not a compendium of CT scans. I learned that lesson years ago and have spent a LONG time developing my pulmonary assessment skills for that very reason. It's a problem for patients because they refuse to believe that a history and physical can be MORE helpful in diagnosis than $10,000 worth of imaging. Imaging is good. It is useful. But it is not the sole method of definitive diagnosis. Worse, it can cause a diagnosis to be missed when either the patient or young physician fail to trust the signs and symptoms and rely falsely on flawed imaging.

2) The expense. Because of the belief that imaging IS definitive, patients insist on it when it is neither necessary nor warranted. Fearful physicians order needless studies "to protect themselves in court" from patients who won't trust a diagnosis without a CT or MRI. Because patients don't understand the limitations of the technology but insist on it anyway and because docs aren't going to fight with you in the very limited amount of time they have, the tests get done. They don't come cheap either. In a fee-for-service system radiology is the hot field to be in right now. Sit down and read a few studies and collect THOUSANDS of dollars. Whose money is that? Everyone's. No one pays for a CT out-of-pocket unless they have enough money to not need it in the first place. Everyone who pays insurance premiums is paying for the glut of imaging studies we don't need to be doing. Imaging technology is the fastest-rising cause of the increase in the cost of health care. Meaning not only is it not getting cheaper to perform the studies, we're spending MORE, on MORE expensive technology, that we actually DON'T NEED IN THE FIRST PLACE!

As it pertains to this discussion, that means that no, you don't need an MRI of someone's back to diagnose the problem. What you need is a competent, conscientious practitioner who will spend the time asking the right questions to narrow the differential diagnosis, follow it with a precise and well-thought-out physical exam, and apply their full and complete understanding of the mechanisms of disease and injury to a treatment plan. That is the practice of medicine.

[AndyK5]

Thank you for your detailed post Jason. Now though the pain moved to about 5 inches above my right hip, right under my right kidney. You guys asked me if the pain was moving and I said no, but now it did. I thought I would just throw that out there.
Also for some weird reason ibuprofen makes things worse. I know it makes no sense but, Aleve reliefs about %90 of the pain where as generic ibuprofen ( both at 400mg's twice a day) increases the severity of the pain. Maybe it's not ibuprofen's fault that the pain is intensifying in that case, it is not doing shit.

[Joe Friday]

I wanna know Don Blankenship's plan of treatment... I bet it includes lots of fried chicken!

[DCdoctr]

Just to update you Andy, I contacted the Capstone yesterday early afternoon and they're compiling a list of Chiropractic Physicians in your area. Once that is completed then they'll email that list to me. I'll go through them and call each one until I find a doctor that is willing to help you out at a reasonable, discounted rate. If I don't hear from them by tomorrow then I will contact them and see if I can get them to speed things up.

Not to alarm you, but just logical advice while we wait for this list, if you ever feel like your condition raises to an alarming level don't try and be a hero. Go to the emergency room. By law they have to treat you, insurance or none. Yes they will charge you an arm and a leg, but your health and life is worth more than any debt. Common problems happen commonly and rare one's happen rarely, therefore this issue most likely, at present, is minor to moderate. I say this to cover all basis so you aren't unprepared for any possible issues, major or minor.

On a side note: Ibuprofen is known to be rough on the kidneys. How is your output of urine? Color? Difficulty? Pain? What is your water intake like compared to your output?

[AndyK5]

My condition is not severe enough to require a visit to the ER. It did not worsen, it just changed, like it is in a different area with a different type of pain. I am not taking ibuprofen anymore, only 400mg Aleve per day. Urine output is good, clear free of smell. I drink lots of fluids by habit anyways. I am trying to compile some of the information in this thread and I think years of bending improperly over a desk ( a mandatory task for physics students) and sleeping on an improper bed that consists of 1 hard 1 soft layer of foam, did the ground work for this. Since my back was weakened ( hence the small amount of pain in lower back here and there), it got exposed during rolling. That is the only reasonable self-diagnosis i can make. When I was younger, my mom bought an orthopedic mattress for me. It's actually very hard compared to what I lay every night now. Last time I visited home, I slept on that mattress and woke up like a champion. Screw the memory foam, water, air and pillow top. First chance I get, I am buying another orthopedic mattress.