We met with Dr. Ram Mudiyam on Tuesday. I knew he was going to be good because of our interaction with his office before the meeting. We were able to speak to knowledgeable and kind staff who were responsive followed through. I was able to incent them to order plain x-rays w/flexion-extension so we had the benefit of them at our first meeting. Even though he was clearly busy and squeezing us into an already packed schedule, Dr. Mudiyam took his time and we had a COMPLETE dialog with all of our questions answered... never with the 'one foot out the door' feeling.
Even though he feels that Diane stands a 50% chance of requiring surgery, he still recommends proceeding cautiously. Since Diane's symptoms are not severe and she does not have any of the 'red flag' neuro symptoms that would indicate immediate surgery... we will take his advice and proceed with ESI and see how things go. Unlike the GP, he recognizes that being an RN on a surgical floor is a high-risk job for someone in her situation and will keep her off work for a month.
As you can imagine... before her MRI was 24 hours old, I was already reviewing her films with many of the top spine surgeons in the world. All agreed that even though her films are very ugly and in most cases would generate a recommendation for surgery, her problem is so new and the absence of severe symptoms - waiting is the best option. It was great to get such unanimous alignment of so many medical opinions... probably the first time this has ever happened!
Diane did not want me to go outside normal channels to assist with getting the ESI. Normal channels took 2 days to get a nebulous, first eval appointment with needle jockey... not an appointment for ESI. Appointment was so far out that she would not have even gotten the ESI before her follow-up appointment to review the results of ESI. (I wish this crap didn't sound so familiar... it's amazing what we face as spine patients.) I was able to do my thing and she will now have the ESI tomorrow!
We'll keep you posted.
Mark
PS.... check out the large fragment behind L5.
