"You don't need to see a surgeon, you're just depressed!"

[mmglobal]

I can't tell you how many of my clients have told me that this is what they are hearing from their doctors. This is even true for many patients who have such profound pathology that you can see in on their imaging from across the room... or on people with multiple surgeries and a ton of hardware in their spines.

Men get it too, but I think it's more common for women: When I first discovered the online patient community and read about these problem, I first thought that the patients were somehow defective... how is it possible that they can't communicate effectively with their doctors? I find it so easy. Then, my pain management doctor called me and said, "I can't help you anymore. You are way too mobile to be experiencing the kind of pain you are reporting. You need to see a psychiatrist, not a pain management doctor."

I had been complaining of advancing S1 radiculopathy for months and my imaging did not support my complaints. (2 months later, my left foot went numb and I had a 15mm protrusion at L5-S1.) He was a good guy who had been doing his best to help me. They have to make judgments based on very imperfect information and they will most certainly make mistakes. They will give heavy meds to those who shouldn't have them and they will withhold meds to those who should. They cannot be right all the time and are just doing the best they can. (The rotten SOB!)

I'm in Straubing, Germany now with a client who had surgery a couple of days ago. She was getting the "you are just depressed" crap from her doctors in spite of the obvious pathology. "It doesn't look bad enough to be causing the level of symptoms you are reporting." She had had a 2-level fusion years before and both the disc above and below were now suspect and verified to be pain generators by prior discography. (How doctors can see the data and still give the "you are just depressed" nonsense is beyond me!)

There were several things that were remarkable about her surgery. First, when the anterior ligament was exposed, it looked very inflamed. This is somewhat rare and I've only seen it 3 other times although I've seen well over 100 ADR surgeries. Many surgeons don't believe that anterior disc problems can be painful, but in the cases I've seen this, the surgeon has remarked that this is definitely a big pain generator. The ligament does not normally have vessels in it.. it's normally white and glistening.. not all pink and swollen. Later, when the surgeon did interoperative discography the contrast media IMMEDIATELY extravasated out the back of the disc into the canal area. I've seen this many times, but never so fast and complete. The posterior annulus and ligament were not intact. The epidurography provided by the contrast (that is why he uses interoperative discography) showed that the spinal cord was more profoundly deformed by the disc bulge than what appeared on the imaging.

It's nice to have findings like these during surgery because it gives more confidence that pain generators are being addressed. We don't know how good she'll get, but we expect her to be much better because the serious problems have been addressed. Once the ADR was in place, we could see from the remaining contrast that the depression in the spinal cord was gone as the disc space was restored and the decompression was complete.

Just a few hours after the surgery, the patient was saying.... "My elbows don't hurt like they used to! Left side pain is gone.. right side pain is still there, but substantially reduced." As the days wear on, we'll know more about early relief. We don't know how complete it will be. We don't know if she'll have the onset of additional symptoms. Only time will tell the results of the surgery and I've seen too much to encourage counting chickens before they hatch. However, based on what we've seen, we are very hopeful and we could not be happier with where she is so soon after her surgery.

This is such a far cry from "you are just depressed." I still don't understand how so many in the medical community can be so far off base.

Sorry for the long rant... all the best,

Mark

[mmglobal]

Note that the pathology described OFTEN cannot be seen on MRI or other imaging. The tests we have available are not definitive answers, they are only pieces of the puzzle and no test should be relied on exclusively to rule in or rule out a problem.

Mark

[dshobbies]

I know of someone who's pain was diagnosed as the problem. Supposedly nothing caused it, it was just pain she would have to learn to live with. I have to wonder where this doctor went to medical school?????

[sahuaro]

I think we could collect precious one-liners and publish them as a best-seller. How about, "You can live without being able to look at the ceiling?"

[fireyangel76]

I just have to say that I have been depressed ever since they suggested I was depressed! No No I really mean this! When as a response to my continued complaints of pain, was the suggestion that maybe I was depressed, I got very depressed, because I knew they were pretty much giving up on me!
I never told the medical professionals that....I am sure I would have been committed.....name and addresss withheld as I don't want people at my door with a straight jacket!

[dshobbies]

Betsy,

Too many of us can completely understand. This reminds me (men, turn away for a moment is you so choose). Yesteryear the medical community thought that a woman's menstrual cramps were 'in her head' and now they know otherwise. Can you imagine what would happen if the doctors of the world would acutally believe their patients for once? The pain level of the world would diminish as new causations were revealed and treated. The one pill fixes all mentality would be replaced with a fix the problem thought process. Researchers would finally get paid more than pharmaceutical companies.

Though your mind can indeed cause physical symptoms, from my observations it's more in your digestive arena or perhaps headaches. I suppose back pain may be induced by stress and of course there are those who will complain about anything but when your life and living envirnment are so negatively affected, it's time for the medical community to put aside their pride and say "I DON'T KNOW"! and refer you to someone who will go that extra mile.

As a previous victim I have learned to dismiss those doctors who don't care about me as a PERSON. Now I have to learn how to determine when that occurs. Betsy, life can be cruel. If you don't stand up for yourself, few others will. There are great doctors out there. Too bad there are also those who think diseases are more important than the people they inflict.

[Poncho]

It makes it just that more difficult to live with a spine condition looking "normal" on the outside, but feeling like you are stuck in a painful shell of a body. Then, trying to justify why you are having the symptoms you are having. This is just one good reason why we should never settle for just one opinion

[fuzzy]

I had a little bit of a painful setback the last few days and the emotional setback was almost as bad as the pain. My confidence went down the toilet.
I managed to town yesterday as a passenger painfully enjoying every bump in the road...
Of cause I do *not* look normal walking arround in town, no reason to even try.

Yes, I was offered antidepresants last year by my doctor, in leu of doing something about the pain. I refused.

Good news! Today I feel a little better.

[fireyangel76]

I am so glad we have this site. If not for all of you and hearing everyone's personal stories I would probably go crazy. So for today I came and read all your responses and I have a smile! That's all that counts..that you all understand what I mean.
I don't think pain of any type can be in someones head. You feel it or you don't. Maybe we all react differently to it but it is not in our head! I do think I carry stress in my spine which is what I think caused me to be prone to injury. I have always had tense back muscles when I was stressed.
I know there are some very fine Md's out there. Trying to find a good one in the managed care arena is difficult.
Take care all....
I glad you feel a bit better fuzzy...

[martyusa]

I've heard some of the same stories.....Yes you have a herniation and an annular tear, with DDD and radiculitis, but we don't see how it could be causing that much pain and problems.....blah blah blah. This MRI, that MRI and finally an EMG to verify I was not going out of my mind. These shots and those shots for pain management. All I wanted was to get it fixed. But procedure would not allow me to do so. This doctor referred me to that doctor who referred me to the other doctor until I found one you did not process me like a number and a medical guinea pig. Finally a Doctor who listened to me, my problems and situation and my goals. I wasn't worried about when I could go back to work. I wasn't worried about monetary situations. I wanted to get the problem resolved so I could have my quality of life back. Cars, houses and stuff can be replaced and I am young enough to recover from the fiscal mess. I just wanted it fixed, not masked.

I think the biggest problem is that the majority of patients to not realize that these doctors we go to are paid by us. So in essence they work for us and we have the authority to fire them and find another one. Not get get the answers you are looking for, but for one to listen and explain things. Not to say touch your toes, bend this way and that way and tell you you're fine. For the most part WE know our own bodies and we know when something is wrong, so listen to us.

However, my wife works for an internal medical/infectious decease Doctor and do I hear the stories about the kooks. So in their defense I can almost see a kind of prequalifying going on when certain medical findings do not support the symptoms. We just have to find the one that can see through this troubled medical system that we have and remember what it is they do. I think every doctor should read and reflect on that oath once at the beginning of every week. And then save the drinks for Friday night. That is if they're not on call.

[Cheryl]

After months of physical therapy, injections I went to yet another spine docotor Here's what he said:

"Sometimes life throws us curveballs, I can't play volleyball anymore and I've learned to live with that. You need to do the same. Here's the name of two mental health professionals" - Dr. in Charlotte

Yeah if I didn't need a mental health professional before him I sure did afterwards!

It sucks looking "normal" and feeling so bad.

[martyusa]

Originally Posted by Cheryl

After months of physical therapy, injections I went to yet another spine docotor Here's what he said:

"Sometimes life throws us curveballs, I can't play volleyball anymore and I've learned to live with that. You need to do the same. Here's the name of two mental health professionals" - Dr. in Charlotte

Yeah if I didn't need a mental health professional before him I sure did afterwards!

It sucks looking "normal" and feeling so bad.

Let me tell ya what you do with that curve ball. You crack that damn thing 450' dead center field with the bases loaded. That's what you do.



I had a very good client give me great advice one day, And yes he was a shrink. This was about 10 years ago.

He said ,"Marty, you're not your chipper energetic self today"?

I told him that I was having some problems at home and would probably be getting divorced.

He asked me if it could be saved?

I told him NO. And explained what happened.

He asked if I felt bad.

I said very much so.

He asks me if I like to feel that way.

I looked at him kind puzzled and said NO.

And he said, "THEN DON'T".

It took a couple of days for that to sink in and realized that I had made a choice to feel that way and I could make the same choice not to feel that way. Our brains are very powerful tools once we learn to control it and not let it control us.

Keep swinging for the fence, eventually you'll get a hold of it.

[Jim M2]

Or maybe: It sucks looking "normal" and being in pain so bad.

[mmglobal]

I can't tell you how many time's I've been approached by spine patients who've been told that "they just need to quit focusing on their back problem"... yada, yada, yada.... when you can look at their films from across the room and see huge structural problems that cause excruciating pain.

Marty... I appreciate the sentiment and there is no denying that how we deal with things may be a huge component of our problem. I don't know if you are suggesting that we have the power to not let our pain bother us... or if you are saying that we have the power to not let insensitive doctors bother us.

In any case.... the person who belongs to this xray, probably does not have the power to not let it make him feel bad.


Note, this picture comes from www.ChiroGeek.com. Douglas Gillard, DC is a
spine patient himself and graciously contributes extensive amounts of time
and energy. I've seen him post for many years on the Braintalk Spinal Disorders
forum and have watched ChiroGeek.com grow into one of the most useful patient
info sites on the internet. Thanks Doug!

[martyusa]

It's like the doctor that tells the patient he'll never walk again only for him to be driven and determined to walk. Although the pain is severe, he finds the right people who actually care about his situation and does not treat him like a number. Then he walks out 8 months later...

All I am saying is don't take for granted what the doctor tells us. Sure the pain is severe, I know that for certain. I have learned to modify my movement to make less severe. And with not doing anything for the past 6 month I am going insane. But, if I let it get the best of me, it will.

I guess my whole point is to never give up and don't let anyone take the drive from you. I'm sorry if that was construed in a different manner.

[fireyangel76]

My new take on the whole "it's in your head" notion.

First I know of very few if any people who like going to the Dr. It is a huge stress for me and not the least bit enjoyable. So if I or any one else continues to go to the Dr. with complaints of pain, limitation of activities, ect...it should be assumed it is a body telling you something. Pain is not normal. It is a warning sign that something is not right. You can ignor it, but then it just gets louder and stronger because your not hearing! Sometimes things are not so obvious on Mri's ect what is really causing the pain. But lets get real...pain that lasts for 3 months to years is probably not "muscle strain" which is what I usually got passed off as.

My new view is it is not what's in my head that is the problem Dr. It is "what is not in your head" that is the issue. Your failure to diagnos the problem and offer a real solution is the issue. So instead of me getting therapy, may I suggest some continuing education in to spine issues! I think that would help me a great deal.

My depression is greatly related by difficulty to finding Dr.s who, after doing tests, and are unable to find the problem, assume there is no problem. Why do they not assume that a problem exists and they are for whatever reason unable to identfy the defect? God forbid if you still have pain after they do surgery and think it should be fixed, then it's either in your head or Fibomyalgia....ahhhhhh that's a whole other way of saying "it's in your head" for some Dr.s!
I'm just getting far to worked up over this whole topic!
Really unless I am being paid to work there I just don't like Dr.'s that much to keep making appts. Infact most of my follow ups appts do nothing for me it just fills their little box of "standard of care".

[mmglobal]

Marty... no worries about your post... it's just a different take on a touchy subject. Nothing but healthy discussion... we can all be adult here. I agree with much of what you said... in some context. Depression is a huge part of the chronic pain syndrome and while, "just pick yourself up and move on" is possible at times... it's not always possible. As Betsy said... sometimes doctors fall into assuming that a huge part of our problem is our psych status and they may be right. However it may also be true that the underlying cause of all of it is the source of the pain.