neuro instead of ortho

[burton]

I am being treated for an annular tear in L5 S1 and sciatica and am seeing an orthopedist and now a pain management doctor. They are giving me epidural steroid shots first in L5 and now in the SI joint. Neither is working and are actually making things worse. They keep telling me the nerves are all inflammed and that is why everything hurts and is sending so much pain down my leg.
My question is- if this is a nerve issue- shouldn't I be seeing a neurologist and not an orthopedist?
Can I request to see a neurologist?
I am in Virginia.

[Bummer Knees]

Welcome to the forum Burton.

I understand what you are saying.

My question is have you had a recent MRI or discogram?

Is it the doctor doing the injections the one telling you there is an annular tear?

I've had 3 injections this summer, and sometimes they work and sometimes they don't. If the injections are making things worse then you need to let your treating work comp doctor know as something else may be going on.

I think it depends where you feel more secure, a neurosurgeon or an ortho, and last who will the insurance company approve as your treating doctor.

[burton]

The injury occured back in April and the MRI was done in the beginning of May. That is when the diagnosis of the annular tear was made by the ortho, who recommended the ESI's in L5 and thats where they did the first one. The pain management doctor agreed that there is a tear in L5 but she thought that they should do injections in the SI joint since the first injection in L5 didn't help. Since getting the SI injection the pain down my leg has increased.
Ortho has never treated the case with any sense of urgency since it is non-surgical and he is a surgeon.... but he is who I was referred to by insurance company panel of three. I am sure I can ask the insurance adjuster if I can see a neurologist... but I don't know if they will let me go see any new doctors.

[AQA]

You can always make a request.

In my case, I was seen by an an ortho and he referred me to a neuro. You may want to see what the next step with the ortho is first.

Has the annular tear been taken care of??????? If it is still leaking, the neuro can not do anything.

[Bad Boy Bad Boy]

Tears are nothin to mess around with. Loss of disk fluid means loss of disk height. That means major pain down the road (no more cushion left to take the "jars" of walking, etc.). You will have to change your life ways. Get out of the car properly, no "rough" sports, etc. Unless you can seal the tear, you are in for a sedentary life if you don't want your pain to get worse. I have heard of tears healing themselves, but in those cases the person really did take it easy--no work, no play, no zippo. nada nil nothing. It can be done, but with a LOT of sacrifice on your part (getting out of the life swing for a few months). Most of us simply cannot do that. The other option is non-invasive procedures which someone has already enumerated. Your case calls for the IDET, but gosh that is prolly the harshest of all the non-invasives because it burns your disk.

You do NOT want to do any inversion therapies or anything that will cause the disk to expand, this will cause (for lack of a better way to say it) air pockets that will allow the nucleus to herniate through the tear. You don't want that to happen in addition to the tear.

Something you need to watch for with tears. You will know the fluid is leaking out when you get "boiling water" feelings eminating from that area. It will cause the sciatic nerve to scream all the way down your leg. Well, some people say boiling water, I just called it "I'm on fire", or it feels like molten lava or I've even heard someone describe it as if acid was being poured. That's prolly the best description as the stuff inside our disks is caustic to our nerves--kinda like a poison or acid. But those are things you need to watch for, because if you get those feelings--you will know your disk is leaking....not a good sign.

Discuss everything with your doctors and therapists. Ask questions (even if you think you are stepping on their toes)--they should have no problems answering anything you ask. Good luck to you.

[burton]

followed up with pain management doc today.... told them epidural shots in L5 and SI joint weren't helping and that the pain was actually worse since the last shot. The pins and needles down my leg and in my foot are horrible. They want to get a new MRI and are referring me to...a Neurologist!! But now I have to wait and see if workers comp is going to authorize it In the mean time I have to go back to the ortho and get him to release me into the care of the pain management doctors...
They also prescribed me neurontin? And they are discussing whether or not I can work light duty while I wait to be evaluated by neuro.... I know I can't work, I don't know what there is to discuss..
So now I just have to keep my fingers crossed that workers comp allows me to go get the neuro consult and subsequent testing....

[Bad Boy Bad Boy]

Burton, if the Ortho doctor has been your main treating doctor, and then referred you to Pain Management, why would you need the Ortho to release you from their care? It was just a thought, that the Ortho be kept in the loop of all your treatment plans from any and all other referred doctor's.

Keep us up to date if you can. Thanks.