L1/L2 hern., FCE sent me to ER, Treating doc closes file

Post questions and answers, and discuss issues relating to workers' compensation and healthcare in general.

Moderator: Webmaster

L1/L2 hern., FCE sent me to ER, Treating doc closes file

Postby Northlodestar » April 14th, 2008, 9:05 am

Hello all -

Injured since 09/07, with an L1/L2 herniation ("up and behind L1, with extrusion into thecal sac"). Radiating pain in right groin area, intermittent right anterior thigh numbness and pain, pins and needles bilateral feet. Cannot tolerate sitting, standing, walking for any length of time, as the pain builds to quite severe.

My treating physician never believed a herniation existed, despite an initial MRI/radiologist saying so, apparently because of lack of radiating sciatica right side. She treated for facet syndrome at L5/S1, and gave steroidal injections (not epidural, as I only recently found out) at L5 (round 1, then, when I reported no relief, gave two more at L1 - but not epidural, only for her theory of facet syndrome).

Insurance company ordered IME. IME doctor concludes not only does the initial MRI show a clear herniation at L1/L2, but the lack of whole-leg radiopathy, and presence of right groin pain, is completely consistent with L1 herniation. Further, L1-S1 showing degeneration throughout. He concludes IME with:

Comments in his record that he did not have radiating pain would certainly be correct if his symptoms were in the lower lumbar area...but an L1/L2 herniation can elicit pain in the right side gluteal area (this examinee's symptom) radiating from a right L1/L2 herniation...."

My doctor ordered FCE two weeks ago, apparently as she sniffed bad faith on my part (FCE states reasons requested by treating physician include, among other things, to see if (I) was giving full effort, and whether my subjective reports of pain square with objective findings).

Got 20 minutes into FCE, extremely minimal testing - began with grip testing, ROM, a kind of standing game of checkers. During "checkers" the pain grew so intense that I had to lay down several times. Shortly after the last of three rounds of 2-minute "checkers," examining PT noted diaphoresis and took my BP - 170/110, with extreme vertigo setting in. They called my treater, who ordered me to the ER.

FCE report concludes I gave complete effort, showed do across all tests performed, and my subjective reports of pain and disability are both "completely consistent and reliable," given objective FCE findings.

Being told by the nurse case manager of the IME's findings and recommendations for surgery, my doc ordered a second MRI last week, out of her disbelief in the IME's conclusions. Said the MRI shows L1/S1 as "completely normal spine."

Prior to her ordering of 2nd MRI, doc said "we were at a crossroads - you will have to decide between surgery and pain management, as no more PT, no more injections."

Last Friday, post 2nd MRI visit, doc closes file. I explained I am as bad a shape as I have ever been, and asked how I can be having this pain if nothing was there; but she said nothing presents as objective evidence as to why. I remain puzzled as to why she hasn't ordered pain management, at the very least.

I brought up the FCE; she dismissed it as invalid as I "didn't complete the exam" (because I went to the ER on her order!); and further, that "some people just have a low pain tolerance."

I mentioned the IME's conclusions again, and my treater basically called him a fraud - "people recommend unnecessary surgeries all the time." She put me back to work at a higher level than I even came in with - regular lifting at 50 lbs., when nothing in my file, anywhere, ever indicated a higher lift load than 20-30 pounds (my bet guess as to weight of cases of wine).

My counsel and I want to move to IME for treater. IME is apparently concerned about a conflict of interest; counsel is working adverse counsel for authorization. Adverse counsel himself said his client is the "most insane client" he's had, and from all I know, though he's doing his job, not only does he believe I'm on the level, but his client's obstructionist tactics (regularly delaying TTD, etc.) are utterly unwarranted, the worst behavior in his practice experience.

Anyone think of any options? Not only has TTD now stopped, but I am now without medical care; post-FCE, worse in some ways than I ever was, which really blows my mind, since we didn't get very far in the FCE, but the little stooping forward we did do sent me through the roof and it hasn't calmed down.
Posts: 2
Joined: April 14th, 2008, 8:28 am
Location: Illinois

Return to Main Injured Workers' Forum

Who is online

Users browsing this forum: No registered users and 1 guest