Back Pain-how to Talk with the Doctor

You did not mention if you have significant morning stiffness. if not it is unlikely your pain in AS. it is also more predominately a male disease but it can occur in women. Luckily the test to rule it in or out is inexpensive, HLA-B27 and an x-ray so it shouldn't be a challenge to get your doc to order them.

As a doc i will say it is hard when patients come in sure of their diagnosis. I feel like it is very important for both the doc and the patient to stay very open through the diagnosis process in order to truly understand whats going on.

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First off, there is no need to tell him where you got your information. Just let him do his job and assess the situation. When he starts talking diagnosis, then ask him to explain how he ruled out ankylosing spondylitis. You could even say, I know I am probably just being paranoid, but could it be ankylosing spondylitis?

What doctors don't like is patients coming in and trying to pretend that an hour on the internet makes them more knowledgable that med school and all the years of practice made him. Also, they get frustrated that the internet often has false information, and people assume that if they read it on the internet, then it must be true!

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I always go in with ideas, especially since you're a nurse you have more of an idea of what's going on. As long as you don't act like you know it all and are sure of your diagnosis it doesn't hurt to be informed!

After ruling out a medical condition, I'd seek out a chiropractor. Pain is the last symptom of a problem. Pain in your back often is the result of a misalignment, which can lead to nerve damage and many other ailments. Your spine is your lifeline and everyone should take care of theirs! Chiropractic helps with back pain but isn't just for pain, it's for overall wellness, look into it!

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First, let me say that I'm sorry you had the experience of a physician laughing at your concerns. It is certainly not an appropriate representation of the field, as I am sure you know being an RN. I hope you have an orthopedist who is more receptive to your concerns. With regards to your back pain, the chances of an adult with chronic back pain (>3 mo) has AS is less than 5%, so go into the appointment with an open mind to alternate explanations. This does not mean, however, that your concerns are not valid. After all, approx. 1 in 20 patients with chronic LBP have AS. As the wife of an orthopedist, and a physician myself, I can tell you if you go in a polite, non-confrontational manner and tell him/her you're concerns and desires to get AS ruled out up front, he/she should be more than willing to placate you, even if they don't think that it is the appropriate diagnosis. I do believe when a patient is fairly certain of a diagnosis, that it is therapeutic for them to have a negative exam, (even if the physician is certain it will come back negative) to put the patient's mind at ease. Most physicians get turned off when patients act like a couple hours on the internet supercedes their 10+ years of training and experience. But if you go in with an open-mind willing to listen and respects their opinions on your low back pain, I hope you will find they will listen and respect yours as well.

P.S. Don't be shy to speak up if you feel the physician is not taking your concerns as seriously as you would like. You really need to be your own advocate in this situation, and point-blank ask for what you want if you feel it isn't being given to you. Just politely say, "I understand what your saying to me, and I respect your opinion, but I am still really concerned about having AS and would really appreciate it if you could order a HLA-B27, CRP, and LS spine series (or MRI if you've already had a spine series) to rule this out". Your health is more valuable than worrying about offending a physician. :)

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I say stick to your guns. I had a Dr. laugh at me then 10 months later I spent 2 weeks in ICU and another 3 weeks in the hospital. With a 6 week old baby and a 15 month old at home I was not a happpy girl. You should stick to your gut reaction. Be forceful but also respectful. Nobody likes to be told how to do thier job. Have you tried a chiropractor?? Make sure it's a good one. They tend to treat problem and not medicate. Good luck!

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Dear T.,

Oh my gosh, there are so many wonderful pain therapsts that do acupucture and Chakras, etc. My daughter has been going to two different ones with amazing results. Each one has special things to offer. Stay away from the orthededic docs for a while and the medical way and go for a more wholistic way. You are right to do your own research on the internet.

Pardon my spelling - done in haste. M. S

PS........Don't be afraid to take aspirin but skip the others. My naturopath got a great anti-inflamatary for me called BCQ. She said don't take ibuprofen.

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You might consider seeing a naturopath instead of an MD. They are often more willing to look outside the box and hear what their patients think. If you're in the Seattle area, there are a lot of great naturopaths since we are the home of Bastyr. I see Tamara Cullen up by University Village and she has been terrific with diagnosis and spends a lot of time with the patient.

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I would think that simply mentioning to the doctor that you are wondering if it could be ____________ and would he refer you for some tests would go pretty far...especially since you are an RN and SHOULD know how to do some research. I know that didn't work too well for you before, but I would not let one experience get you down. That doctor should not have reacted that way. No doctor should EVER laugh in the face of a patient no matter who it is or why. I would also think that since this person is a specialist, that they may even come up with it on their own, or me more willing to listen to you and tell you exactly why they think it is or is not that partiular diagnosis. Good luck!

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I wouldn't go back to a doctor who doesn't take me seriously, and I'm a Musician, not an RN which means I know a lot less than you do.

Keep looking for a good doctor. I have gone to Dr. Degan in Lynnwood for my shoulder problems and he's really good. I'm in physical therapy - the thing I like about him is he takes you seriously, and he uses surgery as a LAST option.

I've had back problems in the past. Physical Therapy taught me how to sit, how to move and how to conduct myself so I've been fine every since EXCEPT when I lay in bed a lot (when I'm sick with the flu, for instance). Then my back flares up again. However, for me this is due to lack of abdominal strength. I'm learning to exercise more regularly between previous back therapy and shoulder therapy, I have learned that if I don't take care of myself thorugh exercise, my body will fall apart before I'm ready for it to, and I'm only 49!! I don't think I'm unique in this either.

Although I couldn't tell you the exact condition name, I can tell you that physical therapy is a LIFE SAVER! The Donaldson Clinic has turned out to be a Godsend. There are several in the area.

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Seems that a whole lot of us end up having back pain. I would expect that you would have back pain since you run an adult foster care home. and you carry around a toddler. Have you been doing exercises long term to strengthen your back muscles? If not I'd expect that the pain is caused by the muscles themselves.

I agree that you should let the dr do his exam and if he doesn't mention ankyosing spondilytis ask him why or how he ruled that out. When you start out giving him a diagnosis you have set up an adversarial relationship with the doctor. We need to enter all aspects of diagnosis with an open mind. Let him talk first. You are going to him for answers. You describe all of your symptoms and let him make a diagnosis. If you still feel certain, ask him about ankylosing spondylosis. This is a rare disease and I wouldn't think to diagnose myself for something so rare.

I have done research before going to the doctor so that I can better understand what he/she says and ask intelligent questions. And when I talk with the doctor I am aware, as I am with any new person, that their way of communicating may be different than mine. If I'm able I conform my words and attitude in the direction that I think will be most effective with this person. Some doctors are relaxed and able to listen to the patient for a longer period of time but others just want to get the job done in 15 minutes and they feel challenged if the patient tells them what the diagnosis should be. First, time is already challenging to the office and second, they have many years of study and experience to back up their diagnosis.

I select my doctor based on a number of factors but I think the most important one for me is their ability to appear relaxed and unhurried and have time to answer all my questions. I also present any concern of mine as a question.

When you do ask about ankylosing spondylitis show that you are aware that your symptoms could be from a variety of causes. Don't just focus on your "diagnosis." If you have an open mind the doctor is better able to maintain an open mind.

I hope that this appointment works out well for you. Back pain can be chronic. To prevent back pain means to be consistent in keeping your back muscles strong as well as using them correctly. This seems to be a part of the treatment for ankylosing sponylisis. I have difficulty do the work it takes to keep my back strong. When I get back pain physical therapy helps me the most because not only does the therapist do therapy but she teaches me better ways of taking care of my back.

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It's important to give as much respect as you hope to receive. I can tell you that there is nothing more irritating to my husband, a veterinarian, than know-it-all RNs who try to boss him around. MDs who bring their pets in are perfectly respectful and rarely bring up their profession (he knows only because it's in the chart). RNs tend to start off with a chip on the shoulder and "I'm a nurse and this is what I think blah blah blah".

Doctors can tell a lot by how much pain you appear to be in. If you don't even need to take aspirin or ibuprofen, that itself is an indicator of what may or may not be the problem.

I would find another doctor, and respectfully tell him/her all your symptoms, and that you wonder if you have a.s. (not that you've self diagnosed and are positive about it). If he/she doesn't think so, ask why and follow through. You'll likely be referred to a specialist. If you are offensive to them, then yes they may put up walls as a subconscious defense mechanism. They've spent well over a decade becoming what they are, and deserve a modicum of respect. I think the saying goes, you attract more flies with honey. It goes the same for any occupation. When one is rude to a server in a restaurant, one shouldn't be terribly surprised with ensuing poor service. That doesn't make it right, but is an explanation. Good luck, and be respectfully persistent.

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Just simply ask the doctor if he thinks that's what it is. Tell him you were reading about it and have a hunch that you fill all the symptoms and want to know for sure whether it is or not. I suffer from back pain as well and honestly it could be a billion things!

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You do need to be an informed patient. As to your doctor laughing and saying it's just aging I have the following story to share.

Mr. Thomsen, 80, was visiting his doctor. He told the doctor that his right leg was hurting. The doctor laughed and said, "Mr Thomsen, you need to remember it is an 80 year old leg!"

Mr Thomsen replied, "My left leg is also 80 years old and it DOESN'T hurt! So find out what is wrong with my right leg."

That being said, maybe you just need a new bed. Or maybe ergonomics at work or the computer has your muscles all tweaked. Take a look at those possibilities first.

I have found a lot of my aches and pains can be attributed to poor ergonomics.

R.

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Sorry this is so late but I wanted to give you a few ideas to do prior to your appointment. I work in a physician's office and you will get a lot farther if you come with all the information. Keep a pain diary: note times of day it is worse or better, location of the pain, if anything helped it go away, intensity of pain 1-10, if it is sharp or general pain, etc. Be very specific. The symptoms for AS could also be associated with many other diagnosis, keep an open mind when he/she is speaking with you about this.

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