Back Pain-how to Talk with the Doctor

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!

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.

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.

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.

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.

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!

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. :)

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!

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!

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.

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.

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!

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.

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.

Hi T.,
I'm sorry that you have to feel the pain that you are feeling and you did the same thing I would always do, figure out what it is first, you know what you're going through better than any dr, and for one to laugh in your face shows he or she isn't a good dr to go to, he's let his head get too big. My Dad had the same experience years ago and he wasn't liking not getting things figured out, with all that he was given to take and to do, nothing was getting better, so he switched doctors and the new one found that he had that condition you're worried about along with fibromyalgia, which is I think a hardening of the muscles, and that proved that he was really hurting and was needing to change things completely. By first having to retire, then I think with help, he was able to get a new bed, one of those ones that fill with air, and as far as I know insurance paid for it because his body was needing it so that he could function properly. Doctors aren't always right, if I would've listened to my neurologist just after having brain surgery, I wouldn't have my youngest little beam of sunshine because she advised that I have an abortion because there was a risk that even my life would've been lost with my brain being in the condition it was in, but I did just fine no problems. So I must say that if it seems like your dr's head is hitting the ceiling, or just isn't giving you an answer you want, then I would get a second opinion if I were you. Be strong and confident, those dr's don't know everything, they are just another person like you and I, not gods. I hope this helps.

No offense to any medical personnel, but I believe that most of back pain should be referred to a chiropractor. I have seen an MD several times for different types of back pain, neck pain and TMJ that was so bad I can't even tell you the thoughts that were running through my brain... I always get offered a muscle relaxer and some sort of prescription ibuprofen, which will mask the pain, but not cure it.

During my pregnancy (with twins) I saw my chiropractor every other week, which I think saved my back. When my TMJ got bad enough to want someone to actually punch me in the face so that my jaw would break and I would HAVE to get some sort of surgery, I found the most wonderful chiropractor who, after one session, made me feel 75% better. After the second session, I had no more pain.

I am a total advocate for chiropractors. I have been going to one since I was in HS in the late 80's.

I understand all to well about Dr and not listening to you. I have a husband with a rare disease that I diagnosed before the DR did. Well one thing led to another and he finally has the diagnoses of MELAS. Well we move back to WA and my hubby has one of his strokes and the Dr that comes into the hospital says "Are you sure that is what he has, I mean it is so rare. How did he get the diagnoses?" AUGH....... Later the Dr came back and said "I owe you an apology, I did not believe you."
Anyways I tell you this to say that you need to stick to your guns. Let the dr know that it would put your mind at ease if he would test for this.
I have gone so far as to print off pages from the internet to show the DR. The Dr hates this one, because they cannot argue with you then.
You do have a little more credibility when it comes to talking with DR than I do, you are and RN. I have had Dr's look at me and ask "so where did you get your medical degree?" I answer with "I know more about MELAS than most Dr's do, in fact before I walked in here today did you even know what MELAS was?" When ever we go to the ER or a new Dr I take in a 5 sheet hand out to give to the DR that talks about meds, history, and the disease and links on the web so that they can find out more.

Anyway good luck.

Have you been to a chiropractor? I'd really suggest starting there. I had a spondylolistheisis and was helped. Now I work in a chiropractic office and we see stuff like this all the time. Try to find one that will help you get better, not just put you on a maintenence plan for the rest of your life. Good luck!

I would say that no pain is normal. Pain is your body's way of talking to you. If you Dr. doesn't take you seriously then you should get a second opiion. I would suggest a chiropractor. There's a Dr. Hansen in Salem but I don't know where you are. I'm sure you could ask around for one in your area. Hope you get better soon.

Hi there: I am thinking that you may have a pinched
nerve. That's what I had and even though I went to
an MD, he couldn't do anything except prescribe drugs
which didn't cure, it only covered up the pain and could
have caused more damage. I went to a chiropractor and
he took care of the pain and I haven't had that pain
since. Your body is controlled by your back and needs
the attention it deserves to make you feel better.
Good Luck, E. A.

If you think that you have AS, then you probably have the other symptoms often associated with the disease.

My suggestion is: type out a list of ALL of your symptoms. Make two copies and keep one for your records, give the other to your doctor with your name, the date and contact numbers on it along with a copy of a reputable source explaining AS. Explain that as an RN, this is your concern. Computers don't need to be mentioned, even though the Internet is a fabulous source of factual information.

Ask for this personally typed information to be come part of your medical records.

After the exam and any tests are run, ask the office manager to have copies of everything to be sent to your home when results come in. Then keep your own file of symptoms and test results.

If you are not satisfied with the resulting diagnosis or treatment, get a second opinion and take along your file and any information about AS that you have copied from the Internet.

This is what assertive patients (clients) do and can do by law. You are paying for expert opinions, but as a professional, you are entitled to YOUR own expert opinion.

Your husband is demeaning whether he means to be or not. Disease and old age are NOT the same. One can be old and NOT have pain and visa versa.

Have you considered going to a chiropractor? After all, it is a back problem, not a systemic health problem. MD's have training to treat disease, as you well know, but can only treat the symptoms of a back problem, not fix it. Go to a chiropractor who will take X-rays and look at your MRI and explain in detail to you the cause of your pain and how he would treat you. (This is all usually done for free to get you in the door.) Then you can make an informed decision about whether to continue with the DC or go to an MD.

good morning,

First off do not drive yourself crazy and self diganosing. I have done that in the past and trying to get doctors to do what you want to do (test wise) and you get frustrated.

Second off, have you seeked chiropractic care? I found more relief with chiropractic care for my low back pain than I ever did with pain killers. Pain killers just mask the pain and do not get to the problem. Most chiropractors simply will take a certain set of xrays to diagnose and run some other tests. I personally use Dr. Jim Warner in Salem, Oregon. His number is ###-###-####. I know that he regliously takes "screening" xrays and comes up with a treatment plan that fits your condition. He teaches other chiropractors and has been a chiropractor for 30 years.

good luck in your path to perfect health.

C.

I'm a PT. There are so many causes of back pain. Is your pain present when lying in your bed only?? It could be your bed. Did you maybe twist wrong? It could be a facet dysfuction or a disc irritation. AS is a harsh diagnosis to give yourself for pain you've had for a few weeks.

You do need to find a good doctor. If you don't feel you have a good interaction with your doctor-it's time to move on. Ask friends-get suggestions from neighbors. Find someone you can trust in--that's important for healing.

In the meantime, if you want to talk more feel free to personally email me. I would be happy to try to help you. I'm in Spokane but I may be able to give you several suggestions until you can get into someone.

I think you need to approach your physicians with an open mind. Granted you are paying all the bills... but when you come to your doctor for his/her expertise and knowledge and won't let them run the tests, look at all the results, the symptoms without a preconceived diagnosis it makes it really hard to be objective. You're asking them to disprove what you believe is the diagnosis. You walk in the door telling them this is my ailment, I want you to fix it. It's like a patient walking in after seeing multiple commercials for a particular drug and telling the doctor these are my symptoms this is what I want, but the patient doesn't see entire problem, doesn't realize what all that 'miracle' drug will do to them. You can do yourself more harm by not letting your doctor view you from a fresh perspective, if you tell this is what I have, they may ignore other tests that could reveal another piece to your health, and point them in a different direction, the correct one. I wish you well. If you have read the information about this form of arthritis, then you know exercise is an important component to your care and treatment, I wish you well. This is a chronic disease, take care of yourself so you will be able to keep up with that little girl.

First off, I have back, hip, neck, wrist, etc... pain from some accidents. I found this unit that has helped me alot. lightrelief.com

When you go to the doctor, bring a list of all of your symptoms. First hear what he/she has to say about your condition. He/she may want to do x-rays which may or may not rule out ankylosing spondylitis. If your doctor does not suggest an x-ray, ask for one. If the x-ray shows evidence of ankylosing spondylitis and the doctor doesn't catch it, mention your concern by asking questions. Say, "As a nurse, I am familiar with ankylosing spondylitis, what do you think about that?" If the doctor does not agree, hear his/her explanation. You may change your mind if the doctor sounds right to you. If not, ask your doctor to get your chart notes and x-rays together, you need a second opinion. Use tact in dealing with the doctor. Don't try to tell him/her what is wrong with you, ask. This might make it easier for them to hear you and not feel challenged by your diagnosis.

It sounds like you really already know how to talk with the doctor. I think some doctors are more open to patients doing their own research, and hopefully you will have one who is (have you asked around for recommendations?). I would approach him with all due respect to the expert that he is, and the human that he is, knowing that he may or may not hear you with the respect you deserve. And if he doesn't satisfy you, I would ask for a second opinion. I'd also suggest, if he does come up with a diagnosis or no diagnosis, that you go to an alternative practitioner for the therapy part. It seems that, in general, the only things the regular MDs know how to do are drug and cut, and there are many many other and usually much better forms of therapy. Wishing you the best!

Hi,

I'm a RN too and know all about diagnosing yourself and others in the family. Luckily, my doctors and I can joke about it and they all know me fairly well. I've been right more than I've been wrong though.

I would actually go to a neurologist or neurosurgeon rather than an orthopedic doctor for back pain. I see an orthopedic as more for the legs - a neurologist looks more at the nerves and is more used to looking at MRI's from the spine. They are a little gentler in their practice I think given their background.

Good luck - back pain is so hard and depressing. It really affects everything in your life. I hope that you are wrong in your diagnosis and it is something that can be fixed easily.

C.

I feel your pain...seriously!! Don't discount your pain when you see the doctor.I have been in radiology (with expertise in x ray, mammography, CT & MRI) for 20 years. I have also had horrible back pain.
The tests you SHOULD have are basic L-Spine (5 views) in x ray.
THEN, after the Dr. looks at those x rays, you "should" have an "MRI Lspine without contrast". Do NOT go for a CT scan (because it is a LOT of ionizing radiation for a person at child bearing age), if THAT is what is suggested, UNLESS you have any sort of metal in your body (i.e. aneurysm clips in your brain, if you did any sort of metal work, metal might be in your eyes, any metal dental work etc...).
The ONLY reason to have a CT is IF you have metal in your body, and IF you end up having one, make sure your ovaries are covered, IF POSSIBLE.
AFTER the Radiologist (Dr. for x ray etc) reads the x rays and the MRI, they will forward their results to your doctor. The best person to see for a LOW BACK (or middle back) problem is a NEURO SURGEON. They have to deal with your bones, of course, but the back is also full of NERVES to be dealt with.
The Dr. may then send you for physical therapy. That may or may not work, depending on your injury. If P.T. HURTS so badly, after giving it a few weeks (of 3 times a week), then let the P.T. KNOW, and tell your Dr.
They may also send you back to radiology for a special kind of shot that goes either directly into your disc(s) or into the facet joints. The shot is a combination of cortisone, short and long acting "caines"(lidocaine & marcaine) and these SHOULD help your symptoms within 3 days.
IF they DON'T, again, let your Dr. know.
The best thing you can do at home is slow stretches for your lower back, and LOTS of ice to the affected area. It isn't very comfortable, but it does work.
Another test, that is NOT very well known, actually sees the "root cause" of any sort of nerve damage. I believe it is called a "Nerve ConductionTest"....but what the Dr. does, is takes a long needle, connected to a machine, and also connected to an energy source. He sticks it (the needle) into all areas of your foot,leg, and graduates up to your back--and as the needle goes in, he allows the enrgy source to "zap" you, and it records your nerve reaction. If the nerve is faulty in any way, they can tell if it is a new or old injury (which I needed to prove that it was a work injury). It hurts, a lot, but that is temporary. It DOES get to the bottom of ANY nerve damage.
SO, enough of the horror stories. If you need help or any other advice, please write and ask me. I am NOT a doctor, but I have worked in radiology (almost) forever, and had to go through the "back injury machine".
Hugs and good luck to you!!
Becca

Hi T.,

I'm sorry you're having back pain. I have 3(that I know of) herniated discs in my back, that were discovered on MRI after I bent down one day to pick up my 5 month old baby, and couldn't get back up. I'd been to doctors *just* for back pain twice before, and mentioned it in several non-related visits, and it took that one doctor to get me the MRI that found the problem.

Two of the discs touch the nerves and cause pain, as well as numbness, tingling, coldness, and a few other things, and from time to time, I can still have problems with my back locking up. The last time it happened, I went to a chiro, and she was awesome in helping me get past it. BUT, she wouldn't have been able to do the exact thing she did if I hadn't have been able to tell her what was wrong with me, as I had the diagnosis back in 1999 at an Army hospital.

I'm not a doctor, but the problem I anticipate w/self-diagnosis, is that one could look up symptoms for 50 different ailments, ranging from minor to fatal, and would probably think they had all 50 of them.

I know there are some not so good doctors out there, but there *are* good ones, and a good one *will* do whatever's necessary to get to the cause of your problem and help you. But I know they see it all the time, people coming in thinking they know exactly what's wrong with them because they looked it up online. Maybe these folks get it right sometimes, just by chance, but I bet that they get it wrong more. It has to be frustrating for docs knowing that people will close their minds and think that they(docs) are disregarding them because they wouldn't listen to what they thought was wrong with themselves, but, doctors have an obligation to try whatever they can to help us, and I bet sometimes self-diagnoses get in the way of effective treatment because some docs just aren't given a chance.

So, I suggest like the others said, go in with an open mind that your doctor knows what he/she is doing, and will get to the bottom of your problem. You could mention the disease you found online and ask the doc what they think, but I wouldn't set my mind on it if I were you. Self-diagnosis is a bit fool-hardy at least, because you don't have the expertise or diagnostic tools the doctors have to be able to accurately diagnose yourself, plus as I said, you might just be barking up the wrong tree. But, the doc might just go ahead and check it out, or be able to set your mind at ease about it by sharing more info about it that you can't find online.

Then, follow the course of treatment your doctor prescribes for you, and go online to check out *that* diagnosis, to make sure you're doing everything *you* can to aid in your own relief and recovery.

If the doctor you see on the 6th ridicules you or disregards any of your concerns or symptoms, then definately see someone else.

Best of luck to you, and I hope you feel better soon.

K. W

The first thing you can do is go in there with as much information as you can for your doctor. By being informed you are better helping him/her help you. That said I had similar problems when my son was just a few months old. It turned out after 2 trips to the E.R. within a few weeks of eachother that I had to have my gallbladder taken out. It started with lower back pain but became so bad I couldn't stand up or sit down. I couldn't take care of my son. Hopefully it's not the same for you. Goodluck