Well, this was my not fun year June 2015-April 2016 I never want to do again! You don’t really want to read this. It’s for my own edification. As the saying goes…getting old is a bitch! I never thought this until this year.
Had been having back pain for several years. Had 2 bad falls in the last 3 years when the back really started hurting and couldn’t walk a block without stopping to rest my back. Began to have neuropathy in the lower legs, ankles and tops of my feet. Bought a gel top bed which helped.
Las Vegas Spinal Center
Had an MRI and epidural injections at the Las Vegas Spinal Clinic June 2015 while visiting my son there. Spinal surgeon prescribed Gabapentin and Hydrocodone. Didn’t like either so I took Tramadol my primary had prescribed for me in the past.
A therapist did a session of deep work on my lower back muscles and hips which was painful but which helped. She gave me stretches and core strengthening exercises but then started traveling to Asia so didn’t do them regularly.
Bangkok Bumrungrad Hospital Spinal Clinic
Then in December 2015, on a hard bed in Thailand, I woke up with the most excruciating sciatica! Neuropathy became much worse.
Piled myself into a taxi to Bumrungrad Hospital in Bangkok and had another MRI. Got epidural injections the very next day.
The chief of the spinal clinic recommended surgery, specifically Oblique Lumbar Interbody Fusion (OLIF) and O-arm 2D/3D imaging. He prescribed Lyrica and said I should try to find someone in Oregon who could do OLIF.
Took massive doses of Lyrica and Tramadol which turned me into a zombie which doesn’t give quality of life any better than pain. But they took the edge off and I was desperate.
Therapist at Bumrungrad said said my pain was not commensurate with what the MRI showed. That the pain was probably my back but also related to muscles impinging on nerves. Which is what the physical therapist in Las Vegas said. So she did Target Point Release with needles into the muscles in my hip and lower right back. I thought I was stepping on a live electric wire!
She said I was to do stretching and strengthening exercises…in other words do all the conservative things for a few months and then reevaluate for surgery…which my anesthesiologist son in Nevada was saying also. She gave me sheets of paper with exercises. I was scared of Thai massage.
Attempt at getting appointment with Spinal Surgeon in Salem
Middle of January I called Dr York from Thailand hoping to get an appointment shortly after my arrival in Oregon Feb 1.
I wanted a second opinion on surgery… specifically Oblique Lumbar Interbody Fusion (OLIF) and O-arm 2D/3D imaging. And as the epidurals were wearing off to have her do another injection before my return to Oaxaca Mexico where I live most of the year even though my permanent address is in Salem where i have a home that is rented out.
My call to Dr. York was returned by email from her receptionist who said Dr York was actually in Thailand and wouldn’t return for another couple of weeks and she would have to talk to her before she could make an appointment for me.
I responded by email giving her a short history with a request that I get an opinion on the OLIF and request for another epidural. I was assuming the receptionist would show Dr.York my email with the history. Nothing was said about the Salem Spinal Clinic.
Salem Spinal Clinic
Arrival in Oregon Feb 1
Called Dr. York’s office for an appointment. It was then I was told that I had to go through the Salem Spinal Clinic and have my case reviewed by a nurse (a nurse would look at the MRI’s???) to get an appointment. This was the first I’d heard of the spinal clinic. I called the Clinic and said I would like an appointment with Dr York and I would hand deliver copies of the two MRI’s on cd’s and the radiologist’s narrative which I did the next day. I can’t remember the rest of the short conversation but that was about it.
Heard back a week later that I could now call Dr. York’s office and get an appointment!
Appointment with Dr. York
Called Dr. York’s office and couldn’t get an appointment for a month!!! Meanwhile I am in pain and paying for a hotel.
Was first seen by the medical assistant who took history. Then Dr. York interviewed me and looking at the MRI on the monitor she said she didn’t recommend surgery. I was so addled by the meds I forgot to ask about the OLIF and she didn’t mention it so she evidently hadn’t seen the history I had sent by email to her receptionist.
I did ask her about epidurals and she said she didn’t do those and I would have to be referred to a pain specialist! I asked her about Lyrica and she said she didn’t prescribe Lyrica but didn’t say whether she prescribed anything else. I didn’t pursue it.
Started to take myself off Lyrica and Tramadol which wasn’t fun.
Salem Pain Center
Waited another 2 weeks for evaluation at the Pain Center. At the evaluation the pain doctor said it would be another 2 weeks for an appointment for the epidurals.
I gave him an earful about waiting from Feb 1 until end of April to get pain relief and he tried to blame the insurance company. However the pain center got a pre-authorization from Regence the same day of the call by the pain center! I said it was Salem’s system that was the cause of the delay! And the month wait for an appt with the spinal surgeon.
Then, gratefully, when I returned to the pain center the next day to give them copies of the MRI’s, a pain assistant worked me in for an appointment the following day to do epidural injections at the Surgery Center on River Road S. Bless their hearts because I had a flight to Mexico the next day that I had made weeks before.
I declined anesthesia as I had before. He did say later in the OR I had made a good case against such a long wait.
Salem Physical Therapy
Meanwhile, before leaving Salem for Mexico, saw another physical therapist who gave me pelvic tilt, hip adduction, strengthening gluteus med, and knee to chest. These really help.
Returned to Oaxaca couple weeks ago. Am now completely off Lyrica and Tramadol. The withdrawal was nasty but now I feel mentally and emotionally human again.
Comparing the onset of sciatica to now (without drugs) I’d estimate 50% relief and pain is tolerable…in comparison. Using a cane now for stability. Neuropathy still there. Will be working with a physical therapist here in Oaxaca. I realize I’m going to have to deal with a certain amount of pain the rest of my life.
In the future I will probably ask my primary for a referral to the OHSU Spinal Center (assuming they are any faster) before going through all that again. Or just go back to the Nevada Spinal Clinic during a visit to my son there.
It appears to me that the Salem system is Byzantine and not in the interest of palliative care but in the interest of the medical community. The system is probably set up to make things easier for the surgeons to screen out frivolous requests for appointments and to screen out people looking for opiates so they can just use their time for surgeries which of course is where they make their money. Their own offices can’t do that? I have no idea if any of this is driven by the insurance companies.
I have nothing against Dr. York but her office could have done a better job of communicating. And giving me an appt sooner. Maybe I should have started crying! I should know by now at my age that as a patient you have to make an impression on a doctor to get a response or they don’t take you seriously.
If I had known I was going to have to wait nearly 3 months for pain relief, I probably would have just gone on to the Nevada Pain Center and had the epidurals done there again. Or have it done again in Bangkok on another trip to see my 2 sons there. The out-of-pocket expense there is minimal compared to what the insurance has to pay in the U.S. It would have saved me a lot of time and money on hotels. And pain. And grief.
And don’t get me started on medical tourism. It would save the taxpayers billions if ins. companies would accept care in other countries.