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Rivet62

Question

I had a weird C&P exam yesterday. My range of motion was like 5 to 10 degrees in every direction in the thoracic lumbar ROM measures.  He didn't seem to question that, as he was looking at my back muscles while I was standing doing the forward flexion and backward extension. I was pretty seized up and he called it muscle spasms, which I'm sure it was.  My C&P was for DDD, painful motion, and lower extremity radiculopathy. I'm waiting to see if he'll call it inconclusive as a result of spasms, but I would argue spasms are part of what interferes with work. Of course, I would rather not have to argue it at all.

What struck me as odd about the ROMs is that he had me sit upright on the examining table and he had me bring my elbows to my side and bent, with my forearms parallel with the floor and my fists clenched then he asked me to twist my torso. I could do all that except twist the torso beyond 5 or 10 degrees.

I looked online and saw no one performing that kind of ROM, with elbow bent and to the sides of the body. Has anyone had that kind of ROM for twisting the back?  What is he trying to see with my arms like that?

I told him he was the first ever to actually measure ROM (but he actually only did it on the top of my head in relation to my back) and he said "well there wasn't much to measure," causing me to think he'll call the C&P inconclusive because muscle spasms have interfered maybe. Well, I have a documented work termination as a result of flare-ups...a medical opinion that I cannot return. I have documented emergency room visits as a result of flare-ups at other jobs. I have lots of documentation.

So, my question here is... can the doctor call the C&P inconclusive as a result of muscles spasms interfering?  Or are the muscle spasms confirming the C&P findings that will lead to an increase of service-connected ratings?

If you look at my signature below my comment you can see my existing ratings.  I guess I'm wondering if muscles spasms are radiculopathy.  I was pretty seized up after the 25 mile drive to the C&P and the hard seats they had while I waited.

I laid down in the examining table and did active straight leg raises, and no more than 25 degrees and he said that's positive (for lower back problems I guess). I didn't get the impression that he was trying to play tricks.

He made some negative comments about the VA medical system. He worked for VA decades ago, or maybe it was an internship.  But what he did say is that he was trained decades ago as a cardio thoracic specialist (he has since practiced as a DO- not an MD)... anyway, it caused me to remember the new sprinkling of heart related issues my new primary care doctor has given life to from old diagnoses that haven't warranted any real follow up.

Do you think that the VBA has purposely gotten this man to opine heart problems and not actual back problems??  I have all imaging and radiology reports that show severe DDD, but an anesthesiologist had told me that smoking interferes with healing the discs and that smoking causes more pain. I know a retired MD and that MD calls that bulls*hit. 

It appears my C&P examiner is not trained in spine specialty, even though VES says he's trained in that (maybe by a VA qualification to perform rudimentary ROM exams). He is a general practitioner. That's been his career as a DO... so maybe he's qualified.

Ok wait.. I'm being silly about this.

Saint Lukes hospital in Kansas City says "These include: Pain in the low back Pain, numbness, tingling, or weakness that travels into the buttocks, hip, groin, or leg Muscle spasms"

https://www.saintlukeskc.org/health-library/understanding-lumbar-radiculopathy

I think my C&P is on the right path. 

This caught my eye while I was surfing the net for answers (although it involves a future cervical spine claim I have):

"Nonoperative treatment includes physical therapy involving strengthening, stretching, and potentially traction, as well as nonsteroidal anti-inflammatory drugs, muscle relaxants, and massage. Epidural steroid injections may be helpful but have higher risks of serious complications. In patients with red flag symptoms or persistent symptoms after four to six weeks of treatment, magnetic resonance imaging can identify pathology amenable to epidural steroid injections or surgery.

Ok... I have the two anesthesiologists who have refused to do epidural nerve blocks on my lower spine, but neither one of them will say why. All they've said is they refuse me as a candidate for epidural injections! Why can't they say why?  I have pressed for answers and they're just button-lipped about it. Is there something about these guys? Some kind of inside code that has them all agreeing that mum's the word when they encounter something they don't want to do?

Edited by Rivet62
Trying to get this right...
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These are tough questions to answer, but valid.  I will give it at least a try.  

As far as your c and p exam, the VA is given a "presumptive" of competency of the examiner, absent your challenge to the examiner's competency.  

I was given a c and p exam by an MD, for sleep apnea, who had zero experince in sleep medicine.  This is a mistake.  The examiner is acting as "an expert witness", and this MD was certainly no expert in sleep medicine.  

You should look into the examiners competency, and, by all means challenge the competency of the examiner IF:

 

1.  The exam report was unfavorable AND

2. The doctor had little or no training or experience in treating or diagnosing disorders of the spine, but was instead a heart doctor or something else.  

   As far as your doctor refusing to explain "why" he does not want to do epidural steroidal injections, he may not have to tell you "why".  

    Sometimes, the answer "may well be very complicated" and you may or may not understand it, even if he did answer "why".  

    Or, the reason he refused may have not that much to do with "you", but it may be for other reasons.  For example, the doctor may not have an assistant he is comfortable with who does epidural injections, and, he may or may not want to do them personally for his own reasons.  So, he may just opt out. 

    An example of this is physical therapy "in the southern tip of Texas."   I understand there were a few doctors convicted of "ripping off" social security by fraudulently ordering physical therapy.  Then some physical therapiists who were "in" on the scam, did not perform the therapy, but billed medicare/social security for it anyway.  

    What happed is, that doc and physical therapists were investigated, and put on trial, and I think one or more were convicted.  But, the good doctors and good therapists dont want to be investigated either..so, many/most just plain "quit" ordering any physical therapy, even for patients the doc thought would benefit, not because of optimizing medical care, but rather, the doc simply avoided an investigation. 

    In a nutshell, many doctors practice medicine "with an eye on preventing lawsuits" which sometimes has priority over optimal care for the patient.  Its sad, but in our sue crazzy world doctors dont want to have to defend a malpractice lawsuit, because they are costly even when the doc is not guilty.  

    Another example is pain med prescriptions.  Many doctors "simply dont write", or quit writing, prescriptions for strong medicaltions such as vicodin, oxy, etc. etc. because the government has a very watchful eye over doctors writing a lot of pain med prescriptions.  

    Unfortunately, for some patients, they have to suffer the pain, when a short term oxy, or vicodin or whatever, would be a benefit.  

     I saw that it my most recent hospital stay.  I had pancreatitis, and most docs understand THIS IS VERY PAINFUL, and, the pancreas does not want to settle down and stop being inflamed, as long as you are in pain.  I was given too low of a dose of pain meds.  

     The docs then referred me to a GI doc.  (gastro intestinal).  This doc was very experienced and KNEW I would my pancreas would not get better until or unless enough pain meds were given to "calm down" the inflamed pancreas, so she upped the dose, and it worked and I healed about after just a couple more days.  But I spent several days in pain, not healing properly, because they were too conservative with pain meds. 

     They were conservative because of the legal liabilities, and the docs were trained not to write too many pain med scripts.  

     However, my prime care doc called me.  She said she was familiar with pancreatitis, and sent me more pain meds.  When I asked her about the risks of addiction to pain meds, she explained "when you have REAL acute pain, such as pancreatiits, the risks of addiction are very, very low, under 1%."  

      And, because they had done abdominal scans "they knew" this pain was real, and I didnt go to the hospital with fake pain trying to get drugs.  

      Doctors do their best to prevent "drug seekers" from getting prescriptions, by faking pain, as they should.  The trrouble is, when people do have real pain, they are also conservative..so much so, it actually made my pain last longer.  

      Well, Im healed up, havent taken any "strong" pain meds for a couple weeks, and have Zero desire to take any more pain meds, "unless" the pain comes back, which it is not.  No addictions for me.  

      There is always a tradoff..they weigh the risks/benefits of prescribing a med, and render a decision.  Unfortunately, the well being of the patient is NOT the only consideration, medical malpractice is also, and a nosey Fed can be a "treatment driver" also.  

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Bronco 

       You are so right about some doctors under prescribing for pain because they are afraid of the DEA.  The VA has become scared to death to prescribe pain meds.  I am on them and I have to jump through the many hoops to get them.

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Well I never wanted there pain medicine.

That how  many veterans got addicted.

I have been in the VA health care system since 1993.

They used to mail me all type of pain medicines in 1993.

If I would have started that stuff I would have been a junkie.

Told my doctor I don't like it .

Next it was the codine pill doctor put me on two every 6 hr. 5-6 years.

I had the shot all that stuff.

 

2001 I start smoking weed It help alot I don't feel all drug out like a the pain medicine does me.

Next I told my doctor that weed help me 2003-4.

She go well if you smoke weed I can give u anymore pain medicine. Ok.

Well fast forward to 4 years ago the doctors and government.

Told everyone these pills are dangerous and slow the give of them by the VA doctors to complete cutting veterans off.

Well to me the government created alot addicted veterans.

An now they don't want to give it to them anymore.

you got a few that turn to heroin.

I seen ppl turn that were at the VA when they got cut them off.

My thing is before you get to taking these drugs.

Try weed or CBD it helps it natural an never seen a weed head turn to heroin because they don't have it or get sick because they don't have it.

My opinion 

I really hate the pain pill thing and the way the government cut ppl off an act like they didn't understand it was going to be a problem.

They basically gave ppl heroin for pain.

Forgot it call medicine. Smh.

 

 

 

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12 hours ago, broncovet said:

In a nutshell, many doctors practice medicine "with an eye on preventing lawsuits" which sometimes has priority over optimal care for the patient.  Its sad, but in our sue crazzy world doctors dont want to have to defend a malpractice lawsuit, because they are costly even when the doc is not guilty.  

    Another example is pain med prescriptions.  Many doctors "simply dont write", or quit writing, prescriptions for strong medicaltions such as vicodin, oxy, etc. etc. because the government has a very watchful eye over doctors writing a lot of pain med prescriptions.  

There's a lot of things that hem doctors in, to the point where I'm beginning to believe what expats are saying about the healthcare in Mexico = cheap and very good.

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9 hours ago, john999 said:

Bronco 

       You are so right about some doctors under prescribing for pain because they are afraid of the DEA.  The VA has become scared to death to prescribe pain meds.  I am on them and I have to jump through the many hoops to get them.

I was working in the MyHealth eVet office when the VA did a sharp reduction of what opioids the doctors could prescribe.  I mean they just cut it off.  Ha! I could see down the hall and into the little glassed-in vending machine area. A vet had come around the corner from the pharmacy and into the vending area where he placed the pharmacy and tore it open and then THREW it across the room. He could be heard yelling all the way down the main corridor, and others in the vending area were cowering in corners...this guy was p*ssed.  security came...security is really good. They de-escalate, instead of throw someone on the ground in cuffs.  The vet was practically crying. It was like he lost all hope of continuing because he knew he couldn't cope with his pain. Who am I to say though.

The other weirdness about the opioid reduction was that it was imposed in Hospice!?  The guy is dying anyway. The nurses did all they could. Even in hospice the VAMC tried to impose diet controls...but the nurses were so good. wink wink

 

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1 hour ago, Mr cue said:

My thing is before you get to taking these drugs.

Try weed or CBD it helps it natural an never seen a weed head turn to heroin because they don't have it or get sick because they don't have it.

Others are telling me that, too.

1 hour ago, Mr cue said:

I really hate the pain pill thing and the way the government cut ppl off an act like they didn't understand it was going to be a problem.

Yeah, and then trying to replace that with 'mindfulness programs'... or some psych-driven pain management to cope with pain, that doesn't really work. Basically telling you to distract your thoughts from the pain...and the VA pays these people GOOD money for the people who work in those bla bla bla programs...more time yakking and less time really treating it.

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