Since this was an initial visit I had to fill out just about as much paperwork as when I joined the Army and then I had to go through another partial physical. Quite standard when seeing a new doc and I have grown accustomed to it. The roughest part of the visit was the long wait before seeing the doctor. Apparently their office is also used for doing patient studies and today was check in day for some of them.
When I did get in to the patient room the doctor was 2 steps behind me and we started right away. We went over my history with back pain and then all the medications I have tried and any procedures that I have undergone such as physical therapy, acupuncture etc... It was perhaps the most thorough questioning a doctor has given me and then he started on the physical aspects, knocking me on the reflex points with his mallet and asking me to move my toes, bend, reach etc...
While I was lying on the bed he had me try to point my toes back towards me. Now I have never noticed the problem that he did apparently it is the cause of my tripping over the flat spots on the floor. He said that I have what is called Drop Foot.
Of course while reading some of the above link this section stood out...
The peroneal nerve is susceptible to different types of injury. Some of these include nerve compression from lumbar disc herniation (e.g. L4, L5, S1), trauma to the sciatic nerve, spondylolisthesis, spinal stenosis, spinal cord injury, bone fractures (leg, vertebrae), stroke, tumor, diabetes, lacerations, gunshot wounds, or crush-type injuries. Drop foot is found in some patients with Amyotrophic Lateral Sclerosis (ALS), Multiple Sclerosis (MS), and Parkinson's Disease. Sometimes the peroneal nerve becomes injured when stretched during hip or knee replacement surgery.
Of course the Spondylolisthesis jumped right out at me as well he mentioned the arachnoiditis as another possible cause. This would go hand in hand with the EMG they did that found the damage to the L5 & S1 nerves.
When he finished the physical part of it he asked me, "what would you like me to do for you?", which kind of caught me off guard. I told him that out of all the meds we have tried the oxycontin by far is the best for the job so he wrote me a prescription for that and then he wrote me a prescription for Oxy IR (Immediate Release) for the breakthrough pain. I left the office with the relief of knowing that I have a doctor who is serious about treating that pain but understands that the patient has a say in how that should be done.
I think this was a good visit. He was interested in what I had to say and it appeared that it was in the same manner as when I see my personal physician. In other words he was interested in my input on treating the pain rather then saying, "no I am the doctor and this is what you will do..."
Before leaving I did have to sign some paperwork stating that I will only get my meds from him, at least in regards to my pain management, and then they asked the name and location of the pharmacy that I use and asked that it be the only one I use. My guess is this is just a built in control to ensure that people are not abusing the system for the purpose of getting pain meds from different doctors or pharmacies. They also said that they will give random urinalysis to their patients to check for illicit drugs or non-prescribed pain meds which again is not a problem for me. While it may seem odd, and I certainly have never been asked to sign similar paperwork this did not bother me and then I quickly wondered how many patients they never see again.
I will see him once a month for the first 3 months and then we go to every 90 days from there.
Well my head is fried right now so I am going to close here and go find something to eat.
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