Kay49

Dr. Corenman,

Thank you very much for your response. I have another question for you and your willingness to be forthcoming is important for me and my health.

I am on medicaid (need I say more?) and I have been trying to see a neurosurgeon for over a year. I have been blown off time and again, however with due diligence and persistent by my PCD, insurance advocate and myself, I managed to make a little headway (not saying much). After the neurosurgeon reviewed my case, he said he wanted an EMG BEFORE he would see me. Without getting into too much politics, to me this is code for ‘If the EMG shows nerve issues THEN we will see you, otherwise, it’s a NO GO’. I was told that this EMG was needed to know best what ‘treatment’ I would be needing. After hours of research, I’ve learned code when it comes to very unfortunate circumstances (my own with this ‘disease’), the great expense that neurology and surgery is (of course I would have issues with the most expensive-potentially), and medicaid that doesn’t pay nearly enough to access the services of a neurosurgeon, hence all the blowing off.

I scheduled the EMG for last week, and ironically the day before, picked up an overwhelming tub full of drenched towels (mistake) felt a sharp pain in the lumbar area, and a ‘thud’ like feeling at the same time. This would be my introduction to an acute flare of what is now dx’d as lumbarsacral radiculopathy. Upon MRI findings, I have at L3-L4-minimal circumferential disc bulging and mild facet degenerative changes. L4-L5- Mild circumferential disc bulging and mild facet degenerative changes. L5-S1- A small central disc protrusion with an associated annular tear. This results (all of the above as well) in no significant canal stenosis, foraminal narrowing or definitive (key word) nerve root impingement. Mild face changes bilaterally.

No big deal. It’s been REALLY fun to have BOTH going at the same time, eh? Anyway, the next day after this incident, the pain was unbelievable and growing worse by the hour. I have had pain, heaviness and weakness in my legs, growing gradually worse over the last year, more so the last few months. My exercises and stretches, walking had grown painful just prior to this. I have never experienced an acute flare and I hope I never do again! I got to my EMG and could NOT sit still for the procedure. I rescheduled. At the ER, the ER doc heard my story and contacted the Spine health center and guess who was on call? The neurosurgeon who reviewed my case. He said he wanted to put himself down as the follow up doc and to call his office first thing Monday morning. Unfortunately, I’ve heard nothing.

I want to ask your clarification the reasons why a neuro would ask for an EMG BEFORE they see you, medically. I would think a responsible neuro would consider the patients OVERALL picture with regards to symptoms and not just an EMG for weighing out insurance issues or ability to pay. I know that if I had private insurance, this would NOT be an issue.

My health is important to me. I’m fine if a neuro tells me they can do nothing, but with what appears to be the seriousness of stenosis, compression, combined with symptoms, I think an evaluation is warranted. I don’t think a medicaid patient should be deemed less than one who has ability to pay, but I know the truth of that, reading stories of so many who are suffering needlessly.

My next question for you is with regards to surgery. This is a ‘disease’ that is progressive. Some faster than others, some with symptoms, some not at all and some in between. Why are conservative treatments tried before a surgery is just done and over with? I know there is more to consider than this per patient and it’s not always black and white, but from what I’m reading this too has become an insurance issue for most, rather than a health issue because logically since it’s progressive, doesn’t it make sense to have surgery done and HALT progression for awhile, or to minimize what will surely be MORE damage later?
I’m also very much against epidural cortisone shots. I see NO purpose in something that seems so risky, is anxiety provoking and painful only to hold off the inevitable: surgery.

I may consider this for lumbar, but with the compression and stenosis in my neck it’s a big NO. WAY.

I guess what concerns me is the stenosis and compression. I can’t ‘see’ what’s going on, only understand my symptoms as I subjectively experience them.

Anyway, any response is appreciated to broaden my understanding and research about my spine issues.