Good doctor for back pain?

[Anonymous]

Keep these coming! Any recs in DC or MoCo?

[Anonymous]

Anonymous wrote:Keep these coming! Any recs in DC or MoCo?

Dr. Laukaitis and Dr. Lack are on K St. in DC.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

NP here. I hate to say it, but unfortunately even if this offers a more accurate diagnosis, there isn't much to be done about it. I've been to three orthopedists and found myself getting hooked on pain meds (finally off now, thankfully). My options seem to be: live with the pain or have surgery -- which no one who's had it recommends.

If you have what OP is complaining about, one of those orthopedists should have referred you to a rheumatologist.

Pain pills in general are not good for a chronic pain condition, though a very occasional pill to get you through a flare is okay. There are medications that I described earlier. In addition you can take steroids to help through a rough patch or get steroid shots. And if your case is very recalcitrant, there are the anti-TNF inhibitors. There is also exercise. Surgery is not really recommended except in some highly specialized circumstances.

Treatments are improving every year. PP--please do not give up. Please take yourself to a good rheumatologist.

Thank you for the advice. I should follow up with a rheumatologist (and I've never been referred to one). Unfortunately, I can't take oral anti-inflammatory drugs because I've had gastric bypass surgery. Ten years later, I discover I have a lot of issues with inflammation -- doh! And when I went down the exercise path, I strained it worse than ever before, so now I'm scared of that too. But I'll explore some of these other meds.

Apparently, you can take methotrexate post bariatric surgery, but it may not be absorbed as well. I understand it also is available by injection so the stomach can be avoided altogether. I found this article, which actually mentions in passing that rheumatologists often see post gastric bypass arthritis syndromes, so it sounds like it is a thing.

http://www.the-rheumatologist.org/article/does-gastric-bypass-result-in-reduced-absorption-of-methotrexate/

[Anonymous]

I had similar pain for over a year. It was debilitating. It went away, 100% after I started an anti inflammatory diet. No grains of any kind (not just no wheat), no dairy, no soy, no nightshades. I also cleared up my candida and corrected multiple vitamin deficiencies (tested through SpectraCell and a hair elements test...neither of which are really accepted or recognized by the mainstream medical community). Traditional blood tests showed be within the reference intervals, albeit barely. Meanwhile, I definitely had functional deficiencies. Also, pay as much attention to correcting mineral deficiencies (especially magnesium - it is a natural muscle relaxer) as you do to correcting vitamin deficiencies.

[Anonymous]

In terms of diet, there are some with spondyloarthritis that swear by a no starch or low starch diet. Others who have tried say it didn't do much for them.

[Anonymous]

Dr. Mohsin Sheikh in Gaithersburg. He specializes in pain management but is very easy to talk to and will spend a lot of time to figure out what's causing your issues before prescribing treatment.

[Anonymous]

You mention that lack of exercise has brought on your back pain. Maybe this is your answer. I've had back problems since my early 30s when I herniated a disk. The only thing that consistently works is regular exercise.

[Anonymous]

Anonymous wrote:You mention that lack of exercise has brought on your back pain. Maybe this is your answer. I've had back problems since my early 30s when I herniated a disk. The only thing that consistently works is regular exercise.

+1. Overweight/obesity and deconditioning is associated with many cases of chronic pain.

[Anonymous]

I was also going to suggest you explore a keto diet (you can google it) there is some science suggesting it could help with inflammation. Unlike expensive doctors and pills, there's no downside to trying it out for a month or two to see if it helps at all. Check out the reddit subthread for more information.

[Anonymous]

Anonymous wrote:You mention that lack of exercise has brought on your back pain. Maybe this is your answer. I've had back problems since my early 30s when I herniated a disk. The only thing that consistently works is regular exercise.

OP here and yes, it has coincided with ceasing regular exercise. However, I am not overweight in the least, I am fairly active, and I have begun walking 2 miles many days and though walking does not hurt at all, it hasn't really helped with the overall issue.

[Anonymous]

I agree with seeing a rheumatologist. If that does not provide many results you can also see a physical medicine doctor or physiatrist. I would not see an orthopedist.

In all these cases they may put you some PT. Having been to many different PTs, I can tell you they are not all equal! If you start somewhere and feel it's not getting better after a while try somewhere else. If you go somewhere and you are out in the big room being given a bunch of excercises, with no hands on work, go somewhere else. Sometimes it is very subtle and/or hands on tactics that can help with chronic lower back pain.

[Anonymous]

Anonymous wrote:

Anonymous wrote:You mention that lack of exercise has brought on your back pain. Maybe this is your answer. I've had back problems since my early 30s when I herniated a disk. The only thing that consistently works is regular exercise.

OP here and yes, it has coincided with ceasing regular exercise. However, I am not overweight in the least, I am fairly active, and I have begun walking 2 miles many days and though walking does not hurt at all, it hasn't really helped with the overall issue.

PP who suggested looking into spondyloarthritis. If you are suffering inflammation, walking is your safest exercise until you can get more definitive insight into what the problem is. Swimming is also a safe bet, assuming no ongoing shoulder pain and that you can do it without pain. I would hold out on anything more rigorous until you see a rheumatologist. He or she will let you know what exercise you should and shouldn't do. The rheumatologist told a friend that he was too inflamed even to do physical therapy; he had to stick to walking for a good six months.

[Anonymous]

OP here. I had to up the ibuprofen today and took 600mg this morning. Haven't taken more yet but it's just been 6 hours. It's really manageable when the meds work but I can tell it's getting more sore.

Appt with Dr. Fisch this week. Seems like many DCUM users like him. I want to start this route first because I want an X-ray.

[Anonymous]

Anonymous wrote:OP here. I had to up the ibuprofen today and took 600mg this morning. Haven't taken more yet but it's just been 6 hours. It's really manageable when the meds work but I can tell it's getting more sore.

Appt with Dr. Fisch this week. Seems like many DCUM users like him. I want to start this route first because I want an X-ray.

It's up to you OP, but if you have back pain that is unexplained by a mechanical reason, has persisted for more than three months, and improves with movement and worsens with rest, you really should see a rheumatologist and not an orthopedist. Orthopedists tend to deal with pain that worsens with movement and improves with rest. Whom you see should not be decided by whom you think will give you an XRay.

A normal XRay of the spine will not find anything if inflammation is the cause. If it is inflammatory back pain, a rheumatologist will first do an XRay of the sacroiliac joints using the Ferguson view. If that is negative (as it usually is when the pain is of relatively recent onset), an MRI using STIR imagery is done.

My DD was repeatedly sent back to the orthopedist for a year and he kept saying it couldn't be anything. We tried several neurologists because she was having great difficulty walking. One of them finally sent her to a different orthopedist and that one said she should see a rheumatologist. The rheumatologist dx'ed her on the spot, doing tests to confirm.

If you want to go ahead with the orthopedist, have him test your C reactive protein, sed rate, and HLA B27. The first two (and you need both, not just one) are inflammatory markers--if one or both are elevated, it is a good clue that inflammation is the cause of the pain. The last test is a genetic test for spondyloarthritis--caution, it often is not positive. Do not permit a doctor to say you can't have spondyloarthritis because the genetic test is negative.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP here. I had to up the ibuprofen today and took 600mg this morning. Haven't taken more yet but it's just been 6 hours. It's really manageable when the meds work but I can tell it's getting more sore.

Appt with Dr. Fisch this week. Seems like many DCUM users like him. I want to start this route first because I want an X-ray.

It's up to you OP, but if you have back pain that is unexplained by a mechanical reason, has persisted for more than three months, and improves with movement and worsens with rest, you really should see a rheumatologist and not an orthopedist. Orthopedists tend to deal with pain that worsens with movement and improves with rest. Whom you see should not be decided by whom you think will give you an XRay.

A normal XRay of the spine will not find anything if inflammation is the cause. If it is inflammatory back pain, a rheumatologist will first do an XRay of the sacroiliac joints using the Ferguson view. If that is negative (as it usually is when the pain is of relatively recent onset), an MRI using STIR imagery is done.

My DD was repeatedly sent back to the orthopedist for a year and he kept saying it couldn't be anything. We tried several neurologists because she was having great difficulty walking. One of them finally sent her to a different orthopedist and that one said she should see a rheumatologist. The rheumatologist dx'ed her on the spot, doing tests to confirm.

If you want to go ahead with the orthopedist, have him test your C reactive protein, sed rate, and HLA B27. The first two (and you need both, not just one) are inflammatory markers--if one or both are elevated, it is a good clue that inflammation is the cause of the pain. The last test is a genetic test for spondyloarthritis--caution, it often is not positive. Do not permit a doctor to say you can't have spondyloarthritis because the genetic test is negative.

OP here. My pain actually does improve/stop with rest. Though the spondyloarthritis sounds interesting, it's not 100% me. I am not sure it isn't mechanical, as I also have flat feet and that was thought to be the root a while back. So yes, I want to investigate mechanical as well.