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M.A. IME in a few weeks
#1
Thank you to anyone who takes the time to read this. I very much appreciate it.

At this point my diagnosis is simply chronic lower back pain. I’ve had different doctors give me different opinions as to what’s causing it, the cause of the pain is still not diagnosed.

Timeline -
In 2013 after the lifting accident at work I was in a lot of pain, back then I was told it was a lumbar strain. In 2014 the pain was getting worse and I did physical therapy with prescribed core strengthening exercises that I would do in the afternoons when I got home from work. Going to physical therapy in the middle of the day while working 8-1/2 hours each day doing carpentry and trying to exercise after work never gave me the results I wanted. In 2015, the pain still wasn’t getting better and I had an MRI:

MRI OF THE LUMBAR SPINE WITHOUT IV CONTRAST: Sagital T2, T1 and STIR; Axial T2 images of the lumbar spine without IV contrast.

The conus terminates At L1-L2 with normal size and signal intensity. There is normal alignment of the lumbosacral spine. The vertebral body heights and intervertebral disc spaces are well-maintained. There is no marrow edema to suggest acute fracture.

T12-L1: Normal

L1-L2: Mild facet ligamentum flavum hypertrophy but no canal or neural foraminal stenosis.

L2-L3: Minimal broad-based disc bulge with facet ligamentum flavum hypertrophy. There is mild narrowing of the lateral recesses bilaterally but no canal or neural foraminal stenosis.

L3-L4: Mild broad-based circumflex and frontal disc bulge with facet ligamentum flavum hypertrophy. There is narrowing of the lateral recesses bilaterally. Mild canal stenosis. There is moderate neural foraminal stenosis bilaterally but no compression of the exiting nerves.

L4-L5: Small broad-based circumferential disc bulge with facet ligamentum flavum hypertrophy. There is narrowing of the lateral recesses bilaterally and contact the descending L5 nerves. There is moderate canal stenosis. There is contact of the exiting L4 nerves by the hypertrophied facets. No definite compression of the nerves.

L5-S1: Mild broad-based circumferential disc bulge. No canal stenosis. There is moderate neural foraminal narrowing and contact of the exiting L5 nerves bilaterally from the disc bulge.

MRI Impression: Mild broad-based circumferential disc bulges as discussed above with mild ligament flavum and facet hypertrophy. There is contact of the exiting L4 and L5 nerves bilaterally and descending L5 nerves bilaterally.

During the time of my first MRI, I was being treated at the St. Elizabeth pain management center where I went through three separate series of spinal injections. I felt little relief from the injections. During my third, final round of injections, I felt excruciating pain during the procedure and was screaming, it was awful. While there, I had doctors tell me that I had the back of a 90 year old man and that nothing could be done to fix it, I also had one doctor tell me I had a healthy back which was nice to hear.

While getting injections I tried physical therapy again. The physical therapist told me I had to build up my core muscles which I had been trying for years.

In April of 2019 the pain was getting much worse then it had been before. I was still doing my core exercises, at different times had tried yoga, a chiropractor, physical therapy twice and I was having trouble lifting even light bags of groceries. It had become very painful to lift my tools while at work and I was having trouble reaching down for things. I can still only bend at the knees to pick anything up. It got to the point that I would slightly turn my body and I would feel a sharp, stabbing pain in my lower right back/hip area. Given my increase in pain, I saw my doctor and asked to do physical therapy a third time.

Towards the end of May 2019, I was working, going to physical therapy but was becoming increasingly sore. I tried massage therapy which did not help. The physical therapist recommended seeing a spine specialist. It was around this time at work ducking ever so slightly under a bush when after a few times of ducking, my back went from its usual soreness then became way more sore then it ever had been. Within a day I was flat on the floor in even more excruciating pain. Ibuprofen, Tylenol, Motrin, Alieve, icing, heat pad, muscle relaxers (which I hate), lidocaine patches all did barely anything for the pain. I went back to my doctor to ask to see a spine specialist at New England Spine Care that was recommended to me by both my physical therapist and my primary care. I saw the spine specialist and he ordered an MRI:

TECHNIQUE: Multi-sequence, multiplanar MRI of the lumbar spine was performed on a 1.5Tesla magnet without the use of intravenous contrast.

FINDINGS: Study assumes five lumbar type non-rib bearing vertebral bodies. Vertebral body heights and alignment are preserved. Conus terminates at L1. The bone marrow signal is slightly heterogeneous. With a hemangioma noted at S2.

Specific findings are as follows:

L1-L2: No significant spinal canal stenosis or neural foraminal narrowing

L2-L3: No significant spinal canal stenosis or neural foraminal narrowing

L3-L4: No significant spinal canal stenosis or neural foraminal narrowing

L4-L5: Mild disc bulge without significant spinal canal stenosis or neural foraminal narrowing

L5-S2: Mild disc bulge without significant spinal canal stenosis or neural foraminal narrowing

Impression: Mild disc bulge is noted at L4-L5 and L5-S1 without significant spinal canal stenosis or neural foraminal narrowing.

To me this MRI seems to be a huge improvement over my first one and I’ve been able to do what doctors told me was not possible, for bulging discs to go back into place. Given how much worse I feel now then when I had my first MRI, I’m starting to question the results of either one and how they relate to my painWhen I had my last MRI, I told the technician where the pain was coming from and he suggested maybe having my hip checked out.

The doctor I’m seeing at New England Spine Care has told me he does not know where the pain is coming from. He told me he thinks it may be joint related. He said that the hemangioma found in my 2nd MRI is nothing to worry about and that the slightly heterogeneous bone marrow signal in my 2nd MRI is something to talk to my primary care about. The doctor told me that if I saw other spine specialists that one of them may offer surgery but that he does not recommend that (I loved hearing that he does not recommend surgery). I asked him what to do about the pain and he told me it was up to me to figure out how much pain I can work through. He’s recommended swimming 3 times a week, prescribed Meloxicam 15 mg once a day (hasn’t helped, makes me dizzy) and has referred me to the New England Baptist Spine Boot Camp physical therapy program and to follow up after.

I heard everything I wanted to hear from this doctor and look forward to trying physical therapy again. It sort of feels like I’ve been told by doctors now three separate times to fix a headache I need to bang my head against a wall, now I’m being told by this new doctor to fix a headache I need to bang my head against the wall a fourth time. He’s essentially referred back to a physical therapist who is the person that referred me to him. With that said, I have not tried the program at New England Baptist yet, I’m always game to try something new or keep trying previous treatments, being proactive feels good.

Pain Description -
The pain is almost always in my lower right and center of the bottom of my back along with both my hips. If I stand in one place for too long, the pain pulls me to the floor lying flat, at times it’s like torture. Lifting, holding any kind of weight (a couple pounds), bending, pulling and pushing and twisting my body are all things trigger increases in pain especially as the day goes on. It’s especially difficult because I don’t always feel the pain at first, sometimes it catches up to me later. When the pain is really bad, it is debilitating. It’s consistently on my lower right side/hip area and lower center of my back. The closest thing I can compare the sharp pain to is that of a broken rib but in the bottom of my back.

Since May, I have had a few times where that sharp pain has been very severe and is always in the same place. When the pain is sharp like that my whole upper back locks up, I have pain radiating from my lower back up my spine and up my sides into my lower/mid rib cage. The pain goes into my hips and into my butt/hip area but not my legs. When the pain is that severe the only thing that seems to help is lying flat or the next best thing is sitting with my legs supported. When I sit too long, it can become painful if I don’t get up to walk around enough.

There have been a few times when I have that sharp pain that if I try to drive, turning the wheel will cause an extreme increase in the pain resulting in a stabbing pain in my lower right back/hip area. I can only sleep on my left side in a fetal position with a pillow between my knees, any other position is painful. Getting in and out of bed has become difficult, I now rely on a barrel roll technique I learned in physical therapy. Opening certain drawers or heavy doors going into buildings can sometimes really aggravate my back. Standing more then 2-5 minutes while doing dishes is always painful. It makes my whole waist hurt, back becomes almost instantly more sore. It feels as if my spine is being pulled down from underneath, it will require me to take a break, lay flat on the floor for a couple minutes or sit with my legs up for a bit to relieve the pain. I then do another 5 minutes of washing dishes and repeat the process over and over until the dishes are done.

The morning of the accident, I could repeatedly lift 80-100+ lbs. with ease, immediately after the accident I’ve never been able to lift much more then 20 lbs. Currently I can only hold something 2-5 lbs for a couple seconds before it makes the pain worse. My last round of pt I never was able to lift more then that without feeling as if I was hit by a car the next day.

The day I was hurt at work in September of 2013, we manually lifted two long, heavy 650lb. steel beams over our heads into place. The first steel beam that we manually lifted had nine people lifting it and 1 employee hurt his back but never reported it. Before lifting the 2nd steel beam, my employer told 3 people that they were not needed. I spoke up, pulled my employer aside and asked him why he would tell three people that we didn’t need them to lift the 2nd steel beam. He got irritated and told me it would be fine. The second steel beam that we lifted into place that day had six people lifting it. The six of us were unevenly distributed across the length of the beam with me at one end. As we were lifting the beam it felt like it was pushing back at me, when the beam was chest high it felt like it was crushing me. I yelled out in pain that I had a lot of weight twice in a row. My employer yelled at me to stop straining and told everyone to lift on the count of three, I did and immediately knew I had hurt my back.

What has helped -
Ibuprofen sometimes helps take the edge off the pain when it’s not too severe. Walking feels ok, hiking feels even better, I’ve noticed that walking on asphalt or pavement seems to bother my back and hips much more then walking in the woods. I feel like the swimming I recently started doing and hiking are helping. I also do daily light stretching a couple times a day on an exercise ball and foam roller which feels good.

Given not one doctor has told me what’s wrong with my back, I’m worried and I’d like to get a second opinion. I just received a letter that I have an IME in a couple weeks. I looked up the IME doctor and he has awful reviews. I plan to meet with a workman’s comp lawyer in the next few days. Any and all advice is greatly appreciated, as are any recommendations for a good lawyer in the Boston area. Thank you again for reading this.
 
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