What kind of specialist do I need

[starfish]

Last summer I started having some pain in my low back an numbness in my left foot. I visited my doctor and he put me on meloxicam for a couple of weeks. Things started getting better. I started see a chiropractor and they helped me a lot with my posture. Then the pain in the back came back and my right calf felt like it was on fire. This went on for a couple of weeks until I lost most feeling in both legs and could barley walk. I also started to lose feeling in my right arm and would have trouble moving my thumb.

I went back to my doctor and he sent me for an MRI. We assumed that I had a herniated disc, but the MRI did not show it. The radiologist said I have spondylitis. The doctor sent me to physical therapy and put me back on the meloxicam for 2 months.

The therapy and meloxicam helped. I stopped taking the meloxicam at the beginning of January. The numbness and radiating pain is mostly gone. Though sometimes when I wake up in the morning my back in very stiff, sometimes it even wake me up at night. I'll feel really bad in the morning then by the time I leave work I feel like I can run a marathon.

This past week it has been getting worse again. I started having the numbness in one leg in the morning and my back is stiff. Today I feel like I have a knife sticking in my spine between the shoulder blades. At the beginning of the week I felt a dull ache at the base of the spine. Then some days I feel like pressure in my spine. I describe as like there are balloons between the vertebrae and someone is inflating them.

There doesn't seem to be much rhyme or reason to what causes it to flare up.

When I last saw my doctor he said he was going to send me to a specialist if it keep bothering me. He mentioned either a neurologist or an orthopedist depending on the symptoms.

I've done some research and I since I seem to respond well to the NSAIDs, I think it is some form of arthritis. My insurance doesn't require a referral, so I can make an appointment with the appropriate specialist.

The pain is no where near as bad as it was last summer, but I don't want to put things off and make it worse in the long run. I just not sure what kind of specialist I need to see. Since the radiating pain and numbness are the primary symptom I don't think I need to see a neurologist.

[mike90]

I would suggest either pain management clinic if you want help with the symptoms or neurology seeing as it seems to respond well to NSAIDs. It sounds to me like whatever is inflamed may be pressing on nerves somewhere which would account for your symptoms and the NSAIDs by taking the inflammation down stop the nerves being pressed on.

If you think it is a kind of arthritis then maybe a rheumatologist would be your best bet. I am sure that they will all be able to refer onwards if they feel that another specialist is better placed to deal with the problem. xx

[KaraBulut]

Who you should see will depend on what you want to do about it.

If you're looking for a diagnosis and medical management, a rheumatologist is probably where you want to start. Testing for a specific genetic marker - HLA-B27- may make it clear what the diagnosis is.

If you're pondering a surgical solution, you can consult with a orthopedist or neurosurgeon who specializes in spinal surgery.

However, based upon your age, the results of your MRI and the fact that you responded so well to an NSAID, probably the rheumatologist is your best bet.

In the meantime, you can continue working with a physical therapist or a chiropractor for symptom management. You might also look into yoga- it seems to help.

[starfish]

I want to avoid surgery if at all possible. I'll start doing research to find a good rheumatologist.


Yoga is a good idea. I have found that exercise helps. A plus side to a Yoga class is that it will help me meet people.

[starfish]

I saw the Rheumatologist today. He sent be to a bunch of blood tests, one of which is HLA-B27. He also had an X-ray of my sacroiliac joint taken. He also sent me to a dermatologist, because of some of eczema spots, might possibly be psoriasis. While they don't look like psoriasis, he wants a specialist to verify. If it is psoriasis the problem might be psoriatic arthritis.

He said that is it likely something belonging to Spondylarthritis family. Might possibly be ankylosing spondylitis. Once he gets the results of the blood tests, X-rays, and dermatologist he will have a better idea.

All together he ordered about 8 blood tests. Hep-B, Hep-C, HLA-B27, Uric acid, are the ones I remember. I was joking with the lab tech. When I saw her pull out all of the vials, I asked her if she was going to leave me any.

I am happy with the progress so far. I am also happy with the doctor. I did not feel rushed and he took the time answer my questions and to ask me questions.

[starfish]

I heard back from the doctor a few days back. The x-rays did not show any inflammation, but he said that it does not always show up on an x-ray.

On the blood tests the HLA-B27 test came back negative. The only notable things are my white blood cell count was low. Not enough to be alarmed, but we are going to keep an eye on it. I was surprised by this as I very rarely get sick. Also my uric acid was a little high.

I've been taking the meloxicam the past week and am feeling much better. I have a follow up appointment in a few weeks and well see if we can figure out what is going on.