Severe slip disc

[rayongchelsea]

My neighbour has just asked me for a recommendation for a doctor. Pattaya or bangkok.

Initially did some decompression in bangkok Rayong hospital - no improvement.

Visited Bangkok Pattaya hospital today and the doctor wants to do some sort of fusion of the spine.

Problem is the person stuffers acute claustrophobia and needs to be sedated for an Mri. The doctor in Pattaya wanted her to see both a heart specialist and an anesthesiologist - they described it as being very pushy and over the top..very confused..and not very responsive to their questions.

She also is suffering from " drop foot"..

They are considering going back to Canada ( they have just arrived for a six month holiday) but the waiting list will be 4 months or so and they think it might be urgent given how it was explained by the doctor in Pattaya.

So overall they seem very concerned.

Any suggestions, recommendations.

Thank you.

[gb33]

After a "doh" moment in the gym a few years ago, I herniated 2 lower disks.

Suffered through all the non invasive techniques for 8 months or so. Finally went to Samitevj on Srinakarin and had surgery.

No fusion but they fixed me right up. Price was also reasonable.

Good luck.

[Sheryl]

First of all - for a herniated disk surgery is usually indicated only if there is compression of the spinal cord. Otherwise conservative treatment will usually suffice, as herniated disks over time retract. If it is compressing the cord, though, then it is indeed urgent to relieve the compression at once. Signs of cord compression would include urinary incontinence, weakness in the legs/impaired sensation

Secondly, if MRI has not been done, not sure that the diagnosis is really confirmed

Best spinal doctor is Dr. Wicharn at the BNH Hospital in Bangkok. He is also usually very responsive to patient needs/concerns (as is BNH Hospital in general)

Sounds like BPH understood the sedation request to be for being altogether knocked out (which would indeed require anesthesiologist etc for safety). If what he needs is just a tranquilizer to calm him (i.e. he is OK to be conscious as long as given some valium/xanax or the like) then be sure to make that clear.

Also - bring along Xray films and results of any tests that have already been done so avoid unnecessary repeat tests/costs. These should be films post-surgery, labs (blood tests) can be pre or post surgery whichever is more recent, ditto EKG, chest films (pre-op work-up: depending on how recent may be able to avoid doing some of them again, if further surgery is indeed indicated).

When back surgery fails to relieve pain it is often because the true cause of the pain was incorrectly diagnosed to begin with. The fact that a disk is herniated ("slipped") does not necessarily mean that this is the cause of the pain - many people have this with no symptoms at all, so it can be an incidental finding So given the history of one surgery already that did not relieve the pain it is possible Dr. Wicharn will suggest some nerve conduction tests to determine which nerves are responsible for the pain. If so I advise he gets it, even though it is fairly expensive (I think 5 - 10,0 baht) and takes a few hours to do - since the last thing you want is to undergo yet another surgery and still not get pain relief. (This test is not in any way claustrophobia-inducing, it''s done in an open room.)

[cheeryble]

Excellent intelligent post from Sheryl.

I've told this one before and I'll tell it again:

I had compression on the spinal chord so severe that I lost the use of two muscles in my leg and foot, numb patches, and numbing penis.

I was offered a laminectomy, a serious procedure involving removal of bone etc so the spinal chord sits in a valley rather than tube, on the dear old NHS, but had the sense to ask the surgeon who had shown me the picture of stenosis of the spine:

"But what do other 50 plus year old spines look like?"

He said "You have a point" and I provisionally passed up on the surgery.

Best thing I ever did and am only left with some numbness in the LEG and one muscle wasted but doesn't matter.

Since my first stay in hospital at age 19 also for sever sciatica my back has never been so good.

It's so often the inflammation and muscle spasm to avoid positions which causes the problem.

Not saying this applies to you at all, just saying rushing into surgery is not always the way though it often seems so at the time.

[rayongchelsea]

Thank you for your replies. They have decided this morning to return home to Canada this coming Sunday.

Cheers.

[wpcoe]

Not of use to the OP, but perhaps of value to others reading this thread: I also suffer acute claustrophobia in MRI machines. The BNH Spine Clinic sent me to Urupong Hospital for the MRI. Urupong has an "open" (not the closed tunnel) MRI machine.

[rayongchelsea]

Just as a follow up.

It was shingles , they have returned to complete their holidays.

One side note, they were appalled that the doctor in bangkok Pattaya hospital had tried to put fear in them to have an "exploratory " operation!!

[Issangeorge]

I've had shingles, and I am very interested in knowing how shingles could be mistaken for a severe slip disc.

[rayongchelsea]

I've had shingles, and I am very interested in knowing how shingles could be mistaken for a severe slip disc.

When I see them in a couple of weeks I will ask.

But it was a neurosurgeon that diagnosed it.

It "attacked" the spine in someway.

In the hospital here in thailand they dismissed it.

[Sheryl]

Shingles can certainly cause back pain. In fact I had it a recent attack of it and initially myself thought it was a back problem. Probably the patient in question, who had a history of back problems, thought the same, and this may have influenced the type of specialist he consulted. And since he has a history if degenerative spine disease, quite likely his Xray was consistent with dgeenration or prolapse of a disk. (MRI was not yet done, see OP).

However, there are huge leaps between someone having back pain and (1) assuming it is due to a herniated disk -especially without yet having an MRI; even if the source of pain is in the back, there are many other possibilities; and (2) recommending surgery (as mentioned before, not usually indicated even when pain is due to pressure from a herniated disc), if in fact surgery was clearly recommended as opposed to mentioned as a possibility (that part I cannot really determine from the OP. Hard to imagine it would be definitely recommended prior to MRI).

Although both neurosurgeons and orthopedic surgeons can do spinal surgery, in my experience orthopedic surgeons who specialize in spinal problems have the edge on differerentiating between types of back pain and knowing when surgery is indicated. The spinal specialist I use and recommend to others, will often have people considering surgery first undergo nerve conduction studies just to be certain that the pain experienced is really from the cause proposed for surgical correction -- because it isn't always so. You can have back pain and a herniated disk or other spinal pathology without the two things necessarily being connected. Lots of asymptomatic people have degenerative disk disease.

Of course in this specific instance, since the cause was actually shingles, a GP might have been more likely to arrive at the true diagnosis than either a neurosurgeon or an orthopod specializing in spine. Specialists tend to have tunnel vision and to look for causes related to their area of specialization, especially in someone with a prior history of related pathology.