International diagnosis for sciatica

[BadCash]

I have been dealing with sciatica for six weeks and it's not getting better despite physical therapy at Bangkok hospital. I'm planning to stay in Thailand for 6 months.

 

Two Thai doctors (BNH and Bangkok hospital) have recommended surgery due to the weakness in my big toe in the affected leg.

 

My insurance company in Sweden says that I need to go to Sweden to get a diagnosis from a Swedish doctor as to wether an operation is necessary. The reason seems to be that they don't "trust" the Thai doctors and think they are too eager to do surgery, where as in Sweden they are more conservative.

 

I find it hard to believe that something as common as sciatica and leg/foot weakness doesn't have s standardized international scale and diagnosis... My fear is that I go to Sweden, they make their own diagnosis and conclude that I don't need surgery - hence the whole trip there was unnecessary. Or that I have to wait a long time for surgery, a procedure that seems to be rather quick and commonly performed, and available the next day here...

 

Does anyone have any experience with something like this? Are there any Swedish doctors that can make a "Swedish" diagnosis in Thailand? Or is it just impossible to avoid going home for diagnosis and a possible long wait for an operation in these cases?

Edited November 23, 2016 by BadCash

[Sheryl]

Sciatica and  weakness in the leg/feet toes are not a diagnosis. They are symptoms, for which there is more than one possible cause. Some of these causes will resolve with time and conservative management, some will not.

 

Whether or not surgery is indicated depends on the cause.  This in turn has to be diagnosed through a combination of imaging studies (Xray, MRI etc) and physical exam conducted by an experienced orthopedic surgeon specializing in spinal problems. Nerve conduction studies may also be helpful in determining the cause of the pain. One of the difficulties is that there can be problems found on MRI in the lower spine in someone with these symptoms without the problem seen necessarily being the cause of the pain -- many people have some degeneration of the intravertebral discs and/or prolapsed discs and yet are perfectly aymptomatic, for example, so finding that does not necessarily mean it is the cause of the pain. It takes a very experienced spinal specialist to sort this out. In other words, this is not a simple or clear cut matter, and it is not uncommon for someone to have surgery that corrects what was assumed to be the cause, only to still have the pain. Having the aforementioned nerve conduction studies, while an expense, can help reduce the risk of that happening.

 

It is not unusual for insurance companies to require a second opinion for back surgeries, precisely for the reasons above.  Yours apparently requires that this be from a doctor in Sweden.

 

I don't know of any doctors in Thailand who are licensed to practice in Sweden, possible there are one or two somewhere, but there will certainly not be one who is a spine specialist.

 

So it does sound like you will have to go back to Sweden, unless you can persuade your insurance company to accept a doctor's opinion obtained long distance, e.g. by sending him your films and medical reports. (If they do allow that, be sure the Thai  doctors  know that needs to make the report very detailed and clear as to why surgery is considered necessary - and get that from both doctors you saw, so that there will be two sets of medical exam reports and conclusions along with the images. Medical reports/records in Thailand tend to be terse in the extreme.).

 

If you do have to go back to Sweden to get another opinion, and the  doctor there concurs with the recommendation for surgery, would it not be possible to then go back to Thailand for the surgery? Thereby removing the wait list issue.

 

The bigger risk is that once in Sweden, even though you had a course of physical therapy already in Thailand, they might insist you do it at a Swedish hospital which would entail weeks. . Also need to be sure you can select the specialist and that it is not one selected/employed by the insurance company.

 

Aside from the question of whether surgery is necessary there is the question of what type of surgical approach. There are some newer and less invasive approaches suitable to some types of spinal problems and these might be mopre readily available in Sweden. Would help to know exactly what procedure was recommended here.

[Bonobojt]

avoid surgery and find a Gonstead Chiropractor and get x rays, I put a video link on this post to show you what I mean, it will possibly save you a lot of money, a lot of people regret having back surgeries 

 

[Sheryl]

I would caution against chiropracty without first getting an opinion from your ortho doctor of what types of manipulation are safe given your specific condition. Otherwise could well make matters worse.  In some cases it can cause very serious complications indeed, e.g. in people with significant osteoporosis it can fracture vertebra.

 

Paralysis due to chiropracter error is not unknown.

[samuijimmy]

As one who has had a sciatica problem on and off for over a year.... There is no easy solution... Surgery is not necessarily going to solve the problem... I have had one Thai specialist tell me that plus to Doctors from Europe who I happen to know. There is  no guarantee surgery will work!

 

I've tried the chiropractic a few times, it has not help as in the above video ^. Therapy at local hospital  helps to a point....but never seems to be long term.

 

Two things that have helped me the most are the simplest things:

 

This was recommended by an American retired Physiotherapist : 

 

Float feet down in water, with weights around ankles....(Big C has in sporting dept, I use three sets on both legs) with an motorbike inner tube inflated and under the arms.... float for at least 15 minutes  or longer, with feet not touching surface! Water needs to be deeper than you!  Whether in the sea or a swimming pool! It looks silly but is does seem to help!

 

Method two: Someone showed me this just a few days ago.... Sit down on a chair. Cross leg on the side where there is pain over the other leg. Then stretch the arm above head and hold twisting your head and upper body to follow your raised hand... for at least 30 seconds or longer .... found this to give an almost instant relief of pain!  and ability to walk without constant pain!

 

It's really a case of trying and seeing what works...Good luck!

 

[michemiche]

It happen to me to have real pain with sciatica.
Of friend of mine send me this video, and it have been a great help, to heal and also to prevent future crisis.
Sciatica

[Sheryl]

Again, sciatica is a symptom, not a disease or diagnosis. Treatment has to consider the underlying cause.  What will work for one case will not necessarily be appripriate to another.

[BadCash]

On 11/27/2016 at 9:34 AM, samuijimmy said:

As one who has had a sciatica problem on and off for over a year.... There is no easy solution... Surgery is not necessarily going to solve the problem... I have had one Thai specialist tell me that plus to Doctors from Europe who I happen to know. There is  no guarantee surgery will work!

 

I've tried the chiropractic a few times, it has not help as in the above video ^. Therapy at local hospital  helps to a point....but never seems to be long term.

 

Two things that have helped me the most are the simplest things:

 

This was recommended by an American retired Physiotherapist : 

 

Float feet down in water, with weights around ankles....(Big C has in sporting dept, I use three sets on both legs) with an motorbike inner tube inflated and under the arms.... float for at least 15 minutes  or longer, with feet not touching surface! Water needs to be deeper than you!  Whether in the sea or a swimming pool! It looks silly but is does seem to help!

 

Method two: Someone showed me this just a few days ago.... Sit down on a chair. Cross leg on the side where there is pain over the other leg. Then stretch the arm above head and hold twisting your head and upper body to follow your raised hand... for at least 30 seconds or longer .... found this to give an almost instant relief of pain!  and ability to walk without constant pain!

 

It's really a case of trying and seeing what works...Good luck!

 

 

Interesting, it sounds like method 1 is similar to the pelvis traction done in physiotherapy, and method 2 is some kind of variant of the piriformis stretch I do. About method 2 - which hand should be raised and in what direction should the upper body be bent?