I sent this privately in response to molarface, but thought it might add some new insights into my quest for answers. Hopefully, it provokes a response or triggers some deep-seeded knowledge in somebody! Thanks for all the responses so far - this is exactly why I love forums like these! Without further ado, here's the (slightly modified) version:
Quote:
"I appreciate the reference [to a DonTigny sacroiliac joint dysfunction article], but I do not believe my problem is SIJD. For one, the worst of my back pain is right at L4-L5, as can be confirmed by pressing on the area. That is, if you press on the left side of the spinal disc at that level with your fingers using acute and specific pressure, it is incredibly sore and painful. Also, I have numbness in the medial aspect of my lower leg, which as far as I know means there is likely either sciatic or deep/superficial peroneal nerve compression, although if it's at the peroneal level, it would have to be a hell of a pinch to cause pain all the way back up to the spine. Every doctor I've seen says that they believe the back pain and the leg numbness to be unrelated, but I'm not buying it. If you have aching and stabbing pain at a disc that an MRI's shows has degenerated and is bulging, and pain that radiates from that pinpoint location down into your rear, thigh, medial aspect of the lower leg, and foot, then there are only so many correlations you can reasonably establish. I still believe that if it looks and smells like a rat, it's probably a rat, unless someone can provide knowledge that figuratively de-masks the gerbil under the rat suit.
I've been through too many doctors in the past 5 years with this and my TOS that knew less than I did about the problems I'm facing. Not because they're not intelligent; to become a doctor certainly requires a fair bit of smarts and intuition. Instead, I believe this phenomenon has two distinctly separate and unique causes: the first is that I spend all my time researching these very granular topics, where they focus on a wider gamut of issues at the perceived cost of having a more shallow depth of understanding of each. In the grand scheme of things, 90% of what they see can be explained with that level of understanding... it's just that I always seem to fall in that other category, the 10% margin. The second is, as the article you linked describes, the self-righteous-egotistical-lack-of-humility-I-know-it-already-so-I-don't-need-to-learn-it-again attitude of many practitioners. I wish it weren't so, but I Know from experience that this mindset is incredibly pervasive throughout many different specialist/sub-specialist practices. If they could get over themselves and open their minds to secondary and tertiary perspectives, patients would undoubtedly benefit, and knowledge would spread infectiously, instead of at the muted pace it does now.
I don't claim to know it all, or to be smarter than my doctors, or even to have a more comprehensive understanding of my specific issues than they do. But I do claim to have an open mind and an unbridled, voracious appetite for understanding the medical literature I've researched as it relates to understanding my problems, and believe that many of my theories and suppositions I posit are either valid or relevant given the medical evidence. I just wish that I could get more than "it's not what you said, but I don't know either, and having no opinion is better than having a wrong opinion," which is not (in my mind, anyways) a valid argument in any interpretation. I'm not so presumptuous as to believe that I'm owed a concrete diagnosis, but I do believe that they should earn their pay by keeping their knowledge current and offering alternative suggestions to my own. Pressing for answers is my duty as an educated patient who's sick of being broken, because nobody else is going to advocate as tirelessly for me as I will for myself.
So again, thank you VERY much for offering an alternative - I'd rather pay you my co-pay than the doctors I've seen so far! It might not be right, but then again it might be - I'm only human, and press forward in one direction until it dead-ends and I'm forced to go in another. I'll do a bit more research on the topic, just to see if SIJD could affect the sciatic nerve or present with the symptoms I've got, but as I understand it, that's not very likely, so I'm doubtful that it's the cause of my problems. I am open to an explanation as to why I'm wrong though - I'd love to be wrong if it means finding out what's right! I still think the degenerated/bulging disc is causing pressure on the sciatic nerve or sciatic nerve roots, or perhaps an outside chance that it's the piriformis muscle or some other soft tissue that's constricting the sciatic nerve on its way down. Perhaps it's even double-crush syndrome at the spine+knee/piriformis+knee (where the peroneal nerve surfaces on the rear/medial side of the knee), or spine+piriformis. Maybe it's weak core muscles causing muscles in the back around the spine to tighten and constrict things. I'm honestly not sure yet - but I'm definitely open to further suggestion and education if you've got it! Thanks!"
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10-05-2010, 10:35 AM
getting back to my old self more and more every week!
