Chronic Pain

Eomer

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But that's not all, because PT's cannot see patients off the street, they require a referral from a doctor
Seriously? That's fucking moronic. I used to need my GP's referral to claim for the PT cost through Blue Cross, but they got rid of that too. And even before then, there's nothing stopping someone from going straight to a physical therapist if they didn't need the referral for claims purposes.

When I bang myself up with a soft tissue injury, there's virtually zero reason to see my GP first. He's just going to check for anything broken and then send me off to a PT. I know shit's not broken, so why bother? I just head straight to the PT for a couple sessions and to be told what exercises or stretches I need to do to get things back to normal.
 

Vanderhoof

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Seriously? That's fucking moronic. I used to need my GP's referral to claim for the PT cost through Blue Cross, but they got rid of that too. And even before then, there's nothing stopping someone from going straight to a physical therapist if they didn't need the referral for claims purposes.

When I bang myself up with a soft tissue injury, there's virtually zero reason to see my GP first. He's just going to check for anything broken and then send me off to a PT. I know shit's not broken, so why bother? I just head straight to the PT for a couple sessions and to be told what exercises or stretches I need to do to get things back to normal.
In my experience, I've had what I thought were severe ankle sprains end up being broken bones or torn ligaments. If you think PT is warranted for an injury, you're better off seeing your friendly, neighborhood nurse practitioner (or a physician, I guess) to rule out more serious injuries. Most people don't know dick about knowing what is wrong with them and people would be showing up for PT for all sorts of dipshit reasons.
 

Azrayne

Irenicus did nothing wrong
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Holy shit. The OP doesn't have TMJ, did you not read what he wrote?

And how fucking ignorant are some of you to sit there and admit that you don't have a shred of professional training or even an ounce of knowledge, and yet sit there and argue with someone who does and suggest ways to treat conditions in which you know absolutely nothing about? And at that you can't even read the original post and see which condition you are offering useless treatment ideas for...

Let's do a little math here. According to Google there are over 300,000,000 people in the U.S. Let's say 1 in 300 end up at a useless physical therapy visit because some ignorant person on the internet suggested it. We'll estimate a cost of $150 for a "new patient" visit at physical therapy. But that's not all, because PT's cannot see patients off the street, they require a referral from a doctor, so that means the patient has to have a doctor's appointment first, but for the sake of simplicity we will ignore those costs. So we have 1,000,000 people all wasting $150, that comes out to $150,000,000 spent because "we should be open minded." Now who bears the cost of that? We all do - by our insurance premium costs. Or if you're Medicaid, the we all bear it too by paying taxes. That's horribly inefficient for something that is simply not indicated. That's just poorly practiced and inefficient medicine.

A lot of screening and treatment decisions for medicine is made in this way. What's the overall cost of something, and does it add enough information or clinical relevance to be worth the cost? (And things are only going to get worse thanks to a certain someone.)
Ok I think you and I have a very different idea of what PT entails, maybe it's different in the US. Here you just call up and make an appointment, you in go in, they do their thing, you pay $40 - $80ish depending on the clinic, and make another appointment if you want. If it really is $150 (which is more, relatively speaking, than $150 would be over here, as I understand it, given things like cost of living and minimum wage) over there and requires a referral on top of that then yeah, that can get fucked. Man your system is fucked up over there.
 

Aychamo BanBan

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Ok I think you and I have a very different idea of what PT entails, maybe it's different in the US. Here you just call up and make an appointment, you in go in, they do their thing, you pay $40 - $80ish depending on the clinic, and make another appointment if you want. If it really is $150 (which is more, relatively speaking, than $150 would be over here, as I understand it, given things like cost of living and minimum wage) over there and requires a referral on top of that then yeah, that can get fucked. Man your system is fucked up over there.
How you schedule an appointment is irrelevant. I know exactly what physical therapy entails.
 

Azrayne

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Either way, we've probably shat up Saladus' thread quite enough already. Don't think there's much left to say in this particular exchange.
 

Eomer

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In my experience, I've had what I thought were severe ankle sprains end up being broken bones or torn ligaments. If you think PT is warranted for an injury, you're better off seeing your friendly, neighborhood nurse practitioner (or a physician, I guess) to rule out more serious injuries. Most people don't know dick about knowing what is wrong with them and people would be showing up for PT for all sorts of dipshit reasons.
And the PT would know right off the bat that something else was wrong and send you to a GP if needed, who could then get X-rays or an MRI done, send you to a specialist or whatever. In terms of backups, at least in the Canadian medical system, it's far more on the GP side of things as PT is for the most part done privately and in much higher supply. Therefore overall for the system it makes the most sense to go to a PT for suspected soft tissue injuries first IMO. And for the individual, other than the cost of the PT appointment (which most people have some sort of private insurance coverage for), it's a matter of booking an appointment and showing up, generally the same or next day. On the other hand, something like 30% of Canadians don't bother to have a regular GP, in which case they have to go to a non-emergency clinic where they'll often have to wait 4-6 hours to see a GP. Or better yet, the emergency room where the wait will be at least as long if not significantly longer and they'll incur far more cost to the healthcare system.
 

a_skeleton_04

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I have been on the diagnosis merry-go-round myself for a number of years but recently have gotten release from the pain. I had daily headaches like the first kind you describe for years increasing in severity last few years to migraines/cluster headaches depending on what doctor I went to and what terminology they used. I had several types with several features and onsets. And yea, I know what you mean about researching seeing all the fucked up shit others go through and wondering what the hell is really wrong with you, and if you are ever going to get any relief.

For me it was a mix of things - two of which Aychamo mentioned in his large post - Pregbalin and Topirimate. I was on Pregbalin first for my body pain (I have fibromyalgia also) and then later I started taking Topirimate in hopes to get the headaches under control and got immediate benefits. It's been a wonderdrug for me, and it very well be the mix of the two. I feel like the birds are singing and sun is shining in the morning. No, they don't make me high - I was in *that* much pain before, and now it's gone. Anyone who even tangentially knows me over the last year has noticed a vast difference. Pain fucks with everything. Mental clarity, mood, energy, sleep - everything. It's too high of a toll.

Regarding the rest. I do meditate and go to physical therapy (various kinds) at the behest of my Rhuematologist and my Neurologist who is old enough to be my grandpa and is the head and former head of a neurology practice here. While we rode the drug cycle of trying things until we found ones that worked for my particular head pains -- everyone wanted me doing that supportive care both before/after/during because stress doesn't help anyone and there is thought that it helps.

Now the drugs which I started taking earlier this year at the time did like 99% of my pain relief -- but as I get stronger and better I'm finding out my muscles are all messed up from literally being hunched over avoiding pain in my neck (sometimes in my sleep). I'm working to correct that now with physical therapy. So now the drugs which are working in the background allow me to do more things with my health, like physical therapy which is providing me greater pain relief so much so that its possible that maybe I won't always need drugs or I wont need to increase my doses as quickly.
 

Vanderhoof

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Again, in my experience, the more cockblocks to specialty services, the better. When I was doing a rotation in family practice, we had people coming in for some of the dumbest shit imaginable. People would come into the office with the sniffles and be furious when I wouldn't prescribe them antibiotics (in the cases where they weren't indicated). If people were allowed to go to schedule appointments for whatever services they wanted whenever they wanted, costs would spiral out of control.
 

Aychamo BanBan

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Again, in my experience, the more cockblocks to specialty services, the better. When I was doing a rotation in family practice, we had people coming in for some of the dumbest shit imaginable. People would come into the office with the sniffles and be furious when I wouldn't prescribe them antibiotics (in the cases where they weren't indicated). If people were allowed to go to schedule appointments for whatever services they wanted whenever they wanted, costs would spiral out of control.
Haha
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Are you in a NP program? Yeah, I pretty much agree with you. Some of the complaints I get are so ridiculous "Well, my arm hurts sometimes when I do this (weird contortion), but it's only hurt twice in the last 6 months, and both times it lasted about 4 minutes. What is it? Do I need to see an orthopedist?" Regarding abx, I usually explain why they either need them or don't need them ("absolutely not indicated for this!"). But I'm a little more liberal for ped patients with a sore throat, of course depending on their insurance (for anyone reading, good insurace will pay for a rapid strep test to find out if the patient has strep throat caused by group a strep, and you can know right then if they have it, but medicaid will not pay for that - interestingly, there are other strep and other bacteria that cause bacterial pharyngitis not idientified by the rapid strep test), and especially with the modified centor criteria and the fact that medicaid will not pay for a rapid strep test. If they get at least 2 centor then I'll start them on amox (pediatrics) and swab their throat, and call them with the results and tell them to stop them if the culture is negative. Sometimes I'll just go ahead and start them and not bother with the swab, bc of course the sequelae of a missed strep throat are so bad.

Haha, we have this schizophrenic that comes into my ER sometimes with the funniest nonsense complaints, but they're actually just weirdly coded complaints. I completely missed them at first until a colleague told me about his history. He'll say "I was pooping in a port-o-potty and a crab came up and bit me." Which to him meant that he was scared he had pubic lice. Or one was something like "I slept with a yellow lady and now I have cancer." Which to him meant he slept with some prostitute with cirrhosis and was scared he caught cancer from her (that was an easier one.) Or "I have this pain that starts in my stomach, and comes up through my chest and then pops." Anxiety.
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Vanderhoof

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I'm finishing a Psychiatric NP program in a few months. My favorite patient with schizophrenia constantly has a sodium in the one hundred teens because he is always thirsty because he refuses to take anything besides Stellazine. We can lock him up in a secured area and he will drink out of the toliet.

To the OP: gl with the neurologists. I imagine they will have an answer for you
 

Anemone_sl

shitlord
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I really might just be crazy, but does this bother anyone else? I've had hearing tests done and rank in the normal range, but the constant ringing in my ears really bothers me. It's not really something you notice when you're focused on listening to something, but when everything is quiet it's always right there. I imagine it to be hearing loss of some sort, and get to be kind of neurotic about it.
 

a_skeleton_04

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The other things regarding coping while they figure out your treatment. They told me but I didn't do far enough of:
Warm/hot baths
Ice compresses
Heat compresses

When the pain became unbearable these last few years, I now own tons of ice packs/gel packs of all shapes and sizes so I have them ready for various body parts, and heat for the same. It's also basic but yes you need to alternate them so you don't get accustomed to the level of heat/ice or burn yourself.

Now all that stuff stays in a chest in the closet and rarely gets used. Except my large heating pad, maybe once a month things will hurt and I'll need it on my shoulders.

As far as the whole 'getting up out of bed thing'. Luckily or unluckily I got laid of a few times and my migraines (even if I beared through them and stayed at work - I'm just not optimal and no one can wipe that much pain off your face) likely played a large part in me getting let go when times got tough at my companies. But I used this time to lay around the house for a week or two, get up when I felt like it, then go see the doctor(s). Then there are other weeks I'm all about 'getting exercise and eating right', but can't beat up on yourself when you have something like this. You aren't gonna be perfect, you can't work 90 hours a week etc.

Fits and spurts. That's all I can tell you. The layoffs and my moving around (I have seen many many different doctors over the years) impeded me getting faster diagnos(es) but I did too. In the earlier years, EQ1 time - I'd just "go to bed early" anyone who raided with me can tell you no amount of raids ended cause I was leaving the raid for the night. I'd tell myself that everyone gets tired at different rates....

What I woulda told dumbass me from back then if I could go back and talk to me is, GO TO THE DOCTOR MORE. Sure I went, even went to a really good gastro specialist, but I didn't *press my case*. That didn't start til shit hit the fan and now I have less resources than I did back then with my Cadillac healthcare working at one of the worlds largest companies and flexible leave and work schedule.

Sure I ran into idiot doctors, or mediocre ones - or just maybe folks who are more attuned to a different part of medicine than what I have, but eventually I found fantastic docs, with great bedside manner. It's just like people at work or finding friends -- you are gonna meet some bad ones unless you are really lucky.

I've had a doc totally focus on high blood pressure (it's familial both sides) when I came in for nose bleeds/migraines from the ER and not get off of the subject til I left his practice. He also walks around in full mask and gloves for cold season. Just not the right doc for me. Maybe for someone, but not me.
 

Cheap Cigar_sl

shitlord
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So then post it in that thread? jfc
This and I was wondering if at any of the other forums you belong to or visit gives prizes for the amount of threads you create. See that box in the upper right hand portion of your page labelled search? Put a word that you think of starting a thread about. If it takes you to a thread that mentions or talks about it do not make a new thread.
 

Anemone_sl

shitlord
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Complaining about the number of threads made on a message board seems kind of counterintuitive to me, but whatever. And while tinnitus is similar to chronic pain in that it's a very bothersome thing, this discussion really doesn't belong in that thread.

Can't we just stay on topic in the grown up forum?
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Anemone_sl

shitlord
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I'm sure someone is going to come along and recommend physical therapy for you.
That's interesting, up until now I had no idea that physical therapy could help with the issue. Just googled it and it looks like it really may help.

Maybe sometime when I'm not a poor college student I'll get some :p