Radiology - Acute to chronic pain

Author

Acute to chronic pain - what to do?

Bob Travis

2006-01-08, 11:39 am

My wife has had bilateral pains beneath her breasts since September 2005.
She has been to a family practice doctor and the emergency room. Neither
were able to come up with a definitive diagnosis and all they have done for
her is put her on Vicodin 7.5 mg and she only takes it when she doesn't have
to drive or do anything that requires her to be alert.

A chest X-ray did not reveal anytning abnormal - no broken or cracked ribs.

I am just wondering what I can do to help. I looked on the Internet and
couldn't begin to figure it out. Finally, today, I was at the local medical
library photocopying some articles for a lawyer friend I sometimes do
research for and I decided to see what was available there on pain diagnosis
and management.

I was amazed at how many books there are on the subject and I could not help
but wonder, with so much having been written on the subjects of acute and
chronic pain, why are her doctors taking their sweet old time trying to get
to the bottom of this? In fact, I told my wife today, I bet if you were
Madonna or President Bush they would have had an answer for you within two
weeks. Do doctors just enjoy watching "the little people" suffer?

I decided to take it upon myself to see what I could find. I thought maybe
if I study all of the possibilities I may be able to think of something her
doctor did not consider but which Madonna's doctors or President Bush's
doctors probably would have considered.

I checked a couple of books out before I left the med library. I checked out
a 1993 book called "Differential Diagnosis of Acute Pain (By Body Region)"
by Stanley L Wiener. I also checked out a book from 2000, the 3rd edition of
"Practical Management of Pain," edited by P. Prithvi Raj, et. al.

Given my very limited medical expertise all these books tell me are:

1.) There are many many possible causes of bilateral chest pain, and
2.) There are many possible treatments.

All I want to know is why her doctors don't read books like these, see how
many dozens of possibilities there are, and administer the apporopriate
tests to exclude the unlikely and include the possible. If a lay person like
myself can make a little sense of the knowledge imparted by these books, and
others like them, anyone with a real medical degree should have little
trouble at all muddling through them to figure out the cause of her pain.
They have billed her Medicare over $700 in the past three months, How much
money is required to get definitive answers, or if not definitive answers at
least an end to the constant pain -- acute pain at first but since it has
been going on for over three months now it is on its way toward becoming
chronic.

All I really would to know is what kind of doctor should I take her to? Her
family practice doctor administers about one new test every three weeks and
that is only if I suggest it. She has not come up with anything on her own
and she graduated med school in 2001 which is practically plenty of time to
become acquainted with the many syndromes which cause pain. She is a very
sweet person but her sweetness isn't helping my wife's pain any.We are
getting impatient, but because we do not have Madonna's money or President's
Bush's influence we feel like we are being treated like second class
citizens, or worse; almost as if we don't really matter at all. I am
wondering what I can do to help my wife and what our next step should be.

Pseudonym used to avoid excessive spam but I gave a genuine email address
and I will certainly answer anyone who has any helpful advice for us.

Thanks,

"Bob"

Cindy

2006-01-08, 11:39 am

Bob Travis wrote:
> My wife has had bilateral pains beneath her breasts since September 2005.

Does it mean the pain area posterior to the breasts or inferior to the
breasts? Which means behind the breasts or below the breasts. Depends
on the area, there are lungs, diaphragm, liver+gallbladder, (could be)
stomach and C-loop+pacreas.

> She has been to a family practice doctor and the emergency room. Neither
> were able to come up with a definitive diagnosis and all they have done for
> her is put her on Vicodin 7.5 mg and she only takes it when she doesn't have
> to drive or do anything that requires her to be alert.
>
> A chest X-ray did not reveal anytning abnormal - no broken or cracked ribs.

Did you read the radiologist's report?

> I am just wondering what I can do to help. I looked on the Internet and
> couldn't begin to figure it out. Finally, today, I was at the local medical
> library photocopying some articles for a lawyer friend I sometimes do
> research for and I decided to see what was available there on pain diagnosis
> and management.
>
> I was amazed at how many books there are on the subject and I could not help
> but wonder, with so much having been written on the subjects of acute and
> chronic pain, why are her doctors taking their sweet old time trying to get
> to the bottom of this?

Because doctors don't want to misdiagnose any patient's disease. If
there is a possibility of complication, how can you pick one diagnosis?
You know malpractice law suits are killing the doctors in this country.

> In fact, I told my wife today, I bet if you were
> Madonna or President Bush they would have had an answer for you within two
> weeks. Do doctors just enjoy watching "the little people" suffer?

In order to take the best decision for the patient, they have to study
the patient's family history, patient's health history, x-rays and other
images, blood test results, urine test, vital signs, EKG and so on.

How did all those test results come out on your wife? Did they tell
you? Did you ask? Just one blood test can tell you many many things
going on a patient's system.

> I decided to take it upon myself to see what I could find. I thought maybe
> if I study all of the possibilities I may be able to think of something her
> doctor did not consider but which Madonna's doctors or President Bush's
> doctors probably would have considered.

It's not easy as you think.

> I checked a couple of books out before I left the med library. I checked out
> a 1993 book called "Differential Diagnosis of Acute Pain (By Body Region)"
> by Stanley L Wiener.

I think the publication is rather old. Is the writer an MD? What
specialist? How long has he been a doctor? Maybe is he a professor?

> I also checked out a book from 2000, the 3rd edition of
> "Practical Management of Pain," edited by P. Prithvi Raj, et. al.
>
> Given my very limited medical expertise all these books tell me are:
>
> 1.) There are many many possible causes of bilateral chest pain, and
> 2.) There are many possible treatments.
>
> All I want to know is why her doctors don't read books like these, see how
> many dozens of possibilities there are, and administer the apporopriate
> tests to exclude the unlikely and include the possible. If a lay person like
> myself can make a little sense of the knowledge imparted by these books, and
> others like them, anyone with a real medical degree should have little
> trouble at all muddling through them to figure out the cause of her pain.
> They have billed her Medicare over $700 in the past three months, How much
> money is required to get definitive answers, or if not definitive answers at
> least an end to the constant pain -- acute pain at first but since it has
> been going on for over three months now it is on its way toward becoming
> chronic.

Dose she smoke? How is her blood pressure? Is she breathing OK?

> All I really would to know is what kind of doctor should I take her to? Her
> family practice doctor administers about one new test every three weeks and
> that is only if I suggest it. She has not come up with anything on her own
> and she graduated med school in 2001 which is practically plenty of time to
> become acquainted with the many syndromes which cause pain. She is a very
> sweet person but her sweetness isn't helping my wife's pain any.We are
> getting impatient, but because we do not have Madonna's money or President's
> Bush's influence we feel like we are being treated like second class
> citizens, or worse; almost as if we don't really matter at all. I am
> wondering what I can do to help my wife and what our next step should be.

You got to make an appointment with the doctor. she and you should sit
down and go over with your wife's history. Ask anything you don't
understand. Don't leave her room until properly explained. You have
the right to do this. It's a law.