My Knee!!! (1 Viewer)

[Terminalxylem]

Just got the estimate for my hamstring repair, a same day surgery: $55K

Before insurance I hope.

That's what insurance pays for the procedure, which on the surface seems ridiculous. My copay is 0, though I know I'll receive professional bills from the orthopod and anesthesia, at the minimum.

 

[JohnnyU]

Don’t bug me man, just put a band-aid on it.

 

[Long Ball Larry]

Just got the estimate for my hamstring repair, a same day surgery: $55K

I've been pretty hard on my body my entire life. The injury page is deep. My hamstring tear was by far my most painful. Just brutal

and NFL fans howl when players on their team don't come back to play after a torn hamstring in 4 weeks

But my fantasy team needs those 6.5 points so I can win my big money league.

 

[B Maverick]

GET THE MRI!!!!

My first knee surgery, the DR was convinced it was just the meniscus, scheduled surgery and found the ACL was torn. Had to go back in a month later to get that fixed. All because he didn't do an MRI. He also didn't do PT before surgery and the PT after was just weight training. Knee has never been the same.

10 or so years later, did the other knee. Used a different Dr. MRI showed what was wrong, PT/Surgery/PT and no issues.

Anyway, just my suggestion. Knee injuries are not the end of the world. Meniscus, ACL, MCL, LCL can all be repaired and get you back to normal. GOOD LUCK!

Wtf? Surgery without any imaging? That’s beyond odd.

I had that when I tore my achilles. Doctor felt and did a couple other tests and said it was a compete rupture and an MRI wasn't needed and a waste of money. Had surgery the next day.

Yeah, this happens. If anything, far too many imaging tests are performed. The classic one is MRI for low back pain.

I’m saying this as someone who just had X-rays, CT, and MRI performed in a single visit. And no, I don’t think all were indicated.

There are appropriate times for each scan for sure. I was having pain in my back and visited several specialists (Primary, Surgeon, GI, Pain Management) after hitting urgent care and the ER. Wasn't until the pain management dr sent me for an MRI did they find an infection in my spine. Wish the ER had done a scan would have saved me a few weeks of pain.

 

[Terminalxylem]

GET THE MRI!!!!

My first knee surgery, the DR was convinced it was just the meniscus, scheduled surgery and found the ACL was torn. Had to go back in a month later to get that fixed. All because he didn't do an MRI. He also didn't do PT before surgery and the PT after was just weight training. Knee has never been the same.

10 or so years later, did the other knee. Used a different Dr. MRI showed what was wrong, PT/Surgery/PT and no issues.

Anyway, just my suggestion. Knee injuries are not the end of the world. Meniscus, ACL, MCL, LCL can all be repaired and get you back to normal. GOOD LUCK!

Wtf? Surgery without any imaging? That’s beyond odd.

I had that when I tore my achilles. Doctor felt and did a couple other tests and said it was a compete rupture and an MRI wasn't needed and a waste of money. Had surgery the next day.

Yeah, this happens. If anything, far too many imaging tests are performed. The classic one is MRI for low back pain.

I’m saying this as someone who just had X-rays, CT, and MRI performed in a single visit. And no, I don’t think all were indicated.

There are appropriate times for each scan for sure. I was having pain in my back and visited several specialists (Primary, Surgeon, GI, Pain Management) after hitting urgent care and the ER. Wasn't until the pain management dr sent me for an MRI did they find an infection in my spine. Wish the ER had done a scan would have saved me a few weeks of pain.

Yeah, there are “red flag” signs/symptoms which are supposed to prompt advanced imagery. Fever is one of those, as is duration greater than 6 weeks.

On the flip side, unnecessary imagery/labs can lead to downstream testing based on incidental, ultimately inconsequential findings. Sometimes that testing includes invasive procedures (eg. biopsy) which have associated complication rates. Impotence following prostate biopsy is a good example.

Spine MRIs in particular are prone to have abnormalities (eg. bad disks, arthritis, mild spinal canal narrowing), especially among older adults. The vast majority of the time, absent relevant clinical findings like weakness, loss of bladder control, etc., the treatment is almost always PT and pain control.

In your case, it’s unfortunate multiple doctors missed the diagnosis. It’s certainly possible they all screwed the pooch, but I’d wager the evolution of your symptoms, including duration, was what ultimately warranted MRI.

 

[fatness]

On the flip side, unnecessary imagery/labs can lead to downstream testing based on incidental, ultimately inconsequential findings. Sometimes that testing includes invasive procedures (eg. biopsy) which have associated complication rates. Impotence following prostate biopsy is a good example.

Well, on the other hand those labs can lead to discovery of a condition not visible on an Xray to experienced health professionals. The tests take time and expertise and cost somebody some money, yes. That's one kind of cost. Non-discovery of a condition not diagnosed on an Xray, and the subsequent harm that condition has or will have, is another kind of cost.

We of course can't test everyone for everything. Nor can we send away everyone with a possible need for a test due to cost. But there's really another decision being made in whether a test should be performed or not. I say performed, not "indicated". The choice is to err on the side of less work, or to err on the side of more benefit to the patient.

I'm not in any way meaning that as any criticism of you personally or the help you provide here. You're great. I'm just not so much in agreement with saying the "treatment wasn't warranted" because health insurance companies and their subs do this every day to deny service, and their motives are not people-driven.

 

[DA RAIDERS]

GET THE MRI!!!!

My first knee surgery, the DR was convinced it was just the meniscus, scheduled surgery and found the ACL was torn. Had to go back in a month later to get that fixed. All because he didn't do an MRI. He also didn't do PT before surgery and the PT after was just weight training. Knee has never been the same.

10 or so years later, did the other knee. Used a different Dr. MRI showed what was wrong, PT/Surgery/PT and no issues.

Anyway, just my suggestion. Knee injuries are not the end of the world. Meniscus, ACL, MCL, LCL can all be repaired and get you back to normal. GOOD LUCK!

Wtf? Surgery without any imaging? That’s beyond odd.

I had that when I tore my achilles. Doctor felt and did a couple other tests and said it was a compete rupture and an MRI wasn't needed and a waste of money. Had surgery the next day.

Yeah, this happens. If anything, far too many imaging tests are performed. The classic one is MRI for low back pain.

I’m saying this as someone who just had X-rays, CT, and MRI performed in a single visit. And no, I don’t think all were indicated.

There are appropriate times for each scan for sure. I was having pain in my back and visited several specialists (Primary, Surgeon, GI, Pain Management) after hitting urgent care and the ER. Wasn't until the pain management dr sent me for an MRI did they find an infection in my spine. Wish the ER had done a scan would have saved me a few weeks of pain.

Yeah, there are “red flag” signs/symptoms which are supposed to prompt advanced imagery. Fever is one of those, as is duration greater than 6 weeks.

On the flip side, unnecessary imagery/labs can lead to downstream testing based on incidental, ultimately inconsequential findings. Sometimes that testing includes invasive procedures (eg. biopsy) which have associated complication rates. Impotence following prostate biopsy is a good example.

Spine MRIs in particular are prone to have abnormalities (eg. bad disks, arthritis, mild spinal canal narrowing), especially among older adults. The vast majority of the time, absent relevant clinical findings like weakness, loss of bladder control, etc., the treatment is almost always PT and pain control.

In your case, it’s unfortunate multiple doctors missed the diagnosis. It’s certainly possible they all screwed the pooch, but I’d wager the evolution of your symptoms, including duration, was what ultimately warranted MRI.

 

[Terminalxylem]

On the flip side, unnecessary imagery/labs can lead to downstream testing based on incidental, ultimately inconsequential findings. Sometimes that testing includes invasive procedures (eg. biopsy) which have associated complication rates. Impotence following prostate biopsy is a good example.

Well, on the other hand those labs can lead to discovery of a condition not visible on an Xray to experienced health professionals. The tests take time and expertise and cost somebody some money, yes. That's one kind of cost. Non-discovery of a condition not diagnosed on an Xray, and the subsequent harm that condition has or will have, is another kind of cost.

We of course can't test everyone for everything. Nor can we send away everyone with a possible need for a test due to cost. But there's really another decision being made in whether a test should be performed or not. I say performed, not "indicated". The choice is to err on the side of less work, or to err on the side of more benefit to the patient.

I'm not in any way meaning that as any criticism of you personally or the help you provide here. You're great. I'm just not so much in agreement with saying the "treatment wasn't warranted" because health insurance companies and their subs do this every day to deny service, and their motives are not people-driven.

Oh, I have no affection for insurers. But for many, if not most doctors, insurance is low of the list of things influencing decisions about diagnostic testing.

I don’t know the exact number, and there certainly is nuance to what one considers necessary, but I’d wager unnecessary tests outnumber needed, useful ones by a factor of at least 10 to 1.

To be clear, I’m not saying treatment for back pain isn’t warranted. I’m saying advanced imagery, like MRI, won’t change the management for the vast majority of back pain sufferers, in the absence of red flags. Moreover, unnecessary testing does more harm than good.

 

[Terminalxylem]

On the flip side, unnecessary imagery/labs can lead to downstream testing based on incidental, ultimately inconsequential findings. Sometimes that testing includes invasive procedures (eg. biopsy) which have associated complication rates. Impotence following prostate biopsy is a good example.

Well, on the other hand those labs can lead to discovery of a condition not visible on an Xray to experienced health professionals. The tests take time and expertise and cost somebody some money, yes. That's one kind of cost. Non-discovery of a condition not diagnosed on an Xray, and the subsequent harm that condition has or will have, is another kind of cost.

We of course can't test everyone for everything. Nor can we send away everyone with a possible need for a test due to cost. But there's really another decision being made in whether a test should be performed or not. I say performed, not "indicated". The choice is to err on the side of less work, or to err on the side of more benefit to the patient.

I'm not in any way meaning that as any criticism of you personally or the help you provide here. You're great. I'm just not so much in agreement with saying the "treatment wasn't warranted" because health insurance companies and their subs do this every day to deny service, and their motives are not people-driven.

Another thing to consider is lab error. Most tests have a margin of error a few percentage points, and normal ranges are usually based on population means +/- a couple standard deviations. So if you do enough tests, you’re bound to encounter a lab error, or “abnormal” value that isn’t representative of pathology, purely due to chance, or where you fall on the bell curve. And when diseases are rare, the positive predictive value of the test may not be that great; ie. false positives exceed true positives. Without getting too Bayesian on you, suffice it to say, this problem is encountered all the time with “shotgun” testing done in places like the ER.

 

[B Maverick]

GET THE MRI!!!!

My first knee surgery, the DR was convinced it was just the meniscus, scheduled surgery and found the ACL was torn. Had to go back in a month later to get that fixed. All because he didn't do an MRI. He also didn't do PT before surgery and the PT after was just weight training. Knee has never been the same.

10 or so years later, did the other knee. Used a different Dr. MRI showed what was wrong, PT/Surgery/PT and no issues.

Anyway, just my suggestion. Knee injuries are not the end of the world. Meniscus, ACL, MCL, LCL can all be repaired and get you back to normal. GOOD LUCK!

Wtf? Surgery without any imaging? That’s beyond odd.

I had that when I tore my achilles. Doctor felt and did a couple other tests and said it was a compete rupture and an MRI wasn't needed and a waste of money. Had surgery the next day.

Yeah, this happens. If anything, far too many imaging tests are performed. The classic one is MRI for low back pain.

I’m saying this as someone who just had X-rays, CT, and MRI performed in a single visit. And no, I don’t think all were indicated.

There are appropriate times for each scan for sure. I was having pain in my back and visited several specialists (Primary, Surgeon, GI, Pain Management) after hitting urgent care and the ER. Wasn't until the pain management dr sent me for an MRI did they find an infection in my spine. Wish the ER had done a scan would have saved me a few weeks of pain.

Yeah, there are “red flag” signs/symptoms which are supposed to prompt advanced imagery. Fever is one of those, as is duration greater than 6 weeks.

On the flip side, unnecessary imagery/labs can lead to downstream testing based on incidental, ultimately inconsequential findings. Sometimes that testing includes invasive procedures (eg. biopsy) which have associated complication rates. Impotence following prostate biopsy is a good example.

Spine MRIs in particular are prone to have abnormalities (eg. bad disks, arthritis, mild spinal canal narrowing), especially among older adults. The vast majority of the time, absent relevant clinical findings like weakness, loss of bladder control, etc., the treatment is almost always PT and pain control.

In your case, it’s unfortunate multiple doctors missed the diagnosis. It’s certainly possible they all screwed the pooch, but I’d wager the evolution of your symptoms, including duration, was what ultimately warranted MRI.

I get most of this and it makes sense. As for the bolded, unfortunately all the Drs botched it and had given up and deciding the pain just needed to be managed. The Pain Management Dr was surprised no one had sent me for an MRI and is the one who scheduled it believing there was something to be found and pain management wasn't the long term answer.

 

[ex-ghost]

I'm in my early 50's and have two tears in one of my knees. Said I am too young for a replacement, but "get ready for one".

 

[Terminalxylem]

GET THE MRI!!!!

My first knee surgery, the DR was convinced it was just the meniscus, scheduled surgery and found the ACL was torn. Had to go back in a month later to get that fixed. All because he didn't do an MRI. He also didn't do PT before surgery and the PT after was just weight training. Knee has never been the same.

10 or so years later, did the other knee. Used a different Dr. MRI showed what was wrong, PT/Surgery/PT and no issues.

Anyway, just my suggestion. Knee injuries are not the end of the world. Meniscus, ACL, MCL, LCL can all be repaired and get you back to normal. GOOD LUCK!

Wtf? Surgery without any imaging? That’s beyond odd.

I had that when I tore my achilles. Doctor felt and did a couple other tests and said it was a compete rupture and an MRI wasn't needed and a waste of money. Had surgery the next day.

Yeah, this happens. If anything, far too many imaging tests are performed. The classic one is MRI for low back pain.

I’m saying this as someone who just had X-rays, CT, and MRI performed in a single visit. And no, I don’t think all were indicated.

There are appropriate times for each scan for sure. I was having pain in my back and visited several specialists (Primary, Surgeon, GI, Pain Management) after hitting urgent care and the ER. Wasn't until the pain management dr sent me for an MRI did they find an infection in my spine. Wish the ER had done a scan would have saved me a few weeks of pain.

Yeah, there are “red flag” signs/symptoms which are supposed to prompt advanced imagery. Fever is one of those, as is duration greater than 6 weeks.

On the flip side, unnecessary imagery/labs can lead to downstream testing based on incidental, ultimately inconsequential findings. Sometimes that testing includes invasive procedures (eg. biopsy) which have associated complication rates. Impotence following prostate biopsy is a good example.

Spine MRIs in particular are prone to have abnormalities (eg. bad disks, arthritis, mild spinal canal narrowing), especially among older adults. The vast majority of the time, absent relevant clinical findings like weakness, loss of bladder control, etc., the treatment is almost always PT and pain control.

In your case, it’s unfortunate multiple doctors missed the diagnosis. It’s certainly possible they all screwed the pooch, but I’d wager the evolution of your symptoms, including duration, was what ultimately warranted MRI.

I get most of this and it makes sense. As for the bolded, unfortunately all the Drs botched it and had given up and deciding the pain just needed to be managed. The Pain Management Dr was surprised no one had sent me for an MRI and is the one who scheduled it believing there was something to be found and pain management wasn't the long term answer.

Well that’s pretty egregious on the surface, unless there are mitigating circumstance I missed.

Did you have any bloodwork? How much time delay before eventual diagnosis? Any restrictions on your ability to get an MRI (eg. Contrast allergy, Metal//devices in your body, severe claustrophobia, large waist circumference, etc.?)

 

[B Maverick]

GET THE MRI!!!!

My first knee surgery, the DR was convinced it was just the meniscus, scheduled surgery and found the ACL was torn. Had to go back in a month later to get that fixed. All because he didn't do an MRI. He also didn't do PT before surgery and the PT after was just weight training. Knee has never been the same.

10 or so years later, did the other knee. Used a different Dr. MRI showed what was wrong, PT/Surgery/PT and no issues.

Anyway, just my suggestion. Knee injuries are not the end of the world. Meniscus, ACL, MCL, LCL can all be repaired and get you back to normal. GOOD LUCK!

Wtf? Surgery without any imaging? That’s beyond odd.

I had that when I tore my achilles. Doctor felt and did a couple other tests and said it was a compete rupture and an MRI wasn't needed and a waste of money. Had surgery the next day.

Yeah, this happens. If anything, far too many imaging tests are performed. The classic one is MRI for low back pain.

I’m saying this as someone who just had X-rays, CT, and MRI performed in a single visit. And no, I don’t think all were indicated.

There are appropriate times for each scan for sure. I was having pain in my back and visited several specialists (Primary, Surgeon, GI, Pain Management) after hitting urgent care and the ER. Wasn't until the pain management dr sent me for an MRI did they find an infection in my spine. Wish the ER had done a scan would have saved me a few weeks of pain.

Yeah, there are “red flag” signs/symptoms which are supposed to prompt advanced imagery. Fever is one of those, as is duration greater than 6 weeks.

On the flip side, unnecessary imagery/labs can lead to downstream testing based on incidental, ultimately inconsequential findings. Sometimes that testing includes invasive procedures (eg. biopsy) which have associated complication rates. Impotence following prostate biopsy is a good example.

Spine MRIs in particular are prone to have abnormalities (eg. bad disks, arthritis, mild spinal canal narrowing), especially among older adults. The vast majority of the time, absent relevant clinical findings like weakness, loss of bladder control, etc., the treatment is almost always PT and pain control.

In your case, it’s unfortunate multiple doctors missed the diagnosis. It’s certainly possible they all screwed the pooch, but I’d wager the evolution of your symptoms, including duration, was what ultimately warranted MRI.

I get most of this and it makes sense. As for the bolded, unfortunately all the Drs botched it and had given up and deciding the pain just needed to be managed. The Pain Management Dr was surprised no one had sent me for an MRI and is the one who scheduled it believing there was something to be found and pain management wasn't the long term answer.

Well that’s pretty egregious on the surface, unless there are mitigating circumstance I missed.

Did you have any bloodwork? How much time delay before eventual diagnosis? Any restrictions on your ability to get an MRI (eg. Contrast allergy, Metal//devices in your body, severe claustrophobia, large waist circumference, etc.?)

This was about 10 years ago so there might be some mitigating circumstances I missed! haha.
A lot of it was the initial diagnosis from the Urgent Care Dr and no one seemingly wanting to look elsewhere.

Did you have any bloodwork? Do not remember actually.
Any restrictions on your ability to get an MRI (eg. Contrast allergy, Metal//devices in your body, severe claustrophobia, large waist circumference, etc.?) No
How much time delay before eventual diagnosis? I want to say it was a couple weeks from the first ER visit until I was admitted into the hospital after finally getting the MRI.

First visit was to Urgent Care because it was a weekend. Actually just finished a FF Rookie draft!
Urgent Care was looking in one direction which is why they then sent me to the ER. ER just wanted to give me drugs and send me home. Primary Care Dr followed the same path even after a second ER visit. Surgeon consult and a visit to the GI followed by a colonoscopy showed nothing. PCP then sent me to the Pain Management Consult. That's when I finally got the MRI and they found an infection in my spine. Then they feared TB and sent me to the hospital. Thank good it wasn't TB with several weeks of exposing others, including my young child.
Some antibiotics, a pic line in my arm for a month and it cleared up, no lingering affects. And changed primary doctors right after.


But back to the OP, when I said get the MRI, its more about the knee and how much more the MRI will show than the manual tests and X-Rays.

 

[Terminalxylem]

GET THE MRI!!!!

My first knee surgery, the DR was convinced it was just the meniscus, scheduled surgery and found the ACL was torn. Had to go back in a month later to get that fixed. All because he didn't do an MRI. He also didn't do PT before surgery and the PT after was just weight training. Knee has never been the same.

10 or so years later, did the other knee. Used a different Dr. MRI showed what was wrong, PT/Surgery/PT and no issues.

Anyway, just my suggestion. Knee injuries are not the end of the world. Meniscus, ACL, MCL, LCL can all be repaired and get you back to normal. GOOD LUCK!

Wtf? Surgery without any imaging? That’s beyond odd.

I had that when I tore my achilles. Doctor felt and did a couple other tests and said it was a compete rupture and an MRI wasn't needed and a waste of money. Had surgery the next day.

Yeah, this happens. If anything, far too many imaging tests are performed. The classic one is MRI for low back pain.

I’m saying this as someone who just had X-rays, CT, and MRI performed in a single visit. And no, I don’t think all were indicated.

There are appropriate times for each scan for sure. I was having pain in my back and visited several specialists (Primary, Surgeon, GI, Pain Management) after hitting urgent care and the ER. Wasn't until the pain management dr sent me for an MRI did they find an infection in my spine. Wish the ER had done a scan would have saved me a few weeks of pain.

Yeah, there are “red flag” signs/symptoms which are supposed to prompt advanced imagery. Fever is one of those, as is duration greater than 6 weeks.

On the flip side, unnecessary imagery/labs can lead to downstream testing based on incidental, ultimately inconsequential findings. Sometimes that testing includes invasive procedures (eg. biopsy) which have associated complication rates. Impotence following prostate biopsy is a good example.

Spine MRIs in particular are prone to have abnormalities (eg. bad disks, arthritis, mild spinal canal narrowing), especially among older adults. The vast majority of the time, absent relevant clinical findings like weakness, loss of bladder control, etc., the treatment is almost always PT and pain control.

In your case, it’s unfortunate multiple doctors missed the diagnosis. It’s certainly possible they all screwed the pooch, but I’d wager the evolution of your symptoms, including duration, was what ultimately warranted MRI.

I get most of this and it makes sense. As for the bolded, unfortunately all the Drs botched it and had given up and deciding the pain just needed to be managed. The Pain Management Dr was surprised no one had sent me for an MRI and is the one who scheduled it believing there was something to be found and pain management wasn't the long term answer.

Well that’s pretty egregious on the surface, unless there are mitigating circumstance I missed.

Did you have any bloodwork? How much time delay before eventual diagnosis? Any restrictions on your ability to get an MRI (eg. Contrast allergy, Metal//devices in your body, severe claustrophobia, large waist circumference, etc.?)

This was about 10 years ago so there might be some mitigating circumstances I missed! haha.
A lot of it was the initial diagnosis from the Urgent Care Dr and no one seemingly wanting to look elsewhere.

Did you have any bloodwork? Do not remember actually.
Any restrictions on your ability to get an MRI (eg. Contrast allergy, Metal//devices in your body, severe claustrophobia, large waist circumference, etc.?) No
How much time delay before eventual diagnosis? I want to say it was a couple weeks from the first ER visit until I was admitted into the hospital after finally getting the MRI.

First visit was to Urgent Care because it was a weekend. Actually just finished a FF Rookie draft!
Urgent Care was looking in one direction which is why they then sent me to the ER. ER just wanted to give me drugs and send me home. Primary Care Dr followed the same path even after a second ER visit. Surgeon consult and a visit to the GI followed by a colonoscopy showed nothing. PCP then sent me to the Pain Management Consult. That's when I finally got the MRI and they found an infection in my spine. Then they feared TB and sent me to the hospital. Thank good it wasn't TB with several weeks of exposing others, including my young child.
Some antibiotics, a pic line in my arm for a month and it cleared up, no lingering affects. And changed primary doctors right after.


But back to the OP, when I said get the MRI, its more about the knee and how much more the MRI will show than the manual tests and X-Rays.

Anchoring bias (where one sticks with an initial impression, rather than critically appraise other possibilities) is a real thing. It really doesn’t sound like your doctors were thinking about severe spine issues at all, though I’d really need more info regarding what prompted the surgical and GI referrals.

All that said, you had a lot done in a relatively short period. MRIs aren’t available on-demand in many places, so waiting a couple weeks isn’t unusual in the outpatient setting.

Also FWIW, TB in the spine isn’t contagious.

 

[B Maverick]

GET THE MRI!!!!

My first knee surgery, the DR was convinced it was just the meniscus, scheduled surgery and found the ACL was torn. Had to go back in a month later to get that fixed. All because he didn't do an MRI. He also didn't do PT before surgery and the PT after was just weight training. Knee has never been the same.

10 or so years later, did the other knee. Used a different Dr. MRI showed what was wrong, PT/Surgery/PT and no issues.

Anyway, just my suggestion. Knee injuries are not the end of the world. Meniscus, ACL, MCL, LCL can all be repaired and get you back to normal. GOOD LUCK!

Wtf? Surgery without any imaging? That’s beyond odd.

I had that when I tore my achilles. Doctor felt and did a couple other tests and said it was a compete rupture and an MRI wasn't needed and a waste of money. Had surgery the next day.

Yeah, this happens. If anything, far too many imaging tests are performed. The classic one is MRI for low back pain.

I’m saying this as someone who just had X-rays, CT, and MRI performed in a single visit. And no, I don’t think all were indicated.

There are appropriate times for each scan for sure. I was having pain in my back and visited several specialists (Primary, Surgeon, GI, Pain Management) after hitting urgent care and the ER. Wasn't until the pain management dr sent me for an MRI did they find an infection in my spine. Wish the ER had done a scan would have saved me a few weeks of pain.

Yeah, there are “red flag” signs/symptoms which are supposed to prompt advanced imagery. Fever is one of those, as is duration greater than 6 weeks.

On the flip side, unnecessary imagery/labs can lead to downstream testing based on incidental, ultimately inconsequential findings. Sometimes that testing includes invasive procedures (eg. biopsy) which have associated complication rates. Impotence following prostate biopsy is a good example.

Spine MRIs in particular are prone to have abnormalities (eg. bad disks, arthritis, mild spinal canal narrowing), especially among older adults. The vast majority of the time, absent relevant clinical findings like weakness, loss of bladder control, etc., the treatment is almost always PT and pain control.

In your case, it’s unfortunate multiple doctors missed the diagnosis. It’s certainly possible they all screwed the pooch, but I’d wager the evolution of your symptoms, including duration, was what ultimately warranted MRI.

I get most of this and it makes sense. As for the bolded, unfortunately all the Drs botched it and had given up and deciding the pain just needed to be managed. The Pain Management Dr was surprised no one had sent me for an MRI and is the one who scheduled it believing there was something to be found and pain management wasn't the long term answer.

Well that’s pretty egregious on the surface, unless there are mitigating circumstance I missed.

Did you have any bloodwork? How much time delay before eventual diagnosis? Any restrictions on your ability to get an MRI (eg. Contrast allergy, Metal//devices in your body, severe claustrophobia, large waist circumference, etc.?)

This was about 10 years ago so there might be some mitigating circumstances I missed! haha.
A lot of it was the initial diagnosis from the Urgent Care Dr and no one seemingly wanting to look elsewhere.

Did you have any bloodwork? Do not remember actually.
Any restrictions on your ability to get an MRI (eg. Contrast allergy, Metal//devices in your body, severe claustrophobia, large waist circumference, etc.?) No
How much time delay before eventual diagnosis? I want to say it was a couple weeks from the first ER visit until I was admitted into the hospital after finally getting the MRI.

First visit was to Urgent Care because it was a weekend. Actually just finished a FF Rookie draft!
Urgent Care was looking in one direction which is why they then sent me to the ER. ER just wanted to give me drugs and send me home. Primary Care Dr followed the same path even after a second ER visit. Surgeon consult and a visit to the GI followed by a colonoscopy showed nothing. PCP then sent me to the Pain Management Consult. That's when I finally got the MRI and they found an infection in my spine. Then they feared TB and sent me to the hospital. Thank good it wasn't TB with several weeks of exposing others, including my young child.
Some antibiotics, a pic line in my arm for a month and it cleared up, no lingering affects. And changed primary doctors right after.


But back to the OP, when I said get the MRI, its more about the knee and how much more the MRI will show than the manual tests and X-Rays.

Anchoring bias (where one sticks with an initial impression, rather than critically appraise other possibilities) is a real thing. It really doesn’t sound like your doctors were thinking about severe spine issues at all, though I’d really need more info regarding what prompted the surgical and GI referrals.

All that said, you had a lot done in a relatively short period. MRIs aren’t available on-demand in many places, so waiting a couple weeks isn’t unusual in the outpatient setting.

Also FWIW, TB in the spine isn’t contagious.

Well, severe pain will prompt a lot of action.
The problem wasn't being able to get an MRI, its that no one thought to prescribe one.

As far as the TB, once they found the infection, they had me check in to the hospital and isolate me in my own room. Masks for anyone coming in, mask on me for transport to exam rooms. Everyone was very concerned which was weird esp when my wife visited and they made her mask up despite having been around me for the whole time. Anyway, once they found it, it got taken care of, spent 2-3 days in the hospital and have had no issues since.


I appreciate the feedback and I am sure I am leaving out some info that may help you make further sense. Between this and my knees, was more of a suggestion to get an MRI, especially on the knee. Not so much looking for "why" in regard to my back.

 

[Terminalxylem]

GET THE MRI!!!!

My first knee surgery, the DR was convinced it was just the meniscus, scheduled surgery and found the ACL was torn. Had to go back in a month later to get that fixed. All because he didn't do an MRI. He also didn't do PT before surgery and the PT after was just weight training. Knee has never been the same.

10 or so years later, did the other knee. Used a different Dr. MRI showed what was wrong, PT/Surgery/PT and no issues.

Anyway, just my suggestion. Knee injuries are not the end of the world. Meniscus, ACL, MCL, LCL can all be repaired and get you back to normal. GOOD LUCK!

Wtf? Surgery without any imaging? That’s beyond odd.

I had that when I tore my achilles. Doctor felt and did a couple other tests and said it was a compete rupture and an MRI wasn't needed and a waste of money. Had surgery the next day.

Yeah, this happens. If anything, far too many imaging tests are performed. The classic one is MRI for low back pain.

I’m saying this as someone who just had X-rays, CT, and MRI performed in a single visit. And no, I don’t think all were indicated.

There are appropriate times for each scan for sure. I was having pain in my back and visited several specialists (Primary, Surgeon, GI, Pain Management) after hitting urgent care and the ER. Wasn't until the pain management dr sent me for an MRI did they find an infection in my spine. Wish the ER had done a scan would have saved me a few weeks of pain.

Yeah, there are “red flag” signs/symptoms which are supposed to prompt advanced imagery. Fever is one of those, as is duration greater than 6 weeks.

On the flip side, unnecessary imagery/labs can lead to downstream testing based on incidental, ultimately inconsequential findings. Sometimes that testing includes invasive procedures (eg. biopsy) which have associated complication rates. Impotence following prostate biopsy is a good example.

Spine MRIs in particular are prone to have abnormalities (eg. bad disks, arthritis, mild spinal canal narrowing), especially among older adults. The vast majority of the time, absent relevant clinical findings like weakness, loss of bladder control, etc., the treatment is almost always PT and pain control.

In your case, it’s unfortunate multiple doctors missed the diagnosis. It’s certainly possible they all screwed the pooch, but I’d wager the evolution of your symptoms, including duration, was what ultimately warranted MRI.

I get most of this and it makes sense. As for the bolded, unfortunately all the Drs botched it and had given up and deciding the pain just needed to be managed. The Pain Management Dr was surprised no one had sent me for an MRI and is the one who scheduled it believing there was something to be found and pain management wasn't the long term answer.

Well that’s pretty egregious on the surface, unless there are mitigating circumstance I missed.

Did you have any bloodwork? How much time delay before eventual diagnosis? Any restrictions on your ability to get an MRI (eg. Contrast allergy, Metal//devices in your body, severe claustrophobia, large waist circumference, etc.?)

This was about 10 years ago so there might be some mitigating circumstances I missed! haha.
A lot of it was the initial diagnosis from the Urgent Care Dr and no one seemingly wanting to look elsewhere.

Did you have any bloodwork? Do not remember actually.
Any restrictions on your ability to get an MRI (eg. Contrast allergy, Metal//devices in your body, severe claustrophobia, large waist circumference, etc.?) No
How much time delay before eventual diagnosis? I want to say it was a couple weeks from the first ER visit until I was admitted into the hospital after finally getting the MRI.

First visit was to Urgent Care because it was a weekend. Actually just finished a FF Rookie draft!
Urgent Care was looking in one direction which is why they then sent me to the ER. ER just wanted to give me drugs and send me home. Primary Care Dr followed the same path even after a second ER visit. Surgeon consult and a visit to the GI followed by a colonoscopy showed nothing. PCP then sent me to the Pain Management Consult. That's when I finally got the MRI and they found an infection in my spine. Then they feared TB and sent me to the hospital. Thank good it wasn't TB with several weeks of exposing others, including my young child.
Some antibiotics, a pic line in my arm for a month and it cleared up, no lingering affects. And changed primary doctors right after.


But back to the OP, when I said get the MRI, its more about the knee and how much more the MRI will show than the manual tests and X-Rays.

Anchoring bias (where one sticks with an initial impression, rather than critically appraise other possibilities) is a real thing. It really doesn’t sound like your doctors were thinking about severe spine issues at all, though I’d really need more info regarding what prompted the surgical and GI referrals.

All that said, you had a lot done in a relatively short period. MRIs aren’t available on-demand in many places, so waiting a couple weeks isn’t unusual in the outpatient setting.

Also FWIW, TB in the spine isn’t contagious.

Well, severe pain will prompt a lot of action.
The problem wasn't being able to get an MRI, its that no one thought to prescribe one.

As far as the TB, once they found the infection, they had me check in to the hospital and isolate me in my own room. Masks for anyone coming in, mask on me for transport to exam rooms. Everyone was very concerned which was weird esp when my wife visited and they made her mask up despite having been around me for the whole time. Anyway, once they found it, it got taken care of, spent 2-3 days in the hospital and have had no issues since.


I appreciate the feedback and I am sure I am leaving out some info that may help you make further sense. Between this and my knees, was more of a suggestion to get an MRI, especially on the knee. Not so much looking for "why" in regard to my back.

Yeah, that’s a common iso mistake. It’s based in misunderstanding how TB gets to the spine. Airborne precautions (the masks + iso room) are only needed for TB active in the respiratory tract. Spine TB is almost always reactivation of latent disease, without concomitant activity in the lungs. Unless they saw abnormalities on your chest X-ray (extremely unlikely, without severe immunocompromise), the iso (and the anxiety it caused) was unnecessary.

Yeah, I know you weren’t looking for my input on your back. I just thought your description sounded interesting, so thanks for indulging me.

As for MRIs, they can certainly be underutilized, or delayed. But I still contend it’s far more common they’re performed unnecessarily.