Images - A way Back

The image on the left is my MRN. Please note the level of detail. I've placed markers on the image to show the very clear nerve roots. The image on the right is my MRi of the exact same area. While I believe a trained professional radiologist could 'see' some of the detail which is made extremely clear in the image on the left, MRN technology should be adopted by every center in America. There's no guess work. You compare and decide for yourself.

Okay, so I start this post by saying the following - as you may have read, my initial Neurologist (ick) placed me on Neurontin. While that medication may be great for some, it yielded undue results in me. Made me foggy, conflicted, severely reduced my cognitive abilities, etc. My new Dr. has replaced it with Lyrica. The change-over was difficult and I experienced symptomatic withdrawal and migraines from it. The first day completely off the medicine all my visual acuity came back. Colors looked normal instead of being enhanced, ethereal almost. In total, I probably saw withdrawal symptoms for about 5-7 days in varying degrees of severity. The first few days was difficult. I'm much better now on the Lyrica.

So, to sum up (at least to this point) - I referred myself to HSS to see 2 Dr.'s - Feinberg and Richman. Feinberg is great, though limited in ability for my ailment. He does appear to be an excellent doctor as patient advocate though. Then Richman, which I'll get to now...

The Dr (Richman) called me back 36 hours after I left a message for him, AT 9:45 PM!!(which I missed because I was soundly sleeping at the time.) The following day, I was now speaking with his secretary. She was telling me that the Dr. wanted to schedule a nerve block for me (yeah, finally..Feinberg had given me a prescription for a nerve block 3-1/2 weeks earlier.) She asked me when I would like to have the block done. I told her "7PM tonight" to which she began laughing. She told me the first available date for a block (guided, under CT scan) was September 11th (which would be 5-1/2 weeks after I was first prescribed for it.) I asked her if she was kidding, and she said, 'no why?' I reminded her of the infamy of the date. I then said that if not taking that date would cause me to fall to the back of the line, I'd take it. (I ended up taking it.) Before the conversation ended I asked to schedule an appointment to see the Dr this week. I wanted to discuss, in person, my failings with the Neurontin and its impacts on me and also his view of the MRN results. With some trepidation she said, okay, if you absolutely have to see the Dr. I have this Friday at 2:30 PM. I said 'done.'

On Thursday afternoon I received a call from the Dr.'s office. Could I reschedule for 10:30 Friday? Hey, sure.

Friday comes around and I wake up, shower, get to my parents house to change to a smaller car, drive into the City and arrive with 30 minutes to spare. Wifey (she accompanied me) and I have a small breakfast in the very decent Cafe within the annex of HSS. We then go up to his office and sit in the waiting room. Countering my earlier visit, we actually got in to an examining room about 20 minutes late. There, we waited for about 20 minutes. The Dr. came in and we began a 20 minute conversation (which occurred in 2 parts - the 1st lasted about 5-7 minutes. The second lasted about 12 minutes. In the middle he plain got up and walked out of the room and disappeared. Without any indication of why or where he was going. We did though hear him speaking with another patient during the time away.)

Having some medical knowledge I asked him about my MRN results. He initially could not recall what the findings were. (As a note, he didn't have my patient file with him, and had not referred to it before seeing me.) He stated he'd have to go look at the files and asked if I had the report with me. (Unfortunately no.) He had left for a scant minute or so and the returned to say that the MRN came back showing some inflammation and scar tissue. (Scar tissue? in my pelvis? I'd had no prior injuries or surgeries there.) He explained the nerve block procedure to me and how it would take place. Under guided CT scan, with Lidocaine and a steroid chaser. He stated that the CT was infinitely better at resolving the nerves than any other machine they had. Then I asked if he actually viewed the films (images) on CD provided by MRN. (Please refer to the top of this post for the actual images. Left MRN, right MRi.)

He asked again for the images from the CD I received. I explained that I know my file in his office had the disk and report since it was FEDEX'd to him last week and I confirmed his offices receipt of them.

He then walked out. 20 minutes later he returned and stated 'while I haven't looked at the images, I did read the report and consulted with the radiologist here. The report and the radiologist confirm there's swelling and scar tissue.' I asked if he was reading my report because I'd read it and it said nothing about scar tissue. He then said, 'we both (radiologist and himself) saw it on your scan. I asked which scan. He said the MRN. Then he said, "you didn't have to fly all the way to California to have an MRi done." I then said, Doctor, I went to Pa. to have it done. He said, "no, you had it done in California." I looked at my wife. We were both dumbfounded. What had happened to this doctor in the last 2 weeks?

Now reeling, I started asking very specific questions. I needed to know if this guy was all there or having a mental break-down before my eyes. I asked what his game plan was. I told him that Feinberg (my other Dr.) had told me that he was looking to Pain Management to take the lead and guide him on next steps. Richman responded caustically "this is it. There are no other steps. I can give you 3 maybe 4 blocks but your at the end of the line. There is no other viable option." I said, "well, I understand you might be limited because of focus (he bristled, but that was not meant to be a dig), but what about being referred to a neurosurgeon." He laughed out loud (I was now offended.) He said 'HSS doesn't have that specialty, that's out of our league.' I shot back, what about other Dr.'s not affiliated with the hospital. He said he didn't know of any. Then he bluntly asked ' so do you want the block or not?'

We were numb. What had happened to this Dr.'s manner and the way he treated his patients in the last 2 weeks. He was certainly not like this when I'd seen him prior. I'd have to say the only time I've ever seen such a drastic change was when someone was going through withdrawal, or hadn't taken his meds. (Not that I'm implying either here.) I just couldn't rationalize what had just happened.

With that, I said 'Yes.' He picked up the phone in this small exam room and called his secretary. I need an appointment for Mr....... (he looked at me.. I then said my name, further adding to my growing horror. He didn't even have my chart available to him to refer back to this unknown patient.) "Whens the next date for a block?" he asked his secretary. I needed to imagine the other end of the phone conversation he was carrying having. It included; "the 12th, at 2:00 PM"; the date then registered with him and he asked the phone "what day of the week that was?" Friday; He then said back 'FRIDAY?' vapid and dripping with contempt; He then said, "what time did you say?" The phone answered back...'2:00 PM'; "You know I only work 'til 12:00 PM on Friday's." The exchanges went on and on and got more and more heated. At least 5 minutes. He was complaining about working until 2:00 PM on a Friday because he typically leaves at 12:00 PM. He then lashed out stating that he'd "told EVERYONE this, EVERYONE knows this. Its been this way for 2 or 3 years." He remade his points another 3-4 times and then slammed the phone down.

"You're scheduled for 2:00 PM on September 12th. I'm doing the block under sonogram." I then asked, "didn't you say that you were doing me under CT scan because of its accuracy, and you didn't want to risk injury by misplacement.?" He said " yeah, well, CT scan is not available for another 2 weeks, plus sonogram is just as good. I'll....I'll make sure I discuss the matter with radiology prior to your block about whether to have it done under sonogram or CT scan." This was now 2 completely different doctors talking to me. It appeared one was frustrated, at knife's edge,..while the other was short but slightly concerned. He then, without saying anything else, left the room. That was it. Nothing else.

We left, shocked. As we walked out the door towards the elevator, my wife asked if I could wait that long, until the 12th. I turned and said..Wait that long? I'm going to be waiting longer, he's nuts if he thinks he's going to give me a block under sonogram, or at 2:00 PM on a Friday when he doesn't want to be around...