Why is it so hard to get an MRI?

WO1 Private RallyPoint Member — Sat, 14 Mar 2020 10:25:14 -0400

I've been dealing with lower back pain for the past four months. Recently the pain has extended down my buttock all the way to my left foot. The pain got so bad yesterday that I had to call 911 and get transported to the hospital. All I got was an X-Ray, steroid shot, and some pain meds.

Response by Lt Col Charlie Brown made Mar 14 at 2020 10:27 AM

Lt Col Charlie Brown — Sat, 14 Mar 2020 10:27:09 -0400

If your doctor is not responsive, get a referral to PT and have them "suggest" it to your doc

Response by SFC Private RallyPoint Member made Mar 14 at 2020 10:52 AM

SFC Private RallyPoint Member — Sat, 14 Mar 2020 10:52:00 -0400

Because an MRI is thousand dollar picture, it takes half an hour to an hour to take one, and your hospital only has one machine. The waiting list for most hospitals is about a month for an MRI. You won't receive one at the ER because they aren't going to cancel someone else's appointment who waited a month unless your condition is life threatening. You have a chronic pain issue meaning it would follow a chronic pain protocol. Just like you don't administer antibiotics and IVs for every illness, you don't start off with the most expensive or invasive treatments for chronic pain either.

Response by CW2 Private RallyPoint Member made Mar 14 at 2020 11:34 AM

CW2 Private RallyPoint Member — Sat, 14 Mar 2020 11:34:50 -0400

Perhaps an appt at the chronic pain clinic? Keep making appts and flood em until they actually listen to you, we need our Soldiers fixed and working.
It's different doc to doc really from what I've seen. Some docs and PAs are very minimalist except for their distribution of Motrin, while others actually listen to the patient and get you fixed quick. First time I got my ankle checked they did an xray (negative, surprise) despite the pitting edema. 2 years later a different doc instantly said "lets get you in the magnet" as soon as he sat down with me about it, a week later MRI done, surgery scheduled - needed to rebuild 2 ligaments.

Response by SGM Steve Wettstein made Mar 14 at 2020 12:03 PM

SGM Steve Wettstein — Sat, 14 Mar 2020 12:03:48 -0400

WO1 Private RallyPoint Member You should also try and get a pinched nerve test. I forget what it called, but they will check the nerves from your foot to your butt. From what you wrote my bet would be that your sciatic nerve is pinched.

https://en.wikipedia.org/wiki/Sciatica

Sciatica

Response by CDR Terry Boles made Mar 14 at 2020 12:43 PM

CDR Terry Boles — Sat, 14 Mar 2020 12:43:47 -0400

Good question. For the past 4-months have your symptoms worsen? Have you received a referral to physical therapy? Does your x-ray reveal any info that could suspect spinal cord nerve encroachment? (DO NOT ANSWER HERE) Is your back pain associated with an injury? Sudden on gradual onset? Again (DO NOT ANSWER HERE) on this forum. This is food for thought.

These are some of the questions and medical history your doctor, and you should have to help decide your plan of care.

IF you have any lingering concerns after all this, then seek a second opinion along with your MRI request.

I wish you the best!!

Response by MAJ Private RallyPoint Member made Mar 14 at 2020 12:49 PM

MAJ Private RallyPoint Member — Sat, 14 Mar 2020 12:49:42 -0400

Sounds like sciatic nerve issues. https://en.m.wikipedia.org/wiki/Sciatica

Most likely either you have ruptured/herniated disc, inflamed a disc in your back, or like most of us who have lifted weights and carried heavy packs for years have the beginning of degenerative disc disease.

Ask for a referral to PT. They can show you some stretches and other exercises to help and they also can urge for an MRI after they evaluate you if they think it’s actually a ruptured or herniated disc.

Just speaking from a differential diagnosis perspective it’s like everything else in medicine. They are going to start with least invasive and then move on from there. So don’t be surprised you got a shot. You should actually be happy you got that to be honest. I had some horrible neck pain recently in the civilian sector. Went to the urgent care. They gave me a muscle relaxant and told me to take ibuprofen and go home and rest. 3 days later pain was no better. Range of motion was no better. Went back to same urgent care at the hospital. They sent me for an X-ray after I insisted and it was of course negative. Then they gave me a shot after I asked for one and a prednisone taper. I had to ask to be referred to physical therapy because they didn’t even want to do that. Took a week to get in for a PT eval. PT confirmed Cervical strain with most likely old ligament tear or strain from back in September and shoulder weakness from compensating for the issue when lifting and working out. Gave me some stretches and exercises to do. Did some manipulation (which was great!) I am feeling about 50% better and have two upcoming PT sessions. Still no one is wanting to do an MRI and this is with my private insurance in the private sector just for some perspective.

Chronic pain sucks. I get it and you have my empathy because it sucks waking up in pain and feeling like your activity is limited. I hope you get into PT and get some relief!

Sciatica

Response by CAPT Kevin B. made Mar 14 at 2020 1:41 PM

CAPT Kevin B. — Sat, 14 Mar 2020 13:41:12 -0400

What is missing is medical systems require their providers to follow "protocol". That is essentially start cheap and go up from there; grudgingly. Demanding something from a doctor that isn't there yet on the protocol timeline is pointless because they can be disciplined for bypassing it. Depending on what it is, the chronic label kicks in somewhere between 3-6 months. You are in the early stages of MIL medicine which is throw drugs at it and go away. You will be made to needlessly suffer until you meet the protocol standards. Likely protocol is you'll get a CAT scan first to take a look at the softer tissue around the vertebrae. Slipped discs etc. are fairly well visualized. If that tells the story, then the response will be according to protocol. If that doesn't work, maybe you'll graduate to MRI. It'll differentiate the soft tissue better along with the nerve sleeves. If that doesn't lead to resolution, you may be out of luck as that is usually the end of the protocol chain. I don't know if a PET scan, which looks at how the body functions on a cellular level, would be viable. These are the most expensive. BTW, CAT scans are relatively cheap now and machines are found in nearly all hospitals. Our small rural hospital (20 beds) has the fastest CAT scanner in Idaho because it's the newest. Head to toes in 54 seconds.

Response by 1SG Private RallyPoint Member made Mar 14 at 2020 2:23 PM

1SG Private RallyPoint Member — Sat, 14 Mar 2020 14:23:40 -0400

Maybe take leave, and give a shot at a civilian ER on TRICAREs dime.

Response by CSM Darieus ZaGara made Mar 14 at 2020 5:14 PM

CSM Darieus ZaGara — Sat, 14 Mar 2020 17:14:04 -0400

Sounding like a sis doc attack. If you had an MRI, it will likely reveal that you have a herniation or a bulge, or even some level of arthritis. This pinched off the nerve and causes that horrible pain. Steroid is what they would recommend. You can ask about a combination of FA spent in and a muscle relaxer and PT. You should have an MRI, just ask for it and wait, as it may take a while.

Response by LTC Jason Mackay made Mar 14 at 2020 5:30 PM

LTC Jason Mackay — Sat, 14 Mar 2020 17:30:10 -0400

I have similar pain. Sounds like a pinched sciatic nerve. You may have vertebrae, your hips, or discs that are damaged or misaligned.

If you are dissatisfied with your care, demand a second opinion and a referral to a specialist. An MRI may or may not tell the provider anything. I remember different providers staring at mine and it didn't tell them much. If they push back, go to the ombudsman or patient advocate at the MTF.

Response by SSG Laurie Mullen made Mar 15 at 2020 1:38 AM

SSG Laurie Mullen — Sun, 15 Mar 2020 01:38:42 -0400

Good luck! It took me 13 years to get an MRI for an injury that I frequently went to sick call for.

Response by CPT Private RallyPoint Member made Mar 17 at 2020 6:46 AM

CPT Private RallyPoint Member — Tue, 17 Mar 2020 06:46:21 -0400

Providers are now trained to only reach for the MRI when red flags are present:
History:
-Cancer
-Unexplained weight loss
-Immunosuppression
-Prolonged use of steroids
-Intravenous drug use
-Urinary tract infection
-Pain that is increased or unrelieved by rest
-Fever
-Significant trauma related to age (e.g., fall from a height or motor vehicle accident in a young patient, minor fall or heavy lifting in a potentially osteoporotic or older patient or a person with possible osteoporosis)
-Bladder or bowel incontinence
-Urinary retention (with overflow incontinence)

Physical examination:
-Saddle anesthesia
-Loss of anal sphincter tone
-Major motor weakness in lower extremities
-Fever
-Vertebral tenderness
-Limited spinal range of motion
-Neurologic findings persisting beyond one month