Getting a Diagnosis

Rachel is a 34 year old, healthy woman. She works at a high-stress job. While getting ready for work one morning, with the onset of allergy season, she violently sneezed. Here is Rachel's story.

"It Feels Like My Bones are Broken"

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Rachel's Story

One morning before work, I sneezed so hard and so violently that I immediately felt an intense, debilitating pain move from the back of my neck to the middle of my right shoulder blade. It felt almost as if a rubber band had snapped. As I slowly straightened up, I realized I couldn't lift my right arm any higher than my hip bone or turn my head to the right. The pain emanated from so deep in my body that I could have sworn it wasn't muscular, but that I had broken a bone somewhere.

When I went to see my family doctor, she was at a loss to explain what had happened to me. She grilled me as to what I had been doing leading up to the sneeze – she wanted to know if I had slept strangely or done something at the gym. Baffled, she called in an accupressure masseuse to consult. The  masseuse explained that all of my muscles were twisted into balls of knots and the pain I had in my upper back was actually coming from my neck.

My doctor prescribed muscle relaxants and anti-inflammatory medication and I started weekly visits with the masseuse to relieve the pain in my neck and upper back. With her help, I also regained mobility on my right side. The masseuse explained to me that all of my stress went into my neck which in turn went to my upper back and right arm. By relieving the severe knots in my neck, she subsequently was able to undo the knots that had twisted up inside the muscles in my back. The sneeze had been just the catalyst for an underlying problem.

Rachel discovered she found relief (for a while) after a massage, however, all of this failed to control her pain long term. Since she could not turn to a masseuse every time her neck and back hurt, Rachel needed to get a firm diagnosis of the problem.

Step 1 to Getting a Diagnosis

What to prepare for 1st Doctor Visit

Getting a complete diagnosis can be a long term process, one you need to be prepared for. The first step in the process is to see your family doctor. Before doing this, you need to get yourself into the right mindset. Prior to the visit, you must understand your symptoms so you can best explain them to your doctor. You need to ensure you communicate to the doctor clearly – writing down and bringing with you what you want to say can be helpful. At the visit, you need to also understand the outcome you want (time off work, limited functions at work, a referral, prescription, etc.) so that you get what you want. Also, be prepared to ask questions to ensure you get an answer to anything you don't understand. Next, ensure to list all of your symptoms and bring them with you to the doctor visit.

Explain the following:

• When the symptoms started
• How often you have symptoms
• What actions in your daily life trigger the symptoms
• The level of pain you have when your symptoms are activated. You can use a scale from 1-10 such as: when typing my pain level is 9, when cooking my pain level is 8.

If you have been off of work due to the pain, you may need to request a doctor's letter for your employer. If you and your doctor agree that you cannot continue to work, your doctor will need to provide additional documentation for your employer that explains how long you will be off work going forward. Or, you may return to work but only on a gradual basis with limited activity. This is something that should also be discussed during your doctor visit.

Step 2 in Getting a Diagnosis Process

Support System

Following the first doctor visit, Rachel did not improve despite time off work, and taking medication. A support system is a helpful tool that can assist in determining what next steps Rachel should take. Rehabcoach is an online product that exists for this purpose. In turning to them, Rachel can be assisted by a Treatment Liaison who can both consult with her and direct her to their online community. The online community is an effective tool in which Rachel can be paired with others who have similar (and sometimes identical) problems. Through discussions in the Rehabcoach community Rachel can learn what it takes to get her body to a healthy state.

Rachel can also fill out a "Symptoms and Diagnosis" form (also found at Rehabcoach) to take to her doctor. With this, her doctor can better determine next steps for further and complete diagnosis.

Step 3 in Getting a Diagnosis Process

Another Doctor Visit and Physical Tests

1. Second visit to doctor where you explain that you are not improving.
2. Recommendation from doctor to see specialist.
3. Appropriate referrals for specialist are given.
4. Physical tests will take place prior to specialist visit which could include X -Ray's, MRI's (Magnetic resonance imaging) and CT Scan's. Due to the many causes of internal pain, these tests are used to weed out what is or isn't causing the problem.

1. Make appointments for battery of tests.

Step 4 in Getting a Diagnosis Process

Seeing a Specialist

Make the necessary appointments from doctor referral to see specialist (s).

Find out if test results will be sent directly to the specialist or whether you have to bring them yourself.

Visit with various specialists so they can look at both the  test results and overall body mechanics to determine a final diagnosis.

Some of these specialists include:

1. Osteopath

Looks at the body as one unit in which its structure and function are all inter-related.

1. Physiatrist

Looks to restore functional ability to the body.

1. Neurologist

Deals with disorders of the nervous system.

1. Neurosurgeon

Treats the central nervous system and spinal column diseases.

The final diagnosis for Rachel after testing and visits to specialists: cervical disc herniation at the C4-5 level compressing the spinal cord. The disc herniation has caused chronic pains and sensory and motor problems.