Should I Expect My Primary Care Physician to Recommend Surgery for My Disc Issue?
I am a 27-year-old woman, measuring 5'4" and weighing 185 pounds. My recent MRI results reveal the source of my intense lower back discomfort: a 6mm extrusion of the L4-L5 disc, accompanied by mild central canal stenosis and constriction in the right subarticular recess. Additionally, there is a slight bulge in the discs at L2-3 and L3-4. For the last month, I have been enduring excruciating pain on my right side, extending to my hip, leg, and pelvis. This situation has significantly impacted my mobility, necessitating the use of a cane for support. Transitioning from sitting to standing or bending over to lift objects has become particularly challenging. Prior to the MRI, my primary care physician prescribed Flexeril and a brief course of oral steroids. The steroids provided the most relief, and while physical therapy has been suggested, the clinic is currently overwhelmed with patients. I am leaning towards opting for surgery. My mother underwent her first spinal surgery at just 15 for a herniated disc and had another procedure at the age of 20. Though the only diagnosis I’ve received so far is hypermobility, I have a strong suspicion that both my mother and I may have hypermobile Ehlers-Danlos syndrome. Unfortunately, numerous visits to rheumatologists have not yielded any helpful insights. My primary concern is whether my PCP would be inclined to issue a referral to a neurosurgeon, or if I would be required to endure conservative treatments for an extended period first. Additionally, could this situation serve as another sign pointing towards hEDS?
Answers (1)
9/5/2025, 4:20:40 AM
OpenHealth AI
It’s understandable to feel anxious about your back pain and the possibility of requiring surgery. Let’s break down your situation to help clarify what you might expect from your primary care physician (PCP) and your next steps.
Main Points:
- Surgery is typically a last resort for disc issues after conservative treatments have been tried.
- Your current symptoms and MRI findings suggest significant pain and mobility impairment, which may prompt a referral for further evaluation.
- Based on your family history and symptoms, consider exploring the possibility of hypermobile Ehlers-Danlos syndrome (hEDS) more thoroughly.
Explanation:
Your MRI shows a 6mm extrusion of the L4-L5 disc, which can cause nerve compression leading to pain down your leg. The fact that you have intense pain, reduced mobility, and the need for a cane indicates that this is affecting your daily life significantly. While surgical options can be effective, they are often considered only after other treatments have failed.
Your PCP might first want you to try physical therapy, even though access may be delayed; this is typically part of the management plan unless your condition is very severe. However, given your debilitating symptoms and your past experience with steroids providing relief, your PCP may indeed consider a referral to a neurosurgeon sooner than usual.
Next Steps:
-
Communicate Your Concerns Clearly: Schedule a follow-up with your PCP and express your ongoing pain, functional limitations, and desire for possible surgical consultation. Make sure to highlight how this affects your quality of life.
-
Discuss the Referral: Ask your PCP specifically about a referral to a neurosurgeon. Emphasizing the impact of your condition on your daily activities may expedite this process.
-
Explore Symptoms of hEDS: Since you suspect hypermobile Ehlers-Danlos syndrome, prepare to discuss your family history and any related symptoms you may have with your doctor. This may help you receive a more comprehensive evaluation that addresses the connective tissue aspects of your pain.
-
Focus on Pain Management: In the meantime, continue with pain management strategies. Over-the-counter medications like ibuprofen or acetaminophen may help, if permissible for you, and consider light exercises that do not aggravate your pain, if possible.
-
Seek Support: Connect with support groups or online communities for people with similar conditions, which may provide you with valuable insights and coping strategies.
Taking these steps can help you engage proactively with your healthcare team, ensuring that your concerns are addressed effectively.
Related Questions
Signs of Irritation After Massage
Age: 28 Gender: Male Height: 6'3" Weight: 200 lbs Ethnicity: South Asian Duration of Symptoms: 1 day Affected Areas: Hands and arms Pre-existing Medical Conditions: None Current Medications: None Tobacco Use: THC Vape Hi there, I made a questionable decision and visited a massage parlor. Following the session, I observed a circular red mark on the therapist's chest, about the size of a quarter. While I was covered elsewhere, my arms were exposed during the treatment. Afterwards, my skin felt warm and irritated, though it wasn’t itchy, and there was no fluid discharge. I noticed multiple bumps appearing on my arms. The following day, I realized the corners of my lips were swollen and felt uncomfortable. I’m concerned I might have contracted herpes or another infection on my lips since I am already positive for HSV-1. Is there a possibility this could be HSV-2, or might the outbreak I’m experiencing be linked? I did engage in some mild kissing. The sores on my lips surfaced the next day, while the bumps on my arms developed just a few hours post-massage. Additionally, I found a red bump in my groin region a day after the massage. I’m becoming increasingly anxious thinking that these issues may have originated from the massage. What might be the cause of these symptoms? I would really appreciate any guidance. The stress from this situation is overwhelming me.
Persistent Itchy Bumps and Rashes Across My Body
Hello everyone. Recently, I noticed the emergence of several fluid-filled bumps on my arms, which have since spread to other areas of my body. The rashes on my arms are particularly intense, accompanied by a fair amount of itching and discomfort. In contrast, the areas on my upper body and legs experience considerable itchiness. Alarmingly, the rash has extended to my neck and ears, resulting in both ears discharging fluid. Despite multiple visits to doctors and hospitals, a diagnosis remains elusive. I've been prescribed a steroid cream that alleviates the irritation for a while, but every morning, I wake up to find new itchy bumps forming. I would greatly appreciate any guidance or assistance you could offer. A bit about me: I'm a 25-year-old male, standing at 5 feet 6 inches tall. For over two weeks now, I have been on a course of oral antibiotics and antivirals.
Concerns About Recent Rib Fractures
I am a 25-year-old female, weighing 169 pounds and standing 5'6". I don't consume alcohol, but I do smoke marijuana daily. In the last month, I have suffered multiple rib fractures. My lifestyle is quite inactive, and I take medication for anxiety and depression. In February, I was ill with the flu and during that time, I experienced intense coughing, which I believe may have led to an injury. Recently, I had another cold and was coughing excessively again, which prompted a visit to urgent care where X-rays revealed that I had fractured ribs 10 and 11. The medical staff advised me to rest for recovery. It's been two weeks since the initial diagnosis, and I have started to feel some improvement. However, two days ago, I woke up with similar pain on the opposite side of my ribcage, which is actually worse than before. I'm starting to suspect that I’ve sustained injuries there as well. My grandmother has osteoporosis, so I've been wondering if that could be a factor along with my daily smoking. Although I typically don't cough while smoking, any coughing I do can now be extremely painful due to my rib injuries. I’m hesitant to stop smoking, as I find it alleviates my pain to some extent. While the doctor mentioned narcotics as a pain management option, I’m not inclined to pursue that route. I have an appointment with my primary care physician on October 2, but I can’t find an earlier slot, leaving me unsure of how to proceed. I'm contemplating returning to urgent care for an evaluation of my current discomfort, as I suspect those ribs may also have fractures. I feel anxious and perplexed about why my bones seem so fragile, leading to these injuries.
Seeking Insights on Unexplained Health Issues
I’m reaching out for thoughts on a perplexing health situation I’ve been grappling with. Here’s a brief overview of my condition and medical background: - **Profile:** 22 years old, 5'5”, weighing 155 lbs. - **Symptoms:** These began within the last three weeks and include: - Persistent lightheadedness - Noticeable increase in heart rate (over 30 beats per minute) upon standing - Irregular blood pressure; my typical baseline is around 120/80, but it's recently dropped to 102/70, with a low of 88/62 this week - A rapid, pounding heart even when at rest, which escalates upon standing - Intense headaches correlating with the onset of other symptoms that last for hours - **Current Medications:** - Adderall XR 30mg (started approximately four months ago) - Propranolol as needed (rarely taken) - **Laboratory Results:** - Hemoglobin: 10.1 (normal range for me is usually 10.6) - Hematocrit: 32.9 (low) - MCV: 75 (low) - MCH: 23.1 (low) - MCHC: 30.7 - RDW: 18.5 (high) - Creatinine: 0.50 (low) - All other values within normal limits - **Diagnostic Tests:** - EKG: showed normal results while at rest and without symptoms - Ultrasound: also returned normal results - **Medical History:** - I have a history of chronic anemia linked to heavy menstrual bleeding. - Additionally, I’ve been vaping for over eight years. **Incident:** Recently, I visited the emergency room due to temporary visual disturbances characterized by blurred, purple vision and significant pressure in my head. Post-incident, I felt clammy. The ER staff attributed this to my anemia and dehydration, providing fluids before discharging me. Now, after consulting with numerous doctors—20, to be precise—I've finally been referred to a cardiologist. However, the prevailing feedback has been around my anemia, which does not address my ongoing symptoms. Notably, my heart rate spikes consistently, elevating over 30 beats when I stand or move. For context, my pulse peaked at 166 after standing from a resting rate of 88. I want to emphasize that I am acutely aware of my body and its signals. The lowest my hemoglobin has dipped was to 6 following an emergency C-section due to placental abruption, yet I wasn’t experiencing symptoms like these at that time, even with a level of 10.1 currently on record. I am convinced there’s an underlying issue that isn’t rooted in my anemia. I can feel it. With my cardiology appointment on the horizon, I want to ensure I’m well-prepared. I’d greatly appreciate any theories or advice on specific questions I should pose to the doctors to exclude other possible diagnoses. Thank you!
Concerns About Potential Growth Plate Fractures in a 15-Year-Old
My 15-year-old son underwent x-rays last night following persistent pain in his hips that began mid-July, shortly after he started attending high school football practices. Initially, he felt discomfort in his left lower back, attributing it to muscle strain. However, the pain progressively expanded to encompass his hip area, leading him to reassess the source of his discomfort. More recently, he experienced similar symptoms on his right side, commencing with back pain before encircling his hip. He has been heavily reliant on ibuprofen for relief, applying ice to both sides and resting after school and practice. Upon returning home, he often moves around gingerly, as if he were much older, due to the pain. After discussing the situation with a friend who is a chiropractor, it was suggested that I should seek x-rays as soon as possible to rule out potential injuries to his growth plates; I hadn’t considered that possibility before! I managed to get him to an urgent care facility, but sadly, there was no radiologist available to analyze the x-rays at the time. My chiropractor friend has also been unreachable for consultation this evening. When I reviewed the images, I noticed two areas on both iliac crests that raised my concerns. I am uncertain whether these areas indicate normal growth plates or if they could potentially be fractures. I expect to receive feedback from the radiologist in the morning, but I’m feeling anxious and am hopeful that someone here might be able to provide additional perspective.