That's what appeared in my 2pm appointment slot yesterday. The "NP" stands for a new patient and the "low back pain" speaks for itself. I see at least a dozen of these a week and they tend to be painful for both the patient and me. At it's worst, these visits consist of overweight depressed smokers who are unwillingly or unable to do anything to improve their health. They tend to bounce around from health care provider to health care provider looking for a magic bullet to their ailment which they often interpret to be in the form of narcotic pain medication.
When I went into the exam room I found a young man in the preferred standing position for those with low back pain. His story from there, however, was quite different from the typical low back pain. While serving in Iraq, this marine received a call that he and his buddies needed to move quickly. To do this they typically used a fork lift to move a 7,000 lb. trailer in front of their vehicle which would be pushed ahead to set off an IED instead of having it hit them. Without having time for this, they attempted to lift the trailer into place, but at some point it slipped down with my new patient still holding on.
He felt immediate and severe lumbar pain with numbness in his legs. He even noted that he had some urinary incontinence (which can be a sign of
cauda equina syndrome, a neurosurgical emergency). He was flown out to Kuwait and then to Germany where he received conservative medical treatment.
Out of the Marine Corps now, he returned to his roots in my small town to receive care from me. I told him he would likely benefit from surgery given the MRI in his chart and my examination of him. He declined this, but would not rule it out if he did not improve. He did not want pain medication, but I found myself almost throwing prescriptions at him to help ease his pain given what he had been through. I thanked him for his service and he agreed to come back in a month to see how he was doing.
His story was certainly not the headline making limb amputation or traumatic brain injury that we frequently see on the evening news, but this injury will likely profoundly impact the remainder of his life nonetheless. Certainly I will not mind seeing his name with "low back pain" next to it on my schedule in the future.
The Country Doctor
When I went into the exam room I found a young man in the preferred standing position for those with low back pain. His story from there, however, was quite different from the typical low back pain. While serving in Iraq, this marine received a call that he and his buddies needed to move quickly. To do this they typically used a fork lift to move a 7,000 lb. trailer in front of their vehicle which would be pushed ahead to set off an IED instead of having it hit them. Without having time for this, they attempted to lift the trailer into place, but at some point it slipped down with my new patient still holding on.
He felt immediate and severe lumbar pain with numbness in his legs. He even noted that he had some urinary incontinence (which can be a sign of cauda equina syndrome, a neurosurgical emergency). He was flown out to Kuwait and then to Germany where he received conservative medical treatment.
Out of the Marine Corps now, he returned to his roots in my small town to receive care from me. I told him he would likely benefit from surgery given the MRI in his chart and my examination of him. He declined this, but would not rule it out if he did not improve. He did not want pain medication, but I found myself almost throwing prescriptions at him to help ease his pain given what he had been through. I thanked him for his service and he agreed to come back in a month to see how he was doing.
His story was certainly not the headline making limb amputation or traumatic brain injury that we frequently see on the evening news, but this injury will likely profoundly impact the remainder of his life nonetheless. Certainly I will not mind seeing his name with "low back pain" next to it on my schedule in the future.
The Country Doctor