Re: Misdiagnosed

[Luchi]

My question involves medical malpractice in the state of: North Carolina

In August of 2013 I started having a mild numbness in my bottom lip that would come and go. By the end of September, the mild numbness had escalated to excruciating pain from my temple, down the side of my face to the center of my chin and bottom lip. I have an extremely high threshold for pain, so when I saw it was excruciating, it was! I went to my primary care physician, and she felt that based on my symptoms, I had trigeminal neuralgia. She prescribed Tramadol, and referred me to a local neurologist that is part of the largest medical practice in the county I live in.

At my appointment with him, he agreed with her diagnosis, and explained why Tramadol does not work for nerve pain. He mentioned that he would put me on Neurontin, and schedule me for an MRI. As I was leaving his office, I asked the nurse about the prescription, and she was quite hateful and said that there was nothing in his notes about a prescription. This was on a Monday. The next day, the same nurse called me to let me know when my MRI was scheduled (the following Monday in October). I asked her about getting something for the pain, and she informed me that the doctor does not prescribe pain medication. I got very upset, and told her that the whole reason I saw the doctor was because of the unbearable pain I was in. She again was hateful and said she would talk to the doctor and call me back. At the end of the day she finally called back and said that the doctor was faxing my pharmacy a prescription for Tramadol. I explained that he had already told me Tramadol does not help nerve pain, and asked why was he prescribing that. Her exact words to me were "Well what DO you want???" in a very hateful tone of voice. My reply was that I want something that works. She then asked me if the Neurontin wasn't working. I asked what she was talking about? She said that a prescription for it had been sent to my pharmacy the day before. I had to inform her that no one had told me that. Her tone changed after that, so i'm going to assume she screwed up.

The following week, on Monday, I had my MRI (at the cost of over $1300). It took until Friday to get results from the doctor, and he said that there was nothing on the MRI, and the only thing he could do is refer me to another neurologist or a pain management clinic. His attitude was that I was exaggerating the extent of my pain and he was treating me like a drug seeker. I declined both since I could not afford to keep going to different doctors when 2 had given me the same diagnosis, and I didn't want to just cover the pain up. I just got used to the pain and was dealing with it.

Fast forward to January, and I go to an appointment with a new dentist. During the series of x-rays that they do for new patients, the dentist sees dark areas on the x-rays that concern her, and she was shocked that the dark areas were not seen on the MRI when I told her I had had one just a couple of months earlier. She immediately sends me across the street to an oral surgeon. He looks at the x-rays, and starts talking about chemo and losing my teeth. He was also shocked that the previous MRI did not turn up these dark areas. I have never been so scared in my life!

It took 2 weeks, but I got an appointment at a local university's dental school (only oral surgeon considered in-network with my insurance), and saw a world-class oral surgeon. What I had was a large tumor on the left jaw bone that had destroyed most of the bone. I was put on a soft diet until surgery to remove the tumor because I had so little bone left, and my jaw could have shattered if I bit down on something too hard. A CT scan turned up a tumor not quite as advanced on the right side of my jaw bone as well. I was told that it is very rare for this type of tumor to be found on both sides. I had surgery at the end of January, and the surgeon was able to remove all of the tumors, with minimal nerve damage and he was able to save all of my bottom teeth. That was a concern because the tumors were up around the roots of my teeth and wrapped around the nerves in my chin.

I would like to have the MRI from October reviewed again. The oral surgeon who removed the tumor was also surprised that supposedly nothing was seen on the MRI.

If the MRI is reviewed by a different radiologist, and it turns out that the tumors could be seen, do I have a medical malpractice suit?

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[Modesta]

I hate to say this, but from the physician's point of view there are some red flags there.

The first is what you were told. Tramadol is actually very effective with nerve pain. Why you were told it doesn't work, I cannot fathom. So, we have that.

What I'm actually seeing though is not so much shoddy treatment, but a whole heck of a lot of wires getting crossed.

Then we have the imaging studies. Unfortunately what can be seen by x-ray may not be seen via an MRI (and vice versa).

But the main point? You were offered a referral for a neuro or a pain management clinic but declined not one, but both. See it from the physicians point of view - why on earth would a genuine pain patient actually refuse such referrals? The timing of the painkillers doesn't help you, either.

My overall impression is this.

You're not faking it. But you've shown a couple of classic drug-seeking tendencies; it's a huge red flag when you offer a patient other forms of management and they outright refuse without even considering how they might help.

If you wish, you can take your records to a med-mal attorney. I'm just not seeing a case.

[Vincent]

I hate to say this, but from the physician's point of view there are some red flags there.

The first is what you were told. Tramadol is actually very effective with nerve pain. Why you were told it doesn't work, I cannot fathom. So, we have that.

What I'm actually seeing though is not so much shoddy treatment, but a whole heck of a lot of wires getting crossed.

Then we have the imaging studies. Unfortunately what can be seen by x-ray may not be seen via an MRI (and vice versa).

But the main point? You were offered a referral for a neuro or a pain management clinic but declined not one, but both. See it from the physicians point of view - why on earth would a genuine pain patient actually refuse such referrals? The timing of the painkillers doesn't help you, either.

My overall impression is this.

You're not faking it. But you've shown a couple of classic drug-seeking tendencies; it's a huge red flag when you offer a patient other forms of management and they outright refuse without even considering how they might help.

If you wish, you can take your records to a med-mal attorney. I'm just not seeing a case.

First, as I stated, I refused a referral because I had already had 2 doctors say that I had trigeminal neuralgia. I can't afford to go from doctor to doctor. Maybe some folks can, but I can't. As for the refusal to be referred to a pain management clinic, my mother was a drug addict when I was growing up, and I avoid any type of medication at all possible. I would rather suffer through the pain than take medication. Why the neurologist I saw said that Tramadol does not work for nerve pain, I can't say. All I know is that he explained that the class of drug Tramadol belongs to does not work on nerve pain. I know nothing about pain medication beyond Tylenol, so I took him at his word, plus the fact that the few pills I had taken after my primary doctor prescribed them did nothing for the pain. I also had people tell me Neurontin was "good", but I had no relief from that either. I threw both bottles of medication away since they did not help my pain. And as it turned out to not be a nerve issue anyway, but rather tumors eating away at my jaw bone, that could be why the Tramadol did nothing for my pain. I imagine most people would find having tumors eat away their jaw bone to be at least a little bit painful, but what do I know.

I'm sure my awesome oral surgeon, Dr. Timothy Turvey, would agree that I wasn't faking anything.

[Job]

First, as I stated, I refused a referral because I had already had 2 doctors say that I had trigeminal neuralgia. I can't afford to go from doctor to doctor. Maybe some folks can, but I can't. As for the refusal to be referred to a pain management clinic, my mother was a drug addict when I was growing up, and I avoid any type of medication at all possible. I would rather suffer through the pain than take medication.

First, please knock down the offended tone. I did not for one second accuse you of anything. With that said, look at this objectively. You asked for something for pain, and when they didn't give you what you needed, you refused other offers of help.

It doesn't matter what I think - I have no dog in this fight. But the bottom line is that you did put up a few red flags whether or not you intended to do so.

Why the neurologist I saw said that Tramadol does not work for nerve pain, I can't say. All I know is that he explained that the class of drug Tramadol belongs to does not work on nerve pain. I know nothing about pain medication beyond Tylenol, so I took him at his word, plus the fact that the few pills I had taken after my primary doctor prescribed them did nothing for the pain

Sigh. Okay, time to educate yourself.

http://www.healthcentral.com/chronic...86/nerve-pain/

http://www.medscape.com/viewarticle/730671_7

http://www.nhs.uk/Conditions/Periphe...Treatment.aspx

. I also had people tell me Neurontin was "good", but I had no relief from that either. I threw both bottles of medication away since they did not help my pain. And as it turned out to not be a nerve issue anyway, but rather tumors eating away at my jaw bone, that could be why the Tramadol did nothing for my pain. I imagine most people would find having tumors eat away their jaw bone to be at least a little bit painful, but what do I know.

I'm sure my awesome oral surgeon, Dr. Timothy Turvey, would agree that I wasn't faking anything.

And your fandabidozi oral surgeon wasn't present when you were seeking help initially.

Feel free to contact a med-mal attorney at your earliest convenience.

[Gina]

First, please knock down the offended tone. I did not for one second accuse you of anything. With that said, look at this objectively. You asked for something for pain, and when they didn't give you what you needed, you refused other offers of help.

It doesn't matter what I think - I have no dog in this fight. But the bottom line is that you did put up a few red flags whether or not you intended to do so.

Sigh. Okay, time to educate yourself.

http://www.healthcentral.com/chronic...86/nerve-pain/

http://www.medscape.com/viewarticle/730671_7

http://www.nhs.uk/Conditions/Periphe...Treatment.aspx

And your fandabidozi oral surgeon wasn't present when you were seeking help initially.

Feel free to contact a med-mal attorney at your earliest convenience.

I apologize if I came off offended. I was just trying to explain my reasons for refusing the referrals. And I apologize for praising my doctor. I think he is wonderful, and he worked a miracle on me so I like to praise him every chance I get.

My question was actually about having the MRI reviewed by a different radiologist. Perhaps I should add that last year, I had to see a urologist due to a large kidney stone in my rt kidney and 2 large abscesses on my left kidney. He had me go across the street from his office to get a copy of the CT scan he had ordered because he did not trust the radiologist's report. He walked into the exam room and told me that he was looking at the report of someone "half dead". He probably shouldn't have told me this, but he said that there is only 1 radiologist in our county, and that the guy has a lot of personal issues, and the urologist did not trust the report from the radiologist, that's why he wanted to view the CT scan himself. As it would happen, my CT scan really was that bad, and I was referred to a specialist an hour away who called me a "medical oddity" because he said he had never seen anyone with kidneys as bad as mine who was up and walking around. That conversation from last year with the urologist has stuck in my mind ever since the dentist and the 2 oral surgeons said that the tumors should have shown up on the MRI from October. I can't help but wonder if my MRI was reviewed by that same radiologist that has person issues, and maybe he missed the tumors. My issue has never been with the neurologist.

Please accept my apology if you feel I attacked you. That was certainly not my intention. It never occurred to me that refusing medication would flag me as drug seeking. What a sad world we live in...

[Pamluva]

It's not so much "refusing medication" as refusing the referrals your doctor gave you. In medicine, sometimes things are not an exact science as people believe. Sometimes it takes multiple professionals, multiple tests, etc. to get a good accurate diagnosis. Sometimes it takes 2 or 3 imaging studies to accurately diagnose. An MRI is completely different from CT scan or x-ray. Plus, the tumor may have been very small during the time you had an MRI. If by some chance you do bring an action against the doctor, you can be sure all the above will be brought out in a deposition. There will be a paper trail of things such as not seeing the recommended specialist, phone calls wanting a different kind of medication, any follow-ups not kept, etc. etc.

[Olowo]

the problem with a medmal suit:

what are your damages?

it would appear you have been successfully treated. Unless you can show the delay caused additional treatment that you would not otherwise been subjected to or it allowed the condition to go beyond a treatable condition, you really don't have anything more than pain and suffering and you are not likely to find a lawyer to take on a medmal case with such minimal damages possible.

and that is only if the tumor was visible on the mri already in hand. You have to realize that there was a 3-4 month span between the initial imagining tests and the dentists x-rays. A lot can happen with a tumor in that time. It can go from undetectable to "whoa!! what the heck is that monster thing?!!"

[Tony]

I apologize if I came off offended. I was just trying to explain my reasons for refusing the referrals. And I apologize for praising my doctor. I think he is wonderful, and he worked a miracle on me so I like to praise him every chance I get.

My question was actually about having the MRI reviewed by a different radiologist. Perhaps I should add that last year, I had to see a urologist due to a large kidney stone in my rt kidney and 2 large abscesses on my left kidney. He had me go across the street from his office to get a copy of the CT scan he had ordered because he did not trust the radiologist's report. He walked into the exam room and told me that he was looking at the report of someone "half dead". He probably shouldn't have told me this, but he said that there is only 1 radiologist in our county, and that the guy has a lot of personal issues, and the urologist did not trust the report from the radiologist, that's why he wanted to view the CT scan himself. As it would happen, my CT scan really was that bad, and I was referred to a specialist an hour away who called me a "medical oddity" because he said he had never seen anyone with kidneys as bad as mine who was up and walking around. That conversation from last year with the urologist has stuck in my mind ever since the dentist and the 2 oral surgeons said that the tumors should have shown up on the MRI from October. I can't help but wonder if my MRI was reviewed by that same radiologist that has person issues, and maybe he missed the tumors. My issue has never been with the neurologist.

Please accept my apology if you feel I attacked you. That was certainly not my intention. It never occurred to me that refusing medication would flag me as drug seeking. What a sad world we live in...

No harm done

Nurse is also correct though; it's not really as straightforward as we might expect.

The issues surrounding pain meds are very close me - a few bad apples have caused many doctors to be very nervous about prescriptions to the point where pain control woefully inadequate.

For your own sake, you really are expected to at least try other methods. Pain clinics aren't the same as your primary doctor. They specialize in pain management and (again, in my opinion) are far more pro-active with their patients.

I'm still not convinced that there's a viable case here but there's nothing wrong with heading down to the closest medmal attorney who can review your file. Generally they'll do this for free.

[marywiltonn]

Hello All,
Misdiagnosed is taken as medical malpractice If patient got serious illness due to doctor’s diagnosis. I would say that you should contact medical malpractice lawyer. I can assist you by referring one in my known: http://www.baizlaw.com/ firm. They helped my friend also but the case was different but I can assure you of their work .