| Dr. Kestner: Was this man’s tailbone pain all in his head? |
Related Articles
|
|
By: By Dr. MARK KESTNER
|
|
 Email  Print
|
This is the story of a patient I never met. I learned of his story through another doctor. The story is about the necessity to occasionally be a little stubborn.
James had been having pain in his tailbone for months. The pain had been steadily increasing in intensity. Initially he had pain only in certain positions. Now he felt pain practically all the time.
At first he had dismissed the pain, thinking it would go away on its own. He finally realized that he needed help. He went to his physician and was diagnosed as having coccygodynia. This translates into what most people would call “tailbone pain.” (I know, we already knew he had tailbone pain, but the Latin makes it sound so much more respectable, doesn’t it?)
He received anti-inflammatory medication and was sent home. He began to feel better, as long as he was taking the medicine. When the medicine wore off he was hurting again. By taking the drugs he was able to continue working … sitting most of the time.
Unfortunately, his problem continued to worsen. He returned to his doctor and was prescribed a stronger medication. Again he felt temporary relief, but the problem persisted.
When he returned to his doctor again X-rays were ordered. Nothing abnormal was found. His doctor recommended he continue the pain medication.
When he returned several weeks later with the same complaint, James’ doctor seemed to be annoyed with him. He recalled that they had done X-rays and nothing was found. James pressed his doctor and said that it felt like his tailbone was somehow “out of joint.” The doctor explained that the human coccyx doesn’t really move like James was imagining and the X-rays showed it wasn’t out of joint.
James left frustrated and still in pain.
He decided to get another opinion. He saw another doctor and insisted on an orthopedic referral. The orthopedist repeated X-rays and ordered a CT scan, which were normal. James explained that now the problem had been present for months. It would flare up and subside, but never went away. The orthopedist found nothing that justified surgery and prescribed a different anti-inflammatory.
James did not give up in his search for help. His initial doctor had left him feeling like he was imagining the problem. Two other doctors had been unable to help him resolve it. He knew something was not right with his tailbone.
He began to research the Internet. The Internet can be a valuable resource for the well-informed patient. It can also be confusing and mis-informative. Using the Internet for consumer medical research requires persistence and common sense.
James found a site that explained that the coccyx does move in many individuals. Although there is a widely held belief that the coccyx bones typically fuse together, in many cases the fusion is incomplete.
The site even explained how X-rays could be taken to evaluate this. An X-ray is taken from the side view with the patient standing, and another film taken with the patient sitting. The angles of the sacrum and coccyx are measured on the X-ray. I should point out that this particular X-ray technique is not standard. This approach was discovered and published about 15 years ago by a medical doctor from France, Dr Jean-Yves Maigne.
Treatment for coccygodynia can vary from manipulation of the tailbone, to injections of a steroid into the joints, and in some persistent cases, the tailbone is surgically removed.
James was able to find a doctor that looked at the material and took the X-rays as indicated. He found that James had a tailbone that moved out of joint only while sitting. That explained why the traditional X-rays appeared normal. James was treated successfully.
Sometimes it pays to be a little stubborn. I’m not talking about being uncooperative or disrespectful of your caregivers. I am talking about being persistent in your search for effective treatment.
Next week I have an informative column that will be valuable for anyone with children or grandchildren.
Until then, don’t learn to live with pain, keep searching for a way to live without it!
Dr. Mark Kestner
mkestner@drkestner.com
|
|
|
|
|
|
Login and voice your opinion!
|
Digg
Facebook
MySpace
Yahoo!