Family Physician says pain is trivial, urge to strangle him suppressed

Steve

Posted 2006-12-28

My tailbone pain started while sitting at the office. It was a specific moment and the tailbone seemed to inexplicably shift a little in my normal computer chair. There was no trauma or injury to the tailbone that I am aware of. The pain is mild in comparison to some of the stories I've read here, but I don't leave the house without the Relaxobak cushion. I'll give a rundown of symptoms and (lack of) successful treatment.

Symptoms

1. Pain occurs only when sitting. It is a dull ache rather than an acute pain. If I shift my weight to the back of my thighs (sit forward) or to one side or the other the pain can be dealt with. The Relaxobak cushion helps but after a while it seems to cause the lower back to ache.

2. No pain at all when lying down or walking. We are remodeling our kitchen and I've been lifting heavy boxes and a cast iron sink with no pain at all.

3. Occasional numbing/tingling in the right outside thigh. I don't believe this is related to the tailbone pain. Also, a feeling of pressure/discomfort on the right side of my neck/underneath the jaw like something is going on there. This started right around the same time as the tailbone pain.

November 2006 - Went to the Family Doctor after about a month and a half of pain. I had an x-ray done a couple days previous to save time. I had already found this site and explained my own research to the doctor. The x-ray was completely normal. He suggested I might have bruised the tailbone and to wait four weeks for the pain to go away on its own. I explained that my father passed away from Myeloma (bone marrow cancer) and that his pain was originally misdiagnosed as a back problem for two months before his condition was discovered. Needless to say I am somewhat terrified that a mysterious bone-related pain has suddenly appeared with no apparent cause. I asked the doctor if I should get an MRI with my family history and he said just to wait. No prescription, no nothing.

I decided not to wait the four weeks and began trying to get an order for an MRI. Even if it was a million to one shot that I had cancer, it was worth the money to me. Suffice it to say that my insurance is not the best. The doctor I had seen was out of the office and another doctor at the practice refused to write an order for MRI because she had not seen me. Like I'm asking for a heart transplant or something.

December 2006 Eventually I get a Lumbar MRI ($1255 before Anthem's write off) and it shows that I have a protruding disc at L5-S1. No herniation and it should not be impacting any nerves according to the lab report. There is nothing remarkable about the tailbone, but a lumbar MRI will not show the entire pelvic region and the report mentions that the image of the tailbone is inconclusive. The Family Doctor refers me to a Neurosurgeon Clinic for evaluation.

Based on my conversations with coworkers I decide to try a Chiropractor first as nothing sounds cheap about a neurosurgeon. At this point I'm thinking the tailbone pain is referred pain from the protruding disc, which must also be causing the tingling in the thigh.

After ten minutes of physical examination, the Chiropractor says that she doesn't think the pain is being caused by the protruding disc. She says that the pain is too low for it to be referred from the lumbar/sacral joint. She has to basically put her hands between my thighs and press into my buttocks to trigger any pain. She believes the tailbone is the problem, which is what I thought all along. She says that it is not unusual for an MRI to show disc abnormalities without any symptoms whatsoever, which I had read the night previous. She believes the tailbone is deviating from its natural position when I sit and we might be able to free it up by loosening the surrounding joints.

I have three lumbar adjustments done by the chiropractor over a couple weeks. The procedure to internally manipulate the tailbone through the rectum is illegal for chiropractors to perform in Kentucky, and she doesn't know of anyone who can perform it in Ohio.

Though I believe the chiropractor has been helpful in her diagnosis, which was refreshingly direct and to the point, her adjustments have not helped with the tailbone pain at all. In fact the pain has gotten a little worse. Not that it hurts more so much as it is takes less sitting to trigger it. At this point I have decided not to return to the chiropractor as there has been no improvement.

Based on my findings on this site, I make an appointment with a new doctor at my family practice. I'm interested in getting a perspective from an Orthopedic doctor. He is a DO, but is practicing as a family doctor. I was hoping his orthopedic background would make a good contrasting opinion. What a waste of money. I'm really angry even recounting this episode. After putting on an aura of irritation at even having to see me for fifteen minutes, he asks if I've been engaging in any anal intercourse. (I'm a happily married heterosexual male). Seems like if I was having anal sex, I could have maybe put two and two together and figured out the cause of my pain.

When I tried to explain that I had read that internal manipulation of the tailbone through the rectum was often helpful he retorted, "I'm not going to stick my finger up your butt, that doesn't make any sense to me." I wasn't expecting him to do it, but I thought he might be able to refer me to a specialist. It quickly became clear that a half an hour of research on this site granted me more knowledge on this subject than a medical degree. Finally he says, "This pain is trivial. You're still working, you're remodeling your kitchen, you're doing the things you want to do.... I wouldn't bother treating it any further. It should go away on it's own." I wanted to crush his skull. I've already seen three doctors at this point and spent close to $1000 to be told that my pain is trivial.

Anyway, if anyone knows a good doctor in the Ohio/Kentucky/Indiana area (I'm close to Cincinnati) it would be very helpful. I don't know who to see at this point other than the neurosurgeon, and that seems pretty pointless.

Sorry for the long post, I hope others find it helpful.

Steve Northern KY/ Cincinnati area

Update, 2007-01-28

First, I want to thank everyone who has written supportive emails. It is amazing how a complete stranger is more willing to help than most physicians.

Anyway, I have made a little progress.

In January a went to see a nurse practitioner at the Mayfield Clinic (Neurosugery/Spine/Disc). He took a look at my MRI and agreed with the chiropractor that the protruding disc at L5-S1 was definitely NOT the cause of the pain. He said he had never heard of anything like this tailbone pain occurring when there was no trauma to the area. He made it clear that he was definitely not a specialist in this type of pain, but he was very interested in helping. When I told him about this site and what I heard researched on my own, he wrote me a script for a sitting x-ray and referred me to a pain specialist.

I got the x-rays and they are actually pretty clear. The only problem I had was that to get me in the right spot for the sitting x-ray, the had to prop me on three foam cushions and it was difficult to put pressure on the right spot to get the tailbone to really hurt, which is what I assume you need to do to get the proper effect on the x-ray. The last two segments of the tailbone look slightly out of alignment to me, but when I returned to see the NP, he told me everything looked fairly normal. He did say, however, that my tailbone was abnormally long. He said this was not based on any hard science, but that he looks at a LOT of x-rays of this area for other procedures that they do at the clinic. I have found a couple references that indicate that people with long tailbones are logically more prone to have trouble with them, though again this isn't something I can backup with hard science.

He said that there isn't anything else he can do, but recommended I try a couple of spinal injections through the pain specialist and see if that helps. He said that he knows someone who can remove the tailbone if that doesn't work. He said the clinic very rarely performs coccygectomies, and only when they need to get access to the base of the spine for other procedures. I was surprised to find out that the tailbone removal is outpatient surgery, and therefore shouldn't be too expensive with decent insurance, and shouldn't involve long periods off of work.

The pain specialist is an anesthesiologist. I was told that whatever hurts, he makes it not hurt.

For my part, I quit my office job and I have taken a new job where I won't be sitting so much. This is partially because of the tailbone, but mostly because I really hated the job. I think I'm going to give it a couple months and see if it just goes away as the x-rays did not show anything significant. Honestly, my pain isn't nearly so bad as what I have read described by most people on the site. As long as I'm using my cushion, I can sit for several hours with little pain. So long as my computer gaming is not drastically interrupted, I can deal with this. Driving is the worst for some reason. It's hard to get the cushion properly situated.

Despite my very good experience with this nurse practitioner, I can't see a reason to list his contact info as there is nothing he can really do. I will update again, once the pain either goes away on its own, or I see the pain specialist.

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