Recent content by powermd

The procedures were all cash, no insurance? Trying to figure out how you get to a $12k balance on two procedures. Maybe I'm doing something wrong.

Where is this, California?

If it can be easily modulated by messing with the piriformis, and the MRI is clean, it's piriformis.

Aside from the basic anatomy of spinal nerves, nope. Just observation that patients with compressed nerves can have varying degrees of radic, and all can respond to ESI. Personally, I have piriformis syndrome. Most of the time it just causes a mild ache in the buttock. If it really flares up...

Degree of compression may matter to extent of radiation. More superficial fbers = more proximal pain. Deeper = more distal.

I think the goal of medical school is to build a foundation for lifelong learning in medicine. I can say the intense competition for grades at my school with people far more talented than me leveled up my abilities in every way. I'm a much better doctor for it, and I'm sure if I had a crutch...

My suggestion would be, #1) Ins pays $50 extra if the procedure is authorized. The whole point is that it saves them money- great, let them pay for the extra work on our end if we've met their criteria. #2) Yes, PA needs to be an absolute guarantee of payment. They need some skin in the game...

Can look up cluneal neuralgia- tough diagnosis to prove, but the patient should have immediate pain relief with injection in the fascia plane lateral and superior to the erector spinae, and medial to the PSIS. It's like a little recess next to the PSIS. L5 radic not radiating to the leg is one...

Fibro PSIS hypersensitivity, cluneal neuralgia, erector spinae/lat/QL tendinitis/myalgias, L5 radic.... all kinds of pain generators in that spot OTHER than the SI joint. I'm personally pretty conservative about calling SI joint pain. I like to see a positive Gaenslen. In my hands, that's by...

Now that's a good question. Why are they micromanaging a joint injection? This was kind of my point from earlier. Docs abuses the system with "too many" of something, the system bites back and tells us under what circumstances they'll pay. Now we don't get to decide the right amount, at least on...

Because getting fluid into the SI joint isn't remotely as reliable as an encapsulated hip, knee, or shoulder. Sometimes you get the perfect SI arthrogram- sometimes it just... won't... go... If you're load is blown at 1.5 mL, what't plan B? Draw up more steroid? Personally, I draw up 3-4 mL...

I get what you're saying buttttt... I find it absolutely hilarious how quickly the resident conservatives break out the "blame the victim" card. You've seen what happens when payors try to micromanage their way to a system that can't be gamed- basically all our procedures. Actual clinical care...

I don't have data to back this up, but to me it seems the risk of infection from compounded steroids would be way greater than the risk of arachnoiditis from whatever timy amount of benzyl alcohol is in the preserved kind. I'll take the latter six ways to Sunday.

Posted on FB Physician Community.

This is the paper that got me started on LDN for CRPS: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3661907/