end chronic pain

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my diagnostic mistake

(The Importance of a Good History)

Cauda Equina Syndrome

The importance of listening to my patients hit me full in the face this week.  On Monday, I had a new patient present with horrendous low back pain.  He had been to an Emergency Room the previous day, examined, sent home, and told to take high dose Ibuprofen.  He came to see me the next day because he could not take the pain.  Although I see people in terrible pain each and every day I am in the office, this individual also presented with……..

  • BILATERAL SCIATICA:   Any time SCIATICA is bilateral, it starts to raise a red flag.
  • SADDLE PARESTHESIA:  He had abnormal sensation on the inside part of his legs that would come in contact with a saddle.
  • TESTICULAR ANESTHESIA:  He could not feel his testicles.  Enough said.
  • ANAL ANESTHESIA:  He could not feel it when he wiped his rear end.  Enough said.
  • ANAL LEAKAGE:  He was leaking feces —- and could not feel it happening.  Enough said.

Any one of these is a potential Red Flag, but when put all together it is truly glaring.  I gave this individual a brief letter, scrawled on my letterhead, outlining my findings.  I also told him to go to a different Emergency Room and give the letter to whomever they came in contact with first — immediately.  Mind you, I did not actually do an examination on this person.  There was no need.  I simply got this information from what he told me during a three minute consultation. 

I wrote on the letter that I believed he had CAUDA EQUINA SYNDROME due to a herniated disc; a serious problem that requires immediate surgical intervention.  I was wrong.   After having an MRI, they discovered a tumor pressing on his spinal cord and causing Cauda Equina Syndrome.   His wife called our office yesterday and told Tracy the story, who then relayed it to me.  He is scheduled for surgery later this month.  Needless to say, she was extremely grateful we listened to them; and then thanked us for going out of our way to help them. 

As an update to this terrible story, this patient passed away about 7 months later.


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