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Dr. Rick, MD
Dr. Rick, MD, Board Certified MD
Category: Neurology
Satisfied Customers: 11089
Experience:  20+ years as a doctor. Internal Medicine Internship in NYC
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I am a reviewing physician WC insurance company) A 28 yo

Customer Question

I am a reviewing physician for the WC insurance company)
A 28 yo female has cauda-equina syndrome secondary to an L5-S1 discectomy (she had a congenital conjoined nerve root) and bilateral weakness described as "give-way." She obviously has real neurologic deficit with bladder incontinence but does use of the term "give-way weakness" by her examining physician imply symptom magnification? Her reflexes are normal except decrease right achilles compared to left.
Patient is being treated with opioids for chronic pain (no drug seeking behavior and pill counts, urine tox has always been consistent) - Treating physician wants to wean but she recently had a fall at home requiring ER visit and increase in opioid dose. She does have an attorney and will probably pursue a malpractice suit against the spine surgeon who performed her original surgery. She was making progress in her physical therapy in terms of improved strength prior to her fall.
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Rick, MD replied 1 year ago.

Hi. My name is***** and I am online and available to help you today. Thank you for your patience.

Question and answer is just one of the services I offer. I can also provide you with additional services, such as live telephone or skype consultation, at a small additional cost. Let me know if you are interested.

How long ago was her fall?

How far did she fall/tell me about the mechanics.....

Do she have any other medical problems or take any other medications?

This is not an answer, but an Information Request. I need this information to answer your question. Please reply, so I can answer your question. I look forward to helping you.

Customer: replied 1 year ago.
Her findings of "give-way" weakness preceded her fall. In addition to opioids, she is also taking duloxetine and baclofen and she is an every-day smoker. Other than her failed laminectomy syndrome and neurogenic bladder secondary to her spinal surgery, she has no other medical problems and is not taking any other medications. She is seeing a urologist to help with management of her neurogenic bladder. Her incontinence was increased and ability to ambulate was decreased after her fall - she is now using a walker/wheelchair). My question really has to do with the implications of the physical finding of "give-way" weakness.
Expert:  Dr. Rick, MD replied 1 year ago.

Thank you for that additional information.

From what you have posted I would not rush to say that what this person is trying to consciously fake increased severity. Her possible legal actions really do not shed any light on this in either direction.

Does this make sense to you?

Hi. My name is***** and I am online and available to help you today. Thank you for your patience.

Question and answer is just one of the services I offer. I can also provide you with additional services, such as live telephone or skype consultation, at a small additional cost. Let me know if you are interested.

Customer: replied 1 year ago.
As I understand "give way" weakness it means that we you are testing a patient's muscle strength by asking them to resist your attempt to move a limb, the response is inconsistent resistance and that this implies a less than maximal effort on the part of the patient. Is this correct?
Expert:  Dr. Rick, MD replied 1 year ago.

That sounds good to me.....but proving that they are faking it means first ruling out every physiological/pathological cause -- which can be very difficult to do, as I am sure you know.

You may also want to consult with your psychiatric colleagues on this patient.

Does this make sense to you?

Don't forget to mash the positive (excellent is the most fun to push) feedback button.....without this important step on your part the funds you left on deposit are not released and my kids will spend another cold winter barefoot ;)

It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I don't go up in a puff of smoke -- I'll still be right here to continue helping you, but, as I do work for tips, I want to make sure you are happy before rating me.

Dr. Rick MD FACS