Danger Signals

The following are danger signals. The bad news about back pain is that almost everyone has some during their lifetime, the good news is that most of it gets better without ever having to see a physician. Sometimes however back pain can be very serious and require immediate emergency medical attention. If you experience a new onset of any of the following symptoms, you should seek medical attention immediately.

  • If you experience numbness or tingling in your arms, legs or feet.
  • If you have difficulty pulling your toes towards the ceiling or you drag your foot while walking.
  • If you have no control over bowel or bladder movement, lose feeling in your groin area during a bowel movement, are unable to control the start or stop of bowel or urination or if (for males) you are unable to get an erection.

Caution if your practitioner:

  • Does not take the time to perform a complete medical history and physical examination before beginning treatment or ordering tests.
  • Asks you to sign an agreement for multiple treatments or appointments in advance.
  • Discourages you from getting another opinion.
  • Indicates that through regular weekly or bi-weekly treatments or manipulations your back pain will be “cured.”
  • Charges prices much higher than what is usual and customary for your area.
  • Suggests alternative therapies without giving you information or time to consider them.
Find the Right Doctor

Most back pain problems will resolve themselves in one to two weeks without the help of any medical practitioner. The information on this web site for handling a back attack will usually do the trick. However, in those instances when you need to see a doctor it is important that you choose wisely. First, there are two kinds of physicians practicing medicine in America, Medical Doctors (M.D.’s) and Doctors of Osteopathy (D.O.’s). Both are similarly trained in chemistry and anatomy and other clinical skills. Both have equal rights and both are subject to the same board certification standards and licensing requirements.

Whether you choose a M.D. or a D.O., select a physician that is “board certified” in their medical specialty. Board certification means that they have passed a rigorous series of written and verbal tests in their specialty and are recognized for their superior command of the subject matter. “Board eligible” indicates that the physician has completed all of the required training but has not yet passed the test. This is perfectly acceptable for a young physician who has recently completed residency. Physicians are not eligible to complete board certification (verbal exams) until they have completed a period of practice after their residency (usually one year).

It is equally important that you work with a physician who believes in and practices a multidisciplinary treatment approach. This means that your treatment may consist of several different disciplines. For example, you may use some prescribed medications, some physical therapy, some aerobic exercise and yoga or relaxation exercises. Choose a physician who will help you organize the different treatment approaches. You can think of this as the “using every tool in the toolbox” approach.

Find out if the doctor uses a conservative treatment approach. Conservative treatment is non-surgical. This is particularly important if you are considering a physician who has training in surgery such as an orthopaedic surgeon.

In addition, ask the following questions of the office staff before you choose a physician:

  • How long has the doctor been in practice?
  • Where did the doctor go to medical school, internship, residency?
  • How many pain patients do they treat per month?
How to Get the Most Out of Your Doctor Visit

In our experience, most folks are very satisfied with the care they receive from their doctors. Nonetheless, we have all heard the tales of long times spent in waiting rooms reading old magazines. Most people understand that inherent in the practice of medicine is an unpredictable schedule. Doctor’s days are often interrupted by medical emergencies or a circumstance that requires more of their time than anticipated. Having said that, a well-run doctor’s office will respect your time as being just as valuable as theirs is. So how do you prepare to get the most out of your time with the physician? Take responsibility for your health care: Approach your health care with the same seriousness you would when purchasing a house or car or preparing for a job interview. After all, what is more important than your health and physical well being? Managing pain requires considerable patient participation. Let the doctor know that you are serious about getting better and that you will work both hard and smart to do so. Doctors, like most of us, respond better to people who are motivated. Let your doctor know that you consider he or she an important part of your health but that ultimately it is you who is responsible for your physical well-being.

Separate administrative and clinical concerns: For example if you have a question about billing or insurance be sure to discuss this with the administrative staff rather than the doctor. Try to maximize your time with the doctor discussing specific clinical issues.

Fill out your paperwork in advance: Have your medical history and billing information sent to you in advance by mail or fax or access it online and print it off. Take plenty of time to review and complete all the information carefully and completely. This will ensure that the doctor has a good sense of your situation well in advance of your visit. This is also a good time to make a short, clear listing of the questions you have for the doctor. Write them down and submit them with your paperwork.

  • List all medications or prescriptions and over-the-counter, vitamins, etc., you are currently taking or have taken in the past six months and identify any allergic reactions or side effects. If you are not sure about the dosage, etc. just bring the bottles with you to your appointment.
  • Be as specific as possible about your family’s health history to include your parents and siblings
  • List any tests you have had in the past two years, including results
  • Identify all other physicians or practitioners you have seen. Include their name, address, phone number and specialty
  • List all surgery to include dates and physician
  • Identify those circumstances that make you feel better and those that make you feel worse

Confirm your appointment:

This may save you valuable time off from work or from needless waiting time at the doctor’s office. If the doctor does experience an emergency despite your good planning be prepared with a good book, some work or needlepoint to effectively utilize your wait time. Plan to arrive ten minutes early just in case there is any other paper work that needs to be completed.

Confirm Referrals: If you have been referred to a specialist by another doctor most managed care plans require you to have a written or emailed referral and/or authorization code. If you do not have this the doctor is not authorized to see you. So be prepared well in advance with a complete referral.

Bring all test results with you: This may save you time and expense. Remember if you paid for the test then you are entitled to the report.

Once you are with the doctor:

  • Allow the doctor to complete the examination and to ask questions of you before you ask your own questions. Remember that your doctor has likely seen conditions like yours many times and is practiced at asking just the right questions.
  • Be firm but courteous. You need never apologize for your condition or for asking questions. You are the customer.
    Be honest and realistic about your pain: Try not to describe your pain as worse than it is or better. The more honest you are the better the doctor is able to help you.
  • Consider bringing along a close friend or relative. Usually two heads are better than one. Sometimes when we are in pain or fearful of our health situation it is helpful to have someone to else along to interpret new
    information or just for emotional support.
  • Do not leave confused. If you feel overwhelmed by the information ask the doctor to slow down and explain it to you again.
  • If the physician has a nurse practitioner or physician assistant working with them you should use them as good source of information. Oftentimes these folks can spend a little extra time with you.
EMG & Nerve Conduction Study: What to Expect

Your Doctor has ordered an EMG and NCS, here is some information on what to expect.

What: Electromyography (EMG) and NCS indicate how well your nerves and muscles are working. EMG’s measure the electrical activity of your muscles. Nerve conduction studies indicate whether and how fast the nerves are conducting impulses. In medical terminology, the procedures are different types of “electrodiagnostic testing.”

Why: The tests can determine whether ongoing nerve injury or muscle damage are contributing to your current symptoms. They provide objective documentation for many pre-surgical diagnoses such as Carpal Tunnel Syndrome, Tardy Ulnar Palsy, and Tarsal Tunnel Syndrome.

How: In an NCS, electrodes send a barely perceptible static-electric impulse through selected nerves in the arm, leg, neck or back region and measure a response. You will feel a mild tingling sensation lasting less than ¼ of a second. During an EMG, one or more electrodes the size of a pin are inserted into the skin of the muscles in the arm, leg, or back area. The electrodes cause a slight prickling sensation as they take readings of the condition of your muscles. The combined tests take between 20 and 40 minutes.

Who: The studies are performed by board certified physician specialists who have received special training in this area of diagnostic medicine.

Where: The tests are performed in an examination room at the doctor’s office. If you would like to bring your spouse, a friend or a relative to keep you company during the procedures you are welcome to do so.

When: Your Doctor will receive the test results in a formal report.

Preparation: There is no special preparation needed, except that you should not apply any lotions or oils on the day of your test. If you have a pacemaker or have had a mastectomy, please notify the doctor before beginning the tests. The tests can still be done, but modifications must be made. If you wish, you may take pain medication before the tests, and you are encouraged to continue your usual medications because they will not affect the test results. Other than a mild tenderness where the pins are placed, there are no significant complications.

Epidural Procedure Pain Relief

You have been scheduled to have an injection or a series of injections to help control your pain. The following information is provided so that you may be well informed about the procedure. Please follow the instructions closely as failure to comply could result in the cancellation of your appointment.
During the procedure you will lie comfortably on an x-ray table. The area to be injected will be thoroughly cleaned and then a sterile drape will be applied. Using a special x-ray machine, your Doctor will carefully guide a very thin needle into the appropriate area. He will then instill a combination of solutions – a contrast dye (to verify correct needle placement), an anesthetic (to decrease your pain), and a steroid (to decrease your inflammation). You can expect the procedure to take approximately 30 minutes.

  • Arrive at least one (1) before your scheduled appointment time.
  • You must be healthy on the day of your procedure.
  • You must notify our office, in advance if you have any of the following:
    • Any infection, fever, cold or flu symptoms, sore throat, dental infection, diarrhea, or urinary
      infection.
    • An artificial heart valve or mitral valve prolapse.
    • Diabetes, especially if you take Insulin or Glucophage (Metformin). If you take Coumadin (Warfarin) or any other type of blood thinner.
    • If you take any anti-inflammatory medication.
  • If you have been on antibiotics recently, you need to have finished taking the antibiotics at least one (1) week before your injection appointment. The Doctor who prescribed the antibiotics must call our office (404.659.5909) to verify that the infection is gone prior to the injection procedure being performed.
  • You must have someone with you to drive you home after the procedure. Some injections may cause your arm or leg to feel weak for a few hours after the procedure. It is not safe for you to drive following your injection.
  • Do not eat or drink anything for at least six (6) hours before your appointment.
  • Take all of your routine medications unless otherwise directed by a doctor.
  • Notify your doctor of any allergies you may have to medications, local anesthetics, (novocaine), iodine, x-ray dye, seafood or shellfish.

Relax during the procedure and let the Doctor and his specially trained team help you.

Epidural Procedure Pain Relied Frequently Asked Questions

  1. When is the earliest you can get me in? We recognize that you are in pain and we have scheduled your appointment at the next available time. If we have a cancellation we will call you to see if you can come in earlier.
  2. How long does the procedure take? About 30 minutes for the actual procedure itself not including preparation time.
  3. If the procedure only takes a half hour why do I have to arrive one hour before my appointment time? Bear in mind that “hospital time” is subject to a wide variety of uncontrollable variables. By arriving one hour before your scheduled appointment time we can be more certain of having you prepared and relaxed for the procedure.
  4. Where will the procedure take place? Procedures are conducted at Gwinnett Surgery Center 770.979.8200 or Northlake Surgical Center 770.270.1284 you will be notified as to which facility. Please visit our website at www.attackback.com and click on the “locations” tab located near the upper right hand corner of the “home” page for a map.
  5. Does the procedure hurt? No. You will be sedated during the procedure. But you may experience some tenderness for up to 3 days after the procedure.
  6. When will I start to feel better? We generally see pain relief begin after about 3 days and judge final results in about 2 weeks.
  7. When can I go back to work? Expect to take off the full day of the procedure and return to work the next day.
  8. Can I eat before the procedure? No. Do not eat anything 6 hours prior to your scheduled appointment time. But feel free to eat as usual after you are discharged.
  9. Why do I have to have someone to drive me home? Occasionally the procedure will cause temporary weakness in your arm or leg that lasts a few hours and it would be unsafe for you to drive
  10. How much does it cost for someone without insurance? Please telephone our office at 404.659.5909 Ext. 103 and speak with our Epidural Steroid Scheduler regarding the physician fee. The Surgery Center fee is separate and you will need to contact them directly. Gwinnett Surgery Center 770.979.8200 or Northlake Surgical Center 770.270.1284.
Trigger Point Injections

Patient Information

In patients with severe muscle spasms, the muscle area is characterized by trigger points. These are irritable areas of the muscle that can cause pain in that area and can also refer pain to other areas of the body. Their location can be confirmed by touching the tender area in the muscle.

An injection can be performed in the physician’s outpatient clinic using a local anesthetic (usually Marcaine 0.5%). Generally two or three injections are given at a time and can be repeated on a weekly basis for up to three weeks. It is at this point that your physician can more accurately determine if
additional injections should be performed.

The risks involved in this procedure are very minimal.

There are no routine orders necessary for the injection. You can drive home after the injection and do not need to alter your diet prior to the time of the injection.

Georgia State Law 360-3-.06

Rehabilitation Physicians of Georgia offers the convenience of an in-house lab to perform qualitative and quantitative analysis labs. At Rehabilitation Physicians of Georgia, P.C. we do randomized drug test as required by Georgia State Law (360-3-06). Urine drug monitoring is an important tool, along with other clinical information, that helps your doctor better determine the best way to treat your chronic pain.

Online Resources

RPG’s Patient Portal is a secure site that will allow you 24/7 access to your medical information.

Simply provide your email and you will be sent an email invitation. For questions accessing our Secure Patient Portal please call 404.659.5909. We hope you will take advantage of this new user-friendly enhancement!
o Appointments
o Provider Messaging
o Medical Records
o Keep RPG informed of personal information

For Patients

1

Insurance:
RPG accepts most insurance plans including Medicare, Medicaid, and Advantage Plans.

2

Forms:
View and fill out our forms to save time when you visit our office

3

Self Help:
View our tips to try to alleviate the pain you are suffering from.

4

National Opioid Dilemma:
Under treating your pain is not an option, but neither is a casual approach.