Question
QUESTION: dear Dr , im suffering with a 30 degree spinal curve ( scoliosis ) my doctor says that it is just a slight curve that donot need any treatment.ive searched from internet that scoliosis are generally not painful.but dear Dr, since 3 to 4 years  , i am going through so much pain in my legs , shoulders, back and lumbar spine region. when i told my Dr about this condition of mine , he asked me to get some blood tests done. all the reports of mine were very good except vitamin D . i have a deficiency of Vitamin D.and i take medicine CALTRATE-D to overcome this deficiency.still the pain persist.please tell me what should i do or which Dr shall i concern.i was also referred to a Rhuematologist by my dr.but i didn't take any appointment of rhuematologist.

ANSWER: Dear Maham Majid,

First of all, I am sorry to hear that you have been experiencing back pain for the last three to four years. I can well imagine that it is not very pleasant to live with, and can leave you feeling worried and miserable.

You inform me that you suffer from what your doctor says is a mild Scoliosis of the spine (a 30 degree curve, as you describe it), and that your doctor does not feel that this necessitates treatment. I understand that you have read on the Internet that Scoliosis is not generally painful. Does this lead you to believe that you must just put up with your situation?

Clearly, you ARE experiencing pain, and this has gone on for quite some time. I note that you have returned to discuss this matter with your doctor, and that as a result, you have had some blood tests which showed a Vitamin D deficiency. You inform me that you take medication to overcome the Vitamin D deficiency. You also tell me that your doctor made a referral on your behalf to a Rheumatologist.

It does appear that your doctor acknowledges your concern regarding your pain, and wishes to try to find out what is causing this. However, it also appears that you might benefit from your doctor explaining to you clearly just what it is that he/she intends to do. Sometimes, it can be difficult to pinpoint exactly what causes a particular health problem (as there may be a variety of things that are possible causes), and a doctor needs to slowly rule out potential "working diagnoses". A working diagnosis is where a doctor has a suspicion as to what may be wrong, but needs to complete further tests or observations before they can be certain if it is correct or not.

I would advise you to make a further appointment with your doctor. You need to be very clear, during this appointment, concerning the fact that you continue to experience pain, and be very clear as to where the pain is. You also need to tell the doctor very clearly if there was anything that you think you might have done to trigger the pain - things such as having a fall, injuring your back, or twisting/turning sharply. You then need to be able to ask your doctor what it is that he/she intends to do to locate the source of your pain, and ask if they have any suspicion regarding what may be causing it.

It is always useful to prepare questions in advance of attending an appointment, so that when you get there, you know exactly what it is that you wish to ask. You might like to ask such things as:

What do you think is causing my pain?
Could it be my Scoliosis, or is it something else?
Is it linked to my vitamin deficiency?
Why do you think my pain has lasted so long?
Do you intend to refer me to a specialist, or have you already referred me to a specialist?
Will I receive confirmation of referral?
Could you advise me as to what the specialist may intend to do?

You might also like to ask how long the doctor feels it may take to reach a decision as to what is causing your pain, and what you can do yourself to ease it in the meantime. Perhaps there are pain killer tablets that, if your doctor agrees, you could take to ease your pain whilst you await a diagnosis of what is causing it?

Continue taking any medication prescribed for you, and make sure that you attend any appointments arranged for you.

I wish you all the best in sorting this matter out.
Elaine Ellis.


---------- FOLLOW-UP ----------

QUESTION: I want to change my dr.so please tell me whether i should report to a rheumatologist or a chiropractor?

Answer
Dear Maham Majid,

I'm hoping that the following advice may be useful, although there are some points that I would like to clarify...
I have noted that you tall me you wish to change your Doctor, however, I am unclear as to which Doctor you are talking about. Do you wish to change your General Practitioner (G.P.), or do you wish to change a Hospital specialist? I can try to advise you as to the steps you could take, as follows:

1. If you wish to change your General Practitioner (G.P.), you are well within your rights to do so. There are different things that you could attempt in this instance. For example, if your G.P. is working at a large practice, where there are other G.P.s, then you could request to see one of the others instead. If your G.P. works alone, then it is a little more difficult. You might be able to move practice, but in this case, you would firstly have to find a practice who have vacancies for new patients, and then you would have to register with them. I would advise telephoning practices in your locality to see if they are registering new patients. If you do telephone, you could also ask how many G.P.s work there, and what specialist knowledge they have. Some practices DO have doctors who are interested in particular health conditions, and offer additional support for patients with such conditions (e.g. Asthma reviews, services for people with heart problems, smoking cessation, weight management). Always try to register with a practice that you feel happy with, and that you feel appears able to manage your particular health problems.

2. If you are talking about a specialist doctor, then things are somewhat different. As a general rule, patients are only referred to specialists via their G.P. or another healthcare provider. You cannot generally refer yourself to a specialist.

Both Rheumatologists and Chiropractors are specialists, with respect to the nature of the services they provide. A Rheumatologist is a physician who has received specialist training in how to diagnose (detect) and treat Arthritis, and other muscolo-skeletal diseases. Such diseases are often termed "rheumatic" disorders, and generally affect the joints, muscles and bones. Rheumatologists generally treat such things as Arthritis, certain Autoimmune Disorders (e.g. Lupus), Osteoporosis and muscolo-skeletal pain. You are generally referred to a Rheumatologist by your G.P. if the G.P. suspects you may have one of these problems.
Chiropractors are physicians who look for areas of the spine that are misaligned or have become stiff, inflexible and "fixed". Chiropractors perform tests to locate these areas, and use manual manipulation of the spine to help realign it correctly. Patients may be referred to a Chiropractor via their G.P., or they may choose to consult a Chiropractor privately.
Given that you appear to have more then one problem that could be causing your back pain, I would advise that you carefully discuss any potential treatment options with your G.P. as a first point of contact. From what you have written, it looks like you may have started down this path. Your Scoliosis may be the source of the pain, but the fact that you have problems with Vitamin D deficiency (which can also lead to muscle and bone weakness, and pain), may indicate a different cause for your symptoms.
I would advise that you discuss matters further with your G.P., and try to find out whether you HAVE been referred to a Rheumatologist, as such a referral would assist you to find out what may be causing your pain. The Rheumatologist could also carry out specific testing, and oversee the coordination of any care or treatment that you receive. I would also advise that you do this, rather than going immediately to a Chiropractor, quite simply because the Rheumatologist would be the best placed practitioner to draw together all of the different aspects of your medical problem, analyze them, and make decisions as to diagnosis and treatment. This is particularly important because there is a suspected link between Vitamin D deficiency and Arthritis.

I hope this may be of help to you.
Elaine Ellis.