Should I go to A&E?

[Aandespine]

I'm 5mo pregnant. Woke up yesterday morning with excruciating back pain. I cannot walk unaided (thankfully have a pair of crutches at home I've been using to shuffle to the bathroom and back), cannot sit, even on the toilet seat I'm having to lean to one side, cannot bend over. I'm struggling to lift myself up from the toilet seat, cannot turn over in bed. I'm climbing the stairs on all fours then I take a while at the top (in a lot of pain) to stand up straight again. My lower back is numb and I'm getting tingling pain under my belly, and shooting pains down one leg. One leg feels heavy and weak.

Have been to see the GP. They can't tell me what the issue is, no advice re recovery time or prognosis. They've just prescribed dihydrocodiene. No other advice besides to go to A&E if I experience incontinence or numbness down below. I pleaded with them for an MRI which they say they'll try to request without any guarantees/it will be at the discretion of the radiographer who will decide if there's an indication for it.

Now I've had sciatica in the past and the pain was in no way near this. I'm in tears numerous times a day and the pain is literally exhausting me. I dred going to the toilet. I'm bed bound. I have a family member taking care of my 2 young children.

I haven't yet been to A&E because I cannot sit and wait there for hours to be told the same thing (pain meds and no further diagnostics).

Please tell me what to do

I had the same sort of thing a couple of years ago, all the same problems but it was a trapped nerve and the NHS were useless. Ended up with a chiropractor. Started out in constant pain, unable to walk or sit and occasionally would have the most awful pain rushing up my back. After a couple of sessions with the chiropractor the pain was much more manageable and after a few more I was able to stand, sit again and walk with crutches, later a stick and eventually back to normal. I do still have a numb patch in my back but it isn't a problem.

I hope you feel much better soon.

What, while she’s sitting in the waiting room of A&E - and has been for most of the day at the point you posted!!

Hope they have an answer for you soon!

I had virtually identical pain. You have my sympathy as it was the worst ever. MRI showed very nasty herniated disc in lower back, resulting in a discectomy. Get back onto the Dr or go to A&E. The squeaky wheel gets the oil!

Hope you're called in soon OP now that you're in A&E

Back home now. Was there was 11hrs.

I saw an absolutely amazing doctor. He ordered an MRI which ruled out cauda equina syndrome and confirmed progression of a disc bulge and the start of another bulge.

Still in pain but much more mobile. Have been referred for maternity physio. Will continue with PKs. Just hoping I can get back to taking care of my DD soon.

Thank you again for all your advice and words of support.

Good luck! Glad you were seen & scanned (clearly not in my part of the country lol, they'd have laughed me out of the waiting area) & at least know what's going on now.

Sods law you'll wake up tomorrow & it will have resolved itself.

She's in A & E ?????

When I was in pain from a ruptured ectopic that wasn’t suspected I just lay on the waiting room chairs on my side. Same, when I was in Labour waiting. No one complained, and I don’t think I was seen quicker. Ended up in a side room with that ectopic and could have died - no one checked me.

But if you lie down and they complain just explain you can’t sit up.

I don‘t know if you qualify for an ambulance and stretcher to wait in? Maybe ring 111? Or your midwife?

It could be nothing much or it could be serious- don’t risk it especially in pregnancy and get seen.

The nhs postcode lottery is very real my local hospital sounds like yours

I experienced this - I picked up my friends’ child in early pregnancy and developed a significant disc bulge in my lower back. The pain was excruciating, caused sciatica and I literally couldn’t put one foot in front of the other. It eased as the pregnancy progressed, my baby grew and my spine compensated. I found an excellent chiropractor who specialised in pregnancy. She was amazing. I had a planned c-section due to the high risk of further damage being caused by active labour. You have my sympathy OP!

thats good you got to the bottom of the issue, hope the maternity physio does good

Op did you ask for a photo of the baby from the mri. Babies look really funny in mri images and when I say funny I'm being polite they look creepy as fuck but It's funny to see

I actually think I was incredibly lucky with the doctor who I saw. I ended up visiting the osteopath first yesterday, and it was he who suggested that pain down both legs was a sign of cauda equina and that I should have an MRI. He advised me it's not likely I'll get it done sitting in A&E and we were close to booking one privately.

At the time of seeing my GP I did mention that I felt that while the shooting pain was primarily down one leg, it had started, albeit less frequently and less intensely down the other leg- but he still did not advise referral to MRI that day and in fact backtracked on his suggestion of referring me for an MRI less urgently. He rung me after and told me that since "there is no real clinical indication for an MRI, it will be at the radiographers discretion to decide whether or not to do it".

Not to be politically incorrect, but the doctor I saw in A&E was Eastern European who had trained in his home country- his management of me reflected this I think. He advised I stopped the dihydrocodeine because of the pregnancy and was quick not only to arrange the MRI, but to send results to another hospital to get a 2nd opinion regarding longterm management of my condition.

It's cheaper to give a pregnant woman in pain dihydrocodiene than arrange an MRI. The NHS is on it's knees, and increasingly, unless you're at death's door, clinical decisions are being informed largely and perhaps even primarily on economics.

I was just very lucky.

I'm glad you where and got a good dr theirs nothing worse then being in that level of pain especially when pregnant where proper pain relief is limited. I hope the physio helps so you can enjoy the rest of your pregnancy

Hope your pain eases. At least you've been seen and you can relax a bit more knowing what the issue is. I think that's half the problem these days - we just want answers so we can know how to look after ourselves better!

Clinical decisions are not made on an economic basis. That’s utter crap. They are made on clinical need. Can you imagine how that would open up clinicians to legal risk? Sorry I knew this patient needed an MRI but didn’t order one and just gave them cheap medication as I was worried about funding? No Dr I know would open themselves up to that kind of legal challenge-plus they’d be struck off for not doing what they knew a patient needed.

Glad you managed to get sorted and that it was a suspected, a disc bulge.

clinical decisions are being informed largely and perhaps even primarily on economics

This isn't true at all. It's just a very lazy soundbite people like to throw out there. NHS doctors, nurses et al. have nothing to do with the financial side of things. It's not "cheaper" for the doctor to prescribe pain meds rather than refer you for an MRI. The cost doesn't affect them. The money doesn't come from their pockets. They base their decisions on things such as risk and clinical need. Where one doctor may think an MRI is necessary, another may not. Neither of them are thinking about finances.

Unfortunately, your idealistic view no longer stands in this country.
I wish it did......

I'm a clinician myself, and have worked for the NHS. You have not heard of referral quotas and practise-based commissioning?

Do you seriously believe your GP was sitting there thinking "She probably has something life-threatening, but the NHS is on its knees so I will just give her painkillers" ?

but to send results to another hospital to get a 2nd opinion regarding longterm management of my condition.

Sorry, am I misunderstanding, or are you talking about long term management of your 'condition' that started two days previously? That was a bit premature was it not, considering it hadn't been diagnosed yet?

Of my condition being the progression of an existing disc bulge. He confirmed that no immediate treatment or management was necessary then awaited the 2nd opinion from another hospital before writing up my diacharge

I'm not talking about my GP- he did not recognise that sciatica pain down both legs was a red flag symptom.

I'm responding to the comment re postcode lottery.

Now you've scared me. My pain is now down both legs and despite the gabapentin and ibuprofen my nights are sleepless with the pain the last few days. I've also urge incontinence so getting through tena lady like tissues. Saw the GP two weeks ago who said lose weight because no consultant will be interested.