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#950738 - 10/28/09 09:51 PM
PM doc question/concern
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Stranger
Registered: 03/05/09
Posts: 12
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Hello everyone. Was hoping I could get some feedback. Long story short (well as short as I can..sorry!)..
I had two large herniations in lumbar spine originally diagnosed in Jan 08. Was treated conservatively for a while until this past spring where I developed cauda equina syndrome. (lost control of bladder, then bowel just prior to emergency surgery. I now have rt foot drop with pronouced weakness in rt leg causing instability when walking even after 6 months of PT)
At my last appointment to set up surgery for carpal tunnel syndrome (as if I need that now... I need my hands to hold onto things when I walk!) my neurosurgeon ordered repeat mri of lower spine and referred me to urologist as now I cannot empty bladder as Im supposed to. He also sent me to a Pain Management MD for what his nurse said was for med management. (I have chronic lower back pain with occas. stabbing sciatia, and throbbing dull pain down rt leg.
Prior to this spring, my PCP would order Lortab 10 q 6 hours. Of course I was on this for a while and developed a tolerance at that level. Post op I was increased to Lortab 10 (1 to 2) 4 to 6 hours the first month, then 1 to 2 every 6. Even with this I STILL had moderate pain.
Fast forward to PM doc. My primary concern is that he wants to do something called radiofrequency nerve root block (burning)to my entire lumbar spine and sacral region. It involves very long thin needles and fluroscopy and will be done in three visits. Please excuse my language but Im scared ***less. I feel like I am still dealing with nerve damage and I, even as a medical professional cannot think logically when it comes to this proceedure. Has anyone here had this? Had it recommended to them? Please please help this nervous girl out!
Also the PM doc did want to change meds and was concerned about the apap. Since I was only taking 1 and 1/2 lortab10 every 4 to 6 hours, he wanted to change it to percocet. I was afraid of not only side effects (increased drowsiness, nausea, etc) but if I took that daily, what would manage my pain post op? He ended up switching to norco (10/325) 1 and 1/2 4 to 6 hours. For those in PM, what was the next step up, so to speak, from norco? If only it would last a bit longer, as it is now, relief is only at most 3 hours.
Thanks for any input and for reading if you got this far.
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#950756 - 10/28/09 10:13 PM
Re: PM doc question/concern
[Re: MissMarie]
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GRAND Pooh-Bah
Registered: 11/15/02
Posts: 3130
Loc: USA
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Hmmm...first off before doing anything with your back, if it were me, I would get a 2nd opinion on it. Also, I would tell the doc that I needed some time to do some research because injections help some people, and it doesn't some. I would see about a spine specialist for the 2nd opinion and also if they don't think it is a good idea, they can talk to the PM doc and tell them no injections for you.
Now, you probably need to be on a long acting med and then even the Lortab 10 would do for break through and you would have less apap, but still enough to help.
Start a pain diary, number your pain on a scale of 1-10, what you take, what it brings your pain level to and times, then talk with the doc about not the meds not lasting long enough.
Now some PM docs want you to go through the hoops of the injections, etc before they will do something like ER meds.
The one thing I would do for sure is get a 2nd opinion from a SPINE SPECIALIST about what he is wanting to do to my back.
_________________________
I Do Whatever My Rice Krispies Tell Me To.
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#952473 - 10/31/09 08:11 AM
Re: PM doc question/concern
[Re: MissMarie]
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Threadhead
Registered: 08/08/07
Posts: 804
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Hello everyone. Was hoping I could get some feedback. Long story short (well as short as I can..sorry!)..
I had two large herniations in lumbar spine originally diagnosed in Jan 08. Was treated conservatively for a while until this past spring where I developed cauda equina syndrome. (lost control of bladder, then bowel just prior to emergency surgery. I now have rt foot drop with pronouced weakness in rt leg causing instability when walking even after 6 months of PT)
At my last appointment to set up surgery for carpal tunnel syndrome (as if I need that now... I need my hands to hold onto things when I walk!) my neurosurgeon ordered repeat mri of lower spine and referred me to urologist as now I cannot empty bladder as Im supposed to. He also sent me to a Pain Management MD for what his nurse said was for med management. (I have chronic lower back pain with occas. stabbing sciatia, and throbbing dull pain down rt leg.
Prior to this spring, my PCP would order Lortab 10 q 6 hours. Of course I was on this for a while and developed a tolerance at that level. Post op I was increased to Lortab 10 (1 to 2) 4 to 6 hours the first month, then 1 to 2 every 6. Even with this I STILL had moderate pain.
Fast forward to PM doc. My primary concern is that he wants to do something called radiofrequency nerve root block (burning)to my entire lumbar spine and sacral region. It involves very long thin needles and fluroscopy and will be done in three visits. Please excuse my language but Im scared ***less. I feel like I am still dealing with nerve damage and I, even as a medical professional cannot think logically when it comes to this proceedure. Has anyone here had this? Had it recommended to them? Please please help this nervous girl out!
Also the PM doc did want to change meds and was concerned about the apap. Since I was only taking 1 and 1/2 lortab10 every 4 to 6 hours, he wanted to change it to percocet. I was afraid of not only side effects (increased drowsiness, nausea, etc) but if I took that daily, what would manage my pain post op? He ended up switching to norco (10/325) 1 and 1/2 4 to 6 hours. For those in PM, what was the next step up, so to speak, from norco? If only it would last a bit longer, as it is now, relief is only at most 3 hours.
Thanks for any input and for reading if you got this far. Miss Marie, the next step up from Lortab IS percocet. Then the doctors can go many ways if they step up higher than that. It could be morphine, low dose Methadone, Opana, Fentanyl patches in low doses, etc. The only medicine they didn't try on me was oxycontin. But actually, Opana works great in the ER version so I was fine with it. The IR is about as bad as IR hydromorphone; meaning useless. I had the nerve burning procedure; in fact, I had it at least 3 times over a 4 year period, maybe more. Didn't help, did cause an increase of pain for about a week, and they did not give me any extra medicine for the extra pain. I lost the ability to completely control my bladder after the 2nd nerve burning, which was never a problem before the nerve burning procedures. They usually give you an IV and put Versed and Fentanyl in it so that you don't feel any pain from the nerve burning procedures. By the time they did the last nerve burning procedure on me I must have been really tender because I cried through the whole thing even with the IV. Never again. Personally, after 4 years of having shot after shot after shot and then many nerve burnings, I won't let a PM doc do anymore procedures. I'll be going to a neurologist to see if I need surgery but no more of their money making shots and nerve burning procedures and monthly urine screens and sitting in the waiting room for 4 hours at a time. What a pain.
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