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WHY IS NS SENDING ME TO PM AT 4 1/2 MO POST A/PLIF?

LeeLeeMccDeeLLeeLeeMccDee Boston MAPosts: 169
edited 03/25/2014 - 11:35 AM in Pain Management
I'm hoping someone out there can give me some input on the process of going to pain management. I had A/PLIF on Nov 13, 2013. The cage spacer inserted into the L5/S1 slot was a size too big causing the disc above it to fracture and collapse. I was diagnosed with the fracture/collapsing of this disc space three weeks post-op after having severe persistant pain (like my bum was going to break in half). To make matters worse, my mom died unexpedtedly on my 3rd day of hospitalization. When I was released from the hospital I had to immediately go and help my dad out with the arrangements. It ended up being a very nice service but because of all the pain and emotional overload, I believe it gave me a very poor initial healing period.I would be endlessly crying over my loss and the pain of my two-level fusion even with the meds prescribed by my NS . My regimen of meds is : 20mg oxycontin every 12 hours, 5-10mg of oxycodone every 4-5 hours and 5mg of valium every 12 hours prn I began water-therapy 4 weeks ago (two times a week), About 2 months post-op I noticed my whole body becoming "swollen"; knees, feet, legs, shoulders and neck. It wasn't too bad at the beginning but progressively worsened as time went by. I kind of ignored it blaming it on all the stress I had been going through. At each post-op exam I've had x-rays done showing "no change" with the healing of the fracture.. AT my last exam I told him about the body swelling and he tested me for auto-immune problems, hormonal and arthritic panels. All of the labe work came back with normal results. He started me on Ibuprofen 400mg every 6 hours for the swelling which has worked amazingly for the swelling but not for the fracture/back pain. So he has decided to send me to PM. Is he giving up on me or just can't prescribe these types of medications any longer? At this point he has no idea what is going on inside. My STD ran out two weeks ago and I don't have LTD as a backup. NS wrote letter to my manager keeping out of even part-time work for another 3 months. I am scared about my future. At four plus months post op, is it too early to worry about long-term expectations?
So long story short.......What can PM doc do that NS doc can't????
Thank you for taking the time to read this thread.
LEELEE
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1

Comments

  • LizLiz Posts: 9,699
    Is there any reason why you typed in caps? it makes it hard to read and a lot of members will skip over it rather than read it.
    Caps are regarded as shouting.

    Liz, 

    Veritas-Health Forum Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • LeeLeeMccDeeLLeeLeeMccDee Boston MAPosts: 169
    Do you really think that 20 mg of Oxycontin twice daily, 5-10mg of oxycodone every 4-5 hours and 2 5mg valium twice daily is a lot of medication for a unhealed fracture and collapsing of L5? What makes you think I'm sedentary? I never said I sit around the house a lot. I go to PT twice weekly and walk when it's warm enough to do so. It has been no warmer than 20 degrees for the past two months. And the swelling is not from "being inactive" because I am not. I drink at least a litre of seltzer water mixed with a bit of 100% Pom juice constantly day to night. I jump at the chance to go with my husband anytime he goes shopping. I try to do as much as I am allowed around the house everyday. This two-level fusion is my fourth operation at L4/5-L5S1. Even my NS said this type of fracture has never happened to him in his professional career, I am his first (lucky me). Maybe I did not explain my situation clearly enough. But if the fracture and collapsing of that area never happened I would most likely be back to work at least part-time. And I actually resent the remark that I am using the medications as a crutch for my mother's death. I have a very strong support system at home and am strong-willed myself and while it was very sad losing my mother so unexpectantly (she was 88yrs old) the initial shock and sadness has resolved itself to warm memories.
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  • LeeLeeMccDeeLLeeLeeMccDee Boston MAPosts: 169
    Liz said:
    Is there any reason why you typed in caps? it makes it hard to read and a lot of members will skip over it rather than read it.
    Caps are regarded as shouting.

    Sorry Liz. I didn't realize this meant I was shouting. That was not my intention. It won't happen again.
    LeeLee
  • I think what this referral means is that your NS thinks your situation requires medical management, rather than surgery, at this point. Has he told you whether the fracture will heal? Or given you advice on how best to let it heal? Like bed rest vs being active etc. it sounds terribly painful and it is awful you had to deal with the death of your mother while going through this on top of fusion recovery. I'm sorry.
  • Everyone reacts differently to meds. I am 3 years out for a multilevel cervical fusion that didn't occur fast enough because I have permanent nerve damage at C6/7. After my 3 appointment, my NS said that the pain I was experiencing was just the nerves that had be pinched from the co press ion working and re growing. What a crock! He continued to prescribe pain meds which were only percocet and a muscle relaxer. I was searching for something other than narcotics and he gave me Ultram which did nothing, so they had to put me back on Percocet. By the time I was 6 months out he referred me to PM because he knew that I would need more than he could give me with what I know was diagnosed with failed neck surgery.they still had not tested my nerve conduction. It was not until one year out and still no reduction in pain that my NS ordered an EMG and Nerve Conduction Test. When he got the results of that and the MRI he said he could operate ob the remaining disk that was still herniated, but it wouldn't help. Basically if a NS can't cut they don't want to waste office time on you.
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  • LeeLeeMccDeeLLeeLeeMccDee Boston MAPosts: 169
    mcjimjam said:
    I think what this referral means is that your NS thinks your situation requires medical management, rather than surgery, at this point. Has he told you whether the fracture will heal? Or given you advice on how best to let it heal? Like bed rest vs being active etc. it sounds terribly painful and it is awful you had to deal with the death of your mother while going through this on top of fusion recovery. I'm sorry.
    Thank you firstly for your thoughtful reply. As far as my fracture goes, my NS did not see "any change" from the original x-ray done that diagnosed my fracture. He did not elaborate so I am assuming the degree of the fracture is the same; no better and no worse. The pain I experience from lifting anything is felt at that exact spot and is so painfull that sometimes I cry which isn't my personality but I guess I've had enough of it. NS gave fracture time to heal up to one year or so.
    Does that mean I'll have this same level of pain that gradually dissipates? There is no sign of fusing at this point either. NS says it is too early. NS gave me permission to lift my grand-daughter who weighs 26lbs (only once is a great while and not to make a habit of it). He said the fracture could not worsen because of the hardware used would keep that bone from furthering the fracture. I still don't understand that statement especially since I show no sign of fusion yet.
    And I finally understand why he is sending me to PM now. I guess I didn't think of it that way but it makes perfect sense.
  • LeeLeeMccDeeLLeeLeeMccDee Boston MAPosts: 169
    sandi said:
    I'm sorry that you took offense, to my question but it is something to consider.....while a fracture is painful, the acute pain is/should have subsided some by now, even if it is not healed . And, yes, taking what is almost 3 times your daily long acting pain medication is a lot of the use of what is supposed to be a breakthrough medication.
    Regular use of immediate release or short acting medications only increases the baseline amount of medication in your system/blood stream and the fact that you are taking three times what your long acting medication is, ( I see you changed the dosage amount of the Oxycontin from 10 mg twice a day to 20 so I am now unsure what dosage is correct) , given the amount of time that you have been taking it from your post, is most likely why the surgeon is sending you to see a pain management doctor.
    Again, I'm sorry that you took offense to my question......and I am truly sorry for the loss of your mother. It is a difficult loss for anyone, no matter how old we are.
    Thank you for your kindness. The amount of oxycontin I am taking is a total of 20mg every 12 hours (or two 10mg pills for a total of 20mg twice daily which is 40mg total in a 24 hour day). And as far as my oxycodone is concerned, how am I taking 3 times the amount that that of the Oxycontin? I take 1-2 tablets of oxycodone every 4-5 hours while awake which in my case is 5-10mg which I usually take at 9:00am, 2pm, 6pm and 10pm for a total of 20 to 40mg's total in a 24 hour day. I do not wake up in the middle of the night to take them if that's what you were thinking. So I don't understand your meaning?
  • Discussion of narcotics was only a very small part of the original post. The main point was asking why the OP was being referred to PM by her NS. It has only become a bigger part of the thread because people have brought up the narcotics in their replies, you included.
  • LeeLeeMccDeeLLeeLeeMccDee Boston MAPosts: 169
    mcjimjam you are my hero. it's a wonderful thing for someone to understand what someone is trying to ask/say. All I wanted to know was what it was a PM doc would be able to figure out for me that my NS couldn't. Will they do more imaging to see why I am still having this persistent pain at the fracture site or just see what makes me the most comfortable in the long run. I wrote out my med regimen because I thought it would be helpful in giving people my condition as a whole. Jeez, I never thought I would have to defend myself on what other people misinterpreted, especially Terror8396's reply. I have no idea where that came from my thread. Thanks for your understanding and support. You made me feel a whole lot better.
    LeeLee
  • LeeLeeMccDeeLLeeLeeMccDee Boston MAPosts: 169
    Well I happen to disagree with your outlook. I know what I was asking in the first place was the difference between what a PM can do longterm that a NS can not. You keep coming back with this drug thing. People interpret how something is written different ways. If I made an error on how I chose to write out my med list then I apologize but there was no malicious intent and I really am getting offended on how you are dwelling on this when I am fine with it. If you don't have an answer to my question then I don't need a lecture on your interpretations of what you think this thread is about. Uggg. Very frustrating.
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