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

LeeLeeMccDeeLLeeLeeMccDee Boston MAPosts: 171
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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13

Comments

  • LizLiz Posts: 9,703
    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, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • You probably aren't going to like some of what I tell you, but, you are on a substantial amount of medication for someone 4 months out, 20 mg of long acting Oxycontin, plus somewhere between 30-60 additional milligrams of short acting medications, around the clock, and valium twice a day as well? No one that I have ever heard of is taking more in the short acting version of a medication, than they are the long acting.
    Surgeons, are there for the acute post op recovery period. For some surgeons, they will see the patient for the first month and provide medications during that time, for others three months is the maximum that they will continue to see the patient for , and provide medications. In most situations, they also have substantially cut down the amount of medications that the patient was getting once the first 4 weeks are past from the surgery...
    I'm sorry for the loss of your mother, and know that that must've and still is very difficult, but have you considered at all that there may be a possibility of you relying on the medications to treat and deal with the emotional pain rather than the physical?
    You should be seeing some improvement in your ability to walk and tolerate some activity with the water therapy, since it offers a bit of resistance while offering little in the way of gravity....how often are you attending water therapy? What other modalities are you using to increase your activity? The swelling comes from being sendentary and not moving enough....the fluids collect in the tissues of your body, and linger there without the physical activity necessary to pump the fluids out of the tissues and into the blood stream so that they can be eliminated.
    The decision to send you to pain management is for your benefit, they can offer you more in the way of treatment options beside relying on just pills to get your body moving again and other therapies that work to ease pain, including more extensive physical therapy.
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  • LeeLeeMccDeeLLeeLeeMccDee Boston MAPosts: 171
    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.
  • LeeLeeMccDeeLLeeLeeMccDee Boston MAPosts: 171
    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.
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  • 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.
  • 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.
  • sandisandi Posts: 6,269
    edited 03/25/2014 - 1:54 PM
    that is so not true........when a patient sees a surgeon for a consult or because of surgery, once the surgery is done and the acute recovery period is over, follow up vists are scheduled as needed or necessary to check the progress of the surgery, but the reason that spine surgeons refer patients out to pain management is that they are only treating the acute recovery phase. If the situation is not resolved by the surgery, surgeons are not the doctors that the patient needs to see for ongoing treatment...unless another surgery is planned.
  • LeeLeeMccDeeLLeeLeeMccDee Boston MAPosts: 171
    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: 171
    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?
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