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Old 04-12-2008, 07:30 PM   #1
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What Questions Do I Ask A Pm Dr.

I have an appointment coming up with a PM DR. My neurosurgeon dismissed me from his care being theres nothing surgical he can offer for the Adhesive Arachnoiditis.

My Neurologist has been doing a fantastic job controling the pain this far.My Neuro said see what they have to say.

The Neurosurgeon wants a spinal cord stimulator put in.Everything I have read that should be the last resort.

Will a PM DR. control every aspect of ones meds.

My Neuro currently has me on dilaudid every 8 hours and oxycodone as a break through.It has been effective.

Also on neurontin for nerve pain.

Spasmatic meds for spasticity are baclofen,zanaflex and valium,the combination is very effective.

Plus ativan at night if needed.

I have no clue what to ask a PM DR. I'm just afraid he will want to remove meds that have been effective.

I was on methadone and that put me in the hospital,adverse reaction to it.

Any thoughts I'd appreciate

 
Old 04-12-2008, 07:55 PM   #2
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Re: What Questions Do I Ask A Pm Dr.

Quote:
Originally Posted by duttin View Post
I have no clue what to ask a PM DR. I'm just afraid he will want to remove meds that have been effective.
This is a very normal feeling you're having. Not unusual for PM patients to experience anxiety when it comes to new Docs, procedures, meds & etc. After all, your pain and your pain mgt, probably controls a good deal of your life. Perfectly normal. Try to not worry about it b/c it's probably making your pain worse.

Quote:
My Neurologist has been doing a fantastic job controling the pain this far.My Neuro said see what they have to say.
I would do just that....See what the PM Doc has to say. It sounds as if all doesn't go well, you can fall back on your Neuro for care. You could also try another PM Doc if this wasn't doesn't set right with you. Since you are being referred by such top notch specialists, I feel quite sure the PM Doc won't question your validity. After all, is a PM Doc going to tell the Neurologist he is wrong? What it will come down to is the "philosophy" of the PM Doc...Many different "theories" out there on PM...Some are super aggressive with meds, some aren't.

Quote:
The Neurosurgeon wants a spinal cord stimulator put in.Everything I have read that should be the last resort.
Naturally, your surgeon wants to operate...That's what he does. I don't know anything about your case, but for me, any kind of surgery would be the last resort....Too many other avenues for patients to take these days to jump right to that. I'm even more gun shy, because a lot of my pain was caused by surgical trauma.

Quote:
Will a PM DR. control every aspect of ones meds.
More than likely, yes....Unless it's routine stuff that your GP handles, like BP & etc. Of the ones you listed, yes. Again, unless the Neuro isn't scripting them all. For example, if the Ativan comes from your GP, the PM Doc probably won't assume it.

Quote:
My Neuro currently has me on dilaudid every 8 hours and oxycodone as a break through.It has been effective. Also on neurontin for nerve pain. Spasmatic meds for spasticity are baclofen,zanaflex and valium,the combination is very effective. Plus ativan at night if needed.
I would be very upfront with the PM Doc about what you're taking and what works. If your regimen is working, then make sure the PM Doc knows. Talk about how well it's doing compared to some other therapy you've tried. My PM Doc is really big on "if it isn't broken, don't fix it." Again, each PM has his/her own philosophy on treating pain.

Quote:
I was on methadone and that put me in the hospital,adverse reaction to it.
When you go over what's working, make sure you let him know that this doesn't, so it will be eliminated from the picture right of the bat.

Hope this helps, and good luck!

Ex

Last edited by Executor; 04-12-2008 at 07:56 PM.

 
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Old 04-12-2008, 08:28 PM   #3
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Re: What Questions Do I Ask A Pm Dr.

EX,

Thank You for the advice.

I will refuse any surgical intervention,I have 3rd stage Adhesive Arachnoiditis,a painful,incurable nerve disease in the lumbar.The nerves have glued themselves together in the spinal canal.

This has been caused by 2 lumbar surgeries in 1998 and 1999.I was having extreme back pain and the legs have been in chronic spasms and pain,so my neurologist decided to step out of the box and have lumbar mri's done.

My neurosurgeon,I seen him for a second opinion,not doubting my neurologist,but for my peice of mind.

All my meds have been prescribed by my neurologist,except for 1 and thats buspar,helps with the mild anxirty.My neurologist has prescribed the rest.

Some of the meds are for the arachnoiditis and others are for multiple sclerosis symptoms.

My biggest fear is having a PM DR. mess all the meds up and I don't need another MS attack.

I don't let my pain consume me, I beleive in being as active as this body will let me.I honestly try to ignore the pain,the best I can.

I've never been big on pain meds,I have tried to advoid them if possible,but I can't ignore it anymore.

My previous meds have been vicodin,then switched to oxycodone and when that wasn't effective they put me on methadone,couldn't take that,so my neurologist put me on dilaudid.

The spasmatic meds I have been on for 3 years and for the most part they have been effective without much of an increase.

I really appreciate your response

 
Old 04-12-2008, 08:40 PM   #4
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Re: What Questions Do I Ask A Pm Dr.

Have you tried the patch? IMO, it's the best pain fighting med out there....Especially for chronic pain.

Ex

 
Old 04-12-2008, 09:08 PM   #5
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Re: What Questions Do I Ask A Pm Dr.

EX,

Yes,I have tried the patch I was hospitalized a year ago and the attending DR tried to control the pain,he put me on 100mcgs of fentynal,oh,lordy was I sick.

At that time I was on no pain meds,ya wanna talk about system shock.The DR should of started out at 25 mcgs.

It scares me to try it now,even 50mcgs was to strong.

Thank You

 
Old 04-13-2008, 06:25 AM   #6
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Re: What Questions Do I Ask A Pm Dr.

This is so scary that so many doctors go from little fentanyl to large doses. It sounds like this is where the problems come into play with this med. I am so sorry this happened to you Duttin.

Reading your post Duttin brought back a flood of memories for me. I went from a surgeon prescribing, to suddenly, no warning saying, I won't prescribe you anything but 1 narco every 8 hours. So had to start from scratch and I actually went over 2 weeks with no meds and raging pain -- so believe me I understand your anxiety. Thankfully you have the anxiety of switching doctors but still have the meds to cover your pain. PRAISE THE LORD!!

I would actually try to go in there with an open mind, let him do his evaluation, and make recommendations. Be prepared he may even lower your dose or change medications. I know this is not want you want to hear but remember that many doctors need to protect themselves from those who are drug seekers, which we know you are not. They also need to figure out exactly what your pain levels are.

I wish you good luck as you go into this, just remember to be honest, take your meds as prescribed, and talk to your doctor. He is going to expect calls in the beginning and remember this is a two way street - you both have to earn each others trust.


Last edited by ms_west; 04-13-2008 at 06:27 AM.

 
Old 04-13-2008, 09:33 AM   #7
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Re: What Questions Do I Ask A Pm Dr.

Duttin,
I had 2 spinal fusions (multilevels) and I also got AA.
My DRs work as a team: Neurologist, surgeon and PM DR.
I see surgeon every 3 month, but Neurologist and PM on a regular basis in a office plus they work on a phone with you if any problems.

PM takes care 100% about my meds: he changes them if needed, adjusts them, etc. I know they consult each other regarding diagnoses, new symptoms, and medication.
Always after prescribing new dose or meds my PM asks me to call him in 3-5 days to let him know how does it work for me.
When i had severe reaction to Fentanyl patch, I called my PM and 1/2 hour later Neurologist called me to find out what am I going through. I love they way it works for me.

I agree with your Neurosurgeon about your AA condition; I am sure you know that patients with AA are not operable, so he really can't do much for you.
I am sorry to hear you got it too, not an easy diagnoses to leave with.

Best of luck to you!

 
Old 04-13-2008, 07:07 PM   #8
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Re: What Questions Do I Ask A Pm Dr.

DietDoctor Pepper,

I'm fortunate that my neurologist won't abandan me.He wasn't really thrilled with the idea of a PM DR.But he had an opened mind about it.He told me to see what they offer,but by no means am I allowed to let them change my MS meds for the spasticty.

My fear is the PM DR. changing my pain med that I just started and its working.

I have all the paper work filled out,they have sent me.

Moldova.

The diagnosis of AA was harder to digest then when I got the diagnosis of multiple sclerosis.Not easy living with the two them.

My neurosurgeon has discharged me,I know that surgery is not an option,nor would I ever consider another on.

I'm not sure if my neurologist and the PM DR are going to work together or not ,that is one of my questions,being the neurosurgeon recommened that I see a PM,but then discharged me.I hoping they do.

I see my neurologist evry 3 months,but if something goes wrong I just need to call him.

Fentynal is not a med for me,to many adverse reactions

I do beleive in true honesty,I hate taking pains,but at a point I don't have a choice.

I will hear the PM DR. out and see what he offers,I'm being referred to the PM DR. on the terms that the neurosurgeon feels that a spinal cord stimulator should be considered.Thats not an avenue I'm willing to travel yet.

I have seen a PM a few years back and quit going,he just wanted to do spinal injections and they were a waste,never goy any releif from them

Thank you for the advice.

 
Old 04-14-2008, 06:37 AM   #9
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Re: What Questions Do I Ask A Pm Dr.

[QUOTE=duttin;3529775]I will hear the PM DR. out and see what he offers,I'm being referred to the PM DR. on the terms that the neurosurgeon feels that a spinal cord stimulator should be considered.Thats not an avenue I'm willing to travel yet.
QUOTE]

Wouldn't this be a problem with the AA diagnosis? It is still surgery.

 
Old 04-14-2008, 09:24 AM   #10
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Re: What Questions Do I Ask A Pm Dr.

dietdrpepper,

Yes this would involve a surgery and this my concern.I personally feel that the spinal cord stimulator should be a last resort.

I have never relied on pain meds until december when all heck broke broke loose.I'd take vicodin only when needed.

My neurologist then prescribed the oxycodone,which was effective in the beginning,but was taking to many,so he jumped it to the methadone,so there was no peaks and valleys,but I had a terrible reaction to it,it put me in the hospital.The neurologist has now put me on the dilaudid three times a day,with oxycodone for the break through if needed.At this time it seems to be effective.

MY GP was not keen on the spinal cord stimulator,factor being I have been on solu-medrol infusions for MS attacks and infection at this point would be to great.After the steroids you have to wait at least 3-6 months for any dental work,surgeries and so forth.

Thank You for all your advice,pain meds and clinics are all new to me and how it all works.

I've heard from many they can be effective and for others they have had horror stories about them.So at this point I'm confused about all of it.

My biggest fear is having a PM DR. change what has been working,especially my meds that control the muscle spasms.But that is something I will have to discuss with the PM DR next week.

I don't want a PM DR. to stop my meds and start over.I can handle the pain,but not the spacticity.

My neurologist stated I had a very complicated case and its figuring out what is Multiple Sclerosis related and what is Adhesive Arachnoiditis related.

Sorry to spill all this out to you.

 
Old 04-14-2008, 11:03 AM   #11
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Re: What Questions Do I Ask A Pm Dr.

Hey Duttin: Please don't apologize for spilling it all out. This is the place to do just that. I know how confusing this can be. There are so many different experiences written about here on the boards. I was so lucky to find the PM doc that I have now. It took a little time for me to find him, and I have to travel an hour away to see him, but it's absolutely worth it.

I just wanted to wish you luck and let you know I'll be praying for you. Keep us updated when you can. God Bless, cmpgirl

 
Old 04-15-2008, 06:17 PM   #12
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Re: What Questions Do I Ask A Pm Dr.

cmpgirl,

Thank You for your kind words.

The dilaudid is finally starting to work,I pray that a PM won't reverse meds back down to vicodin or something that won't work.

Or push for spinal injections or the spinal cord stimulator.

I see the PM in 1 week.So far I have blocked it out of my mind,been busy cleaning up after a house fire in Feb.So thats been my priority.

My neurologist has everything under control so I can work with my contactor and so forth.

 
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