Moldova
04-13-2008, 03:28 PM
Hello to all of you:wave:
I hope you had a nice weekend!
I still have the same question and no answers...
I am a CP patient due to 2 spinal fusions with complications. But the new symptoms started after my second fusion, about 2 month ago.
I developed severe pain in shoulders/arms/hands/elbows. Not much of a neck pain. I suffer 24/7 from it, but when I lay down the worse pain comes. During the night I get up and walk in a room to come it down a bit.
My right hand is pretty weak, I don't feel much tingling or numbing, but pain is inberable. Now i started to have problem to hold things in my right hand and break a lot of dishes...
Recently I had Cervical MRI and it does show arthritis, bone spurs, C-6 T-1 herniation, but my Neurologist doesn't think it can cause such a severe pain in my arms and hands. He performed an EMG test and it didn't show any nerve
damages.
I take pretty strong PK (LA and BT) for my spinal issues and believe or not, helps some of of my back-leg pain, but doesn't help even a bit my upper extremidies pain.
I am really lost and have no idea what can cause it. I did a lot of research on Internet, but still can't find answers.
Anybody, Please......
Thank you in advance for your support and God Bless:angel:
I hope you had a nice weekend!
I still have the same question and no answers...
I am a CP patient due to 2 spinal fusions with complications. But the new symptoms started after my second fusion, about 2 month ago.
I developed severe pain in shoulders/arms/hands/elbows. Not much of a neck pain. I suffer 24/7 from it, but when I lay down the worse pain comes. During the night I get up and walk in a room to come it down a bit.
My right hand is pretty weak, I don't feel much tingling or numbing, but pain is inberable. Now i started to have problem to hold things in my right hand and break a lot of dishes...
Recently I had Cervical MRI and it does show arthritis, bone spurs, C-6 T-1 herniation, but my Neurologist doesn't think it can cause such a severe pain in my arms and hands. He performed an EMG test and it didn't show any nerve
damages.
I take pretty strong PK (LA and BT) for my spinal issues and believe or not, helps some of of my back-leg pain, but doesn't help even a bit my upper extremidies pain.
I am really lost and have no idea what can cause it. I did a lot of research on Internet, but still can't find answers.
Anybody, Please......
Thank you in advance for your support and God Bless:angel:
Sponsor
cmpgirl
04-13-2008, 03:45 PM
Hey Moldova: Sorry you have been going through this. The only things that come to my mind are fibromyalgia and chronic myofascial pain. (I have CMP)
I know with me, it causes major stiffness and pain in my shoulders, arms and hands. And I also have lost a lot of arm and hand strength. Have any of your docs suggested these? There is quite a bit of info on the web, about both fibro and CMP. They share some symptoms, but not all.
I don't know if this is what is going on with you, but thought it might be an idea. God Bless and keep us posted. cmpgirl
I know with me, it causes major stiffness and pain in my shoulders, arms and hands. And I also have lost a lot of arm and hand strength. Have any of your docs suggested these? There is quite a bit of info on the web, about both fibro and CMP. They share some symptoms, but not all.
I don't know if this is what is going on with you, but thought it might be an idea. God Bless and keep us posted. cmpgirl
Moldova
04-13-2008, 03:59 PM
Thank you, girl for your respond.
I do have Fibromoylga, osteo and RA, but i have this for so many years and on meds for it for many years too.
Why all of sudden I got this couple month ago and why my PK don't help the pain? Why do I loose strenght in them?
My Neurologist mentioned something about pain meds. He said that sometimes some medication can cause severe muscle damage and he wonders if this can be my case?
But nothing is confirmed so far. Meanwhile I can't sleep and even typing on computer gives me problems. I don't like not knowing; i would rather know and deal with it.
Thank you so much and feel better, please!:angel:
I do have Fibromoylga, osteo and RA, but i have this for so many years and on meds for it for many years too.
Why all of sudden I got this couple month ago and why my PK don't help the pain? Why do I loose strenght in them?
My Neurologist mentioned something about pain meds. He said that sometimes some medication can cause severe muscle damage and he wonders if this can be my case?
But nothing is confirmed so far. Meanwhile I can't sleep and even typing on computer gives me problems. I don't like not knowing; i would rather know and deal with it.
Thank you so much and feel better, please!:angel:
sammyo1
04-13-2008, 04:13 PM
Moldova, I sure wish I had some answers for you, I feel so bad for you with the whole not be able to lay comfortably at night. Gosh, you have got to be awfully tired at times if not all the time. I know I don't sleep well yet with the surgery deal & I really feel it.
I did want to say I have heard conflicting opinions with the cervical area you mentioned. I myself have issues in that area, but my daughters friends mom called a few weeks ago with a diagnosis of problems such as DDD in the same cervical area & she said her one shoulder hurt like heck & the other was starting to act up. She could not believe how much it hurt, now she was told that was due to the problems with in the cervical area. Now whether it would go into the arms & hand I am not sure. I swear sometimes I think there are compound problems & that is why these doctors can't seem to always find what is wrong. I am learning that they can run test after test & not everything shows. My pt just told me that about the MRI's.
You keep asking & hopefully someone will come along with a clue at least.
To me it is the absolute worse when you do not know what is wrong, it is the hardest thing to sit & wonder. I have had the same where the pain meds just don't touch a certain pain, makes you wonder why & feel alittle desperate. There has to be a reason why. I will keep my ears open for you. Good luck & hand in there. Sammy
I did want to say I have heard conflicting opinions with the cervical area you mentioned. I myself have issues in that area, but my daughters friends mom called a few weeks ago with a diagnosis of problems such as DDD in the same cervical area & she said her one shoulder hurt like heck & the other was starting to act up. She could not believe how much it hurt, now she was told that was due to the problems with in the cervical area. Now whether it would go into the arms & hand I am not sure. I swear sometimes I think there are compound problems & that is why these doctors can't seem to always find what is wrong. I am learning that they can run test after test & not everything shows. My pt just told me that about the MRI's.
You keep asking & hopefully someone will come along with a clue at least.
To me it is the absolute worse when you do not know what is wrong, it is the hardest thing to sit & wonder. I have had the same where the pain meds just don't touch a certain pain, makes you wonder why & feel alittle desperate. There has to be a reason why. I will keep my ears open for you. Good luck & hand in there. Sammy
feelbad
04-14-2008, 01:19 PM
hi moldova, just had a couple of questions for ya. what exact areas have you had fused? did you have any hardware placement done at all? this really does sound like radiculopathy to some degree meaning it IS stemming from your c spine area in some way. the EMG results really don;t have a whole lot of impact if your pain and symptoms are not actually stemming from direct impingemnt or some other issue that is actually impeding nerve flow. there are just ALOT of possible issues that you could have going on up there that would give you the types of symptoms you are having and show a perfectly normal EMG.
just what were your 'complications' all about and where were they? are these more intermittant symptoms or a more constant? do you have any types of symptoms that actually go down to your fingers in any way? if so,which ones are affected? do you know if your fusion is actually taking up there yet? have they done a flexion and extention x ray on you at this point just to check fusion status?
this particular type of x ray really IS the very best possible way to actually check whether or not you have fused,in both surgeries actually. i had a huge non fusion issue but the MRI said 'inconclusive' recommended a CT,and the CT stated i was defintiely fused when i knew without a doubt,and so did my primary,that i was not,not with the ongoing symptoms i was having along with horrid pain. it took that simple type of x ray to finally proove to my surgeon what i had been telling him and his so called 'nurse' for over nine months,i was NOT fused at both endplates,only one. this was despite that stupid CT saying otherwise.
there just has to be some real reason for what you are experiencing,unfortunetly it is a matter of testing and ruling out to find the culprit. tracking it back from where your issues start to the direct nerve root and dermatome really is the best way to get to that source.
do you actually 'hear" anything when you move your neck? any noises like grinding or popping? just how recent was that MRI? why are you only seeing a neurologist when the surgeon should be handling this and finding out why HIS surgery 'did' or is doing something to you? your surgeon just has a certain level of responsibility here in making certain HIS surgery did not actually cause you problems or even further damage during your surgery. he just should be the one trying to find this all out for you,thats all. he has an obligation to you after you get any surgery from any suregon to make certain you are okay and not worse post op ya know?
sorry for all the questions tho.believe me,if they were not important,i wouldn't have slammed you with so may. but they DO matter just knowing the answers to the questions in helping to find whats causing your symptoms.
just wondering if YOU actually read your own MRI report or have actual copies of all reports from all testing that has been done on you? if not,you really DO need to obtain all of this and also the hospital medical records with the "op notes" from both your surgeries. getting all of your medical records from your surgeon will help too. but YOU personally really need to see that MRI and read thru it for yourself if you have not yet done that. you would be shocked at just how much,mostly specialists,will leave out or not tell you about. its really sick,but it happens everyday. and it happened to me with very crucial Dx info and other important things i just had a right to know was going on inside my own body.
hang in there moldova,i know this has not been an easy time for you recently. but hopefully we can help get to the culprit here soon. marcia
just what were your 'complications' all about and where were they? are these more intermittant symptoms or a more constant? do you have any types of symptoms that actually go down to your fingers in any way? if so,which ones are affected? do you know if your fusion is actually taking up there yet? have they done a flexion and extention x ray on you at this point just to check fusion status?
this particular type of x ray really IS the very best possible way to actually check whether or not you have fused,in both surgeries actually. i had a huge non fusion issue but the MRI said 'inconclusive' recommended a CT,and the CT stated i was defintiely fused when i knew without a doubt,and so did my primary,that i was not,not with the ongoing symptoms i was having along with horrid pain. it took that simple type of x ray to finally proove to my surgeon what i had been telling him and his so called 'nurse' for over nine months,i was NOT fused at both endplates,only one. this was despite that stupid CT saying otherwise.
there just has to be some real reason for what you are experiencing,unfortunetly it is a matter of testing and ruling out to find the culprit. tracking it back from where your issues start to the direct nerve root and dermatome really is the best way to get to that source.
do you actually 'hear" anything when you move your neck? any noises like grinding or popping? just how recent was that MRI? why are you only seeing a neurologist when the surgeon should be handling this and finding out why HIS surgery 'did' or is doing something to you? your surgeon just has a certain level of responsibility here in making certain HIS surgery did not actually cause you problems or even further damage during your surgery. he just should be the one trying to find this all out for you,thats all. he has an obligation to you after you get any surgery from any suregon to make certain you are okay and not worse post op ya know?
sorry for all the questions tho.believe me,if they were not important,i wouldn't have slammed you with so may. but they DO matter just knowing the answers to the questions in helping to find whats causing your symptoms.
just wondering if YOU actually read your own MRI report or have actual copies of all reports from all testing that has been done on you? if not,you really DO need to obtain all of this and also the hospital medical records with the "op notes" from both your surgeries. getting all of your medical records from your surgeon will help too. but YOU personally really need to see that MRI and read thru it for yourself if you have not yet done that. you would be shocked at just how much,mostly specialists,will leave out or not tell you about. its really sick,but it happens everyday. and it happened to me with very crucial Dx info and other important things i just had a right to know was going on inside my own body.
hang in there moldova,i know this has not been an easy time for you recently. but hopefully we can help get to the culprit here soon. marcia
Moldova
04-15-2008, 01:47 PM
Thank you so much for your replies and suggestions... I wish you all a better day tomorrow...
Marcia,
my first fusion was on L-4, L-5 S-1, decompression/lami, screws, rods, etc. I have metal plate and metal clips in pelvic area as well. Bone growth stimulator was inserted during surgery and it was surgically removed 11 month later. My levels fused nicely that time. Bone was harvested from my hip. (03/06)
12/07 I had fusion L-3, L-4 with hardware again and old hardware were removed. Showed my first fusion fused completely. Also had decompression, lami, PLIF 360. Some other work, but minor to compare to fusion itself. Again bone was from my own hip.
After my first surgery i was doing very nicely for about 4-5 month. I was in pain, but was improving and pre-op pain was gone. I started walking, i had so much hope.
The only thing was bothering me is increasing pain in my legs, tingling, burning; 8 month later i was diagnosed with failed back surgery syndrome.
Everything went wrong: dropped foot, weakness in legs/feet, pain in bottocks, hips, etc. And so on.
I got to the point that i couldn't walk at all, i was dragging my legs, and needed to go back to wheel chair and walker.
I got condition calls Arachnoidities - this is the worse what could happen to people (you can read about it on Internet). I know this is causing severe pains and not curable or treatable...
After second surgery I got more legs/feet pain. I have so much pain in my legs, feet, bottocks, hips, knees. I can't walk for long, walk with cane, sitting or standing for long time is unbearable too. Legs are very weak.
But my arms/hands pain is new one and very severe: PK don't even touch the pain. I had MRI resently, shows some C-6 hernitaions, bone spurs, arthrities, bulges - but nothing to cause that much pain and severe symptoms.
Hard to lay down, pain starts from shoulder area and goes down to the whole arm and hands. Pinky and next to it finder is the worse pain. I know it's nerve related, but nothing MRI showed to be compressed... so confusing.
My second fusion so far so good, fusing the way it suppose, i did have same ex-rays as well.
Sorry for a long post and thank you so much for all your support!:)
Marcia,
my first fusion was on L-4, L-5 S-1, decompression/lami, screws, rods, etc. I have metal plate and metal clips in pelvic area as well. Bone growth stimulator was inserted during surgery and it was surgically removed 11 month later. My levels fused nicely that time. Bone was harvested from my hip. (03/06)
12/07 I had fusion L-3, L-4 with hardware again and old hardware were removed. Showed my first fusion fused completely. Also had decompression, lami, PLIF 360. Some other work, but minor to compare to fusion itself. Again bone was from my own hip.
After my first surgery i was doing very nicely for about 4-5 month. I was in pain, but was improving and pre-op pain was gone. I started walking, i had so much hope.
The only thing was bothering me is increasing pain in my legs, tingling, burning; 8 month later i was diagnosed with failed back surgery syndrome.
Everything went wrong: dropped foot, weakness in legs/feet, pain in bottocks, hips, etc. And so on.
I got to the point that i couldn't walk at all, i was dragging my legs, and needed to go back to wheel chair and walker.
I got condition calls Arachnoidities - this is the worse what could happen to people (you can read about it on Internet). I know this is causing severe pains and not curable or treatable...
After second surgery I got more legs/feet pain. I have so much pain in my legs, feet, bottocks, hips, knees. I can't walk for long, walk with cane, sitting or standing for long time is unbearable too. Legs are very weak.
But my arms/hands pain is new one and very severe: PK don't even touch the pain. I had MRI resently, shows some C-6 hernitaions, bone spurs, arthrities, bulges - but nothing to cause that much pain and severe symptoms.
Hard to lay down, pain starts from shoulder area and goes down to the whole arm and hands. Pinky and next to it finder is the worse pain. I know it's nerve related, but nothing MRI showed to be compressed... so confusing.
My second fusion so far so good, fusing the way it suppose, i did have same ex-rays as well.
Sorry for a long post and thank you so much for all your support!:)
feelbad
04-24-2008, 01:01 PM
so sorry it has taken me this long to get back to you moldova. things have just been too busy and painful. i am just wondering since you did mention that this pain actually runs down into the ring and pinkie fingers,what exactly did your MRI show between c 7 and T 1? this would be the area that those two fingers would correlate to up in the c spine? its actually something affecting your c 8 nerve(the ulnar).tho you do not actually have a c 8 vertebrae,you DO actually have a c 8 nerve. believe me,this IS the area where my spinal cord damage is exactly. my ulnar and median nerves took one heck of a huge hit in my left after that cord surgery was done. my last tweo fingers on that left hand have been just buzzing? like constatly since the damge/surgery back in 2003.
did you actually read thru your own MRI report or have a copy in your possession? if not get one,if you do,look at what the report actually states in that one area i mentioned. it sounds like from what you stated this is actually on both arms, or just one? if this is actually both arms to some degree,whatever is affecting this up there would have to be more 'centrally" located in order to be giving you the bilateral types of symptoms you are having. like i mentioned before,an EMG really wouldn't show posistional compression going on or inflammtion from irritated nerves or from just spurs. only true nerve flow impairment of some degree will get picked up on an EMG. tho it is a good test for some things,when there is no real compression going on,it is pretty useless.
was your MRI with or without a contrast? that could also make a difference injust what actually gets picked up on any imaging type of scan really. just how old is that last MRI?
i really do think what you are describing IS some level of radiculopathy that would be stemming from your c spine. if you have other conditions as well,it could all be also contributing too. one big thing you have to always keep in mind here is that not everything that is there will always be picked up on any real scan. it is not an actual 'picture' of an area,only a scan of an area,you know what i mean? but i really do think your c 8 area is the most dominantly involved in this or you would not be having those two fingers involved.
the factthat your narcotics are not doing anything for you also makes this sound more radiculopathic,or 'nerve pain'. historically,narcotics just do not always work really well for this type of pain. the pain generated by inflammed or irritated nerves usually respond much better to the anti siezure type of meds or some other of the more 'icky' meds. i personally have not had good luck with these types of meds. the side effects do me in worse than the pain does. have you ever tried like lyrica or neurontin? any of those classes of drugs for this particular pain? how about any level of anti inflammatories? some are good ones. when my herniated disc started to show itself but i couldn;t get it addressed becasue my son was actually going thru liver failure at the time this started,i lived on aleeve for me c spine crap til i could get it fixed. just a thought. it did actually help and only had to be dosed twice a day. just some suggestions that helped me.
but i would really look hard at that area and see what actually is there right now. depending upon how old that MRI you had done actually is or if you used contrast,you may need another. again,sorry it took me this long hon,marcia
did you actually read thru your own MRI report or have a copy in your possession? if not get one,if you do,look at what the report actually states in that one area i mentioned. it sounds like from what you stated this is actually on both arms, or just one? if this is actually both arms to some degree,whatever is affecting this up there would have to be more 'centrally" located in order to be giving you the bilateral types of symptoms you are having. like i mentioned before,an EMG really wouldn't show posistional compression going on or inflammtion from irritated nerves or from just spurs. only true nerve flow impairment of some degree will get picked up on an EMG. tho it is a good test for some things,when there is no real compression going on,it is pretty useless.
was your MRI with or without a contrast? that could also make a difference injust what actually gets picked up on any imaging type of scan really. just how old is that last MRI?
i really do think what you are describing IS some level of radiculopathy that would be stemming from your c spine. if you have other conditions as well,it could all be also contributing too. one big thing you have to always keep in mind here is that not everything that is there will always be picked up on any real scan. it is not an actual 'picture' of an area,only a scan of an area,you know what i mean? but i really do think your c 8 area is the most dominantly involved in this or you would not be having those two fingers involved.
the factthat your narcotics are not doing anything for you also makes this sound more radiculopathic,or 'nerve pain'. historically,narcotics just do not always work really well for this type of pain. the pain generated by inflammed or irritated nerves usually respond much better to the anti siezure type of meds or some other of the more 'icky' meds. i personally have not had good luck with these types of meds. the side effects do me in worse than the pain does. have you ever tried like lyrica or neurontin? any of those classes of drugs for this particular pain? how about any level of anti inflammatories? some are good ones. when my herniated disc started to show itself but i couldn;t get it addressed becasue my son was actually going thru liver failure at the time this started,i lived on aleeve for me c spine crap til i could get it fixed. just a thought. it did actually help and only had to be dosed twice a day. just some suggestions that helped me.
but i would really look hard at that area and see what actually is there right now. depending upon how old that MRI you had done actually is or if you used contrast,you may need another. again,sorry it took me this long hon,marcia
Moldova
04-24-2008, 03:56 PM
Marcia,
thank you so much for your time, very kind of you.
I had MRI done 2 weeks ago. It showed C-6 - T-1 herniations, bulges, DDD, stenosis, bone spurs and stenosis (full house :-).
Yes, my both arms and hands very painful, especially right one and especially around elbows area. Neck hurts too.
I have L-3, L-4 L-5 S-1 fused during 2 fusion surgeries and L-2, L-1 is 50/50
I wonder if fusion and hardware doesn't do damage to upper levels; my second surgery was exactly due to this.
I have my reports and exrays with me (I always keep it for my records).
I was on Lurica, Neurontin and Keppra, but did not get much help from it.
This is what I am going through now becides my lower back and damaged nerves in my legs and feet.
How are you doing? How do you feel?
Best of wishes to you.:angel:
thank you so much for your time, very kind of you.
I had MRI done 2 weeks ago. It showed C-6 - T-1 herniations, bulges, DDD, stenosis, bone spurs and stenosis (full house :-).
Yes, my both arms and hands very painful, especially right one and especially around elbows area. Neck hurts too.
I have L-3, L-4 L-5 S-1 fused during 2 fusion surgeries and L-2, L-1 is 50/50
I wonder if fusion and hardware doesn't do damage to upper levels; my second surgery was exactly due to this.
I have my reports and exrays with me (I always keep it for my records).
I was on Lurica, Neurontin and Keppra, but did not get much help from it.
This is what I am going through now becides my lower back and damaged nerves in my legs and feet.
How are you doing? How do you feel?
Best of wishes to you.:angel:
brianpain33
04-24-2008, 06:29 PM
You might want to try some of the other nerve pain meds. I would think the next step may be: Topomax, Tegretol, or Trileptal. And of course there are plenty of more to try. What about Cymbalta or Effexor? Even though they are SNRI anti-depressants they have been shown to be excellent for nerve pain control. Just some suggestions in case you haven't tried them yet. Is the Oxycontin doing anything for the nerve pain do you think? Has it dropped your pain levels at all?
brian
brian
Moldova
04-24-2008, 08:49 PM
Thank you, Brian for asking.
Oxy helps with pain, but like someone said definitely is not strong for 12 hours. And even though I take 20mg every 12 hours as LA, I still need 2 times at least BT meds.
What would you say: means it working well or not? Still with all this i am never pain free.
My PM is not of favor of Cymbalta, he does not prescribe it to his patients.
I wonder about Tramadol - do you know something about it? What is your opinion about this meds?
Have a good day!:)
Oxy helps with pain, but like someone said definitely is not strong for 12 hours. And even though I take 20mg every 12 hours as LA, I still need 2 times at least BT meds.
What would you say: means it working well or not? Still with all this i am never pain free.
My PM is not of favor of Cymbalta, he does not prescribe it to his patients.
I wonder about Tramadol - do you know something about it? What is your opinion about this meds?
Have a good day!:)
brianpain33
04-24-2008, 09:01 PM
My PM is not of favor of Cymbalta, he does not prescribe it to his patients.
I wonder about Tramadol - do you know something about it? What is your opinion about this meds?
A PM doc that does not prescribe Cymbalta that is a new one for me. I can't believe it considering how much it helps with some people's nerve pain although it was not a good med for me.
As far as the tramadol, that is what I just got off of and I was taking it for over 2 years. I'm not going to put it down because I am sure it helps some people but I will warn you that it can be extremely difficult to get off of. I would suggest trying it and if it does no good then get off quickly. The longer you stay on it the harder it is to quit.
brian
I wonder about Tramadol - do you know something about it? What is your opinion about this meds?
A PM doc that does not prescribe Cymbalta that is a new one for me. I can't believe it considering how much it helps with some people's nerve pain although it was not a good med for me.
As far as the tramadol, that is what I just got off of and I was taking it for over 2 years. I'm not going to put it down because I am sure it helps some people but I will warn you that it can be extremely difficult to get off of. I would suggest trying it and if it does no good then get off quickly. The longer you stay on it the harder it is to quit.
brian
Executor
04-24-2008, 10:35 PM
Oxy helps with pain, but like someone said definitely is not strong for 12 hours. And even though I take 20mg every 12 hours as LA, I still need 2 times at least BT meds.
What would you say: means it working well or not? Still with all this i am never pain free.
I know that you can't use the patch due to what happened, but one of the reasons it works so well (in general) with people is because it delivers a fairly precise amt of med each hour, 24 hours per day. Therefore, the patients BPL stays elevated, and BT meds are only needed for real flare-ups. Those who must change every 48 are the result of the med simply not lasting for 72 hours.
Conversely, the problem with OC is that it doesn't last 12 hours. Additionally, it doesn't deliver a steady hourly dose like the patch. As a result, it just doesn't work as well, IMO. Honestly, your BT meds are probably needed just to keep your BPL up....And you probably don't even realize it.....Or maybe you do.
It sounds as if you need to take your LA med more times daily....Who knows, you may not need as much per dose, but more often. I think as a minimum, you need 3 X day, maybe even 4 X. I would try 10 or 15mg, but 3 or 4 X. For example, 8am, 4pm, and right before bed, no later than midnight. If 4 X, then it would be something like 8am, 2pm, 8pm, and again at bedtime.
Your BPL can't stay elevated because the med isn't lasting 12 hours. I'm willing to bet that you're not getting much, if any med in hours 8-12. Again, that's why you need the BT meds during those time periods (speculation on my part).
Hope this helps.
Ex
What would you say: means it working well or not? Still with all this i am never pain free.
I know that you can't use the patch due to what happened, but one of the reasons it works so well (in general) with people is because it delivers a fairly precise amt of med each hour, 24 hours per day. Therefore, the patients BPL stays elevated, and BT meds are only needed for real flare-ups. Those who must change every 48 are the result of the med simply not lasting for 72 hours.
Conversely, the problem with OC is that it doesn't last 12 hours. Additionally, it doesn't deliver a steady hourly dose like the patch. As a result, it just doesn't work as well, IMO. Honestly, your BT meds are probably needed just to keep your BPL up....And you probably don't even realize it.....Or maybe you do.
It sounds as if you need to take your LA med more times daily....Who knows, you may not need as much per dose, but more often. I think as a minimum, you need 3 X day, maybe even 4 X. I would try 10 or 15mg, but 3 or 4 X. For example, 8am, 4pm, and right before bed, no later than midnight. If 4 X, then it would be something like 8am, 2pm, 8pm, and again at bedtime.
Your BPL can't stay elevated because the med isn't lasting 12 hours. I'm willing to bet that you're not getting much, if any med in hours 8-12. Again, that's why you need the BT meds during those time periods (speculation on my part).
Hope this helps.
Ex
123dietdrpepper
04-24-2008, 11:31 PM
Moldova, Executor is talking about what my doctor did for me. It has helped my pain tremendously up until this past weekend when I over did.
cmpgirl
04-25-2008, 02:33 AM
Moldova, My doc did the same thing as Pepper's. Upping me to 3x/day made such a difference. I was even able to take one less BT per day. I take the 20mg Oxycontin, but he actually wants to go up to 30mg 3x/day next time I see him and see if I can take even less BT.
My PM said he has discussed the Oxycontin dosing with other PM's and they all agree it does not last 12 hours for any of their patients.
I hope your doc is open to this. I will be praying that he is. God Bless, cmpgirl
My PM said he has discussed the Oxycontin dosing with other PM's and they all agree it does not last 12 hours for any of their patients.
I hope your doc is open to this. I will be praying that he is. God Bless, cmpgirl
Round1
04-25-2008, 09:56 AM
Moldova,
I dont know why and you can totally disregard it...... but this thought is stuck in my mind, and it might be completely off the wall thought......... but would it be heart related? You know the way some people complain about pain running up and down the shoulders and arms and loss of power, and tingling?.. it is just a thought, and you can either say now way its not that or maybe......... dont mean to be dramatic or anything but it just kind of entered my head, but my head is rather fuzzy at the moment :confused:
I upped the oxycontin last night and boy am i in an other world.
Take care
Round 1
I dont know why and you can totally disregard it...... but this thought is stuck in my mind, and it might be completely off the wall thought......... but would it be heart related? You know the way some people complain about pain running up and down the shoulders and arms and loss of power, and tingling?.. it is just a thought, and you can either say now way its not that or maybe......... dont mean to be dramatic or anything but it just kind of entered my head, but my head is rather fuzzy at the moment :confused:
I upped the oxycontin last night and boy am i in an other world.
Take care
Round 1
Moldova
04-25-2008, 11:34 AM
Thank you all for a good ideas. It makes sence. I will call my PM now and will explain to him how Oxy works for me and maybe he will change it to what EX, Diet are talking about.
I was thinking about it too, but was not sure if LA meds can be prescribed more often than 12 hours in between. Otherwise why does it call LA? No?
Round1,
Thank you for the thought, I understand where you are coming from. But this is not heart related problem. When you have heart problems (like angina attach) pain in one (left usually) arm is totally different.
This pain i have now started in both shoulders-arms-hands-last 2 fingers. Than neck got involved and now all upper back.
I do see why it can happen due to MRI report, but Neurologist said nothing can be done at this point to my upper back or neck. My fear is not be able to use my hands and arms. Some days I can't wash myself or simply hold a cup...
wakes me up at night many times; in fact at night pain is the worse.
I would rather know what this is and deal with it, than not knowing.
Thanks again for your support, greatly appreciated!:)
I was thinking about it too, but was not sure if LA meds can be prescribed more often than 12 hours in between. Otherwise why does it call LA? No?
Round1,
Thank you for the thought, I understand where you are coming from. But this is not heart related problem. When you have heart problems (like angina attach) pain in one (left usually) arm is totally different.
This pain i have now started in both shoulders-arms-hands-last 2 fingers. Than neck got involved and now all upper back.
I do see why it can happen due to MRI report, but Neurologist said nothing can be done at this point to my upper back or neck. My fear is not be able to use my hands and arms. Some days I can't wash myself or simply hold a cup...
wakes me up at night many times; in fact at night pain is the worse.
I would rather know what this is and deal with it, than not knowing.
Thanks again for your support, greatly appreciated!:)
cmpgirl
04-25-2008, 02:33 PM
Hey Moldova: I have shoulder, arm and wrist/hand pain and weakness. My doc attributes it to the fact that I have 2 bulging discs and an arthritic spur in my c-spine. I sleep on my side at night and usually, just repositioning myself from one side to the other, causes me enough pain to bring tears to my eyes. I also have trouble holding things like the coffee pot and milk cartons, etc. I always have to use both hands. I drop things all the time.
My PM says there has to be impingement and my EMG's show neuropathy on both sides. He gave me wrist braces, like the kind used for carpal tunnel syndrome. I wear them to bed some nights, but haven't seen much in terms of pain relief. I wish I could offer suggestions, but I don't know, myself, how to combat this.
As far as the Oxy not lasting for 12 hours, my PM said that for some reason, the drug companies do not want to admit that it really only lasts for about 8. So that is why insurance companies will sometimes require a special authorization for 3x/day dispensing. It is still long acting, but just not as long as they say. I thought it was just me, until my doc said most of his patients who take it, have the same response. Who knows with the drug companies, but I'm sure it has something to do with money and profits.
Anyway, thought I'd let you know about the wrist braces. Hope you are having a somewhat decent pain day. God Bless, cmpgirl
My PM says there has to be impingement and my EMG's show neuropathy on both sides. He gave me wrist braces, like the kind used for carpal tunnel syndrome. I wear them to bed some nights, but haven't seen much in terms of pain relief. I wish I could offer suggestions, but I don't know, myself, how to combat this.
As far as the Oxy not lasting for 12 hours, my PM said that for some reason, the drug companies do not want to admit that it really only lasts for about 8. So that is why insurance companies will sometimes require a special authorization for 3x/day dispensing. It is still long acting, but just not as long as they say. I thought it was just me, until my doc said most of his patients who take it, have the same response. Who knows with the drug companies, but I'm sure it has something to do with money and profits.
Anyway, thought I'd let you know about the wrist braces. Hope you are having a somewhat decent pain day. God Bless, cmpgirl
feelbad
04-25-2008, 08:00 PM
i totally agree with everyone else here moldova,there is just no way that any OC actually lasts the touted full 12 hours,no way. when i told my PM while we were titrating up when i first started at my PM that my pain was totally out of control after about 8 hours or so,they had no problem at all going to every 8 with me,we even had to go to the 3 times per day dosing in order for me to just have some "stable' pain control with the OC. its the nature of that particular med. it just does NOT last what perdue states it does,no way no how. many many PMs are very very much aware of this and will usually start any given patient out at the required 12, BUT if the patient states that it just doesn;t "feel" like it is lasting that 12,will usually let the patient go every 8. but they will always start the patient at the 12 just so maybe it 'may" work? if it aint broke why fix it type of thing there?
i am having a hard time understanding just why.becasue your PM doesn't seem to care for cymbalta,why in the heck wouldn't he be willing to just give that a go for any patient who is suffering with the type of pain you are? it seems just a bit stupid to me for any PM to notwant to at least try any types of those classes to just see how it would work.we ARE talking about very hard to treat pain here ya know?
i am wondering just how really satisfied you actually are with this PM and if maybe trying another wouldn't help you in many ways? just a thought for you. this one really does not appear to be as 'up' on the ins and outs of true PM if he is actually sticking to that ridiculous 12 hour dosing when just about every other PM just knows from experience that it will not,in most peoples pain processes actually last more than at least 8-10 at best. also,denying any patient a med like cymbalta to at least try and see how it would work in a situation in treating chronic pain just seems a bit inhumane to me ya know? when any PM is trying to actually manage CP in any patient,they are usually more than willing to at least try any med that has had a proven track record of actually working in some peoples pain.
i just cannot imagine what your PM is actually like quite honestly,it just doesn;t appear from just the few things you have stated here about him that he really IS the best type of PM for you and your pain to be treated in the very best ways possible. would it actually be possible for you to try and change to a much better more experienced PM in your area,even if it would take like an hour to get there? honestly,a good experienced and knowledgable PM is really worth their weight in gold to me and i think alot of people who are lucky enough to actually have that type would agree too. you just deserve much better PM than you have been getting moldova,really.
since oxycontin first came out and has actually been tested by the "masses' alot of different things have really been proven wrong just by being taken over the many years by a much wider base of patients. this kind of goes with any 'new' med. but perdue just simply refuses to change their Rxing info to accomodate the 'newer' facts that have come out since it first hit the market and unfortunetly,people like you and those on medicare are the ones suffering. they cannot get the 8 hour or past the two Xs per day dosing either because the Rxing lit says so. you just really desrve better hon and i do think a better PM could be the best move you could possibly make at this point. when an actual PM wont even "try" a med like cymbalta on any CP patient,geez,what kind of a PM is he anyways?
anytime i have mentioned any med(non narcotic since we didn;t need to change that)or therepy that i have wanted to at least try,they are more than happy to at least give it a go for me to see if it may just make a difference in me. that IS their job ya know? i certainly hope you can either convince your current PM to just actually do the right things here for you or even find a much better one. i wish i could help more with that. please keep us posted hon. marcia
i am having a hard time understanding just why.becasue your PM doesn't seem to care for cymbalta,why in the heck wouldn't he be willing to just give that a go for any patient who is suffering with the type of pain you are? it seems just a bit stupid to me for any PM to notwant to at least try any types of those classes to just see how it would work.we ARE talking about very hard to treat pain here ya know?
i am wondering just how really satisfied you actually are with this PM and if maybe trying another wouldn't help you in many ways? just a thought for you. this one really does not appear to be as 'up' on the ins and outs of true PM if he is actually sticking to that ridiculous 12 hour dosing when just about every other PM just knows from experience that it will not,in most peoples pain processes actually last more than at least 8-10 at best. also,denying any patient a med like cymbalta to at least try and see how it would work in a situation in treating chronic pain just seems a bit inhumane to me ya know? when any PM is trying to actually manage CP in any patient,they are usually more than willing to at least try any med that has had a proven track record of actually working in some peoples pain.
i just cannot imagine what your PM is actually like quite honestly,it just doesn;t appear from just the few things you have stated here about him that he really IS the best type of PM for you and your pain to be treated in the very best ways possible. would it actually be possible for you to try and change to a much better more experienced PM in your area,even if it would take like an hour to get there? honestly,a good experienced and knowledgable PM is really worth their weight in gold to me and i think alot of people who are lucky enough to actually have that type would agree too. you just deserve much better PM than you have been getting moldova,really.
since oxycontin first came out and has actually been tested by the "masses' alot of different things have really been proven wrong just by being taken over the many years by a much wider base of patients. this kind of goes with any 'new' med. but perdue just simply refuses to change their Rxing info to accomodate the 'newer' facts that have come out since it first hit the market and unfortunetly,people like you and those on medicare are the ones suffering. they cannot get the 8 hour or past the two Xs per day dosing either because the Rxing lit says so. you just really desrve better hon and i do think a better PM could be the best move you could possibly make at this point. when an actual PM wont even "try" a med like cymbalta on any CP patient,geez,what kind of a PM is he anyways?
anytime i have mentioned any med(non narcotic since we didn;t need to change that)or therepy that i have wanted to at least try,they are more than happy to at least give it a go for me to see if it may just make a difference in me. that IS their job ya know? i certainly hope you can either convince your current PM to just actually do the right things here for you or even find a much better one. i wish i could help more with that. please keep us posted hon. marcia
Moldova
04-26-2008, 08:04 AM
Hey Moldova: I have shoulder, arm and wrist/hand pain and weakness. My doc attributes it to the fact that I have 2 bulging discs and an arthritic spur in my c-spine. I sleep on my side at night and usually, just repositioning myself from one side to the other, causes me enough pain to bring tears to my eyes. I also have trouble holding things like the coffee pot and milk cartons, etc. I always have to use both hands. I drop things all the time.
My PM says there has to be impingement and my EMG's show neuropathy on both sides. He gave me wrist braces, like the kind used for carpal tunnel syndrome. I wear them to bed some nights, but haven't seen much in terms of pain relief. I wish I could offer suggestions, but I don't know, myself, how to combat this.
As far as the Oxy not lasting for 12 hours, my PM said that for some reason, the drug companies do not want to admit that it really only lasts for about 8. So that is why insurance companies will sometimes require a special authorization for 3x/day dispensing. It is still long acting, but just not as long as they say. I thought it was just me, until my doc said most of his patients who take it, have the same response. Who knows with the drug companies, but I'm sure it has something to do with money and profits.
Anyway, thought I'd let you know about the wrist braces. Hope you are having a somewhat decent pain day. God Bless, cmpgirl
Girl, thank you so much for your replay. Your pain sounds so much like mine and I pretty sure we have same problem. So actually your "treatment" is only PK and that is it, right? I really wonder how come i developed these symptoms after my second fusion surgery? feels like my problems go higher and higher above my fusions. I can't leave like this honestly, that is how strong this pain is.
Due to my childhood RA condition I been on a lot of pain medications (not narco all the time though) and my body does not responding as well as someone who did not take much of it. That is why i need so many adjustments and changing doses.
I hope they will find how to help you one day and you get some relieve...
Thanks again and have a nice weekend!
My PM says there has to be impingement and my EMG's show neuropathy on both sides. He gave me wrist braces, like the kind used for carpal tunnel syndrome. I wear them to bed some nights, but haven't seen much in terms of pain relief. I wish I could offer suggestions, but I don't know, myself, how to combat this.
As far as the Oxy not lasting for 12 hours, my PM said that for some reason, the drug companies do not want to admit that it really only lasts for about 8. So that is why insurance companies will sometimes require a special authorization for 3x/day dispensing. It is still long acting, but just not as long as they say. I thought it was just me, until my doc said most of his patients who take it, have the same response. Who knows with the drug companies, but I'm sure it has something to do with money and profits.
Anyway, thought I'd let you know about the wrist braces. Hope you are having a somewhat decent pain day. God Bless, cmpgirl
Girl, thank you so much for your replay. Your pain sounds so much like mine and I pretty sure we have same problem. So actually your "treatment" is only PK and that is it, right? I really wonder how come i developed these symptoms after my second fusion surgery? feels like my problems go higher and higher above my fusions. I can't leave like this honestly, that is how strong this pain is.
Due to my childhood RA condition I been on a lot of pain medications (not narco all the time though) and my body does not responding as well as someone who did not take much of it. That is why i need so many adjustments and changing doses.
I hope they will find how to help you one day and you get some relieve...
Thanks again and have a nice weekend!
Moldova
04-26-2008, 08:21 AM
i totally agree with everyone else here moldova,there is just no way that any OC actually lasts the touted full 12 hours,no way. when i told my PM while we were titrating up when i first started at my PM that my pain was totally out of control after about 8 hours or so,they had no problem at all going to every 8 with me,we even had to go to the 3 times per day dosing in order for me to just have some "stable' pain control with the OC. its the nature of that particular med. it just does NOT last what perdue states it does,no way no how. many many PMs are very very much aware of this and will usually start any given patient out at the required 12, BUT if the patient states that it just doesn;t "feel" like it is lasting that 12,will usually let the patient go every 8. but they will always start the patient at the 12 just so maybe it 'may" work? if it aint broke why fix it type of thing there?
i am having a hard time understanding just why.becasue your PM doesn't seem to care for cymbalta,why in the heck wouldn't he be willing to just give that a go for any patient who is suffering with the type of pain you are? it seems just a bit stupid to me for any PM to notwant to at least try any types of those classes to just see how it would work.we ARE talking about very hard to treat pain here ya know?
i am wondering just how really satisfied you actually are with this PM and if maybe trying another wouldn't help you in many ways? just a thought for you. this one really does not appear to be as 'up' on the ins and outs of true PM if he is actually sticking to that ridiculous 12 hour dosing when just about every other PM just knows from experience that it will not,in most peoples pain processes actually last more than at least 8-10 at best. also,denying any patient a med like cymbalta to at least try and see how it would work in a situation in treating chronic pain just seems a bit inhumane to me ya know? when any PM is trying to actually manage CP in any patient,they are usually more than willing to at least try any med that has had a proven track record of actually working in some peoples pain.
i just cannot imagine what your PM is actually like quite honestly,it just doesn;t appear from just the few things you have stated here about him that he really IS the best type of PM for you and your pain to be treated in the very best ways possible. would it actually be possible for you to try and change to a much better more experienced PM in your area,even if it would take like an hour to get there? honestly,a good experienced and knowledgable PM is really worth their weight in gold to me and i think alot of people who are lucky enough to actually have that type would agree too. you just deserve much better PM than you have been getting moldova,really.
since oxycontin first came out and has actually been tested by the "masses' alot of different things have really been proven wrong just by being taken over the many years by a much wider base of patients. this kind of goes with any 'new' med. but perdue just simply refuses to change their Rxing info to accomodate the 'newer' facts that have come out since it first hit the market and unfortunetly,people like you and those on medicare are the ones suffering. they cannot get the 8 hour or past the two Xs per day dosing either because the Rxing lit says so. you just really desrve better hon and i do think a better PM could be the best move you could possibly make at this point. when an actual PM wont even "try" a med like cymbalta on any CP patient,geez,what kind of a PM is he anyways?
anytime i have mentioned any med(non narcotic since we didn;t need to change that)or therepy that i have wanted to at least try,they are more than happy to at least give it a go for me to see if it may just make a difference in me. that IS their job ya know? i certainly hope you can either convince your current PM to just actually do the right things here for you or even find a much better one. i wish i could help more with that. please keep us posted hon. marcia
Feelbad,
thank you so much for your post and for your support.
I actually very happy with my PM DR. This Dr is very experienced, he works with Dr. Camissa as a group at HSS in NYC. Dr Camissa uses only him as PM Dr for his patients and it means a lot since Dr. Camissa one of the most famous spinal surgeons in a world. He has PM and Neurologist who he trusts and all his patients get helped by this Drs only. And yes, I just found out he is Anesthesiologist also, which I did not know before.
When it comes to Cymbalta - some Dr don't want to prescribe this meds due to side effects and due the fact that very hard to go off it.
My Cardiologist does not prescribe Cymbalta widely also. For example cholesterol medicine Vytorin: some drs love to prescribe it, some drs prefer Lipitor... they have reasons to trust one meds over the other.
I was on Neurontin, which worked fine with me; than my dose were increased and hands and feet got very swollen - they took me off.
I was on Lurica - did not work for me at all, no pain relieve.
I am on Keppra now and seems it works fine so far. But i can't expect pain free since I have very extensive nerve damages after my first fusion and more after second one.
I trust my PM 100%; besides he is a good Dr, he is carrying one. How many Dr call you to find out how are you doing on new medication? His nurse called me once at 11 pm after I came back from ER having reaction to Fentanyl Patch. He is adjusting my doses the minute I tell him i still feel a lot of pain, he believes in "custom made coctail" (like he calls it :)) and works with each patient not under "one size fits all". Do you know what I mean?
Thank you, sweetie, for your concern. I wish you all the best and have a nice weekend!!
i am having a hard time understanding just why.becasue your PM doesn't seem to care for cymbalta,why in the heck wouldn't he be willing to just give that a go for any patient who is suffering with the type of pain you are? it seems just a bit stupid to me for any PM to notwant to at least try any types of those classes to just see how it would work.we ARE talking about very hard to treat pain here ya know?
i am wondering just how really satisfied you actually are with this PM and if maybe trying another wouldn't help you in many ways? just a thought for you. this one really does not appear to be as 'up' on the ins and outs of true PM if he is actually sticking to that ridiculous 12 hour dosing when just about every other PM just knows from experience that it will not,in most peoples pain processes actually last more than at least 8-10 at best. also,denying any patient a med like cymbalta to at least try and see how it would work in a situation in treating chronic pain just seems a bit inhumane to me ya know? when any PM is trying to actually manage CP in any patient,they are usually more than willing to at least try any med that has had a proven track record of actually working in some peoples pain.
i just cannot imagine what your PM is actually like quite honestly,it just doesn;t appear from just the few things you have stated here about him that he really IS the best type of PM for you and your pain to be treated in the very best ways possible. would it actually be possible for you to try and change to a much better more experienced PM in your area,even if it would take like an hour to get there? honestly,a good experienced and knowledgable PM is really worth their weight in gold to me and i think alot of people who are lucky enough to actually have that type would agree too. you just deserve much better PM than you have been getting moldova,really.
since oxycontin first came out and has actually been tested by the "masses' alot of different things have really been proven wrong just by being taken over the many years by a much wider base of patients. this kind of goes with any 'new' med. but perdue just simply refuses to change their Rxing info to accomodate the 'newer' facts that have come out since it first hit the market and unfortunetly,people like you and those on medicare are the ones suffering. they cannot get the 8 hour or past the two Xs per day dosing either because the Rxing lit says so. you just really desrve better hon and i do think a better PM could be the best move you could possibly make at this point. when an actual PM wont even "try" a med like cymbalta on any CP patient,geez,what kind of a PM is he anyways?
anytime i have mentioned any med(non narcotic since we didn;t need to change that)or therepy that i have wanted to at least try,they are more than happy to at least give it a go for me to see if it may just make a difference in me. that IS their job ya know? i certainly hope you can either convince your current PM to just actually do the right things here for you or even find a much better one. i wish i could help more with that. please keep us posted hon. marcia
Feelbad,
thank you so much for your post and for your support.
I actually very happy with my PM DR. This Dr is very experienced, he works with Dr. Camissa as a group at HSS in NYC. Dr Camissa uses only him as PM Dr for his patients and it means a lot since Dr. Camissa one of the most famous spinal surgeons in a world. He has PM and Neurologist who he trusts and all his patients get helped by this Drs only. And yes, I just found out he is Anesthesiologist also, which I did not know before.
When it comes to Cymbalta - some Dr don't want to prescribe this meds due to side effects and due the fact that very hard to go off it.
My Cardiologist does not prescribe Cymbalta widely also. For example cholesterol medicine Vytorin: some drs love to prescribe it, some drs prefer Lipitor... they have reasons to trust one meds over the other.
I was on Neurontin, which worked fine with me; than my dose were increased and hands and feet got very swollen - they took me off.
I was on Lurica - did not work for me at all, no pain relieve.
I am on Keppra now and seems it works fine so far. But i can't expect pain free since I have very extensive nerve damages after my first fusion and more after second one.
I trust my PM 100%; besides he is a good Dr, he is carrying one. How many Dr call you to find out how are you doing on new medication? His nurse called me once at 11 pm after I came back from ER having reaction to Fentanyl Patch. He is adjusting my doses the minute I tell him i still feel a lot of pain, he believes in "custom made coctail" (like he calls it :)) and works with each patient not under "one size fits all". Do you know what I mean?
Thank you, sweetie, for your concern. I wish you all the best and have a nice weekend!!
brianpain33
04-26-2008, 03:37 PM
he believes in "custom made coctail" (like he calls it :))
sounds like a bartender, huh??:eek::nono:
brian
sounds like a bartender, huh??:eek::nono:
brian
feelbad
04-27-2008, 01:00 PM
i am really glad(believe me,thats half the battle) that you are very happy with your PM moldova. i just really don;t understand as this much time has passed with the OC being out there and tried by many many patients,why he doesn't just 'do" the every eight hour dosing schedule for you,thats all. like i mentioned before,most good PMs do know about how long OC really does last in most patients. i just really think that this one adjustment would really help you much more than anything else right now,ya know? it just doesn't sound like your pain coverage is actually lasting long enough,thats all.
perhaps just sitting down with him and discussing this one adjustment may help in letting him know that the coverage just is not there for you the full 12 hours. have you ever mentioned that to him before? like i said,most PMs will actually "start' the patient out on the every 12 and stay with that unless the patient actually has a complaint that it just doen't "feel" like it is lasting that full 12 hours. just this one thing could really help considering the level of your pain hon. believe me, i ment no disrespect to your PM,i was just kind of suprised/confused by a couple things you mentioned about him. if YOU are happy with him thats all that matters. i would discuss this with him tho and see what he has to say. it's worth a shot anyway. hope this pain gets better for you ,marcia
perhaps just sitting down with him and discussing this one adjustment may help in letting him know that the coverage just is not there for you the full 12 hours. have you ever mentioned that to him before? like i said,most PMs will actually "start' the patient out on the every 12 and stay with that unless the patient actually has a complaint that it just doen't "feel" like it is lasting that full 12 hours. just this one thing could really help considering the level of your pain hon. believe me, i ment no disrespect to your PM,i was just kind of suprised/confused by a couple things you mentioned about him. if YOU are happy with him thats all that matters. i would discuss this with him tho and see what he has to say. it's worth a shot anyway. hope this pain gets better for you ,marcia