I left work today at noon. Had to drive an hour to pick up my Mom, then go to my PM appt, get my refills and drive mom to the hospital and check her in. She's having an L5-S1 fusion first thing tomorrow morning with the doc who fused my L4-L5 in 2002. Her first surgeon did TWO microdiscectomies this past January and when they didn't help he wanted to operate on L4-L5! I finally talked her into seeing my doc and yep, her first doc screwed up!
Anyway the point is, I was pretty rushed for time today and considering I spent almost two hours at the clinic I only spoke with my doc for maybe two minutes. He walked in and asked what I felt they could do for me.... HUH? I want them to get me down to a pain level I can tolerate! I'd be perfectly happy if they could get me down to a constant 6. I asked him again about the nerve block injections that he hasn't brought up since my first appointment. He asked what my worst area of pain was so I said my legs but my back is so out of whack that without my brace I can't even work a full shift, and I'm wearing it against my surgeon's advice. He left the room for a few minutes and returned with a DVD about the neurostimulator implant - I'm suppose to watch it and give him my decision a next month's appointment.
I told him on day one that I didn't want to go that route. Having the surgical rods in place after my fusion was terrible but the pain did ease off some when I had them removed last November - that sort of tells me that having foreign objects in my body causes me a great deal of pain, so why would I want to have something else implanted in my epidural space? I guess the part that bothers me most is that idea of snagging those leads on something and tearing them out or partially loose. I work with two people in particular that still "goose" me in the ribs every time they walk by knowing full well the problems and surgeries I've had so there's no way I'd feel safe having leads they could somehow grab onto! The only reason they haven't been decked already is gender protection.
On top of all this, the doc completely ignored my question about the nerve block injections and didn't even ask if the current meds were helping. He left the room and 5 or 10 minutes later a nurse brought in my scripts for the same meds I had last month: 25mu Duragesic patches, 7.5mg Percocet (2 per day for BT) and 4mg Zanaflex. The Zanaflex at bedtime is helping more than anything else they've given me, it really is great stuff and I'm finally getting some sleep at night. Considering I TOLD him I'm taking over 4000 mg of ibuprofen each day just to function, I thought it'd be a no-brainer that the patches weren't strong enough... I guess not.
I'm pretty set against having the stimulator put in but I guess I need some opinions from those of you who've gone that route. The doc himself is "in network" but the surgical center next door (where all "procedures" are performed) isn't, according to my insurance. My end of the three epidural injections was $531 and the discogram added another $200 to $300 (for ONE disc!), I can't imagine what the trial and permanent stimulators would set me back.
Any input you folks can offer will be greatly appreciated. Am I shooting down this option too quickly or am i right in not wanting to go through another surgery and everything this will involve?
Thanks everyone,
Jack
Last edited by Flycatcher; 08-12-2004 at 08:50 PM.
Jack, is seeing another pm an option? It doesn't seem to me that this fellow is doing his best for you. You are not on a very high dose and I personally thing that going to the SCS or the pump is not for you right now. What you need is an increase in meds, or different meds. Mind you, I have nothing against the implants...I have the intrathecal morphine pump...but they should be used when you are no longer helped by medications. As for rejection, many people experience problems with the rods and screws and go on to have successful implants. Different areas, different material. And I doubt if anyone could actually pinch one of the leads....any way you shouldn't have to tolerate that. Don't you have a human resources person you can report them to?
I hope this helps some....I really would look for another pm, though.
Good luck.
Carol
P.S. If you had to bear the cost yourself, I think you are looking at something like $25,000 give or take a few thousand!!
Sounds as though things didn't go as you planned. Your visit sounds typical of many medical visit's I've had with various doctors, they don't take the time to listen. They hear you but they don't listen.
I can't adivse you on the stim, I haven't had one, but you do have the right to refuse one, not sure how he will react to that. I'd think he'd adjust meds before going the stim route, always had the opinion that was something they look into last before a pump but I could be wrong.
If you are truly unhappy with him, and it sounds as though you are, do you have the option of finding a new doctor? I would at least give the current one another chance. Thing is you have to be insistant and politely explain when you see him the medications don't work. Don't let him rush you. They often will do that when over booked. Mine will do that as well but if I really tell him what is going on he does take a bit of time to listen and actually hear what I have to say and go from there before writing any prescriptions or leaving the room. In fact he writes them in front of me but each doc's method is different. My GP has her PA write most scripts and bring them in.
At any rate, I guess what I'm trying to say is don't give up yet but you might keep in the mind or think about a new doctor. See if there's one available in your area and you can find out what type of treatment options they have available without treating I think. Some offices will indicate it, other's wont.
Not sure what else to say. I don't think its fair he forces you to have proceedures where you pay out of pocket due to the network. I'm in a network type situation as well but my docs have all been great in the past and never requested or suggested that I have any type of treatments from someone who wasn't in the network.
I've seriously considered going to another PM clinic. My wife and I are lucky in that there are at least two, possibly three here in Nashville to choose from. One of those is definitely "in network" and would solve all those insurance hassles but I've been seeing this doc since February and sort of dread having to repeat the process and all that trial and error with pain meds.
Some of you here have mentioned that your PM clinics offer accupuncture and other alternative therapies. I'd really like to try that as Eastern philosophy has interested me since college. I've been using biofeedback and transcendental mediatation (TM) since the late '80's so I'm open to just about any approach. I don't think TM would help much with the pain but accupunction along with the meds sounds interesting and if I have to switch to another clinic that's something I'll look into (this clinic doesn't offer the alternative approaches).
I'm still against having the stimulator but I'll watch the DVD like he asked and see what I think then. I wouldn't have to cover the entire cost of any procedure but my coverage drops from 90% to 70% AND I'm responsible for any charges that are considered over the allowable amount, that adds up quickly.
I appreciate all of your support on this, I wanted to make sure I was thinking clearly before telling him no. The idea of missing even more work for it is also a bad idea since I'm on pretty thin ice with my boss with all my missed time. Next time I have my follow up I'll tell him I don't want the implant but would like to try an increase in my patch dosage since it seems to be mildly effective, without the fatigue I got with Oxy, it just needs to be stronger. I'll ask again about the nerve blocks, explain again that I want to clear my bill at the surgical center first, and I'll try to bring up accupuncture.
Yes, I always feel rushed at my appointments. They close at 4:30 and I never get in before 3:00, my next appointment is 3:45. Yesterday my appt was 3:30 and I didn't think I'd ever get out of there. If all else fails I'll look into the other PM clinic in town, I'm assuming I'd have to request that my files be transferred to them and I just really hate going through that. It's always feels like I'm telling the doc "sorry, you're useless to me." That's overstated but you get the idea.
Thanks again everyone, I'll stick with my decision and see what he suggests next month.
Jack
Last edited by Flycatcher; 08-13-2004 at 04:15 AM.
Alternative therapys are very highly reccomended by many PM's. They don't rid you of the pain but more are a coping mechanism to help you through rough periods.
TM and focusing techniques are really great when you have an onset of very dibilitating pain out of the blue. TM is also just a good thing to do to rid your body of stress and help you to relax, it's quite effective to do before heading off to bed and can help for a more sound sleep.
One of the newer things folks are doing is Reflexology, it can also help out with pain. Some folks swear by it but am thinking it's more that they pain is mild to possibly moderate and unlike us with CP we are more often on the severe end. It is worth looking into.
As far as switching docs, you don't have to explain to them why you change, the new doctor may or will ask you. Letting them know that you feel your pain needs are no where near being met or that you feel the doctor isn't compasionate to your needs should be suffice.
The doctor I had who did my cervical spine surgery had the ego the size of the universe, not kidding, I no longer go to him. When asked I tell the new doctors that his bedside manner left little to be desired and ironically the new doctors know the old one and completely agree!
Often in small circles of specialty medicines doctors are aware of the other doctors who practice as well and when they start getting new patients from the same doctor on a regular basis they suddenly can put two and two together.
Had my PM follow up today. 
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