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Old 11-15-2007, 09:50 AM   #1
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Advice Please....

In March of this year I was involved in an auto accident. This happens to be my 4th accident in 6 yrs. None have been my fault, but with each accident my back has deteriorated. The most recent was the proverbial straw that broke the camel's back. After 9 weeks of chiro', I seeked treatment with my primary care physician (she is a PA-C).

After 3 months of hydrocodone pain management I hit a brick wall and hydrocodone would not work. She moved me to 5 mg 2 X daily Percocet. After 3 months my tolerance was such that I was switched to 10mg 2x/day. With my back injuries came massive headaches, and I was seen by a neurologist who was against pain medication. He told my PA-C to cut me off my Percocet and NSAID's for 2 wks. So, today I go to my PA-C with a pain level of 10 (almost in tears, doubled over, after having pulled a chunk of wood out of a 500lb chain at work) and she informs me that since I only achieve pain relief for 2-3 hours with a Percocet 10mg, that she is going to cut me off for 2 weeks and I am to take *** prednisone and Soma, and bite the bullet and live with the pain.

I work in a sawmill 45 hours a week, lifting lumber, twisting, bending, stacking lumber, carrying boards across the mill floor to diff' depts. I am a new homeowner, cannot afford to take time off for back pain. So my PA-C has basically damned me to two weeks of constant pain that ranges from 6-10. I have a signed Pain Contract, have abided by it, and now she has taken me off the meds cold turkey. In her eyes pain is better than getting hooked on painkillers. I told her I didn't think I could handle the pain that it was going to be horrible. She told me just to try it her way, that Prednisone would really help me. I am supposed to check back in a couple wks.

So, my question is...Should I find a new Primary Care, and if I do so, is that considered "Doctor Shopping" the way the law reads?

 
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Old 11-15-2007, 11:20 AM   #2
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Re: Advice Please....

That is how SOME Dr's operate. if you tell them your pain meds are not helping this is what they do to you... I never would say that in those terms. you have to word things more carefully or this can happen. It is very absurd of this PA to do this to you. I would call and ask to see the Pirmaey Dr she reports to and tell her how much pain your in. a pain managment DR might be a better option for you as this sounds like its a real problem for you living in this pain....

Vicadin is a weak pain medication and it does not last but a few hours, so I am not surprised at all that it wasn't helping you.

Also if your back and neck are as bad as you say they are, I don't understand why your doing such physical work right now when you are injured. This job is going to make you worse and its not allowing your back to heal or rest. Why don't you look for a new job or at least ask if you can work in the office? I would not be doing this type of work if I was in that much pain. Its just common sense to stop doing that job right now. It also makes you look bad that your complaining of pain at a 10, but still working doing your sawmill job. I think most Dr's would find that hard to beleive your pain is a 10 but your still able to work? doesn't sound good to the Dr's.

It is not considered Dr shopping if your looking for a new Dr as you were not prescribed any narcotics so you are not breaking any rules. If you are thinking your going to find a new Dr to prescibe heavy narcotics, you will have a hard time findind one to do that.. your better off seeing if your PA'S Dr can see you and tell them you need some more pain meds to allow you to function. along with the prednisone.. Have you had any MRI'S or been to a back specialist yet? that is another thing you need to do. maybe some ESI shots would help your pain or some other modulaties besides narcotics. what about PT? It can really help more, so than a chiro in my eyes.. Also I want to say that you have been on a very low dose of percocet. I would not say that 20mgs a day is a lot for someone in a lot of pain, espeically a 6 -10 you are WAY under medicated!!!! But I don't think a GP is a good option anymore, I think you need to see a back Dr or a pain Dr and see of anything else can help you besides pain meds. good luck.
ss

Last edited by slipperyslope; 11-15-2007 at 11:36 AM.

 
Old 11-15-2007, 11:43 AM   #3
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Re: Advice Please....

Go to the Harborview Medical Center in Seattle spinal clinic for a second opinion. They are great! they saved my husbands life! If you are in soooo much pain Just go to the Harborview ER with all that pain and they will refer you to the spinal clinic. They don't care where you came from or your stupid 'contract' that they are making people sign these days!...OH and yes you need to have a second opinion what they are doing to you right now they all should be shot and those contracts are to protect them and not the patient because they don't want the DEA to investigate them for prescribing reasonable pain meds!!! you need relief so don't think you are 'shopping for doctors'...you NEED to shop around for a doctor that will give you some relief and what they are giving you isn't even close to relief and it is pretty much harming you to have to 'bite the bullet' shame on them they have no idea what they are doing!...However, they will allll tell you that you can't do that work anymore! you will end up in a wheelchair if you don't stop and seek appropriate attention and more than what you are getting.

 
Old 11-15-2007, 12:31 PM   #4
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Re: Advice Please....

Mr Green from the lovely town of Sequim......

I agree with Ann that Harborview is a great place. They can treat you if you have no money. My sister in law just had brain surgery there and she has no income. I think she's on the $5 a month for ther rest of her life plan.
I go to Swedish and see Dr. Irving, the head of the pain management department there and at UW. He has patients that drive in from Yakima and probably Spokane too.

I understand that you can't afford to miss work. I lost my job because I had surgery on my arm and couldn't return to work quickly enough for them. My husband had great care at Harborview after he shattered his heel. He had a nine hour surgery to try to repair it with plates, screws, wires and cadaver bone.
I don't believe he would have received the same level of care at our local hospital.

My pm (at Swedish) recently did the same thing your doc did to you. Sort of.
My tolerance had gone up and instead of raising my dosage he took me off my oxy and gave me other drugs to try. Week one was clonidine...imagine my shock when the pharmacist told me I was taking it for withdrawal symptoms...or maybe high blood pressure...ok maybe for pain. Then I tried Lyrica and ???something I can't remember. The last straw was Tizanidine(zanaflex)...it made me hallucinate. When I showed up at my pm appointment a mess and crying my doctor asked what I'd been doing for the past couple of weeks. I answered, "Lying on the couch, in pain." He said, "Well, that's no way to live." and put me back on the oxy...the one thing that works for me. Sorry to ramble but I do believe that they don't realize how much med changes affect us. If they had to put their lives on hold for two or three weeks they would think twice about what they're doing when they take away medicine that works.

My point...and it took forever to get here...is that, yes it sucks that this happened to you, but now is the time to take charge. Go find a doctor who can help you. I don't know the pm situation in Sequim but if you want to get taken care of and not mess around I would agree with Ann and head to Harborview. If you don't get your pain under control you may not get better. Do you have a diagnosis?
You may have to miss some work but in the long run this will help you.

Again, sorry to ramble. Keep us posted and good luck in your search.~Mush
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undiagnosed lung and back pain after pneumonia in '03, tmj, migraines,(two failed surgeries for) Kienbock's disease

 
Old 11-15-2007, 03:56 PM   #5
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Re: Advice Please....

Thanks everyone for the great advice. For those who think Sequim is lovely, it is only lovely if you are only in town for the Lavender Festival and get to escape.

I was going to be seen at the Neurosurgery Dept, at UW for an arachnoid cyst that is protruding into my middle cranial fossa/borderline Chiari Malformation, so I may as well kill two birds with one stone and be seen by the PM units out there too. Do the Pain Clinics need a referral from my so called PA-C, or can I make an appt myself?

The doctors around here, neurologists included, are only accustomed to treating our large retired demographic. I have had two neurologists here tell me, "Lots of ppl have cysts in the back of their brains, and your cyst could not possibly be the root cause of so many symptoms" So when a younger person such as myself has health issues, we fall through the cracks, case in point....Been waiting a month for a consult with a Psychiatrist. Or, we are treated like we are pill junkies, while the elderly have a carte blank on medication. My PA-C told me that long acting meds are way too addictive for her even to consider putting me on them.

You guys/gals are the latest in a long list of ppl to tell me to get out of the sawmill. But unfortunately, there are very few jobs here that pay the amount of money/benefits that my current job does. I know I need outta there but my kids need a roof over their heads.

 
Old 11-15-2007, 06:15 PM   #6
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Re: Advice Please....

Yes, I guess I can say Sequim is lovely because I don't live there.

Unfortunately, I think you need a referral for the pain clinic. Most doctors would be happy to write a referral. It would take the responsibility off your PA's shoulders. I've always found that if a doctor can't fix you they are more than happy to get rid of you.

I know what you mean about the work issue. I am trying to finish school so I can get some sort of job with health insurance. My husband who works in commercial construction(Benaroya Hall, Safeco field and many, many schools) will not physically make it to retirement. We would be toast without insurance. His migraine medicine alone is $750 every two weeks!!

I would call the pm department and ask about the referral and then go to your PA if you need one. Good luck with the cyst. Do you what treatment they are going for? When is your appointment? Take care.~Mush
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undiagnosed lung and back pain after pneumonia in '03, tmj, migraines,(two failed surgeries for) Kienbock's disease

 
Old 11-15-2007, 06:59 PM   #7
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Re: Advice Please....

Hi Mr Green, It's certainly not against the law to get another opinion. Do shopping is whnen you have more than one doc prescribing similar meds for the same condition, whether it's vicodin from one and percocet from another or Valium from one and Soma from the other, Both to treat the same problem.

You can consult with who ever you want, just be careful you have ended the prescribing relationship with the old doc before fillng a new prescription.

Something that concerns me, Is that this has gone on for 9 weeks of chiro, 12 weeks of hydro and 12 weeks of percocet. If there is something really wrong and you need a surgical opinion to tell you if you need surgery or would benefit from surgery the window of opportunity may have already passed. Meds have just allowed you to put off something that might have had a greater chance of success if it had been looked at from a srugical standpoint and not just a patients comfort. Simply medicating the pain away expecting to do the same level of physically intensive work only leads to more and more medication. That's pretty liberal considering nobody even knows if you might benefit from some type of interventional procedure.

Have you had an epidural steroid injection, have you had triger point injections, have you had an MRI or CT and consulted with a surgeon. It may be in your best interest to prevent you from continuing to damage something that is simply getting worse. You calling it tolerance, maybe its progression of a problem that needs to be surgically fixed. I've done the waiting game, when you can't stand the pain any longer. Waiting till you loose controls of your bowels when you hit a speed nump is the brightest thing to choose to do. I did that when meds simply weren't given to someone unless they had surgery , a major injury or cancer. That's just how it was before the big oxycontin boom n '96.

You have been able to block the pain for 6 monthss, maybe there is a better way and choosing to do damage that may not be able to be repaired if you wait too long, may not be the smartest thing either.

A big pet peeve is accepting a surgical opinion from anyone other than a surgeon. What the GP, PM or radiologist think doesn't really matter. A surgeon has to examine you and see the films themself. Any other doc giving a surgical opinion is stepping way across a boundary. They have no skill or training to perform surgery even if they think it's neccessary. I've yet to meet a surgeon that even read a radiologist report, they want to examine and see for themself. Something like loss of refexes,muscle atrophy and loss of bowel control, don't show up on a rad report. A rad or GP hasn't seen what's under the skin since they went to med school.

Just a diferent opinion. Going without percs to see how much pain your in for a few weeks won't kill you. It gives you a chance to make a decsion when your not clouded by meds and thinking that with enough meds you can continue to do extreme physical labor with whatever may be wrong with your back. Obviously it's bad enough to need the meds, Isn't it bad enough to find out why it hurts so much?

20 mgs of oxy a day is minimal as far as withdrawal goes, 2 weeks is nothing compared the rest of your life in pain that may have been prevented. You can find a doc to give you meds if that's what you want, but I would still seriously consider looking into why you still hurt 10 months later and is it something that's going to continue to progress and your odds worsen the longer it progresses. Without that 8 years of college, years of residency plus years of internshiops and fellowships plus actual practice. A doc may be more qualified to know what is best.

If medicating you without knowing what's wrong, means you're going to continue to engage in physical activity that is only making things worse could easily be seen as doing more harm than good. He's thinking about next year, not next week. Docs take an oath to do no harm and if the meds are just allowing you to make a problem worse, he needs to cover his ars and get a surgical opinion. Even if your PM says you need surgery, an actual surgeon has to agree and the PM opinion doesn't mean squat to the surgeon.

Good luck and try to look at the big picture, Dave

 
Old 11-16-2007, 05:15 AM   #8
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Re: Advice Please....

You certainly gave me alot to think about, I really appreciate you taking the time to write that up.

An abbreviated case history on myself: 9-7-01: 90YO woman T-Bones me, head on collision with power pole @35 mph, deemed to be a catastrophic back injury by all medical professionals who attended to me. MRI revealed bulging discs throughout my spinal region. But due to my age, 22 at the time. Natural healing was decided on vs. surgery. Chiropractor assigned 20% disability , warned me next accident would paralize me. Vicodin for several weeks. 10-04: 85 YO woman rearends me at intersection at red light due to window shopping in her car at 9pm. Endless chiropractic care, vicodin for less than 2 months, back to some semblance of normalcy after 1 year. 11-05: Sitting in parking lot of preschool for parent conferences, Ford Excursion backs into my trunk, more chiropractic and vicodin. 3-06-current: Teenage girls t-bones me after failing to yield at green light on left turn. MRI, CT Scan X 2 reveals bulging discs in both cervical and lumbar regions. After exhibiting severe neurological abnormalities as it relates to symptoms, my arachnoid cyst was discovered .

My current PA-C refuses to refer me to orthopedic surgeon all along, saying my injuries are not serious enough to warrant even a consultation. She did refer me to two diff neurologist for analysis of my cyst and they chalked up my symptoms as the result of Post Trauma Stress. It is a literal crap shoot when consulting with specialists on an arachnoid cyst since most of them refuse to believe that an arachnoid cyst can be anything BUT Asymptomatic. And they will 99.99999% diagnose it as congenital since the only way to definitively tell whether it is congenital vs. secondary is brain surgery. You have to find the perfect neurosurgeon who has training in Arnold Chiari Malformations and cysts. Was told to quit caffeine intake completely, which has calmed my migraines down a couple notches.

You see, I have done everything my medical providers have instructed me to do and have taken their word as the gospel which I now regret LOL I honestly would rather not take pain medication but my doctors tell me that surgery won't help, physical therapy discharged me due to absolutely not one iota of progress, so I am at a crossroads...Meds and function, or No Meds and be told you are a hypochondriac, a head case, and not function due to having the back of a 75YO at only 29 YO... I don't know which direction to take LOL

MATT

 
Old 11-16-2007, 06:48 AM   #9
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Re: Advice Please....

It sounds like you need a complete work up by a spinal surgeon. If you need a referral and can't get one - make a big fuss with membership services. Remember the squeaky wheel gets heard. Tell them you have been in 3 major accidents and are taking pain meds daily which are not covering your pain. You want to have a specialist take a look at everything and give you a complete independent opinion. Tell them you love you GP; however, the spine is not his speciality. If the spinal surgeon, tells you no surgery then fine you will continue seeing your GP.

 
Old 11-16-2007, 01:26 PM   #10
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Re: Advice Please....

Hey matt, I don't know why it's so hard to get a surgical opinin these days. If youhave neuro sdysfunction, you need to be evaluated. I would be t part of the problem is having more than one problem. It really seems to throuigh docs if you have bilateral leg pain from lumbar problems or have both cervicle or lumbar problems. The first question they ask is which is worse, that's what they will focus on.

Strange you mentioned Chiari malformation, my wife has the same problem. It didn't appear untill after she was rer ended and developed abscent seizures. I found the same info too about Chiari, Some believe many people will go through there whole life and never have a symptom and others sebase the need for surgery based on symptomology. Something that has helped my wife reduce pain meds drasticlly is Botox. The relieve the constant state of spacticity inher neck that causes the head pain. She doesn't have true headaches, it's head pain and muscular from the malformation. So botox, TP injections and occipiptital blocks have helped her reduce pain med intake by 2/3rds.

Personally I would demand a surgical consult, preferabbly with a neuro surgeon that specializes in the spine, chiari and the tumor. Obviously the DX sounds worse in your cervicle spine and if you tell them your thoracic or lumbar cause more pain, it's gonna confususe the brilliant docs with no common sense.

I have never met a PM doc that believed only meds will help, In fact the majority didn't believe in opiates, but I've been dealing with CP since 93. A multi disciplinary aproach will always help more than a single aproach. But if your PM doc doesn't use botox, or doesn't do trigger point injections, he's not going to offer it to you. They offer what they know, so the best bet is to find a group of docs from multiple specialties practicing PM that can put their heads together and find the best treatment plan for you. Even if all they can do is manage the pain, there is still more than one way to manage pain. If botox would relieve 15% of your neck pain, why wouldn't they try other than lack of experience and they simply don't want to deal with the paperwork hassles of using a drug "Botox" that is considered a biological agent with potential weapon/terrorist use. So it draws more attn and creates more work for a practice or doc that uses it. The same is true for pumps and SCS , if a doc doesn't use them, manage them or implant them, your average physicatrist isn't going to recomend one. It's just how it is, a lot of ego involved and conviction is his own opinion that is based on what, all his experience with something he doesn't use?

Your story just reinforces my disgust with non surgeons that give surgical opinions. The key word is "OPINION" if your not a surgeon, how do you give a surgical opinion. Perhaps things have changed in the last 5 years and there are devices, techniques and things a surgeon or a PM doc that does interventional procedures is capable of trying that your present PM may never try if he's alone in an office and does no interventional procedures like ESI, nerve blocks, RFA, TP's etc.

Anyone can write a script, but don't let a script writer condemn you to a life of pain for next 40 years with a his DX when you haven't gotten a recent surgical opinion or the chance to try dozens of different modalities available. He will never offer something if he doesn't do it himself or believe in it. What's his basis for not believing something else would work, it's not because he tried and it failed. That's the real test. If something effects you so greatly, it seems hard to justify not trying something that even has the slightest chance of helping.

I you think of pain as a circuit, you can dampen the charge that circuit carries with opiates at one point, the opiate receptors. It doewsn't mean you can't attack different points of that circuit with other modalities to greater reduce the charge the circuit carries. Imagine a hose, If you fold it one time, water still flows out the end, But if you fold it at 4 different points, your more likely to stop the flow entirely. Using opiates alone is simply putting you foot on one spot of the hose hoping to stop the flow of water. The more points you attempt to stop the flow or dampen a circuit, the more successful you will be. That's what a multi disciplinary aproach to PM is.

Good luck, Dave

 
Old 11-19-2007, 02:24 PM   #11
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Re: Advice Please....

I called the UW Spinal Clinic @ Harborview in Seattle today and got the ball rolling. For a self-referral, they are going to need me to fax my medical records and radiologist reports from the MRI and CT Scans in. Then they will make a determination on my medical priority. I also have to do the same for the Neurosurgery Clinic @ UW for treatment of my arachnoid cyst. Am going to a "doctor of last resort" as my attorney calls her for a full medical workup from my toes to the top of my head. Am switching from my worthless PA-C to an MD in February.

So now that I got the ball rolling, hopefully things start to look up.

 
Old 11-19-2007, 04:15 PM   #12
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Re: Advice Please....

Congratulations!!

That's great. I hope all goes well and you get the care you deserve!
Keeps us posted.~Mush
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Old 12-15-2007, 02:17 PM   #13
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Re: Advice Please....

Hello, new to this post:
I was diagnosed with a cyst almost (10) ten months ago, after suffering with migraines for about four years. When I would go to my doctor, they gave me antidepressants, told me it was due to stress and sent me on my way. Well it got to the point of my migraines accuring about every few days, along with nausia, and having what seemed to be panic attacks, turned out to be severe anemia. I would have to call in to work or take off a few hours into my shift, it got sooo bad. My doc when I had insurance shook it off as stress and iron deficiency anemia, gave me anti-depressants, told me to take iron, and sent me away. I felt bad about my job having to cover my shift with temps, that I quit it was not working for me. I was dizzy, co-worker stated I seemed drunk stagering. I was having a hard time breathing, and I got to the point at one time I lost my hearing for about a month, I felt like GRANNY OLD-EHH, I CAN'T HEAR YOU!!!I also have a hard time especially when the migraines accur that I cannot tolerate light, or noise at all. I finally went to the free clinic where the doctor finally took my symptoms, more serious and had an MRI done, which showed the arachnoid cyst. The Neurosurgeon, stated that it was on the right, behind my eye, but would be too dangerous to mess with, and it was small enough not to cause any damage. My general doctor stated it measured at 3.7 the size of a thumbs end, not to worry as they are going to take another MRI in a year. Does any one have any idea of how fast an arachnoid cyst grows? Lately I have been experiencing progressive nervous like ticks, and stiffness in my muscles. Is this normal, or what? I am glad to know they have these forums for all of us to discuss all of this, and hope and pray each and everyone of us can get rid of all our ailments, pains, diseases, and health problems!!!
God Bless You All. MERRY CHRISTMAS and HAPPY and HEALTHY NEW YEARS.

 
Old 12-15-2007, 08:58 PM   #14
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Re: Advice Please....

[QUOTE=MrGreen0411;3308771]

I was going to be seen at the Neurosurgery Dept, at UW for an arachnoid cyst that is protruding into my middle cranial fossa/borderline Chiari Malformation, so I may as well kill two birds with one stone and be seen by the PM units out there too. Do the Pain Clinics need a referral from my so called PA-C, or can I make an appt myself?

QUOTE]


Hi there. I am so sorry for all your pain. I want you to know that Roy47 on the back board suffers from this Chiari Malformation. You both might be able to provide support to one another. I will tell him you are on the pain mgmt board. Maybe you might want to connect since you share this common link.

 
Old 12-16-2007, 05:24 PM   #15
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Mr. Green /ACM1

Mr Green0411,

My pen pal dietdrpepper found you on this web site. I have been diagnosed for a little over 3 years. It showed up when I started getting ringing in my left ear and then numbness on the left side soon followed.

I spent 22 years in the Army and all this happened soon after - words my retirement. It was thought at first that perhaps I was having light strokes; but the EMG showed that that was not the case; the nuerologist then had an MRI of the brain ordered and it was found at this time. The left side a year ago was bigger than the right side. I saw the nuerologist last year right after my back surgery and was having a diabetic seizure as it was falling below 60. So it was kind of rushed as I was rushed to the ER.
It was decided to leave things be for then as it was not giving me problems..

It is now that something has to be done...It is noticable at work as at times they have to tell me things more than they should if you ask me.....
Work is going okay, but could be better as I am a 9-1-1- dispatcher for the Offutt Air Force Base. I have not made a costly mistake and have things repeated after they tell me I repeat it back and then right it down and dispatch the uints that need to go and do thier jobs...But time is not the callers friend and we have to get them out as fast as we can...
The ringing in my left ear is getting louder by the day. I canot laugh becuase of the pain in the back of my head. IT is hard to swallow as well.

The VA has been great to me; one hears so many stories of bad treatment - I must be one of the fortunate ones...

It is now to the point that my entire left side of my face is numb to the side of my nose... There are times when I cannot remember peoples names that I meet 3 days ago; also there are times when it feels like someone has an ice pick and works the left side of my head over. Last week I was done shaving and I got this terrible pain in my shoulders and ribs and was having problems breathing. I went to work 5 minutes away and ended up in the ER. The blood work ws good; chest xrays were clear; and they did a CT with dye on my heart to ensure that the heart was healthy; and all things turned out normal. It took 2 shots of dremeriol to get the pain down to a level that was toleriable.

The ER doc said that it was a severe muscle spasm and had no idea why? I think ACM1 had a lot to do with it.... I have an appt. tomorrow with my GP and an appt with the VA on the 8th of Jan with my nuerologist.

I was treated with great respect and listened to by the ER doc - all the nurses were great. I do not need to experience this pain again.


I completly underatnd what you are all saying trust me....


I am sorry if this is long - but it needed to be siad so that we can relate and help each other
Roy47 now 48

 
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