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Old 12-23-2007, 06:11 AM   #1
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Question Why would PM doc not want to prescribe meds after my surgery????

Hi all,

I was sitting here thinking about my surgery when I remembered that my PM doc made a statement the lst time I saw him about not wanting to prescribe any of my medications after the surgery.

I was under this docs care when I had a WC case and he prescribed meds after my other surgeries. The were for my left arm.

He does not agree with surgery. I understand where he is comming from but the guy has already tried many things to get my pinched inflammed nerves to calm down enough to heal but nothing has worked.

I actuallu have not told him that I am for sure having surgery yet. I don't see him again untill the week after Chrismas.

The thing I am concerned about if the fact that I have a Low pain toleranceand a high Pain med tolerance.

I certainly hope that he lets my surgeon know this. I really like my PM, but, the last few times I have seen him he made the remark about not prescribing meds after a spine surgery if I were to have one and he also made another comment that bothered me.

He has been prescribing me Percocet 5/325 for a few months now and I am allowed to take no more than 6 a day. He knows about my tolerance issues and there has never been any probs with running out or anything like that.
At one point during my WC case he put me on Methadane after my arm surgery because nothing else was working for me. I actuall was off all meds and much much better until I had this car accident and now I have been on the stupid meds since. I hate them!!!

Anyway his statement was while he was reeading the form I fill out when I see him and he read that I take 5-6 5/325 Percocets a day. He said Wow thats alot! I thought to myself what is the deal all of a sudden today you think it is a lot when you have been prescribing them for a few months.

I felt judged and I did not like that.
It is not my fault that I have a hard time with pain and a hard time controling it.
Never has there ever ever ever been any prescription issues. I signed the contract and I am very careful with my meds. Take them as prescribed.

Maybe he did not really mean it in a durogatory way but I sure felt that way.

Should I change PM's if I need to after surgery? His office is about 50 miles roundtrip.

I hope I wont need to be on all this medication after my surgery. I would like to be off all pain meds by the end of April. I am having surgery on the 8th of January. Posterior Cervical Foraminotomy 3 levels. I hope it works so I can avoid a fusion.

Well anyway if anyone has any imput please let me know.

Chrissy

Last edited by skych; 12-23-2007 at 06:16 AM.

 
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Old 12-23-2007, 05:14 PM   #2
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Re: Why would PM doc not want to prescribe meds after my surgery????

Hi Chrissy - Why doesn't your PM agree with your plans for surgery? Doesn't he/she think it will solve the problem? If not, then what does he/she suggest instead of the surgery? A posterior cervical foraminotomy is supposed to be minimally invasive and it sounds like it could be just what you need if the cause of your pain is nerve root compression. Which levels will they be doing? I think your PM doc just doesn't want to be held responsible for treating your pain after another doc has put his hands on you in a surgical procedure. The surgeon really should be the person prescribing your pain meds immediately post-op, and hopefully after a few weeks you won't need anything.......that is if the surgery accomplished its goal, right? It may also be your PM's way of "punishing" you for not listening to him!! It sounds very childish, but who said doctors were always the most mature people on the planet....they ARE human too.....I think!!! Good luck to you - Memere (K'Mac)

 
Old 12-24-2007, 09:47 AM   #3
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Re: Why would PM doc not want to prescribe meds after my surgery????

Hey Me,

I think your right about him not really wanting to be responsible for the meds right after surgey. As for him not wanting me to have surgery the only thing I can think of is that he would have wanted me to try the facet blocks. The problem I saw with tha was that a facet block is only posibly going to block the pain. I do not feel it will help the fact that nerves are compressed in my Cspine.

The levels they are going to do ar C-3-4 C 4-5 and possibly C-5-6

He said he needed to look at the fims agin and then he would decide abou the 3rd level. I hope he does all three because I just can't take the pain anymore.
This visit with the family sonce the 19th has really taken a tol on me. I can't wait to get home into my own bed.
It has been just about six months since my car accident with little or no change.
I fell that I will have good results from the suregery and hope that I will avoid a fusion for a while.

Chrissy

 
Old 12-24-2007, 10:23 AM   #4
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Re: Why would PM doc not want to prescribe meds after my surgery????

Hi again Chrissy - I can only imagine how you feel not being in your own bed and having the little things around you that help comfort us when we are suffering from constant pain. We CP'rs have our own routines and ways of helping ourselves cope with the pain in our own homes. It's never easy to be plopped down in the middle of someone elses household! I just wanted to mention to you that I think you've made a good decision about the surgery. I say this because I get really uneasy when I see how much negativity is written about surgical procedures and the not so perfect outcomes that sometimes happen. You don't usually hear from the folks who have found significant pain relief and a new chance at life after a spine procedure. For me, all of my surgeries....every last one.....resolved the immediate issue that was at hand. I got pain relief from them all. I suffer today from new broken vertabrae, rheum arthritis, scar tissue, loose screw and some hardware problems. BUT...all of this is a result of my severe osteoporosis which allows things to move around. Not having any good bone in which to hold the rods and screws and other hardware in my back and hips is what has caused my "failed back syndrome", but it all worked well at the time it was placed. So, I want to encourage you to keep positive about your choice. All the best - Memere (K'Mac)

 
Old 12-24-2007, 10:41 AM   #5
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Re: Why would PM doc not want to prescribe meds after my surgery????

Thanks so much Me!!

I appreciatie your responses. I can pretty much bet at some point I may need the fusion but if this puts it off for a while great.
I am not stranger to surgery and I know all to well that things do not always come out as well as we would like. That is the way surgery is. It is a risk no matter what kind of surgery it is.
I am looking forward to it and I have a good positive outlook.

Thanks again.
Chrissy

Last edited by skych; 12-24-2007 at 10:41 AM.

 
Old 12-26-2007, 12:03 PM   #6
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Re: Why would PM doc not want to prescribe meds after my surgery????

Chrissy,

I have similar problems with meds, and my PM would not take over pain control after surgery either. They released me, then the surgeon took over until HE released me back to the PM.

After having problems with SEVERE untreated pain after surgery, I did my homework. I talked to the surgeon, the anesthiesiologist, my GP, ect, before my surgery. I talked to them before they rolled me in there. I talked to them when I woke up! I'm sure I was very annoying, but it helped, ALOT. The anesthiesiologist is in charge of your pain control in the hospital. If you know that, and your surgeon does not call the nurses back, or won't change or add a med, have them page the anesthiesiologist on call.

Not only that, but the anesthiesiologist should be one of the MOST important parts of your care, and many people don't know that you can see one regarding YOUR pain relief at any time. If you are having severe pain in the hospital, and your surgeon wants to send you home with something in-adequate, ask for a consult with the anesthiesiology. They can compute what it took as far as meds in the hospital, and tell your surgeon what would be appropriate at home.

I didn't know until this surgery that they are not just there to put you to sleep, they are also there to help control your pain. Utilize them as much as you need to. I had them coming to my room daily, just checking on how the meds were working. Once, after a particularly tough night, they were there first thing in the morning, adding a PCA Pump and more Dilaudid as well as oral meds to "cover all the bases." They even apologized that I had suffered such a bad night. Jeez...where were these guys all the other times I had surgery???

Good luck and I hope this helps!

Amanda

 
Old 12-26-2007, 12:23 PM   #7
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Re: Why would PM doc not want to prescribe meds after my surgery????

Thanks Amanda,

How did you ever figure this out! Did some person in the hospital tell you all this info?

I have talked to my PM some about the concern I have with after surgery pain. I am planning on asking for a copy of his notes and what not to make sure that I will have those for the hospital.
I want his recomendations with me because I do have such a high tolerance with pain meds.

When I had my last arm surgery in March that ulnar nerve had been compressed for so long that after surgery it really flarred up to the point I was put on Methadone. I hated hated hated the side effect form that drug but it really did help me.

I did not have to stay in the hospital for that surgery. I took oral dilaudid and it did not even touch my pain one bit.
It seems that morphine does not really help me much either and it makes me want to vomit!!

Oh so sensitive I am to certain meds. Anyway I will keep that in mind for when I go in.

Oh one more thing what type of surgery did you have??

I will be having Posterior cervical laminectomy/foraminotomy C3-4 C4-5 and possible C 5-6
Well hope to hear back soon...chrissy

 
Old 12-26-2007, 12:44 PM   #8
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Re: Why would PM doc not want to prescribe meds after my surgery????

My PM doctor is an anesthesiologist. I was under an assumption that alot of PM doctors are, what special train do PM doctors have to be PM doctors? Or do they any at all? Is it just the field they choose? I would think and hope that becoming a pain management doctor would require some sort of training. My PM was there through all the surgeries I have had while under his care and came barging in a took over when I was in LABOR and not getting proper pain control at all because the nurses all assumed I was a druggie because I was in pain management and they outright told my family with "my history" they didn't feel comfortable giving me the meds. Oh this was after the O.D'd me on Pitocin causing my contractions to be up and off the charts and waiting to call my OB in when my son was going to come out on his own. I was literally pulling my own hair out when my PM doc came in and started yelling at the nurses. Oh I am so mad just thinking about it now. The hospital was so scared I was going to sue them. They caused my son to be born prematurely and made my labor much worse than it needed to be. I am going off on a rant now and I know it. I am just remembering what it's like to be in pain and not getting relief and being treated like a druggie and it makes me so mad for anyone that goes through it. Of course my son was worth it all but can you imagine telling a woman in labor she can't have pain meds? Argh.

Sorry Chrissy I didn't mean to ramble off there. I hope you have no trouble getting relief after this surgery. Be as bossy as you have to be. Have someone be an advocate for you, someone loud mouthed! Being sensitive to meds doesn't help things either my mom is the same way, I have seen firsthand how bad sensitivity to meds can be on a person so I feel for you there. Good luck!

Last edited by BabyOwensMama; 12-26-2007 at 12:45 PM.

 
Old 12-26-2007, 01:05 PM   #9
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Re: Why would PM doc not want to prescribe meds after my surgery????

Chrissy,

I had an abdominal laparotomy to remove mesh and repair and old hernia that had caused my chronic pain. Morphine is so worthless to me, I list it as an allergy! Not Kidding! Before I was opiate tolerant, they gave me morphine after a major surgery to repair a badly broken leg. I was literally screaming! Then I hear the nurses talking outside my curtain, "I don't know what this patient's problem is.....We've given her enough to kill a horse!" I started yelling, "I AM NOT A HORSE!" LOL Funny now, not so much then!

I have suffered so much with uncontrolled pain, that THIS time I was going to be prepared. I researched and researched! I wanted to know who was in charge of what, who was over them, what was my back-up, ect. No holds bard, I told everyone who would listen how badly I had suffered in the hospital after my last operation. Everyone knew that I was not only terrified of it happening again, I was taking names if it did!

There is so much we don't know about our own medical care, and it's because they don't want us to know. Often there are orders there in your chart, but if that nurse's magic number is 9, and you say 8, you don't get the medication. My anxiety was so high before this surgery that I had to have my GP prescribe an anxiety med in the weeks before surgery. Good thing too. Anxiety makes your pain worse. Turns out, my surgeon followed my GP's lead, and added it to the list of meds I could have in the hospital. (When you list your meds before surgery, it is not only to couter act any drug interactions, it is also the list the surgeon and anesthiesiologists use to write your drug orders when you are in the hospital!) When my pain was particularly bad, the nurse brought me an anxiety med with the pain med. The combo worked wonders on my pain and allowing me to relax.

Also, you absolutely need to stay on the same dose of meds you take now, with additional meds for your surgical pain. There is no need at all to stop your chronic pain meds, and it will actually make your pain harder to treat if you do. The anesthiesiologist agreed with what the research I had read told me. Say you are taking the 6 percocet 5mg per day. After surgery, they give you 2mg of dilaudid. At least a third, or not two-thirds of the dilaudid will go towards what your body is missing from not having the percocet, instead of 100% going towards your operative pain. Does that make sense? If you stop your cp meds before your surgery, you will already have a deficit. Then the pain meds will not be as effective. Once I explained my research to the surgeon, and the anesthiesiologist agreed, there were no arguments about keeping me on my cp meds, with additional meds for the surgical pain.

Also, little things to know help alot. Knowing that the anesthiesiologist and/or a pain specialist can come for a consult, at anytime during your care, is great. If you are not getting proper pain relief, and your surgeon will not help you, you have another avenue. Secondly, I suffered terribly once because the nurses had "labeled me a druggie". I did not find out until AFTER I left the hospital, that there were additional meds ordered by the surgeon AND the anesthiesiologist. The nurses simply would not give them to me! I complained to the higher ups and found out that once one nurse labeled me, they all did. They apologized, but the damage was done.

Even on a PCA pump, you always have something ordered for break-thru pain. An injection in your IV is called a bolus dose. All PCA pumps are pre-set to a certain dosage, at certain increments. These med orders can be changed as easily as any others. In addition to the bolus dose (usually allowed every four hours), they also add an oral med for break-thru pain. Meaning you can be one a PCA pump, have too much pain, and take an oral med as well. Anytime you hear, "sorry, that's all we can give you, or there's nothing we can do, you are getting the max amount...blah, blah, blah, that's bull." Ask them to page the anesthiesiologist. There is almost ALWAYS something they can do.

Also, remember that CP rules do not apply here. Many pain doctors want most patients to be happy with 50% pain reduction. This makes sense, as pain management is to help you function, not knock you out and lessen your function. Post-surgical pain is different. It is acute pain and should b treated as such. If the pain meds make you sleepy, good. You need the rest. This is not a sign of too much medication, like it would be with a cp dose. If after surgery, your pain is well controlled, you can rest easily and as often as you need to, good. Someone is doing their job.

And finally, the surgeon's job is to perform surgery. Notice how that has nothing to do with pain control? That's the anesthiesiologist's job. Start with open communicaion with everyone involved with your care, and remember, this is THEIR job! If they are not doing their job well, say so. If they continue to not do their job, you need someone who will. If that requires asking for someone's supervisor, no problem. That's what they're there for.

Long-winded I know, but I hope it helps! I did do some serious prep, but when you have a nightmare experience like I did, you never want that to happen again. Just remember, knowledge is power. What you don't know WILL hurt you. But not anymore, because you are an educated patient, who knows what her rights and options are.

Your Friend,

Amanda

 
Old 12-26-2007, 02:11 PM   #10
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Re: Why would PM doc not want to prescribe meds after my surgery????

Amanda thank you for sharing this. It makes sense to me now. I was in the hospital, they had discontinued the dillaud pump and they gave me 1 tablet every 4 hours of percoet (5-325). I told them I was in massive pain and took 10-325 mg for pain at home. The next thing I knew I had an anthesologist in the room. They upped my meds to 1 10-325 mg percocet. I complained to the nurses about still being in pain they told me there was nothing else they could do for me. I told them they needed to do something or I was checking myself out of the hospital. The nurses were jibbering about me outside my room. Another nurse came into my room to take away my iv pole. I explained the situation to him and that I had more meds at home. If they were not going to help me, I was going to leave so could he start the paperwork. The next moment, I had the patient's advocate representative in my room along with the anthesilogist. They put me back on dillaudid injections so quick.

Truly you have to speak up for yourself -- it is a shame but sometimes it requires talking to different nurses. I don't think having a pre-plan would necessarily work in a hopsital. You need to talk to the right nursing staff to get action. If I have to go into surgery again, I will talk to my GP and ask for a direct number - he manages my pain outside of the hospital for back up.

Again, thank you Amanda it makes sense why the anthisologist was showing up in my room.

Last edited by ms_west; 12-26-2007 at 02:13 PM.

 
Old 12-26-2007, 05:38 PM   #11
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Re: Why would PM doc not want to prescribe meds after my surgery????

YOU GUYS ARE FREAKING ME OUT!!!

I just typed this huge long thing and it got eraseed...

I am so scared because I have had 6 surgeries in 4 years. I always tell them I can't pee I have a terrible headace I vomit and go to the ER for the urinary retention.
I can not retype my history again as to why I am so opiate tolerant but I am so afraid of being in the excruciating pain.

I am already taking 5/325 percocet 6 a day. I take 2 at a time and it barley touches my pain most of the time.

On a regular basis I walk aroun with a pain level of 7-9. It is awful I am nausiated and sometimes I can;t even think straight because I am in pain.

Several drugs have been used on me postoperativly but after the last 2 arm surgeries one time fentanyl was used IV and that helped but I used the patch one time and it made me itch severly and I had to go back to the percocet. I was gien morphine and dilaudid and that gave me hives and made me sick although I have taken dilaudud oral with little or no pain relif and no hives.

The other thing that happens to me after anesthesia is I can not sleep. I get anxiety because I keep having to get up and pee and I can;t and I feel like I am ready to run a stupid marathon.

I can not type any more my neck it killing me and I have been awake form my pain since 3 30 this morning and I am only allowed 6 crappy pills a day and I have taken that already so SOL for me. I am left to lay down with the heating pad and a muscle realxer and try to regroup and breathe

Thanks Chrissy

 
Old 12-26-2007, 05:52 PM   #12
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Re: Why would PM doc not want to prescribe meds after my surgery????

Heating pads, what a genius idea. Don't be freaked out, you are getting alot of great info along with these horror stories so that the same thing doesn't have to happen to you again. Maybe some other meds can be taken to counter-act the side effects like urine retention which happens to be bad with the Ultram I take. Aren't you glad we know that about each other? We might not be able to share last names but we can share stories of our shy bladders. I feel like sisters in arms! It sounds like you have a high tolerance for opiates and a low tolerance to their side effects, lucky you! I hope you can find something that works for you and with all the helpful info you are getting from everyone you can go in fully prepared for battle if need be to have your post-op pain managed and side effects controlled. You're obviously a smart lady so you have that and all of us on your side.

 
Old 12-26-2007, 06:10 PM   #13
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Re: Why would PM doc not want to prescribe meds after my surgery????

Chrissy....honey, take a breath and try to get yourself focused!! I remember so well when ButterflyGirl was getting ready for her surgery and we all gave her the information about making sure to contact the anesthesiologist BEFORE she arrived at the hospital for her surgery. She was advised to make sure that the surgeon and the anesthesiologist were working off the same game plan and not to just "leave it up to the recovery room powers that be" to figure out her post op pain control. You can and you must be pro-active about your health care. Nobody else is going to go out of their way to make sure that your particular needs will be met. So...before your surgery (and this should be at least 7 days before) call the hospital and ask to speak to the department of anesthesiology. Insist on speaking to the head of the department....leave your name and number so they can call you back. Explain to the doc who you speak to all the intricacies of your particular pain management situation....your nausea from the morphine, the hives and itching from other meds, etc. Tell him the date of your surgery and your docs name. Ask him/her to work in concert with your surgeon to come up with orders for your post op pain management. If you can, ask him/her to be COMPLETELY responsible for your pain control until discharge. You must, and I repeat...MUST, be able to explain to this doc your particular situation. Try not to come off as hysterical (not that you would honey!) or pushy or paranoid. Just try and be calm, in control and speak to this doc as the informed healthcare consumer that you are!! Make sure you get his/her name and be prepared to ask for them if you have any problems. Depending on how close to your surgical date it is when you call the department, they may already have the schedule made up of anesthesiologists and who they are being paired with in the OR. Ask who your anesth will be. If they don't know when you call, ASK FOR THEM before surgery while in pre-op waiting for your surgery. Chrissy, there are plenty of pain meds around now that I'm sure they can find something that will work for you without giving you an allergic reaction. I know everything will work out fine for you!! Keep posting though and get all your concerns and worries out here in this forum. Memere (K'Mac)

 
Old 12-27-2007, 05:00 AM   #14
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Re: Why would PM doc not want to prescribe meds after my surgery????

Good Morning!

I am not really freaked out any more just concerned! Freaked out was to drastic! LOL
I am the total pro-active patient. I know what works and what does not. I think that I am going to call my PM today and let him know that I am staying right around a 7-9 pain range and it is really dragging me down. Maybe he can see me before next week and we can come up with a plan to help the after surgery pain. I know he will not be precribing any thing right after unless I am referred back but he can give a written recomendation of what types of pain control he recomends. I would like to take it with me if I can.

I am asuming my pain will mostly be from the surgery itself and I am thinking that it should subside some within the first week, but who knows what will happen.

Right now I am having a hard time being comfortableet on a daily basis. I am fidgety and restless and in pain and I am trying to get things done before the surgery.

Anyway I will check in later because right now you all are my life line. I could never unload all this stuff on a friend or family member because the would think that I am crazy. They would never understand.

Chrissy

 
Old 12-27-2007, 05:51 PM   #15
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Re: Why would PM doc not want to prescribe meds after my surgery????

Chrissy,

Honey I did not mean to scare you! Like Kathy said, I wanted to tell you all of these things so you would be informed and this stuff would not happen. You also will have a say so and more control in your treatment, which helps with anxiety because you are in some control of this situation. Knowledge is POWER girlfriend!

As far as reactions to meds, I have had many before as well. What I had to do, is think back to any ER visits, procedures, surgeries, ect. and think of what helped my pain that I could tolerate. They can treat the itching VERY easily. It is such a common reaction to pain meds, there is a standing order for Benadryl for most patients on pain medication in the hospital. This is not a bad thing. First of all, if the pain med works well, and the only side effect is itchiness, Benadryl will take care of that right away. Also, like many meds, Benadryl through the IV works much faster and better than the pill you take at home. I got the itches during this last recovery, and after the IV Benadryl had the best nap I had taken in the hospital. Not a bad thing!

Also, if a pain med works, but makes you nauseous, that is easily remedied. Many meds for nausea. I used to always throw up, and embarassingly enough have crying jags after anesthiesia. I started telling the anesthiesiologist, and guess what?? They can treat that beforehand, so it is not as bad or non existant after! Yeah!

Bottom line, Kathy gave you some great advice. This is all to help you be an informed, pro-active patient. You can never tell a doctor too much about what does, and does not work for you, or bad and/or good experiences you have had. Let them know that fentanyl worked great, but you itched like crazy. They may do a combo of fentanyl and benadryl that works wonders. We are all different and respond differently, and they know that.

Good luck sweetie, and I am so glad that we can come here and talk about this stuff. What a Godsend this place is!

Your Friend,

Amanda

 
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