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Old 04-14-2008, 06:13 PM   #1
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Should I be concerned abou this comment my doc made?

I went to the doctor today and here is what the results were. He was really proud of me that I was off the Ultram for one. Second, he is going to increase my patch by 12mcg in hopes of not taking very many Percocets for BT pain. He rx'd it for every 72 hours though which I am not sure why except he is getting concerned with the amount of narcotics in my system. He still rx'd me 120 Percocets for the month. I also asked him about the problem with swallowing & getting food/pills get caught in my throat(on the right side). He said my tonsil was a little enlarged(plus all of my lymph nodes on the right side are a little enlarged). Anyway he said that the tonsil may have to come out but if it does I will be really uncomfortable with the pain. He said that my pain receptors "are oversaturated" so it will be rather difficult to control the pain/discomfort of a possible tonsil surgery So should I be concerned? I am going to save some Percocets in case they are definitely needed after this possible surgery. Now I am a little worried? What do you guys think?

brian

p.s. To those concerned about my tiredness/sedation, it is GREATLY IMPROVED since I stopped the Ultram and also getting completely over the flu.

Last edited by brianpain33; 04-14-2008 at 06:15 PM.

 
Old 04-14-2008, 06:28 PM   #2
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Re: Should I be concerned abou this comment my doc made?

Brian,

Tonsillectomies for adults are just plain brutal! Even for a normal grown-up, the post-surgical pain is typically pretty severe. I sure hope you don't have to go through that. Is it possible that you have some kind of infection that is causing the tonsil to swell? I would avoid it for myself, that's for sure. Whatever painkillers you can "save" for it, I guess I would do so.

I will keep my fingers crossed that surgery is not required and the swelling goes away....

Blessings,
TexMom

 
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Old 04-14-2008, 06:54 PM   #3
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Re: Should I be concerned abou this comment my doc made?

Quote:
Originally Posted by TexMom85 View Post
Tonsillectomies for adults are just plain brutal! the post-surgical pain is typically pretty severe. Blessings,TexMom
Oh man this did not calm my fears at all. Thanks for being honest though

brian

 
Old 04-14-2008, 07:00 PM   #4
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Re: Should I be concerned abou this comment my doc made?

I have read that having one enlarged tonsil is very bad in children, it can lead to leukemia. Did your Dr mention anything about that? I am thinking its just in kids though but it's something they take seriously and will remove if one is bigger than the other in kids. I hope your going to be okay, I have heard its a miserable operation, lets hope you won't need it.

I might go and see an ENT first before I even started worrying myself.
They are the experts in that Dept vs a PM Doc and can give you a definate diagnosis and help you make an informed decision.

don't worry, but if you do go to the ENT to discuss things so your not panicking over this.

SS

 
Old 04-14-2008, 07:46 PM   #5
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Re: Should I be concerned abou this comment my doc made?

Dear Brian,

When I was teaching school--back in the early 1990's--I was contantly getting sick with strep throat and tonsillitis. So, my doctor decided I should get my tonsils removed (especially since I taught High School Choir and needed my voice to function). This was before I was on LA medication, but I was very used to taking Stadol Nasal Spray, Percocet, and Demerol as needed for various reasons.

The Surgeon refused to give me anything stronger than liquid Tylenol #2. Fortunately, I got in touch with my regular doctor who Rx'd liquid Demerol for the first week and liquid hydrocodone for the next two weeks. Even after all of this medication, I was in misery. I can't understand this at all--the pain was just so intense. Don't let anyone do this to you without CLEAR PAIN MEDICATION STRATEGIES!!! What works on an 8-year-old doesn't always work on a 23-year-old! By the way, if I had not had my family around to help me...I don't know that I would have recovered from the pain I experienced from that procedure. There's nothing more convincing than a Mother who is witnessing her son in pain--no matter what his age is!

Finally, Brian...I'm thrilled to hear that you are finally feeling a tad better. Prayers are a significant portion of the Pain Management arsenal!

Sincerely,
Jon (Conductor)

 
Old 04-14-2008, 08:03 PM   #6
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Re: Should I be concerned abou this comment my doc made?

Hey Brian....You've received some great advice thus far, but I wanted to add my .02 if that's ok? I translate what the Doc is saying as two parts:

(1) The surgery itself is very painful, especially in adults. As a general rule, the older your are, the tougher it is. This certainly isn't a walk in the park, that's for sure.

(2) Equally, if not more important, is what he said about your pain receptors. PM patients usually develop more pain as their tenure with pain meds grows. What happens is this:

You're in pain for some condition....Your brain actually sends a signal to your body to say "we're in pain." As a result, you're now "in pain." You take pain meds to help dull the pain. The pain meds either turn down, or off the signal from the brain. The body responds accordingly. Then, over time, your brain says "this isn't right....we're supposed to be in pain, and I don't appreciate being turned off." So, the brain sends more signals and more powerful signals. You then take pain meds more frequently, and in greater dosages. The brain then responds in turn. This cycle goes on and on, over and over again. Therefore, you develop greater sensitivity to pain in general.

You may have already experienced this with a cold, flu, or even a hangnail (literally) where something minor was very painful and you thought to yourself...."This is kinda weird that it hurts this much" or "it shouldn't be this bad." The above cycle is why.

Hence, this is what your Doc means. Not only is the surgery a tough one for any patient, but for you....It's gonna be real rough. Just being honest. Therefore, you would need major planning, including but not limited to appropriate meds for the procedure....Much more so than normal....Maybe way more.

Hope this helps.

Ex

Last edited by Executor; 04-14-2008 at 08:07 PM.

 
Old 04-14-2008, 09:12 PM   #7
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Re: Should I be concerned abou this comment my doc made?

Brian, please don't panic about this. You may have a simple infection and need a round of antibotics only.

Whatever one is saying about the tonsils is true but you are on the computer and will read that for yourself. It is rough for adults.....my dad had his taken out at age 6 and age 25. Yes, you read that right. His grew back and my dad said that age 25 was by far worse then when he was 6.

Just make sure you have lots of slushies, jello, ice cream, slushies, popcycles, ice cream, pudding, yogurt slushies, ice cream, ........you got the picture.....you will eat so much ice cream, slushies, pudding, that you will hate it for the next 6 months. LOL Enjoy!!

 
Old 04-14-2008, 09:35 PM   #8
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Re: Should I be concerned abou this comment my doc made?

Sorry to re-post, but as long as your Doc is fully aware of your PM issues and tolerance, a good, effective PM plan can be established to get you through. However, it's going to require some more powerful meds, that's for sure....Any procedure would...Not just this one.

Ex

 
Old 04-14-2008, 11:11 PM   #9
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Re: Should I be concerned abou this comment my doc made?

Quote:
Originally Posted by Executor View Post
or even a hangnail (literally) ...."This is kinda weird that it hurts this much" or "it shouldn't be this bad."
Ex
LOL I have thought this over a hangnail!!

BRIAN,
Take it one step at a time. Don't get too worried yet. Your pm sounds like he's on the ball so he could probably handle keeping your pain under control if, worse came to worse, you had to have the surgery.

I guess I'm glad I had mine out at 3. Keeping my fingers crossed for you.~Mush
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Old 04-14-2008, 11:56 PM   #10
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Re: Should I be concerned abou this comment my doc made?

Me too Mush...my brother was 5 and I was 3. I think my mom pushed the ENT to do it young, because she had hers out at 24 or 25 and it was not pleasant. I think in the early 60's they were more likely to do it anyway.

My 23 year old daughter has what her pediatrician called "kissing tonsils". They are really large. She has strep at least once a year, since childhood. I asked them to take them out several times, because she would get spiky fevers of 105 or 106, but they wouldn't do it. I never understood why. She's so used to it now, that she just calls the doctor and gets an anti-biotic.

Brian: I agree with the others that you shouldn't worry until you know more. It may not be necessary to remove them. Let's hope it's not. It does sound like your doc would make sure you are taken care of in terms of pain meds. If it does come down to surgery, just make sure you speak directly to the anesthesiologist. My sister-in-law has had many surgeries and has taken narcotics for years. She always makes sure that she speaks to him/her before she goes under. So far, she's had good luck with that.

Hang in there, cmpgirl

 
Old 04-15-2008, 04:24 AM   #11
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Re: Should I be concerned abou this comment my doc made?

Hi Brian, You are getting way ahead of yourself. First off, Whether you need your tonsills out isn't up to your your PM doc, Even if both your tonsills were swollen and or Kissing, you still need a surgeon to have the same opinion and agree that you should have surgery based on one incident at the hight of allergy season.

My throat has been a wreck for several weeks but I can easily link it to the layer of grren pollen I see on my car each and every day, no infection, just soar and swollen galnds and tonsils. I haven't needed a med increase for my soar throat, I opted to try warm salt water. I've been dealing with my daughters tonsils for the last 12 years and allthouh they are large and often large enough to be kissing, she has never met surgical criteria for that type of risk, Meaning they don't cause obstuctive apnea, she has never come close to haveing the 3-4 documented infections a year a surgeon or ENT woukld need to justify it was necessarry. I've gone to surgeons 4 times because the pediatrician thought they should come out and have been talked out of surgery every time by the ENT because although hey are large, she doesn' get strep, doesn't snoar, doesn't have apnea etc etc etc. Only the surgeons opinion counts unless you get so dead set on having them removed based on your PM's opinion your willing to shop for a someone willing to cut you untill you find someone that will, regardless of the standards of practice and medical model surgeons use as a guide to decide whos tonsills they do remove. If you shop enough you will find a doc that will do it simply because you ask and he'll make more money in the OR than seeing patients in the office.

An opinion is just an opinion . What exec is describing is a theory called Hyperalgesia or opiate induced hyperalgesia. However opiates haven't been used long term , long enough on non maliganat patients to substantiate this theory. The only time This theory comes up is when people run into docs looking for a reason not to prescribe pain meds, If it were widely excepted as true, and agrreed upon by the most qualified docs "PM specialists", then starting opiates is wrong to begin with if it only leaves you in more pain needing more meds for less and less significant sources of pain. That theory simply justifes every doc that is uncomfortable prescribing pain meds for intractable pain. It's just a theory with no hard data to support which makes it nothing more than an opinion based on what? What my doc said, my sister in law believes or an article I read suggested.

I don't buy that one cause I haven't seen it happen and opiates haven't been used on intractable painlong enough to substantiate this theory. I've had several surgical procedures during the 8 years I've been on opiates and the 15 years I've been in CP. I go years between med increases, I push myself and allow myself to experience pain rather than avoiding anything that might possibly cause a temp increase and I've yet to develop hyperalgesia. Hang nails don't impact my quality of life and neither did the brusied liver from an airbag deploying into my my gut just 3 months ago that I required no aditional meds. I still use motrin and tylenol and it still works for incedental pain. I push myself almost daily to excercse regardless of pain levels because the benefit outweighs the the temp increase in pain from excercising and I haven't experienced hyperalgesia or met a doc that could prove this theory with any solid evidence from a single study.

The fact is that long term opiate use has not gone on long enough to turn this theory into fact or even a widely believed theory. IMO it's a theory docs use that aren't comfortable prescribing opiates or use on patients that are never satisfied with anything less than complete relief. If the entire PM community agreed with it, we would revert to the old days when opiates wheren't used because the impending doom of hyperalgesia or opiate induce hyperalgesia would outweigh any benefit of continued opiate use in non malignant patients. Where is the benfit if taking pain meds only leads to more pain and increased sensetivity?

It is true that post op pan of any sort is more difficult to manage when your tolerance is higher than any ENT has ever had to deal with. Of course, but I've had lots of surgery and none that I would call fun or painfree. For the dozen or so surgeries I have had since being in CP I have never been given anything stronger than 5 mg percocet to manage any post op pain, and I'm talking 6 level fusions to pulling teeth and oral surgery where my jaw was rebroken and the massiter muscle was released following a severe case of cellulitis following an extraction. I had 4 different surgical procedures to fix my jaw all while on long acting meds and although post op pain sucks, I'm still hear. I didn't die and I was given nothing stronger than 5 mg percs if anything at all.

The problem is simply how to manage post op pain in a tolerant patient, However, the problem is amplified when a patient is used to picking up the phone at the first sign of any increase in pain and asks for more meds, expects thieir call returned within 24 hours and goes into surgery expecting to be pain free during their post op recovery because they know the name of every med and the strength it comes in that isn't being used or they could be taking.

Not that your even close to surgery since you haven't gotten a surgical opinion or mentioned any of the qualifiers an ENT would look for before removing adult tonsills. Diificulty swallowing large pills doesn't really meet the criteria to risk your life with elective surgery. Personally I would be more concerned about the risks of bleeding, infection and general anesthesia before worring about post op pain control for elective surgery you may or may not need.But that's just my opinion.
Good luck, Dave

 
Old 04-15-2008, 06:05 AM   #12
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Re: Should I be concerned abou this comment my doc made?

Brian, like Shawley said don't worry about it! I had my tonsils removed at age 20. No it was not fun, it hurt like heck. Plus infection set in and I started a new job all at the same time. Please check your Bible and read Philippians 4:6-7. If more people did what it says we would be much better off.
Fred

 
Old 04-15-2008, 06:33 AM   #13
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Re: Should I be concerned abou this comment my doc made?

I would agree strongly that before you go any further talking about surgery that you be examined by an ENT....They are the experts...Not some GP or PM Doc. Additionally, given your medical history, I feel quite sure that no ENT would take your tonsils out unless you absolutely need them out. Even then, it may be something you can learn to live with. For example, I have shoulder problems that an Ortho has recommended scoping, and I won't do it...It's minor compared to my other pain, and I'll just live with it. Again, the ENT will guide you correctly.

However, I have to disagree with Dave (for once) about his explanation on increased pain levels. I believe the theory is far more subscribed to than just those Docs not wanting to script pain meds. For example, I have some very caring and liberal Docs....PM, ENT, & Ortho....And all talk about the same concept independently of one another....Especially for patients who have long term exposure to opiates. And, it's not so much that pain meds cause more pain, but rather, you become more sensitive to pain overall. This is what I think your Doc was saying when he talked about your maxed out receptors. If in doubt, you could always ask him for another explanation....That way, you'd know.

Good luck and hope you feel better.

Ex

 
Old 04-15-2008, 07:29 AM   #14
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Re: Should I be concerned abou this comment my doc made?

Brian:

Before you go off worrying needlessly you need to be seen by a specialist. I was 21 (now 48) when they took my tonsils, and the ONLY reason they took them way back then (lol) was because I kept swapping back and forth between strep and kidney infections. One week I'd have strep, then next I would have a kidney/bladder infection. They allowed this to go on for an ENTIRE year.

I ended up having 21 stitches in my throat, and the pain was RI-DIC-U-LOUS!!!! They gave me pills to swallow too!! No liquid pain med for me!! It was awful.

Just because one doc (and a PM at that) thinks that something is called for, doesn't mean that a specialist will. I work in the field of Deafness, and this is one area Tonsils and Adnoids that they avoid at all costs. Whereas they used to pull them routinely, they do not do so today.

Not to be offensive in any way but I think that whatever it is that you call it, your bi-polar, or your tendency to over think things, or your self diagnosing is kicking in. Please don't take offense, because I don't mean to be offensive by it, I'm just trying to help you to see things a bit clearly.

IF you are truely worried about the situation, then I think you should set up an ENT appt. IF that ENT thinks this is necessary, THEN and only then you should worry about pain control, and get with the anesethologist and PM doc about pain control post surgical. But honestly, I don't think with two instances (I think that's what you posted you've had) that an ENT in this day and time will consider yanking your tonsils in a 34 year old male. Especially if there has not been strep in the pic. Normally, a ENT will not consider a T&A unless there has been AT LEAST four cases of strep in a years time, and the strep recurrence has be getting closer together.

Hopefully, I haven't offended you Brian. One of the reasons I don't post much here, and simply read is that I truely feel isolated on this board. When I post a thread or a question there are only a handful of folks (to whom I am deeply greatful) that reply to my posts. Perhaps it is because I am so wordy, when I do post, and folks don't like to read long posts. I don't know, but that's just how I feel. It's my problem alone that I feel that way, and I don't think anyone has gone out of their way to insult me or make me feel that way, it's just the way I feel. I am up front and honest to a fault, it's who I am...and can't change that. If I have done something to hurt anyone, gosh, I am SO sorry. It wasn't intentional.

But I am thankful for each and every one of you. I pray for you all daily, and though you don't know it...the "Pain Management Board" has a Mass said for you each week at 8:15 am on Thursday mornings. I see to that weekly. I love you guys, and you have helped me more than you can ever know.

Hang tough Bri.... and if you feel the need, go see an ENT.

Big Huggles,
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Old 04-15-2008, 08:39 AM   #15
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Re: Should I be concerned abou this comment my doc made?

Spinal- I think you have provided some excellent advice. Additionally, this surgery is not to underestimated....I can be brutal for older people, and for someone on as many meds as Brian, even tougher.

BTW, I enjoy reading your posts.

Ex

 
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