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Old 07-18-2011, 01:11 PM   #1
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I don't know how to approach my Nuerosurgeon about changing my medicines

Hello everyone I am gonna try and make this simple and sweet. Yesterday my pain had gotten so bad I practically begged my wife to take me to the ER since I could not get a hold of anyone at my Neuro's office. A little background on what I have went through. Back in April I had a discectomy done on my L5-S1 and things were beautiful for a month I had absolutely NO pain and I regained all the feeling I had previously lost. Fast forward to June Fathers day and on my way home went to shift my weight in the car and almost blacked out from this INTENSE pain running from the same area I had the surgery to the top of my foot. Before when I injured the disc the pain and numbness would go down the back of my leg now it is going to the outside of my thigh to the top of my foot and some times the 2nd 3rd and 4th go numb.

While I was in the ER yesterday my temp was elevated along with my blood pressure and heart rate which I have NEVER had a problem with so they attribituted that to the pain. They took blood and urine samples and said there was no infection. Now they also took an MRI of my lower back with and without contrast and the ER Dr. basically told me there nothing wrong that he could see. Now I HATE going to the ER because I AM NOT a drug seeker, hell enough people sell them on the street if I really only wanted to get high on them you know.

Anyway I have an appointment tomorrow morning with my Neuro and the medicines he has given me do not work on the pain AT ALL, some refer to it as break through pain. I currently take Hydrocodone 5/500 and they do nothing for me. In the past I have taken up to Hydrocodone 10/500 they worked better but didn't last long. Now when I came out of surgery in April they were giving me Percocets and they seemed to work alot better then the Lortabs. There is such a stigma attached to the use and prescribing of narcotic pain medicines I don't know how to broach the subject with him without looking like a pill seeker? The pain is worse then what it was before the surgery and I understand it takes a while to heal internally. Any help would be much appreciated.

 
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Old 07-18-2011, 01:51 PM   #2
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Re: I don't know how to approach my Nuerosurgeon about changing my medicines

I would have the neurosurgeon refer you to a pain clinic, if you are really bad have him call the clinic and pull some strings to get you in ASAP. Tell him you had to go to the ER for pain.

In general these type of physicians will not give you anything stronger, you have to see a pain specialist for that. Your GP and the ER will not give you anything stronger either, unless you had obvious signs of trauma. It's just not what they do.
I can tell you I was dx with a severe pain causing neurological disorder, I has some issues with my pain doc, and I left his practice thinking the neuro would help me. He did not. I was so bad I could hardly walk, didn't sleep etc. I had to wait to get into a pain clinic.

 
Old 07-18-2011, 02:03 PM   #3
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Re: I don't know how to approach my Nuerosurgeon about changing my medicines

Thank you Bunny I was pretty sure he wouldn't really be able to prescribe anything more or change anything with me. I have been to 1 Pain Clinic that did not believe in Narcotic medicines which I don't mind at all if the non narcotics will work for me but I swear to my mothers spirit and to god above they do nothing for me. I have taken Lyrica, Neurontin, and about every other nerve pain medication there is out there and none of them worked or the side effects were so severe I was taken off of them. For example Lyrica I would get blinding splitting headaches so sever I could not handle even the tiniest bit of light. Neurontin had psychological effects that I contemplated suicide while taking it. And the other just plain didn't work. I stuck with the pain clinic for a while and finally had enough of them and told my neurosurgeon they were doing nothing for me.

I understand I am still in the infancy of my surgery and pain is to be expected but damn this is getting really old really fast. Last night I could not sleep at all. I went from my bed, to my couch to my recliner, to a hot bathtub back to the floor, up walking around the house and yard finally I was so exhausted I laid down and slept about an hour and a half and woke back up once again with hellacious pain. I am at a loss here and I don't know what to do. I feel like screaming and yelling but what good would it do ya know?

 
Old 07-18-2011, 02:19 PM   #4
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Re: I don't know how to approach my Nuerosurgeon about changing my medicines

Oh and I also have and use a TENS unit to see if that will help and alas it doesn't help at all. Thought I would throw that in there too

 
Old 07-18-2011, 06:40 PM   #5
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Re: I don't know how to approach my Nuerosurgeon about changing my medicines

I agree. I think at this point it is time to be referred to pain management Doctor. I imagine your Neurosurgeon is going to be reluctant prescribing anything stronger than he has (most surgeon only prescribe medications for a period of time) and if pain continues they refer to patients to pain management. This can be done while they continue to try and get to the root of the continued pain. A pain management Doctor will be more likely to prescribe a LA medication in addition to your break-through medication and also look at different options that may also help manage your pain better.

I hope you get relief to the pain you're and answers to what is causing it.

~ Fiona Jo
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Old 07-19-2011, 07:25 AM   #6
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Re: I don't know how to approach my Nuerosurgeon about changing my medicines

when they do 'just a discectomy vs a full fusion, is that the same thing or what exactly? i am VERY familiar with the ACDFs and some other spinal procedures, but do not truely know just exactly what they just 'do' with the ectomy? do they simply remove the disc or do they also place at least bone like with fusion? i am only asking because YOUR 'normal' pain and symptoms have also completely changed their pathways per what you stated up there, so that would mean something' else' is now becomming involved or definitely has 'shifted onto very different nerves to even GIVE you what you are feeling now?

don't know if you will see thiws before your appt or not, but your surgeon NEEDS to know about the 'new symptoms and also i am hoping you obtained a copy of the films from that MRI as well? if this issue did not actually show up on MRI do not be too suprised since MRIs just will not 'always' even show everything that IS actually wrong or going on in anyones spinal. its just a scan, and not an actual picture. also obtaining a CT which uses radiation instead of magnetism can possibly show something the MRI did not too. a CT simply really clearly DOES show both bone/harder structures and any metal/hardware that could easily obscure findingws on an MRI.

if you want a clearer picture of what specific nerves are NOW involved, getting an EMG/NCV would possibly show that but only if your overall symptoms of the numbness are present during the actual testing. just a thought. but your actual surgeon just should know based upon how the symptom pattern is simply showing itself just what levels and nerves are being possibly impinged upon right now. they DO know that level of info just from experience.

the back boards here could possibly be of more help with this since it is your lumbar involved? thats where all of the mostly lumbar problems and surgeries are usually mostly disscussed here anyways. and as the others have stated, most surgeons wont go all crazy with the narcotics post op UNLESS patients DO have some level of reaL changes or complications, so you may have a shot there since your whole pattern has changed from pre op, immediately post op initially to now kinda thing. and that just DOES create some brand new issues for you that he simply 'owes you' not only help in figuring out, but accomodating the pain too til it just GETS figured out. but in reality it does all come down to what the surgeon is like and what he just feels about your situation and how to appropriately medicate it too.

i do hope whatever created the 'new' symptoms you are having can be found out soon and not require another surgery to fix. but something HAS changed in that surgical area, thats for sure simply given symptomology along with an increase in your pain. just DO NOT allow him to 'blow off' your brand new symptoms since they ARE trying to tell you/him something. marcia
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Old 07-19-2011, 08:42 AM   #7
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Re: I don't know how to approach my Nuerosurgeon about changing my medicines

I would not live in pain for long esp. after surgery, that can cause other complications such as sensitization. Which is what happened to me.

You have to find a pain clinic that believes in narcotics/opioids, they kind of have 2 schools of thought, some like the injections others like meds. If your neuro is affiliated with a university hospital I would ask to be sent there.
Some of these heavily advertised free standing clinics like doing the injections, they can bill a lot more for those. The one I went to right before my diagnosis wanted to do an epidural even though it was contradictory to my condition and my neurosurgeon said no way to it! When I said no he basically told me injection or no morphine.. can you believe that? I left and had to look at other clinics, and basically tell them it was an emergency. I was where you are- no sleep, pain 24/7, scale 6-8 depending on what I did. It was horrible.

Tell him what you are going through and that you want him to send you ASAP. I'm sure he can make a call for you.

 
Old 07-20-2011, 06:34 AM   #8
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Re: I don't know how to approach my Nuerosurgeon about changing my medicines

while you most certainly CAN be treated for your pain at a PM while being IN that post op position, what I am more concerned about is that 'brand new displaying' of symptoms(and of course that very 'sudden' presentation too) that just HAS to be stemming from yet another source other than the level you had that discotomy on. as long as you do NOT accept anymore narcotics FROM that surgeon while in PM, or once you get them to take over your pain care, it IS doable. but you most certainly also DO NEED some fuller and deeper testing thru that surgeon as well right now to even KNOW the 'whys' and what IS impinging, at least intermittantly, the 'new nerves, hence that change in your overall inital to now symptoms. please do update us on how your appt went when you can. hope all went well for you. marcia
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3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

 
Old 07-20-2011, 12:09 PM   #9
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Re: I don't know how to approach my Nuerosurgeon about changing my medicines

and just to dispel the myth that GP's can't do PM.....My GP has been doing my pain management for the last 8 yrs, after I walked out of a PM Clinic that was hideous and ridiculous in their practice and patients. My GP is certified in PM, as she has continued education over the years that allow her to do so. I have been with this Dr. for 12 yrs, and would never go to anyone else. One of the great parts about is that since she is my GP, she knows all of my medical illnesses and takes that into considerable account when WE are deciding what meds to try or increase or decrease.

kat

 
Old 07-20-2011, 04:27 PM   #10
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Re: I don't know how to approach my Nuerosurgeon about changing my medicines

It can take a few tries to find a good PM clinic. So ask around and find good options. Then schedule for a consultation to discuss the practice's philosophy, treatment options, etc.

My PM doc is amazing. As long as I comply with the meds and do the occasional random urinalysis that shows a therapeutic level of meds in my system I'm fine.

You'd be amazed how many people around you are in Pain Management. Ask your NS and your PCP and any other doctor you have for a referral . If you have a spouse or partner they can call their doctors for suggestions as well "my boyfriend is in need of Pain Management and I was wondering if Dr. Y has any suggestions". My ob/gyn and my PCP both referred me to my current PM doc.
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Old 07-22-2011, 02:56 PM   #11
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Re: I don't know how to approach my Nuerosurgeon about changing my medicines

katlin-

you are indeed very lucky-but the quality kind of gp you have are TOO FEW, unfortunatly.
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Old 07-22-2011, 09:47 PM   #12
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Re: I don't know how to approach my Nuerosurgeon about changing my medicines

Yes they are, and for good reason. She just told me today that in order to keep being able to dispense PM meds she will have to undergo additional more rigirous classes and testing beginning 2013....so the FDA does not make it easy for them.

kat

 
Old 07-23-2011, 06:32 AM   #13
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Re: I don't know how to approach my Nuerosurgeon about changing my medicines

but on the flipside, the more your doc actually KNOWS about pain kat, it makes them that much better as our docs too. but yep, it can be a hassle. mine managed my pain and just sooo advocated for me thru all my surgeries and helped with all my pre op pain til surgery. i am just afraid i will lose him here soon as he is getting up there in age now. i WILL cry if that happens, since no one on this planet just knows my freakshow body/reactionary crap like he does. but even getting the best possible care from our primarys i think it truely comes down to longevity WITH a particular primary and that level of trust you just develop over alot of time spent with the very same primary doc too that would dictate "how' your pain would be treated.

mine, after some heavy discussion after my cord surgery left me with what were truely intolerable pain syndromes, sent me to my current PM. out of the box type pain simply DOES require some 'out of the box' types of ongoing treatments too, ya know?



just wondering how your NS appt went?? any new testing ordered to better pinpoint just why the sudden change in the displaying of your symptoms(you just have had some very significant changes in whats affected now vs at the beginning and also pre op too)? if you could update us when you can, we would love to know how you are doing and what this surgeon is thinking is generating the new symptoms too. marcia
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9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

 
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