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Old 07-23-2012, 12:53 PM   #1
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Unhappy Mri results - what are my options?

Hello~

I woke up on Wednesday, July 11, 2012 with neck pain and sever shoulder blade pain. On the day after, I went to Express Care to see what the problem was. The doctor treated me for a sprained shoulder and sent me home with tylenol 3 and Flexeril. That Friday morning, I woke up and the symptoms were worse and I still had sever shoulder blade pain and the right arm pain was getting worse and now, I had a slight tingling in my index finger and thumb. I had an appt. scheduled with my GP. He sent me home with Prednisone (7 day treatment, 60 mg 1st day and decrease each day thereafter). He told me to continue to take the other meds. the Express Care doc. prescribed.

On that Saturday early morning (4am), I was having trouble sleeping. I could not get comfortable and the pain became ever more excruciating. I took myself to the ER at 6 am. The ER, finally, did an XRAY after I kept telling them of the pain I was in. The XRAY results were the following:

Findings:
There are 7 cervical type vertebrae demonstrated. No fracture or dislocation of bone destruction identified. Retropharyngeal soft tissue planes appear intact. There is some marginal spurring identified at least at C5-6 and C6-7 consistent with an element of degenerative disc disease. Some reversal of the usual cervical curve is identified. If there is persistence of complaint or concern, MR examination can be done.

The CNP in the ER sent me home with Vicodin and told me to promptly follow up with my GP on Monday.

I followed up with a doc. appt. on that Monday and the doc. took me off the Vicodin, put me on Percocet 5/325 (which really don't do much of anything for the pain and I'm taking two now). The doc. ordered and MRI. That Wednesday, I had the MRI done. After the results were sent to my GP's office, (It was discovered that he went on vacation, so another doc. had to take care of it.) they told me to schedule and appt. with a Neurosurgeon. I have an appt. this Wednesday to see what my options will be.

These are the following results from my MRI:

Clinical History:
Worsening cervical radiculopathy sx over the past 7 days with decreased strength and decreased sensation. Plain films show spurring at C5-6.

Findings:
The cervicomedullary junction appears within normal limits. Vertebral body height, alignment and signal intensity are well maintained.

At C3-4, there is mild disk protrusion with no narrowing of the canal.

At C4-5, there is mild uncovertebral spurring without narrowing of the canal.

At C5-6, mild uncovertebral spurring and diffuse disc bulge cause mild narrowing of the canal and moderate narrowing of the neural foramina bilaterally.

At C6-7, a right paracentral disc protrusion abuts the spinal cord and causes moderate narrowing of the canal and abuts the exiting nerve root on the right. Additionally, there is moderate narrowing of the neural foramina bilaterally.

Impression:
Degenerative changes in the cervical spine, most pronounced at the C6-7 level, as described above.


Can anyone tell me what they think my option will be? The pain is extremely excruciating and I'm now noticing my legs feeling weak and kinda like rubber when I stand up! The pain is still in my right shoulder blade, right arm numbness all the way to my wrist, which seems to be getting stiff and numbness and tingling in all of my finger and thumb except for the pinky on my right hand. My left arm has some pain (a dull ache in the bicep area), but that's about it for the left arm. I cannot sit for more than a few minutes at a time as it gets quite uncomfortable. I can barely drive as the sitting position hurts and the vibrating of the car hitting the road is bothersome. Sleep? Yeah, right. That is virtually non-existent. My bed has become too painful to sleep in. I found a semi-comfortable position on the couch to prevent me from moving around so much to get comfortable. But, many sleepless nights thus far since this happened almost 2 weeks ago.

Any input would be appreciated. Thanks!

I'm just curious top see what my options will be.

 
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Old 07-23-2012, 01:35 PM   #2
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Re: Mri results - what are my options?

Radiologists often use the following adjectives to describe the severity of anomalies that they see:

Minimal - I can just make it out

Mild - Clearly there, but probably not problematic

Moderate - Verging on problematic

Severe - very probably problematic

So, at C5-6 you have a bit of bone spurring coming off the vertebrae, as well as the disk bulging out somewhat. The disk - or the disk in combination with the bone spurs - is narrowing the spinal canal a little. This is not necessarily a big deal, as the spinal cord does not fill the canal entirely - there should be spinal fluid all around it - so a mild narrowing is probably not affecting the cord. I wouldn't go so far as to say it ISN'T affecting the cord, but only that the radiologist doesn't SAY it is, and if he observed it doing so he definitely should say so.

The disk and/or bone spurs are also pushing into the foramina - the openings on the side of the spine through which pass the spinal nerves before heading to the shoulders and arms. At C5-6, he doesn't say this is a problem, but he does go so far as to call it "moderate".

At C6-7 it's a little worse. The disk is abutting the cord, which means it has pushed away the spinal fluid in front of the cord. He doesn't say the cord is compressed, flattened or indented, though. The right C7 nerve also has disk material (or bone spurs) up against it, but the radiologist does not indicate that it is compromised.

The C6 nerve - I think - would be the one most to blame for symptoms in your thumb and shoulder, while the C7 has more to do with your index and middle finger.

All in all, I have to say that your MRI - AT LEAST AS FAR AS THE RADIOLOGIST IS DESCRIBING IT - does not look very bad. I've seen much worse. This includes my own - on two occasions - and my symptoms were never as severe as what you're describing.

So I'm a little at a loss. Maybe the radiologist is understating the severity of what he sees. Maybe he just isn't good at reading cervical MRI's. Maybe your problems are not of cervical-spinal origin. Maybe they are, and for some reason you are more symptomatic than might be expected.

I'd suggest calling the doc who sent you to the surgeon and asking him what - QUITE SPECIFICALLY - he sees in the MRI that makes him think you might need surgery. And, of course, you should see the surgeon (actually, you should see THREE surgeons... very important). The surgeon(s) will read the MRI images - not just the report - and may see more than the radiologist did.

All this the opinion, of course, of an amateur will a little too much personal experience...

Last edited by WebDozer; 07-23-2012 at 01:50 PM.

 
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Old 07-23-2012, 02:29 PM   #3
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Re: Mri results - what are my options?

Thank you for your input. I must admit this is absolutely painful, to say the least. I do intend on going to the Neurosurgeon and will see what he says and take it from there. My symptoms have progressively gotten worse in a matter of only 2 weeks.... so, that is a concern for me. Thanks again!

 
Old 07-23-2012, 04:47 PM   #4
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Re: Mri results - what are my options?

Obviously none of us are medical professionals and cannot read or interpret an MRI or any other type of report...

With the language that is on there as Webdozer described...it doesn't seem like anything that requires surgery at this time. So all I can say is if it were me...there is no way I would opt for any type of surgery for this.

Just because you are seeing a Neurosurgeon...does not mean he will want to do surgery...and I would run from any Dr. who wanted to without months and months of non surgical treatment and even then...unless they told me I am under direct threat of paralysis....I am not having any more.

Just for some understanding....if you took 100 people off the street right now and gave them a MRI....at least 75% of them would have things "wrong" with their spine. Degenerative changes just happen to all of us.

The MRI is just a mechanical report but it doesn't explain someone's pain all the time. So, someone with a terrible looking spine on a MRI could have absolutely no pain whatsoever...and then someone like you...can be having a flared nerve root that is causing inflammation and pain.

The next steps are usually cortisone shots/injections into the area of pain. There is traction...there are muscle relaxers (that is your Flexeril..) are you still taking this as needed too?

I just had a huge flare of my lumbar herniations...I accidentally lifted a suitcase the wrong way back on July 3rd and was in excruciating pain. I could barely move at all! The pain was so bad it would bring tears to my eyes. But because I know my body now and my spine with Degenerative Disc Disease and herniations and other issues....I just rested for the last week. I stayed away from walking too much the first few days and then was hobbling around the house with my walker...little by little letting the inflammation go down. So I didn't even call my Dr. as all he would do is tell me the same thing. To rest, take my meds...and start getting mobile again when I could.

Now here we are at the 23rd and I am back to walking my regular 45 minutes each day. The herniations stay there...but only get inflamed and really bad once in awhile. Again..there is no way I will have more surgery unless it's an emergency.

My point in sharing this is that millions of people have issues with their spine and this may be something that happens once in awhile where you back "goes out" and inflames a nerve.

For sleeping...I have a 3 inch tempurpedic mattress topper. I have a tempurpedic head pillow that is contoured. And then I have a long tempurpedic like skinny pillow that goes from my inner thigh to my feet. And then one in between my arms. So this way when I am laying on each side my spine is perfectly aligned...

This is crucial for you when lying in bed. Lying flat on your back will put more pressure on the nerve.

Hopefully your appt. with the Neurosurgeon will go well and he may even prescribe a nerve pain medication to take for a bit. Or as I mentioned...do an injection of cortisone or lidocaine into the area.

I will pray that you are one of the many who this flare will be short lived and you can go back to your regular life again with this only happenng once in awhile.

Hopefully you are healthy otherwise with no smoking (this has been proven now to deteriorate our spine/discs as it's dehydrating) limit alcohol, eat healthy and maintain a healthy weight. The weight part is crucial for our spine. As well as having strong stomach muscles...this supports our back immensley.

And then daily exercise (when you are ok'd by the Dr. to start again). At least 45 minutes or more a day along with some type of stretching/yoga is important to keeping our spine healthy.

Good luck..keep us posted.

 
Old 07-23-2012, 05:18 PM   #5
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Re: Mri results - what are my options?

Thanks for your reply. I was walking every other day 4 miles in an hour and ten minutes. I am a non-smoker. No other health issues. However, I was diagnosed with Disc Degeneration in the Lumbar region when I was 23 yrs. young. I had a sharp pain while I was working, which at that time, was a very physical position. I went to the doc. for the pain. They did an XRay and nothing showed up. They sent me home to do exercises telling me that I had pulled an SI Joint. They told me to do these exercises for 2 weeks. I listened to the doc.'s instructions. However, after 1 week of doing these exercises, I was in excruciating pain and the exercising was only making it worse! I went back to the doc. and he did an MRI. The radiologist, immediately, called my doctor and said that I had a ruptured disc and to stop the exercising because a fragment was hitting my spinal cord (explains the left leg numbness and shooting pain down my buttocks and leg). I had to have emergency back surgery. A lower lumbar laminectomy was performed. I was 23 at the time. That is when I was diagnosed with the Disc Degeneration Disease. I had not had a problem with that area since the day of surgery. Sure, I have had mild back pain, but, usually, Motrin did the trick.

I have a very high tolerance for pain so that is why I am concerned this time around. Prior to going to the doctor and he telling me, originally, it was just a strained muscle, I thought, here we go again! I told the doctor that I thought it was a disc problem. He said if it was an XRay would not show anything anyway, so they treated it as a muscle strain. The pain got so bad that I went to the ER and continued to follow the steps above. I knew this pain because I have had it before, just in a different area of my body.

I know this is more than just a disc degeneration problem. And, I am aware that many people have that from "aging". However, I was 23 when diagnosed with disc degeneration and the doc. even told me that my discs were beginning to crumble at a faster rate than normal. So, I am not shocked to discover that I, also, have disc degeneration in the cervical region. However, I am a little disturbed, to say the least, by my symptoms, because NOTHING thus far has worked to alleviate the pain. Maybe the pain killer is taking the edge off because as soon as it starts to wear off I am in more pain than I am while taking it.

And, correct, just because I have been advised to go to a Neurosurgeon doesn't automatically mean I have to have surgery. However, a specialist is the guy I want to see because this is what THEY DO.

Thanks for the input. I would like to lead a normal life again, as these past two weeks have been pure hell. I'm 38 yrs young and do understand that as we get older, things start to break. But, I want to get back into my walking routine as soon as I possibly can. It really hurts to do anything but lay down. And, even when I am not moving, I have shoulder blade pain, arm pain, forearm pain, hand pain and it seems like the back of my head at the neck line began hurting yesterday, intermittently, and into today. More of a headache than anything, but in the back of my head.

I will post the Neurosurgeon's expert advise after my appt. on Wed.

Thanks for your input....

 
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Old 07-23-2012, 05:46 PM   #6
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Re: Mri results - what are my options?

Ahh...with all the new information you gave in that you have had spine issues before and even a surgery...then you are much more up to speed. Sorry...the way you wrote things in the first post, it sounded like you were really new to all of this so that is why I wrote so much...LOL

And the comment about the Neurosurgeon was thinking this was all new and scary to you so I didn't want you to worry about seeing them as they would push surgery. Many people hear "surgeon" and get worried.

Hopefully your appt. will go well and they will be able to start on some treatment like Physical therapy or injections to help...

I've had 3, two level, cervical fusions over the last 11 years...the last one they went in from the front of the neck AND the back...So I can truly empathize with your pain issues...

With your spine already deteriorating at 23...it's been really lucky that you haven't had troubles in the last 15 years...

So I will pray this particular flare will go away in a few more weeks. That's the unfortunate life with those of us with bad spines

Good luck..

 
Old 07-23-2012, 06:57 PM   #7
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Re: Mri results - what are my options?

I highly doubt it is just a flare. The pain has gotten worse; not better. And, nothing has worked thus far. At any rate, I appreciate your sincerity and compassion. . .

I will, PATIENTLY, await the doctor's diagnosis . . .

 
Old 07-24-2012, 06:57 AM   #8
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Re: Mri results - what are my options?

I guess when I say "flare" I mean a level of really high pain. As in those of us with spine issues....when this happens...it doesn't mean surgery every time we have pain like this. So it's considered a flare up of pain.

Sometimes it can last for a month or so....You mentioned that this started on July 11....

Inflamed nerves can certainly cause a lot of pain.

Anyway...my point is that from what the MRI is reading (again...not a Dr.) it doesn't "seem" to be serious enough for surgery as they usually do this when it gets to "severe" range. Not mild or moderate.

The usual first rounds of treatment are physical therapy, aqua therapy, injections, traction, nerve pain medication, rest, etc.

I hope you get good answers from the Neurosurgeon and they can get started on treatment that helps..

Last edited by Ilovemycutedog; 07-24-2012 at 06:59 AM.

 
Old 07-24-2012, 09:08 AM   #9
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Re: Mri results - what are my options?

gem1974.....Take care and hope you get the answers and help that you need to get out of pain....I know all too well how confusing this can be and scary at the same time
I will be waiting to hear the results of your appt. with the neurosurgeon.
Gentle hugs are sent your way. Lyn AngelinMichigan

 
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Old 07-25-2012, 06:24 PM   #10
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Re: Mri results - what are my options?

Ahhhh.. the day from HELL.

Seen by Intern first.... he does a bunch of reflex tests, asks a bunch of questions, etc.
He tells me he will bring the resident doctor in. The resident doctor asks me a bunch of questions and does reflex tests (same as the Intern did). Approximately 2 hours there now... The resident doctor tells me that I need surgery after looking at the MRI images. He says that it looks like I had an injury or some type of trauma in order to have what he saw on the MRI. I asked about the surgery and he delve into details about it. He convinced me that he knows what he is talking about. He said it will never get better and that eventually I will have to have surgery anyway. He said that they would go in and do the fusion and the at the same time scrape down the bone spurring while they were in there. He then says that he is going to get the Neurosurgeon's input, but he knows that the Neurosurgeon will not agree with him because he is usually against surgery because he specializes in pain management. The Neurosurgeon walks in and by this time I am really in pain and tired of standing, but it hurts too much to sit... so, I continue to stand. The Neurosurgeon says that he is surprised I was able to get an appt. so soon with him because I have only been in pain for 2 weeks and usually they make a patient wait about 3 months before they get to see a Neurosurgeon. Huh? Now... why would he even state that to me? So, maybe I was lucky enough to get an appt. sooner than most? Maybe I slipped in on a cancellation?! Oooookay! On to what his prognosis is. He says that he will not prescribe anymore Percocet. That he will let my GP know that I need them and that he is the one to prescribe me the pain pills because he is the one who originally prescribed them and they don't want a bunch of different doctors prescribing narcotics. So, he says he will email my family doctor telling him it is ok to prescribe the pain pills to me. In addition, he says that he does not want to do surgeory just yet. That he wants to send me to pain management and go for injections first to see if those are successful. Physical Therapy is NOT an option at this time he states. Also, he prescribes Neurontin 300 mg 3x a day for 3 months and flexiril 10 mg 3x a day for 1 month. Also, he told me to try Motrin 600 again. He told me I should be able to get an injection by the end of next week. He tells me that if this does not work in the next 4-6 weeks, then surgery will more than likely be needed. And, you know all 3 of these guys did the foot reflex test with my shoes on and not one of them washed their hands after touching the bottom of my shoes. My mother came with me and reminded everyone of them to wash their hands after touching my shoes. Nice!

Anyway, I walked out more confused than when I walked in. Ugh. I called, immediately, to make an appt. with the pain management dept. to schedule the injection and they told me I could not get in until October! Ha ha ha! The Neurosurgeon had told me when I was there that he would try and get me in sooner if they would not be able to. I call his office and leave a message on his machine and tell him what happened (still awaiting return call) . In turn, I call the Resident's office and his number goes to another Neurosurgeon (one that specializes in disc degeneration and trauma), so I leave a message there, as well because his name was on the prescriptions, not the Neurosurgeon who saw me! In the meantime, I get a voicemail from my GP who leaves a message about my question on Friday about whether or not I should stay on the Flexeril and if so, I would need more because I only had a few left. His message was that I was to wait until I saw the Neurosurgeon and to see what he thought. Uhhhh... I received that answer an hour ago. So, I call my GP back to tell him that I was prescribed more Flexeril and Neurontin and that I was to go to pain management for an injection but I need him to call and get me in sooner and that I need for him to prescribe the Percocet per the Neurosurgeon's instructions because he was the originating doctor. The Neurosurgeon told me it was OKAY to take Percocet (I told him I was doubling up on them because of the pain) and Motrin 600 and the Neurontin and the Flexiril together. Ugh! I seriously don't want to take ALL those meds! I just want to take something that will work for the pain. The Neurosurgeon did say that surgeory is a possibility if the pain does not go away because the herniated disc was touching my spinal cord. Contrary to what the Resident doctor said, he said I needed surgery right away. My mother and I both questioned the Neurosurgeon about what the Resident doctor suggested and he said that yes, surgery is not out of the question, but he would prefer to begin with pain managment (injections) and other meds first, which, of course, I'm not objecting to.

I have decided that I will call another Neurosurgeon tomorrow to get another opinion. In the meantime, I will await one of the three doctor's (well, the Resident, the Neurosurgeon and my GP) return call to see about getting in sooner for an injection and about the pain pills. Honestly, I just want pain relief. I don't care how they do it... injections, different medicines, surgery. Whatever it may be! I just need a good night's sleep... since I have not gotten one in the last two weeks and to be PAIN FREE or somewhat close to that! I need to be able to sit again, feel my fingers and have no arm, shoulder pain. Is that possible?

How long does it take for Neurontin to kick in? Is it really okay to take all those meds together> My poor tummy and liver! I can only imagine what they must be thinking? LOL They will hate me soon enough! Gosh... my instincts do tell me this isn't going to get any better and that the Resident may be right. However, I will see what the injections will do in the next few weeks (if they can get me in before October) and take it from there. This ordeal took 4 hours out of my day today and this pain in my neck has taken 2 weeks out of my dear life. I'm in serious pain and see myself walking back into the ER if I cannot get in sooner for the injection.

As I said, a day from hell today! I'm grumpier than ever now and have a HUGE headache. Hoping this turns around for the better. I just need a new neck and everything will be better! Oh and by the way, I asked the Resident how this happens and he told me that it had to have been trauma that did it, a car accident or some type of injury. Well, unless my pillows were attacking me in my sleep, I don't know how else this could of happened.

A very confusing day.. to say the least...

Tomorrow... make an appt. with another Neurosurgeon for another opinion and follow up with other doctors about pain management injections and ANOTHER DAY ON THE COUCH. =( I'm way to active of a person for this. Maybe that is what got me here in the first place.. being too active...

...And, the saga continues. . . <------dot dot dot

=:/

 
Old 07-25-2012, 07:32 PM   #11
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Re: Mri results - what are my options?

Sorry to hear that it was such a long and confusing appt. I would definitely be following the treatment plan of doing all you can to avoid surgery until absolutely it is the last straw.

It's great that they are prescribing a nerve pain med as well a muscle relaxer. You can space these out through the day and evening to not get too drowsy. Just make sure you do NOT drive until you figure out who these medicines effect you. Neurontin kicks in pretty quickly and can cause some dizziness...Just be sure to read all the literature that comes with it. I didn't do well with that medicine so they moved me to Cymbalta, which is another nerve pain med.

I was on Cymbalta, Flexeril, and Percocet as well before my first surgery. So it may "seem" like a lot of pills but they all work on different areas to help take your pain down a notch..

The goal unfortunately is not pain free at this point as that would be too much medication to do that...It's meant to be about a 50% reduction.

Many people have great success with injections so hope that will work for you as well.

With all of this medicine...you shouldn't need a trip to the ER unless there is a true emergency but usually pain that we know what is causing it isn't considered emergent....If you have any issues...you should call your Drs. and ask them what to do...

Unfortunately with this kind of spine issue....pain is par for the course right now until it either subsides after injections and few more weeks/month....or the decision to move towards surgery.

It really is trial and error with procedures, injections and medication and takes some time to get the right mix to get to that 5 on the pain scale...I am about a 5-7 depending on the day.

At least you are moving forward...making appts....and continuing on. It's hard to have patience when you are in pain...believe me..I know. But hang tough...and use the time to really write everything down about when you take these meds...how you feel....activities and pain levels...and researching the best Board Certified Drs. in the area that you would ask for another opinion and find one that you would trust your life with. That is what is good about it not being a true emergency now with the surgery.

Sending you some hugs (( ))

 
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