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  • The Trifecta: Degenerative Disk Disease, Spinal Stenosis, and Herniated Disks

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    Old 11-26-2013, 05:58 AM   #1
    John1310
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    The Trifecta: Degenerative Disk Disease, Spinal Stenosis, and Herniated Disks

    Hi: I have been a longtime lurker on this site, but recent events have convinced me that it is time to actively seek out some input.

    My goal is to explain my situation and my plan of action, and to hopefully garner insight from others in similar situations.

    Approximately 10 years ago (22-24ish) I began having sporadic back pain. I was an undergrad at the time, so I'd go to my local student clinic, obtain a small amount of low dose Vicodin (typically 5mg) and rest for a few days. This pattern continued until approximately 4 years ago, at which time the pain became more frequent and more intense. After having a MRI that showed DDD, SS, and slightly bulged disks, I went to a surgeon.

    The surgeon recommended that I try every possible method of conservative treatment before surgery, which I whole-heartedly agreed with. Over the subsequent 3.5 years I completed 4 rounds of physical therapy, began working with an acupuncturist, and began working with a reflexologist. I also purchased a TENS machine and an inversion table. Unfortunately, part of this method of treatment included the use of medications. I started with 5/500 Vicodin, which were taken only 1-2 times per day maybe 3 days a week. The frequency increased until they began to lose their efficacy, so the dose was increased to 7.5/750. I became concerned with the amount of acetaminophen I was taking, and the 7.5s were starting to lose effectiveness, so I was switched to Norco 10/325 in March of 2013.

    Initially, the Norco was taken only in the evenings. Because of my type of work, I limited myself to Tramadol during the day. I would take 2 10/325 Norco immediately after work and a third immediately before bed. This amount would obviously increase on bad days (i.e., days that I was physically unable to put on a suit), but I was carefully to never take more than 3grams of acetaminophen in any 24 hour period of time.

    Eventually the pain became unbearable, and had changed from "back" pain to pain in the buttocks, hips, legs, and feet. In October, I made the decision to take a month leave of absence from work beginning in November of 2013 in an attempt to control the pain (another round of physical therapy, etc.) By this time I was missing more work than I was making, the pain was unbearable on most days, and I was taking 6-8 10/325 Norco per day.

    I decided to have another MRI before taking a leave of absence, which showed that my L4/L5 disks were bulged 7-8mm and were pushing on the spinal cord. I ended up opting for a bi-lateral Laminectomy and Discectomy, which was performed on 11/18. These procedures were supposed to be relatively non-invasive (1 night in the hospital, 3 days without driving, largely able to care for myself, etc.). By the time the surgery was performed, however, both disks had ruptured and one had essentially exploded. Additionally, the disks had calcified which created significant problems removing the affected portions. In short, the relatively simple procedure had turned into something quite different.

    This brings me to my current situation. My surgeon largely left me high and dry with regard to pain control despite the fact that I informed him of my tolerance to Norco and that I have literally *never* had a pain med prescribed by anyone other than my family physician of 25 years. The surgeon told me to continue taking 2 Norco every 4 hours, as well as 10mg of Valium every 8 hours. I again made it clear to him that this would be insufficient to control, but he was unsympathetic. I was released from the hospital after three days (not one) and went from shots of Dilaudid every 3 hours to essentially nothing. I spent the first 2 days home taking 10 Norco a day and crying due to the pain

    I contacted my family physician, who immediately gave me Percocet 10/325, hoping that the change from Hydrocodone to Oxycodone would ameliorate the tolerance issue. They helped, but not so much so as to make me comfortable. My family physician thinks that the obvious tolerance to opiates I've built over the last 4 years is part of the reason for difficulty controlling my pain, but also that the surgeon allowed my pain to become such a problem that it is taking far more to alleviate it than normal.

    Today my family physician prescribed 5 Fentanyl patches, which have me more than a little nervous. He believes that it is "cleaner" for me to use these patches in the short-term (15 days maximum) while the surgical effects heal, supplementing with Percocet for breakthrough pain as necessary. He said he'd rather me use a Fentanyl patch and 3 Percocets a day than 6 Percocets, 6 Norco, and 4 Valium a day.

    I'm posting to gather opinions as to this course of action. As indicated, the patches make me nervous even if in the short-term. I recognize that Fentanyl is a whole new level of narcotic and I personally know people that have developed a significant addiction problem due, at least in part, to Fentanyl patches. Conversely, I hate how much acetaminophen I'm putting into my body and the pain is bad enough that I am unable to dress myself 7 days after the surgery.

    How have others fared with the patches? Is the level of opiate tolerance I described sufficient to warrant Fentanyl use? Has anyone used the patches in the short-term (I know that they are normally a long-term maintenance medicine)? Relatedly, I have already hired private Pilates and yoga trainers, as well as a personal trainer, which I plan to start as soon as the surgeon gives the okay. Has anyone had any luck managing significant spinal issues with these types of intervention (yoga, Pilates, etc.)? My hope is to heal from the surgery and work as hard as I can to avoid any similar issue in the future (the surgeon report warns that spinal fusion may become necessary in the future - I'd obviously like to avoid this). It is likely that I will always have some amount of pain, but I'd give anything to go back to the days of the 5mg Vicodin once every three days.

    Sorry this post is so long, but I thought the full history was appropriate to really provide an informed opinion. In the end, I will voice my concerns with my family physician, but I would welcome any thoughts that you may have.

     
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    fentanyl, herniated, laminectomy, percocet, pilates



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