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    Old 03-31-2005, 07:20 PM   #1
    StMishl
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    My Story...(for Shoreline and anyone else)

    Okay-

    This the story of my back issue (plus a brief interlude on the RA/asthma/osteo) ...from the begging. Shoreline asked some questions which made me realize i've only posted desperate "begging for help" posts here, and never the whole story. Maybe writing this will help me (part vent??) and also so everyone who has been so helpful knows my whole story. This was partially posted earlier under the "doctor devil update posting", but I realized that was getting incredibly long and off-topic of the original post... so here we go, it is a novel, so be warned...

    I had severe endo dx after the birth of DD #1 (now12) but had symptoms since onset of menst. resulted in many treatments (about every one available) leading to total hyst immed following birth of DD #2 (now 9) at age of 26. Also have severe asthma (mostly controlled now), and Rheumatoid Arthritis. Took HEAPING doses of Prednisone by earlier PCP (not my current) for both RA and asthma, before transfer to cuurent PCP how referred me to Rheumatologist (now taking Rhemicaid and Methotrxate and Sulfasizine (sp??) instead of prednisone, so hopefully that will help. I have found the Remicade - a 2-3 hr IV infusion med every 4-6 weeks in office- to be a Godsend), and Pulmologist. Now both are under control. I now save prednisone for severe asthma emergencies only, only 2-3 times per year. Unfortunately though, between the hyst, and all the prednisone, and a family history, I have osteoporosis (T-scores are -2.9 hip and -3.4 spine). I have taken fosomax for the past 3 years, it seems to be slowing the bone loss some, but not stopping it. I fracture very easy (example in last 2 years have had 2 wrist fracturs and 3 ankles, plus at least 3 compression back fractures-all from non-major trauma -tripping, very minor car accidents, slipping on wet floor etc...-basicly if I fall down, something will break )

    My dr did/does know of the osteo. (At least he has been told, and I made a point of asking if/how it affected the fusion pre/post surgery as I was concerned -he has evidently NEVER been concerned about its effect ??)

    My original pain (I'd never had back pain before) began in August after Falling (of course), then 2 "moving" adventures (1x us, 1x my brother), then my daughters (9/13) roughhousing and jumping on my lower back (& then my mom "helped them" and did too)-that was the LAST STRAW. My initial pain was in two spots, lower back and bra-line. The "upper" spot has never been evaluted beside 1 x-ray that "looked fine". Where it doesn't hurt like the lower area, it does still ache.

    We tried: rest/tylonol/advil, etc.../ice/heat for a week or so before I went to any dr, then to PCP who gave me tylonol w/codenine and more of above and an x-ray, after no improvement I was referred to an ortho "spine associates" (Dr Devil) who did MRI found DDD, the osteo (which I knew about and have been treated for for years, ), and hernitated L4 herniated L5 something about nerves being very tightly mushed together and stuck between the vertebre and the prolapsed vertebre shoving against nerves and blah-blah-blah.... (needless to say I don't have the report her with me but hope this gives you the basic idea- I can read from the report later, i'd like your take on it... the major issue was that the neves were being mashed my the displaced discs at L3/4/5). So then we went the route of ESI 2x which 1st x the sedation didn't work at all and the dr couldn't visualize the nerve so he "had to" hit it (MUCHO PAIN) - this was under the flouroscope. I had increased pain for the entire week following then it was time to go again, yippee! 2nd x the sedation worked much better (yeah!) but again no relief - these actually knocked me completely off my feet for over 1 week, crawling to the bathroom, etc... I didn't go back for #3.

    At this point I was told my choices were surgery #1 : a mini-disc. which would "probably not work" and would need to be be relaced by a fusion in "less then 1 year" or #2 the fusion of L4-L5. I went all for the Fusion which at least was 1 surgery vs 2. He did the "TLIF" fusion, using rods and screws and BMP sponges (now I realizes that was not a good choice as with osteo my chances of fusing would have been much better with my bone). I've done more reading since surgery (yep, should have done this pre-surgery) and now know 1. My dr wasn't board cert., 2.TLIF fusion are "new" but not necissarily the best way to go and tend to be unstable, 3. BMP is the least stable way to go (GREAT reasearch after the fact!!)

    I do use a bone stim 24/7, and am in a corsett brace. During surgery he "saw that the nerves were really tight at L3" so did a Lami on L3 also. I don't really understand what that means.

    The reason my dr thinks my screw is "loose" is due to the fact he placed "radioactive" (his word) markers (that glow) during surgery where the screws were placed (so he could see where they were supposed to line up??) and one is signifigantly moved. Addidionally for not fusing, he has said that nothing is showing up on the x-ray as far as new bone growth. At first he said this was "still early" and he'd expect to see by 2-3 months something, but it is now at nearly 4 months he still sees nothing (at what he earlier showed me as the great black empty space where someday bone will be is still empty).

    I was more comfortable at about 4 weeks-6 weeks post-op, then steadly became worse. I fell (yep, I'm a klutz too!) and was checked by x-ray and he said no damage, but that was about when it began. Since then I began developing numbness when I sit or lie "just right" down right leg and hip and butt (like it get cold and pins/needles) and I can feel something "shift" in my back. This happens Very quickly (seconds) so it isn't as if its been sitting in on spot too long. Additionally, while my surgery pain is gone, the pain in my lower back and hips and down right upper leg is gnawing and continuous... it is nauseating.

    Today I am taking 10 mg oxy 2x day + Vicodin 5/325s and 2 Soma and right now at 7ish pain level. As stated earlier, I've been able to go off the oxycontin, and I've never (despite DD's accusations) had any drug or drinking issues and am really not concerned about my usage - I am perfectly willing to use whatever meds that will releive my pain (and i'm not asking for 100% here, but I need something better then what i've got!!). I don't have to have oxycontin. I've been at work since 9 and will go home in 10 minutes to nap until 3:30 when my kids come home, then up til maybe 10 then bed... this is my life ....

    So hit me with your wisdom...I know you have been through so much more, and I could use whatever advice you have to offer. Thank you so very much for reading this novel i've written.

    Also, I had this amazing moment of realization today as I was leaving work.... I SMACKED my "funnybone" hard and realized that pain (the nauseating pain from when you first hit it??) is almost the exact type of pain as my back has(that weird sensation of breathe-taken away"). I used this to describe my pain to hubby tonight and think for the first time he "got it" a tiny bit. Does this give anyone any ideas as to if L3/4/5 IS the pain generator or if this is bone/nerve/muscle pain or anything??? I have never had a discogram.

    Also, the "loose screw" is the "top right" one and my pain radiates down the right side (acroos lower back/both hips, right butt, and right leg but stops mid-thigh), although I go numb to my toes when the numb thing happens.

    Thanks for reading,
    Michelle
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    Failed Bk Fusion, facet joint/hip issues & RA -Wish I could Jump like him!

    Last edited by StMishl; 03-31-2005 at 07:43 PM. Reason: to put it in chronological order

     
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    Old 04-02-2005, 07:33 AM   #2
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    Re: My Story...(for Shoreline and anyone else)

    Hey Michelle, Thanks for filling in the gaps, I've been sitting to long now but I'll come back and talk about options. Not board certaiified and using BMP and doing a TLIF with no bone? Good god. Don't feel bad about the hind site thing. When were in cdesperate need for reief and surgery is is the only option being offered, w e smetimes have to roll the dice even with bad odds. The net can gbe a great thing as far as finding info. I didn't even have a cmputer prior to my 3 failed surgeries. After I added everything I had working against me, I came up with a 120% chance of failure with the last surgery and my guy was board cert and had done a spine felowship, but his ego was much greater than his ability and the technique he used wasn't the greatest either. They used crushed cadavor and BMP and created a paste that failed to grow.Did your bone growth stim have a warenty, I remebr mine gaurenteed 60bone growth, How do I get my mney back? LOL

    Anyway, I'll be talking with ya later.

    OH yeah, the bad thing about the net is we have access to all the negative info about specific procedures and specific Bio agents and hardware that might be better not to know. Was your doc aware of the steroids you still use and did you use them during the first 3 months of fusions, another factor that adds to failure of fusions.

    I'll explain what a lami is later, but it can also create instability called post laminectomy syndrome, without a solid fusions your likely would meet the criteria for that DX too.

    Hang in there, Dave

     
    Old 04-02-2005, 11:06 AM   #3
    StMishl
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    Re: My Story...(for Shoreline and anyone else)

    Thanks for posting =)
    Boy, I don't even want to add up my % for likely fusion failure, UGH!!

    Yep, I developed the flu, which went into my chest and then I was coughing up blood, then emergency asthma = ER (around post op week 9-ish... gasping, I accepted both the injected and oral steroids after my pulmogist said that a fused back would do absolutely no good if I died from lack of oxygen (I'd "toughed it out a bit too long withough the prednisone)...the Remicade I take intentionally destroys part of my immune system... YEP, again, each doctor insists they understand what the other is doing to me... I even take ALL my meds to each one about 3x a year to make sure....

    SO, is my plan to try to "tough this out" until I get to the magic time where another back dr will touch me (6-9 months), going to do MAJOR damage in the long run? As stated, I have literally called every dr o my insurance plan (and some NOT) and NOBODY will touch me until that much time has passed.

    Any ideas for making it less painful to get there? IUp til now I always thought I had a reasonably high pain threashold (natural childbirth etc...) I'm supposed to start PT (but dr is moving very slow on this, no call back all week, despite my 3 calls to him)... Do I pursue this or will that make things worse?

    I know I keep pounding you w/ questions, sorry. I just feel like you are YODA who is the the one who has ANY answers

    Thank you more than words can say... you make me realize there is a slim chance I am not crazy...

    M.
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    Old 04-05-2005, 12:56 PM   #4
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    Re: My Story...(for Shoreline and anyone else)

    Bad News Good News You decide??

    Sunday, I fought the washing machine and the washing machine won.

    What are the odds I herniated the leval above?

    I decided that the pile of laudry (some since December) was never going to get done on its own, so I did some. Towel got jammed in washer so I lifted wet (heavy), STUCK towels up to resettle the load. As i was pulling and fighting them, something(??) made the pain go to where what I thought was pain into a whole new realm of pain, and my right leg and top of left foot went cold/numb. Hubby 1/2 carried me, half drug me to bed. I'm trying to function, but right leg is alternating between numb on backside and hurting on top. Top of legs have "curled in", and I can't stand upright or walk well. very nauseaus. Havn't upped any pain meds - scared to. Back hurts at "higher level" (about waist level), "hurts" doesn't begin to describe it. Emotional basket case, crying over nothing.

    Hubby offered to take me to ER but I declined. So tiered of spending endles $$ on my damn back!! Devil Doctor is gone on Mondays... but got through today, and am off for another xray in 1 hr STAT call in and then based on those results maybe / likely an MRI.. . and a new xray/mri could be good, but I hurt...badly... its higher then usual though. Any guesses of what I did??

    thanks, M
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    Old 04-06-2005, 06:21 AM   #5
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    Re: My Story...(for Shoreline and anyone else)

    Hey M, Fusions natuurally put more stress on the discs above and below the fusion site, so it is possible you did smethng but if you were wearing your brace, hopefully it's just a muscular problem. We loose most muscle tone and alot of strength and stamina after spending 3 months in a turtle shell so it's very easy to strain or pull muscles that haven't ben used, this causes spasms and can certainly increasepain. If a nerve hapens to pass through the muscle that's in spasm, you can also have referred pain from the nerve being squeezed by the muscle.

    If your doc is hesitant to start regualr PT, have ya'll talked about aqua therapy, The weight bearing is actually good for your fusion, , it promotes growth by creating pressure on the end plates of bone where they are trying to fuse, They normally rough the suface prior to implanting donar bone or BMP pads to cause bleeding into the fusion material or BMP pad, this helps bone grow, as does weight bearing.

    The good thing about aqua therapy is it's very low impact and unlikely you would hurt yourself during the next few months as you wait to see how things turn out. You also get toget out of the brace which I knowis a strange feeling the first few weeks. It's very easy to become dependent on it. I needed help standing in the shower without the brace for a solid 3 months and still sweat for a half hour after showering, there is just something about the shower or perhaps the head is too low and I'm bending in some awkward position.

    Definitely put some anti skid tape in your shower so you don't slip. I've heard some horror stroris from falling in the shower. We also loose balance when in the brace so you have to start redeveloping it if you notice your balance is off. Thisusally happens from your core muscls, Abs and back muscles not having the strength to compensate as weight shifts, aqua theapy will hel that too. It's also fairly easy to do with a theraball, the big rubber balls at PT. The cost 2-32 bucks, I remeber barely being able to lift a leg without rolling off, my balance and strength was so shot.

    A laminectomy is when they remove the posteror spinous process which is the boney joint that sticks out n your back. As you feel up your thacic area those ridges are the spinous process. The spinous process covers the lamina, "the thinner posterior part of the vertebrea." But it the spinous process do interlock and create joints, rRemoving another joint can cause some instablity and aloow front to back motion which can grow into spondyliothesis. Vertabrea shifting off the other vertabrea when hardware fails and you don't fuse. A major problem for me that has me back n a brace when it starts shifting and grinding.

    But often they need to do lamis to reach a specific area to trm a bulging disc prior to fusion or during a discectomy. A laminotomy is when the drill holes trough the back side of the vertabrea to gain access, the laminotomy is a little less invasive and doesn't remove as much bone from the vertabrea, where the laminectomy removes the entire spinous process and then they clip the back side of the vertabrea "The lamina" out to gain acces.

    The low impact aspect of aqua therapy will help you regain some strength with low risk of damage and at last you feel like your doing something to recover rather than simply waiting for another opinion. Should you need additional surgery the gain you make during aqua therapy will prevent even further deteriortion and loss of muscle and strength from more down time. Anything you can do to keep or gain the strength you have if you facing another possible surgery is a good thing. At this point it is hard to call it a complete failure.

    Also if you haven't seen gains from using Fosomax, there are other meds on the market, and people that use a combination of these types meds, LIke myocalcum nasal spray and one of the orals like Fosomax. My wife had good results with Fosomax and after 2 years had a 20% increase in density, If fosamax can do this for her, perhaps another med may be more suited for you and the added bone browth can only help stabalize the screws and ideally promote aditional bone growth around the threads of the screw that seems to be loose.

    I even looked into usng human growth hormone after my last fusion but it';s not used in the states, but is used outside the states. I don't know if traveling is an option but perhaps they have made more progress geting HGH aproved for more conditions. It seems to make some sense to me, the bio agents like BMP use the same idea. It mgfht be worth asking about. I haven't looked into it for years.

    It's not like were not guinea pigs anyway, BMP wasn't FDA aproved when It was used on me, just something they were studying that worked very well on rats while my doc did his spine fellowship. How do rats get their little paws to work those velcro straps on the turtle shell? LOL There are just so many variables when doing a fusion it would be nice if someone actually did a study to gage the success of each different aproach and what effect adding BMP has, how benefiical bone growth stims are and what aproach "postriorvs Anterior Vs both, some docs use cages and pedicale screws and rods and fuse both the facets and you have the cage growth. Cadavor Vs harvested, Bone plugs Vs shavings Vs paste with BMP and what hardware has the best odds. Unfortunately there hasn't been such a study. It wouldn't benefit all the different makers of very expensive hardware, My frst set of screws and rods was 17k and the second almost 42K.

    Docs that aren't borard certified or haven't done a fellowship in spinal surgery learn fusion techniques n wekend outins to nice places like the caymens or palm springs, Like their has to be a perk in learnig a surgery technique. New things like the BMP pads or the latest hardware manfacturers have docs that ran their clinical trials teach other doc in one wekend how to duse the new hardware ofr Bio agent and it's scarry not knowing if your the first patent or the 1000th that e's tried it on. Docs are obviously told that what they are learning is state of the art and will increase the success of all fusions, however the info tends to be a bit biased when it comes from the manufacturer of a specific product they are encouraging docs to use.

    Is your bone growth stim implanted or the external belt you wear 4-6 hours a day? In theory it pulls more blood into the healing area due to the iron content of your blood, If your enemic in any way, it may not be as effective or you may need to suplement your iron to get max benefit from the stim.

    Please, no more battles with the washer, the tend to always win, and if you have to fight be sure to wear your armor to protect yourself. Hang in there and let us know what 's happening once you get the Xray.
    Take care,
    Dave

    Last edited by Shoreline; 04-06-2005 at 07:38 AM.

     
    Old 04-06-2005, 01:06 PM   #6
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    Re: My Story...(for Shoreline and anyone else)

    Wow!
    Thanks for all of the info. I am hoping for the aqua therapy, I finally am approved (and aqua therapy is on the list) but due to the lastest issue... been told to wait until we find out what is going on now...

    X ray came out with no new fractures - which I figured, (over the phone he said nothing about the fusion or the screws), and the hardware looks okay. So I go in tomorrow morning (quote Nurse: "if you are still having pain he says you can come in" GEEE thank you, I can barely walk!!). The nurse says he will likely send me for an MRI (1st since surgery), so it will be good to see those results, and I will definately get a copy of the latest x-rat (keeping my own sets of everything now for when I am FREE). Anxious to hear more about the x-ray, but unsure why we did it (as I didn't fall, I was lifting heavy towels???)

    The pain increase has become the "new norm" - not gotten any better since Sunday, but I am growing used to it. My biggest scare is the numbness in my legs. It is really hard to walk, could that be muscle?? During the x-ray yesterday even the tech was concerned that when there was pressure on my back (from the table) I'd loose feeling in various areas of my legs. When I walk now I have a serious limp (this is all new since Sunday). I also feel like my back and hips are slipping with each step, as if they are trying to do some crazy dance move all on their own. Mt legs though are the worst. Pre-op I had a sharp R leg pain that went in a straight line from back to butt to hip to knee, now its the whole thing, VERY WEAK, very sore, and very dragging. Left leg is just numb.

    I don't have a turtle shell brace, just a light wrap around velcro/stretch corsett. I understand the dependancy on it. I had been trying to use it less (thank goodness I had it on while doing war w/ the kenmore). It feels very strange without it (like in the shower --yes, lots of NO-SLIP tape ).

    I am hoping its a muscle pull but BOY, these weird leg things are painful, and annoying and crippling (I hate even using that word--but this is the only word that describes this feeling). I've gotten the walker back out again, but even using it is hard. I am being very tentative as with each step I am not sure my legs will support me (primarily my Right but my Left foot keeps going to pins/needles). I hate that EVERYONE keeps asking what did I do to my leg. I'm alternating ice/heat, but UGH!!

    Thanks too for the explanation of the "lami". Dr. had said he did it due to the fact that all of the nerves in the area were VERY tightly wrapped and crunched together, and to allow me more space. I'm trying to align this with your explaination.

    What is very easy to "fit together" is the Weekend warrior image. This doctor is "sponsered by..." everyone but PEPSI. My pre-surgery included visits from every vendor available in the Phoenix area... I'm sure he got kick backs from each. Probably learned to do the proceedure on a booze-cruise. My stim is external (to be worn 24/7 except showering) for 260 days (it will beep END when done, my usage can be down loaded at his office -to "tell on me"). I swear, if a vendor had told him he'd get $1000 to put blue jelly beans in my back, he'd likely have done it... No WONDER my hospital bill was so high...

    I am anemic, so will add iron vitamins to the grocery list... Also, my Rheumatologist is talking about adding "Forteo" -sp?? (the injectable) for bone dentisty, the *newest*, but supposedy has great results. I think its pretty amazing how many YOUNG-ISH women have osteo now... I wonder why this is, don't you?? I'm 33, how old is your wife? I don't post on the osteo board (only this and sometimes the back board-but try not to scare them as they are mostly pre-op there) but am amazed at how many under 50's there are with this disease. Too much soda?? Prednisone?? My hubby works for a dairy processing plant - GOT MILK????

    Anyways thanks for the tips. I've also bribed my 12 year old to do laundry I have a therapy ball (back from the "conservative therapy days" pre-op... good idea to try to re-build up the musles... DYING to get into water (I live in phoenix and its already over 80 here, I so want to be able to at least get into a pool this year!!)

    If I herniated a level above the fusion - what do they do then? I really think that this time it is ABOVE the initial injury... Besides encasing myself in bubblewrap, is there ANYTHING they can really do?

    This morning (I usually take my pain meds at 7:00 a.m.) I decided I was hurting so much I'd try to go without my pain meds to see if they are making any dent in the pain (dumb idea but hey, why not) so I went no Oxycontin or Vicodin since 7 p.m. last night... you know what?? They make NO DIFFERENCE in pain levels.... I just took them at Noon (about 1 hr ago)... because I know the oxy is time released. I also know it was stupid, but the fact i'm on 10 mg 2x day is pointless. I'm not even going to mention this tomorrow (I'm sure the dr will assume i'm invented the washing machine issue just to get a med increase) - but should I just stop taking them if the oxy is doing nothing??? I think I will ask to take more vicodin... This is too much.

    How many levels are you fused? What was your initial injury? You give everyone else so much help, but I don't know what happened to you? Thank you so, so much.. I wonder if you know how many people's lives you make better and how many people you keep sane?? You give many of us (me included) strength and encouragement and knowledge and wisdom we don't have access to otherwise.

    -M
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    Failed Bk Fusion, facet joint/hip issues & RA -Wish I could Jump like him!

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    Old 04-07-2005, 12:43 PM   #7
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    Re: My Story...(for Shoreline and anyone else)

    4/7/05

    Saw Doctor today... he decided that I had MUCH swelling, but when I "pointed to where it hurts" it is NOT in area where the fusion was... more in the Thorasic-L1-ish area?? He prescribed prednisone (UMMM, wasn't that a big NO-NO?? ) to reduce the swelling to see if that helped the leg issue, and wants to see me in 1 week... if the swelling is still as bad, he said he'd inject cortisone (not as ESI, but in the area where all the swelling is??). I asked about the prednisone, as I am 1) on fosomax and been told NO PREDNISONE unless it is for major asthma issues (he said it was the best way to reduce the swelling and worth the "risk") 2) Would it effect the fusion ("Nope").

    Leg is still numb and dragging and same -- Hips and back still HURT UGHHH!!!

    Not doing an MRI (as his nurse said they would likely do)? I think my insurance company must DING hin for each penny he authorize be spent on me

    I've been told ice, advil, current meds, now prednisone, rest...
    would muscle cause the leg thing? When will it stop? Could I have herniated another disc, if so, if I messed up L1 and have L3-5 messed up/fused what happens? how stable will the whole mess be?

    thanks as always,
    M.
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    Old 04-07-2005, 03:49 PM   #8
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    Re: My Story...(for Shoreline and anyone else)

    HI Michelle
    I still do not understand the reasoning behind NOT ordering the MRI, and why advil if you have not even began to fuse. I know you are just trying to buy time until you can see another doc. but you may just want to stay away from the advil since you are taking the prednisone for inflammation the advil is not going to do anything on top of that. Did he dare say anything about the meds being cut down this time or did he leave it alone now?
    You will not Know anything about the discs above and below without some real testing, but even so with as delicate as everything sounds rest would be best until you can see someone else unless something urgent comes up.
    Good luck and you are in my prayers.
    shelley

     
    Old 04-08-2005, 07:49 AM   #9
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    Re: My Story...(for Shoreline and anyone else)

    Hi! Nope, No word on the meds cut down (and I sure wasn't going to mention it) But he actually had me take the brace off and touched me back (a first for weeks!!) and felt where the swelling was.

    I did'nt get the whole "advil" thing either - thought that was a NONO whille (attempting) to fuse...(sort of like the PREDNISONE)... also, kind of like do you really think an ADVIL will help the pain???? Give me a break here???

    Anyways, I'll thankfully take the goodthoughts and prayers and send my own your way... My hubby says i'm walking like a duck lately, so here I am known as the duck-mama

    -Michelle
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    Failed Bk Fusion, facet joint/hip issues & RA -Wish I could Jump like him!

     
    Old 04-11-2005, 01:25 PM   #10
    StMishl
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    Re: My Story...(for Shoreline and anyone else)

    UPDATE,

    Ok, been on prednisone (a medrol dosepack) since Thursday)... still hurting, a little less numb unless I sit just right (wrong?) then my right leg/left foot go numb/pins and needles. Any ideas what this is??

    I Sat in a jaccuzzi at a friends on Sat (first time since surgery) and felt wonderful. I'm hoping I can include something similar once PT starts (delayed again due to newest set back).

    Shoreline, if it was muscular, would I still have the numbness? after a week plus? Would it still hurt this much??

    What should I expect or better yet demand (ask for polietly??) at Thursday's follow up?? I think its time to ask for more meds, I thought I could do this but I just can't... even if i'm accused of being a drug addict, I am so tired of hurting so much... I feel like I'm barely holding on here...Wednesday will be 4 months since surgery...Shouldn't I be ALOT better by now??? I had imagined being able to do tons more this summer... hahaha. I'm getting headaches daily too, but I think these are from stress...I feel ancient....

    Anyways, suggestions for the follow up? And how bad is the prednisone? And if he wants to inject more prednisone should I just say no??

    -Thanks,
    Michelle
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