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Could use some guidance

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Old 02-18-2007, 09:21 AM   #1
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leebrown61 HB User
Cool Could use some guidance


I have read over many of the postings on this board and feel that maybe someone could offer me advice.
I am 45 years old and have had bad back pain since a microdiscectomy in 1999. I see a family practice doctor for my pain. I have had several MRI tests. My lastone was about 14 months ago.
They showed: Facet arthropathy at l5-s1,50% disc height loss at l4-l5, a herniation at l4,l5,l5,s1, l4,l5, broad base and global disc bulges, desiccation and type II endplate chage, a radial tear in the annulus. My doctor said it is arthritis.
I also have arthritis in my right hip. I guess that is what it is, the test showed osteophytes in the femoral joint. My hip sometimes hurts more than my back and my legs ache and burn. It is really hard to walk sometime. I have been taking hydrocodone 7.5 mg 1 twice a day and hydromorphone 1 twice a day for quite a while. I don't take them at the same time. The hydrocodone does not help much, the hydromorphone helps some but wears off after about 3 hours (sometimes 4 hours). I take (or took) Ibuprophen but it bothers my stomach so much. I have GERD and I think the ibuprophen aggravates it. I have had numerous injections in my spine. The last 2 were the worst. The doctor that did the injections said there was too much debrie in the way. He did it under a ct scan but the most it did was make me feel numb for a few days. I have taken neurotin and the other variations. I also went to physical therapy and now do it at home. I try to walk a lot for exercise. The last time I saw my doctor and told him it was hurting worse he told me to take 1/2 of a 5 mg valium before bed. I live in northern vermont and I have not been able to find a pain clinic and my doctor has never offered. I asked by doctor what is causing my pain and he said I have DJD, but I have read that DJD does not cause pain.Can the things that the MRI showed cause this much pain? I initially injured my back while serving the the Navy. That is what led to the surgery. I don't like to complain so I don't really seek help and I have a hard time talking when I see a doctor. In the Navy, doctor's were officers and you just did what you were told. I am starting to get depressed but I fight it because that would only make things worse.
I also had a brain mri about 18 months ago with showed deep white matter and white/gray matter juctions lesions, too numerous for age. I saw a neurologist to rule out M.S. He said I did not have M.S. so that it good.
Does anyone have knowledge as to if the things the MRI showed would cause my pain and any suggestions. I also went to the spine clinic and they just wanted me to have more injections but my doctor said he did not see the point since they don't help. I can't think of much else to do but this is really effecting my life in a negative way (all aspects of my life, I don't even feel like a man anymore). I limp when I walk and I feel ridiculous.

Thanks and sorry this was so long.

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Old 02-18-2007, 10:03 PM   #2
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Re: Could use some guidance

I have read your post and can relate to the "I limp when I walk and I feel ridiculous." When I don't feel good and am bent over like an old lady that is the way I feel. I do not know anything abou the problems that you have as mine are different but we do both have pain and that is the culprit. I think you need to go to another doctor. I live in a small town and went to a PA for years; he knew me and all about my migraines. But, he was not helping me when I started having much more pain from spinal stenosis. I called for a doctor's and he was gone so I got a female doctor and I really like her. She finally refered me to a pain clinic - 2 1/2 hrs away. Please go to another doctor and get a second opinion. Pain can drive us crazy. Let us know what happens.

Old 02-19-2007, 02:44 PM   #3
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leebrown61 HB User
Re: Could use some guidance

Thanks for your reply. I guess I do need to do something since not only is the pain bothering so much but it is bothering all aspects of my life. I am using the right tab to reply. I have not used this web site or any others before. I guess I just don't want to go to the doctor's often. I went in November. I guess I am my own worst enemy. It is just in the military I was taught to not complain. I was a medic and medics take care of people, they don't get sick . I searched the web for pain clinics around here but did not find anything. They have to have one though. I have read a few letters here and wonder if this short acting meds (hydrocodone and dilaudid) are the best things for me. I am sick of waking up in pain everynight but I space my medicine so it last me through the day and never take more than prescribed. I guess I am kind of surprised that my doctor always writes be refill scripts by my just calling his office. I am thankful that he give me something because I have seen messages from people who have a hard time getting pain meds. But I have been on these things for over a year, the hydrocodone for about 3-4 years. I use to take 1-2 every 3-4 hours but told my doctor I wanted to decrease it. That probably was not the best move I ever made. It was good to see your reply, it has been a rough day. Hurting alot. I watched my 3 year old niece today and she said "Uncle Lee why do you walk like that". I had no answer, I don't know why I limp.
Thanks again for the support. I feel bad that people are in pain but I guess it helps that I am not alone.

Old 02-19-2007, 02:59 PM   #4
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Re: Could use some guidance

Hi leebrown61, I was reading your post and I see that you had surgery on your back. I suffer from a disease called RSD (Reflex Sympathetic Dsytrophy) it is a disease that effects the nerves. Two of the characteristics of this disease is terrible pain and burning in the effected area. It could be possible that something from the surgery could have caused you to end up with this. Look on the message board for RSD and it lists the symptons of RSD and see if any of these apply to your condition and I wish you luck on finding you a doctor who will help you.

Old 02-19-2007, 10:30 PM   #5
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Re: Could use some guidance

Hi lee, You have a crushed disc, a torn anulus, bone spurs and arthritis, and some dig bat did an MRI of your brain to see why you limp? I really think it's time to travel and find a doc that doesn't have his head inserted in an outbound tunnel.

Where did you read DDD doesn't cause pain. As discs collapse and narrow with age they can compress nerves and that certainly can cause burning leg and hip pain, so can bone spurs and arthritis if nerves have to travel over a rough area of bone or have a spur embedded into it. Yes everyones discs eventually dehydrate but that doesn't mean a torn anulus isn't spreading it's caustic material to the surounding nerves or a piece of disc isn't trapped in an outlet that won't show in an MRI but wil show in a meylogram or a discogram that can isolate the cause of pain to that one disc. Although you have quite a few problems going on, RSD is a pretty large leap in the face of the obvious. Many problems cause severe burning pain, radiating pain down your legs and pain in the aflicted area that aren't RSD. Torn discs can alow framents to float into nerve outlouts and the slightest nerve compresion can cause burning pain or altered sensation.

My point is, get opinions from experts in the field and remeber it's just there opinion. If you haven't had a disco gram how can a doc rule out the pain being discogenic. What a radiologist sees is no more than a suggestion to look closer at the problem he sees. A radiologist just reads films and has nopatient contact. GP's are barely qualified to read Xrays and PM docs treat the symptoms when there isn't a way to resolve the problem. When it comes to surgery, only a surgeons opinion counts and it's likely you could see 5 surgeons and get different opinions. Just because one doc says injections won't help it doesn't mean nothing else can be done. There are at least a half dozen completely different injections i can think of off the top of my head.

I've been in PM for 14 years before, during and after 3 failed surgeries and there are still things I haven't tried. I limp on bad days, it's nothing to be ashamed of and cetainly not as bad as having to change your underwear every time you hit a speed bump to fast. Althouigh the surgeries failed, they did relieve the burning leg pain and I regained control of bodlily functions I wasn't willing to loose control over at the age of 30.

They can do a disco gram and determine if your pain is discogenic in nature, if it is, untill you stabalixze the problem and prevent it from worsening, it will become harder and harder to manage the pain. The easy answer is to take stronger longer acting pan meds, but what damage is going to be masked as it it gets worse if pain meds are the only thing being used to treat it.

It isn't supposed to be easy to get opiates because they are widely abused and sold on the street. Masking a problem that could be fixed is doing harm IMO , and docs take an oath to do no harm, even PM docs.

One of the bigest pet peeves I have is when GP's and PM docs give patients their surgical opinion. They don't know if you need surgery because they aren't surgeons and without the pproper testing even a surgeon can make a bad call. Surgery may relieve the majority of your burning pain. It may also make things worse, there are no gaurentees other than physical dependence from continued opiate use, death and taxes.

There are plenty of things they can do, including more diagnostic testing but if you have to suggest a treatment plan or specific test to your doc
you should really look for one that can actually think for themself. The fact the hydro no longer works after 7 years just means you have become tolerant, something new like buring pain suggest a nerve compression or a spur rubbing a nerve. However nerves can be decompressed, spurs can be removed, and as far as DDD not cauing pain, it may not in some people, but in other people it's totally disabling. It's like saying MS doesn't cause pain, and plenty of neurologist believe that rediclous statement.

Why would they even look at your brain when you have obvious back and disc problems aklong with artgritis in your spine and hip. Those are the obvious causes of leg pain. If a spur is sticking into a nerve it wil light that nerve up like a christmas tree. A torn anulus can do the same thing but a doscogram and meylogram can help a surgeon figure out which is the most likely cause.

The idea is to treat the problem, not just mask it with pan meds untill you no longer have reflexes, can't raise your toes "foot drop" or loose control of bowels or bladder. Having to a wear a diaper would make me much more self conscious than limping.

If you let a problem that could be fixed go untreated because masking the pain is easier ,you can do permanent nerve damage that can't be reversed. If one surgeon says you don't need surgery, see another. If a PM doc said you don't need pain meds, wouldn't you do the same?

When my cousin was 20 he had severe testicular pain and it took 42 docs, many trips to the ER and 18 months to catch something so simple to DX if only the right tests had been done. He had lost 45 lbs and was within months of dying when doc #42 did a simple ultra sound, DX the cancer and began treatment. Because of his age, and more comon problems among men his age like epiditimitis and how easy it was to label a 20 year old a drug seeker, he's lucky to be alive. He's only alive because he wouldn't stop untill he found an answer, not just a way to manage the pain and nausea.

Good luck and welcome. Dave

PS. Ya know what they call the med student that graduates last in his class.....?

The answer is Doctor!!

Old 02-20-2007, 12:14 AM   #6
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Re: Could use some guidance

Oh lee, however can I relate. I was injured on an amusement park ride (Six Flags Great Adventure in NJ in 1987). I was on a water ride (Roaring Rapids) and my seat contacted a concrete wall going about 35MPH. Had it not contacted the wall the boat would have turned over and my children would have drowned. I went through 16 weeks of PT and basically my doctor told me that I would have to deal with this from time to time but that as I got older it would cause me some problems. How right he was. I did have some problems periodically, but nothing could have prepared me for 2002/2003. My mother-in-law had just gotten an exercize bike. I figured since we had recently moved to California, that I would start to do some light exercize, nothing drastic. Well after about 3 days I started to have some numbness on my L lower lumbar area. I worked for a doctor (I was the office manager) and since I was in charge of a lot, I just went in. I can relate to the Navy thing in some aspects. In the medical field you work sick. It is just a given. My boss asked me what was wrong and I told him what had been happening. He wrote me an RX for some pain meds and told me that I had better go see a neurologist. He also had an MRI/CT scan request filled out and had me make an appointment while he was standing there (I am not necessarily the most patient, patient if you catch my drift). I had both the MRI/CT scan done and sure enough it showed moderate to severe DDD on L4-L5, S1. I had a 2MM broad based posterior disc bulge which has now grown to 4 MM. I have end plate changes with edema seen at the L5-S1 level. These findings most likely represent severe degenerative changes but there was no infection noted. I also had degenerative facet changes at multiple levels that go into my thoracic spine as well. My herniated disc at L4-L5 is also bilateral. I have mild encroachment by spur formation in that area as well. Additionally my neurologist wanted a cervical spine CT done due to my having numbness in my fingers (ring finger, pinky on L, middle, ring and pinky on right). That turned up an 8MM spur formation with limitation of canal contents at C5-C6, and C7-T1.

I went back to my neurologist once the MRI/CT was complete and the only option I have at this point is a spinal fusion and at my age (I was 42-43 when diagnosed) that was totally out of the question and my neurologist who is one of the top doctors out here in LA said so. I fully agreed with him. Too many people have their back operated on and they are never right afterward. So he referred me to a pain management doctor. I started getting injections under fluroscopy and they helped a little but the pain was unbearable. Finally after the last of the injections I was no better off than I was when I started. At this time, my boss advised me he was closing the office and moving back to NY. That was fine because I started my own business doing medical billing and it worked out well. He gave me the equipment and I was off to the races. However the back was still there and wasn't going anywhere anytime soon. I went onto my husbands insurance which was an HMO and I was referred to my current pain management doctor that I have now. I first started out on Soma 350mg TID (3 times per day) and Vicodin ES QID (4 times per day). That worked for a while. However as with all of this medication you do build up a tolerance to it. I was then switched to Norco 10/325mg TID, Flexaril TID. I was also getting regular injections in his office of some Lidocaine and cortisone (which you can only get 4 times per year). This has been my regimine since then. I have had about 5 medication adjustments. I cannot take Kadian which is morphine. It made me very shaky. I also had a very strange reaction with it when I took a medication that I have because I have Crohn's disease, which is a whole other subject. I have had morphine via injection and also Dilaudid and I do alright with it. There was just something in the Kadian that did not agree with me. I am now on Norco qqh (every 4 hours), Dilaudid 8mg QID and Soma 350mg TID. I just started this regimine and as usual I am up at midnight. This always seems to happen to me as well when there is a change in my medication.

The fact that a doctor would tell you that you wouldn't have pain with this type of disorder/disease troubles me. However he is a general practioneer and not a pain management doctor. Have you tried calling They indicate that there are doctors within Vermont that do deal with pain management. [removed]. A successful course of treatment I think would do wonders for you. There is no magical cure as I am sure that you are finding out. However if you can control the pain or at best keep it at bay, your outlook will greatly improve. I know it did with me. Keep searching for what will work for you. Sometimes we as patients have to be our own best advocate. I have seen it from both sides. I have been in the medical field for over 20+ years which gives me a different perspective. However I do know that I refuse to be in pain. Weather can set off DDD. I am more accurate than any weather person on TV.

I hope that you are able to get some relief. Your not ridiculous. People that don't experience chronic pain and sometimes those that work within the field (auxillary staff, medical assistants, office managers, receptionists, etc.) are sometimes not pleasant and have been known to blow people off. My PM doc recently went through a change at the position of office manager. The previous manager was very cold and unaccomodating. The new manager is very nice and since she has come on when I call up if I am in pain and between appointments, I am always able to get in. That didn't happen with the previous manager. I can feel for you though when you say that you feel less of a man. I have the reverse since I am female. I feel like I am letting my husband and my kids down but I am very lucky. They are very understanding and have gone to numerous appointments with me so they do see what I go through when I get the injections and understand that I am having pain.

I hope all works out for you. I just think you need a proactive doctor to work with and you will feel quite different. Good luck to you.

Last edited by HBMod07; 02-20-2007 at 12:57 PM. Reason: Please read the Posting rules, you may not post phone numbers for any reason

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