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galalena 01-01-2012 06:35 AM

Negative toxicology - be aware
I am sharing a very serious issue I had with pain management and urine toxicology tests. I had been on opana and percocet for breakthrough pain. The opana was BID, the percocet (5mg) TID, PRN. For a couple days before a tox screen, I was feeling lightheaded and dizzy so did not take the percocet as it was PRN.

So, of course, the test comes back negative, with a cutoff of 100 ng/ml. The doc is cold and harsh - cutting off the percocet immediately and told me to get another pain management doctor, and snidely says "is there something you want to tell me?" and "this is a legal issue." I was hysterical and told him to get me off all meds ASAP. I asked for copies of my tox screens.

As it turns out, the staff person who completed the lab requisition marked down the Percocet as "prn - NO" by MISTAKE. So of course the lab flagged it, expecting to see positive levels. It should have been "prn - YES"

Caveat - if there is an unexpected result - ask for, and closely examine, the entire tox result. I am off all that crap anyway - definitely NOT worth the hassle.

feelbad 01-01-2012 09:53 AM

Re: Negative toxicology - be aware
while the UAs can be a huge issue depending upon sooo many different factors, and of course 'human error' is probably the worst? the one thing that I started doing and i really think anyone in PM should also do to simply avoid ANY misconceptions about 'how' someone is using their meds, is to bring IN any extras to simply 'show' that everything IS on an even keel with them. if you were taking thse PRN, it would or should be understood that they just may not actually show up in any UAs. while i know your situation WAS caused by human error, if you did have the ones you did not take, at least it would SHOW everyone BEFORE that UA was even done that at least you STILL had them, ya know what i mean?

i had the same crap occur with my MS on a UA a few years ago, only because i had taken my very last MS the day before around noon and my UA was not til 4:00pm the next day. i also hypermetabolize everything and anything that simply goes into my body from sympathetic nervous system damage(i am stuck in the 'fight or flight' mode from when they hit my symp chain while digging around inside my cord), which did not help. but there was also an issue with one of my meds that i take that i found out FROM my pain clinic after that test, actually helps to accelerate the metabolization of MS as well. and i also have a kidney disease and DO drink a TON of water every single day. all of this added up to me not 'meeting' the threshold, tho i KNOW without a flippin doubt i DID have to have at least 'some' in my body, just not enough to 'show'.

after THAT scarey result, i simply brought in my MS at every single visit ,not that i was told to, but i just really wanted to show them that i WAS doing exactly as was directed by my docs. i am only allowed two MSIR 15s per day no matter what. but doing this just made ME feel better and i do think, since i have always had a good level of trust with my PM clinic staff, that i WAS believed. they also did two other UAs after that insane result one too and they were perfect(and these were on the very last day of my cycle too, so it HAD to be dead on). in the world of PM, anything that we can just even possibly 'do' to prove we are taking everything as rxed is never a wasted effort. it just does help us when this crap just kinda happens.

what i still cannot believe is how many actual PM clinics still do NOT actually understand just how certain narcotics actually break down and metaboolize into a completly different form of narcotic metabolites and the poor patients actually get terminated ONLY because even the stupid PMs do NOT know whats up with the very UAs they use to try and determine compliance. now THAT is plain stupid, but it is still going on out there with some clinics, and its us, the compliant patients who get the brunt of the docs/clinics stupidity. i mean seriously, in this day and age, and considering just what IS riding on EVERY single patients UA results, take the freakin time to just pop onto a PC and look up how this crap just works instead of discharging and tainting the names of totally compliant people? THAT one just makes me sick when i see yet another innocent compliant patient getting terminated ONLY because the actual doc does NOT know what they should know, inside and out regarding basic UAs. okay, i have vented now,sorry, but this one really gets me.

i do hope you can find another much more on top of things type of PM to help you with your pain galalena. just remember, when you have not taken a dose of ANY med when they are going to do a UA, just as a rule, ALWAYS bring any 'extras' to EVERY appt. i know its a huge pain to have to carry this around, but man it CAN sure save your butt if they pop a UA on you, even IF its a PRN script(even going in to an appt on the very last day of your cycle, you really 'should' have at least something left to show)? if you have even ONE little pill left, it matters alot in showing them you are not abusing this stuff by taking it ALL well before you are supposed to. in this wild world of PM, anything that we as patients simply CAN do to show full compliance, the better off we are in like every single way. good luck hon,and really sorry this even happened to you. i would think once they figured this out, that you would have been okay? hopefully the next doc is way better. take care, marcia

galalena 01-01-2012 11:52 AM

Re: Negative toxicology - be aware
I did have some left, he never asked me to bring any in, the previous tox screens were fine. In fact, one came back at 60, with the cutoff being 50 (another lab), so even that would have been flagged at 100. But it was positive. The opana results were perfect - you'd think those would be of more concern than 5 mg of percocet. He never gave me a chance to say a word, just made implications of illegal activity.

Since this is an obvious human error, with incorrect parameters, that test is getting thrown out and invalidated, even if I have to threaten legal action which will be easy since both my husband and i are lawyers.

To be honest, the meds do not even help enough to put up with this horrible experience. I went to another PM doc at a university practice - the first was private. The nurse, a guy about 40, kept telling me "that doctor is a JERK." I've got tramadol, and volteran cream and that will have to do as I refuse to ever go through such a horrendous experience again.

Oh, and I had an orthopod refuse to see me for a second opinion because I taken narcotics and he said anyone who has taken narcotics is a poor risk for surgery. OK then. What a crazy world - one that I didn't want to enter, and one that I am getting out of as I would rather suffer than put up with any of this any more.

BB07 01-01-2012 06:56 PM

Re: Negative toxicology - be aware

please-be careful. dont know what your source of pain is or how much you are willing to suffer. but i will say this-chronic pain will affect all aspects of your life both personal andd social. not only physically, but mentally. wish you the best. dont go by all your neg encounters within the medical field-i have had plenty as most cp eventuallly encounter, but there are good, well trained empathetic ddocs who specialize and will treat you properly-they are just not always easily found. i hope you show your doc the errors of his way!

galalena 01-02-2012 04:17 AM

Re: Negative toxicology - be aware
4 failed shoulder surgeries within 20 months after an "high impact" traumatic accident. I couldn't even get a doctor to order an MRI for 3 months- went to 4 who refused, saying it was a degenerative condition - even though I went to the ER that day. Finally went to a chiropractor who ordered it. Then the orthopod says, Uh Oh - severe bone and tendon injury. The 4th surgery, a partial replacement, was 4 months ago but I still cannot lift my arm above 90 degrees and have constant pain. 4 of the 5 shoulder tendons have been repaired. Injuries like that should be treated within 4 weeks- mine was 4 months. NO - not happy or impressed with the medical profession at this point.

feelbad 01-02-2012 09:47 AM

Re: Negative toxicology - be aware
the thing about the percs(short acting) compared to the opana(long acting) is the likelyhood of abuse actually lies much more with the percs than the LA in most cases anyways. i would be sooo angry at the 'human error' in all this and WANT to prove that too. "they', a member of their staff is the one that screwed up, not you. when i mentioned to just bring in your 'extras" you just do this on your own so you simply HAVE them in hand incase they should ever pop a lil suprise UA on you. it just shows the PM that you still have some left, despite nothing(or that stupid threshold) not being up to par, ya know what i mean? its simply protecting our own butts. like i mentioned in the other post, ANYTHING that we as patients can simply 'do' to prove total compliance per the directions on our meds really shows them alot about 'us' and how we are using our meds. just something to keep in mind should you go to another PM in the future. its just really sad that this even happened to you. there just IS a big difference in actually having at least 'some' of the med in our system that we are being tested for, and that stupid threshold being met. its there, just 'not enough' to show itself per the parameters set.

i also want to ditto what BB stated up there. it really sounds like you have had the worst luck in the world when it comes not only to PM, but also a stupid surgeon too. my ortho alone(have had a total of 6 surgeries and an aneurysm coiling since 2001) has done three seperate surgeries on me(and am on since 2005, 70 70 60 of OC) and we had no problem in treating my pain with, at first in hosp that night only til about 9:00 am next morning, dilaudid PCA(highly needed) and the very next day with going onto my normal meds along with adding 10/325 percs. which considering the very last one was also my rotator cuff repair, really amazed me that i was still able to take that ugly a** edge of THAT horrid level of pain from THAT particular surgery. i was told by my ortho post op in his office and by his PA both, that for whatever reason, the rotator repair surgery IS one of the most painful that they do as far as post op pain and hypersensitivity. i thought it was just 'me'. but that IS one of the tops in post op pain, even moreso than a total hip replacement from what they both told me. and i sooo believe that one, it was pretty ugly there esp that initial week post. but this surgery also was one where eventual full on PT was an absolute needed thing just to even be able to get all my ROMS back. did this suregon ever send you for really in depth PT after like that initial six weeks was up,and also have you doing at least some form of PT at home too before that part?

just what was the full extent of your damage per op in that shoulder? i am only asking because i know my supra at the top fully snapped on me and my next tendon underneath which the name escapes me right now were BOTH torn badly and was an ongoing thing for many YEARS and suddenly one morning my supra just totally snapped in half on me. but the one trying to compensate was pretty torn too, and i KNOW this was going on for 'years', not 'just' months. if your ortho had done his job right G, everything 'should have' simply healed normally. in most cases after a extensive rotator repair(and yours was pretty extensive, plus fracture of bone too), its that really in depth PT they are supposed to order that truely is needed, that realistically works your ROMS back to normal over weeks of time. but knowing what bone was impacted and how badly the tendons tore would help me to get a better understanding of what you are/were dealing with after an actual traumatic impact. honestly G, your overall care has really not been at all what you deserved, no way, no how. it simply should NOT take an actual chiro to order what IS a highly needed when you have lost actual shoulder ROMs and after trauma impact MRI.

while 'some' areas just "could" be looking/appearing like there is some levels of real degeneration in your shoulder, that too can come from trauma as well. but either way, a good ortho should simply be able to "properly reattach tendons and get your ROMS back with 'appropriate' therepies post op too. i also had some bone that was deteriorated(and some he showed me the actual pics he took while in there with scope that have this wierd reddish veining in the bone too which is a form of deterioration) that with some he had to shave off during my surgery. i think we all get 'some' with age? it kinda goes with the territory. but that does NOT mean that they simply do nothing to try and repair the tendons in there. i really do think considering everything you mentioned that you unfortuently had a really crappy ortho. i still cannot believe that an actual chiro was the one to" finally" even order that much needed MRI to be done there and not even your own primary, who 'could have' did not bother? my primary has probably ordered well over half of my like 20 some MRIs that i have had to have for various crappy things since 01.

just what 'type' of trauma did you suffer on that shoulder? MVA or something else? just what type of 'scan' was even done when you were in the hosp the day OF the injury? your tendon damage was just VERY extensive. some was probably due to wear and tear too like i found out mine was. that ongoing wear and tear on certain body areas just will MAKE those areas much more susceptable to even GETTING damaged too in most cases when ANY real trauma is introduced to the specific areas. it just kind of 'sets it up" for potential injury.

but depending upon your overall pain levels here G, you may still require some level of PM, like BB mentioned, just to even HAVE a day without screaming pain and to try and live a somewhat normal life. i would just make darn certain that any other PM you may see actually knows every detail of what took place with that stupid UA. it wouldn't hurt to also obtain your very own copies of any and all records from your prior PM to just be able to read thru them and see what was written about you, and ANYTHING that is false, get them to change this if possible. otherwise, depending upon the 'way' things were written about you with esp the UA crap, it could come back to haunt you in some sick ways(this also gives you a lil 'heads up" as to what is just IN your PM records too). i always get all of my many docs records, including my PMs too at least once a year and depending upon how often i see the other docs. the bigger thing is just about everyone who SEES any doc has at least 'some' form of actual mistakes in the records. it can happen from how the doc simply blabs into their lil tape recorder down to how the transcriber does 'their job' too. docs just tend to see way too many patients in any given day that really can cause them to even superimpose real conditions from one patient into another patients file/dialogue while blabbin on. i would also definitely obtain ALL and any records from that ortho surgeon too, down to ALL of the in hosp surgical records that would include his 'op notes' too that simply are a transcript of your surgery. every surgeon HAS to make the op notes after every single surgery they do, and they ARE very much accessable to the patient. could be an interesting read there with THIS ortho and what he 'felt' about the extent of injury or what he referred to as degeneration? that would be mentioned if it was found when he simply wrote his op notes too. but honestly G, from what i researched when i had to have my tendons sewen up and what the time frame for how my ongoing damage took place over years, that timeframe really should NOT have mattered as much as you were told. what matters more here is the 'how and the 'what' your ortho decided to do when he chose to operate on the tendons themselves that would better dictate YOUR outcome. and of course what HE decided to do as far as your ongoing PT to get the ROMS back to where they should be too. do you know if you also have ANY actual anchor pins sitting in what would be right at the very top of your humorous? i found out my ortho did place some in my shoulder once things were sewen back up just to keep that supra anchored til everything healed. that was a fully torn tendon at the top(the supraspinatus).

i know i went thru some pretty grueling weeks of in depth PT, with me doing other excercises(and those pullys too) at home that started right after my discharge. but i also had ordered by my ortho what is called the CPM chair(its a continuous passive motion device that you attach the arm to on the surgical side to that slowly moves your arm up and down for you with ONLY moving that joint, no tendon or muscle, so they can heal) too. this is just a big old mechanical type chair that they deliver to your house(takes up quite a space there too) for you to use 'just' to get that main shoulder joint moving every single day and many times a day, along with the 'pendulem excercises" too. it helps keep the entire arm/main joint from kind of 'freezing up" on you while you really can't 'do' a whole lot else. it really DID help me tons in kickstarting my PT.

i really do hope that you just CAN find a much more knowledgable and just caring PM out there to try and help with your ongoing pain galalena. no one deserves to have to sit and suffer when there just ARE docs out there who DO care about peoples pain. i would just make certasin tho to always be completely and totally honest with anyone new you see about what the heck happened with that UA. it WAS pretty sick, and then to be discharged over that 'staff members" mistake on top of it? i would send this PM a ceretified letter asking him to please 'fix' your actual clinic notes about that UA and tell WHY it even happened. you should have had your say before being dumped. it simply left alot of room for error the way the order was even written with HOW you were taking your meds actually being wrong. this is another reason tho that you NEED to obtain all the records from this place too just to see THAT UA which in every single case where i have obtained all my PMs records, that UA result, the whole result sheet IS also included too. this would also give you 'PROOF IN HAND' that 'they' are the ones who screwed you up, then just kicked you out that door for no reason. PRN just MEANS PRN. i do wish yopu a ton of luck in just getting the 'proper' help G. marcia

galalena 01-02-2012 10:18 AM

Re: Negative toxicology - be aware
I have all my records. When I picked them up, the PM doc had not yet signed off on my notes, so could not get that one. However, even though he was on vacation (still is), his nurse managed to get me a refill on the percocet, so they are very aware of the error. However, I did not fill the script, and will not since I have already gone to a new PM doc.

Suffice it to say, I filed a complaint with the state medical board in MAY - I have called 3 times for the status, and it is an "open and ongoing investigation." The first ortho I saw, (3rd MD) said, when I asked for an MRI on my therapist's advice "Why should i spend $2000 of someone else's money on you?" then proceeded to insist on giving me a cortisone shot. The surgeon who did the first two surgeries admitted that the delay caused a lot of my subsequent problems, but then he left town and I had to go elsewhere. There are a lot more details I won't go into, and a lot more to the story - everyone tell me I should write a book.

Anyway, I was basically slammed by an ex-race horse, while standing next to him. He panicked, whalloped me from behind - I went flying about 10 feet, and landed full weight on my elbow. The pain in my shoulder was immediate and excruciating. This was not a degenerative issue. The supraspinatus was immediately ruptured and shredded - the humeral head most likely contused from striking the acromion. I've had the rotator cuff repair, then lysis of adhesions, synovectomy, SAD, then bicep tenodesis (excessive scarring again), distal clavicle resection and acromioplasy, then hemiarthroplasty (using a cap) and capsular release.

I will do my best to steer clear of any more entanglement with PM. I have an appt to discuss this invalid test with that doctor in a couple days.

galalena 01-02-2012 11:41 AM

Re: Negative toxicology - be aware
I replied but it hasn't shown up. I have had plenty of good PT - the docs each time told me to stop due to the tenuous nature of the tendon. It is a long, sad story. The PM doc was not the only "jerk." It really is too long to relate - let's just say the state medical board is now involved on my behalf.

feelbad 01-03-2012 06:56 AM

Re: Negative toxicology - be aware
sorry you had to go thru first that level of deep injury(that just IS alot of underlying damage), then be treated like that from the very people who are supposed to be helping you too. it sounds like way more than one alleged 'doc' actually dropped the ball on you too G. there are some really great PMs and surgeons out there, but unfortuently, even the 'docs' that graduate LAST in their classes are also called "doctor/surgeons" too, ya know? unfortunetly i too have had a couple that i cannot believe ARE even MDs of ANY kind while dealing with all of my crap. i am glad you DID file againt this idiot, geez they 'should' just know better. i do hope your new PM actually "does' all the right things for you.

just always make certain to try and cover your butt as much as YOU possibly can in the future. every little bit helps with that much needed trust factor. just considering the "how' you left the other PM, they just 'might' pop a couple of suprise UAs on you(just because). so just always carry those 'extras' in your purse to every visit so you can show them, at least the SA meds? i felt horrible when the MS i WAS taking if i needed it did not show up in my UA, despite having the three extras at home, that would have helped me if i had even thought to bring them and show them BEFORE i did the actual UA too, so i know where you are at there hon and what i 'could have' done right away that would have shown my total compliance. i just 'assumed' my MS would have still met that threshold cut off, sick suprise. it just makes things MUCH easier for 'us" to have anything in hand, depending upon when we actually even took our last esp SA meds, and if they should just decide to pop a suprise UA on us. which they just can do at any given visit. ya live and learn in the world of PM, and sometimes the hard ways. and of course, that 'human error which can screw us up in MANY ways if we do not check out our own stuff too that we all usually 'assume' is all 'right" but yet, may not be.

i am glad you are meeting with this PM if he ever comes back into town? geez, someone likes their "vacations" don't they? if you have not yet gotten your own copy of that UA, make darn sure you not only get your copy, but check it over to make CERTAIN that this also has that 'screw up" still on it, as in 'no one changed things'(if done, that would ALSO be 'altering an official medical document' as well)? i would also return that perc Rx back to them too and make CERTAIN that gets documented right in front of you too AS being turned back in, and YOU at least signing underneath that or initialing it(in your file), so YOU know this has BEEN documented. you just want nothing in your posession from this old PM, except the apology you are certainly 'owed" by the time you walk out that door. i sincerely wish you all the luck in the world with everything galalena. please let us know how your little "visit' goes with the EX PM. and i AM glad you found a good PM to take over for this so called 'clinic/staff".

galalena 01-03-2012 08:06 AM

Re: Negative toxicology - be aware
I will take the script back tomorrow, and am close to being off the opana completely. down to one/day, then every other day - almost there. I have not taken a percocet since that day -just tramadol now, which was prescribed by the new doc. It is just too much trouble and headache. I have a lot of sympathy for those who are in worse pain and go through this nightmare. It just isn't worth it to me. I already wrote 2 letters to the first one, regarding the invalid test, so I don't think it will be a problem. Helps that my husband is an attorney - don't think he was squawk much. When I called last week, I told the nurse to get me the doc's lawyers name since he was on vacation. That got immediate attention.

babs17 01-18-2012 08:37 AM

Re: Negative toxicology - be aware

I'm really sorry that you had that accident. It sounds painful, and quite the frustrating to get diagnosed!!

I'm also sorry to hear that you've had such bad experiences with PM & the medical field, overall. I admit, I had to go through MANY doctors throughout the 1st year of my injuries in order to get not only the correct diagnosis, but also a great rapport & trust with the right Physician. It's a tough process to get "the right match". It's like finding your "Doctor-SoulMate"....haha. In all seriousness though, I would hate to see you quit looking due to frustration. Once you DO HAVE a great PM Physician and/or Ortho Physician, the amount of help you will receive will be extraordinary. And I'd hate for you not to have that in your future. Most injuries have a tendency to get worse as we get older, and to rule-out any PM Physician, or any stronger medication/Narcotics at this point, might put you in a rough position if and when the pain worsens. THAT would be a lot more frustrating (that is, dealing with terrible 9/10 pain) than the position you are in right now. I'm sure many CPers would agree with me that once you get to that point (where the pain literally takes over everything- physical, mental, emotional) you can only pray that your Doctor will understand and have many options to help your pain to decrease as much as possible. Having my PM Physician "in my corner" REALLY helps with my fight against pain & degeneration.

I do wish you the Best of Luck, and as many pain-free moments as you can reach. I also pray that you are able to find that positive & helpful Doctor-Patient connection.

galalena 01-18-2012 10:28 AM

Re: Negative toxicology - be aware
I appreciate your opinion - thank you. After I sent 4 letters to that PM doc, he sent me a copy of the last visit note AND a note from the meeting I had with him with my husband. He did acknowledge the mistake on the requisition and said it was a false negative based on incorrect requisition parameters. So that is a good step.

I did stop everything successfully within 2 weeks, and will stay on Tramadol only for another month. I have an appointment to see a nationally recognized surgeon who specializes in failed surgeries, so I HAVE to stay this way at least until then so they have a way to measure my pain levels and ROM. Believe me, my arm is about glued to my side these days to avoid movement.

I have a feeling the PM I see now is not going to be very cooperative, so I again wrote to the original one, explaining my reasons for wanting to stop the meds, and that I may want to have a conversation regarding my position after this consultation. He definitely has his tail between his legs, and I give him credit for stating the truth even though it was a mistake by his office staff. So we will see.

Which all just goes to show if there is an unexpected report - ask for your records and the test results. It took me awhile to figure it out, closely examining all three tox screens, and what was recorded in my visit notes (that I SAID I wasn't feeling well the two days before that test, so took my PRN meds AS PRN - I was feeling so bad and lightheaded that I didn't take the limit of the PRN, only the ER as prescribed.

Shoreline 01-19-2012 06:01 AM

Re: Negative toxicology - be aware
Hi Galenena, I kniow you had a bad experience based n themistake of a nurse, But if you have a frozen shoulder and refuse totake meds tio enable you toendure the PT to unfreeze your shoulder, it really sounds like you have put docs on a pedestal that no doc can live uop to, You going to see a nationally known surgeon buyfor frozen shoulder when you refuse totake meds to allow you to particpate in PT. Sometimes we are our own worst enemy. No surgen is going to free up your shoulder with no post op pain and a lot of work in PT. The longer you keep your arm strapped to your body to prove a point, that you can go without pain meds, the less likely you will ever have full range of motion, Then you will be once again disapointed by the medical comunity when surgery fails because you aren't willing to do your part if the docs require a UA, pill counts or contracts regardimg the s of meds rhat werent even available 10 years ago. to expect unearned complete trust froma doc when it comes to opiates. Your attitude and refusal tomove your arnm makes yu a worse candidate for successful surgery than someone being on opiates. But if this is the way you want to play the game, don't be shocked by the outcome.Youhave cleared up the misunderstanding, you could be actively treating the pain and working on ROM, but your going to toss your shoulder ROM out the window over a clarical error that you blame a diligent doc for. I know it's not what you want to hear, but your participation is required if you ever want the use of your shoulder back, otherwise you can be a marter of the medical system but don't forget your part in the grand scheme of things. Somebody hurt your feelings so you will will teach them and allow this to diable you. Doesn't sound like a good candidate for surgery either. Good luck with the magic surgery that you make more difficut every day you refuse to take meds or move your arm. That's just the facts and you are the only one that will pay the price. I'm a firm believer that cuting off your nose to spite your face is something we should adress when it's so blatently being done. May not be the cuddles and hugs you expected, but someone should say something rather than watch you sabotage yourself when it coms to a possible positive outcome from a surgical revision. You can select or ignore my post and the advice of every doc that has told you what your doing is the ablute worste thing you can for a frozen shoulder. The future seems pretty obvious given the situation. Just because you have an apt with a reknown surgeon doesn't mean you are the type of patient he wants to to operate on when you go to such extremes to prove a point. Did this doc say he wouldn't operate if your on opiates, or was that just the opinion of one of many docs you are now assigning to all docs.
I can wish you luck but it's going to take more than luck and a great surgeon to get your ROM back, Take care, Dave

galalena 01-19-2012 07:05 AM

Re: Negative toxicology - be aware
Thank you for your thoughts, but I do not have a frozen shoulder. I went through more than the requisite PT and only stopped after my orthopod said to stop because of stressing the tendon - but still continued at home. The problem is most likely with the rotator cuff being deficient. ON the xrays you can clearly see the superior migration of the humeral head out of the socket. PT isn't going to help or fix that. Of all the docs I have seen, only one - the first surgeon - would prescribe pain meds once the initial course after surgery was done. I did not stop to prove a point - another expert refused to see me while on nacotics, and both PM docs said that is fairly standard. I can wait a month. If he cannot help me, it will be time to reconsider. Believe me, I know ALL about shoulder rehab! Maybe I was being dramatic about keeping the arm by my side, as I do stretch and do what I can do. But the reason for the pain and lack of ROM is mechanical - if I raise the arm to the side, it is definitely out of whack (shoulder significantly elevated) and there is a deep impression in the armpit (clean shave is out of the question!) I am all for pain relief but the war on drugs, particularly in the state where I live, is terribly oppressive due to really bad and criminal pain clinics in the southern part of the state.

There is an article in the New England Journal of Medicine - Alleviating Suffering 101 — Pain Relief in the United States

P.A. Pizzo and N.M. Clark | N Engl J Med 2012;366:197-199

It refers to Relieving Pain in America produced by the Institute of Medicine. That is available for free on the web. We haven't received that issue yet, but when I do, I will summarize it. The IOM publication sounds promising for those in pain.

feelbad 01-19-2012 07:18 AM

Re: Negative toxicology - be aware
you make a good point dave. i was also going to ask, when i read the "arm is glued to me side' if there just WAS any actual PT going on at ALL right now or you simply 'cannot' do it at this point out from the initial surgery/trauma"? frozen shoulder occurs from "disuse" usually following a surgery where PT was not pushed to the max in order to even GET ROMS back(but when it comes to traumatic damage, the level of actual damage FROM trauma can also tend to dictate just what even CAN be PTed back. if anything actually 'shredded' in there as in major tendon, it will not be able to be 'fixed appropriately" or just in the more "standard ways). but what ends up happening with FS is the surgeon has to kind of "break apart"(under anesthesia) the areas where like usually the "joints/boney areas" have frozen up(we have more than one joint in that rotator cuff) to even TRY and regain any mobility. even just trying to do those "pendulem' excercises can really help in getting that main shoulder joint at least moving some. the pendulem PT actually ONLY moves joint without tendons(the 'swing' of your arm using only your knees, side to side generates the movement of the affected arm/shoulder) in this very basic/starting PT situation, EVERY little bit DOES count G.

whatever YOU just can do pre op as far as ANY ROMS(at LEAST try the PT/ROMS that do not actually move tendon, just joint) is a big plus for the best shot post op rehab/recovery. unfortuently, that IS just how esp any major joint gets its ROMS back. and YES it does suck, but everything you put into it if you just possibly can at all, really DOES make a huge difference in being able to simply help "move" that shoulder, and all the tendons, muscle and ligaments in it post op, and there ARE alot in that rotator cuff. just make certain this new ortho does a follow up MRI on you too just to see where YOU are at right now within that shoulder too. they usually do anyways(pre op, they ALWAYS want one that is less than a year old and no further back), but try and get this with some level of contrasting agent too for the best possible films.

just make certain that when Dr 'vacation"gets back, that you also obtain the documents he had not yet signed off on, esp that screwed up UA. we ALL just really DO want the best possible outcome for you G. marcia

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