It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Pain Management Message Board

The Trifecta: Degenerative Disk Disease, Spinal Stenosis, and Herniated Disks at L4/5


Post New Thread   Closed Thread
LinkBack Thread Tools Search this Thread
Old 11-26-2013, 02:24 AM   #1
John1310
Newbie
(male)
 
Join Date: Nov 2013
Location: Lansing, Michigan USA
Posts: 4
John1310 HB User
The Trifecta: Degenerative Disk Disease, Spinal Stenosis, and Herniated Disks at L4/5

Hi: I have been a longtime lurker at 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 am inversion table. Unfortunately, part of this methods of treatment included medications. I started with 5/500 Vicodin, which were taken only 1-2 times per day. 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.

Initially, the Norco was taken only in he 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 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 Amy 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. I decided to take a month leave of absence from work in November of 2013 in an attempt to control the pain (another rounds of physical therapy, etc.) By this time, 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 far for myself, etc.). By the time the surgery was performed, however, both disks had ruptured and one had largely 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 have literally never had a pain med prescribed by anyone other than my family physian 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 made it clear to him that this would be insufficient, 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 contactedy family physician, who immediately game me Percocet 10/325. They helped, but not so much so as to make myself comfortable. My family physician thinks that the obvious tolerance to opiates I've built over the last 4 years is part of the reason, but also that the surgeon allowed my pain to become such a problem that they are now having a difficult time getting it back under control.

Today my family physician prescribed 5 Fentanyl patches, which have me a bit nervous. He believes that it is "cleaner" for me to use these patches in the short-term while the surgical effects heal (15 days maximum), supplementing with the 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.

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. 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 out of 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)? 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 physically to avoid any similar issue in the future. 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. Also, sorry for typos... It's 5:30am here and I typed this on my phone ;-)

Last edited by Administrator; 12-02-2013 at 08:51 AM.

 
The following user gives a hug of support to John1310:
Beedy Bo (11-28-2013)
Sponsors Lightbulb
   
Old 11-27-2013, 09:36 AM   #2
teteri66
Senior Veteran
(female)
 
Join Date: Nov 2010
Location: USA
Posts: 9,023
teteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB User
Re: The Trifecta: Degenerative Disk Disease, Spinal Stenosis, and Herniated Disks at

Welcome to the board.

I am more concerned about why you are in so much pain ten days post surgery. Did you have an open surgery, and I assume it was at L4-L5 and L5-S1, without a fusion...is that correct?

Usually hospitals try to get a patient on an oral pain medication at least 24 hours before release. It sounds like the surgeon gave you a pretty standard prescription for this type of surgery. When a patient has been on pain medication for a long time, some surgeons make the person cut way back prior to surgery so that pain can be controlled post surgery.

It may be a combination of your situation not being handled optimally, and perhaps some unrealistic expectations on your part. It would be unusual for you to feel comfortable this soon after surgery. Are you primarily having surgical pain or is it nerve pain like you had prior to surgery?

 
Old 11-27-2013, 10:53 AM   #3
John1310
Newbie
(male)
 
Join Date: Nov 2013
Location: Lansing, Michigan USA
Posts: 4
John1310 HB User
Re: The Trifecta: Degenerative Disk Disease, Spinal Stenosis, and Herniated Disks at

Yes, it was open surgery with Laminectomy/Discectomy at L4 and L5 without fusion. According to my family physican and the written surgical report, the surgeon had to fish around for various pieces of the disk that had disintegrated, causing more manipulation of surrounding nerves than usual. He also had to use some type of implement to remove a portion of the calcified disk that was attached to the bone. Basically, a lot more force was used than normal, which increased the post-surgery pain.

I ended up using the Fentanyl patch and am feeling much better. I don't think my expectations were/are unreasonable, as I fully expected to have pain and discomfort post surgery. I continue to expect pain/discomfort for weeks to come. I do not believe, however, that the pain should be sufficient enough to cause an individual to cry despite prescription medication use. To the extent that my expectations were off the mark, I believe it was due to a significantly different surgery than described. I was told one day in the hospital and spent three. I was told that I would be self-sufficient when I returned to my home, but hired in-home care for three days because I couldn't get myself to the bathroom. There is a reason for these discrepencies, and unfortunately I had to go to my family physician as opposed to the surgeon to figure out what they were.

I followed all orders, which included using/increasing prescription medications over the span of 4 years. To me, common sense dictates that an increase in the strength of medication would occur after surgery (i.e., if someone is taking 7.5/325 Norco prior to surgery, they would need 10/325 for a period after surgery). I explained this to the surgeon both before and after the procedure, and he assured me that the pain would be well-controlled. I think that if he had simply prescribed the Percocet for a minimal period of time I would not have needed the Fentanyl patch.

Ultimately, I feel much better, I am sure due to both passage of time and the Fentanyl patch. My original post was to garner opinion as to the use of the patch, as it is clearly a significant step up from Norco. Now that I have been using it for two days, I am comfortable and happy with the decision.

 
Old 11-28-2013, 10:16 AM   #4
teteri66
Senior Veteran
(female)
 
Join Date: Nov 2010
Location: USA
Posts: 9,023
teteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB Userteteri66 HB User
Re: The Trifecta: Degenerative Disk Disease, Spinal Stenosis, and Herniated Disks at

I am glad the patch is having the desired effect. It is unfortunate that some surgeons are much better at handling meds post surgery than others. You should not have had to go to your family doc to get the support you needed. One thing I have learned from my personal experiences through several surgeries and from being on the board awhile is to take what surgeons say with a grain of salt. I have yet to hear of one who wasn't overly optimistic in terms of length of recovery, etc. nor one who doesn't tell the patient that the surgery went really well, implying that he did a great job.

Any time nerves have to be touched during surgery, the patient has a more difficult recovery. Now that you seem to have the right amount of medication, your recovery should be smoother...but it will probably not be any shorter. Nerves are notoriously slow to recover when they have been seriously aggravated. Do not be surprised if you continue to have nerve pain for many months.

But hopefully, you are now on the road to recovery and will be feeling better soon.

 
Closed Thread

Tags
fentanyl, laminectomy, percocet, pilates, yoga



Thread Tools Search this Thread
Search this Thread:

Advanced Search

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off




Sign Up Today!

Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

I want my free account

All times are GMT -7. The time now is 05:13 PM.





2018 MH Sub I, LLC dba Internet Brands. All rights reserved.
Do not copy or redistribute in any form!