Discussions that mention tylenol

Pain Management board


Hey Vicky, I will answer your question about what I know now and what would I do in a few minutes.

I completely understand that high risk activity is high risk activity for anyone, Skydiving is risky, you get jerked when the chute opens, you land hard, anyone thrown from a horse can be paralyzed or killed, even the healthiest person. Chris Reeves for example. So obviously that's not an activity he would risk. But would normal activity cause additional harm or risk? Going to dinner or a movie, walking on the beach, normal relations with you, going on a trip, being able to vist friends and family,. The worst thing for men or anyone is the self esteem they loose when not contributing to the household. Seeing you go off to work and being home alone all day. There are only so many movies on cable TV, I've seen them all. CP cost us our home, credit, and those are just tangable things. What it does to the psyche is even more devestating if it goes untreated.

Unfortunately I'm hurting now because I stepped out of the shower and due to foot drop my foot got hung up on the side of the tub, I went face first and twisted and landed against the sink cupboard and toilet, bruised my arm, hurt the ankle that turned under and twisted the heck out of my back. I'm going to pay dearly over the weekend for it. But with the use of opiate meds for rescue pain I know I'll be alright, no permanent damage done, I would probably be in so much pain beyond what the pump can mange I would be in the ER or making an apt at my PM clinic if I didn't have real pain meds available.

PM docs give us BT meds so we have the means to manage incidental pain or breakthrough pain. Even with the pump, knowing how easy it is to over do things and how I would react to knowing I didn't have the means to keep myself out f the ER I would limit my activity as not to cause an increase in pain. I understand being in as much pain as you think you can possibly tolerate, But there will always be good days and bad days and I can't agree with depriving yourself of relief, depriving your family of participating because of fear of addiction which is a completely different thing than simply being physically dependent.

If I had fallen out of tub 6 months post op, I would have been so concerned about damaging the fusion or hardware I would have called my surgeon and made an apt or had my GP Xray to make sure I didn't snap anything. I'm fused from L1-2-3-4-5-S1, have 12 screws and 8 rods in my spine. A couple screw tips left imbedded in vertabrea from the last time I broke hardware which I never noticed, not that it would have made a difference, they broke from the stress of bearing all the weight because the fusions failed. I just finally had it checked when I couldn't stand the pain, but I wasn't taking anything but OTC meds at the time. Nothing could have masked it anyway.

The last attempt to revise my fusion also failed and I have sheared the heads of the screws in L5 and the screws in my sacrum toggle back and forth in holes twice the size of the screws now. Hardware isn't supposed to be the support system for life, it's supposed to hold things in place as the fusion process takes over.

Once properly fused many docs remove the hardware as it serves no purpose once bone growth is achieved. The harvested and implanted bone has since died and been reabsorbed and portions of my spine are held solely by the hardware which is why I continue to brake the hardware and screws are toggling because of the failed bone growth. It's like hammering a nail into dry wall and then toggling it back and forth until the nail is just hanging in a huge whole and can be pulled out with your fingers.

I would have been concerned about falling like we have all learned that pain is our natural warning signal that something is wrong. But chronic pain is different in so many ways than acute pain, the pain is no longer a signal something is wrong. It's a signal we are over doing it, going beyond out limits, and part a true indicator that chronic pain si very different than acute pain. IF you go to the web sites you can see the diagrams of exactly how different acute pain is received and interpreted. Chronic pain is very different, It releases cell destroying peptides and amino acids, It releases substance P which is a powerful neuro inflammatory agent and these things don't happen with acute pain. Once the injury is healed, everything returns to normal;. With acute pain, although we may have heled, the process has gone on so long it changes the way pain is perceived and responded too.

Your husband skydiving would be as crazy as me bungie jumping. I live in a resort area and have a 11 year old daughter. I had my first surgery 30 days before she was born. What bothers me most is the things I can't do with my daughter. I will never be able to spend the day walking through Busch gardens. I bought tickets to Disneyland "the one in FlA" the Christmas before I found MY first set of hardware snapped. I had surgery in april and was still in a plastic turtle shell 18 hours a day when it was time to go, so my wife daughter and mother in law went and I stayed home.

The next year MIL took them both to universal studios, something else I couldn't do other than hang out at the hotel. Why pay to do that when I live at the beach. The next year my wife and daughter went to Austin TX. to visit her sister and go to Sea World and see all the cool stuff in Austin. Again I stayed home because my pain wasn't managed and I could barely walk or stand for 15 minutes, sitting on an airplane or walking through an airport wouldn't be possible. Part of the problem is my hesitance to getting a wheel chair. But once the pain was managed with oral opiates, I was able to take the hospital bed out of the den, sleep in our bed, take a shower by myself. I knew I would have limits, I knew there was only so much medication could do for me and I knew of the pump and the posibility of better relief. But with the right oral meds I could limit side effects and drop my pain nto a mnageble level. If you can do it with orals, the side effects aren't a problem, then why do something as invasive as the pump ansd still need other oral meds for nerve pain, spasm, sleep, etc.

With all the mechanical problems it seems there will always be a limit on what I can do whether it's with a pump or with oral meds.

Something you need to understand is that pure opiates do no organ damage. The Tylenol, 650mgs in a
Darvecet N100 limits your dose to one pill at a time and 5 pills a day. More than 4000mgs of tylenol/apap can cause liver damage. If you use tylenol daily for chronic pain, you need to cut that number in half . Which would mean 3 Darvecet a day to be sure you don't damage your liver. OTC NSAIDS like Ibuprofen or Aleve/naproxin or any other NSAID can eat wholes in your stomach and damage your kidneys. I know a guy that has a third of his stomach removed twice due to NSAIDS, and and OTC pain relievers. So he has 1/3 left and is pretty much the same size as your husband now. He went from happy healthy succesful, to 130lbs and dieing from bleeding ulcers from trying to manage his pain without opiates. He had terrible osteo perosis and they tried to fuse him and the first time he stood up all his hardware shifted, the bones couldn't hold a single screw.

So knowing that pure opiates cause no organ damage, have no ceiling regardless of how long you take them, you can always increase or change and be no more impaired than the previous dose of meds you were on. The negative side effects will deminsh and a simple change can restore the same relief he once had but lost due to tolerance. If orals don't work, cause to much impairment or too many side effects he can always do the pump later.

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