Saw my Doctor today

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misterkatamari
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Date Joined Jan 2011
Total Posts : 374
   Posted 2/10/2011 12:28 PM (GMT -6)   
So I finally saw my normal doctor today. He went over my MRI results and everything to get caught up. He told me to only take the Hydrocodone if I 'really' needed it, and only up to 4 times a day. He prescribed Naproxen and Flexiril, and also physical therapy. All of which is identical to what he had me do last year around this same time. He says the severe pain I have, which is new, is completely separate from the other pain I experience which is due to the complications from the scoliosis I have.

So the physical therapy is basically for the scoliosis, which is what it was the last time I had it done. It seemed to help a little at the time, but I just don't feel like it's sort of useless at this point. As in, i'm going to him for the severe pain not the old pain but the treatment seems to be for that. But I'm not a doctor so I'll probably go through and do exactly what he told me, I just wish I could get a very clear answer as to what I can expect.

He said that the herniated disc is L2-L1, and that I have the chronic 'normal' pain from L-5. He told me to follow whatever the neurologist and orthopedic surgeon suggest, however, and that their opinion on if I need surgery is the one I should listen to. The only thing he really said is that he doesn't like to use narcotics for this type of pain, but personally...I don't know, I feel more uneasy taking the Naproxen in all honesty. I mean I took this exact same combination last year for months with no real improvement, and i just can't really see how healthy it is to be taking the Naproxen twice a day every day for almost a year.

But I feel like if I say anything they'll be offended, because again, I'm the patient. So I just don't know. I'm still confused, still in pain, and still wondering what on earth I am supposed to be doing.

Chartreux
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Date Joined Aug 2006
Total Posts : 9664
   Posted 2/10/2011 12:44 PM (GMT -6)   
If your regular doctor is having a hard time prescribing these medicines to you then
maybe it's time to seek out a better pain management doctor, for better help, PT can be
prescribe by pain management doctors too, along with procedures..seems like
your normal doc is out of options for you and doesn't know what to do..from what you
said. a pain management doctor might also try you on Lyrica or other medicines.
Also if you do get told you need surgery from a orthopedic surgeon then please make sure
to get a second or even third opinion...Surgery is usually last resort and once surgery,
always surgery, so make sure you start with the best...Keep us posted and hopes you
can get a low pain day soon...
(((((((((((((((((((((((((((((((((((((((((((((((((((((misterkatamari)))))))))))))))))))))))))))))))))))))))))))))))
well wishes and healing hugz
**********************************************
* So many dx's I could write a book* "It would be nice if we could use the edit button in real life"...
********>^..^<********>^..^<*******

Testosterone
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Date Joined Jan 2011
Total Posts : 52
   Posted 2/10/2011 12:59 PM (GMT -6)   
Hydrocodone is not a "severe pain" medication so what is your dr talking about? It's use on the controlled substance list says MILD TO MODERATE.

straydog
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Date Joined Feb 2003
Total Posts : 16278
   Posted 2/10/2011 1:53 PM (GMT -6)   
Hi Mister, I am assuming this is your PCP that you saw. One thing you should know by now they do not like to rx pain meds long term for anyone. Hydrocodone is usually about the strongest you will ever get from a PCP. That is where pain mgt specialists come into the picture for people with chronic pain. Pain mgt drs are specialized in treating pain and they are more more educated in using pain medications whether its a combination of meds or a single med. They also are big on doing injections and different procedures, but keep in mind these are not cures, its like putting a bandaide on the problem and its temporary and none of it may help you. Its a real crap shoot.

I think I have suggested to you before to get an opinion with an neurosurgeon. Do you have an appt with an orthopedic in the future? You keep mentioning this and I cannot remember if you have an appt with one or not. Regardless of what the orthopedic says, you would be wise to get a second opinion with a neurosurgeon and then make a decision on what you feel you need to do. Some of our people here at the forum have had surgery and not had the results they hoped for by having surgery, but that does not mean it will happen to you. If they had done well after surgery, they would not be hanging out here at Healing Well, instead they would be out and about getting on with their life. Surgery can and does help many people if they have an excellent surgeon and if the patient does their part afterwards. Its a two way street. Not all surgeries are failures. If they were then people would not have it and we would not have surgeons out there. It is something that is very individualized and only you can make the decision. Do your homework and educate yourself about your condition.

Take care and let us know how you are coming along.
Moderator Chronic Pain Forum

mrsm123
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Date Joined Dec 2007
Total Posts : 1235
   Posted 2/10/2011 2:32 PM (GMT -6)   
Just one other thought to add to everyone elses', I am in total agreement about you needing to be seen by a pain management doctor. The strongest pain medication that you will get from most primary doctors is percocet and even that is harder to get these days. A proper pain management doctor will not only help manage the pain better, they will also get you referred to the correct doctors for the herniations.
If there is nerve impingement, you probably should see an spinal neurosurgeon , if the problem is mechanical, then you should see an spinal orthopedic surgeon. I have seen both in my life and they both have their advantages and disadvantages. But if they both agree that surgery needs to be done, then you will have two concordant opinions.
Surgery is not done for pain relief, but rather to relieve either a mechanical problem with the spine or to relieve nerve impingement. No surgeon worth his salt will tell you otherwise so if they tell you that there is a 90 % chance it will relieve the pain that you are in, run........

misterkatamari
Regular Member


Date Joined Jan 2011
Total Posts : 374
   Posted 2/10/2011 3:16 PM (GMT -6)   
Thanks, everyone.

I saw a neurologist who set me up with an orthopedic surgeon on the 16th of this month. So if he does say I need surgery, I plan to get a second opinion from a neurosurgeon. Apparently surgery is being mentioned due to the herniated disc messing with a root nerve.

I don't know why my doctors wouldn't suggest a pain management doctor, if they are uneasy about prescribing medication? Should I tell them I want to see one myself, because I assume I'd need a referral.

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16278
   Posted 2/10/2011 3:21 PM (GMT -6)   
Yes, you will need a referral to a pain mgt dr. I imagine he may want you to wait until after you have seen all of the specialists and see what is recommended and what your decisions are. Also, be aware there are two types of pain mgt drs out there. One will will injections and procedures only-no medications of any kind, the other will do the same but will also rx medication if deemed necessary. So, if you end up going to a pain mgt dr be sure to call before the appt and make sure he does give medication if he feels its needed. No, you will not sound like a drug seeker either when asking this question. Just tell who ever you speak with that you are aware some pain mgt drs will not prescribe meds.
Moderator Chronic Pain Forum

misterkatamari
Regular Member


Date Joined Jan 2011
Total Posts : 374
   Posted 2/10/2011 3:24 PM (GMT -6)   
Thanks, straydog.

So I guess I'll have to wait and see what these other doctors say and what they want me to do before I see a pain management specialist. I see my PCP on the 15th of March, which will be after all the other appointments, so if needed perhaps I can bring it up then.

misterkatamari
Regular Member


Date Joined Jan 2011
Total Posts : 374
   Posted 2/10/2011 6:09 PM (GMT -6)   
Testosterone said...
Hydrocodone is not a "severe pain" medication so what is your dr talking about? It's use on the controlled substance list says MILD TO MODERATE.


Things like this are what really make me want to bring it up to my doctor. Just to ask why he thinks I should take that in this regard, but I feel like I'd be way over the line and get an attitude like usual. I'm very patient and listen to everything my doctor says, but it seems like lately I have been meeting with a lot of touchy doctors...

straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 16278
   Posted 2/10/2011 7:40 PM (GMT -6)   
Mister usually the best thing to tell a dr is the medication is not helping with your pain and the pain it is interfering with trying to manage your daily activities and what can he do to help you with now. That way you are not asking for anything but his help. Try to hang in there.
Moderator Chronic Pain Forum

Chartreux
Veteran Member


Date Joined Aug 2006
Total Posts : 9664
   Posted 2/10/2011 8:27 PM (GMT -6)   
It depends on where your at, sometimes you don't need a referral.
But it's a good starting point, but like any speciality you have good and bad
ones and I hope you find a good Pain management doctor.
**********************************************
* So many dx's I could write a book* "It would be nice if we could use the edit button in real life"...
********>^..^<********>^..^<*******

misterkatamari
Regular Member


Date Joined Jan 2011
Total Posts : 374
   Posted 2/10/2011 8:42 PM (GMT -6)   
Thanks again.

I did say that basically. I never mentioned a specific medication, just that I wasn't getting any real relief at all from it and I'm really not able to do anything. Even drive or sit up. So I guess to them that means I can wait a few more weeks and see what the next person says. :P

If I really need to, I could get a different PCP. But I'd rather not have to. I guess I will wait and speak with the surgeon and see what his plans are and what I can expect. If this is something that may be helped, that is one thing--even if it still sucks short term--...but if I will have this level of pain for the long haul, then I'll need to hunker down and get 'serious' on getting better care I guess.

cogito
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Date Joined Oct 2010
Total Posts : 926
   Posted 2/10/2011 9:17 PM (GMT -6)   
misterkatamari,

In addition to some other medical issues, I too have scoliosis, though in a different area. You mentioned the sacral and lumbar area, whereas mine is in the cervical-thoracic.

Nevertheless, I want to share my experiences. I'm in my mid 40's and never had any pain from my scoliosis until my later 30's. The scoliosis is fairly mild and I hardly gave it a thought.

But then from routine work around the house, I started to experience pain in my upper back and shooting down my left arm. The pain persisted for a few months until I finally went to see a doctor. He looked at the x-rays and said -- his words -- that I "have the back of a 70-year-old". That is, spurs, disk degeneration etc..

A few months later, I went for an MRI which confirmed what was obvious given the pain -- narrowed neuroforamen, etc..

I have tried quite a bit of PT and chiropracty. Heat, Ice, massage, etc. all help briefly but often the pain is back 30 minutes later. One PT gave me great exercises for my hip problems (from an accident), but I've not found any useful exercises for scolosis. There is, however, a PT method for scoliosis I recently read about "scroth": http://www.schrothmethod.com/ But I couldn't find any local practitioners. It also looks too good to be true.


So, I use Ultram ER 300mg, which has been helpful until lately. For breakthrough, hydrocodone or oxycodone.

Usually, scoliosis pain gets worse with age as the disks continue to degenerate and the nerves face greater impingement.

So, if you haven't seen a doc. who specializes in scoliosis yet, I suggest you see one and discuss your situation. But also, as others have noted, a pain management doctor is quite appropriate. GP's are typically not going to prescribe adequately for chronic pain. They also don't have the expertise. You might have to explore various time-release and break-through combos based upon what side effects you encounter.

Regarding surgery, let me suggest that you be very cautious. Aside from injections, I've not had any surgery on my spine and would only risk it if the pain gets so bad that I'm not able to keep working otherwise (and I thankfully have a job where I can work from home most days). You might want to visit scoliosis.org and look around for discussions of further medical options.

When you talk with your GP to ask for a referral, you may want to bring up the long-term degenerative nature of scoliosis and that you'll need a doctor to address issues of long-term pain management.

Sorry if this is a bit of a ramble -- it has been a bad day.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs)
RT hip and SI joint damage from car accident
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10-15mg, or oxycodone 5-7.5mg. .5mg ativan as needed for sleep.

misterkatamari
Regular Member


Date Joined Jan 2011
Total Posts : 374
   Posted 2/10/2011 9:27 PM (GMT -6)   
Thank you so much, Cogito. Feel free to 'ramble', its helpful to me too. :P

Your situation sounds almost exactly like mine. My PCP used the same terminology of 'back of a 70-year old' and such. He said mine is in worse shape than someone in their 80's, and probably will deteriorate. Then I see a different doctor and he tells me its muscular pain from scoliosis. Very different and very confusing.

I think the main part of my scoliosis is in the lumbar, but it 'corrects' itself up higher. So its sorta 'S' like in that it over corrects up higher, my PT told me it seems to be affecting my neck as well. But none of it is severe enough that it is in danger of harming organs or respiratory function thankfully.

I've learned, mostly, to deal with the scoliosis pain. Then I get hit with this and I just feel like my back has been getting worse year after year. But it was so hard for anyone to even look passed my scoliosis, until I actually got the MRI results. I'm kind of angry, but mostly just confused--so it helps to rant on here. :)

I'm willing to at least listen to what this surgeon says. Then I'll get another opinion. I'm 22, so if I get a bad surgery I'm stuck with it for life. So I don't want to run into anything, but I also can't live with this level of pain every day.

Thanks so much for your post, Cogito, hope you post more. :)

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 926
   Posted 2/10/2011 10:37 PM (GMT -6)   
Hi again misterkatamari,

Glad I could help.

When a doctor says that your pain is muscular from the Scoliosis, that's only part of it.

As I understand it, the pain comes from a few different mechanisms.

1) your nerves don't have adequate space so activity irritates the nerve sheaths which then irritates the nerves. You get nerve pain from that (burning, shooting).
2) but also, you brain registers this and acts as if that part of the body is damaged, so your muscles tighten up. That's one source of muscle pain.
3) also, given the asymmetry, your muscles are taking an uneven load all day. So, one side will get more fatigued.
4) There are also connective tissue issues, possible organ problems, etc. depending upon the severity of the curve. In my case, I have one lung larger than the other. I also have some heart issues that often go along with thoracic scoliosis.

These are some reasons for finding a scoliosis specialist -- scoliosis research society has a "find a doctor in your area" feature: http://www.srs.org/find/


For the muscle pain, do remember that heating pads, hot showers, etc. can reduce tension and for the nerve pain, I think ice helps. I also use those chemical heat pads with adhesive backings, especially when I have to go in to the office. For heating pads, there's one made by sunbeam that has a strap on it so you can sit up and have it stay in place: "Sunbeam Flexible Moist Heating Pad w/ Adjustable Straps"

When I'm at home working (sitting at my computer), I'll use hydrocodone because it doesn't interfere with my concentration and I can't work lying down (though I've tried some elaborate set-ups). I also have severe trouble eating (while in the position where you bend forward as you raise the fork to your mouth, I get a hot stabbing pain in my back -- absolutely excruciating).

But when I can spend time just relaxing, I can often avoid opioids. One mental test is that if I can pay attention to the plot of the show I'm watching or follow the novel I'm reading without the pain distracting me, then don't use anything.

I also keep a thorough chart of all my opioid use and just stay in bed some days and not use anything if I think I've been taking too much recently. I know it may be excessive, but I am overcautious about drug dependency and tolerance. I have probably 30-40 years of life left and need to pace my use. Unfortunately, I think my time with Ultram is coming to an end and will have to switch to a stronger time-release opioid soon

Since you're just 22 and have 50+ years more of life, I suggest that you also think about a system to ration your opioid use to prolong their efficacy. You might want to come up with some mental tests, as I have -- whatever suits your personal situation and find a balance between current quality of life and a commitment to your likely opioid needs in the decades to come.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs)
RT hip and SI joint damage from car accident
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10-15mg, or oxycodone 5-7.5mg. .5mg ativan as needed for sleep.

spinal soldier
Veteran Member


Date Joined Dec 2009
Total Posts : 687
   Posted 2/11/2011 2:54 PM (GMT -6)   
neurosurgeon only! pref. one that only does spine surg. the website "SPINE UNIVERSE.com" can help you find them in your area.
L4,L5,S1 bilateral Laminectomies, Foraminotomies 2002
L4-S1 PLIF with instumentation 2008,

current Rx: fentanyl patch 75mcg. , Roxicodone 30mg prn qid,vistaril 50mg prn nausea, Lyrica 150mg 2x,Adderall 20mgs 1x A.M. 10mg PM prn, Soma 350 mg 3X, Elavil 25 HS, diazepam 10mg bid prn, Supplements: CO-Q10 100mg, Vitamin D 2000IU, Fish-Oil1000mg EFA, B-Complex50 3x/day, GABA 750mg,

misterkatamari
Regular Member


Date Joined Jan 2011
Total Posts : 374
   Posted 2/13/2011 12:33 AM (GMT -6)   
Thanks everyone, again.

Right now I've been using an electric heating pad. I just feel bad about staying in bed and being cooped up in my room all day, especially when lying down is actually worse for me right now. So I sorta lounge around on the couch, which reclines. Reclining seems to be the best position, so I do that and use the heating pad.

The doctor wants me to do physical therapy here soon, but I kinda wonder if I should wait until I see the surgeon on the 16th or what.

Apparently my PCP says that lots of the pain I am having is from a flare up of my 'normal pain' because it corresponds to L-5, which I guess is where my scoliosis causes my spine to be rotated slightly. He said the herniated disc is L-1 L-2, which I'm not sure what that means. If it means like the disc between those two or what. But regardless, he said that the pain from that would be different than what I described to him. He also said my muscles are very tense and hard.

But I just feel that him proscribing the naproxen and the flexiril and physical therapy is useless. I just did it last fall and it didn't really help. My muscles were much loser, and the PT said my 'hump' had gone down a lot, but I felt the same! I think that perhaps my muscles and scoliosis are aggravated, but I really do not think that is what is causing this severe pain. What happened was I had this severe pain and then I got sorta glued to my couch and bed and got out of shape, which I think just aggravated the other things. So to me I just feel that doing all this to treat my 'normal' scoliosis-related pain is sort of just treating the symptom, not really the cause. If that makes any sense.

Regardless, I plan to still do it. Still haven't gotten my Naproxen or Flexiril because the pharmacy is closed until Monday. His treatment basically calls for using all that, going to PT and using heat.

I've been on muscle relaxers for so long, I'm just not quite sure what they are even supposed to do at this point. Between taking the flexiril I was on robaxin or something of that sort. When I saw my PCP while taking the Flexiril and described to him how I wasn't sure how it was helping, other than it helped me sleep--he basically told me to just keep taking it for that reason then. So I just don't really get it, I guess. lol!
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