Have my first PM appt and have some questions

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Baileysmom
Regular Member


Date Joined Mar 2012
Total Posts : 21
   Posted 4/3/2012 12:03 PM (GMT -6)   
Hey y'all.
So I have an appt 4/18 and I'm excited and nervous. I'm filling out all the paperwork for them, including global pain scale, etc.
I know they will drug test me on my first visit, which is fine, but I have a few questions: I'm currently taking lortab very sparingly and I hope I'll be able to get a refill from my neurosurgeon bf the visit, or else it won't be in my system.
Second, the medication that really works well for me is nucynta. I have three left. Should I hang on to it so they can see the bottle? And how do I explain that I'm not currently taking it but would like the opportunity to try it again in the future, if the doctor agrees.
I know he's going to want to do an epidural, which is fine, but is it usual to get meds and a procedure or is it one or the other?
Also, what's the chances they would want to start you on ER meds off the bat?
Not sure how I feel about that, but they're the doctor.
Thanks so much for your help.
L5-S1 microdiscectomy 5/11; right ulnar nerve transposition repair 3/11
MRI 3/12: C4-C7 disc bulge, C5-6 broad bulge with cord effacement
MRI 3/12: L3-L4 disc bulge, L4-L5 diffuse annular disc bulge with bilateral foraminal narrowing, L5-S1 laminotomy defect with granulation tissue surrounding L S1 nerve root. Disc bulge to bilateral foramen. Impingement of L5 nerve root.

Chartreux
Veteran Member


Date Joined Aug 2006
Total Posts : 9664
   Posted 4/3/2012 1:24 PM (GMT -6)   
First visit is yes, they'll do a drug test on you...sometimes it's not covered by insurance.
Then after that it's an office evaluation, re asking you most of the questions you filled out on the forms
ect...Then going over what you expect...and if any tests or mri's are old they might redo
those...my emg testing was old so I had to have that redone and will be getting a procedure soon
when I'm well enough to handle it...So chance are very low you'll get much done on your first visit...
Write down what your taking, everything including supplements...I always provide a list of
all my medicines even supplements... What your taking is what your doctor will consider, but
no I doubt if ER meds are given right off the bat...Hope this helps...
Try to relax some, and I hope this info helps...many well wishes to you, others will come by with
better advise, so pay attention to them...
**********************************************
* So many dx's I could write a book* "It would be nice if we could use the edit button in real life"...
********>^..^<********>^..^<*******

Baileysmom
Regular Member


Date Joined Mar 2012
Total Posts : 21
   Posted 4/3/2012 1:48 PM (GMT -6)   
Thanks so much for your advice. Especially about making a med list. It might b good to bring someone w me...
L5-S1 microdiscectomy 5/11; right ulnar nerve transposition repair 3/11
MRI 3/12: C4-C7 disc bulge, C5-6 broad bulge with cord effacement
MRI 3/12: L3-L4 disc bulge, L4-L5 diffuse annular disc bulge with bilateral foraminal narrowing, L5-S1 laminotomy defect with granulation tissue surrounding L S1 nerve root. Disc bulge to bilateral foramen. Impingement of L5 nerve root.

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 932
   Posted 4/3/2012 6:14 PM (GMT -6)   
I've been to two PM doctors and the initial appointments were quite similar.

Both had me strip down to underwear and wear a hospital gown. I'm not sure why and I suspect that they were looking for signs of drug use, i.e. track marks. I could chalk it up to thoroughness, but they didn't conduct any other examination or tests (other than Urine).

They both had their PA's take histories: duration in pain, diagnoses, surgeries, procedures, meds used, etc..

Then both indicated that they require their patients take an ER medication. The first PM started me on 200mg of Ultram and the next PM moved me up to 300mg. If I recall correctly, the first PM wrote be a script for hydrocodone as well, but I'm not sure if my memory is correct. The other PM wrote me a script for dilaudid, just 15 or so pills to try and scheduled an appointment 2 weeks hence.

With the second PM, one issue we were dealing with was that I couldn't sleep after taking any opioids, so in the succeeding months, he wrote me scripts for just about every IR out there. So, if you have negative side effects from some, of course mention it; and if you've found that others help a lot, it will likely be a good idea to mention that too.

I realize that there is a risk that by mentioning a specific med, a doctor may think you're just out to get it. But if the PM is any good and accepts that you have real CP, there should be no problem bringing up what has helped. Further, since it is Nucynta, vs. say, Oxycodone, you should be fine. It doesn't have the same abuse profile as some of the more common opioids.

As for meds and procedure -- that may depend a lot on the details. But one issue is that they may not want to start you on anything new at the same time as an epidural since they will want to see if the latter helps.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, pectus excavatum, supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds: Ultram ER 300mg & 2-3x 10mg Hydrocodone daily. Oxycodone 10mg for BT. .25-.5mg xanax as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray

No Worries!
Regular Member


Date Joined Sep 2011
Total Posts : 225
   Posted 4/3/2012 8:57 PM (GMT -6)   
Both have given you good advice and I just want to add that it's very important that you be honest and upfront with your Doctors. If you already have medication you feel is working then unless additional medical tests show it is harmful I would guess they would continue you on it.

I also recommend you write down and questions or concerns you have regarding your pain and what you expect from your new PM. I like your idea of having someone go with you. I'm on a lot of pain meds that have all but ruined my memory, so I either write things down in a simple check off list or I bring my wife with me. She sees how much pain I'm in and sometimes she can better explain how I'm suffering and what is or is not working for me.

I have been dealing with several PM doctors over the past two years. I started putting my new meds on my smart phone, because it's easier to carry and I keep having to edit it after each visit! I always make a copy of my "New Paitient" medical forms, but that's because I'm in the middle of a Worker's Comp. nightmare litigation. Well, I'm also slightly OCD too. Remember, once you have completed the initial paperwork and had your first visit; each future visit you will probably need to fill out a 1 to 2 page documenting your current pain level and list of meds. That's where it's much more convenient for me to have it on my cell phone. I simply go to where I stored it and copy onto the form. Sometimes I just write "ditto" or same as last week.

Also, I try to get them to send a copy of their medical notes to my Primary Care Physician (PCP). My PCP prints them out on the rare occassion that he receives them and gives them to me for free. Where as for my PM doctor and other specialists I see, they charge me $25-$30 to get my medical records! I hope my babbling has been helpful. Keep us posted on your visit and how you are doing. I hope you are able to find some form of long lasting relief from your CP.

Take care,

Charles

rjbeck
Regular Member


Date Joined Feb 2008
Total Posts : 255
   Posted 4/4/2012 3:36 PM (GMT -6)   
Hi,
make sure your neuro sends in copies of your most recent medical records and all mri's,CT-scans and xrays. Also don't tell the PM doc you are taking the xanax for sleep. (Thats a big no-no)you have to tell him you are taking the xanax for anxiety due to your C.P. Good luck Randy
AVASCULAR-NECROSIS (AVN) in 6 joints. HIPS,KNEE'S and SHOULDERS-Replaced RT shoulder.Left hip 2011
Bilateral Empyema-Thoracotomy with Decordication.(Removed the Lining of left lung)Bilat Pneumothorax (2005-2008)
COPD.
Hiatal Hernia-needs repair-Severe GERD
MED'S-methadone 45mg's Bid---oxycodone 30mg's Bid--nucynta 100mg-Prn
Former Respiratory Therapist/Perfusionist
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