This wasn't complete as my finger touched "post now" and into the ether it went. (#% ^%#. iPad) Oh well, it's close enough.
I still think his urgent need is a decent neurologist. I don't see any heightened danger from alternating some Motrin in. We're all at risk of overdose whether it's aspirin, Tylenol, Motrin, morphine or fentanyl! That's why we must read labels and consult our docs.View Thread
He mentioned early on that that was one of his problems as the levels of acetaminophen being too high were causing stomach aches. He said he was as trying to reduce the acetaminophen of his 10-325 percocets by alternating some Motrin. That's why I assumed (and asked) if his current physician is a pain management doc. To be prescribing percocet long term you almost have to be as the DEA has limited the ability for doctors to write opiads (especially oxy) long term.
Again, it's why I suggest he needs to stay in close communication with his current treating doc while he finds a better neurologist. He didn't state the total dosing per day, but it's often recommended to combine ibuprofen with acetaminophen as ibuprofen is a better anti inflammatory Then acetaminophen. Keep in mind he's 6'3" and well over 200lbs. There's nothing in his post that would be cause for alarm. As always, his doctors should know the details, but the percocets have less than half the acetaminophen a 10mg Vicodin would have. There's even a drug called Maxigesoc wich is a combination of acetaminophen and ibuprofen. As for goal dosing/day that's between him and his doctor. Suggesting otherwise is practicing medicine.
I feel his current doc is good and has been conservatively doing what he can to help. None of us would want to hear a doctor that immediately recommended a scalpel.View Thread
That's a lot smaller than a 10 awg wire. Size 10 wire is a little under 1/8" in diameter (#8 = 0.1258" ~1/8" #10=0.1019"). The stimulator is 1.3mm which is 0.050" or about a #16awg wire. So yes it's very small.
That being said, it's a long way to get to that as a solution.
Neurostimulators are based on the work of Dr Wall and Melzack. They work on what's called the gate control theory which defines the manner in which pain signals are sent to the brain or ignored. Simply put, if you can distract the brain with a benign signal it won't turn the gate on that sends the pain signal to the brain.
Sounds like you have continuing degeneration of your lumbar that is impinging sciatic and other nerves exiting the collapsing joints. You would need testing to find out, but my gut says that núero distraction is not likely going to solve your problem.
I go back to the neurologist you saw. He may have made some people happy, but he did you a dis-service. You need a neurologist that is willing to look seriously at your spine.
The term physiatrist and pain physiatrist is thrown around a lot. While specialty certifications are managed at the state level they're pretty standard. A physiatrist by definition is "a doctor of physical medicine" they specialize in anatomical issues and rehabilitation. They are not surgeons and not certified pain specialist.
A licensed pain specialist is an MD that has furthered his training to become specialized in chronic pain care modalities, psychology and pharmacology required to manage long term pain sufferers.
Now here's where it gets wound up. Some physiatrists are also board certified pain specialist. This is a great tool set for someone early on in their spinal issues, working through modalities for best functionality or late when rehabilitation for quality of life is the only course left.
Numerically, most pain specialist come from anesthesiologist backgrounds. It makes sense as much of pain management is (unfortunately) dealing with pharmaceuticals and anesthesiologists have the training to best understand that.
Neither is better as these are only generalities. The best pain doctor is the one that works hard to help you find the best solutions for your chronic needs. A good pain doctor understands that a psychologist may be as valuable as a surgeon, an acupuncturist or physical therapist.
I once saw a physiatrist that was also a DOM (doctor of oriental medicine). I thought who better to help me than a western MD (Physiatrist) and an acupuncturist. He was a great guy, but politely told me there was nothing he could do for me.
None of the credentials above are licensed surgeons. Pain specialist do many procedures and mine was able to implant my pain pump and catheter, but spine surgery should only be done by a spinal orthopedic or neurologist.
This brings me to my opinion regarding your sciatic and foot pain. It's my opinion that your attending physician is right, you need a neurologist. It's too bad the one you saw was arrogant and didn't try to understand your needs. FIND ANOTHER ONE.
In your case I think you need a neurologist, but in the broader brush thinking that I was describing above, don't get caught up on labels. Good doctors are good doctors and bad doctors bury their mistakes.
I think the world of physiatrist and have a good friend that is a practicing physiatrist in the same office as my orthopedic surgeon, my pain management specialist and now a great pain psychologist that I've seen. I see the physiatrist socially, but medically there's nothing he can do for me.
Demand a neurologist that will look hard at your problems. If you end up with a nuero stimulator the neurologist will be of great value there too.
It takes backbone to survive a bad back. You have to demand the treatment you need which you won't know until you find it. It takes a team, but you need to be the quarterback. It's your life, how much work is it worth?
I can see why you'd be upset. For years you've been doing everything right only to find yourself in a bad predicament. I don't think I would change anything drastic right away, I would ask your doc if there's another neurologist he could refer you to? Second choice would be an orthopedic spine surgeon.
To answer your question I've heard long term nerve impingements go both ways. Sometimes the nerves don't respond as we'd like and permanent damage occurs. Sometimes the impingement is removed and recovery is miraculous. You never know with nerves. The nerves exiting your spine are right at the juncture of the sympathetic nerve system and the peripheral nerve system. Some re-growth and regeneration does occur in these nerves unlike the central nervous system. (Upstream of the ganglia)
This is really the territory of a spinal neurosurgeon. Pain down the outside of the buttocks down the leg and under the foot sounds like (IMHO) nerve impingement in the lumbar. The nerves supporting the legs come from L4-S3. L4/L5 goes around the buttocks down the leg, back of the calf and under the foot ending in your middle toes. So this reconciles with your prognosis. That's really the only nerves remaining in your spine that low in what's no longer considered spinal chord, but a handful of nerves called Cauda Equina (horses tail)
Sounds like your treating physician has been working with you for at least 3 years and you've worked hard with PT losing 30lbs. This is usually ideal. Nobody wants to rush into spine surgery as a first alternative. I say you did it right, I think you need a second neurological opinion.
A good friend of mine just had his entire lumbar rebuilt and fused from a specific type of scoliosis in which the lumbar just collapses on itself. This took over a decade to manifest into surgical necessity.
Some docs have great resume's, but that doesn't make them the perfect doc for you.
Was your doctor a pain management specialist? Is that why you were drug tested...as part of your contract?
It seems like you could argue the poppy seed story fairly easy. You said clas II, I assume they were opiads? Don't poppy seeds metabolize as an opiad? The blood tests we take to satisfy our contracts don't give a computer print out of every drug in your system. They identify family types and different effects such as amino acids and also verify we're taking our prescribed meds (many people don't take them and sell them on the street). I can't remember the exact details of the test data.
Are you saying you tested positive for poppy seeds or you ate poppy seeds and tested positive for opiads?
Unless their willing to spend thousands of dollars and hours of lab work, the urine tests we take for our pain contracts are fairly rudimentary. Did they re-test a new sample for a more definitive answer?
If you can't convince your old doctor You're innocent you're on a _hit list that is hard to get off of.
Along with the urine test and possible contract I'm assuming yours was a pain management doctor since you said "ten years." Surgeons and primaries are almost forbidden by the DEA to dispense analgesics for anything other than trauma or post surgery recovery.
I would plead my case with your old doctor and if he takes you back look for a new one (pain specialist).
If you can't get back in you're in the same boat, but with a big "drug seeker" label on you.
You'll still need to find a new pain specialist to manage your long term needs for pain meds.
Good luck, the DEA has made it difficult for doctors to treat long term pain issues. That's why most pain management doctors are board certified anesthesiaoligists. The knowledge of pharmacology is almost necessary to stay ahead of the DEA these days.
I don't know your condition, but fusing L5/S1 is fairly benign. On this Dave has hit a key point, a physiatrist, whether he's a pain management specialist or not, may help you properly rehab so you won't even need class II drugs to have a better life.
A physiatrist that is also board certified as a pain management specialist could work up a great rehab program and work with your long term analgesic needs.
Good luck, I've read about poppy seeds causing problems with employment testing, but never heard anything firsthand.
Thanks Dave, I have until August so I will be researching. I do believe there's a knee surgery in my future so I'm waiting until im on Medicare.
Like you said, I have to see the diff between standard and under 65 disability and then plans by state.
I was just dying to hear some real data. All I've gotten so far is advertising dribble.
I did talk to SSDI today and they said I get part A free and pay $104/month for part B. I can add whatever I want to that. So I need to cover the donut hole and pay for scripts.
I've been renewing the family's plan for 2015. Looks like we got a 1.7% increase (COLA) foe SS and SSDI, but my insurance went up about 25%
My wife is working at a local elementary school right now as a temp. The principal says they should be able to hire her permanently in the spring. I'm crossing my fingers as that would be a God send. Not only would she be getting a paycheck again they have insurance plans. I could either stay on Medicate alone or keep it as secondary.
It would probably be close in price to what I'm doing now, but this National health plan is a nightmare. You just don't know what each Januay is going to bring. The company I had bailed so now I'm figuring out a whole new plan tha requires you pay 100% out of pocket until your deductible is met. The good news is the deductible is $1,000 per person $2,000 family max and $2,000 max out of pocket.
It will be a kitty painful up front, but then $0 once deductible is met. I think my pump refill is $800. I'll just make them payments.
My wife is diabetic so one good set of labs will likely hit the $1,000 mark easy.
Hey if I hit my deductible early maybe I'll get my knee worked on.View Thread