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Pain Management Message Board


Pain Management Board Index


Hey Stardust, Sounds like you have a very opiate phobic doc. There is nothing in Norco "hydrocodone and Tylenol" that could possibly prevent a fusion from being succesful. Anti inflamatories and a few other meds, including smoking, can cause problems with fusions being succesful. I also can't think of anything an injection could possibly do that would cause any kind of slippage, If anything, you develop more scar tissue in the area and the scar tissue may prevent slippage from spondy if that's why your having a fusion, instability.

It sounds like anything that goes wrong, unmanageble pain, falure of surgery, slow progress in PT , He's already decided will be the fault of whatever pain management treatment you have had.

A couple Norco per day, wouldn't make normal post op meds they used 10 years ago on me innefective. I've said it a few times but every surgery I had, 3 back surgeries, 2 of which were fusions, the last a 6 level. I got the same pain meds. 2 5mg percs every 4 hours, after several weeks or so they dropped me down to the lortab 7.5, didn't have Norco back then either. But if he used the standard post op regemin for fusions, 5mg percs or tylox, It would be a signigficant increase over the meds your presently taking which barely manage the pain. So I can't even imagine why he wants you off all opiates. Is he going to do a UA and refuse surgery if he finds a trace of Hydro? Your present dose doesn't even create any extra challange as far as anesthesia.

Personally this would scare me to death at this point. If your in such bad shape that you need a fusion, and he thinks you can live without any type of pain control, what is he going to do post op? Say your fixed and shouldn't need anything? If he's uncomfortable with two 7.5 norco a day, what's his comfort level going to be as far as post op pain meds? Will you even have PCA when you wake up with IV meds, or will you jus get a couple 5mg Vicodin? This would have me looking for another surgeon today!!!!!

He sounds like he's more interested in you being off meds than he is in helping you in any other way. If the fusions not succesful, It will be because your a drug addict or something the PM docs did, If you complain of pain post op when he believes he fixed you, same thing.

You need proper pain control post op in order to heal. That's absolutely well documented. You need proper pain control to do the walking you need to do to prevent wasting of muscle and to be upright putting weight on the fusion to cause it to fuse. Without meds, you won't be verticle for weeks or months. If he leaves you laying in bed for 3 months because you hurt to much to move, you will be in bad shape when it's time for the brace to come off and start PT.

I'm sorry, but there is no reason related to a succesful fusion that you can't have minimal pain control weeks prior too and even more scarry weeks post op. Poor post op pain control can result in chroncic pain because the pain becomes imprinted into the nerve tissue and even with a succesful fusion, your post op care could leave you months behind anyone else or debilitated, weak, exhausted from no sleep with pain that's permanantly imprinted into nerve tissue. There is this concept that nobody evr died from pain, but t's just a concept. CP atients are 700 times more likely to commit suicide, I had a heart attack at the age of 36 with a cholesterol level of 102 and no family history of heart disease. My heart attack was from High BP from years and years of untreated pain.

It makes no sense whatsoever. Epidurals, and nerve blocks and trigger point injections are all part of the process of deciding that a fusion is neccesarry. If those things don't help and your spine is so unstable you need surgery, why would a doc complain about you trying other methods before diving on to the OR table and begging him to operate. Even with the DX's I had, where fusions seemed innevatable, all the opiate phobic PM docs did these procedures, used meds like anti inflamatories and skelaxin/felexerill and anti-depressants.

Something sounds terribly wrong and I wouldn't be comfotable with this surgeon. He's more interested in detoxig you from a redicoulously low dose of meds than helping you. Did he even tell you not to take Advil or aspirin or anti-inflamatries because they can prevent fusions from occuring.

What other meds were you on at PM, did it take months to taper you off high doses of LA opiates for this guy to become comfortable operating on a totally clean patient?

Bad Bad vibes, :rolleyes: Even if changing docs delayed the fusion a few weeks, I can't imagine a surgeon thinking your in such bad shape you need surgery and not at least givng you some means to manage the pan untill surgery, even if it was darvecet or Tylenolk 3, 4-6 times a day.

Sorry, that's just the impression I get when you tell me he wants you off all meds because I can't think of a single reason other than he's not even comfortable with 7.5 norco. What is his idea of post op pain control, 2.5 mg Vicodin, Ultram, take two tylenol and don't call and complain or I'll send you to drug rehab??

What levels are you having fused, what type of doc, NS or OS is doing this. IS there no other doc in town or doc outside of his loop that you can get a second opinion from now. Either someone, somehwere has given him info to make him believe you have an opiate problem although your only using them for the most severe pain or this guy is just a screwball.

With my first fusion /second surgery, I had my NS from the first surgery do the nerve work and an ortho who I thought had the worst bed side manner I had ever met do it together. I allowed this guy because he had a great rep as a great surgeon and great technician. I figured I could put up with the rudeness, him spending more time stareing at my wife than actually looking at me and the rediclous comments abut my med use. Like having a drug problem when I hadn't had pain meds in 2 years. I guess I was a dry addct? But he was suposed to be the best.

I had surgery in the morning, he came around at about 3pm to check on me because he was heading to the Bahamas the next day and said we have to get you off this PCA "Patient controlled anesthesia. " A macine that delivers a continous dose of IV pain meds and has the abilty to deliver bolus doses every 3-15 minutes depending on how they set it. I thought getting off the IV meds, 4 hours post op was crazy? Was this guy nuggin futz. Fortunately when he left for the Islands, MY NS took over and didn't DC the IV meds untill 2 days later when they discharged me.

I would normally say I would rather have a great technical surgeon than any old surgen with a great bedside manner, but there are cases where even the best technical guy has to have some type of understanding of healing and pain control. I honestly fear for you.

One of my old neighbors had a fusion done in the Navy at a navy hospital, They had him on PCA Morph or Dilaudid for 3 days and sent him home with darvecet, That night I saw him being taken to the local ER By ambulance simply because his wife couldn't get his pain under control and the guy was out of is mind in pain. I can see that happening in the military, but not in private practice.

You have choices, and this guy doesn't sound lke the right choice, I wouldn't care if he's supposed ot be the greatest spine surgeon in he world and works at MGH or Mayo or the Texas spine institute, something sounds very wrong and seems like he's sending you a very clear message as far as what to expaect post op.

I'm sorry, I don't mean to freak you out 10 days prior to surgery, but post fusion pain will reset your entire pain scale without proper management, what you once thought was unimaginable, may be what you get to deal with daily once this guy cuts on you.

MY advice is find a new doc, A NS that has done a felowship in spine surgery and does nothing but spines, there are plenty out there , you may have to travel to a larger city, but this is really archiac and I would hate to even imagine what his post op pain phylosophy is. The pain from surgery will release enough endorphins and enkephlins that you won't need medecine????????
No way, no how.
Good luck, Dave





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