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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by mopeck on April 9, 2006, at 23:13:15
Posted by mopeck on March 27, 2006, at 19:09:10
Hey there, i'm new to this posting board and in the past month have found out i have more troubles/issues/problems than i could ever dream of....
My L2-3 thru L5-S1 are shot, with degenerative disc disease, diagnosed osteoporatic at age 29, have facet degeneration, spinal stenosis, meralgia paresthetica, and NOW undiagnosed PTSD, SAD, GADD, depression, the start of OCD, and who knows what else....
L2-3 has disc bulge w/mild right neural stenosis. L4-5 has broad based disc bulge w/major facet degeneration. L5-S1 has moderate bilateral neural stenosis w/mild facet degeneration. I don't understand all of that, but it sure does HURT!!
In October of 2000, I was told "it" was inoperable. I was 30yrs old & told my back looked like a was retired construction worker, like a 60yr old. I was asked if I rode horses due to the squashed disc damage. asked if I raced dirt bikes, anything to explain the damage, other then squating, leaning, pulling & lifting..pop... then 3 days later.. YIKES, spasms, phone call to mom, crawling... crawling... almost there... out the door & to the emergency room. UGH! In October of 2000, i was put on the same 4 drugs i take now:
oxycontin 40mg 5TID
oxycontin 80mg for breakthru pain.
neurontin 400mg 3-3TID
methocarbomol 500mg 1-4TID (now just as needed)
zanaflex 4mg 2-4TID
ADDED AS OF 3/22:
paxil 20mg 1 tab in morning
klonodin 1mg 1/2 tab twice dailyThe Oxy was started out at 2/day and tapered up, but the others 3 were and have been the same. October 2005, I ask to speak with surgeons again, they have cadavers disc, they insert the little balloons to inflate discs, they have the med pump similar to that of a cancer/hospice patient with morphine (i believe jerry lewis promotes or sponsors it) anyways in October 2005, my back went out & I called for some 80's for breakthru pain & told that my pcp didn't feel comfortable writing the script, he felt he would be medicating my depression & not my back pain. (yet he neglected to write out an AD) And sent me to 'comprehensive pain clinic' to meet with anesthesiologist, physical therapist & a psycologist. once again told inoperable. was taught deep diagrammatic breathing (my 1st injury was in 1989, I have been taught this millions of times in the past..) I have a tens unit that I use religously. I have self medicated with marijuana sine 2001, when my partner of 7yrs OD'd on my oxycontin & alcohol, i know how bad it is. i know I am now physically, mentally, emtionally & socially addicted to this medicine. but yet without it, I cannot walk, i can't stand up straight anyways, i have 2 self made curvatures in my spine & due to my limp(almost gone) & i have lost almost an entire inch on my right leg. Eww, close your eyes & picture me... That's Mrs. Hunchback to you.
I may have PTSD, SADD or GAD with no DAD and whatever acronym they are throwing out. in 2001 after the suicide/accidential overdose, I tried some SSRI's & some not SSRI's (I don't know all of the ATC's & stuff) so lemme just name them. prozax, zoloft, paxil, effexor, celexa, LEXAPRO (can you say Zombie?!?!), remeron, and trazadone. needless to say, I did't continue with the AD's and started to self-medicate with Marijuana. I don't drink due to the Oxy. quit smoking cigs in aug '05 and quit smoking pot jan'06, so there is some anxiety from that. but HOLY SCHNIKES!! wow, i get sooo angry now, just firey-mad, throw things. yell, scream, i do this really good evil eagle eye, the one the old gives you when your a kid & go into the candy store. i cry. ALOT; like at hollywood video, albertsons, stop lights, the freeway, the highway. so i was referred to this psycologist who tells me last week that her & her boss think that i am HYPERALGIES (sp). My problem is, that she is not going to give me anything for the pain during the down time. in january i just tapererd down to 2 oxy's while taking 14 - 10mg methadone. got a allergic reaction to it & they had given me .3mg clonidine for the opioid withdrawals. NOW i am having to taper down to 2 oxycontin AGAIN, but with nothing to replacement it for pain management. i know this was long, i apologize about it's length.MY QUESTIONS:
1) approx how long does Paxil 20mg take to get into the system? was told 2wks for 1st ffects then abt 4wks for full effects. (i am 35yr old female, 5ft8in abt165lbs-if it matters)
2) i had 2 panic/anxiety attacks the first night & took 1/2 my little yellow klonopin and waited & waited so my 70yr old mother, who lives over in beaverton called the tualatin valley crisis center line to ask what to do.... i don't think 1/2 of a 1mg tablet twice daily is enough. i am having these things/attacks/episodes between 4-7 times a day. worse when the phone or doorbell rings. TERRIBLE when i have to go out somewhere. (there are many triggers from my ex who OD'd, she was very abusive both physcally, mentally & emotionally)
3) any suggestions for switch up on meds? in january it was either methadone, MScontin or duragesic patches (not the fentanyl ones) for pain, but nothing was talked about with the neurontin or the zanaflex and they just droppped the methocarbomol like nothing..
4) does anyone have any information regarding this condition "hyperanagesia" the psych couldn't pronounce it & my pcp never even mentioned that.... HELP please.
5) what about Dilaudid for breakthru since he won't give me the green 80's? (he said no way to the dilaudid, too addictive)he gave me celebrex (bloody bowels is not for me sweetie) and then called in Dolobid, which did nothing to touch my pain.
i feel like i need to jump outta my skin. 'cept i finaly took a full 1mg klonopin (first time w/whole pill whoopie - i know) and i felt so serene and peaceful. just typing away. not even caring that my left lower back is on fire, just typing. never able to sleep. any suggestions would be great. i will also post in other folder about mental issues.~mopeck head check~
update: 4/9/06
pain doctor decided that the psychologist wasn't right & am searching for "psychiatrist" who can prescribe meds. my main pcp accused me of taking the klonopins wrong AGAIN. rolling his chair over and saying 'we talked about you taking your meds THE CORRECT WAY' and then mom handed the bottle & he counted them, they were correct. he then handed the bottle & a new script to me. but no apology. i see the pain doctor again tomorrow morning. hopefully they aren't taking me down to 4 oxy this month then 3 and so on.. i really don't know what i would do. and my PCP also said HE WOULD NOT give me Xanax & klonopin @ the same time; his comment was that he would let the psychiatrist give out the xanax or any other anti-anxiety meds. so i started smoking again last week, right after my girlfriend of 3.5yrs decided that "this was just too much for her". so YES i need something for my anxieties. it really sucks with my insurance, but i have 50 visits, and pay the 20% they don't pay. we'll see tomorrow. first posted to newbies. sorry.
Posted by Caedmon on April 10, 2006, at 1:28:09
In reply to Scared about pending diagosis', posted by mopeck on April 9, 2006, at 23:13:15
Wow! You may not realize it but I found your post very engaging! <--- I am a nerd.
I don't know anything about the actual back physiology and only a little about pain management. The pain management clinic sounds like a good idea though I don't see why they would put you on less meds if you're in pain.
I read someplace that benzos are contraindicated in chronic pain. It's a sentiment that makes no sense to me, but I have heard that from doctors. It sounds like you just need more Klonopin. Dosing for panic disorder goes up to 4 mg, and that's a lot more than what you're on.
I'm not sure what hyperalgies is.
> MY QUESTIONS:
> 1) approx how long does Paxil 20mg take to get into the system? was told 2wks for 1st ffects then abt 4wks for full effects. (i am 35yr old female, 5ft8in abt165lbs-if it matters)Yes, that's about right.
> 2) i had 2 panic/anxiety attacks the first night & took 1/2 my little yellow klonopin and waited & waited so my 70yr old mother, who lives over in beaverton called the tualatin valley crisis center line to ask what to do.... i don't think 1/2 of a 1mg tablet twice daily is enough. i am having these things/attacks/episodes between 4-7 times a day. worse when the phone or doorbell rings. TERRIBLE when i have to go out somewhere. (there are many triggers from my ex who OD'd, she was very abusive both physcally, mentally & emotionally)>
Yes, I'd say it's not enough either. You may just need more. It can't hurt to ask.
> 3) any suggestions for switch up on meds? in january it was either methadone, MScontin or duragesic patches (not the fentanyl ones) for pain, but nothing was talked about with the neurontin or the zanaflex and they just droppped the methocarbomol like nothing..>
I doubt more neurontin will do a heck of a lot and I don't know about the muscle relaxants. Benzodiazepines like Klonopin can have muscle relaxant properties as well.
I don't understand why the switch from oxycodone to MScontin, which contains morphine. I would think that's more "controversial", if anything.
Maybe you should ask about tramadol? It has some opioid elements, good for certain chronic pain states, and it has some antidepressant activity too (acting on serotonin and norepinephrine).
> 5) what about Dilaudid for breakthru since he won't give me the green 80's? (he said no way to the dilaudid, too addictive)he gave me celebrex (bloody bowels is not for me sweetie) and then called in Dolobid, which did nothing to touch my pain. >
I wouldn't expect dolobid or celebrex to do a ton, they are only NSAIDs after all. Sorry they aren't giving you the pain meds you need. Maybe you should do a few complementary lumbar punctures on your docs, see how they like it. :b
Er, my two cents.
- C
Posted by med_empowered on April 10, 2006, at 1:52:11
In reply to Re: Scared about pending diagosis', posted by Caedmon on April 10, 2006, at 1:28:09
sorry about your situation. As I see it, you have 2 big problems: you're not being adequately treated for pain and you're being more or less un-treated for your anxiety problems.
I don't know about benzos+pain killers--I don't see why it would be such a big deal, but you should ask a doc, I guess. Like the previous poster said, Klonopin dosages can get much higher than you're on--4 to 8mgs/day is workable (ideally, though, you should try for 1-3).
I've had docs accuse me of "misusing" meds with no actual proof before. Its kind of ridiculous, isn't it? My advice would be to no longer see that doc--you don't pay him to make accusations; his job is to treat your problems--period.
I think you may find that with better pain management your anxiety goes away, at least somewhat. What a lot of docs seem to ignore is that long-term opiate use really isn't all that big a deal; as long as the patient is kept comfortable, very few will abuse/misuse their meds, and very few actually develop any sort of drug "problem". The same goes for benzos, too, although some shrinks seem convinced that every patient they put on benzos is going to start popping pills Courtney Love style.
In my experiences with docs, it pays to be assertive. I mean, it sucks, because your life is already difficult and they really **should** just do their best for you w/o prodding, but alot of them need to know that you mean business--its like dealing with a playground bully. So, just be up-front: look, I have severe pain, severe anxiety, and I need you to do your job and make this better. I do not abuse meds, I will not abuse meds, and I demand that you give me the high-quality care I am entitled to.
I'm not saying you should push a doc for higher doses of whatever--it is their decision--but I **AM** saying that you and every other patient out there deserves the **BEST** care available, and you should make this clear to your doc. If your doc is unable or unwilling to improve your quality of life, then get a new one.
Good luck!
Posted by Declan on April 10, 2006, at 5:07:47
In reply to Scared about pending diagosis', posted by mopeck on April 9, 2006, at 23:13:15
There's a lot of stuff in your post. I had a disc out (L4/5) because it was ruptured. Nothing works for nerve root pain, but opiates do for a while. If you have to do with a tens machine it might be worth, strictly in the long term, to think about where you can get *therapeutic* Pilates. I think it's great, but there are no guarantees. I found back pain depressing in itself. It felt like my life was always going to be like this. Dilaudid sounds like the shot (for everything while it works). I would imagine that you need pain relief and freedom from further drug problems, but.....hmmmm..... All the best though,
Declan
Posted by bassman on April 10, 2006, at 6:01:56
In reply to Re: Scared about pending diagosis', posted by Caedmon on April 10, 2006, at 1:28:09
Tramadol and Paxil interact; be careful. As was mentioned, chronic pain in itself is depressing. With all the meds you may need, it really does sound like you need a really bright pain clinic that is also knowlegable about depression/anxiety management. Too bad about the AD's; many people seem to think they are very helpful for chronic pain, by some unknown (at least to me) mechanism. Is the klonopin really yellow? Maybe check and seee if it is really a 1 mg tablet. Also, some people (like myself) find klonopin depressing, so maybe be aware of that.
Best of luck-I think you need some really good docs and to research your problem yourself so you feel comfortable with your treatment.
Posted by Phillipa on April 10, 2006, at 20:09:45
In reply to Re: Scared about pending diagosis', posted by bassman on April 10, 2006, at 6:01:56
I hate to say this but today I saw a neurosurgeon for discs and narrowing of the spinal column and loss of feeling in my right arm at times and back pain. Well I was informed that now they only use pain meds for a short period of time after surgery and wean you off then pt and other non medication interventions. Goggle www.carolinaneurosurgery.com. I think you will be as surprised as I was at the lack of meds being used due to "addiction". Love Phillipa
Posted by Phillipa on April 10, 2006, at 20:15:23
In reply to Re: Scared about pending diagosis', posted by Phillipa on April 10, 2006, at 20:09:45
Same website but easier to remember www.cnsa.com. Love Phillipa
Posted by bimini on April 12, 2006, at 16:02:32
In reply to Scared about pending diagosis', posted by mopeck on April 9, 2006, at 23:13:15
Pain is a debilitating condition. If ignored the pain takes on a life of its own, pain sucks the energy out of you. Pain can lower your immune system and cause more problems.
Hyperalgesia is pain from inflamed tissue. Have you tried z-joint blocks?
How about activity? When you are more active it is ok for while then knocks you flat for days.. kind of thing? Does the pain refer to other places, like into arms and legs. Does TENS, heat and watermassage help?
Have you had specialized training from a physical therapist? He can show you how to stretch and strengthen the muscles surrounding the spine. Has anyone mentioned fusion?
bimini
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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