Is there a doctor in the house? non emergency

[pmajka]

Man i am fuming!

My wife has been in one sort of pain or another since a car accident (2yrs ago) .

Bulging and/or herniated discs in neck and back. Seemed to be under controll (ie less pain). 2 Months ago, she had such a pain, she went to ER thinking here kidney blew up (previous personal and family history of kidney problems/failure ). Kidney was fine, Probley radiculopathy, (confirmed shortly after) ER doctor put here on Diclofenac for 2 weeks and Oxycontin (spelling).

THen the family Quack puts her on soma for 2 weeks, this didnt help (DUH!). Then on Perks, this doesnt help (DUH!) but makes her not care bout the pain. Another unrelated trip to ER for 4 day migrane compounded by Sinus infection (previous history of both migrane and Sinus infection X 24 years).

So now Family doctor says , "Golly, nothing seems to help, you need shots in your Discs to get the inflamtion down.

HOLD THE PHONE HERE! I just found out the details of her Prescriptons this morning. She hasnt been treated for the problem for 6 weeks!!!!!!!!!!! All she has been given 3 Narcotics and 1 non narcotic pain reliever.

The cocktail (naprosyn and tylenol) dont work for her, we know this.

But, What other Antiinflamatory should she have been put on?? she needs at least a 4 week treatment. ( i should know, i have 2 discs herniated too and that is what my doctor always did for me)

[Tobra]

If she had injury several years ago, and has had recently increasing symptoms, she should probably have a repeat MRI done. This should be compared to previous studies.

Radiculopathy is pain secondary to nerve injury. The nerve is compressed by the disc against the vertebra, the somawas to treat the muscle spasm you get secondary to the muscle trying to reduce pressure on the nerve. The idea with the epidural steroid injection(Shot in the back) is to reduce the inflammation and swelling. Ibuprofen 800 mg 3x daily or Naprosyn(alleve 440mg) 500 mg twice daily, of course with food. Does not really sound too quacky so far to me.

How long did she continue physical therapy following the initial injury?

[pmajka]

A comparative Mri was done, mmm, 7 weeks ago. Show ing new injury not caused by car accident. PT lasted 3 months, although 2 years ago.

point is the doctor didnt prescibe anything but Narcs for the last 6 weeks. No antiinflamatories for the disc issue!

How long would she need to take

Ibuprofen 800 mg 3x daily or Naprosyn(alleve 440mg) 500 mg twice daily, of course with food

, for?

[madmmac]

Celebrex was the only thing that worked for my blown and herniated discs.

[gchappel]

It certainly sounds like you don't think much of her present physician-"THen the family Quack." She has seen several ER doctors and her family doctor and it sounds like you dissapprove of all of them.
There are several different approaches to back pain treatment, and it is often not a simple cut and dry approach, as you seem to assume. Some doctors use nsaids alot for back pain, some do not. Some use narcotics, some use PT, some use surgery. Which one of these approaches is appropriate in this case cannot be determined without imaging and examination.
These are not questions that can or should be answered on line without seeing the patient.
Many medical problems, such as back pain, are complex and often may not be cured even by the best, but if cure is not rapid many patients assume their doctor is a moron and somehow screwed up. I doubt if all the physicians in her area are quacks.
Ask her present physican to explain the rational for his treatment, and if you don't agree you certainly have the right for another opinion.
gary

[pmajka]

Gary, I agree with much of your post, and I dont think all doctors are Quacks. I come from a Medical family, I even dropped out of Med school. I have faith in the advice of my family and my previous Family doctor, (who my dad does work for). My wife chose her new Family practioner, cause he is a 3 Wood drive up the fairway.

My wifes doctor, having skipped NSAIDs and going straigt to injections has my nickers in a twist.

Only the ER doc gave her any kind of NSAID.

[Noah930]

I don't treat back pain, but it sounds like this is a chronic problem, if it's been going on for 2 years. Hence, if it hasn't been solved in 2 years, you know it's not going to be an easy fix, regardless of who you see now. For one thing, narcotics (like percocet and oxycontin) are (in general) bad ideas; tolerance and addiction are real issues in chronic pain issues. That being said, NSAIDS are worth a shot, if her stomach can tolerate them. Motrin/ibuprofen, naprosn, advil, aleve, celebrex, etc are all anti-inflammatories. Only one type should be taken at a time. Sometimes one type won't work, yet another drug in the same class will. Odd. Anecdotally, I'd have to say that Vioxx probably worked the best, though it's been pulled by the FDA as you probably know. You can try celebrex or mobic (same class as vioxx).

A muscle relaxant (like soma) can also be added on. Though, if it's not pain related to a muscle spasm, then that might not be of much benefit.

But if you would like someone more specialized in taking care of this sort of thing, you can try seeing a Pain Management specialist (essentially an anesthesiologist). He's the one who will be giving any injections, anyway. Not that that's the only thing they do--they'll have a lot of phamacologic therapies, too. Definitely worth going to see, if you're not happy with your PCP's management of the issue.

[Joeaksa]

Originally posted by madmmac
Celebrex was the only thing that worked for my blown and herniated discs.

Celebrex has saved my life the last 10 years! Totally agree and would recommend it for anyone with neck/back issues.

Have been with Doctors who use the "painkiller treatment" and it has never worked with me. Celebrex started working in 12 hours... It reduces the imflamation in the area, which kills the pain.

[pmajka]

is celebrex by prescription only?

[dhoward]

Agree with Noah. Find a pain management specialist. Then find a neurologist specializing in lower back. He will also tell you where to get good images. Very important. Don't screw around with a PCP, you're well beyond his capabilities. I know very well.
My wife had L5-S1 fusion in 2000. It failed to produce the desired results, and has been hell for the past 6 years. In fact, she ended up at the track hospital in Indy this weekend, due to back issues while we were at the race.

[madmmac]

Yes, Celebrex is by prescription only.

I had tried many of the others including Vioxx and for me they did not work at all.

When I used Celebrex I felt like a teenager. No knee, shoulder, back or neck pain. I only took it as long as I needed it, about 3 months and then quit. Have not needed it since the pain has subsided.

Good luck,

[Joeaksa]

Originally posted by pmajka
is celebrex by prescription only?

Yes but its well worth a try. Ask the doctor if you can get a sample or try 3-4 pills. Try to get the 200 mg, which is 24 hour dosage. I take one at night and am good for 24 hours.

If I do not take one the next day I am stiff by the afternoon, and the second day my neck is pretty well locked up. I can move it but only with fair pain and its not fun. With the celebrex I have no issues what so ever and its even allowed for me to take while flying, and the FAA is very difficult with medication and pilots.

Joe

[Nathans_Dad]

It's difficult to judge treatment on a patient you haven't seen, but I would be a little more cautious before you pass judgement on the "quack".

I treat back pain all the time and while I do use NSAIDS for acute flares, tylenol is the mainstay of most chronic back pain. Back issues that have been present for 2 years are not likely to have a huge inflammatory component to them simply because they are chronic. Of course there is SOME inflammation, just not as much as back pain from an acute spasm or wrenched back.

Narcotics are commonly used in treating back pain, I am a little more conservative than most when it comes to narcs in back pain, simply because the pain is usually chronic and that then dictates chronic narc use, which of course can lead to dependence. I don't like to open that Pandora's Box if I don't have to.

I actually sounds like your wife received pretty good care, she has had a recent MRI to evaluate the new radicular pain (which can be a sign of early nerve compromise and might require surgery depending on what the MRI looks like). Injection therapy has also worked well for me in the past, often it works when everything else doesn't.

One small caveat about Celebrex. I personally try to stay away from the COX-2 inhibitors if I can due to the possibility of increased cardiovascular event risk. Vioxx was already pulled from the market for this and Celebrex was allowed to stay on with a warning on the label. I wouldn't be surprised if Celebrex fades away in the future due to these concerns. Mobic is a good choice if used at the lower dose, 7.5 mg per day. At this dose it acts like a COX-2 but without the CV risk. At the 15 mg dose it pretty much acts like the other NSAIDS as far as side effects goes. If your wife is going to be on chronic NSAID therapy her doctor might consider putting her on a proton pump inhibitor to protect against damage to the stomach.

Anyhow, I'm not trying to change your opinion of the situation, I'm just saying that there really isn't anything "quacky" about how your wife has been treated. I'm sure the doc is trying his best to get your wife some relief. Chronic back pain is one of the most difficult conditions to treat sucessfully. Consider cutting him some slack.

[dhoward]

Just remember, 50% of the doctors finished in the bottom half of their class...

[pmajka]

Just remember, 50% of the doctors finished in the bottom half of their class...

In regards to the guy who finished at the bottom of his class: Someone has an appointment with him tommorow.

[dhoward]

[Nathans_Dad]

You know what they call the guy who finishes last in his class in medical school??

Doctor.

[Moses]

Originally posted by dhoward
Just remember, 50% of the doctors finished in the bottom half of their class...

How about law school? I think you can get into law school with just a pulse and a check book.

[artplumber]

Originally posted by dhoward
Agree with Noah. Find a pain management specialist. Then find a neurologist specializing in lower back. He will also tell you where to get good images. Very important. Don't screw around with a PCP, you're well beyond his capabilities. I know very well.
My wife had L5-S1 fusion in 2000. It failed to produce the desired results, and has been hell for the past 6 years. In fact, she ended up at the track hospital in Indy this weekend, due to back issues while we were at the race.

Chronic pain is very difficult to deal with from both a physician and patient's standpoint. Unfortunately, there is no magic bullet, and drugs often come with significant side effects. For NSAIDS it's stomach and kidney, and now maybe heart, for opiates it's dependency, diminishing returns (yielding higher doses and constipation etc). Nonpharm means are preferred IMO.

D, unfortunately, back surgery also is not a silver bullet, look up the data, it's certainly not close to 100% success rate. I would seriously investigate other strategies eg/accupuncture, biofeedback etc. As one pain spec used to say, "pain is just a nerve impulse after all. Its purpose is to keep you from killing yourself, but it won't kill you." Kinda sounds harsh in one sense, but helps put it in perspective and keeps one from jumping on the "gimme a pill" bandwagon.

[M.D. Holloway]

Originally posted by Moses
How about law school? I think you can get into law school with just a pulse and a check book.

so true. It takes on the average 7 years after your Bach to get a PhD in eng or chem and they get paid on the average about 70K annual and with 20 yrs of experience they might crack a hundred. It doesn't seem right does it.