Follow up scheduled with Dr. Elborno for next Friday, 10/23/2009. Have to call and start the referral for it, it'll take them until next Thursday to do it.
I asked what I'll need to take with me to the neural surgeon, Dr. Salehi, next week and they said the images I have and the discography report. They said the report wasn't ready and that they would fax a copy to me and Dr. Salehi's office on Monday, 10/19/2009. They also said I should call them on the 20th and make sure it was faxed, even though they put a note somewhere for it.
I'll tell you what, you have to REALLY keep on doctor's offices to get things done. If you leave it up to them NOTHING would ever happen. I've been told by the nurse at Dr. Elborno's office that I'm the best HMO patient they have because I follow up and take care of the insurance part. It's not because I like it, it's because if you don't, you'll never get treated. That, and if I don't keep up on the referrals, I'd get stuck with THOUSANDS in medical bills. Insurance companies already look for any reason not to pay a claim, I don't need to help them out.
Here's one example, after many of the cervical epidural's I get a letter from our insurance company (Humana) asking me to call this number and answer questions about a claim. I call and what they want to know is if the neck problems are the result of an accident or are work related, I say no, it's degenerative disc disease. EVERY time the operator asks "what is that" and I explain it. One time, even after I explained it, the person asks again "is it the result of an accident"?... No, it DEGENERATIVE, it just HAPPENS! Almost every time I had a procedure, I'd get one of those letters. They wouldn't pay the claim until I called and answered. Wonder what would happen if I didn't call huh? Gee, let's just take a guess....
Friday, October 16, 2009
10/16/2009 - Discography done
Well, the discography is done. I took my book with me but only had a chance to read some in the waiting room, it went pretty fast. Other than me being used as a guinea pig for one of the nurses to learn how to do an IV, they were as efficient and professional as always.
Instead of lying on my front like I have for all of my previous procedures, such as epidurals and RF, I was on my back facing up. They placed a rolled up towel in the middle of my back which was a bit uncomfortable but not all that bad. They gave me the usual "mild" sedation and I remember having some sort of blue colored thing in front of my face so I couldn't see.
What I do remember is some painful periods with Dr. Elborno asking questions. I checked the clock before they took me into the procedure room and when I got out it was about 30 minutes later. I remember moving from the procedure table to a bed that was moved to a recovery room. They gave me some sort of pain killer in the IV which basically made me want to not move anywhere and quite dopey.
I was able to walk out this time, as opposed to after the RF when I went out in a wheelchair... I left with some 30mg and 60mg samples of Cymbalta along with a script for more of the 60mg ones. I wasn't sure why I had these because from I remember it's an anti-depression medication. Later in the day my wife read the information packet that came with it and it says it's also used to treat nerve pain. I also left with images from the fluoroscope to take with me to the neural surgeon, have to make sure that's all I need.
Well, after getting to the car at the hospital my wife drove me to get my usual beef/sausage combo sandwich from Portillo's and went home. After eating my wife said I looked tired and said I should go lay down. Well, I did and woke up later that evening at like 7:00. Not sure what they gave me, but whatever it was knocked me out.
Overall, the procedure isn't that bad, some pain here and there during it. One of the nurses told me that they used to do it with people awake and with no pain killers which would have been HORRIBLE. She also said some places still do it that way. Tell you what, if you're with a clinic that does it without sedation and pain killers, GO SOMEWHERE ELSE.
Instead of lying on my front like I have for all of my previous procedures, such as epidurals and RF, I was on my back facing up. They placed a rolled up towel in the middle of my back which was a bit uncomfortable but not all that bad. They gave me the usual "mild" sedation and I remember having some sort of blue colored thing in front of my face so I couldn't see.
What I do remember is some painful periods with Dr. Elborno asking questions. I checked the clock before they took me into the procedure room and when I got out it was about 30 minutes later. I remember moving from the procedure table to a bed that was moved to a recovery room. They gave me some sort of pain killer in the IV which basically made me want to not move anywhere and quite dopey.
I was able to walk out this time, as opposed to after the RF when I went out in a wheelchair... I left with some 30mg and 60mg samples of Cymbalta along with a script for more of the 60mg ones. I wasn't sure why I had these because from I remember it's an anti-depression medication. Later in the day my wife read the information packet that came with it and it says it's also used to treat nerve pain. I also left with images from the fluoroscope to take with me to the neural surgeon, have to make sure that's all I need.
Well, after getting to the car at the hospital my wife drove me to get my usual beef/sausage combo sandwich from Portillo's and went home. After eating my wife said I looked tired and said I should go lay down. Well, I did and woke up later that evening at like 7:00. Not sure what they gave me, but whatever it was knocked me out.
Overall, the procedure isn't that bad, some pain here and there during it. One of the nurses told me that they used to do it with people awake and with no pain killers which would have been HORRIBLE. She also said some places still do it that way. Tell you what, if you're with a clinic that does it without sedation and pain killers, GO SOMEWHERE ELSE.
10/14/2009 - Pain clinic called
Pain clinic called to confirm me getting to the hospital at 10:30 on 10/15 for the discography. Wife has to get the little one on and of the bus so she'll have to shuffle things around to get me back and forth (thanks honey).
Tuesday, October 13, 2009
10/13/2009 - Discography on for Thursday, 10/15/2009
Wife called and said she got a call from the pain clinic at the hospital that the discography is scheduled for 10:30 AM on Thursday, 10/15/2009. They gave the usual don't eat or drink 8 hours before, however, other people at the clinic have said don't eat for 8 hours but you can drink up to 2 hours before. Better safe than sorry though.
Every time I have gone there for a procedure I have a bunch of time waiting for things, waiting to get in, waiting for the IV, waiting for the procedure so this time I'm taking a book to read. I usually play solitaire or bubbles on my phone but that's getting old.
I'll post after the procedure is done to record how it went. I also made an appointment with the neural surgeon, Dr. Salehi, for next Tuesday, 10/20/2009 at 8:30. I'll go over the results from the discography and the MRI's and see what he wants to do.
On another note, the pain has dramatically increased again and the neuropathy (pins & needles) is back in my left hand. I used to be able to sleep on my right side and it would go away, however it's there either side I sleep on. Needless to say, I'm not getting much sleep lately even with all the medication.
Here's what I'm on now:
20mg Oxycontin (no generic), 2 times per day
10/250mg Hydrocodone/APAP (Norco), 2 tablets every 4-6 hours (as needed)
50mg Toprol (metroprolol), 1 tablet daily (this is from my previous high heart rate)
5mg Flexeril (Cyclobenzaprine), 1 tablet before bed
25mg Elavil (Amitriptyline), 1 tablet before bed (I take this an hour after the Flexeril)
100mg Neurontin (Gapapentin), 1 tablet with the Flexeril
He put me on the Oxycontin because the Opana ER wasn't helping. He also upped the Norco from 1 every 6 hours to 2 every 4-6 hours PRN. 1 just wasn't touching the pain any more. And to be honest, this regime is cutting the pain down maybe 50%. Going to have to talk to him about it next visit. What I've discovered during this is to tell your pain doc what works and tell them if it's not working.
Every time I have gone there for a procedure I have a bunch of time waiting for things, waiting to get in, waiting for the IV, waiting for the procedure so this time I'm taking a book to read. I usually play solitaire or bubbles on my phone but that's getting old.
I'll post after the procedure is done to record how it went. I also made an appointment with the neural surgeon, Dr. Salehi, for next Tuesday, 10/20/2009 at 8:30. I'll go over the results from the discography and the MRI's and see what he wants to do.
On another note, the pain has dramatically increased again and the neuropathy (pins & needles) is back in my left hand. I used to be able to sleep on my right side and it would go away, however it's there either side I sleep on. Needless to say, I'm not getting much sleep lately even with all the medication.
Here's what I'm on now:
20mg Oxycontin (no generic), 2 times per day
10/250mg Hydrocodone/APAP (Norco), 2 tablets every 4-6 hours (as needed)
50mg Toprol (metroprolol), 1 tablet daily (this is from my previous high heart rate)
5mg Flexeril (Cyclobenzaprine), 1 tablet before bed
25mg Elavil (Amitriptyline), 1 tablet before bed (I take this an hour after the Flexeril)
100mg Neurontin (Gapapentin), 1 tablet with the Flexeril
He put me on the Oxycontin because the Opana ER wasn't helping. He also upped the Norco from 1 every 6 hours to 2 every 4-6 hours PRN. 1 just wasn't touching the pain any more. And to be honest, this regime is cutting the pain down maybe 50%. Going to have to talk to him about it next visit. What I've discovered during this is to tell your pain doc what works and tell them if it's not working.
Monday, October 12, 2009
10/12/2009 - Discography a go!
Pain clinic called today and said the insurance company approved the discography. Said they might have a cancellation on Thursday and if not it'll be the next Monday (10/19).
Thursday, October 8, 2009
10/8/2009 - Discography cancelled
The pain clinic in the hospital usually calls the day before any procedures and gives me the usual "don't eat or drink for 8 hours, etc...". When I was driving home from work yesterday I asked my wife if they called the house because I didn't get a call from them and thought that was odd. So, I thought we would go to the hospital at 8:45, the time I as supposed to be there. Before I woke up my wife called the clinic and they said the procedure was canceled. For some reason, even though I had the referral from our IPA, the hospital called the insurance company to make sure the procedure was covered. Well, as it turns out, it's not. Dr. Elborno's main nurse, Lynn, said she's been on the phone with the IPA (Hinsdale Physician Healthcare or "HPH") and that it's with the insurance company for review.
Now, had the hospital not called and I had the procedure, who would have been responsible to payment? I would venture to say that the insurance company would have denied the claim and said I was responsible. Now, I have a referral from my primary care physician that is stamped "HPH Approved" so who dropped the ball? The primary care? The IPA (HPH)?
At any rate, the procedure wasn't done and I'm waiting for insurance approval. As a result the appointment with the neural surgeon has been canceled as well, no reason to go to him without the discography details.
I really want this procedure done to identify *which* disc is actually causing the pain. The MRI's show C5-C6 to be in the worst shape but the pain is much higher than that, more like C2/C3/C4. Dr. Elborno keeps asking where the pain is because where I point to isn't what shows up in the MRI. What I DON'T want to happen is have C5-C6 fused when that's not the source of the pain. Of course, I'm guessing the insurance company would pay for C5-C6 to be fused then go back and have another set fused right? And if they fuse the one that isn't causing the pain what then? Are they going to pay for the additional time off work to have the CORRECT one fused since they don't appear to want to pay for the discography? I doubt it. Sort of like them not paying for stop smoking options but are willing to pay for cancer treatment...
More to come later.
Now, had the hospital not called and I had the procedure, who would have been responsible to payment? I would venture to say that the insurance company would have denied the claim and said I was responsible. Now, I have a referral from my primary care physician that is stamped "HPH Approved" so who dropped the ball? The primary care? The IPA (HPH)?
At any rate, the procedure wasn't done and I'm waiting for insurance approval. As a result the appointment with the neural surgeon has been canceled as well, no reason to go to him without the discography details.
I really want this procedure done to identify *which* disc is actually causing the pain. The MRI's show C5-C6 to be in the worst shape but the pain is much higher than that, more like C2/C3/C4. Dr. Elborno keeps asking where the pain is because where I point to isn't what shows up in the MRI. What I DON'T want to happen is have C5-C6 fused when that's not the source of the pain. Of course, I'm guessing the insurance company would pay for C5-C6 to be fused then go back and have another set fused right? And if they fuse the one that isn't causing the pain what then? Are they going to pay for the additional time off work to have the CORRECT one fused since they don't appear to want to pay for the discography? I doubt it. Sort of like them not paying for stop smoking options but are willing to pay for cancer treatment...
More to come later.
Wednesday, October 7, 2009
10/7/2009 - Starting out
I'm starting this blog in the hopes that someone else might benefit from my experience. As I've searched for information on degenerative disc disease all I have found are dr.'s and other stuff, nothing from people.
First, a little background. In early spring 2008 I started having neck pain, I've been told that I've complained about it for longer than that, but spring 2008 is when I really remember it starting. I went that summer taking constant Ibuprofin, around 800mg at a time and it helped somewhat. By August 2008 it hit the point where it was starting to impact everything. So, I went to my "primary care" physican. He said it was probably me sleeping wrong, perhaps a new pillow would help. So, I went home, tried various things and nothing helped. My wife was lathering Tiger Balm on my neck every day and I was still taking Ibuprofin all the time.
In either September or October 2008 the pain was so bad my heart rate was elevated and I couldn't sleep so I took myself to the ER one night. They thought I had Meningitis and wanted to take a spinal tap, other than that option, they had no idea what was wrong. I refused the spinal tap since I had ONLY ONE of the symptoms of Meningitis (the neck pain) and left.
I went back to my doctor again and explained that it can't be "something from sleeping" as it's been going on for months. He prescribed a muscle relaxer, Norflex, and a steroid, Medrol Dose Pack, and sent me on my way. That helped a little, although the script was for a week's worth. After I stopped taking those the pain immediately returned. So, I called the doctor office and was told "he's not going to prescribe any more, it's strong medication". So, I went back to the Ibuprofin and suffered.
Now, at this same time I had a sinus infection which I didn't know if that was causing the neck pain. I was sent to an ENT who said the infection wasn't that bad and they don't cause neck pain. She said perhaps I have a problem with one of the disc's and should have it looked at. I called the night time number for the doctor and got someone *other* than mine. He said the sinus infection couldn't cause the neck pain and after me explaining what was gong on, he said I probably have something else going on.
The next day I made an appointment with that doctor since he seems more helpful. This was around Christmas 2008 and he prescribed the same muscle relaxer and some Vicodin. I have relief finally over Christmas but after I stopped taking those, the pain came back.
In January 2009 I went to see this second doctor again who I asked to write an order for an X-Ray. He agreed that it was warranted since the pain had been around for a while. I made the X-Ray appointment and had that done. When I followed up with the doctor about the results, he said there were signs of degenerative disc disease and ordered an MRI. By that time is was February and I had the MRI done. Same results, degenerative disc disease at which point he referred my to a neural surgeon. Dr Salehi. Finally, some progress!
So, my wife and I go off to the neural surgeon. He says it's bad enough that what he would do is a cervical disc fusion but to try non surgical options first. He referred me to the Midwest Academy of Pain and Spine, Dr. Elborno. I made an appointment with him and that's where those treatments started.
Dr. Elborno immediately started me on Norco, Elevil and Neurontin and I started getting some relief. I had 3 cervical epidurals done from February 2009 to early May 2009, none of which helped more than a few days. Oh, I forgot to mention that for the past several years I have suffered from "pins and needles" in my left hand, I had always assumed it's because I work on computers all day for a living and it was the start of carpal tunnel. What I didn't know what it's called "neuropathy" and is common with disc problems where the nerves in the neck are getting pinched.
In late May 2009 Dr. Elborno performed a cervical "Radio Frequency" (RF) procedure on my neck and after a week I was off the pain killers. I got maybe 4-6 weeks of relief from this, at least enough to take the pain down to a sort of manageable level. But by July the pain had returned. So, I went back to Dr. Elborno, he put me back on medication and performed 2 more cervical epidurals in July and August, neither of which helped. Dr. Elborno wrote an order for another MRI in August, which was 6 months after the first one, to see if anything had changed. I should note that I had a follow-up visit with my primary care physician after the second MRI and he basically said nothing has changed. My visit with Dr. Elborno regarding the second MRI had different results. He said it's slightly worse and that "he doesn't like my disc"... Funny doc, neither do I.
In August or September 2009 he put me on 10mg of Opana ER twice a day, Norco for the "break through" pain and Elavil and Flexeril later in the day and at night. By that point the Norco by itself was really just touching the pain and it only lasted a couple hours. The Opana was supposed to give more extended relief. So, I tried that up until late September when the pain increased exponentially. I went to see him and was changed from the Opana to Oxycontin and Norco, again for the "break through" pain. I'm still taking the Flexeril and Elavil at night which helps me sleep, well, most of the time.
So, now we're up to today. I have a cervical discography scheduled for tomorrow, October 8th 2009, and from what I understand this is going to "map out" where the source of the pain is. MRI's aren't detailed in what they can see but give a good general idea. The discography is performed under "waking sedation" and essentially he's going to stick a needle in the spine and see where I yell OUCH. When he finds those spots he will inject a dye into the area and use the fluoroscope to take detailed images of that area. I can then take the results of this to the neural surgeon, Dr. Salehi, who I have an appointment with next week (Tuesday, October 13th, 2009).
I've read mixed opinions on the discography, people that have had it done say it's painful, other doctors say it isn't. I'll post my experience here after it's done.
From my previous visit with the neural surgeon, and my conversations with Dr. Elborno, the only real option left is the cervical disc fusion (ACDF). The previous MRI's show one disc with "moderate to severe" protrusion, another one shows "moderate". So, one of the goals this week is to determine which one is causing the pain and if it's worth a multiple disc fusion while they have me opened up.
I have also read and been told differing information as to recovery time for the disc fusion. I'll have to go on short term disability (STD) at work for this, my question is how long we have to go with 80% of my paycheck. Of course, work also wants to know how long I'll be out, I guess I'll know more after the discography and follow-up with the neural surgeon.
More to come tomorrow after the procedure....
First, a little background. In early spring 2008 I started having neck pain, I've been told that I've complained about it for longer than that, but spring 2008 is when I really remember it starting. I went that summer taking constant Ibuprofin, around 800mg at a time and it helped somewhat. By August 2008 it hit the point where it was starting to impact everything. So, I went to my "primary care" physican. He said it was probably me sleeping wrong, perhaps a new pillow would help. So, I went home, tried various things and nothing helped. My wife was lathering Tiger Balm on my neck every day and I was still taking Ibuprofin all the time.
In either September or October 2008 the pain was so bad my heart rate was elevated and I couldn't sleep so I took myself to the ER one night. They thought I had Meningitis and wanted to take a spinal tap, other than that option, they had no idea what was wrong. I refused the spinal tap since I had ONLY ONE of the symptoms of Meningitis (the neck pain) and left.
I went back to my doctor again and explained that it can't be "something from sleeping" as it's been going on for months. He prescribed a muscle relaxer, Norflex, and a steroid, Medrol Dose Pack, and sent me on my way. That helped a little, although the script was for a week's worth. After I stopped taking those the pain immediately returned. So, I called the doctor office and was told "he's not going to prescribe any more, it's strong medication". So, I went back to the Ibuprofin and suffered.
Now, at this same time I had a sinus infection which I didn't know if that was causing the neck pain. I was sent to an ENT who said the infection wasn't that bad and they don't cause neck pain. She said perhaps I have a problem with one of the disc's and should have it looked at. I called the night time number for the doctor and got someone *other* than mine. He said the sinus infection couldn't cause the neck pain and after me explaining what was gong on, he said I probably have something else going on.
The next day I made an appointment with that doctor since he seems more helpful. This was around Christmas 2008 and he prescribed the same muscle relaxer and some Vicodin. I have relief finally over Christmas but after I stopped taking those, the pain came back.
In January 2009 I went to see this second doctor again who I asked to write an order for an X-Ray. He agreed that it was warranted since the pain had been around for a while. I made the X-Ray appointment and had that done. When I followed up with the doctor about the results, he said there were signs of degenerative disc disease and ordered an MRI. By that time is was February and I had the MRI done. Same results, degenerative disc disease at which point he referred my to a neural surgeon. Dr Salehi. Finally, some progress!
So, my wife and I go off to the neural surgeon. He says it's bad enough that what he would do is a cervical disc fusion but to try non surgical options first. He referred me to the Midwest Academy of Pain and Spine, Dr. Elborno. I made an appointment with him and that's where those treatments started.
Dr. Elborno immediately started me on Norco, Elevil and Neurontin and I started getting some relief. I had 3 cervical epidurals done from February 2009 to early May 2009, none of which helped more than a few days. Oh, I forgot to mention that for the past several years I have suffered from "pins and needles" in my left hand, I had always assumed it's because I work on computers all day for a living and it was the start of carpal tunnel. What I didn't know what it's called "neuropathy" and is common with disc problems where the nerves in the neck are getting pinched.
In late May 2009 Dr. Elborno performed a cervical "Radio Frequency" (RF) procedure on my neck and after a week I was off the pain killers. I got maybe 4-6 weeks of relief from this, at least enough to take the pain down to a sort of manageable level. But by July the pain had returned. So, I went back to Dr. Elborno, he put me back on medication and performed 2 more cervical epidurals in July and August, neither of which helped. Dr. Elborno wrote an order for another MRI in August, which was 6 months after the first one, to see if anything had changed. I should note that I had a follow-up visit with my primary care physician after the second MRI and he basically said nothing has changed. My visit with Dr. Elborno regarding the second MRI had different results. He said it's slightly worse and that "he doesn't like my disc"... Funny doc, neither do I.
In August or September 2009 he put me on 10mg of Opana ER twice a day, Norco for the "break through" pain and Elavil and Flexeril later in the day and at night. By that point the Norco by itself was really just touching the pain and it only lasted a couple hours. The Opana was supposed to give more extended relief. So, I tried that up until late September when the pain increased exponentially. I went to see him and was changed from the Opana to Oxycontin and Norco, again for the "break through" pain. I'm still taking the Flexeril and Elavil at night which helps me sleep, well, most of the time.
So, now we're up to today. I have a cervical discography scheduled for tomorrow, October 8th 2009, and from what I understand this is going to "map out" where the source of the pain is. MRI's aren't detailed in what they can see but give a good general idea. The discography is performed under "waking sedation" and essentially he's going to stick a needle in the spine and see where I yell OUCH. When he finds those spots he will inject a dye into the area and use the fluoroscope to take detailed images of that area. I can then take the results of this to the neural surgeon, Dr. Salehi, who I have an appointment with next week (Tuesday, October 13th, 2009).
I've read mixed opinions on the discography, people that have had it done say it's painful, other doctors say it isn't. I'll post my experience here after it's done.
From my previous visit with the neural surgeon, and my conversations with Dr. Elborno, the only real option left is the cervical disc fusion (ACDF). The previous MRI's show one disc with "moderate to severe" protrusion, another one shows "moderate". So, one of the goals this week is to determine which one is causing the pain and if it's worth a multiple disc fusion while they have me opened up.
I have also read and been told differing information as to recovery time for the disc fusion. I'll have to go on short term disability (STD) at work for this, my question is how long we have to go with 80% of my paycheck. Of course, work also wants to know how long I'll be out, I guess I'll know more after the discography and follow-up with the neural surgeon.
More to come tomorrow after the procedure....
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