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What exactly should I tell my doctor?
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Anhedonist posted:
Hi, I wanted some advice on how and exactly what I should tell my Dr. when I see him for my following appointment. I'm 19YO and I have Spinal Stenosis, Spinal Lesions and a herniated L3. It's getting worse and the Hydrocodone 10mg/325 + Gabapentin 300mg doing as much anymore. I'm going to physical therapy and I'm icing the hell out of my back but my legs and butt feel numb/hurt at the same time. The butt thing is new.
I'm also having more frequent panic attacks that make it extremely difficult to leave my house. And last night I couldn't maintain an erection during sex and I blame my spinal nerves. What I'm asking is how exactly do I tell my Doctor this? I mean, wouldn't it seem really strange to ask for a stronger opiate, a benzodiazepine (Clonazepam was the one that had this under control) and Viagra? Should what I have be under control with just Norco? What can I tell my Doctor?
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annette030 responded:
Everyone is different, so no two people will necessarily respond the same to medicines. I believe the best thing it to just be honest with your doctor. Tell him everything that is going on with you and really listento his recommendations.

Many things can cause problems with erections, and often it is just part of being a man. No man your age really believes that losing an erection happens to all men as some time, but it does. Losing an erection one time does not mean it is due to your spinal nerves so don't worry about that until it is time. As my mom said, "Don't cross that bridge until you come to it." Could it be a spinal nerve problem, maybe so, it could also be due to diabetes, medicines, and many other things.

No one should just take Viagra, you should see a urologist and find out if and why there is a problem, then they can treat it the right way for you.

Doctors and nurses have heard it all, you can't say anything that will shock them. You will be far more embarrassed than they will be, your doctor should make it easier for you once he understands what you are getting at.

Talk to your doctor about all this, it will be fine.

Take care, Annette
 
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Anhedonist replied to annette030's response:
Thank you, Annette for replying. Your Urologist comment made a lot of sense, and so.. wait, should I even tell my doctor about the potential ED? It hasn't happened before and I don't have diabetes. The only drugs I take are the aforementioned ones.

And as for the not shocking professionals... I have a NOS Personality Disorder and well, technically I can't feel shame and I'm not too sure if I have a conscience & I haven't told my doctor but if I did he might think I'm anti-social... and will think I want drugs but all I want is to be like you.. a normal human person who doesn't have panic attacks just about every time they go out and who can bend down without feeling like they will break in half, you know?

P.S. Should I tell my doctor a recommendation for Oxycontin or will he be insulted?
 
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annette030 replied to Anhedonist's response:
I would just tell your doctor what symptoms you are having and how your present meds are working. Tell him about the episode where you lost your erection, but don't jump to conclusions about ED. Ask him if he feels you need to see a urologist. He may ask you a lot of questions about sexual function. You probably do not have ED. Wait and see if it happens again and again.

If you are a smoker, you should quit. Smoking can effect erectile function.

I would not ask for a specific opiate. I would just tell him how you are doing (not well), and that you believe something stronger might help you.

I am not a strong believer in Oxycontin specifically. It is only available in brand name form and is pretty expensive. There are other long acting opiates that are available in generic that would be cheaper and probably work just as well. I have been on opiates daily for about 15 years, and do quite well on generic pain meds.

I think your doctor probably knows best what to try you on.

Take care, Annette
 
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Anhedonist replied to annette030's response:
Yeah you're absolutely right. I'm still fearing however that because of my age, my Doc might not want to give me anything stronger - which is unfair because I'm not even a full adult yet and everyday I wake up in pain. I have two more questions though, if you don't mind answering.

1. Is my pain even bad enough to be on this board? I qualify as a chronic pain sufferer right?
And
2. Which analgesics are you talking about?

P.S I don't smoke.
 
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nowthis responded:
Anhedonist,

Wow, im really sorry your going through everything you are. It sucks to be in so much pain at a young age, i know as well since i have been dealing with pain for the last 10 or 11 years, mine started around 14/15.

You should do just what you said, tell him exactly whats going on, this will help him in determining exactly what he/she needs to do for you. It's not uncommon for meds to lose their effectivenes, it's called Tolerance and it happens to most everyone, and doctors know this.

Just describe how its effecting your life. That is the best way. Don't go in & say, this isnt working i need something stronger, that doesnt usualy sit well with doctors as they may think you just want stronger meds.

Have you discussed with your doctor about adding a Extended Release med to your current regime? That may be just what you need to get you on track.

The erection problem is a problem that a lot of men have when taking pain meds, unfortunately its just something you will probably have to mostly deal with, but it's important to tell him as it may be a new symptom instead of just a side effect especially since you say your butt has become numb as that sounds to me to be something to do with a nerve with your herniated disc.

Hope you have good luck talking with your doctor & getting what you need to get your pain under control.

Johnathan
 
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annette030 replied to Anhedonist's response:
Anyone who has pain or even deals with someone who is in pain "qualifies" to be here, in fact anyone can post here.

Most places chronic pain is defined as pain that has lasted at least three months, some places say six months.

Glad to hear you don't smoke, that is a nasty habit that does bad things to so many parts of our bodies.

I have taken long acting morphine, then methadone, and hydrocodone/APAP and oxycodone/APAP for breakthrough pain. But there are lots of different kinds of opiates available, just discuss that with your doctor when the time comes.

I agree that especially because of your young age, as with everyone of any age, you should try all other available meds before you decide to go on long term opiates. They are not meds to be taken lightly, but they do work for many people, including me. They do have some side effects, but they vary for everyone.

Take care, Annette
 
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David Maine, MD responded:
If your pain is secondary to true spinal stenosis then you may need to consider definitive treatment options with your doctor. Going up on your opioid or/and adding a benzodiazepine may not be the best choice. Your anxiety is a separate issue that should be addressed as such particularly if that is preventing you from leaving the house, My advice to you is be honest about your concerns and listen to your doctors thoughts on management options. Good luck
 
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Anhedonist replied to David Maine, MD's response:
Thank you all, everything seems to be going better now. My pain is not completely under control yet, but my PM Dr is a cool young guy who understands and I like him. I got my first Triamcinolone Epidural and he saw firsthand just how panicky I can really get. As of now, my treatment plan consists of Neurontin 400mg, Methadone 5mg and Percocet 5mg for breakthrough. This was better than the last treatment but it's still not honestly full pain management yet. He said if it doesn't work then we're trying out MS Contin.

I want to tell him that because I'm still not in control of my pain, I'm starting to become mean and I lashed out at my gf yesterday. I don't think Percocet is doing the best it can with breakthrough pain. I hope I get something just a little bit stronger than Percocet, maybe like Roxicodone or maybe just up the dose to 7.5 or 10mg of the Percocet like he wanted to at first but I was scared.

I'm so glad I'm not easily sedated because I got a stronger dose of Klonopin and I also had Valium 10mg for the Epidural and I wasn't sleepy. In fact I was sociable and terror-free, the same happens when I get Morphine injections at the ER. I'm assuming it's because I'm young, right? Or am I just lucky?
 
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annette030 replied to Anhedonist's response:
Oxycodone is the opiate in percocet and roxicodone both. It really does not matter which formula you opt to use, it is the dose that matters.

I personally have mixed feelings about using any benzo along with any opiate. I don't think it is a good idea as an ongoing treatment plan. That is my personal opinion. It is one thing getting an injection of valium or versed for a procedure, another thing altogether when you take something on a daily basis.

That is between you and your doctor.

I am a bit confused by your comment at the beginning of the last paragraph of your post, "I'm so glad I'm not easily sedated because I got a stronger dose of Klonopin....." I personally think the smaller dose you can use of any drug (and still get effective treatment) the better.

The point of giving valium before an epidural is to take away the anxiety, so I am glad they got that right for you.

I am glad you have found a doctor that you feel comfortable with, I hope you have a long and fruitful relationship.

Take care, Annette
 
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Anhedonist replied to annette030's response:
I meant that I've noticed I get a "Paradoxical Stimulation" from benzos and that's why it kicks the crap out of my Social Anxiety, GAD and Panic Dis and makes me a bit chatty. I get the Klonopin fro Panic Dis and Valium rarely for the Epis. And thanks for your comment, it was nice. I hope.. it's fruitful too.
 
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annette030 replied to Anhedonist's response:
Well, hang in there, and see what happens with your new doctor, hopefully, things will go well and you will gradually feel better.

Take care, Annette
 
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Anhedonist replied to annette030's response:
They better, I'm seeing him later today for a quick visit for my Methadone Rx. It kinda bothers though how he has my chart and he can see that I'm opioid tolerant and yet he gives me stuff that I know won't control my pain like 5 little milligrams of Percocet and Methadone. Are you serious?
I took Hydrocodone 20mgs, sometimes 30 for a year give or take. That must be why the Percs & Meths aren't working too well right?
 
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annette030 replied to Anhedonist's response:
The number of milligrams in each pill is not an indication of the comparison of strength between two different meds. The oxycodone in percocet is stronger mg. for mg. than the hydrocodone in other meds.

Methadone is generally used as a long acting opioid on a set schedule, and is completely different from hydrocodone or oxycodone. In my experience methadone is usually started out at 5 mg. per dose for chronic pain, it is then titrated as needed.

Maybe your visits are too quick? Do you have time to explain to him just how you are feeling? It sounds like you are using two different meds now, the methadone and the percocet?

Did the doctor you went to before prescribe hydrocodone 20-30 mg. at a time? Or is that just how you decided to take it?

Take care, Annette
 
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Anhedonist replied to annette030's response:
My visits seems a bit quick, yeah. But the good news he delivered last visit is that if the upgrade in current meds: Methadone 10mg 2x daily
Percocet 7.5mg/325mg every 8hrs
doesn't prevent & control the constant back/legs pain then we're going with
Roxicodone (unknown mgs, unknown x a day)
MS Contin or Dilaudid (unknown mgs, unknown x a day). And I didn'teven ask for the Hydromorphone. I think he was okay with Oxy w/o APAP & a stronger non MU receptor opioid/opiate after I showed him the film report of my back.
On the brightside, I finally become a real boy, well a non constant douche because I'm in unmanaged pain boy. The half empty side is .. well damn, I guess it's that bad. The Ortho also said surgery is a definite option but I'm too afraid. He said it's a last resort. I agree.

My reg MD just prescribed Norco 10/325mgs after also seeing my MRI XRAY film report. He told me to take one every 8 hrs if I remember correctly. Sometimes, honestly I would take a 4th because I couldn't sleep and going to the ER for Morpine, well I went so often they recognized me. Besides, I could of done without the Panic Attacks (I get them usually at ERs).
I'm just being honest with you guys. If you guys ever suffered through Panic Dis GAD AND Social Anxiety w/Agoraphobia you would understand. Now the Klonopin I'm taking is doing an 80% job at kicking the crap out of those 3 disorders. The Valium adds the extra 20% PLUS muscle pain relief and relaxation that Robaxin or Flexeril and even Soma couldn't touch.


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