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Pain Management?

 
Old 05-14-2019, 02:22 PM
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Originally Posted by vette6799 View Post
That sounds like my experience also. I had mine done in the afternoon and was home the next morning. It took me about three and half weeks until I was able to drive and I was walking without a walker or a cane at the five week point. I was doing three miles a day of walking at the 10 week mark.

But, not everyone has the same result and some require more time than others for recovery. These procedures typically have a fair amount of blood loss, in my case 1.2 liters and that can knock you a bit low for a while until your hemoglobin count starts rising.

Good luck.
I hope I can drive sooner. I've only arranged for 1 week vacation for this followed by one week work at home (because of the no driving thing). I hope I can drive in week 3.....I could last time..... But then again, last one was my left leg. Easier for driving (at least with an automatic). This is my right leg....much worse for driving. Hmmmm.....maybe I need to arrange another week now that I think about that....

The ONLY concern about this one is that it's side #2. Now I won't really be able to favor a side anymore. Both need to work very well for the foreseeable future. And I won't be easy on them. I intend to resume serious hiking by August (I hope). I didn't get to do as much as I wanted over this winter because of this. I'm missing spring now. And I sure as hell don't want to miss this summer too.

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Old 05-14-2019, 02:23 PM
  #22  
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I took opioid medication for 5 years (from 2009 to 2014). Me and my doctor mutually agreed in Dec 2014 not to prescribe me anymore after they changed Hydrocodone from a schedule 3 to a schedule 2 drug, making it more difficult to prescribe, and therefore making life harder for everyone. The withdrawals were unreal but worth it.

Bottom line is it's been so abused, mishandled, etc that those few (who abuse them, and sell them illegally) have screwed things up for those of us who had a legitimate need for it. Most doctors in Houston quit prescribing it for fear of getting raided and losing their license. Only pain management doctors are prescribing and even they are clamping down hard.

It's one of those 5% that screw things up for the other 95%.
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Old 05-14-2019, 02:26 PM
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Originally Posted by NY09C6 View Post
For that type of surgery you will get opioids. Just don’t expect a 30 day script with 3 refills.
You may get a prescription for a small amount of drugs but many people do not need them. I had my hip done at the University of Michigan. All hip replacement candidates were required to take about a three hour course that described what would happen before, during and after the surgery. We were told that more and more, particularly with the anterior approach, a significant number of patients did not require narcotics for pain relief. That was my situation. The pain level two hours after surgery was a fraction of what I had been living with for close to a year.
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Old 05-14-2019, 02:30 PM
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Originally Posted by X-ZZ4 View Post
I hope I can drive sooner. I've only arranged for 1 week vacation for this followed by one week work at home (because of the no driving thing). I hope I can drive in week 3.....I could last time..... But then again, last one was my left leg. Easier for driving (at least with an automatic). This is my right leg....much worse for driving. Hmmmm.....maybe I need to arrange another week now that I think about that....

The ONLY concern about this one is that it's side #2. Now I won't really be able to favor a side anymore. Both need to work very well for the foreseeable future. And I won't be easy on them. I intend to resume serious hiking by August (I hope). I didn't get to do as much as I wanted over this winter because of this. I'm missing spring now. And I sure as hell don't want to miss this summer too.
You have been through this before so you know what to expect. It took me longer than I thought it would to drive, but after that, things happened quickly. Let your body be your guide.

Do you have any problems with side #1?
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Old 05-14-2019, 02:33 PM
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I have chronic pain, but fortunately for me, it isn't that bad. Lumbar spine, disks, facet joints, SI joint, and both hips give me pain. So far, I've been able to manage it with lots of physical therapy, NSAIDs and a few epidural steroid injections. Never goes away though.

It will of course, continue to get worse as I get older. I will need hip replacements. No idea how the back will go with time. Degenerative disks are hard to predict.

Opioids (aka narcotics) don't really help reduce the underlying conditions. NSAIDs do, as do steroids by reducing inflammation. But narcotics can provide tremendous relief. I have a few norco left from wisdom tooth extraction. They're backup when nothing else will work.

The thing is I've seen this whole pendulum thing swinging back and forth on pain killers before. About 25+ years ago, medical practice was to greatly limit painkillers. Then they did some studies and found that outcomes were better with more aggressive pain management. Great. Then it went nuts and doctors were writing all kinds of scripts for powerful narcotics for things. Unscrupulous companies pushing them, unscrupulous pill-mill docs, lots of illegal diversion.

The deal with narcotics is they are very cheap to make, so the drug makers really like them, lots of profit. Insurance companies love opioids because they're cheaper than surgery, PT or other treatments If they can pacify the patient long enough with cheap dope, maybe they'll change plans, lose their jobs or become someone else's problem.

The bad part is, people who are legitimately suffering and have no other options, or need temporary relief while waiting for surgery or other intervention will not get them.
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Old 05-14-2019, 02:39 PM
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Originally Posted by vette6799 View Post
You have been through this before so you know what to expect. It took me longer than I thought it would to drive, but after that, things happened quickly. Let your body be your guide.

Do you have any problems with side #1?
Nothing significant at all. And I abuse the crap out of it.

This past summer I was putting in 15+ miles just about every other day on some pretty serious trails with elevation. I put in over 1000 miles in calendar year 2018 hiking. Never let me down. I would get some soreness at times.....but you'll get that in even a "normal" hip at my age with workouts like that.
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Old 05-14-2019, 02:42 PM
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Originally Posted by X-ZZ4 View Post
Nothing significant at all. And I abuse the crap out of it.

This past summer I was putting in 15+ miles just about every other day on some pretty serious trails with elevation. I put in over 1000 miles in calendar year 2018 hiking. Never let me down. I would get some soreness at times.....but you'll get that in even a "normal" hip at my age with workouts like that.
That's terrific. I'm really glad for you that you are able to do so much. I've done about eight miles a day of serious walking and that leaves me a bit sore. Later this summer, I plan to test my hip in the Rockies.

Hope your next procedure works out as well as your prior one did.
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Old 05-14-2019, 02:44 PM
  #28  
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Originally Posted by larrysb View Post
I have chronic pain, but fortunately for me, it isn't that bad. Lumbar spine, disks, facet joints, SI joint, and both hips give me pain. So far, I've been able to manage it with lots of physical therapy, NSAIDs and a few epidural steroid injections. Never goes away though.

It will of course, continue to get worse as I get older. I will need hip replacements. No idea how the back will go with time. Degenerative disks are hard to predict.
Sounds like you and I could swap medical reports......I just happen to be at a bit more of an advanced stage.

Opioids (aka narcotics) don't really help reduce the underlying conditions. NSAIDs do, as do steroids by reducing inflammation. But narcotics can provide tremendous relief. I have a few norco left from wisdom tooth extraction. They're backup when nothing else will work.

The thing is I've seen this whole pendulum thing swinging back and forth on pain killers before. About 25+ years ago, medical practice was to greatly limit painkillers. Then they did some studies and found that outcomes were better with more aggressive pain management. Great. Then it went nuts and doctors were writing all kinds of scripts for powerful narcotics for things. Unscrupulous companies pushing them, unscrupulous pill-mill docs, lots of illegal diversion.
Exactly! That's why I compared it to eggs in my OP. It seems like every other year they change their opinion on them.

The deal with narcotics is they are very cheap to make, so the drug makers really like them, lots of profit. Insurance companies love opioids because they're cheaper than surgery, PT or other treatments If they can pacify the patient long enough with cheap dope, maybe they'll change plans, lose their jobs or become someone else's problem.

The bad part is, people who are legitimately suffering and have no other options, or need temporary relief while waiting for surgery or other intervention will not get them.
Huey Lewis had it right.......I Want A New Drug.

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Old 05-14-2019, 02:47 PM
  #29  
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Originally Posted by vette6799 View Post
Yup!!

I had a hip replaced in October via the anterior approach. That approach is more complicated and isn't for everyone, but if you are a candidate, it most definitely has less post-surgical pain and a much lower chance of dislocation which is a big deal. In my case, I had a prescription for10 oxycodone but never filled it because my pain was relatively minor and much less than what I was living with unmedicated before surgery.
Well good deal! I didn't know you had a problem. Our most senior ortho doc just had his done anteriorly. He doesn't do the procedure himself. I mean on his patients! lol
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Old 05-14-2019, 02:49 PM
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Originally Posted by vette6799 View Post
That's terrific. I'm really glad for you that you are able to do so much. I've done about eight miles a day of serious walking and that leaves me a bit sore. Later this summer, I plan to test my hip in the Rockies.

Hope your next procedure works out as well as your prior one did.
The Pacific Crest Trail is my bucket list high ticket item.

In reality, I plan to break it down into each state at a time, not an all-in-one all year type journey. I'm just hoping I can complete the Oregon section to begin with. My goal is to retire at 62 and do this the first year.

Goals are good.

Last edited by X-ZZ4; 05-14-2019 at 02:51 PM.
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Old 05-14-2019, 03:03 PM
  #31  
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Some more thoughts:

As far as the comment about insurances loving opiods, that has not been my experience. When I had to get my own insurance, they would all ask me if I took opiods. I had to be honest and answer the question YES. No one would touch me, couldn't get individual insurance. Group coverage yes, obamacare, yes (we won't go there, obamacare was a JOKE).

As far as pain management goes, true the hydrocodone did not relieve the pain, it only changed how your mind interpreted the pain. The pain was still there. You just no longer cared.

Percocet however, was VERY effective in pain management. I'm done with those drugs bottom line though....

Last edited by htown81vette; 05-14-2019 at 03:04 PM.
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Old 05-14-2019, 03:08 PM
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Originally Posted by htown81vette View Post
Some more thoughts:

As far as the comment about insurances loving opiods, that has not been my experience. When I had to get my own insurance, they would all ask me if I took opiods. I had to be honest and answer the question YES. No one would touch me, couldn't get individual insurance. Group coverage yes, obamacare, yes (we won't go there, obamacare was a JOKE).

As far as pain management goes, true the hydrocodone did not relieve the pain, it only changed how your mind interpreted the pain. The pain was still there. You just no longer cared.

Percocet however, was VERY effective in pain management. I'm done with those drugs bottom line though....
Weed does that for me (it' more complicated than just weed.....but I like that word...it pisses some people here off ). That's what I meant in my OP when I said I'm on my own plan . I'm done with those other drugs too. Thank God I live in Oregon where the **** is legal (no matter what Owebo says). Serious.
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Old 05-14-2019, 03:17 PM
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Originally Posted by moose.b3 View Post
Knee jerk reaction to the opioid overdose problem.
I agree. Couple years ago I woke up one day with a stiff neck, 2 weeks later I was OMFG WTF is going on and went to see the Doc (PCM) who gave me some Percocet. After taking 135 Percocet for pain management I hit the operating table for an ACDF (same as Paton Manning) procedure and the surgeon gave me 90 more Percocet on discharge. During recovery I took the remaining leftover Percocet from my PCM during recovery for about 3 days and threw away the new bottle of 90 Percocet from the surgeon.

When I tell that story people ask me how did you not get hooked on pain meds, I say because I'm not a drug addict. Guess what I'm trying to say is nothing wrong with pain meds if prescribed correctly and use for the right reasons.
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Old 05-14-2019, 03:23 PM
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Originally Posted by Hoonose View Post
Well good deal! I didn't know you had a problem. Our most senior ortho doc just had his done anteriorly. He doesn't do the procedure himself. I mean on his patients! lol
Thanks...my orthopod friends all call hip replacement the single best procedure done in orthopedics. It can help someone tremendously and recovery requires minor exercising but not the heavy rehab that a knee replacement necessitates. I've been told that if you are getting an anterior approach hip replacement, you should wait until the surgeon has done at least 100. Someone has to be 1-99....

As for pain meds, I believe that docs, particularly in the ED, are using different protocols than they were using not too long ago. Many, if not all, states have databases that track narcotic prescribing, and it has gotten lots harder to get drugs than it used to be, particularly due to PMP's, Prescription Monitoring Programs.
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Old 05-14-2019, 03:26 PM
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Originally Posted by rudutch View Post
Preliminary data showed 1,941 of the 2,729 overdose deaths in 2017 were opioid-related
Wonder how many of those 1,941 deaths were people with no medical condition requiring drugs?
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Old 05-14-2019, 03:31 PM
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Originally Posted by X-ZZ4 View Post
Weed does that for me (it' more complicated than just weed.....but I like that word...it pisses some people here off ). That's what I meant in my OP when I said I'm on my own plan . I'm done with those other drugs too. Thank God I live in Oregon where the **** is legal (no matter what Owebo says). Serious.
Agree 100%, if I have to go on long term pain management I would turn to weed first before jumping into a bottle of pills everyday.
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Old 05-14-2019, 03:32 PM
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Originally Posted by vette6799 View Post
Thanks...my orthopod friends all call hip replacement the single best procedure done in orthopedics. It can help someone tremendously and recovery requires minor exercising but not the heavy rehab that a knee replacement necessitates. I've been told that if you are getting an anterior approach hip replacement, you should wait until the surgeon has done at least 100. Someone has to be 1-99....

As for pain meds, I believe that docs, particularly in the ED, are using different protocols than they were using not too long ago. Many, if not all, states have databases that track narcotic prescribing, and it has gotten lots harder to get drugs than it used to be, particularly due to PMP's, Prescription Monitoring Programs.
i always laughed when they sent me the monthly totals! Over time us older and ethical docs simply accumulate more of these patients.
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Old 05-14-2019, 06:10 PM
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Originally Posted by Hoonose View Post
i always laughed when they sent me the monthly totals! Over time us older and ethical docs simply accumulate more of these patients.
The beauty of statistics./s
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Old 05-14-2019, 06:32 PM
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just curious, have you tried (been given) Gabapentin. I've had fairly good luck with it, but some people say it doesn't work for them . . .
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Old 05-14-2019, 06:35 PM
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Originally Posted by BadUmp View Post
just curious, have you tried (been given) Gabapentin. I've had fairly good luck with it, but some people say it doesn't work for them . . .
Works for some, not others. It's cheap and relatively benign, so many times it's worth a try.
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