Weaning off the meds!

[Rob]

I had an L4-S1 Anterior / Posterior fusion on 3/15/10. Since leaving the hospital on 3/18 I've been sequentially on the following meds:

- started out on 10mg/500 Oxycodone every 4-hours for approximately the first 5 days (6 + 1 extra at night / day)
- switched to 10mg/500 Hydrocodone every 4 hours for approximately 7 days (6 / day)
- switched to 7.5mg/325 Hydrocodone every 4 hours for the approximately the past 31 days (6 + 1 extra at night / day)

I had my 6-week post-op check-up yesterday. All the hardware is in place and 'looks good'. ‘Too early to see any bone growth’, that apparently will be visible on the 12-week post-up check-up. Interestingly the PA was annoyingly surprised that I had still been taking the 7.5 Hydrocodones every 4-hours (7 per day). He repeatedly lectured me on the fact that it's time to get off of them.

It's a bit interesting that the nurse that prescribes the meds, and has been with the surgeon for 21 years, seems to think that it's not an issue although 'yes it's a good idea to start weaning' but wasn't as dramatically enthusiastic as the PA about it. Funny but none of them have every had back surgery! I’m not in too much pain / discomfort so reducing the meds shouldn’t really be an issue and I think it’s about time to do so. Just a bit befuddled on how insistent the PA was about it!

The meds have made it possible to sleep, albeit in 1-2 hour increments, and walk ~2 miles / day. Walking was another point of contention. Originally the instruction, when I went home from the hospital, was to walk as much as possible without causing any additional pain. I got up to ~2 1/2 to 3 miles a day with some pain (3 walks of 20-25 minutes each). When I spoke with the PA at ~ the 4 1/2 week point he informed me I'm way over walking and should only be walking approximately a half mile /day. I reduced my walking to just under 2 miles / day, as a half mile in a day is really nothing and other than walking I'm doing exactly that, nothing! This visit (the 6-week post-op) he increased his instruction to 1 mile / day.

Can anybody chime-in on where they are, or were, with their meds and at what point they were weaning themselves?

Thanks,

Rob

[Jack-of-all-trades]

In the overall scheme of things, yours is not a very big dose. Most of the concern deals with withdrawal. The extent of withdrawal is dependent of the dose and strength of the opioid, and the length of time you have taken them. You have first hand experience on what the medical community's attitude is toward the use of opioids for pain. On one hand, it would be called "using" opioids, on the other it would be called "needing". Both sides of the debate are charged with emotion.

[Cindylou]

Although I totally agree with Jack of all Trade's sentiment, I think it would be prudent to start the weaning process at this point in time. There was certainly a better way for the PA to handle it, but he missed the boat. Hopefully, he gave you adequate instructions for weaning, unless he was too busy squashing you like an unwanted bug. Are you sure the nurse was the one prescribing your opiates? I didn't think they had that capability....only a Nurse Practitioner, a PA, or the doc, of course. Is she a Nurse Practitioner? Good luck in the weaning process and congrats on your surgery. Sounds like you are doing quite well. Good for you! :thumpup:

[scduggan]

Dear Rob,
I started a thread about this very subject a while back. This is a huge deal for me because I find I am extremely torn. If it is any consolation, I think the PA is a big ding dong. My surgery was February 18th and I am still taking narcotics. I am finally tapering. The research coordinator at Texas Back Institute told me the rough goal to shoot for is the three month post-op mark. Like you, I am not having what I would call high pain levels. I am however, completely thrown back in to my full responsibilities and my LBP and hip pain is DIRECTLY tied to my activity levels. If I could still be fully concentrating on healing and walking I would be off the meds. I hope you are able to continue to take what you NEED. You will get off the narcotics when it is the right time. I was EXACTLY where you are a few weeks ago. I finally decided to chill out and not worry about it so much. Would you say you are feeling a little better each week? I have to look at it by week. You sound like you are doing really well. Hang in there. PM me if you want to discuss this further. I fear I may have rambled on. I just know what you are going through.
CD

[Carmen]

Dear Rob,
I started a thread about this very subject a while back. This is a huge deal for me because I find I am extremely torn. If it is any consolation, I think the PA is a big ding dong. My surgery was February 18th and I am still taking narcotics. I am finally tapering. The research coordinator at Texas Back Institute told me the rough goal to shoot for is the three month post-op mark. Like you, I am not having what I would call high pain levels. I am however, completely thrown back in to my full responsibilities and my LBP and hip pain is DIRECTLY tied to my activity levels. If I could still be fully concentrating on healing and walking I would be off the meds. I hope you are able to continue to take what you NEED. You will get off the narcotics when it is the right time. I was EXACTLY where you are a few weeks ago. I finally decided to chill out and not worry about it so much. Would you say you are feeling a little better each week? I have to look at it by week. You sound like you are doing really well. Hang in there. PM me if you want to discuss this further. I fear I may have rambled on. I just know what you are going through.
CD

HI Rob,
Did they offer you any drugs to help with the weaning? I was given suboxone. Please take them in small dossages. Large ones will leave you nauseated. The smaller ones do the trick but you just have to take them more often. Hope that helps some when you are ready. Carmen

[Katie]

sc, please don't feel like you are 'rambling'. Every thing that you have shared helps so many more people than you know...me included. Everyone else's experiences helps me understand the healing process, including the medical side of it. Thanks.

[Rob]

Hi everyone,

Thank you for your replies and support! I have started the weaning process on the day I started the thread. (re Carmen) I wasn’t offered any meds to help me wean off of the Hydrocodone, it wasn’t even ever mentioned. I went down to one 7.5mg/325 Hydrocodone every 6 hours for approximately 4 days (4 + 1 extra at night/day). Then on Tuesday I dropped it to one every 8 hours (3 + 1 extra at night/day). (re Jack) I believe I’m having some withdrawal symptoms such as being a bit more tired and feeling a bit crappy!

One interesting note, I hadn’t sneezed from the day of surgery up until this past Tuesday (~7 weeks). I believe this is due to the meds…

(re Cindy) The nurse may not have been actually prescribing the meds, however she’s the one I call when I want the meds changed or when I need a refill called in. She’s extremely accommodating and has never not honored my requests. She may very well be checking with the doctor every time. However for all I know she could be a Nurse Practitioner. She’s been with him for ~21 years and was his surgical nurse until recently taking on more administrative duties.

(re CD) I believe I’m doing fairly well, things seem to be slowly improving every week. The surgical pain isn’t bad, still mostly discomfort. The anterior incision area feels pretty good. The discomfort is mostly around the posterior incision, I believe from the muscles healing around the hardware (rods & pedicle screws). The discomfort is more pronounced whenever I try to roll over while in bed, causing twinges of pain in this area.

I have a secondary unrelated pain issue. I injured my shoulder in October of last year. The pain continued to get slightly worse over several months and I decided to go to an orthopedic in February as I was approaching the fusion surgery. After reviewing an x-ray, to confirm that there wasn’t any arthritis or other bone issue, I was diagnosed with tendonitis. I was given a prescription for PT. The PT gave me some exercises to do at home that I would be able to do after the fusion surgery while recovering without compromising the fusion recovery process.

However, after my fusion surgery, and ~ 4 weeks into recovery, the tendonitis developed into 'frozen shoulder syndrome', as diagnosed on 4/20 by a shoulder surgeon. This is where scar tissue on the sheathing that covers the muscles and tendons, from past injuries that I never realized caused any permanent anything, creates adhesions that stick and prevent you from moving your arm / shoulder. The pain at its worse is similar to what I believe would be like having a knife stuck into your shoulder. When this happens it causes me to immediately stop what ever I’m doing, grab my arm, crunch over (but cognizant not to crunch too far to compromise the fusion!!!) and wait for 20-60 seconds for the pain to subside. Needless to say it really makes finding a sleeping position all the more difficult.

The few interesting things I learned about ‘frozen shoulder’ is that it only happens to 4-6% of the population, typically adults between the ages of 40-60, more common woman than men, and once successfully treated you’ll likely never get it again. It’s typically treated with a combination of a steroid injection to reduce the inflammation and pain, and PT. In a discussion with my back surgeon I asked about the interaction of a steroid injection in regards to the fusion. He strongly recommended that I don’t have the injection unless it’s completely intolerable (what ‘completely intolerable’ mean) as it can interfere with the fusion. Well I certainly don’t EVER want to go through the fusion surgery again so…

I'm now seeing a PT for my shoulder! While weaning of the meds it’s become apparent that the pain in my shoulder is now worse than the pain from the fusion surgery. The pain during and following the PT is even worse. The PT Nazi explained that he needs to break the adhesions to free the sheathing to get my range of motion back, which is also supposed to eliminate the pain. This involves VERY deep tissue message over very specific areas, the adhesion points, which make my eyes fill with tears while hyper-ventilating in pain. Of course all the while being cognizant not to twist or crunch over too much to compromise the fusion recovery!!!

How’s that for rambling CD!:^) As you can see I’m extremely bored!!!

Rob

[Carmen]

Hi everyone,

Thank you for your replies and support! I have started the weaning process on the day I started the thread. (re Carmen) I wasn’t offered any meds to help me wean off of the Hydrocodone, it wasn’t even ever mentioned. I went down to one 7.5mg/325 Hydrocodone every 6 hours for approximately 4 days (4 + 1 extra at night/day). Then on Tuesday I dropped it to one every 8 hours (3 + 1 extra at night/day). (re Jack) I believe I’m having some withdrawal symptoms such as being a bit more tired and feeling a bit crappy!

One interesting note, I hadn’t sneezed from the day of surgery up until this past Tuesday (~7 weeks). I believe this is due to the meds…

(re Cindy) The nurse may not have been actually prescribing the meds, however she’s the one I call when I want the meds changed or when I need a refill called in. She’s extremely accommodating and has never not honored my requests. She may very well be checking with the doctor every time. However for all I know she could be a Nurse Practitioner. She’s been with him for ~21 years and was his surgical nurse until recently taking on more administrative duties.

(re CD) I believe I’m doing fairly well, things seem to be slowly improving every week. The surgical pain isn’t bad, still mostly discomfort. The anterior incision area feels pretty good. The discomfort is mostly around the posterior incision, I believe from the muscles healing around the hardware (rods & pedicle screws). The discomfort is more pronounced whenever I try to roll over while in bed, causing twinges of pain in this area.

I have a secondary unrelated pain issue. I injured my shoulder in October of last year. The pain continued to get slightly worse over several months and I decided to go to an orthopedic in February as I was approaching the fusion surgery. After reviewing an x-ray, to confirm that there wasn’t any arthritis or other bone issue, I was diagnosed with tendonitis. I was given a prescription for PT. The PT gave me some exercises to do at home that I would be able to do after the fusion surgery while recovering without compromising the fusion recovery process.

However, after my fusion surgery, and ~ 4 weeks into recovery, the tendonitis developed into 'frozen shoulder syndrome', as diagnosed on 4/20 by a shoulder surgeon. This is where scar tissue on the sheathing that covers the muscles and tendons, from past injuries that I never realized caused any permanent anything, creates adhesions that stick and prevent you from moving your arm / shoulder. The pain at its worse is similar to what I believe would be like having a knife stuck into your shoulder. When this happens it causes me to immediately stop what ever I’m doing, grab my arm, crunch over (but cognizant not to crunch too far to compromise the fusion!!!) and wait for 20-60 seconds for the pain to subside. Needless to say it really makes finding a sleeping position all the more difficult.

The few interesting things I learned about ‘frozen shoulder’ is that it only happens to 4-6% of the population, typically adults between the ages of 40-60, more common woman than men, and once successfully treated you’ll likely never get it again. It’s typically treated with a combination of a steroid injection to reduce the inflammation and pain, and PT. In a discussion with my back surgeon I asked about the interaction of a steroid injection in regards to the fusion. He strongly recommended that I don’t have the injection unless it’s completely intolerable (what ‘completely intolerable’ mean) as it can interfere with the fusion. Well I certainly don’t EVER want to go through the fusion surgery again so…

I'm now seeing a PT for my shoulder! While weaning of the meds it’s become apparent that the pain in my shoulder is now worse than the pain from the fusion surgery. The pain during and following the PT is even worse. The PT Nazi explained that he needs to break the adhesions to free the sheathing to get my range of motion back, which is also supposed to eliminate the pain. This involves VERY deep tissue message over very specific areas, the adhesion points, which make my eyes fill with tears while hyper-ventilating in pain. Of course all the while being
cognizant not to twist or crunch over too much to compromise the fusion recovery!!!

How’s that for rambling CD!:^) As you can see I’m extremely bored!!!

Rob

Here I want to make a joke....at least the shoulder is allowing you to forget about the pain of the fusion surgery. Were you able to have XLIF? or anything minimally invasive. I think I read that you had a 360. I was told I am having the same thing. I want my whole surgery minimally invasive, so minimally that I don't even notice it. yeah right. Before my surgery I want God to come down and say he is bringing all the good people up to heaven. Therefore it will make my surgery unnecessary. Well anyway I can dream...Hope you are doing better soon but with your sense of humor you will do fine in everything you
do. Carmen

[scduggan]

Dear Rob,
Man oh Man.....don't you just want to scream about the new shoulder stuff? I have never had shoulder issues but have heard they are HORRIBLE because of exactly what you said....you cannot get a comfortable sleeping position. How may sessions have you had with your PT for the shoulder? I think the massage he is doing is going to "HOOK YOU UP" big time. I know it hurts like a big dog right now. I have had ten sessions of PT and my therapist is also doing the massage. I think it might be called myofascial release massage. Ten sessions in I am really getting significantly better. It does hurt. I even get a little embarrassed at the sounds I make when my therapist has his elbow smashing in my glutes. YIKES! This will be good for your shoulder. Good luck getting this straightened out.
CD

[Rob]

Hi Carmen & CD,
(Carman) Yes I did have a 360 degree fusion. I kept hoping for the same. Some sort of our patient arthroscopy! I believe I wrote a lot of details to you about my surgery on 4/5/10 under ‘Spondylolithesis ‘ shortly after coming home. My surgery was MAXIMUM invasive!:^) It involved both an anterior (front) and posterior (back) approach. The vascular surgeon made a vertical 4" incision from the left of my belly button down. through the skin and fat as all the muscle and then moved my organs to the left and right providing a straight shot to the front of the spine for the my orthopedic surgeon. My orthopedic surgeon prefers the anterior approach because there's no need to cut through muscles and remove the lamina (back part of the vertebra) to access to the discs.
After removing the discs they placed an ‘infix’ device between the vertebras (Zimmer Spine - InFix Lumbar Interbody Spacer System). The ‘infix’ device is basically a metal (titanium) cage. There are other styles and types of cages, it’s really the surgeon’s preference on what they use.
The ‘infix’ cage is filled with BMP (bone morphogenetic protein) as opposed to actual bone. If they used bone it would have been necessary to harvest it from my hips or pelvic which would require additional incisions. My doctor / surgeon explained that BMP has a 95%+ bone growth success rate versus 85%+ for actual bone.
They then closed up this anterior incision, turned me over during surgery, and made two parallel 2" incisions on the left & right side of my spine through the muscle on my lower back. Through these incisions they inserted titanium rods and pedicle screws to minimize movement and support my spine to facilitate the fusion process.
Though the anterior / posterior approach is more invasive, it is probably less traumatic since they don't have to remove the muscle from the back of your spine and don’t have to remove the lamina to access the discs. I certainly gives them the most access to help insure success, but of course with the risks associated with the invasiveness!
As previously mentioned earlier this week, I hadn’t heard of an XLIF but looked it up on the web. There’s a site that gives a pretty concise description of the procedure (http://www.neurosurgeryspinecenter.com/pg_xlif.html). It’s not clear to me how they would use this procedure for repairing spondylolithesis as this requires realigning the spine which seems would require a bit more ‘hands on’ approach.
(CD) Yes, man oh man!!!:^) I believe you’re right and it is called ‘myofascial release massage’. I can only understand about 60% of what the PT says. He’s speaking English but for some reason…However, when I look up ‘MRM’ it says that it’s a light to moderate pressure. I think what he does is called ‘cruel & radical myofascial release massage’!

I’ve had four PT sessions. Like you I also make a lot of sounds, but I add a LOT of expletives to get the point across! I had to stop him on Wednesday as I was hyperventilating and was getting dizzy and thought I would pass out. I REALLY think he’s a sadist! I’m still extremely sore from Wednesday’s session. I’m glad I won’t see him again until Monday. I told him I’m happier to see him leave then to see him when he arrives.

Rob