I'm down to the wire

[+ Gar1eth]

Regarding Patient-Controlled Analgesia:

 

When it is properly used, the patient would have 1-2 valid requests per hour. Fewer, and the dose is too much; more, and the dose is insufficient. Also, during times of rest, there would be no drug administered, and a basic "safety rule" is that PCA can maintain adequate analgesia, but cannot create analgesia.

 

If I have the choice between two or three oxycodones tablets every three to four hours, versus pushing the button every twenty minutes: I'll take the former.

 

Which is why PCA fell out of favour. Discussion of the use of a baseline infusion to maintain analgesia in times of rest should be regarded as an indication to head out to the nearest pub for a pint or three.

 

 

That's interesting because friends I've seen in the hospital recently have frequently been on a PCA pump after surgery. And I've heard the nurses speak of my friends being on a basal rate through the pump as well as additional medication when the button is pressed.

 

I think I also have vague memories of being on a PCA pump for a day or so after surgery to repair my broken tibia-but that was 17 years ago. So back when you say they were more common. I don't remember if I had a basal rate. But I think I enjoyed the relief after pressing the button.

 

Gman

[+ Gar1eth]

PS: The anesthesia and stress of surgery is making you spell like Mike Carey-"favour".

 

Gman

[+ Gar1eth]

Perhaps your attending physician will be open to suggestions. http://www.boytoy.com/forums/public/style_emoticons/default/rolleyes.gif

 

http://boostblogtraffic.com/wp-content/uploads/2012/04/Doctor-examination-300x200.jpg

 

Nevertheless, glad it's behind you! http://www.boytoy.com/forums/public/style_emoticons/default/thumbsup.png

 

 

The guy on the right-his chest reminds me of my neighbor's whom I talked about in my Adam Russo thread in the Gallery. I think my neighbor's chest was just a tad more hirsute. YUM!!!

 

Gman

[gallahadesquire]

That's interesting because friends I've seen in the hospital recently have frequently been on a PCA pump after surgery. And I've heard the nurses speak of my friends being on a basal rate through the pump as well as additional medication when the button is pressed.

 

I think I also have vague memories of being on a PCA pump for a day or so after surgery to repair my broken tibia-but that was 17 years ago. So back when you say they were more common. I don't remember if I had a basal rate. But I think I enjoyed the relief after pressing the button.

 

Gman

 

Although capable of providing better analgesia with less drug, PCA requires significantly more manpower, for education and "maintenance" both of equipment and patient pain relief, especially with respect to the patient who falls behind, drops his drug level, and needs to have analgesia restablished.

[+ Gar1eth]

Although capable of providing better analgesia with less drug, PCA requires significantly more manpower, for education and "maintenance" both of equipment and patient pain relief, especially with respect to the patient who falls behind, drops his drug level, and needs to have analgesia restablished.

 

I made sure I was hitting the button correctly. :D

 

One side effect I noticed while I was on the PCA Pump- it was difficult to micturate. I actually had to concentrate on relaxing my muscles. It was very weird. :rolleyes:

 

Gman

[gallahadesquire]

I made sure I was hitting the button correctly. :D

 

One side effect I noticed while I was on the PCA Pump- it was difficult to micturate. I actually had to concentrate on relaxing my muscles. It was very weird. :rolleyes:

 

Gman

 

Obviously, they wired the PCA wrong.

[+ Gar1eth]

Obviously, they wired the PCA wrong.

 

I think it's a well-known side effect of narcotics.

 

Gman

[Epigonos]

The doctor who performed my two knee replacements does only hip and knee replacement surgeries. I was in the hospital for 48 hours with both replacements. While in the hospital I was given Norco (which I don't really like) to control pain but at home I used Vicodin (which I much prefer). With both of these drugs I experienced virtually no pain. After three days at home I creased using the Vicodin and was pain free. For about two weeks, after the surgeries, I had difficulty getting comfortable to sleep but that was caused more from the swelling than pain.

[+ Gar1eth]

The doctor who performed my two knee replacements does only hip and knee replacement surgeries. I was in the hospital for 48 hours with both replacements. While in the hospital I was given Norco (which I don't really like) to control pain but at home I used Vicodin (which I much prefer). With both of these drugs I experienced virtually no pain. After three days at home I creased using the Vicodin and was pain free. For about two weeks, after the surgeries, I had difficulty getting comfortable to sleep but that was caused more from the swelling than pain.

 

 

Unless I'm mistaken Norco and Vicodin are the same. They each contain hydrocodone and acetaminophen although in different combinations. Now I'd be the last to say that just because two drugs contain the same medication that they act exactly the same. I'm on a combo pill for hypertension. One of the drugs is a diuretic. I may be wrong, but it seems to me that since I had to switch to the generic the diuretic effect is a lot more variable than with the name brand drug.

 

Gman

[+ Funguy]

Unless I'm mistaken Norco and Vicodin are the same. They each contain hydrocodone and acetaminophen although in different combinations. Now I'd be the last to say that just because two drugs contain the same medication that they act exactly the same.Gman

 

Norco and Vicodin are almost the same: they are both hydrocodone/acetaminophen but they are different combos:

Norco - 5mg (HC) /325 (tylenol) 7.5/325 10mg/325

Vicodin - 5mg/300 Extra strength Vicodin 7.5 mg/300

 

You can see that Norco has more tylenol and can be formulated slightly stronger that Vicodin. I preferred Norco after my back surgeries and continue today to prefer it in the 10 mg form. And no, I am not addicted but I have developed a "tolerance" so I require higher doses when needed. My problem with it is that it takes a full 45 minutes to kick in so I reach for it as soon as pain starts.

 

I also sometimes do a change up and with to Ultram (tramadol) and I have a much greater choice of dosage - 50 mg tabs so I can take however many I need (the lowest dose that works being the safest) and it kicks in in about 15 minutes.

 

And, as a MD, I have my pain specialist write ALL of the RX's so he can keep tabs on my usage.

[Epigonos]

Funguy I found your post highly informative. I have NEVER received much relief from Norco. Additionally I might as well take a sugar pill for all the good tylenol does for me - I find it absolutely worthless. For minor aches and pains I stick the aleve.

[Diverdan]

So glad the surgery is over and that you are recovering. Amazed that you have the stamina to be posting, but maybe that is a good diversion from the pain and you can think of pleasant things here on the Forum. Please know that you continue in my thoughts and prayers, and I do say that is repeated by everyone here who has posted for you. Hope the pain gets under control, and that you are visited by a very hunky and good looking male nurse who will be well equipped to give you an all over sponge bath and make you feel much better !!!!!

[Rudynate]

I've had two spine surgeries. Both times I was kept substantially pain-free with dilaudid given by PCA for the first couple of days followed by 2 Norco every 4 hours around the clock. I also was being given valium and neurontin.

 

The first procedure was a decompression/discectomy and I was done with pain meds in less than two weeks. The second procedure was a multi-level fusion and it was 4 weeks before I was done with the pain meds.

[+ Funguy]

Rudynate - I had the opposite order: first the fusion, then the discectomy. For the discectomy i was done with meds and back to work in 10 days. The fusion was a different animal: chronic pain (albeit 90% better after the surgery) for past 20 years. Some days fine, others Norco 1-4 times a day for a few days. The only thing that keeps me going and "relatively" pain free is working out at the gym with my trainer 2 days a week.

[Rudynate]

Rudynate - I had the opposite order: first the fusion, then the discectomy.

 

Adjacent segment syndrome?

 

After both procedures, I worked my ass off at rehab. For both procedures, I had the same surgeon who has a reputation as being one of the best spine surgeons in the region. Kaiser is legendary for the poor quality of their followup care and rehab, so both times, I designed my own program. After the decompression, I worked one-on-one with a Pilates instructor with a rehab credential for six months. It worked great, but obviously not great enough to keep from going under the knife again.

 

My goal after the second procedure was to be pain-free at the end of a year. I used an exercise program called The Foundation, developed by a chiropractor named Richard Goodman. I didn't make my goal of being pain-free at the end of a year, so I moved it back six months. Still didn't make it, so I moved it back another six months. Finally achieved it about three years after the procedure.

 

I know it defies conventional wisdom, but I have been doing squats and deadlifts for nearly two years and I feel now like I never had either surgery.

[gallahadesquire]

Regarding Patient-Controlled Analgesia:

 

When it is properly used, the patient would have 1-2 valid requests per hour. Fewer, and the dose is too much; more, and the dose is insufficient. Also, during times of rest, there would be no drug administered, and a basic "safety rule" is that PCA can maintain adequate analgesia, but cannot create analgesia.

 

If I have the choice between two or three oxycodones tablets every three to four hours, versus pushing the button every twenty minutes: I'll take the former.

 

Which is why PCA fell out of favour. Discussion of the use of a baseline infusion to maintain analgesia in times of rest should be regarded as an indication to head out to the nearest pub for a pint or three.

 

Let me take this back. I learned to give oral pain meds by the clock, with dose adjustment. I have had 8/10 pain all night. I may have to get uppity. I was pretty good, all day. Phrases like "Massachusetts Nursing Association," "Commonwealth of Massachusetts Board of Registration in Medicine," and "Patient Representative" come to mind.

 

TWO Sleepless nights. I think they send me home Thrsday am. I'll have my cat, my house …

[gallahadesquire]

Norco and Vicodin are almost the same: they are both hydrocodone/acetaminophen but they are different combos:

Norco - 5mg (HC) /325 (tylenol) 7.5/325 10mg/325

Vicodin - 5mg/300 Extra strength Vicodin 7.5 mg/300

 

You can see that Norco has more tylenol and can be formulated slightly stronger that Vicodin. I preferred Norco after my back surgeries and continue today to prefer it in the 10 mg form. And no, I am not addicted but I have developed a "tolerance" so I require higher doses when needed. My problem with it is that it takes a full 45 minutes to kick in so I reach for it as soon as pain starts.

 

I also sometimes do a change up and with to Ultram (tramadol) and I have a much greater choice of dosage - 50 mg tabs so I can take however many I need (the lowest dose that works being the safest) and it kicks in in about 15 minutes.

 

And, as a MD, I have my pain specialist write ALL of the RX's so he can keep tabs on my usage.

 

This seems to be as good a place as any to chirp in. After years of relative insanity, the acetaminophen in Norco and Vicodan is scheduled to go away. This will take these drugs from Schedule III to Schedule II in the U.S. But the Tylenol poisoning will go away. It's already happened with Tylenol #3.

[BabyBoomer]

Why didn't you ask for an ambien to help you sleep?

 

~ Boomer ~

[gallahadesquire]

Why didn't you ask for an ambien to help you sleep?

 

~ Boomer ~

It's the lack of pain relief that's keeping me up. Oh, and I had one already.

[BabyBoomer]

What kind of script do you expect to be sent home with for the pain?

 

~ Boomer ~

[+ Gar1eth]

So I thought hospitals were supposed to be so much better at managing pain these days. Nurses even ask you to rate your pain on a routine basis. I'm really sorry about your pain. Shouldn't they be doing something when you tell them it's persistently 8/10? And you are a physician. If they are treating you like this, what would the rest of us be going through?

 

Gman

[Rudynate]

This seems to be as good a place as any to chirp in. After years of relative insanity, the acetaminophen in Norco and Vicodan is scheduled to go away. This will take these drugs from Schedule III to Schedule II in the U.S. But the Tylenol poisoning will go away. It's already happened with Tylenol #3.

 

The tylenol is supposed to potentiate the opiate, so that you need less of the opiate.

[gallahadesquire]

The tylenol is supposed to potentiate the opiate, so that you need less of the opiate.

 

I can understand the theory behind that, but take the opiate and the APAP separately.

[Diverdan]

I sure hope they relieve your pain soon, or at least send in a hunky male nurse to give you that overall sponge bath!! That might take your mind off the pain for awhile! Seriously, my man, I do hope they get that pain relief to you soon, especially if you are going home on Thursday.

[+ Funguy]

Adjacent segment syndrome? ...

 

I know it defies conventional wisdom, but I have been doing squats and deadlifts for nearly two years and I feel now like I never had either surgery.

 

It has taken me literally 20 years and I finally have tolerable discomfort unless I sit for long periods or am on my feet all day.

I, too, am finally able to do squats but one side is still far weaker than the other and probably will always be so I have to be very careful.