doctors in houston?

[holly]

Greetings to all,

Does anyone know of any family practice or int. med doctors in the Houston, Tx area who may be up to date and sympathetic to spinal adr patients? I'm currently looking for one as the int. med doc that I've been seeing is completely against this procedure, even though I proved to be a candidate and have already had it done. Dr. Zeegers performed the surgery (L-4,5) at the Beta Klinik in Bonn, and it was successful. My only problem now is a malfunctioning with some overly aggressive physical therapy (in Holland) that brought my pain levels back up due to an improper exercise that I did last week. I contacted Beta and they said it sounds like a muscular/ligament issue, which I will have checked out at my 6 week check up next week. They said to stop all pt for now and just do waliking and maybe short cycling. Since I return to the states Oct. 19, I would like to find a different doctor who will be able to work with me in therapy an pain management. Dealing with the pain here in NL and Germany has been diificult because the pain med I was taking from the US is unavailable and my doc in the states says that he will not prescribe any when I return because if the surgery was successful, he sarcastically said I should have no pain at all - period. I would love for that to be the case, and it may be; but if I do have any "flare ups", I would love a doctor who is understanding and not critical.

I was able to locate Dr. Christoph Meyer, an orthopedic surgeon who has been doing adr surgeries for several years in Houston. I thought it might be a good idea just to have a local orthopod close by in case I do have any unforeseen problems down the road, and his staff has said he could definitely work with me for those purposes. But for the present, just knowing that I have a good family practice doctor would be invaluable - not just for the adr but for everything else. The doctor I mentioned in my first paragraph has also misdiagnosed me when I was sick with bronchitis. When he realized the mistake, he backtracked and finally ordered the right medicine.

Please - any ideas would be greatly appreciated.

[Harrison]

...for every patient that overdid it after surgery, I'd be rich! So sorry for your latest turn of events. Please take it real easy...

When you can, use the search utility and the term "houston." You'll find some useful topics like this:

Need Good Spine Doctor In Houston, TX

Hope this helps. In the meantime (this week), what meds are you taking? Are you also looking for a pain mgt. doctor?

[2cool4U]

I'm sorry I don't have any specific recommendations to answer your question. I do have strong opinions about the response you got from your current doctor. Run, don't walk, to someone who specializes in pain management. Surgery is not instantly curative, and it's not a sure thing to eliminate all pain.

The reactions you've received from your doctor are inappropriate and show ignorance of the many advances in the pain management field. You'll need regular checkups from a pain specialist until you've fully recovered from surgery. I suggest not relying on primary care doctors, as many are not comfortable prescribing sufficient doses or treating for any reasonable length of time. They usually have one or two meds they are comfortable with, and they don't like to treat more than a few weeks or months. Pain management specialists are usually anesthesiologists who have completed an additional 1-2 yrs of pain management training. They have more methods available, and many times can treat with meds other than opioids. Mine was even very good at recommending specific exercises that greatly helped several months after surgery.

Once again, don't tolerate any sarcasm or lack of sympathy from a doctor. It's this type of thing that gives medicine a bad reputation. There are many good and caring physicians for each unsympathetic one, but it just takes a few to make the whole system look bad. Sorry, soapbox rant done.

Good luck, and I hope others with specific names can help you.

-tc-

[Jack]

tc gave good advice. Pain management is now a specialty and most were initially trained as anesthesiologist with a fellowship study in pain management. My family practice doc (and my wife who is a nurse anesthesis) advised me on the names of those trained.

I found out the had way all PTs are not created equal too. I had one who insisted I do stuff that I knew from experience would hurt not help. After a little research and asking blunt questions to prospective care givers, I found one who specializes in backs.

[holly]

Regarding pain mgt. doc's - I have been through the "ringer" with those in Houston. I saw 4 and only one (the 4th doctor) wanted to treat with a diagnostic epidural marcaine injection. It was for regional complex nerve syndrome and not any structural problems. After putting it off, I finally agreed to have the injection just a couple of weeks before I came overseas for surgery. The injection, as expected, did nothing for the pain and only proved that I didn't have RCNS. I asked about pain meds that he could give, and the only one he recommeded was neurontin. His nurse said that he never prescribed any opiates.

The very first pain doc I saw referred me to a cancer doc who in turn ordered a myelogram. It made my pain 10 x worse. The 2nd doc wanted me to go to group therapy discussions with other back pain patients and the 3rd was the worst of all. He promised during my initial consult to diagnose and treat my pain. He even thought I needed a saline injection for spinal fluid leakage from the myelo and a "new" post myelo mri. I came back to see him the next day with a new mri and to receive the saline inj. While I was waiting for the saline inj., he informed me that he could not treat me for back pain until I saw a rhuematoid arthiritis specialist - one of his friends from Baylor. I told him I had already had blood panels that ruled out RA, but he insisted. So, over a week later, I see the RA doc and as expected said I did not have RA.

The week following, I called the pain doc's office and they told me he was out of town on vacation, but had decided he would not treat me for back pain, even after the negative RA results. The only reason the nurse could give me was that he thought that pain managemt, ie. facet blocks, epidurals, were too risky, but that I should see another pain mgt. doc that he thought could help. I asked about any meds I could take for pain, and they said that he didn't like to precribe anything stronger than Aleve. So, as you can see pain management are bad words in my vocabulary as none of the doctors mentioned above tried to help alleviate the excruiatiing pain I was experiencing. All they did was collect from the insurance company and waist my time.

For the pain meds - I begged my old family practice doc for something before I left for overseas and he prescribed a limited amount of norco, robaxin, and zolpidem. Then to add to that, I have a friend who gave me a few 5 mg oxycontin capsules, which to tell the truth I'm a bit scared to take. The norco 1/2 tablet every 2-3 hours along with 1/4 robaxin tablet worked great, but, I am almost out of these and not taking to try and save for the plane ride home and until I can find someone who will truly help manage the pain.

The norco is what saved me post op in Bonn, because what they have is either too strong or not strong enough. What is widely available here in nl and germany is paracetamol/codeine. It's very different from the hydrocone in vicodin and norco. It doesn't really touch the pain, but has some bad side effects like rash and constipation. Anyway, the family doc I have seen here has prescribed that for me, and I have been trying to take it. I almost forgot, the anesthesiologist at Beta wanted me to use a fentanyl 25 mg patch and take 500 mg of ibuprophen post op as needed. I tried the patch, but all it seemed to do was give me a dry mouth, and I was afraid to take that much ibuprophen at one time. So what I have in the arsenal is the para/codeine, fentanyl. ibuprophen, robaxin, neurontin, and oxycontin (and just the very few norco that I am saving). I go to the 6 week post op next week - maybe they have something else?

I realize this is a lot, maybe even tmi, but if you are familiar with any of these, maybe you can help.

Many thanks...

[Jack]

Many docs here, even some podiatriatrist, list themselves in the yellow pages as pain management doctors. As noted before, 95%+ true pain management dics are specialty trained. All the rest do not want to risk losing their medical license by Rx narcotics, especially Schedule II to someone more than once or twice. Family practice and internist will treat with PT, muscle relaxers and anti-convulsive drugs used to treat neuropathic pain such as Lyrica and neurotin.

Just for reference, if you expect narcotics, expect to sign a opioid contract on the first visit and be willing to do random drug screens. If you don't see a contract, don't expect narcotics or if you do get narcotics long term, the doc is setting himself up for a visit from the DEA. You should not get narcotics from friends as you may well get a visit from the DEA. Especially don't tell or take narcotics from friends and see a pain management doc or they will show you the door.

Paracetamol/codeine is tylenol with codeine. The prescription dose of ibuprophen is 800mg three times a day (rarely 4 a day) but you need a cast iron stomach to take this much long term. A 25 mcg/hr fentanyl patch is a narcotic that is considered quite strong for a person who is not opioid tolerant. It contains no tylenol so you can take tylenol and ibuprophen with the patch. If you have trouble with it sticking cover it with Tegaderm or Suresite cover at most drug stores. Be very careful with the patch. If a pet or child or anyone tries to chew it they will most likely die unless medical treatment is available ASAP. Even the old ones have more than enough narcotic to kill. A more effective, in my opinion, muscle relaxer is a centrally acting one called Soma (carisoprodol). Make sure the dry mouth was not a result of other drugs.

[holly]

Thanks for the advice. I will most certainly take heed regarding the narcotic drugs, and when I get back to the states I will check on the muscle relaxant - that is a preferrable route if it can help with pain. I asked the family practice doctor here in NL about taking a muscle relaxant and he said they are not prescribed in this country. I go back to the states in 3 weeks and if I still need one I hope that I can find a legitimate pain management doctor.

[kimmers]

Holly,

My pain doctor is an anesthesiologist and specializes in pain in the spine.
This is technically the second pain doc I have had as I started out with a rehabillatation and pain doctor. That doctor had not treated ADR patients so after ADR I switched.
I found my second doctor a lot more versed in what spine patients need and he is just better. Perhaps, he is more skilled. But the pain pills are very controlled. He also does several types of injections and treatments.

Like others said on here, I would not take a hodge-podge assortment of pain relievers. You could get in trouble with side effects. After surgery, you want to have control of your pain as your body heals better and quicker when you are not in pain.
Mixing some of these medications could cause you to have a bad reaction such as difficulty breathing. You DO NOT want this.

I found my pain doc through my neurosurgeon but I would try to go through word of mouth, knowing someone in the medical field is helpful, if I was you. And if that fails, see the internet. You do have to be careful as with my pain doc I found comments on one of the sites that I did not think was applicable to my doctor.

I had to sign a contract but to this date I have not needed to take a urine test. My doctor knows I would prefer not to be taking pain pills. He also keeps very careful track of when the pills are going to run out and that I take the proper amount and dose.

Also important to use the same pharmacy, keep with the same doc that prescribes the pain pills and use the medication as directed or you will have problems and will be red-flagged by the DEA.

Kimmers

[holly]

All 4 docs that I saw in Houston WERE anesthesiologists who claimed to specialize in the spine. I looked up their credentials to confirm, and 3 of them came highly recommended by people that I knew. At this point, I found the name of an ortho spine surgeon through the rehab/pt specialist I will use when I return to Houston. His name is Christoph Meyer. Their office has already recommended a family practice dr that they work with and so maybe they will have the name of pain specialist, too. I don't know what area of the country you live in, but it has been very difficult for me to find decent drs. in thr Houston area, specifically the Woodlands area of town. The entire medical community seems to run on a "good ole boy" system. The other problem I had, maybe to be discussed on another forum topic is diagnostics. I had a stack of images - ct scans, bone scans, xrays, myelogram and 3 mri's - which we took with us to Beta Klinik in Germany. Only 1 doctor out of 8 in Houston made a diagnosis of a herniated disc and ddd based on these images - and he was a cancer doctor! None of the neurospine, orthospine, or pain docs saw anything. At Beta, they said they would look at the films but also run their own tests. At the end of the day, they showed us an mri that had much more clarity and detail than any that were done in Houston. And that's a dilemma - if the imaging quality is low - doctors are going to miss things. The disc L4-5 showed up on the Beta mri as a black disc - no more fluid - with pain generation confirmed by discogram the next day. I will try to regain it, but I have lost much faith in the Houston medical community - when it comes to the spine. They have cancer and heart disease nailed, but spine patients have to play the odds there. You might get treatment or you might not (unless you are workmen's comp and then you always get treatment). BTW, Kimmers, what part of the US are you in and where did you have your ADR?

[Slackwater]

Originally Posted by holly

I would like to find a different doctor who will be able to work with me in therapy an pain management. Dealing with the pain here in NL and Germany has been diificult because the pain med I was taking from the US is unavailable and my doc in the states says that he will not prescribe any when I return because if the surgery was successful, he sarcastically said I should have no pain at all - period.

I have no data, surgical follow-up options in your area, w/o look-up and guessing.

Agree with you, it is time for a new doctor, ref:
o "my doc in the states"
o "should have no pain at all".

I am just a patient in the queue, so do not rely on what I write.

Numbers, numbers statistics, ..., my limited recall is it is possible to be off pain killers etc after ADR / TDR / TDA surgery after a recovery period. Let's assume standard metrics, two (2) years for a measurement in the below.


ref:

SPINE Volume 32, Number 11, pp 1155–1162
©2007, Lippincott Williams & Wilkins, Inc.

1160 Spine • Volume 32 • Number 11 • 2007

Results of the Prospective, Randomized, Multicenter
Food and Drug Administration Investigational Device
Exemption Study of the ProDisc®-L Total Disc
Replacement Versus Circumferential Fusion for the
Treatment of 1-Level Degenerative Disc Disease


Narcotic Use.

Before surgery, narcotic usage was 76%
in the control group and 84% in the investigational
group. Of patients achieving overall success at 24
months, only 31% of control and 39% of investigational
patients remained on narcotics. In patients not achieving
overall success, narcotic usage remained relatively unchanged
(76% control and 79% investigational).

Your US doctor, surgeon, that was prescribing medication, may not be the right person at this time. However, there may be a change in "Point-of-View", if Dr. Zeegers dropped an electronic mail to his/her attention.


Best wishes,

slackwater_sf