Getting postop care in the US?

[Dingie]

Hi,

Am working towrds a plan for a 1 poss 2 level ADR L2-L4 with Dr. Clavel in Barcelona. I havent had my phone consultation with him yet. But here are my questions to those of you who have already been through the process.

I went to my PCP to see what or whom he would recommend to follow me in the US. The ortho I had been working with had said he would see me, but the last time I was in to see hom he was so sarcastic and really rude that I was asking him to take care of me when he didn't get to do the surgery. Not confidence inspiring. My PCP recommended a pain managemnt group and a neurosurgeon I have seen before. I have an appointment next week to see him although his staff said it is unlikely he will be willing to follow me. Th pain management people said they will not see me at all.

Sooo, how did you all handle things like followup care, I am an RN and it seems unlikely that I wouldnt need anything for pain 2 weeks after surgery. Maybe I wont, however I have had chromic pain for so long its hard to imagine yhat scenario. I would appreciate any advice.

Laurie

[laid up doc]

I have followed up with a pain doc... what i have needed is:

1. rx for valium (30 total)
2. trigger point injections, once so far
3. rx for PT
4. order for xrays at 12 wks
5. gen surg and plastics for incision issue - not a problem at all, didn't even look at me funny!
(note though - i wasn't ever on narcotics on anything but a rare prn basis...)

so really, a pain doc makes the most sense.... you might also try a physical medicine and rehab doc.

why won't the pain people follow you? i can see why surgeons won't (sort of...), but why not a pain doc? is there perhaps another pain group in town?

i will say that one pain group here is firmly under the thumb of surgeons... so i had to go elsewhere. was going to get very tricky and i don't like that sort of practice.

[Dingie]

I spoke with 2 pain management groups one that had done all my injections prior to referring to a surgeon. One said they are only interventionists and the second said they wont work with anyone in the immediate postop period as I should be followed by a surgeon.

I currently take Lortab and zanaflex. I have been treated by the ortho md i mentioned above who is copping an attitiude since I am not having the surgery with him. Not my choice, am allergic to nickel. I spoke with my PCPs RN and they are supposed to get back to me. i am in Florida and I guess there is some new legislation that is making it hard for docs if they have to prescribe narcs?

Other than pain how did you know when to start PT? Have anyone followup your films and incision site. i know you are an MD, but still I would think u would want another pair of neuro or ortho eyes?

I am in a quandry and very glad I started looking now as this is not gomg to be a smooth transition I am afraid.

Laurie

[laid up doc]

Clavel gave me instructions for the first month or so, and i'd been to so much PT in the past that i knew how to progress the transverse abdominis and multifidus exercises already. a lot of what you'll need depends on what your pre-op condition is and what your symptoms are. i knew that i had a not insignificant component of myofascial pain and am usually a biomechanical mess, so i kinda thought i'd need PT at some point, and likely trigger point injections (i was right) -- but otherwise, the recovery really has been easier than i had thought it would be.

i knew i needed PT when the muscle issues wouldn't resolve w/ my home treatment - weekly massages, tennis ball, meds, stretching, etc. i needed needles and the pain clinic nurses asked me 4x if i needed an rx.

if i hadn't had such knowledge, i would have probably sought my own PT 3-4 weeks out. i already knew of a PT who had experience w/ ADR patients, though the therapy isn't really anything special as long as you don't push your ROM or lift over 10kg.

all along, Clavel told me that walking really was the best therapy. the main reason i needed PT really is that i have such a persistent case of plantar fasciitis, that is really affecting my ability to walk. the incision issue slowed my getting into the pool...

hard to believe the pain people are that difficult... but i'd say in the immediate to subacute post-op period, you really don't need much unless you have an incision issue. for that, as i said - a neuro/ortho is useless, i saw a general surg then plastics.

hope that helps some...? might help to say where you are in FL, as there are a few pts on here in FL and maybe someone knows your area? (all i know is that FL isn't a particularly dr-friendly state, and there are a lot of pill mill pain drs...)

[Dingie]

Thanks for the info, I am in Jacksonville, FL. I am hoping my PCP will have some luck, he told me he would make some calls if I hit a road block, in any event he would see me although he really doesnt want to take any responsibility for after care as he is a board certified internal med and "not a spine surgeon" as he tells me everytime I see him

He is a good doc I have been his patient for 15 years which is helpful as he knows me well and my motivation. I have never run across these "drug mills" although up until a few months ago I had refused narcs on a reg basis. Now i am just wanting to organzie a plan of care and perhaps the docs would agree if I were able to speak with them. I guess that is where my PCP comes in, he can do an MD to MD review.

I will keep my fingers crossed and see if I can find an aqua PT, I am pretty sure I know where we have one....

Laurie

[Girth19]

Laurie,

I had a long conversation with my PCP prior to leaving for Spain. I explained to her that I spoke with the 2 orthos I consulted here and neither would follow me post-op because I wasn't abiding by their recommendations. We had a good heart-to-heart and she advised that she understands that we can't always get what we need on US soil. She agreed to help me with the following when I got back: disability paperwork PRN, PT Rx, follow up XRs, and meds. However, once I got home I had to remind her a little of our conversation so I could get what I needed, but it has worked out. As with LUD, with all the years of pain and back issues, I have been to PT several times and pretty much know the routine. However, I have to say, that aqua therapy has been very helpful! My hips/legs have been so tight, and still are to this point being 8 weeks out, but the water has been helping. Dr. Clavel was very pointed when he said that the best recovery tools was to walk, walk, walk. Daily, I have been trying to increase my distance and endurance and see that it is helping. I didn't see that I really needed someone to "follow" me per se...if you follow the d/c instructions and make sure to keep your incision dry and clean (as you already know with your yrs of RNing), then you will be fine. The hardest part of recovery for me, even with having a 3 level replacement, was the healing of my incision. I had more abdominal pain than back pain. But now...it is flat and the SQ has healed and I'm proud of my 8 inch scar! :-) It proves that I have made it through something so many have no clue about. At least now I'm even, one posterior and one anterior! :-)

Like before, feel free to contact me with any questions or concerns and I will answer as best as I can. Hope you had a great holiday season and as we talked about that you weren't going to worry about the back issues until 2012.

Happy New Year and know that you have con't support here,
Kim

[Jstuckey]

My family physician was on board through the whole pre-op research phase to post op. therapy orders. He ordered MRIs, lab work (MRSA screen, urine test, etc), post-op 12 week xrays, pain med refill when I got home, etc. Anything I needed related to the overseas surgery. This was directed by my overseas surgeon, but actually ordered by my local physician at my request. (I sometimes provided the email to my local doc for clarity in writing the orders.)
I didn't feel it was necessary nor did it even make sense to have a post-op local ortho follow me. He doesn't know a thing about my non-FDA approved devices, nor could he do anything with them if they were in trouble. My theory was go to the best in the first place, then post-op will only be for incidental things that my family doc can handle. So far, so good!
Waiting on an electronic response from my far-away surgeon on the 12 week xrays I sent for his review right now, which were ordered by my local family doctor. (I even let the xray tech read the email so they could see the exact angles he was looking for).
It's a different way of looking at after-care than what seems sensible at first, but now that I've had such a good outcome, I wouldn't have it any other way. I don't need a local ortho!

[beaner1]

I started PT 5 weeks out. I am so glad I am doing this. I have learned a lot. I have not had the experience of much PT before so for me it was new and I knew I needed it. I do agree with walking. It does make a big difference. Good luck finding a doc for aftercare.

[nanfromsactown]

Having gone overseas myself just 7 weeks ago, I can firmly say there is very little needed for followup care. In general, you stay overseas long enough for any problems to show up. My surgeon wants xrays at 3 months but basically thats all he will need--xrays.

I have been in treatment with a pain management specialst for many years and they have been very supportive and agreed to give me whatever support they could, and this was a conversation I had with them prior to going. Being on meds and being opiate tolerant I knew meds would be something I'd need, so the pain doc has helped out with that. Currently I'm going to contact them to ask for a PT referral just to find out what my limits are for stretching, etc. Sounds funny but I have a fusion at L5S1 and ADR L45, so knowing the limit is important.

So again, not a whole lot of followup is necessary, but you do need to have a game plan in case there IS a problem. I know that if I had a problem I could contact my surgeon and he would tell me what steps to take.

[Dingie]

I have to say I love my PCP. i have been his patient for over 15 years. I went everywgere he sent me but all roads led back to him. I am so grateful that he is willing to treat me when noone else really wanted to engage in this european complication.

That is a total relief he has assumed the role of pain managment and has agreed to see me if I need help with wound care and folowup xray pt etc. When I told him my last followup with a US MD that went from bad to worse and ended with him trying to get financial information for his own practice, as he was thinking about getting into this ADR thing if people will pay him cash

My PCP just looked at me and said...Well that was disappointing...I think It my be in your best interest if I assume primary care and we will only involve the other MD if a specific need should arise...

So got my recommendation from Dr, Clavel and am waiting for my Skype appt. I am ready to just get this over with!!! I have a grandbaby coming in July and I plan on being a hands on Grandma

Thanks to all, the advice helped immensely!

Laurie