My Thought Process for Delaying Surgery
 

So... I was a new member back in 2013 when I go to the point where the pain was pretty bad (L4/5, single level). I live in the Dallas area and I have TBI in my back yard. My orthopedist referred me to a fusion specialist which after my own research declined, which led me here. Sticking with conservative measures, I was able to reduce the pain to a manageable level and delay/canceled surgery.

fast forward 3 years.... Helping a friend move (I have truck and trailer :Dead:), I re-aggravated my back. This time conservative measure (decompression, chiro, epidural injections, did not help at all. ADR is now an option again. This time I consult Clavel, Zeegers, and Bertagnoli. I wanted their opinion since I "thought" I was serious this time. Remember, Zeegers detailed report and analysis does cost a good chunk of change (in excess of US$1000.00). I wanted to be sure. Zeegers treats the patient not the images or films.

Ultimately, Dr. Blumenthal would be my go-to guy for the surgery. One of the best in the US, covered by my insurance, and follow-up would be logistically simple.

My quality of life has finally been affected where I was mentally ready to undergo surgery. My workouts were limited, no impact sports that involved running or jumping. I have a desk job, so my ice pack became my best friend.

So just before my consult with Dr. Blumenthal, I finally broke down and asked my orthopedist (spine rehab doctor) for medication that may help with the pain because I was going on vacation and I wanted to enjoy it the best I could. There would be scuba diving, lots of hiking, zip-lining, and ATV riding. I did not want to stop living.

That is when my ADR surgery decision became blurred. he prescribed Tramadol (Ultram), 50 mg, twice a day. Any more could lead to liver issues.

After being on this forum for 4 years, I know some of you feel tramadol may be addicted although it is not medically identified as an addictive drug. I did not want opiates, or mentally altering solutions.

That was back in March 2016. It is 2 months later and I have decided to put my ADR surgery on hold. The pain is minimal when on Tramadol. When I do not take it, the pain level does spike. My biggest fear is what happens when it stops working?

I was afraid that my disc will collapse more. I already has an annular tear and I have lost significant height, and I believe the protrusion is 8mm. My fear is that at one time disc height was a contraindication for ADR surgery. According to Dr. Blumenthal that is no longer true. Then I worried about my facet joints adjusting even more and causing issues if I wait to have the ADR surgery.

I share my story not for advice, but because members of this forum helped me through the past 4 years. I am not very vocal on this site, but I definitely absorb a lot. I wanted to give back. If my documenting my thought process and situation could help one person or provide insight for them, I would feel it was not a one way street.

So....I have decided to delay surgery for now. I am able to workout, perform cardio, ride my motorcycle, and do a subset of my enjoyments in life. Until that quality of life is reduced to some unknown level, I think I will hold off on ADR. Hopefully, there will be some technological advances over the next few years. What started in 2013 as prodisc-L, has now advanced to Activ-L. Only time will tell.

I do welcome feedback, comments, etc.

I do have one major question: How long has people stayed on Tramadol before is no longer had the lasting affects?

Now back to your regularly scheduled programming,
Jim

Don't have much to add except that I've talked to some specialists regarding annular tears, and they do heal, but they take a longggg time (3-4 years sometimes). Is your disc bulge compressing a nerve root? What about Selective Endoscopic Discectomy for the discogenic pain?

Just wanted to point out that Tramadol is a semi-synthetic opioid. Even though it is not considered a narcotic, it's effects are similar to narcotic. The effects of Tremadol are similar to morphine and hydrocodone and it can be addictive. I have recently taken it and it is definitely mind altering like other opiates. Having said that everyone reacts differently to it.

Something to remember is that use of opioids prior to and up to surgery makes it more difficult for the anesthesiologist to control pain immediately post op.

I´m on oxycodon for about 2 - 3 months now. It´s OK so far, although it doesn´t fully take the pain away. I asked my surgeon if I should get off of it before my ADR, but he said I should keep taking it and we get off of it afterwards. I´m not sure how much it will help the incision pain as I just recently had to increase the dose already. From what I read your body builds up a tolerance level over time. So I hope in hopsital they can give me something else, which gets me off the oxycodon whilest controlling the pain
and no withdrawal symptoms.

A friend of mine went through Oxycodon withdrawals after lumbar surgery. She was really pissed off at her doctors for not warning her more about it. I have been fortunate and never gone through it but, I also worked hard at taking the least amount as possible. Personally, I would listen to your body. The drugs are toxic but, if you need them you need them and each person responds differently. Sometimes the pain is just too unbearable without them and some can get by on less but, read the label and think they should do that. When I took them, I cut them into quarters and took them that way. I wrote about the combination of NSAIDs and Tylenol I am on post surgery in my thread. That's something to consider with the help of a physician's advice. I don't know how much you are taking (responding to a few people here on different drugs) but, if it were me, I would taper off and see if it made a difference in my pain levels. Last year when I stopped them all together I did it because I didn't find that the relief was worth the side effects I was experiencing. Eventually, after long term use, the drugs seemed to build up in my soft tissues and I felt generally ill all the time on top of the pain I was experiencing. If you have a pain specialist, I would ask that doctor. Surgeons will give you an answer to the question but, they are really not the best doctor to be asking IMO. Ask a few different types of doctors and then decide. I don't think there is a one size fits all answer.

Glad you have found an approach that works for you.

My understanding is that tramadol works like an antidepressant. It is well researched that antidep can plateau and thus require a dose bump or switch to another kind of antidep. I've usually heard of it bein years for that to occur. Maybe the drug manufacturer could tell you more?

Best

I never did find a way to manage my pain with drugs. I just had surgery again!

I had a few RFA's that gave me about six to eight months of relief in the lumbar and cervical spine. Then in February of this year I had two RFA's that made my pain 10 times worse! That is also supposed to be an unusual reaction according to the doctor and the literature online.

I guess it's about figuring out the least of all evils that work for you. I hate to give advice because we are all different. I just talk about what has worked and not worked for me but, I don't think we all respond the same to drugs, herbs or surgery. I strongly believe in paying attention to and writing down what works and doesn't work for my body. I then bring these lists with me when I see doctors.

Right now, I am trusting the combo of NSAIDs and Tylenol because I trust Dr Clavel's opinion. But, my situation is different than your's. I sure hope you get this figured out. Have you tried dry needling or acupuncture yet?

Some very sage advice Cynlite. I agree on all points.
Being a recovering alcoholic for a time, I avoid medicine of any types and when in GmbH I finally found out what the little pink pill was that goofed me up so bad from the one nurse that could speak the best English. My wife figured out how to split the OxyContin in half with the nail clippers and I half dosed through the night. It was still GD tough. On day 3, I was subbing extra strength Tylenol and the next day, Aleve to mix it up as my trauma unit daughter instructed me. By week two I was off pretty well everything but an occasional bedtime Advil.
I've found over the years of being off of aspirin etc that my body has an incredible tolerance and ability to quench pain should I keep it clean and exercised (sweat the toxins out). Consequently I still have €200 of OxyContin in the bathroom and a ton of muscle relaxants and ibuprofen.
I've found the most natural works for me and exercise is my addiction now and learning to quit the 'white' food/toxins including sugar.....not an easy task for an ex-drunk.

Fathub, exercise was always my go to solution for many things that ailed me too. It's such a bummer when we can't move like the body was meant to move.

I used to cut up a Flexeril patch and put a 2 inch piece on my shoulder when my bursitis acted up. It's an NSAID that can be placed right on the pain for inflammation. Once again, I used a piece not the whole patch! Then when the pain got really bad I had the steroid injection

Interesting point about switching off the two drugs.

Percocet - oxicodone
 

My advice to you is to get off this drug ASAP. Getting off it is like going through agonizing death for 2 weeks. Tramadol may be similar to opiates, but it is two schedules lower than Oxi, and getting off of it is by far easier.

I personally believe Percocet should be banned. It builds the same dependency as heroin. IMHO.