Changing Medications (Level of Trust Required)

[mlooney 3,417]

Isn't something that normally requires surgery to fix?

[ProfessorTomoe 1,308]

6 hours ago, mlooney said:

Isn't something that normally requires surgery to fix?

Yep - painful surgery with painful recovery. Neither Mrs. Prof nor I are looking forward to it. However, if it means that the pain will eventually go away, then so be it.

[mlooney 3,417]

I was able to get over my  rotator cuff issues with just PT, but mine wasn't totally torn and didn't have any bone spur to deal with.  Hope you get some relief there soon.

[ProfessorTomoe 1,308]

Spoke with my representative at the pain management doctor's office today. Asked for an "official" upgrade to 5mg of Dilaudid. Was told that this wasn't possible, since pills only come in 1mg, 2mg, 4mg, and 8mg sizes, and that they're limited to prescribing 180 pills per month. Still, I asked if she would increase my dose to something more than the 4mg that I've been taking since I got out of the hospital (I was taking 5mg in the hospital - it's complicated). She said she'd talk to the prescribing doctor, and if I didn't hear back from her, then something would have been approved.

Well, I didn't hear back from her, so I called my pharmacy. Turns out the doctor called in a supply of 4mg pills and a supply of 2mg pills. I'm guessing I'm being bumped up to 5mg that way, with me taking half of a 2mg pill, although how they're getting around the 180 pill limit is beyond me. Should have asked. Anyway, the prescription won't be ready until Monday, so I get to start cutting pills here with my current supply. I either get to cut one pill into quarters and hope the pill doesn't shatter, or give myself a temporary upgrade to 6mg by cutting a pill in half. I'll figure that out when the time comes.

I normally repost these updates on Twitter, Facebook, and Counter.Social. I think only CoSo will get this update, for reasons I don't want to go into.

[mlooney 3,417]

11 hours ago, ProfessorTomoe said:

I'm guessing I'm being bumped up to 5mg that way, with me taking half of a 2mg pill, although how they're getting around the 180 pill limit is beyond me.

Maybe it's 180 pills per size?

[ProfessorTomoe 1,308]

I am having hell trying to stay awake this morning. Don't know what the culprit is - sleep deprivation, anemia, sedating drugs, whatever - but it's got me dong the standard "halt, freeze, everything goes black, then next thing you know you're waking up from an unplanned sleep session. Urgh.

Coffee doesn't help anymore. I've had to move on to Monster Zero Ultra energy drinks (sugar free). Two of them usually keep me kicking for a good part of the day. I'm on my second one now, but I'm having trouble staying awake long enough to drink it! Come on, brain, give me a break...!

[mlooney 3,417]

1 hour ago, ProfessorTomoe said:

Don't know what the culprit is - sleep deprivation, anemia, sedating drugs, whatever

All of those sound like a good cause for sleep.  Unless there is something important to do, why don't you lay down and take a nap?  Unless there is a medical reason why you shouldn't do so, napping can be good.

[ProfessorTomoe 1,308]

8 hours ago, mlooney said:

All of those sound like a good cause for sleep.  Unless there is something important to do, why don't you lay down and take a nap?  Unless there is a medical reason why you shouldn't do so, napping can be good.

See, that's the thing. I don't know which end is up anymore. It's like my sleep schedule is shifting to a night shift schedule. Maybe. I don't know. I'm not sure if that's the case, or if I'm just having trouble staying awake at any point around the clock.

In any case, I feel like I'm sleeping way too much, almost all day long sometimes, most of it uncontrollably so as mentioned previously. 

[Pharaoh RutinTutin 1,586]

I'll be the one to ask.  Uncontrolable sleeping?  Are you experiencing any other feline symptoms?

[ProfessorTomoe 1,308]

32 minutes ago, Pharaoh RutinTutin said:

I'll be the one to ask.  Uncontrolable sleeping?  Are you experiencing any other feline symptoms?

Well, there's a desire to consume seafood, and a small overgrowth of hair, but that's about it.

[mlooney 3,417]

1 hour ago, ProfessorTomoe said:

Well, there's a desire to consume seafood, and a small overgrowth of hair, but that's about it.

As long as you're not coughing up hairballs you should be OK.

[ProfessorTomoe 1,308]

Update 8/29/22 (yesterday)

Spent the day setting up appointments for diagnostics. I first set up an appointment for an MRI under general anesthetic of my right shoulder (the one with the complete tear/rupture of the rotator cuff). Later, I set up an appointment with my spine surgeon to get my neck surgery reassessed, since I'm having trouble I shouldn't be having (acute numbness/weakness returning in my  left hand).

As it turned out, this wasn't good enough for Mrs. Prof, since she wanted me to get an inevitable neck MRI done at the same time as the shoulder MRI to avoid multiple bouts of general anesthesia. So, at her prodding, I contacted my spine surgeon and inquired about the possibility. Make a long story short, I wound up having a telemedicine appointment so that the spine surgeon could make the request for the simultaneous MRI scans. I'm now waiting for a phone call to set that up, plus a nerve scan on my arms to try and pinpoint any signs of radiculopathy. I'm pretty sure it's come back on my left arm, but as the doctor inferred, he doesn't want me getting involved in the diagnosis part of the exam. 

 

[Don Edwards 548]

10 hours ago, ProfessorTomoe said:

As it turned out, this wasn't good enough for Mrs. Prof, since she wanted me to get an inevitable neck MRI done at the same time as the shoulder MRI to avoid multiple bouts of general anesthesia.

I approve.

Not that my approval matters... but I approve anyway.

[Darth Fluffy 302]

23 hours ago, ProfessorTomoe said:

.. avoid multiple bouts of General Anesthesia.

Yeah, I've heard his long-winded speeches, they'll put you right to sleep. One is bad enough.

[ProfessorTomoe 1,308]

Had an EMG (electromyography) test run today for my spine surgeon to try and detect any neuromuscular abnormalities. I had one run prior to my neck surgery at the end of February, and I can guarantee the results from this one won't be the same. My right arm hurts now (it didn't really back then), and my left hand is in poor shape, with the last two fingers now weak and numb. I'm hoping my spine doctor will get the results prior to an MRI he's trying to co-schedule with my orthopedic surgeon (who's doing one of my right shoulder), so he can pinpoint the area that needs to be scanned for him.

[mlooney 3,417]

1 hour ago, ProfessorTomoe said:

I'm hoping my spine doctor will get the results prior to an MRI he's trying to co-schedule with my orthopedic surgeon (who's doing one of my right shoulder), so he can pinpoint the area that needs to be scanned for him.

At least MRI don't generate any ionizing radiation to make it actively dangerous if they don't have a pin point to aim at.  Good luck!

[Darth Fluffy 302]

2 hours ago, ProfessorTomoe said:

Had an EMG (electromyography) test run today for my spine surgeon to try and detect any neuromuscular abnormalities. I had one run prior to my neck surgery at the end of February, and I can guarantee the results from this one won't be the same. My right arm hurts now (it didn't really back then), and my left hand is in poor shape, with the last two fingers now weak and numb. I'm hoping my spine doctor will get the results prior to an MRI he's trying to co-schedule with my orthopedic surgeon (who's doing one of my right shoulder), so he can pinpoint the area that needs to be scanned for him.

Rooting for you!

[ProfessorTomoe 1,308]

Update 9/7/2022:

I'll be going in to the hospital today at 7am to have an MRI done on my right shoulder - and hopefully, simultaneously on my neck - while under general anesthesia. As I've mentioned previously, I'm having it done this way because I can't lie down for any extended length of time without the pain in my shoulder skyrocketing to at least a 9 on the 0-to-10 scale that hospitals use to rate pain in patients.

I fully expect to wake up from the end of the MRI procedure into level 9 pain, as I did the last time I was under general anesthetic for a horizontal procedure. I will try to convey this to the anesthesiologist, in the hopes that he can mitigate the situation for me. I have my fingers crossed that a)he'll listen to me, and b)he'll be successful.

I will post another update once the procedure is done.

[Darth Fluffy 302]

I hope they do well for you. Mend, my friend.

[mlooney 3,417]

I hope they did it right this time.

[ProfessorTomoe 1,308]

Update 9/7/22 Post-Procedure:

The neck MRI order did not get faxed over to the hospital, so only the shoulder MRI got done. They put me out before inserting me into the MRI tube, then woke me up after removing me. Their pain management was vastly improved over the last time they put me under for a similar procedure. I did not exceed pain level 8.5 the entire time, although it took 2mg IV of Dilaudid to knock down that pain once I was in the recovery room. I now have the MRI CD and am waiting for my orthopedic doctor appointment.

It didn't go as smoothly as it looks above, but I'm too tired to type up the messy bureaucratic details about the neck MRI. I blame the drugs.

[Darth Fluffy 302]

3 hours ago, ProfessorTomoe said:

Update 9/7/22 Post-Procedure:

The neck MRI order did not get faxed over to the hospital, so only the shoulder MRI got done.

Lovely. So, for screwing that up, they get to charge you (or someone) for another surgery. Great business model, how do I jump on board that train?

[ProfessorTomoe 1,308]

I got the results back from my MRI scan. It looks at first glance like I do in fact have a complete rotator cuff tear, plus some bonus goodies like arthritis. Here's the wording from the report:

IMPRESSION:
1. Full-thickness full width supraspinatus insertional tear with medial tendinous retraction to the glenohumeral joint. Full-thickness tear extension to involve the anterior half of the infraspinatus insertion. In total the tear measures up to 2.1 cm in AP extent.
2. High-grade partial tearing of the upper insertional fibers of the subscapularis insertion.
3. Moderate to large joint effusion with foci of nodular synovial thickening/articular bodies.

FINDINGS:

Rotator cuff tear with full-thickness and full width tearing of the supraspinatus insertion and medial tendinous retraction to the glenohumeral joint. Full-thickness tear extension involving the anterior half of the infraspinatus insertion. High-grade partial tearing of the upper insertional fibers of the subscapularis insertion.

The rotator cuff musculature is normal in volume and signal intensity.

Long head biceps tendon is intact.

No labral tear identified.

Moderate osteoarthritis of the acromioclavicular joint. Slight type II morphology of the distal acromion.

Mild glenohumeral chondral where.

Moderate-sized shoulder effusion with foci of nodular synovial thickening/articular bodies.

[ProfessorTomoe 1,308]

I received the results of the EMG (electromyogram) test during an appointment with my neck surgeon yesterday. They found several things. Allow me to transcribe from their report:

1. There is electrodiagnostic evidence supportive of left C6 radiculopathy.
2. There is electrodiagnostic evidence supportive of moderate right and mild-moderate left median sensorimotor neuropathy in its wrist segment, as seen in carpal tunnel syndrome (CTS), with bilateral APB reinnervation on needle EMG.
3. There is electrodiagnostic evidence consistent with moderate, left ulnar neuropathy in its elbow segment (UNE) that affects both sensory and motor fibers, with left FDI/ADM reinnervation on EMG.

The doctor read this and then did a few diagnostic tests on me, including a squeeze test for strength on my hands. He did one test that hurt the top of my left hand like hell, then stopped and said, "Whoa! Wait a minute." He looked down at my left hand and said, "you've got muscle atrophy!" Sure enough, and I don't know how I missed this all this time, I saw that there were divots in my left hand - one on the back side centered above my ring finger, and another in the flesh between my thumb and forefinger. He told me there was no need for me to get the MRI that I had scheduled for him, since he wouldn't be able to treat the problem - I would need to go to an arm and hand specialist.

So, I now have a referral to an arm and hand specialist, with the following commentary:

     Reason: Patient has left hand wasting and left cubital tunnel syndrome. Please evaluate and treat.

     Diagnosis: G56.22 - Cubital tunnel syndrome on left

                         G56.03 - Bilateral carpal tunnel syndrome

I've been told that there is a possibility that the cubital tunnel syndrome can be treated without surgery, but I don't know what the doctor is going to do about the wasting of my hand muscles. We'll find out.

[ProfessorTomoe 1,308]

Medical update 9/17/22:

I've learned that my Cubital Tunnel Syndrome is directly responsible for my left hand wasting. Go to this link and read the bit about, "What happens if cubital tunnel syndrome goes untreated?"

https://my.clevelandclinic.org/health/diseases/21997-cubital-tunnel-syndrome

That's what's happening to me.