Re: questions

March 7, 2001

Ask the one I just posted about scar tissue.

R

At 02:57 PM 3/7/01 -0500, Moulton wrote:

Please, if you have any questions you'd like

this physiatrist to answer, now

is the time to submit them to Sue.

March 9, 2001

Hi everyone,

Here is the list of questions so far. Ihave not taken out ant duplictes

yet, or arranged them in any kind of order either. I hope to do that

tonight or tomorrow. With all the discussion going on about Core Questions

I thought that you might want to see what we have so far, and I' hoping

that these questions might spark questions that you have not thought of

yet.

Please email me directly at: JRF25@... if you havequstions to

add to this list.

Thanks,

Sue Mc

Questions for Specialists

1. What effect might chronic pain have on cognitive functioning, even

if the chronic pain is relatively well controlled?

2. Could chronic pain cause memory loss, loss of language fluency,

etc?

3. Might the drugs associated with chronic pain control also cause a

loss of cognitive functioning?

4. I am three years post-op from cord release surgery. I continue to

have symptoms with mild new ones accumulating - most recently started

taking detrol to help with bladder spasms and major leakage. My

neurosurgeon says he dismisses his patients when they are 19 or so (I'm

middle aged) and does not wish to see me any more. There are no other

neurosurgeons in my area who deal with tethered spinal cord.

Should I insist on seeing mine again, or look elsewhere for follow-up, if I

can convince my insurance company?

5. Why are muscle spasms so common as a lasting problem after surgery?

6. What is the advantage of seeing a pain management doctor, as

opposed to seeing a primary care physician for pain relief meds?

7. What would you consider adequate monitoring and pain control for a

patient with TCS?

8. Are you ever concerned that a patient will become addicted to pain

relief meds?

9. What is the difference between addiction and dependence?

10. What do you do with a chronic pain patient if you are unsure that

she/he is abusing meds?

11. Could it be that the patient is not abusing meds but is under

medicated, and uneducated on alternatives?

12. How do you treat a patient that has chronic pain but is also a

recovering addict?

13. What is break through pain?

14. What is the difference between referred pain and radiating pain?

15. Do you treat pain in children differently than in adults?

16. Do patients with chronic severe pain get a high from narcotics?

17. What is an epidural injection?

18. How many epidurals (cortisone) can a person have in a year?

19. What about alternative medicine for pain (herbs, Reike,

acupuncture)?

20. What is a pain psychologist or neuropsychologist?

21. Are they different than regular psychologists or psychiatrists?

22. What does a pain, or neuro, psychologist do?

23. How does stress effect chronic pain?

24. How does chronic pain effect one's ability to deal with stress?

25. How does pain, external, affect blood pressure and the heart rate?

26. Are support groups helpful?

27. Do men and women experience or deal with pain differently?

28. How much will a MRI show in relation to a tethered cord? i.e.:

Will it show nerves " stuck " in a lipoma? Will it show which nerves are

tangled or out of place?

29. Which part of the spinal cord controls or is responsible for

spasticity/spasms in the legs/buttocks? Would nerve blocks stop this?

30. Which exercises would you recommend for people that have a

tethered spinal cord?

31. There are many people we have in our groups that have declined

within a short period after surgery. If there is nothing wrong

anatomically after surgery, what in your opinion would be the cause of this

in so many?

32. Would you recommend someone with a tethered spinal cord be a

candidate for a spinal cord stim for pain control? If so, what type of

pain do you foresee this controlling?

33. Some of us have been referred for intrathecal pumps. What are the

long term implications of these? Do you recommend testing for allergic

reactions to any of the pump's components before implanting or the test

dose?

34. With such a small amount of medicine needed to have control over

pain with the pump, does your body still have a physical dependence on the

medicine given?

35. Would please explain the difference between addiction and physical

dependence in regard to narcotics given to those with chronic pain?

36. For your patients with chronic spasticity that deforms the feet

and toes (i.e.: hammer toes, tight heel cords, raised arches, etc) do you

recommend surgery for them? There has been discussion on this issue

because of the fact that the spasticity is not under control and continues,

the surgery may only be a temporary fix at best.

37. What is your opinion on eastern medicine such as acupuncture,

etc?

38. Do you ever use or recommend nerve blocks for pain control in

someone that has a tethered spinal cord or pain from the spinal cord?

39. Many of us had had to have laminectomies during our surgeries.

What, in your opinion, are the long term implications of having 2-7 disks

that have had laminectomies? Does this make our backs inherently weaker?

If so, what can we do to minimize the effects?

40. Are botox injections that are done to help ease the effects of

spasticity dangerous if done for a long time over the life of a person?

41. On the subject of intermittent self catheterization:

42. a) What are the long term effects of this?

43. Do you foresee any new research into this field that may

make it possible for some to be able to empty on their own without the use

of a catheter?

44. Given the implications of a tethered cord, could this cause

someone's blood pressure to be lower than their normal?

45. How important do you see the role of the physiatrist with someone

that has damage due to a tethered spinal cord?

46. If you are familiar with Chiari 1 malformations, what are the

symptoms and is there anyway to separate which symptoms would be from the

tether and which are from the Chiari?

There has been much talk about Chiari's relation to Fibromyalgia. What

is your take on this relationship?

March 10, 2001

Here is another Question, if you want to ask it.

If the Trauma from Surgery(Spinal Shock?) caused Leg Spasms,

immediately following Surgery, in your opinion, normally how long

should they

last? When would these Leg Spasms be considered Abnormal after

Surgery, and

may indicate another problem arising, in your opinion?

If you can reword it to make it sound better that would be fine,

as long as Subject is kept in tact.

Take Care,

Brande, RHIT

mymocha@...

> 5. Why are muscle spasms so common as a lasting problem after

surgery?

>

November 23, 2008

Hi ,

I'm so sorry you are feeling bad. It's good to hear from you again. I know the

issue with your son is weighing heavy on you. It seems like you've had a good

relationship with his adoptive parents since the adoption. If I were you, I

believe I would just have a talk with his adoptive parents and tell them that

your cirrhosis is caused by Hep C and that there is a small chance that your son

could be infected as well. Explain however that you are not sure that you even

had the virus when you were carrying him. Tell them he should be tested just to

be sure. They don't even have to tell him until the results are in. They can

just carry him if for a checkup and ask the doctor to order the test as a part

of the regular lab workup. It can be handled discreetly and there's no need to

make a big deal of it unless absolutely necessary. I will be praying for you

and for your son. Let us know how things turn out.

Hugs..........

Diane

________________________________

To: livercirrhosissupport

Sent: Sunday, November 23, 2008 12:36:21 PM

Subject: questions

hello family,I haven't posted for a couple weeks,I have been going

through the " I hate the world syndrome " My platlets are 81,now shouldn't

I get some new ones(I'm trying to be humorous)I had wrist surgery in

the beginning of July and my bruising is still VERY here...and this

FREEZING all the time Crap is for the birds,isn't there any vitamin to

help?I also have a serious dilema..I gave my son up for adoption 16 yrs

ago thruogh a private adoption,I know the parents,and they have always

sent me pictures and keep me had kept in touch,well i hadn't heard a

word in a couple years and she sent me some recent pictures (usually

for the last 7 yrs. the have always gone on some sort of Carribean

cruise and he gets to put up a tree for the first time in a long

time,so happy that made me,but i need to know if he deffinatly has the

HepC if i had it when he was born? I don't want to alarm them if I

don't have to but I don't think that is possible,I feel so horrible

inside if I have harmed him.They don't know about the Hepc (YET)They

know I have cirrohsis but think it is from me drinking.What do I do?

Thank you.God Bless, oh! this backwards sleeping thing is really

confusing to me also and I try to get the nights to be nights but for

some reason the daylight makes me want to sleep....Go figure.

November 23, 2008

Diane,thanks for the uplift,but the sad part is I had a blood transfusion in the

mid 80's , and didn't find out I had hepC till 2001,he was born in 93.What I

meant to ask is it a deffinate that he would be born positive? I know I have to

tell them but that means he has had it all his life and could be very bad

off,there is a new girl on here that is 21 can't remember her name,but the

timing was weird because she was born with it and is very sad over all this and

that is what made me think Oh shit! what about my son,I guess it was the selfish

part of me that honestly never even thought about that issue. It had been so

long and it is still painfull even though I know he has had a lovely life.

Subject: Re: questions

To: livercirrhosissupport

Date: Sunday, November 23, 2008, 2:16 PM