Brief Answer:
Pain Pumps are something you could discuss with your team.

Detailed Answer:
Hi there XXXXXXX

Thanks for coming to HealthCareMagic,

I've gone through the information you've given here and I want to confirm a few details with you before I move on to my suggestion.

From what I have understood, you suffer from severe spinal stenosis centered around your lumbar spine (lower back) and your neck (cervical spine). To manage this stenosis, and the pain that comes with it, you have undergone endoscopic spinal surgery. The surgery done was to remove the lamina of the vertebrae in the lower back, remove parts of the discs that are bulging out and decompress the nerves that exit the spinal cord at these levels of the spine. To treat the pain you are suffering from you take Tylenol, Motrin, Ultram, Lyrica and Cymbalata. You are also going for regular physical therapy and you use a TENS unit to help with the muscle stiffness and pain.

I hope I got the details right.

Now, assuming that I have, lets get to your query. What are the NON-surgical ways that this can be dealt with. I really wish I had better news for you here. Given your history though, I can't really see a non surgical way forward.

You could possible get a second Opinion from a Rheumatologist regarding your pain and arthritis. Occasionally, inflammatory issues like arthritis can be due to immune issues rather than just age related degeneration of the bones and discs. It's a reach however and I don't think you should hang your hopes on the idea that a second opinion from ANYONE would solve your issue altogether.

I'd like to suggest another possibility though. Maybe a minimally invasive procedure could help your pain issues. I don't know what kind of surgery has been suggested for you. It may be that your spine team is recommending open surgery to redo the spinal decompression, if they are, let me know, we can discuss it further. The option I would like to suggest is the implantation of a pain pump.

A pain pump is basically a really advanced medication delivery system. The pain pump itself is a device which works on its own and stores a large amount of the pain medication selected by your team. The pump is implanted in your abdomen and a small catheter (which starts from the pump and enters your spine) releases pain medication into your spine on a regular basis. I've worked with a few of these over the years and they seem to work pretty well when implanted for the right reasons.

So, it is a surgery, just that it's a pretty short and minimally invasive surgery that is safely reversible if you don't like the effects. The pump is easily refillable and the dosage and type of the pain med that is given can be tweaked to give you the best effect possible without exposing you to unsafe dosages of narcotics and the like. Since the medication would be going straight into your spine, you wouldn't need to take that much orally and you would be taking less medication overall.

I hope I have helped you understand your options a bit. I hope my suggestion strikes you as a possibility that you could discuss with your team. Let me know what you are thinking and we can discuss things further.

Vinay

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Brief Answer:
Your primary doctor has to keep track of everything

Detailed Answer:
Hey there XXXXXXX Thanks for coming back!

I'm glad you gave me more information. I think there are a few things that need to be done here.

Firstly, i'd like to reiterate my earlier suggestion, a rheumatologist is a good person to go to at this point. Rheumatologists are specialists when it comes to issues with the immune system. The fact that you had NTM and were on antibiotics for such a long time points to an immune issue that has not been diagnosed yet. So thats something you can discuss with your primary doctor.

Now, your Primary doctor HAS to be the one who keeps track of all these issues and keeps all the suggestions straight from all the specialists. That's their main job. Its always good to discuss each specific suggestion with the specialist when you go to them, but you have to have a conversation with your primary so they can integrate all the previous treatment you've had along with all the other suggestions from specialists. Think of your primary as a kind of Master of Ceremonies.

Now, lets see if we can address a few of the things you've mentioned.

You're knee issues may be contributing to your problems with movement for sure. The most basic treatment for these kinds of things is 2 fold, weightloss (if you are overweight that is) and physical therapy. Strengthening the ligaments in the knee would help stabilize the joint and minimize pain. Another option is steroid injections into the joint. That may reduce the inflammation and the pain.

Now to the lower back, spinal fusion and fixation is a very well understood and well accepted treatment modality. I've seen it do wonders for lots of patients who have arthritis in the spine.

If you want to avoid that surgery, the best i can think of right now is my earlier ide of the pain pump.

Could you do me a favor and upload the MRI's that were done on your back? I could take a look and see if I agree with the Spine guys recommendation.

The website (HCM) is telling me that you live in St. XXXXXXX That right? If thats the case, the only really solid recommendation is to go to the Florida Spine Institute.
When I was training in the US, we heard alot of good things about them.

How does that sound? Let me know what you are thinking and we can talk further.

Vin

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