Wow: Serious update!!! Might get somewhere w/ Friday Phone appt with my previous MD!!

Hi all!

I had my hip surgery Friday, April 15; and yes-I was able to avoid the total hip replacement!!! Yay!!!

I had, instead, a "core decompression," which is basically when they drill into the femoral neck; only one hole through there, and it's a "thin" hole, but it is through the most vulnerable part of the hip; by definition. Then they back down several times, and at different angles, they drill more holes up to the part of the hip (you have left, that is; I was late Stage II AVN). This causes the hip bone to "bleed" (yup, and the blood leaks where??? Into the thigh muscle of your leg which makes it hurt like...well, a lot!!!); and hopefully the "bleeding" causes the hip to revascularize, and then to heal and then, most hopefully, to grow new bone. Not all ortho's support this procedure: I had my fifth consult before I found a doctor who'd do it; and it's done. He said if it works to any degree on this hip; he's happy to do the same procedure on the left, if and when (when) the time comes...a similar procedure worked on my right knee in 2003; bringing me more than 8 years of relief and more importantly, time, so fingers (ok, toes, but not feet!) are all crossed.

The pain? Unbelieveable!!! I told the doc I had expected it to hurt, but not like this. While I was in the hospital, though, the ortho nurses (except one; whom we call "dim-wit") were excellent at documenting my response to my meds. When they told me oxycodone was what was ordered, that it simply had been "increased" (yeah, by 5mg/dose, and bumped to what it should have been in the 1st place, every 3-4 hours, b/c the liquid goes through you in no time flat); and I finally had a tantrum of sorts. I said "absolutely not." I repeated that for the last six months, I had practically screamed from every rooftop in the PMR clinic, and of course, the RN promptly told me that the doctor's notes "reflected it had worked with great success." Gee, wonder why? I told her that basically no one was to go anywhere near my PCA until I spoke with the weekend, on-call doctor: that was where my luck finally changed.

He came in, and introduced himself, and I told him why I felt the oxycodone didn't work, he said it's "pretty advanced" jargon for the average person, and I told him I was a former orthopedics nurse of four years, before that ICU, before that ER, and so forth; he asked where, and we were off and running. His PT degree was exactly 10 years (to the date) before I recieved my nursing degree-from the same university. His RN wife went to the same nursing program I did. I am a twin; he has triplet daughters: two are identical, the third fraternal; and he was unfamiliar with the phrase I'd learned early on with the first set of triplets through my NICU rotation: "A pair and a spare." He laughed, and said he'd never heard that before. Then we moved onto other topics, and finally, he looks at me, folds his arms, and says, "Ok, so what works and how much?" Yup, I finally got my "Royal Flush." And should I feel guilty for playing it? Not a bit. I told him exactly what worked: that pills were not amongst them--that I've had 25+ abdominal surgeries-not counting the Incise and Drain surgeries when I had MRSA in my postop wound infection that extended hip to hip and belly button to pubic bone. He took the time to find the records, and look. And look at all it took to manage my pain: 100mcg duragesic patches, and the fentanyl pops (400mcg) as needed for BTP.

"You got it, kiddo." He did write that I was to attempt a (crushed) 4mg of diladud before the fentanyl pop. But here's what happened when I was given the "crushed" diladud:

Within 30 minutes, I was sweating, crying, half-screaming, restless (not from withdrawal-they'd actually increased my methadone; and my PCA meds were still "hanging around."), and refusing to even let the aides take my blood pressure. The RN's knew to bring the pops and fudge the rest when I asked for meds: but here's where dim-wit came in. And she refused to crush the pill, so I had to chew it (ick), and no-no help. Or they'd bring in both at the same time, knowing that it was not the diladud that was helping me. So, I lay in bed another 40 minutes, and by then, I was screaming, and by then, I did not care, and it was shameless-I was in horrible pain: I essentially have multiple fractures of my right hip, thank you. And they're bleeding into my thigh muscle: it friggin' hurts like heck!!!!! And I was sweaty, and the aide tried to take my pressure anyhow, and I still refused; not even a pulse. And that is not me: Usually I will permit vitals, because I know it can back up how much pain I am in; especially since I have been diagnosed with POTS. Lol, and finally, an RN who wasn't even assigned to me sticks her head in and asked if I needed pain meds...yeah, that's a thought. Gritted teeth, I said "Yes, please...can you ask the RN to bring the fentanyl pop??? PLEASE???" She said yes. 20 minutes later-nothing. More shameless screaming and refusal of care, and my eyes were nearly swollen shut from the crying. I had my video camera on at that point-caught every miserable moment, and it is hard to watch, trust me. But I finally put my call light on. Dim-wit came in, "Can I help you?"

Then the "Poltergeist" in Jenna came out. I think a monster came out, and it was like I was possessed. "Bring my fentanyl losenge-NOW! Your damned f***ing pill didn't work, so bring my BTP meds, and do it now!!!" I think she was afraid I really was possessed. You know how it's like when you speak and there's a "creature" in you that comes out, and it's really not you. I think she got scared, she was back in 3 minutes flat with it, and a pair of scissors would have had the package open in seconds; she was ripping it open with a pen, to get it open as quickly as possible; like in a grip of panic. Almost funny if I hadn't been screaming in pain because of her. Let the dim-wit panic. Got the pop in my mouth, and in 5-10 minutes, I was restored to a human being, and asked the aides if they wanted to do my vitals and stuff now. LOL, but no joke.

So, emailed this very description to my new (previous) prescriber; about how well it was working. I told him I was shipping the rest of my oxycodone back to his office for him to do with as he pleased: I don't want it anymore.

But of course, upon release from the hospital: matters get more complicated. They prescribed 50 of the fentanyl pops. They retail, generic, for over $900 (just back in 2003, I paid $110 for about 30); and so I now need a prior-authorization--which I was not informed of when I inquired about the coverage; but no matter: in 2 short days, I will have relief.

And the RN's also documented that I made the consumption of them last for 2 hours; and that for me, relief seemed, straight off the PCA-first dose; last for an additional 2 hours. I could get enough relief; put it down, eat lunch/dinner, and then, watch some television, and go back to the pop, and have some more; and so on. So I wasn't chewing the whole thing and asking for another.

I am taking diladud in the interim, and quite honestly, and no-my bipolar is still in remission; but I don't like it. I have to chew it; it barely works at the maximum prescribed dose; and being taken every 4 hours, I am awake at night, about every 3-3 1/2 hours, in pain, my body screaming, muscles cramping, and the bone just aching. It's simply not even that as effective.

I spoke with the pharmacist at my insurance company; and relayed all of this to her; and her recommendation? They remove me from even the methadone, and put me on the duragesic patch; probably the 100mcg; but since I sweat a lot; they would not, in my case, recommend the generic--there's issues with them not adhering to the skin; and also that my rate of absorption would be different; and I'd need to change it every 48 hours, mostly because the adhesive would be "worn out."

How do we like them apples????????

I know I do!!!!!!!!!!!!!!!!!!!!!!!!!!!!! When the insurance company recommends the more expensive option-there's a clue!!! She even offered to start the paperwork for the prior authorization for me to get the right amount of patches, since they only allow 2 boxes (10 patches) per month. Oh, is the "devil" on my shoulder having a party!!!

Oh, been emailing regular updates to my previous prescriber--he's not really made too many comments one way or another; but seems to be "absorbing" the information. But it's written about extensively in my journals, and I'm going to fax the key pages/entries to him and do it tomorrow: we have a phone appointment Friday. Any suggestions on how to "present" the information would be appreciated: he does listen to me, but when I am excited, I get my "panties in a bunch" and I repeat myself (ya think?), and I give too many extraneous details (really?).

SO I really need some help here....I even went online, and found out how to figure out, based on my med doses now, what patch would be the right one (and any way you figure it; it's the 100mcg patch); and I am totally dying to get this right: I feel like this is my one shot, and I can't mess it up!!!

Constructive suggestions, please!!!!!!! I want to, as previously said (see what I mean) get this "right" and I am nervous as heck. I have no reason to be; he's always been open and willing to listen. I just can't help it after six months of he** with the PMR jerk-off!!!

HELP!!!