Cervical spine problems after lumbar surgery

[nicolas18]

Hi guys,

There are a lot of posts on this forum about hospitals and especially the top hospitals in Bangkok, so I thought I would give my opinion about the hospital which literally ruined my life.

Back in November, when I first arrived in Thailand, I started to experience some back and leg pain. After a few weeks, my right leg started to get gradually numb and weak. I then decided to go to the hospital which was nearest to my home, BNH Hospital. I had read some great things about the hospital and thought that it would be the best place to take care of my problem.

I went to their Spine Clinic where I was diagnosed with a lumbar herniated disc. After a few weeks, it was clear that the situation was getting worst and worst, so the surgeon told me that I would need surgery to fix the problem. During those pre-op weeks, the pain was becoming unbearable but the only pain killer that the doctor prescribed to me was some Tylenol with Codeine, which is usually used in the West to treat minor pain such as headaches or mild muscular pain. I asked for something more adequate of course but he told me it was impossible to prescribe anything stronger.

The surgery was performed in the first week of January. The first two days post-op were great. I had almost no pain and I was able to walk. On the third day, while I was still at the hospital, I woke up and felt a horrible pain in my right leg. It felt as if my entire calf and angle were covered with a second degree burn. It was so painful that even a little breeze blowing on my calf was awfully painful. Since I was still in hospital, I was given injections of morphine which helped tremendously. I was told that the pain was caused by an inflammation of the nerve roots and that there weren't any cure for it, I would just have to wait weeks, months, maybe even years for this nerve pain to disappear.

I was discharged a few days later. When I was about to leave the hospital, I was given a bag full of medicine. I looked at the various pills and saw that I was given again the same Tylenol with Codeine, along with the maximum dosage of Neurontin, Lyrica, Biocalm and a whole set of other pills. I asked the pain specialist at BNH why I couldn't get anything stronger for the pain but she told me that it was impossible in Thailand to give morphine to out-patients and that the Neurontin and Lyrica would take care of the nerve pain anyway.

So I went home and lived for a few days in complete agony. The pain was unbearable, even putting light trousers on was impossible since the friction between the trousers and my calf was causing tremendous pain. I then went back to BNH to see the surgeon and the pain specialist doctor. I begged her to give me something more powerful for my pain but she refused again. This time, she told me that it was possible for an out-patient to get morphine but that she wouldn't do it because it would make me an addict. So, she basically admitted that she had been lying to me the first time. So, instead of giving me some real pain killer, she maxed the dosage of the Lyrica, even going over the normal daily limit.

I went back home, depressed and feeling really awful because of the pain and also because of the way she treated me, making me feel like an addict begging for his drugs. Of course, the Lyrica didn't help with the pain. Instead, the extremely high dosage was giving me extremely bad side effects, the worst one being that I was fainting at least twice a day.I then decided to go back to BNH to see her and ask again for a real pain killer. As I arrived at BNH, I started to feel my head spinning, and as I approached her office, I fell on the floor, unconscious. I was taken to the ER and , after a check-up, I was readmitted on the surgery floor.

I then spent the next six days at BNH. During those days, I was given morphine again and it felt like heaven. The pain was almost gone. On the evening of my second day as an in-patient, the pain specialist came to see me. A few days before, I had talked to someone on another forum who had been admitted at Bumrungrad for the same problem than me and had the same surgery. He had told me that when he went home, he had some limited pain, but he was nevertheless given something called Fentanyl. Basically, Fentanyl is an opioid-based patch which is a lot more powerful than morphine! So, I told the story to my doctor who immediately replied "No, it's not true. Fentanyl is only for cancer patients", basically telling me to my face that I was a liar. I then asked her again if she could give me morphine when I went home and she refused, saying that pain is a natural process and that I should be able to endure it! "Suck it up, boy", in other words.

The next day, I was getting seriously depressed. I spent a good part of the day crying in my room. The nurses even called a psychiatrist so he could talk to me about my problems. I have to say, it feels awful when you are in terrible pain and someone denies you the one thing which can take care of that pain and makes you feel like an addict asking for his fix.

At the end of the day, I saw the doctor again. As usual, I asked her to prescribe me some morphine when I would be discharged of the hospital. As I was asking this, I was crying again. She flat out refused again, told me that the Lyrica should take care of the pain (yes, the same drug which made me faint and did nothing for my pain previously) and that if she gave me morphine, I would be put on some kind of secret list by the government. Being put on that list would prevent me from ever getting a job in Thailand. Another blatant lie, of course.

On the final day of my second day at BNH, I saw her again and litterally begged her for some morphine. She finally agreed to prescribe some MST Continous to me, telling me that I could only have it for one month. After that, she couldn't prescribe it to me again. I was nevertheless relieved and went back home happy and almost pain-free.

The week after I was discharged, I found a teaching job and started to work. Since I had been unable to work for three months due to my injury and my second stay at BNH, I was totally broke, so that job was a real golden opportunity for me.

My first week at work was OK, but I started to experience some serious pain in my upper back. The following week, I also started to get some chest pain, along with some pain in the fingers and arms.

Two weeks ago, I lost my job. It turns out that the permanent position I was offered was only a temporary one to replace a farang teacher who had to go out of the country for one month. Of course, the school only told me about that the day before he came back. Along with those bad news came some weakness and serious numbness in my arms and hands. After a bit of research and seeing a doctor at another hospital,I found out that I now have a cervical herniated disc.

My first surgery was paid by my travel insurance. Unfortunately, the contract expired in February, meaning that I now have no money to pay for a new surgery. If left untreated, my new condition could cause paralysis and even tetraplegia.

Finally, last week, I found out from a doctor friend of mine in Belgium that a cervical herniated disc is a common consequence of a badly performed surgery for a lumbar herniated disc. If the hospital staff doesn't move your body the right way during the surgery, it can very easily cause a cervical herniated disc. Since the symptoms of this condition started to appear merely four weeks after the surgery at BNH, I assume it was caused by their hospital staff.

Conclusion of this very long rant (sorry...) : I now have no job, I have 1000THB in the bank, I'm in awful pain because the limited supply of morphine they gave me at BNH has run out and I have a new extremely serious condition which I can't get treatment for. I also spent a month in pain and suffering from serious side effects because of this hospital, not to mention the way that doctor treated me, which is unacceptable. So, if you need to have surgery at BNH, please think twice.

By the way, if you have experienced the same kind of story at BNH, I would like to hear it

Thanks

[Dakhar]

if you "need to have surgery" anywhere, think 4 times, then 8 times more

[nicolas18]

if you "need to have surgery" anywhere, think 4 times, then 8 times more

Yeah, unfortunately, I didn't have much of a choice... my right leg was becoming number and weaker by the day... I would have ended up in a wheelchair.

[JimmyTheMook]

And you could have stopped going back to the same hospital and doctor that you felt were not treating properly.

Have you found somewhere to score ?

[nicolas18]

And you could have stopped going back to the same hospital and doctor that you felt were not treating properly.

Have you found somewhere to score ?

Thank you for all your compassion. Yes, I tried to go to two different hospitals but they said they couldn't help me because they were not the ones who performed the surgery. Therefore, they told me that it was BNH's job to take care of me.

[jackoneilone]

there was sooo many options available.

In bnh for example I know because I did that fire the doc and get another doc who will give u what u want.

Take ur records and go somewhere else eg bumrungrad and get what u want.

Fentanyl used in patches is for chronic pain. But again you had many other options oxycodeine, hydrocodeine etc to ask or get.

I am sorry to hear about all this but you had soooooooo many options both within BNH and elsewhere. Honestly if that had happened to me I would have fired the Docs right there and then and asked for others and if they made excuses I would get the complaints laison (those guys and girls walking around and being ur personal attendee) to sort it out and even get the director etc in. All else fails get crazy on their ass. Very least I would have gotten my records and gone to bumrungrad etc because I know at the very least I could get myself seen by a specialist there with MRI's xrays etc to check and get my drugs.

You can still deal with this by getting in touch with higher ups and lodging formal complaints.

I keep saying this over and over. The hospital is not a symbol of the doctor/surgeon's excellence. Obviously not all doctors at BNH are excellent neither at Bumrungrad or anywhere else for that matter.

And before anybody hopes on and does something find all u can about ur surgeons, their planned treatment method, post op and personal at home pain management etc.

Who was your surgeon?

Edited March 23, 2009 by jackoneilone

[nicolas18]

Who was your surgeon?

Dr Eakpatipan.. The "pain specialist" was Dr Supranee.

[jumnien]

The body sometimes produces sufficient pain required to mandate prescribed pain killers. The circle of pain and prison of prescriptives is not fun, I know. Google AA Thailand, there is a solution.

[nicolas18]

The body sometimes produces sufficient pain required to mandate prescribed pain killers. The circle of pain and prison of prescriptives is not fun, I know. Google AA Thailand, there is a solution.

Errr?

I'm not an alcoholic or a drug addict... I have nerve pain and a new herniated disc. In case you aren't aware, those are seriously painful conditions.

I'm sorry but attitudes like yours and like the one of the "pain specialist" at BNH are insensitive and hurtful. Not only am I in serious pain but you also suggest that I am a drug addict looking for a fix. That is really insensitive, to say the least.

[Sheryl]

If the hospital staff doesn't move your body the right way during the surgery, it can very easily cause a cervical herniated disc. Since the symptoms of this condition started to appear merely four weeks after the surgery at BNH, I assume it was caused by their hospital staff.

The above as worded is not exactly correct and could cause undue alarm. What is correect is that in people with pre-existing cervical spine disease, the usual positioning used to intubate (insert tube into windpipe for anesthesia) can exacerbate the problem and may sometimes lead to cervical disk protrusion, and special precuations should be taken in such cases. Persons planning to undergo surgery on the lumbar spine are well advised to have the cervical spine evaluated as well pre-operatively so that this can be done if necessary. Cervical and lumbar problems do often co-exist in the same patient, especially when the problems are degenerative in nature (related to aging).

However if this were what had happened in your case I would expect the symptoms to have been immediate, not delayed by 4 weeks. I'll be interested to hear what FBN thinks but to my mind the 4 week interval between the surgery and onset of acute symoptoms make it unlikely that the lumbar surgery precipitated the herniation and make it more likely that you simply had degenerative changes in both the cervical and lumbar spine, lumbar being more severe and now corrected surgically, cervical worsening. FBN?

I note that, minus this recent update, you previously posted this saga on TV almost word for word in January. Regarding the pain management issue:

- The Thai FDA is extremely strict regarding use of opiates and doctors and hospitals must submit detailed records of everyy dose given, prescription written etc, and may be questioned if theior prescribing pattern seems unusual. Due to this and perhaps what they are taught, Thai doctors are exteremely gun-shy when it comes to prerscribing these drugs, this you will find virtually everywhere you go.

- That aside, the pain killers and adjunctive drugs you were discharged with are in fact adequate for the vast majority of people undergoing that type of surgery (and the Lyrica, Neurontin etc do in fact reduce nerve pain and the need for opiates). Unless there is something wrong, it is very rare for people to not get adequate relief from the meds you were given. Of course, índividual pain thresholds vary, and yours may be unusually low. Even people in very severe pain (advanced cancer etc) do not usually react in the way you describe (crying, fainting, suicide threats etc). Having it in your mind at the onset that stronger drugs were required may also have played a role. Frankly I can understand from what you describe and the way you describe it why the hospital staff may have gotten the imopression you were drug-seeking. I am not saying that you were, only that I can understand why they got that impression.

I have edited the title to be more objectively factual and less inflammatory. Content left unchanged.

[wasabi]

First of all I have been in Chronic pain before and know it is a frightening and awful experience. I'm not trying to belittle you with what I say but I have a few questions and comments.

One why didn't you go to your home country to have your surgery? Particularly after the failed surgery that brought on all this anguish? Also from a medical caretakers perspective you have been acting like an addict and it is true as Sheryl said that narcotic usage is very heavily regulated in Thailand more so than most of the west which is already pretty strict. I wouldn't be surprised if some type of blacklist does exist. Fentanyl could have been used for your problem but that is a very strong drug and it is most often used for cancer patients though not only these. Given the aforementioned it's not surprising you weren't prescribed this. My father who was a doctor said he would always get a second opinion on everything so you should pursue second third even fourth opinions, Medicine is as much an art as it is a science.

I really do sympathize with your pain and the fear of not knowing what is wrong and will it improve but I don't think returning to BNH and begging for Morphine is going to have a positive outcome. I also agree that even the top hospitals in Thailand can be lacking and I personally would never have surgery here unless it was a matter of life and death.

[nicolas18]

First of all I have been in Chronic pain before and know it is a frightening and awful experience. I'm not trying to belittle you with what I say but I have a few questions and comments.

One why didn't you go to your home country to have your surgery? Particularly after the failed surgery that brought on all this anguish? Also from a medical caretakers perspective you have been acting like an addict and it is true as Sheryl said that narcotic usage is very heavily regulated in Thailand more so than most of the west which is already pretty strict. I wouldn't be surprised if some type of blacklist does exist. Fentanyl could have been used for your problem but that is a very strong drug and it is most often used for cancer patients though not only these. Given the aforementioned it's not surprising you weren't prescribed this. My father who was a doctor said he would always get a second opinion on everything so you should pursue second third even fourth opinions, Medicine is as much an art as it is a science.

I really do sympathize with your pain and the fear of not knowing what is wrong and will it improve but I don't think returning to BNH and begging for Morphine is going to have a positive outcome. I also agree that even the top hospitals in Thailand can be lacking and I personally would never have surgery here unless it was a matter of life and death.

I didnt go back to my home country because I don't have any money left and no family.

Also, I only started to get depressed about twenty days after the surgery during my second stay at BNH. The pain specialist had already refused to give me any strong pain killers for three weeks. I even ended up in hospital for that second stay because she maxed the lyrica in a desperate attempt to control my pain without giving me any morphine or fentanyl. I only started to get really depressed when it was apparent that she would do nothing more for the pain. I was in hospital, with almost no money left already because I had been unable to work for three months and I was starting to realize that, due to this excruciating pain which wasn't taken care of, I wasn't likely to get a job anytime soon. Also, I may have had some crying fits and I may have asked the doc repeatedly for morphine, but I do not look like an addict type of person... Every time I asked her for morphine, it was argumented.

Regarding the Lyrica and the Neurontin, yes they are used to treat nerve pain. However, they did absolutely nothing for the pain I was experiencing. Even at high dosage, the intensity of the pain remained absolutely the same.

Regarding the "blacklist", it is a blatant lie. We both know how Thailand works and we know that no employer ever checks your name against any list when hiring you.

And finally, regarding the cervical herniation, I had a different opinion from a doc friend of mine who lives in Belgium. He told me that being positioned in the wrong way on an operating table can cause a cervical herniation. If the herniation is massive, it can cause immediate symptoms, sometimes even a temporary tetraplegia. If it is not as serious, the symptoms will only gradually appear as the herniation progresses.

I sincerely hope that none of you will ever be in a situation where you experience excruciating pain and you are denied proper treatment. Add to that the fact that the doctors and people on this forum regard you as a drug addict and you would begin to understand how I feel these days...

[jackoneilone]

Ok thanks for that.

May I ask why you did not go to Dr Wicharn Associate Professor who clearly is the best at BNH and well trained overseas too?

Or others eg at Bumrungrad Dr Areesak Associate Professor who trained at John Hopkins and UCLA or Nanthadej w his overseas trainings and fellowships ?Dr Nanthadej at Bangkok Hospital etc?

for your pain you could try Bangkok Hospital's Chronic Pain department specialising in pain management and diagnoses?

there is help out there and there were better doctors to choose from etc even in the first place (though i havent seen anything bad about that doc yet and 1 board member recommended him). 4 weeks later does seem very odd for a herniation to pop up then and this blacklist business just seems like a scare tactic as they are veryyyyy strict about opiades etc. have u tried to simply get some of the other meds like oxycodeine, hydrocodeine etc?

[nicolas18]

Ok thanks for that.

May I ask why you did not go to Dr Wicharn Associate Professor who clearly is the best at BNH and well trained overseas too?

Or others eg at Bumrungrad Dr Areesak Associate Professor who trained at John Hopkins and UCLA or Nanthadej w his overseas trainings and fellowships ?Dr Nanthadej at Bangkok Hospital etc?

for your pain you could try Bangkok Hospital's Chronic Pain department specialising in pain management and diagnoses?

there is help out there and there were better doctors to choose from etc even in the first place (though i havent seen anything bad about that doc yet and 1 board member recommended him). 4 weeks later does seem very odd for a herniation to pop up then and this blacklist business just seems like a scare tactic as they are veryyyyy strict about opiades etc. have u tried to simply get some of the other meds like oxycodeine, hydrocodeine etc?

Well, I didn't know anything about Dr Wicharn or Dr Eakpatipan... So I just took the one the nurse recommended to me...

Yes, I tried to get oxycontin but they refused as well. I was prescribed Tylenol with Codeine before the surgery but it didn't do anything for the pain. The pain level is simply too high for that drug to work, especially since the pain level is actually higher now than it was before the surgery.

[jackoneilone]

Ok thanks for that.

May I ask why you did not go to Dr Wicharn Associate Professor who clearly is the best at BNH and well trained overseas too?

Or others eg at Bumrungrad Dr Areesak Associate Professor who trained at John Hopkins and UCLA or Nanthadej w his overseas trainings and fellowships ?Dr Nanthadej at Bangkok Hospital etc?

for your pain you could try Bangkok Hospital's Chronic Pain department specialising in pain management and diagnoses?

there is help out there and there were better doctors to choose from etc even in the first place (though i havent seen anything bad about that doc yet and 1 board member recommended him). 4 weeks later does seem very odd for a herniation to pop up then and this blacklist business just seems like a scare tactic as they are veryyyyy strict about opiades etc. have u tried to simply get some of the other meds like oxycodeine, hydrocodeine etc?

Well, I didn't know anything about Dr Wicharn or Dr Eakpatipan... So I just took the one the nurse recommended to me...

Yes, I tried to get oxycontin but they refused as well. I was prescribed Tylenol with Codeine before the surgery but it didn't do anything for the pain. The pain level is simply too high for that drug to work, especially since the pain level is actually higher now than it was before the surgery.

tylenol , paracetamol+codeine, ibuprofen etc would all be useless idiots.