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Help!  Lumbar fusion client

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  25. Thelonewolf:
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Hi all, need some input here.I have a new client who injured her back in summer 02, had a discectomy in fall of 03 (L4, L5, S1).  Still had intense pain so dr recommended fusion in fall 04.  Fused L4, L5, S1 and put in rods and pins.  Pain is worse than ever and now her left leg constantly hurts.  Basically she was told that they can do nohting more for her and referred her to pain management.  She takes Percoset every 5 hours for pain and wears a Lidoderm patch on her sacrum 12 hours on, 12 hours off.  She came to me via gift certificates as a last resort.  I've worked on her twice and she would like to continue, if only to reduce some of the stress she's under (she's unsure whether or not massage can help).  But, money is a huge issue since she's not able to work.  She thought workman's comp would cover it but her dr won't recommend massage, though he doesn't oppose it.My issue now is she would like me to write a letter to her dr stating benefits of massage as they directly relate to her, hoping he may decide massage could help her.  I'm at a loss as to what to include in this letter.  I've never done this before and, while I have some experience working with lumbar issue, I'm definately no expert.Any suggestions?
 

some girl

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Help!  Lumbar fusion client

I have a client who  has had 5 lumbar surgeries with bolts and plate to support disks that have degenerated.  He comes every 3-4 weeks.  Been coming for more than a year now.  I would write a letter to the MD citing sources regarding the following.Scar tissue and massages ability to help break it up.Low back pain and Sacral ligaments (massaging ligaments alleviates pain).  QL treatments.  Contract/Relax vs. resistance on QL stretches the tight mm and restores hip imbalances.Psoas, erector mm. TFL, quads, on and on and on.  Site the clients Postural assessment and which mm present themselves as either overstretched or contracted to compensate.  A client in pain is likely not breathing properly, lymph not moving properly, digestion affected, etc.  Leads to chronic pain cycle, long term stress (cortisol) etc.  Massage can help break that cycle to allow better healing.  You could go down the line of every system of the body and how it's affected:  circulatory, lymph, endocrine, etc.Maybe someone else has a better idea of how to deliver the message.
 

Drummer435

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Help!  Lumbar fusion client

But, money is a huge issue since she's not able to work.  She thought workman's comp would cover it but her dr won't recommend massage, though he doesn't oppose it.
Is she still a work comp patient?If so, she should have a "patient advocate" (a.k..a case worker or case manager) on her case.Usually this is provided by the state.  Usually an R.N.These nurses are usually really good at their job, and though many people who are under work comp feel like the "state" is thier enemy, if you can actually get a face to face meeting with your "patient advocate", you stand a greater chance of getting a lot of things done.Another thing that can be done is to change treatting physicians.  I am not saying she has to, but it is an option.  She can go find a treating physician who is a bit more sympathetic to the need, then sign the paperwork for the change and get the script that way.  From what I remember, the change is not the problem, but you can only change "treating physicians" one or maybe two times... so you need to make sure this is a good physician you are going to.  There is a specific form that must be signed, and the "new" physician should be able to provide this.Comp cases are usually always complicated, as I am sure you know, but, I hope that helps.
 

Ranging

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Manahana, I was thinking along the same lines as you.  My first thought was the incredible amount of scar tissue that must be present.  BJB, she was told he wouldn't Rx massage because it *wasn't medically necessary*.  I dont' know if a phone call would help or not, never thought of it actually!Texas-gal, she is still a work comp patient and she does have an advocate.  She was working on getting in touch with her this week but since she's been passed on to pain mgmt she's moved down the list of priority patients.  The dr she's seeing is a pain mgmt dr, as everyone else has given up on her.  I don't know if she's considered changing docs, I'll feel her out next time I talk to her.This is so frustrating to me because I know she can benefit from massage but I'm afraid she's going to be denied once again.  I can't imagine the pain she deals with on a day-to-day basis and I know if I'm frustrated, she's more than frustrated.  I willing to work with her on payment issues if work comp won't pick it up but I'd rather  neither one of us have to deal with that!Thanks!Jen
 

John Carriere

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Help!  Lumbar fusion client

Being a massage therapist I am very aware of how it can help. I have a herniation at L-5 with problems in S-1 and many bulges all the way up.Before this career a  few years ago I was a candidate for surgery and my friend a Chiroprator gave me McKenzie exercizes to do which stopped me from getting surgery. Thanks to the muscles holding better.I was thankful for that but was not told about massage in the area and I developed stiff tight in-flexible lower lumbar-sacro area which I have to stretch as best I can everyday. I would have given anything to know about massage and how that would have prevented the condition I have now.Back to the main point though I was still getting relapses with pain and sciatica off and on and in school learned about the muscles that effect that especially the Psoas and Piriformis. I had NMT also which helped and I learned to treat myself with it in my classes. In doing so I realized that the severe pain I experienced at the time of the herniation was actually the muscle imbalance which went away as I corrected that through massage.I was not told that by any doctor. I still have the herniation and buldges and of course I am careful. Aside from the tightness and some inflammation sometimes I never have pain or sciatica which was constant before.I had a re-visit with a new MRI to follow up the one done in 2001 when I was in severe condition and the results were the same with a slight worsening but no pain. My point being I would have had the surgery and would have still had the pain because the muscles would not have been addressed. This is not just something I heard but I lived and still live this.I cringe when I hear of so many people having this type of major surgery and nothing is corrected-usually followed by more surgery, etc.I don't know why the medical profession does not put more weight and value on what massage can do before they go any further. My doctor is an angel and he listen s to his patients. He was totally supportive of me and always looks for the alternative method as a viable option. I believe that is why he is so loved by everyone.Mylower back tightness improved when I started school and was getting massage regularly. Everyone used to say "wow" look at this tightness when they were working on me and used to wonder how they could see that. I finished school and moved to Las Vegas and cannot afford massage right now. That is why I am stiffening up. Hopefully soon I can find someone to trade with here when I pass my National and can begin to work. Once I get massage regularly and then do my strengtheing and stretching with it I probably will be great. ::)If a doctor does not believe in this method there is not much you can do to convince them.Thanks Barbara
 

nirvana

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Help!  Lumbar fusion client

How's it going with this client? Any updates?
 
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