Dr Muzin Questions + Answers - 5/15/12

1.       Do I still need to wear the back brace?  I dread it.  Actually wearing it for most of the day is not so bad, but by the end of day it usually hurts quite a bit.

a.       Would a smaller, elastic “girdle” type of support be sufficient to prevent damage and promote healing?

b.      At this point, is it “dangerous” to go without the brace, especially when it is causing considerable discomfort?

c.       Trade off – no brace, no vicodin; brace, vicodin?

Yes, wear the brace.  The bones need stabilization, and a smaller brace won’t do it.  The 3 lumbar vertebrae that I’ve broken are 1-3, and the numbering starts from the top.  [I think as a result of a Google search] the lumbar vertebrae extend up to where your lowest ribs attach to thoracic vertebrae, so you can’t stabilize them with just a lower back brace.  Yeah, it is a major pain, but healing is happening, and it should just be another 3-5 weeks.

2.       It feels as if the problem is migrating up in my torso.  The primary pain is now in my rib cage.  Could it be that my ribs are turning to mush as well?  Or is that the reaction of my breathing muscles to being constrained by the back brace?  Now in the evening it really hurts to cough.
Dr Muzin ordered a set of x-rays.  He will call if the x-rays reveal anything that is unusual or dictates a change of treatment.

3.       I am getting no exercise.  Are there exercises I can do while waiting for my bones to heal? – Weights with arms? Or those stretch bands?  Recumbent bike? Stationary bike? Eliptical (no impact)?
Hold off until the bones are healed.  Then he will recommend a course of physical therapy.

4.       I have given blood + urine under a program dictated by an endocrinologist.  Presumably the tests will shed light on why I have osteoporosis.  Do you have any insight as to why I am in this condition?  Does the MRI give any clues?  I am due to see Dr Rosen in at BIDMC this Friday.  Should anything that you have gathered be fed onto him?
[I neglected to ask this question.]

5.       My wife found Coumadin study that shows men who have been on Coumadin for more than a year have a 63% increase in the incidence of bone fracture.  http://www.drugs.com/news/warfarin-raises-bone-fracture-risk-1705.html.  Have you seen other men who have developed this condition while using this drug?  [Shouldn’t a bone density scan be recommended with the use of this drug?]
He was unaware of this study.

6.       I don’t know if it is an after-effect of the hip operation, but lying on my right side while sleeping does not last long.  At times my right foot also feels tingly.
He tested my legs and back for strength and responses.  All appear OK.

7.       What is the prognosis for (1)healing of the lumbar vertebrae

a.       Upper back/posture reversal

b.      Regain full function.  Time line?

He did say that PT can address the old lady’s hunch I now have.

8.       Do you recommend PT?  

I held off on this, as PT will come after the bones can handle some strain.

9.       Who should manage this type of “disease/injury” – you or the endocrinologist?
He handles the pain and manages the broken bones.  The endocrinologist figures out what caused the osteoporosis and fixes that.

I then went to have x-rays.  It was a major issue to get down flat on my back, as my backbone was protruding from my back, and lying flat on my back hurt.  We started with x-rays while I was lying on my left side, and then I could roll over onto my back.  You’d think a slightly soft surface to lie upon while getting x-rays would be a no-brainer.  By the time I got home, the upper back was in full revolt, so I shed the back brace, took a vicodin, and went to bed.