Stuck in a rut!

Work has not been going well, even walking from one end of the building to the other is not getting better. I am a therapist at a school that has 4000 students and is 500,000 square feet, they call the place the fortress. I do have an elevator key but still need to walk alot. Different part of the building every 30 minutes. The physical requirements beyond the walking and carrying a 20 pound bag are not that much. I am not wrestling with preschoolers or requiring to restrain kids any longer. I thought I could manage this, now I am having second thoughts. I cant exactly ask for a change in locations without divulging exactly why this is a problem, and where would I go next, this is the least physical caseload I can have.

I am taking my BT med every 4-6 hours for the most part, I am prescribed 10-20mg oxy up to every 4 hours prn. During school I take 10mg, but as soon as I am home I take 20mg for my next dose. I do not take every 4 hours all day, but at least 4 times per day. I also take Zanaflex 4mg 3x day, during school I try to take 1/2 pills every 4 hours. Same daily dose just split up.

I am thinking its time to talk to the pm dr about increasing my LA. I have really been able to keep my fentanyl at a low level, 50mcg for several years. We have tried higher and I never tolorated it well in the past.

I am happy with my SCS. It does a great job on my RSD areas and a decent job on my leg and foot pain. However it doesnt do much for my lower back. I should say, so far it hasnt helped my lower back, I should probably call for a reprogramming to see if we can tweak some more.

I am also considering, talking to the pm dr about STD/LTD. He has suggested it multiple times in the past but I was so hesitant to even consider it. I have no idea how it works. I have the insurance for my family from my job, we cant afford to lose that. I do know that since I am vested, If I am determined permanentely disabled by the dr they will start my retirement benefits immedietely. Not a huge ammount at this point but its something. Can anyone fill me in on STD? I am so hesitant to call my HR department and ask any questions since I dont want to raise any questions about my health and issues.

Any suggestions on meds or disability would be appreciated.

Thanks all,
Shell

Hi Shell, sorry to hear things are going pretty rough for you. I know how hard you have pushed and worked to keep yourself in the main stream of life. Its a tough battle, but sometimes when things get to where you are, its time to reevaluate and take another look at the big picture.

You asked about STD, do you by chance have any of your books that should have been given to by your employer? If not, why not just go up to HR tell them you cannot find your book and would like another one and leave it at that. These policies vary because it depends on the type of policy the school has, most regular policies are a 60 STD, then if the person is still unable to work they kick over into the LTD. Usually if a person applies for LTD they are also required to file for SSD. If you are in a union if could be totally different, not all schools are in a union. Its really hard to answer your question on this because it depends on the type of policy the school has and what their clauses are and that sort of thing. If you had a booklet that would answer your questions. I wish I could be more helpful.

Anyway, I wanted to pop on and say hi and I hope you can get to feeling better...Susie

Shell,
Sorry your having a bad time. I also wanted to mention that if you are union, your union rep should also have the information regarding disability.

Best of luck to you!

Hi shell, I had typed up a nice long reply for you last night, and then my phone died. I'm just going to paraphrase what I wrote last night.
1. LTD/STD as an employee of a school is very different, and a lot of it hinges on if your covered under a collective bargaining agreement or not, being a therapist, and a provider of services, I'm assuming your a confidential employees, which, here in Ca, are not usually union positions. One of the biggest things is your employee contract, how many days are you allowed to miss, and still have your contract renewed, do you have to exhaust your sick leave, ect. If nothing else, you should be protected for 12 weeks under FMLA.

Another recommendation of mine, is to use a rolling brief case/backpack/box, instead of carrying your stuff, might help a little. Also, I have a (I believe it's Rubbermaid) collapsible stool in my bathroom for my son to use, you might look into one of those, I've heard putting your feet on a foot stool can make a lot of difference for your lower back.

My final thought, if you are union, contact your union rep about STD. They might be able to tell you a little about it. It really varies from school to school, but since you're not a teacher, it might be a little more simplistic than if you were. Like I said, there's a lot of variables for that, and I'd have to look at your contracts and STD/LTD policies, to be able to tell you what the full picture is. I can tell you that filing for it should be pretty straight forward, you get the paperwork, you fill out one portion, your doctor fills out another, and then you file your claim and wait for approval, beyond that, it depends on your school district.

Take care, and I hope you're able to get your SCS tweaked to a more beneficial setting. Good luck.

 

        morning Shell!...I feel your pain and worry, as I'm going through much the same and work as well. You have been given some good replies here, so I don't have much to add. I just wanted you to know that we care, and feel the worry and stress along with the pain.

  Lets hope things work out for you there, and you can continue to work.

 SE

Matt, I hear you on that! Its why I am so hesitant to approach HR. Thankfully I am 3rd from the bottom in my department and due to my position requiring certification there are not other people in the organization that can bump me. Butof course if HR wanted to I am sure they could find a way to use it against me to bring someone in and pay less. I have scoured the website for the last hour and found very little that was helpful. My collective bargining contract explains FMLA and that they will pay medical benefits, but it says to refer to the organization website for "income protection/STD and LTD" info as part of the employee handbook. It has a heading under the table of contents "FMLA/Disability" but nothing on those pages goes beyond the 12 week FMLA, with the exception to call HR.

Tomorrow I have a teacher friend that was out last year I may call, but she falls under a different union. I will also make the call to my rep. I should be able to have the nion rep make requests for that sort of info I would hope, keep my name out of it and confidential till I would decide if it was something worth pursuing.

Thank for for the adaptation ideas Matt, pretty much what I would tell my patients when I did acute rehab, but its hard for me to do for myself,lol. I have a cart I use, but I broke the handle last week. Thankfully I dont need to carry more than a handfull of files and my computer but it does get heavy.

You guys are all so great, your comments make me understand I am not crazy or giving up on myself.

That's good news to hear shell. Hopefully tgey can at least do a med adjustment while they get that SCS tweaked some more. Sounded like they have more stuff they can do to that unit?

I know in your line of work, meds can mean such am incredible liability, I was subbing at one of our middle schools, right after my gastric bypass, and had taken some day quil, and as I was driving to the school, started to feel drunk and completely loopy! Didn't realize at the time that it was dumping, I felt awful though, so I had to call in and they had to have another sub come in. I stay away from dayquil now lol, that feeling always lasts for hours with that.

Well, I hope your PM takes good care of you, and hopefully they'll get things squared away so that you don't have to go on disability. Take care, and God bless.

Todays appointment went ok. Not great but at least we are trying to make some changes. We are doing a course of steroids, then on the weekend upping my long acting. No change to my breakthu, but I will take it one step at a time. I was hoping for a change to try something different. She said with my gastric bypass she wanted to stick with what we know has worked and what I can tolorate, the liquid med has done good for me in the past. But playing with the long acting really makes the most sense in the long run.

I have something else that I had used in the past that worked wonderful with no noticable side effects and good pain control, I could actually use it during the day without an issue, but when I changed insurance it was no longer covered. I also thought about asking her about starting a new set of appeals for it. Maybe if we cant get a handle on things I will suggest this. If I could afford to pay out of pocket I certainly would but its not an option.

She did mention about some injections, but I am very hesitant to go this route again since I have never had real success. But I am open to try whatever plan they feel will be most beneficial. Just one day at a time.

Thank you all for your support!

I am so very beyond frustrated at this point. Pain levels are so high, all I can do is lay here. I was able to schedule another repromgramming with my SCS to see if we cant get the lower back covered a bit better without losing the legs and feet, so I meet with them on Monday, my rep just texted me.

Today we upped my LA meds. They wanted me to go to the ER last night but with my grandson there was no way for me to do it.

I just opened my husbands lock box and found a box of leftover BT meds, the kind that really works well for me, but the insurance no longer pays for. Yes, they are absolutely mine, prescribed by my current dr but over 18 months ago. We just stopped using them due to the insurance and cost of self pay. I just dont know if at this point that may be breaking my contract if I used them, since we have moved on to another med. What do you think? If it was a weekday I would just call the PA. I realize that I am either over thinking this or trying to justify to myself, but cant decide which it is, I am just at my wits end. Just want to get a nights rest without waking up crying every hour.

Luv you all!!

I know you are right Susie. Funny thing is that it is the same med as my LA, just IR. Just wish it was during the week so I could call. When I get to this point I am just grasping at straws. After almost 2 months straight of this I am completely fried.

Thank you for your thoughts Susie!

I have really tried to keep spirits up and just keep plugging away. In the long run my inability to accept limitations and take it easy is pulling me down faster I fear. I am unwilling to accept a happy medium I guess. In the past I have requested meds for depression and I am thinking it may be time to head that way again, just for my own sanity. Increased pain, equals increased frustration/anger and that equals increased depression, I wont ever deny that. Not for everyone of course, but I would say a very high percentage of CP patients that is probably the case.

I dont think I had unrealistic expectations for my spinal cord stim, I am thrilled with what it does for my burning from waist down and for my heavyness and pain and my feet. That is a success! I just know this is pretty much the last ditch effort to combat everything and my pain levels, as a whole, are much higher today that they were pre stim. Yada, yada, yada, you all know how that is,lol!

So far so good on the increased long acting, just a bit tired, in the past I have had significant issues when that was upped. Pretty much related to an increase in my central apneas while sleeping, which could be why I am more tired today. Even though I havent been using my CPAP since I lost the weight, I think I am going to use it for a while till I am adjusted to the new dose, just to be safe. After a few nights it should give me some data to let me know if its happening or not.

Again, thank you so much for your responses!

Just a quick update. So far no such luck with any changes. My PA gave me the go ahead to use the BT med that I had stashed away. But once its gone its gone pretty much. So I will use it at work only when absolutely needed. She is willing to start a multi level appeal again but it does not look promising with the exception we can make a case for my poor absortion from the gastric bypass. In the past the insurance has stuck by the prescribing info that it is to only be used for cancer pain. We will see.

I had my stim reprogrammed and although it is hitting some more effective areas its not significantly decreasing anything. We upped my long acting and I seem to be tolorating it pretty well.

I am going to see my pcp next month, so if I cant get out of this vicous circle I will likely ask for some sort of depression med. Believe me Susie, I am ready to cry Uncle! For me thats very hard to admit.

Thank you for everything!

Susie, the pump is one thing we havent discussed. Not sure if it would ever be an option for me. Just feel that I am not making real headway with these meds working the way they should. Is that typically considered once your doses are super high or are there other possibilities?