Low dose Amitriptyline Vs CAA?

[blue up]

I've been chatting with our company medical advisor (a non-pilot) about back pain and sciatica problems and he has mentioned the possibility of a low dose (circa 10mg/day) of this anti-depressant as a short term trial against pain and associated sleeplessness.
Any ideas as to what the UK CAA are likely to say? I'd hate to start something like this and then find out that the advisor/doc had prescribed something on the no-no list.
Glucosamine Sulphate and honey are not banned substances. I've already checked!

[HEATHROW DIRECTOR]

Give them a bell and get a definitive answer..

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I've had a reply to the message I sent them. They've suspended my Class 1 medical in anticipation of me collecting my prescription this afternoon.




I'm reminded of the opening lines by Hugh Grant in "4 Weddings & A Funeral"

[gingernut]

Similar stuff here.... http://www.pprune.org/medical-health/456730-can-neurontin-taken-work-while-flying.html

Guess only the CAA can give you the definative answer, they get nervous about such drugs- it's worth mentioning that the dose we use for pain relief, is a fraction of that we use (d) for depression.

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For the benefit of anyone finding this thread in the archives in years to come...I've had the best 2 nights of sleepin a long time! I managed about 2 miles of walking without any noticeable pain. The downside is that my mouth tastes like I've been chewing cardboard all day and I have to lay off of the booze. I'd say that it represents a fair trade-off.
The UK CAA want me to have been off the stuff for 2 weeks and to see an AME before I get my medical revalidated.

MRI scan booked on Monday. Fingers crossed.

[blue up]

Just been to look at my MRI scans.
2 discs bulging aftwards and the vertebra between them is shoved forwards. He also thinks the vertebra looks fractured. Words uttered included something like "Spondidlyosis" and "Parrs fractures". I'm off for a few hours of Googling!
Injections, an epidural or fusing surgery. Any suggestions or personal experiences?

[Rotorhead1026]

I didn't have the fracture, but had one bulging disk and one ruptured. L3 was displaced. Much pain initially due to muscle spasms; these died away but I lost a lot of strength in my left leg due to nerves being pinched. L2-L3-L4 were fused and some stenosis cleaned up. I'm all better now (almost three years out).

Note I had been having mild spasms for a few years before the disk gave way. When this happened, there was NO DOUBT what the problem was. Many people have this operation too early, when the cause isn't very apparent. The results in these cases aren't always very good. You're past that point, like me.

Use the drug to carry you until you can get the surgery.

[homonculus]

Spinal surgery is a speciality in itself and one that is rapidly advancing

Please do not use this site to get advice. Anyone who gives advice without seeing your MRI (and being able to read it) should be ignored

All I can advise is to ensure you get seen by a specialist who does nothing except spines.

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I'm not actually asking for someone on Pprune to come round and glue my back together. I think it is safe to ask on here if anyone with actual experience of this matter can advise on post-op pain levels, recovery times, personal improvement in the short and long term etc.

I asked my wife about the epidural she had and her response was that it was fairly painless. Not sure I trust her.

[homonculus]

Sorry I didnt make myself clear

Without looking at your scan and taking a history I can't tell exactly what is wrong nor what operation you need so I haven't a clue what your postoperative course might be

For example some fractures can be left, others treated with an epidural, some with an operation taking ten minutes under local anaesthetic that provides instant relief but others need multiple open operations and weeks in hospital

That is why asking other people who may have had a totally different problem is misleading

[blue up]

Likewise, I guess I haven't explained myself properly. What I wanted to know is if anyone here has had injections in the back, if they hurt, if the CAA frowns upon such things, if Epidurals need you to be admitted overnight or if you are likely to go straight home, if you can drive home after an epidural, if it treats the symtoms or the cause etc etc. Personal experiences. What sort of things might I expect.

[homonculus]

Spinal injections or blocks are normally done under sedation as a day case

You will be in hospital for 2 hours

You need to be accompanied and cannot drive that day or go out

You can return to work the following day unless you are a pilot as you need to notify the CAA

15% of patients have flare up of pain for a few days, 15% have immediate relief and the remainder have some benefits

Relief can last for several months and you can have several injection,s over time.

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Thanks. Just what I was looking for (except the pain bit)

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http://i82.photobucket.com/albums/j279/foggythomas/badback1.jpg

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Quick update. Had bilateral Pars blocks and a Caudal epidural. They gave me Rohypnol for the op and I can recall the juice going in and then the bloke (can't spell anesthesiologist) saying that it would start to take effect in about 30 seconds. Next thing I remember is having a cup of tea in my hand, sat up in bed. No idea at all about what happened in between but I was awake for the whole thing, so they say. Scary stuff, Rohypnol!
12 hours of feeling a bit doped up and then 48 hours of total relief. Next few days have been reasonable with a return of the tremors during the morning and backache whenever I've been exercising the back. Pins and needles have remained throughout. Fingers crossed that I'll be back flying soon. Next appointment in 3 weeks and then a few weeks without meds before a CAA visit.

The pic above shows the displaced vertebra and the 2 discs either side which are slipped aft.

[blue up]

5 weeks since the injections. Backache has returned to the pre-injection levels so I'm back to where I was before. Next step likely to be a bit more invasive. Still taking the amitriptyline and will continue to do so until the pain has gone.

[Loose rivets]

A subject close to my heart.

Be clear, this is just general conversation between you and a retired pilot.


I'm puzzled about why it is thought the vertebra is displaced per se.


Significant Edit:

The front looks in line, with no sign of significant spurs. The 'leading edges' of L5 and S1 are naturally very pronounced.

I can only assume the hollowing in at the rear is the intervertebral foramen - on the red cut scan line - viewed from the opposite side . It will show as white.

[blue up]

Thanks for the input. The rest of the images also show that same vertebra misalignment to the rear.
I went along today for a check-up and he agrees that I'm back to where I was a few months ago and that the only real option now is Fusing. He showed on his whizzy computer program where the sticky-out bits of the rear of the spine had broken away and allowed the front of the spine (where the disc sits) to slip. Quite clear when he pointed it all out.
The op requires 5 days approx in hospital and 3 months off work, minimum. They have to go in from the front AND the back to remove the damaged disc bit and the then screw in some titanium to hold the bones together. Only got back 20 minutes ago so will be Googling tonight, with the approval of the surgeon.
Anterior lumbar interbody fusion


And, YES, it will make the security machine go PING!


The only other option is to join you in retirement at the age of 43.:uhoh:

[Loose rivets]

It certainly sounds as though you are getting the best possible care.

Good luck!

[airbus.skydriver]

BlueUp you have a PM

[blue up]

PM'd back.


PS Lovely weather to be out in the garden in a comfy hammock with a coffee and a choc biscuit.

Been waiting 2 weeks for an appointment with another quack.

[blue up]

Yippee! Class 1 medical!

I hadn't noticed that I'd lost the ability to stand on tip-toe. Kinda explains the tripping up when trying to run up the stairs. The nerves to the feet were obviously disturbed but after 2 months of very intensive exercise I have developed enough strength to operate the brake pedals. I recorded 7700 calories in 4 weeks on the treadmill, Rotary Calf Muscle machine and bicycle alone. Here in Wales you can get a GP referal for the gym on the National Health Service so it only cost me the £50 fee for handling and the use of showers etc. Dread to think what it might have cost otherwise.

I stopped taking the Amitriptyline a few weeks ago and have had many restless nights and some bizarre dreams since then. Probably takes a while to adjust back to normal life.

Cup of tea and some chocky bix and then maybe a Curry tonight.:ok:

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Brief update. Got worse again (long story!) and finally was forced into having the fusion Op.

I can now (Op + 1 week) feel the top of my right foot again, pee freely, sleep and am 2.5cm taller than I was before. Time will tell if I can get back to work and there seems to be a suggested minimum of 6 months recovery. Photos, for those with a strong stomach, here...

http://i82.photobucket.com/albums/j279/foggythomas/DSC00237.jpg
http://i82.photobucket.com/albums/j279/foggythomas/bonesx2.jpg
http://i82.photobucket.com/albums/j279/foggythomas/DSC00233.jpg
http://i82.photobucket.com/albums/j279/foggythomas/DSC00232.jpg