Ketones in Urine in SCS pre-op labs

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Timeoutofmind

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Weird situation here...

I inherited a patient from this other pain clinic. They had done the SCS trial and he got good relief. He is not following with them anymore because they no longer accept his insurance. I agreed to do the permanent (I am a hospital employees so payor mix does not matter for me).

On his preop labs he has ketones in his urine, but no glucose. I know this is consistent with alcoholism, and suspect this is the case because in reviewing his records on one of his labs at the other pain clinic he did have + ethanol in UDS (one of the reasons I am not prescribing opioids for him).

Only other comorbidity is COPD. He is a smoker. I have talked to him at length about his elevated infectious risk with this procedure for that reason.

What would you do?

Classically, implanting in someone with substance abuse is considered contraindicated. Also, I worry about surgical and medical complications of the procedure given what alcoholism does your health. And if he is not going to take care of the wound in a drunken stupor etc. I have seen him in the office once and talked to him on the phone once and he seemed stone cold sober both times.

I could send to the PCP for "clearance" but how is that going to help me? I could require that he go through some sort of treatment program with appropriate documentation before I agree to implant? Just refuse to do it all together?

Thanks in advance.

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check an ethyl glucoronide level and a urine tox for alcohol next time you see him.

if positive, reconfirm that psych eval was appropriate and have him go back to see psych.
 
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