### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Im looking for orthopedic surgeon and pain management dr. who can help me going forward,with surgeries to my knees and lumbar, Ive qualified for disability,waiting for final approval paperwork. until it goes thru would be a self pay. I have rhuemetoid arthritisis,my hands (especially thumbs and joints) are in terrible pain, I have a fusion at C5C6C7, herniation at C4,C3. The lumbar is seperated at lumbar and sacrum and herniated at L5L4L3, my knees healed wrong, and my right groin was torn and have terrible pain with my right hip, all due to a fall down a L shaped staircase, landing upside down. the Cervical spine, due to a construction truck running a stop light and stopping once he hit me. The pain I deal with on a daily basis as at a 8, that is just dressing, trying to do at least 4 meals a week, Im in the Baltimore area. Ive been through so many different regiments of medicines, therapy is impossible until my knees, hip and lumbar are addressed hopefully with the least amount of surgery possible, I found after my fusion, the scar tissue and the healing years later has its own set of problems. My goal right now is to maintain the ability to be a home maker with the least amount of pain until surgeries can be done, and even then those aren t guaranteed to take away a lot of the pain, as I learned with my cervical surgery. Fentanal patches, gave me my life back, my break through medicine was reduced to 15mg.1 to 3 a day max.My goal is to have the least amount of medicine with the most amount of quality of life, ive been dealing with this pain for over 10 years now, my last doctor whom I loved and was an amazing gift, finally was able to go into the field he longed to do, which was childrens cancer, leaving me searching for a dr. but not finding one that could address my pain and have a plan long and short term plan for surgery and pain. My pain management plan re: surgery was interuppted with a bacterial infection from an infected kidney stone, which became sepsis, and I nearly died, I had a nephrostomy tube and 3 stents until the surgery was finally performed to remove my the infected stone and it took months to get my health back. Trust is critical and Im looking for that trust and care close to my home if possible. Thank you Sandie

### output:

You have made an excellent PM HOI. It gives lots of inputs. You need to focus on your diet, sleep, exercise plans. This works in most of the RA cases. Pain and aches are disabling which is acceptable. Keep a positive attitude. Do regular yoga breathing exercise like Panama, eat healthy food, sleep properly and do regular ROM and strengthening exercises. Improve your endurance levels as the metabolism should function good and support the immune system. As you must have Google by now what your condition is all about. So kindly focus on all proper guidelines. Surgery might give a temporary relief but nothing more accurate than the self-induced efforts to fight back. All the best. I can prescribe some exercise if we get some close communication. Thank you