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Old 07-17-2008, 09:22 PM   #1
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Question Couple questions.....

I am beginning to learn that my experience with my first PM was unusual, to put it mildly.

I am trying to get back to the point where I am again complying with all regulations and rules. Until I'm in compliance again, I can't have a decent relationship w/ my PM. I know that some of will say I can't ever have a decent relationship with her until I have been completely honest about what happened. I may wind up feeling that way and have to switch PMs as a result. Thanks for your support.

Last edited by Confused089; 08-24-2008 at 05:27 PM. Reason: Same reason - editing out info that has been posted elsewhere multiple times.

 
Old 07-18-2008, 08:26 PM   #2
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Re: Couple questions.....perhaps for Executer if she stops by again?

Quote:
Originally Posted by Confused089 View Post
I don't really know what information PMs get and have access to on their clients when they first take on a patient, and then track the patient's progress. I know my PM knows if I get a scrip for another narcotic, but does she know about *all* the scrips I fill, particularly if they are not at my regular pharmacy? For instance, I got a prescription for clonidine to help withdraw. Will my PM have this info? I don't have a primary care doctor right now. I got it through a health clinic and filled it at a pharmacy close to my house, but not the one I usually go to.
Your PM Doc's access to your prescription records depends on what state you live in. Some states have Rx monitoring, while others do not. For those who do, it only involves controlled substances....Meaning that any controlled substance that is filled, gets entered into the state database. Thus, any pharmacy or Doc office can pull you up and see your controlled Rx history.

Some states only document CIIs while others document all controlled. Since
clonidine is a blood pressure medicine, he will not see it. I say this with a fairly high certainty, but again, it's up to your state.

It's also important to note that with the controlled, Docs will only know if they search your name. That's not to say you won't get caught, but I imagine most legit PM Docs search every so often in order to patrol the waters so to speak. Also, you would have had to give them permission to do this, BTW....i.e. signed a form.

Quote:
Second, is a ua going to show that am on more fentanyl than I should be? I am supposed to switch patches every 48 hrs. and wear two 75 mcgs. At this point, my body needs a rest from tapering. I'm exhausted and have a cold. So, the next time I see my dr., I imagine I will be wearing one 75 mcg patch on the third day when I should only be wearing two for 48 hrs. The graph of CMax, TMax etc. on the Fentanyl info that comes w/ the matrix patch shows a large variation in individual levels of absorption and elimination.
Probably not. While a UA will show a concentration of the drug in your system, they are simply looking for the presence of the med as well as other meds or street drugs that shouldn't be there. Only sophisticated tests show the exact level and everyone's metabolism and etc. come into play. If your tested via a basic UA, you'll be fine. However, if your Doc uses the Ameritox, then it may be a different story. I've heard they are very sophisticated and thus, why they cost a lot of money. Overkill IMO, but that's another topic.

I think you're bigger issue is only wearing one patch during the visit when you should be wearing two. What if the Doc asks to see where you're wearing them. I'd try to get back on schedule as quick as possible and then be set for my next appt. As you've said, you've learned a valuable lesson and once you can get back on your regular schedule, you'll be in good shape. I truly hope all works out for you. I have a friend who went through something similar and the taper was tough, but once through it, he had a much different regard for PM....His Doc was a real tough one and he felt certain if he spoke to him about it, he would be dismissed. Everyone has to make their best choices based on their particular situation.

Take care, and let me know if I can help.

Ex

P.S I don't frequent this board much, so you may have to let me know via the PM board if you need support here.

Last edited by Executor; 07-18-2008 at 08:30 PM.

 
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Old 07-19-2008, 09:22 PM   #3
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Re: Couple questions.....perhaps for Executer if she stops by again?

Executor, thank you.

For me, this would all be very normal with in any other kind of medicine.

I wonder if the timing seems right to mention that I tend to do fairly extensive research on health issues.

Thanks again for the help and advice you have provided. I don't think the PM board is the appropriate place for this.

Once again, I am grateful for the help, advice and support you have offered. Many thanks.

Last edited by Confused089; 08-24-2008 at 05:25 PM. Reason: Editing out material that has been posted multiple times in other posts.

 
Old 07-19-2008, 10:00 PM   #4
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Re: Couple questions.....perhaps for Executer if she stops by again?

Fentanyl patches must be placed at or above chest level. You can't put them on your lower body. (This is from the prescribing info included w/ the patches.)

Be careful with Clonidine. My own experiences have been that it makes my blood pressure drop dramatically; so I will stand up and immediately fall down.

I am also having big problems with compliance and the patches. I just saw my PM doc (who makes recommendations to my primary) and my primary (who writes my scripts), and they agreed to taper me off of these meds, very slowly so as not to kick up the pain levels, while starting some alternative therapies that may well help a great deal.

I do not know about your pain situaition, but mine stems from a number of nasty injuries (including a probable, but never formally diagnosed) brain injury. At this point, I have been medicated for so long that I don't even know how much pain control I am getting from my meds, if any.

Unlike you, I have fought a virtually lifelong battle with addiction to almost every drug you can think of (except, ironically, alcohol - I occaisionally have a beer but will never be an alcoholic - as well as pot & hallucinogenics. These I have used but have no inclination to abuse.) But as far as seriously addictive drugs go, well...

For now, I am doing my best to comply with my doctors' orders. I see this as the only chance I have to stop living my life chained to this stuff. I also know that western medicine - pain management, medications, the whole ball of wax - has failed me. I need to have a long heart-to-heart with my shaman and find a different way to deal with the pain.

Hope some of this helps; know at least that you are not alone with this problem. If I find any answers, you will be the first to know.

 
Old 07-20-2008, 06:12 AM   #5
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Re: Couple questions.....perhaps for Executer if she stops by again?

Good morning Confused,

I have never had chronic pain or needed any kind of long term pain meds.

I just wanted to say you need to chill out a bit

Your long rambling posts show that you are totally obsessed with your pain meds and your visit to your PM Doctor. If you keep this up, you'll be a mess when you see your PM doc.

My suggestion to you is try to calm down about this (I'm sure it's easier said than done), take the meds you have as prescribed and if that's not enough add some ibuprofen to see if that helps - you never know, it might.

I'm not in any way trying to down play your chronic pain. I just want to let you know how totally obsessed you sound with this and that you may be 'over thinking" things.

Best wishes,

JB

 
Old 07-20-2008, 07:23 AM   #6
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Re: Couple questions.....perhaps for Executer if she stops by again?

I definitely "over-think" things, so you're probably right! ;-) However, in PM, one mistake can be the end of PM, depending on your dr. and my problems w/ pain have interfered with my ability to work and care for myself [do basic stuff like cleaning the house, carry groceries, etc.]. Since I don't have anyone to take care of me, the medication is only way to ensure that I can make a living, etc. Given the way PM works, and the fact that mistakes are often not tolerated, I am trying to make sure my mistake doesn't cost me access to pain management. So, at the moment, I'm a bit obsessed with getting back to the right dose and not losing my PM. If I lose my pain management, I lose my housing, car, pet, etc, because I can't take care of myself.

Last edited by Confused089; 07-28-2008 at 11:24 PM.

 
Old 07-20-2008, 07:27 AM   #7
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Re: Couple questions.....perhaps for Executer if she stops by again?

Quote:
Originally Posted by Confused089 View Post
In short, there are plenty of reasons to give me a UA next time. I don't know if one UA showing higher levels than normal is enough to get me thrown out. And, I could be all wrong, there may not be a UA - perhaps the pill count will be sufficient. I do know that I will be very lucky if I make it down to 3 patches by then. Getting down to 4 seems much more realistic given the amt. of time left, my dwindling supplies for w/d, and the small amt. of time left bef. the next appt.
UAs are usually done "randomly" by the office computer. I guess a Doc could "order" one for certain patients, but that would be unusual, I would think. Regardless, if you're weening trying to get back on track, I would simply get back to where I need to be very quickly and simply suffer through it....I would rather face some short term WD than getting kicked out of PM....Honestly. But, that's a decision you have to make.

Quote:
I have thought about telling her that I spaced out and forgot to remove the 2 patches on my back when I switched. I know she would be ****** and unhappy with me, and I don't know if I've told her how spacey and forgetful I get when I am under a lot of stress.
Not sure this would work, honestly. I would just take them off and deal with it. I'm still not clear why you are still wearing extra patches. I realize you did @ one point because you weren't using your other med, but I thought now you were back to using both? The effect you're getting after day 3 is nominal. There may be extra med in them, but you should be taking them off.

Quote:
Once I get down, I should, in fact have good pain control for the first time in a long time if I haven't blown my tolerance.
I would agree. Your body will re-set itself....It just takes time.

Quote:
So, I can certainly be more careful about displaying my knowledge and raising red flags. If my pain is finally relatively well controlled after a year of having a lot of pain, there may be little need to discuss meds.
By all means ask the questions you need to, but clearly, there are some things you don't need to ask about, or discuss. I think all Docs will be leery of patients who go down certain roads.

Good luck.

Ex

Last edited by Executor; 07-20-2008 at 07:29 AM.

 
Old 07-20-2008, 07:42 AM   #8
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Re: Couple questions.....perhaps for Executer if she stops by again?

But please do share your experiences b/c someday, when time and money allow, I'd like to try going off/down on the meds and try to replace them w/ alternative therapies for pain.

Last edited by Confused089; 08-24-2008 at 05:22 PM.

 
Old 07-20-2008, 08:22 AM   #9
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Re: Couple questions.....perhaps for Executer if she stops by again?

I have covered all this in other posts. It's redundant and repetitive at this point.

Last edited by Confused089; 07-25-2008 at 11:59 PM. Reason: clarity, grammar

 
Old 07-20-2008, 01:44 PM   #10
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Re: Couple questions.....

Hi There~
I can see you are having a rough time, so Im not here to bust on you.
Try not to get so sensitive, I know its hard not to, but Ex IS on vacation, and does try to answer everyone's questions when they ask, and also is one that likes to have everything up front so she can answer what you are trying to ask. Shes tried to help you a ton in all of your posts, and honestly if you read your last comment to her, you are basically telling her that you are sorry for bothering her, ect.

She can stand up for herself, but that bums me out as a fellow boardie here, because Ex is always one to help no matter what, and it sound like since she hasnt told you exactly what you want to hear you are feeling sorry for yourself. Please dont be afraid to tell me if Im wrong. Its just how it comes across as I read it, and possibly others, as well.

Ive read all of your posts, Im a CP patient, and Im trying to figure this out, but Im lost as to the posts from the 2nd of this month until where you are now. The last post I read here on this board is locked, so I skipped over to the PM board and read there, and now this thread. You are just trying to get back on track with this doc correct?

And I think that Granny was just trying to get you to slow down in your head so you wouldnt sound frenetic to your doc and he would think you were a basket case. I post on the board for the same reason you do, and believe me, I have some pretty crazy things happen, but they always work out. I can be my own worst enemy at times, and then I wonder why I stressed so much.
Its sad that nowdays we cant even try to be "up" on our own care, because doctors will think we are smarter than they or doing something shady. I can see why you feel so badly. My doctor makes huge mistakes, hes a GP not a pm doc and its very frustrating. I correct him and add, "I may not be right, but...." And he usually says, "oh wow, youre right." But I have a different relationship and doc than many PM patients do, I thank my lucky stars.
In one of the posts Ex asked you about the convo. where the doc was asking you about diverting, and why did that come up? You didnt ever resond. Do you think your doc thinks just because you are trying to make ends meet right now that could be happening? That would insult me if I hadnt ever given them any reason to think that. How did that come up?
Anyway, I think from what Ive read, every one here is wanting to help you, try not to be so sensitive. A lot of people skip over or dont read long posts. I usually dont or wont. I like for ppl to spit it out, and get it over with. Same with in person conversations. but thats just me. At least Im honest.
Sometimes it takes a while for everyone to gel and get involved in ppl's cases to get to the guts of it all.
I used to read med inserts all of the time, and all it did was make me crazy. If your doc and pharmacists cant be trusted to give you the same advice as in the inserts, then Id be looking for someone else. I wish you well~ keep posting because we do want to help you~
xoxoxo,
IZZY'SMOM

Last edited by IZZY'SMOM; 07-20-2008 at 03:03 PM.

 
Old 07-20-2008, 03:17 PM   #11
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Re: Couple questions.....perhaps for Executer if she stops by again?

Quote:
Originally Posted by Confused089 View Post
I've done two "medium" strength withdrawals at this point and my body is completely wiped out - physically and emotionally. Since I was tapering Fentanyl and uncertain how much I had in my body, I went more slowly than I might have done otherwise. I got sick last week and have been exhausted.
I understand....Not to mention the "mental" stress of worrying about the process....This has probably contributed to you overall physical drain as well.

Quote:
More than half the med remains in the patch after the 3rd day according to what I have read - i don't know why this is the case. Wish I had known this - I would have been more cautious.
Not sure where you've read this, but it's contrary to everything I've researched. I'm not saying I'm right and you're wrong, but rather that I've never seen that. I could be wrong, I guess.

Are you sure you're wearing them correctly? Because if so, there shouldn't be over half the med left. The med that is visibly left is a lot of byproducts & such...Not Fentanyl. When I was on the patch, I had to go to a 48 schedule, because by hour 50 or so, I was going into mini WDs....Thus, I had used up the med and not enough was left for 72 hours, much less longer. If the patches are worn exactly as directed, they can not release the med properly. Where are you wearing them? Are you pressing them down for 30 seconds upon application to create a good seal?

Quote:
Given the graph on the RX info that comes w/ the fentanyl, it seems unlikely that I would fail a UA with wearing half my normal dose one day longer than usual, unless I happen to be unfortunate enough to be someone who absorbs more fentanyl than most people.
I agree. Even if the levels are somewhat abnormal, everyone metabolizes meds differently....As we've discussed. UAs test for two main reasons....(1) To ensure the med is in your system and not diverted, and (2) To ensure one isn't taking other meds they aren't supposed to, or illegal street drugs. I've heard from my PM Doc that # 2 is far more common than # 1. As long as the fentanyl shows up and isn't @ some far out wacky level, you'll be fine....I think.

Quote:
At any rate, I'm getting the impression that you're tiring of all the questions and 'ramblings' at this point. I directed my questions to you because you seem well-informed. Thank you for the help you've given me. I appreciate it. I won't ask you directly for help again. Obviously, if you want to weigh in, great. I appreciate your knowledge and expertise, but I won't ask specifically for your time.
Not @ all....Not sure why or how you got that impression, but I'm glad to help....I've even said such @ the end of my posts. I will continue to help as much as I can.....Assuming you want help. If not, no big deal...You won't hurt my feelings.

Hope you are feeling better.

Ex

Last edited by Executor; 07-20-2008 at 03:20 PM.

 
Old 07-20-2008, 04:11 PM   #12
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Re: Couple questions.....

Quote:
Originally Posted by IZZY'SMOM View Post
Hi There~
I can see you are having a rough time, so Im not here to bust on you.
Try not to get so sensitive, I know its hard not to, but Ex IS on vacation, and does try to answer everyone's questions when they ask, and also is one that likes to have everything up front so she can answer what you are trying to ask. Shes tried to help you a ton in all of your posts, and honestly if you read your last comment to her, you are basically telling her that you are sorry for bothering her, ect.

She can stand up for herself, but that bums me out as a fellow boardie here, because Ex is always one to help no matter what, and it sound like since she hasnt told you exactly what you want to hear you are feeling sorry for yourself. Please dont be afraid to tell me if Im wrong. Its just how it comes across as I read it, and possibly others, as well.
Yes, I am on vacation, but am more than willing to help. I've got my laptop and get on-line when I can.

Quote:
Ive read all of your posts, Im a CP patient, and Im trying to figure this out, but Im lost as to the posts from the 2nd of this month until where you are now. The last post I read here on this board is locked, so I skipped over to the PM board and read there, and now this thread. You are just trying to get back on track with this doc correct?
I too am somewhat lost in terms of knowing exactly what is going on...I have trouble following all that has been written. I am very willing to help you devise a plan to help you get back on track, but I can't seem to exactly follow what your script is and what you've been doing incorrectly.

Quote:
I think that Granny was just trying to get you to slow down in your head so you wouldnt sound frenetic to your doc and he would think you were a basket case. I post on the board for the same reason you do, and believe me, I have some pretty crazy things happen, but they always work out. I can be my own worst enemy at times, and then I wonder why I stressed so much.
I couldn't agree more. Docs will pick up on these things and start making notations in your chart if they perceive one to be acting strangely. I'm not saying you are, but could be if you're not careful.

Quote:
In one of the posts Ex asked you about the convo. where the doc was asking you about diverting, and why did that come up? You didnt ever resond. Do you think your doc thinks just because you are trying to make ends meet right now that could be happening? That would insult me if I hadnt ever given them any reason to think that. How did that come up?
Yes....This remains one of the missing links, IMO. Just because one is struggling financially, doesn't mean diversion is a possibility. My PM Doc for example, deals with many, many disability & medicare / medicaid patients....Doesn't mean they will divert. This is why I was wondering how this topic arouse @ one of your visits....Was something said inadvertently that led your Doc to ask the question? Like Izzy, I would practically die if my Doc ever uttered such a thing.

Quote:
Anyway, I think from what Ive read, every one here is wanting to help you, try not to be so sensitive. I wish you well~ keep posting because we do want to help you~
IZZY'SMOM
I agree strongly.

Thanks Izz for the aircover....You're a great asset to these boards....I hope you are doing better also. We're so much alike, you'd be surprised to know how much.

Ex

Last edited by Executor; 07-20-2008 at 04:15 PM.

 
Old 07-21-2008, 12:24 PM   #13
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Re: Couple questions.....perhaps for Executer if she stops by again?

Quote:
Originally Posted by Executor View Post
I understand....Not to mention the "mental" stress of worrying about the process....This has probably contributed to you overall physical drain as well. Ex
Yes, a lot of other things going on in my life at the moment as well that have created a lot of stress. But, my body is healing and I'm feeling better overall.

Quote:
Originally Posted by Executor View Post
Not sure where you've read this, but it's contrary to everything I've researched. I'm not saying I'm right and you're wrong, but rather that I've never seen that. I could be wrong, I guess. Ex
Unfortunately, I don't recall where I read it, but it wasn't a board.

Quote:
Originally Posted by Executor View Post
Are you sure you're wearing them correctly? ..Not Fentanyl. When I was on the patch, I had to go to a 48 schedule, because by hour 50 or so, I was going into mini WDs....Thus, I had used up the med and not enough was left for 72 hours, much less longer. If the patches are worn exactly as directed, they can not release the med properly. Where are you wearing them? Are you pressing them down for 30 seconds upon application to create a good seal? Ex
Yes, wearing them correctly.

Quote:
Originally Posted by Executor View Post
Not @ all....Not sure why or how you got that impression, but I'm glad to help....I've even said such @ the end of my posts. I will continue to help as much as I can.....Assuming you want help. If not, no big deal...You won't hurt my feelings. Ex
I apologize, it might have been how I read a response [and like email, it is hard to tell how a person feels or the signals they are giving by looking at written words on a page. I'm not even certain if that was it. I may have written that the day I was feeling sick and emotional. I truly appreciate the help you have given me and welcome you comments in the future. It may have been my sense that I was "bothering" or "pestering" you with too many questions. Since my pereption wasn't accurate, please disregard my comment as best you can.

Thank you again for the help.

Quote:
Originally Posted by Executor View Post
Hope you are feeling better. Ex
Yes, cold is nearly gone

Last edited by Confused089; 08-24-2008 at 05:19 PM. Reason: edited superfluous material

 
Old 07-21-2008, 01:12 PM   #14
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Re: Couple questions.....

Quote:
Originally Posted by IZZY'SMOM View Post
Hi There~
I can see you are having a rough time, so Im not here to bust on you.
Try not to get so sensitive, I know its hard not to, but Ex IS on vacation, and does try to answer everyone's questions when they ask, and also is one that likes to have everything up front so she can answer what you are trying to ask. Shes tried to help you a ton in all of your posts, and honestly if you read your last comment to her, you are basically telling her that you are sorry for bothering her, ect. because Ex is always one to help no matter what, and it sound like since she hasnt told you exactly what you want to hear you are feeling sorry for yourself. Please dont be afraid to tell me if Im wrong. IZZY'SMOM
I agree that Ex has helped me a ton and I am very grateful for her help. If you read my response to her, I observed that I made an error and that it was likely due to feeling ill, misinterpreting, or feeling like I was pestering her too much. She has been exceptionally helpful.

Hmm, I don't think she told me things I didn't want to hear....perhaps earlier on. More recently, we have disagreed on a few things but I can't see how they would be personal. But honestly, I don't think that was where my reaction was coming from. My best recollection right now is that I had asked some questions that were skipped over, but when I looked back at my post, I could find no questions [direct anyway], that were skipped. I'm not sure why I thought that..At any rate, hopefully my apology has been accepted and we're back on track.

Unfortunately, I haven't been back to this thread in a couple days [I think] - time is a bit blurred, so it may have been yesterday, but think it's more likely I was last here on Sat or Friday.

Quote:
Originally Posted by IZZY'SMOM View Post
Ive read all of your posts, Im a CP patient, and Im trying to figure this out, but Im lost as to the posts from the 2nd of this month until where you are now. The last post I read here on this board is locked, so I skipped over to the PM board and read there, and now this thread. You are just trying to get back on track with this doc correct? lZZY'SMOM
Yes, I have a few more questions but will likely post them later.

Quote:
Originally Posted by IZZY'SMOM View Post
And I think that Granny was just trying to get you to slow down in your head so you wouldnt sound frenetic to your doc and he would think you were a basket case. I post on the board for the same reason you do, and believe me, I have some pretty crazy things happen, but they always work out. I can be my own worst enemy at times, and then I wonder why I stressed so much.lZZY'SMOM
I do believe I felt criticized by Granny. I don't plan to go in worked up about any of this stuff - the energy will be all wrong. I went in last time w/ weird energy [tho it had a lot to do with the other things happening in my life as well as PM]. It wasn't frenetic, just kind of bummed out energy.

It has been impt to me to get back to a place where I feel like I can be straigh tforword w/ my doc w/i the confines of the PM world. The close I am to my reg. dose, and the more honest I can be, the better I'm going to feel about my interaction with her and the better the energy will be. But I'm not going to mess it up by going in w/ a million and one worries -at least not about PM! I'm pretty close to my dose now.

Quote:
Originally Posted by IZZY'SMOM View Post
Its sad that nowdays we cant even try to be "up" on our own care, because doctors will think we are smarter than they or doing something shady. I can see why you feel so badly. My doctor makes huge mistakes, hes a GP not a pm doc and its very frustrating. I correct him and add, "I may not be right, but...." And he usually says, "oh wow, youre right." But I have a different relationship and doc than many PM patients do, I thank my lucky stars. lZZY'SMOM
Yes, you are fortunate. Sounds like a good approach to say "I may not be right," as a preface...I certainly plan to keep trying to find docs whose self-esteem is bigger than their ego and are open [and excited?!] about having it be more of a health collaboration. Tougher in PM, I realize. Think my PM has been pretty good about it but not sure how she "feels" about what I say.

Quote:
Originally Posted by IZZY'SMOM View Post
In one of the posts Ex asked you about the convo. where the doc was asking you about diverting, and why did that come up? You didnt ever resond. lZZY'SMOM
Strange - I did respond at length to the Ex's q. I'm not sure if I responded in the wrong post or what, precisely occurred. I said that the dr. seemed to ask the q as sort of a checklist she goes thru every appt. I haven't been offended b/c it hasn't felt personal. However, I did not know it was uncommon to ask. Perhaps I posted my response to this q in another thread [only Ex seemed to agree] -- I thought I posted a good long paragraph about the diversion question..I suspect I posted it in a different thread than the one it was asked in, but not sure.

Ok, I hope I've responded to most [possibly not all b/c I'm running short on time at this pt. and I will probably be cutting way back on my time on the board soon b/c of everything on my plate. I feel everyone has been very generous with their help and i have also tried to begin giving back as well.

Need to get going at the moment. I am grateful for all the support and help I received - i definitely did not mean to stir up bad feelings or trouble when I said I would refrain from posting directly to Ex. I do think I was out of line, misunderstood, or something. But, Im not sure that's uncommon. However, I can imagine it might not have felt good since EX spends so much time trying to address people's concerns [ineluding mine.] so I am sorry if it came out in the wrong way. Thank you again.

Plan to post on PM board from now on unless there is some specific reason to post here. And, I can't really see any...

Take care,
Confused

Last edited by Confused089; 07-28-2008 at 11:19 PM. Reason: edited quotes

 
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