123dietdrpepper
03-04-2008, 06:04 PM
My doctor has me on oxycontin with percocet as breakthru. He has asked last month if I could try to take one tablet per day breakthru and wrote my script for 30 tablets per month. I did not say anything and underneath I thought this would not work but I wanted to be compilant and give it a try.
I emailed him earlier in the month because my sciatica nerve flared up while I was in the hot tub asking to take more than 1 possibly 2 or even 3 if needed. He told me to take the least amount possible per day but no more than 3 per day. I took 2 and sometimes 3 for 4 days then went back to my normal dose of 1 per day if needed. Now my back is flared up again....do you think it is okay to take the higher amount again or should I email him again.
I will exceed 30 tablets this month and will need another script. Do you think that will be a problem because the bottle said one per day?
I have also found it a struggle to only take one tablet of the breakthru a day but I have muddled thru it. Should I let him know this or wait until my appt in 2 1/2 weeks.
I feel bad because I have had to email him twice this month. Is it normal to communicate this often with your pm or do you think I am bugging the man to much? I just don't want to bother him to much but on the same line I don't want to do anything to have him question me or violate my pain contract.
I emailed him earlier in the month because my sciatica nerve flared up while I was in the hot tub asking to take more than 1 possibly 2 or even 3 if needed. He told me to take the least amount possible per day but no more than 3 per day. I took 2 and sometimes 3 for 4 days then went back to my normal dose of 1 per day if needed. Now my back is flared up again....do you think it is okay to take the higher amount again or should I email him again.
I will exceed 30 tablets this month and will need another script. Do you think that will be a problem because the bottle said one per day?
I have also found it a struggle to only take one tablet of the breakthru a day but I have muddled thru it. Should I let him know this or wait until my appt in 2 1/2 weeks.
I feel bad because I have had to email him twice this month. Is it normal to communicate this often with your pm or do you think I am bugging the man to much? I just don't want to bother him to much but on the same line I don't want to do anything to have him question me or violate my pain contract.
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brianpain33
03-04-2008, 06:29 PM
hi dietdrpepper::wave:
I have a question for you. What dose of the Oxycontin are you taking and how often are you taking it? If he really does want you to take as little BT med as possible then logically it would seem that you might have to up the LA med (Oxycontin in your case). I know it doesn't make much sense and you would think the opposite would be the case. But, if he doesn't have any problem prescribing the Oxycontin then you gotta do what is necessary to get your pain under control. I would e-mail him and tell him exactly what your pain level is averaging on a scale of 1-10. Tell him you are having a hard time coping at this level. If you have a good relationship, then ask about increasing the Oxycontin. Let us know what happens.
Brian
I have a question for you. What dose of the Oxycontin are you taking and how often are you taking it? If he really does want you to take as little BT med as possible then logically it would seem that you might have to up the LA med (Oxycontin in your case). I know it doesn't make much sense and you would think the opposite would be the case. But, if he doesn't have any problem prescribing the Oxycontin then you gotta do what is necessary to get your pain under control. I would e-mail him and tell him exactly what your pain level is averaging on a scale of 1-10. Tell him you are having a hard time coping at this level. If you have a good relationship, then ask about increasing the Oxycontin. Let us know what happens.
Brian
123dietdrpepper
03-04-2008, 06:36 PM
Hi, I take 40 mg. 3 x per day of the oxy. On my last visit, he talked about reducing my dose of oxy. He really does not like it but my surgeon put me on it then dropped me at 3 weeks post op. He has also talked about switching me to the methadone everytime I visit him so I doubt that he will increase my dose.
brianpain33
03-04-2008, 06:55 PM
He has also talked about switching me to the methadone everytime I visit him so I doubt that he will increase my dose.
What is the hangup about not going on the Methadone? Have you ever tried it before? If it is going to work better at controlling your pain then it would be the better choice. I tried it once and itched like crazy and couldn't take it for more than a few days. But, as you well know, it has been seen as the "magic bullet" of pain meds for many people on here. I think you really should just ahead and try it out. I know the "stigma" concerning Methadone but just think you are on Oxycontin and you know the "stigma" concerning it in the news and among doctors. I know just how hard it is to overcome stigmas or to switch to a new medication that you don't know what kind of side effects you will have, or you might have worse pain in the beginning until the dose is at the right point. If you do start the Methadone, I would definitely suggest e-mailing him every 3-5 days if the dose is not working out and he can adjust it accordingly. Good luck.
Brian
What is the hangup about not going on the Methadone? Have you ever tried it before? If it is going to work better at controlling your pain then it would be the better choice. I tried it once and itched like crazy and couldn't take it for more than a few days. But, as you well know, it has been seen as the "magic bullet" of pain meds for many people on here. I think you really should just ahead and try it out. I know the "stigma" concerning Methadone but just think you are on Oxycontin and you know the "stigma" concerning it in the news and among doctors. I know just how hard it is to overcome stigmas or to switch to a new medication that you don't know what kind of side effects you will have, or you might have worse pain in the beginning until the dose is at the right point. If you do start the Methadone, I would definitely suggest e-mailing him every 3-5 days if the dose is not working out and he can adjust it accordingly. Good luck.
Brian
123dietdrpepper
03-04-2008, 09:02 PM
Thank you Brian. I hestiate to have my meds changed because this is the second month my pain has been controlled in over a year. I also have never been on methadone and have a tendency to have major reactions. I am allergic to morphine, neurotin, dillaudid, keflex, pencillian, elavil, and palemor.
As far as the stigma goes, no problem here.
As far as the stigma goes, no problem here.
Executor
03-04-2008, 09:32 PM
I think I would e-mail him and be very upfront about your pain and say that you've been following orders of no more than 3 per day, but even at one day (at 3 per day) during the month, you're going to come up short (if you were only given 30 pills) and you want to give him a heads up and let him know in advance. I'd be very honest about how you've struggled and "muddled" (to use your words) through it and that things aren't going well. Do you have enough meds to get to your appt, or will you need some type of script prior?
Just speculation on my part, but it sounds as if your Doc is one of those "I'm afraid of Oxycontin" Docs....He may just be throwing out the methadone concept to see how you'll react. I'd be very upfront about not wanting to switch due to the potential impact on your life. Yes, it may work, but the downside may not be worth it. Why change to the unknown if things are working. My PM Doc is very strong on the concept of not changing things if they are working.
As I've posted before on a number of different PM topics, the pain mgt field is all about the cost to benefit ratio....Does the "cost" of some therapy and / or med outweigh the "benefit" or does the "benefit" outweigh the "cost"? The key is finding some balance and it sounds as if you have, with the exception of the BT med. To be honest, I don't think you're BT med is strong enough....It's just a tad more Oxycodone than you're already taking and probably why you need several to take an impact. Quite often, PM Docs will use a different active ingredient for BT (than the LA med)....For example, OC for LA and then fentanyl or Morphine for BT.....Or vice versa....The fent patch for LA, then some form of Oxy for BT. PM isn't an exact science, that's for sure.
Hope this helps, and good luck.
Ex
Just speculation on my part, but it sounds as if your Doc is one of those "I'm afraid of Oxycontin" Docs....He may just be throwing out the methadone concept to see how you'll react. I'd be very upfront about not wanting to switch due to the potential impact on your life. Yes, it may work, but the downside may not be worth it. Why change to the unknown if things are working. My PM Doc is very strong on the concept of not changing things if they are working.
As I've posted before on a number of different PM topics, the pain mgt field is all about the cost to benefit ratio....Does the "cost" of some therapy and / or med outweigh the "benefit" or does the "benefit" outweigh the "cost"? The key is finding some balance and it sounds as if you have, with the exception of the BT med. To be honest, I don't think you're BT med is strong enough....It's just a tad more Oxycodone than you're already taking and probably why you need several to take an impact. Quite often, PM Docs will use a different active ingredient for BT (than the LA med)....For example, OC for LA and then fentanyl or Morphine for BT.....Or vice versa....The fent patch for LA, then some form of Oxy for BT. PM isn't an exact science, that's for sure.
Hope this helps, and good luck.
Ex
SpinalMalady
03-05-2008, 07:54 AM
Hi DietDP:
IMHO I think good communication is important in PM. You have the luxury of e-mailing your doc. I would use it. I would not up any medications again without prior approval, just because he approved it one time before. Those are the types of assumptions that could possibly get us into trouble as CP'ers, and having just found relief or some semblece of it, I would not want to risk jeopardizing that relationship. Look at what just happened to Fabby as a good example: honest dosing mistake, doc having bad day, and takes it out on her and leaves her without medications for a week to go into withdrawl. I say shoot him an e-mail, explain your pain, how it is affecting you, AND that IF you increase your meds, you will run out and will require an early re-fill. That way you have documentation of whatever he tells you to do, and he can't go off on you later for being non-compliant. I sure wish my clininc would institute this practice of using e-mails.
My PM (with whom I have a GREAT relationship with) insists on knowing if I have any flare ups during the month. He wants to know whether or not the meds prescribed are covering the pain. He doesn't mind calls into the office, and has ALWAYS returned a call by 5pm on the day I have called. Luckily, I have not had to call very often. Last month, I felt like a "problem patient" because of the switch from the Patch to the Avinza, and then less than a week later getting rear ended. I felt awkward calling him, as I have never really had to in the past, and he re-assured me each time I called, "don't hesistate to call ever", and he stressed it again at my appointment yesterday.
Good luck and let us know what the outcome is. I hope your pain is under control very soon.
Blessings,
IMHO I think good communication is important in PM. You have the luxury of e-mailing your doc. I would use it. I would not up any medications again without prior approval, just because he approved it one time before. Those are the types of assumptions that could possibly get us into trouble as CP'ers, and having just found relief or some semblece of it, I would not want to risk jeopardizing that relationship. Look at what just happened to Fabby as a good example: honest dosing mistake, doc having bad day, and takes it out on her and leaves her without medications for a week to go into withdrawl. I say shoot him an e-mail, explain your pain, how it is affecting you, AND that IF you increase your meds, you will run out and will require an early re-fill. That way you have documentation of whatever he tells you to do, and he can't go off on you later for being non-compliant. I sure wish my clininc would institute this practice of using e-mails.
My PM (with whom I have a GREAT relationship with) insists on knowing if I have any flare ups during the month. He wants to know whether or not the meds prescribed are covering the pain. He doesn't mind calls into the office, and has ALWAYS returned a call by 5pm on the day I have called. Luckily, I have not had to call very often. Last month, I felt like a "problem patient" because of the switch from the Patch to the Avinza, and then less than a week later getting rear ended. I felt awkward calling him, as I have never really had to in the past, and he re-assured me each time I called, "don't hesistate to call ever", and he stressed it again at my appointment yesterday.
Good luck and let us know what the outcome is. I hope your pain is under control very soon.
Blessings,
123dietdrpepper
03-05-2008, 01:50 PM
Executor - yes I will run out of meds. I actually emailed my primary this morning and gave him a complete run down of my breakthru meds and explained that I increased my physical activity per pain mgmt which has turned into a disaster and I am muddling thru and struggling with only one pill a day. I explained that since Monday I have been a 8 and 9's on the pain scale and went back up to 2 pills but really need 3. I asked for a temporary increase and stated that I know he wants me to use the least amount possible. I also explained that I will run out ahead of time since I was dispensed 30 pills.
He emailed me back within seconds and said, Yes. Only if absolutely needed and I will walk another perscription over to the pharmacy.
So thankfully, it looks like he is going to work with me. This whole pm stuff is enough to cause anyone anxiety - you don't want to do anything wrong for fear of the pm doctor cutting you off completely.
Spinal Malady, thank you for the encouragement to email him. You actually gave me that push I needed and it was wonderful to receive an email back within seconds of emailing him. It was a tad brief but hey at least he got back to me. I am glad that your pm doctor has been so open to you calling him anytime -- it should definitely put you at ease knowing that he cares and wants to know what is going on with you.
Thank you Brian, Executor, and Spinal Malady for your responses and encouragement. I just hate dealing with all this but unfortunately it looks like this will be lifelong for me.
He emailed me back within seconds and said, Yes. Only if absolutely needed and I will walk another perscription over to the pharmacy.
So thankfully, it looks like he is going to work with me. This whole pm stuff is enough to cause anyone anxiety - you don't want to do anything wrong for fear of the pm doctor cutting you off completely.
Spinal Malady, thank you for the encouragement to email him. You actually gave me that push I needed and it was wonderful to receive an email back within seconds of emailing him. It was a tad brief but hey at least he got back to me. I am glad that your pm doctor has been so open to you calling him anytime -- it should definitely put you at ease knowing that he cares and wants to know what is going on with you.
Thank you Brian, Executor, and Spinal Malady for your responses and encouragement. I just hate dealing with all this but unfortunately it looks like this will be lifelong for me.
ibake&pray
03-05-2008, 04:40 PM
Pepper,
In addition to e-mailing your PM, keep a log of your days. Bring it with you to your apts. or send it to your PM at the end of the month before your next appointment. This way you can track what you have done and how it has caused you to flare up and what you have had to do to "live." This will also validate your life for him and what you are doing to keep compliant.
If he wants to know what you do to keep within his paramiters, then so be it. If nothing else you can type, right babe? This is the best way to make sure that you have covered your bases and he has no reason to complain or to not believe you.
hang in there girl...Ella is really lonely you know!;)
In addition to e-mailing your PM, keep a log of your days. Bring it with you to your apts. or send it to your PM at the end of the month before your next appointment. This way you can track what you have done and how it has caused you to flare up and what you have had to do to "live." This will also validate your life for him and what you are doing to keep compliant.
If he wants to know what you do to keep within his paramiters, then so be it. If nothing else you can type, right babe? This is the best way to make sure that you have covered your bases and he has no reason to complain or to not believe you.
hang in there girl...Ella is really lonely you know!;)
123dietdrpepper
03-05-2008, 05:06 PM
Great idea. I will print out emails and submit with my pain/exercise log each month. I guess we need to protect ourselves at all times.
I just can't imagine doing this for the rest of my life. Ughhhhh
I am happy to see you posting again!!
I just can't imagine doing this for the rest of my life. Ughhhhh
I am happy to see you posting again!!
brianpain33
03-05-2008, 05:20 PM
dietdrp:
I think that you are really going to be kind of really "pushed" toward using the Methadone. I think your doctor is trying to maybe get you to reach the point of the pain starting to get out of control and then you would finally say "ok give me the Methadone". I would really think that it would be worthwhile to try it starting after your next appt. You could go on a low dose to give it a try and slowly lower the oxy. I don't think he is going to continue to give you the oxy for whatever reason. Keep us posted.
Brian
I think that you are really going to be kind of really "pushed" toward using the Methadone. I think your doctor is trying to maybe get you to reach the point of the pain starting to get out of control and then you would finally say "ok give me the Methadone". I would really think that it would be worthwhile to try it starting after your next appt. You could go on a low dose to give it a try and slowly lower the oxy. I don't think he is going to continue to give you the oxy for whatever reason. Keep us posted.
Brian
ozzybug
03-05-2008, 05:32 PM
Diet-
I think Brian may be on to something. It does sound like your doctor is kind of trying to steer towards you trying the methadone. I can't swear to it (that this is what he's doing), but this is what my PM doctor did.
He started mentioning it, then at one appointment brought it up, asked me why I was affraid to try it and then explained to me I should give it a try.
I trust my PM doctor, and do NOT want to ever not give something a try that might work, so I told him "ok, lets give it a fair chance". We tried it and it worked for the pain, but unfortunately I had bad side effects that didn't go away with time. We gave it plenty of time, but the side effects continued and were getting worse, when I broke out in hives he took me off of it. It's a shame because it really did help.
Please don't totally discount the methadone. There are many people here who will testify as to how well it works. Plus, it's cheap AND many people have been on the same dose for years and haven't had to increase.
I think Brian may be on to something. It does sound like your doctor is kind of trying to steer towards you trying the methadone. I can't swear to it (that this is what he's doing), but this is what my PM doctor did.
He started mentioning it, then at one appointment brought it up, asked me why I was affraid to try it and then explained to me I should give it a try.
I trust my PM doctor, and do NOT want to ever not give something a try that might work, so I told him "ok, lets give it a fair chance". We tried it and it worked for the pain, but unfortunately I had bad side effects that didn't go away with time. We gave it plenty of time, but the side effects continued and were getting worse, when I broke out in hives he took me off of it. It's a shame because it really did help.
Please don't totally discount the methadone. There are many people here who will testify as to how well it works. Plus, it's cheap AND many people have been on the same dose for years and haven't had to increase.
SpinalMalady
03-05-2008, 05:32 PM
Diet:
You are most welcome, I'm glad I could help. We are all here for each other. It is a major drag for most of us to know that we have to live with this CP thing for the rest of our lives, however, it is just another reason why we must document, document, document, in order to protect ourselves and remain compliant.
I'm really happy you were able to get a response so quickly, and to hear that he wrote you another prescription. Way to stand up for yourself. This is something that has been hard to learn to be an advocate for myself. It's all still a learning curve, and not a fun one at that! :(
You are most welcome, I'm glad I could help. We are all here for each other. It is a major drag for most of us to know that we have to live with this CP thing for the rest of our lives, however, it is just another reason why we must document, document, document, in order to protect ourselves and remain compliant.
I'm really happy you were able to get a response so quickly, and to hear that he wrote you another prescription. Way to stand up for yourself. This is something that has been hard to learn to be an advocate for myself. It's all still a learning curve, and not a fun one at that! :(
Moldova
03-08-2008, 01:08 PM
Diet,
i don't think is bad to communicate with your PM that much. In fact my PM insist me to call every week and report how meds are working for me. And I do. As you know i had a problem with Morphine, did not work for me at all, I called them that week 3 times and they called me back couple of times.
Now I am on patch and they called me 2 times in one week to make sure I am OK.
Do you have a contract with you PM?
If yes, I would definately let him know that i take more pills than it says on a bottle. They are pretty strict about it. Just let him know that that amount is not enough for you. The fact that he does not understand one break through a day not enough for you sometimes concerns me a bit.
Nobody wants to take more meds than we need, but if you in a lot of pain I believe it has to be controlled, especially in your case. You are not newby with this problem, you are CP patient, so why do you have to suffer.
Good luck to you, girl!:)
i don't think is bad to communicate with your PM that much. In fact my PM insist me to call every week and report how meds are working for me. And I do. As you know i had a problem with Morphine, did not work for me at all, I called them that week 3 times and they called me back couple of times.
Now I am on patch and they called me 2 times in one week to make sure I am OK.
Do you have a contract with you PM?
If yes, I would definately let him know that i take more pills than it says on a bottle. They are pretty strict about it. Just let him know that that amount is not enough for you. The fact that he does not understand one break through a day not enough for you sometimes concerns me a bit.
Nobody wants to take more meds than we need, but if you in a lot of pain I believe it has to be controlled, especially in your case. You are not newby with this problem, you are CP patient, so why do you have to suffer.
Good luck to you, girl!:)