I have a question...My first PM visit with a new doc is in a few days. I have scripts for oxycontin 20 and oxy 15 mg for BT. My doc told me that I could take two BT only if needed since I was stepping down a dose on my oxycontin, but not every dose. Im seriously so undermedicated, but I was afraid to ask my ortho for a higher dose as he was just helping me out since my reg. doc and I have decided PM would be best for me and Im not driving hazardous conditions and 6 hrs to get my scripts every month. Most of you know the story...
Im at half of the dose I was at, and I have been grossly undermedicated at THAT dose. My reg dose used to be 35 mg oxycodone 3xdaily and 20 short acting compound for b/t from my old doc. I was just so greatful to have my ortho help me that I didnt want to bother with the compounding pharmacy, he isnt familiar with the procedure and doses, ect. I was just trying to keep it simple.
Im to take b/t 4 times daily as needed and honestly I could take two every dose, but Im terrified that at my first appt they said to bring ALL meds. It would look really bad and possibly the doc wouldnt take me right then and there if they did a count. Do they do that? Has anyone ever had a pill count when youve taken your meds in on a first visit? Also when you get your med counts done do you ask to be present? I would absolutely just die if someone said my meds werent right and I knew they were.
I went down a dose, scared that this lady may not take me, and to be prepared, and its really been bad. My ortho gave me these meds to get me thru to see the PM, and Im not about to bug him and ask him what to do. Hes done enough.
Also the doc sent me a pain chart to fill out. Time of day, amount of pain, meds taken, ect. I have a problem writing at ANY time that my meds arent working and not enough. But its true. Im just scared and lost as to how to try to tell my doc this on my first visit.
. Any help or replies would be so appreciated. where is everyone??? I miss all of my pain buddies! Thank you so very very much~
Just be honest. In my experience with my new PM (we have had 2 appointments so far) thye have only been interested in what did and did not work for me so we could find the right balance. If your meds aren't working the way you have them now you should tell them. Don't try to be a hero and pretend you are handling the pain or you wouldn't be going to see them in the first place. I was scared too. I did sign a contract (it made sense to me that they would want to keep track of where I filled my meds) I did pee in a cup the first time but not the second. I have not given them a reason to think I am going to abuse the medications. I am a mature (47) adult with my records and recommendations from my Ortho and GP along with the pharmacies I was using.
There is nothing new you can tell these folks-they have seen it all. Its your first visit-don't tell them you are "scared" or they will wonder if you are feeling guilty about something. My new PM maintained the short acting med I was using as well as adding two others- long acting and a muscle relaxer I had not tried. On the second visit we upped the amount of med in my short acting(break thru) so I would feel better and more productive during the day.
it was a great experience even tho I started as nervous as you. My PM said I was hurting myself by "chasing the pain" -only taking meds when I started to hurt. He has me taking them on a regular schedule now so I DON"T start to hurt. I stay around a 1-2 all the time now instead of going from a 7-8 down to a 2-3 then cruising up thru the 4-5 back to the 7-8. Its too hard on your body. I do have days where I feel great and really over do it! That is when I feel the old pain come back and I have to stop-ice-rest-let my back catch up with the rest of me-lol.
Blessings my friend-be at peace, fill out your pain forms honestly and I will be praying for pain relief for you so you can get on with your life!!
First, I'm so sorry that I haven't been around in a while. I've had some nasty medical issues (not necessisarily CP related) going on for the last couple of months, and I haven't really been able to get on and read or post.
I hope I'm not too late to respond to your questions........
My best advice would be to fill out the pain charts to the best of your ability. And definitely be 100% accurate when describing your pain and how your current meds help or don't help. This is exactly what the PM needs to know, so that he/she can help you.
Have you got your medical records for the last year or two? Or have they been sent to this new doc by your previous doc? I think this is crucial as well. This new doc needs to see exactly what has worked best and or what hasn't in the past. I know your records are a little different because of the types of meds your previous doc had you on. (the compounded hydro, etc.) If that was what was working better for you in the past, maybe this doc will take the lead and progress from there. You never know!
Remember, all PM docs are different. If they are asking you to bring in your meds, then they will more than likely do a pill count. They may also do a UA (Urinary Analysis) It is standard operating procedure at many PM practices.
I know you probably have fears about "asking" for specific meds, etc. but I think if you just explain to the best of your ability, what your pain levels are, when you have been on each med regimine, it will give the new doc some sort of "jumping off" point. You don't have to ask outright. Most docs just want to know your pain levels, what meds you take for them and how those meds are working, or not. Don't be afraid to tell the doc that your quality of life has diminished considerably. Actually, I think it's the most important thing to tell him/her. For many PM docs, it's all about "quality of life".
Write down everything you can think of and bring your notes with you. Think of any and all questions you have for the new doc and also, documment as much as you possibly can, how you function (or don't) each and every day. The doc won't have issues with you bringing in notes/reminders. I think most appreciate it because the patient can't always remember every detail and details are important.
I can't think of anything else right now, but if you have any questions at all, please just ask. I can't promise you that I'll have all the answers, but I can promise you that I'll try! I also promise that I'll check in as often as I can to see if you've replied. Hang in there, girl. And please know that I am praying for you and that I love ya! Try to relax, as much as you can. (I know, easier said than done!) We've all been through these "first" appointments and truthfully, it's not even remotely as scary as we thought.
one big thing you need to remember here is that since this pain clinic did NOT actually Rx your pain meds,you are realy under no obligation to 'them' as far as accountability to them,ya know what i mean? they just want you to bring in all of your meds so they can go over them with regards to dosages and mg amouts more than anything else,not to open them up and actually count them to see where you are at with them(this is pretty standard with any new doc you are seeing that is taking over care from another doc). they simply have no real authority to do that,they could but your current accontability is simply not with them or to them,that would be to your former Rxding doc only,you know what i mean? i really would not worry about this overly much,its pretty standard procedure considering what this particulardoc/clinic will be doing for you and nothing more.
just be honest when filling out that paper work,that will tell them in the best way just how your pain has been and what you took to try and calm it down(and make certain to also write down any other therepies or tools that were also used,even if they were not some form of meds. they simply like seeing that you are also trying other modalites other than just narcotics,ya know?). i do think you maybe reading way too much into something,ya know what i mean? we are always suspiscious of anyone who wants to see our meds,for any reason. they make us this way by the rules and protocals we are forced to live under. just concentrate on getting your pain documented as well as possible and don't sweat the small stuff im,K? please keep us posted hon,and good luck with the new doc. Marcia
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.
My first pain management appointment they just asked me what I had been taking, what dosage, waht I had tried and didn't try etc. I had my MRI with me and other results along with a card with my pharmacy name and my PCP's card. Since then I have never called in or showed up early, missed any appintments or had any issues with my UA.
My Dr does random UA so we never know WHEN. I have heard other patients "getting in trouble" for showing up almost 2 weeks early for meds and getting an earful. Like Michelle said, they have heard and seen it all. BE HONEST. My PM told me just this morning that I am one of her "STAR patients" as I am always so honest with her and never question HER authority but will ask questions if I need to. She actually was surprised I hadn't want to come OFF the Durgesic patch after hearing my horror with it. Again, I was afraid to "ask" for something else. CP'rs are always srutinized anyway because of all the regs and everything we and the Doctors have to follow and because of the " bad seeds". Don't let THAT keep you from getting the relief YOU deserve. I finally spoke up ( meekly but speak i did) and now an on MSContin. Wish I had asked SOONER.
Thank you SO much for all of your replies. Maybe I should word it different. My fear is that if I take more than is directed on the bottle, and Ill be documenting that and showing it to her, will she not take me because she thinks Im abusing my meds?
My b/t is 4xdaily and I could take TWO not one, thats what it takes, but Im afraid to write that down. Same with my oxycontin 20 mg 3x daily. That amount makes it bearable, but Im afraid to go in there having gone thru my meds two weeks early.
That's our point-they will see what you are currently taking wasn't precribed by a pain specialist (i.e.-them) and that what your Dr felt comfortable writing is not working for you. I took in all my bottles of EVERYTHING-even vitamins-lol. The doctor just chuckled when I held them up. He said they just wanted to make sure they had the correct names and dosing instructions of everything I take for their records. They were NOT checking to see how many of each pill I had.
If what you are currently doing was working you wouldn't need the PM. They understand and want to make you comfortable. I wouldn't worry about them scrutinizing you until later if you start calling early every month for more meds or use another doctor for pain meds. You don't have a bad history of switching pain docs so you are starting with a clean slate.
I can't wait till you post after your visit and tell us how great it was!
Dear Izzy, I'm still rather confused about how you take your breakthroughs. Could you please elaborate? Also, it has been my experience in PM that if you are prescribed, let's say MS Contin, and it makes you very nauseated,and you want to try something different, then you'd be asked to bring the MS Contin in, before they try something different for your pain. This has happened to me more than twice. It of course is not a problem for me, because in the case of MS Contin, I just had no use for it-due to the severe nausea. The doc said he would be flushing the remainder of the MS Contin in the toilet.
Other than this kind of situation, I have never had a pill count. I consider my PM quite strict, yet I have never had to sign a contract, or take a urinalysis in the past few months I have been with him. He is ADAMENT (spelling?) about Pool Therapy and using the TENS Unit. In fact, he will NOT prescribe meds unless you are in Pool Therapy, using TENS Unit- or not following his advice. Also, he does NOT believe in Short-Acting Pain Meds. ONLY Prescribes Long-Acting Pain Meds. This has all worked well for me I hope all goes well with your first PM Visit-Keep in Touch!!--janiee
Izzy...Don't worry. Girl, if you weren't in dire need of better pain relief, you wouldn't be seeking out a PM in the first place! I've never had a PM count my meds that were NOT rx'd by him/her. You've decreased your meds drastically, so it's not like you're creeping up from your highest dose. You're just trying to keep your nose above water and your body needs your normal dosage. All of this will be fine, I firmly believe. You are trustworthy and intelligent, and your new PM will see that. If you weren't, you could never have found a doctor (and now an ortho) to prescribe the amounts of oxy/hydro that you've needed (even compounding). Just remember this, the Good Lord has already gone before you, and He knows how wonderfully it will turn out.
Didn't your old doc have a policy of OK'ing med changes over the phone sometimes? In my experience, most PM docs, etc. don't usually do increases (temp or perm) over the phone and there might be a chance that your old doc didn't put that in your chart every time it happened. This might lead the new PM to misunderstand how you have been instructed to take your meds by your old doc.
I think it's important that the new PM doc understands your old doc's policies and his slightly more relaxed prescribing methods. My PM will rarely instruct me to alter my doses in between appointments, but it's always cleared with him first. In the PM world, there are all types of docs and each one has their own way of treating their patients.
I'm sorry this has been such a painful process. (Sorry about the pun) It has to be so hard when you live in a remote area and have to travel such long distances to see specialists. My PM is an hour away, and I would go farther, if I had to, because he is such a good doc. How far do you have to travel to see this new PM? I know the old doc was quite far, but I was hoping, for your sake, that this new one was much closer.
Again, hang in there as best as you can. It's not that far off now. I'm sending good thoughts and lots of hugs your way. God Bless, CMP/MM
Izzy, I believe it was a very wise person here that advised me not to offer anything that I was not asked when going to my first PM visit. So just in case I took all my meds with me, that way I had them if my PM asked to see them or do a count, but he never did. When he ask what I was taking I showed him but he just glanced at them. Wrote out scripts as I was running out of all my meds & ask me to sign for all my records to be transferred from any other doctor who treated me for this problem. The one thing he did not do it try anything new the first appointment, but as I said he did not have all my records in advance. They sent papers to sign at home & alot more when I arrived.
I believe I was told here that most PMs are concerned more with what you do when you are under contract or their care more then what you do before you enter PM. I have noticed the pharmacist keeps an eye on my fill dates as I am allowed a pretty decent quanity & I am sure if she or he had any doubts they would call my PM as I never attempt to get my meds filled before the date due.
I did not offer anything that was not asked. The one thing the PM asked for where my MRIs which I did not bring & had to go home & bring them back to his office.
The only time I had to bring meds or a post dated script in was when he made a change to the meds. I realize all PMs are different but hope this helps you out some. good luck & god bless, Sammy
This is your first appointment & most people would not even know that PMs do med counts so I would guess alot of people would not even bring their meds in the first appointment. After all not everyone has a great support group like we do & unless asked they may not even think about it. I was prepared, or tried to be for everything I could think of just in case. I think if I were you I would do the same just be prepared, especially because of the distance.
When I went to my first appt, they did not do any kind of actual counts, but they did ask me to bring all applicable medicines. I was drug tested, however. I think what another poster offered in terms of only offering what is asked is appropriate.
You should also not be taking any meds or qtys outside your prescribed dosage. All this talk about taking extra meds gives pain patients troubles. Self medication is not allowed in pain mgt. I realize you may be under medicated, but you should discuss this with your doctor.
Good luck at your appointment. If you don't care for this one, you could always seek out another. I took me three tries to finally get one that understood what I was going through with my back.
I am glad that your appointment is finally around the corner. Hopefully, she will be able to help get your pain levels down and keep them under control.
I am a bit concerned though about what you posted about having taken more meds than what your current ortho has prescribed.
If your ortho only prescribed a set amount of breakthrough meds, that is what you should have been taking.....he was your prescribing doctor. Even if it was not working as well as you would like, he set a dosage amount that he felt, in combination with talking with your previous GP would hold you over until your PM appointment. Now, you are out or just about out of your breakthrough meds or two weeks short.
Honestly, everyone cares about you, but I am not surprised that you have gone through your meds early. It worries me. You worry alot about getting called in for pill counts or urinalysis, more than anyone that I have ever read. I am concerned that you are abusing the meds, quite honestly.
I am telling you this, because I think that you have a problem, and have for some time. I care and don't want to see you wind up creating a huge problem for yourself .
To answer your question, yes, when I changed PM, I did have to bring my meds and he did count them, right there in front of me. I wasn't worried or concerned, because I had the right amount of them, even though it was not working as well as it once had. We discussed changing some of them around, increasing two and adding something else to help manage the pain better.
He did not do a urinalysis at that time, but I know that most PM's do these days as a screening, to check on what you have in your system, and what amounts.
Izzy, I hope that you take what I wrote in the spirit it is intended, and because I care about you, but I think that you need to address the problem with the pain meds, and not by trying to get more, or different amounts , but by being honest with yourself about what really is going on.
I don't doubt that you have pain, I believe you do, but I also believe that you have found yourself in a place that you don't want to be, and don't know how to go about getting out of.
My ortho oked me to take the extra meds. it must be in another one of my posts... He offered to even call her since I have already gotten my records from him sent to her. I had stepped down a whole dose, and he and I both didnt know if it was going to work.
Thats why Im going to a PM...Ive never been, and Im sorry for all of the questions, but Im not going to go to my new PM doing something that isnt ok or documented or that my doc wont back me up.
I was asking because I havent ever been to a PM. also I do worry alot about my meds, ect. I have to drive 12 hours to get to see a doc and our pharmacy here doesnt have the meds I need so I have to send them by mail and wait a week or more at times to get my meds. I live in a town that has two pharmacies. I have had to use a compound pharmacy for over two years....
So yes, I worry, obsess, freak and all of the above. I had also stated in one of my posts that I would gladly pay cash IF they didnt take my insurance. I use my insurance always, and have never paid cash for anything, no scripts, ect. I had been with my doc for three years going on four, and never once asked to go under contract, and all of his other pts were.
I have never ever once been asked to come in and do a pill count, ect. in three years. My doc never turned me away for a script to get filled nor did the pharmacy ever question me or call my doc.
Cmp...You have known me for a long time, and you are so correct about my old doc. I have sent for his records and Ill pick them up tomorrow morning and see what is written. Im so glad you thought of that.
a PM doc is like a 180 for me
I dont have a problem with my pain meds. I have a problem getting my pain managed. Thats why Im asking all of the questions. This is the reason for the LONG awaited PM appt.
Last edited by Administrator; 12-08-2008 at 07:37 PM.
Reason: Edited: DO NOT post defensively. Never alter a post edited by Admin.