Hello all, i just discovered this board recently, and i cant believe how many kind folks are here. I'll keep this short if possible. I got hurt on the job 3 years ago. I blew out L-4, L-5 S1 with a few annular tears. I had a lamictomy in June of 08 with little success. The pain then went into my left leg with a vengence. Four Dr's told me i was a bi-level fusion candidate after my first surgery. But because of my age , 33 at the time they wanted to go the discectomy route. I did that, which only made matters worse.
Now after getting 3 opinions from surgeons telling me i need that bi-level fusion, i'm having major difficulty from my PM Dr. His practitioner had me on 90 mg of Roxycodone, Soma 3 times a day and switched me from Avinza 90mg to Fentanyl 50mcg. When the PM Dr found out i was on 90 mg of Roxy, he felt that was too high of a dose. He decided to increase that God offal Fentanyl and reduce the roxy to 60mg. I asked him about Oxycontin opposed to Fentanyl and he said that he doesn't prescribe it.
I told them that the Fentanyl was making me nauseous, so his answer was to reduce it to back to 50 mcg and keep the Roxy at 60 mg.
This is a Workers Comp claim and not all Dr's will take my insurance. If there is anyone that can help me find a more compassionate Dr in NJ. It would be much apprecciated. I understand that we need to use the pm option for such conversations. Thanks
No, Avinza didn't touch my pain. I asked him about Oxycontin and he said that he doesn't prescribe it. I want to go about this the right way. I dont want to seem like i'm Dr shopping, but i just dont feel like the Dr i'm seeing gives a **** about my pain.
Have you signed any contract yet? It is your right to go back to your pcp doctor and ask for oxycontin. That is not doctor shopping. Most doctor prescribe Oxycontin as far as I know. what about tramadol extended release?. this one is 24/7 relief from pain and not too much narcotic. You can ask your PM for it and if that doesn't work you can go back to your pcp.
My experience with PM were really bad. One did not even look at me. I was thinking to myself, what is that? a doctor who is not looking at you?. she didn't believe that after so many years I can still suffer. Next PM was worse, he told me 90% of my pain is my pure imagination. and sleep? that has nothing to do with pain, that's what I was told.
None cared about me at all. It is because they do not know what it means to really suffer from chronic pain 24/7. You only know.
While it is possible to change drs, you need to take a couple of precautions. You can go ahead and make an appointment with another pm, BUT you need to make it clear when you make the appt that you are looking for a second opinion. If you are currently under contract you need to be especially careful, and not accept so much as a tylenol from the new doc until you have terminated your contract in writing. I would also avoid asking for any particular medication by name. You can say "I've taken X and it works well.", Or "Y makes me very nauseous and doesn't handle the pain very well." but going in and asking for or trying to demand a particular drug ESPECIALLY oxycontin is very likely to land you out of the PMs (or your pcp's) office red flagged as a drug seeker and unable to get any dr to even see you, much less prescribe meds.
Can you ask your pcp or the dr that did your surgery to refer you to another PM? Many PM docs, especially those that DO prescribe meds long term, don't accept new patients unless they have a referral from a pcp ortho etc. Good luck finding another doc. Getting the right meds is somewhat trial and error to find the ones that work for you with the least side effects, you shouldn't be stuck with something that makes you nauseous all the time.
Hi neighbor, where in NJ?
I dont like to play Doctor here, but I have to say this. Because you are working comp case, it is very hard to find a DR who will take it and the worse part is the fact that they cant Rx to you whatever they want or whatever you really need; even certain, expensive tests are not easy available to you, you will need to put a long and tough fight for everything they must do for you.
I knew so many people on this and other boards, who had pretty bad health issues, needed serious treatments and surgeries and it wasn't done unless they involve a lawyer or some other sources to help them. This is include Pain Meds.
Another thing, be extremely careful with Fentanyl patch, you can find tons of information even in this board, on Internet. I am pretty sure many on this board still remember when I almost died 3 years ago when my previous PM Dr increased my dose from 25 mg to 50 right the way. I ended up in a Hospital, and lucky to be talking to you here today. If you read on this opioid, you will see that most deaths from opioids come from this particular drug. I am talking only about legal drug and legal Drs who Rx it. WE all very different and what is good for one, not good for another, so go only by how you feel, not how others take or feel on it. If you body tells you something, you let your DR know.
I feel very bad about your pain, I know what this all about. Unfortunately you are not free to go to any DR. Otherwise we are so lucky to have Hospital for Special Surgeries next to us in NYC and some other great hospitals in NYC. I am not sure where in NJ you are, but living in central part of a state, I hear many wonderful things about Dr. Cohen. Before my first spinal fusion, I went to him for second opinion, another really great one, has big good reputation is Dr. LaSpinosa. He is hard to get, will have to wait for an app, but it worth it. He operated on many Drs here, pretty conservative and not "knife happy". Even if you go for second opinion if need one to someone as good, you can have an idea what is your problems are. B/c we all know how hard working comp. cases are. One lady here couple years ago, needed back surgery big time, she needed to have discogram to be diagnosed, working comp told her NO, you don't need it, b/c they dont want to pay and paying for discogram out of pocket is a lot of $$$.
Then we have excellent spinal ortho at Robetswood Johnson Hospital in New Branswick, I completely forgot his name, but he is a chief of the department, it will be easy to find him.
Best of luck you dear heart, hope things will work well for you.
Wow, thank you so much for your post and kind words. I'm in central NJ and just saw Dr Cohen a few weeks ago. He recommends a bi-level fusion at L4 L5 S1. My PM DR is concerned with a tear at my L-3. Dr Cohen was the third Dr that gave me that same opinion. My PM Doc cant even get my pain under control, so i'm doubting his opions more and more. As you know, this is a workers comp claim, so i kinda feel stuck with this guy. I'm going to see him this week, but i dont expect any change. I'm waiting to see if wc will cover the surgery by Dr Cohen. Maybe then, he can recommend a PM Doc that cares whether or not i'm in pain.
Thank You again
Who is your PM Dr? I heard about a good one from Roberts wood Hospital, but don't know them personally at all.
Before I start going to HSS in NYC, I was send to one of local of PM - what a waist of time and money, he was wearing Armani suits, this is only nice thing about him, but as a PM Dr he was terrible and to compare to my PM Dr now at HSS, I realize how little he knew about pain mgmt field and about opioids as well.
I know you are still young, but please know (you always can consult a lawyer about it too) that if you unhappy about decisions WC makes for you, you always can fight for yourself.
They are tough cookies to fight, but they don't want to be sued if something goes wrong with you, so they always have a window where they can give up on something. Do you like Dr. Cohen? He never operated on me, but I loved the fact that he knew I am there just for second opinion and he knew my surgeon and could agree with him without looking at my CD, every film out of 20 I brought to him, examining me for a long time, talking to me in presents of 4 of his students he has that day. He took big box for it, but he spent 2 hours on me and only after that he wrote his opinion. I was very impressed by him and heard very nice thing about him as a surgeon.
Another thing I want to add. Be careful when you ask for Rx for opioids. If you have Pain Mgmt Dr right now who prescribes you your medication, doesn't matter if you have contract with him or not, you are not allowed to ask someone else to Rx you opioids. This is against the law and every DR can dismiss you from his practice. Make sure you are not ending up in this tough situation, b/c they may put on your chart that you are "drug shopper" and then will be very hard for you to find a Dr who will take care of your medication. Not a good place to be.
I dont have any contract with my PM in NYC, he is a very big Anesthesiologist and PM (By the way, the best PM Dr are Anesthesiologists, they know pain meds in and out) but doesn't believe in any contracts. He says if he doesn't trust a patient, he checks him out and if he betrays his trust - he is simply out and never to be taken back. So each time if I end up at the Hospital or some other pain I have (like my Rheumy prescribed me once pain meds), I always tell them that I am under Pain Mgmt care and he is the one to Rx them for me. Either they say OK, or they ask for his phone # to confirm what is my issues and what is better way to handle them. This is the right thing to do, b/c if they find out of someone else Rx you your meds - you are the one who may be punished.
I also want to share with you one thing; my Pharmacist is my neighbor and she told me one that it really doesn't matter what Pharmacy people use to refill their opioids, b/c since Pain medication was prescribed to you as to a Chronic pain patient and you get your re-fills every month, you are on their special Central system. You can be in Alaska, but if you refill their medication Rx by another Dr, not the one who always Rx it to you - they will get this information in your regular Pharmacy and they must report this to your Doctor without even notifying you.
How about this? this is why people have to be very careful not to put themselves in bad situation. Honesty is a key I believe.