I read your response to my prescription and insurance post and now I am freaked out. I did not do anything wrong. Before I left for Boston, I went to my primary care doc and basically begged for some pain relief. My old oral surgeon had cut me loose saying their was nothing else he could do for me. I saw a new one down in Virginia, and the guy was a horror show and I did not trust him or like him. So when I went to the primary care doc, I told her I was going to Boston for treatment and she gave me enough medication (Norco and valium) for 2 weeks. She knew I would be seeing someone once I got here. I saw the new pain doc here with the referral from the surgeon I am going to be seeing. I had a phone consult with him ( the surgeon) before making an appointment to see if he could help me. Why waste his time and mine if he felt he was not going to be able to help me. The surgeon was the one who set up the appointment with the pain doc for me. I told him I had seen the primary care doc and that she had given me enough medication for 2 weeks. He said if that medication was working, he would not change it. I saw him again later in the week when my 2 week supply was just about gone. It would have ran out over the weekend. When she had prescribed the Norco, she wrote it for 3 times daily. I discussed that with the pain doc here in Boston and said it was not giving me enough coverage during the day and I was picking my 6 or so hours a day that I would suffer. He told me to take it 4 times daily and when he refilled it for me he wrote it for 4 times daily. He also wrote the valium for 4 times daily, as that what was working for me. The primary care doc wrote the script in Virginia for 2 times daily but gave me 60 pills and said that was for 2 weeks (you do the math) I still had valium left when I dropped the scripts off which was on a Friday, not a Saturday. I told them I would pick it up Saturday. I had all the kids with me and did not want to wait around for it. I really don't feel like I was trying to get over on anyone. I was very upfront with both doctors. The primary care doctor told me she would not refill the Norco without a office visit. Which was fine because I knew I would be seeing someone here. She knew that too. She offered to continue any protocol the docs up here gave me. I would have to get it in writing from the docs here. I am seeing the surgeon next week. He wanted me to see the pain doc before I saw him. If they decide to do joint replacement, they want me on a medicine regime prior to surgery to avoid any additional neuropathic pain that would result from the joint replacement. Did I screw up some how? I may have done some doc shopping but only because I got dropped by my old doc and needed to find a new one. I really don't want to mess things up because the medication I am on now is working so well and I feel better than I have in a year. I am able to function again. I can play with my kids again and smile again. I am not up crying every night in pain. I am sleeping again. Did I mess up??
Hey Amy, I did the math, A script written for 60 pills with directions to take 2 a day is a 30 day supply, Period. It doesn't matter what your doc said was OK to do. He can tell the pharmacist and that may drop the whole deal, but won't change the day supply and your insurance companies policy on early refills.
Now you have a 3rd doc in the mix. The specialist that you didn't like or trust but excepted his scripts, the GP that increased the hydro and wrote a script for 60 valium with instructions to take one twice a day "30 day supply", and a Boston doc that was even more helpful..
Who is going to be your doc that writes next months script for valium and Norco, you can't have all 3 do it and not expect problems. Why fill a script early and raise red flags when you don't have too. You GP can do the math too and ask the same questions. Obviously the pharmacist did.
I don't think the police would get involved, But I do know a pharmacist will put red flags in your file that read, Watch for early refills, watch for doctor shopping, verify all controlled substances and that one pharmacist, at that one store, has now entered it into the entire Walgreen's system. No matter where you go, the first thing a Walgreen's pharmacist sees about you is the red flags.
When a Boston doc gets a call from a VA pharmacist and says did you know that Patient Amy received X and Y from doc 1 on x/04 , Y and Z from her GP on x/04 and your scripts all in the same month, most docs are not going to risk their license to make one patient more comfortable with those meds. Even if he was foolish enough to battle with a pharmacist that simply needs to report to the medical board that he was informed of the pattern and did nothing. If he continues to prescribe, you can't get meds from your GP, Or your GP need to take the reco from the Boston doc and prescribe in the same manner and refill when that script runs completely out.
But what you have done is doctor shop. I'm not saying it to scare you, but because you don't seem to understand, how the whole day supply thing works and how important it is to be the perfect patient to keep pharmacist and docs calling the one you want to continue your treatment.
The only way to assure you will remain with a working regimen is to use one doc and be compliant. I doubt one month and 3 docs is worth investigating. But people use the same tactics all the time to hit a dozen docs a month to obtain Valium and Norco, 2 of the more popular drugs of diversion.
AS hard as it was to find something that worked, why risk it with an early refill? Needing meds because your going on a trip is just such a common tactic used by seekers, Being in town and having lost your scripts, moving to a new town and saying you need to find a doc to continue care are tricks seekers use on a daily basis. Every thing that sounds very reasonable in your mind can be very suspect in someone else's.
So just think of how they are going to perceive a script for 60 Valium, take 2 a day. The math says you were given a 30 day supply. Three different docs prescribing opiates and benzo's is also simple math too. You only need one, your only allowed one and yet you have 3 and are refilling early. That math is easy too..
I understand not everyone knows how pharmacies work and the whole day supply thing. But any pharmacist could deny your refill and keep your script. The explanation that the doc said it was OK to take extra will just put the doc on the hot seat. Why not right the script for 3 times a day if that's what he/she suggested. Docs will back down quick when confronted by a pharmacist or another doc. Perhaps being a bit scared is a good thing to realize how important it is to play by the rules. Not refill when it's convenient, wait till day 30 or however many days supply was calculated or get your doc to write the script the way you were told to take it.
The pharmacy knows nothing about the take extra conversation. They simply look at 3 sets of scripts in one month for all the same meds from 3 docs.
Appearances are just as important as your actions because you may not get to explain your side. Doc shopping is rarely prosecuted without the extra's like forging scripts, altering scripts, selling scripts etc. But I would expect doc 1 that was no help and your GP to be contacted if not the doc in Boston. You used the same pharmacy for all 3 scripts.
How it appears Is, you saw a specialist, excepted his scripts, agreed to his treatment plan and filled those scripts.
Then you went to your GP, didn't like the specialist' plan and he/she changed it but didn't indicate on the script the same thing you were told. Then you went to Boston and got a greater supply of the exact same meds. and tried to fill them 2 weeks into your one month supply. That's how it appears.
Knowing the system, knowing what your going through and understanding your logic, I can justify it in my mind, But I can also see the problem you are creating, why the pharmacist wouldn't fill the script, He should have kept it so you couldn't go elsewhere if he felt it was hinky. What is the plan for next month, If you have refills on your scripts, the one with the most from the Boston doc. You need to cancel the remaining refills from the other docs, they need to know who and what has been prescribed and you need to know who's going to continue your care.
The difference between getting different opinions, consulting with different docs and doc shopping, Is excepting the scripts, which means you agree to abide by his treatment plan, not go out 2 weeks later and find a more generous doc, then go out of state and find an even more generous doc. Have you told the specialist you won't be needing him, you found someone closer or whatever reason you want to use to change docs. BY not calling him, It appears your leaving that door open for the quick emergency fill if you run out or become tolerant and need more than you presently have. If you haven't ended that relationship, it could appear your waiting for his next refill date even though his meds aren't quite as strong.
Someone doc shopping wouldn't end that relationship. They would call him back a few weeks after you run out of the meds he prescribed and appear your not even taking that much, so this time he gives you a script with a refill. People keep 3 or 4 docs on the line like this, get a 1 month supply filled every week and appear to be compliant. There are more tricks to it than that and I'm not going to spell it all out but I'm not risking my relationship with my doc over a few extra pills or an early refill if managing your pain means that much of a difference in your life.
The play with your kids, the functioning, the pain and all it includes I understand. But if you don't learn that appearances can mean more than the explanation, because you may not be given a chance to explain before being discharged from a doc, you will continue to have problems.
If I wear you I wouldn't fill another script until your down till your last valium and last vicodn or norco from all 3 docs.
Don't be scared, just don't be blatantly non compliant and understand 60 pills prescribed twice a day will be entered as a 30 day supply at the pharmacy and to your insurance regardless of the conversation you had with your doc about taking extra. Your right, the math is very simple.
I did end the relationship with the "quack" i saw in Richmond. I called his office and requested my xrays and told them I was going elsewhere. I also told them to cancel my future appointment with him and I would not be coming back. I explained as nicely as I could that his one size fits all approach to treating his TMJ patients doesn't work for me. I am not some new TMJ patient and have been going at this for a year. Finding a competent doc to treat TMJ is very difficult. All of them have different opinions and methods of treatment. Some have worked for me, most have not. I have now found a doc here in Boston that I trust and will stick with and that is it. I trust him and he knows what he is doing. End of Doc shopping. You are right, appearance is everything. The vicodin I got from the Quack doc in Richmond has no refill on it and I still have most of them left as they do me no good. I have a whole cabinet full of meds that have not worked. The Norco refill I got here was because I was out of them and had taken them as prescribed. I did stick to the letter of the law. Your right, the GP wrote take 2 times a day but that was not what she said to me. But that is of little consequence in reality. I should have not taken the valium script in to be refilled because I still had quite a few left. That was my error. I don't know how long I could hold onto the script before it expired (do they expire?? How long can you hold onto one before getting it filled?) Truthfully I did not even look at the orgininal valium script as to the dosing info I just did what she told me. My mistake again. I will have to be more vigilant. This is all so new to me and I am just trying to learn how things work. I am unsure how this will work long distance either. I like this doc here and if they decide to do the joint replacement I will have to be on different meds prior to surgery. The surgery probably wouldn't be until after the first of the year. I cannot stay up here that long. I am confused and scared and really have had quite enough of all of this. Oh by the way, the quack doc in richmond did not give me a valium script. So it was only 2 docs. I felt I had no choice but to doc shop as my OS who had been treating me for a year said I can't do anything else for you. What was i supposed to do? I went to the doc he recommended I try. The guy is 82 years old and should have retired years ago. The new doc up here, when I told him who I saw, all but called him a quack (He just used nicer words). When I showed him the splint he made for me he said "that is the worst piece of junk I have seen in a long time" Thanks for your advice and helping all of us newbies to navigate our way around all of this stuff.
Hey Amy, sounds like you did the right things down here in Va as far as discharging the local doc and severing ties. Like I said, I have never heard of a prosecution directly from doc shopping, it's when people start playing doc themselves and writing their own scripts, tampering or forging scripts when the police are clled, Being out of state, you wouldn't have a problem with VA or MASS.You may want to find a friendlier pharmacy than Walgreens, I was shocked when They told me they don't price match and the same 120 dilaudid at sams Club that cost 26 bucks would cost me 78 dollars at walgreens. Sams also just cut the porice of Soma in half making them about 80 bucks chaeper on that med too. Are you going to stay in Masss for a while or untill you decide if you need surgery again.
Once some pharmacist puts a red flag in your file you get treated differently and any action is looked at with suspicion. Weekend fills, after hour fills, anything a pharmacist can grab on too and make an issue out of. This happened to me too, years ago. I was taking meds post op as I was told but the script didn't jive with what he had said or the refills he repeatedly wrote, but some floater put a stop to what they call and "early refill" when they called my doc, he backed right down and said wait to fill it and I went 10 days without. Even docs loose their backbone if they are confronted and therir prescribing is questioned.
The real shame would be too have another surgery, even with the best surgeon if your pain could be managed as easily as it seems to be now.You here about people that have had 8 and 12 back surgeries, or 4 TMJ surgeries, and it's basically because the patient is in so much pain they are willing to roll the dice even with very poor odds when nothing else is being offered.
The technology for doing fusions has changed tremenedously in the last 5 years and I'm sure techniques, hardware and aproaches will change for treating TMJ.
Out of curiosity, have you been able to get your medical side of your insurance to handle your TMJ or are they saying it's a dental problem, use your dental ins. This leaves lots of folks in a bind and with no choices other than pallitive care. My wife also has TMJ disfunction and we have been through several 800 dollar mouth gaurds and splints.
It's a shame you have to go so far to get treatment but if you have confidence where your at , ya gotta do what ya gotta do. I 've met folks that travel from as far a way as WV, MD, NC, and PA to come to tidewater for PM. 1 day every couple months is certainly worth the improved quality of life that proper PM can provide.
Good luck, Dave
I am staying up here at least until the end of this week. At this point that is my last appointment. I am seeing the surgeon tonite and see what he feels in terms of surgery. While I am being managed fairly well in terms of pain, it is also a matter of function too. I have limited mobility, limited eating ability (I have lost 18 pounds since January). Lateral movement to the left is extemely painful regardless of the medication I am on. If the doc feels I am not a surgical candidate I do have an appointment at the GELB center for craniofacial pain up here on Thursday. I am trying to keep my options opened. I guess at age 40 I don't want to be "managed" forever in terms of pain, but it seems I really have no choice. Surgery is no guarentee. But I would really like my eating ability to improve. (I miss Big Macs and italian subs). If I end up with surgery, I will probably have to wait until after the first of the year. THis surgeon is very busy and I am not sure I want my jaw wired shut through Thanksgiving and Christmas.
My medical insurance has covered all of this treatment I have had. They paid for one splint (day time one) but do not want to pay for the night time one so for now I am without. It cost $950.00 . I don't have that laying around for sure. Today will be the big decision day for me and I am nervous and excited at the same time. I am willing to roll the dice again. I simply want a chance at a reasonably normal life again. The pain management is fine and I will probably have to continue this for at least a while post surgery.
I am for sure going to be more aware of the medication issues you mentioned and try and do it right.
Linear Mode
