Re: Pill Count Question.
HI Derek, I have to take all my meds to every apt, IF they do a count they do it in front of me. If they didn't this would put the PA or NP in a precarious position of their word against yours. As far as partial fills on class 111 meds like norco or muscle relaxers, a partial really doesn't throw the count off. As long as you are not owed any pills at the time you go in for the count.
It's not unusual to find that Avina or Kadian doesn't last the entire 24 hours or that OxyC or MSC doesn't last 12,. This period in which they are adjusting your meds is the toughest. It takes the most self control not to self medicate when the dose isn't efffective, but try to look at the process knowing there is light at the end of the tunnel. It may take 3 or 4 or 12 adjustments to get your dosage correct, but as long as you know your moving in the right direction, risking loosing the first doc to treat your pain agressively isn't a risk most chronic pan patients will take.
Docs have allready heard every excuse you can imagine as to lost pills, stolen, short fills etc. So asking a doc to believe that you're the exception rather than the rule they have seen with patients that will never be satisfied or never be compliant really isn't a wise move.
They use the same tray and plastic knife they use in a pharmacy at my office to dump the meds out and count by hand just like the would at a pharmacy. They check the date the script was filled to be sure it wasn't filled early and it's an easy calculation to figure out how many pills you should have left at any given point in the month. I always count before I go just to be sure we come up with the same number and if the nurse makes a mistake, it's really not a big deal to have to recount to see if you have 16 pills left or 14.
Definitely take a closer look at the contract you signed just so you're aware of all scenarios. My contract says not to except a partial fill on class 11 meds, meaning if they only have 25 avinza and you need 30, they aren't going to write you a second script for the other 5 if you choose to accept a partial fill. I'm supposed to find a pharmacy that has the entire amount and notify the clinic within 72 hours if I have used a different pharmacy.
It's really not that hard to be compliant when having your pain treated is the difference between being bed wridden or being able to walk. I'm also not willing to put myself through withdrawal in order to make a count look acurate and I know my doc is not obliged to contue to prescribe should I screw up.
Docs can and will cut you off cold turkey regardlessof what med, what dose and how long you have been taking it. People don't die from opiate withdrawal and we do have the option of seeking help for addiction. So it's not like they are obliged to give us a comfy taper as they discharge us from a practice.
Counts are really no big deal unless compliance is a problem. If it is, use tools to make it easy, like pill organizers, have your spouse hold your meds, whatever it takes to stay on track, whether it's from forgetting if you took a pill or thinking an extra pill every now and then is no big deal. 2 pills short is a big deal. IN the case of avinza, it means severe withdrawal for 48 hours or possible discharge from a practice and a letter being sent to the doc that referred you to PM explaining why you were discharged.
The fact your being seen every 2 weeks at the beginning of a new drug is a good sign that the doc expects he may have to make adjustments. Taking avinza twice a day isn't unheard of and there just isn't any way a doc can look at you or your DX and know how much medicine it will take to manage your pain.
If you looked at ten 40 year olds, all with degenerative disc disease. Some don't need anything stronger than apap, some may need 60 mgs of avinza and some may need 300 mgs. There is no general rule as far as what dose is required to manage any specfic problem.
A person with a failed 1 level fusion may requre more than a person with a failed 6 level fusion. As long as the doc is working towards a reasonable goal, hang in there and hopefully the doc will find the right med, the right dose and right schedule to take your meds on.
It may take a couple of adjustments or a dozen or you may run into side effects that require a change in medication and starting over. Whatever the case, no doc is obliged to prescribe opiates and their goal isn't to relieve all your pain, it's to improve function and they generally shoot for 50% relief if that's even obtainable. I wouldn't burn any bridges when you know you have pill counts. A few bad days when the meds feel like duds is nothing compared to the years ahead or behind when nothing was prescribed.
Good luck, Dave
Last edited by Shoreline; 06-20-2006 at 08:09 AM.