It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Pain Management Message Board
Post New Thread   Closed Thread
LinkBack Thread Tools
Old 07-03-2009, 09:04 AM   #1
Member
(female)
 
Join Date: May 2009
Location: Texas
Posts: 62
Brosiah HB User
Surgeon not authorized to RX pain meds?? How is this possible?

I mentioned in another post how my surgeon's nurse told me that my current prescription will not be increased after surgery. I take Norco (10mg) 4x daily. When we talked to the nurse more about this she said the reason why is because the doctor is not "authorized" to prescribe anything stronger. How can a surgeon be limited on the pain releif he can give his patients? This seems absurd to me. Shouldn't a doctor be able to RX what ever his patients reasonably need with out limiations? I am having a 360 fusion and know the pain is going to be pretty intense. Obviously the meds I take are not going to be able to tackle acute surgical pain. Is there any other option? I heard that a surgeon might be able to refer me to a PM doctor for after surgery. Is this routine? Should I be arranging this now? My surgery is in a couple of weeks.


What do you guys think? Anyone ever heard of this before??

 
Sponsors Lightbulb
   
Old 07-03-2009, 09:24 AM   #2
Senior Member
(female)
 
Join Date: Jun 2009
Posts: 276
jdsun HB User
Re: Surgeon not authorized to RX pain meds?? How is this possible?

I would get myself to a Pain Management doctor ASAP! I have learned that surgeons are great at what they do......surgery. What they lack is the knowledge of pain management. I had my surgeon tell me that I should only take motrin and not vicodin....yeah right! I was then referred to a pain doctor and he has been my savior. They understand pain sooooooo much better.

So, YES....get yourself to a pain doctor who will be able to help you with your post-op pain. Good luck! I myself am facing a 360 sometime in the future.

 
Sponsors Lightbulb
   
Old 07-03-2009, 09:35 AM   #3
Inactive
(male)
 
Join Date: Jan 2008
Posts: 4,017
Executor HB UserExecutor HB UserExecutor HB UserExecutor HB UserExecutor HB UserExecutor HB User
Re: Surgeon not authorized to RX pain meds?? How is this possible?

Quote:
Originally Posted by Brosiah View Post
I mentioned in another post how my surgeon's nurse told me that my current prescription will not be increased after surgery. I take Norco (10mg) 4x daily. When we talked to the nurse more about this she said the reason why is because the doctor is not "authorized" to prescribe anything stronger.
This is a direct lie. No surgeon is limited to Norco. To be very candid, I'd find a new surgeon. Mine told me that there is no reason why someone should be in pain given the resources available today.


Quote:
How can a surgeon be limited on the pain releif he can give his patients? This seems absurd to me. Shouldn't a doctor be able to RX what ever his patients reasonably need with out limiations?
Yes, it is absurd. Many patients get morphine drips, demerol, or something similar. One of the main reasons surgical patients are kept overnight is so they can adequately address the pain mgt needs. They can't send people home with what they use in the hospital.


Quote:
I am having a 360 fusion and know the pain is going to be pretty intense. Obviously the meds I take are not going to be able to tackle acute surgical pain. Is there any other option? I heard that a surgeon might be able to refer me to a PM doctor for after surgery. Is this routine? Should I be arranging this now? My surgery is in a couple of weeks.
You are absolutely doing the right thing by bringing all this up ahead of time. In fact, if it were me, I'd bring the whole thing to a grinding halt. No way would I go through any surgical procedure without knowing that my PM needs would be addressed. I'm very sorry you are experiencing this, but look on the positive side....Better now than suffer later. I've heard too many stories about this type of thing. Hopefully, some with experience will chime in.

Regards,

Ex

 
Old 07-03-2009, 10:04 AM   #4
Senior Veteran
(female)
 
Join Date: Dec 2003
Posts: 10,133
feelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB Userfeelbad HB User
Re: Surgeon not authorized to RX pain meds?? How is this possible?

a big fat ditto on everything ex just told you. if you are dealing with this much crap now, you will NOT get the best possible care post op. i too find it very very hard to believe that ANY surgeon would 'only' be able to Rx a class III med for post op purposes. the only POSSIBLE reason that this even be remotely true would be if this surgeon got himself into some kind of trouble with rxing class IIs and had his privledge to write for them taken away by the AMA. but that would be remote at best and if it was the case, you NEED to get thee to another surgeon asap.

if this were me and this is what i had been told was my 'only' option post op with that level of surgery, i would be seeing another surgeon anyway. it is up to any surgeon once they cut into you to 'appropriately" manage any post op pain. many use the PCA at last on the day of and even the next just to keep the patient as comfortable as possible. to even BEGIN to try and manage the type of pain we are talking from a very invasive type of surgery like you are having with only hydro is really insane at the very least. YOU DO have the right to opt out of any surgical procedure at any time,even if you are actually IN the pre holding area at the hosp and ready to go into the OR. that is ONLY up to you.

you just REALLY do need to seek out another surgeon at this point, if for nothing more than to gain that very important second opinion and find out just how well that particular surgeon would manage your pain too(and tell him your fear of subpar management with this too). i would actually tell any new surgeon just what that other surgeon, according to his nurse anyways was actually planning on trying to use to even begin to try and cover the post op pain and see what he or she has to say too. i would think it would be just plain impossible given the limits of hydro. i don't know what it is, but something really just does not sound right about this surgeon to me. i seriosly would seek out another who just really understands what their patients pain would be like post op. they ARE out there, believe me. my six surgeries were done by different surgeons at certain times all since 2001, and i can tell you, even getting my second opinions i ended up with some great ones and one that practically had me litterally running out of his office too(he never had the chance to touch me thank god). but your post op pain and after discharge pain DOES deserve respect and appropriate management. its just a pretty basic thing for any good knowledgable surgeon to do. it would actually be rather inhumane to do to you what this surgeon is actually planning.

you are not beholden to this surgeon(you just will not be able to continue your med arrangement) and quite frankly i am rather amazed that he even agreed to manage pre op pain since this really is not the norm and considering his ideas of post op pain management as well? but you CAN seek out other opinions. you are the one and only person who is going to have to live with any surgeons decisions. it should at least be someone who gives a crap about your post op pain. i would actually try and look up this surgeon just to see whether or not he HAS had his hands slapped by the AMA at some point and really 'can't" rx any class IIs, ya know? this would be very telling about his decision making and his surgical skills as well. you just NEED to know before your surgery that you have made a good choice in all that needs to be considered. i do wish you luck with this. please keep us posted, marcia
__________________
3-22-01,herniated C-6-7
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.

 
Old 07-03-2009, 02:13 PM   #5
Inactive
(female)
 
Join Date: Jan 2007
Location: Florida, USA
Posts: 508
Boxerluver HB UserBoxerluver HB UserBoxerluver HB UserBoxerluver HB UserBoxerluver HB UserBoxerluver HB UserBoxerluver HB UserBoxerluver HB User
Re: Surgeon not authorized to RX pain meds?? How is this possible?

Double ditto, I can't believe she out right lied to you. I definately would not trust that doctor and nurse although the doc might not know this is what the nurse is telling you. I'd make an appointment to see the doc before I would go through the surgery. If he refuses to appropriately address your PM needs for surgery and post op then it's time for a new surgeon.

Melissa

 
Old 07-03-2009, 02:53 PM   #6
Senior Veteran
(female)
 
BrittleBones's Avatar
 
Join Date: Jan 2005
Location: Central Maryland
Posts: 898
BrittleBones HB UserBrittleBones HB UserBrittleBones HB UserBrittleBones HB UserBrittleBones HB User
Re: Surgeon not authorized to RX pain meds?? How is this possible?

I agree with Ex & everyone else who posted!! I would RUN, not walk, to another surgeon and get the pain management portion of the puzzle taken care of BEFORE you wake up in the recovery room! Having just come through another fusion two weeks ago, I can tell you that you more than likely will need more pain medication than you normally take. I personally would not go under the knife with a surgeon who didn't believe in providing the best pain relief post-op that they could. If he can't prescribe anything stronger than Norco, he's either not telling you the truth or he is the kind of doctor whose philosophy on life is "cover thy butt"! Sounds like he's scared of a lawsuit down the road if he should prescribe a stronger drug and you become sick or addicted. Good luck to you on the surgery.

 
Old 07-03-2009, 04:36 PM   #7
Senior Veteran
(female)
 
emmie54's Avatar
 
Join Date: Feb 2008
Location: Louisiana
Posts: 920
emmie54 HB Useremmie54 HB User
Re: Surgeon not authorized to RX pain meds?? How is this possible?

I'm wondering if the nurse said this because this is the only class that can be refilled by phone/fax instead of having to come in and get the script. Maybe he/she is just trying to make his or her life easier? It's much more of a hassle if someone on a higher schedule drug needs a refill It's easy for the nurse to okay a refill of the lower class without bothering the doctor.

Just a thought. But even if for some bizarre reason this was the case, it is indicative of how you will be treated post-op.

emmie

 
Old 07-03-2009, 05:12 PM   #8
Senior Veteran
(female)
 
Join Date: Feb 2005
Posts: 1,115
slipperyslope HB User
Re: Surgeon not authorized to RX pain meds?? How is this possible?

I feel like a broken record LoL, but you need to go back to your GP for your pain meds. He was gladly prescribing your meds for you and your surgeon asked you if you would allow him to take over your meds, and you said "sure " I think others have forgotten about that..remember all of the headaches you have had with the nurse giving you grief, making you go in W/D all weekend and now this? I mean why is he prescribing your meds when your GP was doing a really good job and you never had any issues.

I would be worried to if he was my Surgeon. I feel that if I am going to put that much money in a DR'S pocket and trust him with such a Major operation that I would want my DR to be able to prescribe what I needed.

Especially post op if my pain got really bad.

He is not being truthful with you. He can prescribe anything he wants too, he is a surgeon. He might have a policy where that is the strongest medication "he" is comfortable prescribing, but that is his own personal policy and belief, its not a rule and I bet he has and does prescribe stonger meds when needed his nurse could be lying to you, as she has given you a hard time before. Its not the law. Anyhow If you really want to use this DR than ask your GP to manage your pain meds post op and tell your surgeon that you are going to work with your primary care DR for pain control because you are scared you might need something stronger and given his policy your GP Wants to be involved. Since he isn't willing to give it to you, that this is worrisome to you. You also don't want to sound like a drug seeker and he is starting to make you feel like one. With all of the hassles you have had, it might start to make him suspicious of you.

I would just go to your GP for your meds but get it all worked out ahead of time and do this before you talk to your Surgeon.

If your set on having him prescribe ask him if he will at least increase your dose should you need it. You may not need more than 4 per day so try and stay positive that this isn't going to require much more but what if its not enough what will you do? and what will he do?

I am trying to be positive for you, that you won't need much more than 4 a day but what if you do? I would get this worked out ahead of time. This is getting scary this DR and his meds. And you are very worried about so nip it in the bud and go back to your GP.

good luck, SS

 
Old 07-03-2009, 07:09 PM   #9
Inactive
(male)
 
Join Date: Jan 2008
Posts: 4,017
Executor HB UserExecutor HB UserExecutor HB UserExecutor HB UserExecutor HB UserExecutor HB User
Re: Surgeon not authorized to RX pain meds?? How is this possible?

Quote:
Originally Posted by slipperyslope View Post
He is not being truthful with you. He can prescribe anything he wants too, he is a surgeon. He might have a policy where that is the strongest medication "he" is comfortable prescribing, but that is his own personal policy and belief, its not a rule and I bet he has and does prescribe stonger meds when needed his nurse could be lying to you, as she has given you a hard time before. Its not the law.
Yes, as I posted earlier, I think she is lying to you. Either a Doc can prescribe controlled meds, or they can't. When a Doc gets into trouble and loses his/her ability to prescribe controlled meds, it's all controlled meds, not just IIs or IIIs.

If you really want him to do the surgery, or you just want to get to the bottom of things, I would call him out on it...In a nice, professional way. I'd schedule an appointment and point blank tell him that you're very concerned about your pain mgt needs and this stuff about only getting Norco. Let him know that you've done your homework and see what he says. Then, if he says that he's only comfortable going with Norco, then I'd tell him that you're not comfortable using him as a surgeon. You're paying him big bucks for this. Quite frankly, being significantly under medicated after major surgery is just short of torture.

Best of luck to you.

Regards,

Ex

 
Old 07-03-2009, 10:33 PM   #10
Junior Member
(female)
 
Join Date: Feb 2009
Location: Richland, WA, USA
Posts: 25
Lovemydegus HB User
Re: Surgeon not authorized to RX pain meds?? How is this possible?

I would be very scared of this surgeon, who knows, MAYBE he's also limited on what he can use i nthe operating room to sedate you.....I've heard many stories fo people waking up during major surgery. I would quickly find another surgeon. And if you dont have a PM already established for pain after surgery, remember that getting in as a first time patient can take months. But whatever you choose, good luck. Just remember, it's your body and you deserve it to yourself to make sure you have the best care possible.

 
Old 07-04-2009, 12:22 AM   #11
Senior Veteran
(female)
 
Join Date: Mar 2008
Location: Australia
Posts: 520
Jema X HB User
Re: Surgeon not authorized to RX pain meds?? How is this possible?

Hey there,

This is getting quite complicated so would you mind if I asked a couple of questions so that I'm sure I understand, hopefully you can work something out without having to change surgeons...but that may not be possible. Lets see.

First up, you heard this directly from the surgeon abou the norco? Or was it just from the nurse? I would make an appointment to see him asap and discuss your issues, I'd tell him that he won't be doing the surgery if you are not provided with enough analgesics post op because there is much research that shows that not treating post op pain aggressively enough leads to CP. I can PM some data to you if you like. What I don't understand is where is the anasthetist in all this? They are the people that will write your meds while you're in hospital.

I recently had another fusion and the hospital discharged me on the same meds that I was taking post op - talk about just plain unacceptable. I rang my GP immediately who contacted my PM and had my meds raised for post op recovery.

Can you ring your PM and make an appointment to see them before the surgery? If you have a good relationship with them and you explain what happened with the surgeon taking over (and lowering) your meds he may step in for you.

I don't think you need to worry about while you're in hospital - there's no way that you'll be waking up on norco. The anasthetist wouldn't allow it for a whole bunch of reasons but I do think you need to find out who your anasthetist wil be and talk to them. It's insane that your meds have been lowered in the first place, it's bad medicine to say the least - they used to do it but the research has shown that pre and post op pain needs to be treated aggressively.

I think that you may be able to recover this situation and go ahead with your surgery, if you feel comfortable with the surgeon. First though, I'd definitely talk to the anasthetist regarding your post op pain relief and what you'll be discharged from hospital with. Second, I'd talk to my PM and ask them to take over the post 'post op' pain relief once you are home and have finished your 'going home' meds. Does this make sense? I've been in a similar situation but sometimes it's not so easy to change surgeons. He may not even need to know until you're home that you've swapped back to your PM. PM's deal with this all the time - mine was sooo frustrated when my GP rang him last week regarding my post op meds. He made sure I was not in pain when I got home. Your PM should be able to give you some good advice on how to proceed.

(I'm assuming that your PM doesn't mind about your surgeon prescribing meds because he's doing the surgery).

I wish you the best of luck and hope that it can be sorted out. You don't need stress like this.

 
Old 07-04-2009, 02:11 AM   #12
Senior Veteran
(female)
 
Join Date: Jan 2002
Posts: 2,369
AnnD HB UserAnnD HB User
Re: Surgeon not authorized to RX pain meds?? How is this possible?

There must of been a misunderstanding somewhere along the chain of command. In the united states some states are going toward all scheduled pain meds being given by Doctor specialists ...perhaps the hospital has a pain management team that will take over your pain after surgery. I wouldn't get all excited until you speak with the surgeon or someone else that knows the scoop. good luck.

 
Old 07-04-2009, 09:27 AM   #13
Senior Veteran
(female)
 
Join Date: May 2008
Location: State of Mizery, USA
Posts: 629
tiggertoo2174 HB Usertiggertoo2174 HB Usertiggertoo2174 HB Usertiggertoo2174 HB User
Re: Surgeon not authorized to RX pain meds?? How is this possible?

Quote:
Originally Posted by Lovemydegus View Post
I would be very scared of this surgeon, who knows, MAYBE he's also limited on what he can use i nthe operating room to sedate you.....I've heard many stories fo people waking up during major surgery. I would quickly find another surgeon. And if you dont have a PM already established for pain after surgery, remember that getting in as a first time patient can take months. But whatever you choose, good luck. Just remember, it's your body and you deserve it to yourself to make sure you have the best care possible.
Surgeons do NOT perform anesthesia in the OR, that is the job of the Anesthesoligist. No hospital would allow a physician to perform a major surgery such as a fusion without an Anesthesologist present in the OR. They would absolutely require it for no other reason than the lawyers would shut them down otherwise. Instances of people waking up during surgery when under general anesthesia are very, very rare. You might wake up a bit, or remember some small part of a procedure like a root canal or epidural injection where you are very sedated and they are using a local anesthesia combined with sedation, but not really under anesthesia, but it is extremely rare when dealing with general anesthesia.

That said, please find another surgeon. Unless you are particularly set on that person doing the surgery, it's just not worth the headache of dealing with a nurse like that. Any physician who does not have a good staff backing them up isn't the best person for the job. If the nurse is lying, that's bad, who knows what else she may do. If the surgeon has had his liscence restricted so that he cannot prescribe controlled substances that is worse.

 
Old 07-04-2009, 11:04 AM   #14
Inactive
(male)
 
Join Date: Jan 2008
Posts: 4,017
Executor HB UserExecutor HB UserExecutor HB UserExecutor HB UserExecutor HB UserExecutor HB User
Re: Surgeon not authorized to RX pain meds?? How is this possible?

After surgery, either the anethesiologist or the surgeon will administer your first round of pain meds, usually in IV form. After that, it's typically the surgeon's call as he/she will make "rounds" and check on his patients. If one is to stay over night, the surgeon will leave "orders" to the night shift nurses on what (and when) to administer meds.

Also, when you are discharged and sent home, the surgeon will be the one writing your script, as well as any follow up care. It's standard procedure for the surgeon to address your pain until you are told not to take the med anymore. Depending on the procedure & etc., this may be for a couple of weeks.

You're absolutely doing the right thing by addressing this issue with the parties to be up front. If it were me, I'd get an appt right away with the surgeon and ask pointed questions. I'd also tell him what the nurse told you. You are the customer...You're paying him. You deserve answers.

Best of luck to you.

Regards,

Ex

 
Old 07-05-2009, 09:19 AM   #15
Senior Member
(female)
 
Join Date: May 2008
Location: VA
Posts: 154
shananava HB User
Re: Surgeon not authorized to RX pain meds?? How is this possible?

I agree with a lot already said. I also would not take the nurse's word though. I had a PA doing a lot too for him. My second surgery I was more direct about better pain control & it worked out better. glad you are being proactive now. I had suggestions from PM dr in case the surgeon didn't send me home with anything.
Shannon

 
Closed Thread

Similar Threads
Thread Thread Starter Board Replies Last Post
Ortho Surgeon Appt. Thursday. What should I ask and say or not say?? Please Help!!!!! skych Chronic Pain 20 02-15-2011 06:15 AM
Possible Fentanyl Patch Overdose superstressed Pain Management 27 12-05-2010 09:29 PM
surgeon and pm pmtest Pain Management 11 05-14-2009 10:20 AM
surgeon released me with PM recommendation but no meds to last sammyo1 Pain Management 52 06-05-2008 07:22 AM
My surgeon is cutting my meds back sammyo1 Pain Management 14 04-23-2008 07:35 AM




Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off




Sign Up Today!

Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

I want my free account

All times are GMT -7. The time now is 12:38 AM.



Site owned and operated by HealthBoards.comô
Terms of Use © 1998-2014 HealthBoards.comô All rights reserved.
Do not copy or redistribute in any form!