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Old 10-31-2009, 10:42 PM   #1
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Attitude

As I've mentioned to others on the board, I truly believe attitude plays a very big role in how well meds, titrations, design changes, etc. work. I have a friend who recently joined a different board other than HealthBoards, and her attitude is just about as negative as it can possibly get. In short, she wanted a particular painkiller, and her doctor wanted her to try something else to start out with. She claimed only the one particular med would work, even though she hadn't tried anything else before. The Dr. prescribed a different med, which normally is just as effective as the one she sought. Through out the trial, she had herself convinced that she wasn't getting ANY pain relief. She ended up being admitted to the hospital for observation, and was told that she would be starting the med she wanted all along. They didn't tell her when the change would be made. About a day and 1/2 later, she was raving about how her pain was under control; she felt great; she just knew the med she had wanted would do the job. Thing is, they hadn't made the change yet. When she found out, she was so embarassed, and learned a good lesson that attitude has everything to do with pain management, and if you're open-minded, things go much easier. That's not to say that if you think positive, every med will work for you - BUT - if you are negative and convince yourself that a certain med won't work, chances are it won't.

 
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Old 11-01-2009, 06:37 AM   #2
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Re: Attitude

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Originally Posted by daveseavy View Post

In short, she wanted a particular painkiller, and her doctor wanted her to try something else to start out with. She claimed only the one particular med would work, even though she hadn't tried anything else before. The Dr. prescribed a different med, which normally is just as effective as the one she sought.
Great post Davey. I'll add something else if you don't mind.

In many cases, PM Docs are looking for little clues to see if the patient is really serious about getting better, or just wants meds. It should go without saying that when a new patient is very insistent on wanting a particular med, it sends off red flags to the prescribing Doc.

Conversely, if a person is really serious about getting better, they will put the "team first" hat on and be willing to try a thing or two. Then, if things don't improve, then I think a patient has the right to be a little more insistent.

Once a patient has a long term history with a particular Doc, then one is in much more of a position to be a bit more authoritative. Chances are, you've tried a bunch of different things and have at some point, really zeroed in on what works. These situations are not to be confused with those experienced by a new patient, or someone new to PM.

Regards,

Ex

 
Old 11-01-2009, 02:36 PM   #3
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Re: Attitude

I would have to say that to a certain extent you are right, but there is a point where the paitient has to put their foot down and say NO MORE to an approach that just isn't working. I went to a PM doc for nearly three years. In that time I had 3 rounds of epidurals, innumberable triggerpoints (and I now know she never actually injected a triggerpoint, just tender spots), and several nerve blocks, not one of which helped AT ALL. I was placed on three different anti-depressants all of which caused VERY high blood pressure and tacycardia - the last of which put me in the hospital for two days while they tried to get my BP down out of stroke range, and two anti-convulsants both of which caused severe nerurological problems. At no time during that period was I given ANY opiate pain medication except for 3 days - 9 tablets ONLY after an epidural and that 5mg vicoden - one tablet every 8 hrs. The ONLY muscle relaxer they would use was baclofen. At the end I was having severe muscle spasms right below the bra line, so severe at times that I had trouble breathing. For one month I was prescribed two 50mg ultram (IR not LA) one every 12 hrs, my pain levels were consistantly 7-8 at that time and that JUST DIDN'T DO MUCH. At some point around the end she also suggested an SCS trial even though TENS made things worse. At this point she wanted to do more epidurals. Since my husband had just been diagnosed with prostate cancer and was getting ready to have radiation I said ONLY if we can start next week. Each epidural put me able to ONLY get back and forth to work for about 2 weeks for a total of 6 weeks - two weeks for each of three injections. Despite knowing that the Dr. COULD have scheduled me IF she wanted to, they said the earliest was, I think one month away which would have put finishing them right in the middle of my husband's treatment. He had been thru radiation before and we knew that by about the middle I would have to take over everything he normally does or we would have to hire it done. Although lawn and all could be hired, SOMEONE had to grocery shop and cook, we couldn't eat takeout 3 meals a day for weeks on end. So I said NO. She refused me any further treatment because I refused the epidural, and I left the office in tears from the pain and having no treatment at all and terrified that I was likely to end up in the hospital with my BP out of control from withdrawl from the ultram since she refused me any to get off of it safely even though she knew I had BP problems.

I would have tried any medication she suggested except another anti-depressant since my internist and the cardiologist had said NO MORE after the hospital incident. Fortunately I didn't have much problem with getting off the ultram, at least with my BP and I was able to see my internist the next week. She gave me a script for IR oxycodone and a different muscle relaxer. After every cause for the muscle problems but myofascial my internist convinced me I needed an LA med and I tried MS Contin which works pretty well, and increased the doses of the oxy which later got changed to percocet because of the oxy shortage. I also see a massage therapist once a week (which insurance does not pay for) and am on my second round of PT since she took things over.

I think when a PM refuses to even CONSIDER any opiate, injections are not at all effective and other medications have life threatening side effects they are guilty of malpractice. I put up with the injections that didn't work for three years, and if my husband hadn't been having radiation I would have submitted to another three epidurals in the hopes that it MIGHT work. I think I went far beyond what should have been asked of anyone before trying pain medications.

I would agree that someone who comes in and only wants X and won't try anything else might be a problem. However, when opiate pain medication is the ONLY thing that hasn't been tried and they are even suggesting a surgical implantation of a medical device the doctor is just trying to bilk the insurance company for big bucks. After all the $2000 or so they get for an epidural is a lot more than the $60 or so they get for an office visit to write a prescription.

Tigg.

 
Old 11-01-2009, 07:28 PM   #4
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Re: Attitude

Quote:
Originally Posted by tiggertoo2174 View Post
I would have to say that to a certain extent you are right, but there is a point where the paitient has to put their foot down and say NO MORE to an approach that just isn't working.
A great topic.....

I think you're exactly right Tigg...I've been a strong proponent of patients being their own best advocate. When something isn't working and one has been a trooper and tried everything in an effort to be a compliant patient, there comes a time where one has to speak up. if not, one really risks a situation where the Doc thinks you are ok with the regimen.

Too often, patients are "afraid" to say anything and endure an extended amount of time without the right care. I realize that PM Docs ultimately control our meds and thus, a big part of our future, but if we don't speak up when something isn't working, Docs often assume that we are "ok" with what is happening. And the longer this goes on, I think the less serious a Doc will take someone because they'll assume that things couldn't have been that bad, or one would have spoken up before now.

There's definitely a delicate balance between being your own advocate and coming across as a demanding patient. I guess the biggest thing is giving the Doc a chance to employ their own ideas / treatment. Over time as a relationship develops between Doc & patient, certain requests or types of requests, are much more tolerable. One definitely doesn't want a track record of a lot of different PM Docs either....That can send an unintentional message as well.

But certainly, Davey is right about new patients who "demand" certain meds or treatments. Remember that old hair commerical...."You never get a second chance to make a first impression."

Regards,

Ex

 
Old 11-02-2009, 12:49 AM   #5
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Re: Attitude

I agree with what dave had to say - a new PM patient demanding a drug? Red Flag time and probably the start of a bad relationship. It's unfortunate that starting with a new PM often means changes but sometimes those work out for the best - why not be open minded? If your pain is still not controlled after you've given it a go, something else can be considered.

Ex and Tigg!! Yes, I agree completely. I've had 2 stays in hospital in the past month because my thoracic nerve pain has been through the roof and I couldn't breathe properly (turned out to also be a partially collapsed lung on the side of the injury). I was treated wonderfully by the ER (where I went first because both times it was around 4am) and then admitted by my neurosurgeon. My PM was away at the time and the hospital had their PM come and see me. After seeing me twice for 10 minutes over two days he wanted to do this:
Bone Scan (I can live with that)
CT guided nerve block
meeting with his psych and a Medtronics rep
test of SCS while I was still in hospital
implantation of SCS
initiation of methadone

My PM currently prescribed OC, oxy for BT, cymbalta and would have been furious had he been there - the thing was that the hospital PM planned to do all of this during the 3 weeks that he was still away. Thankfully my neuro stepped in (after I'd caused a massive scene by refusing to have my bed wheeled into radiology - I literally had to sit up and put my feet out (the hospital PM was furious lol)). My neuro was horrified and thankfully managed to barr him from treating me. If I hadn't kicked up such a fuss (and my mother and partner - and the wonderful neuro nurses), goodness knows where I would be right now.

Scary, hey?

 
Old 11-02-2009, 11:26 AM   #6
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Re: Attitude

Hi!

I think Dave you hit the nail on the head on this one!

Attitude is everything when dealing with CP and with chronic health issues in general.

Staying as positive as possible and as open to new treatments as possible is VITAL not only for one's over all health and well being but for one's relationships with their doctors.

I also agree with EX on being an advocate for oneself, which at times may require being assertive about what it is YOU need to live the healthiest life possible. Once one has a relationship and trust with their Doc(s) being able to advocate for oneself becomes a lot easier.

Bottom line is that at the end of the day YOU answer to one person..YOURSELF. To best serve yourself as your number one advocate often requires being OPEN to new things/therapies/meds and giving them an honest try. It ALSO requires being OPEN and HONEST to the docs about what is working and what is not.

The person you know learned a hard lesson about being open to new things and to the power of a positive attitude and out look. She will now be a better advocate for herself.

Wishing you health,

SW
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SW

 
Old 11-02-2009, 07:21 PM   #7
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Re: Attitude

Quote:
Originally Posted by silentwarrior View Post
Bottom line is that at the end of the day YOU answer to one person..YOURSELF. To best serve yourself as your number one advocate often requires being OPEN to new things/therapies/meds and giving them an honest try. It ALSO requires being OPEN and HONEST to the docs about what is working and what is not.
Great way to summarize everything. Well said....

Ex

 
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