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Old 07-24-2010, 03:01 PM   #1
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how to approach doc if I'm going to run out of BT for the first time in 2 years

Hi everyone, I've been in pain mgmt for about 2.5 years. I have a great doctor, never suspicious and I never do anything that would provoke suspicion. I'm young and have had 2 neck surgeries with chronic severe pain in my left arm and shoulder and now neck, too. I had been hopeful that more injections would help, but my doctor just looked at my CT and said the surgeon used so much bone growth protein in my last surgery that the bone growth has block all access to the nerve roots along my spine. So, for now I don't have any hope of relief on the horizon.

This month is the first month ever that I think I am going to run out of break-through pain medications. I don't take more than prescribed, but probably like most of you, I can take up to 8 a day, but if I did that for all 30 days I would run out about half-way through. (I get 120 per month) I don't take anywhere near 8 a day on average, it's usually around 4, but this past month has been worse recently and early in the month I had several (about 6) 8-pill days in a row That set me way behind for the rest of the month and I just counted and at 4 per day for the rest of the month, I'll run out 4 days early.

I have never asked for an early refill. Unfortunately, I don't have the kind of pain where I can just take a holiday. I would pass out if I didn't have medication available when it spikes. I'm trying to be overly conservative now and "taking" more severe pain than I normally do (i'll ride out an 8/10), but it's still not going to be enough, because my pain gets to a 9 many days out of the week without bt meds.

Have you guys handled this situation with your doctors before? I was treated very badly in the ER once and I am very fearful of being label a drug addict. I do take long-acting medicine, too, and that of course is fine because because it's just 2 a day no matter what.

In addition to that fear, I am terrified of being left in pain with no help due to some previous trauma of being left in intractable and untreated pain when my injury first happened. This fear is with me every day and I'm really worried about the next couple weeks. What's the best way for me to approach my doctor? I'll have to call in because I don't have an appointment for another 4 weeks, and I'll run out in about 10 days. I would normally get a refill in 14 days. Please help me.

 
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Old 07-25-2010, 12:28 AM   #2
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Re: how to approach doc if I'm going to run out of BT for the first time in 2 years

Toonces1, I will admit that I have been in this same situation and there is NO shame in it. I suspect there are others that have also been here too, but are either afraid, ashamed, or worse-worry that other's on the board will chastize them for it. Let's be clear; I in no way condone taking more than the doctor prescribes, and here is where my answers's come in. When you see this is happening, (running short) because of an unusually painful week/month you have one of two choices as I see it. You can choose not to inform your doctor and suffer. Don't forget other's around you are probably suffering around you as well. The other choice is to call and inform your doctor. Now you have to be very careful about one thing. I'm not sure how your PM does these things, but mine doesn't do ANY med changes over the phone. So you don't want to give the receptionist the impression that you want the doc to call over more meds at the pharmacy or anything like that. I would simply tell them the honest truth and tell them that you would like to make an appt. to discuss this ASAP. You should be in good standing with your PM doc since you said that this is the first time this has happenned to you in two years. However, ultimately, it is your decision. Good Luck with whatever you decide!!....janiee

 
Old 07-25-2010, 04:09 AM   #3
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Re: how to approach doc if I'm going to run out of BT for the first time in 2 years

Hi Toonces, If you have a PM contract I'm sure this issue is addressed. Yes I have beeen in the position due to a neighbor breaking into my home. I filed a police report, He was cought and prosecuted for the the credit cards he stole from a drawer, but the meds were gone and that was simply looked at as his word against mine. My contract explains very clearly that lost or stolen meds will not be replaced, so there is no point of asking even with a police report where you claim to have lost X number of pills during a break in. The police can write down whatever you claim, but where is the proof you weren't already out when you make that claim. My neighbor was arrested because he was cought on video and confronted by security when using my creduit cards, there wasn't a tape of him taking pills from a bottle with my name on it so no charges were brought for the theft of my pills. Instead I bought a safe and installed a security system so it would never happen again.

The group of docs I've been with for 8 years doesn't make exceptions, they tell you up front, they have you sign a new contract every year, so it's not like the patients don't know what the outcome of this scebario will be. They don't give everyone one free pass a year or 2 free passes every 5 years. The contract is extremely clear and I signed my name agreeing to these terms. Having a bad week, a flair,dental surgery surgery where you weren't given enough meds and had to use your own doesn't matter acording to the contract.

If you don't have a contract you can always beg for forgivenesss and hope he hass mercy or you can do something simple in this case like reduce your dose to 3 BT doses a day instead of 4, you will get through the month without going a single day without anything or risking loss of all pain meds by simply reducing your BT meds 25% for the next 2 weeks.

IF your unable to do this, I don't really understand why you would risk loosing everything and spend the next 6 months looking for a doc to trust you with anything at all.. If you believe that your case is somehow different than everyone elses and your doc is going to make an exception for his "special patients," than Jamies" advice is fine, but it still sounds to me like a huge risk of loosing everything when there is a simple solution. Yes you will be more uncomfortable than your used too, but isn't that better than loosing your doc entirely.

I don't understand the diference you see between running out of LA meds and BT meds unless your contract distinguishes some kind of difference in the need for compliance? Only you know what it says, It's easy to say don't worry when it's not you taking the risk. Sop I'm not ddoing it. I'm not judging you, I'm just suggesting not taking a risk I wouldnt take myself. Although you say your can take up to 8 doses a day, doesn't your doc expect 120 pills to last 30 days the same way he expects 60 LA pills to last 30?

I wish you luck and my advice is to follow the rules of any contract you sign, this is the only way to absolutely ensure you won't have a problem that could potentially end your treatment with this doc. If your rely on BT meds for the bulk of your pain relief perhaps you should discuss your base dose with your doc so that BT meds don't continue to be an issue.
Take care, Dave

 
Old 07-25-2010, 05:32 AM   #4
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Re: how to approach doc if I'm going to run out of BT for the first time in 2 years

I agree with Dave. Wait it out.

 
Old 07-25-2010, 05:46 AM   #5
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Re: how to approach doc if I'm going to run out of BT for the first time in 2 years

I have to say I agree with Shoreline on this. On this very forum there is a member who had an established relationship with her PM Doctor for a couple of years and had a very similar situation recently. She attempted talking to her Doctor about it and was immediately released. I just have to say in this is situation, it's not worth the risk. At this point your best option is to look for ways to make the meds you have left last until you're able to refill.

However, at your next appointment definitely discuss the pain issues your experiencing and look at this as an opportunity to increase your monthly prescription of your breakthrough medication
. This way you're sure you're covered for the future. Unfortunately, the reality with pain is it is impossible to know when bad flare will occur, so ensuring you have enough medication is really important - as is open communication during your monthly visits.

Others may have other perspectives. So, definitely do what you feel is right for you. But, honestly I have heard of so many patients dropped for this very "innocent" situation and it is such a difficult position for any pain patient to be placed in - it just causes more stress trying to establish oneself with a new PM Doctor.

I'm so sorry about the pain you're experiencing. You're in my thoughts.



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Old 07-25-2010, 11:06 AM   #6
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Cool Re: how to approach doc if I'm going to run out of BT for the first time in 2 years

Hi, You have been given some great advice, I can only add what I would do if this happened to me.

First thing I would do is call right away and ask for an emergency appointment.

When you see the doctor, tell him that you are having a serious pain flair, and then ASK HIM what you should do.

At that point, he will either:
Raise your breakthrough meds for this month only, which gives you a script and solves your problem,
OR
Raise your long acting drug permenantly, which will help you while you drop your breakthrough dose to 3 a day for the next two weeks thereby also solving your problem,
OR he will
Tell you under no circumstances will he consider raising the dose of either med, which answers your unasked question and lets you know you have no choice but to drop to 3 a day for 2 weeks and then try and be more compliant.

This is the only way I can see that is risk free and lets you know where you stand.

But from then on, You MUST be honest with your doctor, If he won't raise your doses, you are free to look for a doctor that will, or try something else if offered. But the time to ask for a raised dose is before you help yourself, it only hurts us in the long run, I know it is stupid and frusterating to have to play by all these 'rules' but your credibility is your most valuble alli as a pain patient. Good luck and please let us know what happens!

Your Friend, Fabby

PS~ I know you didn't cheat or anything, I have had the same type of script, where if you take it as written, you will run out early, that's why I gave you the advice I did, I know you are and were techically compliant.

Last edited by Fabrashamx; 07-25-2010 at 11:14 AM. Reason: adding ps

 
Old 07-25-2010, 01:17 PM   #7
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Re: how to approach doc if I'm going to run out of BT for the first time in 2 years

Thanks for taking the time to give me your advice. I think I'm going to try to get through it. It just seems so insane to me, you know? my doctor knows me, she spends 45 minutes with me every other month, she has been through 2 surgeries with me, seen me in the hospital, knows everything I'm going through, but then I have to be careful telling her about my health? I can't imagine any other health problem being this way. If someone needed more blood pressure meds, would we say, "well, you'll have to wing it until the 3rd." It is just crazy. There is nothing about me that says "drug addict." But, I have know a few drug addicts who play the game really well, too.

This makes me really want the narcotic registry to go through so doctors can have more confidence that their patients are not doctor shopping. The weird thing is I have never had to show my meds when I come in (though I bring them every time just in case), I have never been drug tested, I did sign a contract, but when I handed it in I don't think even checked to see if I signed it. Maybe my doctor hasn't been burned badly enough yet.

I have some tramadol which works a teensy bit, so I'll try to rely on that for my first bt dose of the day.

shoreline: the reason the long-acting thing is different for me is there is no variability in it. I take one in the morning, one at night, I never have to vary it. With my BT meds, some days I won't need any at all, and some days will be terrible. It is totally variable, I never know what I am going to need. I don't take exactly 4 per day, that has just been the average, but I have to keep counting them everyday to see how I am doing. I should probably create a schedule I can monitor everyday to see how I am doing. I don't have to count my kadian because it doesn't change day to day.

anyway, thanks everyone. Please keep your fingers crossed that the next week or so goes well for me.

 
Old 07-25-2010, 07:40 PM   #8
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Re: how to approach doc if I'm going to run out of BT for the first time in 2 years

And in your discussion with the doctor address maybe there's a better LA medication for you as well as choosing the best BT medications.

I did ask for an early refill once of my BT meds but it was Friday and my appointment was on Monday. I hadn't paid attention when making the appointment and I was actually nearly 5 weeks between appointments so they were fine with filling it 3 days "early" since technically I was already beyond a month. My fear had been I'd run out over the weekend and in the end I probably would have been fine but would have run out the morning of the appointment.
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Old 07-26-2010, 06:16 AM   #9
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Re: how to approach doc if I'm going to run out of BT for the first time in 2 years

I think we have all been where you are. I have had a jaw flare where I literally had tears come from my eyes, and I needed that ONE extra pill that day...but if my jaw was out of control for a week, you can see where one extra pill for 7 days would put me out of meds early. Where I get my meds from my rheumy, I have a LOT more room than those in the pain clinics...still....I never want to be the one that they question if I needed an early refill. I mean, that we all get nervous that they "may" just frown upon us in any way.

When this situation DID happen to me, for the rest of the month, I had to go with less breakthrough meds, which sucked, but the alternative of running out was FAR worse. I would rather have ONE pill than nothing! I also take LA meds so thank God I always have that!

I feel for you. I personally would play this safe. I like the idea of getting an appt., NOT telling them that you may run out and just see if the doctor would change your prescription mid-month to help you out.
Let us know how you are doing. I feel bad for you and I am sorry you have to suffer. Chronic pain is really TOUGH to deal with at times.

Madison

 
Old 08-01-2010, 06:41 PM   #10
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Re: how to approach doc if I'm going to run out of BT for the first time in 2 years

by the way, I made it. Today is day 30 and I made it with using less BT meds over the past 10 days. I lived with a lot of pain and I didn't enjoy it, but it was a good learning experience. I certainly couldn't live this way all the time, as my heart rate and blood pressure were up because I get a lot of adrenaline when I'm trying to deal with severe pain. just in case you were wondering...

 
Old 08-02-2010, 09:12 AM   #11
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Re: how to approach doc if I'm going to run out of BT for the first time in 2 years

I am glad you are okay toon...thanks for checking in!

 
Old 08-02-2010, 11:34 AM   #12
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Re: how to approach doc if I'm going to run out of BT for the first time in 2 years

I am glad you made it, but I am so sorry you had to suffer to do it. I hope you will ask your doctor next visit for an increase, sometimes it's not even because our pain is worse, it's just the chemical fact of physical dependence meaning eventually we will all need more meds to do the same job. Hang in there, I hope you are feeling better.

~Fabby

 
Old 08-02-2010, 12:05 PM   #13
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Re: how to approach doc if I'm going to run out of BT for the first time in 2 years

I didn't get an increase one time when I talked to my Doctor about relying on my BT meds more than my LA. She changed my BT meds until they were doing what they should.. only when needed

 
Old 08-02-2010, 05:16 PM   #14
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Smile Re: how to approach doc if I'm going to run out of BT for the first time in 2 years

So happy you made it and are doing well!


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