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Old 02-23-2013, 02:20 PM   #16
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Re: help needed truely unsure what to do

Dear living rock, If I were you I would ask the PM dr face to face again or call & leave a message asking the dr to call me & if i had to give reason i would say pain keeping me awake most of the night. And, I would say to his face or his ear that the oxycontin is not lasting but 16 out of 24 hours & that in that 8 hour period of time that I hurt too much to sleep & it is really an issue now & what can we do to fix it. Going to a new PM dr is too hard, having to wait for the trust to build, etc, I would give my dr another chance before leaving & ask directly what can we do this is affecting my life too much to ignore now.

P.s. Have you ever tried 20mg 3◊ a day or asked the dr about that option? Of course, they would have to be prescribed that way b/c oxycontin cannot be broken or cut.

Last edited by gmak; 02-23-2013 at 03:01 PM. Reason: ps

 
Old 02-23-2013, 02:50 PM   #17
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Re: help needed truely unsure what to do

Living,
When I was considering changing PM doctors, I simply called a few practices around me, making it clear that I was coming to interview/consult with the new doctor regarding my treatment and to see what he thought he might be able to do or not. I knew full well that there was nothing surgically , at that point anyway, or injection wise that he could offer but wanted to meet the doctor, and find out what he thought he would do in my case...it turned out to be a great way to meet the new doctor, spend some time talking with him, gave him a chance to review my records, and I wasn't expecting him to take over my meds so it gave us time to talk-and I got to feel him out, he got to feel me out, go over my condition and go from there...
One of the mistakes that I see often is that a patient goes into a new doctor appointment expecting that the new doctor is one-going to give them prescriptions right off the bat, and two- just follow whatever the patient tells them. I didn't do that, in fact, the first thing that I said to any of the new ones that I interviewed was that, I had a current physician and wasn't happy with the current plan and wanted to see what they would suggest. At the end of the appointments, all reached the same conclusion ,medical management was the only option for me and they all offered to take that on if I wanted them to...it was far more relaxed that way, I didn't have any expectations of going and getting meds that they were not familiar with- I brought copies of my print outs from my pharmacy and all records/reports with me , so we could review them together...so I would do something like that .
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Old 02-23-2013, 04:22 PM   #18
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Re: help needed truely unsure what to do

Great advice/post as to a solid,honest a realistic approach to meeting and hopefully retaining a new PM doctor

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Old 02-23-2013, 07:07 PM   #19
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Re: help needed truely unsure what to do

I agree with that advice. You can ask your primary doctor if there is any other pain specialist they refer to, but most only have one they typically refer to. Likely you will need to search out some options on your own. Schedule some appointments and treat them as interviews. Ask what their long term treatment plan would be for you. That would give you a good idea on their feeling of medication management.

Definitely have your records ready, as you will need to obtain them to give to the new doctor (they cannot request them until you are an established patient, and they need them before that). If you don't want to clue your doctor in that you are thinking of leaving, just ask to pick up a copy of your charts yourself, instead of having them directly sent to a new doctor. That way you can also make copies for multiple doctors, and have a copy for you as well (to review...check if everything is correct).

Be sure not to get any meds from a new doctor until you have notified your old docotr / cancelled any contract you have. Best to have an initial appointment with the doctor, they schedule the next appointment at your next refill date (or maybe the one after that, if its too soon). Then cancel your contract / notify your old doctor between that.

Good idea to find a new doctor as yours does not seem to listen. Its one thing if they do not want to increase your total opiate dose, but they should have some response and action to every question you ask. It can be tough to find a new (good) PM doc, but it should be good in the long run. Best wishes.
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Old 02-23-2013, 11:01 PM   #20
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Re: help needed truely unsure what to do

Thank you all for the quick replies!

I think I'm going to take your advice, and 'interview' new PM docs. I was kind of already thinking I was going to go that route, but I feel a little more comfortable now that I know some of you have tried and were successful. I just want to get back to a life with some normalcy. It sucks that I cant even do the stuff I'd like to be doing with ny daughter (shes 7). I know my life wont ever be what it was 10 years ago, but not being able to function isnt an option either. Its 1am, and I dont see any sleep for me tonight.

Thanks again everyone.

 
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Old 02-24-2013, 05:16 AM   #21
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Re: help needed truely unsure what to do

I agree that it's hard to have to play ignorant, but thanks to diversion and addiction, that's the culture right now. As your relationship grows with your doctor, and a mutual trust develops, there likely will come a time that you will be able to discuss different medications. I spoke at a medical convention recently about this subject, and many doctors admitted that they are aware people have more knowledge than they want to reveal out of fear. They also know that with the web and all the information available, people are going to have information about different pain meds than what a patient would have had twenty or thirty years ago. After being on narcotic painkillers for several years, and seeing the same doctor throughout that time, Best of luck - keep us posted.

 
Old 02-25-2013, 01:35 PM   #22
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Re: help needed truely unsure what to do

Livingrock, good luck with the search for a new doctor. I agree with what the others that said its probably time to start looking, if this guy wont even acknowledge your issues. Let us know how it goes. Sending you positive vibes and gentle hugs to you.

 
Old 02-25-2013, 04:17 PM   #23
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Re: help needed truely unsure what to do

Hello Friends,

I was prescribed OxyContin, MS Contin and Opana years ago, all needed to be dosed TID. Since that time I have switched to the IR versions -primarily for the price differential and the ability to control the dosing and pill split if needed. I don't recall any red flags or opposition from my Doctor. Generic Oxymorphone worked very well for me q6h. Since losing my insurance recently I had to switch to Oxycodone 30's q6h. The term 'long acting' refers both to the release mechanism design of the pill -and somewhat to the nature of the narcotic itself. Hydromorphone is naturally very short acting in its IR form, the Long acting variant is called Exalgo and it is hideously expensive, almost obscene, nearly $4,000 a month. On the other hand Oxymorphone is a fairly long acting narcotic in its native IR form. The Opana variant only adds an hour or two to the activity of the medication, hardly worth the $500 extra per month for Opana. Bottom line is that an argument can be made to a doctor that cost is an issue, the other is pill splitting, and also being able to control or modify your dosing times. The long acting meds also take an hour or so just to begin offering up relief where the IR versions can be on the job in 30 minutes. I've felt that dosing every 4-6 hours with an IR medication offers plenty of consistency and creates a stable blood plasma level. Most of the long acting offerings need to be dosed 3 times a day for true 24/7 coverage. Why bother with them and the cost and the inflexibility. Personally, I don't mind the hassle of taking a pill every 4-6 hours. I prefer it.

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Old 02-25-2013, 04:42 PM   #24
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Re: help needed truely unsure what to do

Dave, you spoke at a medical convention regarding your experience? I'd be very interested in this if you care to share.

 
Old 02-28-2013, 05:03 PM   #25
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Re: help needed truely unsure what to do

Did you try the I did some research on my own talk with the Dr? Some hate it some love it... I wouldn't be like hey I am on a forum but I would say you did your own research.

Also I know that a lot of people will say this is a no no but that is up to the Dr not other people. But I have had amazing results with a prescription sleeping pill at night.

For me it gets me knocked out at least initially so I can at least get to sleep. It will keep me knocked out usually for at least 4HRs but I will usually stay asleep at least an 1 or 2 hours after it stops working. There are ER versions of the meds to which is probably best at first but they are usually the same dosage as the IR. If you do go that route though have someone watch you the first time you use it because they can be very dangerous. The main reason why a pharmacist will tell you it is a bad idea is that it has potential for respiratory depression and so do opiates. For me though that is not the actual danger... the real danger is sleep walking and it's not real sleep walking it is you do things you normally do but a little off and not remembering it. This happens to a lot of people and I think a big reason it happens to people is they take the pill and then do something like watch TV or use the internet... then they don't fall asleep and start buying stuff on eBay. If you go that route turn off your cell phone, do not have any weapons, and put your keys somewhere a little difficult to grab because a senator was caught driving with his robe on because of sleeping pills.

I hope you figure it out. The sleeping pills probably need to come from your primary but you need to tell your PMP you are going to ask for them. I always keep my meds transparent between the 2.

Also for your finding a new Dr it might be an area or state issue but it can be hard to find one that does scripts. A lot of them are injections and procedures only so keep your chin up if you have to get several consults. I am in the same position but because of insurance change.

Also probably don't mention that you accidentally received the wrong meds... because your Dr is probably not going to believe you and think you got it from a friend. That medication is a C2 afaik which has some major implications if they screwed up on dispensing it.

 
Old 03-01-2013, 07:34 AM   #26
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Re: help needed truely unsure what to do

I'm going to comment on the previous post (it's too long to clog things up with the quote feature).

Obviously, it's up to your PM doc as to whether a sleeping pill is indicated or whether he's willing to prescribe one but personally sleep was and is a real issue with me. Basically, I sleep in a recliner every night because I just need to be upright'ish to pull it off. I still only sleep 4-5 hours a night, although I can doze off during the day sometimes. But my PM doc definitely stepped up to prescribe Ambien for me. Unfortunately, it's not quite a high enough dosage, but I'll take what I can get.

As to your "research" and personally knowledge of your problem and possible solutions, I make it my mission to read and know as much as I can. I started my current PM relationship with, I have been in PM for sometime and I take it personally. I told the doc I read what I can and communicate with others in the same boat. To his credit, he was pleased and we got on to business. I would refuse to act stupid when it comes to personal healthcare. Don't play the game, IMHO. Good Luck!

 
Old 03-01-2013, 12:25 PM   #27
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Re: help needed truely unsure what to do

Dear living rock, The pharmacy accidentally giving the roxicodone instead of oxycodone reminded me of a true story that happened to me. Before any long acting formulas were given to me i took synalgos dc for pain & for very severe pain i was presccribed demerol 100 mg by mouth one per day as needed. I had waited about a week after dropping off my Rx's before i picked up all my back medicine & colitis medicine at the same time so it was quite a bundle, opened it when i got home & in the sack was my demerol#30 in a small brown bottle along with the other big big bottles of asacol, colestid, carafate etc & one of the biggest bottles was huge white with no child-proof cap, i looked closer & it was the stock bottle from the pharmacy shelf of demerol 100mg, it looked like there were 500 of them!!! I flipped out. Instead of putting it back on shelf the pharmacy had put it into my sack! My mind starts to go crazy with wild thoughts like it was a set up & when i got in my car to take it back the DEA would pull me over & accuse me of God knows what or when i walked in the pharmacy store they would arrest me! I immediately took it back scared to death that i would get a ticket, found the pharm mgr & asked to speak with her & she said go ahead , its ok what? I insisted that she come out by the chairs & she did, annoyed a little so then i told her, whispering in her ear & shoved the sack in her lap. She was dumbstruck @ first & then said the strangest thing she said that they had not noticed it missing yet & thanked me & good thing i brought it back b/c they never would have known it was gone & that i could have kept it!! I almost had a heart attack having it in my possession for 15-20 minutes! They didnt count it & it had been in my sack on their shelf for a week already & left the store! I thank God i wasnt pulled over for a ticket or even worse just left it in my car for a few hours to do errands or left it out on my kitchen counter where my kids could have seen it! I have never understood how a controlled substance is not counted @ a huge conglomerate chain pharmacy! Ive seen & heard of hospitals & the like having to account for every pill & your pharmacy just said sorry too , right?I wonder if you know the regulations that the pharmacies are supposed to use? And also, about going to a new PM, do you think the VA would let you just talk to the PM there in an appt about a treatment plan & if no prescribing in their plan they could make a private PM recommendation ?

Last edited by gmak; 03-02-2013 at 09:24 AM. Reason: typos

 
Old 03-01-2013, 12:54 PM   #28
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Re: help needed truely unsure what to do

Gmak, for the record, nice tale but I'm assuming that took place awhile ago. As in, most of those records are computerized and some even have automated systems, like many hospitals, where a machine dispenses the medicine and obviously keeps track of all the counts. We've come a long way baby!

 
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Old 03-02-2013, 07:27 AM   #29
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Re: help needed truely unsure what to do

Yes in 2001, & i know about pixit or whatever its called but i have watched @ pharmacies, big chain 24 hour stores, to see if they use those automated machines like in hospitals & the answer is no. They get a bottle off the shelf & manually count them out, still today in 2013! I have pain contract & so i use the same pharmacy but occasionally have to go elsewhere due to the particular med being out of stock so ive watched for the automated systems @ about 5 pharmacies & still i have not seen them in use yet. And with all the healthboard members posts about being shorted on their meds by their pharmacies i dont know for sure but it makes me think that their pharmacies dont have computerized, automated machines either. So, i know the technology is availiable but as far as it being implemented, i wonder when it will actually be put to use when i read about advice being given to watch the pharmacist count your pills manually before leaving the store & this roxicodone error. I live in the 4th largest city in US, have been in PM since 1998 & i have yet to see or be in a pharmacy that doesnt take the bottle off the shelf, put the pills on a tray, count them out, pour them in a bottle & slap a label on it. I wish we had come this far!

Last edited by gmak; 03-02-2013 at 01:55 PM. Reason: typo

 
Old 03-02-2013, 08:09 AM   #30
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Re: help needed truely unsure what to do

Some pharmacies now have a regional facility where they refill prescriptions (probably with the computer systems) which don't need to be filled the same day. For example, the automated system asks what day you need it, or says it'll be available the next day unless you ask for it sooner, etc.

Its important to go to a pharmacy you can trust when it comes to scheduled meds. Yes, they do now need to have exact counts at all times on scheduled meds, but it could take them awhile to notice a mis-count if its not something popular, or of course, the pills could always be taken from a bottle which is on the shelf waiting for a customer.

Crazy story, gmak! I'm always concerned that someone else would be able to pick up my meds. I'm sick of waiting for my pain meds to be filled and I have enough, so I always just drop off the scripts and come back the next day, but of course that leaves more time for things to happen.

Often they don't ask for a birth date, or just say it and ask you to confirm thats correct. I hope its just because they know me though. Thats a good reason to use the same pharmacy so they can get to know you by name (for folks like me who are in there a couple times a week lol). Best wishes.
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