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  • Finding New PM ... so crazy

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    Old 06-08-2015, 07:14 PM   #1
    sjemad
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    Finding New PM ... so crazy

    Hi all: My wonderful pm doc left practice in January and his replacement doesn't really want the extra pt load. I have been recently dx'd with Lupus (after a looooong journey to many drs to figure this out...almost a YEAR worth). My PM said the rheumatologist should be prescribing all my meds and not him. He wants me to transition to my rheumatologist for all meds.

    Right before I was dx'd with Lupus, I found a full-time job that I LOVE. First one in 3 years since I had a compound fracture that led to osteoporosis dx and many more medical issues.

    My PM thinks my rheumatologist should take over my pain meds and he is decreasing them whether I like it or not. My rheumatologist doesn't prescribe opioids and said that the Lupus drugs are not going to help my chronic back and hip pain. My PM won't even prescribe a TENS unit at this time. My rheumatologist wanted to talk to him and the PM refused. I told the PM I don't want to give up my job because it's the first job I found in 3 years that I can do and succeed at and they accommodate my Lupus flares.

    My PM said, "What is more important...your job or your health?" My rheumatologist thought that is crazy to ask that question and told me to find another PM. I want a PM doc who will work with my rheumatologist. This one will not.

    I've had 3 PM consults in Westchester County NY and 2 in Rockland County NY and no one really wants to take over maintenance PM. I need facet joint injections but right now I can't take off the time to have them. I feel like a drug seeker when I go in to see them and I don't know what to do. My pain meds are almost at zilch and I am feeling it every day. I have been coming home earlier and earlier from work because I can feel the pain. My rheumatologist said I am definitely not a drug seeker. I'm a chronic pain pt looking for relief. Today my back pain went into my leg during a work meeting and I had to suppress a yelp which was really hard.

    My Lupus drugs have definitely decreased the inflammation but I still have facet joint pain and other arthritic pain from spondilytis and scoliosis. It gets worse as the day wears on. As I go down in pain meds I am feeling every second between pills. I'm about to go down to 2 pills a day and that is just boggling my mind (as well as my rheumatologist who thinks I need to run, not walk, to a new dr but finding one is so hard).

    Any thoughts on how to find a new PM? I am at a loss and can't take more time off from work running around to find one.

     
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    Old 06-08-2015, 07:26 PM   #2
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    Re: Finding New PM...so crazy

    Quote:
    Originally Posted by sjemad View Post
    Hi all: My wonderful pm doc left practice in January and his replacement doesn't really want the extra pt load. I have been recently dx'd with Lupus (after a looooong journey to many drs to figure this out...almost a YEAR worth). My PM said the rheumatologist should be prescribing all my meds and not him. He wants me to transition to my rheumatologist for all meds.

    Right before I was dx'd with Lupus, I found a full-time job that I LOVE. First one in 3 years since I had a compound fracture that led to osteoporosis dx and many more medical issues.

    My PM thinks my rheumatologist should take over my pain meds and he is decreasing them whether I like it or not. My rheumatologist doesn't prescribe opioids and said that the Lupus drugs are not going to help my chronic back and hip pain. My PM won't even prescribe a TENS unit at this time. My rheumatologist wanted to talk to him and the PM refused. I told the PM I don't want to give up my job because it's the first job I found in 3 years that I can do and succeed at and they accommodate my Lupus flares.

    My PM said, "What is more important...your job or your health?" My rheumatologist thought that is crazy to ask that question and told me to find another PM. I want a PM doc who will work with my rheumatologist. This one will not.

    I've had 3 PM consults in Westchester County NY and 2 in Rockland County NY and no one really wants to take over maintenance PM. I need facet joint injections but right now I can't take off the time to have them. I feel like a drug seeker when I go in to see them and I don't know what to do. My pain meds are almost at zilch and I am feeling it every day. I have been coming home earlier and earlier from work because I can feel the pain. My rheumatologist said I am definitely not a drug seeker. I'm a chronic pain pt looking for relief. Today my back pain went into my leg during a work meeting and I had to suppress a yelp which was really hard.

    My Lupus drugs have definitely decreased the inflammation but I still have facet joint pain and other arthritic pain from spondilytis and scoliosis. It gets worse as the day wears on. As I go down in pain meds I am feeling every second between pills. I'm about to go down to 2 pills a day and that is just boggling my mind (as well as my rheumatologist who thinks I need to run, not walk, to a new dr but finding one is so hard).

    Any thoughts on how to find a new PM? I am at a loss and can't take more time off from work running around to find one.
    I am in a similar situation in that my pm doctor, since 2005,just announced that they are closing the office where I live. My suggestion would be checking your insurance website for a physiatrist who works with a pain management doctor.

     
    Old 06-08-2015, 09:46 PM   #3
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    Re: Finding New PM ... so crazy

    I would think that your rheumatologist could give you some suggestions.

     
    Old 06-09-2015, 04:21 AM   #4
    sjemad
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    Re: Finding New PM ... so crazy

    No, he said he would talk to my plan manager.

     
    Old 06-09-2015, 04:23 AM   #5
    sjemad
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    Re: Finding New PM ... so crazy

    No, he said he would talk to my plan manager if he were me. Meaning I should talk to my insurance plan but that doesn't help much as most PMs take my insurance. So I'm left with just about everyone.

     
    Old 06-09-2015, 07:34 PM   #6
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    Re: Finding New PM ... so crazy

    Sorry you are dealing with this. I agree, it is scary, especially considering you have a time frame. It can be tough to find a new pain doctor without personal recommendations, but not impossible. I would work from a list of pain specialists within a reasonable driving distance which take your insurance (per insurance website), then try to pare it down. Some eliminations can be made, such as if their appointment wait time is too long, if they have a large amount of negative reviews, if they only seem to focus on International pain management (ie. procedures) instead of a variety of methods including medical pain management (ie. medications which often include opioids). As you said, you may have a tough time finding someone to take over your prescribing.

    Unfortunately a lot of doctors are moving away from using opioids for chronic noncancer pain, even in patients who have done well on the same dose for a number of years and who have failed numerous other treatments. My doctor cut my dose by 2/3 for example. Keep in mind that especially starting with a new doctor they will want to have you try any other applicable therapies first before starting you on opioids or considering a dose increase, such as the facet joint injections, and typically cost or time off work or such is not a valid "excuse". A good doctor however should however have more than one treatment on their list for you to try, so one could be delayed and another one moved up the list. Just something to keep in mind, that you need to be open to all ideas.

    For example if a doctor told me they wanted to taper my meds down, I would be ok with that, but would want to hear their exact plan for how they planned to do it (ideally a small percentage of total dose cut per week/month, not dropping from 3 to 2 to 1 pills for example which is way too big of a cut and increases in percentage when it gets tougher at lower doses) and their alternative treatment ideas to try to pick up the slack. I've had plenty of doctors tell me I need to get off the opioids but then not have any reasonable treatment idea, besides just see how things are afterwards or re-try some treatments which didn't have a specific reason to be re-tried (such as if it was believed a procedure was done wrong, or a med wasn't tried at a high enough dose or for long enough).

    You may then want to make 2 or 3 initial appointments with the best candidates, and get a feel for what their treatment plan for you would be and if they are a good fit. As long as you do not accept meds from them or sign any treatment contract, there shouldn't be an issue. Its unfortunate your doctor no longer seems to want to work with you. So your rheumatologist couldn't at least tell you the names of a couple pain docs which their patients see, even if they couldn't specifically recommend them? I had the same issue...none of my doctors had any recommendations for pain docs so I ended up having to go my own way in finding one (I had been seeing my primary doc for pain meds but they weren't comfortable changing my med/dose in any way). It took four tries, but I found one which was a good fit for me. Hopefully you find a new one which is helpful. Best wishes.
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    Old 06-12-2015, 06:18 PM   #7
    sjemad
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    Re: Finding New PM ... so crazy

    Thank you for your suggestions. Thank you for taking the time to write. I've spent some time the past week trying to do what you're saying.

    What I am finding is that pain management drs will not tell you whether or not they prescribe medication before I get there. Two wouldn't discuss medication at all (I don't know if they prescribe or not! Both wanted to talk about injections only). My old PM would cycle my meds, and had me on a TENS unit and occasionally would cycle a pain patch in. His replacement doesn't believe in cycling meds. He also insists on doing injections in the hospital and you need a ride home. My last PM would let me take a taxi so long as I'm not driving. He's made it impossible and I can't seem to find someone who will talk about anything but injections. Injections lasted me about 3 weeks (I had epidurals and facet joint) and I can't do injections every 3 weeks. My rheumatologist told me that the Lupus meds wouldn't address the back pain and he is so right. I have been in so much pain and I know I'm due for another decrease in a week.

    I wish someone, somewhere, had a recommendation of a NYC/tri-state dr.

     
    Old 06-13-2015, 12:21 PM   #8
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    Re: Finding New PM ... so crazy

    Sorry you are having such a tough time finding a pain doc. I agree that places are really moving away from meds/opioids and pushing injections. Unfortunately I can see why, as it lowers their risk and makes significantly more money for the business. I found the pain clinic's websites to be helpful. If they only mention they are an 'interventional" pain clinic and have articles about different types of injections and such, they are less likely to be a good fit for someone who wants a well-rounded pain management experience. My pain clinic actually goes so far to mention they do "Pharmacological Pain Management" on their website and list the categories of meds (including opioids), although they have lots of info about procedures and such too.

    They are unlikely to tell you over the phone whether they will prescribe opioids, as if they tell someone yes, but they the doctor doesn't feel they are a good fit for their case, then that looks bad for them. Just based on location (driving time), my personal preferences (I prefer independent places not associated with hospitals), and wait time (didn't want to wait 3 months for an appointment), I didn't have that long of a list to work with. Some doctors/clinics have online reviews that will have patients mention what types of treatments were offered, so that can be another clue. You may just have to make several initial consultations with the best options and see how it goes (ask what their treatment plan would be for you). The sooner the better, as once you are completely tapered off the opioids it may be nearly impossible to get a doctor to start you up on them again, despite your high pain levels.

    Would your doctor at least slow down the taper, if you cite your increased pain and withdrawal and such? Note that a taper should be percentage based, not pill based. For example, going from 4 to 3 to 2 to 1 pills is increasing the rate at which the dose is decreased (25%, 33%, & 50%). It should be the other way around, as tapering gets more difficult as you get to lower dosages. Maybe you could point out that by reducing by a number of pills, the rate of dose decrease has been increasing for you over time, and you are struggling? Ask instead for a percentage drop. This is more difficult for the doctor as they need to prescribe lower mg pills and/or ask you to cut them in half, but is much easier on the patient. A simple approach would even be to drop by 1/2 a pill at a time instead of 1 pill, but depending on how many pills a day you are taking, that could still be a big drop.

    Also, if you get the facet injections, the doctor may be more likely to work with you on the pain meds (seeing you as more cooperative). It is difficult for them to justify opioids in patients who have not recently tried all other non-opioid options. There is unfortunately a financial incentive for them to perform procedures (they pay a lot more than office visit co-pays). As long as the injections are not done excessively, and won't cause financial hardship, why not try to make it work, as far as work & transportation? You could however discuss with your doctor that even if you were doing injections, if they last only 3 weeks but you can't get them every 3 weeks, then what would be the plan for in between? Not in a challenging way, but say you are confused what his treatment plan is for you as far as replacing your pain meds with injections. I imagine the doctor is hoping for the best case scenario of the block helping for several months. It does sound like you need a new pain doc, but that isn't going to happen overnight, so also trying to work with the one you have is another good strategy. Hang in there! Best wishes.
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    Old 06-18-2015, 04:43 PM   #9
    sjemad
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    Re: Finding New PM ... so crazy

    Thank you. I do the injections. I haven't found them useful thus far and my last PM doctor was nervous about all my other medical issues to put me under anesthesia.

    My current PM (the one that hates me and wants me out) won't give the new one my medical records unless I pay 75 cents per page. I have been there 4 years and can't afford that. So I'm hoping to go back to the new person and get new xrays done and hopefully a well-rounded PM program.

     
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