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    Old 03-21-2007, 08:02 PM   #1
    IZZY'SMOM
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    Need Advice Talking to my Doc~

    Hi all~
    You all have been so helpful, and I need some advice. Just to refresh, I m currently on 50 Fent patch 1 every 2-3 days and compounded hydro 15 mg. 1-2 twice a day.
    Heres my problem...
    This amount holds me daily. But he has been pushing me to use it only on the 3rd day of the patch. I try to make them last 3 days, and I can if I can take 1-2 of the hydro a day. I made one patch last 4 days this week, and got really sick on the 4th day. I only did it because my insurance wouldnt cover it until that date.
    The second part of my problem, is that he is always telling me that he thinks I am using the b/t meds in ANTICIPATION of the b/t pain i have. Which is totally the opposite. I have asked him to up my patch then to 75, and he says the side effects would be too much, as we had happen before.
    I feel really stuck. I dont feel like he is hearing me. I dont anticipate my b/t pain. I take my b/t when I need it. I love my doc, but he is getting retirement age, and sometimes I have to even double check my scripts and take them back because of errors. Dont get me wrong, hes an amazing guy, and i feel a lot like he doesnt remember what he tells me.
    Also its 15 mg. Extended Release...not the instant release.
    He tells me its only for the last day of the patch, but then lets me change it every 48 hours, I guess hes wanting me to go 3 days, which I will try to do. But I have tried backing off of the hyrdro and I have withdrawls.
    When I told him this, he said we should start to taper down, because i shouldnt be having withdrawls from the hydro if I dont take it. Ive been on this combo for over a year, and on or about the second day I DO have withdrawls. I told him today about the w/d's and he said I shouldnt be having them if Im on the patch. I have them I know...
    He just wrote me today 120 15 mg tabs of hydro for b/t for a month at 4 a day, which is very generous.
    How can I let him know that on one hand I am dependant on the hydro at one point, but not taking it in anticipation.
    Sorry if this is confusing....
    Any help would be greatly appreciated, and thank you in advance!
    xoxoxoxoxoxox,
    IZZY'SMOM
    p.s. help from everyone is appreciated!!!!!!

    Last edited by IZZY'SMOM; 03-21-2007 at 08:06 PM.

     
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    Old 03-22-2007, 04:33 AM   #2
    SpinalMalady
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    Re: Need Advice Talking to my Doc~

    Heya Izzy,

    I'm so sorry you're going thru this. I hope you get some answers soon.

    Can you tell us what are some of your w/d symptoms you are experiencing? I'm a bit confused and concerned. I have been on some form of opiates since my back injury in 2004. Last year, I started seeing a PM doc, and I too am on a Patch. Was on 25mcg initially, then went down to 12.5, but on March 9, I had an Emergency MicroD and 2 level fusion due to CES (caudna equina syndrome). Basically my bladder quit working on me. I'm now back up to 25mcg patch. I also take 7.5 mg of Percocet every 6 hours, though yesterday I was able to stretch that to every 8 hours.

    Before the surgery I was on 7.5 mg Perc for BT pain. Sometimes I would go DAYS without taking it. My patch is a 3 day cycle. I've never experienced w/d.
    Please understand, I'm not saying you are NOT experiencing w/d, or making this up, but it's my understanding that with the patch you shouldn't go thru w/d because of the med in the gel patch is fentynal, which is something like 100 times more potent than morphine. You are using the brand name right? I could be waaaay off base here, and if I am, I humbly apologize.

    I had a screw up at the pharm this past month and ended up with generic, the day before my surgery and I let it go. I was so scared when I got home from surgery that the patch would not be effective, especially after having my back laid open, but I've been fine, thank goodness. When I went to the dr the next day before my surg. to have my emerg. MRI read and he said I had to have surgery that night, I about had a duck (in shock really). Then 5 days later when I got home from the hosp., I realized I had the generic patches, I was really scared, but someone up there ^^^^ has been looking out for me.

    Again, I'm not doubting you, I'm just worried about you. Is it that perhaps you have unrealistic expectations on where you want your level of pain to be? Even with the patch, and the meds, most of us realize that we will still have to live with some amount of pain. I'm happy to be at a 5. I can still work at a 5, as my job is as a teacher, and I can remain relatively happy, because my pain levels had been at 9-10 prior to getting them "under control". Would I love to be at a 0 or a 1...oh hell yeah! LOL.

    I'm praying for ya Izzy, and praying LOUD. Hoping you can get the answers you are looking for. How is mom and dad doing? Hope dad is much better. Mom and Dad have been in my prayers too.

    I'm just wondering if there is perhaps something else going on here. Something medication related, meaning some type of mild allergy or something like that. I'm also worried for you that your doctor is going to get fed up with all the med changes, and requests for upping, etc. You two have such a great relationship and with no other PM in your area (do I remember that right?) it would be a terrible blow to your healthcare.

    I hope you don't take offense to me expressing my concerns. I don't mean to offend, but am worried about you. You are such a kind and caring person to all on this forum, and I want to be there for you like you are for others.

    How was the bahamas?? Didn't you have to go for work? I'm supposed to be returning from Las Vegas today. LOL. My trip for Spring Break to Vegas had to get cancelled cuz of my Surgery. How bad does that suck? I've been very depressed about it, cuz it was my daughters 21st b'day present that I gave her for Christmas. Oh how I'd love to be in the Bahamas right now or hitting a huge jackpot in Vegas, I guess I'll have to go there in my dreams. LOL!

    Big Huge Cyberhugs for you. ((((IZZY))))

    Bg

     
    Old 03-22-2007, 08:17 AM   #3
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    Re: Need Advice Talking to my Doc~

    Hey Izzy-
    I know you feel you are stuck between a rock & a hard place right now. I'm really sorry to hear that.

    If I understand correctly, BT meds are prescribed for those times when the LA meds and other meds (i.e. maintenance meds like Neurtontin, Lyrica, Cymbalta) are not keeping your pain at a manageable level to keep you functioning throughout the day. If BT meds are being taken every day, at certain intervals each and every day, then they really are not BT meds, but actually are being used as "maintenance" meds and not BT. If I am wrong, someone please correct me, and also accept my apologies.

    I know you went through a lot of effort and research to learn about, and also have your doctor prescribe the compound hydro, and was really happy for you when you posted that your PM doctor agreed with giving it a try.

    From reading your post, it does sound like your compound hydro isn't technically being used for BT pain, but rather part of your maintenance, which in turn, makes it sound like your LA medications aren't cutting the mustard. I say this because you are having to take them every day to help the patch along.

    Was it you who had problems in the past with the higher dose patch? If so, then is there some other LA med that your doctor might be willing to try? If it wasn't you who was having problems with the higher dose patch, forgive my brain malfunction.

    You are right in that your PM prescribing 120 of the compound hydro is generous when they are used for BT pain, because that really allows for them to be taken every day. Some doctors will only prescribe a small amount of BT meds for the month. It sounds like he is trying to make sure you are covered.

    This is a catch 22 situation for you and him both I guess, because he feels one way, and you want to make him understand that your pain levels require the steady use of the BT meds (hydro). I don't know what to tell you other than to be honest with him about your pain. It's not uncommon for CP patients to develope tolerance, and yes our bodies to become dependant on these meds when we have been taking them on a regular basis long term. None of us wants to sound like a seeker or an addict, nor do we want our doctors to feel like we are "problem" patients. I know we all need to accept that our lives will involve daily pain of some sort. Some days will be better than others, but there will also be days that our pain totally interferes with out ability to do anything other than get up and go to the bathroom.

    Izzy, I really wish I had some sort of advice to give you, because you always are here to help others and give them support. If you are able to do it, please just be honest with your doctor and try and make him understand that the two of you need to find some sort of solution to getting those pain levels down. It does sound like he is a very understanding doctor who is open to suggestions and input from his patients.

    I wish you the best, and please take care of yourself. I'm sending positive thoughts your way!

     
    Old 03-22-2007, 10:16 AM   #4
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    Re: Need Advice Talking to my Doc~

    Hi Izzy,

    I am on the patch as well...the 75. I get 15 a month because I have found for me that I only get 2 days relief, which I have been told is not uncommon. You may have the same metabolism and need the same cycle. As far as the compounds, again, you are just getting something that is released slowly and is not there to "kick it in the butt" so to speak.

    I was always told to TAKE the b/t BEFORE it got so bad that it was out of control...you take more meds trying to get back to where you started. I was told to anticipate, and here you are told the opposite.

    Also, if you live in a warm area of the country (I am in AZ so summers are HOT), I really need my patches every 2 days. The heat of the body draws the meds in, like hot showers, hot days, etc. I was told by my Dr that if I could make it to the third day with the patches, that I could put a heating pad on the patch to draw them remaining meds out for some help. Maybe that could be helpful.

    It sounds as though you can't win...your Dr seems very set in his ways, and probably at his age, hasn't taken the time to educate himself on what is new and working in pain management. I am afraid if you keep telling him, he will throw up his hands and take you off everything...that is frightening.

    After moving here 4 yrs ago, and leaving the best Dr in the whole world, in my opinion, I had to "adjust" to anothers new way of thinking...it was awful. This just didn't have to do with how many meds I got, or how many hoops I had to "rejump" through for him...it was is whole way of interacting and doing the same treatment to every patient no matter their situation...Communication is my first priority with a Dr....and when there isn't any, you wonder if you're even being heard.

    I have also had w/d with my pathes...I try to leave them on as long as I can, but if you wait too long, you on a rollercoaster and that is not good either...the premise is to stay as steady as possible. I wish you the best.

    Dani

     
    Old 03-22-2007, 01:15 PM   #5
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    Re: Need Advice Talking to my Doc~

    Izzy, this is my opinion and only my opinion. A lot of your post talk about how do you go about talking to your Dr? You're very unsure of yourself and your relationship with this Dr. I understand he is an older gentleman and a small country GP, and he only has 3 pain patients and trust you will all his heart that you are a wonderful compliant patient and would never doubt you or think anything but the best of you, but he is doubting you now. It also seems he never thinks your taking your B/T meds correctly and its never enough. It seems that you have not been satisfied with any of the pain meds he has given you. The patch doesn't work the 3 f or 4 full days like it should, the vacating IR wasn't working well or he wasn't allowing you take enough of them, so than he switched you to compounded vicadin based on your recommendation, and that also didn't work well for you so now he has increased this? I am not sure I am confused..

    OKAY, so here is what I think you need to do. You need to see a pain management Dr. bottom line. this man is not trained for chronic pain, you need to see someone that is more experienced and someone your not so afraid to talk to about making adjustments and asking for more meds if your not getting good pain coverage.....

    If you read back through your post you have not been happy with your pain control for very long. you are for a short time than you want more or something else, and your not comfortable asking him to increase you and your not sure how to ask for what you need.

    A Professional pain management Dr knows more than he does, and knows how to help you and what meds work with certain B/T meds. personally I think maybe you need a totally different regimen, maybe methadone, or morphine or something else other than the patch and the 4 vicadins a day. I hope you can get some help that you so need as its been going on for quite awhile now and it needs to be addressed or he might begin to cut you back on the meds or take you off your pain meds... the patch is supposed to be one of the strongest of all narcotics... He might get cold feet with all the changes and increases/ decreases. I understand you live very rural but there has to be a pain doc that you can see somewhere within a few hours from you.... Think about all the time you spend thinking about how your going to address the Dr, and put that time into driving somewhere every month to get the real help you need....

    good luck!

    SS

     
    Old 03-22-2007, 03:42 PM   #6
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    Re: Need Advice Talking to my Doc~

    Hi guys~
    Thanks for all of the super advice.

    SS, I have two choices I think at this juncture. I need to find other PM help as you suggested, and I can go 8 hrs once a month. OR I can be satisfied with what I am on at the present.
    I am allowed to change my patches every 2 days if needed. What he would like to see me do, is to use the patches and on the third day use the Hydro.
    I have tried that, and the pain isnt covered. so I tried the 75, and it did make me pretty whacked out, and with my employment, I cannot be altered at all. If something makes me feel the least bit uncomfortable, I just cant do it. So that is why there have been a lot of changes with doses, ect. Without disclosing my job status I have to let it go at that.
    Its not that Im unhappy, I do adore the doc, and yes Ill probably have to find someone else, anyway because he will retire soon. What is vacating IR? Can i ask what you mean?
    IHe has maybe 4 pts a day and works 3 days a week, and answers his phone no matter what and calls back asap. He does it for everyone. So Im pretty spoiled. He always tells me I can call no matter what, any time, and I dont try to bug him, I may talk to him once a week.
    Anyway, I will try the patches this month and use the 4 day 15 mg that Im alotted if I need it, and maybe try to even cut back on those unless Im really really dying.
    Since Im allowed 4 per day, I started today with taking one in the AM, as I always do...one 6 hrs later, ect and so on, and they are ER, and it has been a really good day! so maybe that needs to be my plan. Im going to give it a shot. I dont want to get taken off of my meds yet, so Ill try it.



    Trip...I live in a colder area, but when I was in the Bahamas a while back, I actually had NO prioblems with my patches! I was thrilled!


    Ozzy~
    He wont go any higher than what Im on for b/t pain control. He wont prescribe oxy or morphine to anyone. My friend is his receptionist and says that he doesnt, for anyone. so I may have to try another doc, if I need.
    Sometimes I need to remember how bad it is for others, and I mostly have pretty good pain coverage, compared to lots, Im sure. Maybe Im a wuss Thanks for all of your kind words~

    BG,
    Thanks for the advice, and kind words, as well. As far as the WD I have had them before, and they are typical w/d symptoms. Sweat, the runs, chills, you know the drill.
    I dont get them with the patch but when I go without the hydro for 2 days I get w/d. Maybe its my body, but Ive been on opiates before and am pretty sure its w/d. So even tho Im on the patch and its supposed too be strong and all, I do experience w/d when I stop the hydro. Mom and dad are home and better. I dont know if i posted but mom ended up in the hosp. 2 rooms down from dad because of the flu, but the doc said it was stress. They are home and both better. thanks for the prayers and thoughts. thats so nice~

    Thanks for everyones advice and help, and I know my posts are rambling and probably confusing. a lot of the times when I get to post, Im wiped from work, or dead tired and some things can sure come out wrong.
    My Bahamas trip was work and it was super stressful, it was a circus, and hasnt let up. I only got to lie in the sun 1 day and that was for about 4 hours in the afternoon.
    But I did get to have a super spring break with my son when i got back and got to spend time with him and get a bit of rest.
    Thanks to everyone again, and I apologize if I left anyone out or didnt adress a lot of questions. If there is anything that I didnt clear up, please let me know and Ill to re read thru all of these again and answer your questions~
    xoxoxoxoxox,
    IZZY'SMOM

    Last edited by IZZY'SMOM; 03-22-2007 at 04:40 PM.

     
    Old 03-22-2007, 04:11 PM   #7
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    Re: Need Advice Talking to my Doc~

    Dear IZZY'SMOM,

    There have been some good points made thus far, and I'll try to do my best in response to what I perceive as the difficulty.

    Someone else already mentioned it when they used the phrase "roller coaster". Many of us who use the fentanyl patch change it every two days. Originally, the patch was to be worn for 3 days at a time, but over time it was discovered that many of us metabolize the medication within a 48-hour period. This leads to the "roller coaster" problem. If you use all of the medication within the patch during the first 48 hours (like I do), that third day is awful. Let's face it...You're coming off of the fentanyl and your pain is being felt by your body (and those around you--according to those family members who think they are comical). ALSO, using hydrocodone on that third day will not compensate for the loss of fentanyl your body is experiencing!! This gives you that unpleasant "roller coaster" experience!

    In my small opinion, I think your situation would be improved if you could use 15 patches per month instead of 10 patches per month. This comes out to wearing each patch for two days (48 hours).

    Concerning the type of patch you use: There are MANY differing opinions on this. So, here's my opinion. Janssen BRAND NAME and Sandoz GENERIC are both produced by the same lab. This is probably why both types look the same--the only difference being that Janssen has the word "DURAGESIC" printed on the patch, while the Sandoz patch does not. These two patches utilize the gel-like medicine in the same manner. The Mylan patch is smaller and does not seem to have the same gel-like medication in it. Apparently, the drug is absorbed in a slightly different method.

    Frankly, I am a Sandoz (or Janssen) supporter. When I used the Mylan patches for a month, I quickly began not feeling very well. I had all of my pain return with absolutely NO RELIEF from the patches. In fact, I went back to Brand Name Duragesic until I could get a chance at the Sandoz. To this day, my pharmacy orders the 75 mcg Sandoz Patches for me only. Everyone else seems to get along fine with the Mylan. They don't carry the Janssen any longer unless you ask in advance and are one of their regular customers.

    I think the point of BT (break-through) medications has been explained. BT medications shouldn't be needed daily at regular intervals. That defeats the whole point of having it in case you need it ON OCCASION.

    IZZY'SMOM, it seems like your best bet--in my feeble mind, of course--would be to have your base medicine, the 50 mcg Patch, adjusted by your doctor so that you change it every 2 days (I notice that your instructions say, "every 2-3 days"). That would give you CONSISTENT coverage. Then, you could tell how this affects your overall pain. And, you could then try to use your BT stuff just as true break-through medication! Since your doctor is approaching retirement age, it would be great to get this settled before you get stuck starting the pain management process over. AS WE ALL KNOW, you never know which way that will go with a different doctor!!

    Please keep us posted. You are always so helpful to us, and we want to help you back!

    Take care,
    Jon (Conductor)

    Last edited by conductor; 03-22-2007 at 07:13 PM. Reason: Slight adjustment in meaning.

     
    Old 03-22-2007, 04:27 PM   #8
    IZZY'SMOM
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    Re: Need Advice Talking to my Doc~

    Thanks Jon~
    You made me feel so happy. I am going to do what you suggested. Eveyone has given me so much good advice. I know I may have to find someone at some time, but I really love this guy, and he has really tried to help me and is good to my family as well.
    Ill try every 2 days and let you know what happens. Thanks again for your post. I know i may sound picky or spoiled, but it would really have to be a big decision to go to a PM doc and have a contract and all. I will give this a shot first. If I could keep my pain level at a 5 that would be ideal. I love to do the things I used to do, and Ive always been super active, and if I can do a few things IM happy. Also I only use the Sandoz. I have my pharm order it in special for me. I hate Mylans.
    Gotta get back to the grind, thanks again so much, Jon and everyone!
    xoxoxoxoxo,
    IZZY'SMOM

    P.S. Is it uncommom to have w/d from taking the hydro every day and then quitting after a year or so? The patch is a different drug...even though its stronger? Even when my patch is on the first or second day and IF i have gone without the hydro for 2 days Im miserable. Full blown w/d/. I take 60 mg a day. Wheres SHORE?????
    Thanks!

    Last edited by IZZY'SMOM; 03-22-2007 at 04:37 PM.

     
    Old 03-22-2007, 04:47 PM   #9
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    Re: Need Advice Talking to my Doc~

    I meant Vicadin IR. Sorry about that. I just worry with all your med changes and complaints your doc might stop prescribing. to you in fear you might be getting into trouble with them.. maybe you just need to stick with his plan and be hapy with it until you find a new doc to help you. I don't know of many GP'S that will even prescribe what your on so your pretty lucky but if your pain is not being managed than its time to find someone else. I am amazed a pain doc is 12 hours away. where do you live by the way??? that seems really odd to me. what a bummer spot your in and I am sorry your suffering so much, it really bites...

     
    Old 03-22-2007, 04:55 PM   #10
    IZZY'SMOM
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    Re: Need Advice Talking to my Doc~

    Hi Slip~
    Im 6 hours one way to Denver Co. And when its winter and you have to go over two 14,000 ft passes, it does BITE! WE do have the longest and largest runway besides DIA in CO though, and I can fly out of here a lot. If not Id be screwed for my work. Im going to try what Jon suggested, and try harder just to be satisfied with what I have for now. I could go anywhere and get PM help, but my injuries are such that we are hoping that by possibly the end of the summer I can get off of this stuff altogether. Ill have to dig up my MRI. I have disks in my neck that are bad from a rollover and head trauma as well. Ive had numerous plastic surg to my face and head as ell as cosmetic for my face, and the neck thing has been the one that keeps on hanging in there. We may do another MRI soon. My last was 5 months ago.
    Thanks!
    xoxoxoxoxoxo,
    IZZY'SMOM

     
    Old 03-22-2007, 07:33 PM   #11
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    Re: Need Advice Talking to my Doc~

    Izzy: I have questions that are not related to your thread...First of all...Hi, I read in your thread that your trip went well...my question is where did you put your patch? Were you able to swim without it falling off? What is Compounded hydrocodone? Just a few questions. I wish you well!!!

     
    Old 03-22-2007, 07:34 PM   #12
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    Re: Need Advice Talking to my Doc~

    Dear IZZY'SMOM,

    You know, when your body is used to something...It is used to it!! I do realize that fentanyl is the absolute TOPS when it comes to Pain Management--it's our strongest ally!

    However, I don't know--at all--how these different receptors deal with the differences between hydrocodone and fentanyl. I'm positive Shoreline will have one of the best explanations for all of this. Hopefully, he'll see your "distress signal"!

    Let me know how it turns out, OK? I'll keep looking on the items that contain your screen name.

    Take care,
    Jon (Conductor)

     
    Old 03-22-2007, 08:19 PM   #13
    IZZY'SMOM
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    Re: Need Advice Talking to my Doc~

    Hi Jon~
    I did put out an SOS for Shore! Im sure he will have the answer. thats exactly what I am thinking about the receptors, ect. Thanks for all of your support and kinds words. It means alot.

    Onyx~
    Hey girl~
    I wore my patch under my boob directly under and about 1 inch from the bottom of my underwire. Right center. Ive worn it down further too, Heres what I do....I sit upright, and bend forward and see where it stays flat. Im not bragging, but my upper body is pretty tight, and I can Put it from my boob line down to where I want to. It was fine and I wore a 1 piece for my few hours of sunning, but it works for me there even when IM out and about and trying to get some golf in. Its my fav spot. You may want to not get RIGHT under your boob, because you can sweat there, try to go at least 2 inches or more. That way your bra strap wont interfere as well.
    I dont care if you asked, who cares! This is what its all about!
    Good luck, and i hope you are doing well.
    xoxoxoxoxox,
    IZZY'SMOM

    Again, thanks to everyone for your kind words and help..Every one has something valuable to add, and I appreciate all of it.
    XOXOXOXOXOX,
    IM~

    Last edited by IZZY'SMOM; 03-22-2007 at 08:23 PM.

     
    Old 03-22-2007, 10:12 PM   #14
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    Re: Need Advice Talking to my Doc~

    Hey Izzy, I saw your post and and I feel for you. I've talked extensively with a patient that took part in the clinical trials of duragesic for non malignant pain. This was back in the 90's when if you didn't have cancer, few patients were lucky enough to be treated with opiates. The results of trial produced positive results but a very interesting fact that's not included in the full prescribing info.. It's been several years and I've lost contact with this person but I believe the percentage of people that actually got relief for the entire 72 hours was 7%. However that 7% allows the med to be marketed as up to 3 days of relief.

    Docs are introduced to meds by reps, they recieve major kickbacks and trips and incentives to prescribe meds they have never used based solely on the information of the sales rep, who isn't a doc, isn't a researcher, For the most part they are energetic and atractive people that call on a quota, have sales goals and if not succesful are replaced.

    So the doc that's never prescribed duragesic is told this med is wonderful, abuse proof and last 72 hours and prescribes it safely by following the manufacturer guidelines. Large quantities of BT meds are something most PM docs are scrutinized about. Yours are compounded because they don't make a strong enough dose. I'm in the same position where I know my clinic has monthly meetings where the docs and NP's sit down and reveiw every case. Despite the progress I've made in the last year, prescribing 120 Roxicodone has been an issue for the last 2 years, In the past I was able to have a doc come in and explain I sometimes need to take two at atime, sometimes I split one in half, Just because I have a steady dose from a pump doesn't mean 1 dose which lasts 4 hours is going to manage the pain from working 8 hours. I get home at 8 pm and I'm lucky to be in bed by 3am and get 2-3 hours sleep before getting up at 7 when the alarm goes off for my wife and daughter. What am I supposed to do at 12pm when the first dose wears off.

    When I'm at work I do well without BT meds, I'm distracted, buisy, and have a hard enough time working the multiiple computer systems we use,especially with the constant changes from a merger of two large companies into a unified billing/activation system system. It changes month to month and frustrates the heck out of me. I'm getting off topic, but my point is, when the pain gets out of control and it does after every day I work and the entire next day, 2 doses a day doesn't do much. I don't want my base dose increased as I have to deal with aditional side effects I shouldn't have too.

    I've been honest about my BT med use with muy docs. Some times I take 1/2 a pill somemes I take a whole and sometimes I take 2 at a time and they still feel like tick tacks after being on my feet all day, but roxicodone works better than anything lese I have tied.

    I guess I would have better off lying and saying I need two pills to get going in the morning and two pills to sleep at night, but I know my honest description of my irradic dosing of BT meds comes to question every month. Last week a new PA came in that I had never met, He doesn't even know what's wrong with me and decides I need to change meds to something they can get away with dosing twice a day, more importantly prescribing 60 pills a month. This is what gets me flagged every month. So he says lets try Opana, we will start with 5 mg pills, gave me 120 and said if these work we can give you 60 10 mg pills next month. A week into it and they have wrecked my stomache, I'm sick as a dog, don't get near the relief but I feel I have to give them a fair chance.

    If they made a 60 mg Roxi they would have no problem prescribing 60 pils a month. Same number of mgs, but their 60 pill a month BT goal would be met. I would break them into quaters and halfs and continue to use what works for me. How can they argue with succes. I've lost 35+bs, excercising, and returned from the dead and back to work part time. But they are under so much pressure from the DEA to comply with their requests, I have too play the game , give it a try and with the name brand cost of Opana and my doughnut hole aproaching for name brand meds, IT couldn't cost more to compound 60 mgs oxy tabs or capsules. I've tried everything but Aqtiq, and told them I don't want it.

    The number of pills they are precribing and following manufacturer guidlines that suggest needing BT meds more than twice a day means the base dose is too low seems to outweigh all the beenfit of what''s been working without a change or request for change for a couple years now.

    I do think that hydro and fent are so different and 60 mgs is a large enough dose that it would cause problems when discontinued, especially on the third day when the patch is wearing off. Unfortunately what I think doesn't matter much to your doc. It's just my opinion.

    Everyone reponds so differently to each med, You may have to find something that suites his prescribing comfort. I'm well aware of what my docs comfort levels are. The DEA pretty much sets them for him. I can't posibly see the logic in changing something that has been so well docuamnted to be working for me, but that 120 BT meds things keeps poppng up every few months. Unfortunately keeping BT doses to 60 pills a month seems to be more important than a patient returing to work to the DEA.

    I'm fighting the same battle not to loose ground, all I can do is remind them where I was 18 months ago, and where I was up untill the change last week and what the change is doing and costing me. In the end we may have to make a change. I don't think printing out date or studies is going to make a difference, but if I'm going to have to pay 300 a month, I'd rather pay for compounded 60 mg oxy.

    In your case, something as simple as changing to 60 hour patch changes or 48 hour changes may make the difference they want to see. If that's not an option, then you may have to change meds all together. If your not getting enough relief to be functional then you may not have much too loose by starting fresh with a new drug. I hate the prospect of doing this because it means titrating a new med and starting low. If the doc isn't avaialable, it makes it even worse. If your doc is absulutely unwilling to work with you, than you may have to consult with someone else that has a different perspective or opinion.

    I know I didn't give you any absolute answer but maybe something I said is useful and your doc is willing to consider. But it sure seems obvious to me that if you need the bulk of your BT meds on day 3, the patch isn't working 72 hours jusy like it didn't work for 93% of the other patient that took part in the initial clnical trials. I haven't seen this info in print from the manufacturer, but ehy do recognize the need to adjust dosing and strength for each patient. I do believe my friend when he said he was part of the first trial for non malignant use and that was the outcome.

    I'll move this to your other post because mush is right, and our mod has a problem with asking for someone specific although there is a group of us that have been here for years and have kinda gotten to know each other.If you need me, just post "anyones help please" and I'll try to respond. Take care, Dave

     
    Old 03-23-2007, 06:59 AM   #15
    Sammiejoe
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    Re: Need Advice Talking to my Doc~

    Hi everyone:
    Izzy, it seems to me maybe you should ask your doc for compounded hydro IR instead of the ER? After reading Shore's reply, I guess your doc wouldn't feel comfortable rxing 2-7.5 vicodin every 6 hours because that would be taking 8 pills a day, so maybe the compounded hydro IR would be a better choice?
    It seems like docs aren't so much concerned with the mg of the pill verses the number of pills you take everyday? I don't understand the logic behind that at all! If the DEA is concerned with diversion, I would think they would be more troubled by a doc rxing a higher mg rather then the number of pills. For instance, if your getting 5mg roxicodone and taking 2 every 4 hours for a total of 12 pills a day it is 60mg of oxy which is still much less of a dose than if you got 1-30mg roxi every 6 hours which equals 120 mg a day. I would assume people abusing meds would rather take 1 pill rather than a handful of pills?

    It's very confusing to me, but, if something is working for a patient and they have taken it without any increases for a while then why would a doc want to change it for a stronger med, but fewer pills a day?

     
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