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    Old 08-18-2007, 09:30 AM   #1
    eddieJ85
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    What next step to take

    I have posted my situation before, i have had 3 back surgeries , the last being a spinal fusion in late april. I had both chronic lower back pain and pain shooting down my left leg due to a pinched nerve. For a while after surgery I was feeling a lot better, than the leg pain and back pain came back. Since then the leg pain has gone way down and is not really the problem, although it still can get bad at times, the major problem now is my lower back has become increasingly painful.

    I have two problems, the first is that my insurance ran out in July. The only thing I really have is a special card to get discounts of prescriptions. The second problem is that on top of it all, I can't seem to be able to find someone willing to give me pain medication, or at least not enough.

    I got meds from my surgeon up until around a couple weeks ago. He told me to go see a PM or a GP for pain medication. I had to go see a GP because PM is more expensive and I also need to go there frequently, at least with the PM I last used. When I first saw my GP he was flat out reluctant to give me anything, but eventually did. He told me I could only take 3 a day, and gave me 40 Vicodin ES. I explained to him that it would have to be 3 weeks before I could see him again and if he could give me a 3 week supply, which would of been around 60. He looked at the script he had wrote and said it would be enough, so I said ok. I waited a few mins and the nurse gave me the scripts and I noticed he had not changed it from 40. Which was barely a 2 week supply at the amount he told me to take.

    Anyways, because of this I ended up seeing him again last monday, . I did this for 2 reasons. The first was that on my previous visit I had high blood pressure and he had prescribed me meds for that as well. My concern was I was under a lot of stress and in pain, what if that was the cause and a one time thing? I wanted to visit him again before I filled the meds to make sure. If my blood pressure was consistently high then I would gladly do on meds. The other reason was because of the meds I was taking. I have been taking vicodin ES for a long time and I need 2 pills each time for relief. This presents a problem because to take 3 a day would be impossible. I could take 2 at one time and then one at another, but that would be wasted. I was just in a lot of pain so I resorted to instead of 3 a day, 4 a day. 2 in the morning, 2 before bed. Well 40 pills, 4 a day thats a 10 day supply and it would of run out by the end of the week and I could only get in to see him on monday because he had a cancellation that day.

    What I had planned to do is ask him to switch to norco 10mg/325mg. Simply because then 1 and a half norco would be equal to 2 of the ES, and it would also contain drastically less tylenol. This way I could go down to 3 a day, by taking one and a half each time. I also wanted to check my blood pressure again. Well, the doctor didn't seem to take to this kindly, and seemed to get a bit ****** off. It was like he did not listen to me. At first he said he'd give me some in 2 weeks. Which I could not understand, since the last supply he had given me would of run out waay before 2 weeks from then even if I had only taken 3 a day. He made a big deal about oh you were only supposed to take one every 8 hours, in which I told him that I had been taking the meds so long I had built up a tolerance and one did not provide relief.

    He then said he'd give me 20. Which I said no that is a very short supply I wanted at least a 2 week supply which he didn't like. Then he leaves the room and comes back and says that I need to pay half my bill right upfront or he wont give me any prescriptions. So I had to pay, and then when they gave me my scripts the norco wasn't there, so I asked the nurse and she went up to the doctor and came down with a script for 25 norco. I didn't know what to say so I just left. It was only when I had gotten to the pharmacy that I realized he had given me 5 mg norco. I did just not know what to say. Anyways the directions for this script said take 1 at a time, 4 a day. Which is a 6 day supply. I ran out of them even quicker than normal because I needed to take 3 at a time The problem is he told me that I can make another appointment but still need to pay the rest of the bill before I can get anymore prescriptions. I won't be able to do that for a couple of weeks.

    So I called my surgeon and explained the situation to his nurse on the day before I ran out. Told him I was not able to get sufficient medication from my doctor at the time, and if he could please give me a refill until I can. I knew that he might not do it since he was the one that told me to go elsewhere, but I was in pain and figured it was worth a shot. Well his nurse called back and told me no they could not refill it. She said I am addicted to the medication. I said you know what could you have the doctor call me? She said I can tell him you want him to call you but that doesn't mean he will. So I said ok, thinking he would call me, since last time I asked him to he did. Well no call came. So yesterday I ran out of pain medication and in addition to pain, I had symptoms of withdrawal as well which added even more to deal with. So I tried calling the surgeon again, desperate, saying I was not only in pain but sick, since I have been on the medication for a while and then just abruptly stopped. Again she just said you know we can't feed your addiction or else we are just dope dealers.

    She then told me to go into an ER. She said I could be in there for a few days and that they would sedate me and keep me comfortable while I got off these meds. It just felt like she wasn't listening. She then called someone she knew at the local hospital specializing in addiction and he called me and basically told me no if I came in I wouldnt get an IV or have to stay, he basically just suggested going to support groups. This is what I dont need, the medication is what makes it possible for me to function as close to normal as I can.

    My question is..I have been considering going to a county hospital, even though I know the wait will be long. I just have nowhere else to turn. Has anyone ever had to goto such a hospital for back problems, and if so what happened? Do they give you prescriptions? If not, my only other option seems to be to call my GP next week and tell him you know you knew I couldn't come see you for a while and yet you only gave me a 6 day supply, and simply ask him for maybe another week and a half's supply, but I doubt that will work. I guess I'm just looking for any advice on what the next step is and anyone who has had to goto a county hospital or free clinic type place.

    Last edited by eddieJ85; 08-18-2007 at 09:34 AM.

     
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    Old 08-18-2007, 09:43 AM   #2
    yvette777
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    Re: What next step to take

    I am so sorry to hear this, and as a fellow spiney it ofcourse scares me. I hope you find a doctor who will listen. The review are mixed with ER's some will treat you with respect and give you meds others will treat you like an addict. It sucks. Has this been your long term physician? I would call around and find another one. Hang in there.

     
    Old 08-18-2007, 11:45 AM   #3
    ms_west
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    Re: What next step to take

    Eddie my heart goes out to you that you are having to fight for medication. I am in a similiar situation. However, I hope you don't take offense to what I am going to post. They may think that you are seeking and abusing your meds because you are taking more than the script is written for and running out ahead of time.

    I do understand your pain - my surgeon has reduced mine to bare minimum as well and at times I need more than he prescribes to survive.

    If your GP/surgeon are not willing to write enough for adequate pain relief, I think you need to seek another surgeon or possibly a pain management doctor for assistance. I would think a pain management doctor would have more compassion since this is his speciality area.

    Good luck and I am lifting you up in prayer.

    Last edited by ms_west; 08-18-2007 at 12:00 PM.

     
    Old 08-18-2007, 12:07 PM   #4
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    Re: What next step to take

    Eddie, it's unfortunate that so many doctors have this attitude. Of course you aren't addicted; you are dependant and there's a big difference. I would advise you to try to find another gp...and if necessary, still another, until you find one who isn't so uncomfortable with treating you. Too many doctors just do not understand chronic pain and have no sympathy. Of course, you could go to ER but if anything, they will only give you enough meds to help you through withdrawals, and that's not solving the problem.

    Shame on your surgeon for putting you in this position. When my first ortho spine specialist retired, I had another ortho who promised to give me my meds. At the time, I was on vicodin, 5mg with darvocet for breakthrough. Well, when I went to see him, he backed out and offered a small supply of darvocet which I refused. I reminded him of his promise and he said he just couldn't keep that promise and shouldn't have made it. It didn't take me long to find another ortho spine specialist and he has prescribed for me for over 10 years. I pray that the next dr. you see will do the right thing for you.

    Carol
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    Old 08-18-2007, 12:48 PM   #5
    Justoneofus
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    Re: What next step to take

    This is not an uncommon issue for chronic pain sufferers to have in getting adequate, regular medication. For reasons for your protection and the doctors.. they are being very stingy with your meds. Why I have no idea, but I see quite a bit of posts from you that relate directly to your docs not wanting to provide you with pain medication.

    My heart goes out to you!

    You post stated you were hoping they doc would give you enough to get you by another week and 1/2. What then? You will still have the problem with refilling your scripts and the cycle continues.

    It's important that you try not to shift around from doctor to doctor, in a effort to get medication. This is a HUGE flag to doctors that the patient may be abusing drugs. And you asking to speak directly with the doctor to state your case about your meds.. again.. another flag.

    Can you be beyond dependent on the medication to being addicted? Yes, that is possible.

    So go and ask for help. Ask for help, plain and simple. I would call the PM doc and ask for a consult to discuss your surger(ies), your pain, medications, and management of your pain. Both about your responsbilities and how the medical community can help you. What's the worst that will happen from that. You walk away with no help. That is where you are right now. But you might grab the attention of a doctor that sees you are willing to do what is necessary for treatment and management of your health, which includes pain management.

    Wishing you peace and some resolve with this.
    __________________
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    L5/S1 bulging @ 18, now 46; still there (but no pain)
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    Solidly Fused Nov-2006
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    Old 08-19-2007, 06:23 AM   #6
    yvette777
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    Re: What next step to take

    Also as far as not having insurance, if you need surgery. you can apply for medicaid through your local social security office, there are different medicaid programs, and they don't usually just tell you. I did qualify for it and that is how I was finally able to have the surgery. But you have to be in medical need and apply for social security first. I pretty much had a letter from my family doctor, explaining my situation physically and all I had went through, God Bless him.

    Don't give up, just keep going forward. Call friends and family and find a doctor who is more friendly or be seen at a hospital like a teaching hospital that goes off your income or is state funded.

     
    Old 08-19-2007, 08:29 AM   #7
    eddieJ85
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    Re: What next step to take

    Well the problem about going to see different doctors is that it cost money to have records transferred, etc.

    I know I have become dependent on the medicine. I would honestly rather have that then not be able to function at all.


    My next step is first thing monday to call county hospitals to see if a doctor will see me without insurance. Hopefully someone will be sympathetic to what is going on.

    It just feels like the doctors aren't really listening. My surgeon tells me it is perfectly normal to still be in pain at this point, yet refuses to give me anything for it.

    As for my GP, well I went to the same GP for about 18-19 years, then I switched to my current one, who I have seen a total of about 4 times. I guess I can also call him and tell him he gave me a short supply and see what he does. I'm also considering calling back my surgeon, not for pain meds but just to ask what he thinks I should do next.

    I thought about stuff like medicaid, but I was told it is hard to get and even if you do it takes months..which I don't have

    Last edited by eddieJ85; 08-19-2007 at 08:33 AM.

     
    Old 08-19-2007, 03:34 PM   #8
    Justoneofus
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    Re: What next step to take

    Hi Eddie. I think the choice you noted.. call your surgeon, is the best NEXT choice for you. Dont seek medical counsel for short term solutions. You need to look at the long range picture here.

    You have admitted you think you have a dependency issue with the medication. So make the appointment, and tell him that. Tell him you want and need help. Even go one bigger, ASK if he would be willing to team with your PM to help you through this. (And yes, I heard you when you said you don't have insurance. But a patient in need that is willing to sit down take responsibility, reach out for assistance, at the very least, gets some respected attention.) If neither is willing to help you, you at least have your own respect that you tried.

    You are right, it's totally normal and common to have serious ongoing pain out of spine surgery just a few months. BUT, if a doctor suspects a patient has a serious dependency issue, boardering on addiction.. they will withhold medication almost everytime. Medical malpractice is at an all time high and docs are losing their licenses to practice medicine. Some of course.. deserved.

    Dont put all your eggs into one basket.. You said doing the medicaid things is drawn out, etc. Well, while you are trying other avenues.. you may exhaust them and at least you have medicaid processing in the works in the meantime. What's the worst could happen, you get it and you don't need it. So why not begin the process.

    Please let us know how you are doing.
    __________________
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    Old 08-20-2007, 04:06 PM   #9
    BrittleBones
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    Re: What next step to take

    Hi Eddie! I would agree with some of the posters who suggested that your actions (at least in your doctors' eyes) are very common drug-seeking behavior. I know what it feels like to be in withdrawal and not know where your next pain pill is coming from. My spine surgeon reached a point where he refused to Rx anymore pain medication for me. Surgeons are not usually doctors who prescribe pain medications for more than 4-6 weeks. It is their responsibility to get the patient over the immediate post-operative phase of their recovery, including the management of their pain. But, after that time period is up, it makes more sense to refer the patient to a pain management doctor who is better equipped to handle the long-term prescribing of meds or the initiation of other therapies to help us handle the pain. So...you already know all of this...I know, I know!! What you seem to be doing though is looking for an immediate and constant fix for your predicament, without being willing to do the footwork that's necessary to find a long term solution. You should be finding the time to get to the Social Security office or the Medicaid office to start the ball rolling towards getting authorization to see some of the doctors that you will need to see, whether that be a pain management doc, another surgeon, a physical therapist or an addicionologist. Yes, it's a hassle to fill out all the paper work, etc., but as one poster already pointed out....at least you can turn your attention to more immediate needs while the paper-pushers are doing their job trying to get you some insurance. If you live in a major city (I can't remember...but did you say you were from Chicago??), you should pick up the phone and call the closest hospital that is affiliated with a university. Most of these hospitals will see patients who are waiting for medical assistance or may see you on a sliding fee scale. They probably have some sort of pain managment clinic within the hospital setting and would be more likely to take you on. You might want to consider seeing a doctor who specializes in pain management for people who have had some problems with self-medicating or taking more medication than is prescribed, an addicionologist. They can often find therapies, including medications, that are more geared for folks who might have a compliance problem or history. I'm not saying that you are a drug addict! You just may need to look at all the kinds of doctors that are out there these days. I sure hope you can get some help with planning your next move and your long-term treatment plan. While you are in the middle of post-op pain, without the meds you feel you need and are experiencing drug withdrawal, you AREN'T in a place that allows you to make well thought-out decisions about the future. All you can think about is IMMEDIATE RELIEF from your symptoms. Hope you find the help that you deserve buddy! All the best - Memere

     
    Old 08-20-2007, 05:50 PM   #10
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    Re: What next step to take

    I am so sorry you are going through this! I truly feel for you. I wanted to give you an option. When I went to my current pain doctor, I did not have insurance or much money. I persisted until I got past the receptionist to talk to someone about a payment plan. Turns out they have a program for indegent patients. I only had to pay $20.00 a month until I was working. Now after almost two years in pain management, I am able to work full-time, so now I have insurance, AND I agreed to pay the balance of what I owed.

    There are MANY doctors that will work with you. But you MUST play by the rules.....PERIOD. No doctor will work with you if you take more of your meds than prescribed. That is just a sad fact. I went MANY months on doses that did not touch my pain. But once they trusted me, and I continued to describe the things I wanted to do in life, that the pain was keeping me from, they finally got me to a dose that helps me work.

    So start calling, and stick to your doctors orders. They MUST see that you can and WILL be compliant. There are too many penalties for prescribing to patients that "abuse" their meds, even if it's need.I hope and pray you can find help soon!

    God Speed!

    Amanda

     
    Old 08-21-2007, 04:52 PM   #11
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    Re: What next step to take

    Edie, I really sympathize with you...and I was in the same exact place for a long time.

    I was taking many Vicodin per day. I needed something MUCH stronger, but that was all my doctor would prescribe. #30 vicodin a month. When in reality, I should have been on something like Oxycontin or MSContin or probably even the Duragesic patch. I was in a boatload of pain due to several herniated discs and sciatica in both legs.

    I was treated like crap by doctors who were floored when I told them how much vicodin I was taking -- 2 every 4 hours for a total of 12 per day. I was trying to tell them, look how much I am taking and I am still in pain. I knew I needed something stronger. They said how addictive it was, etc. Very ignorant about pain management, they were. Also, I had no health insurance and no money, I was disabled and could not work -- so I was going to county clinics, and they are notorious for treating every patient like a drug-seeking addict and for having blanket policies of NO OPIATES. A friend said her county clinic has a sign in the lobby that states: "We do not prescribe opiates." Can you imagine? That sounds like malpractice to me and a violation of the pain statues that are on the books (in some states).

    Some states have better pain treatment that others. For ex. Calif. is pretty good.

    Eventually I got on the methadone clinic because I did not know what else to do. It helped a lot with my pain.

    Mind you I am not an addict...I am dependent on my meds for pain.

    Anyway, I was on the clinic for a year, and then I found my current pain management doctor. He treated my pain aggressively from the start, with different therapies including opioid pain meds.

    In my experience, pain management doctors are the best option. I went to many doctors and my pain was SEVERELY UNDERTREATED by all of them. Even by my surgeon, who also only prescribed regular-strength vicodin after major back surgery. Yep! They said they did not prescribe anything stronger. At the time, Sched II required triplicates and the dicharge doctors at the hospital -- well, I don't even think they carried the special pads! Can you imagine, no matter what you get surgery for, you only get sent home with Vicodin? It was a joke. And this was, of course, a county hospital, you guessed it.

    You don't sound like an addict to me, you sound like an under-treated pain patient. It does not sound like your pain needs have ever been fully addressed. The most that so many doctors will prescribe is Vicodin, even when something stronger and longer-acting is called for.

    How long have you been taking pain meds? If it is for any length of time, then I seriously doubt (and by your own admission) that one vicodin is going to do squat.

    Find a pain doctor. See if your county offers any programs that will allow you to see a specialist. Or see if, like someone else said, you can work out something with a doctor who will see you even without insurance. But don't expect a GP or the surgeon to do much for you. I can tell you already by the way your GP acted, you will not be getting adequate care from him. He cannot even do basic math to see how long a prescription should last.

    Have you heard of the phrase "pseudo-addict" -- that can come about due to undertreatment of severe pain. Once appropriate action is taken, these "addictive behaviors" disappear.

    It took me a long time to open up to my pain doctor and feel safe asking for what I needed. I was so scared because of the abuse I had suffered from the medical establishment. My friend calls this "battered patient syndrome." I had to re-learn how to advocate for myself.

    That is why I orginally went to a methadone clinic, I had asked so many doctors to help me and they did nothing for me. I did not have insurance, so I understand completely how that factors into this. I have since gotten insurance, and the way I am treated is SO MUCH better. Even going to the ER WITH INSURANCE, I have been treated MUCH better. It's not right, but it's just the way it is.

    -Wren

    Last edited by Wren9; 08-22-2007 at 04:01 PM. Reason: spelling

     
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