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    Old 07-31-2009, 06:48 PM   #1
    Rhiannon62
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    Cool feeling bullied by PD

    Hi
    My name is Rhiannon and I am new here I am desparate for advice on dealing with my pain dr... she is relentless on taking away my short acting hydromorphone, I have cut it to 4- 4mg a day for break thru, my primary physician was allowing me 6 a day... she is mking me feel like i just have to deal with the pain... I also take 30mgs of ms-contin 3 times a day, she made me try methadone and it was awful, now she has me on gabapentin which i just started so not sure if it will work yet..
    i also take cymbalta for depression and fibromyalgia.. and xanax as needed for anxiety.
    why doesnt she understand that i need something for breakthru pain.
    she even accused me of taking vicodin, which i am allergic to, said that it showed up in my drug screen along with the hydromorphone and morphine. so unless i am sleep walking or having total blackouts i have a drug in my system i have no reccollect of taking????
    how do i stand up for myself without coming across as a addict??? I would rather work with her than against... can long acting pain meds cover all pain all day and night??? Help!!
    Rhiannon

     
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    Old 08-01-2009, 07:26 AM   #2
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    Re: feeling bullied by PD

    Hello and welcome to the boards. Hopefully others will jump in here too...You many try posting in the regular PM section...More people will see your post.

    If your pain Doc is that combative, I would ask you primary to either re-assume your pain mgt or ask to be referred to another Doc. I'm afraid the drug screen may have triggered this Doc's behavior...finding the Vicodin. Depending on how long it's been, I would ask about having the urine re-screened because there is no way you took an other med and you're offended. I would, that's for sure. Many have been kicked out of PM for that, so you may be actually lucky. Or, maybe the Doc herself isn't 100% convinced the screen is accurate and that's why she didn't dismiss you.

    Regardless, if the PM's attitude is that you are to put up with pain, then that's not good. The PM should be there to help you. Most PMs are usually pretty liberal with their Rxing for that reason. And they have measures in place to protect their practice, so they can prescribe heavier amts than regular Docs.

    I'd be curious to see what some of the others say, but I would move on, or got back to my other Doc. I'd start with my GP and explain everything, including the UA and see what he says. I'm betting he says to try somewhere else as well.

    Take care,

    Ex

     
    Old 08-01-2009, 09:45 AM   #3
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    Re: feeling bullied by PD

    Hi!

    I agree with Ex. Go back to your primary doctor and ask him/her to either reassume your care or refer you to another PM doctor. Life is too short to spend all your time in pain when it is not necessary. I wasted close to two years going to a PM who completely misdiagnosed me, refused to prescribe anything but baclofen as a muscle relaxer and anti-depressants and anti-convulsives, and ultimately refused me any further treatment at all, unless I submitted to yet another series of epidurals (no previous ones done by that Dr. had offered any relief whatsoever). My internist handles my care now and I am fine with that. If it were me I'd go back to my primary doctor and ask him/her to continue your care, or to refer you to someone else. Depending on the source of your pain you might benefit from injections, or other types of therapy a PM can provide. Chronic pain paitients deserve to be treated just as well as any other person with a medical problem.

    Tigg.

     
    Old 08-01-2009, 11:26 AM   #4
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    Re: feeling bullied by PD

    Hi Rhiannon. I too might try a new doc if you can find one in your area. My dad was also in PM and was taking both short acting and long acting morphine. His doctor tested him and called to drop him because he said the test showed hydromorphone and accused him of being a drug addict. This was absurd because my dad was 65 and confined to bed. He was completely paralyzed from the chest down and literally could not sit up by himself. How on earth he would get his hands on dilaudid in the area he lived was almost hilarious. The doctor was convinced. We finally convinced the doctor to research the results again and the doctor (a pain med expert) found out that when his long acting morphine was metabolizing, it was showing up as dilaudid. The doctor called to apologize and took my dad back as a patient and was more compassionate after that. That goes to show that these tests are not perfect.

    That said though, I don't know if I would stick around with this doctor if his/her expectation is that you just live in pain. The whole idea of pain management is to get you into a spot with you are living with LESS pain, not more. I don't know if you have any other options where you live, but you could try your primary care doctor as the others have suggested.

     
    Old 08-01-2009, 07:34 PM   #5
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    Re: feeling bullied by PD

    It's unfortunate that pain doctors rely so much on "lab results," because it's been proven many times that "results" are very often inaccurate. Based on her demeanor and attitude, I would quickly find another doctor. PM doctors have also been known to outright lie about lab results, just to get a rise out of you. Don't take the bait, just find another doctor. You're the customer, and if you're not satisfied, you have every right to go elsewhere. I always remind people that we are responsible for our health care, and there is no reason to put up with the kind of treatment you're receiving. I hope you can find someone who has a little more of a professional attitude. Good luck and keep us posted.

    Last edited by dave490; 08-01-2009 at 07:35 PM. Reason: spelling

     
    Old 08-02-2009, 05:42 AM   #6
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    Re: feeling bullied by PD

    Hey There-
    I'm really sorry you are feeling bullied by your doctor. You have enough on your plate as it is. I'm not going to repeat everything already suggested, but I will simply say, "Ditto" because everyone has given sound advise.

    I do have to say that my former PM doctor told me that Vicodin & hydromorphone break down in the body in the same way, and therfore show up as the same substance in blood & urine screenings. Vicodin breaks down chemically into hydromorphone, so it wouldn't suprise me that it showed on your tests since you take hydromorphone. Your doctor should know this, so there should be no reason for her to acuse you of taking Vicodin, unless she is simply trying to cause problems or make you confess to something you haven't done.

    Sorry I can't add anything else, but everyone else seems to have covered all the bases. Take care, and I really hope you are able to get some resolution because there's no need for you to be made to feel so uncomfortable from doctors who are supposed to be helping you.

    Last edited by ozzybug; 08-02-2009 at 05:44 AM.

     
    Old 08-02-2009, 07:23 AM   #7
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    Re: feeling bullied by PD

    Quote:
    Originally Posted by ozzybug View Post
    I do have to say that my former PM doctor told me that Vicodin & hydromorphone break down in the body in the same way, and therfore show up as the same substance in blood & urine screenings. Vicodin breaks down chemically into hydromorphone, so it wouldn't suprise me that it showed on your tests since you take hydromorphone. Your doctor should know this, so there should be no reason for her to acuse you of taking Vicodin, unless she is simply trying to cause problems or make you confess to something you haven't done.
    Yes, this is accurate and I have a document that shows all the different breakdowns and etc., if you're interested.

    I would very professionally talk to the PM about it because it's all about your reputation in PM. For those the Docs "trust", liberal prescribing is typical, but no so for those they don't, or those they have questions about. I've heard so many stories like this, it's really sad. I would head back to my GP and go from there.

    Regards,

    Ex

     
    Old 08-02-2009, 08:08 AM   #8
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    Re: feeling bullied by PD

    you have gotten a ton of really great advice here but i just wanted to add a couple things? number one, if you have ANY actual documentation of how you discovered you were actually allergic to vicodin like an ER report or some type of real reactionary documentation by your primary doc when you took it, that would help tons with getting this PM to simply really believe that you would never take it knowing that. also, the one thing i found out when i first started my 'new" PM back in 04, was that they just really don't like their patients on anything BUT long acting meds. i had to practically beg for BT meds. i had been on oxycontin with percs, four allowed per day when i started there. but once i got there, they were upping my oxycontin and took away the badly needed BT meds. i was finally able to actually get two roxicodone per day added, but i KNOW as of right now, my PM will NOT allow any patient to actually even be on more than those two pills per day no matter what. so that may be what you are also dealing with here too, you know what i mean? this just could be why they actually dropped you down in the first place. it may just be a facility policy and not actually 'you' kind of thing.

    i totally agree here with the others tho. if this type of behavior continues there, i would not hesitate to go back to your primary for a chat about either him continuing to Rx for you or a new referal for another PM facility. no one should be treated that badly by their PM. and also being new does not help either. it just takes alot of time at any PM to simply develop a good level of trust. i do wish you lots of luck with this. marcia
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    Old 08-02-2009, 09:09 AM   #9
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    Re: feeling bullied by PD

    Quote:
    Originally Posted by feelbad View Post

    so that may be what you are also dealing with here too, you know what i mean? this just could be why they actually dropped you down in the first place. it may just be a facility policy and not actually 'you' kind of thing.
    Marcia's post was very good all the way around, and in reference to the above, she's right, it just may be the "philosophy" of the Doc. However, I can tell you without a doubt that some pain just doesn't respond to 2 doses of BT per day.....Especially, if your body has been conditioned otherwise. That's what makes PM so difficult....It's not a one size fits all type thing....Not in the least!

    Best of luck to you.

    Regards,

    Ex

     
    Old 08-02-2009, 09:31 PM   #10
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    Re: feeling bullied by PD

    Not to start anything, but if your needing 6 pills a day for "breakthrough pain", that means your having breakthrough pain ALL day, and to me that means you need a higher dose or a diffrent med then the long acting med your taking right now. When I got up to the right dose on my long acting meds, I hardly ever needed anything for breakthrough pain, I remember geting 6 Actiqs a month, and that was more then enough for when I had any breakthrough pains. This could be the reason for this PM doctor to wanna cut down that med from 6 a day to 4 a day and tried you on something else like the methadone, hoping it would get your pain under control. But the fact that she gave you methadone, tells me right there that she is not against you taking less narcotics, as methadone is stronger then morphine from my experieince and most other people that tried it (but of course not for all people as every person's body is diffrent). To me, taking as little meds as possible is wonderful, and I use to take several diffrent pain meds to help control my pain, and now after finding the right med and dosage, I only take two pills a day, sometimes one, and of course my Cymbalta, so all together I take 3 pills a day, and this is nothing compared to when I use to take 20+ pills a day, most of them for pain. But other then that, I would ask for them to redo your tests, and bring documentation about your allergies and anything about hydromorphone turning into hydrocodone, maybe even your pharmacist will know this and they can call your doctor.

    Goodluck

     
    Old 08-03-2009, 07:33 AM   #11
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    Re: feeling bullied by PD

    oh tell me about it ex. i do need more than the two and always really have with all the generators i just have. the thing that is the 'better" side of being dropped down tho was it simply forced me to look much harder for other ways to really manage my pain too. so that has been a good/bad type thing? but overall, i too see this as a more one size fits all type thing too when we ALL know that no two peoples pain is exactly alike in MANY ways. i do wish they would individualize more, but i am just thankful for finding the other 'tools' for back up when things hit the fan, ya know? the more little "tools' you just have in the ole pain management chest, really do help tons. these are what has managed to really keep me from having to seek out the ER crap to really manage the nasties when they hit.

    i do kind of know the basic 'rule of thumb' with the LA meds and BT med thing is if you require more than two BT meds per day, generally the LA needs to be raised up. but in reality, that is not the way things usually go in PM. marcia
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    Old 08-03-2009, 08:15 AM   #12
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    Re: feeling bullied by PD

    Quote:
    Originally Posted by feelbad View Post

    i do kind of know the basic 'rule of thumb' with the LA meds and BT med thing is if you require more than two BT meds per day, generally the LA needs to be raised up. but in reality, that is not the way things usually go in PM
    Not necessarily Marcia...Lots of different theories out there in PM. For example, my Doc is more about higher BT doses / qtys than LA. He thinks that if you have too high of a LA med, it just "re-sets" your baseline (over time). Conversely, he'd rather have a conservative amt of LA med in your system and then hit the pain when needed with BT meds. Otherwise, you just creep up and up and up. It's worked well for me. For example, my head and face pain get so bad at times, there's no amt of LA med that will prevent / touch it. However, I very much appreciate the liberal use of BT meds to "hammer" the pain when it comes....And, that I do. I don't hold back either. I try to hit it early and often, till it subsides. And he gives me two different types of BT meds...A stage 1 and stage 2.

    Take care,

    Ex

     
    Old 08-03-2009, 08:57 AM   #13
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    Re: feeling bullied by PD

    now THAT is the way it should be too in my eyes ex. i too just NEED to be able to really HIT that pain before it goes insane on me unfortunetly my PM chooses to think very differently about that. this is actually more the NP that i had for about the last four years(tho this particular NP was just kinda 'removed" from my care for some unknown reason?)? she WAS doing some really crazy things here since about the first of the year? my actual PM knows much much more about my body insanity than any NP i have seen there ever. unfortunetly we can only see that man when we have procedures. my actual PM is the ONLY one to ever actually listen to me and do the one and only raise in my oxy since i started there in 04,once we were stabilized three months after i started. kinda sick isn't it? but i now have a new NP who i am getting to know as we go, so maybe something can change along the way here soon? i really do like her. i have built tolerance at this point that just NEEDS to be addressed, but because of the weight loss crap i could never actually get my other NP to really just 'do' for me what has been needed for so long. i am hopeful at least with the new NP anyways. and so it goes. Marcia
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    Old 08-03-2009, 09:35 PM   #14
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    Re: feeling bullied by PD

    Hi,

    wow you are all so amazing, thank you so much for all the sound advice and information...
    I belong to a HMO and my Vicodin allergy is part of my medical record available to both my PC and my PD, I do believe the PD doesnt take special care to have any attention to detail, as she refilled my Morphine at 3 times the amount I usually take and also accused me of having Xanax in my UA not paying attention that my PC has been giving me a scrip for it for the lst 3 years..
    I had also heard that many drugs breakdown to others, you all have just relieved my mind more than you can imagine I was thinking I was losing it even made a appt with my mental health provider...
    I agree my pain is out of control and that LA meds are the answer to this problem,, I would just feel more comfortable with a small amount of SA available for BT pain. once we find the right dose of the LA.
    I am going to discuss how I am feeling about my PD with my mental health provider and returning my care back to my primary care provider or if she has any suggestions.., cause I do have way too much on my plate to feel so stressed by someone who is supposed to be helping me..
    Again thank you for all your wonderful replies, much appreciated.
    Rhiannon

     
    Old 08-04-2009, 10:56 AM   #15
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    Re: feeling bullied by PD

    Hi Rhiannon,
    I feel for you. I have always, 100% disclosed all my meds to all of my doctors. When my RX insurance changed, I was caught up in a tangled web when they reviewed patients who received Schedule 2 & 3 meds. My primary at that time claimed that I did not disclose my Valium to him - I've been taking it 20 plus years. I asked the nurse to pull out my application when I first saw him and sure enough it was there. He still discharged me but his ex-partner picked me up and told me that the former doctor was typically like this! No attention to detail. it was both the worst and best thing that ever happened to me.

    Good luck! I can't get LA meds from my PM doctor due to abuse by others in his practice (I think) but I hope to change PM clinics in the next year or so.

    Best wishes and keep posting here - there are so many willing to share their knowledge, experience and advice without judging that it is truly amazing!
    T

     
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