Discussions that mention botox

Pain Management board


Hey Tony, The meds used in pumps are preservative free so they have to be compounded to whatever strength per ML your doc orders. They usualluy star at like 15 mgs per ml and move up and cap at about 30 to prevent granular custs.

I ran into the same thing when trying to find out what my costs wee going to be, I got a lot of misinformation from both my docs billing office and my insurance company. I almost want to say that in 2004 there was a max out of pocket of 2000.00 Betwqeen the hopital copay, the bill from the hopital and the bill from anesthesiology, I think I hit my max. But then Maryveiw negotiated my potion basedon my present income. and I ended up paying just the copay and the ansthesiologist, my surgeon wrote the rest off and I absolutely know I had the same concern about durable medical goods and my potential portion of that. It wasn't billed as durakle medical supply at 50% and I didn't pay 20% of 30K to have this put in. Doesn't medicare still have an anual max out of pocket?

Perhaps it's the size of the docs practice and the number of pump patients that determines how they bill the meds. It's not like they would bill your part D plan if they gave you a shot of demerol at your clinic or his office, and the hospitals don't bill your prescription plans for meds used during procedures but something similar is done with my wifes Botox through her HMO. She doesn't have medicare and instead of it being covered like a shot of demi or toradol , she does have to use her sript insurance for Botox and fax them the script which has to be authorized. The first couple she had, they supplied the Botox, but apearently they lost quite a bit of money doing this so they started having the patient use their script insurance for Botox which her part for that is a 100 bucks a vial.

I would think the best info would come from a patient of his that has medicare. IThey ask me to council or make myself available for his other prospective pump patients abou a year ago when I returned to work. I'm their pump poster boy I guess and I've talk to 1 or 2 people a month and some I strictly give details of procedures too and some want to know more about effectiveness and expectations and I'm honest enough with them that some don't go through with it. The prospect of starting from scratch, giving up your orals and posibbly taking 6 months to get back where you were scares some people off. It does take a tremendous amount of truist that your not going to go through all this only to have your doc leave you underr medicated if he believes nobody should need more than 5mgs of morphine or 2 mgs of dilaudid per day. Yes some Pump docs have the same ideas about max dosage as some PM docs have about orals.

I've met people that had to change pump docs 5 times to find one willing to set it high enough to actually be efective. Turning control over and trusting they will titrate you quickly enough to prevent great suffering takes alot of courage and faith. It's not for those looking for imediate satisfaction, pumps are started low and you work you way up. I started with morphine at 2 mgs a day, 6 months later I was dong well at 12 mgs a day. It was a rough 6 months, but this is the rest of my life, not a quick fix that just needs a quick adjustment. My doc looks at it as a lifetime comitment and so do I. They actually have monthly meeting and decide which candidates they will actually allow to do a trial. If the patient has compliance issues, problems showing up for apts or is constantly rescheduling to their conveinance. The docs aren't going to make their commitment unles the patient can comit to making it to every apt on time and not missing apts and then demanding to be fit in because their pump is going to run out.

Hopefuly your doc has some patients that you can talk to that actually know what the deal is as far as their refills and what the pay each month. My docs have a huge clinic with 5 docs, 5 NP, 2 PA's a shrink and surgical suites onsite to do procedures. They have hundreds of pump patients, so it wasn't hard finding another patient for me to talk to. The cool thing about being someone that gets to talk to perspective patients is my docs don't mind if the patient changes his mind because of something i told them. They would rather me weed out someone with outragous expectations or some great sense of entitlement that feels the doc owes them something and should work around what's conveinant for them rather than when it conveinant for the docs.

Hang in there, and remeber, although a pump may be right for you, this doc may not be the right one to manage your pump. Youhave to decide that too.
Take care, Dave
Hey Tony, I never asked my doc if he had a limit, my trust was based on how he managed my orals. I never asked my docs if they thought my dose was high, they seem more interested in the reults and what I do with the relief I am given.

I have had a few nurses make some remarks but the nurses don't make the decsions. I doi get the feeling I am one of his higher dose patients but I have certainly seen folks on hogher doses. I was 13.2 mgs of morphine when he switched me because of fear of granulomas and I was only getting about 35 days between refills. I would say anything above 10-15 mgs of morphine or 5-7 mgs of dilaudid is getting up there but he's never made me feel like I couldn't continue to titrate, It was my decsion to stop where I was at, never the docs.

I have read where some docs won't go above 2 mgs of morphine because they believe that's when you start inhibiting your own endorphin production, but that was just one docs opinion who's specialty was RSD and with nerve pain, it would be hard to ever be satisfied. Prior to surgery, Percocet worked fine on my back but didn't touch the leg pain back before i had the tolerance of a horse.

As far as opiates, go, It's not quite so crucial that they be delivered directly to the sight of pain, opiates are going to bind to whetever receptors they come in contact with. If your hoping for relief from numbing agents, that's when delivery needs to be more site specific or acurate.

What's going on with your neck, Do you have arm pain or headaches caused by the neck pain. Having a pump doesn't mean they can't continue to use anything else that might provide relief like botox, trigger point injections, etc. Asking a doc how high he will go is kind of a touchy subject, you might try to get the answer in a round about way, like asking where does he see the bulk of his patients get relief at with similar conditions, Does he use BT meds with a pump? Is there a dosage he starts to worry about granulomas at, etc etc.
Good luck, Dave