New Worry

My dearest, best-est ( is this a word?) friend in the whole wide pain world. All the feedback coming thru my email and support groups is that pee-pee time is coming for all sooner or later. My guess is that Your Dentist was toying with you about taking another pill ? As for the wacky weed showin up on the pee pee test I believe that is one of many drugs them there Pain Medicine Security Guards are lookin for. So be carefull. With Methadone I felt like I was takin the old black beauties ( Iam showing my age) and Meth really speeded me up and made sleep even harder to get but we are all different in how drugs react with us.
Ya be carefull now ! HoneyChile

Hello Worsenow: Scotland -I was in Scotland what seems like another life. Beautiful Country, Wonderful People ( like You) In a couple of days I'll be laughing with you and hopefully, the laughter will help lead You to feeling better. To me You can go off track anytime You want which by the way You didn't. Love to share stories from across the Ocean. Take care Scottie

worsenow!!! said...
what part were you visiting Tom? it must have been a lifetime ago, places and people change. like i said earlier if you read the post on ibs under funny story for everyone that should get you laughing, even if only for a wee while. anyway that is my break over with back to the decorating I go. take care
amanda

Amanda: I went to Glasgow and that Valley around it. I was there for work but did do a lot of sight seeing. Read Your IBS post, Wow what a problem ! Guess Your my kinda Gal anyone that can share their pain and the unpleasant side effects and turn it into a funny story is just what i would do. Keep up the funny stuff ! this site and the world can use people with sense's of humor.
Bless Ya. Tom

I just started reading this thread and I have numerous misgivings about this situation - both from a personal, pain-patient perspective and from a professional point-of-view.

One glaring, obvious red flag for this company from a professional point of view is that this laboratory does not seem to be an accredited lab recognized by the credentialing agencies that all clinical labs must have in order to be licensed to test patient blood / urine samples.

All labs in the US that are allowed to accept insurance and governmental reimbursement (like medicare . medicaid) for sevices must be CLIA '88 certified and undergo rigorous biennial inspections (at the least). All clinical labs that we are most familiar with have met this standard. Independent labs like the one mentioned in this thread - which may operate from direct billing (non-third party payers)may not meet these standards and most likely will not have any independent evaluations / inspections which ensure accurate testing with reliable methodology by following a rigid quality assurance program. I also have great unease in that the sample report seems not to meet required specifications that an accredited lab it required to incorporate into its reporting system. For example, the units of measurement for the individual analytes are not reported along with the interpretation (the "negative" is not a result but rather an interpretation) and methodology information is not provided - which alerts the ordering physician to limitations of how the information is to be applied to the individual patient - as well as other glaring unprofessional aspects to this report (no proof of license; no director name, no contact information, etc).

As a patient, I would insist on having proof that this lab meets federal government standards for credentialing (which all labs which test patient specimens must do) and if the clinic cannot provide this information then I would refuse to submit a specimen. By law you have the right to view a copy of any clinical lab's certification - it must be provided on demand. And if no certification is available your doctor may be violating several laws - especially if he is demanding payment from you or your insurance companies. At the minimum I would request your insurance company to investigate the lab to ensure that they are accredited by a CLIA 88 recognized agency. If not, this will nip this outrageous invasion of patient privacy, as well as morally repugnant activity, in the place it will hurt them the most: their bank account. Because an insurance company can legally refuse to pay a lab which is not certified; and so can you if you were mislead in any way.

All in all this whole set-up seems very fishy to me. From the way the specimens are collected to the way the report is generated. Definitely not within the normal range of normal clinical laboratory testing - and probably not even within a forensic point of view (which is even more heavily weighted towards chain-of-evidence integrity). This is a very scary situation and as a clinical laboratory professional, I think that this laboratory may not meet the standards of testing that each of us deserves.

I know that this really doesn't help most of you in a situation like that describe above when it is forced on you - I know that the doctor can threaten you with "if you refuse to take the test then I will not write your 'script" and I understand the helplessness that this situation engenders. But I just wanted to offer the above opinion to help you realize that testing blood and urine is much, much, MUCH more compllcated than peeing into a cup and waiting for a machine to spit out a number. Based on what I sensed from this thread and the linked website, I would suspect each and every number that is being generated by this drug testing lab and highly question the accuracy and relevance of the numbers they are reporting.

I say shame on any doctor who takes this route!


(oh - I also wanted to add for the poster who was surprised that many of us use methadone for pain control that Methadone use in the US is not limited to heroin addicts - it is recognized and accepted by most health care professionals familiar with pain management that methadone is a very effective pain medication for certain people in certain circumstances. It is one of the more highly prescribed pain management narcotics. Used under close physician supervision and within the parameters prescribed it can be a safe, effective and affordable medication for pain patients).

Post Edited (Disce Pati) : 8/7/2008 10:00:42 PM (GMT-6)

Hey Tom,

I started with pain management back at the very tail end of March of this year. A really good friend of mine who was injured on the job months prior (neck disks, which he is now having to undergo surgery for - sounds scary!) actually is the one who informed me this sort of dr. even existed. Previously I had only been dealing with my Orthro (until I walked away from him) and my regular everyday doctor(GP)... I had fallen in July of 2006 down cement steps and did some number on myself shattered right leg tib/fib and also left index finger, needed a bunch of surgeries for both and they even put a greenfield filter in me... so pain was something I was well aware but after 6-8 months I was doing better and was back to work F/T. It wasn't again until early this year I started having severe pain bouts that sent me into a severe depression and I started missing alot of work etc. Then my friend told me about pain management, so I got a referral from my GP and asked around... my friend's PM Dr. didn't take my insurance, so I found another, and thankfully he turned out to be a really nice guy, very caring but also takes his job very seriously.

Prehaps it was my fault because I ended up not showing up for my very first appointment with him due to a family emergency, but apparently that is a big no-no, red flag in PM. My friend that had told me about PM - his dr. never ever tested his urine, so I wasn't prepared for it either. Well at first I thought it was because I was a no-show, I got tested at the next 'first' appointed - my friend thought maybe because I was a woman they needed to be sure I wasn't pregnant (which I new I wasn't but in some ways at the time I guess that made sense)... and the Dr.  informed me I made him nervous and he thought I maybe was a drug seeker, but after meeting me and speaking with me, I had even agreed not to go on anything at first until he got a feel for me, that I could assure him I was here because I was serious and needed someone's help in fact I still tell I don't want to be on these pills forever that someday I do hope to have a family etc and I worry about the long-term health effects of taking these sorts of meds over and over again. It ended up creating a really good professional relationship between us and once he had heard my entire story, he actually felt he could help me and became very sympathetic to my pain and how I was treated previously and pretty much left all screwed up by my previous surgeon and my job rushing me back when I was in the stage I really needed PT... and still tells me to this day (4 months later) he really thinks I have a shot and has been very happy I have been following his treatment plan and he notices the changes and tells me constantly he is proud of me etc. Matter of fact I was so scared of him in the beginning and then with the urine test was so put off I thought god this will never work and that he wouldn't end up signing me out of work etc. In the end he got so involved with my case him and my counselor I see for the depression talked and he agreed I was under way to much stress and took me out of work to work on myself full-time which includes regular  Physical Therapy, a foot dr.that  he recommended, the meds of course and home exercises/diet. He's actually kept me out longer then he initially wanted, mainly because my job got so intense with the paperwork and harassing his office for notes and calls, and I was in his office in tears overwhelemd by the paperwork and all the phone calls I had to keep up with... he actually filed a complaint against them on my behalf saying his patient (myself) was being harrassed and he wouldn't stand for it because what I have he has noted on several occassions and it is not a condition that is going to go away any time soon and they need to let him do his job.

None the less I'd say it's probably every other appointment with him, where he still does the urine the test (so like every 6-8 weeks) , and he apparently treats all his patients the same way. Matter of fact he is so diligent if he changes your prescription in any way to either a new drug or new dosage or takes you off it completely  etc. he actually makes you bring in the current bottle and together you flush the remainder of that perscription down the office toilet and he hands you the new script. I also had to sign a paper stating I would only attend the one pharmacy. At first I found this rather strange and wasn't really sure I agreed with it but now I see he really is just trying to weed out those who really need help vs. those who just want the meds and a quick fix or maybe have an addiction problem. In fact he's even got me on meds it seems no ones ever heard of because he doesn't believe in long-term pain pills such a the Vicoden/Percocet - so I'm on something called Opana, then he put me on Topomax also for pain and to help aid in my depression/anxiety plus I have a script for muscle relaxer and these great lidoderm patches. I wasn't taking the pain killers regularly at first would wait until I had pain, then he kept me in his office one day for over a half-hour and gave me this entire medical lesson on how they work and how he wants me to take them 3x a day because he is trying to maintain a specific blood level so I am not chasing the pain etc. Very interesting indeed! Truth is I wouldn't go to another pain dr. now and actually missed PT appts this week because for some reason the pain has been really, really  bad all week, so am hoping he doesn't get upset with me, but it's also coming down to the time we need to have the return to work talk because my paid time and job protective time (fmla/non-fmla) is expiring early next month. I just hope he agrees with me that going back full-time right now will be way too much for me too handle, as I do feel I am improving and getting stronger, the pain is still bad, some days not as bad but some days so, so bad... so really hope he continues to do right by me and allows me to go back but with specific restrictions so I can work on building myself back up slowly and not at a level too difficult that I just get stressed, more hurt and feel more defeated adding to my depression. I'd rather start small and feel accomplished, then work my way back up, with any luck I can be working full-time again in 6 months or maybe a year - he seems to think I have another year where I will need the meds as my body's strength returns - muscles in my leg rebuild, joints get stronger and less stiff etc. Plus also with the left index finger too I can't type etc like I used  too.

In the end I don't have an issue with them checking urine etc. if it's going to allow me to get better care and be taken seriously and be respected as a patient by the dr. I've come across alot of horrible drs. / surgeons etc that really shouldn't be in practice because they just don't give a crap and don't seem to understand the suffering... I've come to the conclussion no one should be allowed to practice a speciality unless they actually experienced it themselves lol... you haven't broken a bone you can't be an orthro etc. So if urine is needed, now I just give it with a smile because I know I am following the plan in place and have nothing to hide, whereas initially I did feel it an invasion of privacy - maybe if I didn't end up having the professional relationship I do now with the Dr. I'd feel differently, but thankfully he's in practice because until I met him I never thought anyone would understand let alone take me seriously and help me... the orthro consult I had gone to in March before PM that my GP sent me too - that guy when I told him about my pain levels said he didn't agree with pain medications and just wanted to send me to PT without anything to help me get through it. I remember just looking at him (because by now I had, had it with surgeons) and said to him so how exactly should I deal with the pain shall we hold hands and sing kumbyah (spelling?) and walked out, never returned. Even the foot Dr. the PM  assigned me too... when that dr. found more issues I just broke down and cried in his office and said thank god I'm not crazy, there is something, the pain is real and that Dr. has been on my side since too, always treating me so nice and so understanding - really comes down to having the right team in place and then it's still a tough road!