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Posted 8/10/2008 3:44 AM (GMT 0)

Hey gang,

I went to see my PCP on Thursday, after being denied a refill on my pain meds.  Currently, I'm dealing with acute stomach and back pain of unknown origin, probably a GI bleed somewhere in the area that I had a gastric bypass several years ago.  Anyway, the stomach problem is in addition to my regular pain issues.  Having gone round and round all day with the employees/nurses at my PCP's office on Wednesday, on the phone and in the office, I figured the only way to get a refill was to actually talk to my PCP.  One of the stupid office personnel actually told me I should "just take some tylenol".  ARRRGGGHHH!!!  I could have come across the counter and smacked her!!!  I'm in serious pain...tylenol isn't going to cut it.  It's like cutting the end of your finger off and reattaching it with a bandaid!!!  DUH!!!

Well, started off Thursday morning waking up with a migraine...thus, really not in a good mood.  Got my dad to take me to the DR's office, especially because I don't always communicate effectively when I have a migraine.  Apparently, my PCP had left me a message on my answering machine the night before, saying he was NOT going to keep me on the Percocet that I had been taking for the last couple of weeks.  My cats must have thwarted me again, as they like to step on the flashing buttons on my answering machine...thus, I didn't get the message. 

Anyway, for some reason, my PCP thought it was another month before I get my endoscopy done, so he said there was no way he would keep me on the Percocet that long, "too much...too strong".  I told him it was only a week away, so finally he lightened up and gave me a prescription for #30 pills(5/325) that have to last me a WEEK!!!  That's barely four a day.  Definitely not going to keep me in the least bit comfortable.  I explained to him how the Percocet greatly improved my quality of life, that I could actually do a few housekeeping tasks I haven't been able to manage in months.  That completely fell on deaf ears.  I told him that I almost felt a little human, better than I had in a very long time. Didn't matter.  He's been saying for several months that he would really like to take me off my normal pain med(Lortab 5/325) since it really wasn't improving my quality of life.  WELL DUH!!!!  If he gave me a stronger dosage or switched me to Percocet it would improve.  This isn't rocket science. 

I just don't get why my doctor refuses to prescribe medication on a regular basis that would allow me to have a somewhat decent quality of life.  Is it so wrong to want something that would make life worth living?  You all know how debilitating and depressing it is to be in constant pain.  Am I so wrong to want something that would be so easy to make happen?  It's not like I'm asking for Oxycontin or a Fentenyl patch for a hang-nail.

Do you guys see my point or am I totally off base here?

Leigh Ann a.k.a. VERY CRANKY1 mad

Posted 8/10/2008 4:44 AM (GMT 0)
Leigh Ann,
You don't sound off base to me, but hey, I don't get to rule the world of pain management! I only hope maybe you can find someone else after you go through the remainder of the tests you need. It just doesn't seem like this PCP is giong to help you.

As far as the next week, can you "stretch" the percocet by adding one tylenol with some instead of taking two? I take 6 of those percs a day, and have to stretch those. I know you can't take NSAIDS, and I've been using that for a little BT until I can get better PM (3 hours away!).

I wish I had a better solution - for all of us!

PaLady
Posted 8/10/2008 6:33 AM (GMT 0)
Leigh Ann,

I with you kiddo. You need a new doctor. Do not pass go, do not take two hundred dollars, Get a new doctor!!!!! This one is apparantly deaf.

Lindaloo
Posted 8/10/2008 6:33 AM (GMT 0)
Leigh Ann,

I with you kiddo. You need a new doctor. Do not pass go, do not take two hundred dollars, Get a new doctor!!!!! This one is apparantly deaf.

Lindaloo
Posted 8/10/2008 3:44 PM (GMT 0)
Leigh Ann:

I am sorry to hear about your struggles here. I have to say I agree with you that it seems pretty silly not to at least consider trying out percocet or a bit more of the lortab. I think (I may be wrong here, but this is from a conversion calculator I researched at one point) that 7.5 mg of lortab is essentially the same potency as 5 mg of percocet, so maybe your doc would be more amenable to trying a slightly increased dose of the lortab?

I am wondering if you've ever seen a pain management doctor? I have the opposite problem that you have - my PCP is the one who DOES help me with prescribing pain medications whereas my PM doc harbors an unwavering prejudice against anyone taking any kind of narcotic pain medication (unless they have cancer and only weeks to live). But from what I have read here and elsewhere, it seems my case is not the norm. In most cases, PCPs are highly resistant (like yours is) to prescribing narcotic pain medications to their patients on a long term basis. Perhaps if you found a pain management doctor they would be more willing to effectively manage your pain.

I hope the endoscopy reveals some helpful information for the doctors and they are able to treat your issues and knock the pain down to a more manageable level for you.

Ry
Posted 8/10/2008 4:04 PM (GMT 0)
I would insist on another doctor. I did have to beg for enough prednisone (inflamitory pain really only responds to prednisone and I can't take narcotics and function) to last until I could get into my rhuemy but my doctor did eventually listen and stop prescibing medrol dose packs one at a time (I had a six week wait) and give me a steady dose of pred.
Your doctor does not seem to be listening. If you only have a week left until your endoscopy you should have been given enough medication to keep you reasonably comfortable until then. Immediately following your endoscopy the GI should decide what treatment you will need and when and either he or Your PCP should decide on pain management until the treatment is accomplished.
Posted 8/10/2008 11:37 PM (GMT 0)
Don't feel to bad I used to have a doctor that did not believe some one after surgery should have anything for pain boy I am so glad she is not my doctor anymore
Posted 8/11/2008 1:40 AM (GMT 0)
GET A NEW DOCTOR ASAP!!!! That is ridiculous! You NEED the perks to function and your Dr should understand that. Dr's are supposed to LISTEN to their patients. I'm very happy that I don't have that issue with my Dr, if I didn't listen he wouldn't have been my Dr for long. I was taking 10/650 of perk until I had a really bad side affect which was crazy because I had been taking them for 9 years. I'm going to my Dr next week to get some new pain meds though. I wish you luck with finding a new Dr that will LISTEN to you :)
Posted 8/12/2008 8:52 AM (GMT 0)
Leigh Ann:
I agree with everyone -- a new doctor for you.
Sometimes it's not the doctors fault exactly. The Drug Enforcement Agency plays
their role. They are not doctors but they rule.
The DEA went into a hospice in CA and took all the Marijuana away from the patients
along with their other Opiods ... Dying patients! The middle of the night and these
police broke in with their heavy boots and in full uniform. A terrifying visual.
It is a cruel world for those of us with Chronic Pain. (or any pain!) People don't understand.
Doctors are Paranoid.
Good luck to you and to all.
Pamela Neckpain
Posted 8/12/2008 8:53 AM (GMT 0)
Leigh Ann:
I agree with everyone -- a new doctor for you.
Sometimes it's not the doctors fault exactly. The Drug Enforcement Agency plays
their role. They are not doctors but they rule.
The DEA went into a hospice in CA and took all the Marijuana away from the patients
along with their other Opiods ... Dying patients! The middle of the night and these
police broke in with their heavy boots and in full uniform. A terrifying visual.
It is a cruel world for those of us with Chronic Pain. (or any pain!) People don't understand.
Doctors are Paranoid.
Good luck to you and to all.
Pamela Neckpain
Posted 8/12/2008 7:04 PM (GMT 0)
Pamela,
I wonder if you could provide a citation for this story. Where did you read it? Because even though the DEA does some things I'm not a fan of, there has to be more to this story. Seizing legally prescribed opiods (and a legitimate hospice has M.D.'s on board) would have to be done with some reason. The other issue could relate to licensening, but that's not a topic that's ok to discuss here according to the forum rules. I guess I just think there's more to this.

PaLady

Post Edited (PAlady) : 8/12/2008 4:20:51 PM (GMT-6)

Posted 8/13/2008 4:43 PM (GMT 0)
PAlady,
I shouldn't have written what I wrote because I don't have the little newspaper. It
had many sensational stories. The information came in the mail in a kind of newletter thing
to people who had signed up for it.
It did not work for me at all. I felt even more places where I had pain and then
I acted goofy with my husband. Not 4 me!
E-mail me if you like.
Pamela
Posted 8/13/2008 8:09 PM (GMT 0)
Cranky - they may be reluctant to prescribe you pain meds until they know what is going on in your gut. You don't want anything that is going to cause more bleeding or constipation or even mask a blockage or something. I agree that they should at least be doing more to find the source of your problem and to give you more solutions! But as someone with crohns I often hear that the solution is worse than the problem.
Posted 8/14/2008 4:08 AM (GMT 0)

Leigh Ann, Hi..

Your primary care physician is one of those PCP's that probably does not have too much experience with treating chronically painful conditions.  He may also believe that your condition is acute, and that it really does not qualify as "chronic" pain.  Either way, you have a right to have your pain treated adequately by your physician.  Regardless of whether or not he is unwilling to treat you as a chronic pain patient, or whether he understands how to treat chronic pain, you are due the treatment you deserve. That being said, I think that if you value your relationship with this PCP, it is time to make your feelings very clear to him.  I'm sure that he understands that you cannot keep taking acetaminophen based pain medications forever, due to its liver and kidney toxicity.  He seems to understand that he is at a crossroads with you; he can longer really keep you on the Lortabs because they can really cause damage to your internal organs, on the flip side, he's obviously not comfortable with prescribing a time released opiate pain medication.  Aprapoe, you must make it known to him that neither him nor you really know how long the pain issues will last, and therefore, you need to establish a long term plan for dealing with your pain.  He seems all to willing to push you off on the gasterenterologist; its like he believes this specialist will take over for him for dealing with the long term pain.  If your PCP is not willing to deal with your pain on a longer term basis, then you must demand a referral to a COMPREHENSIVE pain management physician, and the COMPREHENSIVE, in case you cannot tell, is vitally important.  Many pain clinics will try to treat you with homeopathic and non traditional remedies; be careful, these pain clinics and docs are known as INTERVENTIONALIST pain doctors.  Anyways, you need to give your PCP this option.  Be prepared to leave him if he will not be reasonable about your request.  Set your appointment, but do some research into other PCP's in your area. Also, do some research into Comprehensive Pain Management physicians in your area. Pick one, and be prepared to ask for a referral to this doctor.  Some docs don't require a referral, but all of them require proper and complete medical records that document your condition.  This is what covers their rear ends if the DEA comes a knockin. Anyways, you have gotta change your mind set. You have to get it through your head that you have a legal right to have your pain controlled by your doctor; if he's not doing the job, fire him.  Finding a pain management physician that is knowledgeable about all of the peripheral issues that surround chronic pain will help you tremendously.  Any educated pain management doctor knows that chronic, unrelenting, and unrelieved pain leads to stress, depression, troubles with family and friends, problems at work, financial issues, can lead to loss of employment, and too often, suicide.  There are a million reasons to relieve pain, and no good reasons to not relieve pain. 

PainKiller

Posted 8/14/2008 4:47 AM (GMT 0)
I agree with Painkiller on this one.....Ask for a referral (if your insurance requires one) to a pain management doctor. Some of them will do procedures, some will only see you in consult and recommend a medication but have your PCP do the prescribing under their recommendation, and some will prescribe medications along with procedures/injections, etc.
Posted 8/15/2008 3:15 AM (GMT 0)

I've been doing the "pain management" doctor thing for years.  UNfortunately, the PM docs in these here parts are procedure happy.  They only want to treat "parts" of people, and only with procedures, not medications.  They LOVE sticking people with needles, anywhere, anytime.  The only med I've ever gotten from a PM doctor is Ultram/Tramadol, which helps as much as eating a couple of pieces of chalk.

I'm also in a catch-22 situation because I have both chronic and acute pain.  Doctors don't want to treat my acute pain because I have chronic pain.  And frankly, it's taking so long to find out what is causing my acute stomach pain, it's starting to seem like it's chronic.  It's been bothering me for three months or more, and I had the same pain last June that put in in the hospital for four days.  Never did find the location of my GI bleed.  Now it's back or something very similar pain-wise.  My PCP gave me a whopping two weeks of Percocet between my seeing the nurse practioner at the GI doctor's office until I got my endoscopy yesterday.  My GI didn't find anything, but scheduled me for a CAT scan, and told me to go back to my PCP for pain meds.  My PCP cut off the Percocet so I'm back to the weeny dosage of Lortab.  UH, HELLO...getting the edoscopy didn't lessen the pain any...DUH.  Percocet works so much better for me than the Lortab, at the same dosage 5/500 which is the bottom strength on both.  Oxycodone works better than the hydrocodone, but compared to the many heavier medications available, I'm not asking for something unreasonable.  I'm so sick and tired of the pain and constantly having to fight with the doctors for a little relief, which is easily attainable with the flick of a pen.  I'm sure I'll have to see my PCP before I find another one to transfer too.  I'm going to ask him flat out why he refuses to make my life more bareable when it wouldn't cost him a thing.  The answer should be interesting.

Leigh Ann (Still VERY Cranky) mad cry

Posted 8/15/2008 3:44 AM (GMT 0)
Leigh Ann:

I know it stinks, and I'm not condoning any under-treatment of pain here... I've been in the same situation, so I feel for you sweetie. But here's the cold hard facts of your situation... Your current approach just doesn't seem to be working. That doesn't make them right, so please don't be angry with me for saying that. It's just the way things seem to be, right? So we need to start trying to figure out how to help you find an approach that WILL work. Or at the very least that will get you to a doctor who will help you.

idea Have you tried keeping a pain diary? I mean every single day. Chronic pain, Acute pain, everything. Write down how you feel at every part of the day. Tell when you notice the pain increasing, when you notice the pain is even a tiny bit better, what things you try to do to help yourself and how well do they (or don't they) work, what things can you or can't you do because of your pain, and so on. Write it all down. Document everything. Take this with you to your doctors. Show them all. Don't ask them for pain medication. Just ask them for HELP. You can SHOW them in print how what you are doing is not working. That the medicine you have does not cut it for you. Show them how you are doing your very best to be a picture perfect compliant patient and still you are suffering for these many hours of each day - they can see it on the graph. (you can search this site for a great pain diary that Chutz posted).

idea Another thing you should definitely do is find someone you trust who can attend all of your appointments with you. Someone else needs to start speaking on your behalf. Obviously, for whatever reason, your doctors aren't hearing you. Bring someone else, and then another someone else, until you find someone they will listen to. Often times doctors are much more willing to believe a patient advocate when that person tells the doctor that the patient is suffering and in extreme pain. It shouldn't be this way, but it seems to be the case.

:-) I wish you the best and hope you are able to find some relief.
Ry
Posted 8/15/2008 12:14 PM (GMT 0)
Hey Ry,

Thanks for the reply, but unfortunately, I've been there and done that.  Been the diary route, and always take my Dad with me cuz he can do a better job of talking a lot of the time and has witnessed all that I go through on a daily basis.  It has occasionally made a difference, but as you can tell by my post, I've practically run out of ideas.

Leigh Ann smhair

Posted 8/15/2008 2:31 PM (GMT 0)
Hi Leigh Ann. I am so sorry for how you are being treated. I feel for you. Keep trying, don't give up.
Just wanted to wish you all the best in this difficult situation.
God Bless You
Posted 8/15/2008 5:11 PM (GMT 0)
Leigh Ann,
I noted your mention of SI joint issues, which I also have (in addition to LS and CS stuff!). I have learned that my SI join being out of place can multiply my pain in my legs and my feet ten fold! Had to learn this by process of elimination over time. My PT gave me some relatively simply exercises to try to tighten the ligaments that hold the SI joint in place (this doesn't always work) and then finally I got an SI joint belt, which is really like about the width of a normal belt (couple of inches) and you wear it around your SI joint area (got to wear it quite low and it takes awhile to get used to but it's not bad). It has a velcroe closure for adjustment. I'm wearing mine now as i type! You're supposed to wear it for about 6 weeks and then hopefully, between that and the exercises, they have tightened your ligaments. As my PT explained it to me this is not about muscle but ligaments, which are almost like bone. Once they are loosened (he thinks that happened when I fell) they sometimes won't tighten back up, or stay tightened. Fortunately, my PT knows how to slide it gently back into place - he has extra training that's a little like a chiro move but much more gentle. The exercises alone (without the belt) were working to hold my SI joint in until I had my surgery last fall. Then i had to stop (of course) doing the exercises until a couple of months ago. So SI joint problems resumed. But I'm back with the exercises and the belt and hoping I can tighten those ligaments up because it makes a huge differencel

If I havve to wear this belt for the rest of my life it would be worth it, although a bit annoying, especially for us women at bathroom time! But you get used to it! LOL

PaLady
Posted 8/16/2008 7:48 AM (GMT 0)
Leigh Ann,
The PM doctors that you have seen in the past, from your description, are all Interventionalist physicians. These physicians, by nature, do not treat pain in a comprehensive way. In addition, epidural procedures, whether under general anesthesia or not, are extremely profitable for these doctors. For Interventionalist physicians like this, they get all of the benefit of doing these epidural shots, and because they don't treat with medication, they have none of the regulatory fear that comprehensive pain management doctors do. In short, the previous PM doctors you have seen really don't want to prescribe because the cost benefit risk assessment is not in their favor if they prescribe opioids for pain management. Can you blame them? They constantly see their comrades being prosecuted by the DEA for frivolous and trumped up charges. This is why PM docs that do prescribe need to cover their rears with opiate contracts, blood and urinalysis testing, pill counts, and complete medical record backup.

I would suggest this: Its clear to me that you absolutely need to see a specialist pain management physicians that treats comprehensively. If you give me your location, I can check into it for you. Otherwise, internet search pain management clinics in your area and specifically look for physicians that are board certified to provide comprehensive pain management care. When you find one, look for patient testimonials. Patient testimonials, if posted on the website, are a really good way to get a feel for the pain clinic. They won't tell you specifics, but they will tell you how similar people to yourself feel about the treatment that they recieve from that particular doctor. You really need this sort of specialist to sort through your pain Particularly because you are dealing with Acute and Chronic Pain..

PainKiller
Posted 8/16/2008 8:14 AM (GMT 0)
Leigh Ann, Painkiller hit it right dead center with you. I do differ with him on having a PCP prescribe opiates. That is a rare and difficult thing to find is a PCP willing to do this. You need the proper mgt dr that will prescribe the proper medications. You have been given some excellent pointers here, now its up to you to follow thru. Not being willing to make some changes is only going to hurt you instead of helping you. With CP you have to be willing to be flexible at times. Good luck, Susie
Posted 8/17/2008 5:46 PM (GMT 0)

Straydog said...
You have been given some excellent pointers here, now its up to you to follow thru. Not being willing to make some changes is only going to hurt you instead of helping you. With CP you have to be willing to be flexible at times.

Straydog...

I don't mean to be rude, but what in the hell to you mean by insinuating that I've got my feet stuck in the mud and refuse to make any changes in my attitude or treatment?  I'm so flexible it's ridiculous.  I have bent over backwards to work with all the PCPs, PM mgmt, and other specialists I've seen over many years.  You've got some nerve...what ever happened to being supportive, not judgemental?  Maybe you should check your attitude at the door before you make a post.

Painkiller...

Thank you so much for your offer to locate a decent PM doc, as I've resorted to going out of state at this point.  I live in Lynchburg, VA, right in Central Virginia.  Not very close to any major cities.  I would be eternally greatful if you can find someone instate, cuz I'm willing to go anywhere for some help.  I really appreciate you help.

Leigh Ann mad

Posted 8/17/2008 6:54 PM (GMT 0)

Sorry Leigh Ann if you felt I was being judgemental as thats the last thing on my mind. People of this site know me well enough that I am never judgmental of anyone in these forums. We all need all the compassion and consideration we can get. Maybe you were having a bad day when you read my short post. You have a terrible problem thats not being cared for properly by your drs. So, when that happens we do have to be flexable and go others avenues such as searching for a dr that will help us and continue to search until we can get the proper help. Its not easy finding a good dr as we know.

Perhaps you are the one needing to check the attitude problem at the mat before posting. Susie

Posted 8/17/2008 9:07 PM (GMT 0)

Hey Straydog,

I reread my post and you are correct.  I was a bit over the top in responding to your post.  I was not only having a bad day, I've been having a bad life...this week in particular.  However, just because you are "known" for not being judgemental, does not prevent you from posting something worded with those connotations.

My frustration this week comes from having an endoscopy which showed no explanation for my serious stomach pain.  Having normally low blood presure, my BP dropped dangerously low after the procedure and the medical staff were concerned I might flatline.  Luckily I rebounded, but it's pretty scary to think about.  The following day I suffered through excruciating injections to my SI joints, without the benefit of anything to take the edge off of the pain.  Tomorrow morning, I have a CAT scan scheduled, and have all 32oz. of that gunk to drink prior to the test.  With stomach pain, not something I am looking forward to doing.

I apologize for my strong words in my prior post.

Leigh Ann cry

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