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Posted 6/17/2009 11:13 PM (GMT 0)
I am going to see my new pain doc for the first time tomorrow (Thurs). I am somewhat apprehensive because I had been seeing my previous doctor for so many years. I am not sure how to approach this new doc and come off the right way. I don't want to appear to be a "pill seeker" but yet that's exactly what I need right now. I am nearly out of my last prescription. I do not yet know how this doc feels about writing narcotic Rxs. Some don't at all. Some do but only after trying all sorts of other procedures. And yet, I hear stories of people in my situation getting Rxs at the first meeting. I have been "pacing" my usage so as to stretch my limited supply not knowing how long I might have to wait. I know that the pain meds really do work because now I am in serious pain. The more pain I am in the less clearly I can think. I can't really expect this new doc to pick right up where the old doc left off. And then there is the issue of what should I tell the new doc about my reason for leaving. I want to get this relationship off to a good start but I am getting desperate thinking about how long I would have to wait for medication. Am I being overly concerned? Have I become addicted and don't even know it? At this point I am feeling really messed up and that is not not my normal outlook. This whole doctor transition thing has got me confused, desperate and not thinking clearly. What to do? Any ideas, gang?

Modelmaker
Posted 6/17/2009 11:25 PM (GMT 0)
modelmaker I was in your shoes 3 months ago. Worried to death that I would have to deal with pain if they didn't want to prescribe pain meds. I was so scared!!!!! When I got into the office my nw doctor asked alot of questions on where it hurts and how much. What has been tried and is there anything i might want to try. He even asked about my eating habits down to how I sleep. How much pain I'm to all the way to what causes more pain.

In the end he asked me what I was taking and if I felt like it was working? At that moment I felt confused, thinking is this a set up question or an honest question. All I did was answer truthfully that i still hurt throughout the day. He then increased my meds and asked me if I had any questions. The next appointment I was better with having nerve blocks but my nights still hurt really bad he then added a 24 hour release pain medication.

I hope this helps you relax some for I went through the same stress.

Laurie

Please post an update after your appointment tomorrow please......
Posted 6/18/2009 2:52 AM (GMT 0)
Hi modelmaker,

I do think that you are being a little bit overly concerned, but rightly so. There is so much stigma surrounding pain medication (and the people who take it), that it makes it hard on us. It is ridiculous that we have to think about looking like "pill seekers" just because we switch doctors. If it was any other doctor that you were switching, you would never worry about that sort of thing! And no, I most certainly don't think that you have become addicted. You'd know it if you had, after having dealt with CP for so many years. From what I can tell, you don't have any of the classic symptoms of addiction. You are just afraid. I would be too. You are heading into unknown territory, and no one wants to have to suffer through withdrawls.

If you make it clear to this new PM that you are switching over to his care, I honestly cannot see why he would give you a problem with your need for a refill. Especially if he has both your records & can see the pill bottles of you meds & when they were filled, etc. Even if he did want to adjust your pain management regiment, there is a good chance that he wouldn't do so on the first appointment. Maybe you will come up with a new plan, but he won't implement it (or at least any med changes) until the next time you meet.

And as for reasons why you want to switch your care... As you said, just be honest. Tell the doc that you just weren't happy with the way your former doc was treating you anymore. I'm sure that you are not the first, nor the last patient that this new doc has seen switch doctors after years with another doc. You can explain about all the advanced technology that they have at your new office & how you feel that they are perhaps more up to date on all of the most modern & cutting edge techniques - especially with you considering an SCS & all. I'm sure you have good, legit reasons for wanting to switch, so don't fret.

Just calm down. Stop worrying about what could be & try to think positively. Try not to worry too much about tomorrow, tonight. Perhaps take some time to think about any questions you might like to ask this doc, or things that you would like to talk about. If you keep a pain journal, then you might want to think about bringing that along, or writing out a sort of 'overview' of your pain & even past treatments & meds you have tried, for your new doc. Walk into that office prepared & confident tomorrow. Honestly, I promise that you will be just fine! And if for some reason (although, as I've said, I can't see why they wouldn't) they won't give you a script for your refill tomorrow, maybe you can always see your old PM one more time before you officially leave him (assuming you have not done so already), with your new PM's permission of course.

If this new doc is any good, he'll see you for what you truly are. A good patient, in terrible pain, who is only trying to make the most out of his life! I wish you the best tomorrow! Let us know how it goes!

hugs,
Skeye
Posted 6/18/2009 5:30 AM (GMT 0)
Modelmaker,
Skeye's given you some great advice in her post. I do understand your anxiety, because we all are so vulnerable when we have to go into unknown situations with a new pm doc - because so much of our life hinges on that treatment (or lack thereof).

But all you can do is focus on what you symptoms are/have been, what has/hasn't helped as far as meds and treatment, and even a statement like what you had in your post - that you know the meds have been helping because of the increased symptoms you're having with being short. The thing that's often not good is to go in demanding (sometimes even just requesting is enough to do it) a specific pain med - especially narcotics.

Thing is there's only so much we can control. You can be honest, report your symptoms, etc., and if you get a doctor who's not going to listen or treats you poorly when you know you're being reasonable, then maybe he/she's not the one for you anyway.

Let us know how it goes. I will be hoping you return with reports of a positive interaction and start with a new doc!

PaLady

Post Edited (PAlady) : 6/17/2009 11:33:17 PM (GMT-6)

Posted 6/19/2009 12:14 AM (GMT 0)
Well, I saw the new pain doc today. Real nice guy. Very strong credentials and experience so I respect his opinion highly. His take at the end of our consultation was that he was cautious about taking on a patient from another pain doc first of all. He claims that the level of oxycodone I am on now is excessive, roughly ten times the max he would ever prescribe to his patients. I have to come down to no more than 30 mg. per day tops before he will see me again. I am currently up at 250-300 mg. per day to cover the pain. He claims, and I have to believe him, that I am not doing my body any favors at levels that high. How did we get there? Simple. Gradually building physical dependance. End of story. So I can either walk away from him and find another doc or go through a gradual reduction to get down or off of oxy. I have had three docs now tell me the same thing. The only doc who didn't is my old pain doc and he is the one who broke down on me as you recall. That does not speak well for his recommendation. So I guess I will heed the messages and get myself back down. I have done it before. I can do it again. My old pain doc had me as high as 80 mg. Oxycontin 3x a day plus 20 mg Oxycodone IR for bt pain! I even thought that was a bit much.

I wonder if I have any recourse on the original pain doc for getting me up this high? I had no idea when I signed on with him that he would get me in this position. In fact, when questioned about this, he told me not to worry, everything was fine. These were perfectly normal levels for pain patients. Now I find that is not so. What do you guys think? Any lawyers out there care to chime in with opinions?

Modelmaker
Posted 6/19/2009 12:27 AM (GMT 0)

wow you are on alot of oxycodone.  My PM will only prescribe max 40 mgs a day.  Thats what I take.  We also use procedures and 200mgs of tramadol er at night.  We have more meds that we can attach on throughout treatment in the future when the pain progesses.  But when it comes to oxycodone 40 is the max.

I really don't have any advice other than I will think about you throughout your ordeal.

Laurie

Posted 6/19/2009 1:43 AM (GMT 0)
 

 

       *warmest huggs*

 

      I am very glad you were able to find someone with a strong expertiese in Pain Management. You have alot of tuff decisions on your plate right now, and I just know.. With as strong and independant as you are? You will come out on top.

 

      When it comes to how much medacine you are taking, I hope he wasnt accusatory towards you. I had a friend go through a terribly painful ordeal with cancer and was told "We dont want you to become dependant.". I tell you she was writhing in pain everyday. It broke my heart. I guess im trying to say that though attitudes / public opinions and laws change over the course of time, in the end you do what you have to do to survive at the time. Peroid. I would have done the same in your shoes.

 

       As far as the doctor who got the dose "high" (im not really sure what high.low/normal doses are).. I do have a question. Was he preditory in his manner of care? Was he going out of his way to attack you for personal gain? (even if it was just to "keep" you in his patient list). If yes? Sue. And make sure letters of your ordeal are made public record everywhere possible. Now, I might be recalling something else entirly.. but arnt the "payment agreement" from wrongful medical stuff paid out when the client wins the case? I could be totally off my rocker there, as i have had no personal dealing with anything of that particular nature.

 

      I wish we could go out for coffee. shakehead

     Hang in there.

 

*warmest huggs*

 

Dani

Posted 6/19/2009 2:54 AM (GMT 0)
Hi modelmaker,

I'm sorry to hear that the transition was not as easy as you had hoped. But it does sound like this guy knows what he is doing, so I am glad that you are thinking about taking his suggestion. I do know that sometimes being on massive amounts of opioids can actually increase our pain! I think it might be called opioid induced hyper-analgesia? You certainly are on a lot of oxycodone. But then again, everyone's body is so different. When I was taking oxycodone, I got up to 90 mg/day, and then called it quits, as I was only getting some slight relief from it. My doc was willing to continue going a little higher (maybe another 20 mg), but 90 mg was already much higher than he usually prescribes (I have a ridiculously high tolerance to any & all opioids, it seems, & we are about to give up & proclaim my body as completely resistant to opioid pain medication, as I get NO pain relief, nor any side effects, with the exception of constipation). My doc is a pcp (internal medicine specialist), but he has been treating CP patients for years & stays up to date on the latest in pain management, and isn't afraid to admit it when he doesn't know & seek the help of a certified PMS (as he is currently doing in my case).

It definitely won't be an easy road, getting down to just 30 mg/day, but it might be worth a try. Although, do remember, that decreasing the oxy is likely to increase your pain, not only because your pain is increased, but also as a part of the withdrawal process- it can cause you to feel more pain than you actually have. My doc always tells me that I won't know what I truly feel like at such & such decreased level, or when I come off an opioid completely, until about 2 wks after holding that dosage steady. I hope that either your new PM or your old one is guiding you through this process. Best of luck! It sounds like this new guy might be able to help, if you decide to give him a chance. It also helps that 3 other PM's told you the same or a similar story, so you know that this guy isn't just some under-medicating quack, but perhaps, on the cutting edge of pain management. Best of luck to you! Of course we'll be here for you throughout this whole process!

Skeye

Post Edited (skeye) : 6/18/2009 9:00:15 PM (GMT-6)

Posted 6/19/2009 3:38 AM (GMT 0)
When I was on oxycontin/oxycodone, I was on 160 mg a day and the breakthrough amount was 15 mg every 4 hours if needed on top of that. I seldom used that much breakthrough and I had my own concerns about the amount of oxycontin/oxycodone that I was on. I decided after discussing it with my PM that I wanted to try something else and I weaned myself off that large of a dose by a simple taper over a month's time. It wasn't bad, and honestly, other than once when I made too large of a cut down in my dose, I barely knew that I was tapering at all.
I know it might be a bit intimidating to try to cut down from the dosage that you are on, but did the doctor discuss any ways of doing that with you? There are several ways he can take you off the oxycontin and switch it for something else, using the standard formulary to convert you from one medication to another, or he can substitute the oxycodone with methadone and hopefully at a much lower dose, you might find better pain relief. Or you can simply try to taper down with his support. The one thing that concerns me is that it almost sounds like he wants you to do this on your own and that I would find highly irresponsible for him or any other doctor to do.
With the amount of oxycodone that you are on, you are going to need medical support , if not emotional support to do this. And you are going to need prescriptions in different dosages to help you get through the various cuts in dosage as well.
Hang in there,
Sandi
Posted 6/19/2009 2:49 PM (GMT 0)
Dani,

Thanks for your reply and concern.
To answer your questions, the new doc was very surprised that any doc would prescribe that amount of oxy. He never would and said that most docs wouldn't. He never came out and said that the old doc was overprescribing but I could see it in his eyes.

The old doc has a history of "overprescribing" and is well known in the medical community as well as the medical board. They are after his ticket. I do remember signing some papers when I started with him about agreeing to treatment and knowing the possible consecuences of opiods. So I don't know if that would stand up to a legal challenge or not. I'm not sure it's worth the effort. I've already been through one drawn out legal action in another matter and I can't say that I would look forward to doing that again. But I might be swayed by a good, aggressive lawyer.

I guess my biggest challenge now is to come off it without killing myself in the process. I've already prepared a taper off schedule, now I'll see if it is doable on my own.

I am so glad to have the support of this group. I know that I am going to need it over the next few weeks.
I'll keep you posted.

And Dani, I would love to have coffee and discuss it further!

Modelmaker
Posted 6/19/2009 3:25 PM (GMT 0)
Dani,

I reread your post and I don't think I answered you completely. No, I don't believe that old doc was trying to hook patients in. I truly believe he thinks what he is doing is good medicine.

And, no, new doc was not accusatory in his tone at all. He just didn't want to become involved in "bringing me down to a level he could deal with". I think he meant we didn't want to write scripts that large....ever.

New doc did say that with the amount of oxy in my system it would interfere with his efforts to determine exactly where the pain is coming from. That made sense to me.

Modelmaker
Posted 6/19/2009 5:10 PM (GMT 0)
Modelmaker,
From what I've read - and I apologize for not reading too closely and clearly today - you've been given some good advice already. I would be concerned about your coming down from this on your own, but I always feel changes like this should be medically supervised. Plus you may be able to get something to ease the withdrawal some.

Reading about your pain doc (the old one who prescribed the high amounts) reminds me of everything I hear about the only pain doctor in my area who still prescribes. And I've heard it from numerous sources. I think he must know how to skirt the line, as a friend who works in the court house says the District Attorney keeps a very close watch on him. It's the main reason I haven't wanted to go to him. I've also known former patients of his who said how much trouble they had getting off all the meds he put them on. His background is as an anesthesiologist, although he is Board Certified in PM, so I wonder if this affects a doctor's perspective.

I don't know if going through another legal process is worth it, but that's up to you. I've also tried that route, esp. W.C. and was denied and then later when I got laid off I had a strong hunch the fact I fought the W.C. denial played a role, although I could never prove it. You may want to consider filing a complaint with the state's medical board, however. In PA, you can do this online. They do ask for supporting documentation, however, but that may be even showing your prescription history from your pharmacy. And if there are others protesting, it might not be your complaint that tips the scales, but you probably won't be alone. And something like that may be a lot easier on you.

I do wish you all the best. Please take care in lowering your dose; I hope you can get this new doctor to follow you.

PaLady
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