pm appointment yesterday

Had a PM appointment yesterday, my last before surgery. The appointment went well... sort of. Had a random urin screen right when I got there, just a home kit, no lab. Always a little awkward to have a nurse staring at you while you're anxiously telling certain muscle groups to work lol. The real kicker there was when she started going off about a "low level" she pointed at the cup, and showed me the test strip, and said there should be at least two lines on it.

Fortunately, I was prepared with my PM contract, which the PM had specifically prepared with the idea that with my gastric bypass, I would most likely test in such a manner. I held it up and said I have a drs note. She looked at it, and said, oh, you're the one she was talking about, I expected you to be younger. Not exactly my favorite complement of the week lol.

So, after far less of a wait than the old PM, I went in and saw the doctor. She asked if my current regiment was sufficient, and I told her that the dosing schedule was great, which is 1 pill every 3 to for hours, but I fealt that the tremendous strength of them, is really setting me up for the possibility of less effectivness in the long term. So we talked about that for a few minutes, and came up with the plan of trying something less intense, which she set me up with a months supply of, which is 5mg oxycodone at the same intervals, and having the ability to go back to the other if needed, but this time, giving me 10mg instead of the 15, which if I need the 15, I can simply take one of each.

I'm very happy with the change so far, I feel a little clearer minded on the lower dose. Though obviously, it's not quite as effective, the constant 15mg was keeping me between a 5 to a 6, the 5mg right now is keeping me around a 7, but I'd rather not use the higher doses unless I really need them, I'm really scared that this upcoming surgery may totally redefine my "10" for me.

After the appointment was awful, the pharmacy at the hospital was closed to non hospital prescriptions, and after a visit back to the PMs office, she told me they only fill her prescriptions on Mondays, Wednesdays, and Fridays, and that Id have to take it to Costco. Went to Costco, and waited an hour and a half, to finally get a call saying the prescription hadn't been dated, so they couldn't fill it. Tried calling the PM several times without luck, and not knowing what else to do, and with a dead phone, I wrote the date on there and took it back. Apparently that's a big no no.

So, they handed me it back, and this time I actually drove back to the PMs office, only to find what my phone found, nothing, went to a couple areas in the hospital to inquire where she would be at, and finally was told that she generally does injections across town on Thursday afternoons, so after a few failed attempts to call over there, I ended up driving over there, found a very rude receptionist, who said she was there, but booked with injections, and I'd have to wait at least three hours. After 30 minutes, a nurse came out and called a patient in, so I went over to the nurse and handed her my botched prescription, and explained what was going on, the PM was out there two minutes later, writing me a new one... finally some luck! She looked at me and asked when was the last time I had taken anything, of course, I being as smart as I am had only brought enough for half the day, and it was 4:30 in the afternoon by that point. So she walked back, and came back out with a little plastic cup with a pill and a glass of water, which by that point, I was dying for.

Finally got back to Costco, handed them the new, and the old prescriptions, and they had me ready to go in 15 minutes. And of course, the cart of stuff that I had filled up, was still waiting for me to take to check out, had to have a box guy change out the frozen chicken nuggets though lol. Well, after getting two guys to throw the stuff in my car for me, I ended up reclining my seat, taking my allowed 15 mg dose, and having my brother drive my other brother down the hill to take me home. No way was I in any kind of shape to make that drive on my own.

Oooyyyyy, what a day. Moral of the story, always make sure your prescription is completely filled out. I'm taking a nice needed rest today lol. My back hurts.

At least you got your script on the same day it was written! I had to get my Fent patch script early since I ran out earlier this week (about 3 patches short, see my new topic). I called the doctor on Tuesday to explain the situation, having problems with my patches sticking and I was 3 short for the rest of the month (well, until my doctor appt that is coming up on the 28th, where I was to receive my next refill), having to wait until Wednesday for the doctor's assistant to call me back and tell me that the doctor will give me an early refill this month but there would be no more early refills so I had to make my 30-day supply of patches (10 patches) last, and that the script was waiting for me at the hospital at the check-out area.

I go in to pick up the script (while starting to WD at this time, mind you!) and I take it to Costco as well. Ends up, they are out of the Fent patches until Friday (today) and that my insurance didn't go through since it was an early refill ($353 cash if I wanted to pay out of pocket). So I leave and call the doctor back, explaining that my insurance wouldn't accept the script until the 27th at the earliest and that the pharmacist said that if it was a script for a different amount or dose, insurance would pick it up no problem. The doctor tells me that it is an issue with me and my insurance company and she can't help me.

I end up calling my insurance co. right after that, and after about a 30 min conversation, I finally get an answer that I was looking for: my insurance covers lost medication and early refills on my pain meds! Yay! So, while still in WD-mode, I call back a different Costco (one that is a 25 minute drive away from me) that has the Fent patches in stock. However, since it is an early refill, they have to confirm the prescription with my doctor before they can fill it. They tell me they will call and let me know when they can fill it, since I wasn't about to drive out there if they couldn't fill it.

After waiting all day Wednesday and not hearing anything back, I call back on Thursday morning. They say my doctor still has not confirmed the script. ***?! So I talk to a new pharmacy tech there and she says to just bring the script in and they will try the doctor again. So I go out there (with my brother driving) and drop off the script and kindly explain to the pharmacist that it was early refill and she calls back my doctor, this time directly to the office.

5 mins later she tells me that the person she talked to said that my "notes" said that there would be no more early refills and they would not fill it. I tried to explain to her that I had gotten this script on Wednesday and my doctor said that there would be no more early fills FROM NOW ON, NOT RIGHT NOW. I was like, if they said no more refills, how the hell do you explain this typed out script signed by my doctor?!

After calling my doctors office again and again, I finally end up talking to someone who actually helps me out. She finally has the refill nurse call the pharmacy and after waiting for 2 hours at Costco (and feeling even worse from my WDs) they finally fill my script and get the insurance to go through. Finally! I was feeling so crappy that I had to put my patch on in the car on the way home instead of waiting.

Matt, that was quite the ordeal, but sounded at least that it all worked out in the end.

Yes, there is a trade off with pain meds. To kill all or most of the pain, you may have to end up being too drugged feeling, and if you take less, you have a clear mind but a hurting body. That is why it is so important to have a caring and cooperative doctor, that will work with you to get the right "mix".

My ongologist is a good one, and very sensitive to my situation, so he's always willing to listen to me and make adjustments to my meds as needed without any hassles.

Yes, I have learned to look my scripts over closely, or have my wife ( a nurse) look at them before I turn them in to be used, because even doctor's make honest mistakes.

Hope you do well enough with the lower dose, good luck to you.

David in SC

Matt,

That was a wild story. I get so fed up with all of the red tape we have to go through in order to get our meds. My doses of oxycontin are so high, I can't imagine what people are thinking when  they fill them. Not that it matters what they think!

I've got a concern I thought you might be able to advise me on. In all of the posts I've read, I've never seen anyone reference taking as much oxycontin as I do. That worries me a lot.

Last May I was in terrible shape. I was barely able to walk due to the arachnoiditis. The pain was between 8-10, & I had just gone through a failed attempt with a pain pump. I had been on Fentyl patches & dilaudid for break through pain for about 3 years so I asked my PM to switch me to ocycontin.

He started me on what he said was an equivalent dosage of oxy. I went on it at the beginning of summer & as a teacher, I had two months off. I felt really good because I didn't have to do anything. I sat in my recliner, went to my parents & swam in their pool...it was great.

We started school again the 1st of August and I'm almost back to where I was last May. On an average day, I start low & build to b/t a 5-7 with my meds, but I'm working on my feet and from a scooter. My feet and legs swell, and now that he's added dilaudid for "break through pain"lol, I get sleepy around 1:30 in the afternoon. I stay sleepy the rest of the day, and some afternoons my pain will shoot to a 9 or 10.

You guys talk about tolerance, I've been on opiads for 11 years. I'm afraid my tolerance is maxed out. Is that possible. I don't know how much of this stuff you can take, but I'm taking more than I've ever seen anyone else take and it's really scaring me. The only way I get relief is bed rest, totally medicated, and I still wake up in horrible pain, unable to move.  Can you tell me if your body can shut out opiads?

I don't know, I'm just really scared & with my PM leaving, I really don't know what to expect. What ever you can share, I'd appreciate hearing.

Lizbeth

izbeth, I know you said your husband has been unemployed for some time now, if I remember correctly, I think you said about 3 1/2 years. I can't imagine how that must make him feel, what did he do for trade out of curiosity? There are some regions of the country in very high demand for certain trades, while other regions have zero demand for the same set of skills. I think if this was the issue, you might have to entertain the idea of looking far outside your comfort zone, for him to find work. I really think you should pray as a family about your options there, because with you telling me that you are on a scooter in the class room, I think its safe to say that pulling off the rest of the calendar year is going to be too much. But I know your going to do what you have to to take care of your family, regardless of your health, I kind of get the impression that this is the measure of your resolve.

I honestly couldn't remember the amount of Oxycontin that you said you are on. I don't think the number is really that significant for the question at hand though. Well to be quite honest with you, I'm just a little out of my league to give you some really informed information about tolerance. I do know that it's an issue that every chronic pain sufferer will eventually deal with. Most of my knowledge on the topic is theoretical, no first hand experience per say, but I do know I have a great fear of it, which is one of the reasons I've asked my PM to let me try to back my dose down while I can. She told me she thought it a wise but unnecessary move at this stage, but also said it may make dealing with acute pain from the surgery next week a little easier, but only because of perspective, not because of true tolerance.

What she told me, is tolerance is really indefinite, and said a patient with enough years and a steadily increased dose, could actually build their tolerance to a point where it could take full grams of oral morphine to have the same effect. She said it's just like snake bites, one could kill a normal person, but a person who's psycho enough to start with small doses of venom and work their way up, eventually their body could tolerate multiple bites with no lethal effect.

What she said is people with tolerance just have to get high enough doses for it, and said that some people can build it pretty quick, while other people can stay on the same dose for a decade or more before it really starts to be a problem, but also said, as long as we stick to our medications as prescribed, tolerance should take a while to develop.

My understanding, is that PMs will sometimes switch to a different acting drug, and give the patient a long break from their old, in order to decrease tolerance. What I don't know is if that switch is minor, from say oxycontin, to ms-contin, or methadone, or something major, like putting them on Nucynta, which works a lot different than regular opioids, and really changing up the ball game. I almost wonder if you might actually benefit from Nucynta, since its a centrally acting drug, to me the description of it seems to put it right in the middle between a nerve pain med, and a regular opioid.

I think when you do get secured with a new PM it's definitely something you should talk to them about. I know each drug acts slightly different, but I'm not sure if building a tolerance to one, means you build a tolerance to all of them. But, I think the biggest issue at hand, is to find you a new PM that you can trust. I think once that's set up with the PM AIMHJI8

Well regarding tolerance, I think the best thing to do is to get some of the members with a lot mors experienc at them, or at least a few members with a lot more time with CP than I, I think one or all the Mods, would ha e more of a clue at than myself. I also know there was a member who knows the actual science of all this, very well, and perhaps he might be able to offer some more guidenc, I'll email one of the mods in the AM, and see if they can possibly offer more more guidance on this, or possibly get someone who can.

Bumping this up so others can read Lizbeth's (spiderwoman) question, I appreciate anyone who takes a moment to read it.

Hi dhitt, what's oxyfast? Somehow, I rather dout it to be ike slimfast lol.