Scared I may have ruined it!

I saw a pain management center almost 1 month ago. They put me on a 5mg Butrans patch, 3/dy Percocet 10's, Tramidal, Zanaflex. I called this this past Wednesday in a lot of pain. They still haven't called me back. I asked them if I could take more of the Percocet because my pain was so bad. The lady I spoke with told me I wouldn't do that, but I will have the Dr. call you. Well....I've been in excrutiating pain so I went ahead and have increased my Percocet without their approval. (The Dr. I saw before this PMC had me on 8 Percocet a day). I have to see them next Thursday and will have to give them a Urine sample which probably will not show the Percocet in it. I'm really scared, I don't want to be fired! I can't afford an ER visit and I can't get anybody from their office to call back. I've called them everyday since Wednesday and they keep telling me a doctor will call back. Does anyone know if I show up with an empty bottle of Percocet and it not showing up in my urine, will I get fired? Please help, can't stand the pain, but can't get a doctor to call back. Increasing my Percocet has helped me enough to be able to walk and sleep. Any thoughts would be appreciated.

Hi Chelle, sorry to hear that you are suffering so. Did you sign a Contract with the pain mgt dr? Look at it & see what it states your responsibility is in honoring the Contract. It is a possibility that the dr kicks you to the curb, and you called & the lady said she did't think you should take more. I am quite sure there was a note made & put on your chart about the call. We all suffer here with chronic pain & I am not trying to be harsh or ugly, but the bottom line is regardless, we have to take the meds as instructed by the dr.. Otherwise, we are leaving ourselves wide open to not have a dr or not be able to get another one to take us on as a patient. They are so strict now because of new guidelines & rules when treating CP patients.

Some Contracts say you cannot get pain meds from another dr & that would include an ER dr. It really does not matter how many Percocets the other dr had you on. It is what the current dr rx'd. Good luck next week.

My pain management center always has people when they arrive do a urine test and then send them back out to the lobby and wait for the doctor to see you. How am I going to be able to tell the doctor before my urine test? If they finally call back today, should I go ahead and tell them that I have increased them?

If I am understanding you correctly, you went to a new PM doctor, who put you on butrans patches, and, tramadol along with percocet 3 times a day. On Wednesday, you called them to see about increasing the dosage of the percocet due to an increased pain level, but they didn't call you back, so you went ahead and took extra doses of percocet anyway, after being told not to by the person who answered the phone?

You are currently on three different pain medications, yet two days later, you are now out of percocet? How many of the percocet did you take per day? In order to run out a week early, you must've been taking significantly more than one or two extra per day-

As Susie said, you may very well find yourself without a doctor come next week, given that you are out of the percocet, especially after you were specifically told NOT to do that.

Since you are not new to PM you must've known that taking more than you were prescribed was not something you should have done until you talked to your doctor first and got his okay, especially since this is a relatively new doctor to you from the sounds of your post.

You always have other options than to take more of the medications than you are allotted, using simple over the counter remedies, hot showers, heating pads, resting, ice, topical heat patches or pain rubs all would have helped to ease the pain.

When the doctor does not return a call regarding a patient requesting to take more of their meds than they are supposed to is in fact, an answer, and that answer is no.

 

I'm sorry you are going through this, Chelle. And I'm very sorry that what we are saying may not be what you want to hear but it's all true, unfortunately. And now that you are without any of your percocet, will you be able to manage you pain until your next appointment?

If you are not dismissed after this situation... cause some docs are very compassionate and will grant a second chance (from what I understand having read on different message boards) I would use the methods you plan on using this week while having no percocet the next time you find yourself having a flare up.

I also agree that honesty is the best policy. I wouldn't even wait for a drug test to be brought up, I would tell your doctor what happened when you go in next week. Perhaps they can adjust your meds to manage your pain better.

Good luck to you. I hope things work out in your favor and your pain is managed. Keep us updated. I'll say a prayer for you, if that's okay. :0)

So sorry about your situation. For lack of a better way to put it: been there, done that!Some of you may remember that was when I joimed the HWCP community.:) I went in to the office as soon as I ran out and talked to the desk dragon. (love that!) I was honest and explained my i had taken the meds early. ( I had fallen and was in excruciating pain) I didn't ask them to replace my meds, I just wanted to make sure they understood my situation before my appointment. She was really very compassionate and she talked to the doctor. When I went fo may appt. 5 days later they didn't do a urine test and the doctor was empathetic. Going in to the office, not calling, made all the difference.
It may not help but it couldn't hurt. (no pun intended)
Let us know how it goes!
Lesley

Hi Chelle,

I'm sorry to hear that your pain has been worse lately. We've all been there, and it is certainly no fun indeed.

I don't really have much to add, as you've gotten some good answers from some of our other members. However, I will say that when I was with a previous PM doc several years ago, I also had trouble with him returning my calls when I had a medication question. I ended up just making an appointment for as soon as I could, so that I could discuss it with him in person. I know that that costs money, and that you already have an appointment for next week, but it's just something to consider if you have a problem like this in the future. Sometimes messages get lost, or doctors get so busy that they can't possibly return all of their calls the same day -- or even for a few days. If you can't get ahold of the doctor by phone, a face to face meeting is a potential solution. You can't be ignored or forgotten about if you have an appointment.

Now, I personally did end up switching doctors several months later -- one of the many reasons being that my calls were never ever returned, regardless of what they were about (scheduling an appointment or procedure, a medication question, a post-procedure question, etc). But regardless of what you choose to do if you run into this sort of problem again in the future, it is never a good idea to change your dosage without consulting your doctor first, and getting his/her approval. I know that you said that you've been on a higher dose in the past, but besides the fallout that everyone else has discussed, it is potentially dangerous to change your medication regiment yourself -- especially if you are currently taking more than one medication. You could inadvertently cause a serious drug-drug interaction, or other unexpected side effect. People die from self-medicating. I can tell you as a medical professional myself, that there are many factors that doctors must consider when prescribing a particular medication, or changing a dosage. It is not always such a simple thing. Sometimes even small changes can have devastating effects. Unless you have the medical knowledge and training, you are really flying blind, and playing around with your medications is a very good way to get hurt. You didn't this time, but that doesn't mean that you won't next time.

As others said, if nothing else, this is a lesson learned. I think we can all understand why you did what you did -- we all know how miserable pain is, and how helpless you feel when your pain levels are high and your meds aren't touching it. However, as tempting as it may be, you've got to be careful about self-medicating in the future (ie. don't do it), and always be honest with your doc.

Skeye

Post Edited (skeye) : 6/1/2013 10:14:51 PM (GMT-6)

I think it's really going to come down to the type of person your doctor is and how he feels about these types of situations, it really is a trust issue, like Purgatory said.

I wish I could tell you not to worry, but in all honesty, I wouldn't be surprised if he dismissed you as a patient. The discussion you had with the office manager today was helpful for future reference if you stay with that doctor, but I don't see it making much of a difference in terms of what happened.

When you called and asked about increasing your dose, chances are that exchange was noted in your chart, along with the fact that you were advised *not* to increase your dose. That's the part that worries me the most. I'm afraid that your doc will be less sympathetic because technically you went against orders twice.

Please let us know how it goes!

You still did the right thing by being honest, can only hope for you, that your doctor see's it that way when you have your appointment.

Good luck,

david

Wow, that's not nice. I've heard they get very upset when someone goes against the contract but at least you came clean about it. There's not reason to be rude to anyone, even if they will be dismissed (not saying that you will be!). Hopefully they have a better attitude on Thursday.

You have enough of the rest of your meds to get you to Thursday, right?

I don't want to sound negative, but this is something that is very basic when it comes to a pain mgmt clinic and the contracts you have to sign to stay with them. Last year I when I was hospitalized for 10 days for renal failure, the doctors at the hospital took me off the morphine ER that I was currently being prescribed for my pain at my pain mgmt clinic and put me on fentanyl patches instead. When I was admitted to the hospital, I clearly told the doctors there everything about my pain doctor, the location and phone number, as I was concerned about taking a new medication for my pain. They insisted that I use the patch instead because I was having liver/kidney problems that caused me to remain in the hospital.

After I was released from the hospital, I called and tried to make an appt with my pain doctor regarding my hospital stay and the fact that they put me on patches instead of my morphine for 10 days. The office dismissed me that day even without letting me come in and even talk with the doctor. I had been there for 2 years and had never failed a drug test or did anything wrong. Because of this I had to resort back to the hospital where I was being seen at for renal failure, and since then have been seeing a new PCP at the internal medicine dept there. They are great and I get much better care there than my old pain mgmt clinic.

They don't treat me like a "drug seeker" like a pain mgmt place does, or at least my old one. All of my visits there were quick, cold, and it seemed like they didn't care about me. At the time I was upset at being dismissed so fast but now realize this was a blessing in disguise and my new PCP at the university hospital (plus the entire staff) are MUCH MUCH better and seem to really care about my overall health and helping me get rid of the pain.

So bottom line, if you do get dismissed, don't freak out. I would highly recommend finding a new doctor at a University Hospital in your area if possible. These are teaching hospitals with dedicated doctors who really seem to care more than your average pain mgmt clinic. The doctors there usually (and should) be licensed to treat chronic and severe pain for long periods of time, even if they are not labeled as "pain management" doctors. Just something to think about if things go south for you.

Good luck.

I know you're relieved but did you actually tell him you took more and ran out?

Most dip urine for presence of opiates in the office and then it goes to the lab for specific drugs and amount.

If you didnt tell him so would expect a no show or low show you could still have problems. Many will simply send you a discharge letter and you then will not get a chance to explain yourself.

I would not take one pill over the order and make sure if you still have butrans left don't use them after he d/CD them. Keep the counts on your meds exactly right as they could call you to bring them for a count to document this isn't a recurring problem,covers himself.

Its a very tight rope we walk thanks to the abuse and diversion of these meds to the street. Is it fair? No but most of us understand the why's and the consequence of not going along.

Hope the Opana works for you and it's a very low dose make sure you call and get permission from a specifically named person before you change anything or do anything different then he ordered it.

I even go so far as using my cell to make those calls and record the conversation. Have had office staff over the years actually deny talking to me. Dont take chances anymore.

Chelle,

Don't want to put words in your mouth, from what I read, you never told your doctor what you actually did?

If your UA comes back and shows what you are hoping it won't show, the ceiling could still fall in over you, and then the doctor would have no reason to show mercy or give you a second chance.

Not judging or thinking ill of you, worried for you. Again, perhaps I mis-read your post, but if you didn't tell him, you missed your window of opportunity to come clean.

Hope and pray for you, that you will still be in good standings with your doctor regardless.

Good luck, will keep fingers crossed.

david