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Did something I shouldn't have, need advice how to handle it

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Posted 7/27/2015 7:27 PM (GMT 0)
Ok so Ive been in pain management for almost a year now for chronic kidney stones. Im prescribed 60 norco 5's a month and sometimes I use them all, sometimes I don't. It all depends on the frequency of my pain because I only take them as needed as opposed to around the clock. Some months I take more than others and it just always evens out. This last month however was a particularly bad one and I took 60 plus the dozen or so I had left from the previous month. Its been HELL, I think Ive got another major obstruction. Anyway I've got an appt with my urologist and radiology to check on that next week. My pain mgmnt doctor however is not covered by my insurance and about a week before my appt I had to call and reschedule bc I didn't have the $100 to see him. So I pushed the appointment back 2 weeks in hopes I'd have it then. When the pain continued and it was clear to me that I needed to get in asap I called again and rescheduled once more moving it up a week to tomorrow. Here's the rub, Friday night I dropped a 10 cup glass pyrex bowl on my foot. Awful pain and I went to the er right away, had x-rays and turns out I crushed my big toe. The er dr prescribed tramadol which I figured would be okay bc its not a narcotic although i guess it might still be an issue but the tramadol didn't work at all and at 3 that morning I went back bc it just hurt so freakin bad. I mean Ive broken my baby toe before and this is completely different. Anyway he prescribed me norco's and I filled the script knowing that it was probably a really bad idea. Im admittedly a huge baby though so at that moment I didn't care. Now Im nervous about how it looks. I know it was a dumb thing to do. My last appt I was given a urine test (everyone was that day) and it may have been completely "clean" because that was an awesome week and I hadn't taken my meds. The frequency in which i take them can vary a good bit but like i said it always tends to even out so i never thought much of it. Now i need to know the best way to handle it. I think i need to reschedule the appt again anyway because I was going to walk since I don't have a car and thats out the window. But when I do get in there Im worried my dr will be extremely ticked and suspicious and I can't blame him. Does the "clean" drug test help or hurt? Im not dependent on them bc when I don't take them for days at a time I don't feel different or have the urge. Does it matter at all that I had missed my pm appointment before the er visit or that it was for something completely different? I just know how bad all this looks and honestly I'm not always the most articulate person. Im not sure the best way to explain all this to my dr. Any advice?
Posted 7/27/2015 7:39 PM (GMT 0)
Did you sign a pain contract with PM? This is important.

You could have told hospital/ER about PM. It's water under the bridge now, but your best stance with doctors is always going to be transparency. "I see this person, I take this already."

You can be honest with PM. Bad week pain-wise and financially. Accident with er visit. Severe pain, tramadol and norco prescribed. Take the paperwork. Be prepared for PM to be angry.
Posted 7/27/2015 7:56 PM (GMT 0)
Thank you for responding. Yes I did sign a contract with my pm which is why I know I really shouldn't have filled the script from the er. It was a huge no no. I didn't tell the er about my pm dr because I really just didn't think about it at the time. They asked for my pcp and what meds I was taking. I told them my pcp and norco and indomethacin. I wish I had just borrowed the $ and kept my original appointment. I'm really kicking myself for this string of bad decisions. I of course am planning to lay it all out for my pm dr but I just know it looks so bad. Honestly I haven't allowed myself to think that I'll need meds long term. Every month I see him I think to myself that it might be the last month. Even though its been a year I still think things could turn around any day and go back to normal. I should've been more careful not to mess things up because I might not be getting better. Reality is sinking in
Posted 7/27/2015 10:30 PM (GMT 0)
Welcome to the chronic pain forum. Well, you know what you did was not the right thing to do. You violated the contract you signed & there is a chance the dr will kick you to the curb. It doesn't matter how many clean UA's a patient has its all about that contract. Trying to hide it will only make matters worse because you are in the monitoring system so that would not be the wise thing to do. Trying to act like it didn't happen is only adding fuel to the fire.

Good luck.
Posted 7/28/2015 1:01 AM (GMT 0)
In my experience, I've just taken the paperwork from the hospital and the medicine bottle with me for my next appointment, explained what happened and no problems. Acute pain is different from chronic pain. We have the right to be treated for acute pain as well as our chronic pain. I take my medicine bottle to every appointment, empty or not. Honesty is the best policy.
Posted 7/28/2015 6:15 AM (GMT 0)
Well as they say "if you dance you have to pay the fiddler" and unfortunately you may be finding out just how dependent you really are on them. PM patients just have to think about it and missing appointments,rescheduling multiple appointments are all indications to the Dr that for some reason you don't want to be seen or possibly tested. They're a suspicious group to start with and you would be surprised at how many people postpone the appointment so that they have ran out of meds and therefore have reason for not having them show up in testing.

The tramadol still counts since it's a controlled substance and both scripts should have been copied and faxed to the PMs office and followed up with a call.

As for what now? Make the best of a bad situation is about all you can do and I am really surprised that you got a pharmacy to fill it. The truth can't hurt you any worse now and just don't be surprised if he discharges you he may have no choice since each state has some very clear rules as does the DEA about what's expected from you under a contract and what the Dr has to do in response to a violation of the contract.

Good luck
Posted 7/28/2015 1:59 PM (GMT 0)
Hi, thanks to all for the responses. I of course plan to be 100% honest about everything with my pm. It has never even crossed my mind not to be or to try to hide anything. I've never been one to think that lying or hiding anything will get me anywhere i want to be if that makes sense. I still don't have the $ to keep my appointment today, after reading some of the responses I realize that may make me look even worse but I just can't help it. I have zero income right now. I'm currently on food stamps for myself and my children and my insurance is through medicaid which my pm doesn't accept. Hopefully it will be clear to the dr that I just don't have the money. $100 is A LOT for me right now. I don't even have a phone, I had to ask my mom to call and see if she can't cancel the appt for me so I don't have an extra fee the next time.
Posted 7/28/2015 2:21 PM (GMT 0)
If what you meant by "clean" ua is that the prescribed norco didn't /won't show in the last testing , and you are planning on telling the doctor that you are self dosing, meaning not taking them as scheduled/prescribed on some days, and taking more than prescribed on others, that isn't going to go over well. Neither is canceling three appointments, going to the ER twice and getting scheduled meds,without notifying them before filling either med.
You could have easily called the office and made payment arrangements prior to your visit.
Or borrowed the money from someone, but canceling three appointments in a row, after a urine screen coming up negative for your prescribed meds, and two ER trips where you obtained meds doesn't look good.
Posted 7/28/2015 2:29 PM (GMT 0)
I am not told to take mine regularly. Mine are meant to be "as needed." I have never been screened. I have signed the contract. I might be finding out how the transition to a new doc goes soon as I'm not happy with the path my current guy has me on.

I hope your doctor is understanding of the circumstances. Best wishes!
Posted 7/28/2015 3:55 PM (GMT 0)
Honesty goes a long way with PMDs.But they also like to see the meds they are prescribing in your drug screen.

I don't think a clean screen is as bad as having something they didn't prescribe in your system but it still raises some flags.

I wish you the best at your next appointment.

Rick
Posted 7/28/2015 5:45 PM (GMT 0)
You asked how bad your behaviour looks.

It looks as though managing your pain on your own is more important to you than complying with your PM contract.

My PM contract allows for an emergency situation. Otherwise, I make certain I comply with my contract. Missing appointments and prescribing your own meds or doses are red flags.

I am not particularly fond mf my PMD but he is respected in the community, has a long history here and
I have worked hard to ensure I have a long history of compliance with him. I do this in an attempt to manage my pain the best way possible, and to ensure I get my meds refilled. The next nearest PMD to me is more than an additional hour's drive each way. How would you feel if you were to get the boot by your PMD?
Posted 7/28/2015 9:14 PM (GMT 0)
Actually , having a clean screen for prescribed meds is just as bad,as having meds not prescribed to you in your system. There is no legitimate reason to have none of your meds show-which to almost all pm's is going to lead them to believe you are self medicating/abusing /misusing the meds prescribed or you are selling them.
None of the options is good in the eyes of your doctor.
Given the types of testing available today and their use in most pm offices, if you are taking meds as prescribed, there is no reason to have none show.
Posted 7/28/2015 10:36 PM (GMT 0)
Okay my mother came home early (living with my parents atm) and agreed to loan me the money so I kept my appointment. My dr was very nice and understanding. I told him about the er first thing when he walked in to the room and he said that as long as i sign oan auth to release records from the hospital so he can verify that its fine. I just need to call the office and let them know next time. To the posters who remarked about me not taking my meds on a regular schedule, I take meds for chronic kidney stones so the meds are prescribed as needed not on a daily set schedule. Some weeks I use more some weeks less, it just always tends to even out in the long run. My pain only comes during spasmodic episodes of renal colic and those vary with frequency so of course my pain med usage does also. My dr is perfectly fine with that, I realize thats not how it is for most people in pain management. Thanks for all the replies and I hope Ive cleared up any confusion.
Posted 7/28/2015 10:54 PM (GMT 0)
Oh and to the pp who made mention of payment plans and notifying before I filled a new rx, I already checked on payment plans and my dr is strictly pay as you go and I i broke my toe on friday night so I couldn't call bc (call me stupid) I didn't know my dr had an answering service. I just didn't, other than my ob I've never had another dr that had one to my knowledge and I just didn't know. Like I said call me dumb
Posted 7/28/2015 10:54 PM (GMT 0)
I am so glad things worked out!
Posted 7/29/2015 12:58 AM (GMT 0)
What a relief you must feel!! So glad it worked out that way. Thanks for letting us know.
Posted 7/29/2015 2:18 AM (GMT 0)
Glad this worked out for you, and it's good that you know what to do now. I also want to point out, if the dentist prescribes you pain meds for a toothache you need to also report that to your PM doctor...It applies to all pain meds for whatever reason. Just a heads up to let you know...
Hopefully your toe will start healing up soon, those do hurt, I have broke a toe before...
Many well wishes...
Posted 7/29/2015 4:13 AM (GMT 0)
I'm glad your PMD was understanding.I'm sure that's a big load off your mind.

Honesty is always the way to go.

Take care.

Rick
Posted 7/29/2015 7:30 PM (GMT 0)
Thanks everyone! This seems like a very supportive board. I appreciate all the responses, even the less than favorable ones. I'd rather get honest advice and opinions than have it sugarcoated. Thanks again for all the great advice!
Posted 7/29/2015 8:26 PM (GMT 0)
just tell them what happened. be honest, bring medication bottles and ER discharge paper. acute pain due to trauma or emergency is not a sin to seek help and relief for. if a urinalysis is done as long as nothing outside the norco and tramadol (not certain if tramadol is detected on standard lab work) show up it is a 2nd witness for you. i would even volunteer to give another urine sample. broken bones and the pain it causes are not deal breakers. we have to be perfect citizens to be able to have our suffering controlled and while i agree the illicit opioid abuse and sales in America is crisis level, no other sick person; epileptic, diabetic, ect has to go through such things, and for 2 Norco per day! i have almost reached my threshold with the affordablecare act's authority that in Virginia have stopped the pharmacies from allowing you to pay cash that is a remainder of what is left above what insurance agrees to pay, if you have insurance you cannot buy a perscription period with cash if the insuance company disallows coverage and if you cancel your insurance so you can obtain your meds you cant because you are then forced to purchase obamacare, or fined. i am done, best wishes to you, i believe you will be ok. NICK
Posted 7/29/2015 8:30 PM (GMT 0)
if you do not have the pills you did not use to show the Doc then a clean test hurts. they need proof your not selling them or taking all of them in the first week or so. your levels are tested also. a physician journal called Practical Pain Managment has some good articles that can give you some guidelines about that.
Posted 7/29/2015 9:57 PM (GMT 0)
You are not the only one with "as needed" meds. As anyone can see from my 'signature' I have several different issues to deal with. The only prescription I use thus far is Tramadol. My doctor writes the standard 60 pills. If I took it every 6 hours, that bottle would only last, what, 10 days? It usually takes me about 2 months to use them all. I have plenty of other methods of pain relief to minimize the use of the prescription stuff. Ice, heat, massage, NSAIDS, mental stuff (meditation, etc). If tested right now, nothing would show up. I also haven't seen my doc because I haven't been able to pay the $46 co pay from the last visit! My primary refuses to write a scrip. Push come to shove, I'd have to go to the E.R. if I needed something right now. Sad that things have come to this, being lumped together with those that don't/didn't do the right thing.
Posted 7/30/2015 4:30 AM (GMT 0)
It is up to each Dr what they put in their pain contract and how they deal with patients that break them. There are no laws governing these matters, only guidelines and suggestions. You mentioned wanting to change pm drs. You may want to be sure you can find another pain Dr that accepts self pay patients. Not a lot of pain drs accept self pay and $100 is cheap. Do you live in Louisiana? The reason I ask is because Louisiana Medicaid won't pay for a pain management Dr.
Posted 7/30/2015 1:39 PM (GMT 0)
I live in alabama, its not really that I want to change pm dr.'s its just that I cant always pay the $100 and so last time I had to reschedule. There are no pm clinics I'n my area (possibly state) that will accept medicaid. I like my dr just fine and the office is within walking distance which is a huge plus with no car. I think i just live in a state of denial that my problem is really permanent. It never used to be this bad and I still think its possible I'll improve. Im 32 and I've gotten stones since I was a teen, used to be just once or twice a year but for the last year and a half my left kidney is always full of stones. Last ct in april there were 3 in the ureter, one in the pelvic junction (10mm) and too many to count in the kidney. Thats pretty typical for me. Along with the obstructions I have a lot of kidney infections and I've got permanent kidney damage. I like to think that it could turn around anytime so every month I see my pm dr I think to myself it could be the last. I might get better and not need to come back next month. I feel for everyone in chronic pain who know that they won't improve. I can't imagine what that must feel like.
Posted 7/30/2015 2:21 PM (GMT 0)
Wow rachelb.I hate to hear of your kidney problems.

I've panicked a little before with my PMD.I thought about what would happen if suddenly I didn't have a PMD.

It 's in all our best interests to be transparent with our Pain Management Doctors.

Always talk to them before filling pain meds from another Dr. or Dentist.

Better safe than really sorry.

I live in N.E. Alabama.My PMD doesn't accept Medicaid.I'm fortunate to have Medicare.

Take care.

Rick
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