New here - question

Please I know I rambled, I just don't know if I should see an arthritis specialist, if they treat OA of the spinal area if that's what I have or if it's more. Right now I am on 800 mg of Ibuprofen 3 times a day and it's hard on my stomach and I still hurt. I'm scared no one is going to make me feel better anymore for some reason. I don't know what happened as to why is she is taking me off of it and not really giving me anything?

I did after they had labs pulled, but it was her Nurse Practicioner because she was out of the office and she didn't know why. But then I was told I was in violation of contract, so I figured I would need a new PM. I just don't know if it would be better to go to another PM dr. or an arthritis specialist. I did just send an email to the dr. through their patient portal, which they prefer over phone calls, and said my Primary Care dr. wanted to know why she was taking me off of the tramadol?

Do you have a copy of your contract? Does it say what is considered 'violation'? What could have shown up in your labs?

I don't have my contract in front of me, but, I know I can't have ANY other doctor, not even the ER or Dentist prescribe ANY pain medication for me without contacting my PM. Just because a med is prescribed by a doctor, doesn't mean we're 'allowed' to take it.

You say you're prescribed Tramadol XR now. Does that mean your doctor discontinued the 50mg tablets? Or, are they 'break through' meds now? If the 50's were 'discontinued' and you took some, along with the XR, you'd have too much in your system which would be a violation.

Every contract is different. I suggest you read yours over, find out what 'violation' was committed and go from there.

ctrymom:
Low cortisol (hypocortisolism or secondary adrenal insufficiency) is not correlated to depression or the taking of anti-depressants but it is correlated with taking opiates/narcotics over long-periods.

The risk of secondary adrenal insufficiency is now prominently listed as one of the potential side effects of taking narcotics, this as a corollary to the "National Pain Strategy" guidelines released in April-2016.

If you have low cortisol you will feel "punk." I often describe it as feeling as though I have an ongoing case of the flu x 100. Muscle and joint pain can be severe and is often generalized throughout the body - small and large muscle groups and small and large joints. The pain is widespread and non-discriminating.

Prior to my diagnosis with Addison's disease (primary adrenal insufficiency) my physician simply wrote on my chart notes: "Total body pain." The entirety of my body hurt.

Realize that adrenal insufficiency is not on the routine radar of physicians. You will need to bring it to their attention as a possibility and that you want baseline testing for hypocortisolism. There are two main diagnostic testings:
1. Saliva cortisol testing - you swab the inner surface of your cheek at 8 different time periods through the day/night. Cortisol levels for each of the time periods is compared to statistically expected values.
2. Blood laboratory draw - a morning blood test for baseline cortisol and baseline ACTH (the hormone produced by the pituitary that instructs the adrenal glands to produce cortisol). The test is time specific and must be conducted between 7 and 8 am.

Cortisol is not a fixed nor a static value in the body. The level of cortisol varies through the day - in response to perceived stressors and in response to the body's natural diurnal pattern. It is important to know that time that any cortisol value is take so to compare the value to the expected value at that time of the day.

That you have been on Tramadol for some length of time + having received steroid injections does leave possibility for hypocoritsolism.

People with undiagnosed hypocortisolism universally are depressed with low affect. That you are depressed/sad may also be a reflection of low cortisol and less a psychiatric state of being.

Cortisol is a life-essential hormone. Every single cell in the body relies on cortisol. Anyone with undiagnosed cortisol is going to feel fairly crappy, simply because of cortisol's far reaching effects on the body.

Testing for cortisol is easy. I highly recommend that you pursue one or both of the screening tests that I listed above. You will know more for looking than for not looking.

Before I was diagnosed with Addison's disease, I honestly felt like a zombie. I was barely existing. Everything was a challenge because I felt so unwell and hurt so broadly. Diagnosis was several years in the making for me. I try to educate people about hypocortisolism with the hope that someone else will have the fortitude of advocating for testing to enable a more timely diagnosis and treatment.

I hope things begin to improve for you, on all fronts,
- Karen -

You're taking ibuprofen AND meloxicam? STOP!!!!!!!!!! They are pretty much the same med and can cause bad gastric problems! Pick one or the other!

Hey, if you want a bleeding ulcer, by all means, keep taking both.

cntrymom:

It seems as though you are a bit adrift right now with the loss of your pain management physician and discontinuation of Tramadol.

I feel for you. I do. Feeling unwell for an extended period of time without a understandable source or cause is discouraging and taxing on one's emotional psyche.

I would encourage you to establish care with a trusting primary care provider - MD or nurse practitioner. I have a nurse practitioner and find that I get more attentive care with a nurse practitioner - nurses, at their core, are more attentive listeners than physicians. And I am a true believer that each of us, in sharing our narrative of our health with a care provider, holds the critical key to a correct and meaningful differential diagnosis.

An "arthritis" specialist would likely be a rheumatologist. Be aware that waiting times for new patient appointments with a rheumatologist can be 3-4 months. The speciality is underrepresented in actual physicians. The same is true with endocrinologists. Both specialities can have long wait periods for new patient appointments. The point being: Get the name of a rheumatologist and make an appointment ASAP.

Secondary adrenal insufficiency is an endocrine condition. It can be caused by the taking of corticosteroids (oral or injections). That you have had prior epidural injections leaves it open as a possibility.

Secondary adrenal insufficiency affects the body broadly because the hormone cortisol is a life-essential hormone. Cortisol is required by every cell in the body. A general feeling of malaise, of having an ongoing case of the flu x 100, is a general manifestation. Profound fatigue (standing to fix a simple meal is enough to drive you back to bed), generalized severe/moderate joint and muscle pain, nausea and low appetite, low blood pressure, difficulties with thinking and concentration.

The treatment is replacement steroids of hydrocortisone or prednisone. It is not a quick or easy "fix" however. Most people with adrenal failure always feel chronically unwell. There is simply no way to replace the intricate hormonal pathways that are the HPA axis (hypothalamus-pituiutary-adrenal). I never feel well. I make the best of an unfortunate situation.

A general practitioner could order the basic testing necessary to rule in or rule out secondary adrenal insufficiency. If the testing (which I mentioned in a posting earlier on this thread - saliva cortisol test or blood laboratory testing for morning cortisol and ACTH) is low-normal then a consultation with an endocrinologist would be necessary. This disorder is not easily treated but can be somewhat managed. But certainly you would feel better than you do now. Testing for secondary adrenal insufficiency would be worth your while.
- Karen -

CM, go to Drugs.com & read about Mobic & the Ibuprofen. Both are anti-inflammatory meds & taken together can cause GI issues. This was the point Pitmom was trying to make. You may want to go to your pharmacy & talk to the pharmacist to get something OTC to help protect your stomach.

Take care.

Lynnwood, Talking with a friend of mine who is a nurse. It's not a great combination, but sometimes one type is not enough either. It's like danged if you and danged if you don't. I also take an omeprazole to kind of help. I have an all over feeling of flu. They don't want you on too many anti-flammatories and they don't want you on narcotics..it's like what are you supposed to do.

You are right Seashell, I have been kind of adrift lately. Don't know what I'm doing. I don't like how this pain management is working. I used to see a regular MD who took care of it..had me ketoprofen and 3 - 50 mg. of tramadols' during the day as needed. It worked, but I can't remember now, why I changed, I think in part I didn't feel I could talk to him anymore. He had changed me to Meloxicam because ketoprofen was getting harder to get. Well I have the made the decision today, and made the call to another MD. The NP is a great and I can talk to her, but they are also an Urgent care and I think that takes up a lot of her time and I'm not sure I'm getting the exact care I need. Does that sound right. My nurse friend sees this one dr. and she recommended him, said he listens and does prescribe. I'm trying to get enough tramadol to get through until I see him, since as a new patient I can't get in until April 3. I haven't technically been dropped from the old PM yet, even though I thought I had, they emailed me and said they are taking me off ibuprofen since I said it wasn't working and putting me on diflocan.

Seashell, I am feeling more vocal since being on the new antidepressants so I plan on speaking with the new dr on what you said about the adrenal and see if he will run test for it. She said he will run tests and see what's going on and that he is easy to talk to and from what reviews I have read online that's what I need. He's around my age, so maybe that will help..lol. I know tramadol works and the NP prescribed Tylenol with codeine and I told her it knocks me out and I can't work while on it..I can't even take regular tylenol. On my original post I mentioned "Advil" I meant naproxen. Naproxen has never worked for my pain except monthly cramps...lol. Never for arthritis.

I know taking both anti-inflammatories is not good, but until I can do something else, with the new dr. I will do what I can to get through the day. ONE DAY AT A TIME has been my motto for years...sometimes I forget though.

God Bless
Reva

CM, you would be much better off with a regular GP taking care of you instead of a NP in an urgent care. You need a dr that you can build a relationship with over time & someone that knows your history.

I know your nurse friend says this dr prescribes, however, I will be very honest with you. Several years ago, primary care drs that has treated patients for 15 yrs or longer stopped rxing pain meds. They do not have the staff or time to handle chronic pain patients. These guidelines that are in place & the drs being monitored as they are they want no part of it. With the DEA, CDC & NIH involved, PCP's bowed out on rxing pain meds quite a few years ago. This is why people are seeing PM drs. So, I guess what I am saying is do not be surprised if this dr tells you I cannot give you pain medication. I have a feeling tht you have not kept up with all of the changes that has been made in drs handling chronic pain patients & rxing pain medications. What he can do for you is get an accurate diagnosis as to what is causing you so much trouble.

Take care.

Candyapple has some good advice and suggested areas to review with a rheumatologist.

Blood work/laboratory values are not always definitive for auto-immune and rheumatoid conditions. That is, the conditions are slow to develop over time and lab values can wax and wan. Sometimes you have to follow a rheumatologist as a patient for months to arrive at a tentative diagnosis. But a good rheumatologist will also get you started on a treatment plan and use your response to the treatment as a diagnostic barometer.

Either way, getting established with a trusting primary care physician while waiting for a new patient appointment with a quality rheumatologist is what I would recommend you focus on as first steps.

For all my years of chronic ill-health, I have usually been buoyed once I had a plan in place for a specific problem/condition. A little emotional lift of sorts. Once you have an appointment scheduled on your calendar you may feel a new mental fortitude - you are making steps in tackling a diagnosis toward treatment that brings you a more comfortable body space.
- K -

Thanks guys and I think I will ask about a good rheumatologist. Last one was quick went off labs only. How do you find a good one?
I was pretty good mood Thurs because I did make an appointment to an MD but yesterday was not a great day kept wanting to sleep and went to bed at 9 because it felt better to be in bed like I was sick but I wasn't. I knew I wasn't much company anyway. Hopefully by the end of the of the week I can get some tramadol in that month is up and I will see a MD before the month.