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Confusion about my PM Doc

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Posted 11/14/2009 6:39 PM (GMT 0)

Ok, I have been seeing the same PM Docs for over 6 years, and I have been pretty happy with them...until lately.  The last appt. I had the Doc decided to make some changes in my meds...that was ok because I have been on Methadone for the entire time and felt it was time for a change.  So, he wanted to decrease the Methadone to 80 mg. a day and add Opana ER 20 mg. twice a day...That didn't work out because of my insurance not wanting to cover BOTH long acting narcotics at the same time...so the Doc raised my Methadone from 120 mg. a day to 150 mg. a day and NO BT meds... I had been taking Oxycodone 30 mg. 4 times a day...now I had nothing... After calling the office 2 times they gave me another appt. to come in...I thought I was going to see one of the Docs that I had seen before, but NOOOOO....they put me with some NP that was new.  Remember, I had already been in for my regular appt. 2 weeks prior and gotten my Methadone....So, this new person did me like it was a regular appt. and even though I told her why I was there she gave me another script of 450 Methadone...and no BT meds again....I told her...I already had my Methadone and needed something for the BT pain...wasn't that why I was there?  She said that until she talked to my Dr. she could only give me Oxycodone 5 mg. and only take them 3 times a day!!!  nono   NO NO NO.... That's crap!!!  The Dr. walked right by the door and waved at me...but she couldn't ask him one freakin question???  I left very upset....

 

Now, I go back for my regular regular appt. on the 23rd.  What should I do?  I really want to try the Opana ER but if they don't get it straight with my insurance I'll be in the same place I am right now...

 

The Dr. that I like, he's a pain specialist with all kinds of degrees and awards...so you'd think he would know what he was doing...right?  Why me?  After all these years I had hoped I would be in a better place as far as pain goes...At least when this first started I had some time where the pain was under control...not anymore..

 

Is this what I have to look forward to?  Is this the way it will be? 

 

Me.

Posted 11/14/2009 6:59 PM (GMT 0)
    Unique, I have very limited experience with PM's and tried twice to get in to just one of them, and did not ever have much luck. Both of them seemed to be over loaded with patients, and I also had the problem of seeing a PA instead of the Dr my PCD wanted me to see. I think the problem is that some of these places have grown their patient base too quickly and they are over loaded, thus they can't effectivly treat who their supposed to. I think your PM attemped to do the right thing by switching you to a different med though, as he is right, you have been on one kind of med for way too long. It is not as easy as one might think to do that though, and it takes time to redial in a new med. I would call again, if your problem is impossible to live with until the 23rd. Thats only my limited opinion though, and I' m sure others here may have a much wiser answer for you. Hang in there, and of course keep us updated.

Post Edited (Screaming Eagle) : 11/14/2009 12:02:47 PM (GMT-7)

Posted 11/14/2009 8:22 PM (GMT 0)
Rhonda,
First I'd say take a breath. That's not meant to sound condescending, but you have what sounds like a PM doc you're happy with. That's a step ahead of many of us. So you've hit a little bump in the road - it's fixable, but your anxiety I think it's getting the best of you right now.

Insurance companies and/or office policies many influence or even dictate how many appointments you can get with the actual doctor a month. They're all different codes and messy stuff like that, and since you were just seen probably you got put into a slot with the NP. Next time be sure to ask if the appointment is with the doctor himself, although you may have to wait longer. But you do have an appointment in a couple of weeks. It's also possible the doctor wants to see how you respond to the increased methadone before prescribing more BT meds. That's reasonable if you think about it. I'm not saying you should be in pain, and if it's severe certainly you should call the office and report that.

But try to think that this is temporary, you have a great doc that you're going to see on the 23rd (make sure that apointment is with him), and try to relax and see if the increased methadone is helping at all. The other thing you might do is see if there's any kind of appeal process with your insurance company. Sometimes they'll deny, but there may be situations in which they would make an exception but you have to fight to find those out - they're not going to make it easy! Or they just may have a firm policy about no 2 ER medications at the same time (that they'll pay for). I don't think (but I don't know) methadone is very expensive; is it possible you could discuss with your doctor private paying for the methadone and having the insurance pay for the Opana? Just a thought. But again, discuss it with him so you don't appear to be doing anything against anyone's rules. You know how crazy this all can get!

(((((((((((Rhonda)))))))))))

PaLady
Posted 11/15/2009 12:00 AM (GMT 0)
Rhonda,
PA Lady is correct. He may have been trying to see if the increase in the methadone dose would better treat your pain than giving you an increase or even just staying at the same dose with your break through meds. The goal is to have the patient using the ER release meds to cover most of their pain, and only using the BT meds infrequently and only in severe exacerbations of pain. If you are taking your BT meds daily or even most days in a month, adjusting your baseline med (ER) makes more sense than it does to give you more or different BT meds.
As far as your insurance goes, PA Lady again is exactly right. Your insurance refused to pay for both meds at once so now your doctor either needs to increase the med you are on already ( which he did) or you can call your insurance and ask them what you need to do to get the Opana approved while you are titrating down on the Methadone.
You know that Methadone is an extremely long acting medication and given that he just increased your regular dose 30 extra milligrams, he may not have wanted to take a chance of you overdosing by giving you the regular dose of BT meds that you were on previously. The NP may have had the same concerns once she understood what you were there for, which is why she offered you oxycodone at 5mg.
You may do very well with the increase in your regular dose of Methadone and the 5 mg oxycodone might have been just enough to bring the increased pain levels back down given that increase....you should have given it a try.
Most PM's when they change a dose of you ER meds will either lower or withhold your BT for a bit to see if the increase in the ER meds are going to work.
Sandi
Posted 11/15/2009 2:27 AM (GMT 0)
Hi Rhonda,

Is your next appointment with the doctor, or the nurse practitioner again? Hopefully it is with the doctor & you can just talk with him and work things out then. Maybe he can pester the insurance company for you/try to get you an exception, good doctors will do that for you. I hope the appointment goes well, we all know how frustrating it is trying to find meds that work!

hugs,
Skeye
Posted 11/15/2009 2:49 AM (GMT 0)

Thanks for all the responses...let me clarify a few things.  The Dr. that I saw on the 27th was my Doctor...the one that I really like and had before but TennCare took their time in getting him back on the plan...so I am happy about that.  He is the one that told me to call if I needed my BT meds back, and to give it a few days...I did, and I called him (or rather the nurse) and she said that there was a note in my chart to make an appt. for the first one available...that's all I knew. I thought it was so he could actually give me my script back and had to see me in order to do that.  Then I see this NEW NP... and it was like I was a new patient starting out at square one.  She didn't really even look at my chart because she gave me another script for Methadone... I immediatley handed it back to her and explained that I had all the Methadone I needed and was here for BT meds..this is something I made perfectly clear during my time with her...so for her not to know this meant that she wasn't paying attention.  And....she tried to give me Lortab 5's at first!!!  The last time I took Lortab was 3 years ago and they were the 10's...so the 5's are like eating Pez.. I just really felt hurt by the whole experience...I know it sounds weird, but I have been going to these Dr.'s for over 6 years...and I guess I expect too much.

The insurance thing is perplexing...they actually cover BOTH Methadone and Opana ER, but not together...since Methadone is the cheapest of the 2 I think I will listen to you guys and pay for the methadone and let TennCare pick up the Opana ER...that' s the only way I can try this combination...  I feel like I should have left things alone... I'm the one that mentioned how long I had been on the Methadone and that I felt like it wasn't helping as well...and I'm the one that mentioned the Opana ER...so i think this is all my fault.

I have read from so many CPer's how their Doc's change up their meds after so long so they won't get "tolerant".  So I thought since it has been so long that I should bring it up.

Anyway, the 5 mg. Oxy's aren't helping at all...even with the increased Methadone.  I have read that after 100 mg. of Methadeone there really isn't a difference in the pain relief...so taking 150 instead of 120 doesn't change much.  The one thing it does is make it so I can't sleep...The crap keeps me up all night. 

Ok, there it is.  Tell me what you think.

Me.

Posted 11/15/2009 3:17 AM (GMT 0)
Praying, When you said that the Opana ER gave you problems what exactly were you talking about? Just curious, I like to have as much info. as possible.

Thanks.
<Me>
Posted 11/15/2009 4:06 AM (GMT 0)
 

   Dear Rhonda,

 

      Good evening! *warmest huggs* I am glad to hear from you.

 

     I am so sorry to hear about the NP. It doesnt seem to me that it would take much effort on her part to get up, walk down the hall adn just ask the doc. I dont really understand why all she did was give you MORE . Perhaps she forgot to turn on her brain that morning. As for what to ask the doc... You know, after so many years.... Just tell him what you would like to try. See if you two can come up with a compramise. I mean, I know it normally isnt good to be forward with the doctors these days... It just seems to me that after all these years, noone knows your pain and your needs better than you do.

 

     In anycase I wont chatt endlessly, but please know you are in our hearts here. I sure hope they come up with a better option, and soon!

 

*huggs*

   dani

   

Posted 11/15/2009 4:15 AM (GMT 0)
Rhonda,
What I think is that you need to talk to your doctor about all this. Just call and make sure your next appointment is with him. And check with your insurance company to see exactly what the policy is about being on 2 ER medications. What you don't want to do is violate any regulation by self-paying for the methadone. I only mentioned it as a possibility, but some of the staff at your doctor's office ought to be able to help you figure this out.

Other than that, there's not much I could add except to remember that everyone reacts to meds. differently. Be glad you have a good doctor that you like - that's a major part of the battle won right there!

Good luck!

PaLady
Posted 11/18/2009 1:17 AM (GMT 0)

 

 

Thanks for all of the help... My next appt. is with my Doctor on Monday the 23rd...so I can wait it out.  Unfortunately waiting it out means no relief from the ongoing BT pain...those 5 mg. Oxy's aren't doing a thing...so I am taking about 3 or 4 of them at a time.  I know, I know...that's a no no...No pun intended.  But if it isn't helping what else can I do?  I already called and told the nurse about it and what I was doing...she said that since I was so used to taking the 30 mg. Oxy's that what I'm doing won't hurt...so that's a relief....

 

When I go in I hope that they have all of the ducks in a row as far as my meds go..I don't want a repeat of the last time.  That NP said that she thought I came in every 2 weeks and that's why she wrote my methadone...But wait!!!  That would mean that I am taking 900 methadone a month....What a dumba*^!!!  I don't think so.

 

When I talk to my fave Dr. J. I plan on either going back to the way things were...taking 120 mg. methadone and 30 mg. Oxy IR every 4 hours as needed.. I mean, it worked for the most part, but I really think I want to try the Opana ER...I guess I'm hoping for a miracle drug...I just get soooo tired of not ever having pain free time anymore.  I know that I'm getting really depressed about this CP...I can't help but dwell on the fact that for over 20 years I have been dealing with this... That's almost half my life.  Too much to handle.

 

So, what's next?  Oh yeah, I had this thing come up on my face that I thought was a pimple...right by the lower corner of the bottom of my lip on the right side...only now it feels like a cyst...and I'm worried about that too. 

 

Man oh Man....will it ever get better?

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