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Need suggestions on how to approach PM.

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Chronic Pain
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Posted 8/15/2010 11:46 PM (GMT 0)
Hi All,

Because of some serious stressful situations, my Psych recently began giving me a higher strength Xanax (CR) that is really having a strong reaction on me.  You can't break them because of the release mechanism and there is no dose between the 2 and the  3 mg, so it's either one or the other.  I needed more than the 2 mg right now for sure.

I've also been on Clyndomyacin four times a day for several weeks due to infection and although I have just finished a round, I may have to start back because my toe(s) both had to be lanced again tonight (and it has been WEEKS).  So I'm also taking (with the xanax 3 mg...15-20 mg ambien (at night), magnesium (2 x day), calcium w/D (2 x day), human growth hormone shots  (.2 mg right now), vitamin(s) D & B-12, two baby aspirin, 30 mg prevacid (2 x day), birth-control pills, torsemide, coreg (2 x day), fenobibrate (160 mg -- new), claratin, and both Ultracet 37.5/325 and 2 mg Dilaudid 4 times per day each for pain control.

My problem is that I can't seem to handle (or even remember) to take everything on the 4 times a day schedule.  I was fine with everything before they added the Clyndomyacin and increased the xanax, but now I find I'm a little too "high" when I take all of the pain meds I'm supposed to.  Both my PCP and my Psych agree that I should take the pain meds as needed and they are certainly needed on many days, but the PM said I have to take them every day exactly as directed.  They do the serious drug testing where they look at exact amounts in your system and how your body breaks them down.  I'm scared to tell him that I haven't been taking the meds exactly like he said because they make me too dangerous to drive or function and I can't live like that, but I don't want to give up the security of having my meds when I need them so badly.  If we drop the dose and then my body adjusts to the new strength of the xanax, I'll be in such a horrible state again that I won't be able to do anything but cry from the pain and you all know how hard it is to get your meds at a place where they work (for the most part).

Any ideas on how to handle this.  My next med pick up is near the end of this week and I have MRI's tomorrow for several hours.  I was thinking of maybe going by his office and talking to the nurse, but they don't always give the messages correctly.  I also thought about a note, but I don't think that will work either. 

I take my pain mgt and my meds very seriously.  I never do anything I shouldn't with my meds and I never violate the pain contract.  I just don't want to have anyone question my situation as I am adjusting to the new med levels from the psych DR. 

Posted 8/16/2010 1:30 AM (GMT 0)
RM,

Ahhh, I've been there and feel for what you are going through. I've never had any side effects from my pain meds except for when I've needed short-term use of an anti-anxiety med (Ativan or Xanax). It then becomes an option of - cutting back on your pain meds and having your pain flare up OR cutting back on the anti-anxiety med and being an emotional mess.

For me, the decision for what to do would be based on the relationship you have w/ your PM doctor. Technically, you *should* be able to go in and talk w/ him (or the nurse) and explain what's going on.... have them document it or whatever and not be worried about them cutting back your meds (just maybe temporarily adjust the doses, etc). That's how my PM would handle it. That being said, I know not all PM docs are like that.... so it really comes down to what you think your PM will do.

Also, when you say you have a med p/u at the end of this week - do they do a drug screen for you at that time? If not, then you might give it a few more days to see if your body adjust to these med increases.

I'm a "rule follower" too... and I do believe honesty is the best policy... That being said, I've also had this back-fire on me, too :) Let us know what you decide to do... and I hope these new side-effects wear off quickly so that you are feeling better.

--Tina
Posted 8/16/2010 1:40 AM (GMT 0)
I would call his office and ask to have him call you back and then explain about the Xanax and how that is effecting you and the interactions with the other drugs and ask what he suggests. He may change one of your meds to three times a day or something. But if you call and ask for his advice he might handle that better then you calling and saying this is what I am going to do.
Good luck and I hope you feel better soon.
Posted 8/16/2010 2:51 AM (GMT 0)
Hi Mom,

I was happy to read on your other thread that you were able to take some time & get your personal issues under control. That being said, I agree with sjlky that at the very least, you should call your PM's office & request a call back. Another option is to try and set up an appointment with him sometime this week, before your med refill would be do.

I think it is best to be honest with him about the medication interactions & your subsequent need to reduce your meds. The goal of pain management is not just to reduce pain, but to improve your ability to function, and if your meds are impairing your ability to function & potentially compromising your safety, then something needs to be done. I can't see why your PM would be upset, or have a problem with this.

I hope this helps. Sorry if there are any typos, I'm on vacation & typing this on my phone, so it's hard to hit the keys correctly, especially since the letters are small for my eyes.

Hugs,
Skeye
Posted 8/16/2010 3:55 AM (GMT 0)
Oh Good Grief! Everyone beat me to it! There all good answers! :)

Just wanted to stop by and help, but then I saw the list of meds and thought Oh my!....this calls for the Big Guns! :)

Take care mom! :)

SE:)
Posted 8/16/2010 5:09 AM (GMT 0)

   Dear Retired,

    I am glad you had a chance to stop by. *hugg* Though it sounds like you are between a rock and a hard spot, no doubt. I also suggest sitting down and having a talk with your doctor. You never know, he may have some ideas to help?

    I understand how you feel, though I cannot help you much with which direction to take. I recently had new additions and increases in my meds. It is hard.  But what more can I do? The pain is debilitating and I need help. Help apparently comes with tiredness, physical exhaustion, "loopyness" and general forgetfulness. I guess my husband was right afterall... I really AM crazy rolleyes    How long have you been taking the 3mg xanax? Do you think you will adjust to the side effects a bit better or is what you are experiencing now, the best your body can adjust to it all?

     I am not allowed to drive any longer (Last christmas they found that the tissue in my eyes was degenerating and the cells of the lenses are stripping). If I did have to drive I would feel the same way you do. I would have the same concerns. How long do you go without a dose? Is it only a few hours? or do you skipp a full dose at times?

     Sorry, I am not much help. I do hope you and your doctor can come to a compramise you are both comfortable with. I hope your MRI goes well tomorrow. You are in our hearts and prayers

*hugg*
  dani

Posted 8/16/2010 12:58 PM (GMT 0)
RM,
I agree with the others. You have to at least try to get a message through to him. Even if his office is like my PM's & only the nurses will talk to you it's at least worth a try. If you try to explain it to them & they get the message wrong then you can offer that as your defense when you go to pick up your meds on Friday -- "I called on Monday & explained the situation. I thought the nurse understood that I can't take the full dose. I'm really sorry." Or maybe you'll get lucky & they actually will get the message right (it does happen every once in a blue moon :).

But if you say nothing, nothing good could possibly come from that. You'll get caught & then they'll ask you why you didn't even bother to call before self-adjusting your meds. In fairness to your doc, he is responsible for you while you're under his care. He can get into trouble too.

And then I would say for sure to bring your med bottle with you to your next visit so they can do a pill count if they want to. Sometimes, though, even with a pill count they won't always believe you & it can turn out pretty badly. So it really is best to call.

peace & prayers,
frances
Posted 8/16/2010 6:39 PM (GMT 0)
Thanks guys!

I called my PM today and left a message for a return call from the nurse.  The receptionist was exceptionally confused about what I was trying to tell her, so I thought it best just to ask for the call back.

I appreciate the info you guys so freely give.  When it's you in the situation, it's hard to decide what is best.  I really hope they don't mess with my meds because I honestly do think I will adjust in a few days, but I have to be sure to do what is best.  I knew today for sure that my pain meds were absolutely essential when they did my MRI's.  It was all I could do not to cry from the vibration of the machine.  Naturally, I could get a copy of the digital films today, but no copy of the report.  So now I wait again until somebody will tell me what the films say.  They did decide to add contrast at the very last minute and then run another series of my lower back to check on the possibility of infection.  Apparently it would not have shown up unless I had the contrast.

Thanks again!

Posted 8/16/2010 8:42 PM (GMT 0)
I just got a call back from the PM office. It was a good thing that I called. I need to start keeping a log of all the meds I take now and what time I take them. They said come on in and pick up meds just like normal this week and then go in next month with my meds sheet and let them know what I needed to take when. Apparently they have figured out that I am one of those people who is over cautious and they had no problem working with me since I took the time to call.

Thanks all!
Posted 8/16/2010 9:11 PM (GMT 0)
Sounds like you have a good doctor and I am glad you called.
Posted 8/16/2010 11:17 PM (GMT 0)
retiredmom,

I'm so glad you got such good advice from everyone. It sounds like you did the right thing. Now maybe you will start to feel better. I know I always need my pain meds when I have any type of procedure done. Good luck and take care. Gentle hugs. Heather

Posted 8/17/2010 1:34 AM (GMT 0)
yea. I'm so glad it worked out for you. :)
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