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Posted 9/25/2013 2:48 PM (GMT 0)
I had a disastrous PM visit on Monday. My PM has 2 PAs, one is great, the other is terrible. She is antagonistic and doesn't seem to follow what I have to say.

Overall, my whole pain management saga has been to balance pain against my need to concentrate. Tramadol has always been the best for that, but as the pain gets worse during the day, absent something stronger, I can't work.

My PM use to prescribe two IRs for me, because of this. But the office policy has changed. Although I've been receiving 120 oxycodones per month for BT, this PA wanted me to use just tramadol -- so I went from an average of 20mg of oxycodone per day to 100mg of tramadol (along with my unchanged/ongoing 300mg of Tramadol ER)

From 20mg of oxycodone for BT to 100mg of Tramadol for BT!
As you all might imagine, I've been dealing with withdrawal as well as loads of pain.

I haven't seen the actual PM for the better part of a year and there is no continuity of care. This morning, after a second night of negligible sleep, I decided to call my PM...now waiting for the nurse to call me back.

They may have had it with me and I'll be kicked - or I might just start looking for a new PM.

oh, let me add that I have quite a few months work of oxycodone stocked up -- but so far, I've followed "doctor's orders".

Post Edited (cogito) : 9/25/2013 9:00:26 AM (GMT-6)

Posted 9/25/2013 4:05 PM (GMT 0)
Dang Cogito! Why would they just add another 100mgs of tramadol? That's about the craziest thing I've heard in awhile. I've got my own feelings about PA's and there not any of them nice enough for a family oriented forum.

I think there's a place for them and its not in ERs and any kind of specialists office dealing with complicated issues of pain management when they've got no training in place to cover that's ridiculous.

I dont know what state or what kind of insurance you have but not seeing a Dr in over a years a huge NoNo. Albeit that someone is getting billed for a Dr visit not PA.

I would definitely be looking!
Posted 9/25/2013 4:44 PM (GMT 0)
I have to wonder with PM headed in the direction it is these days cutting out one of the IR's was bound to happen eventually. Things are going to get a whole lot worse before it gets better I think in the PM area. The writing has been on the wall for good while.

It may be time to look for someone that actually has time to see his patients instead of pawning them off on PA's. I am not much for PA's because I have yet to have a good experience with one. If you decide to look for a new one good luck.

Susie
Posted 9/25/2013 5:44 PM (GMT 0)
Just wow, how can you not see the PM Dr. for that long. Getting Oxy replaced with Tram is not good. Your withdrawl after you're done with them is going to be severe.

Start looking for a new PM, you can go at any time even if you had the last appointment yesterday. Since getting a new PM is hard and takes time then start now. My current PM Dr. took like a month to get in. He's awesome and helps me big time.

In my State you can't have two BT meds, it's 1 BT and 1 ER. So your Oxy for BT and Tram ER would be the correct mix. Taking away the Oxy is a huge mistake and will make you worse.
Posted 9/25/2013 5:55 PM (GMT 0)
I'm not doing well at this point -- arm & back are really sore so it is hard to type.

Still waiting to hear back from PM's nurse!

I've tried everything to quell the stomach issues, including immodium.

Anyhow, I fully agree it is time to find a new PM, but as we all know, that is difficult. I have an appt. with my primary care on Friday (he takes today off and had no slots for tomorrow).
Posted 9/25/2013 6:02 PM (GMT 0)
If you're home, take a Xanax and sleep. I'm here suffering at work, I just took immodium too. I've been off of Exalgo (dilaudid) for 7 days now and I didn't know it would be this bad. On top of that the pharmacy has been out of my Nucynta for days but they called and it's ready today. I can't keep anything in on top of the sneezing and running nose. Hopefully the PCP will get you a script to hold you over and don't be afraid to ask either. They can do this once in awhile but not every month like PM Dr does.
Posted 9/25/2013 8:48 PM (GMT 0)
No call still from my "old" PM, but a new PM is being set up for me. I have a friend in the medical field and he knows more or less all the details. He contacted the new PM for me, who is a close friend of his, and she emailed saying "happy to help"

Now, just a matter of when.
Posted 9/25/2013 9:21 PM (GMT 0)
Cogito, I cant tell you to take more immodium then recommended but for W/DS it works (double) fast as in 2x's faster?

If you can soak in hot water that helps greatly! If you can get another Dr that's great!

If you've got meds saved up as soon as I got ahold of someone my first question would be shouldn't I be tapering the oxy? Tramadol will nvr cover oxy well enough for prevention of w/d.

Drink, drink and drink! Cant say that enough and I know it tastes like sewer water no matter what your drinking but it truly helps. You can dehydrate real fast. I prefer hot liquids, tea hot chocolate even.
Posted 9/25/2013 11:23 PM (GMT 0)
That's crazy. Frankly, I think it's irresponsible.

I am not fond of most PA's either, especially dealing with these types of situations. Your PM putting you off like that, is lazy and unethical in my opinion. It also sounds dangerous because, as Vickie mentioned, it really does not take a rocket scientist to know these meds should be titrated for safety purposes.

I'm beside myself with disbelief and utter confusion.

I wish you the best of luck with your new PM because it sounds like you are in need of a new practitioner who actually sees their patients.



Merrida
Posted 9/26/2013 12:38 AM (GMT 0)
Now that you have anew PM who knows the situation, I'd take some from your "build up" and feel better.
Posted 9/26/2013 12:49 AM (GMT 0)
Hi All,

Well, I never got a call back from the PM's nurse as I requested at 8am today. It is hard to say what that means: (a) I'm booted; (b) the receptionist never handed over the message; (c) the nurse just never got around to it.

It is now approaching 60hrs and I'm hoping the worst is over. I'll take some xanax tonight to sleep and will see how I'm doing in the morning.

So far, pain has kept me mostly in bed, stomach issues have been pretty bad, shortness of breath, asthma (which rarely bothers me), and, of course, loads of anxiety. I'm suppose to go into the office in the afternoon for a meeting. It may be a good distraction if things aren't too bad.
Posted 9/26/2013 2:19 AM (GMT 0)
I'm so very sorry this is happening to you! you should've been weaned off this medication and not cold turkey like that...I hope your doing better soon, maybe call your pcp and get seen. Your pcp might be able to provide help until you can get seen by a new pm doctor...
Keep us posted, hope you made it threw today...
Posted 9/27/2013 1:30 AM (GMT 0)
Hi All,

Here's an update:

I called the "old" PM again, and told them that the nurse never called. The receptionist said she would "flag" it.

An hour later, the nurse called. I told her I have been on at least 20mg of oxycodone for a couple years and so dropping it all at once has left me in acute withdrawal.

She seemed upset, and got me an appointment first thing tomorrow morning.

Oddly, I later got a phone message saying that "it does not make sense that I would go into withdrawal at such a low dose" and this is something the PM wants to discuss in the morning. That sounds like they may be trying to cover their ***. But we all know -- at least 20mg of oxycodone daily for two years? What should you expect? BTW, looking back at my scripts, they had me written at 70mg daily for a while (40mg of oxycontin, 30mg of oxycodone -- which was far far too much for me).

In the mean time, I've collected MRIs, etc. to remind them of what is going on medically -- anyone who looks at a spine with scoliosis will see the obvious. I also put together a spreadsheet of all the prescriptions they have written over the past two years.

I still assume I'll be moving to a new PM, but I don't mind seeing what happens in the morning. Maybe the PM will acknowledge that the PA made a mistake. He usually is a very nice guy and I'm ready to give him the benefit of the doubt. Since his office is just a couple minutes drive up the street from my house, it would be convenient vs. the 15 mile drive to the "new" PM.
Posted 9/27/2013 12:02 PM (GMT 0)
Cognito, good luck to you this morning. I'm glad you got an appointment with your actual doctor!
Posted 9/27/2013 12:59 PM (GMT 0)
Cogito, just wanted to let you know I'm finally done with WD symptoms from the Dilaudid. It took about 6 days total but I kicked it straight up, even have some pills left which I won't be taking. I feel pretty good and even proud I did this on my own. I don't have an addictive personality so I have the ability to fight this stuff. I quit smoking cold turkey 20 years ago, now hate second hand smoke. Was a drinker in college, like every day. Didn't like the way I felt, so cold turkey again. Haven't touched a drink in, can't even remember. When I was younger I use to smoke, you know for the pain at night for years, kicked that too after my kids were born. I am strong!

Hope you're feeling much better. Be strong!
Posted 9/27/2013 3:57 PM (GMT 0)
JP, glad to hear that you made it through your WD.

I understand the pride, as I suffered for 3 days -- diarrhea, cramps, cold sweats, shortness of breath, asthma, anxiety, and, of course, added pain. Although I didn't yet see the light at the end of the tunnel, I still suffered despite having a few hundred oxycodones stored away.

I finally did, though, take 5mg yesterday after my "old" PM called and set up an appointment for this morning. If I was going to be able to function for my 3hr meeting, I had to.

So, on to this morning's events...

I was the first patient to arrive and was brought into the examination room after just a few minutes wait. After the intake nurse spoke with me (very nicely), I waited just a few more minutes until the PM opened the door.

Oddly, the first words out of his mouth were "Sorry Cogito [fill in my real name] -- wrong room". He then added "we'll get this taken care of". A minute later the "good" PA came in.

We got right to business, I explained that I felt that my current regimen wasn't sufficient for the pain, but I didn't want to add anything stronger before maxing out Tramadol. However, somehow that wasn't registered correctly and the "bad" PA instead withdrew everything but the Tramadol, resulting in acute withdrawal.

I then went on to explain that the oxy makes it harder to focus, especially as the day advances. So, I wanted to increase my Tramadol as it doesn't have that effect.

I further added that I thought I was quite clear about it and though "you guys know bad-PA much better than I do, I personally don't feel she maintains the level of excellence I otherwise experience with everyone else here". I also added a bit more, with the caveat, "but of course, she might have much better relationships with other patients". Lastly, I brought in a few printouts of X-rays and MRIs showing the blatantly obvious scoliosis curve. I asked that they show them to the bad-PA and have them included in my file. The good PA said he will.

Anyhow, the good-PA was totally accommodating. He said that they do have a one IR policy now, but it really does sound in my case that this is a good option. So, they agreed:

Tramadol ER 300mg
Tramadol IR 50mg x2
Oxycodone IR 5mg x4.

I'm still going to have a consultation with the "new" PM, but assuming that the above works and I'm treated with respect, I think I'll stick with my current PM... it is just too hard to beat his location -- as noted before, literally up the street -- vs. the university hospital pain clinic 15 miles away.

So, a week lost to withdrawal, frustration, anxiety, fear, pain. But, the withdrawal was probably good for me psychologically -- I know what to expect and know that I can withstand it.
Posted 9/27/2013 4:26 PM (GMT 0)
Kudos to you for your strength.

I'm sure many of us here have the unfortunate experience of dealing with the "good" and the "bad" in the offices we go to. I've found the same situation, regardless of circumstances, that inevitably there's someone in there that seems to get a sense of personal satisfaction by being condescending.

At my PCP's it's the same way,...she has two PA's and one is so snotty, that inevitably when "she" is there, my BP is through the roof.

The other PA,...not so much. She's more humane and doesn't treat me like a caged and rabid animal.

Good luck with your new doc. My fingers and toes are crossed for you. (Yep, even the toes...that's what ballet does for ya!)


Merrida
Posted 9/27/2013 5:18 PM (GMT 0)
Glad to hear you got this straightened out. Isn't a shame how someone's view can affect us? In an instant she removed one med for another and totally through your body off.

I'm lucky in that my PM Dr. is awesome, has great people working for him, they treat me like a King and the pharmacy next door is incredible.

Maybe you'll have better luck with this Dr and don't have to look for another one. I hated changing PM Dr. but my first one was a kid fresh out of College. He did some God awful painful injections and sent me home with Ultram script. After the third time I told him he was horrible and I'm in worse shape after these visits. A few weeks later I got into the place I wanted all along and totally happy.
Posted 9/27/2013 6:59 PM (GMT 0)
Cogito,

Kudos to you for handling this situation as well as you did! I am not sure I could have!

I have been in Pain Mgmt since November 2007 and had the exact same doctor until this January when he left and went to another office. My new pain mgmt doc is actually a Registered Nurse Practitioner that I have been seeing since Jan of 2013. I was really nervous switching to her, but she has been great, absolutely wonderful and she really cares about her patients, just as my first pmd did!

Unfortunately, I live 75 miles away from them, it takes me 1 1/2 hours to get there, and I always give myself a 1/2 hour window for traffic, so I leave 2 hours early for every appt. I would love to have a pain mgmt so close to my house as you, but I have tried to find others and the docs around my town don't "get it" and really don't seem to care much about their patients welfare. I even absolutely refuse to use the 2 ER's closest to me and will actually have a family member drive me to my ER that is 75 miles away unless I have to go by ambulance, then I have no choice.

I am so glad that you got to see the good PA and that you are back on the plan that works!!! We really need the docs and PAs that care!

It was wonderful to hear of a good resolution for you!
Trudy
Posted 9/27/2013 9:16 PM (GMT 0)
I'm so glad you were able to get a positive resolution! On this board we've heard so many horror stories that I love hearing about things working out. I hope your pain levels are evened out soon!
Posted 9/28/2013 3:27 AM (GMT 0)
Thanks everyone for your amazing support!

It really has been a terrible week for me, but it looks like it came to a positive resolution.

Time will tell whether or not my relationship with this PM strengthens or if I'll end of having to switch anyhow.
Posted 9/28/2013 4:05 AM (GMT 0)
Lahaina,

You brought up a great point! I have almost a hundred Elavil in a large bottle where I throw my 3 - 4 leftover every month (I get an actual 30 day script for that one but I go every 28 days) and I never thought about them going bad. I just figured I'd keep them in case I have trouble paying for a script one month and just take those instead. Now I think I probably should look at disposing of them. I've been on them for six years so I'm sure some are pretty old.

Thanks for that helpful and insightful post! I totally didn't think about it that way!

Linds
Posted 9/28/2013 4:13 AM (GMT 0)
Hope your doing better with your pain and medications...had me scared and worried, sorry you had to go threw all that, because of one bad PA.
Many Prayers and well wishes...
Posted 9/28/2013 3:45 PM (GMT 0)
That's cruel and unusual punishment.I'm on Nucynta 150 now.It works pretty well but I went through at least a 2 week withdrawal just switching from Lortab to that.

Hope you're feeling better,
Rick
Posted 9/28/2013 4:37 PM (GMT 0)
Lahaina,

I understand your concerns, but let me explain.

First, I do have a few hundred extra of ALL my meds, including my heart medication (realized through two decades of filling each script a bit ahead of time). However, I rotate them all out - so that I use the oldest I have in storage and replace it with the new fill. That way, whatever I have stocked up is no more than a few months old.

As for quantities, there are days I need 30mg of oxycodone, days I need just 10mg. More or less, I average 20mg but over a few years, the extra 10 or so I have left over each month has added up. In addition, my PM's office has such bad bookkeeping, that they were writing more scripts than they should have.

I used to get 180 5mg oxycodones every other month. I know that's weird, but that is what they were doing for about a year. However, sometimes, they would give me that amount monthly. For quite a few months when that happened, I would just refuse the script. But once I decided to take the extra script (roughly a year ago). Through the combo of that month and my various extras, I was able to store up an emergency supply.

My recent experience with my PM has reinforced to me that this was the right decision, for if necessary, I can ration my available meds for a few months.

As for why I held off and went into withdrawal -- a few reasons:
a) I wanted to see if I had the mental fortitude just to do it.
b) I wanted to show the PM that I would follow their instructions
c) If that truly was the end of my PM care, then I felt it would be best to get through the withdrawal right away.
d) of course, there may be the appearance of something "passive-aggressive" here too - but even if it was in the mix, the others were also. I really wanted to see how well I could handle the withdrawal -- and I think some of the strength I showed in dealing with this fiasco came from my confidence that I could manage the withdrawal on my own.
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