Posted 12/18/2013 7:14 PM (GMT 0)
Thank you all so much for your ideas. :D
What are "modalities"?
My expectations are that we would have some sort of plan for managing those flare-ups. My current PM has said that his plan is for me to call his office and schedule an urgent care appointment if the pain is either so severe I cannot make it to the washroom, if the pain prevents me from doing my job for 4-5 days in a row, or if the pain is very severe and due to a specific identifiable event (e.g., falling on the ice, slamming on brakes to avoid an accident, illness that prevents me from keeping down oral meds). Then my PM meets with me to decide whether to do shots or to up my meds for a couple days. Without treatment, it usually lasts at least 5 months because the kind of pain I need urgent visits for is due to severe inflammation & I have a medical condition that causes the inflammation levels to take far longer than average to drop back down to normal without intensive intervention.
I'd be fine with some alternative to that, but that was his plan (my old neuro's plan was to write me for a small quantity of Toradol to keep on hand with the understanding that I couldn't take more than 4 doses in 2 days & no more than every other month). I've tried repeatedly to ask him for a different plan, but he says he doesn't have any ideas; he's worried about LT side effects of me taking Toradol even occasionally. I get that Pain Medicine isn't as easy as it once was, but neither is my job. I, too, face a nightmare of mandatory paperwork, increased useless regulation, more complicated client issues & still 24 hours in a day for less pay and useless insurance (oh, the joys of civil service -- the only field where federal insurance regulations don't apply), plus, there is this "wonderful" new trend in the field of education where FMLA no longer applies because districts claim that teachers "only work 6.25 hours per day, 40 weeks per year". I'm not complaining. I absolutely LOVE my job. My only point is that it isn't just pain doctors that have to deal with more government regulations & that is part of what his job now entails. It sucks & I think it's mostly stupid & pointless, but I'm not just going to roll over & die. I'm sorry, but it's just really poor planning on my PM's part not to set aside a single appointment for urgent care visits -- especially when he includes such visits as part of his patients' treatment plan. The only way I get in to see him between visits is if there is another person who cancels their appointment. I'd love to keep him as my doctor. He's gotten me to a much better plan than where I was when I started seeing him 9 years ago when he was an associate at another clinic. When he decided to buy his own clinic, I followed his practice to another town. Maybe it's just that he's got payroll & employee reviews & supply ordering and all that other kind of stuff that he now has to provide feedback on. It's a small clinic so while he does have a few employees to help, all their questions go to him as the sole owner of the practice. He does have a new associate that he just brought on earlier this year. I checked with the clinic's receptionist/scheduler and she said that doctor's schedule is much more open than my PM's. I've met her & my PM actually suggested when she first came on board that maybe I'd like to switch, but I was hoping that by bringing on a PA at the end of last year & a 2nd associate PM this year that his schedule might open up a bit. The reverse has been true.
I hate to start from scratch, but it's insane to think that the next 35 years of my life, when I ought to be working, that instead I would be on disability solely because I don't have a workable plan to deal with flare-ups in my inflammation levels (we tried daily NSAIDs like Celebrex and Mobic, but I couldn't tolerate the side effects and they didn't even help that much). I used to be able to take double doses of Advil for days on end but my poor tummy can't take that anymore.