When will this witch-hunt end? And what will be left when it does?

Started by Obsidian Isolabella, September 25, 2014, 05:44:29 AM

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Obsidian Isolabella

((SIDE NOTE: I put it on my FB page before here. So you might see some of that in it as well.))


To many chronic pain sufferers getting up daily and performing normal mundane but necessary tasks of life can become rather unbearable. For a chronic pain sufferer if the management of pain isn't well under controlled with the method or methods that best work it is truly a hard thing to get up or do anything let alone the normal things that everyone should.

No one is oblivious to the drug abuse problems all over America and even world-wide. But, I'm writing this to bring in another point of view to something that has left me upset and rather outraged by America's medical field.

Some, or none, of my facebook contacts may or may not know that I am actually a chronic pain sufferer. After having my last epideral with my son Oliver my back has never been the same. I felt back achiness after having Kiera, but it was nowhere near what I can feel on a daily basis with my back now. Two of the conditions that I suffer from unfortunately work against each other or even with each other to speed up eating away at the cartilage in my back. I do have Degenerative Disc Disease and SI dysfunction in my lower back. These conditions didn't show up until after I had my son, and I did my best to ignore them for a while since I was working as a server at Ruby Tuesday in Fayetteville and mostly brushed off my pain in my back to the job duties I performed every night.

However, it got to a certain point where I couldn't handle it anymore. I needed help to find a solution that didn't leave me half bent over at the waist just to walk when I got out of my car after a night at work.

In my opinion, I'd say out of everyone in my family, I am the one who has certain points of my body that have very very low tolerance of pain. My back is one of them. So naturally I sought out a orthopedic doctor in Fayetteville and she told me that I had those two conditions and we had planned on getting me into physical therapy since I'm young enough to start reversing the damage and slow it down. But, we moved not very short after that and moved to Gulfport MS.

Its a very beautiful and fun place to visit for a family vacation on the beach but I will not ever recommend someone move here. And here are my reasons why:

1. The doctors here LIE - They flat out lie to your face about certain things and I wouldn't even have known that if I hadn't gone to Miller Motte to study becoming a Medical Office Assistant. Most of the doctors, not all though, I've seen have lied to my face and treated me poorly.

The doctor I saw when I moved here I explained to him my conditions and what the orthopedic doctor had been planning to do. My coverage at the time didn't allow me to get into physical therapy so my option was medicine to control the pain and exercise to get the weight off so it eases the pressure. It really does sound like a simple clean cut plan, doesn't it?

Except... My doctor threw me a curve ball that I didn't know enough about and if I had? I would have flat out said no. He sent me instead of to an Orthopedic Doctor, which would have been a very much better idea, to a Pain Management doctor. I had ZERO idea what these doctors were. Going into the first appointment I thought maybe they were a facility that does something therapeutic to help pain or something.

Pain Management doctors are doctors who prescribe narcotic medications along with other types of medicines and procedures to help control pain. I was a little wary of this, but I listened to the doctors options which were: spinal injection.

A lot of people OPT for spinal injections. However, my back pain didn't START until after my last epidural. So, my answer was flat out NO. I was not going to take the chance of "helping" my back by possibly making the situation worse. The only other option was anti-inflammatory medicine, narcotics, and skeletal muscle relaxers. And here is where this comes in why I do not like doctors here.

The pain management had been doing a wonderful job of helping my pain. I could work 8 hours at my job at Ruby Tuesday because of the pain medicine and it never left me feeling looped out like most feel. Because of my pain levels, it gave me energy to push through the pain, and work better. But as time progressed my back pain was starting to get worse in the winter of 2013-2014. I called my pain management doctor THREE times in one month. I talked to the nurse and told her that what he had me on was not helping with this pain.

SIDE NOTE: For anyone who has never been to a pain management doctor? They make you sign contracts that state you are not allowed to get ANY pain medicine from ANY kind of doctor. I wasn't told that when I signed it. I was told that I was not to receive medicine from another doctor about my back pain.

It is absolutely 100% a pain management's doctors responsibility to take care of their patients and if they are calling in and telling the nurse that the pain is getting that much worse it is their responsibility as the treating doctor to get that patient taken care of. And here's where the blatant lying now comes into effect.

Between the months of March and April I was in an excruciating kind of pain with my back. I could hear popping and grinding going on in my back. I called in March twice I believe and the nurse rudely told me that the doctor already gave me my monthly RX and to just add Tylenol and it should help. When THAT didn't do a damn thing I ended going to the emergency room (AS the Pain Management's OWN NURSE told me to do.) So I would end in the emergency room with back pain and they would either treat me or not. Often times I had to lie about what was wrong with me because I was in that much pain and not getting the care that was professionally required by my PM doctor.

April came around, and the pain was not going away, I spoke to the doctor he bumped up my daily dosage to see if it would help. Did it help? Not at all. I called his office again after that and his nurse once again rudely told me he wouldn't do anything else for my pain (which is a lie) and that if it was that bad to seek the ER.

So I ended up again in the ER several times because the medicine he gave me was not enough to handle the pain that was increasing. I ended up in the hospital that month because I started to scratch up my back with a kitchen knife because of how much pain I was in. They saw this as a suicide attempt and that was cleared up VERY quickly by not just one therapist, but two. I was not trying to kill myself in any way shape or form. The second therapist I saw that morning told me that it is absolutely 100% my pain management doctors fault for not taking care of this issue.

So in June, I had to go to the ER again because of something legit. I was having stomach pains, and throwing up constantly for three days. It turned out to be that I could have IBS. The ER doctor sent me  home with some non-narcotic pain medicine to help with my stomach pains, some nausea medication, and very low doses of pain medicine. It was in July that I got rudely pulled from my pain management doctor for a breach in my contract.

The reasons why I think it is truly different in this case is because I'm a 23 year old young woman who had never heard of Pain Management until I moved here. I was NOT given a copy of my contract and when I signed it I thought it was for that doctor to be treating my back only and no other doctor to do so. The other part of this situation that was rather unfair in my eyes and didn't really make sense; Why did his nurse tell me to go to the ER for my back pain getting worse? If receiving medicine for pain from an ER doctor puts me in violation with the contract then why did the Pain Management doctor get me into his office ASAP to take care of the issue? There have been MANY pain management patients who often need what is called "breakthrough" pain medicine. Sometimes you go through days/weeks where the pain just gets worse and they CAN give breakthrough medicine.

Instead of treating me properly, this doctor "fired" me from his clinic, and now because of this even my own Primary doctor will no longer treat conditions he has been treating like my insomnia.

I'm sure there are some of my friends here on Facebook that will think I'm a whiny brat trying to get her way, and that's an opinion and I respect those. But I'm not the only one who this has happened to in the world of Pain Management. We get treated like "junkies" and most of us who get released from one PM doctor the others refuse to touch. It becomes a catch 22 and I'm honestly sick of it. I've gone three months now without relief from pain and not going to the ER or Urgent Care because I want to find a solution. But, instead of doctors seeing that as "Hey, she is aware of the policy and procedure of pain management now that she has been informed correctly, and she's trying to show other potential PM doctors that she isn't seeking out ER's for pain medication or anything like that when I REALLY need it.

And there is no doubt in my mind that some people will read this and from now label me a junkie. Thats their own opinion. But what I actually seem to have is what is called pseudo dependence. This is a condition that happens when a patient in legitimate pain is UNDER-treated for their pain, and is desperate to find that perfect balance of pain relief so that they can function in their daily lives. Most doctors don't even consider this when a patient comes in and is in pain and mentions specific drugs.

Just because we know what drugs there are out there doesn't mean that we are seeking the medicine for fun!! When I was taking my pain medication, I was in SCHOOL, and WORKING. Now? I'm at home all the time, rarely do anything that involves too much standing or walking because I have nothing to dull that pain.

So where will this witch hunt end? Are doctors and pharmacists now going to treat unfairly treated patients like myself like we are druggies and should be turned away at every turn?

The Medical Field is changing, some for the better, and some now for the worse. Doctors have issues believing that a nearly 24 year old young woman has pain problems because she is so young. Yet, I have MRI results, and CT scan results that prove I have what I do. And with the added 110 lbs on my body it makes it impossible to get up and do regular chores. So when will this stop? When will it stop turning into an unfair witch hunt that leaves human beings that the medical field has taken the Oath of Hippocrates to do no harm. Direct quote: 'and I will take care that they suffer no hurt or damage.' 

I'd never thought much on the way that the medical field now works, but I've ended up the victim of its practices. Doctors have become less and less willing to listen and understand their patients needs. And many don't even believe the ones who are in legitimate pain. So, where exactly do we turn? Doctors treat us like junkies from the streets when all chronic pain sufferers like myself want is to feel able to go through my normal life without having to constantly do so in pain.

I think that in many ways the Medical field has progressed with medicines and treatments for many new things. But, I also think that the medical field has turned into a cold and unfeeling profession where doctors see pain and under treat with things that are MORE harmful than pain medicine such as NSAIDs.

So, where does it end? Are we as people just going to allow doctors to tell us our pain isn't real or give us medicines time after time after time that prove they don't work? I'm honestly sick of it. I spend every day now in pain and instead of getting it taken care of by the people who have sworn to uphold the noble oath of Hippocrates they do more damage than good now.

Callie Del Noire

Well.. I know that my continual joint pain from the Navy isn't on your scale.. but I can relate a little Raven.

Part of these things come from a massive legal state of war on doctors. In some areas Malpractice suites have ruined sections of the medical community. When I lived down here in Jax before, it was literally economically unfeasible to be a labor/delivery specialist (what is the technical term of 'baby doctor') due to malpractice insurance in the area at that time was hellishly high.

Part of the restriction is due to legal responsibility. The contract.

That being said.. he failed to get informed consent with you..and provide you with a full disclosure of what he was holding you to. That tap dances on the edge of being sueable for it.

From what I can read in your post.. I'd say that he forgot the Hippocratic Oath somewhere down the line and doesn't listen to his patients anymore. The medicines he is giving you are heavy duty right? The restriction could be for reactions with other medicines. I had a teacher in highschool was given a pain killer that supposedly in higher doses was used as an anti-psychotic. She spent a weekend literally on the floor watching water pool in the kitchen because she couldn't move for nearly 30 hours. So, part of it is definitely a concern for your safety.

The other part.. a deep lack of empathy for his patients though. I hope you can find options that help out. At 25 I was only hurting in one knee, today I have both, my right wrist, elbow and both shoulders and occasionally a nerve in my back that goes from twinges to occasional boughts of numbness.I can't imagine the pain you're going through.

Pumpkin Seeds

There does seem to be a bit of confusion about the Hippocratic Oath on this one.  Please read the oath before saying that a doctor is violating their oaths and keep in mind that a doctor has a responsibility to not over treat their patient.  As one can see from the media there is a great deal of pressure on physicians in regard to over prescribing pain medication and to also avoid patients that are doctor shopping for medication.  That is the purpose behind the contract is so the pain management doctor can remove a person from their practice that is attempting to shop around for pain medication.  Let's keep this in perspective, nobody is going to die from back pain.  They may want to, they may feel as if they are but they will not.  People do die from drug overdoses and interactions.

Formless

Quote from: Pumpkin Seeds on September 25, 2014, 06:07:09 PM
There does seem to be a bit of confusion about the Hippocratic Oath on this one.  Please read the oath before saying that a doctor is violating their oaths and keep in mind that a doctor has a responsibility to not over treat their patient.  As one can see from the media there is a great deal of pressure on physicians in regard to over prescribing pain medication and to also avoid patients that are doctor shopping for medication.  That is the purpose behind the contract is so the pain management doctor can remove a person from their practice that is attempting to shop around for pain medication.  Let's keep this in perspective, nobody is going to die from back pain.  They may want to, they may feel as if they are but they will not.  People do die from drug overdoses and interactions.

And this mentality is exactly what is wrong with the medical field these days.

Sadly , not only does it apply to pain medications , but to practically any health issue a human may feel.

Please , even if you are a medical professional , you have no right to say something like that. If you're living through everyday with a similar chronic problem , good for you. But don't say that feeling pain isn't going to kill someone. Especially when the pain is associated with the simplest tasks of moving their bodies to walk.

Pumpkin Seeds

A medical professional has every right to tell a patient that they are not at risk for dying due to their pain.  Honesty is a hallmark of medicine and a virtue that I would hope continues with the practice of medicine and nursing.  The problem comes that my statement of nobody dies from pains is viewed by others as a condemnation of the condition of pain and a lessening of her symptoms.  My statement is neither.  As I said, this is a statement to set things into perspective.  A physician cannot immediately give life threatening medication, which narcotics can be considered, to someone that is not at risk for imminent death.  A doctor, as per their oath, must administer medication and treatment prudently and responsibly for the betterment of the patient.  This takes time and this can be a frustrating process, but there should be no cowboys in medicine.  That is the problem with viewpoints in medicine, ignorance.  This is the problem from both the public’s standpoint and medicine’s stance. 

Being honest and telling someone the truth of their condition is not the problem.  I do not care less about her pain or condition because she is pain and not actively dying, but her lack of being in imminent danger does alter her treatment options and allow medical practitioners to take into account a great many things.

Obsidian Isolabella

Pumpkin Seeds, I was not suggesting that the doctor was in complete non-compliance with the Hippocratic Oath, but in a way, yes he was. He was not giving me anything really heavy-duty and it WAS his responsibility under the same contract that I signed for him to treat for the pain he was giving me the medicine for. He refused to see me or even speak to me about why my pain shot up those two months and instead he told his nurse to tell me to go to the ER where they had to have known that they would give me pain medicine for. The blurring line that doctors are now swaying to is that if you're not bleeding or a bone isn't broken then it isn't possible for your pain to be so bad as to need a narcotic pain killer. That is severely under-treating a patient, and I've heard of cases where patients are in so much pain that they actually do MORE damage by overdosing on the sacred NSAIDs that doctors seem to swear by.

Am I saying that they should be handing out the pain medicine like ice cream and candy? No, of course not. But, it has now turned into this witch hunt that if you aren't bleeding or don't have a break then you don't need the medicine. And, I find that neglectful of doctors. I realize that they are now under a very large microscope because of drug seekers and junkies. But, the medical field has turned into something that is more okay with letting patients writhe in pain instead of cautiously prescribing medicine that might ease their pain.

I've gone into an ER after literally popping out the ligaments in my right knee. Thankfully it didn't swell that badly, but that hurts so badly to do. Especially since I was at work and my knee locked up in the same position after the ligament popped out. It took 30 minutes for my manager at the time to even get my ligament back in place and for me to move my knee. I went to the ER and I was astonished by the reaction that my very real pain got from the doctor who saw me.

She told me in a very callous voice that I couldn't be any pain because the swelling was non-existent and I broke no bones. And this is where the medical field has kind of come to. You have a lot of doctors who are rather cold and uncaring of pain or just flat out don't believe you. I understand proceeding cautiously in their field now a days because of lawsuits, but what happens when they tell a patient no you're not in pain and the patient is in very real pain? That's doing harm by being neglectful and uncaring and unbelieving of that patient.

I have been in school for a career in the medical field, and I finally dropped it because I realized that I don't want to be part of this field that everyday turns more callous when they are supposed to be the healers. I've seen more doctors who undertreat patients and then see those same patients end up in the ER's for conditions that their doctors should have been taking care of. Myself included. My primary care doctor about three weeks ago refused to provide me sleeping medication that I've been taking since I was 14 years old and this last weekend it ended up with me having a panic/anxiety attack because I had gotten no sleep and then worked a 16 hour shift at work. My doctor already knows that I have a long history of insomnia and the medication he was prescribing has been the only thing proven to help me sleep. And he suddenly decided to yank it three weeks ago. There was no rhyme or reason other than the fact that I got released from pain management after that doctor informed me to go to the ER for my pain. I got released because I didn't know the extent of my contract that I agreed to with that doctor and that is on me. But then because of that, my other doctor just pulled my sleeping medicine and refused to help me.

I definitely think that the medical field has gone way down hill. Patients get treated like the criminals and doctors just don't care that much anymore.

Pumpkin Seeds

The post you originally laid out indicates that you spoke to the physician during those months.  This pain management doctor even adjusted your dose of pain medication.  Of course the doctor is going to want at least a month's time to pass before making any adjusts to the medication regiment.  There has to be time to evaluate, treat and then re-evaluate the course of action.  So the doctor was doing as you just stated was your request.  A gradual increase of pain medication.  The physician also recommended spinal injections, which you refused.  There is also the recommendation given for physical therapy that your previous doctor indicated as well and you stated wanting, but that your insurance could not cover.  You also indicate a need for weight loss which would help quite a bit since your problem is with your back.  These are all steps the pain management doctor was attempting to do with you.  That is his treatment plan.

As for your disdain for NSAIDs, I don't know what you are making reference to with their overdosing damage.  From what I am seeing on my stats of 100,000 episodes of NSAID digestion and use, only 12 suffered death.  Four of those deaths from over the counter ibuprofen.  Of 36,848 episodes of opiod digestion, 161 resulted in death.  The majority of deaths from respiratory compromise.  So there is definately greater risk from narcotics than NSAIDs.

As for the knee, you suffered an injury that was fixed by your manager, a person not licensed to perform medical treatment.  So arriving to the emergency room then with no actual damage to your body and able to go through having this body part manhandled by someone that doesn't know what they are doing.  I would be surprised if the doctor did give you anything more than ibuprofen, maybe Toradol.  Also in your post you indicate going to the Emergency Room several times for pain and even lying to the ER to get pain medication along with scratching up your back with a knife.  Also if two therapists saw you then that was not cleared up quickly. 

You indicate being in pain at the start of this which is why the referal to the pain clinic.  So the pain medication was not working.  Your body only build up a tolerance to those medications and you are only 23 years old.  The path the pain management doctor was moving you down is the only path that will lead to any sort of pain recovery to be honest.  Also the sleeping medication was given to you at age 14 so how do you know there is no other way to help the insomnia ? 

Honestly the disservice being done to you that I can see was that you were placed on so many medications already at the age of 23.  I am not even sure what you would consider heavy-duty pain medication since most people would consider any narcotic a heavy-duty pain medicine.  I am, for the most part, seeing physicians that are trying to give you a long term plan of care to avoid addiction and dependency on drugs.

Zakharra

  That's pretty cold, Pumpkin Seeds. Raven has said the doctors she was working with more or less ignored her complaints and refused to see her. They pain management one even went as far as to have her sign a contract that explicitly forbade her from receiving -any- pain meds from anyone else but him, and didn't inform her of that fact. They were cold and callous and the impression I got was, their attitude of the doctor and nurses was 'You're in pain? Suck it up bitch. we're not giving you anymore drugs.'  That's not in line with the Hippocratic oath. You might think it is, but when a doctor and his staff is ignoring the obvious and clear pain a patient is in, something is wrong. Yes the doctor did adjust her pain meds, once, but when she made it clear it wasn't working, he did nothing else when he should have. He wasn't helping his patient and that's not following the Hippocratic oath.

And I must respectfully disagree with your assessment of Raven's ligaments popping out. Even if there wasn't any swelling, something like that hurts, a LOT. She should have gotten some pain meds to help against that pain until it healed (the ligaments would have been stretched or maybe even a little torn or something), but telling her she should have more or less 'walk it off' is very cold sounding. Knee injuries are not something to sneeze at and ignore.

Sho

Quote from: Zakharra on September 26, 2014, 08:35:45 AM
Yes the doctor did adjust her pain meds, once, but when she made it clear it wasn't working, he did nothing else when he should have. He wasn't helping his patient and that's not following the Hippocratic oath.

Every pain prescription takes time to adjust to - as Pumpkin Seeds said, up to a month. Unless the prescription is making a patient physically ill, a doctor will usually tell you to push through what you have (even if you're in pain) to see if your body can adjust to it. Does it really, really suck? Yeah, absolutely. Do they have to do it? Yeah. The Hippocratic Oath is about helping people, sure, but it's primarily about keeping people safe and doing what you can. I think you all are ignoring the fact that narcotic-based medicines are considered VERY dangerous and are very carefully controlled (as they are also incredibly addictive) and that doctors are loathe to hand them out, particularly when the patient is taking a sleep-inducing medicine as well.

I don't think Pumpkin Seeds is meaning to be cold - she's not telling the OP to 'suck it up and get over it', at least not as I read it. She's saying that it's awful that the OP is going through so much, but that the whole matter with the doctors is more complicated than it may seem at first blush. All in all, this is the sort of thing that we can't properly weigh in on without seeing the contracts or understanding what sorts of medicines the doctors put her on. We're not doctors (and even if we were, we don't have the proper medical information to operate on at this moment), so we can't really say that we know her doctor was derelict in his duties.

I know that after I had a cadaver ligament implanted into my knee I was given oxycontin, but when I dislocated my knee I was told to take Tylenol 2 (slightly stronger than OTC Tylenol). It hurt like hell (seriously, I've never felt pain like that), but they wouldn't give me anything stronger because of the concerns about prescribing medicine that strong. Pumpkin Seed's point about potential fatalities is a legitimate point - she's not saying that the OP's pain is invalid in any sort of way, just that pain, awful as it is, doesn't usually lead to death whereas an accidental overdose of pain pills almost certainly will. That is one of the primary reasons doctors are so tight-fisted with those sorts of pills (that, and the risk of addiction).


Pumpkin Seeds

Any physician can write pain medication.  Doctors are able to write narcotics as part of their practice, which is simply part of what a physician is allowed to do.  At one time doctors did write for a multitude of pain medications for a great many reasons, not understanding the long term effects.  Now our medical teams and societies are beginning to understand the devastating effects of long term pain medication use.  This patient was on pain medication, a larger amount than she is currently taking now as she points out.  She was not getting relief any longer which is common because the body develops a tolerance.  So essentially she is on an escalation of pain medication, which is why she was referred to a pain specialist so that the escalation can be stopped before wandering into dangerous territory.

The job of a pain doctor is to manage her pain.  He is not there to write her narcotics and eliminate pain, but to find a balance between pain medication, alternative therapies and her body’s own ability to alleviate pain.  Everyone’s body has the capability to handle pain and he is trying to find the minimum amount of medication to assist her body.  If allowed to continue her pain would continue to be uncontrolled simply because her body is developing a tolerance to the medication.  In this way he can help her treat the symptom, pain, while also working on contributing factors like weight and physical training.  This is a holistic approach rather than a simple arrangement of patient complaint and pain medication.

As for ignoring her, the doctor did not.  His nurse returned her calls and recommended the Emergency Department.  The Emergency Department is recommended so that they can perform an assessment of her back and see if there are any changes in her condition.  The ER is not an alternative source of pain medication, which she eventually used the Emergency Room as by lying about her symptoms in order to gain more medication.  The doctor meet her at the beginning of their time together, wrote a month’s supply of pain medication and then re-evaluated her after a month’s time.  Then he increased her dosage, adjusting her medication as per her request.  He did not ignore his patient.  The physician gave her pain medication and then increased the dosage when she reported that her pain was not relieved after a month’s time.  Helping the patient does not mean giving them what they want.  Notice that is also part of the Hippocratic Oath.

As for the ligament, pain medication is not going to fix her knee.  Pain medicine is not going to fix her back.  So saying, be careful with that knee does not equate with giving someone medication.  Also I stated she might be ibuprofen or Toradol, both are good painkillers.  Why reach for the narcotics so quickly?  People complain about the cost of medicine, the flood of people into Emergency Rooms and the rise of pain pill addiction in this country.  This is where the cycle starts.

She is twenty-three years old and is already developing a tolerance along with what appears to be an addiction to her pain medication.  At twenty-six what is she going to have without some intervention?  The pain medication will simply be increased and expanded.  Maybe she’ll graduate to muscle relaxers along with narcotics.  Then eventually she will need a stool softener because narcotics slow your gastric motility.  Eventually she’ll probably need a laxative and then maybe develop a bowel obstruction which requires more surgery.  Surgery causes more pain which means more pain medication.  Which by the way her tolerance is now well developed and so she will need a lot more pain medication, deepening her addiction.  Other symptoms will develop as well such as lethargy, weakness and by the way her pain will still be there.  She will gain more weight because pain pills also have someone gain weight due to that reduction in gastric motility and the lethargy.  She might then gain diabetes, develop painful joints, etc. etc.  Now there are also the cardiac function problems as she goes up in age.  This is how pain was handled until recently.

You think you are being compassionate by giving her more pain medication, but I am the one looking out for her future and safeguarding her quality of life.  You want to give her a moment and I’m trying to protect her life.  Explain to me which of us is being compassionate.  People that “live” with their chronic pain accept that pain is part of their lives and many understand that pain medication is there to help, but not eliminate pain.  Most simply accept that activities will hurt and many strive to cut back on the contributing factors to their pain.  People with chronic pain need to know that their future can very well be what I described without proper management of their pain medication and without a comprehensive pain treatment plan.  The answer is not throw pills at her.

If you think that is cold than I am sorry you feel that way.  I would gladly do anything I could to give her relief, but not at the cost of her life.  We have had enough of that in the history of medicine. 

Kythia

Sorry, what was the lie? 

EDIT:  The one your doctor told, I mean, not the ones you told.
242037

Formless

Its not what the physicians need to write for their patients. Its how any patient who states any form of chronic pain is immediately labelled as a ' junkie ' prior to any form of consultation.

Example : A patient just moved into a new city and suffers from any chronic joint pain. The Receptionest , the Nurse & the physician handles them with the first thought in their mind that they're junkies trying to ' loot ' some drugs. Of course they will do the required tests and diagnosis. But knowing that the first thought they have about a patient that they're a junkie and how they first need to confirm that suspicion is just sad.

Also , Stating how ' you're protecting ' her life and how you ' don't want to throw pills at a patient ' isn't really something I'd be mouthing these days. You see , doctors follows rules and regulations administered by the FDA or whatever medical governing body the country has. They're ' taught ' how to handle the cases accordingly or they will fall into malpractice errors.

Rofecoxib was a drug used as an anti-inflammatory medicine for osteoarthritis. It was deemed ' dangerous ' in 2004 because the medicine causes heart attacks. However , since the medicine was released in 1999 , any patient who stated any vascular problems of any sort was referred to a cardiologist. Many even died because of the drug. Why did the doctors stopped prescribing the medicine? Because the FDA then issued a ban on the medicine. Not because the doctors were concerned about the life of their patients. If it was up for the doctors , they would've kept prescribing it because ' it was a fitting drug at the time '.

And that is just one example of how physicians hardly have any form of judgment of their own regarding their patients.

Oniya

Some of that is due to Big Pharma.  There's a tremendous push to get new drugs to market, and I personally think it's gotten worse since they started being able to advertise prescription drugs on TV.  Long term testing, which is what would have revealed the cardiac impact, is deemed a financial liability - it works, let's start making money off it get it to the people who need it!

Meanwhile, laypeople who have seen the drugs advertised are asking their doctors about it - sometimes even demanding it for inappropriate applications.  When Levitra first came out, the ads were so vague that I couldn't tell what it was for - it looked like it might have been an arthritis medication with the way the guy started out having trouble throwing the football. 
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Kythia

Quote from: Oniya on September 26, 2014, 12:56:15 PM
they started being able to advertise prescription drugs on TV. 

What?!  I mean...seriously?  It's not that I massively think you're lying or something but...seriously?  Seriously?  Why?
242037

Oniya

I know - considering the amount of fine-print that used to be in the full-page magazine ads for medications, it's essentially impossible to fit all that information into a 30 second sound bite.

(If you'd like me to link you a few examples on YouTube, PM me.  I don't want to derail the thread too much.)
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Obsidian Isolabella

Pumpkin, I am not at all saying that I don't value my life because I do. I want to be able to live a long life, so I understand what you are saying in that regards.

As for what I meant by heavily medicated? I was on a Norco 7.5 three times a day and Meloxicam 7.5 once a day. The Norco wasn't helping because I was only taking it three times a day and only one of them. The meloxicam did me 0 good and actually upset my stomach most of the time.

When I was in pain back in March and April, all the doctor did was say instead of one pill twice a day make it three times. I was never asking for like Percocet or Oxycontin which are things I've heard some PM doctors will prescribe people Oxycontin + Vicodin. I never requested for that kind of treatment because the plan was to get my weight off so the pressure wasn't as bad on my back. I cut up my back in April because no one was listening. I even went to my normal doctor that month in TEARS because my back had started to grind and pop and they threw MORE heavy anti-inflammatories at me that I didn't want to take because they weren't doing that much. I also do not like muscle relaxers because those medicines make me feel entirely out of control of my own body and another thing I can't take steroids. I have horrible reactions to them. So the doctors were limited. And I didn't want an epidural or injection because my back didn't get messed up until after my last c-section.

Am I saying I want a free for all of pain medicines just so I have an excuse to say I'm in pain? Heck no! I want to be able to get my weight off without being in agony when I try to exercise. That is all I want the pain medicine for. I am going to be starting physical therapy again soon to see if it helps.

When I first moved to Mississippi I didn't even know about PM doctors. My primary care doctor sent me to a PM doctor instead of to an Orthopedic doctor. So this has been one big circle after the other. I do not want to be permanently be on painkillers for the rest of my life. I want them to help me be able to exercise and perform normal functions everyday so that I don't sit around MORE and gain more weight. Which is the primary cause of why I have heart issues right now. It isn't the pain meds that caused my high BP or heart rate.

As for the pain killers making me tired and not wanting to move around? They don't do that. They actually help me have energy to get up and get stuff done because they significantly lower the pain in my back.

Formless

Quote from: Oniya on September 26, 2014, 12:56:15 PM
Some of that is due to Big Pharma.  There's a tremendous push to get new drugs to market, and I personally think it's gotten worse since they started being able to advertise prescription drugs on TV.  Long term testing, which is what would have revealed the cardiac impact, is deemed a financial liability - it works, let's start making money off it get it to the people who need it!

Meanwhile, laypeople who have seen the drugs advertised are asking their doctors about it - sometimes even demanding it for inappropriate applications.  When Levitra first came out, the ads were so vague that I couldn't tell what it was for - it looked like it might have been an arthritis medication with the way the guy started out having trouble throwing the football.

I am not against the whole medicine protocol. I support it in my own practice. I was against the notion that Doctors put their patients first and that is not true. Their career and license comes before their patients.

Though it is true that any form of drugs shouldn't be advertised on TV. We started with simple pain killers like Paracetamol and Diclofenacs , and now there's an advertisement for practically any kind of medicine. Especially as you stated , how only the ' intended ' effect is advertised and none of the down sides of it.

But that brings us back to the point I was trying to explain. A Doctor wouldn't mind prescribing a drug even if it causes certain side effects if there's no official ban on it. The extent of what they'll say is ' You'll have to see X physician for the X side effect. '

And if this is going out of the thread's topic I apologize.


Zakharra

Quote from: Pumpkin Seeds on September 26, 2014, 11:38:03 AM
Any physician can write pain medication.  Doctors are able to write narcotics as part of their practice, which is simply part of what a physician is allowed to do.  At one time doctors did write for a multitude of pain medications for a great many reasons, not understanding the long term effects.  Now our medical teams and societies are beginning to understand the devastating effects of long term pain medication use.  This patient was on pain medication, a larger amount than she is currently taking now as she points out.  She was not getting relief any longer which is common because the body develops a tolerance.  So essentially she is on an escalation of pain medication, which is why she was referred to a pain specialist so that the escalation can be stopped before wandering into dangerous territory.

The job of a pain doctor is to manage her pain.  He is not there to write her narcotics and eliminate pain, but to find a balance between pain medication, alternative therapies and her body’s own ability to alleviate pain.  Everyone’s body has the capability to handle pain and he is trying to find the minimum amount of medication to assist her body.  If allowed to continue her pain would continue to be uncontrolled simply because her body is developing a tolerance to the medication.  In this way he can help her treat the symptom, pain, while also working on contributing factors like weight and physical training.  This is a holistic approach rather than a simple arrangement of patient complaint and pain medication.

As for ignoring her, the doctor did not.  His nurse returned her calls and recommended the Emergency Department.  The Emergency Department is recommended so that they can perform an assessment of her back and see if there are any changes in her condition.  The ER is not an alternative source of pain medication, which she eventually used the Emergency Room as by lying about her symptoms in order to gain more medication.  The doctor meet her at the beginning of their time together, wrote a month’s supply of pain medication and then re-evaluated her after a month’s time.  Then he increased her dosage, adjusting her medication as per her request.  He did not ignore his patient.  The physician gave her pain medication and then increased the dosage when she reported that her pain was not relieved after a month’s time.  Helping the patient does not mean giving them what they want.  Notice that is also part of the Hippocratic Oath.

As for the ligament, pain medication is not going to fix her knee.  Pain medicine is not going to fix her back.  So saying, be careful with that knee does not equate with giving someone medication.  Also I stated she might be ibuprofen or Toradol, both are good painkillers.  Why reach for the narcotics so quickly?  People complain about the cost of medicine, the flood of people into Emergency Rooms and the rise of pain pill addiction in this country.  This is where the cycle starts.

She is twenty-three years old and is already developing a tolerance along with what appears to be an addiction to her pain medication.  At twenty-six what is she going to have without some intervention?  The pain medication will simply be increased and expanded.  Maybe she’ll graduate to muscle relaxers along with narcotics.  Then eventually she will need a stool softener because narcotics slow your gastric motility.  Eventually she’ll probably need a laxative and then maybe develop a bowel obstruction which requires more surgery.  Surgery causes more pain which means more pain medication.  Which by the way her tolerance is now well developed and so she will need a lot more pain medication, deepening her addiction.  Other symptoms will develop as well such as lethargy, weakness and by the way her pain will still be there.  She will gain more weight because pain pills also have someone gain weight due to that reduction in gastric motility and the lethargy.  She might then gain diabetes, develop painful joints, etc. etc.  Now there are also the cardiac function problems as she goes up in age.  This is how pain was handled until recently.

You think you are being compassionate by giving her more pain medication, but I am the one looking out for her future and safeguarding her quality of life.  You want to give her a moment and I’m trying to protect her life.  Explain to me which of us is being compassionate.  People that “live” with their chronic pain accept that pain is part of their lives and many understand that pain medication is there to help, but not eliminate pain.  Most simply accept that activities will hurt and many strive to cut back on the contributing factors to their pain.  People with chronic pain need to know that their future can very well be what I described without proper management of their pain medication and without a comprehensive pain treatment plan.  The answer is not throw pills at her.

If you think that is cold than I am sorry you feel that way.  I would gladly do anything I could to give her relief, but not at the cost of her life.  We have had enough of that in the history of medicine.

The thing is her doctor wasn't doing the best thing for her. He explicitly got her in a contract where only him and his office could write her any pain subscriptions. Then did not bring this to her attention (ie they hid it). It shouldn't take a month to settle most of the effects of pain meds, especially when the patient is definitely telling you they -aren't- working, several times in the month.  And when she is sent to the ER by the doctor's secretary where she is going to be subscribed something, which put her in violation of the agreement she signed (and wasn't given a copy of, for shame doctors), which she hadn't even been made aware that could happen (remember they didn't tell her of that stipulation). And was subsequently kicked off the plan she had, leaving her without any doctors at all. 

She'd been in chronic pain for a month too. Something no one should be in.  I am sure you mean well, but your view of what's good for her isn't hers and I am sorry but this statement by you: 'Let's keep this in perspective, nobody is going to die from back pain. ' and the attitude you seem to be projecting is 'Suck it up and deal with it'. She hurts a lot now. You don't.  She has to have some pain meds to be able to function at all. Telling her to basically deal with it without some form of pain meds comes across as very cold and callous. The doctor is supposed to help her to function and from what she has said, he failed to rather badly.  And your list of reasons in the last part your post above to not give her more pain meds doesn't help how you come across as either. That makes you seem like you know how to run her life better than she does and that you'd rather have her suffer the pain than her might having the list of problems you list. Again I reiterate, what you might think is best for her isn't necessarily true, especially if you're not suffering the pain she says she is.


Pumpkin Seeds

There might be an issue of context here once more.  The medications being listed here, the OxyContin and Vicodin regiment proposed are given to people after knee and hip surgery.  Not simply after a broken bone, but after a physician has gone into the body and replaced a joint.  These are seriously painful procedures and these people are subjected to physical therapy, thus receive this sort of medication so that they can work those joints and prevent post-operative complications.  Having Norco 7.5 three times a day along with a NSAID three times a day, then claiming those do nothing because they aren’t enough should demonstrate that simply having more pain medication is not the answer.  That you hurt yourself in order to gain attention should also demonstrate the dangers of feeding what seems to be a growing addiction.  Pretty much every warning bell that can be rung regarding addiction to pain pills has been touched upon in just a few posts here. 

That is the problem you are not seeing here Zakharra is that continued pain medication can actually increase pain later.  The body stops producing endorphins and managing its own pain because the medication is telling the body there is no pain to manage.  Those receptors are going to require more and more medication to send those same signals, developing a tolerance to pain medication and to the body’s own ability to manage said pain.  As Raven develops a tolerance to the pain medication, she will feel more and more discomfort.  So increasing the pain medication is not treating her pain, only feeding a growing addiction.  Her pain will not get better with this course of treatment and so a stopping point has to be set and reached.  So the contract of no other pain medication is in her best interest as the pain management doctor is trying to balance her addiction with her pain requirements. 

As for your comment about doctors simply writing medication, this seems a little odd considering we are discussing a person that is begging for harmful drugs and her doctor that is trying to wean her from them while finding alternative sources of pain relief such as weight loss.  The very action of this doctor seems to counter your point.

Zakharra

Quote from: Pumpkin Seeds on September 30, 2014, 04:38:25 PM
There might be an issue of context here once more.  The medications being listed here, the OxyContin and Vicodin regiment proposed are given to people after knee and hip surgery.  Not simply after a broken bone, but after a physician has gone into the body and replaced a joint.  These are seriously painful procedures and these people are subjected to physical therapy, thus receive this sort of medication so that they can work those joints and prevent post-operative complications.  Having Norco 7.5 three times a day along with a NSAID three times a day, then claiming those do nothing because they aren’t enough should demonstrate that simply having more pain medication is not the answer.  That you hurt yourself in order to gain attention should also demonstrate the dangers of feeding what seems to be a growing addiction.  Pretty much every warning bell that can be rung regarding addiction to pain pills has been touched upon in just a few posts here. 

That is the problem you are not seeing here Zakharra is that continued pain medication can actually increase pain later.  The body stops producing endorphins and managing its own pain because the medication is telling the body there is no pain to manage.  Those receptors are going to require more and more medication to send those same signals, developing a tolerance to pain medication and to the body’s own ability to manage said pain.  As Raven develops a tolerance to the pain medication, she will feel more and more discomfort.  So increasing the pain medication is not treating her pain, only feeding a growing addiction.  Her pain will not get better with this course of treatment and so a stopping point has to be set and reached.  So the contract of no other pain medication is in her best interest as the pain management doctor is trying to balance her addiction with her pain requirements. 

As for your comment about doctors simply writing medication, this seems a little odd considering we are discussing a person that is begging for harmful drugs and her doctor that is trying to wean her from them while finding alternative sources of pain relief such as weight loss.  The very action of this doctor seems to counter your point.

She specifically pointed out that her PM doctor had her sign a contract, then specifically didn't inform her that only he was allowed to subscribe her pain medications and also did not give her a copy of it, two things he damned well should have done.

Also from what it sounds like, she cannot function without some pain meds because the pain is too much. It's nice to say that people can have their pain meds reduced to nothing or something like that, but some pains cannot be controlled without medication. some people with crippling injuries need those medications just to function somewhat normally. The OP sounds like such a person you might not intend to mean it that way, but your attitude is coming across very much as 'get off the meds and suck it up. If it hurts, too bad' That's not a healthy attitude to have. If she requires meds, then it's the doctors responsibility to find the best medications possible with the least amount of side effects. if she has to have them, she has to have them, end of story (and I'm not talking about addicts and people like that, just the idea that some people, despite what you are saying NEED their meds to be able to function.)

Kuroneko

Just to interject another experience with chronic pain and pain speciallists...

I have chronic pain from fibromyalgia and back and neck injuries from two severe car accidents. I've lived with chronic pain since I was teenager. I also see a pain specialist as well as a rheumatologist and an occupational therapy doctor. I have a narcotic prescription, but it takes me about 3 years to go through 30 pills because when my body gets into a pain loop that no other method or medication can break, I'll take half a vicodin and that breaks the pain reflex arc and it resets everything. Then I'm good until the next severe flare. I've never been treated like a pill seeker by any of my doctors because they know how I use the medication. It's an important part of my chronic pain toolkit, but it's a last resort kind of tool. I also have Voltaren gel, lidocaine patches, massage, acupuncture, exercise, meditation, guided imagery, breathing, herbs, supplements and an alkaline, anti-inflammatory diet in that kit to help my pain and to help me cope. But I agree with Pumpkin; narcotics are the big guns of pain management. My pain doctor doesn't want me using them every day for all the reasons she mentioned, and I don't want to either. For one thing, vicodin gives me migraines  :-\

Raven, I've never had to sign a contract of any kind with my pain specialist that he and he alone will be the one to prescribe any pain medication, muscle relaxers or what have you for my conditions. I've never heard of that before. I don't know if that's a legal requirement in your state, or just a preference of your particular doctor, but I would check on that. And if I were you, I'd look for a different doctor too. It's important to find one that you can trust and discuss your concerns with openly and feel comfortable with as you develop a pain treatment plan, and that may not be the first one you go to. It doesn't sound like you current one is a good fit. Yes, it may be true that you're going to have to learn to live with a degree of pain in your life. I've certainly had to. But most of the time, even though I'm going through a particularly rough spot with it at the moment, I have pain, it doesn't have me. It doesn't define who I am.

In the meantime, you need to find a doctor that will do the tests you need to find out what's causing all this acute pain and who will refer you to the specialists you need to help you learn to cope with and live with it.  Maybe, if you can find a Naturopath in your area you might have better luck. Most of my main doctors are D.O.'s (Doctor's of Osteopathy) rather than M.D.'s, and that seems to make a difference. My heart goes out to you, and I hope you find the healing partners you deserve in the medical field to help you.

As a last note, for me, the Voltaren gel is incredibly effective. Maybe it's something you could ask your doctor about?
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Obsidian Isolabella

Okay, I really feel like what I've stated has now gone and turned into something else entirely.

Pumpkin, I have repeatedly said a few times in this thread now, I do not want pain medication for the rest of my life.

It has been touched upon a lot that I need to get this +100 lbs of excess weight off of my body because it is the biggest thing causing my back problems to be so severe. I have DDD (degenerative disc disease) and the SI joint dysfunction and the added weight on both of those is causing almost all of this pain. The conditions themselves shouldn't be that far along to cause severe pain if I lose the weight.

My problem with what has been going on with the doctors:
My PM doctor knew that my pain was getting worse. I didn't necessarily want to be on a heavier dosage of Vicodin, but I did need something a little stronger to get through the pain. Pain medication is supposed to be faster acting than NSAIDs or anti-inflammatories. The anti-inflammatories and NSAIDs can work relatively quickly, but the pain meds help with dulling it quicker. I was in the hospital after cutting up my back because of my PM not listening to me about my pain levels rising and the level of medicine not being enough. I only did that due to the sleeping medicine I was on and not going to bed immediately like I normally did.

I understand that I'll always have a level of pain to deal with from these conditions as they continue to get worse as time goes on. I'm not saying that this is like a small backache and whining that I can't deal with that level of pain. That would be rather ridiculous. But, your attitude towards what I'm saying is actually proving my point that the world of medicine and healthcare has progressively gotten worse. The pain in my back without pain medicine AND combined with the anti-inflammatory medicines is unbearable at a certain point. I will literally start shaking from the pain and have to BEND forward in order to alleviate the pain. THAT kind of pain? Isn't normal. I have been in school for a medical field career and I have learned enough about body parts that I know that kind of pain is not normal.

At this point? I don't want to see another pain management doctor. I would rather see a Ortho doctor who is going to help me alleviate this unbearable kind of pain long enough to help me start losing some of this weight and getting into an exercise routine that will help get the pain eased. If THAT is considered addiction then I feel sorry for others who are likely in the same position as me.

That pain management doctor needs to have his license revoked. He did not follow proper medical procedures that I have found by the laws of my state demand he follow. I've now complained to the patient's advocate manager at the hospital where he works because I know damn well that he wasn't doing his job properly. And even SHE told me that he wasn't following the laws that he was supposed to.

He was obligated to give me a copy of that contract that he made me sign. I was also supposed to be talked to about the entire contract and what it said as well as given a copy. I was asked to sign it and told by the nurse, and not someone in that office who handles the contracts as was supposed to be done I found out in July when I was released, and he was supposed to be managing my pain if it got worse. When I was in the hospital for messing up my back I spoke to a therapist who also used to be a pain management doctor and even that man said that my pain management doctor was OBLIGATED to see me immediately if the pain continued to progress and to treat it. He informed me that the pain management doctor is legally allowed to prescribe controlled substances and that he is not prohibited from prescribing more than one narcotic per patient.

I am not an addict. I have a problem that is only going to continue to get worse because of people who view me as an addict when I physically need a pain medicine to help ease the pain so that I can function normally to get this weight off. And that is why I think the medical field is slowly going downhill because doctors no longer seem to really care about what a patient is going through. They have become very narrow minded and instead of taking care of problems health wise in the proper way I've seen nothing but overly cautious doctors who ought to have their licenses removed.

There are many times and circumstances that conservative treating methods should be used. But, when the conservative methods don't work, and the patient is in such pain it affects their life and the ability to function normally? Then it is obvious that other methods need to be taken in order to help ease the immediate symptoms or pain and work on a long-term plan to get the issue fixed. This is where I have a problem with the doctors I've seen lately. They act like they are blind, dumb, and deaf to what I say to them about what hasn't worked.

And now, my primary care doctor is now treating my insomnia differently ONLY because of pain management releasing me. He was treating me with a sleeping medicine that actually works for me. And he already knows that anti-anxiety and anti-depressants do not help me sleep. But, because of the pain management doctor releasing me, he refuses to treat a condition that had nothing to do with pain management or what they were treating me for, and has actually caused me to develop more health problems because of that. I would not have had that panic/anxiety attack if I had the sleep medicine which works for me.

I don't understand how what I'm saying is being taken as an addiction problem. I'm not in an emergency room or doctors office every night asking for medicine. I don't go to the streets, or purchase illegally obtained medications and I don't go trying to get other substances as substitutes.

What I would like to know, Pumpkin, is how what I'm saying be turned into signs of addiction when I've clearly stated that I only would like to be on pain medication for a couple of months so that I can get in the routine of an exercise program or whatnot and start getting my weight off. How is that a sign of addiction? I actually think that it is a rather wise plan of action since it helps me more in the long-run as well as in the immediate present/future. I do not even want to see another pain management doctor because I don't want to be on pain medicine for a long time. I don't want to build a tolerance to the medicine because when I need them in the future, like surgeries or whatnot, they won't help.

So, with all of that re-stated again, how do I appear or sound as though I'm addict?

Sho

By the way, Raven, since you've said one of your priorities is taking off the 100 or so pounds adding stress on your joints, have you considered swimming? It can be a bit of a pain to find a pool, but it shouldn't cause you any real pain to use it. It's low-to-no-impact exercise.

Also, have you tried spinal numbing shots?

I'm surprised that your doctor has an exclusive contract, though. I suppose the only lesson to take from it is to very carefully read every line of a contract before you sign it in the future.

But yeah - you should try swimming as well as resistance bands. They at least will allow you to address the weight issue. Hope that helps.