A little funny, follow up about DF (long) okay when are they not?

Discussion in 'The Watercooler' started by Star*, Feb 25, 2010.

  1. Star*

    Star* call 911........call 911

    Hi Family,

    Some of you may remember me posting about DF's pain management doctor telling him a couple of months ago that he would no longer prescribe Methadone for pain. I posted it here and once again I got great advice. Thank you so much Susie* for the phone call, and Timer for the phone call, and Janet for the phone call. You ladies are too kind, and very knowledgeable.

    DF's story has been long, hard, painful and stressful on us both. Botched surgeries (5) and then the neurosurgeons wanting him to attempt physical therapy without pain medications for years, then trial this medication and that medication? It's left us pretty broke, and at the end of our rope. We've been together 11 years without an argument between us, and very few disagreements. However put him on the wrong medication, and I'm moving out. I've been there done that to the extreme, and I'm no nurse, nor do I play one in real life. At ALL. -Remember me? The one that threw ice cubes i hand picked out of the koolaid down the hall?

    So when the PMD (Pain management Dr.) said "No more methadone." After checking, I found out you should NEVER come off Methadone cold-turkey. But this is well-respected PMD and he said "No big deal." I was gobsmacked. He didn't want DF to TAKE methadone because of some 'supposed class action law suit involving heart attacks." Timer checked - NOPE. Janet checked - NOPE. Susie* checked-NOPE. Wow - Three corners of the world - NO CLASS ACTION LAW SUITE. I called the FDA. Nope....no class action law suite. PMD? Liar. Or he's being sued privately.

    Then we trialed the first Morphine? WAAAAAHHHH OMG....I am leaving on a jet plane. When did Mr. Hyde arrive? Whooooooo. I've spent the better 1/2 of the last 3 weeks playing "Lets avoid the crabby fiance." WOW. If I didn't have some pain patches from heaven? OMG he would have never survived. (He's nearly covered in them now)-no not really. Would have loved to have put one over his .....mouth. -yes really. So I asked him if this is how it was going to be, and what other options PMD offered. (Was there a ticket involved in it for me to go to New Zeland?)

    PMD only offered a different kind of morphine (FOR ME? hahah - he didn't laugh, then again I didn't either) and then said DF could seek another doctor. So DF left, got a new prescription and came home. I BELIEVE I was in the bedroom when DF burst through the door and I announced that his NEW medication was not working either, I was going to call PMD and give him a piece of my mind, and that in 11 years we've never had an argument, but WOW was he a SOB. He needed to get the name of that new DR. that would prescribe what we knew after trialing 15 medications over 8 years - WORKED. I wasn't going through this again, and that him and that bloody dog of his could just pack a bag and go bite someone, somewhere else.

    So I left, and had no clue he called the PMD's office. He got the referral to the new doctor. He went yesterday and the new doctor looks like (If you watch Bones?) Gordon-Gordon. He ALSO has a personality and spent 30 minutes talking to DF and even let loose a few yucks. In 9 years? The other PMD has rarely spoken to DF. He sat DF down, and chuckled and said - "Did you really call PMD's office and say (and I quote) "I think you had better get me that referral today, My fiance and I have always gotten along...and today she told me this stuff makes me a REAL SOB and that me and the bloody dog can pack a bag and go bite someone. - that's about as strong as it's ever gotten in 11 years."

    DF chuckled and said "Yes, I did." and new PMD said "An SOB huh?" then he laughed and added "You and the bloody dog? What kind of dog?" Then they both laughed. DF added "This has all been so hard on her, and she's a wonderful woman." I thought that was nice - at least I didn't sound like a banshee.

    Good news is? He's back on Methadone, and out of pain again, and back to himself as it were. The BAD news is? That the old PMD is going to get a call from the new PMD because for TWO months DF has suffered through Morphine Sulfate - okay doesn't sound SO bad does it? Well the dose? 12% of what the methadone dose he was on. Nearly 1/4 of the pain medication. OMG no WONDER he was so crabby.

    So anyway - just wanted to say thanks for all the help, post replies, and support and knowledge, and calls. It really helped to know you had our "back" -snort.....get it? hahaha. (soooooo clever)

  2. Shari

    Shari IsItFridayYet?

    I'm glad to know our friend Star* won't be cuffed and stuffed in the near future for suspected murder of her missing DF....
  3. DammitJanet

    DammitJanet Well-Known Member Staff Member

    See...thats what kills me. Docs can change pain medications if they dose them correctly. Go from medication 1 to medication 2 but only if the dosages equate! You sure wouldnt put someone taking tylenol on morphine and you wouldnt put someone taking morphine straight back on tylenol!
  4. gcvmom

    gcvmom Here we go again!

    And they lived happily ever after. :couple:

    Or, better living through chemistry. :doctor:
  5. crazymama30

    crazymama30 Active Member

    I can so sympathize. husband's pain has been bad lately, his pmd is trying some different stuff, so far so good. Now if the **^&^ BiPolar (BP) would cooperate. If it is not one thing flaring it is another with him.

    I am glad you like df again.
  6. ML

    ML Guest

    I am soo relieved to hear that he's *back*. I'm proud of him for going to a new doctor and that he was motivated by his concern for your relationship. This guy is a keeper!
  7. Lothlorien

    Lothlorien Active Member Staff Member

    Wow, what an donkey's patoot that doctor is, huh?
    Maybe he's a candidate for the poopsenders! Haha

    Seriously, glad to hear that things are back to as normal as normal can be in the Star household.
  8. totoro

    totoro Mom? What's a GFG?

    I thought the birds were singing a little louder and acting a bit more chipper!
    There could never be another DF and Star* combo, we would have had to possibly intercede.
    In all honesty I am so happy that DF is "back" to his loving self.
  9. KTMom91

    KTMom91 Well-Known Member

    Glad to hear DF got his referral, and that life is beautiful once again!
  10. gcvmom

    gcvmom Here we go again!

    I just cleaned out the coop today... PLENTY of material for sending! :bigsmile:
  11. 'Chelle

    'Chelle Active Member

    ummmmmmmmm wouldn't this have been more pain medication for you? I know it's one I wish I could get rx'd for my husband :rofl:

    Glad to hear that the new doctor seems a good fit and your DF has gotten the pain relief he needs.
  12. judi

    judi Active Member

    As a prescriber, you do have to be careful with chronic narcotic use. Here is one article from the Institute on Safe Medicine Practices:


    From Medscape:

    10 Steps of Universal Precautions in Pain Medicine
    1.Diagnosis. Identify causes of chronic pain through appropriate imaging, electromyography, and other testing. Identifying the pathophysiology for the pain supports the use of opiate therapy.

    2.Psychological assessment, including risk of addictive disorders. Assess for depression, as some patients tend to cope with depression or anxiety by using opiates. Nontreatment of depression makes it very difficult to obtain adequate pain relief. Screen for patient/family history of any substance abuse. This does not rule out chronic opiate therapy, but does raise the level of risk and may indicate need for referral to a pain/addiction specialist.

    3.Informed consent. Discuss the risks and benefits of chronic opiate therapy, including side effects and risk of addiction. There is also a risk that the pain may not respond to the opiates, and they may need to be discontinued if pain and function does not improve. Patient and provider should sign an agreement that specifically addresses these points prior to starting opiate therapy.

    4.Treatment agreement. Also called a narcotic contract, this specifies the conditions under which opiate therapy will be continued or discontinued. Typically, the patient agrees to obtain prescriptions for opiates through one provider, take only the prescribed amount, undergo random urine drug testing, and abstain from use of illicit substances or alcohol with the prescribed drug. Both the patient and the provider should retain a copy of the agreement.

    5.Pre and post intervention assessment of pain level and function. Document pain scores and level of function at baseline before opiates are started. A set of simple questions such as "Are you able to complete your job duties/household chores/self care activities?" can be rated on a 1 to 10 scale and reassessed during treatment, along with a pain score, to support continuation of therapy with improved function.

    6.Appropriate trial of opioid therapy with or without adjunctive medication. Antidepressants, muscle relaxants, neuropathic medications, and anti-inflammatory medications can improve the response to opioids. Titrate the opiate dose to obtain pain relief and minimize side effects. If there is no improvement in pain and function, the medication should be titrated back down and discontinued.

    7.Reassessment of pain score and level of function. This should be completed at each visit and used as the basis for continuation or adjustment of therapy.

    8.Regularly assess the "4 As" of pain medicine. Routine assessment of Analgesia, Activity, Adverse effects, and Aberrant behaviors will support the current therapy and alert the provider to problems with medication use. Aberrant behaviors range from low risk (associated with inadequate pain relief) to high risk (more associated with substance abuse) ( Table 1 ).[7]

    I can't cite the URL unless you join but if you are a member of Medscape - its easy to find.

    Chronic use of methadone can also cause prolonged Q-T which can lead to sudden death:

    QTc prolongation: [U.S. Boxed Warning]: May prolong the QTc interval and increase risk for torsade de pointes. Patients should be informed of the potential arrhythmia risk, evaluated for any history of structural heart disease, arrhythmia, syncope, and for existence of potential drug interactions including drugs that possess QTc interval-prolonging properties, promote hypokalemia, hypomagnesemia, or hypocalcemia, or reduce elimination of methadone (eg, CYP3A4 inhibitors). Obtain baseline ECG for all patients and risk stratify according to QTc interval (see Monitoring Parameters). Use with caution in patients at risk for QTc prolongation, with medications known to prolong the QTc interval, promote electrolyte depletion, or inhibit CYP3A4, or history of conduction abnormalities. QTc interval prolongation and torsade de pointes may be associated with doses >100 mg/day, but have also been observed with lower doses.

    These are all from reputable websites.

    And...I'll be honest, I am tasked by the DEA to document, document, document and cont to document attempts to wean, change to a different medication, offer PT/Occupational Therapist (OT), etc..
  13. DammitJanet

    DammitJanet Well-Known Member Staff Member

    Judi, those are all reasons that in late 2004 when my pain began to get remarkably better after both a hysterectomy and one knee scoped, I approached my doctor and told him that I wanted to try reducing from 10 mg oxycontin bid to 45 percocet prn per month. I also made them notate the chart that this was completely per patient request. LOL. At first I had a hard time getting them to do my wishes. First they thought I wanted to increase medications to oxycontin plus percocet. NO...only percocet. Then they had trouble with the idea anyone wanted to reduce pain medications. Well...I did.

    Then I didnt like the percocets and decided to go down to lorcets. Those work better for me so I have 90 of them I can use a month...again...prn. Of course, my doctor trusts me. If and when I need to work back up, he will be there for me. Obviously if I wanted to be abusing the things I wouldnt have gone off the stronger ones.

    I also have done the PT/Occupational Therapist (OT) and I do cortisone shots and those gel shots in my knees.
  14. judi

    judi Active Member

    I don't wnt to come off that I don't believe that narcotics have a place in pain management. That isn't the case. Its just that prescribers are being forced into so much documentation by the DEA that many of us are leery.
  15. Marguerite

    Marguerite Active Member

    We have a lot of paperwork hoops to jump through here in Australia too, Judi. But if patients need it, and if they are functioning on it, the paperwork warfare is worth it. Well and truly.

    Star, he may well have been OK on morphine, if the dose had been right. That pain doctor sounds like he's more concerned for the paperwork, than for his patient's welfare. He really needs to be in touch and to talk to the patient, to stay on top of the pain. You DO NOT let chronic pain get out of hand.

    I haven't really taken methadone. I have been given pethidine in emergencies, but my current drug of choice (for long-term management) is morphine. Over the years since I began taking morphine, I've had a few specialists try to heroically get me off the morphine, in the mistaken belief that it is bad for me. OK, it would be ideal if I didn't need it, but I need SOME level of pain management and the alternatives are actually a lot less healthy. The last "genius" to try and "get me off morphine" thought prednisone long-term would be better. Idiot!

    I'm fortunate to have a good pain specialist. The way it works here in Australia, is the pain specialist has to be part of a team and it all filters through the GP. The paper trail means every prescription is organised through the government and health department. The GP is not permitted to prescribe unless the pain specialist has already filled in the paperwork.

    Pain isn't something to muck around with. Trying to change one pill for another, requires supervision regardless of what sort of pill it is. When it's strong pain medications, you don't mess around with it. I'm appalled he was on the wrong dose of morphine. That is just so wrong on so many levels.

    And now, after the doctor has been through all the fun and games and DF is back on his methadone - what was achieved by all this?

    Flamin' drongo.

  16. Star*

    Star* call 911........call 911

    Judi -

    I believe you are ABSOLUTELY correct. Sorry it took so long to get back to you (Been playing in the snow, dealing with Dude et al) okay - so here's the thing in a nutshell. When he was IN pain for years? This PMD took his good old time about helping us at all. We spent countless nights without sleep,countless nights at the ER and I mean countless -even the nurses are like OMG when they open his file to the point that when he would go to the ER seeking help - it was almost like a drug addict seeking behavior. The screams, contortions,fits, tears, falling to the floor, blood pressure said otherwise - you can't fake BiPolar (BP).

    So eventually the ER doctor contacted the PMD and said "Hey look, this guy has been here at least 2x a week every other week and I'm curious why you have him on Vicodin" , or whatever the cocktail o' the day was. The PMD's standard answer was that DF walks like a biker, looks like a biker, and must be a biker with drug seeking behavior. In other words if DF had cut his hair, worn a pair of khaki trousers, a long sleve dress shirt, Bass boat shoes and had the same pain? He'd have been given scads of pain medications years earlier. ER docs words not ours. We were furious.

    So DF had a talk with PMD. They agreed to start Oxycodone with a stipulation - urine tests. DF assured PMD that he was NOT, is NOT and is not seeking drugs other than for pain management - so the PMD agreed finally. Oxycodone was a nightmare. HE slept, he ate, he slept, he ate - he was a mean, mouthy, opinionated person and as I read the potential side effects of this drug? I was scared for the what if's. Moreso than I am with methadone. Then genius that the PMD is? He offered to put him on Gabapentin. I looked it up and was just as confused as ever - YES - Gabapentin.
    From there we said UM no.....There have been trials of about twenty medications before the Oxycodone - Tylox was one of them that if they ever give to him again? I'll leave. It makes DF (my avatar x 10) and I won't be around to see if it happens again.

    So when the doctor worked his way up to Methadone after nearly seven years of trials and pain, ER visits, OUR quality of life being in the toilet, our savings depleted, our home? Well what's left of it - falling down around us completely - and nothing has been repaired to the point of embarrassment beyond explanation? (You just can't even imagine) He finally agreed to Methadone. Low dose at first. Within a week? He had relief for the first time in almost seven years. Manageable pain - see they botched his surgery, he got a MRSA at the hospital - and due to that? He had to have all his teeth pulled without anesthesia (27) it's just been horrible- we had nurses at our house for three months every day. He has adhesions too. He's gained weight - he's depressed. It's been the toughest to watch him go downhill not being able to do almost anything and not feel like he's contributing.

    So when they said Morphine? He said - Well...I'll try it. But this guy just did Methadone today - and Morphine tomorrow but nearly 1/12th the strength less. BIG no no. Even the new PMD said - this is not good. He's questioning the practice of the old PMD. We're not suing - we're not writing the medical board or anything like that - we're just upset that he's been treated like dirt for years. The new doctor isn't giving him the full prescription of Methadone either (I'm glad) he's 1/2ing it. He said he'll see since he's been off of the full strength for 2 months if he can manage. I'm okay with that. DF is in pain again - but we're hoping it's 'residual' or what the PMD calls 'ghost' pain. (I get what he's saying I think.)

    I don't know what would have been better. Actually I do, for them to have done the surgery right to begin with. For the hospital to have been clean and for the nurses to have not allowed a surgery patient to sit in a filthy room in his own throw up for 8 hours to being with. Maybe in other states it's a little more up to date but here in SC it's been nothing but horror stories. He needs 2 knee replacements and we won't have them done here.

    Your knowledge is appreciated and incredible. I do worry - I'm just not sure what else there is out there he could take that would eliminate or lessen the pain and not harm him. Neither does he. We're open for suggestions though. Anything but Methadone would be welcome. If you can think of anything let us know. We're open to suggestions all the time. Really really -

    Thanks a bunch a bunch a bunch...I'm really impressed with your knowledge...keep it coming because you never know when you will have something that I need, or someone else does. Weighing all options is good.

    Hugs & Love
  17. Star*

    Star* call 911........call 911

    Marg -

    Flaming WHAT? Lol

  18. Marguerite

    Marguerite Active Member

    "Index of Australian words".

    Share this one with DF. although it is an insult, it is not as publicly offensive as many other insults. We use Hansard as a guide (although some words used in Hansard are banned on this site). Hansard is the daily transcript of what is said in our national parliament by our Illustrious Leaders. If it's good enough for the PM to say it (and a couple of PMs ago, Paul Keating, was very free with some choice words, he was a bully) then we are permitted to use the words in general usage as publicly deemed to not be offensive.

    I think.

    Here is the definition from "Index of Australian Words".