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  #1  
Old 06-23-2011, 10:03 PM
The Real Regency Elf The Real Regency Elf is offline
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MD won't write scrip until I get my annual exam - common behavior

Recent history: I have discovered that 5mg of Ambien taken with 3mg of Melatonin and 530mg of Valerian Root helps me fall asleep much faster than any other sleep medication I've tried. I have never had odd behaviors while on Ambien. It just makes me sleepy. I have been taking this combination of OTC and prescription dosages for over two months with only one sleepless night so far (anxiety over possibly losing my job; job is now safe).

The last time I spoke to my doctor about my sleep problems, she said she would give me one refill of Ambien and then nothing more until I got my annual Well Woman exam at her clinic. I should add that I'm 42, and in excellent reproductive health. It feels to me like the doctor is holding my Ambien hostage so I'll be a good little patient and submit to the speculum. I already have a gynecologist in the next town over who I'm seeing in August. I was seeing the first doctor solely for regular physicals and the sleep issue.

All I want is reliable access to 5mg of Ambien a night, not even every night, but when I need it most. BTW I have no history of addiction or drug problems of any kind, so I don't think that's the issue here. I just want to freakin' sleep like a halfway normal person and not have to "earn" this medicine that helps. 40+ years of insomnia...I'd say I've paid my dues.

So is my situation a common one at all? What's the best way to respond? I'm not even sure just how ethical her request is, but for now I'm staying neutral and looking for advice. Thanks for any wisdom you have to impart.

Last edited by The Real Regency Elf; 06-23-2011 at 10:04 PM..
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  #2  
Old 06-23-2011, 10:15 PM
IvoryTowerDenizen IvoryTowerDenizen is offline
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Yes. In my experience doctors are very reluctant to keep refilling Rxs without a yearly exam.
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  #3  
Old 06-23-2011, 10:18 PM
Alice The Goon Alice The Goon is offline
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If usage of this drug didn't require monitoring, it would be over the counter.
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  #4  
Old 06-23-2011, 10:19 PM
SnakesCatLady SnakesCatLady is offline
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Sounds like the doctor is a jerk. I'm glad my doctor isn't holding my sleep meds hostage to an exam.
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Old 06-23-2011, 10:19 PM
Markxxx Markxxx is offline
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I agree, it's normal. I can't even get a rescue inhaler for asthma. Or a refill on high blood pressure med much less Ambien.

Last edited by Markxxx; 06-23-2011 at 10:20 PM..
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  #6  
Old 06-23-2011, 10:27 PM
SnakesCatLady SnakesCatLady is offline
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Guys, did you read the OP? The doctor is withholding sleep medication until the OP gets a GYN exam. That has nothing whatsoever to do with monitoring usage of sleep aids.
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Old 06-23-2011, 10:32 PM
IvoryTowerDenizen IvoryTowerDenizen is offline
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Yes, I read the OP. Some women get their annual physical by their GYNs. If that's the doc prescribing the Rx, then that's the doc responsible for monitoring its usage. She can get the Rx switched to a general practitioner or internist if she wants and avoid a gyn exam all together. This is what doctors do- they don't keep writing refills year after year without checking in.

Last edited by IvoryTowerDenizen; 06-23-2011 at 10:34 PM..
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  #8  
Old 06-23-2011, 10:34 PM
Obsidian Obsidian is offline
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I'd tell her you have your own gyno, and that you're seeing her/him in for your annual in August. Say you're happy to come in for a regular Dr. visit re: the ambien, or some sort of physical. . . but your insurance company only pays for one annual a year, and you'd like it with your own gyno.

I have had my doc want me to come in for a check-- for the issue for which the medication in prescribed. I've never had one demand I get a gynecological exam for non gynecological medications. They shouldn't be related.

ETA: BTW, If you're over thirty, and your last 3 paps were normal, the guidelines are every 3 years now.

Last edited by Obsidian; 06-23-2011 at 10:36 PM..
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  #9  
Old 06-23-2011, 10:51 PM
Joey P Joey P is offline
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Originally Posted by SnakesCatLady View Post
Sounds like the doctor is a jerk. I'm glad my doctor isn't holding my sleep meds hostage to an exam.
The doc isn't holding the meds hostage, she gave the OP two months worth and said she could have a new script as soon as she comes in. If the OP ran out because she didn't find some time in the last 60 days to make an appointment for calling the docs bluff that's her own fault.
I learned this the hard way as well with my inhalers.
This is VERY common.

OTOH, one of the reasons I switched from my last doc is because the last time I needed a refill on my inhaler he said he wanted to see me first. Fair enough, I haven't been in for a few years. I made an appointment, took half a day off work, sat in the waiting room, got called back, waited some more, the doc showed up and said "So, what can I do for you?" I told him I needed a refill on my Albuterol but he said that he wanted to see me first. He wrote the script, handed to me and that was it. That really bugged me. Didn't ask any questions, didn't listen to my chest, nothing. I mean, even if we assume he wasn't just doing for the money, you'd think he'd want to put something in his chart that said my lungs sounded clear or that I wasn't coughing etc.
Also, WRT to the OP. The time before that, when I had to call for a refill, they told me that I would need to stop in before I could get another one and they kept that promise.


Okay, I've re-read the OP. My suggestion, if I'm reading everything correctly. Would you be willing to use your normal gyno as your GP (which is what I believe you are seeing the ambien doc for)? If you are, call your normal gyno, tell them you'd like to set up a well visit to coincide with your upcoming visit (assuming this is possible). If this works for them, you'd be coming on as a new patient. Since you've been with them for a while, upon receiving your file from your other doc, they may be willing to write you enough ambien to get you to your upcoming well visit/well woman visit.

If you want to leave well enough alone, I would just call them back and explain to them that you already have a gyno that you see on a regular basis and that you just see this doc as a GP. If you've already had a well visit this year let them know, if you haven't you could schedule it now, but see if, upon scheduling it, they'll refill the ambien to tide you over until then. It's entirely possible that, being a gyno office, the appointment manager just noticed that you hadn't had a well woman visit and tried to schedule you for that and it's nothing more then a mix up. They probably don't have many women that use the doctor as a GP only so it created some confusion.
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  #10  
Old 06-23-2011, 11:02 PM
Dangerosa Dangerosa is offline
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Originally Posted by The Real Regency Elf View Post
So is my situation a common one at all? What's the best way to respond? I'm not even sure just how ethical her request is, but for now I'm staying neutral and looking for advice. Thanks for any wisdom you have to impart.
Common

Make the appointment

Her request, very ethical. As a doctor, she needs to monitor you - as Alice said, if it didn't require monitoring, it would be OTC. If she isn't monitoring you and phoning in scripts, she is abusing her license and could potentially get into trouble.
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  #11  
Old 06-24-2011, 12:22 AM
CairoCarol CairoCarol is offline
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Originally Posted by The Real Regency Elf View Post
she said she would give me one refill of Ambien and then nothing more until I got my annual Well Woman exam at her clinic. (bolding mine)
If she really insists that you have your exam at a facility in which she has a financial interest, then yes, that seems unethical.

If she is willing to accept documentation from an outside practitioner ... well, I guess I personally would be slightly annoyed in your shoes, but I do see how it is within bounds and is presumably being done with your best interests at heart.
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  #12  
Old 06-24-2011, 12:54 AM
Jenaroph Jenaroph is offline
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Originally Posted by Dangerosa View Post
Common

Make the appointment

Her request, very ethical. As a doctor, she needs to monitor you - as Alice said, if it didn't require monitoring, it would be OTC. If she isn't monitoring you and phoning in scripts, she is abusing her license and could potentially get into trouble.
Again, did you read the OP? She won't get a scrip for a SLEEP AID until she gets a GYNECOLOGICAL exam. At that particular clinic. That sounds a bit off the wall to me. I'm agreeing with those saying to see if this doc will accept that you're seeing another gyno; if not, look elsewhere.
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  #13  
Old 06-24-2011, 01:47 AM
Hirka T'Bawa Hirka T'Bawa is offline
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Very very common. When working in pharmacy, I see a lot of times a doctor will call in a refill for a medication, and put a note on it that "no more refills until seen for doctor visit". If it has been awhile since you saw the doctor last, they will want to see you to monitor for the medication...

But, also to add, since this is an GYN prescribing a sleep aid (actually very common, a lot of women treat their OB/GYN as their PCP), the DEA has been cracking down on prescribers that prescribe a controlled substance (which Ambien is, Schedule IV) without having a "doctor/patient relationship", and have been revoking doctors DEA licenses. What is considered a valid "doctor/patient relationship" isn't set in stone, but is a lot of times considered seeing the patient at least once within a year.

So... If you have an appointment set up already, ask them to call in enough to last till the appointment, most doctor offices will do this. If you are going to a new doctor, have the new doctor call in the script before the appointment.

Also, be aware... This is a controlled substance you are talking about, so your pharmacy won't be able to loan you any, no matter how much you ask or beg. Work it out with your doctor before you run out.
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  #14  
Old 06-24-2011, 01:49 AM
Magiver Magiver is offline
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Originally Posted by IvoryTowerDenizen View Post
Yes. In my experience doctors are very reluctant to keep refilling Rxs without a yearly exam.
Yep. A year is a long time to write a prescription without an examination to verify that all is well.
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Old 06-24-2011, 01:59 AM
SeaDragonTattoo SeaDragonTattoo is offline
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To be clear: In order for a doctor to prescribe medication, they have to have an exam on record within the previous 12 months. Prescribing medication without an exam on record within the previous 12 months is grounds for them to lose their license to practice medicine, let alone their DEA license for controlled substances.

If you are using your GYN as your primary physician, and that GYN is practicing through a Women's Clinic, then of course a yearly GYN exam will go along with a regular wellness checkup. Or perhaps there's some other medication besides Ambien that the OP is taking, that would also require a yearly PAP rather than a 3-year, too.
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  #16  
Old 06-24-2011, 05:52 AM
Avarie537 Avarie537 is offline
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To be clear: In order for a doctor to prescribe medication, they have to have an exam on record within the previous 12 months. Prescribing medication without an exam on record within the previous 12 months is grounds for them to lose their license to practice medicine, let alone their DEA license for controlled substances.
This is even harder for dog/cat owners to understand! We recently had someone call wanting a refill of a prescription for a dog we hadn't seen in four years. It was "just an ear medication" but the very same restrictions apply for DVMs.
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  #17  
Old 06-24-2011, 06:50 AM
The Real Regency Elf The Real Regency Elf is offline
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OP checking in very quickly before going to work. Thank you everyone who took the time to read and respond. I have a much better understanding of what's going on now.

A bit more explanation to help clarify my initial uncertainty:
I moved to this area last year and found an Internist/GYN near my first job, got the annual physical/well woman exam in April '10. I also did a sleep study with a sleep specialist, who found that I did have insomnia but nothing physically wrong. Changed jobs and insurance plans in August '10. In Feb '11 I began having a choking feeling in my throat and worsened insomnia. I had several visits with this new GP who is close to my new job during late winter/early spring. GP gave me the Ambien and also sent me to an ENT doc to get my thyroid checked. Then my insurance co. began refusing to pay for my sleep-problem-related visits. I didn't know if it was a billing issue with the new GP's office, or BC/BS, but it threw a huge monkey wrench into the works. The GP's billing people...weren't helpful. Claimed to know nothing and refused to lift a finger to investigate. So JoeyP is right, I brought this on myself due to a lack of time, but not a lack of effort (or money!).

Long, dumb story short: I would much rather go to this new GYN who is also close to work. I *think* the GP will let me send in physical results and labwork from elsewhere so she can make a better judgment call on the Ambien. If she's not willing to do that, I'll speak to the GYN and failing that, the internist from last year who's a bazillion miles away from work.

Again, thank you so much, everyone, and hope I didn't come off too much like someone who's avoiding doing "the right thing" to get the sleep aid. I guess I still didn't appreciate just how controlled Ambien is - gosh, all it does is make me juuust drowsy enough to snooze! But nobody gets to be a special case in this matter. *grumble grumble*
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Old 06-24-2011, 07:02 AM
Dangerosa Dangerosa is offline
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Originally Posted by Jenaroph View Post
Again, did you read the OP? She won't get a scrip for a SLEEP AID until she gets a GYNECOLOGICAL exam. At that particular clinic. That sounds a bit off the wall to me. I'm agreeing with those saying to see if this doc will accept that you're seeing another gyno; if not, look elsewhere.
She needs a well woman exam. That's a physical that involves a gyn exam. My last two well woman exams didn't even involve a speculum (without a suspect pap smear, I guess I only need them every three years).

Women have other parts on them than their hoo has. If she wants a gyn exam from a gyn, she can get a general physical from her general physician and have the gyn records faxed. The GP may still want to do his own gyn exam (but probably not bother with a pap) or maybe not. Or she can ask her gyn to prescribe Ambian (mine referred me to a GP when those sorts of things became more common than 'birth control refills, infertility, and pregnancy - he was willing to treat insommia as a one time thing, but chronic complaints not involving my female bits were not up his alley), or she can drop the gyn and have her pap done by a GP.

It sounds like she recognizes this in her last post.
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  #19  
Old 06-24-2011, 07:07 AM
twickster twickster is offline
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Mod note

We're putting threads requesting medical advice and anecdotes in IMHO these days, so let me move this thither for you.

twickster, MPSIMS moderator
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  #20  
Old 06-24-2011, 07:28 AM
Eats_Crayons Eats_Crayons is offline
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It's common. Heck, even our veterinarian refused to re-prescribe my partner's dog his flea meds until he came in to get his yearly doggy physical. The time span between his last round of blood work and check-up had exceeded some time limit and they like to be sure they have current data before renewing any medication. I don't know their limit on "current." The dog is also on a long-term medication. The physical was required to make sure that he isn't getting any kind of liver damage or other issues from those meds that might cause problems with the flea meds.

I don't know about a "Well Woman" exam, but my annual physical by my family doctor includes the gyn exam and a general work-up to make sure I haven't developed any new health issues. The last time I had to go on any kind of medication for an extended period of time, I had to get a physical.
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  #21  
Old 06-24-2011, 11:10 AM
Mama Zappa Mama Zappa is offline
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Originally Posted by IvoryTowerDenizen View Post
Yes. In my experience doctors are very reluctant to keep refilling Rxs without a yearly exam.
Though I'm surprised at the doctor insisting on the GYN exam being part of the process - that's a bit odd. My primary care doc has certainly insisted on seeing me before redoing scrips - that just makes sense - but knows I see a Gyn in another practice and has zero problem with it.
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Old 06-24-2011, 11:18 AM
Mama Zappa Mama Zappa is offline
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Something interesting about Ambien scrips: It's a Schedule IV controlled substance in the US, and therefore scrips expire in 6 months. Ditto Sonata. So the doc might well insist on seeing you every 6ish months (though as schedule iv, apparently they *can* phone / fax in the scrips vs hardcopy which is required for some higher-schedule drugs).
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  #23  
Old 06-24-2011, 11:30 AM
Little Bird Little Bird is offline
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Just imagine the malpractice suit a person could file against a doctor who prescribed them medication for a couple years without doing a checkup--and then has a bad reaction due to some condition the doctor would have picked up in a checkup. Too much of medicine is now CYA for the doctors--I can't blame the doctors but it sucks to have the extra cost passed to us.
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Old 06-24-2011, 11:34 AM
MeanOldLady MeanOldLady is offline
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I had a doctor refuse to give me birth control until I got my lady exam. Fast forward a little over a year after I graduated but wasn't working so didn't have insurance, I went to Planned Parenthood and got birth control without all the fuss. They made sure I wasn't knocked up, then sent me on my way.
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Old 06-24-2011, 11:51 AM
booklover booklover is offline
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Hell, my doc's office is even more uptight...their rule is no refills if the doc hasn't seen you in the past 3 months. I recently encountered this when I ran out of refills on my levothyroxine, a medication I've been taking for more than 25 years.
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Old 06-24-2011, 01:07 PM
Qadgop the Mercotan Qadgop the Mercotan is online now
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As has already been noted by others:

Docs are obliged by law to not prescribe any med for over 12 months at a time, and follow-up visits are required, often by law, nearly always by regulation by the Medical Examining Board, and more and more often by health care systems, that an exam must occur yearly before a chronic medication is refilled, other than in emergency circumstances.

This is not the whim of an unreasonable physician. It makes for good patient care, too.
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Old 06-24-2011, 01:28 PM
IvoryTowerDenizen IvoryTowerDenizen is offline
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Originally Posted by Mama Zappa View Post
Though I'm surprised at the doctor insisting on the GYN exam being part of the process - that's a bit odd. My primary care doc has certainly insisted on seeing me before redoing scrips - that just makes sense - but knows I see a Gyn in another practice and has zero problem with it.
Well, to be fair, if you are using your gyn as a primary care doc, they are going to do what they specialize in, after all. Although all we know was that they wanted a "well woman" visit. I'm not sure it was confirmed that an internal exam was required.
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Old 06-25-2011, 03:19 AM
Lynn Bodoni Lynn Bodoni is offline
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Originally Posted by booklover View Post
Hell, my doc's office is even more uptight...their rule is no refills if the doc hasn't seen you in the past 3 months. I recently encountered this when I ran out of refills on my levothyroxine, a medication I've been taking for more than 25 years.
My doctor's office also has this policy. Annoyingly, though, they didn't TELL me that the reason the doctor wouldn't approve the refills was because I hadn't come in in the last quarter. If I called up the doctor's office and had a hissy fit, then I'd get my refill approved without having to make an appointment...so I didn't know that the doc wanted to see me every 3 months. How the hell was I supposed to know this if nobody told me?
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  #29  
Old 06-25-2011, 02:08 PM
The Real Regency Elf The Real Regency Elf is offline
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Lynn, yes, exactly! Mama Zappa mentioned a six-month rule for Ambien, but my doctors have been even more restrictive than that. The sleep specialist gave me only a two month prescription for it last year, and it took several phone calls after the pills ran out to find out that I was required to come back for a visit every 2-3 months (never did get a straight answer about the number of months). It appears to be the same thing with the GP I mentioned in my OP. And as the insurance company was charging me $150 per insomnia-related visit to the GP, I just couldn't afford to keep going back.

After thinking about this some more, I believe the reason the GP wanted me to come back for the GYN exam was so she could do the insomnia consultation at the same time. But because their billing department is so screwy, I'm not sure that I wouldn't have been hit with another big charge anyway. Repeat every three months for the rest of my life. Sigh. There has *got* to be a better way to do this.
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  #30  
Old 06-25-2011, 03:48 PM
Broomstick Broomstick is online now
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Well, you could have a talk to the doc about the scheduling and billing issues and how they're making compliance with his/her directives difficult.

Recently, my GP wanted to see me every three months, instead of once a year. I asked why. He said that I had reported more asthma symptoms and he wanted closer follow ups to determine if it was the start of something serious, or just a temporary increase due to cold air/stress/other transient problem. So that's what I did. Last check up he said I seemed to be back under proper and consistent control, see you in 8 months. 8 months? Yes, because I needed to get my annuals tests/screenings/etc done by end of November both for good practice and to keep the insurance company happy. OK... but that's September. Yes, but it generally takes 6 weeks to do all the subsequent scheduling of things like blood testing (which, due to insurance idiocy, I can't have done at his office, I have to go to a clinic across town) and mammogram and so forth. Oh, right. See you in September, doc.

Then again, my doc seems a bit more aware of insurance/Medicaid/Medicare insanity than most. Can't really fault him, the vast majority of his patient load are poor people with little or no insurance, crazy rules to live under, often intermittently employed when working at all, and often with chronic conditions. I have to deal with the insurance idiots myself, but he's been very good at communicating. I like to think I have, too. It does make things easier.

My spouse has more issues with Rx's running out than I do - and given he has diabetes (along with a couple other less immediately dire problems) that's a serious issue. Yes, sometimes he winds up having to make an extra appointment in order to take care of these things - as it happens, our insurance doesn't charge him for the office visits so we are VERY lucky! (By some miracle, whoever set it up actually understands the concept "preventive care".) But we've had all kinds of craziness with neither the doc nor the pharmacy knowing what Rx's are covered sometimes, sudden discontinuation of coverage which requires a visit to the doc before an alternative can be prescribed, phone calls to the insurance company, faxes to the pharmacy.

Really, it's not always the doctor's fault. If you are going to be taking an Rx for the rest of your life, or at least the foreseeable future, you will run into this. I'd suggest when you see the doc to ask what the rules are for being prescribed Ambien, frequency of follow-up visits, and schedule those visits for before you run out. Yes, it would suck if you have to pay extra for additional visit(s). With some planning maybe you can avoid that.
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Old 06-25-2011, 10:28 PM
BigT BigT is offline
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You're lucky, My doc does the 3 months thing. And, no, I don't buy that he'll get in trouble, as I'm the only person who would tell, and not only has he known me for all but two months of my life, but, if I told on him, I wouldn't get my medication. And, while it isn't scheduled, my life is hell without it.

Heck, I'm going to try to bargain this time for six months, if I can get up the nerve. I would love to have your doctor, OP. In fact, if I can get any citations about the requirement being only within the year, I would greatly appreciate it.
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  #32  
Old 06-26-2011, 02:47 AM
PandaBear77 PandaBear77 is offline
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Originally Posted by The Real Regency Elf View Post
In Feb '11 I began having a choking feeling in my throat and worsened insomnia.
IANAD.

Mr. Panda, 'bout a year or so ago, started getting a choking feeling in his throat, particularly when he laid down to sleep, which would also trigger a nagging cough. It wasn't one of those deep, rib-cracking coughs -- it was just cough-y enough to be annoying as hell ... which of course screwed with his sleep.

Turns out the symptoms he had are very common side effects of Lisinopril, the hypertension med he was on at the time.

Just throwing it out there, just in case.

***

As far as your situation, I think it may vary from state to state. When I lived in WV I had to see my shrink every 3 months to get my Adderall script. ("Hi, how are you, are you suicidal? Hearing voices? No? Ok, hereya go, seeya in 3 months.") I live in another state now and my GP prescribes it and only has to see me once a year.
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  #33  
Old 06-26-2011, 10:32 AM
Jackmannii Jackmannii is offline
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I love the "MD won't write scrip" from the thread title.

There's a memorable section of one of William Burroughs' books where he talks about how he and fellow addicts value finding "a croaker who'll write scrip" (in this instance, for opiates like morphine).* This has become a commonly used phrase in our household to refer to docs who readily write for prescription refills in general).

While recognizing the need for patient monitoring, a croaker who'll write scrip is a valuable find.

*not suggesting that Ambien and morphine are in the same class, of course.
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  #34  
Old 06-26-2011, 10:35 AM
IvoryTowerDenizen IvoryTowerDenizen is offline
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I'm on lisinopril and I've had the choking feeling occasionally and I had no idea what it was!

Thank you!
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Old 06-26-2011, 10:41 AM
Qadgop the Mercotan Qadgop the Mercotan is online now
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I'm on lisinopril and I've had the choking feeling occasionally and I had no idea what it was!

Thank you!
Yeah, Lisinopril and the other "pril" meds (ACE, or Angiotensin converting enzyme inhibitors) do cause a histamine buildup, so a dry cough, head congestion, scratchy throat and other symptoms of too much mast cell degranulation can occur.

If one really needs the effect of an ACE inhibitor without the messy side-effects, an Angiotensin receptor blocker (ARB) can do about the same job without histamine buildup.

ARBs are more expensive, though. At least at present.
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Old 06-26-2011, 10:52 AM
Joey P Joey P is offline
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Originally Posted by BigT View Post
You're lucky, My doc does the 3 months thing. And, no, I don't buy that he'll get in trouble, as I'm the only person who would tell, and not only has he known me for all but two months of my life, but, if I told on him, I wouldn't get my medication. And, while it isn't scheduled, my life is hell without it.
No, you're not the only person who would tell. A lawyer would tell if something went wrong. Let's say that one of the side effects of taking Ambien long term is, for example, esophageal cancer. Now, because of this, the doctor may want to see you at least once a year (at the same time as your well visit) to ask you some questions, look at your throat and teeth etc and keep an eye on this. If he keeps an eye on this and notices symptoms of it and deals with it, he's in the clear. However, if he just lets you take it for years and years and years without ever checking in on you and you end up developing this cancer, he could face a malpractice suit.

Similarly, I use an inhaler. Once a year I have to stop in and see my doc, I always figure that want to make sure that I'm still using it for asthma and that I'm not trying to self treat for something like bronchitis or lung cancer with Albuterol.

Another thing, do doctors ever have their prescribing records audited? Is there any federal agency (FDA?) that might randomly (however unlikely) look at the OP's record and fine the doctor for prescribing Ambien for several years without seeing the patient?

Also, you have to remember, just because YOU are taking Ambien correctly, doesn't mean other people are. And because other people aren't, you still have to abide by the rules. It's like saying to a cop when you get pulled over "I know the speed limit is 55, but I can drive safely at 70, really." I'm sure you can, but we all have to obey the rules.

Last edited by Joey P; 06-26-2011 at 10:54 AM..
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  #37  
Old 06-26-2011, 11:31 AM
Eva Luna Eva Luna is offline
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Quote:
Originally Posted by The Real Regency Elf View Post
Lynn, yes, exactly! Mama Zappa mentioned a six-month rule for Ambien, but my doctors have been even more restrictive than that. The sleep specialist gave me only a two month prescription for it last year, and it took several phone calls after the pills ran out to find out that I was required to come back for a visit every 2-3 months (never did get a straight answer about the number of months).
Hell, I see my GP at least once a year, often more (annual physicals, plus whatever other things pop up during the year, and there's usually at least one round of asthma flare-up or bronchitis or something else). Once, maybe 3 years ago, when I was complaining of chronic insomnia (which I've had on and off for maybe 8 years), he prescribed me 20 tabs of Ambien, with instructions only to take one if I was desperate and hadn't slept properly in 2 - 3 days. I have no history of addiction of any kind, no relevant chronic health issues except mild intermittent asthma, and heck, I didn't even take most of the painkillers I was prescribed after surgery because I don't like the feeling of not controlling what my brain is doing.

It took me over a year to use those 20 tabs, and when I mentioned insomnia again at my most recent physical, he said he was really reluctant to prescribe anything, and I should give melatonin another shot (it works for me sometimes, but not always). Sigh - I don't like taking Ambien either - it says to leave at least 7 hours for sleep, but for me it's really more like 10 - 11 - but hey, people need sleep!

My gyno, OTOH, when I talked to her about it, wondering if it was perhaps hormonal (she thought probably not once I described my pattern), was perfectly willing to prescribe me Xanax. (I didn't take her up on it, but she did mention that maybe it would help to take melatonin every night instead of just when I couldn't sleep, which has proven to be the case for me.)

So yeah, as others have already stated, it's not weird at all for a doctor to want to see you before renewing a prescription, particularly for a controlled substance.

Last edited by Eva Luna; 06-26-2011 at 11:33 AM..
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  #38  
Old 06-26-2011, 12:28 PM
Dangerosa Dangerosa is offline
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Ambien seems to really spook a lot of doctors. I've gotten the same lecture on Ambien along (and also don't like taking it - for me its the sleep of the damned - better than no sleep at all, but the hangover sucks).

(For me, a combination of melatonin, valarian, and benedryl works as well as Ambien and its all Otc. Don't take valarian along with any antidepressants without talking to your doctor)
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  #39  
Old 06-26-2011, 12:59 PM
irishgirl irishgirl is offline
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Ambien (Zolpidem) has a potential for addiction, abuse and resale.
An annual visit to check your mental health, sleep issues and BP before giving you the script is entirely reasonable.

Otherwise your doc has no way of knowing whether:
1) You're stockpiling meds for an overdose because you're depressed.
2)You're selling your meds for profit.
3) You keep taking the meds but have horrible side effects/ they aren't working and you should be on something else.
4) You have developed an addiction and are buying extra meds as well as the prescribed ones.
5) You would like to stop the meds and would like support and advice on how to do this.

You can decline a pelvic examination if yours isn't due, but your doc is trying to be a responsible and ethical prescriber- not a big meanie.

I have patients who are required to see a GP on a weekly or fortnightly basis for their sleepers (because we're pretty sure they have addiction issues or are selling their meds). It could be worse.
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Old 06-27-2011, 09:56 PM
PandaBear77 PandaBear77 is offline
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Quote:
Originally Posted by irishgirl View Post
Ambien (Zolpidem) has a potential for addiction, abuse and resale.
An annual visit to check your mental health, sleep issues and BP before giving you the script is entirely reasonable.

Otherwise your doc has no way of knowing whether:


4) You have developed an addiction and are buying extra meds as well as the prescribed ones.
This is not true here in the US. As far as I know, every state has a controlled substance database. They can run your name through and see everything you've filled in a specified amount of time, what pharmacy filled the script, what doctor wrote the script, the date, the number of pills dispensed, etc.

People who see doctors for chronic pain issues generally have to promise to only use 1 pharmacy and to NOT get meds from other places* ... and a lot of docs will do spot checks. If you're busted, you're discharged from the practice.



*There are some exceptions to this. Some pain doctors - especially where I live - don't require you to sign a contact to get meds from only them. Other docs are ok with their patients getting meds from other docs under certain circumstances. My mom saw an MD for her back pain and had a contract with him, but he was ok with her getting painkillers at the ER whenever she had one of her dozens of kidney stones.

Last edited by PandaBear77; 06-27-2011 at 09:57 PM..
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Old 06-28-2011, 02:21 PM
Foxy40 Foxy40 is offline
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Quote:
Originally Posted by PandaBear77 View Post
Th



*There are some exceptions to this. Some pain doctors - especially where I live - don't require you to sign a contact to get meds from only them. Other docs are ok with their patients getting meds from other docs under certain circumstances. My mom saw an MD for her back pain and had a contract with him, but he was ok with her getting painkillers at the ER whenever she had one of her dozens of kidney stones.
The rules are getting very strict regarding controlled substance prescribing. If you live in Florida, effective this Friday, you can't get a refill without seeing the doctor every three months, signed contracts will be mandatory and a written treatment plan required for every patient given a CS. OP will have to see her doc every three months, not just once a year if she lives in the Sunshine State.

Personally I think it was irresponsible for her doctor to give her 12 months of ambien without a check up. She was opening herself up for potential litigation especially due to the side effects reported with this type of medication.
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Old 06-28-2011, 03:10 PM
ladyfoxfyre ladyfoxfyre is offline
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Quote:
Originally Posted by PandaBear77 View Post
This is not true here in the US. As far as I know, every state has a controlled substance database. They can run your name through and see everything you've filled in a specified amount of time, what pharmacy filled the script, what doctor wrote the script, the date, the number of pills dispensed, etc.
A lot of states don't currently have this, actually.

Quote:

*There are some exceptions to this. Some pain doctors - especially where I live - don't require you to sign a contact to get meds from only them. Other docs are ok with their patients getting meds from other docs under certain circumstances. My mom saw an MD for her back pain and had a contract with him, but he was ok with her getting painkillers at the ER whenever she had one of her dozens of kidney stones.
These docs who don't require contracts are what we call in the industry "pill mill docs". A real pain management MD knows that you don't take Vicodin from him for your back pain, and then the other vicodin from your dentist for your tooth pain, and then the other vicodin from the ER for your kidney pain...etc.etc....

Last edited by ladyfoxfyre; 06-28-2011 at 03:11 PM..
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  #43  
Old 06-29-2011, 12:19 PM
irishgirl irishgirl is offline
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To be clear- I meant buying extra sleeping tablets on the black market, not OTC in a pharmacy.

People will actually admit this sometimes. One patient, for example, came to see me because his dealer was on holiday and he couldn't get his usual Diazepam- could I give him extra so he didn't withdraw while the dealer was away?

We also have to watch for:
Left my script on the bus.
Meds were in my pocket when I put my clothes in the washing machine.
Dog ate my tablets/script.
My husband thought they were painkillers and took them for a headache and now I don't have any.
I'm going on holiday for 6 weeks to Spain and need extra (without being able to supply airline tickets).

I have patients on daily dispense from a named pharmacy, with weekly GP visits, alerts on their record at the GP out of hours system and every A&E in Northern Ireland that they must NOT get opiates or benzos unless life threatening emergency situation.

NHS scripts and named GPs allow easy correlation of patients with medication. GPs, GP out of hours and A&Es are the ONLY places you can get meds on the NHS. Hospital consultants request medication, but the script is done by the GP and entered onto the GP system, and you can only be registered with one GP at a time. The right hand pretty much always know what the left hand is doing.

We have systems in place for people we know have problems, and the only way you ensure someone doesn't have a problem is to see them every so often.
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Old 06-30-2011, 12:21 PM
The Real Regency Elf The Real Regency Elf is offline
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Quote:
Originally Posted by Foxy40 View Post
The rules are getting very strict regarding controlled substance prescribing. If you live in Florida, effective this Friday, you can't get a refill without seeing the doctor every three months, signed contracts will be mandatory and a written treatment plan required for every patient given a CS. OP will have to see her doc every three months, not just once a year if she lives in the Sunshine State.

Personally I think it was irresponsible for her doctor to give her 12 months of ambien without a check up. She was opening herself up for potential litigation especially due to the side effects reported with this type of medication.
I just want to set this straight - I live in VA and have never gotten 12 months of any prescription medication. The GP referenced in the OP only gave me two months at a time. I had one visit for the throat problem/thyroid exam in midwinter and then two separate consultations with her during late winter/early spring that were for the sleep problems and the Ambien. During the first consultation there was no mention of labwork. She said I would have to come back periodically to continue getting the meds, a directive I understood and agreed to. During my second Ambien consult she said she'd consider giving me another couple of months on the Ambien *if* I came in to her for the GYN exam at the same time. It seemed to me at the time like this was a new condition that she was suddenly imposing, hence my OP here.

Quote:
Originally Posted by JoeyP
Also, you have to remember, just because YOU are taking Ambien correctly, doesn't mean other people are. And because other people aren't, you still have to abide by the rules. It's like saying to a cop when you get pulled over "I know the speed limit is 55, but I can drive safely at 70, really." I'm sure you can, but we all have to obey the rules.
Whoa, whoa, whoa! Did you not see my earlier post where I said "I guess I still didn't appreciate just how controlled Ambien is - gosh, all it does is make me juuust drowsy enough to snooze! But nobody gets to be a special case in this matter."?
I have been trying not to come across like an entitled airhead in this thread. Sigh.

I get physicals every year whether required by insurance/work or not. I understand that many medications can't be prescribed without labwork. I also never said this doctor was a bad person. I just didn't see what the GYN exam had to do with the continued refills for Ambien, seeing as neither the GP nor the other sleep doctor I saw before had made any request of that nature in the past when writing an Ambien scrip. I should have asked the GP for more details during the second Ambien consult. Hindsight 20/20.

Sorry if I didn't make the above clear enough in my previous posts. Again, I do have some knowledge of how doctors and scrips work. (BTW Jackmannii, your post cracked me up! Opioids are definitely not for this elf ).
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