Out of curiosity I looked up some of the OP’s previous posts.
This one, dealing with chronic pain, seems lucid and makes sense. It’s a little frightenin to see the contrast.
http://boards.straightdope.com/sdmb/showpost.php?p=19961387&postcount=123
Yes he has been hospitalized since then, but nonetheless…he needs someone clear headed I think.
I’m going to throw in my opinion because there are a few things that haven’t been said.
First of all, the OP is angry at his PCP for prescribing morphine when he has kidney disease. However, he notes above that he was on morphine for 8 years. Is he upset that this kidney disease has developed over the eight years or is he saying that the PCP raised the dose which precipitated the acute hospitalization? In either case, let us assume that he feels that the PCP was negligent in prescribing morphine and wants to consult a lawyer. In this case, why in the world is he still trying to see her? The first thing a defense attorney would point out in court is that he continued to see her and request medication and that therefore he clearly didn’t think that she practiced medicine negligently.
To the OP: if you feel your PCP is not treating you appropriately, you can find another one. You say you have Medicare. Unless you are part of an HMO, you don’t need a referral or permission to see whoever you want. If you are unhappy with your PCP, find another one. If you do have an HMO, call the HMO and request a new primary doctor. Tell them that you feel that she practiced negligently and was responsible for your hospitalization. They will absolutely let you change your PCP. Don’t see somebody in the same clinic. See somebody entirely new.
Now, let’s look at things from the perspective that I am most qualified to assess, that of the PCP. She has a patient with chronic pain, who is on chronic narcotics and benzodiazepines. He has apparently been either unwilling to see a pain specialist or unable to find one. She has given him medication and finds him hospitalized with acute kidney failure, which may be attributable to his medication dosage. During his hospitalization, his benzos are tapered and the hospital doctor informs her that his dose is being tapered. Let us assume that she now educates herself on current prescribing standards and informs the patient that she wants to now follow current guidelines to avoid another episode of kidney failure. She also informs him that she is aware that his benzos should be tapered and tries to set up a plan to give a lower dose. She likely assumes that she and the OP have reached an agreement to taper the medication. I am not sure whether she has a formal narcotics/benzo contract with the OP but she should have one that explicitly states that if he gets his medication from another source he will be cut off. (This is standard practice. I can’t tell you how many patients get “fired” from the pain docs here for taking narcotics from their dentists for a root canal without telling the pain clinic). She finds out that he has gone over her head to the clinic director and gotten a second prescription for medication so he can subvert her taper and go back to the prior dose. She therefore cuts him off,
To the OP: Do you have a written controlled substances contract with your doctor? If not, find another doctor who will write one. This will protect your interests by specifying what medications you will get and how often so there will be no confusion about doses. If you are so sure that your doctor is not qualified, why are you upset when she informs you that she is adjusting her practice to accord with current best practice guidelines? Do you not want her to practice quality medicine?
Lets also note the factors that could make this PCP worry about addiction.
Things the OP has in common with addicts:
-He admits to using multiple doses of medication, even exceeding maximum recommended doses.
-He admits to mixing medications with alcohol
-He has excuses why he cannot see a pain specialist and/or a sleep specialist
-He blames the physician for his condition while at the same time requesting medication
To the OP: There are reasons why your PCP may be worried about addiction. In addition, your chronic pain may actually be due to excessive medication use. The best thing possible might be for you to get off of all the medications then restart from a fresh slate. This won’t be easy. However, one suggestion might be to admit that you are physically dependent on the medications and get yourself into a good inpatient detox program. Withdrawing from opiods won’t kill you but withdrawing from benzos can cause DTs and as noted above, being in a monitored setting where they can give medications as needed until you can get off them maybe the best course of action. You aren’t going to die from pain and you aren’t going to die from insomnia (unless, that is, you are one of the approximately 100 people in the world with fatal familial insomnia, in which case, your family is probably already being extensively studied and you should definitely be evaluated at a formal sleep center). You will tell me that you are in horrible pain and you cannot live without your medications but you also say that your life is horrible on the medications. What you are doing not only isn’t working but almost killed you. It is time to try something new.
As far as ethics goes, everybody else here has already pointed out that the PCP has not abandoned the OP. In fact, according to the OP, what she has done is try to correct what he asserts is prior poor care by educating herself and trying to adhere to more updated standards. She has not done what many primary doctors may have already done, which is to write a letter stating that the OP has 30 days to find a new physician and prescribing a 30 day course of medications and refusing any further care. He states that the PCP hates benzos and I agree with this point. This in unfortunately a highly addictive medication that can potentially kill you if stopped suddenly and patients can absolutely, positively be noncompliant with tapering them. You sit down and carefully write out a taper schedule only to have the patient call a week later to say that they felt anxious and went back to the prior dose. You explain aqain and again how the taper needs to work, and again and again the calls for refills come before they should. You state that the next prescription absolutely WILL NOT be filled one day early, only to have the patient call right bang on time for the refill. You then find that he has been seen at 3 different ERs in the past 3 days and been given benzodiazepines at each of them. You can’t cut him off because he could go into DT’s, you can’t get him to an addiction specialist because he says he “isn’t an addict-he just needs to sleep” and you can’t in good conscience continue to prescribe ever-increasing doses of medications. So you are put in an impossible position. Why is the OP’s physician gone for so long? Maybe she had a nervous breakdown. Or maybe her mother is sick or dying or she needed emergency surgery. The OP assumes it has to be about him and his case when in reality, she is a human being and things happen in life.
To the OP: Your PCP may have personal reasons for being off work but to circle back to my original point, if you are unhappy with her care, you need to see another doctor (and by all means bring an advocate with you).
Once again (sorry Bunny - too long and too weak)
1949 - born
1961 (approx) - puberty-onset insomnia. Note: this is every damned day since
(by) 1969 - Realized that the CNS depressants (pain, sedation, sleep, anesthesia) don’t work for me
1969 - see University Psychiatrist re sleep/wake cycle. Am prescribed Demerol (a very ugly sleeper, long withdrawn) and dexamphetamine - yes, a full-blown amphetamine for a college kid. I luckly find hallucinogenics and avoid the consequences of full-blown addiction at age 20.
1973-2000 What the MD’s call Etoh - booze. Cheap beer (Old Milwaulkee was $1.29 cold) eventually replace by 100 proof Stoli (good money available at last), boosted by Unisom gel caps
[COLOR=“red”](see "CNS Depressant, above) [/COLOR]
EVERYBODY - see "CNS Depressant, above
Side note - for as long as I was aware of blood pressure, mine was 165/105.
AGAIN: I DID NOT WANT TO TAKE PILLS _ EVEN CHEAP BP MEDS
2000 - accept sleeping pills form doc. Took 6 months to find one that actually worked
NOW: Pay attention to time line
2005 - Osteoarthritis - the jiont cartilage disappears, leaving bone-on-bone pain.
Only women who actually go through with “natural” childbirth know this level of pain.
OA is the only (common) means for a male to experience the pain level of childbirth.
I pity the poor woman who discover that equivalence.
Now - remember CNS TOLERANCE? The only pain meds I know which work are Vicodin and Demerol (you can look them up. I’m tired of explaining them.
Both are opioids.
For the OA, we start with Vicodin. When that stops working, we go with Diluadid (hydromorphone - and analog of morphine, as Vicodin (hydrocodone) is of codeine.
By 2008, I am going through 240 Dilaudid 4 mg per month.
2008 - economic forces me to leave hometown
2008 - ULTRASOUND CONFIRMS KIDNEY DAMAGE - CKD STAGE III
THIS IS NOTED PROMINENTLY ON MY MEDICAL RECORD
2009 - move to new area, go looking for new MD. My only requirement is that the MD be willing to write narcotic script - several will not, under any circumstances.
2009 - new doc looks at 240 count Dilaudid and promptly writes out Morphine Extended (12 hour) Release - 45 mg 3x daily. We keep 60 count Dilaudid 4 mg for breakthrough pain (hope to your god that you never fully understand that term).
A morphine OD is characterized by the paralysis of the diaphragm muscle. Didn’t happen.
The new doc has the exact same record - they both work for UCD
I was remodeling a beater house - lots of good excercise - and bone pain.
I note that adding another 30mg tab of morphine gets me a full night’s sleep without the pain waking me.
New doc promplty changes script to 15mg - 90 and 30 mg -120.
For sleep:: I continue to require 1.5 hits of largest sleep pill dose. Being poor, insurance coverage is critical.
There are two benzos which will work - clonezepam and temazepam. Temazepam is the nicer “ride”. For insurance purposes, one is a hypnotic (sleeper) the other is classed as anti-anxiety and is covered also.
Eventually, I can get sleep on 30 mg temazepam instead of 45 mg. Should have kept my mouth shut, but tell her and we discontinue the clonazepam.
Please review this history as needed - we keep going through it.
2015 - DEA is alarmed by increase in accidental deaths caused by people using opioids who should not have ever been allowed in the same room.
Rugs rats are finding opioids on floor, teens are playing, and some folks can’t remember last dosage. Then there are the oxycontin folks - oxycontin is called “white crack” or “white heroin” - and it is popular among “trailer trash” and unemployed coal miners ("Bring back coal - 100%!* not withstanding).
This brings us the great news that opioids scripts are way down!. I saw exactly one story of "ya know - some of these folks are getting hurt!’
Doc promptly, no warning, cuts 45 mg to 15 mg. So much for remodeling. I stay in bed 3 days a week.
On the plus side, had I continued the 45mg, I would not have survived
2/16/17 - Shower, start to get dressed, pass out. Wake up, continue dressing, pass out again. Can’t get up. Call roomie “911. Ambulence. Passed out twice. No idea”.
I remember roomie saying the crew demands I lock up kitty. Roomie is allergic to kitty. Kitty gets to watch the fun
Next I remember, two huge fire/rescue types have me standing and give me the option of taking a ride or have roomie transport me. I’m poor.
I remember: approaching ER. On gurney. transferred to bed. being wheeled on bed rapidly down hall.
No memory - blood draws, IV port, elevator ride, being wheeled into hospital room, undressed, connected to god-no-what.
I do have a vague memory of genitals being touched and a bizarre rippling sensation. I did conclude “catheter”.
By 2/21 I still could not dress myself, walk more than 15’ or eat much. Or sleep.
(if you still don’t know why I couldn’t sleep - isn’t there a kitty thread somewhere for you?)…
The roomie with the 45 db voice was reporting a fever. My list of tests (postedZ) include MRSA (see google) scan.
I don’t know why they kept him and discharged me early - but the fear of MRSA is quite real. Chris - you will never be a friend, and I do wish your family had learned soft speech - but I do hope your fever was not MRSA - nobody deserves that one - and certainly not the decent nurses and docs attending us.
I get home, kitty and I have tearful reunion, I sit and pee again, grab a bite and take a sleeper.
When I find only 2 sleeper remaining, I raise hell with clinic.
I then saw that doc had stopped the script on 1/24. My failing health kept me from noticing the why the pills had not been delivered by mail, as they had been for years.
The “if you want to talk to me, make an appt and I will consent to see you” doc now calls to tell me she has called in the sleeper - and that the new, 1/2 dose was not her idea, but those of the hospital.
On 1/24, you stopped the script. The hospital did not know I existed until 2/16.
The discharge papers may have something, but I didn’t see it the 2 times I have read it.
This was your idea.
this is long; afraid to lose
The hospital room was not normally equipped with a laptop. One time, awakening dozing after 3-4 days no sleep), there were two docs reading a laptop.
They had found my emails to the doc, which documented my descent to acute kidney failure.
to say they were interested was an understatement.
They were esp. fascinated with the one requesting blood work.
“Do you have a background in healthcare” (see timeline above - you could say I have a passing familiarity)
“no”
“Did you write this note requesting blood work?”
“Yes”
“How?” (I have known “CBC and BMS” since 1997 - I have learned muchj more than I ever wanted, thank you).
“If you look up my “recurring tests”, you’ll see that list”. The Nephrologists (spell check doesn’t know that one) have me scheduled for those every 12 weeks. They used to see me on 3 month intervals. My renal function was rock solid, so it was changed to 6 months.
For my doc to go from “make appt” to calling me in person - I suspect the docs who found those emails had a bit to say.She was incommunicado from 2/16 until yesterday - her "break was repeatedly extended.
Yesterday, I told het the Fentanyl was working for all pain except L4-L5 (spine) and requested either Fentanyl IM (injection) or an orthopedic surgeon for spinal fusion.
No response.
Now, all of you who know better than I how to live my life - feel free to continue your sniping, but at least know the history.
Note: if a know-to-me MD or RN wants, I will provide the user id and password for my medical record.
Snippits above were provided for general population, few of whom have even bothered to learn what creatinine or eGFR are. But, still, somehow know how to play my hand better than I do.
and. for the kind person who spent 10 minutes of his life googling “non-benzodiazepine hynotic” - my PCP in 2000 was an expert in Internal Medicine and Oncology (way to sign up for a life filled with human misery, doc). If a 10 minute search for non-benzo hypnotics was of value, I suspect he would not have gone so quickly to the benzos.
But what do I or he know?
I really an sorry, Bunny - your concern appears real, and your level of knowledge is quite refreshing.
But: from 2/16 - 2/21 I was completely off meds.
Every doc since 1996 (and the idiot at the Student Health Center (Purdue) in 1969 has no problem realizing my insomnia is real - it preceeds HIGH SCHOOL! Why can’t anyone figure out that this is NOT any form of insomnia with which they have ever had any contact?
I was in Junior High (Middle) School when I started seeing 2:00 AM on my 5 tube GE clock/radio.
I rigged a urinal so I did not have to go down the stairs to the bathroom and wake everyoner (eventually, I just peed out the window).
Even UCD uses the term “idiopathic” (no known origin or suspected origin - it JUST IS!) for this insomnia.
I have gone through this how many times in this and the “what a 3 yr old sees” thread.
After 5 days with NO MEDICINE OF ANY KIND - I still could NOT SLEEP.
I went through medically-supervised withdrawal for Etoh - and Ativan (lorezepam (yes! it IS [another benzodiazepine!) was damned handy for the anxiety. Did absolutely nothing for sleep.
Now do you see a pattern?
I had a good income, excellent health insurance, and was seeing top-grade MD’s.
They all knew I was using one benzo for sleep - and benzos are not nice drugs. It takes either a very good MD who trusts his patient or a complete fool to prescribe two benzos at the same time.
But, again, Bunny - thank you for an intelligent and compassionate post
Bunny - I promise to read you post in its entirety when I feel better - am much better today, thanks!
The problem was taking away the dilaudid (as safe as any opioid for renal function) and substituting morphine. I suspect that, had morphine been as good as it gets, then the various synthetic opioids would not have been developed.
The reason I will not change PCP is exactly as you might suspect - litigation.
I had an appointment with a new (Internist) MD when thw shit hit the fan. The UCD people could not tell me what would happen if her name was no longer on the “PCP” line of my chart - would the internal referrals be screwed? Would the BP meds be affected?
Let alone "a defense of “He fired me - it is his own fault he stopped treatment”
(yes, I spoke with both medical and legal malpractice lawyers in that previous life)
I also score 96th percentile on the LSAT, if you want a REALLY old past life.
So: we have a smart guy who has been dealing with life-long insomnia and inability to use any OTC pain/sleep med. Since 1962.
5 doctors have not found a way to deal with either situation except, as the fellow who upped the Dilaudid circa 2007 said:
“Unfortunately, all we can do is increase the dosage”.
The address of this practice is 925 Hyde, SF CA. These are not bottom-drawer MD’s and probably knew me and my body chemistry better than I.
But don’t let that stop anyone from telling me to get a bottle or Tynenol and clean up the bedroom (or other helpful suggestions for dealing with insomnia)
I have been in a very clean, well-appointed 4 star hotel room. All I did in the room was sleep (never have a parent die when there is a convention in town. The only rooms are the priciest)
I still needed the sleep meds of 1989 - 100 proof Stoli.
At least it was readily available and, most importantly, OTC.
OK - I will say it once more - after 6 months on pills, I tried the Stoli and Unisom.
I also tried not taking anything for 4 days (I will not try to drive after the second day).
You’ll never guess what happened.
Okay, there are still some point that are not clear to me.
Who are “both” here–the new doc and the one you’d been seeing since 2000? or is there a third doc in here?
If 30 mg temazepam “worked,” why do you think you should you have kept your mouth shut?
Okay, so you think doc’s decision saved your life. Are you still wanting her to go back to 45mg? When did she cut the morphine, and how does that correlate to the events of 2/16 - 2/21/17?
So your roommate was admitted to the hospital too?
Did she tell you (via email, in person, whatever) that she was cutting the sleeper in January? [If not, that is further evidence of her lack of bedside manner.] Do you know for sure what the hospital docs said about the 1/2 dose sleeper, as in did they talk to you directly at any point about sleeping pills, or is all you’ve got what she is claiming they said? Do you know if the hospital docs suggested 1/2 dose as a way of tapering down, not knowing she’d already cut you off, or are they suggesting 1/2 dose BECAUSE she’d cut you off too abruptly? (That’s not necessarily something they’d put in the discharge paperwork, although they may have. Have you seen your actual charts from the hospital?)
So the emails you quoted above were from before your hospitalization, not after? I thought you discussed in them the cut to your sleepers, which by your timeline occurred after the hospitalization (which may be why I’m getting confused).
Is her email still blocked from MyChart? If so, do you have grounds to think she’s actually getting the emails you’re sending by hitting reply?
Have any new medications come on the market in the seventeen years since then?
They gave you no meds at all in the hospital, or just no sleepers/morphine?
Did you really think this rage was caused by a reaction to pain meds?
Sadly, as stated (in that and a few dozen other threads here), I have virtually no psychosomatic reaction to any of the opioids/opiates of the last 12 years.
Creatinine is the toxin produced by muscles (including heart et al). When the kidnays cease removing it, something very resembling death occurs.
Brain function IS muddled.
And, if the victim knows WHY this happened to him, rage is an entirely normal reaction.
Also sadly: “hospitalization”, either in the literal or casual sense, is not a panacea - in either the literal or casual senses.
Hospitals are, after all, the places many people go to die.
You can thank the Boomers, this one last time for the change to “at least let her go home to loved ones and die in their arms, not a nurse’s they can’t even recognize”.
As far back as I can remember, the only people who got the option to die, with medical attention, in home, were the very rich with doctors who came to them.
The poor went to warehouses called “Nursing Homes”, unless they had the good fortune of dying very quickly - before the hospital could get rid of them.
Yes, I AM still my old, cynical self.
At what point did you learn that morphine was contraindicated for patients with kidney failure? You were on it for 8 years.
I HATE CAPS LOCK!
Just check clinic email (now 17:22 local). MD had responded to my assessment of lumbar pain (L4-L-5) and request for either Fentanyl IM or Ortho surgeon. A nice, polite, professional exchange.
She offered a referral to SpineCenter for surgical evaluation.
I tried to reply with “Yes, Please” when the system informed my her email was again blocked.
Hey - I tried to explore options.
P.S. - if I don’t like pills, guess what I think of cutting? The only thing scarier than eye surgery (I may have benefited from RK - my beloved niece had it and was ecstatic) is spinal.
When I volunteer for spinal surgery, take my word for it - your Aunt Edna’s home remedy for her bunion is probably not a good fit for me.
When, somewhere after being undressed and in the hospital room, a young man in a white lab coat awoke me to ask “What are your kidneys like*”. I responded with eGF.
He continued: “whatever it was yesterday, it is half that today - or less”.
He then outlined the plan - give my remaining renal function as much time as required to clear the morphine clogging the kidneys.
That was 5 days, no meds of any kind, and no sleep (I’m tired of explaining that one).
That the food was inedible was not actually part of the plan.
(not a recommended weight-loss plan, but I did lose 3 pounds/day)
Idk, I guess I take a more involved, proactive approach to any sort of potential medical treatment offered to me. I absolutely would have put the responsibility on myself for finding out as much information re the morphine treatment and it’s potential to harm to my kidneys.
I definitely would not just blindly take it for 8 years without arming myself with as much knowledge about the medication as possible. When you are dealing with serious medical issues, you have to be your own advocate. No one else will be (unless you take the initiative to appoint someone else to that position).
usedtobe,
Have you ever been tried on lithium, Depakote, or Tegetrol?
Let me know if I have your story right -
Insomnia onset by age 12 yo. Would pee out your window at night. It seemed the rational thing to do.
Early 20s hallucinogenics use.
24 to 51 yo fairly heavy alcohol use. Somehow though managed to stay employed with a decent enough job that had health insurance.
51 prescribed sleep medicine.
56 yo dx’ed c OA and treated c various opioids.
59 yo, after decades of untreated hypertension (you don’t like taking medicine after all so diastolic of 105 chronically was okay by you), dx’ed with advanced kidney disease.
Age 60 yo moves. Shops around in order to find a doctor who will prescribe narcotics as the “only requirement” - finds one. Gets on cocktail of opioids and benzos both at high doses.
Apparently even with opioid dose very recently decreased has an ICU admission related to excessive medications.
After that admission PCP begins to taper benzo as well, apparently with strong input from her colleagues.
Believe (with some grandiosity) that you are significantly more expert and knowledgable about what constitutes abandonment than multiple professionals in the field and are sure that your knowledge of CBC and CMP is a sign of your great intellect as is further evidenced by your past LSAT.
Believe (delusionally) that your PCP’s medical plan is something that you can prevail against, maybe with a lawyer, maybe by raising enough hell. You need your meds and you’ll get them!
Ideas tend to race forth from you. The high risks associated with your medication behaviors are relatively immaterial to you.
Now 68 and pretty much completely disabled. Sometimes more angry sometimes more depressed.
Is that all pretty much right?
Can you tell us more about your teen-aged and young adult years other than in regards to your insomnia, and the hallucinogenics and alcohol use? What was your mood like then, before the pain kicked in? What sort of plans did your have for your future? What sorts of decisions did you make in other life aspects? Did you have relationships, either long lasting or short-lived? Where was family as all this shit went down?
Oh, another medication that I am curious about - ever been on gabapentin?
MD started “taper” long before any noise from me - again - the DEA caused UCD to produce lists of opioid scripts.
While they were at it, they produced one of benzo users.
My (not top drawer) MD did not like the attention.
She cut the morphine about a year ago and then completely eliminated the Dilaudid.
NOTE: FROM A HEALTH/SAFETY STANDPOINT, THIS WAS 100% BACKWARDS - the dilaudid was reinstated by the hospital docs who told me the MORPHINE WOULD KILL ME IF I USED IT.
That exact line is highlighted on the discharge document.
She was NOT acting in my best interest - she threw me under the bus to get her name off those “scary scripts” lists.
YES, SHE DID TELL ME THAT - AND I HAVE REPEATED THIS AT LEAST 5 TIMES IN THESE THREADS
Now. Other than the confusion of how/why I got to not only using nasty drugs, and when/how/why they were removed, you have the timeline fairly well.
Your post represents a leap of reading comprehension.
My life pre-OA was actually good.
I will not draw too much fire by stating that a person who scored 96 percentile LSAT did well on the IQ tests in school.
My mother was very bright (graduated cum laude Ohio State - at age 19) but made some really bad decisions. Her death was about the only death which has caused me to cry like a baby.
Hallucinogens were part of college 1967-1971. Never touched them after.
Never drank (except Sailing Club parties) except for sleep. As stated - $1.29 for beer was all I could afford, and the experience with Demerol was downright scary.
And that, folks, is coming from an acid user.
After bumming around, I got my stuff together, picked up a cheap diploma, and, for my 30th birthday, gave myself a one-way ticket to San Francisco.
I was an instant hit in the DP/MIS/IT/IS program/design/configure world and did short-term contracts. No health insurance - I paid for that out of pocket, but the pay was good.
For 30 years, I had a life much better than I even dreamed of.
20th century was good to me.
21st, absolute hell.
The docs though I was improving - BP under control, off the etoh/unisom.
All hell broke loose in 2005 with the OA.
As an old man on Medicare, I am no longer assumed to be capable of making intelligent decisions about the risks/rewards I accept.
Some (esp in this thread) seem to think I must be protected from the very drugs that have served me well so far.
No matter what others may say/think, I will state it again:
The hand I hold is better than anything else anyone has offered., You still can’t beat something with nothin.
I cannot sleep without one of 4 drugs. That is a permanent fact of my life. If the drugs have nasty side effects - so what - ever consider the effects of not sleeping?
Look up FFI - Fatal Family Insomnia.
I heard of this 30 years ago. The case I heard of is a family in Italy which produces kids who are completely normal until about age 35. Then they stop sleeping.
The result is always death within a very short time.
You can also look up “Sleep Deprivation” - a form of torture (prohibited, I think by the Geneva Accords).
NOT SLEEPING IS NOT AN OPTION.
If I wanted to die, I would have done so by now. I want to be able to sleep.
I did not remember my back as being as painful as it became in those 5 days of hell 2/16-2/21.
Today, it is actually almost quiet.
Please note I am NOT taking any pain meds since this morning, nor am I using the Fentanyl patch.
I really, really do not take them if I don’t have to.
(spoke too soon - lumbar area tightening back up)
Just saw the last line. Incredible. Please do a search on gabapentin in this thread.
My relationships are none of your business.
Straight, several lovers all female, none lasted.
For me:
The “one that got away” turned out to be both gay and very short-lived. Started smoking at 14, dead of cancer at 50. And she was one of the brightest people I have ever met.
The “one I got away from” - sweet, dumb, and she really didn’t believe me when I said “never getting married”. After not finding hubby a college town, enlisted in US Army. Came home pregnant and alone. Moved back to tiny (pop 5000) town, lived with parents while raising her kids (it was twins). Took job in another town, found dead on the floor of her apt shortly after starting new job. Was RN, may have been suicide.
How do I have all this on a person last seen in 1973?
Small town newspapers run very long, detailed obits.
After finding those two dead, have stopped searching.
Family - both parents dead 1989 lung cancer. I quit smoking in 1991 or 92.
3 siblings. One is one of those who nobody likes, and married one even nastier. No contact since 1989.
one was very different life, got along well enough until a child picked a fight with me - and lost.
Long, long story. FWIW, history has proven me right, kid VERY wrong, and parent looking foolish.
We again exchanged notes upon the death of spouse (who was one of the nicer people i’ve met).
This leaves kid sister, the “peacemaker” of the family. She and I have a close-to-normal sibling relationship. Her choice of hometowns is depressing, and I moved 2500 miles away.
Can you please explain what you mean by this? I cannot make one lick of sense out of it.
DSeid gave a good summary except for the fact that the PCP started tapering the medications before the hospitalization. The OP believes this is because she was “scared” of the DEA. There is also the probability that the DEA was able to educate her about prescribing narcotics and she realized that she needed to change the OPs regimen.
What I still do not understand is why the OP does not leave this doctor if he is unhappy with her care. He cites “litigation” but it does not take a genius to realize that staying with this doctor hurts any case he might have. All the defense has to do is get up in court and say “If he was so unhappy with her care, why did he keep coming back?” If he feels she abandoned him then finding a new PCP would be the right thing to do. The ONLY reason not to terminate the relationship is that it gives the PCP a reason to stop prescribing controlled substances.
In regards to FFI, as I noted above, there are about 100 known cases in the world. If you are part of a known family with this then you should definitely be followed by a sleep clinic. Otherwise, going without sleep will NOT kill you.
With regard to the renal disease, I understand that you are trying to blame the morphine but let’s be honest here. Uncontrolled blood pressure is a much more likely cause of the renal failure. The morphine only comes into play when the kidney function has already decreased significantly. Should the morphine be decreased? Absolutely, if your renal function is getting worse. You point out that your PCP was actually in the process of doing this when you were hospitalized. According to your timeline, she apparently didn’t taper the narcotics soon enough to prevent the hospitalization.
The OP also quite rightly points out that only a fool would prescribe 2 different benzodiazepines. Heath Ledger, Whitney Houston, Michael Jackson-all had prescriptions for multiple benzos. All dead. Taking multiple benzos is a good way to end up dead. And speaking of multiple medications, I note that the OP is also on 2 long-acting forms of narcotics. Best practice is to stick to one long-acting form. Maybe that was what the PCP was trying to do by tapering the morphine when the OP was already on Fentanyl. He states that the Fentanyl does not relieve all of the pain. Perhaps it is not at the correct dose.
The OP points out that he has had insomnia for years and benzodiazepines are the only things that work. However, medical knowledge has actually improved over the past decades. There are better medications available. There are combinations of medication that he may not have tried. Has he ever tried suvarexant?
Finally, since the OP is well-read, I am sure he is aware of opiod-induced hyperalgesia which is why it is so important to get him to a pain specialist who can potentially get him on a better regimen.
To the OP: I do understand that you are in a lot of pain and you are suffering greatly from the fact that you cannot sleep. However,
-Your current regimen is not only not working but is also potentially killing you.
-You cannot continue with your prior regimen; it has already put you in the hospital once. Now is the time for a change.
-The opiods may actually be causing increased pain.
-There are new treatments available for sleep that you have not tried.
-If you truly want to pursue litigation against your PCP, the absolute worst thing you can do is to not find another doctor; you will have no case for either malpractice or abandonment if you continue to contact her and to request medications from her
-Your termination of the relationship on the other hand, is evidence of nothing more than the fact that you are unhappy with her care. The ONLY way it can be used against you is if you then want her to continue to prescribe controlled substances despite the termination. If this is the only reason you are reluctant to terminatie the relationship then the problem is clearly not her quality of care.
-The more detail you give, the more it appears that your PCP has been trying to practice evidence-based medication despite your insistence that you know better.
-According to your own statements, she may have actually saved your life by tapering the morphine when she did.
-It is obvious that you have communication problems with her. It is obvious that you have problems with her absences recently. There is NO EVIDENCE that this has ANYTHING to do with you or your care or with narcotic prescribing. However, if you feel that she is not available enough for you then you should really find another doctor.
Just as an aside, I am interested in what the OP feels would be the ideal regimen. You are well-educated on your symptoms. What according to you would be a regimen that would allow you to function optimally without the risk of further kidney damage? Would it be a Fentanyl patch with dilaudid as needed for breakthrough pain with temazepam as needed for sleep? What doses do you think you need?
OK, I officially quit.
Yes, I have the Controlled-substances agreement. It was presented as “sign this or no more pain meds”.
I am NOT BLAMING the morphihne for the kidney disease. The CKD predates the morphine.
See timeline.
Again.
I blame the morphine for doing exactly what the UCD hospital said it did: give me acute renal failure, making me very nearly dead.
Yes, that DOES piss me off. I’m funny that way.
As explained, this is a large, complex operation (University of California - Davis Campus) I was also seen at UCSF.
If I change PCP on their system (which I DID!), it may screw up other stuff. They can’t tell me.
They can tell me I can’t see another MD unless I either get a referral from current PCP (which is probably not even possible, given the structure - it would be a lateral move, referrals are only used for specialties) or replace the name on"PCP". Medicare
The legal question I will leave alone. I take it you are not a lawyer either, so I will not argue the point.
The MD is/was practicing CYA - cutting the dialudid and keeping the morphine kinda blew any chance of “I did it for his benefit!” defense.
I actually like the Fentanyl much better than the pills - if she was so concerned about my well-being, why did not hear of Fentanyl from her? Instead, she cut the only drug which was NOT actively trying to kill me (dilaudid).
Cutting the sleeper without replacement/warning even though she knew I required it for sleep was 100% inexcusable.
If I continue the benzo (since 10/2000 for those with short memories) it may kill me in another 20 years. If I don’t sleep, I will die a whole lot sooner.
And “sleep clinics” did nothing for the insomnia.
Why the hell do you parrot a line about “Sleep Clinic” as though one would somehow save me? I’ve been to 2 - and the only improvement was a CPAP - which is great for “sleeping”; not so good with “getting to sleep”.
Insomnia, in my case, is not GETTING to sleep - once asleep I’m good (unless noise/pain/etc).
Bye now
FROM THE ECHART, MY NOTES ON THE “MEDICATIONS” TAB:
S OF 15 AUGUST 2012:
MS Contin 15mg
MS Contin 30 mg
Hydromorphone 4 mg
Temazepam 30mg
Clonazepam 1mg
Mirtazapine 45mg
Atenolol 100mg
Amlopidine 5mg
Indomethacin 25mg