He doesn’t want another doctor. He wants more drugs.
Regards,
Shodan
UCD - University of California Davis campus - big med school. UC operates huge medical centers all over CA
The reports causing PCP to run for cover:
The DEA is justifiably appalled by a spike in OD deaths from prescription opioids.
In response, UC prepared lists (having simply everything on the cloud/web has good and bad points) of every patient (I’ve been on UCD since 2008, UCSF and I go back to mid-90’s) with active opioid script(s).
Just for the Hell of it, they also prepared a list of all Benzodiazepine users.
The term “benzo” used throughout this doc refers to these drugs. For my purposes at the current time:
3 of the 4 drugs known to be able to put me to sleep are benzos.
See "benzodiazepine side-effects and contraindications for a quick overview of why some are scared of these.
My name was on both lists. Surprise - I’ve been using benzo sleep aids (hypnotics) since Oct 2000, and opioid pain meds since the Osteoarthritis diagnosis in 2005.
It is not like I am in now in some huge danger that just appeared.
So: What changed from 2014 when PCP was happily writing out absolutely huge scripts for both sleep and pain?
Those lists - with her name on them.
If she were a highly-regarded MD, she might have said:
“Yes, I DO write those prescriptions, and here is why:”.
She is a approaching middle age (part of the reason I trusted her substituting morphine for the dilaudid (if you do not know why this was a huge problem, please go back to post #1 and re-read this thread) and is still in the same pay grades as 27-35 yr olds.
She decided not to try to defend her prescriptions, but immediately cut them )and seems to be determined to eliminate all of them), saying, in effect “ooppps! Sorry! See - I’m not going to do that again!”.
Hence the “ethical” question - do you defend your Dx and Rx? Do you throw the patient under the bus?
Ya know, I am tired of fighting the UC system to be able to sleep every day, like a normal person.
I would really like to do so pain-free, but that may be too difficult.
How many times have I said why I have not yet removed this doc’s name from my (medicare) PCP field?
How many times have I explained what a “discussion” with PCP is?
Once more: “I am going to do this. Your concerns are not my concerns”. If you want pain meds, here is a list - you find one. (not surprisingly, few want either another Medicare patient or an opioid user.
How many can tell me why I use opioids? Hint: it is not for fun.
You are making no sense.
Hmmm…
In the beginning of this post you mention the increase in OD deaths. Many many of these deaths are the result of narcotic / benzodiazepine combinations.
Hmmm…
Long term narcotic use will lead to physical addiction.
Hmmm…
You keep saying you don’t like pills.
Bull.
Like I said, you don’t have to remove any doctor from your “PCP field” to get a second opinion. In fact, you don’t have to be seen at your current clinic or hospital;you could go to one of many different hospitals in your city and they will have no idea who your PCP is unless you tell them to . Not all patients even have a PCP. There is certainly no “PCP field” that follows you around to every new office. In fact, none of your information can be transferred to a new doctor unless you specifically request it, or it is immediately needed for your care.
Also, if your doctor is keeping up with the latest information, she is aware of recent data showing increased risk when narcotics and benzos are combined and quite appropriately is not blindly defending what evidence now shows is not optimal prescribing behavior. You want her to never take into account any new studies or new data that show that there might be a better regimen but instead stand up and defend a plan that evidence shows could be improved. Why should she not try to give you the highest quality of care?
You also still have not commented on whether or not you have tried the newest sleeping medications.
What changed from 2014 is that new studies became available showing an increased risk of combining narcotics and benzodiazepines, which is why’d UCD is trying to identify patients on both medications who are at the highest risk so that their regimens can be chap.
I agree with all of the above FWIW.
I think psychobunny has gone out of their way to try and help you.
However, **one ** bit of information will be available to any MD in California.
California has a prescription drug monitoring program.
Bunny -
the problem with the hospital list is not Fentanyl. It is not dilaudid. It is not the combination (which actually is working for 90% of pain - lumbar still gets ugly).
It is the combination of saying “2 Sch II opioids” + Tylenol.
And yes, kids, I did try acetaminophen. Last week and the week before.
I did try the 15 mg sleeper. It worked one time, shortly after discharge when I was still massively sleep-deprived (no, I am NOT going to post the same story 20 times in same thread).
I have a very simple test for a hypnotic.
When I take one, put on the CPAP, turn off the lights and close my eyes, do I:
- Wake up more than 4 hours later feeling refreshed?
- or -
- Lie there and pay attention to the cat’s presence all night?
If (1) - it works! No change required. For at least 4 years, I had this pill coming to me in the US mail.
If (2) - it does not work. What is known to work? Get one that is known to work.
I do NOT want “more drugs” - I am eliminating them from my diet, actually - only vitamins, blood pressure, muscle cramp, pain and sleep remain.
This thread is is mainly about sleep.
On 1/24 MD stopped the sleeper script.
Had you read the email I posted, you would have noticed that her “make an appt to discuss your lack of oxygen to brain” also included “and discuss your sleep regimen” (which is her shorthand for “I’m cutting this one too”).
I did not even notice that line until I found myself out of sleepers 2 days after discharge.
There is an old trick in the MD playbook - cut off a script and they will scream - and you’ll get paid for another office visit.
Playing this game with ear drops may be OK - but there are some classes of meds you do not mess with.
Dup script: second script for same drug. Only the opioids are controlled by the new DEA database.
Sleepers are a gray area - any given script at any given pharmacy cannot be refilled early.
If another doctor is aware of the first script, it is professional judgement to write a dup.
In the case of the opioids, the DEA has created a single point of reference for every drug going to (or near?) a single person.
The classic “drug shopper” would see multiple MD’s in multiple offices and get multiple pharmacies to fill each MD’s script.
As in:
Dr. Abba writes 5 mg - I take this script to CVS
Dr. Bubba write 5 mg - I take this script to the independent (are there any left) pharmacy across town
Dr. Chan write 3 mg - I take this to Walgreens.
Both CVS and Walgreens have their own databases and will note if I try to fill two Sch II scripts at different CVS/Walgreens stores.
CVS did not know that Walgreens had a script for this drug for me, Walgreens did not know about the CVS script.
The independent would not have known of either.
This is where the DEA database (which is why I call it a “tattletale” DB) comes in - now every pharmacy will know about every script - regardless of who wrote it, who filled it.
I imagine there is a great deal of panic (and some very creative thinking) going about right now as everyone is comparing notes.
Until Jan?, the Sch II drugs required a paper script (very special DEA script form) - originally a triplicate form) be picked up at MD’s office, taken to pharmacy and presented with VALID ID (some State’s DL are still not good).
This is why, when I found a CVS on the way home one time and had the script filled there, I got shit for it.
Good little druggies never use more than one pharmacy.
Now, the DEA database requires the MD to log on, select patient, select prescription (or enter new one), select pharmacy, and click “Authorize” or whatever.
My doc does not have a lot of patients. This should not be a problem to keep this straight.
Anyway, first time out, she knows I use Walgreens. I actually use two Walgreen “stores” - the retail shop and the mail-order shop (which is in AZ. We are in CA).
That first time, she actually sent a morphine (gotta love her) script to the mail-order center in AZ.
Um, doc - I don’t think they mail morphine any more.
Up until that order, there had been two bottles - one morphine (which kills kidneys) and one dilaudid (which only bruises them a bit).
When I picked it up, there was only the morphine.
“Uh, doc - the morphine came through OK, but the dilaudid (hydromorphone) did not”.
PCP “That’s part of the “taper” - no more dilaudid”.
Once again, folks - that stunt kills any defense based on “acting in patient’s best interest” - she killed the one drug that I could (reasonably) safely take and continued the one that caused the kidney failure.
For those who have concluded I am a drug-crazed psycho demanding drugs which will kill me: maybe try remedial “reading for comprehension”.
For the rest: remember the DEA’s concern for “opioid OD deaths”? My hospital DX was “morhine OD”.
It was, but not even close to what any person reading the term “morphine OD” would imagine.
If I take so much morphine I die within minutes-hour, it is because the morphine stops the diaphragm muscle, and victim can’t breathe.
This “OD” took 7 years of creatinine build-up to overwhelm my remaining kidney function.
For those who think “Opioid Taper” is a valid technique:
Is this what you consider a “taper”
Jan - Morphine: 45mg 2x, 75mg for sleep daily + Dilaudid 4 mg 2x daily as needed for breakthrough
Feb - Morphine 15mg 4x daily + Dilaudid (unchanged)
Incredibly, she then refers to the remaining 15mg as “High Dosage”. She didn’t seem to appreciate my (almost suppressed) laugh.
When discussing the UCD lists, she said - “you are also on another list because of that other drug you use”.
Any MD seriously concerned for my health would have known which drug that was.
She did not say what the criteria for the second list was, (it was the Benzo list, as it turned out), and I was puzzled and suggest Mirtazepine? She shook her head. I gave up.
The second drug was, of course, temazepam, the sleeper
We get it. You are unhappy with your PCP. You have still not given a valid reason why you still go to her. “I need to continue to see a doctor that I do not trust and who I feel is at risk of killing me and does not understand the medications she is prescribing because I might want to sue her for abandonment” is not a valid reason.
OK, this is getting completely out of hand.
How many times do I need to say that, as a Medicare Patient, the UCD system is not particularly friendly.
In Jan I went to see the folks in Internal Medicine. When I asked if any of the docs were accepting new Medicare patients, I was given a list of 4 names.
When I called the number listed to make an appointment with one of them, the scheduler told me I would have to put that MD’s name on my “PCP Name” field to even chat. This would be, of course, an "establishment appointment’.
I know enough about doctors and insurance to know that change is serious shit.
AGAIN - IF I DROP THE PCP, SHE CAN SAY "ANYTHING THAT HAPPENED TO HIM AFTER (DATE) IS HIS OWN FAULT - HE STOPPED “TREATMENT”.
Did anyone notice that, after she called in a new sleeper script, the problem may be headed for resolution until I can find out exactly what would happen to my status with UCD, Medicare, and now, even Walgreens is I remove her name?
At a min, the BP meds would disappear (I have lots of backups for those), the Fentanyl is now under her name (originally a hospital doc - she never mentioned the drug, just kept up the morphine).
For those wondering:
No, I did NOT rush home and take the morphine (the Fentanyl was an unknown and had not yet taken effect). I did put it in a safe place.
Remember the 45mg MSCONTIN (Morphine Sulfate ER 12 hour) 3x (plus a 30mg kicker for sleep)? AND the 4mg DILAUDID* (Hydromorphone) for breakthrough?
With 45mg of morphine in me, breakthrough was rare.
I saved it.
It was that stash than allowed me to sleep the first night.
The Fentanyl (25 mcg/hr) trans-dermal is now effective except for L4/L5, for which the Dilaudid still controls - but not at the new (2mg/day).
The dosage of that will be discussed with new MD.
I am debating giving the PCP’s group a shot of resolving the remaining (huge in the case of the sleeper, not so much with the pain) dosage problems.
The “Dr. B” I saw on 3/9 (and who was the only Family Medicine to EVER order the blood work I requested (see about page one for that email exchange)) was arranged by another Family Med doc I had not heard of.
She said something (in response to flood of emails about the sleepers) about “I will have one of the Staff Doctors review your…”.
If she could set that up the next day, she may be able to goose PCP.
Of course, contacting her/not contacting her could affect litigation.
Am I still a druggie strung out by lack of opioids?
I don’t know how anyone got this far without realizing that the opioids is a historical problem (again: Fentanyl + Dilaudid IS WORKING).
The current issue is the refusal to renew a drug she knew I required for sleep until I was nearly killed by her morphine.
After the firestorm she got over that (remember - the hospital docs found the email chain in which I documented my failing health, resulting in near-death) she re-instated it - but only at 1/2 dose.
When informed that the 1/2 dose (15mg) could work only under ideal conditions, and requesting a restoration of the 30mg, she flat-out stated she “had no plan” to EVER again write that dosage.
But yeah, I’'m the bad guy here. :rolleyes:
Um, maybe the PCP is just now realizing the problem with opioid + benzo.
I have been aware of those deaths for at least 5 years.
I haven’t used this on all day:
In the grown-up world, sometimes there are NO, NONE, ZERO, ZILCH “good” options. In those cases, you go for “least bad”
That would, it seems, mean using Dilaudid, not Morphine
I am getting disgusted having to repeat all this, but:
HIGH TOLERANCE FOR ALL CNS DEPRESSANTS
This is not only how/why I ended up using Vicodin/Dilaudid/Morphine/Fentanyl + Dilaudid for pain, but benzodiazepines (how many know how to spell that one? Ya think "maybe this guy HAS some familiarity with them?) for sleep.
I haven’t said this the required 20 times yet:
In the 12 years I have been using opioids, I have had (exactly, I believe) 11 instances of a psychotropic reaction. Usually, first thing after waking when skipped dinner night before.
I have never come close to a serious reaction to:
opioid
benzo
etoh
and diphenhydramine
I have dropped the etoh.
AGAIN - I DON’T WANT MORE PAIN MEDS
THAT IS HISTORY
CURRENT DISPUTE IS 15MG OF BENZO TEMAZEPAM
W/30MG - I SLEEP
W/15MG I DO NOT.
YEP, WORTHLESS PILE OF PROTOPLASM MAKING LIFE DIFFICULT FOR CARING, COMPASSIONATE MD.
(can you believe it? When a claim of Medical Malpractice require the testimony of 5 other MD’s, no doctor ever lost a Malpractice case?)
I will not go to UCD hosp. again until they get the dosage fixed. I’ll take an old 30mg bottle with me and try my luck with another hospital.
Until yesterday, it was looking like I’d be back in a hosp. (I asked my (home) roomie to check in on me as I sleep - he gets up before I do). I have been clear for almost 3 days.
Hot showers get cut off early - ask your MD why a hot shower will make you feel faint.
(and ask why the spots before your eyes when standing up quickly)
Fentanyl isn’t new. and according to this, it is covered by medicare.
Please tell Walgreens. They are the ones who hold it up every damned time because 'it isn’t covered by your insurance".
You might also want to drop a note to my PCP - she had never heard of it - or she failed to even mention it as a possible replacement for the morphine she was feeding me.
So you just assumed it was new? Based on the fact that your doctor didn’t prescribe it?
Actually, since the hosp set up the Fentanyl + Dilaudid, the risk of her killing me is greatly reduced. After 17 years on benzos (except for a brief fling with the Z drugs), I’m pretty sure the temazepam is not a problem.
Which leaves her as a source for BP, nose spray, skin cream, etc - she is good with treating symptoms, and, since signing up with WebMD, I can find the stuff she misses:
- I describe muscle cramps - sharp pain right under rib cage at times when I bend at the waist. Her: Interesting, palpates liver and kidneys, shrugs.
Google “muscle cramps” + kidney.
WebMD has abstract of study in which patients with the dialysate’s magnesium level is raised from .75 to 1.00 report markedly fewer muscle spasms/cramps.
Buy bottle of magnesium pills. No more cramps. - Edema and puritus (itch) of lower legs. Classic kidney symptom.
Her: skin cream
WebMD: Gabapentin 300mg
(three docs (including PCP) have tried gaba 300 as Hail Mary before going with opioids.
Plenty on hand
No more itch.
You’re right of course - the real reason I still see her is her GREAT LEGS!
Why are you violently opposed to obtaining a patient advocate?
Raven - getting desperate, are we?
I am ahead of PCP on “pain meds with promise” and your best response is “MY info is old”?
Give it up - you are embarrassing yourself.
I have never heard the term. My old insurance policy once offered to set me up with a “Patient RN”, but I am not familiar with the term “Patient Advocate”
Going out on a limb - is this like the “I promise to resolve any/all disputes through arbitration” legal maneuver?
Sign this paper, and whatever deal we cut, you are bound to it?
…Not a doctor, but a quick google search shows that magnesium can easily become toxic in patients with CKD, as the body depends on the kidneys to clear excess magnesium. It didn’t occur to you that maybe she didnt give you magnesium because it could cause cardiac arrest? Nor did it occur to you to search for more info instead of self-treating?
Bunny - was it you who asked about the “Controlled Substances” “agreement”?
It was shoved at me and told “required. sign or no more controlled substances for you”.
I once lost the paper scripts. PCP demanded “(agreement) allows for one replacement, no questions”
(after grilling me seriously) “Do you want to use it?”
That was the only hint I have ever received as to its content.
Wild guess: screw this up and nobody will ever think of prescribing aspirin?