No. It’s a neural party, with a medical background, who accompanied you to medical appointments and assists you in getting proper treatment. That may include going to your doc, going to a different doc, getting refers to specialists, etc. It’s what several of us have been asking you about in your train wreck threads. You insisted you didn’t need one because you can die just fine on your own. I’m curious as to why you’re continuing to hammer away at the same points over and over, making yourself look like a raving lunatic, when the issue could be solved by stepping away from the computer and making a simple phone call.
For all:
Is “Drug Addiction” ALWAYS a "Bad Thing ™?
I get accused of being “addicted” to both pain relievers and sleeping pills.
I strongly prefer to be pain free as much as possible, and, I must admit, have a strong preference for being able to get to sleep.
Since both the osteoarthritis and insomnia are “for the rest of your life”, exactly how important is the question of either physical or “emotional” addiction/dependence?
Yes, I DO depend on these drugs for these purposes.
If I had had a choice, I wouldn’t have chosen them, and will gladly dump them if something better comes along (as with the fentanyl replacing morphine, the morphine replacing the dilaudid (bad move) and the dilaudid replacing the vicodin)
Once the die is cast, does the label really matter?
If I will need the drug for the rest of my life anyway, why the concern over “addiction”?
Methinks “addiction” is the new “atheist” - always evil, never acceptable.
I have never been offered a patient advocate, and have no idea where I would find such a beast.
It is not like I do not know my symptoms or my reactions to the various treatments.
What could a Patient’s Advocate do when a doc says “I am discontinuing you pain meds”?
How would that be different than what I have done to date? Is there to be a sidebar discussion among the “Medical Experts” in the room? What?
My question is this thread was quite simple (if one assumes I am both rational and truthful, both of which have been challenged repeatedly) was, given her actions, does her behavior violate medical ethics?
The link provided on medical abandonment would seem to indicate that her actions regarding the temazepam would rise to legally actionable.
My question was about ethics and sudden refusal to provide critical medication.
Good gawd.
The nephrologist (they are the kidney experts) knew I was using magnesium supplements (as would the PCP if she ever looked at my chart). We now include a magnesium test with the P04 test.
Want to try another attack?
Some more questions for the OP:
Why did you not get a copy of you controlled substances agreement? Did you not read it before signing it?
Are you not aware that best practices recommend that Fentanyl be prescribed by a trained pain specialist? And no, it is not a new medication.
You acknowlege that a “newer” narcotic is effective so why are you so afraid to find out about the newer options available for both pain and sleep?
Also some questions I am asking again:
Do you belong to a Medicare HMO that requires you to be seen at the UCD practice? Otherwise, why are you so tied to this particular practice?
Have you tried suvarexant for sleep? Why not?
The fact that you insist on trying to manipulate a physician for whom you feel such obvious contempt does not speak well of you. Why are you not seeing a doctor that you trust so that you can work as a collaborative team? Again, if you belong to an HMO that restricts you to this one practice, maybe it is time to change your health care plan. If you sign up for regular Medicare, there is no PCP listed on your card. You can go to any Medicare doctor without a referral. You can check them out, assess their qualifications, and perhaps find one you trust. Nobody will be telling you anything about your officially listed PCP because Medicare does not have any official PCPs. Under Medicare, you can see any doctor you want at any time.
Another thing that makes no sense it that you were apparently very happy with your treatment with Morphine for years until you got sicker. Now you are all upset about it and want new medications. However, at the same time, you insist that only temazepam will help you because you have been on it for 17 years, ignoring the fact that there may be something better available. Saying “I saw a specialist 17 years ago and they could not find the cause of my insomnia and this worked then so nobody will ever find a cause and nothing else will ever work” is a cop-out for somebody who purports to know more about medicine than his doctor.
Saying that you will just go to another pharmacy to get your prescription filled at a higher dose will definitely get you pegged as an addict. Having pharmacies communicate with each other not only weeds out the addict seeking multiple medications from multiple doctors, it also prevents patients like you from inadvertently taking two medications that can interact. It saves lives just like flagging patients who are on multiple controlled substances saves lives.
In the end, though, your attitude is not going to help you get better. Dealing with chronic pain and insomnia requires chronic adjustment of medications, especially in somebody with fluctuating renal function. It requires flexibility and the ability to change doses and even medications if needed. Rigid, inflexible adherence to one particular medication at one particular dose will kill you.An adversarial relationship with your doctor will help neither of you.
That was GOOD!
The doc who passes out lethal level of morphine didn’t mention magnesium because she was afraid IT would damage my kidneys?
you really are embarrassing yourself
Fentanyl was developed in the late 1950s, first as an intravenous drug, and the patch (transdermal) version was first released about 20 years ago. It is sometimes better known by the trade name Duragesic. Given that it is probably THE most-prescribed synthetic opioid, I have a hard time believing your doctor had never heard of fentanyl. However, the patch has fairly lengthy history of overdose deaths and FDA warnings, so the doctor may not have thought it any safer or better than the morphine that you were already taking, apparently successfully as far as she knew.
It is covered by all Medicare Part D plans, but it is not a “preferred” medication for all of them, so co-pays could vary wildly depending on what plan you have, and there may be other plan restrictions (e.g., only with prior approval from the plan) that you may not have met. If you have only original Medicare, without a part D plan, then it is almost certainly not covered.
A patient advocate could be somebody you hire, or it could be a relative or friend that you trust to attend your appointments with you, listen to your conversations with medical personnel, discuss your medications with your doctors, and so forth. I’m not sure what the problems are exactly, but it is pretty clear that there have been multiple failures of communication here, with both your doctor and with the hospital personnel. (SOMEBODY made that checkmark under stop the sleeper; another set of eyes might have caught that on the discharge paperwork while you still had opportunity to ask the hospital doctor what was up with that, for example.)
One way or another folks - either PCP is wonderful and I need to trust my care to “the professionals” or I need to scan all medical literature and find (and try) every new drug which comes along.
Did we not notice the experiments with th Z drugs when they were new, promising sleep meds?
Have we not noticed that I did start the “replace MD” process before the hospitalization?
I am quite aware of her shortcomings, and am doing my damnedest to cover my own ass given the treatment I get from UCD - how many of the experts here routinely google every symptom?
Why UCD?
Known quantity in an unknown town. Are you familiar with the UC medical system?
I used UCSF and got good/ v. good treatment (they are the ones with the 4 units transfused).
Esp. as a Medicare patient - not being wanted by the pain docs is not surprising - my old docs in SF will not see Medicare patients.
And I serious doubt that some of the tests I received there would never be authorized by my current coverage. No, I did not write down the names of the endocrine system tests.
How about this:
As soon as I have an entire week of being alert enough to drive, I will contact lawyers and then find an MD (I would prefer to stay with UC, and, anywhere near here, that means the huge UCD complex) who will provide a reliable way to get to sleep, will renew the fentanyl, dilaudid, gabapentin, BP med(s), and a few I have probably forgot. Oh - indomethicin. For some reason, getting that silly thing re-upped is sometimes difficult.
It should be noted: aside from her Dx shortcomings, and the screw-up with bronchitis, PCP and I got along just fine.
Until “THE LISTS” came along.
Just went looking for “Controlled Substances Agreement”. No copy, but did find hardcopy, dated 3/18/11 of UCD MyChart “Health Summary”.
Compared to current version, is kinda cute and small.
It has polyarthalgia instead of OA (strange - the OA Dx came with me from SF in 2008.
But, right under “Chronic renal disease, stage IV”:
HYDROMORPHONE 4 MG 2x daily as needed - PCP
MORPHINE 15 MG SR 12HR TABLET 1 every 8 hrs - PCP
MORPHINE 30 MG SR 12HR TABLET 3 per day* - PCP
Temazepam 30 MG - PCP
INDOMETHICIN - PCP
CLONAZEPAM 1MG - PCP**
-
- this pre-dates the extra 30 mg at bedtime.
** - this was when we were running the 2 benzo sleepers due to my requiring a dose = 1.5 pills.
Let’s see if Raven catches the huge gotcha in this list
At this point, with the bizarre, antagonistic reactions of the OP - I don’t know that he has any friends he trusts to advocate on his behalf.
This concept (patient advocate) has been explained to him multiple times.
the fact that I am somehow embarrassing myself by pointing out that fentanyl has been around for decades or that magnesium is not a preferred treatment for someone with CKD - well, someone is embarrassed, but it is not me.
I truly am sorry that he is suffering, and I truly do believe that he is making matters worse for himself.
Quick question for you OP - which is a greater medical emergency, opiod withdrawal or benzo withdrawal?
PS I dont think anyone has argued that your doctor is wonderful, and it has been mentioned that you need to take a role in your own healthcare. That role is NOT “GIVE ME MY PILLS!” but rather a more educational direction.
ETA Jesus christ, I am not trying to “gotcha.” Stop being such a dick.
Every once in a while my lifetime of “loner” comes back to bite.
The only person who I would trust to deal with an MD would be the one sib ID’d above - and the 2500 mile distance is set to become 3200 (approx. - no I did not check it on a map).
But she knows “go to store, buy OTC”. Spouse was Dx’d with diabetes II years ago but apparently does not talk about it with her.
I have no idea why, they are fine people who are joined at the hip, I am not asking.
Obviously, the trust that needs to exist between MD and patient is gone from this relationship and cannot be rebuilt.
I knew that long before the trick with “let’s cut off his sleeping pills and see if he notices” on 1/24 (yes, 1/27 is the date of the email from Walgreens - their attempt to renew was rejected 1/24)
So a new MD is on the list. But somebody is going to pay for 5 days of uncontrolled hell I went through because of this person - I don’t care who gets blamed - the PCP (my choice, duh) for the morphine, or the nephrologists for not catching it - it is on UCD/UC
I really hate to spoil your fun (you had a good lead with the magnesium - too bad it had been checked and approved by professionals), but I was unconscious for the first 2 days, so probably missed any withdrawal symptoms.
Isn’t that annoying - a perfectly good “addict” gets off without the punishment God intended - withdrawal.
The only folks I know who know enough about medicine to double check much of anything are MD’s - none of whom have ever been in my social circle.
Since I was both disabled (OA is a bitch, in case you hadn’t heard) and poor (otherwise, I’d still be in SF) when I got here, I have not had much contact with anyone.
Let alone one I’d put in a medical discussion with an MD.
and - to date, being a loner has served me well. I will turn 68 in a couple of months.
Parents both died at 74. Longest surviving grandparent was 82.
But I’m supposed to be concerned about long0term consequences of the only meds which enable me to even care for myself?
I don’t think so.
I am on extended hospice at this point - were I 30, I’d be concerned about long term. But not now.
To the other health care professionals who have engaged at all in this thread -
Would any of you NOT have dismissed him as a patient by now?
If you were his doc what would be required from him in order for you to agree to continue as his physician?
Given that several medical professionals have weighed down in on best practices and such, my WAG is that the chance of getting a court to side with you on a quest to get cash for those five days would be zilch.
The OP would disagree, but that’s expected.
Finding an attorney who would take on a losing case on a contingency basis is less than a snowball’s case in hell. They may not be as brilliant as the OP, but they ain’t stupid. It’s their time and money they would be wasting.
The question of what is wrong with addiction is beside the point. It’s pissing in the wind because it’s not up to individual doctors to make that call. Pissing and moaning ain’t gonna change that.
Looking at this in game theory from the OP’s POV, pretty much it just sucks to be him. Sorry about being blunt.
He wants something which the US has decided to not provide for its residents. Other MDs aren’t going to do what his doctors used to do and it the current ones can’t continue.
Since the OP had one set definition of a win and anything outside of that is noise at best but more likely annoying to him, there really isn’t any way of helping. It doesn’t help because his question is not how to manage pain and insomnia, it’s how to get the meds he wants. And they ain’t coming back.
Yes, this is the voice of experience. I wish I had learned how to disengage from one particularly stubborn brother decades ago. He also didn’t want help, he wanted everyone to see that he had the only solution. Something else in common was that he was also obsessed with impressing everyone with his brilliance.
No doubt that the OP will be snarky about this. I already know he’s going to reject anything which disagrees with his opinion.
All I can really say is good luck.
In a very dark humor sort of way the op is kind of humorous. Accepting his narration at face value anyway.
As a person with multiple medical problems, including but not limited to long time uncontrolled hypertension, chronic kidney disease (stage 3 by 2008 and stage 4 by 2011 and unclear how much he had kidney disease from childhood causing hypertension vs the unmanaged hypertension causing the kidney disease or both), and likely some psychiatric condition(s), he searched for a doc with the “only requirement” being that the doc was willing to write his narcotic scripts. And then of course he is livid because, by his take of it, he found a doctor who allegedly did just that, and he did not end up with a doctor who more aggressively managed his complete picture, lowering or possibly eliminating/replacing his opioids in response to the kidney disease degree.
When I was dealing with something like the UC system, and approaching the front desk of one of its clinics, I think I was safe in assuming little things, like:
Speaks English like a native
Has valid MD license and requisite education for that license
Has some experience in Primary Care
Was accepting new patients
Beyond that, what other requirements did I need to specify?
Again - reading comprehension. I was not going through Craigslist looking for an mD.
I was at a primary care clinic of the UCD system.
I have run into enough MD’s who refuse to write Sch II prescriptions that i put it up front; neither the doc nor I need to meet if my requirements cannot be met.
Since 2005, serious, narcotic pain control has been a requirement.
As to CKD status:
Again, reading comprehension.
Note the date on the hardcopy I found - 2011
Note the “list of current conditions” posted above.
Sometimes, a patient’s condition improves; other times there is a temporary 'dip" in the readings.
My eGFR, as stated multiple times, is 33 - the range for Stage 3 goes down to 30.
Or, as I put it - hanging onto stage 3 by a thread.
In 2011, there was a dip for unknown reasons. That dip is probably why I took that hardcopy - I hadn’t taken one before and hadn’t taken one since (until 2/16).
So - are we clear that "only requirement was the WILLINGNESS to write Sch II?
Good, then, once we have a doc at a primary care clinic run by UCD who is willing to write controlled substances, we run into the big problem.
I take in my bottle of 4 mg Dilaudid (hydromorphone) qty 240. This qty has been going up since the vicodin became useless.
Instead of increasing the Dilaudid, she took it upon herself to replace it with MSCONTIN (Morphine sulfate ER 12 hour).
Even with the chart noting CKD. And my telling her “CKD”, she writes morphine.
She is a grown-up, employed by a reputable organization.
I am now faulted for both trusting her Rx and for now questioning it.
Almost dying and being told it is because you used morphine will make you a bit pissed.
But I have undiagnosed mental problems - and that is why I am pissed.
Got it.
I love the one about how my doctor not only didn’t provide magnesium, she didn’t even mention it, is because she knew I was a kidney patient and didn’t want to tax my kidneys.
Good One!
She gives me morphine but withholds magnesium - out of concern re kidneys.
She knew nothing about opioids and kidneys - if she did, she would have NOT given me morphine, she would have upped the hydromorphone.
Instead, she (as part of her compassionate “taper”) cuts off the hydromorphone and leaves morphine.
Has that point sunk in yet?
You do not give a kidney patient morphine without watching them like a hawk - but she may have ordered some blood work many years ago - but she didn’t even order the CBC + BMP I asked for in the email. “Make an appt and w can talk about it” is not optimal response to a person in rapidly failing health.
but yeah, I’m the irresponsible one - I took her at her word, used drugs as prescribed, and pretty much died as a result.
But I’m the irresponsible one.
We have a new player!
Actually, there were docs who came up with pain control without heavy hitters - the Fentanyl patch is wonderful.
So why was I not even told about this drug by this PCP who was looking out for my best interest?
Why did she cut off the one drug she was providing which the hospital docs reinstated, but kept giving me morphine?
In case you haven’t picked it up:
Her “taper” went from 45 morphine, 8 diluadid
to 15 morphine 8 dilaudid - instantly.
She then cuts off the dilaudid completely, leaving the 15mg morphine 4x daily.
The hosp docs tell me “DO NOT USE THE MORPHINE. IF YOU USE THE MORPHINE, YOU WILL DIE” (the nice nurse even highlighted that for me).
The hosp docs prescribed:
Fentanyl 25 mcg/hr trans-dermal + 2 mg DILAUDID (the stuff the PCP cut off, they re-instate while telling me I will die if I continue using the stuff the PCP is providing.
That is about the 25th time I’ve made these 2 points:
Morphine Bad
Dilaudid Better
Fentanyl Best
do we all have that now?
As to "why did she start this “taper”?
We have 2 theories:
She was suddenly blinded by righteousness and saw the narcotics as the EVIL they are
- or -
As she herself stated on at least 2 occasions: UCD made up lists of naughty prescriptions and she didn’t want her name on those lists.
Smart move choosing Peds. 
Exactly. Which is why I would have to drop him as a patient (I’m a nurse, not a doctor.) Simply because I couldn’t be of any help. He’s not open to education, he’s not open to alternate interventions…there’s just nothing I can do here. So Imma stop taking Medicare’s money, because I can’t actually provide you with care. It has nothing to do with judging anyone for being an addict or “undiagnosed mental illness” (where did that one come from?) or anything else, really. It’s that the stuff I went to school to learn, and that the state has licensed me to do, isn’t of any help here. If I’m not going to be able to do my job, then I shouldn’t be charging your insurance for doing my job.
I have had this kind of patient a few times. And yes, I’ve had to tell my boss, “Look, I’m not getting anywhere here. I’m not able to help the patient achieve his goals. Continuing to make housecalls is tantamount to Medicare fraud at this point. Do you want me to discharge him, or should we give another nurse a crack at it first?”
I have no moral issues with drug use, misuse, abuse, or addiction. As long as you’re not hurting anyone else, then you do you. But there’s just nothing I can do here if that’s the route you’re going to choose.
Right? I would have put, “Well versed in managing kidney disease” rather higher on my list of requirement. But what do I know?
Oh that one comes from me. If I was on adult-side certainly I’d refuse to care for him without a psychiatric evaluation as part of his care plan.
Early adolescence onset severe insomnia. In teen years first rigging up a bedroom urinal then peeing out his bedroom window which to this day he sees as the rational and considerate thing to do. Hallucinogenics then alcohol use (only as self-medication man!) but of course a body too pure to defile with treatment for hypertension that was severe for as long as he can remember hearing the numbers (hate pills man!), self-medication with otc drugs and use of powerful prescription medications in manners other than as prescribed (WebMD and me!) and seeking out providers who will continue to enable such behaviors, distrust and some contempt of health professionals other than to give him as much opioids and benzos as he can get, self-assessments that are quite grandiose, posts that are expansive and full of flight of ideas and some thinking that at least seems delusional.
I know what I think that is until proven otherwise.
Especially for patients who say things like -
I don’t think anyone reading the thread has any doubt that you are very, very familiar with them. Very, very.
Yes.
Regards,
Shodan
usedtobe you do be funny.
You describe a long history of not trusting your PCP and self-diagnosing and self-treating with the help of WebMD - using leftover gabapentin, supplementing yourself with magnesium, so on - but when it came to getting ample opioids and benzos, of course you trust completely. No you did not trust her at all. Never did. She was adequate for you as long as she enabled your drug use at the dosing you wanted. Pretty sure that as long as she would keep doing that you would have no rage at all
FWIW I’m not “a player” in whatever self-serving and self-destructive game you are playing. I don’t know you, don’t care about you, have no relationship with you that places me under any obligation to you, am not giving you any medical advice*, and do not have enough interest to parse much through your expansive posts.
*The only medical advice I have is that a hypothetical someone with your sets of problems would be best served by taking advantage of the specialty care available within a university system, docs who not only know the most recent options but who have the expertise to use them with finesse, for sleep, pain, possible psychiatric needs, and how it all interplays with stage 3B (overall) kidney failure that really could use nephrology input. Someone with your sets of problems would be best served with a PCP who was skillful at being a medical home, helping coordinate that care. I don’t know how long until you are dismissed by your doctor and the system or why your PCP has not done such long ago, but your opportunity to get that multidisciplinary state of the art approach may be gone soon as a result of your self-destruction. Good luck with that.
[Gives great thanks that I’m in peds and don’t have to deal with patients like this. Wow.]