Is this good medical practice?

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L5-S1 Radiculopathy
New Member


Date Joined May 2009
Total Posts : 11
   Posted 12/11/2009 6:01 AM (GMT -7)   
Good morning all:
 
I've been on Percocet 7.5 since the end of 2007.  This year I've been taking 2-3 per day with a script direction of up to 3 per day as needed.  The medicine, along with 3 epidurals per year has me feeling pain on a 3 scale, without it I'm on a 8-10 scale on any given day.  The doctor's policy was that you must be seen every 90 days to receive monthly refills.  The policy changed to requiring monthly visits, but nobody told me.  The PA denied my refill request I made last week, scheduled me to be seen next week, and I run out of medication today.  The scheduler tried to get one of the doctors there to get me a prescription to tide me over two days ago, but he or she declined (my doctor & her PA only work Tuesdays).
 
So today, I'm out.  I know what withdrawals feel like because I learned after surgery that you don't just stop taking dilaudid.  Am I about to be put through undue suffering?  Should I be making more of a stink about this?  Thanks for your time. 

1988 - L4-5 herniation
2006 - Partial Laminectomy with Components of Cauda Equina Syndrome L4-5] (left side)
2007 - Minimally Invasive Spinal Fusion L4-5
2008 - Right-side radiculopathy L5-S1
Standing order for epidural/nerve blocks & monthly Percocet refills


Screaming Eagle
Forum Moderator


Date Joined Sep 2009
Total Posts : 5005
   Posted 12/11/2009 6:46 AM (GMT -7)   
     Hello L5! Welcome to the Chronic Pain forum! You will love it here! Can you tell us alittle bit more about your pain history...what causes your pain? I'm a guessing that you have back problems from DDD? Are you seeing a PM or a PCD (Primary Care Doc)? It looks like you are in a tight spot, but you should not have to worry about that happening again after you get on there schedule. One thing that I do....is to suffer alittle bit and hold onto a few extra pain meds, so when something like this happens, you will have a backup when needed. Also you may ask your Dr to perscribe a lower dose so that he can write the script at the same time as your regular script. I'm on Oxycontin, and my Dr wrote me a script of 60 of the 40mg...I believe they can only do this every 30 days, but they can also write for a lower dose in the same month. Even if it is for the same type of med. They look at it as though you are getting a completly different med. I would make sure you discuss this with your PCD and tell him what happened to you because of the policy change they have. Sometimes my refill hits on a weekend, or the PCD is on vacation....so I make sure I call it in early, so that I don't have to do without....in any case I have extras that will get me by. There will be others along in a while with probably better advice than I have to offer at this time, so keep checking here often, and give us a little more information if you can. Again...welcome!
 
What mg of Percocet are you taking? I'm on #10 325mg X2 or as needed,... plus the Oxycontin 30mg X2
 
 
     Michael

L5-S1 Radiculopathy
New Member


Date Joined May 2009
Total Posts : 11
   Posted 12/11/2009 7:38 AM (GMT -7)   
I'm on 7.5 mg. Been going to the Physiatrist at the Pain Center since my disk fragmented into the spinial canal and killed/damaged L-4-5 nerve roots causing chronic pain in the legs & feet. I can't run and can barely walk. I've taken more than a few falls--but I get up & keep going. The L-4-5 disk replacement is stressing L3-4 and S-1. I did have 11 days worth of meds when I phoned this in.

I've never asked for a dosage adjustment, and I've never taken more than 60 of the 90 pills prescribed.
 
Based on the lack of response, I supposed this came off as a negative post.  I was really just trying to find out if anyone else has been treated this way, or if the withdrawal looming is no big deal.  My last epidural is wearing off, so no medication + the discomfort of withdrawal seems like needless suffering.  I just don't understand how chronic pain patients can made to suffer further. 


1988 - L4-5 herniation
2006 - Partial Laminectomy with Components of Cauda Equina Syndrome L4-5] (left side)
2007 - Minimally Invasive Spinal Fusion L4-5
2008 - Right-side radiculopathy L5-S1
Standing order for epidural/nerve blocks & monthly Percocet refills

Post Edited (L5-S1 Radiculopathy) : 12/11/2009 8:59:42 AM (GMT-7)


uniquelyme
Veteran Member


Date Joined Nov 2008
Total Posts : 1037
   Posted 12/11/2009 10:23 AM (GMT -7)   
L5-S1 Radiculopathy,
Wow!! Policy changes are happening all over...I think it's because of people taking advantage of the system and getting over on the Dr.'s. Unfortunately it's hurting us regular patients. But for them to allow you to go without your meds is uncalled for. Maybe I misunderstood you but I thought you said that you only took 60 of the 90 pills anyway...so why are you out? If I am mistaken then I apologize... Even if you are out you shouldn't have withdrawls too bad for only a couple of days...I'd say that the actual pain will be the problem. I know that when I run out early it's mostly mental for me...but not for everyone.

Rhonda
I have been a spectator for so long..Now it's time to participate.......
 
Post Lamenectomy Syndrome, Spinal Stenosis, DDD....
1999 Hemi Lamenectomy/2005 Spinal Fusion(L4-S1)
Methadone 120 mg. a day/  30 mg. Oxycodone as needed(up to 4 x a day)
High Blood Pressure: Lisinopril HCTZ 10 mg. daily
Type 2 Diabetes: (March 16, 2009)
Metformin HCL ER 1000 mg. at night..Glipizide 10mg. 2X in the morning
Lantus 35 units at bedtime with Solostar Pen                                                                   

 


straydog
Forum Moderator


Date Joined Feb 2003
Total Posts : 13451
   Posted 12/11/2009 1:00 PM (GMT -7)   
Hi L5 and welcome to Healing Well. Your PM drs was practicing fairly liberal if he only made his patients come in every 90 days, wow. Mine have always had us in once a month.
 
But, you know the FDA has been squawking about drug safety and really trying to make it difficult for us peeps that are legit. They started the REMS thing, I believe that is what it is called and this could be something that your dr decided he needed to change in his practice, some of it could be just for legalities. Changing horses in mid stream is tough for the patients if they are not notified of changes in policy. I know any changes that were going to be incoprorated in any of my drs offices, they have huge bright colored paper notes taped up announcing whatever they are changing. I am sure the drs office felt it was not economical to send letters out to patients advising them of the changes being made. You can bet they are not about to set someone to calling the patients either. I imagine there is a lot of upset folks out there that was in the same boat as you. Personally speaking, I think they should have come up with something to notify the patients of the changes being made. I am confident that many people were on medication like you and knowingly putting a patient at risk for potential WD is just not right. The patient should be given enough meds to make it till their scheduled appts. Now, would this qualify for receiving sub-standard care, I am not sure.
 
I hope you don't end up with any bad WD. Any chance of your PCP giving you enough to make till you get a script. What about giving you something to help with any potential WD's. I wish I could come up with a solution and be able to say whether or not you are headed down the road to WD but I have no idea. I would certainly tell the dr what his change caused though, you can bet on that one. Take care and please post and let us know how you are doing.
 

crohns disease dx 2002 & small bowel resection, still looking for remission whatever that is, chronic pain 22 yrs, added ulcerative colitis 6-05 to the mix, high blood pressure 28 yrs, aortic heart valve insuffiency, depression, osteoarthritis, osteoporosis lumbar spine, scoliosis lumbar spine, peripheral neuropathy hands & feet, COPD & on oxygen therapy, lupus & psoriasis and psoratic arthritis. Several other health issues just not enough room to list it all. Too many surgeries to list and too many medications to list. Currently on 17 different daily medications. Intrathecal pain pump implanted June 05.


Screaming Eagle
Forum Moderator


Date Joined Sep 2009
Total Posts : 5005
   Posted 12/11/2009 1:16 PM (GMT -7)   
      Hello again L5! We are here to help you not judge you...so don't worry about a negative post...you are far from that. You have a Legitimate concern here! When I went to my PM, they told me that I was way under medicated...and I was able to convey that to my PCD and he increased my dose. Took an act of congress though. You have plenty of room to move up on your dosage with the meds....and I would think he would do this for you with your condition and the pain your in. Right now the goverment is keeping a close eye on all of this, and like Unique said, the patients with real pain are suffering for it...as the Dr's are tucking their tails in a bit. Also, please keep checking here for your replies....this is a busy time of  year for everyone....and some of the experts..don't come on line untill after the moon shows her face. One other thing that helps, is to post something so that your question raises to the top of the page. When it gets to the bottom or lands on page two...many of us don't see it...so post something to keep it seen. I'm very sorry to hear that you are hurting so bad...and truly hope you can find some relief. Also...there may be a good chance that you may need to seek out another PM if this one is not getting the job done. Is this possible for you?...is there more than one PM in your area? and can you explain the question that Unique asked about the 60 vs 90 ct on your meds. We love to have new members...and hope that you will give us a good try....and really, I have found this to be the best site concerning a CP forum. One last thing, have you tried any other pain meds yet?...has he tried Oxycontin on you? If at all possible...and of course you would be wise to follow your PCD's orders....ask him about a med that will last more than a few hours...such as an extended release medication....it is much more comfortable....and you won't have the up's and down's with it. Tske care...and I hope you keep posting here with us.
 
      Michael

Post Edited (Screaming Eagle) : 12/11/2009 1:22:10 PM (GMT-7)


privey
Regular Member


Date Joined Oct 2009
Total Posts : 453
   Posted 12/11/2009 5:48 PM (GMT -7)   
L5,
Do you have a "doc in the box" or a fast track clinic that you can access over the weekend? Maybe they would prescribe something for you to get you to your next appointment. I know what it is like to hurt and wish I could help in some way. I'm on oxycotin elixir and have to get a new RX every time I have it refilled. I don't have to see the doc and can call the docs office and they write it out and have him sign it but I have to make the trip to his office and to the pharmacy everytime I get a refill. If it comes up on Friday and it looks like I may run out I will call and get it refilled because most of the pharmacies in our town don't work on the weekend. The one I use is only open from 3-5 on Sunday so it I don't get the script filled on Friday I'm SOL for the weekend. Good luck

Tirzah
Veteran Member


Date Joined Jul 2008
Total Posts : 2279
   Posted 12/11/2009 10:33 PM (GMT -7)   
Hi,
I think you've already gotten a lot of good advice about how to handle the withdrawals. Take fewer if you can, cut them in half if you can (check with pharmacist first b/c some drugs are unsafe when cut).

If you can manage one a day, it will be easier than dealing with the withdrawals. If you still end up running out before your appointment, call your PM and ask if they can give you something to help with the withdrawal (my PM will write for Catapres patches -- generic=clonidine; it is not a pain medication, it will only help lessen some of the withdrawal symptoms. it is on-label for treating high bp). If that doesn't work out & you are still really miserable, see if either your PM, or if not, your PCP will write your for meds to treat the individual symptoms -- anti-nausea, anti-vertigo, anti-anxiety.
FOR AT HOME
1. Get plenty of water (3 or more liters/day). A little Gatorade can help some too, but generally the liquids things that count are need to be clear (see through), no sugar, no caffeine & no carbonation.
2. Eat only small meals -- sometimes it helps to munch on just a little food for much of the day rather than having sit-down meals.
3. Stay as warm as you can -- hot baths, hot showers, heating pads, ThermaCare heat wraps if you need to work, warm clothes, warm drinks.
4. No caffeine (coffee, soda, chocolate) or alcohol.
5. If you can handle it, exercise helps, but stop if you get sick.
6. Try to get rest as much as you can. Try to relax.
7. Keep reminding yourself that it will just be miserable for a few days & then things will be okay again.
Pretty much mostly all the same things you would recommend for someone with the flu.

Of course, if you are losing a lot of fluids/not able to keep them down... if your heart rate is not just faster than normal but WAY faster than normal... or if anything else is feeling a lot worse than the flu, call your doctor or go to the ER. It is VERY rare that someone develops serious complications from withdrawal, but it's important to know the symptoms that are normal vs. those that aren't right.

Also, I know that my legs & arms have the worst creepy crawly feeling. I've yet to find a medication that helps for that. Brushing my hands quickly across my hands or legs does help some. It is a nerve sensation, so rubbing them like they are sore muscles doesn't really help -- but whatever works for you, go for it. I usually can't stand to be walking around very much because my pain is also out of control, but some people can walk around & find that walking or jogging for short distances several times a day can help (hydration is even more important if you are going to be working out ). Usually that starts getting better after the first day or two of withdrawal.

I know Cathy was trying to help you, but if your doc is such a stickler for the rules, I can't imagine he would be okay with you picking up meds from another PM while waiting for your next appointment. With them being so strict, odd are they have also started routine drug testing of all their patients. If you get tested & show positive for your meds even though you were supposed to run out a week early, you could get kicked out of your clinic & they might even let other clinics know the reason why so that it will become nearly impossible to find another clinic to take you. Trust me, withdrawal is not so horrible that I would ever risk losing my PM to avoid it. It's pretty miserable, but is it really worth losing your doctor (& possibly future treatment at other pain clinics) to avoid a few days of feeling really under the weather?

Let us know how things are going & how we can support you.

take care,
frances
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