Pain Clinic - Not Happy....

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Regular Member

Date Joined Apr 2010
Total Posts : 72
   Posted 6/18/2010 3:28 PM (GMT -6)   
Hi All - I also posted this on the fibro board but thought I'd post here as well in case I can get some more feedback.  Thanks!
Not sure if you guys remember me but I posted a while ago about how I was finding it hard to find someone to prescribe hydrocodone for my fibro, that along with Zanaflex is the only thing that seems to help. 
I only took, at the most, one a day, when I got home from work and it helped me function.  Believe me - I am not looking for drugs to get high, just want to be able to live a hal-way normal life and go to work every day so I can survive.
My Primary went on early maternity leave and her "successor" would not continue with her prescription so I have been to 2 rheumatologists, the ER and a new primary care.  The second rheumotologist suggested accupuncture but I just can't afford it.  My husband was in a car accident back in March and hasn't worked so we are struggling to pay our ortgage and for the meds we both need.
This particular rheumotologist that sent me for accupuncture is very nice.  He originally prescribed Tramadol but I can't take that as it makes me so dizzy, I can't stand up.  He could not or would not prescribe the hydrocodone.  He even said that he could tell that i was not someone who would abuse drugs.  He also cautioned me against taking Lyrica or Savella as they are forms of Gabopentin, which I had a problem with about 10 years ago.  I became suisidal after about a week and a half of taking it.
So I suggested a pain clinic.  He thought it was a great idea and told me - in sort of a roundabout way - that they would be able to prescribe the hydrocodone for me as he couldn't.
Well, the long awaited appt was last Monday.  I had kept a pain diary for 2 weeks, had typed up a couple of pages telling about the oset and history of my fibro.  The nurse spent quite a while with me and asked me what had worked for me in the past.  So I told her, a combo of hydrocodone and Zanaflex.  And I told her about my issue with gabopentin. Well, then the doctor comes in, he was so cavalier about my condition!  He said, what's with this suicide thing?  I was so shocked that he was so rude!  He then suggest I try Lyrica, and I told him my reasons for not wanting to try it.  I also have a severe panic disorder and I do not want to add anything to my mix of meds that will give me any other side effects.  I am funtioning and working now and can't afford to mess that up.  The hydrocodone doesn't give me any lasting side effects and doesn't interfere with my other meds.
Well, he did up my Zanaflex to 2 before bedtime, so that was great and has helped but he said he would not prescribe hydrocodone and prescribed Lidocaine patches.  He told me to "put them where they hurt" - Honey, I hurt EVERYWHERE!  Does he have a wet suit made of lidocaine?  He then proceeded to tell me that sometimes Fibro goes away!  Really?  You are a pain doctor and this is what you've seen in your practice?
He wants me to come back in a month to see how I'm doing.  I already paid this guy 40 bucks to insult me.  Not to mention that he and the nurse were giving each other little looks during the whole time.
I called the rheumotologist the next day, told him what ahppened and asked him if he would prescribe for me and he said, "I can't.  Unfortunately, you'll have to play the game with this other doctor.  Go back and tell him that what he gave you doesn't work and then maybe he'll prescribe."
Frankly, I do not want to go back to this insulting and unfeeling man, pay him 40 more dollars and still not get what I need to make me feel better.
I can barely move and NOTHING is helping.  I have a feeling that he wouldn't give me the scrip because of the suicide issue I told him about.  This happened 10 years ago, I was on a medication that can cause suicidal thoughts and they went away when I went of the med.  I do not see this as a problem.
Really, what is the issue, WHY can't I find anyone to help me?  I am SO tired and sick and tired.  I am now starting to look like a drug seeker.  I have never done any illicit drugs in my 52 years.  I barely took an aspirin until I was 28 years old.  Why is the medical community making it so hard for me to get help?
I feel like Elaine on Seinfeld when her chart was marked "diffiduclt" and every doctor she went to had access to it.
Sorry, just needed to vent.  Thanks for listening!

Regular Member

Date Joined Dec 2007
Total Posts : 104
   Posted 6/19/2010 12:06 AM (GMT -6)   
"Does he have a wet suit made of lidocane?" That is the funniest thing I've heard in a while! Not to downplay your situation, but I know what you mean. People not in pain, even the doctors who try to help us, have no true idea of how convoluted pain and trying to EXPLAIN our pain to them can be wrought with anxiety and frustration.

It's strange that the Hydrocodone wasn't prescribed. That is the basics of what most doctors prescribe for pain: Vicodin for the pain, Xanax or Ativan for the anxiety it brings, and maybe a muscle relaxer like Soma or like you have- Zanaflex. Those are the lowest levels on that DEA drug list or whatever it is. The higher levels being of course, Oxycontin, which isn't prescribed to us in real pain thanks to the jerks on the street who sell it to get high. I want to start an advocacy site or something for people who are truly in pain who are denied pills that work because of the criminal element abusing them. I digress. Sorry for the rant, but I bet you can find a PM doc who will prescribe Vicodin. If it is really helping your pain, then they can't deny you that priveledge.

Lots of people get depression and suicidal thoughts when they get over the "denial" stage of their pain and the "reality" stage of it sets it. I became depressed. I wasn't suicidal, but I was a walking zombie due to the unrelieved pain. Paxil changed my life. Thank goodness. Also, a "prescription" caused the suicidal thoughts. They warn of that on TV commercials, so I don't understand that doctor's surprised take on it??? And that's unprofessional to tell someone that they "look like a drug abuser." I would complain to a medical board for that. Doctor's can't say slanderous things like that to a patient. How horrible you must have felt! My jaw would have dropped to the floor had a doctor ever told me that!

Don't "play any game" with a doctor who is not helping you. That is absurd and horrible advice. Seek out a good Neurologist, Rheumotologist, or a Pain Management doctor who is willing to listen to you and understand your needs.

I wish you the best of luck and keep me posted.

Regular Member

Date Joined Dec 2005
Total Posts : 256
   Posted 6/19/2010 2:22 AM (GMT -6)   
I have the same problem with lidocaine patches....that and they irritate my skin, as well as the feeling of lidocaine in my bloodstream makes me feel like i've been injected with liquid plastic, a very odd and "toxic" sensation.

They do wonders, for short periods, suppressing the pain of my sacro-iliitis. But they can't fit/stick in a location that works for my worst localized pain in the *front* of my pelvis, and frankly that's too close to certain structures/nerves I really don't want to numb even though they carry a fair share of that pain.

Plus: as you've said, I'd have to wear a full-body lidocaine suit because my pain is spread out over almost every joint in my body. Particularly places with a high density of joints that patches won't fit/stick on, like hands and feet and knees and elbows.

Lidocaine patches are really meant for topical use, such as with shingles....they aren't really intended to penetrate very far past the skin into muscles, joints, or deep nerves.

Sadly, your doctor is being bluntly honest with you. There *is* a game involved in getting "controversial" meds like opiates from most doctors. And unfortunately there are times when honesty/frankness will get you nothing but trouble, no matter how good your intentions or how responsible you are with your meds. Docs will do everything possible to discourage you from getting opiates or any other meds they consider "potential trouble" for their practice.

Docs are business people first, and compassionate a DISTANT second. If it's even on their list, which is a rarity.

You can't use words like "suicidal" with a doctor, no matter how true or reasonable your related point about GABA-acting drugs like Lyrica or Neurontin (Gabapentin) is. They'll label you a "trouble patient" and be even more risk-averse in terms of prescribing you anything that could ever make them look bad if you had the slightest trouble with -- or someone even merely accused you of having trouble with. The facts are of little consequence to the doctor here. It's all about perception, reputation, perceived risk of drama, and perceived risk of malpractice insurance cost hikes/legal entanglements.

The really sad thing is that you probably gained nothing by telling the pain doctor that you've had that specific problem with could have phrased it more benignly, something like "experienced intolerably bad side effects and no discernible benefits" would have sufficed.

The sad fact is, if you aren't extremely cautious in what you say to your doctor, excessive honesty and frankness can get you in all kinds of trouble while giving you absolutely no benefit in return. That we have to self-edit is unfortunate and can in some cases lead to not getting the most from the advisory roles of our doctors....but it's a fact of life as a chronic illness/pain sufferer.

To be blunt, I think you're lucky that your rheumatologist is so up front with you and so relatively understanding about you saying some of the same things to him. Of course he's shirking his responsibility to help you control your pain in a reasonable most specialists do, including "pain management" docs....but at least he's being straight with you about what it's going to take with other docs to get what you need.

Don't get me wrong. I'm not advocating dishonesty, per se. I'm advocating selective honesty. You have to choose your battles, and avoid certain "hot button" words like the S-Word. My 10-year illness has left me thinking suicidal thoughts -- even though I would never follow through because I am determined to endure my sufferings as long as humanly possible to stick around for my family -- on hundreds if not thousands of horribly painful and bleak days. But I've never used that phrasing with any of my doctors. I use other terminology to describe how difficult it has been and how I am often not sure how to endure it despite having some of the best coping skills/tools anyone could hope for....but never the S-Word. I know that would result in nothing good.

Honestly, I think that it is a completely different thing to have "suicidal thoughts" only while on a problematic medication short-term than to report it from situational depression that has no clear physical basis. It's also completely different to think them because you're going through an extremely difficult long-term health drama than to be thinking of offing yourself because you broke up with your girlfriend/boyfriend or something like that. One situation is temporary and can be fixed by changing your life, getting your love back or finding a new one....with an untreatable/incurable disease that involves vast suffering and constant fear of getting worse, it is an entirely different animal.

Docs are getting more and more paranoid about meds that are in any way "controversial" or likely to end up getting them in the newspaper because some patient of their was irresponsible with their medication. Soma is a major victim....I got it for years from my primary, but now he's absolutely unwilling to prescribe it (and seems to have some confused ideas about why it's bad....he thinks it's metabolized into Demerol [meperidine], a rather undesirable opioid molecule....when actually it's metabolized into meprobamate, a completely different molecule that is generally harmless in normal doses). There are any number of others.

If you end up finding no other solutions for your Fibro pain....look into Low Dose Naltrexone (LDN). It's a very promising for pain as well as for many chronic conditions themselves; it has potential to be an actual treatment, if not an outright cure, for many underlying conditions rather than just another band-aid to help us cope with the symptoms.
Conditions: Reactive Arthritis (AKA Reiter Syndrome), Crohn's Disease, Chronic Pelvic Inflammatory Syndrome, Sacroiliitis, Costochondritis, As Yet Unknown MS-Like Relapsing/Remitting Neuropathy, and a partridge in a pear tree.

Medications: Currently not that many are taken daily, but there are many at my disposal for part-time use. Low dose pain medication, after years at high doses. Working on innovative ways of taking lesser-known pharmaceuticals and non-prescription supplements to maximum benefit.

Forum Moderator

Date Joined Feb 2003
Total Posts : 13366
   Posted 6/19/2010 3:07 AM (GMT -6)   
Hi Suz,
Well, I am sorry to hear the appt with the pain mgt dr was such a bust. Glad to know you did get an little increase with the Zannaflex. I have used them in the past very successfully and a warning letter came out a couple years ago about a potential problem if used with certain other meds and now my current pain mgt refuses to rx them to me. She has taken all of her patients off of the Zannaflex and really her thinking is unfounded,  printed off the warning letter from the FDA site and took it with me to an appt and she still refused to budge, lol.
I know you probably feel you are being targeted by this dr for not rxing the Hydrocodone, but its a popular medication that many seekers like and of course those are the ones that have made it nearly impossible to get pain meds. PCP's and the other drs are all running scared bcause there is so much hype out there daily over pain meds being abused. Something I am wondering about in the back of my mind with this dr, is most pain meds have little to no effect on nerve pain, this is why they all rx meds like Lyrica, Cymbalta & Neurotin. I am wondering if this may be his reason for not providing you with it, who knows.
Your rheumy was so correct when she said "play the game", sad but true. You options are try to find another PM dr or make one return visit back so that you can say I did what you requested and I am no better off with hopes that he may rx the Hydrocodone.
I wish I had a solution fo you but just cannot think of anything to offer except a lot of understading. Take care and let us know what you decide on 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.

Regular Member

Date Joined Apr 2010
Total Posts : 72
   Posted 6/19/2010 10:05 AM (GMT -6)   
I'm glad you got a little giggle out of my lidocaine wetsuit Elenor - humor is how I try to deflect from my pain - sometimes it works and sometimes it doesn't.

Exitwound - I hear you - my problem is that I'm extremely honest to a fault. My husband has a prescription for his broken neck of 100 oxycodone. I could be taking those but they are nto my prescription and I think it's dangerous and dishonest to take someone else's prescription. So I guess that proves, in one way that I'm not looking to "get high" - which in actuality - I hate! I have spent my panic ridden life trying to get away from that feeling - which I associate with my panic attacks. I but now it's out there with that doctor - so I'm pretty much out of options. Why doesn't the FDA worry about people selling these drugs on the street instead of the people who really need it. Yes, there are unscrupulous docotrs out there but obviuosly, I haven't found one yet! LOL - Sorry - there's my sick humor again.

Better get on with my day. Thanks to you all! Suzanne

Veteran Member

Date Joined Jul 2009
Total Posts : 2042
   Posted 6/19/2010 12:31 PM (GMT -6)   
Out of curiosity have you ever tried Cymbalta for your fibro? My wife takes it for her Fibro, 60 mg/day, and has had good results. If you haven't tried it before you might want to think about it and talk it over with one of your doctors. If you do try it make sure they start you off at 30 mg a day for around 2 weeks before increasing it and give you a couple of weeks before any increases in dose. Some doctors want to start people off at 60 mg/day and many people have trouble with side effects at that level when starting out. If memory serves you can go up to 120 mg a day with the Cymbalta.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.

Veteran Member

Date Joined Aug 2006
Total Posts : 9607
   Posted 6/19/2010 12:42 PM (GMT -6)   
I found your lidocaine wetsuit, funny...I can't tolerate the lidocaine here as it get too hot and I get sick
Heat and those patches do not mix's 108 f with heat index today...
Anyways I hope you get a low pain day, soon...
keep us posted....
Sometimes finding a good PM doctor can be hard, Maybe look at getting a different doc...
* Asthma, Allergies, Osteoarthritis, Spinal Stenosis, Degenative Disc (Lower Lumbar S1-L3 and Cervical C5,C6, C8 and T1), Fibromyalgia, Gerd,
Enlarged Pituitary Gland, Sjogren's, Ocular Migraines, mild carpel tunnel, ect.... "Would be nice if we could use the edit button in real life"...


Mrs. Dani
Veteran Member

Date Joined Jun 2009
Total Posts : 2787
   Posted 6/19/2010 12:52 PM (GMT -6)   
    Oh my gosh, Suz!!! A wet suit!! HAHAHAHAHAHAHAHA!!!!Oh my gosh my side hurts! So true thou! What heck is that guy thinking? Does he not understand what Fibro is??
   On a more serious note.. The new pain clinic doctor doesnt sound like he is listening to you atall. I really do not see why you are not perscribed hydrocodone. It sounds like it is perfect for you. LIke Jim, I too wonder if you have tried Cymbalta? It might be worth a try??
   Above all else, I am so terribly sorry you were treated so badly. I might be reading too much into things.. But I don't think the doctor you saw is worth seeing anymore. I do not know if you even have access to anyone else in your area? I hate the thought of you seeing someone that treats you with such careless disreguard.
    I do hope you are able to come to some sort of compramise. It really isnt fair that you waited SO LONG, for this appointment just to have that happen to you. Please, know you are in our hearts and prayers here. Stay strong!!
Two roads diverged in a yellow wood
And sorry I could not travel both
And be one traveler, long I stood
Chronic Pain Moderator

Veteran Member

Date Joined Nov 2008
Total Posts : 1037
   Posted 6/19/2010 6:45 PM (GMT -6)   
OMG!! When I hear stories about Dr.'s NOT prescribing pain meds to someone that actually needs them I want to find them and make them hurt and NOT give them anything for pain.... Why do some Dr.'s do this? I guess I've been so lucky with finding a great PM Doc and I don't understand what the problem is.....

Is it just a certain part of the country? Is it certain Doctors? I have never heard so many stories of PM Docs that are so unwilling to give pain meds. What are they so scared of? The DEA? Unless these Docs are already under investigation there is no reason for them not to help you....

I wish there was somthing I could do to help you....

Spinal Stenosis, DDD, DJD, HBP, Type 2 Diabetes

Methadone 120 mg. X daily
Oxycodone 30 mg. 5 X daily
Lisinopril HCTZ 10/12.5 2 X daily
Metformin ER 500 mg. X 2 @ bedtime
Novolin 50-0-50-50
Novolin R 0-50-0-0

That's all....but OMG!! isn't that enough?

Regular Member

Date Joined Mar 2010
Total Posts : 90
   Posted 6/19/2010 9:52 PM (GMT -6)   
I also suffer from fibro ( am having a skin hypersensitivity attack actually as we speak - and I am not ok spending the day in because i can't wear clothes..blah...besides the point).  The reason I found you in this forum is I have a lot of other things aside from fibro and am currently in a "last resort" chronic pain program.  It's done wonders, and my goal is to get off a lot of the meds (I'm on 9 multiple times daily and 6 as needed) and I'm only 26.  I'm on a fairly lower dose of hydrocodone but couldn't get out of bed in the morning if I didn't have it so I completely understand your pain and sympathize.
One thing to think about that sort of bothered me was the Savella comment (not your comment, but the doctor's) . I don't want to jinx myself but I had absolutely no luck with Gabapentin and it's simlar Lyrica buddy, but Savella is a completely different class of drugs (more similar to the Cymbalta that someone mentioned earlier).  I can now pinpoint specific points of pain and although i still have days like today....after I get up and get moving in the morning and have had my half hour heating pad time :)  I am feeling much better on the Savella.  Also helps to stabalize my mood - which can really help chronic pain patients.  Just a suggestion to maybe talk to someone about trying a titration pack.  It doesnt' take the place of a breakthrough med or hydrocodone supply, but it really has helped me greatly so far.
Really wishing you luck - it's so frustrating and difficult.....bless you!

Veteran Member

Date Joined Mar 2008
Total Posts : 2976
   Posted 6/19/2010 11:36 PM (GMT -6)   
Hi Suz,

Frankly I'm not surprised that your new PM wouldn't prescribe you any pain medication. First of all, from what I've heard, many PM's will make it a point NOT to prescribe medications at the first appointment. They don't know you & what kind of patient you are, etc, and so they don't feel comfortable writing prescriptions for pain medications at your first appointment.

Secondly, many, and perhaps most, doctors will only prescribe pain medication as a last resort. So, like your other doctor said, you just have to tough it out and "play the game" for a while until you've exhausted all other options. Don't take it so personally, they do this to everyone.

I know it is frustrating, but try to stay positive. Maybe something new that the doctor tries you on will really help you. In my opinion, it is worth trying everything and anything.


Regular Member

Date Joined Apr 2010
Total Posts : 72
   Posted 6/20/2010 9:17 AM (GMT -6)   
Thank you all SO much for your kind thoughts and word.

Regarding the Cymbalta - the reason I am not on it is because of my panic dicorder. I take 40 mg of Lexapro daily and this works wonderfully for me, I am able to leave the house and go out to work everyday, which is essential for me. I wish I had the lusury to stay home but I don't. So in talking it over with my psychiatrist, we decided that swtching to Cymbalta, would probably not be a good idea and adding anything new like that, might mess up the delicate balance I have. I just cannot go back to hiding in my bedroom - it's taken me 10 years to get to this point and aside form the fibro pain, mentally, I'm doing well.

What's funny is that I didn't even ask for the hydrocodone, the nurse asked me what has worked for me and I told her. I didn't even mention it to the doctor, he was the one that brought it up. I do think that certain areas of the country make it harder to get pain meds. My sister lives in Florida, has a much worse case of Fibro than I do and her doctor prescribes 180 10 mg Lortabs a month.l Not a problem at all for her AND she's on Cymbalta.

I do think the doctors are scare of the DEA - I swear, since Heath Ledger died and with the Michael Jackson debacle, they have gotten worse. I'm not asking to be anesthetized!

At this point, I'm trying to figure out whether I should "play the game" to the tune of $40.00 per visit or start to look elsewhere. I have a few weeks to figure it out.

Pennstate - I thought the skin hypersensitivity was all in my head - thanks for confirming that I'm not crazy - I just want to crawl out of my skin somedays....hope it gets better quickly for you!

You are all AWESOME. Thanks for listening to me and hope you all have a pain free (or as close to) day.

Regular Member

Date Joined Apr 2010
Total Posts : 72
   Posted 6/24/2010 12:44 PM (GMT -6)   
I went to my psychiatrist today (I've been going to him for over 5 years and I totally trust him!) I told him about what's been happening and he asked me if I would try Cymbalta as he thinks it will help me. I was under the false impression that it would mess up my Lexapro but he says that it most likely will not. He wants me to start out with 30 mg at bedtime for 2 weeks and then if I'm tolerating it, then go up to 60 for 2 weeks and then he'll prescribe it for me. The only thing that I see wrong with this is that it will probably be another $50.00 copay per month so that's kind of scary. Hope it works for me! Also - he gave me a months worth of samples.

My sister takes it and if she take the 60 mg - she gets manic but the 30 is okay for her.

Veteran Member

Date Joined Jun 2007
Total Posts : 702
   Posted 6/24/2010 2:39 PM (GMT -6)   
I am so sorry this is happening to you, But everyone is right. There is a game involved in pain magaement. I went to one clinic who would rx nothing but pT. They had me in tears. I decided to try another clinic. I have to play the game. The first visit they do not give out meds. They "size" y ou up first. Decide what your risk levels are. They check my urine every visit. I have to go to PT, try accupunctire, massage, and basically anything they say in order to get my rx's I had to see there sleep doc, their therapists (even though I have had my own for years) and their pysiatrist (sp?). They dont want you to just get meds. They want you to work on yourself to get to a better place with your body so supposedly the meds work better and you need less.

It has cost me and my insurance a LOT of money to go there. I just had a urine test that was $1200 (luckily ins covered it) My copay is $30 every month just for med management. I have had 5 $5,000 procedures (inj) and multiple trigger point inj. sleep studies you name it.

Its alot. I think that is how they weed people out.

I say stick with it if you can unless you get some majorly good reccomendations on another place. If you start going all around town you will look like a drug seeker.

I also was suicidal on Lyrica and neurontin so you are not alone. Savella made me vomit so much I had to take an ambulance to th er.

Cymbalta works wonders for my depression and a little on my pain. SO it may be worth a try.
The other thing is in my opinion you need to attack the pain from all angles. Nerve pain needs different meds than muscle pain, and inflammation. I was given a rx for Meloxicam to use on days I cant function and ity has been amazing. It is a strong NSAID.

I have to admit that I am too honest sometimes too. It can cause more trouble than its worth at times. I just answer the pain docs q's and leave it at that.

Good luck. I hope you get the relief you need.
Chronic Lyme Disease,Fibromyalgia, CFS, PCOS, sleep apnea, hypothyroidism, type 2 diabetes, bulging discs to name a few

Regular Member

Date Joined Apr 2010
Total Posts : 72
   Posted 6/24/2010 2:56 PM (GMT -6)   
Thanks merrygirl. It's funny how the people who are just so sick and tired are the ones who have to jump through hoops to get what they need. Thanks for the name of that NSAID - although I have really bad gastritis so it might not work for me.

I hate not being honest but I guess I should just keep my mouth shut from now on. It's not even like I asked for the meds, they asked ME what worked for me and I told them.

It's horrible how expensive everything is. I am working off of just my salary right now because of my husband's accident and every other day it's another medical expense. Between the 2 of us, we're keeping our local medical industry hopping!

Veteran Member

Date Joined Nov 2008
Total Posts : 1037
   Posted 6/27/2010 4:18 PM (GMT -6)   
Oh Honey...if I didn't have TennCare I wouldn't be able to see any Dr. and forget about all the meds....I couldn't afford my insulin let alone the pain meds....

Spinal Stenosis, DDD, DJD, HBP, Type 2 Diabetes

Methadone 120 mg. X daily
Oxycodone 30 mg. 5 X daily
Lisinopril HCTZ 10/12.5 2 X daily
Metformin ER 500 mg. X 2 @ bedtime
Novolin 50-0-50-50
Novolin R 0-50-0-0

That's all....but OMG!! isn't that enough?

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