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Epidurals, Fentanyl Migraines and a Doc Who Doesn't Know Left from Right

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Posted 8/27/2009 1:01 PM (GMT -8)
I just got home from the latest epidural I had done. This time he did three epidurals at once. I had an EMG done and it showed 2 pinched nerves on my right side. He had upped my Fentanyl patch to 200mcgs and was having me change them every 48 hours. The Fentanyl at that high a dose is giving me migraines and I have had a steady migraine for the entire last 7 days.

So I went and he did the epidurals and even though I was asked if it was the right side they were doing (and answered YES) four times, he still managed to do the LEFT side instead. He kept apologizing afterward and seemed pretty upset. He explained that the epidurals on the left side (all three) would not make any difference in my pain, then quickly back-pedaled and said he had put in "a lot" of the medicine and he hoped that it would also make a difference on the right side as well. So, all in all, he screwed up and made me go through all this again for no reason and I will probably have to go through it again in a couple of weeks (this time on the right side).

So after he was apologizing all over the place for screwing the whole thing up royally, I asked him what we could do about the migraine problems due to the Fentanyl. He told me to "take them off", I asked him, "and then what?" He looked at me blankly like he didn't have a clue what I was talking about. He told me that after the epidural "you shouldn't need them." I didn't even bring up the fact that I am on 200mcgs of Fentanyl and have been on Fentanyl for over 9 months now. He somehow thinks I should go from 200mcgs to zero in one day. What in the hell is that?

I finally just asked him, "when I am on one patch, my back pain is about 8 to 8.5 at the best of times. When I am on two patches, I am down to a 6 or 5.5 when laying down but the migraines are at about a 9 almost all the time. Can we just do something else altogether and ditch the patches completely and go for a med that doesn't have all these side effects?" He said (when I interrupted him in the middle of apologizing) "YES" quite loudly (like he found a way out of me being pissed, I hadn't given him an ounce of grief at all), but then backpedaled again and said that this was an "inappropriate place to do this." He said I would have to talk to him about it at the followup two weeks from now.

So now I am back at the place where I was before. I am on one 100mcgs patch w/no breakthrough meds. I am able to change them every 48 hours so I won't be getting WD all the time (which is good) but my pain levels are still at best a 7 on these things. They seem to plain out just not work for me and have all kinds of drawbacks and side effects.

The last epidural I had basically incapacitated me for a week and that was just ONE injection. Today he did three and I am not looking forward to seeing if this messes me up so badly that I want to rip my spine out (all for no reason, mind you, since he did the wrong side anyway...) when the numbness wears off.

So here is a minor breakdown:

1) 3 epidural injections for no reason and on the wrong side of my back.
2) Pain meds decreased by 1/2 due to side effects.
3) Two week wait for followup where he will probably just deny my requests to change the Fentanyl for something else.
4) The threat of being taken off Fentanyl without any decrease over time and probably ending up in the hospital because of it simply because this guy (a pain management Dr. no less) seems to have no clue about medications.
5) Just waiting around for tomorrow morning to see just how badly these epidurals are going to hurt me this time. If it is like last time, it would almost certainly be three-fold.
6) There has to be more but I don't want to dwell on it. I am finding it harder and harder to even give a crap anymore. I don't think anyone can or will help me whether they want to or not.


Skrape
Posted 8/27/2009 1:14 PM (GMT -8)
Skrape-
Wow...Sorry this has happened to you. I am at a loss. How can he be a pain management doctor and be this way. I have only have 2 epidurals and one was when I was out for surgery. I didn't like the feeling of the one I had awake and can't imagine 3 at a time...and then on the wrong side to boot. I thought I was having a bad week.
((((((((Skrape)))))))) I hope you get some relief out of this. If nothing else I pray the migraines stay away.

Take care,
Bill
Posted 8/27/2009 3:25 PM (GMT -8)
Skrape,
I am sorry this has happened, but I would run - not walk - away from this "doctor". I don't know much about fentanyl other than it's a highly potent medication (one used in operating rooms at times!). In the other thread people expressed concern with how fast this doctor had increased your dose - and how much. Now he does three injections on the wrong side after having asked you several times which side????

This is IMHO medical incompetence. May even be worthy of a visit to a lawyer, but if it was me I would never return to this guy. Again, just my opinion, but he scares me!

Hugs to you!

PaLady
Posted 8/27/2009 3:34 PM (GMT -8)
i get 2 epidurals at a time, but they go through one hole..i guess using a catheter. They dont cause much pain for me. but then again i get them on the correct side and such, GOsh I hope it feels ok.
I also take 15 mg oxyxcodone for pain with my 50mcg patch.maybe you can add that on?

200 mcg of fentanyl sounds like a lot, good luck,

melissa
Posted 8/27/2009 3:35 PM (GMT -8)
Wow - I have to agree that it is time to look for a new PM doctor ASAP. This guy or gal is really doing some sloppy work. There are no excuse for these mistakes other than he is either way too busy and isn't taken time to review his charts or he doesn't view a crap about anything by $$$$. You do not what this man using you as a pincushion doll. Start looking for other highly recommended PM's in your area.

I am so sorry this is happening to you.
Posted 8/27/2009 3:36 PM (GMT -8)
AWE Skrape,
I'm so very sorry you've had to go thru all this and you have lots and lots of soft hugz
from me...
I would tell you the same thing the other have and to try to find a new pm doc, if you can
and the sooner the bettter, as it might take a month or two to get into a good pm doctor...
and at the same time keep this follow up and take a friend or loved one with you and
ask these same questions, you asked him and more...

try going to chat tonight, others here might be able to help!

more hugz....
you so deserve better treatment!!!
Posted 8/27/2009 4:31 PM (GMT -8)
My heart is out to you. I as well as many others know the pain of Dr. incompetance. I personnally would have to be restrained from hurting that quack if still able to move. Get yourself a good lawyer and they sometimes have contacts to get you in the Dr.s door a little quicker. If only they had a speed other than slow
Posted 8/27/2009 4:41 PM (GMT -8)
I have to agree with everyone else. Don't quit this doc until you find a new one, but you need to get a new one ASAP. I can't imagine what is wrong with you, but I'm pretty sure that 200mcg/h is the maximum dose they can prescribe of the patches. That is a huge amount of pain meds. From my own experience with the med (although I was only on 25mcg/h patches), when I had successful injections, I wouldn't need as much fentanyl for managing pain, but it is an awful withdrawal (short, but really miserable) & for that reason must be carefully managed by a PM. Switching to another narc should prevent the withdrawals but just stopping the fentanyl completely, especially after being on so much, seems like a really bad idea. Maybe there is some special reason why you would be okay with that, but even going off of a much lower dose, I've had heart issues from going off too quickly.

Please do take care of yourself. It seems like your doctor is not doing too great of a job taking care of you. And I think it is totally insane that he couldn't get the epidurals right. How is that even possible? If it were a procedure you had to be put under for, I would suggest having him use a surgical marker to circle where to do the injections, but since it was only an epidural & you were awake to tell him where to do the injection & did tell him, I can't see how he could have screwed that one up. Wow. I thought my crazy PM had issues. That's really awful.

take care,
Frances
Posted 8/27/2009 8:24 PM (GMT -8)
Wow its scary to think that there are doctors like this one out there!!! I must agree I'd be getting second opinions and fast. Migraines are no joke in themselves . It really sounds as if this isn't the med for you. I got a bad migraine when I had pneumonia whether from the infection, coming off my arthritis drugs suddenly or from the triple doses of antibiotics I don't know but they ended up giving me an anti depressant for a few days as narcotics didn't touch it. Heart goes out to you, golitho.
Posted 8/27/2009 10:02 PM (GMT -8)
Skrape, I know from some of your previous threads that you felt you were at the end of your ropes before and then a new doctor on the scene. Is that right? I would ask for a copy of your files with the lastest procedure to make sure he documented the error in the procedure. Otherwise he could argue that he did it right you just thought he did it wrong. You are a chronic pain patient who uses drugs and he is a doctor who are they going to believe? We seem to have multiple doctors that specialize in the field of quackology.

I am not sure how easy it would be to find a new doctor at this point but it does not sound like it is not a bad idea to be looking. I am not sure what your insurance situation is but they would probably flip if they were billed for the epidurals that were improperly given. You have to become your greatest advocate to get either this doctor to look at the patch vs other meds in reality instead of uncertainty. Hang in there. Even though it seems at times that nothing seems to go right, we still are able to find times of victory amidst the failures. But the only way we find them is to keep trying and not giving up. Keep us posted as to where things are at.

Posted 8/28/2009 12:47 PM (GMT -8)
Sorry guys, this thing didn't notify me by email for responses like it usually does. I didn't notice all the comments until now.

I had an epidural done (just one) late last year that basically incapacitated me; which is why I have ended up w/a lot of the problems I have now. I was anticipating this one would hurt even worse because it was actually 3 separate epidurals. I could tell last night that it was not as bad as the previous one was. When I woke up this morning, I sat straight up and didn't even think about the procedure. I am sore and have been trying to take it easy today but my post procedure pain is nothing compared to the first epidural I had. I think this kind of proves that the Dr. that did the first one did something very, very, very wrong.

I understand and even agree with all the comments and concerns with finding a new Dr. This WAS supposed to be the new Dr. darn it! I have only seen him for the first visit (where he upped the patch to x2 the previous dose and the frequency upped by a third) and for the procedure yesterday. It would be best to find a new guy ASAP.

He said after the procedure yesterday that he wanted me to follow up in 2 weeks so he could ascertain how I was doing. BUT now I get a call today asking me to schedule an appointment w/the Dr. for the 31st (Monday). So instead of following up 2 weeks later like he originally wanted to do, he wants to follow up 4 days later. I am not entirely sure what to make of this. I did schedule the appointment because I already had an appointment w/the new Neurologist the same morning; so two birds w/one stone and all that. I will be keeping my appointment w/him on Monday to see how things go. At any rate, I would have to stay w/him until I could find another Dr. anyway.

On another interesting note; I was on my last two patches so I had my wife take the prescription he wrote for the patches that were for 200mcgs x 48hrs (20 patches total for a 10 day period I guess) and my pharmacist refuse to fill it because he said it was a "ridiculous jump in the amount of medication!" He told her he absolutely could not fill the prescription until he called the Dr. to ask them about it. I called when my wife got home to ask for some advice regarding the patches and he had said that he did fill them because the Dr. verified that he did write the Rx for that much. He (the pharmacist) told me that he had only once seen a person on 200mcgs of Fentanyl every 48 hours and had NEVER seen a jump from 100mcgs to 200mcgs at once. He said it was a crazy amount and that (he thought) it would be the highest dose a doctor could ever prescribe for me. I will be going back down to 100mcgs every 28hrs regardless because the side effects are so bad (migraines, etc.). I asked the Dr. about this and he said Ok but I am really trying to push him for a med completely different that would not give me bad side effects. He did say that, "Yes we definitely can do that." but he said it would not be appropriate to do it until the followup. I am hoping we will cover this on Monday....

I will let everyone know how both the Neuro and PM Dr. go on Monday. Oh, and hopefully the email notification will work on the comments back about this issue as well.

------------------------ EDIT ------------------------

BTW, I do not know how I manage to have all these crazy things happen to me. At first I get a Dr. that only wants to throw meds at me to get me by, then I get a Dr. who is afraid to give me Fentanyl any more often than every 3 days when even the manufacturer says a lot of people need it every 48 hours, then I get a guy who throws ridiculous amounts of medication at me but cannot even do a procedure on the correct side of my back... How I get these guys, I don't know.


Skrape
Posted 8/28/2009 12:53 PM (GMT -8)
I can't believe he did the wrong side!!! That is EXACTLY why surgeons are required to ask the patient which side they are working on & what they are doing, and then physically sign the surgical site. AND they must verify that they have the correct patient, procedure, and side with the OR staff once in the OR & before starting the procedure. Even when I had nerve blocks done, my PM would do this. There is really no excuse for him doing the wrong side, especially three times! I think I'd be looking for a new doctor as well.

Skeye
Posted 8/28/2009 1:11 PM (GMT -8)
See, that's the thing! I was asked at least 5 times that "we will be doing the right hand side, correct?" and I answered "Yes." every time. Even when they started the local anesthetic and stuff, it felt like it was on the left-hand side but they were still talking aloud (I think there was a dictation mic on the ceiling, they talked like they were making a record of it) about doing it on the right-hand side so I decided they maybe were going in at an angle or something, *shrug. When they are still saying aloud "we are doing 3 epidural injections on the right-hand side", I figured THEY knew what they were doing, etc. I won't make that mistake again.

BTW - I never signed anything on my back and they didn't mark my back, etc. I looked on the discharge sheet I had to sign and it is checked for the Transforaminal Epidural with a hand-written "Left" beside it. I did make sure it said the side they actually did and I DO have the EMG results for that test showing "Right" for the "side" column. So if I do run into trouble, I have proof they did the tests in the right-hand leg and right-hand side of my back BUT that they actually did the procedure on my "Left" side. So I have paperwork to back up my story, etc.

I don't know if I am being naive about the paperwork but I just hope to get something, anything done to help the pain. If he tries to give me the boot for some weird reason and hope to just be rid of me or something, I have a paper-trail of what went on...

I am not the type to want to cause trouble or start a lawsuit or anything like that; as long as this guy doesn't try anything funny at least. This procedure didn't really hurt me at all and I am waiting to see if this epidural may help me anyway, regardless of the side it was done on. I am curious as to why he changed the followup from two weeks from now to 4 days from now (the next closest business day)... I guess I will find out for sure on Monday.

I am still trying to get my head around the rollercoaster of meds and procedures, etc. I have been through in the last 7 days. After 9 months of sheer torture on these stupid patches, at least I get to change them every 48 hours at the very least.

Oh, almost forgot... FatherJohn,

Yes, you have the right guy. I have had so many ups and downs that I don't really know what is going on anymore! Thanks for remembering though!


Skrape
Posted 8/28/2009 1:39 PM (GMT -8)
Skrape,
It sounds like you might have a decent pharmacist, and they can be a wealth of information. My suggestion would be to try to talk with him/her over the weekend, and ask for some ideas for pain management, considering your side effects (the migraines) and the drastic increase in dose this PM gave you. Make sure you speak with a pharmacist (hopefully the one who filled you script - name should be on the label) and not a tech. Then you could at least go in Monday with some suggestions, and you could say "my pharmacist suggested..." rather than having it appear to come from you.

My hunch is the reason you're not having many problems with this injection is because they weren't done where your pain was originating. Really, the procedure should not even be billed to your insurance company. They may not want to authorize more injections very soon, thinking these were done where they should have been. Someone suggested getting a copy of the records, and as long as you're going Monday I'd ask for them. Wouldn't say why, but that you just want them for your records (not a bad thing to do anyway). It could create a lot of problems down the line if these are being documented as being done on the left side, and that is seen as the correct side. Other physicians down the line will look at these and may determine treatment plans based on them. You also have a right to place a letter in your file describing what happened, and I would definitely do that if you find the records don't reflect accurately what happened. You can't make a doctor change his/her records, but you can ask your letter be added to your file (and then make sure you deliver it to each pm doctor, and your PCP and others treating you. It's an aggravation to say the least, but it will help you down the line.

Good luck! And don't be afraid to assert yourself on Monday about the fact you were asked several time which side, and this doctor needs to own up to that. We'll see if he/she does.


PaLady
Posted 8/28/2009 1:46 PM (GMT -8)
PAlady,

Thanks for all the great suggestions! I did call and ask the pharmacist what he thought but I couldn't get a lot out of him except that he wanted to make sure that I knew exactly what I was doing and what was going on. He did say that it would be a good idea to get me on another medication that does not have the bad side effects that the Fentanyl does. From what I understand, headache is a very common side effect for this medication.

I am definitely going to check out what is in my file about the procedure being done on the wrong side of my back. I would be very interested in seeing what they had to say about that in writing in my file.... Again, I thank all of you for the wonderful suggestions about this transition. Hopefully this will work out in the end....


Skrape
Posted 8/28/2009 1:53 PM (GMT -8)
Skrape,
Just thought I'd add I'd still look for another doctor if I were you. This doctor hasn't shown much in the way of competency either with the injections or the medication. You may need to hang onto him for a bit as you search, but I wouldn't have him do any more procedures on me - but that's just MHO.

Also - be sure your pharmacist knows all the meds and OTC meds, supplements you're taking. There could be some interactions going on. Many of the pharmacies now can plug in programs with supplements and OTC meds along with prescription medications and see if there are interactions. Sometimes they can also negate eachother, or intensify eachother.

PaLady
Posted 8/28/2009 1:58 PM (GMT -8)
I didn't know pharmacies do that now. I use the local Rite-Aid and they (I think) are a national pharmacy so hopefully they do this as well. I will have to ask them about that the next time I get in there.

I had all of the OTC items listed in my signature because I copied the med list from the one I just made yesterday for the procedure. I saw how big it was and went to delete all the ingredient info out of the OTC stuff but it will not take the change in the signature. It shows the right thing in my profile but always shows the previous signature in my posts.... SO, sorry for the super-long med-listing. I don't know why the change will not be reflected in the posts or replies.


Skrape
Posted 8/28/2009 2:12 PM (GMT -8)
Skrape,
Definitely take a list with you to Rite-Aid. Or you can call and ask them if their computer systems does all this. I know here CVS does do it. And even though we may give these things to our doctors, many of them might not even know the interactions with the supplements and such. That's why the computer programs are great. You might even be able to do it yourself online, but I'm not sure which credible site to use. If someone can recommend a credible site that would be great (maybe your pharmacy).

PaLady
Posted 8/28/2009 4:07 PM (GMT -8)
Skrape,
I am wondering when the headaches started. Was it before or after the epidural injections?
Posted 8/28/2009 6:09 PM (GMT -8)
The headaches originally started when I first started the Fentanyl, about 9 months ago. Before 9 months ago, I used to get a headaches approx. once a month (if that!) and would take a couple of Excedrin and that would take it right out. Since I have been on Fentanyl, I have headaches that do not really go away. I have gone through the max amount of Excedrin I can (8) in a day, every day. Sometimes they will go away for a few hours but they always come back. Other medications (like Wellbuterin) will spin that Fentanyl headache right into a migraine immediately. Since I took myself back down to the 1 patch every 2 days (as opposed to 2), I have had headaches but they go away again if I take a couple of Excedrin and stay away for a number of hours. It isn't like it was when I was wearing 2 patches at a time, that was constant migraine that never went away, no matter what! I haven't notice any headaches specific to the epidural. I read that those can happen and they don't sound fun so, knock on wood....


Skrape
Posted 8/28/2009 6:55 PM (GMT -8)
Sorry for butting in...but I was reading and wanted to mention you may be having MOH-medication overuse headaches also called Rebound headaches. When I read that you had taken up to 8 excedrin in one day, and done it repeatedly it just sent red flags for me. It may not actually be the Fentanyl at this point?! Do you know what MOH/Rebound Headaches are? I can post info..but wanted to ask you first.

I hate that you are going through so much right now. I would be hunting for a new doctor and carefully watching this one.
Posted 8/28/2009 10:46 PM (GMT -8)
Skrape, The advise to see the pharmasist is excellent and make sure you keep the record of when meds were started or when dosages were increased. The pharmasist can pull up your records if you use the same pharmacy. I would be carefull when going back to the doctor and mentioning to directly "this is what the pharmasist said" as some doctors don't like thier kingdom being challenged by others. But as PAlady stated, the pharmasist often can give you more information about drug interactions then your doctor. It just does not sound like your doctor is taking a comprehensive look at all the medications you are taking and what the side effects that are raising their ugly heads. I finally went back to my PCP who is doing much better that the pain specialists I have seen. I hope monday is a great day for you and that your doctor at least is open to asking the right questions.
Posted 8/29/2009 9:48 PM (GMT -8)

Geez Skrape,

What an awful situation!  I agree with what everyone has posted, not much I can add.  Except please DO find another PM Dr. very scary that you repeated 5 x's which side and he still screwed up...which means he really wasn't listening!!

Keep us posted!

XXOO
Patti

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