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newname
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Date Joined Jun 2011
Total Posts : 95
   Posted 8/7/2011 3:19 PM (GMT -6)   
Okay, I went to see my doctor on Wednesday for a check up. It's a regular three month deal. I told him I had no refills on a couple of my prescriptions, including Tramadol. For nearly a year now, he's given me prescritions for 180 a month, to be taken as needed two at a time no more than three times a day.
 
He didn't spend much time with me or ask how I was doing on my other medications. The guy seemed a little hurried, actually. But he did write out the prescriptions and send me on my way. When I looked at the prescriptions after leaving his office, I noticed that he'd reduced the Tramadol to no more than four a day. That's a monthly reduction of sixty pills. He didn't say anything to me about reducing the dosage, either.
 
I felt like going back into his office and asking if he'd made a mistake, but was too wimpy to do so. Call me whatever, but I was afraid to get on his bad side and be yanked off the medication completely.
Am I wrong for thinking he should have discussed it with me instead of simply reducing the medication? Is it possible he was so busy that he wrote the prescription wrong? Either way, what should I do? Ask him about it and risk his wrath, or just deal with it?

Alcie
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Date Joined Oct 2009
Total Posts : 4979
   Posted 8/7/2011 3:47 PM (GMT -6)   
That's a huge reduction if you were taking and needing all of them. You could end up having withdrawal.

I'm shy about questioning too, but that's so much you might want to call and ask if that's what he intended and was there a reason. You're likely to talk to an office girl, so it's not as terrifying as getting the doc right away. He may just have her tell you the answer. Some docs call back themselves, some don't.

I was taking tramadol 4/day and pain doc cut me to 3/day, but he had me trying something else new, which didn't work out. I didn't ask about it, but realize now I should have read the Rx before I left the office and simply asked if that's what he intended instead of making myself nervous over it.
Alcie
 
 

newname
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Date Joined Jun 2011
Total Posts : 95
   Posted 8/7/2011 3:59 PM (GMT -6)   
I'd usually take five a day. Sometimes only four, but on other occasions six. Now I guess I'll have to stick to four and maybe toss in an ibuprofen every now and then. If I do start having any withdrawls, he's going to hear from me. I have done nothing to make him think I'm taking more or need less than what he's prescribed for the last year. So yes, I'd like to know what's up. That problem is, he's the man with the power. It's not like I can make him increase the dose back to 180 a month. All I can do is confront him and risk being taken off the medication altogether or damage the relationship between he and I, which has always been good up to this point.

Snowbunny21
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Date Joined Jan 2010
Total Posts : 3557
   Posted 8/7/2011 4:24 PM (GMT -6)   
Hmm...now that it's been a few days...and you've already filled the prescription...it's going to seem a bit weird to call tomorrow and say you just noticed this...


I'm betting it was just a simple mistake...In my PM's office...it's actually the nurses or NP's that print out the prescriptions (not hand written) and my Dr. just signs them and then gives them to me. So it's happened before a few times and I just show them real quickly and they apologize and redo it....Unfortunately even Dr.s or nurses do make mistakes so that is why I've learned to read them carefully in front of the Dr. to make sure they are correct...

If you have a good relationship with him...then it certainly wouldn't hurt to call them and see if it was a mistake or not...or what is the reason for the reduction.

Does the instructions on the prescription read the same? Or did that change along with the total amount of pills.

Again..it could be some simple mistake and if it's going to cause any withdrawals or added pain for you...I would go ahead and call tomorrow if you have been seeing him for a long time..

Keep us posted!
SB and "the pup who snores loudly" 
 
ACDF C5-C7, (no hardware), with autograft bone Nov. 2001
(reabsorption of bone 2 years later...still lost in body..expect to burp it out at anytime..haha")) 
ACDF with hardware, allograft bone Nov. 2005 
Anterior and Posterior CDF, allograft bone with BMP, removal of old hardware, use of titanium plates, rods, screws, & kitchen sink (lol) Oct 2006
 
 

newname
Regular Member


Date Joined Jun 2011
Total Posts : 95
   Posted 8/7/2011 4:39 PM (GMT -6)   
I barely had the chance to mention anything.
@Snowbunny what was was odd in this situation was him drastically slashing the number of Tramadol I can use a month without explaining why. The reason I didn't notice he'd reduced the dosage until I'd already left his office is that he didn't say he was going to. Could I have gone back and requested to speak to him about it? Yes, but he was obviously very busy that day. I probably should have said something, but like I said, I was afraid of upsetting him.

Post Edited (newname) : 8/7/2011 4:43:25 PM (GMT-6)


Mysti
Regular Member


Date Joined Jul 2011
Total Posts : 101
   Posted 8/7/2011 5:18 PM (GMT -6)   
I don't blame you for being upset, but I think there is a good chance this was just a mistake on the doctor's part.  I don't think you should have gone back into the office to confront him or be confrontational in any way.  However, I do think you need to call him tomorrow morning and leave a message with the nurse that you just need to clarify the dosage.  He really should have explained any new medication instructions to you when he handed you the scripts.  That's why I'm thinking it was a mistake.
 
 
DDD, 3 bulging lumbar discs, bone spurs, facet joint arthrosis/sclerosis, osteoarthritis

mtgman
Veteran Member


Date Joined Mar 2005
Total Posts : 1289
   Posted 8/7/2011 6:24 PM (GMT -6)   
i bet it was an honest mistake- i would have gone back and asked...my doc messed up last month- i was going out of town so i needed my script refilled 8 days early...when i got it the date was the normal one so i had to have him write up a new one...
37 year old male living in AZ. Diagnosed with Crohns at age of 15.
Currently on 20 mg prednisone. still taking Asacol. Done with Remicade- antibody level was over 8! Waiting for scope results to see about Humira or Cimzia.
In the middle of a bad flare now for 2 years...it's been one heck of a ride!

newname
Regular Member


Date Joined Jun 2011
Total Posts : 95
   Posted 8/7/2011 7:10 PM (GMT -6)   
Okay, I guess I'm just a wuss. I was afraid to press my doctor on the subject. In my defense, I didn't notice the reduction in dosage until waiting in line to get that one and my others filled. Perhaps I should have asked the people at Walgreens to call my doctor to inquire about it, but I'm not sure if they would have. Besides, at this point it's probably best to wait until my next appointment and take up the issue then.

momtofourangels
Veteran Member


Date Joined Apr 2010
Total Posts : 2261
   Posted 8/7/2011 10:11 PM (GMT -6)   
Hi newname It was probably a mistake. My doctor accidentally gave me 30 tablets of oxycodone and told me on the script that I could take 2. I asked her about it Friday when I saw her, and she said that she didn't know why it happened. I would advise you to call your doctor's office later today and ask him about it. It could be an honest mistake since it's so much less than he's been prescribing.

love and hugs
Loretta
Dx: osteoarthritis, bursitis in left hip, Osteoarthrits in right hip, compression fracture in thoracic spine due to falling on frozen ground March 2001 , ddd, spinal stenosis, bone spurs, osteoarthritis in spine, osteoarthritis in both knees
Meds: Fentanyl patch, oxycodone, otc: BenGay, Tylenol Arthritis on occasion

flower123
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Date Joined Apr 2009
Total Posts : 856
   Posted 8/8/2011 3:36 AM (GMT -6)   
I think it was a mistake. I'd call definitely.

Trudy2
Regular Member


Date Joined Dec 2010
Total Posts : 213
   Posted 8/8/2011 6:35 AM (GMT -6)   
I also think this was probably a mistake. I would not wait a full month and asking him at the next appointment. If you do that, he may think that 4 a day is enough for you since you put up with it all month and did not mention it or complain about it.

Trudy
DX pyoderma gangrenosum, Acute Myelogenous Leukemia, Bone Marrow Transplant, Chronic Pain syndrome, Chronic Kidney Disease Stage 3, Major Depressive Disorder, Radiculopathy, Bilateral Hip Pain, Insomnia,Left Groin Hernia, Bulging Disk in Lumbar Spine, Tear in Lumbar Spine, Tendonitis and Bursitis in both hips, hypoxia due to sleep apnea and new problems with my lungs. Have had 2 abnormal CT scans.

newname
Regular Member


Date Joined Jun 2011
Total Posts : 95
   Posted 8/8/2011 6:55 AM (GMT -6)   
I guess it just came down to me not wanting to tempt fate. Even in the relatively small midwestern town of Madison, Indiana (Beautiful historic city, by the way. They even made a movie about us. Look it up), we've got more than our share of dope fiends. In the last few years, there have been several armed robberies of pharmacies here, the last one being at the CVS. My doctor has confided to me about having several patients who he believed were faking pain to get narcotics. He didn't mention their names, but I certainly don't want to get on that list. Plus, my doctor was in an obvious hurry that day. I think there were a bunch of kids there getting their check ups before school starts. I was afraid of annoying him. And remember, he didn't say anythng about to me about reducing the dosage and I didn't notice it until I was getting my prescriptions filled.

Snowbunny21
Veteran Member


Date Joined Jan 2010
Total Posts : 3557
   Posted 8/8/2011 7:40 AM (GMT -6)   
It's certainly your choice...but what I think might happen then if it was a simple mistake...and you don't call in..If you go through the whole month with the lowered dosage and not saying a thing...He may think that your pain is ok now to be at this dosage so he ends up keeping it this way from here on out..Because he figures if your pain level was higher..you would call and say something.

I don't think that it's tempting fate at all by staying calm, giving him the benefit of the doubt...calling and being very nice on the phone and asking about the change as it wasn't discussed in your office visit. You should never have to be 'afraid' of your Dr. and talking about your own health..

If this was blood pressure medication...you would call immediately when seeing the error as it matters going down 40 pills in the month.

Now..if you call and are angry...or start getting on the Dr.s case and it's a simple mistake...then that might ruin the relationship. But you have every right to kindly ask if it was a typo...or is he changing your prescription..

Again..it sounds like you are set in not calling...I'm just worried that it might backfire and he continues the lower dosage next time as a Dr. wants his patient to be on the lowest amount of medication to help your pain...so if you don't speak up...he will assume you were ok this whole month..
SB and "the pup who snores loudly" 
 
ACDF C5-C7, (no hardware), with autograft bone Nov. 2001
(reabsorption of bone 2 years later...still lost in body..expect to burp it out at anytime..haha")) 
ACDF with hardware, allograft bone Nov. 2005 
Anterior and Posterior CDF, allograft bone with BMP, removal of old hardware, use of titanium plates, rods, screws, & kitchen sink (lol) Oct 2006
 
 

newname
Regular Member


Date Joined Jun 2011
Total Posts : 95
   Posted 8/8/2011 8:54 AM (GMT -6)   
What I'll probably do is wait a month and then when I see him again, let the guy know that the decreased dosage of Tramadol just isn't cutting it and that I'm having to add Ibuprofen to the mix to make up for it. Then again, I might call and ask his nurse. I know I have to make up my mind quickly, but it's not an easy decision.

Screaming Eagle
Forum Moderator


Date Joined Sep 2009
Total Posts : 5005
   Posted 8/8/2011 9:06 AM (GMT -6)   
 
        I had this same thing happen to me several months ago, and I called right away. Found that he decided to script every two weeks, with the orignal 120ct Percocets. Dr told me he would rather have paper work with 60ct on it than 120ct. Med's have since been changed, and I'm back to the 90ct every 30 days, since the Ocycontin has been upped.
 
     One of the best things that has happened to me in a long time, was the extra added 20mg...now making it every 8hrs now. What a dfference it has made in my quality of life. The 12hrs was not cutting it by a long shot...and I'm going to shake the mans hand when I see him the next time.
 
    I would call the nurse, and have her double check on it, and not wait. However, it's your choice, and I understand the reasoning behind it.
 
   Take care,
 
  SE wink
Moderator Chronic Pain Forum

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NiNi53
Veteran Member


Date Joined Mar 2011
Total Posts : 816
   Posted 8/8/2011 12:44 PM (GMT -6)   
Hello, newname, Kathy here, I also used to be afraid to speak up to my doctor, not because of his attitude, but due to he attitude of others before him.  I really dislike that feeling.  I do think these doctors know this also, and they know we are only going to rock the boat but so much.
 
Im telling you I agreed to getting this useless piece of metal in my back for just that reason.  Against my better judgement, after a trial with this that had gone terribly wrong.  I still had the surgery, just because I thought thats what my doctor wanted.  I was very new to his office at this time, and although he gave no indication that he would kick me off his pain managment practice, I had this surgery that was completely useless for me.
 
I dont blame hiim, I do blame the fools before him for making me feel this way.  He is wonderful and I am so glad to have found him.  So believe me I know how you feel.
 
I had to begin to leave behind me the doctors who had mistreated me and realize that not all of them are alike.  This was very hard for me to do.  I had serious trust issues.  But you have build yourself up and realize you do have certain rights also.
 
Good luck to you and take care.
degenerative disc disease, fibromyalgia, osteoarthritis, neuropathy, lumbar laminectomy july 1998 no help, rechargeable neurostimulator unit low right back w/lead wires to left side and right leg unit not working just sitting there.i am 57 years young in may will turn 58. i have 2 grown daughters, 25 and 29. i have 2 grandchildren, 9 year old grandaughter and 5 yr. old grandson

cogito
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Date Joined Oct 2010
Total Posts : 926
   Posted 8/10/2011 12:34 PM (GMT -6)   
Newname,

I take Ultram ER 300mg, which is the time-release branded tramadol. I assume you're being prescribed 50mg pills. So 180 per month = 6/day. That's 300mg and that's the standard peak daily dose in the U.S.. Seizure risk increases as the dose increases but 300 or 400 is thought to be safe. In Canada, some companies make 400mg time-release pills.

You might want to look at the prescribing insert for Ultram to help you get a better picture of the daily dosing: http://www.ultram-er.com/sites/default/files/ultramer.pdf

Of particular interest is the top chart on the right. It compares the metabolite levels over time between 50mg tramadol every 6 hrs and 200mg ultram ER. Surprisingly, the immediate release tramadol deviates from the Ultram ER levels only very slightly and thus 50mg 6x daily should be comparable to 300mg of Ultram ER, an acceptable and very common dose. Depending upon your relationship with your doctor, you might want to print out the pdf and bring it to him.
C4-T4 Scoliosis (disk degeneration, stenosis, narrowed neuroforamen, bone spurs), RT hip and SI joint damage from car accident. Also, pectus excavatum, supraventricular tacycardia and mitral valve prolapse syndrome.
Current meds: Ultram ER 300mg daily, breakthrough - hydrocodone 10mg, or oxycodone 5-7.5mg. .25-.5mg ativan as needed for sleep, Verapamil 240mg SR (for tachycardia). [/gray

newname
Regular Member


Date Joined Jun 2011
Total Posts : 95
   Posted 8/10/2011 2:43 PM (GMT -6)   
I called his nurse this morning and she said they'd get back to me.
As of yet, they have not.
Calling again would probably only annoy them, so I guess I'm just going to have to wait for them to call or simply mention it to my doctor on my next visit.

Post Edited (newname) : 8/10/2011 2:49:42 PM (GMT-6)

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