Went to the PMD like a good little patient.

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Veteran Member

Date Joined Jul 2009
Total Posts : 2042
   Posted 9/20/2011 11:50 AM (GMT -6)   
If you recall, back in the spring my PCP wanted me to go see a PMD because she was uncomfortable Rx'ing me any more pain meds than I was already on. (I was taking 6 mg of Dilaudid 3x day)

Th earliest I could get into a PMD was today and in the meantime my PCP changed her mind and started Rx'ing my Dilaudid 4x a day, which is all I had been asking for all along. I have been doing pretty good on that 4x/day which takes out almost all the gaps in pain coverage and what remains is bearable.

So anyway I have this 8 am appointment but they want me there by 7:30 to fill out some special forms and since this PMD is 60 miles away it means getting up and out the door really early. It also meant having to pull my kid out of school for the day since I didn't have anyone available to watch him and take him to school this morning and take him with me.

Well we get up there, on time, which was a miracle due to having a morning from hell starting with the alarm not going off. I fill out their paperwork, like I really needed to be up there 30 minutes early to fill out a 1 page questionnaire that was printed up in at least 18 pt text. rolleyes

Anyway the doctor comes in and within 30 seconds I knew this visit was going to be a bunch of BS. She started firing off all the questions you would expect but she would start asking the next one before you got half way through answering the first one. During the interview she asked me 3 times everything I had tried and all the medications I had been on, and the real proof that she was not listening is when I told her that a few years ago I had been on morphine for around a year but had to come off of it because of it causing me severe memory problems and not 30 seconds later she suggests me stopping the dilaudid and taking morphine. rolleyes She says that the problems people have on morphine such as memory loss go away with time. Uhhh I was on it for a year and my memory problems didn't start for 6 months and got worse in the next 6 months.

Then she proceeds to ask me what kind of insurance I have and I told her Medicaid. She then starts talking about all of these long acting pain meds. I told her that unless they are available in generic Medicaid will not approve them. The only long acting, name brand pain med they will approve now is Kadian, and that is morphine and I will NOT take morphine long term. She then starts in talking about Exalgo and how "affordable" it is saying she has a Medicaid patient who is on it, right after I told her that if a medication is not covered by Medicaid and costs more than $5 per month I can't afford it.

The last part of the visit was her wondering why I was even sent there. I tried telling her (PMD) that when the appointment was first made my PCP was uncomfortable doing any kind of dose increase and wanted someone with more knowledge of pain meds to suggest a treatment plan and then the PCP would be willing to handle the monthly scripts, but since then my PCP had went ahead and upped the daily dose of the dilaudid and now I am thinking she just wanted a 2nd opinion that it was Ok at that level for the long term or if some other route might be better.

In the end I was sent on my way, on the same treatment program I am on now, except she wanted me to check into how much Exalgo would cost (no problem I already knew it is not covered) and that if my PCP wanted the PMD to take over the pain meds that I would have to go back up there and sign a drug contract (didn't matter that I already signed one at the PCP's office and both work for the same organization) and that I would have to make a monthly drive to get my scripts. Yeah like that is going to happen if it can be avoided with gas at $4 a gallon.

In the end this doctor is just like 90% of the rest of them out there. They don't listen and they have no concept of what life is like in the real world. They don't know what it is like living paycheck to paycheck anymore, they don't understand how much it really costs to make these 120 mile round trips or what it is like to be denied medications you need because of a bunch of bean counters.

Regular Member

Date Joined Jul 2011
Total Posts : 101
   Posted 9/20/2011 1:56 PM (GMT -6)   
Hi Jim...I totally can relate to your feelings with your new PMD. I'm going through some similar stuff with the one I just started going to, as you have replied to my posts. I started going to PM because my PCP is rx-ing the max amount of meds she wants to do, which was no longer giving me relief, so she first referred me to an orthopedic surgeon...one that I had gotten bad references from friends, so I just decided to go to my brother's PMD and asked my dr's office to send my referral and records to...which they did, but apparently the PMD herself wasn't aware that her office staff did it...or she forgot or something...at any rate, she isn't comfortable with me seeing a PMD, as she asked "why" I was going to pain management when she is rx-ing pain meds. So I'm feeling very uncomfortable and awkward with the whole thing. There is a struggle going on between the PMD and the PCP....the PMD is just telling me to continue on with what the PCP is rx-ing and letting her do it. So the PM dr hasn't given me any pain meds...so what's the point? He does prescribe...he changed my muscle relaxer and increased my Lyrica, which I feel is going to be awkward or questioned by my PCP because those are meds she is rx-ing me.

At my pain mgmnt visits, they just constantly ask what percentage did I get relief on my recent epidural injection. That seems to be all they wanted to know. I didn't feel like they listened to me, either. The staff and the dr just kept asking "So would you say 50% or 60% relief?" I kept saying "NO relief" and then they would say "50%?" Uhhh what??? Then the doc comes in and says "So it says here you got 50% relief with your injection..." Omg....that kind of drove me nuts!

Jim, I wish I knew what to tell you, except that I share your frustration and feel the dr doesn't listen. I hope this works out for you, though. I hope they can find the right meds for you. My sister has been on Dilaudid for a few years and is a chronic pain patient due to a brain aneurism and stroke which left her with severe left side nerve pain...they call thalamic pain. Dilaudid is the only thing that has helped her and she has tried everything.
DDD, 3 bulging lumbar discs, bone spurs, facet joint arthrosis/sclerosis, osteoarthritis

Regular Member

Date Joined Apr 2011
Total Posts : 235
   Posted 9/20/2011 6:47 PM (GMT -6)   
Hi Jim ,sorry you had to go thur that ,wow! It's so hard to find a good understanding dr.Have you ever tryed the pain clinic,I belive your dr has to refer you ,but they are far more understanding,also much better knowledge of pain meds .Iam glad your old dr did give you the meds you needed,if something like this happens again ask to go to a pain clinic.I do hope you relax tonight ! take care

Retired Mom
Veteran Member

Date Joined Feb 2010
Total Posts : 1753
   Posted 9/20/2011 7:16 PM (GMT -6)   
Hi Jim,

What a nightmare when you feel like you are talking to someone who's really on vacation....I don't even understand why they talk to you because they don't listen. I wish I had advice, but at least they didn't totally screw with your meds and keep you from getting what you need. I just hope they didn't write something insane in the file. I keep finding out that my Dr's notes are not near the same as what they say in the office. It's very frustrating!!

I am happy that you are able to get the correct amount of dilaudid though. It's a difficult med to get so many times and when I finally got mine to the correct amount, it stopped working for me. I didn't even realize what was going on until my PM made the change to oxy IR.

I wish you the best!!
TLIF L5-S1/failed, Pituatary disorder w/HGH deficiency, Fibro, Failed Bladder Surgery & Nissen, GERD, OCPD, GAD, MDD, CFS, TMJ, Migraines, Pre-glaucomic, HBP, Idiopatic Reactive Hypoglycemia w/Diabetic reaction to HGH, Bi-lateral CTS (surgery related trigger finger), Edema, Tarsal Tunnel Syndrome, Peripheral Neuropathy, Plantar Fascitis, Tibular Tendionitis, Adult Onset Flat Feet & much more.....

Regular Member

Date Joined Aug 2011
Total Posts : 59
   Posted 9/21/2011 1:22 AM (GMT -6)   
Jim I know exactly what your dealing with especially in the sense of living check to check and being denied the medications you need because of insurance decisions that are not medical informed decisions no matter how much they try to say there so called doctors they pay are qualified. Almost all doctors as well as every insurance company do not have even the slightest fathom of what dealing with actually reality of life is especially when your in constant pain. For insurance companies to deny coverage of medications that are crucial to the next step in treatment even after doing everything covered previously is completely idiotic. To force patients to have to use the money they do get each month to pay for scripts which means making the choice between food and other essentials or the medication you need that they should be covering is inhumane, which you hit the nail on the head as there all extremely expensive if there's not a generic. Drug companies are just as evil as the insurance company.

My regular doctor which originally was like your PCP is that did not want to prescribe higher doses and wanted specialists to take over treatments has been with me for basically 7 years dealing with my issue and I do not trust anyone but him with prescribing so he does prescribe higher doses then he ever would before but that's because I've went through the gambit of a lot of specialists as well as hospitals and done everything we possibly can and are now completely stuck as the insurance refuses to use common sense let alone any intelligent reasoning and is denying everything which should be illegal for them to get away with this but surely enough they can get away with anything anymore.

I am on Dilaudid (well the generic but its the same) at a dosage of 8mg 4x daily which I wish I could say even helped a little. I've also been in the hospital and in the outpatient area to get IV-Dilaudid the whole way up to a 8mg bolus which resulted in just depressing me even more. The dosage I am on now is simply to at least attempt to be doing something as we've done everything from high dose fentynal (which is what I was meaning earlier when I meant about deciding between food and other necessities which those patches were ridiculous the cost for 5 in a box which weren't helpful so I wasted money) to high dose methadone, high dose oxycontin, morphine, lidocaine, nerve blocks, lidocaine infusions, SCS, epidural trial to see if pain pump would be worth while which it was proved not to be helpful, etc. Nothing has been able to help and my last few options left to me in terms of possibly getting me to a somewhat manageable state my insurance will not approve which infuriates my doctor at how there treating me let alone how I feel about there complete ignorance.

I hope you are able to work things out with your PCP maybe if you talk with her about the situation especially with the idea of travel and cost to you that she will change her mind. As well as find some pain relief. I know especially when your in pain and getting crapped on by not only those who are suppose to help you(the doctors) but also by the insurance things can become severely even more darker and depressing then it all ready is but always remember to believe in yourself and continue fighting and never give up. There will be good to come for you! Keep us posted please.
I currently take: Cimzia 2-200mg injections, Adderall 5mg 1x daily, Vyvanse 70mg 1x daily, Dilaudid 8mg 4x daily
Health Issues: RSD, Crohns, Gastroparesis, Arthritis, Osteoporosis, Dysautonomia, & Remicade Induced Psoriasis.
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