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TDS Need some advise on how to confront doc.

BellaLegosi

BellaLegosi

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Joined
Dec 5, 2013
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5
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PDX
Hello all. Where do I begin? My story isn't new or by any means special. I have been suffering from some medical issues for the past 10 years, without medical insurance of any kind. The ER became my clinic and the black market became my pharmacy. I began to self medicate around 03' or 04'. I started out buying vicks or percs. When those connections were lost I was introduced to methadone. I spent 2 years self medicating with methadone using up to 110mg a day at my worst and needing at least 50mg to stave off being sick. I eventually was able to kick the methadone entirely, but replaced the addiction with cocaine and percs. Soon the money that came in was going entirely to these drugs and I kicked them cold turkey, on my own, in my own home. But due to the medical issues I have (female reproductive) I tried doing the right thing and got in touch with a clinic and see if there wasn't something that could be done. Well that was 5 years ago and the clinic I see my PPC is geared towards rehab and since I had no insurance for any type of diagnostics to prove I have dealt with severe pain this clinic only gives me 30 5mg vicks a month. Last September I was put on a narcotic contract for this amount. I have been able to hide the length and scope of my self medication and have successfully have been able to fool their UA (marijuana smoker).

With in the last year some new health issues have come up and with the issues I have had for the past 10 years what my doc prescribes really isn't effective. I have voiced this to my doc on a few occasions, only to get looked at like I am playing her and she will write for 7.5 vicks, but nothing stronger and absolutely no benzos (I have to see their mental health shrink for those even though I am diagnosed PTSD) This has led me down the Black Market road again. After kicking the coke and percs I lost contacts with all my dealers and a couple have died. I have been self medicating with morphine 30mgs or OC 40's. It is starting to get out of control. I am now having to take up to 90mg of morphine a day or every 3 days just to not get dope sick and am starting to get panic attacks from hell. When I was dope sick AND in genuine pain, I took my BP at a store and it was 149/101 pulse 110. This is starting to really scare me. I am not a total youngin', just turned 30, and I am not a big girl either (height or weight). When I am buying these meds it is just too fucking easy to take a little more to get out of pain and get loaded. I tell myself, "I pay enough for these fuckin things, may as well have a little fun with them." At the most I have been able to snort 120mg morphine w/ a 40mg Oxy. This is how high my tolerance is. I have gone thru my vicodin prescription in less than 4 days. I know the dangers of Tylenol toxicity and usually CWE these to by pass that.

This January I finally got approved for my state health plan and it covers everything, including maintenance programs. I desperately want to approach my doctor about this and come clean with her. I have already made the steps to start seeing a shrink to deal with some of the addiction/self medication issues and to help deal with the PTSD (I am losing control with it this last year). But, I don't know how to start that conversation and am scared as hell that if I do come clean with her I am going to bury myself and potentially fuck up the diagnostics I have scheduled. I have had very bad experiences with OB/GYN's (these were docs who worked for 'charity' cases) who have said that this was all in my head, even though they had done NO diagnostics and the medications given to me caused super massive yeast infections or PID.

My doctor does believe that what problems I have are very real and has made sure I will not get treated like that with the docs who will be doing my laproscopy/colonoscopy. But, I fear that if I come clean with her and tell her just how out of hand my self medication has become she will see me only as a med seeker. I feel bad every time I see her that I haven't come out and said, "I need some fuckin help. This is ruining my life and has been for 10 years!" What do I say or how do I say it?

I am completely lost both physically and emotionally. I desperately want help, but scared to death that my medical issues (which started this whole fucking addiction) will be put on the back burner once again. I don't know what to expect either. Will she pull what meds she does give me and tell me to go into inpatient treatment? I have never gone to any treatment center in the past. I have been able to get clean on my own (haven't touched coke in 5 years now) and feel that if I get locked up I will really lose all hope and top myself. I don't want to be locked up. All I want is some fucking help maintaining this addiction until these doctors can figure out what the fuck is wrong with me and fix it. When these medical issues are resolved I would be very willing to do in/out patient treatment, but I will not do this until the medical issues I have are resolved.

So where should I start? I have an idea on how to start the convo, but would love some advise on the subject. This is all very new to me. I don't want to lose my PPC, she is a good doc, but I can no longer continue doing what I have been.

Bella:?:(
 
Bella, I feel your pain - as a fellow pain patient on escalating doses of pain meds with complex diagnostic issues also. I am now tapering off morphine. I had exactly the same as you with the panic feelings etc., and it kept getting worse.

Read about opioid induced hyperalgesia before you do anything. Opiates cause increasing pain when taken long term.

The escalating BP, panic attacks and rising tolerance are signs that you are reaching your limit. The dope sickness will only get worse from here on in. You are approaching a stage where quitting on your own won't be an option without medication and medical supervision to manage the rocketing BP and other symptoms in withdrawal.

Start by writing down your exact doses of meds per day, stabilise at a set dose and start tapering down. It's the only way when this stage is reached, otherwise a physical or psychiatric crisis is in the post.

This has to be your immediate priority. Any medical procedures involving anaesthesia or medications will be high risk if the medics do not know that you are on high dose opiates. Unfortunately you may have to choose between putting the tests back several weeks or more, or, reducing these opiates.
 
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Thank you sooooo much for the reply and link. I have reached out to a few people I know and trust who have been thru similar situations with the pain/tolerance/addiction. I have said pretty much what I have said in the post. They know the clinic I go to and have advised me not to disclose all of this to my primary care doctor. They gave me the same advise and warnings that you have in your wonderful post. I am lucky enough to have some support with the tapering down (this I have done before on my own, with support of friends or family) and have procured something to ease the panic attacks. I am pretty self-controlling with benzos and know the risks of combining the opies with benzos and do not do that even for recreation. I have also taken the steps to see a psychiatric therapist and am going to disclose some of the self medication issues with him or her. I still need to call some methadone clinics and see what my options are there. My insurance will not cover Suboxone treatment, unfortunately. I would really prefer Subox rather than methadone. I have heard more positive things about that drug vs. methadone.

Since there is a lot of demand for specialists my initial appointments with them are already a month away. I hope to have gotten some control over the self medication and the PTSD panic attacks by then or at least made a vast improvement.

A few years ago I lost contact with many people who sold lesser intense medications and am limited with transportation. In a way this is a good thing and bad. It is the heavy duty meds that are beginning to wreak havoc on my body and mind, but it is a good thing that I am not around so many dealers like I was in the past. I have let these 2 people know of my intentions and they are going to limit what I get and how often. I hope to be seeing a shrink very soon and feel that therapy will help a great deal and hopefully the shrink can begin to prescribe something for the panic attacks as well as hold me accountable for what I am prescribed. I know it is the lack of self control that has led me to the place I am now and has effected my life in other ways. At least with a psych I won't be alone in holding myself accountable and that I wont feel judged by the doc. I have major issues with some members of my family. They used to be someone I would trust and go to with situations like this, but because the nature of addiction and all the shittyness that comes with it I have caused a lot of mistrust and "You bring this upon yourself! Deal with it!" a lot. I have confided in some only to have what I have confessed thrown in my face or used to justify their obvious venomous words that strike me right in the heart. I don't feel that way with shrinks. I have seen one before (that's who diagnosed me with PTSD) and found it very very rewarding. I was making a lot of progress and didn't have to be medicated with SSRIs and because of my then young age I wasn't prescribed anything for my panic attacks. I was taught other ways to pull my self out of those and to lower my BP with breathing. But, that was 15 years ago, and a lot of things have happened since then and I can no longer control the panic attacks or PTSD.

Wow......this was a lot longer than I anticipated! I hope I didn't bore you. This really is a new ballpark for me and I find that writing in this type of forum to be a therapy in itself. Thank you for reading and I look forward to reading any reply you may post. I am open for any critique you may have on how I am going about this situation of mine. What you advised sounds very reasonable and is very simiular to what others have advised me of too. I appreciate this immensely. Thank you.

Bella
 
Bella

Primary care doctors do tend to be judgmental and will always cover their own ass not yours, so tread carefully there.

Families can grow very divided over this stuff. They never understand the real difficulties of living with improperly treated chronic pain, especially for a young person still trying to have a life of some kind!

I think you have done the right thing by trying to get a handle on all this now and recognising that things cannot continue like this.

The starting point is getting to a consistent dose daily and writing it down so you can establish a reduction plan.
 
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