back pain issues, drug tests/counts, doctor-patient relationship
I am new to this forum and hope I can get some answers that have been on my mind lately. My mother and I see the same PCP, my husband fired him and said nasty things to him over the phone (he is very ill, in the head and was hopspitalized for months at a behaviorial health hospital) hubby got mad because he wouldn't prescribe him painkillers, or do tests from head to toe. Hubby has a new doc now.
My problem: I got into an accident in stopped traffic, a large loaded logging truck rear ended me, sending me to the hospital on July 15, 2010. I was x-rayed, have MRI's done and they found out that I have 2 discs that are swelled along with sciatia nerve pain in addition to pain in my left foot (I have hardware in it from 2004). My doctor put me on oxycodone 5mg tabs. On my visit back in August, he said he has to do a urine test and a pill count on my next visit, he put me on those tablets 4 per day, if needed for pain. he said "I cannot keep you on this drug, only while you are healing) I go to Phys. Ther. 2x per week, as directed by him, along with going to a pain mgmt. clinic for steriod/cortisone injections in my back and sciatia nerve, they wear off. Okay, my mom goes to the same doc. I am 50, she is 73. He told me he does a ua on all his patients...he lied because my mom is on percocet 15 and he never ever tests her. He keeps asking me if I'm working! How can someone work with a back problem? I was a janitor and opened a restaurant heavy lifting, etc...We live in a tiny little town on the ocean in Maine. Now why the heck is he doing this to me??? He asks if I still live with hubby along with other questions. In November, I had fallen out on the deck (it was icy) right on my back. I called his office and he was off on that Friday. I was alloted 20 pills, and picked up the script at his office and had it filled. Dec. 1st was my next appointment and I was running out. When I went to see him, he was very very angry at me, his assistant was in the lobby waiting for me with the Calloway Lab. cup and told me to go urinate in it, which I did. He told me in his office that he can't keep writing out prescriptions forever and he was so angry he forgot to give me a script for my Ativan. Now, I will be honest, I smoked some green earlier in the week, a friend came to visit and I did smoke some. I didn't tell the doc that, in fear that he would not prescribe me the pain meds. I also told doc please don't give me 120 all at once, I am broke and need to wait for SSI check to come to get the rest of the script. He said 3x per day now, so that would be 90 altogether, so he wrote the script out for 60 of them to be filled that day. I am really confused because he owes me a script for 30 more this month. What kind of ua is this? Do they send it out? The reason I'm asking is because he can do a test with results in 5 minutes, or send it out to the lab for a more accurate test. How will he react with THC in my system? Do they test just for the drug(s) I'm on? He asked if I still take vicodin, I don't so I said no. Now, I'm afraid to call him for my other 30 pills!!! He counts my pills, but not my moms'. What is going on here? I had him as my doc for 12 years. If he did test for THC, will he call me, send a letter to me in the mail or what? There is another person I know that goes to him, she had an accident with lesser damage to her body and told me he never tests her or counts her pills...she is on heroin! She told me she happy he doesn't treat her that way because she would be booted out by his ua immediately. I know he lied to me. I am so mad and confused and scared to even go near the place right now. I want to ask if anyone can help me out in telling or offering me help on this one. I will be out of my pain meds next week. Any advise?
he's testing you for a couple of reasons.
he basically doesn't trust you...
if he's writing you for opiates (be it vicodin (hydrocodone) or percocette (oxycodone) and you're selling them you'll come up clean... you're busted.
if he wants to have fancy tests run they can tell if you're say selling the vicodins/percocettes and doing a different opiate... i.e. heroin (and just because you don't have needle marks doesn't mean you're not smoking or snorting it)... but usually they won't go that far... it takes a far fancier (more expensive) test to differentiate between similar opiates than just clean vs dirty.
if you're smoking pot, and he's not cool with that, he'll test and you're busted...
that's actually the easiest test to fail because the metabolites are in your system for like a month+ (depending on the cutoff level of the test he uses and how much water you've had to drink in the previous 24 hours)
like Gregory House M.D. (love that show) says "everybody lies"... he lied, you lied (you admit it too... about pot)
he's just running the numbers and figures you're more likely to be fiddling the system at 50 (you were a teenager in the 70s) than your 74 year old mother.... it's just a matter of HOW you're fiddling the system... janitor in restaurant = not enough money = likely to be selling the pills... especially if you're getting them via insurance, workman's comp, etc... or doper who just wants more dope...
and never ask for a smaller script than what he's writing... you can always ask the
PHARMACY to only fill half, or a week's worth, or whatever because that's what you can afford and get the rest later... real common.
hubby going off on him, his nurse, his front desk staff, etc is
BAD ... generally treat docs polite.... like a cop... he's your drug cop.
my experience with steroid shots hasn't been good myself... though I've had short cycles of oral cortical steroids with good results... but the back pain relief was only "good" not "great" and generally not worth the side effects which are worse for men than women... though women don't want to bloat up either.
but I'm lucky... I've got a GREAT doc who respects my 30+ years of dealing with pretty severe back injuries (I was RUN OVER by a car) and the resulting pain... and I respect his years of experience and education too...
he has a sign in the patient rooms to bring in your scripts/bottles for counts...
I did it once just bringing in the schedule stuff because "I don't think you really care about the diuretics"...
I hadn't come close to using all he'd written me for and I never hassle him for more (except ONCE for a single day's worth of STRONG pain meds so I could deal with being strapped down for an 8 hour scan (the scan was for a heart issue and he knew I couldn't stand being strapped down for 8 hours without being in excruciating pain... he had my x-rays etc for my back... he wrote me, and I thanked him my next visit (for a couple of months I was in one doctor or another every week for tests etc related to my heart/circulation/breathing/etc)
but I don't hassle my doc for "more"...I don't claim to have flushed them down the toilet, lost them, the dog ate them (though when I found my ex wife was stealing my soma and klonopin I fixed that issue... I divorced her! but I didn't complain to him about them for another bottle of soma because she took them)
but I'm looking for a new doc long term...
he's winding down his practice with an obvious path toward retirement (he's about the right age)...
limiting his practice to 400 patients and going toward what amounts to a fancy concierge practice with some bells and whistles that are pretty cool...
that probably WILL help my health in that since to be one of the privileged 400 costs 1500$/year and if I'm shelling out 1500$ for "membership" (it's a multi-city multi-doc etc setup)
I'm going to use it and I really do have other health issues that really could stand more attention...
and I don't really like most docs... I was in the computer support end of the state medical school... this put me in doctor's offices, clinics, hospitals, etc... and seeing what goes on outside the facade the doc wants you to see.... and this guy is exceptional.
he's a doctor for the right reasons... to help people... not just money, prestige, and privilege.... and that's pretty rare.
but I'll hit my health insurance's deductible pretty quick...
so yea I'll be in there more than twice a year... (to get my basic blood work done and fresh scripts (schedule III scripts can be refilled but expire at 6 months))...
and I'll get the things I kinda just "let ride" paid more attention to... with regular attention I can probably get my long term foot issues dealt with more successfully.
and since I'm at the doc anyway I can use more schedule II pain meds than "doubling up" on the schedule III stuff... (tylenol is hard on the liver) it's not that he's stingy on the pain meds... I've got multiple sealed bottles of 5 and 10mg hydrocodone w/acetaminophen for example... he can (and has) written scripts with refills to avoid the repeat visits... but I'll be there so I can just get a monthly script each visit of the schedule II stuff with no tylenol.
but enough rambling...
you're not being singled out per say...
if you're on an opiate for pain, and ativan for stress/anxiety you're probably a little "anxious" (stressed, freaked out, whatever you want to call it) and that's a red flag to most docs...
the symptoms for chronically undertreated pain are really pretty similar to "drug seeking behaviour"...
like I've told my doc when asked if I needed refills for my scripts (this was early in our relationship) I said "sure... it's not like I'm out, I've actually got a full bottle from the last script left over, but having an extra bottle in the cabinet makes me feel better since I know that if I'm standing at the sink with the water running at 4am in bad pain shaking out a couple of vicodins to try and get some sleep, slip and I accidentally dump a whole bottle down the sink that I've got a spare bottle safely in the cabinet and I'll be OK... and that makes me feel better knowing they're there if I need them"...
this has gone on for a while now... I -always- get -all- my refills and he knows this... I tell him... so now I've got sealed 100 count bottle of 5mg hydro/apap -and- a sealed 100 count bottle of 10mg hydro/apap
at each house (long story, I'm not rich or anything but I'm remarried and because of the shitty housing market we've still got both houses...)... that's 400 pills still in sealed unopened bottles.... plus the oldest bottle that I'm actually working on.
we dropped the 5mg's last visit... but I'm still picking up 270 (3 month script) of the 10s this weekend... and he knows I've got unopened bottles... and it just makes me feel better to have extras...
he trusts me
I trust him
your doc obviously doesn't trust you...
and you don't trust him to give you good treatment (if you've got sciatica plus other stuff and all you're getting is cortisone shots and 5mg percocettes for sciatica outbreaks (which I know can bring you to the depth of hell with those lightning bolts of pain shoot down your leg... so you're NOT getting good/adequate treatment/pain-control)
so you need to find a good doc... one that your ex hubby hasn't blown up on... one that doesn't have a doctor/patient relationship with your mother... and one that you can build an honest/trusting relationship with.
to me keeping my doc is worth 1500$/year (plus regular fees etc)...
and I ain't rich... I'm on disability.... but I've got -1- doc I can trust... he's a generalist (technically an Internist) so he can treat almost anything I'd allow...
like a couple of orthopaedic surgeons have "offered" to amputate my lower leg and replace it with a prosthesis .... yea yea I know technology is grand and it probably would work better than my buggered up original equipment... but I'm sentimentally attached to it :D
one cardiac guy I was referred to about a possible bypass pushed (hard) for a heart transplant... and his office visit/consultation was little more than a hard sales pitch... and what passes for a success to him (and his press department... he's getting LOTS of press lately) looks a lot like failure to me...
like one article... the guy DIED (heart stopped... and not when they were planning it) 4 times, he was in a coma for almost a year, his wife divorced him, had a stroke related to the transplant, awoke from the coma with major paralysis (had to relearn how to talk, walk, eat, everything all over) taking several years...
and this was a success because he hasn't rejected the heart... yet.... there are things worse than death...
needless to say I'm not about to consent to a transplant, or a bypass (they kill you for that too)... I'd rather just die nice and clean... I know how to administer a nice big OD of barbs... I'll just "put myself to sleep"... treat me at least as good as a faithful hunting dog!
so find a new doc... it's the only thing that'll work long term... the sciatica ain't going away... the PT may eventually help with the disk issues... but really you'll need something along the lines of celebrex every day... having some opiates available for use as needed (and that's more than you're getting... but YOU have to be able to control your use... just because you've got the percocettes doesn't mean you have to take them for every ache and pain... there's a level of pain in between pain free and popping percs you've just got to deal with...
you might want to suggest some non-schedule pain meds (not nsaids like celebrex, nor cortical steroids) like Soma (a non schedule but pretty effective muscle re-laxer) and Ultram (tramadol)... a non-schedule opiate like pain killer that is effective for some (and worthless to others)... but worth a try... some people have interesting side effects... I gave my wife a tramadol for cramps and it made her horny
but having options (i.e. tramadol, soma, THEN percocettes) can work...
but suggest the options with the doc (tramadol/soma so you won't have to use as many percocettes) might help you short term with the doc you're seeing now... and find a new doc.