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10 Things Your Primary Care Doctor Does That Should Make You Run for the Hills
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Dr Orrange received her BA in Biology at the University of California San Diego and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health She received her MD from the USC Keck School of…
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The Week In Tragedy...5 Things we can Learn.
1) Demerol: I'll never forget a lecture I attended as a resident by a well known toxicologist who said Demerol should be pulled from the market...that it doesn't work any better than any other pain medication and patients love the high it gives them. The American Pain Society said in 2003 that Demerol has no role in acute pain management because it "offers no advantages over other opiods as an analgesic and has unique neurotoxicity." This same organization has said Demerol is "not recommended for the management of chronic pain." It is a terribly addictive drug and I cringe when I hear it's possible Michael Jackson was getting Demerol injections daily for pain. In my previous blog I addressed prescription drug abuse http://www.dailystrength.org/blog/532-danny-gans-dilaudid-and but Demerol use is really tragic to me and I blame this partly on those of us in medicine.
2) Pick a Doctor who is board-certified. There are many strange things about Michael Jackson's personal doctor including that he was paid 150,000 a month, now we learn that MJ's "cardiologist" wasn't board certified. Neither was the plastic surgeon who performed Kanye West's mom's surgery. Yes, doctors who ARE board certified get in to trouble as well and yes, getting certified and re-certified in your specialty is a PAIN...it costs money and requires many long hours of study prior to your test but DON'T YOU WANT THAT COMMITMENT FROM YOUR DOCTOR! We should all want to know that our contractors, architects and physicians stay current and up to date because they become certified by the Board in charge of their specialty. People please pick a doctor who is currently board certified!
3) So much is out of our control, let's try and control the things we can control: eating right, exercising, getting enough sleep, doing your form of a 5-10 minute meditation every day (bath, walk, prayer) and SCREENING...mammograms, pap smears, PSA tests, colonoscopy, bone density scans...let's screen for the things we may be able to see coming.
4) Billy Mays dead at 50. All of these stories have been so sad and I saw the interview of him the day before his death. My first thought was that he looked a little weary and gray during that quick interview and his wife reports he went to bed at 10 PM that night because he didn't feel well. If this turns out to be sudden cardiac death from coronary artery disease I suspect he felt nauseated and just not right the night before. I hear this story all the time from patients and their loved ones prior to suffering heart attacks. Remember angina is not always substernal chest pressure or pain radiating down the arm, it can be a vague sense of doom, nausea, sweating, weakness, pain or pressure in the throat or jaw. If you feel weird and you know its "weird" trust your instincts and go for help. My patients who say to me "I just don't feel right" scare me the most.
5) Leaving your job for 5 days: This story should get us all thinking about priorities, unrequited love and responsibility. If I were on call at the hospital and left town for 5 days I would be fired on the spot when I returned. I care less about the affair though it is an assault on his wife and sons; I care more about bailing out of the country when you are the Governor. There are so many times my interns and residents could cut corners in the middle of the night just to get 15 minutes of shut eye...and they don't......because when you have a job that carries responsibility (pilot, firefighter, doctor, nurse, Governor) you should know where your moral compass points.
"Why can't we get all the people in world that we really like and then just stay together? I guess that wouldn't work. Someone would leave. Someone always leaves. Then we would have to say good-bye. I hate good-byes. I know what I need. I need more hellos."
~Snoopy~
I'd love to hear your thoughts.
Dr O.
UPDATE 8/9/09: Well, it seems Billy Mays had Cocaine and Dilaudid in his system at the time of death and it appears likely the Cocaine contributed to his hypertensive heart disease which took his life. Another sad story of drug use and possible abuse.
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Displaying comments 82-63 of 82
Got a Question?
Seems like a junkie can get a high whenever they need it, but the chronically ill with terrible symptoms are all too often dismissed as whingers and denied any adequate pain relief.
Surely there must be a better way? Surely those that suffer horribly ought to be given scripts for something that will help them, the doctors MUST surely know the difference between those who are horribly ill and those who just like the high???
I've had tonnes of surgery, terrible pain, obstruction, yet even now I still sometimes get dismissed by ER docs that don't know me. Not often thank God as my notes are so full of how ill I've been.
I recently ran a little opinion poll amongst people who suffer similar terrible pain constantly as me. Very few were allowed any proper pain relief to use at home but all agreed "addiction" would be preferable to constant suffering.
There HAS to be an answer.
When pain management medication is taken as prescribed it is ot addictive.. quite the opposite - most people in chronic pain situations would rather take less of the meds prescribed....
Further, uncontrolled pain soon becomes uncontrollable - demanding extraordinary high doses to get the pain under control and then titrating down... titrating up when pain is uncontrolled is agony for the patient.
Lastly, when did political commentary become part of doctoring? The Governor of SC did not have pain..... an, unfortunately, many of us with chronic pain often have to take five days off or are disabled and can't work....
If I had loads of cash, it would be a different story altogether.
And as far as those expensive screenings go, who would pay for all those? Even with Medicare, I can't afford to go to a doctor for anything that is not imminently life threatening, or absolutely necessary like my glaucoma care. Medicare only pays for about two thirds of my medical care at best. I hear these messages all the time about screenings, but nothing about paying for them.
Just try to imagine living on an after-taxes, utilities, and vehicle expense income of $150 a month for a while and see how much medical care you can squeeze out of that.
How interesting that it's the doctors saying "ooooh, it's terrible, it's addictive, it's evil," but us patients saying "er, no, it's fine for me, it does relieve pain, it's a lifeline"
I'm sorry, but I have spent my whole life WISHING doctors would listen a little more and stop thinking they have all the answers.
I also heard once that addiction is less likely if you are IN PAIN than if you take something for pleasure.
I am EXTREMELY allergic to morphine and all it's derivatives including codeine and fentanyl.
The only strong pain killer I can tolerate is Pethidine strangely, and have used it on and off for 15 years.
I've never become addicted, always stopped using it when my symptoms ease (severely surgical crohn's disease) and don't suffer from any of the neurotoxicity associated, though I do get the normal opioid side-effects.
I take pethidine 100mg IM (given myself) 4 hourly when acute.
Maybe I just have very odd opioid receptors or I'm extremely lucky or it's a gift from God as I can't take anything else.
Either way, PLEASE don't campaign for it to be withdrawn as I'd be subjected to a life of misery!!!
I had to go to the ER once when I felt truly bad and they gave me Demerol. I was SHOCKED that they gave it to me, because I didn't even ask. I can honestly say that I didn't feel a BIT of euphoria. I actually thought I would and expected it, but didn't even feel like they'd given me anything except for the fact that it took the edge off and I was able to think about other things other than the intense pain I was in. I did it's job. I didn't go back for another shot, never had have another shot of D and would be fine if the situation arose again to have it again. It worked and did exactly what it was it was supposed to do. Relieved the pain!
I get very upset when I hear doctors talk like this. That things should be removed because they don't work. That's VERY easy for this tox doc to say, he's not a chronic pain patient. I can guarantee if he were, he'd have the opposite opinion.
Does someone who doesn't suffer pain get high from it, probably. Do they want it again, possibly, but if we pull everything that is addictive off of the market then we'll never have anything that's going to help those of us who truly need it. The reason we have doctors to prescribe meds for us is to monitor us, the DEA monitors them, and when does it become OUR own responsibility what we put in our bodies? I think if I want to be an addict, if I like the high, it's not going to matter one iota whether it's a legal substance or illegal substance. If I can't get demerol then I'm just going to find something else.
I know I happened upon a website a year ago. At the time I was on Oxymorphone. Strong pain pill. By script only. There were people all over that website talking about how they crushed it, injected it, enjoyed it, and were buying it everyday. They had no problem at all getting it. None! So who is it who suffers if you pull Demerol, or any equivalent off of the market? Is it the people who are abusing it? No, it's the one's who truly need it for pain, and get no high from it at all. We're the ones who will suffer for it.
Walk a day in my shoes, and you'll never agree to pull a drug like that off of the market again.
My two cents.
Thank you, God Bless!
Demerol does not cause me this reaction and I've never felt high from it
I've only been prescribed it a few times after I've had surgery and it was a godsend!!! Whenever I've had surgery and been prescribed other pain medicines, I'm bouncing off the walls... The doctor says to go home and rest and all I want to do is run around the block a few times. I can't sleep on them so I have to stay up all night either because of pain from not wanting to take my pain medicine or in not so much pain but all wound up because I did take pain medicine
When I finaly found Demerol, I finally was able to follow doctors orders and get the rest I need
(I've had about 20 surgeries btw)
I pray Demerol never goes off the market and I am never in the hands of a surgeon who refused to prescribe it
Demoral, Deprovan and drugs like them are simply anesthetics, not analgesics.
As for the subject of demorol. I have used it a few times in the hospital when I was very sick. (not dope sick) I didn't crave it years later. It did help me a little then. It was not in bliss as many have described. And never it was on the top of my list for aiding in pain.
My feelings are simple to those who use any med for a high. It is not the medicine that is bad. It is not the person with the disease "addiction" that is bad. It is the action. The question still remands how do so many get what they do not need? Only seeking a high or bliss. While countless others are unable to or will not get there meds for fear.
I Think the truth on pain needs to come out. Not just those who abuse, misuse and take advantage of others. But, the good for a change. How pain meds help when used correctly. Education is the key.