RN, I assume you're a RN. I am too, and it's especially difficult for us when we can't help our loved ones. It's like we believe we must help them. I think you're trying your best.

It's such a complicated situation. Of course, a pm doc would be best for your friend. I don't know what area you live in and whether or not there are a number to choose from. A good pm doc is worth their weight in gold; a bad one (like the ones she saw) are a scourge on the medical profession.

Of course she'd need narcotics for breakthrough pain while weaning off the methadone. Obviously, oxycodone 3x/day isn't enough. Why didn't they increase the dose or change it to something else?

And I don't understand why she was not a candidate for SCS (if that's what you mean by stimulator), because she hadn't had PT. Either you're a candidate or you're not. If it's neuropathic pain, then she is a good candidate for SCS (I have one for RSD pain).

And I agree that maybe she needs an anti-depressant. Who wouldn't be depressed, given her situation and how she's being treated? Encourage her to try something like Cymbalta, that helps depression and pain.

Don't give up! Is she on Medicare? Their website has a physician locator on it. I've never used it, but my pm doc was on there because he accepts medicare. And she should call around and find out what their philosophy is about treating cp. Some are strictly anesthesiologists who believe that you should only get injections and blocks for pain. True pain mgt. docs know that no two pts. are alike and will take the time to learn a pts whole story.

Good luck with this and please encourage your friend to come and join us here. We are a supportive group of people and can help.

Sandy

Hi there!! I am another RN that is a member here and I totally agree with what Sandy told you. I don't have anything else to add bc she covered everything very well. I can understand after all she has been through that she would be depressed as would anyone in that situation. I also want to encourage you to tell her about this site as it has helped me tremendously!

I believe the PM who is an anesth. told her that because she violated the contract by not going down the way he counted (actually miscounted) and therefore no longer would he recommend thdecongestante stimulator until she started over with PT, acupuncture, etc. She is so depressed. After 30 years, going off the methadone to 3 oxycodone (5mg) is not enough. She is probably in the throes of withdrawal also. Add to that the Bells palsy and the flu and she has had it. She begged her GP to increase the oxycodone, and she refused saying she did not want to interfere with the pm dr. In addition, her husband , who has the same flu like symptoms went to ER got two antibiotics, ( for a virus, does not make sense) cough meds, decongestants, and told to use nebulizer, and Vicodin, for his body aches. She got a med for her ear, and Theraflu. That really sent her over the edge. She is an LPN, but I have never been able to convince her that viruses do not need antibiotics. SHe thinks if her sputum is colored she needs antibiotics. whether or not, SHe also has sarcoidosis, and thinks tis means her immune system is comprised. SHE IS basically just at her wits end. I did recommend calling thenurse at the PM office and asking what else she could do, to get through this, but she thinks it will do no good. She is one of those pts. that also cries when the dr addresses her or questions her. SHE was RIGHT, and the DR wrong when he counted the meds last time, but he walked out and would not go back in. I asked she explain this to the nurse, and have her look at the copies of the scripts and count them out. She has been on narcotics for so long, the PM says go off for awhile and see if they are helping. The psych component is definitely an important one for her. We do not live where there is pm. We drive 100 miles and then there are 3 offices and all do injections, epidurals, etc. I am worried but do not want to overstep, were she my pt, I would have that dr on the phone ,but not the situation.

Did she have a contract with the PM? If so, and it's like mine is, she cannot receive any kind of pain meds without going through PM, doing
so would stop any further treatment from PM.
I could easily have misunderstood but was she receiving pain meds from 2 different drs.?? Under my contract, that is absolutely not allowed, no exceptions either.

I'm not any kind of medical person and I think the others know far more about all this than I do. I'm just wondering about that contract you'd mentioned and how much of a role that is playing in all this?

I had to have oral surgery and the dentist couldn't even give me anything for that unless my PM ok'd or increased my current meds.

I was recently in our ER for another reason, was offered 3 different meds even though I'd told them I had a contract with my PM dr. who is part of that hospital's staff and could not accept them.

As far as an antidepressant, can she get into a psych dr., would she even consider that?

I sometimes wonder, with all due respect, if some nurses, like some dr.s are their own worst patient? Her reluctance to call the nurse to double check the count is what makes me wonder about that theory.

In my area, there is a nasty virus going around and darned if patients
aren't always being put on antibiotics which I'd always was told would not help with a virus.
My heart goes out to her with all that she is struggling with and do hope she will be able to find some kind of help sooner rather than later. Being on pain meds for 30 yrs. and then coming off them cannot be at all easy and I do believe/agree, medical intervention is mandatory.
I don't mean to create any fear but what has been put in her medical records with both dr.s about all this? I think it would be interesting to see just what was there as far as her med usage. I
f there is even a hint of abuse, though untrue, it could negatively affect any future dr. visits:(:(

No doubt your friend is indeed depressed:(:(
I hope at the least, she will heed your good advice about looking into an antidepressant at the least.
Please check the Medicare site for providers, most all drs. take that unlike a lot of "regular" insurance.

You're a very good friend to her, everyone should have that blessing.

She was only taking the meds given by the PM Dr., going down on methadone and the oxycodone up to 3 a day. The dr miscounted, that is why I think she should call the office and have the nurse go over it with her. She is so overwhelmed she isn't thinking straight, all she can think about is the meds she does not have. I told her after getting off the methadone, please do not go back on , now without trying some of the alternatives. She is in pain, and just cries, and then her family degrades her further, with comments meant to hurt. Before methadone, she was on MS Contin and morphine and valium, and could barely function. I could not even understand her on the phone. The methadone cut back the sedation, gave her adequate pain control, and now NOTHING> IT is a problem, one more and more of us are going to have to face. SHe says they made me an addict, they prescribed the meds, and I took them as ordered. TRUE< but now they do not want us to have meds. IT is really a hard story.

I guess i"m a little confused by all the different Dr.'s you mentioned and which Dr. is saying what? Routine EKG's when your taking high dose pain meds for long periods of time are normal. I've been in Pain Management for 26 years and have been on high doses of several narcotics daily for the last 10 years and I have a routine EKG at my Dr.'s office every 3 months, because daily high dose narcotic use can cause long intervals between heartbeats that then throw off the eletrical system, etc.

If both of these PM Dr.'s you mention are in the same practice and they told her different things, she's not voiding a contract because her contract would be with the "practice". If she's seeing 2 separate Dr.'s and the 1 that "yelled" at her was wrong about a count, then she needs to calmly go back and confront him about his mistake and bring it to his attention unless she just wants to give up and let him screw her out of her pain meds.

At her age, and as long as she's been on pain meds, it's going to be very, very difficult to find a PM Dr. to treat her, that's just a fact. So, if she's going to have to look for a new PM Dr., she needs to make sure her records are clear and that some idiot Dr. didn't make a note that she broke her contract if she didn't. That kind of red flag, coupled with her age, medical issues and drug HX will make it darn near impossible to find a decent Dr.

The thing is, she got off of a helluva lot of narcotics and got down to 20 mgs of Methadone, if I read what you said correctly....and she was getting decent pain control with that. If so, she needs to fight to keep that. 1 pain med is way safer than the 3 or 4 they had her on together at high doses. If a Cardiologist said her EKG was fine, then she needs to fight for her right to stay on that treatment.

As for the depression, no, she shouldn't ask the PM Dr. for Depression meds, they don't like handing out psych meds, it's not their job. She can go to a Pdoc (psychiatrist) for depression help, but she has to disclose any and all meds she's on to her PM Dr. as many psych meds when combined with narcotics will cause false positives for other drugs in urine tests. There are things she can do first before jumping into anti-depressants....herbals like St. John's wart, Vitamin D (up to 3000 I.U. per day), get at least 20 minutes of sunshine a day to boost natural Vitamin D production, etc. There are many non-prescription things you can do to help Depression.

I'm sorry your friend is having such a hard time and I really hope she's able to get someone to listen to her and get her pain care back under control. I'm also sorry for you, I'm sure it hurts you very much to see her going through such a hard time.

Take care,

Kat

The PM she had for the last 7 years is a clinic at Iowa Univ. and the dr has changed as they rotate in and out. The last one was upset that none of the back injections helped her like the methadone. Yes, the methadone of 20mg day is a low dose, but this PM kept telling her she was on WAY TOO MUCH MED. Ironically, the last apt, she had, the resident told her he was very happy that she had not had to increase it, and was happy with the dose. BUT the PM told her the prolonged qt meant she had to quit. She did not tell her this in person, but called on the phone, and gave her no choice. However, her cardiologist did say it did not bother him or threaten the pt. in anyway. BUT THE PM did not listen. SO she went to the first one in MO, and then the second, as the first did not want to keep her on meds. THe 2nd PM in MO is the one who jumped to conlclusions and said she broke the contract. I have asked her to calmly call the nurse, and point out the mistake, but she has no faith that they will treat her with respect due to the treatment last month. Then she gets bells palsy while going off meds, and the 3 oxycodone, of course, do not last all day, not even 10 or so hours, would be my guess, so no sleep, and then all the anxiety with it, add the viral influenza and she is at her wits end. I am afraid as her family has always treated her like dirt because she requires pain meds. IN reality, the drs, put her on meds, kept her on meds, and she was happy, pain controlled enough she could do some housework, and function. NOW she spends the days crying and being the person her family accused her of being. THey demean her, and treat her horribly it all adds up to toooooooooooo much, and I fear for her. I do know she will probably not find a dr, but she has always done exactly like she was asked .

Sadly, it seems like this is the way the world is going. The more we socialize medicince the worse it will get. The elderly simply are no longer of any value to society and are being brushed off.

In Canada where medicine is socialized, a frined of mine was DX'ed with cancer that is easily treated and cured. Based on her age, she was "triaged" for an appointment with oncology for six (6) months from the day she called for an appointment. She died waiting to see the doctor without any treatment.
It is cheaper to have patients die than for the state to pay for care. And patients can not sue the government for stalling until the patient passes away as long as the rules are written to allow such "quality of life" issues to matter with respect to care.