I saw a new pain doc July 2014; it was my first return to Western medicine pain managment since late 2011. I believe in setting myself up for success in all situations, by speaking as clearly and concisely as possible to reduce and eliminate unnecessary confusion from poor communications.
Months before I scheduled my new patient consult, I met with this doctor to interview him for Spinal Trap because I found his varied and broad training very appealing as someone who had made the immense progress that I did on my own, by going herbal.
I made this fact enthusiastically clear to him; as well as the facts that I do not take any pain Rx's daily as the rule and opt to suck up and suffer a lot of pain in lieu of suffering the probable damage that will happen with long term use of Rx's, due to my congenital heart and kidney issues as well as my (then) poorly controlled high blood pressure.
Despite all of these truths, he insisted on putting me on what he called "long term opioids" as a maintenance Rx.
Out of the many docs I'd seen in almost 9 years of being a chronic pain patient, I never before had any speak of "short term opioids vs. long term opioids" to me.
I told him this, said I found it interesting and wanted to better understand what he was saying and basing his reasoning on; because as a proactive patient, I want to know why my doctors make the decisions that affect my body, mind and health. (ALL pain pills regardless of long or short term opioid status will impact your mind and not in any good ways!)
Initially, he was very interesting to listen to because of his widespread range of specialties/knowledge. The problem was, he had so much to say about so many different topics that he quickly switched topics and I never got a full understanding of many as a result.
Thus, I shall be pursuing this subject with another medical professional when able and writing about it so that you too can best understand the decisions that impact your long term health and quality of life as a chronic pain person on (likely, many) maintenance Rx's.
A maintenance Rx means that a person takes a prescription on a recurring basis for a chronic, long term condition. Chronic pain people are often on multiple maintenance Rx's for pain, depression, anxiety, insomnia, etc...
At my first appointment, I requested an Rx for Nucynta 50mg and although he gave it to me, it was begrudgingly because it is a short acting opioid and he said that he doesn't like to put chronic pain people on them, he prefers they be on long acting opioids.
Not having a clear understanding of this all yet, I complied with his wishes to also start a long acting opioid. Thus, he also gave me an Rx for Nucynta 50mg ER (ER means extended release) to be taken BID (twice daily).
In a very short time, I realized that although this option may make sense for many, it sure didn't for me given the totality of my specific health status, major success with herbs, and stance on only using Rx's as the exception, not the rule, for pain management.
Nucynta ER didn't exist the last that I asked my prior pain doc for a refill on it in Jan 2012. Thus, being fair and open minded, I felt I had to try it, despite it going against my natural health goals.
Pain truth: pain is personal, subjective
and unpredictable.
More truth, when you have multiple types of damage, i.e. spinal cord, herniated discs, muscles, nerves, ligament, arthritic joints, etc...it is far more complicated too; as a result, what does work for many, also doesn't work for many others.
In other words,
there is absolutely no
"one-size-fits-all" approach
to pain management.
It is simply a matter of trial and error.
Try everything and see what works for me, is my motto.
Thus, you may try Nucynta 50mg ER and think its the best invention since remote controls...so please do not be deterred from trying it, if you are okay with being on long term opioids. I am not okay with that.
Now, permit me to say that as much as I detest pain pills, Nucynta 50mg (not the ER one) is the only one, out of the many I've had throughout the years, that does NOT make me nauseated, dizzy, cloudy headed, and constipated. Each of those side effects in and of themselves, are horribly unhealthy, let alone combined!
Think about it, when you get sick and you vomit, you feel better, right? That's because you were able to release the toxins causing the nausea, from your system.
But, when I get nauseated from pain pills, though I have vomited, I rarely do; instead, I just stay chronically nauseated, which, when already battling severe pain is really unacceptable.
When you don't throw up
and are severely constipated,
chronically,
there is no releasing the toxins
from your body.
Instead they just get absorbed into it on a deep,
cellular level and will eventually cause you
new health challenges as a result.
For me, some of these byproducts have been my glucose being elevated and developing diverticulitis.
With long term use of pain pills, this toxic residue will also affect your brain and reduce your ability to think clearly and well, even if you don't exhibit the aforementioned side effects. If it happens gradually, you may not even realize it for a very long time.
Ironically and contradictorily, this same dr. who insisted on giving me long acting opioids that I did not want, which cause me (and many!) severe constipation, would exclaim "Constipation is unacceptable!" when I told him of this issue.
Yet, he didn't want to give me the one and only Rx that I knew doesn't do that to me. I'll give you 3 guesses as to what was unnacceptable...
Until I was first given Nucynta 50mg in 2011, it was my (horrible) experience that pain pills did more to numb my brain, than my pain!
NOT GOOD PEOPLE.
Hence, my sucking up pain as much as I can and not taking pain pills, daily, as the rule and recommending to all chronic pain people that you try to find the same success as I have, by going herbal and natural, daily for your best quality of life, despite chronic pain.
Please see my Herbs page and speak with a dr. who is open minded about herbs and/or your pharmacist to see if it is a safe option for you and your specific patient case history.
As I said above, I gave the ER version of Nucnyta 50mg a chance, not because I had any intention of being on a pain pill twice daily for life; but because I pride myself on being fair and you can't judge what you don't know. (Okay, you can, and we humans do, but we shouldn't. Please read my "Judging Wrongly..." page for proof.)
Thus, I gave it a chance to see if it was a good option or to rule it out as such. All of my pain pills prior, were written to be taken one pill every 4-6 hours as needed for pain; and I never exceeded 3 per day.
This long acting opioid was prescribed to be taken one pill, twice daily, every 12 hours. I was hoping that like regular Nucynta 50mg, it would let me function really well.
Nope! Though its side effects weren't as severe, it was definitely NOT for me. It made me completely lethargic and non-functional; to its credit, although nausea and constipation were present, it wasn't nearly as severe as when on codeine based Rx's.
Thus, any improvement in those areas is critically important; BUT logic dictates that a chronic pain person shouldn't have to suffer those at all if he/she knows a different pain pill doesn't do that and conveys this to their doctor.
Therefore a doctor who has this all made clear to him/her and proceeds to completely disregard patients input, knowledge and quality of life needs, is showing absolutely no respect for their patients and is not a professional that educated and motivated patients should tolerate and continue to see.
Nucynta ER's last unhealthy trait is that it would get me to the verge of falling asleep, and then, not let me! Nothing is more annoying then when you need to sleep and can't; especially when in pain.
Thus, after taking it and losing more time out of my life to being non-functional thanks to an Rx, I said DONE!
Until 2014, when I did see a dr. for my pain flare ups, it was only to get a Toradol injection.
Toradol is a super strong anti-inflammatory that has been a real life saver for getting me out of severe pain flare ups, when given properly. Read about it on my Toradol page under the Rx's heading.
The problem with it, is that it is very harsh on the kidneys; thus, Dr. Matt Schocket of Capitol Pain Institute in Austin, TX told me in 2011 when he suggested it, that I can only get a few per year to minimize its potential harm.
Dr. Schocket is an excellent dr. but I didn't return to him right away in 2014 when I resumed pain management care because this doc was not only trained in western medicine but many of the natural healing modalities that I hold in high regards.
Thus, that fact appealed greatly to me; as well as that he came highly recommended by someone I respect. I couldn't wait to be his patient; and I couldn't have been more disappointed.
At my second and final appointment when I told him that the Nucynta ER was holding me back from achieving anything at all due to the lethargy they caused, his reply was "So what, who says you have to get anything done?" I was shocked and appalled.
When I told him I won't be functionless because I have goals to reach with Spinal Trap and life in general that I can't accomplish if I am on pills that leave me lethargic, nauseaous, cloudy headed, chronically constipated, etc...he got existentialist with me saying that "it didn't matter", "there are no deadlines", etc...I couldn't believe my ears.
Absurd begins to start describing this awful patient experience, and worse, more time wasted out of my life thanks to pain and the wrong pain pills.
This time though, it wasn't due to still trying to figure out the best pain pill for me; it was due to a small, doubled minded dr. doing what he thought best for him, instead of me. (Keep reading to find out why he was like this.)
When you have fair and reasonable care
needs and a dr. denies them
without merit, RUN.
As a holistic life coach, permit me to add on that fair and reasonable expectations should be applied to all of your relationships, personal and professional.
When you are fair and reasonable in your behavior and expectations and not shown any respect by another party, it is never going to be a healthy relationship and therefore, shouldn't be a continued one. You don't need your doctors to like you, but you absolutely do need them to respect you and you need to be able to have respect for them as well.
Upon my second and final visit with this doc, I told him again of my preference for Nucynta 50mg due to it being the only pain Rx out of the myriad I'd tried through the years, that yields me the least unpleasant side effects.
Despite his telling me at our initial meeting “I treat patients in their paradigm, not mine.” his actions belied those words and and he insisted that I try another long acting opioid. I said “Like what?” He said “How about Methotrexate?”
My eyes got huge and I said, “I used to have a neighbor who was a drug counselor and she said that they gave Methotrexate Rx’s to drug addicts who were trying to come off meth, and that they pooped their pants! I really don’t want an Rx known for that!”
(Especially considering I'm very anti-drugs; I've never even tried pot so I'll be damned if I was going to get on a pain pill with the common use of weaning addicts off of meth!)
He said “Interesting that she would say that; so I guess due to the stigma, you don’t want it.” I said, no, I don’t. Then he moved on to suggesting morphine in an extended release pill because he made pain management about his peace of mind, not mine.
I instantly got that instinctual dread in my gut as I strongly suspected this Rx would fail me on the nausea front and I said to him “My Promethazine (an anti-nausea Rx) are all expired, so if it makes me nauseated, can I call you and get a new Rx for it?” He said "Of course".
I went to Sam’s Club and the pharmacy clerk said they only had 42 of these morphine pills in stock, and that if they issue me the 42 vs. the 60 for which the Rx was written, they would NOT be able to dispense me the remaining 18.
I replied “That’s okay, I hate pain pills, I probably won’t take more than one anyway so it really doesn’t matter if I don’t get 60.” I paid $41 for 42 pills and left.
This was on a Friday. That night, at 10:08pm I took my first and last morphine pill because exactly one hour after taking it, WHAM! My stomach went crazy sick. I broke a sweat and spent the next 24 hours in nauseated/constipated hell. I then had intermittent bouts of nausea for 12 more hours thereafter.
Needless to say, I called his office Monday to report this situation.
I didn’t bother asking for the previously discussed Promethazine Rx because I had the weekend to think about the fact that there is something inherently wrong, with having to take a pill, to force my body to take another pill!
A fact with which he unhesitatingly agreed.
When I talked to the dr., I asked if he wanted me to return the morphine Rx to him? He said no, throw it out or flush it. I said that I thought one of those wasn’t supposed to be done? He said it doesn’t really matter because in the long run, it all ends up in the same place anyway.
I decided since his advice hadn't been kosher with me so far, I wasn't doing what he suggested. Instead, when feeling better, I contacted Sam’s to see if I could turn it into them? (Not for a refund, but as a safe disposal place.) No.
However, Shelley at Sam’s Round Rock, TX pharmacy was kind and proactive, and looked up Rx disposal data and let me know that Saturday 9/27/14 was a collection day for exactly this purpose!
Thus, I dropped the bottle of remaining 41 morphine pills off for proper disposal to the booth outside of the Cedar Park Police Department.
While there, I spoke with the DEA Agent overseeing the operation, Agent John Schexnayder. He was very kind and we chatted about pain and pain pills for a few minutes. He explained that it was a federal program and all Rx’s collected would be incinerated.
I had many questions since I had not done this before and wanted to get strong and accurate data about it to post on Spinal Trap.
He doesn't do interviews but gave me a name and phone number for someone who may. I shall add all relative data if and when that happens.
In the meantime, please click on the link below, to educate yourself about this terrific program; which by the way, has a dual purpose.
One of course, is to not contaminate our water and earth with such pharmaceuticals; but the other I was informed, is to prevent drug abuse and selling.
As someone who has never abused her Rx’s and has always been anti-illegal drug use, I was very glad to hear that this program has been a huge success in diverting drugs from abuse and the streets!
CHOOSE NOT TO ABUSE!
Life is too short.
You wanna get high? Take Gingko Biloba 24% extract capsules! I’m not kidding! I can be in horrible pain but still have a happy attitude thanks to taking one of these daily, along with my Holy Basil, and of course, thanks to God, who has allowed me this victory so that I may educate and motivate millions of you to have it too!
At my initial consult with this new pain doc,
he reviewed my patient psych profile answers,
looked at me and said:
"It's amazing, you have all of the depression markers but to look at you and talk with you, you'd never know it."
That is a victory worth its weight in gold!
It's taken me years longer than I wish, but the good news is that I have beaten depression naturally!
Ironically, if I had stayed on his long acting opioids, my mood would NOT have been the happy and upbeat person that he complimented!
You would think that immutable fact would've made him realize that his trying to force me to be on long acting opioids for life was an extremely poor choice for me and my specific patient facts.
During our last conversation, he let me know that he’d had patients who died of drug overdoses; hence finally knowing why he had such great hesitation to write short acting opioid Rx’s.
I told him that I appreciated knowing that and I respect that he and other docs, work long and hard to earn their medical licenses and do not wish to lose them.
I also understand that losing a patient, has to be a horrible situation.
However, what I do not understand is why doctors punish non-drug abusers like me for the actions of those who don’t have the discipline and desire that I and MILLIONS of others DO possess?
It’s like being found guilty of a crime
that you didn’t commit,
before you even go to trial.
Call me silly but I would like to think that a doctor is smarter than the average person when it comes to the court of public opinion vs. making fact based opinions.
That’s not how our
legal system works
and it sure as hell isn’t
how our medical system
should work.
If we let fear
about potential worst case outcomes,
rule our decisions,
no one would ever leave their house!
No one would fly, ride in a car, swim/surf in the ocean, etc...no one would climb Everest or ever do anything great!
Hell, for that matter, no one would even take any prescription pills because if you ever stop to read the pharmacology sheets that come with them, they are pretty overwhelming in their warnings about side effects.
But as a fair and reasonable pain person, I tell myself, I can't let the fear of its numerous, horrid, potential side effects keep me from finding out if its pain relief benefits to me, are greater.
Doctors need to realize that we patients have fears that we have to overcome too.
Fear of needles.
Fear of prescription side effects or worse, new health damage from long term use.
Fear of becoming paralzyed by a wrongly done procedure.
Fear of being left in more pain by an ineffective and/or poorly done procedure.
We have fears too but ultimately, we have to put our trust in you and you must do the same with us.
And just as some patients do not deserve the benefit of the doubt, neither do some doctors.
There are bad patients and their are quack doctors.
As an almost 10 year chronic pain patient who has been exceptionally involved and motivated in her care, here is my bottom line, and it should be every patient's:
I respect and expect,
a doctor to make
fact based decisions,
I do not respect or expect one,
to make fearful, paranoid based
decisions with absolutely
no merit when a patient
presents with no history of
abuse and/or suspicious drug
addiction type behavior(s)
and/or physical signs thereof.
Especially when there are millions of patients like me exist that do NOT want to be on Rx's daily, for life and have the discipline to deal with suffering pain vs. popping pills at every ache or stabbing pain.
Additionally, since I only take my pain related Rx’s prn (as needed), after all of my numerous, natural methods have failed to manage my pain, when at my first visit, and they did an unexpected urine test on me, it came back completely clean of ANY prescription drugs!
Thus, that alone should have substantiated my claim that I do only take my Rx's prn, NOT daily, or even, weekly so that at my second visit, instead of again insisting that I waste time, money and peace of mind on morphine that I didn't want, that made me greatly ill and lost me a weekend of functioning, on top of time lost feeling lousy from the Nucynta ER when I could've just been given the regular Nucynta Rx.
When I saw this doc, I'd been a chronic pain person for almost 9 years; I believe that this was my first ever urine test for drugs. Since drug abuse has been a non-issue for me, I don't actually know anything about urine tests in how long of a time period the urine can trace back and if it varies drug to drug.
Also, his staff member accompanied me to the restroom and held my purse outside of it; thus, they know beyond the shadow of a doubt, the clean pee, was indeed mine.
I even took my bag of pain prescriptions to my initial consult, which showed I didn’t even finish many of them, such as Oxycodone; and Oxy is known to be a highly abused drug.
I honestly didn't see what the big whoop was all about. They didn't appeal to me anymore than the hated codeine based pills that I will never take again.
Thus, common sense dictates that not even finishing the one Rx for Oxy that I got, combined with a quick call to my former pain doc to confirm that I never asked for a refill and to ask his opinion of if there is a reason for concern, should all go to disabuse a doctor’s fears about whether or not a new patient is an abuser.
Many times, we patients already waited up to 2 hours to see you, so please, take 2 more minutes to call our prior doc so that we may all have more peace of mind about having our reasonable and fair care needs, met.
After all, it was another pain doc who put me on Nucynta originally when I told him I couldn't function on codeine based pills. So really, where is the foundation for such paranoia?
It sure as hell didn't come from me, my patient history or behavior.
If asked, I would’ve gladly furnished him with the names of the docs that I saw for Toradol injections during my 2.5 year break from Western medicine as the rule; they too could confirm that no pain Rx’s were dispensed to me.
After almost 9 years of pain and many Rx's taken as the rule for the first 5+ years, I just don't think as fast as I used to; thus, it didn't occur to me to offer this data because I know I'm not an abuser and am not used to being perceived as such.
Thus, again, doctors need to assess the whole patient picture and prescribe or deny, accordingly, based on each individual's patient's case facts.
Furthermore, I'm not educated on the signs/symptoms of drug abusers but I should think doctors are!
Thus, why a dr. doesn’t assess a patient’s body for these signs, as well as take a patient's overall body language into consideration to help him/her determine that myself and others, are not abusing our prescription drugs, is a question I am going to start asking because this year, for the first time ever,
I am seeing
a scary trend
this year
in doctors
practicing paranoia vs. medicine and doing what is in
the best interest of the patient
and that
is as unacceptable
on their end,
as abusing drugs is on a patient’s end.
DEA link for drug take back initiative and more!
http://www.deadiversion.usdoj.gov/drug_disposal/takeback/index.html
