Join the forum discussion Dear Va: This is Pain Care?; Ian McLeod; War on Doctors/Pain Crisis blog of the Pain Relief Network; 2007-11-08. See also: I’m in an almost impossible situation. I live in a very small town in the middle of Oregon. I have been treated for chronic pain for the past eleven years or so by the VA in Portland, and was recently switched to a local clinic about 48 miles away. A med I used as a muscle relaxer and sleep med, carisoprodol, was summarily discontinued by a substitute clinician in the clinic who had never seen me before. He did a pill count, called me and told me I was abusing them, simply on the basis of the prescribed amounts, added that to the Drug Seeking Behavior file in my chart, and that was that. It was the only med aside from the herbal one I’ve been offered and refused due to the DEA’s stance on it that worked without debilitating and, in my situation, dangerous side effects. So now I sleep even less than usual, which was an hour or two at a time, or sometimes in a night. A few months ago, a new group of what I call “Narco-Nazis” arrived at the VA, and forced all pain patients to sign a draconian pain contract on threat of losing all care. Now, I am being forced to see this new “pain specialist”. He got his MD at OHSU, a degree in pharmacology, and work in “an interventional pain clinic” at OHSU for couple of years. He’s using a new standard from Washington, he says. It insists that 150mg equivalent to morphine is the maximum dose, and anything above that is a toxic level and carries a danger of respiratory depression. I am on 200 micrograms per hour of fentanyl, and WAS taking my former breakthrough meds as a regular dose, as the VA wouldn’t allow an increase in the patches. That was 10-15mg of Norco (10/325) and ½-1 15mg morphine IR PO Q4-6. Oh – the carisoprodol was 1 ½ (less does nothing) with that usually, and 1 ½-2 HS. Of course my pain levels when I get to the clinic are higher than usual, and they are higher than they should be anyway, but I’ve had to refuse neurontin (he says all the negative stuff I’ve read about it is wrong), SSRI’s because they make me very ill and short-tempered, baclofen, another dangerous meds I won’t take. So he’s decided I’m uncooperative. The VA has forced me, on threat of being cut off entirely, to see this so-called “pain management expert” (he isn’t) who is trying to force me to take meds I know don’t work or make me sick or that are far too dangerous. He’s an authoritarian, does not like being questioned (he got very angry when I asked for his credentials - I got ‘em anyhow, and he’s NOT qualified), plays dominance games, etc. He’s changing my regimen, in part to reduce the expense to the VA, to the detriment of my care! So far he’s canceled one pain med (without even notifying me) saying I can’t have both a short and long-acting one, removed the muscle relaxer that works and left me the one I loathe (diazepam), put me on too little of a med that doesn’t work well and makes me ill in a stacked dose (oxycodone), then at my insistence, changed me back over to the one he had canceled as the sole pill, but at too low a dose that he thinks is appropriate. He also intends to remove the patch it took a doctor almost a year to talk me into (turned out it worked better with fewer side-effects than anything ever has, but it’s expensive), and so on. I have no recourse within the VA system, because they have me down for “Drug Seeking Behavior”, meaning my condition requires opiates to control, and when they screw up I keep calling until it’s fixed. As I said, if it gets to where he’s aiming for, I’ll be barely able to move, and there is no other help here for my wife. If I can find a new doc, he has to take Medicare - it’s all I have - and I still have to find a way to pay for meds. Oh, he’s also referring me to the psych department (more trips I have to leave my wife alone for, try to beg a ride, get there very sore, and as always, all in the middle of my “night”), and an ophthalmologist four hours away, the latter for migraine-like visual effects. I TOLD him that’s the wrong specialty, but he won’t listen. He knows I have an unsafe vehicle I can’t do anything about, and that I have to leave my wife alone while I’m gone. He could care less. Not his problem. My 23 years with this condition, my own medical training and years in EMS and hospital work (Navy Hospital Corps, ICN and other such), the information I’ve collected over the years about pain management, all my MRI’s, CT scans, 6 back surgeries, psych test results from OHSU’s Neuropsych Dept. (I learned awhile back they had purged them from my VA record and replaced them; they may be gone again), the fact that I’m in an extraordinary circumstance as chief cook, bottle washer and everything else for an essentially bed-ridden wife, or that the trip to the VA plus the choice of hard chairs in the waiting room, then his forcing me to sit instead of lie down curled up when we meet adding to my pain – it all means nothing to him. He says my pain levels are up, so that justifies lowering my meds according his “standard” because my regimen isn’t working. If it goes much further I won’t be able to get to the clinic without an ambulance or a medical transport because of pain, and he’ll be able to throw me out of the VA system entirely for failure to show. The regimen I was on DID work – just not as well as before. Taking it all away and putting on medications that never helped before will only make things worse. I’ve spent decades learning what does and doesn’t help, and the meds I was on gave me back my life for a little while. I could move my equipment, play and sing a couple of nights a week, cook and do a little cleaning – until my wife got case #4 of pneumonia, and empyema and then the COPD. [END] As always, we ask that you help PRN fight to protect the rights of patients and the doctors who treat them. Thank you for clicking the link below.
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