Posted by JohnX2 on April 20, 2002, at 2:07:19
In reply to Re: help! (rant; advice?), posted by JohnX2 on April 19, 2002, at 3:09:33
> > > A few months ago I moved and had to find a new pdoc. She seemed pretty good at first, but it turns out that she has a lot of attitudes and assumptions that I recognize because a lot of people on PB have reported similar behavior in their (your) doctors. So I'm hoping someone here has some idea how I might approach this problem.
> > >
> > > This new pdoc wrote a prescription for Xanax as-needed, but she only gave me 10 doses per month (keep in mind that Xanax is a short-acting drug -- I think it wears off in about 4-6 hours for a typical adult). This month I ran out early and had to ask her to call in a refill. When I saw her the other day, she asked me if I'd been "overusing" the Xanax. (She said this in a way that strongly implied that she felt that I'd "overused" it the month before. The way I see it, the amount she'd prescribed hadn't been adequate.) I tried to explain that I'd been having problems with insomnia and back pain that had contributed to my need for more Xanax than the amount prescribed. Then she got freaked out and accused me of abusing it -- it's "not indicated" for those problems, and so forth. I explained that insomnia and muscle tension can be symptoms of anxiety. She gave me the generic heard-it-a-thousand-times lecture about how I should find other ways to "manage" chronic pain. (I've tried all that stuff, and besides, I don't want to "manage" it, I want to treat it!) In the end, she wrote another 10-dose prescription for this month.
> > >
> > > I also told her that I'd been having problems with early-morning depression sometimes, which I speculated was caused by the last buprenorphine dose of the previous day "wearing off" overnight. I don't remember exactly how I phrased it, but I did think it should have been clear what I meant. She somehow managed to interpret it to mean that I was becoming tolerant. (She also claimed that if I was becoming tolerant, it must be because I was using it to get high. Tolerance to benzos occurs almost exclusively in the context of abuse, but this isn't necessarily true of opioids. I didn't bother telling her that, though.) I pointed out that I had said "wears off," not "stops working." She backed off a bit, but she didn't think that this problem was worth doing anything about. (I'd thought that a small bedtime dose of buprenorphine might be worth trying, but I was scared to make that request after she verbally jumped on me -- it made me feel like I didn't deserve it, you know?)
> > >
> > > After all this nonsense (all in a single appointment, mind you), I was faced with having to remind her (I had told her this before) that I need 20 mg/night of Ambien, that 10 isn't adequate (I asked for a prescription for Ambien because I haven't been sleeping very well -- she put up a little resistance to this, too, of course, but compared to the other stuff, she was being very rational and laid-back!). Some background: I first took Ambien in 1996 and it has always been clear that 10 mg isn't effective, but 20 mg is (it's not like Ambien just doesn't work for me or I grew tolerant from "overusing" it or something). She insisted I "try" 10, even though I told her that she could confirm what I was telling her by talking to the pdoc I'd seen while I was in Boston. This is a big problem for me because I don't have another appointment for two months; sleeping fitfully and inconsistently for that long is bound to have nasty effects. This pdoc talks about wanting to see functional improvement from the medication, but she doesn't seem to want to do what it will take to bring about that improvement.
> > >
> > > I don't abuse or misuse or overuse any drugs, including psychiatric medications; and I've always been responsible about my use of medications, in particular of those prescribed for as-needed use. So the way my new pdoc has been acting is naturally off-putting -- it's clear she's just assuming that I'm up to no good, for some reason. (What that reason might be is a mystery to me: I've *never* gotten this much crap about supposed "drug abuse" from any doctor I've seen.) How am I supposed to deal with this woman??? I want (and need) her to trust me, but she seems bent on mistrusting me. What can I do/say?
> > >
> > > Any ideas?
> > >
> > > -elizabeth
> > Elizabeth,
> > Anecdote: I was taking Klonopin to treat myofacial pain and needed to up the dose. It started to wear off over time (poop-out or maybe my neurological tick got worse? who knows) and I was getting frustrated that other medicinal routes weren't helping. So eventually I upped the dose behind my doctor's back and ran short on the refill. I called the stand-by doc and he was leary about refilling the med, he just wouldn't do it (I went without it for a day and my life really sucked). When I got a hold of my pdoc (who actually is really understanding), I just told him "look, this is the only medicine that works for me, you sent me to the best neurologist in town who said he could not help me any other way, I refuse at this point to go on with my life in anymore pain. I don't care if I have to raise the dose of my medication in the meanwhile." (I had been hinting at suicidal ideation over this chronic pain). Point being, if the medical system did not have anything to alleviate my pain and suffering better than Klonopin, then what else was I to do in the mean time? Unless they had a better option, who are they to deny comfort.
> > I guess I understand where you are coming from.
> > Fortunately I did find another med to treat my pain subsequent to this.
> > I don't know what to say, but I understand the frustration. :-(
> > Also, I found a few of my own cheats to manage my particular pain and rebound insomnia (non-standard approaches with unknown risk)..but gotta have some quality of life.
> > Your bastard-of-late empathetic friend,
> > John (returning from planet mania)
> Can you comb thru the phone book (or whatever your health provider's directory is) and just get a couple appt with whomever are the 1st available pdoctors? I don't know what area it is (or what your finances or insurance situation is), but if it is well populated, then you should be able to find *someone* who can get you in shortly (a few days or week). Granted this is a baromoeter for a bad pdoc in general (crowded restaurant theory), but if you get in the door and start with a clean slate and "tell the right story <- this is the trick, ahem", you will walk out the door with what script you require. You can juggle multiple pdocs simultaneously until you get your situation more settled. (Sorry for the timid reader, this may sound ugly, don't try this at home). Maybe you'll get lucky and develop a better report with the new pdoc anyways.
I want to clarify that I don't advocate obtaining prescription medications for the same controlled substances from various sources simultaneously. In this case I wondered how quickly Elizabeth could find another pdoc to help with the Xanax and Ambien, but who would also prescribe the buprenorphine (don't have much experience with this class of med or how open in general pdocs are to them..)