Friday, October 17, 2008

All Patched Up and Ready to Go

The stuff on the hand is Lidoderm patches, not Fentanyl. That's a $25 patch job you're looking at on that hand, there. I have 4 Lidoderm patches left, meaning 2 more "wraps". But I know I'll be okay. One way or another, I think I can keep that hand working, as Walter looks into voice software.

The Fentanyl is safely pasted elsewhere, with 2" silk tape wrapped entirely around my upper arm, holding it securely on as usual. Dr. E says the maximum benefit is first reached around 17 hours after it's applied. I slapped that sucker on there around 5PM Friday. By midday Saturday, I'll be back where I'm supposed to be, pain control-wise.

One day I'll go off on a rant about why we should never feel shame for treating pain. Oh, and a fine graphic detailed disquisition on the myriad kinds of pain I feel, like that broken bone ends rubbing together one; and what living with constant pain has done to my life...But for now? A small reminder of why pain treatment must be conducted with care. Having gone five days late with the Fentanyl was an experience that could have been terrible. Fortunately, it wasn't.

To decrease properly from any opiate use, slow is the key. Going "cold turkey" like that is physically dangerous as well as painful. As part of the Pain Management Agreement protocols I have with my Florida pain doc, the doctor must agree not to leave the patient suddenly unmedicated. The problem that arose here was simply being out of town unexpectedly. I'd packed two months' worth of new prescriptions. When they ran out and we still weren't home, I had to find a local pain doc. My Florida doctor can't mail a new Fentanyl prescription across state lines, it's either illegal or against regs or some such. I knew I'd need a Missouri doc. Okay.

What threw me off was the unusual way Missouri uses a *primary* doctor. In Florida, that term means our insurance gatekeeper. But in Missouri, one can't just call up a pain doc for an appointment. Not allowed. First you must see a "primary," who then may or may not refer you to a pain doctor. It has nothing to do with insurance, it's state law (or regs or whatever).

Or, the primaries may take it upon themselves to simply write you the prescription on their own. This time? After some phone calling, faxing of release permissions, verifying my long-time status as a perfectly - perfectly - compliant and lawful pain patient, displaying printouts of the Rx records spit out of the Sam's and Walmart's computers - that's what my new local primary doctor did.

Following one's pain patient protocols is excruciatingly important. I have never *run out* of any pain med prescription before I was supposed to, or called to say they'd been lost or stolen or accidentally spilled down the sink. I show up to my appointments as scheduled. I drink no alcohol. I submit to random urine tests as requested; I have absolutely nothing to hide. I don't boost my prescriptions with marijuana here and there, even though I believe it should be legal to do so.

I've interviewed with one prospective pain doctor who was a sadistic weirdo, and I declined to use his services. Once, a temporary pharmacist at my usual Walgreen's called a surgeon to clarify why I presented a (perfectly legitimate and protocol) new Rx for post-surgical pain meds. That was embarrassing. The pharmacist soon admitted to me that he did it as harassment for his personal amusement. He showed no remorse - in fact, he was still laughing - and his little amusement cost Walgreen's five figures in sales per year from my prescriptions alone. They lost Walter's business as well.

I have never, ever had any doctor or any other pharmacist question or dispute my pain meds use. Ever. I behave so carefully because it's safest for us all. And having a perfect long term history is what gave the new primary the comfort level he needed to write me my new local prescriptions.

The funny thing about it was the doctor's reaction upon seeing the Rx printouts I picked up at Walmart. Apparently he had no idea this could be done. He was really amazed. I hadn't wanted to swamp the poor man with papers, but I was paging through them, circling the Fentanyl refill histories so he could see how nice and steady I am. And he couldn't get over the fact that one can walk into the pharmacy with proper ID, say --Please print out my prescription history from January 2003 to the present-- wait a few minutes, and walk out the store with all 47 warm pages in hand.

heh! This is why doctors should always hire CPA's to do their taxes.

Anyway, the timing mess-up was nobody's fault but mine. Luckily, I had a good supply of oral opiates and the knowledge to use them correctly. Not to mention, a very intelligent, tolerant, watchful, honest, and loving partner to hold my hand through the process. Thursday was pretty rough - I'll spare you the gory details, I've had enough of this subject for now - but Thursday was soon over, and I'm safe again.

And back in business.

Well...after a niiice nap, that is.

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Cefenix said...

Glad to see you "back in action" Hope the Fentanyl kicks in...

Jan said...

Oh, K..I feel for you, and I understand why you are so careful and precise with your medications.

My mom was on those Fentanyl patches(Duragesic 100) for several years, and when she went into the nursing home where she was dropped and injured so badly, they almost killed her by removing her patch, cold turkey, because the admitting doctor could no longer write prescriptions, and the nursing home doctor was on a hunting trip, and unavailable.

They pulled it the first night she was there, and she went through hell for a week, on the verge of death, experienceing withdrawal..and in her fragile condition.

It's something that I never want to see anyone go through, again..not even my worst enemy.

Yes, there are horror stories out there, and helpless people at the mercy of horrible people.

I'm so glad that you and Walter are educated in your own health care, and are able to speak up for yourselves.

My prayers are with you, as always.

Joyce Ellen Davis said...

Mine, too. And with that, I am about to take my little Tramadol pain pill and go to bed!

k said...

Blogson, I am very happy to BE back in business. And even typing too. ;-)

Joyce, yay! I remember the first time I was able to go to sleep, really sleep, because the pain was under control. What a revelation.

Jan. Oh, Jan. How horrible. She's lucky to have survived. I remember you saying she was using the Duragesics, but not what happened with them at that place.

This is when I can see, so clearly, why doctors get sued for malpractice. They did so many things wrong. Just in this one instance, leaving aside everything else like dropping her and mishandling the injury and the MRSA: why did they feel the need to pull the patch that was already there? And why in the world didn't they get another doctor? How could they operate the facility with the only doctor totally unavailable?

I've had some rough experiences with medical care, but nothing even approaching what your poor mother went through. And then I wonder - what will happen to you and me and Walter and Lucky and Nancy and 'Pup and everyone else if we get to where we can no longer kick the jerks back into proper behavior? This is scary, Jan. Your mother - just one person - had way too many bad things happen to her. And she had great family support. I don't even want to think about what would have happened to her if you weren't there.

I'm so sorry. I had tears running down my face when I read that.

She was a very brave woman. You must miss her so much.

And thank you for understanding. I hate the reason why you understand it so well, what proper pain control means. But surfing around, I still run into so many commenters who just don't get it. They think we're weak or whiners or fakers or drug addicts looking for a thrill. Then I get mad at myself because I lose all sense of humor on the subject, and even worse, I start thinking evil thoughts at those people.

People like that? I have this thing I do in my mind, something not very nice at all. What I do is, I close my eyes and wish they have to live in a body like mine, feeling everything I feel, just for a day. Or a week, if they said something really mean.

Then I have to forgive myself for being so angry and wishing misery on them.

You see, it's people like that who we have to be afraid of. For ourselves, for our mothers and fathers, for anyone we love who can't defend themselves any more. Maybe most of all for those who are defenseless, and also have nobody left who loves them, nobody left who can ever help them at all.

And those people think it doesn't matter, the way they feel when they write those comments. They just don't get that their failure to put themselves in the other person's shoes could come back to haunt them one day.

JP Mac said...

They look like mummy hands.