Avatar universal

Help, foot and medicine problem

Hi all!  

First post, just registered. 28yo M from Milwaukee!

In February of this year I noticed a bump forming on the top of my foot. No pain at that point, went about my business. Then one day in March it started to hurt a lot and it had increased in size. It was a constant aching almost dull pain. I attributed it to the abnormally active day I had. It hurt so much I took some leftover percocet 5/325 (OTC didn't touch the pain), from a car accident in Oct, 2009 (T4 compression fracture). I only had a few and it got me through a couple days. The pain had calmed down by then, but of course about a week later the pain comes back on a less then active day. It came back with a ferocity.  

I went to the ER at the end of March told the doctor everything and he asked me twice "Are you sure you didn't injure when your were intoxicated?", I told him both times I don't drink or any do any type of drugs, and I don't. The only thing I was taking was the percocet. He said I'm not going to just give you narcotics.  I then said I never even asked for anything. I am here because I am in a lot of pain and there is a bump on my foot.  He then proceeded to tell me that I've had those. That doesn't hurt as much as you say, it's probably just a cyst. Long story short he berated me a little more and then prescribed me a couple percocet until i could get in to see my doctor.  

Beginning of April I go in to see my PCP, he thinks it is a cyst as well.  e ordered an x-ray and started me on oxycodone IR 15mg and Naproxen 500mg. Follow up appointment, x-ray came back negative, so he orders an MRI and Hep C test,  continues with current medicine. Follow up appointment, MRI and Hep C comes back negative. He then says it is a foot abnormality and refers me to a podiatrist. He then tells me he isn't comfortable with pain management and prescribing narcotics past a certain time and said all my future medicine will have to be from a pain management clinic. He then refused to give me anymore medicine because I would be getting it from someone else. As soon as I leave it takes me most of the day to find a place that takes my insurance. I tell them I need to get in ASAP because my PCP isn't comfortable with pain management or prescribing narcotics. They tell me one week and I should ask for a bridge script. They said it is unusual for a doctor not to do this. I call my doctor's office back and explain that I need a bridge script. The lady then told me they don't prescribe that medication. I told her he has been prescribing me this since March, it is now June. She said hold on and then came back on and said the doctor will not prescribe you anymore you have to get it from a pain management clinic. I asked why and she rudely said he already told you why, have a nice day and hung up.  

So I wait it out a couple days. After not be able to fall asleep because of the pain at midnight I go to a different ER. After 5 hours of waiting and then some scolding a nurse comes in and says here she gave you 4 percocet 5/500. I look at the discharge paperwork and in all caps it says "NO REFILLS FROM URGENT CARE. NO MORE PAIN MEDICINE TO BE PRESCRIBED FROM THIS CLINIC."  At that point I was so mad. I just handed everything (including script) back to the nurse and said this is ridiculous, I have been here since midnight it is now 5am and I have been treated horribly, I am not drug seeking I am relief seeking.  I stormed out of there, well as much as you can "storm" with a limp.   :-)

The next few days were just horrible then I see the PM doc do the whole contract and drug screen. He gives me a month supply which covers me a little past my appointment with the podiatrist and says I will have to get my next refill from the podiatrist who will be more familiar with my diagnosis. The podiatrist cancels on me twice. First time I was triple booked by accident and then the next time oh sorry we scheduled you on his vacation. The PM doc keeps writing bridge scripts after speaking to them.

So I finally go in to the podiatrist at this point I am excited to maybe start getting some closure it is now August 20th. He looks at my foot reviews the x-ray and MRI summary and says well it's either a cyst under some tissue that's why we can't see it or it's a fatty tissue mass. He then says it's 50/50, I can inject it with a steroid and if its a cyst it will go away and if it's not it will make it worse. I was in shock and a little scared at that point.  I asked him is there anyway we can be sure before we make a decision. He says he will order another MRI and give me some vicoprofen and that should help. I am no idiot when it comes to opiate medication.  When I had my car accident I researched the heck out of that stuff. I always do otherwise I am not comfortable taking any medication. I said that isn't the same as what I've been on, oxycodone. He says it is the same thing, not wanting to broadcast my knowledge and explain why I know so much, I just showed him the bottle and he says oh yeah that is different. The vicoprofen would have done nothing, especially since I have been on something a lot stronger for a while. He then copies the script from my PMC exactly. He even wrote the script for a count of 26 the exact same as my bridge script that was on the bottle I gave him.

Well a couple days before I run out I call back for medication and to find out the status of MRI.  They never sent it in for insurance approval and told me he his only in on Fridays, they were booked until September 17th and there was nothing they could do about my medication. It was Monday of last week. So I go back to my PCP as a walk in and explain the situation. He was understanding and gave me more medication just until I can get in to see the podiatrist.

Then disaster my medication is stolen Saturday while I was helping my sister in law setup her entertainment center. I was in such a rush because I was late and the baby in the back seat was crying. I didn't think to make sure the glove box was locked and I left the driver side window down. I never do this. Of course the one time I do it bites me in the behind. I immediately call the police, they come out get some fingerprints and tell me i could pick up a report for my doctor in couple days. Sunday evening came around it was now about 36 hours since my last dose.  Not only is pain unbearable but I am starting to feel the symptoms of withdrawal.  So I go to another ER and they are very nice and understanding (after showing police report).  The gave me more until I could see my PCP this Tuesday.  Well I go in right away Tuesday morning.  When he comes in I apologize, explain my medication was stolen, show him the police report, tell him how I will make sure this never happens again and ask what he thinks the best thing to do is.  He then gets very mad, hands me back my police report, says I can't help you and starts to leave the room.  I then said what advice can you offer what can I do, where can I go.  He says I don't know, you are on your own, I refuse to help you in anyway.  I said that the ER told me I was going through withdraw when I came in and I don't want to do that again, can you taper me down so I can just get off this medicine and deal with the pain.  He flat out tells me no and walks out of the room.  So I call my PMC and his on vacation and no one can help, then I call the podiatrist and they moved my appointment up to this friday.  So it has now been 36 hours again and I just got back from the same ER I was at just before and explained my situation.  They told me that they really do believe me and are sympathetic, but they just can't keep prescribing me narcotics without possibly getting in trouble.  

Any advice on how to manage the next few days or ideas of what could be wrong with my foot?

I really am sorry for the book, I had to vent a little.  No one understands what I am going through.
10 Responses
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Avatar universal
Unfortunately for you, this is a very common situation for many healthcare professionals. We see it all the time! Someone "stole" their medication, the specialist "rescheduled" their appointment. All excuses of "drug seekers"!  Even if your story is true, most healthcare workers are programmed to not believe it. You can blame the bottom-feeders of society for that, not the medical staff. They CAN get into trouble for over-prescribing narcotic medications and the pharmacies often call them to check out the validity of the 'scripts! You are just going to have to be a persistent pain in the *** to get what you need.
Helpful - 0
495284 tn?1333894042
Bottom feeders of society??  
Helpful - 0
547368 tn?1440541785
Hello Fellow Wisconsinite,

Welcome to the Pain Management Forum. I must say that I am completely confused by your post. In Wisconsin it is not the PMP that prescribe opiate medications on a continual basis as is the rule in many other states. In our state it is the PCP that follows and prescribes for the chronic pain patients.

Indeed major PM Clinics even have a statement attesting to that fact on their web-sites. Here's one from the largest PM Clinic that I know:

BEGIN: "Please also be aware that we cannot permanently prescribe pain medications. Once we find an effective regimen, we help you to transfer care back to your primary care physician or other referring provider." END

So I am totally baffled by your PCP referral to a PM Clinic. That's normally done when they dismiss your pain. When you are referred to a PM Clinic normally they will diagnosis and assess your level of pain after a comprehensive multi discipline evaluation.  In my experience, then and only then do they percribe a trial of medications to evaluate effectiveness and transfer you back to your PCP to continue the regime. So the fact that you were prescribed narcotics on your first visit with no work up at all was close to miraculous.  

I am sorry but I have absolutely no suggestions for you except to wait to see your PMP. I am not saying that I disbelieve your story by any means. It just seems to be the opposite of everything I know about pain management in our state. Possibly it is different in you  your specific geographical location of WI, ie: Milwaukee.

I do know that all physicians are reluctant to prescribe narcotics. However with proper documentation and substantiating diagnostic testing a compassionate and well educated PCP does treat chronic pain. I think you may be running into the fact that your foot is not considered chronic pain. Indeed you don't even have a diagnosis.  

Good luck to up. I will be interested to hear how this concludes.

Take Care,
Helpful - 0
1340994 tn?1374193977
My sister-in-law had a ganglion (cyst) in her foot.  She had it drained a couple of times and it went away.  No big deal.  That's just not the kind of thing you keep taking pain meds for.  Red flags go up when a patient asks for a specific medication.  Pain meds don't stay effective over the long term.  They are better left for short-term pain, such as after surgery.  You are addicted, so your brain is telling you to get more, and nothing else makes sense to you.  Have the surgery.  Until then, tolerate the pain using ice and elevation or a lidocaine patch.  Pain won't kill you.  I've got nerve pain shooting down my leg, and refused narcotics for them because I know they are not a long-term solution.  Instead I've found triggers for the pain and reduced it by manipulating the triggers.  
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Avatar universal
Thank you for all responses! Any advice, opinions or criticism is welcome.

My podiatrist's office called me today and told me they just received approval from insurance for another MRI.  They said they set an appointment already for me tomorrow, because they know I want to get this taken care of ASAP.  So Thurs 2:30 MRI, and Fri 3:00pm Podiatrist! I am so excited to be getting close to some closure.  That thought alone helped me through today and I'm sure will continue to.  It also helps me when I think about everyone else out there who is in more pain and that I should be grateful it's just my foot.  Just to be clear I have never once directly asked for medication from any of my providers.  I just tell them the same thing every time. That I just want this to go away and get back to my regular life. I am always polite and professional.  I've never argued with a doctor. I have always respected their decisions (maybe not their attitude at times).  I even told my PCP that I respect his decision to not give me more medication after it was stolen, but simply asked what else can I do.  When I get upset I always make sure they understand that I'm just frustrated at the situation and not them.  The ER I "stormed" out of after I gave my speech and paperwork back, I told the nurse directly I'm not mad at you, it's just been frustrating.  He understood.

To: swool621
I have given up and accepted my circumstances, much easier after that.  They have informed me that they can get in trouble for over prescribing.  I always tell them that I've never received multiple narcotics at similar times "doctor shopping" or have I ever had anything refilled early.  They confirmed this with a call to my pharmacy.  They always question the amount of doctors who have prescribed me narcotics and then I have to explain the situation which takes forever.  It's funny then they always ask a bunch of questions about everything I just explained.  I'm would to, I find my situation unbelievable.  I am so sick of explaining my story.  :-)

To: Tuckamore
Did you go to state fair this year?  Krispy Kreme burger?  I skipped it this year, I didn't want to do all that walking.  I'm sure all those calories would have been bad anyways.  :-) Your post made my head spin.  I was not aware of this fact.  Everything makes more sense now, thanks.  Now I know why my PMP looked confused when I explained the situation.  Now I believe my PCP wanted to just confirm my pain.  My referral slip from my PCP to PM said Chronic Pain right foot, foot abnormality.  How can it be chronic if
nobody knows what it is?  

To: Caryopteris
They've ruled out a cyst.  That was my original diagnosis, but since the MRI and x-ray it is now a ????????.  I am aware of the increase in tolerance with opiates.  That's why I am upset this is taking so long.  If I have to ask for a higher dose, just take me off.  That road is a dead end.  The only change I have asked for is for it to be changed from IR to ER.  They had me take one every 12 hours, so it made no sense to take something that will only last 4 hours when I can have something that lasts twice that.  Addicted, no, physically dependent yes.  I have been on this since March so of course withdrawal symptoms would happen, but they don't last that long.  I am already in a little better spirits today, well I had a little help from my friend loperamide.   I don't crave the drug, I crave relief and closure.
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Avatar universal
It literally disgusted me to hear you refer to a drug addict as bottom-feeders of society.  That is very rude and disheartening to say the least.  I wouldn't consider ever "wanting" drug addiction upon anyone, but just ONE day of it might teach you a valuable lesson, that you seem to be needing.  Don't consider yourself "above" becoming an addict, because you just might regret it one day.....
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Avatar universal
Personally I blame, Purdue Pharma, and media.  Purdue made it OK to take a strong narcotic with out worrying about addiction.  Then when it did get out of control the media spread it like wild fire.  You say "oxycontin" to people, they know exactly what you are talking about, but hydrocodone, hydromorphone, and codiene they more then likely have no idea what you are talking about.  Even if it's oxycodone not the brand name "oxycontin" they still call it oxycontin.  You have all these kids in school who now know hey my parents/grandparents/whoevers medicine can get me high.  I think that is why we have had such a surge of opiate addiction in the last decade.   I believe that's why we have more addicts.  Just my opinion.  
Helpful - 0
1429373 tn?1284070414
I am so very sorry for how you were treated hon, and you're right! You have a valid reason for taking pain meds until you get the dx via MRI and get it taken care of. It's a shame that your GP didn't keep refilling for you until that could get accomplished. I missed it- Is the cyst on the top of foot or bottom and is it near your toes? Thanks
Helpful - 0
547368 tn?1440541785
In Wisconsin it's almost a crap shoot. If you have an PCP that is educated on chronic pain and you have "reason" for pain you will be treated.  PMP do not function as they do in other states. Granted they perform procedures and may do some trial pain medications but most of them are not narcotic. Basically it's up to your PCP.

I am assuming that your PCP did not feel justified in prescribing opiates for a cyst or cyst like condition. You and I know they can be very painful and interfere with our ability to function...however most physicians do not view it is the same light.

I have confirmed and multiple reasons for CP, yet it took me over ten years to find a compassionate and educated PCP that recognized my level of pain and prescribed opiates.

There is a difference between addition, recreational drug use and opiate dependence. Yet they are all lumped together due to the ignorance of the general public. Until the difference is repeatedly publicized and the public is educated this ignorance will continue.

No Stare Fair for me. I can barely make it through the grocery store. :o)

Best of luck to you.
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Avatar universal
So Friday last week I saw my podiatrist.  The MRI results showed that everything was normal.  So he recommended physical therapy for treatment.  He then also prescribed me more medication for 10 days.  

Today I had my PT appointment.  The PT was more informative and helpful then all the doctors put together.  I wish I could have seen this guy first.  He said he thinks it is tendinitis with fluid build up.  He said he can a see ridge on the "bump" and he explained that is the tendon with fluid pushing up around it.  So we are doing steroid treatment twice a week.  He said if this doesn't work he doesn't know what else it could be, but said he was pretty confident that's what it was.  Especially since I had a car accident in October, 09 it could have come from that.  I could have hyper extended the tendon and not have even known.  So I am hopeful.  

Also my podiatrist's office is in the same building.  So I went to talk to him about more naproxen, my copay is $1.  So as I am talking to him, he brings up my other medication and says he can't prescribe anymore because he usually only gives this medication to people who are out of surgery.  I told him that is what Dr. Razzaq started me on in April.  Then he freaks out and says I am addicted.  He explained that I have to be addicted since I've been on it so long.  So I said ok then should we stop it.  He then told me no we will have to taper you, but I want to talk to your PCP, PMP, and pharmacy.  I gave him all the details and after that he was real stand offish.  I hope he has generalized physical dependence as addiction.  We shall see on Monday, that is my next treatment and when my medication is up.  

I can't wait to just be done with all of this.  
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