What if your doctor refuses to talk to you?

[pattisun]

I have severe pain and have been taking a number of pain meds for almost ten years now. I also had gastric RNY bypass and this limits what pain meds I can take and I believe it affects how my meds are absorbed and metabolized.

My pain doctors (who just give me steroid shots) do not prescribe meds. They want my primary doctor to do that. I was increased to 50 mcg of Fentanyl with vicodin for breakthrough (my pain doctors suggestion). I went to my doctor every four weeks complaining the Fentanyl patches would not stay on and the side effects were not worth it. I wanted less Fentanyl and weaker vicodin (she had changed me to Norco--wanting me to only take 2 per day). This last visit 2 weeks ago I finally got back on a weaker Fentanyl patch and I am doing much better. I decreased my Norco from 4-5 day down to 3. When I went to refill my RX for Norco my doctor refused it. They will not answer my calls and I guess I no longer have a doctor.

I am fine not taking Vicodin--but I have pain so I did take ibuprofen. I am not supposed to take that because of my bypass surgery.

Anyone get kicked out of their medical group? I am not worried about Vicodin withdrawal I'm sure I can get through that---but what about Fentanyl withdrawal? How to I find a new doctor without looking like some crazed druggie? I think I should never take vicodin again. I've taken all the other types of pain meds (like Ultram and Neurontin, etc.) prior to Vicodin (I refused percoset, Oxy, and morphine-Kadian).

How/where do I find a doctor that will understand my needs and believe that I have no interest in getting "stoned" just would prefer to stay active and have my pain decreased.

[dominosarah]

You might want to post this in the Pain Management forum.  They are a good bunch of people there and will be able to give you some suggestions......all the best      sara

[broknbck]

are you leaving anything out? it doesn't sound right.
a lot of doctors who perscribe pain meds will make you sign a contract to only get meds only from them. if you break it, they let you go.

this is very poor behavior for a doctor to leave you high and dry on the fentanyl patches. they are not suppose to be stopped all of a sudden.

[Tuckamore]

Hi Pattisun,

Welcome to the Pain Management Forum. I am very surprised that the clinic is just refuses to return your phone calls. When a physician dismisses you they must give you notice, not simply just quit returning your calls.

Who answers the phone? Certainly they can provide you with some answers. Make an appointment so you may discuss the physicians refusal to refill your RX in person. If they refuse your request for an appointment there is a patient abandonment law that protects you from this very thing. You might want to bring up that fact if they refuse to see you.  

Did you sign a pain management contract with the PCP?  If you are reducing your intake of narcotics why would the PCP refuse to refill your RX?

I agree that something is missing in the information you have provided or I am just plain stupid. We are not here to judge you. Help us try to help you by providing additional information. We can offer better suggestions if we have a better understanding of your situation. I will look forward to your next post.

Best of luck to you,
Tuck

[NoMoMeth4me]

As Tuck so correctly points out, your physician has a moral and more importantly legal obligation to treat you and if releasing you as a patient, to provide you with a valid reason for doing so.

They also have to titrate your meds down and do not as a practice just 'cut you off cold turkey'. This can be very dangerous to the patient for many reasons.

If you have left anything out I'd suggest posting here and in the substance abuse pages as there are 'MANY OTHERS' here who have experinced this very thing.

I'm not saying this because I don't believe you, but as others have rightly pointed out, Dr's will not do this unless they feel it is completely right to do so.

Step one should be requesting a meeting with you Dr to explain your side/case/concerns as this may well be a huge misunderstanding.

Best of luck.

Keep us posted on what happens.

Warm regards.

Brian.

[bmdad]

I agree with Tuck. I would call and set up a appointment so you can talk to your doctor face to face so you can get answers. What do you mean by they are not answering your calls? Are they not answering or just not returning your calls? I don't see how they could not answer their phone. If you think they are screening their calls dial *67 before their number and your number will not show up on caller id. Are you able to get through at all? Some smaller clinics do sometimes close down for vacations and such at times. Have you tried going to the office in person to talk to a the secretary or nurse there?
Your doctor could be charged with negligent abandonment for ending your care without appropriate referral or transfer to another doctor or clinic. Or he must inform you in writing and must continue to treat you for 30 days while you search for another physician.
Something just doesn't seem right about this. I could see if you were constantly bugging them about trying to get stronger pain meds but for you to ask for a lower dose should make the doctor happy and also a good way to earn his trust by allowing him to know that you are taking them for pain and pain only. It may not hurt to make a appointment at another clinic as a back up plan as you shouldn't go cold turkey off of fentynal. I would only go to another clinic if you know for a fact that your doctor will no longer treat you so you won't get accused of seeking pain meds from more than one doctor which we know isn't the case.
I hope you can get to the bottom of this and please keep us informed!
Best of luck!
Brian

[TrayCee]

"Your doctor could be charged with negligent abandonment for ending your care without appropriate referral or transfer to another doctor or clinic. Or he must inform you in writing and must continue to treat you for 30 days while you search for another physician."



this info is INCORRECT.

Dr.'s. can completely discharge you without any notice and for any reason or for no reason.
They have NO legal obligation to treat you or continue treating you.

this is a huge misconception

[TrayCee]

I stand corrected.

I just read the "patient abandonment law".

However...in the time it takes to find an attornney who is willing to take a malpractice claim, file the papers....you could be dead

[pattisun]

Hello all---(the lady who's doctor refuses to call me....

It is ME again. I'll recap. There is a pain management group at Univ. Cal. where I get shot full of steriods (yeah, they freak out over some Vicodin but I get shot up with steroids every 10 weeks). I have spinal stenosis and severe nerve impingement down my legs. Plus some other conditions that are painful.

My pain doctors (who don't prescribe because they are short-staffed) decided I should take Fentanyl patch vs. Vicodin. I was at 25 mcg + 12 mcg Fent. patch per day. Doctor raised my Vicodin (I think I had Lortab 750/500) to Norco (1000/500). About two month later the pain doctors decided since I was still taking 3-4 vicodin per day that I should have a stronger patch. They sent my primary doctor an electronic note saying I should increase patch to 50 mcg and not have more than 2 vicodin per day. (I should also note I had gastric bypass surgery and I believe it may affect how I metabolize any pain pills.) OKAY== I hated the 50 mcg patches. One brand would not stay on (my doctor said just tape all over it==not supposed to do that); the other brand was bigger and it stayed on but my upper back broke out in rashes. I visited my doctor each month (my own idea to see her, she only requires I see her every three months) and complained about this. After meeting with the pain doctors (october) specifically for pain medication I explained I wanted OFF the Fentanyl 50 mcg. Their answer was take Kadian three times a day (because of my bypass surgery) and stay on the Vicodin until I get my pain controlled. I saw my current doctor Oct 29 and told her I didn't want to take morphine, it makes me nauseated and I think its a nasty drug for my system (been in the hospital a lot and thats their drug shot of choice).  AND I asked her why is it okay for me to pop morphine three times a day but not Vicodin? She put me on my old Fentanyl 12 + 25 mcg patches. I started on that and have not had problems with the patches staying on and got continuous relief. Since I started the patches Oct. 29 my vicodin use went from 4-5 a day down to 3. She prescribes my Vicodin with 60 and 2 refills. On Monday when I requested a refill on the Norco she must have done the math and got really pissed that I was taking too much Vicodin. (RX says take one tablet every 6 hours) I don't think she believed me that I could not keep the 50 mcg patches on.

So after I posted this morning I called the administrators at UCSD. The lady said "no, your doctor is not mad at you"--I asked how does she know? I asked her to go into my chart and read the nasty notes about me. I did cry for a second while I was talking to her---i just feel like I am being punished and I also feel like a big time drug addict. She insisted everything was fine. I KNOW that they called down to my doctors office and let them know I called.

This afternoon I got a message from my nurse who said the doctor does not want me to take 4 Norco a day along with the Fentanyl patch and she'd like to talk to me. BUT no refills are being given. My appointment is not until December 2.

SO...I am just not taking Norco anymore and have been crying and in sometimes severe pain. I guess it may be withdrawal or maybe the patches don't have quite enough pain control. This *****....  THANKS for listening.

[bmdad]

If you are still having quite a bit of pain maybe you could try and get in to your doctor a bit sooner. I would call and let them know how much pain you are in. More than likely the secretary will have a nurse call you back. Just let them know that with the pain you are having December 3rd is just too far out. Ask what you should do in the meantime for pain relief. You could also ask the scheduling department or the secretary to make a note and if anyone else cancels their appointment to give you a call as you need to be seen asap. I also suffer with chronic back pain from scar tissue hitting my sciatic nerve from a previous surgery, spinal stenosis, and arthritis in my back so I know how difficult it can be to live with pain. I pray that you can get in there sooner and get your pain properly controlled. One thing that really does help is to take hot baths as hot as you can stand. It really helps relax the back and the rest of your body. Also ibuprofen does help a bit. Try heat or cold on the areas you are having pain as our bodies react differently to each. Best of luck and hang in there! Let us know how it goes.
Brian

[bmdad]

One more quick question....you said you got 60 vicodin at a time and were to take 1 every 6 hours. Are those 60 suppose to last you 15 days? Did you run out early and try to get a refill sooner than when it normally would have been called in? If so, this could be the reason the doctor didn't want you taking them as she may have thought you were abusing them or just concerned on the amount of pain meds you were on. It does sound like she wants to see you so you can find something that works that you both feel comfortable with.

[Tuckamore]

Thank you for explaining your situation. I am glad that you called the administrators. It was the right thing to do and at least now you have the reasons for the denial in the refill. I know that doesn't make the pain any easier to deal with but knowing what you are facing can help you cope and hopefully rectify the situation..

I lost over 3 feet of my small intestine, the important portion where nutrients and some medications are absorbed. Gastric by-pass is similar but should not effect the vicodin or morphine absorption.

I agree with Brian, call the nurse back and request a sooner appt, explaining your high levels of pain. Sometimes you can be placed on the cancellation list, meaning if someone cancels they call you to fill the appt time.

Dealing with two physicians for pain medication is a tricky situation. Do you have to see the PMP? Can you just stay with your PCP? If so I suggest that you do so. It sounds like since they became involved you have had more problems.

According to my physican and pharmacist it is ok to tape the fentanyl patch. I don't know who told you that it was not acceptable. Actually the manufacturer will send you a specific type of tape like material to apply over the patch if you request it.  

I am sorry that you have not resolved this issue as of yet. Brian is also correct that IB can help with some of the pain, provided it is not contraindicated. Please keep in touch. Let us know how you are doing.

[pattisun]

Thanks for your support. As far as my bypass surgery they cut me at the Duodenal? or something like that. I cannot absorb enough calcium, iron, B12, etc. I have to go the hospital and get iron infusions, sometimes blood, and my vitamins need to be liquid, quick absorb (Iike under the tongue) or else I don't absorb them. (bad surgery!!). So, I have no idea if this affects pain pill metabolism?

The bigger Fent. patches did not stay on longer than about 6=8 hours. I'd tape it all around the edges after that but it didn't stay flat on my skin and would eventually fall all. So I'd go 2 days in that situation and then put a new on one. So--I was taking 3-5 vicodin/day during the 8 weeks of those patches.  I went to my doctor twice and explained this but I don't thing she believed me. And, my Fent. patches have a big DO TO TAPE over patch warning. (I promise!!) I tried to get the pharmacy to order a clear dressing patch that I could put on but they couldn't find any to order. They use them at the infusion center to cover your ivs. BUT, when my doctor finally got me back to the tiny 12 & 25 patches 3 weeks ago I got continuous pain relief and only needed 3 vicodin per day. Because of my prior problems with the patches I did try to refill my vics too soon and she cut me off. I'm not blaming my doctor, for all she knows I was selling them or getting high (but, again, I don't get a high/good feeling from pain meds since my surgery, everything has changed). And she is looking out for my interest and her liability. I like your idea---I intend to tell the pain doctors that their "advice" on my medications has made for a bumpy relationship with my PCP!!

I am doing fine with no vicodin (like no withdrawal symptoms) but the pain level is at times REAL high and burns like crazy. I am going to try the hot bath. I have foam matress pad, heating pads, massage chair, aspirin cream, and lidoderm patches. They all help. I have taken a few advil but I am NOT supposed to take anything like that because of that surgery I had.

Living with constant pain is such a chore. Only a group like this would understand. It's nice to have people to talk to. Most of the time I stay positive and only my husband and sons understand what kind of pain I live with. None of my friends/family know or could they really understand....  

I'm cooking Turkey today (early Thanksgiving for my NYC family that flew in)!! Have a great day.

pattisun in Sunny San Diego  :-)  

[bmdad]

You are right about your doctor just looking out for your best interest. It really just shows that she cares and doesn't want you to hurt yourself by taking too many pills. I know you weren't taking too many as at the time your patches we not sticking. Anytime someone tries to call in a refill early the doctor is going to question it just to be on the safe side.
When you go to your doctor maybe try and work out a different pain med protocol if what you are using is not working. Are there more than one brand of fentynal? I know with other medications they may be different from one pharmacy to another. I wonder if you tried a different brand of the 50 mcg patches if they would stick better? There are also many different type of time released pain meds out there. I know you said that morphine doesn't work and most pain meds are derived from morphine so your choices may be limited.
Just be upfront and voice your concerns about your pain relief. I would also bring up the fact again that the reason you ran out of the vicodin was because your patches were not sticking. Tell her you are sorry for not following the prescribed dose and now realize you should have called and talked to them about your dosing options first. The more honest you are with your doctor the more your she will trust you and in turn will help you find a med regimen that will suit your needs.
Be sure to write down all questions to ask and comments that you plan on making to her. Keep us informed and best of luck with all!
Hope you have a great early Thanksgiving with your family!
I'll be checking the mail for my plate of early Thanksgiving dinner!!!!!

Brian

[NoMoMeth4me]

I am also a LAP GBP patient and it was two years for me in September 2009. I have often wondered how my Endocet's are absorbed now?

As for Fentanyl, it has worked wonders for me since I started it about six months ago.

I lost about three patches in the early days and even called Sandoz as I was told they supply free medical tape which isn't true by the way.

I got a tip from another member here so here goes. It works WONDERS for me now!!!

Get the 'weed wacker' out and do some yard work downstairs of you catch my drift here??

DON"T shave but trim closely your pubic area and apply each patch slight off midline of your body. Your underpants will actually help to keep the patch on and in place and that part of your body usually stays relatively straight all the time.

Don't give up on Fentanyl yet, give this a try and let me know how it works for you.
Trust me, I was ready to dump the patches and try something elase until I found out about this method I use Endocet 10/324ng 1 every 12 hours as needed.

All the best.

-Brian.

[samson1]

i had been on oxycodone hcl 15 mg tabs for years. I had been on fentanal and other stronger pain meds tha I felt were to strong or the patch would not stay on. In june of 09 my doctor stated that my last urine test indicated that I had taken a drug called dalodin which  I denined taking never had taken and didn't need to take because the pain meds she was giving me were strong enough. She informed me the test had been ran twice and the results were the same and if it happened again she would have to cut my pain medication off. In augest of 09 I was in her office for a routine check up and requested a urine test because I knew for a fact I had done no other types of pain killers at anytime and wanted to show that I had nothing in my system but what was perscribed to me. She reluctantly gave me the test and I left her office on augest 24th 09 I recieved a letter from her stating my last urine test showed drugs in my system she had not perscribed and would do anything else for me but perscrib pain killers for me again. On the same day I was involved in a serious auto accident. I was bed ridden for months with no pain medication. To this day I suffer everyday with out any pain medication because I fear asking another doctor to help me because I fear she red flagged by records. I need the medication for my back knee arm  neck and joint pain. I can not be operated on to repair the areas because of my lung condition and doctors are afarid I will not come out from under the aantistesaa after the operations. I take other medications for my heart which prevents me from taking over the counter paain killers like asprin, ibprophin tyanol etc. With out my pain medication most days I can't get out of bed and my weight keeps climbing. At one time with my pain under control with the oxycodone I had lost 150 lbs could get up and be fairly active to spite my lung condition what can I do can anyone tell me ?

[igarfy]

Get another doctor

[sandee1818]

Samson1,
I would get a new doctor right away. There are some major problems with the urine test and many people have been left with no recourse. I would be up front and honest with your new doctor and explain that you were so outraged at the test results that you requested another test be done. Since you did request the second test it will look much better in your records. These test are not infallible and doctors do realize this.
Look for a pain management doctor in your area and make an appointment. It may take a few appointments to build trust but do not give up and live in pain:)

[pattisun]

Did you ever try one of the over the counter drug tests that parents give their teenagers? See if you get a positive...Maybe something in your body chemistry or some other type of medication causes a false positive.  Have you tried a community hospital or tried going to a doctor in another city/'county?

I had a problem with my doctor about 9 years ago--my old doc left and new one refused to prescribe Klonopin (long-acting Xanax)--I had to go to a psychiatrist to get my Klonopin and he wrote a long explanation to my new doct as to why my current meds were effective and I should stay on them. That really made her mad. Then I got into an accident and was injured. Things got worse with this doctor, always accusing me of lying or exaggerating to get stoned?? (on SSRIs???)---anyway I changed medical groups/hospitals and started all over again. After about five years I went back to another doctor at my original medical group. They did not connect me with my old records and I lived happily ever after..... (BTW, when they Subpoenaed my old medical records for the lawsuit for my accident I think my old doct. kept my records at her house because they have long since linked all old records and the ones when I was visiting her are long gone).... hmmmmm

GOOD LUCK

[Dshell]

Doctor have been made so afraid of narcotics they sometimes forget their empathy button.  I lost my insurance and now go to the county clinic for my primary but thankfully have been able to keep my pain management clinic. However, I lost all of my sub-specialties. I live in a smallish Northern California town with 2 Rummys in the same practice who make you sign a waver that if you see one you cannot be seen by the other.  My Rummy and had a disagreement when he told my to get a positive attitude and a hobby and I would feel fine.  

However, my rheumatological issues have worsened and I had no choice but to try to seen said hated Rummy though the county program.  The Rummy denied the referral due to a $10.00 pending balance.  I paid the balance today but he still will not see me.  My GP is going to try to refer me to UC Davis, which is a good thing.  I just wanted to point out there are many uncaring doctors out there and it is our right to be heard and taken seriously.

[pattisun]

Hey Dshell I agree there are MANY uncaring (or just have GIANT egos) doctors out there!! You have to be your own health advocate which sites like this one tell you to do. I worry about the elderly and the severely disabled that don't have anybody to fight for them--they may get pushed around! I faced my primary doctor (internist) in January after I'd been off my pain meds (except patches) for over a month. I apologized to her in case she had thought I was trying to get extra pain pills---that I was aware that people get high and/or sell their meds and that with the current publicity on prescription meds that I may have put her in a position to get into trouble. At first she laughed and said that was not her thought but by the end of our visit she was appreciative of my attitude (I also told her I would see her every month until we get my pain pill/patch usage at a livable point for both of us). At this moment we are at a happy place but I know that can change.

She prescribed some NSAID cream/gel but I can't afford to get that and I just found out I have an ulcer starting probably from taking NSAIDS when my pain meds don't work (I had RNY gastic bypass) But even though I can't afford to pick up my paid meds this until next month at least I am at a good place with my doctor. Life is like that, you get one thing straight and the other things (like my income) fall apart! haha

In regards to Rheumatologists---I had ONE nice Rheumie that I've met. The other ones I've met have been very arrogant, telling me to get a hobby and take depression meds. My best care has been with my internist. But I am on my fifth internist because my other good doctors have left to go into executive (expensive) healthcare. Oh well....KEEPING QUALITY OF LIFE while in constant pain requires a positive attitude (not always possible for us) and a determination to FIND A GOOD DOCTOR that will listen to us (easier said than done).  Best wishes to all

[Dshell]

You are so right. As soon as you get on area under control it seems to give another area of your life permission to fall apart.  I hope you can get your meds soon and appropriate your awesome attitude!  The hunt for quality care continues.

:)

[ddllpn]

My cousin goes to a pain management doctor who has continuously increased her dosage of methadone until now she is getting 480 tabs per month, He has suggested epidurals as well as a visit with a neurologist (the apt has been made and is May 21st). It is believed she will need back surgery.
She has one epidural and did have some relief with it but on the date of the 2nd scheduled epidural she cancelled because she was sick and the same for the 3rd scheduled epidural. She has irritable bowel syndrome and I think she gets herself all worked up over getting the epidurals that she cant get off the toilet.
Anyway, she just got off the phone with her pain mgmt. doctors office who said they will no longer treat her because she cancelled 2 epidurals and they said this means she is abusing her pain meds.(?)
They have left her to go "cold turkey" and I am hoping someone out there can help us to find a way to have the doctor be understanding that he cant prescribe meds of that quantity and then stop it cold turkey. She made the neurologist appt as requested and did have the one epidural so she is trying..., Any suggestions? Thanks, Debbie

[TrayCee]

In PM you MUST keep ALL appts.  Or risk being discharged

So sorry about the situation you find youself in.... This is my NIGHTMARE that this could happent to anyone at anytime for any/no reason
good luck!!

[debbiedoeshair78]

Thursday morning, i was getting ready for work when pain hit my chest and neck, almost brought me to my knees. i have severe COPD but keep on working for fear that if i become docile, i will wilt away, not my style. i was whisked away to the county hospital by my fiance and was took directly to the back for an EKG. Hmmm, nothing there. so, next step is to talk to these drs to see if there was possibly another answer. about three months ago, i had been in the same hospital to get a cat scan with dye, surprisingly i remembered that my personal physician told me that in this pic, you could see the diverticulitis flair-up, so i told the dr from this group and sure enough it also showed a hiatal hernia (classic heart attack symptoms) in the meantime, my COPD is giving me a run for my money and i am having panic attacks, asthma attacks, dizzy, etc.....you name it..i was a mess.. i now weigh 100 lbs more than i did a year ago from all the Prednisone, despite all my efforts, it will not budge. so, i was in the hospital for 9 days, and had a cardiology group from Jacksonville who did extensive testing on me, but found nothing, so they signed off on me. great people. now i am left with a doctor who calls himself a lung specialist, only has no degree as to such. i asked him about my condition and all he told me was :be patient (as he walked away.)  now i'm scared. about a year ago, there was a spot discovered on my lung, but no one ever did anything about it, so i asked him if there was a way to tell what this was...again. be patient. WHAT? is this all you have to say. as far as the other dr goes, the one from the internist, i was on flagile i.v.s, along with Prilosec and Nexium, and who knows what all else. the amount of i.v. steroids that i was being given was so high that it could not be reduced to pill for in order to turn me loose to go home. so, on the 9th day, Dr. "Be Patient" came in and said, ready to go home? not another word, no further instructions other than that i have severe emphyzema
(Really, knew that), then it was the other dr.s turn to maybe make this right. well, he refused to talk to me at all, with no further prescriptions, no explaination as to what my prognosis was, no nothing. i left the hospital feeling totally empty inside, like someone had stolen 9 days of my life. i went straight to my drs office and she gave me enough steroids till i go in on monday 8a.m. what the heck, you recon? can they really just stop treating you, kick you out and refuse to talk to you? do i have grounds to sue these people? help, i need a serious answer, please!