Pain In The Doctor (Part II)

By sunshinegal43oh Thursday, August 05, 2010

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You'll have to forgive me the title of my share post....It's blatent plagarism...stolen straight from Chuck! (Thanks, Chuck! I've been giggling ever since!)

I went to appointment number two with the pain management doc from hell yesterday! I'll tell you what, I was a nervous wreck going in! Isn't it amazing, that even when you have nothing to feel guilty about, some people STILL have the ability to make you feel guilty?

So let me say that Monday this week was a horrible day for me. I woke up all swollen and stiff. My fingers were so stiff and swollen that it took almost four hours to unkink them! I called off work and basically stayed in the bed the whole day! I seriously thought about a trip to the ER, because the Ryzolt (tramadol) wasn't doing much for me! But.......I was worried doing so would be a breach of Dr. Jekyll's pain management contract, so I just stayed home!

So yesterday, he runs 45 minutes late! I had a book, so no big deal. He breezes into the room, never making eye contact, looking over my chart, and asks, "So, how are you?" Hmmmmm.....Hello? McFly? If I was OK, would I be HERE???? LOL

So I told him I was OK. I had called his office on Monday to ask if going to the ER would cause problems. So, he says, "I see you went to the ER on Monday. What did they say?" I told him I hadn't gone for fear it would breach his contract and get me in trouble. He shrugged his shoulders and said, "Now, you CAN go to the ER if something's REALLY going on. But if they tell me you're there just to get pain medicine...well.....". I just sat there and said nothing.

He listened to my heart and lungs. Looked at my hands and felt for swelling in my ankles.

He said, "So you're using just one pharmacy now?" I told him yes. He said, "Are you having any problems with your medication right now?" I told him no. He read over my chart some more, still not making eye contact, and said, "OK. Keep taking what you're taking and I'm going to write the Ryzolt for you today. And I'll see you back on a Thursday, say, 9/2?" I said fine and he breezed out of the room.

Appointment over. I sat there, waiting on the nurse to come back in with the script, wanting to ask if he was on mood enhancers or something. LOL His mood swings are giving me mental whiplash!

But at least I made it thru the appointment unscathed. He didn't accuse me of being a drug addict. He couldn't. He knew there were no grounds for such an accusation.

So....I left the office feeling quite VINDICATED! I practically danced as I left the office (good thing most of the people in the lobby had cleared out by then...someone's retinas might have been burned!)

So...even though my pain is no better than before, I feel like I'm in a good place as far as Dr. Jekyll is concerned. I'll go back on 9/2, and see what he has to say. Surely, when he sees I've gone another 4 weeks without getting any other medications than my RA meds, he'll see he was wrong. I know he'll never admit it. But once he relaxes and changes his mind about me, that's when I'll swoop in for the kill. You know us girls, we NEVER forget anything! Just when he's feeling confident and has the warm fuzzies about me as a patient, I'll say, "Hey, doc, remember that first appointment, when you accused me of being a druggie?" He'll pretend to remember no such thing. I'll still forge ahead saying, "Gee, I'm glad you're not the A-HOLE I once thought you were!" LOL LOL LOL LOL LOL

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Comments (7) | Add comment

V, Health Guide

8/ 5/10 7:18pm

I still say the guy is a wacko! I guess there aren't a lot of pain management docs around. Too bad he has to be such a strange, strange man. The first rheumy I went to ten years ago thought I was a drug seeker. I was so angry that I never went back. I told my GP about it and she said she had never heard anything good about good-old-doc arrogant from any of her patients. I suffered for ten years and she finally convinced me to see a rheumy again. I told her I would NOT go to Doc Arrogant again unless I was having a heart attack and he was the only doctor for miles and I would die if I didn't let him touch me. She found that amusing, but agreed w/me and found another Rheumy for me to see. My GP knows I am in no way a drug seeker. It takes her a long time to convince me to take any medication on a regular basis. Sigh. I guess docs are like everyone else, some are good at what they do and some aren't. Some are personable and some aren't. Some are wacko, and some aren't. Hang in there fellow patient!

sunshinegal43oh

8/ 6/10 12:13pm

Thanks for sharing your Rheumy story with me! RA pain management would be SO much easier if my Rheumy would just include pain treatment as part of the overall RA treatment! I don't like having to see two different doctors for issues so closely related!

I agree with you, V. This doctor is a total whackjob! At this point, after what I've been thru (being labeled an "addict"), I loathe starting the process over again! I live just north of Cincinnati, OH, and there are not many pain management specialists around these parts! Lucky me! LOL So hard as it may be, I'll stick with him for now.

Thanks again for your thoughts and have a great weekend!

Amy

V, Health Guide

8/ 6/10 8:48pm

Hey, Shine Girl! I grew up in northwestern Ohio. Go Bucks!!! I lived about an hour and a half north of Columbus. Columbus has a lot of great doctors, but Cincinnati is down on the river isn't it? Columbus would be a long, long way for you to go. The worst thing about bad doctors is that they can make a person doubt himself/herself. Don't let that happen to you. You know your body better than they do. Hope you have a wonderful weekend. And, did I say........ Go Bucks!

Lene Andersen, Health Guide

8/ 7/10 12:18pm

My dear friend... why did you tell the man you're OK when you are in so much pain you wanted to go to the ER earlier in the week and had spent four hours on kinking your fingers in the morning? It may just be me, but that's a really interesting definition of "being OK"...

I understand that you've been burned so severely by this doctor that you're afraid the "drug seeker" label is going to follow you and you would therefore chosen what seems to be the lesser of two evils, i.e., staying with this nutjob. You obviously have to do what feels right to you and there's definitely some gleeful anticipation on my end waiting for the time when you pull the rug out from under him (rubbing hands and cackling). Still, you deserve a better doctor and I would recommend the next time you see your GP, as well as your rheumatologist, you tell them about this experience. They need to be aware of who this doctor is, as it may get them to refer people to another pain specialist. The fact that you signed a treatment agreement may complicate matters in terms of you seeing someone else, but I was still recommend that you at least talk to your rheumatologist and your GP about it. Karen Lee Richards, the Expert on the Chronic Pain site, wrote an excellent post about treatment agreements and our Migraine site has a good post on what to do if a doctor terminates you do to supposed breach of the agreement - not that I anticipate this will happen to you, but it's good information to have in your back pocket.

Keep us posted, please?

sunshinegal43oh

8/10/10 9:38am

Lene,

Thanks so much for all the good advice! You don't know how MUCH I appreciate your information and kind words of support!

I guess the reason that I am sought a pain management specialist is because my Rheumy will not prescribe anything for my pain. Her favorite saying is, "If I treat your pain, I'm not treating your disease!" I do understand what she's saying. She's trying to get to the heart of my RA and get it under control in order to control its symptoms. But I also know that she is afraid to prescribe narcotics to me because of the strict regulations that surround them and my chance of addiction. My Rheumy is great at the RA part- she diagnosed me from symptoms only (I'm a sero-negative RAer) when no one else would (I saw another Rheumy before seeing her) and got me started right away on Methotrexate which helped immediately, then Enbrel.

Another problem is my Rheumy is NOT convinced that my pain stems from my RA. She reviews my bloodwork and sees no increased inflammation markers. In her mind, no inflammation means no RA flare! She leans heavily toward Fibro. Since I'm not a doctor (but I play one on TV! LOL) I'm willing to take whatever suggestions she hands out and try the medications to alleviate those issues. However, when I've tried Fibro medications for a month and my pain is the same, she should be willing to concede that it could actually be my RA causing my problems. If I'm sero-negative to begin with, could it not also prove true that I could have an RA flare even though my inflammation marker is normal? For most of us it is frustrating enough dealing with our disease. But it's much harder to fight the disease and a stubborn doctor LOL

I know I shouldn't have told this pain management doc that I am "OK". But if I'd pushed the point, I think it would have just pushed him further into his thinking that I'm a drug seeker. I'm going to see him once more, on 9/2/10. If, at that point, he's not willing to give me something stronger than Ryzolt for my pain, I'll leave his practice and go back to the drawing board, trying to find a new pain management doctor. OR really talk with my Rhuematologist and explain what I've been thru in trying to find a pain specialist and hope that she'll be willing to treat both my RA and my pain together!

Again, Lene, I appreciate all you've said. You're so helpful and knowledgeable! I feel blessed to know you!

Amy

ronie

8/10/10 3:38pm

Hey Sunshinegal,

You kinda sound like me when it comes to pain and pain meds. I have never had a GP or rheumie ever prescribe me any pain meds other than NSAIDS (which I can not longer take because of an ulcer). And I often time laugh and joke off the pain I am in because I don't know what else to do.

Well, unfortunately, I did that long enough for everyone to ignore some overall symptoms and poof 3 weeks after some xrays, I am in the hospital getting a shiney new left hip and ortho plans to do the right knee as soon as rehab is over.

Please don't put yourself in my position I was in where I was saying I was okay until my body overspoke me.

You sound like you trust your other doctor but you do not trust your pain management doc. However, you mentioned you have not received anything stronger than tramadol which is non narcotic. Why would you fear being labeled as a "seeker" when you are not currently on anything to be addicted to. Believe me I have been there too. I shook with fear when I asked my GP for something for the pain because tramadol was like a mere tylenol. Then after a while I realized that the worst thing they could say was no. But by that time my medical records spoke for themselves. I had several joints crunching and breaking and collapsing. And it sounds like your records can speak for themselves as well.

I believe we as RA'ers are aware of our pain levels and needs. Most of us treat whatever narcotic painkillers we do receive like gold because it is so rare we get them. We hold on to them like "my precious." And please remember that there is a big difference between addiction and dependence. As people with chronic pain we depend on our RA meds and even our narcotics for quality of life. We are not the ones who run to the quacks for 120 percocet every month to misuse and/or sell. (#1 most of us can't get a percocet to save our lives) And we should never allow a doctor make us feel like we are the abusers. If your pain manager is not managing your pain then he is not doing his job and you should not be paying him the big buck. Go back to your trusted physician and get another referal, hopefully to someone who will look at you and not just your chart, talk to you and not the wall, work with you to understand your pain, switch and mix your meds until you get your RA under control and you no longer need the pain meds.

I speak from the heart and from painful experience on this one. I have been exactly there. The best heckle and cackle you can have is to call or go back sooner than you next appt, ask for whatever pain medication you believe will work for you. If he refuses, then look him in the eye and fire him. Word of mouth back to your trusted doctor will also drop some of his repeat business.

Good luck on your advocacy. Hope you get something stronger than tramadol.

Ronie

Lene Andersen, Health Guide

8/10/10 7:58pm

Although I generally think that rheumatologists ought to familiarize themselves with a certain level of knowledge regarding pain management, I do understand that they are specialists in treating RA/inflammation, not pain management specialists. The fact that the disease comes with chronic pain is the reason I think it's not good enough for rheumatologist to say they don't treat pain, but that's a rant for another day. So yes, obviously you need somebody to treat the pain and if your GP can't do it - as is often the case when you need the bigger painkillers - then your choices are limited, as there aren't that many pain management clinics or doctors available. The perception out there, both from regular people and unfortunately in doctors, too, is that there's a high risk of addiction when taking opioids. Karen Lee Richards posts about a review of studies regarding this that revealed that when prescribed and taken correctly, your chances of addictions are a quarter of 1%. Unfortunately, the issue has been used politically (in my opinion) to twist the reality to point where people needing pain meds are now viewed with suspicion. I think it's important for those of us live with chronic pain to do our best to inform our elected officials about exactly what is involved in the reality of it.

Sorry. I got on my soapbox by mistake.

When you wrote about you pain levels not having changed despite medication, a couple of things popped to mind. First, do you think your RA it is suppressed? You mentioned being diagnosed based on symptoms and I assume that include swelling and inflammation? If so, have these symptoms been reduced? There are two kinds of pain that comes with RA - there's the pain of active disease and there is the pain from the damage done to your joints by the disease. Depending on how long you've had untreated RA, your pain might be from damage to your joints - it's different than active disease pain, sharper, somehow.on the other hand, it is possible to have active RA without swelling, but if your RA initially presented with swelling in your joints, etc., and you currently don't have any, there may be a difference explanation.

The second thing that came to mind is related to fibromyalgia. I have it, too, and in my experience, medication is only one tool used to control it and quite often, it doesn't do that. One of the frustrating things with fibro - again, in my experience - is that often, pain meds don't really do anything. If you've been on Lyrica, it should take the edge off to some degree that it hasn't, maybe talk to your doctor about increasing the dose or switching to another medication.

What has been far more effective for me in terms of fibromyalgia is learning the tricks of managing it. The best way I can describe my fibromyalgia is it's like micro spasms, tensing everything up. One of the most important ways of controlling your pain is to make sure you break that pattern, otherwise you end up with spasms of top of spasms and before you know it, your muscles are so seized up there is no letting go. One way to break the pattern or prevent it from getting really bad is to make sure you stay warm - if I get a draft, my muscles seize up and before I know it, I'm in a lot of pain. If I can make myself sweat, my muscles let go, so a hot tub, sauna or warm bath might help you. Meditation helps a great deal - check out a wonderful audio program called Mindfulness for Beginners which teaches you different ways of meditating. A glass of wine may help as well - it's a terrific muscle relaxants, but make sure you drink responsibly.

When I first got fibro about six years ago, I was in excruciating pain for months before I figured out that the coping mechanisms to deal with fibro pain are the opposite of dealing with RA pain. With RA pain, if you sit still, things get a little better. With fibro pain, if you sit still, your muscles seize up and the more still you are, the worse it got. The solution is to twitch quite a bit. Change positions, get up and stretch or make a cup of tea, etc. I try to make sure I switch positions or take a break from what I'm doing every half an hour or so because if I don't, the pain can get really bad. Check out the fibromyalgia area of our Chronic Pain site for more information about the condition, including tips on dealing with doctors and dealing with pain.

Pain In The Doctor (Part II)

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