|
|
Post by johneppstein on Feb 11, 2021 15:10:58 GMT -6
Get well soon. Sugar at 38 is scary!
|
|
|
|
Post by johneppstein on Feb 11, 2021 15:14:13 GMT -6
Get well soon. Sugar at 38 is scary! Kaiser keeps trying to get me to take Gabapentin for a bunch of things it's not FDA cleared for. Gotta watch that stuff. Want an extra bottle or 3? No, you don't.
And the bastards cancelled my codeine because I tested positive for pot, which has zero serious side effects at any dose.
|
|
|
|
Post by chessparov on Feb 12, 2021 9:48:35 GMT -6
You know better than me John, but can another Doctor "over rule" that assessment?
When my late wife was on Dilaudid for extreme pain...
We had to switch doctors a couple of times, for her to get proper treatment.
Chris
|
|
ericn
Temp
Balance Engineer
Posts: 14,921 
|
Post by ericn on Feb 12, 2021 13:57:29 GMT -6
You know better than me John, but can another Doctor "over rule" that assessment? When my late wife was on Dilaudid for extreme pain... We had to switch doctors a couple of times, for her to get proper treatment. Chris In the last 4 years it has gotten harder to get any schedule 2 drugs. Throw in “pain contracts and insurance companies, pot is just easier. |
|
|
|
Post by johneppstein on Feb 12, 2021 17:09:06 GMT -6
You know better than me John, but can another Doctor "over rule" that assessment? When my late wife was on Dilaudid for extreme pain... We had to switch doctors a couple of times, for her to get proper treatment. Chris Over rule? When my doc is head of the department?
Not likely.
More likely would be switching doctors and trying to sneak something by... maybe.
|
|
|
|
Post by chessparov on Feb 12, 2021 19:29:52 GMT -6
I may kid around a lot, but...
I just want the best, for all you guys.
Chris
|
|
|
|
Post by Tbone81 on Feb 12, 2021 19:43:34 GMT -6
You know better than me John, but can another Doctor "over rule" that assessment? When my late wife was on Dilaudid for extreme pain... We had to switch doctors a couple of times, for her to get proper treatment. Chris Over rule? When my doc is head of the department?
Not likely.
More likely would be switching doctors and trying to sneak something by... maybe.
These days I run into two types of doctors (in my day job). The first type are scared to death to get in trouble by over prescribing opiates. The second type will write someone a prescription for 600 Oxys/month and hand them out like candy, these are the guys that sometimes get raided by the DEA...it seems like finding a middle ground (in anything) is damn near impossible these days. |
|
ericn
Temp
Balance Engineer
Posts: 14,921
|
Post by ericn on Feb 15, 2021 20:31:59 GMT -6
Over rule? When my doc is head of the department?
Not likely.
More likely would be switching doctors and trying to sneak something by... maybe.
These days I run into two types of doctors (in my day job). The first type are scared to death to get in trouble by over prescribing opiates. The second type will write someone a prescription for 600 Oxys/month and hand them out like candy, these are the guys that sometimes get raided by the DEA...it seems like finding a middle ground (in anything) is damn near impossible these days. At this point if you want something stronger than Tylenol for anything other than cancer or end of life it is assumed you are chemically dependent. Well I am dependent on those chemicals to get rid of the pain. You know that 1-10 pain scale? Even on 100 mic/ hr of Fentynal a 3 was a good day. Was oxy over prescribed, absolutely. Did I walk into my pain Drs office and wonder what 1/2 the people were doing there, absolutely but some of us a very small portion actually need the stuff. |
|
|
|
Post by Tbone81 on Feb 15, 2021 20:54:52 GMT -6
These days I run into two types of doctors (in my day job). The first type are scared to death to get in trouble by over prescribing opiates. The second type will write someone a prescription for 600 Oxys/month and hand them out like candy, these are the guys that sometimes get raided by the DEA...it seems like finding a middle ground (in anything) is damn near impossible these days. At this point if you want something stronger than Tylenol for anything other than cancer or end of life it is assumed you are chemically dependent. Well I am dependent on those chemicals to get rid of the pain. You know that 1-10 pain scale? Even on 100 mic/ hr of Fentynal a 3 was a good day. Was oxy over prescribed, absolutely. Did I walk into my pain Drs office and wonder what 1/2 the people were doing there, absolutely but some of us a very small portion actually need the stuff. I 100% agree with you and will take it a step further. I’ve treated patients that were legitimate drug addicts, hooked on heroin, oxys etc. But here they are in the hospital for a fractured femur, in immense pain, and the RN’s will only give them the minimum dose pain killers because they’re addicts....when really they should be getting like 2-3x the “normal” dose because they have opiate tolerances that are through the roof. I don’t what to say other than good judgement is hard to come by. |
|
ericn
Temp
Balance Engineer
Posts: 14,921
|
Post by ericn on Feb 15, 2021 21:34:50 GMT -6
At this point if you want something stronger than Tylenol for anything other than cancer or end of life it is assumed you are chemically dependent. Well I am dependent on those chemicals to get rid of the pain. You know that 1-10 pain scale? Even on 100 mic/ hr of Fentynal a 3 was a good day. Was oxy over prescribed, absolutely. Did I walk into my pain Drs office and wonder what 1/2 the people were doing there, absolutely but some of us a very small portion actually need the stuff. I 100% agree with you and will take it a step further. I’ve treated patients that were legitimate drug addicts, hooked on heroin, oxys etc. But here they are in the hospital for a fractured femur, in immense pain, and the RN’s will only give them the minimum dose pain killers because they’re addicts....when really they should be getting like 2-3x the “normal” dose because they have opiate tolerances that are through the roof. I don’t what to say other than good judgement is hard to come by. So much of this my friend is the fact that they have taken the thinking out of it. We now have federal rules for how much you can prescribe schedule 2 narcotics. MD’s don’t have to use their brains, Epic or Cerner tells them everything, (ironically EPIC was a good client,yet they don’t have a cat agora for burns over 90%. Now being in KC a fair number of close friends work for Cerner). If you have a computer why think? |
|
|
|
Post by drbill on Feb 16, 2021 11:04:52 GMT -6
When my son shattered his Tibia up into his knee, shredded his ACL, tore up his meniscus and pretty much everything else between his thigh and ankle - the docs put him on a minimum 5mg OXY dose every 6 hours, and sent him home out of the hospital within 3 hours of surgery - both times. Insane. He couldn't even make it 2 hours on that dose.
When confronted with intolerable pain - they said to alternate the oxytocin's with Tylenol if we need to. WTF!!!!!!!!!!!!!!!!!!!!!!!!!!!! I have spent more nights awake all night with screaming profanity and pounding walls than I ever care to hear again. Finally, after well over a month - he got to a legit pain management doc who pretty much took care of him.
The surgeons wouldn't prescribe even enough for a minimal dose, and when they did, it would only be for like 5 days and insurance would not cover refills. The pharmacists who are scared out of their brains will not renew perscriptions without an act of God. And even with the dedicated pain management doc, it was rough. Social Security Disability (he's on it) has crap insurance, and morons who run the med side will often not let a prescription thru EVEN if the DOCS prescribe it. insane system, and I hope I never have reason to have serious pain meds. The folks who don't need em can get it easily, and the folks who really need it and who don't know how to work the system illegally suffer.
Good luck to you Eric and all the guys who need the meds to survive.
|
|
|
|
Post by chessparov on Feb 16, 2021 14:53:58 GMT -6
Sorry to hear all this guys...
My late wife died in 2004.
Even then it was getting tougher, to get proper pain dosages.
Chris
|
|
|
|
Post by Ward on Feb 16, 2021 20:09:29 GMT -6
One of my best buddies was on the liver transplant list, was doing well and suddenly took a downwards turn. They took him off the list and put him in palliative care this morning.
Mortality is a very fragile thing.
|
|
|
|
Post by dmo on Feb 16, 2021 21:32:07 GMT -6
So much of this my friend is the fact that they have taken the thinking out of it. We now have federal rules for how much you can prescribe schedule 2 narcotics. MD’s don’t have to use their brains, Epic or Cerner tells them everything, (ironically EPIC was a good client,yet they don’t have a cat agora for burns over 90%. Now being in KC a fair number of close friends work for Cerner). If you have a computer why think? Not quite accurate Eric- it's not that docs don't want to think but the health care system is trying to put everyone into treatment algorithms to "standardize care" and control costs of "unnecessary" tests and "inappropriate" use of meds. They build these programs into the EMR's - I'm on MHS Genesis (modified Cerner) - and now to order a CT or MRI I get a menu list of possible reasons I'd want the study - the computer will then flag if it feels the study isn't indicated (or not best study) and I have to go through several more screens justifying why I want the study. Pain meds are even worse - it calculates my dose and if I prescribe over the accepted limits (which are too low IMO for acute pain) - flagged again and another set of justification screens come up that I have to go through to get meds prescribed. Add on that the pharmacist is also getting double checked and reviewed with everyone afraid of "overprescribing" and it's becoming really difficult to address acute pain - and worse for true chronic pain patients. I realize that a lot of this is being driven by the opiod crisis and all that entails - and the medical community isn't blame free in this - but at the end of the day my duty is to the individual patient I'm taking care of, not some ideal statistical model where I'm treating the average on a bell shaped curve. In the ER people have acute issues, and I still write appropriate pain meds when indicated. I also at times refuse to write pain meds for chronic issues and try to get those folks to have a pain management plan through their primary or a pain med specialist. But the pressure to avoid prescribing narcotics is huge and we'll be struggling to get the pendulum back towards the center for a while on this. Apologies if I inadvertently offend anyone - I usually avoid responding to med type posts as they can get heated but consider this group to be friends and wanted to provide another perspective. Hope you find someone good to help manage things Eric, sending good vibes
|
|
|
|
Post by dmo on Feb 16, 2021 21:36:35 GMT -6
One of my best buddies was on the liver transplant list, was doing well and suddenly took a downwards turn. They took him off the list and put him in palliative care this morning. Mortality is a very fragile thing. Ward - so sorry to hear about your friend. Sometimes all we can offer is palliative options - but always a hard call in my experience. Again, thoughts and prayers to you and your friend. |
|
ericn
Temp
Balance Engineer
Posts: 14,921
|
Post by ericn on Feb 16, 2021 21:40:07 GMT -6
One of my best buddies was on the liver transplant list, was doing well and suddenly took a downwards turn. They took him off the list and put him in palliative care this morning. Mortality is a very fragile thing. So sorry to hear this. |
|
|
|
Post by Ward on Feb 18, 2021 12:59:23 GMT -6
ericn and dmo - Thanks guys. I finally got the ok to go in and see him this evening, There are some 'Covid 21' British B117 variants in the hospital so it has been on lockdown and very difficult to get special permission to visit him before he passes. Sun Tsu got his wish
|
|
