topic Re: I this normal protocol today? in Wellness

I this normal protocol today?

bathina — Sat, 15 Dec 2018 14:40:51 GMT

My 75 year old neighbor has been taking Vicodin for 5 years for severe arthritis in her ankles. She walks with a walker and is in pain, even after taking the Vicodin.

Long story short, she had her annual exam with her primary care doc and he told her he would no longer prescribe the Vicodin. He sent her to a pain clinic for an evaluation and they sent her home with an antidepressant. That was last week. She has been off the Vicodin now for 3 days and she is in agony. She called me this morning and asked if I would help her put a turkey in her oven for company she is having this afternoon.

I cannot believe the doctor would cut this woman off without a plan to manage her pain. She is clearly in withdrawal- heart racing, nausea, diarrhea. Coupled with the pain in her ankles and her inability to walk, I am very concerned.

I understand there is an opiate epidemic, but is the protocol now to remove that option for people who have been successfully taking an opiate for pain? Does anyone have experience with this?

Re: I this normal protocol today?

dex — Sat, 15 Dec 2018 14:53:44 GMT

@bathina@It seems cruel to do that to an older person.They can’t recover and get back to good health the same way a younger person could potentially.I think she should go back to her doctor and tell him that she can’t function.I wonder if medical marijuana would help her pain.

Re: I this normal protocol today?

patbz — Sat, 15 Dec 2018 16:05:32 GMT

@bathina: Same thing happened to DH. He has taken Hydrcodin for 10 years (dose has never changed). Earlier this year his Dr. was out of country for two weeks and he needed to renew prescription, so another Dr. In practice was assigned to him for duration. She cut his dose in half. He was in a great deal of constant pain until he got back on old dosage. When he went back to regular Dr. , my DH was in tears just telling his Dr. About it. The sub was the "drug compliance officer" for the practice! Why doesn't government go after the doctor shoppers or places that issue prescriptions in the thousands in areas where only hundreds live?

Re: I this normal protocol today?

bathina — Sat, 15 Dec 2018 15:21:26 GMT

I think it is cruel too! But a part of me understands the reasoning for wanting people to explore other options. My neighbor is 100 lbs overweight and has mobility issues even WITH the pain med. Maybe the thinking is she will need to take more and more as time goes on because her body will be immune to the med? I don't know. I just felt awful when I saw her this morning. You would think they would slowly taper down the med so she wouldn't have to deal with hard withdrawal (which I'm convinced she's in).

Re: I this normal protocol today?

bathina — Sat, 15 Dec 2018 15:25:13 GMT

@patbz wrote:
@bathina: Same thing happened to DH. He has taken Hydrcodin for 10 years (dose has never changed). Earlier this year his Dr. was out of country for two weeks and he needed to renew prescription, so another Dr. In practice was assigned to him for duration. She cut his dose in half. He was in a great deal of constant pain until he got back on old dosage. When he went back to regular Dr. , my DH was in tears just telling his Dr. About it. The sub was the "drug compliance officer" for the practice! Why doesn't government to after the doctor shoppers or places that issue prescriptions in the thousands in areas where only hundreds live?

She told me this happened with her regular primary care doc. Has had him for years. When it happened, she dropped him as a doctor and went to another. She wishes she had stayed with the original. At this new doctor, she says she is seeing a D.O. No idea what that means. And that D.O. said no more Vicodin. Pain clinic. I'll continue to check on her. I'm glad she's got company coming over. She needs to let others know this is happening.

Re: I this normal protocol today?

Deanie — Sat, 15 Dec 2018 15:29:05 GMT

If I can recall the dates, maybe the 80s and 90s, the AMA was pushing the concept of pain management with a deliberate agenda of managing physical suffering. The plan at the time was to "get in front of" it and the way this was done was to prescribe pain meds and included in this were opoids. This went on for decades. WOW, all of a sudden there was an epidemic of people addicted to paid meds. Who would have "thunk it" Of course now the pendulum is swinging back hard, violently and fast. Caught up in this new agenda are those that are elderly, and, frankly, who cares if a 75 year old is addicted to pain meds at this point? Anyway, the scrutiny is now on the MDs writing scripts for it. A pain clinic is the best place to go at this point. But, cynic that I am, as always, follow the line of the money.

Re: I this normal protocol today?

QueenDanceALot — Sat, 15 Dec 2018 15:39:24 GMT

My understanding is that opioids must be tapered off of, not just withdrawn "cold turkey".

I think that sounds like malpractice to just take a patient off VIcodin (or any other opioid), as well as being cruel.

Re: I this normal protocol today?

henderson — Sat, 15 Dec 2018 15:57:01 GMT

My primary care dr. will not prescribe pain meds. I've been going to pain management for over 5 years and am on hydrocodone for my back. I always get a new prescription each month and have to visit pain mgmt every 3 months. I've tried steroid injections and I do not quality for an ablation. Your neighsbor (in my opinion) should have been given a prescription and if they deemed it necessary, weak her off to a lower dosage. She needs to go back to pain mgmt with someone who can be an advocate for her. Never should pain meds be stopped so quickly. No wonder she is in pain and withdrawal symtoms.

Re: I this normal protocol today?

spent2much — Sat, 15 Dec 2018 16:06:11 GMT

Unfortunately, chronic pain patients are suffering terribly today because of the "opioid crisis." From what I've read, however, the majority of overdoses/deaths occur when people have mixed street drugs with opioids, or have bought opioids from unscrupulous dealers. Chronic pain patients have a DEPENDANCE on opioids to ease their pain. They are the ones suffering because of the actions of people who are misusing drugs... to get high, not to ease pain.

Re: I this normal protocol today?

cherry — Sat, 15 Dec 2018 16:12:56 GMT

I don't know. They cut my bil off his ,and sent him to PT. We have a pain management clinic at out local hospital

I would suggest people try medical marijuana. I have never used any, of recreational drugs, but ,if I were in severe pain, I would try M.M.

Re: I this normal protocol today?

lolakimono — Sat, 15 Dec 2018 16:13:29 GMT

@bathina

RE D.O. vs M.D.- it has to do with their philosophies/approaches to medicine and patient care.

Re: I this normal protocol today?

patbz — Sat, 15 Dec 2018 16:50:54 GMT

DH is in such chronic pain that he supplements opioids with MJ in the evenings so he can get reasonable sleep. He has a medical MJ card.

Re: I this normal protocol today?

bathina — Sat, 15 Dec 2018 17:00:50 GMT

Thank you for all the information. It sounds like there is a new push to remove people from the pain med treatment. I'm going to check with my neighbor tomorrow and ask her a few more questions and pass along the info I got here.

Part of me feels they should just leave this poor woman alone and another part of me feels like it may be a good thing- lose weight, get stronger, reduce the pain naturally. She may be 75, but she is sharp and witty and kind. I would hate to see her incapacitated with pain and depression. Although she has started taking the anti-depressant meds given to her by the pain clinic doctor.

Re: I this normal protocol today?

sidsmom — Sat, 15 Dec 2018 17:10:21 GMT

@spent2much wrote:
Unfortunately, chronic pain patients are suffering terribly today because of the "opioid crisis." From what I've read, however, the majority of overdoses/deaths occur when people have mixed street drugs with opioids, or have bought opioids from unscrupulous dealers. Chronic pain patients have a DEPENDANCE on opioids to ease their pain. They are the ones suffering because of the actions of people who are misusing drugs... to get high, not to ease pain.

(bolding for emphasis)

It’s a slippery slope.

Addiction doesn’t have a particular demographic.

The mental aspect of habit to obtain that dopamine hit is still the same.

If the chronic pain patients were given an opportunity to

ease their pain, to the point eliminating all pain & removing

all pain medication.....they still wouldn’t accept it.

That’s a sign of addiction.

Re: I this normal protocol today?

GraceLady — Sat, 15 Dec 2018 17:34:56 GMT

@bathina wrote:
My 75 year old neighbor has been taking Vicodin for 5 years for severe arthritis in her ankles. She walks with a walker and is in pain, even after taking the Vicodin.
Long story short, she had her annual exam with her primary care doc and he told her he would no longer prescribe the Vicodin. He sent her to a pain clinic for an evaluation and they sent her home with an antidepressant. That was last week. She has been off the Vicodin now for 3 days and she is in agony. She called me this morning and asked if I would help her put a turkey in her oven for company she is having this afternoon.
I cannot believe the doctor would cut this woman off without a plan to manage her pain. She is clearly in withdrawal- heart racing, nausea, diarrhea. Coupled with the pain in her ankles and her inability to walk, I am very concerned.
I understand there is an opiate epidemic, but is the protocol now to remove that option for people who have been successfully taking an opiate for pain? Does anyone have experience with this?

I love that you are concerned for your neighbor. She does need help to manage her pain, and an advocate like you to help her understand what her providers are telling her. She may be inclined to hear things differently right now because she is in distress.

If her arthritis is so bad, she needs to see a rheumatologist. There are so many things that can be done for arthritis that don't involve pain meds. You don't say what type of arthritis she has, but that does make a difference. The problem with "weaning her off" opiates is that she has access to them. She has a dependence/addiction. The pain will get the better of her and she would most likely take her usual dose at some point.

Her doctor, in fact any doctor, would be irresponsible to continue prescribing pain meds to her. Addiction to opiates can happen in a less than a week. Once you have built up a tolerance to opiates, that is irreversible. Should she need surgery in the future, pain control could be compromised. Urge your neighbor to see a rheumatologist to see what treatment options she has. Should the rheumy decide she needs to continue on pain meds instead of the newer treatments available, a pain clinic will be better equiped to handle her pain.

Again, she is lucky to have you caring so much for her. Best of luck to you both.

Re: I this normal protocol today?

Kachina624 — Sat, 15 Dec 2018 18:39:18 GMT

@cherry wrote:
I don't know. They cut my bil off his ,and sent him to PT. We have a pain management clinic at out local hospital

I would suggest people try medical marijuana. I have never used any, of recreational drugs, but ,if I were in severe pain, I would try M.M.

@cherry. My friend tried marijuana and said it did help some and was okay if you didn't mind being in a fog all the time. I wouldn't want that.

@bathina. The doctor probably sent your friend to the pain clinic with the thought that they would assist her withdrawal from the Vicodin. They probably didn't want to bother with a little old lady. She needs an advocate who would speak up on her behalf.

I wonder if she could take a NSAID? This opioid addiction business has turned political and has been badly bungled. I had to discontinue my NSAID due to reduced kidney function after being on it over 25 years for arthritis. Doctor gave me scripts for first one, then another controlled pain killer. You should see the hoops you have to jump through. Doctors are being closely monitored. As it turned out, both of the pain meds made me sick and I could take neither. I'm now taking a half dose of my NSAID and am doing okay.

Re: I this normal protocol today?

BalletBabe — Sat, 15 Dec 2018 18:55:04 GMT

@bathina This is happening, because the Government is trying to get opiods not prescibed as often. The insurance companies are also fighting it. I think it is terrible to do this to the elderly and it is not going to solve the opiod abuse in this country.

I have heard so many people complaining about this. I think Dr.'s prescribed this stuff way toooooooo often and now the patients will be the ones that suffer.

I get so irritated when I hear they want to push anti depressants on people. Seriously anti depressants are addicting, and cause some to get more depressed. If you are in pain what the heck is a anti depressant going to do???

When my husband died almost 3 years ago and I went in for a 6 month follow up, he tried to put me on one because I was crying telling him how I found him dead in the morning. It had only been 2 months. He mentioned about giving me an anti depressant, and I looked at him and said seriously???? If I wasn't depressed, that would not be normal. These Dr's irritate me so bad.

I said NoThank You! Time is what I need, not a anti depressant.

Re: I this normal protocol today?

Tadaki — Sat, 15 Dec 2018 19:03:24 GMT

@BalletBabe wrote:
@bathina This is happening, because the Government is trying to get opiods not prescibed as often. The insurance companies are also fighting it. I think it is terrible to do this to the elderly and it is not going to solve the opiod abuse in this country.

I have heard so many people complaining about this. I think Dr.'s prescribed this stuff way toooooooo often and now the patients will be the ones that suffer.

I get so irritated when I hear they want to push anti depressants on people. Seriously anti depressants are addicting, and cause some to get more depressed. If you are in pain what the heck is a anti depressant going to do???

When my husband died almost 3 years ago and I went in for a 6 month follow up, he tried to put me on one because I was crying telling him how I found him dead in the morning. It had only been 2 months. He mentioned about giving me an anti depressant, and I looked at him and said seriously???? If I wasn't depressed, that would not be normal. These Dr's irritate me so bad.

I said NoThank You! Time is what I need, not a anti depressant.

I agree! This is another thing they seem to prescribe without thought. The doctor suggested this to my aunt and she went to another doctor. And I might add, she has been quite well for all the years since then.

Re: I this normal protocol today?

Carmie — Sat, 15 Dec 2018 19:22:49 GMT

Vicodin is not a drug that is used to treat arthritis. Whomever put her on that drug and prescribed it for years is criminal.

Right now this poor woman is having withdraw symptoms. She should be in a hospital to wean her off and get her clean. Take her to the ER.

She should also be going to a doctor who specializes in treating arthritis. They will give her the proper meds to treat as well as releive her daily pain. There are many new drugs on the market that made for this purpose.

She should also drop her primary doctor. What was he thinking? He is a jerk for doing this to her and leaving her to suffer.

Thank you you for being a good neighbor.

Re: I this normal protocol today?

IMW — Sat, 15 Dec 2018 19:24:44 GMT

At my Hematologist/Oncologist apppointment for ferritin infusions I heard a nurse calling 3 different

pharmacies to fill an OxyContin rx for a very, very sick and in pain elderly cancer patient. None had the rx in stock.

In this country we use a sledgehammer to fix a problem instead of selectively using a mallet.

Same approach was used for the mentally ill. Years ago they were locked up sometimes for years. Today we can’t hospitalize them except for a very, very short period of time, hence the homeless problem exponentially increased.