![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by Elizabeth on April 19, 2002, at 1:52:57
A few months ago I moved and had to find a new pdoc. She seemed pretty good at first, but it turns out that she has a lot of attitudes and assumptions that I recognize because a lot of people on PB have reported similar behavior in their (your) doctors. So I'm hoping someone here has some idea how I might approach this problem.
This new pdoc wrote a prescription for Xanax as-needed, but she only gave me 10 doses per month (keep in mind that Xanax is a short-acting drug -- I think it wears off in about 4-6 hours for a typical adult). This month I ran out early and had to ask her to call in a refill. When I saw her the other day, she asked me if I'd been "overusing" the Xanax. (She said this in a way that strongly implied that she felt that I'd "overused" it the month before. The way I see it, the amount she'd prescribed hadn't been adequate.) I tried to explain that I'd been having problems with insomnia and back pain that had contributed to my need for more Xanax than the amount prescribed. Then she got freaked out and accused me of abusing it -- it's "not indicated" for those problems, and so forth. I explained that insomnia and muscle tension can be symptoms of anxiety. She gave me the generic heard-it-a-thousand-times lecture about how I should find other ways to "manage" chronic pain. (I've tried all that stuff, and besides, I don't want to "manage" it, I want to treat it!) In the end, she wrote another 10-dose prescription for this month.
I also told her that I'd been having problems with early-morning depression sometimes, which I speculated was caused by the last buprenorphine dose of the previous day "wearing off" overnight. I don't remember exactly how I phrased it, but I did think it should have been clear what I meant. She somehow managed to interpret it to mean that I was becoming tolerant. (She also claimed that if I was becoming tolerant, it must be because I was using it to get high. Tolerance to benzos occurs almost exclusively in the context of abuse, but this isn't necessarily true of opioids. I didn't bother telling her that, though.) I pointed out that I had said "wears off," not "stops working." She backed off a bit, but she didn't think that this problem was worth doing anything about. (I'd thought that a small bedtime dose of buprenorphine might be worth trying, but I was scared to make that request after she verbally jumped on me -- it made me feel like I didn't deserve it, you know?)
After all this nonsense (all in a single appointment, mind you), I was faced with having to remind her (I had told her this before) that I need 20 mg/night of Ambien, that 10 isn't adequate (I asked for a prescription for Ambien because I haven't been sleeping very well -- she put up a little resistance to this, too, of course, but compared to the other stuff, she was being very rational and laid-back!). Some background: I first took Ambien in 1996 and it has always been clear that 10 mg isn't effective, but 20 mg is (it's not like Ambien just doesn't work for me or I grew tolerant from "overusing" it or something). She insisted I "try" 10, even though I told her that she could confirm what I was telling her by talking to the pdoc I'd seen while I was in Boston. This is a big problem for me because I don't have another appointment for two months; sleeping fitfully and inconsistently for that long is bound to have nasty effects. This pdoc talks about wanting to see functional improvement from the medication, but she doesn't seem to want to do what it will take to bring about that improvement.
I don't abuse or misuse or overuse any drugs, including psychiatric medications; and I've always been responsible about my use of medications, in particular of those prescribed for as-needed use. So the way my new pdoc has been acting is naturally off-putting -- it's clear she's just assuming that I'm up to no good, for some reason. (What that reason might be is a mystery to me: I've *never* gotten this much crap about supposed "drug abuse" from any doctor I've seen.) How am I supposed to deal with this woman??? I want (and need) her to trust me, but she seems bent on mistrusting me. What can I do/say?
Any ideas?
-elizabeth
Posted by JohnX2 on April 19, 2002, at 2:48:29
In reply to help! (rant; advice?), posted by Elizabeth on April 19, 2002, at 1:52:57
> A few months ago I moved and had to find a new pdoc. She seemed pretty good at first, but it turns out that she has a lot of attitudes and assumptions that I recognize because a lot of people on PB have reported similar behavior in their (your) doctors. So I'm hoping someone here has some idea how I might approach this problem.
>
> This new pdoc wrote a prescription for Xanax as-needed, but she only gave me 10 doses per month (keep in mind that Xanax is a short-acting drug -- I think it wears off in about 4-6 hours for a typical adult). This month I ran out early and had to ask her to call in a refill. When I saw her the other day, she asked me if I'd been "overusing" the Xanax. (She said this in a way that strongly implied that she felt that I'd "overused" it the month before. The way I see it, the amount she'd prescribed hadn't been adequate.) I tried to explain that I'd been having problems with insomnia and back pain that had contributed to my need for more Xanax than the amount prescribed. Then she got freaked out and accused me of abusing it -- it's "not indicated" for those problems, and so forth. I explained that insomnia and muscle tension can be symptoms of anxiety. She gave me the generic heard-it-a-thousand-times lecture about how I should find other ways to "manage" chronic pain. (I've tried all that stuff, and besides, I don't want to "manage" it, I want to treat it!) In the end, she wrote another 10-dose prescription for this month.
>
> I also told her that I'd been having problems with early-morning depression sometimes, which I speculated was caused by the last buprenorphine dose of the previous day "wearing off" overnight. I don't remember exactly how I phrased it, but I did think it should have been clear what I meant. She somehow managed to interpret it to mean that I was becoming tolerant. (She also claimed that if I was becoming tolerant, it must be because I was using it to get high. Tolerance to benzos occurs almost exclusively in the context of abuse, but this isn't necessarily true of opioids. I didn't bother telling her that, though.) I pointed out that I had said "wears off," not "stops working." She backed off a bit, but she didn't think that this problem was worth doing anything about. (I'd thought that a small bedtime dose of buprenorphine might be worth trying, but I was scared to make that request after she verbally jumped on me -- it made me feel like I didn't deserve it, you know?)
>
> After all this nonsense (all in a single appointment, mind you), I was faced with having to remind her (I had told her this before) that I need 20 mg/night of Ambien, that 10 isn't adequate (I asked for a prescription for Ambien because I haven't been sleeping very well -- she put up a little resistance to this, too, of course, but compared to the other stuff, she was being very rational and laid-back!). Some background: I first took Ambien in 1996 and it has always been clear that 10 mg isn't effective, but 20 mg is (it's not like Ambien just doesn't work for me or I grew tolerant from "overusing" it or something). She insisted I "try" 10, even though I told her that she could confirm what I was telling her by talking to the pdoc I'd seen while I was in Boston. This is a big problem for me because I don't have another appointment for two months; sleeping fitfully and inconsistently for that long is bound to have nasty effects. This pdoc talks about wanting to see functional improvement from the medication, but she doesn't seem to want to do what it will take to bring about that improvement.
>
> I don't abuse or misuse or overuse any drugs, including psychiatric medications; and I've always been responsible about my use of medications, in particular of those prescribed for as-needed use. So the way my new pdoc has been acting is naturally off-putting -- it's clear she's just assuming that I'm up to no good, for some reason. (What that reason might be is a mystery to me: I've *never* gotten this much crap about supposed "drug abuse" from any doctor I've seen.) How am I supposed to deal with this woman??? I want (and need) her to trust me, but she seems bent on mistrusting me. What can I do/say?
>
> Any ideas?
>
> -elizabethElizabeth,
Anecdote: I was taking Klonopin to treat myofacial pain and needed to up the dose. It started to wear off over time (poop-out or maybe my neurological tick got worse? who knows) and I was getting frustrated that other medicinal routes weren't helping. So eventually I upped the dose behind my doctor's back and ran short on the refill. I called the stand-by doc and he was leary about refilling the med, he just wouldn't do it (I went without it for a day and my life really sucked). When I got a hold of my pdoc (who actually is really understanding), I just told him "look, this is the only medicine that works for me, you sent me to the best neurologist in town who said he could not help me any other way, I refuse at this point to go on with my life in anymore pain. I don't care if I have to raise the dose of my medication in the meanwhile." (I had been hinting at suicidal ideation over this chronic pain). Point being, if the medical system did not have anything to alleviate my pain and suffering better than Klonopin, then what else was I to do in the mean time? Unless they had a better option, who are they to deny comfort.
I guess I understand where you are coming from.
Fortunately I did find another med to treat my pain subsequent to this.I don't know what to say, but I understand the frustration. :-(
Also, I found a few of my own cheats to manage my particular pain and rebound insomnia (non-standard approaches with unknown risk)..but gotta have some quality of life.
Your bastard-of-late empathetic friend,
John (returning from planet mania)
Posted by JohnX2 on April 19, 2002, at 3:09:33
In reply to Re: help! (rant; advice?) » Elizabeth, posted by JohnX2 on April 19, 2002, at 2:48:29
> > A few months ago I moved and had to find a new pdoc. She seemed pretty good at first, but it turns out that she has a lot of attitudes and assumptions that I recognize because a lot of people on PB have reported similar behavior in their (your) doctors. So I'm hoping someone here has some idea how I might approach this problem.
> >
> > This new pdoc wrote a prescription for Xanax as-needed, but she only gave me 10 doses per month (keep in mind that Xanax is a short-acting drug -- I think it wears off in about 4-6 hours for a typical adult). This month I ran out early and had to ask her to call in a refill. When I saw her the other day, she asked me if I'd been "overusing" the Xanax. (She said this in a way that strongly implied that she felt that I'd "overused" it the month before. The way I see it, the amount she'd prescribed hadn't been adequate.) I tried to explain that I'd been having problems with insomnia and back pain that had contributed to my need for more Xanax than the amount prescribed. Then she got freaked out and accused me of abusing it -- it's "not indicated" for those problems, and so forth. I explained that insomnia and muscle tension can be symptoms of anxiety. She gave me the generic heard-it-a-thousand-times lecture about how I should find other ways to "manage" chronic pain. (I've tried all that stuff, and besides, I don't want to "manage" it, I want to treat it!) In the end, she wrote another 10-dose prescription for this month.
> >
> > I also told her that I'd been having problems with early-morning depression sometimes, which I speculated was caused by the last buprenorphine dose of the previous day "wearing off" overnight. I don't remember exactly how I phrased it, but I did think it should have been clear what I meant. She somehow managed to interpret it to mean that I was becoming tolerant. (She also claimed that if I was becoming tolerant, it must be because I was using it to get high. Tolerance to benzos occurs almost exclusively in the context of abuse, but this isn't necessarily true of opioids. I didn't bother telling her that, though.) I pointed out that I had said "wears off," not "stops working." She backed off a bit, but she didn't think that this problem was worth doing anything about. (I'd thought that a small bedtime dose of buprenorphine might be worth trying, but I was scared to make that request after she verbally jumped on me -- it made me feel like I didn't deserve it, you know?)
> >
> > After all this nonsense (all in a single appointment, mind you), I was faced with having to remind her (I had told her this before) that I need 20 mg/night of Ambien, that 10 isn't adequate (I asked for a prescription for Ambien because I haven't been sleeping very well -- she put up a little resistance to this, too, of course, but compared to the other stuff, she was being very rational and laid-back!). Some background: I first took Ambien in 1996 and it has always been clear that 10 mg isn't effective, but 20 mg is (it's not like Ambien just doesn't work for me or I grew tolerant from "overusing" it or something). She insisted I "try" 10, even though I told her that she could confirm what I was telling her by talking to the pdoc I'd seen while I was in Boston. This is a big problem for me because I don't have another appointment for two months; sleeping fitfully and inconsistently for that long is bound to have nasty effects. This pdoc talks about wanting to see functional improvement from the medication, but she doesn't seem to want to do what it will take to bring about that improvement.
> >
> > I don't abuse or misuse or overuse any drugs, including psychiatric medications; and I've always been responsible about my use of medications, in particular of those prescribed for as-needed use. So the way my new pdoc has been acting is naturally off-putting -- it's clear she's just assuming that I'm up to no good, for some reason. (What that reason might be is a mystery to me: I've *never* gotten this much crap about supposed "drug abuse" from any doctor I've seen.) How am I supposed to deal with this woman??? I want (and need) her to trust me, but she seems bent on mistrusting me. What can I do/say?
> >
> > Any ideas?
> >
> > -elizabeth
>
> Elizabeth,
>
> Anecdote: I was taking Klonopin to treat myofacial pain and needed to up the dose. It started to wear off over time (poop-out or maybe my neurological tick got worse? who knows) and I was getting frustrated that other medicinal routes weren't helping. So eventually I upped the dose behind my doctor's back and ran short on the refill. I called the stand-by doc and he was leary about refilling the med, he just wouldn't do it (I went without it for a day and my life really sucked). When I got a hold of my pdoc (who actually is really understanding), I just told him "look, this is the only medicine that works for me, you sent me to the best neurologist in town who said he could not help me any other way, I refuse at this point to go on with my life in anymore pain. I don't care if I have to raise the dose of my medication in the meanwhile." (I had been hinting at suicidal ideation over this chronic pain). Point being, if the medical system did not have anything to alleviate my pain and suffering better than Klonopin, then what else was I to do in the mean time? Unless they had a better option, who are they to deny comfort.
> I guess I understand where you are coming from.
> Fortunately I did find another med to treat my pain subsequent to this.
>
> I don't know what to say, but I understand the frustration. :-(
>
> Also, I found a few of my own cheats to manage my particular pain and rebound insomnia (non-standard approaches with unknown risk)..but gotta have some quality of life.
>
> Your bastard-of-late empathetic friend,
> John (returning from planet mania)Can you comb thru the phone book (or whatever your health provider's directory is) and just get a couple appt with whomever are the 1st available pdoctors? I don't know what area it is (or what your finances or insurance situation is), but if it is well populated, then you should be able to find *someone* who can get you in shortly (a few days or week). Granted this is a baromoeter for a bad pdoc in general (crowded restaurant theory), but if you get in the door and start with a clean slate and "tell the right story <- this is the trick, ahem", you will walk out the door with what script you require. You can juggle multiple pdocs simultaneously until you get your situation more settled. (Sorry for the timid reader, this may sound ugly, don't try this at home). Maybe you'll get lucky and develop a better report with the new pdoc anyways.
John
Posted by Bekka H. on April 19, 2002, at 6:52:44
In reply to help! (rant; advice?), posted by Elizabeth on April 19, 2002, at 1:52:57
Hi Elizabeth,
Did you like your previous doctor (i.e., the one who was in the town you recently moved FROM)? If so, perhaps that doctor could speak with the new one to assure her that you are responsible and not "abusing" the meds. At first I was going to suggest finding yet another new doctor, but unless you've gotten a referral from someone who knows you well, it usually takes a while for a new doctor to get to know you, so it's possible you'd run into the same problem if you tried someone else.
By the way, have you tried Klonopin instead of Xanax? About 5 or 6 years ago, I took Xanax for a few months, and I found I had to increase the dose. Klonopin is longer-lasting and seemed to be a little better for me, but I had to take teeny, tiny amounts in order not to get too tired from it.
Bekka
Posted by fachad on April 19, 2002, at 9:57:21
In reply to help! (rant; advice?), posted by Elizabeth on April 19, 2002, at 1:52:57
The Controlled Substance Catch-22 is my worst fear. Your post hit my brain like ice water on a root canal with a nerve-exposed dry socket.
I was totally freaked out about this last August when I got a letter in the mail telling me that my pdoc was closing his practice. I posted my angst about this dilemma here:
http://www.dr-bob.org/babble/20010804/msgs/73612.html
Now you know why I was so scared!
This situation is a Catch-22 - a classic double bind.
Any effort that you expend trying to convince your pdoc to keep you on a controlled substance (CS) will be interpreted by your pdoc as "drug seeking behavior" and will be counted as further evidence that you need to be taken off that CS.
On the other hand, if you do not expend any effort to stay on CS, he will take you off of it. So you are dammed if you do, and dammed if you don't!
Further, if you try to get the dosage changed to an appropriate level for you, and that dose does not jibe with what this pdoc arbitrarily started you out with, then you are further guilty of "dose escalation", which is more proof of drug seeking behavior, and further evidence that you need to be taken off your CS.
But it gets even worse! If you decide that your doctor is being irrational and you choose not to work with someone who does not trust you, and you then try to find another pdoc, you are guilty of the worst crime of the most pathetic, desperate drug seeker: you are guilty of "Doctor Shopping"
Drug Seeking. Dose Escalation. Doctor Shopping.
Those are some of the most pejorative words ever used in medicine and in behavioral health care. In so many ways both medicine and mental health has tried to get away from pejorative language and pejorative concepts, but when it comes to controlled substances, they sometimes become self-appointed judge, jury and executioner in a trial that is rigged with a built-in bulletproof Catch-22.
I have wrestled mentally with this worst-case scenario since the first time I realized that I had a unique and dramatic response to CII stimulants for depression. Thankfully, I have not yet had to face it in the real world. (Knock on wood.)
But I have thought it thru, comprehended the vastness of the dilemma from a theoretical standpoint, and tried to work out rational solution scenarios.
(BTW, this activity in itself would meet DSM IV Criteria 5 for Substance Dependence: "a great deal of time is spent in activities necessary to obtain the substance...” I had to interject that because I know how much you love DSM-IV. And it just further shows that this Catch-22 is all encompassing and bulletproof.)
The solution scenarios I have come up with so far focus on trust, personal and professional stability, and long term relationships with medical personnel.
Can you have your medical records transferred from your old pdoc to this new pdoc? Could you contact your old pdoc and ask for a "letter of introduction" that addresses you, your CS(s) and your responsible use of them over time?
Did you always fill at the same pharmacy where you lived before? Did you go into that pharmacy often enough that the pharmacists remembered you? I consider my pharmacy records to be sacred transcripts documenting my years of rigid compliance. They are a permanent record of my responsible use of controlled substances. If I ever find myself in the CS Catch-22, the first people I would call for help would be the staff of my pharmacy. Even if they did not like me personally, they have years of records that reflect very favorably on me. Even the fact that the same pharmacy has been used for years builds a case for stability.
I would hope that the combination of extreme openness, medical records, and pharmacy records would prevail to swing the benefit of the doubt in your favor.
If it did not, I think the appropriate move would be to try to find another pdoc. The key to avoiding the “doctor shopping” charges would be to preemptively tell the new prospective pdoc what is going on. Bring your medical and pharmacy transcripts, and tell the new pdoc right off about what happened to you and how you felt like you were not trusted from the start. Invite them to call the offending doc and discuss why this other doc thought you were an abuser.
I think any rational person, and most pdocs are rational, intuitively understands a Catch-22 situation. Besides, if you are not hiding anything, there is no reason to doubt your sincerity.
Please post some follow-ups for us, and let us know how it is going, and how it worked out, because the only thing standing between any one of us taking a CS and this awful situation is blind luck.
-fachad
> A few months ago I moved and had to find a new pdoc. She seemed pretty good at first, but it turns out that she has a lot of attitudes and assumptions that I recognize because a lot of people on PB have reported similar behavior in their (your) doctors. So I'm hoping someone here has some idea how I might approach this problem.
>
> This new pdoc wrote a prescription for Xanax as-needed, but she only gave me 10 doses per month (keep in mind that Xanax is a short-acting drug -- I think it wears off in about 4-6 hours for a typical adult). This month I ran out early and had to ask her to call in a refill. When I saw her the other day, she asked me if I'd been "overusing" the Xanax. (She said this in a way that strongly implied that she felt that I'd "overused" it the month before. The way I see it, the amount she'd prescribed hadn't been adequate.) I tried to explain that I'd been having problems with insomnia and back pain that had contributed to my need for more Xanax than the amount prescribed. Then she got freaked out and accused me of abusing it -- it's "not indicated" for those problems, and so forth. I explained that insomnia and muscle tension can be symptoms of anxiety. She gave me the generic heard-it-a-thousand-times lecture about how I should find other ways to "manage" chronic pain. (I've tried all that stuff, and besides, I don't want to "manage" it, I want to treat it!) In the end, she wrote another 10-dose prescription for this month.
>
> I also told her that I'd been having problems with early-morning depression sometimes, which I speculated was caused by the last buprenorphine dose of the previous day "wearing off" overnight. I don't remember exactly how I phrased it, but I did think it should have been clear what I meant. She somehow managed to interpret it to mean that I was becoming tolerant. (She also claimed that if I was becoming tolerant, it must be because I was using it to get high. Tolerance to benzos occurs almost exclusively in the context of abuse, but this isn't necessarily true of opioids. I didn't bother telling her that, though.) I pointed out that I had said "wears off," not "stops working." She backed off a bit, but she didn't think that this problem was worth doing anything about. (I'd thought that a small bedtime dose of buprenorphine might be worth trying, but I was scared to make that request after she verbally jumped on me -- it made me feel like I didn't deserve it, you know?)
>
> After all this nonsense (all in a single appointment, mind you), I was faced with having to remind her (I had told her this before) that I need 20 mg/night of Ambien, that 10 isn't adequate (I asked for a prescription for Ambien because I haven't been sleeping very well -- she put up a little resistance to this, too, of course, but compared to the other stuff, she was being very rational and laid-back!). Some background: I first took Ambien in 1996 and it has always been clear that 10 mg isn't effective, but 20 mg is (it's not like Ambien just doesn't work for me or I grew tolerant from "overusing" it or something). She insisted I "try" 10, even though I told her that she could confirm what I was telling her by talking to the pdoc I'd seen while I was in Boston. This is a big problem for me because I don't have another appointment for two months; sleeping fitfully and inconsistently for that long is bound to have nasty effects. This pdoc talks about wanting to see functional improvement from the medication, but she doesn't seem to want to do what it will take to bring about that improvement.
>
> I don't abuse or misuse or overuse any drugs, including psychiatric medications; and I've always been responsible about my use of medications, in particular of those prescribed for as-needed use. So the way my new pdoc has been acting is naturally off-putting -- it's clear she's just assuming that I'm up to no good, for some reason. (What that reason might be is a mystery to me: I've *never* gotten this much crap about supposed "drug abuse" from any doctor I've seen.) How am I supposed to deal with this woman??? I want (and need) her to trust me, but she seems bent on mistrusting me. What can I do/say?
>
> Any ideas?
>
> -elizabeth
Posted by Ritch on April 19, 2002, at 10:39:24
In reply to help! (rant; advice?), posted by Elizabeth on April 19, 2002, at 1:52:57
> This new pdoc wrote a prescription for Xanax as-needed, but she only gave me 10 doses per month (keep in mind that Xanax is a short-acting drug -- I think it wears off in about 4-6 hours for a typical adult). This month I ran out early and had to ask her to call in a refill. When I saw her the other day, she asked me if I'd been "overusing" the Xanax. (She said this in a way that strongly implied that she felt that I'd "overused" it the month before. The way I see it, the amount she'd prescribed hadn't been adequate.) I tried to explain that I'd been having problems with insomnia and back pain that had contributed to my need for more Xanax than the amount prescribed. Then she got freaked out and accused me of abusing it -- it's "not indicated" for those problems, and so forth. I explained that insomnia and muscle tension can be symptoms of anxiety. She gave me the generic heard-it-a-thousand-times lecture about how I should find other ways to "manage" chronic pain. (I've tried all that stuff, and besides, I don't want to "manage" it, I want to treat it!) In the end, she wrote another 10-dose prescription for this month.........
....... How am I supposed to deal with this woman??? I want (and need) her to trust me, but she seems bent on mistrusting me. What can I do/say?
>
> Any ideas?
>
> -elizabeth
Elizabeth,She *doesn't* trust you. I can tell by all of her replies. You are going to have to just tell yourself: "She doesn't trust me, now what do I do?" She has made up her mind already and she is being chincy on the quantities purposefully to get your reaction. And it appears that she feels that your "reaction" is "drug-seeking", and of course that is bad. My pdoc plays that game to some degree as well-except I get plenty of Klonopin (i.e.), but the qty's I am using are carefully checked out (through need for refills, etc.) Only when it was plain as apple-butter that what I *said* I took was what I *actually* took, then I see some refills. Sometimes they are just hyper-paranoid about diversion. They think you are selling your meds for $10 a pop or something and then they get their ass in a sling for facilitating that. The trust thing could improve with time, but you might be better off with a different pdoc. I wonder if she already has a *plan* for you that doesn't involve bupe or Xanax and you will either follow her plan or you will be seeing somebody else (and that's probably fine with her-whew!-no paranoia!). I bet she is just scared.
Mitch
Posted by Ritch on April 19, 2002, at 13:37:07
In reply to The Controlled Substance Catch-22 - My Worst Fear » Elizabeth, posted by fachad on April 19, 2002, at 9:57:21
....
> Drug Seeking. Dose Escalation. Doctor Shopping.
>
> Those are some of the most pejorative words ever used in medicine and in behavioral health care. In so many ways both medicine and mental health has tried to get away from pejorative language and pejorative concepts, but when it comes to controlled substances, they sometimes become self-appointed judge, jury and executioner in a trial that is rigged with a built-in bulletproof Catch-22.
>
> I have wrestled mentally with this worst-case scenario since the first time I realized that I had a unique and dramatic response to CII stimulants for depression. Thankfully, I have not yet had to face it in the real world. (Knock on wood.)
.........Fachad,
Fantastic posts! I experience feelings of euphoria and mood elation (med-induced hypomania) from SSRI's which are not even controlled substances. Stimulants, OTOH, are controlled and I tend to get quiet and somewhat "flat" on them. When I take a slightly larger dose of Celexa than usual I will get a remark at work like: "I wished I had some of what you are on!". When I am on a stimulant and involved with a project I get a response like: "Gee, you are awfully quiet, are you OK?" How ironic. I have a got a drawer filled with all sorts of SSRI, but it is a teeth puller to even attempt a trial of a stimulant. Man, you should have seen the looks I got at the pharmacy yesterday when I brought in a Focalin script for fifteen tablets! (for a trial)
Mitch
Posted by katekite on April 19, 2002, at 15:54:15
In reply to help! (rant; advice?), posted by Elizabeth on April 19, 2002, at 1:52:57
I have moved a lot. I've seen, I am counting now, probably 10 pdocs in 10 years.
Some have big issues about benzodiazepines, but if benzos work for you and you feel comfortable with it, that's more important than dependence concerns. My life vastly improved after a valium prescription 4 years into working on finding meds that helped. Now finally I'm in a position, happily, to get off of them altogether and can't wait. But that's beside the point.
Last summer and fall I had my first pdoc who doubted me. I had moved from leniant CA to conservative east coast. He felt I was "non-compliant" after I took the sample pack of paxil from him in his office (after he badgered me into agreeing to try it after I repeatedly said no, it didn't work before, it puts me to sleep, I don't want it thankyou, what are the alternatives etc etc etc well fine ok i'll try it again) and then once home got disgusted at myself for wimping out, changed my mind, realizing that I'd only agreed out of wanting to end the conflict. But I used tiny doses of paxil occcasionally as a sleep aid (5 mg knocks me right out). I didn't call because I couldn't deal with it at the time.
So to him, not only was this non-compliant, I was 'self-medicating' and 'playing doctor'. And here I was basically too shy to call him to tell him I wasn't going to take it, would have told him at the next visit, and was just trying to make it through to that next visit. Wow. He never got over that. Every time I saw him after that, maybe 4 more times, he would ask me "are you really taking that much?" "So what else have you taken?". Every time asking me what I was taking, with this composed face so that he wouldn't raise his eyebrows if I said '400 mg of ativan a day'. Shit like that that only made me feel bad. As if I would take heroin on a whim, or for my birthday start dropping acid daily.
It was news to me that using previously prescribed meds in the way that helped me, without becoming dependent on them, was considered so terrible. 6 previous pdocs and 2 previous therapists had never made a comment on my educated guess uses of medication, one even went to phone only consults because it was more convenient and they trusted me to verbally convey what was going on, they understood I was poor, etc.
I was so down at the time I went along and saw him for months after his trust deteriorated, I assumed he would 'like me' if I 'was good'. I even spent time feeling bad about it. I just stopped telling him that I occasionally used paxil to sleep. Then I felt bad, was nervous in the appointments. Not a good solution. Need to be able to tell them everything.
So I've had extremely variable levels of trust and it doesn't seem to have anything at all to do with ME.
You need to find a pdoc to work with that you trust and who has some respect for you. Keep looking!
Incidentally I've now found it helps to control their benzo addiction worries if every time I mention benzos or sleep aids I also say how much I hate using drugs of any kind, that I worry about the addiction potential. Not every appoitment, but definitely the first time. It seems to turn the tables and they sit there and tell me really its ok. I know, that's manipulative, but darn it, we need to be assertive and get what we need.
kate
Posted by JohnX2 on April 19, 2002, at 16:07:08
In reply to you need a new pdoc, posted by katekite on April 19, 2002, at 15:54:15
> Incidentally I've now found it helps to control their benzo addiction worries if every time I mention benzos or sleep aids I also say how much I hate using drugs of any kind, that I worry about the addiction potential. Not every appoitment, but definitely the first time. It seems to turn the tables and they sit there and tell me really its ok. I know, that's manipulative, but darn it, we need to be assertive and get what we need.
>
> kateThis worked in my case, but I wasn't being manipulative, it was the real story. 2 pdocs wrote hefty doses of Klonopin on the 1st visit without hesitation. (I wasn't juggling pdocs, I moved).
John
Posted by katekite on April 19, 2002, at 16:44:38
In reply to Re: you need a new pdoc, posted by JohnX2 on April 19, 2002, at 16:07:08
Actually for me too. Every time I pop one of those klonopin I am both thankful for it and disturbed about it. I absolutely hate being dependent on anything.
sorry that had nothing to do with original thread poster's post.
Posted by rainbowlight on April 19, 2002, at 16:45:30
In reply to help! (rant; advice?), posted by Elizabeth on April 19, 2002, at 1:52:57
I can totally relate. I have to agree, I think she doesn't trust you. Maybe she doesn't trust any of her patients with these types of meds. I have personally found that the better the quality of pdoc (more experience, more med knowledge), the less paranoid they are about prescribing the benzos. I personally would find a new pdoc. I am not sure where you are located if there are other pdocs available to you. I am in California where there is a pdoc on every corner. Most of the pdocs I have had have never requested medical records from the old doctor and took my word at what meds I was currently on. So I guess it is pretty relaxed here in California. I think it is reasonable to at least have a prescription of 1 pill a day for the month. I think it is ridiculous that most of the doctors don't want to prescribe these meds when they are so helpful to so many people. What are they for then? LOL!
Posted by shelliR on April 19, 2002, at 19:19:22
In reply to help! (rant; advice?), posted by Elizabeth on April 19, 2002, at 1:52:57
Hi Elizabeth,
I'm so sorry that you have to go through this. You are more careful about increases in drugs than almost anyone I know. It is humiliating to be treated this way, plus you're not getting what you need.
I guess the complication here is that she *is* prescribing the bupe for you and I know you were worried about that. If it wasn't for that, I'd say leave her behind. But given your situation, you really need to know what your options are before you leave her.
And it is possible (can't remember who just said this), that you could now be spending your time looking for a new pdoc without letting this doctor know. And actually interview before you decide, because sometimes doctors say things on the phone than they pull back when actually asked to prescribe what you have asked for. (I had one guy like that.) And I think also whoever said that you'd have the best chance with a very experienced pdoc was probably right. They are less concerned with pettiness. My pdocs have never given me any problem about sleep meds (valium, trazadone, or aterex)
You have a legitimate reason for finding a new pdoc. You just left one who trusted you, and you have always worked with doctors where there was mutual respect. I think it may take more than one call, but I do think you'll find it; all you want is to continue the regime you had with your old pdoc. You're not asking for anything new.
Another approach is to be totally upfront with your new doctor about how her questioning affects you. You could talk to her about how her doubts make you feel very insecure about your relationship and your ability to remain stable.
And lastly, you might go to a pain doc in addition to your pdoc and get a script for a sleeping med to manage your pain, while you are looking for a new pdoc. When my pdoc disapproved of vicodin for premenstraul depression, I got ten a month from my gyn, and that did the trick.
Anyway, that is my 2 cents. I wish I had more to offer.
All the best,Shelli
Posted by BobS. on April 19, 2002, at 19:48:30
In reply to Re: help! (rant; advice?), posted by rainbowlight on April 19, 2002, at 16:45:30
Reading this just infuriates me. I find that no matter how anxious I am, fighting an injustice relieves anxiety and invigorates me. First, find a new pdoc. Next go back to the sh**head and tell'em you are thinking about reporting him to the state medical board or something for malpractice. Next, tell'em you are thinking seriously about suing for malpractice, libel/defamation or anything else that you can think of in a tort action. That should make the pdoc anxious. When you see his anxiety up a notch, yours will go down. It's like CBT.
BTW, I take Xanax 1.5 tid and have a script from someone who is not intimidated by the government. If you live in NJ/NYC area I can get you to this pdoc. He is very good and not afraid.
Regards,
BobS.
Posted by alan on April 19, 2002, at 19:48:31
In reply to help! (rant; advice?), posted by Elizabeth on April 19, 2002, at 1:52:57
> After all this nonsense (all in a single appointment, mind you),
>I've *never* gotten this much crap about supposed "drug abuse" from any doctor I've seen.) How am I supposed to deal with this woman??? I want (and need) her to trust me, but she seems bent on mistrusting me. What can I do/say?
>
> Any ideas?
>
> -elizabeth
************************************************
Nonsense indeed. You'll NEVER change this person - I know from my personal experience - even with all of the constructive suggestions abouy forwarding records, teleconfrencing from Boston, etc, you are still up against what faschad describes above so well as the Controlled Substance Catch 22.Now the whole thing is that for some docs that UNDERSTAND this phenomenon and that have YOUR best interest in mind, not theirs, there wouldn't be a problem. Well, how do you get there from here is what I sense you're asking. And with your vast knowledge of medications and your own individual responses to them as you've explained so eloquently here at PB over the last year - at least from what I've read - you have one leg up on your doctors anyway.
You need to interview a pdoc or two - having your treatment summary from your Boston pdoc in hand and their telephone number if these two things become necessary to establish trust - not just earn it - at least not with the disrespectful way that you've been treated already in that regard.
Do you not have access to a doctor that is affiliated with a university or teaching hospital that is up on their stuff? One that you could challenge the slighest mistrustful and disrespectful blather with the type of voracity that you demonstrate in your many posts here at PB? My heavens, you personally have been an inspiration to me in that regard with a command of the facts and an assertiveness that is most impressive! Can you do this towards you pdocs? With the honesty and persuasiveness that you've demonstrated here many times before?
I'm not trying to be patronising at all. But if you would find a doc that would respond to your free flowing knowledge about yourself and medications and your history with them it would be wonderful. I know that this is the big question.
I went through (fired) three docs until I even found one that knew that addiction and medical dependence were not the same thing, one that ultimately asked me one important question when wanting to find out how a drug worked for me personally ("Well, do you feel better?"). That's when I knew I found the right person...not spending my time trying to earn the trust or change the attitude of the doctor. I did that for almost 10 years and 3 pdocs until I found someone that wasn't an idealogue or was reading from a script! And I just about lost my top of the career job doing it in the meantime - damn anxiety!
All I needed was BZD monotherapy but in high enough doses. Now how was I going to find that out if my pdoc didn't give me the latitude to find what a theraputic dose was in the first place? Of course the doses would have to go up (until they stopped for God's sake) if I were to find a theraputic dose in the first place.
Please don't waste your time with this person that has all of the warning signs of a person reading from a script. It'll just be a power struggle in the end. Just like with my previous 3 pdocs. One said that I could go through the yellow pages until I found someone that would give me the meds that I wanted (that's when I got up and walked out on him). Outrageous. They were going to discontinue my ativan because they thought that an ssri was going to conquer my anxiety disorder - after 3 years of experimenting with ssri's!
I got the last laugh though because I went to the pdoc that he recommended as I was walking out of his office (telling me all the time that he wouldn't give me what I wanted either) and low and behold....this new doctor asked me after a 1 hour interview of my history with my recordds in his hands, "Well, do you feel better and can you function on the ativan?"
That's all that I needed to know. Been with him for 3 years and have never felt better - and have experimented with many other drugs in the meantime - at his encouragement!!! Call it dumb luck but with your knowledge, ability to explain things clearly, and your perceptiveness, I don't see why you can't avoid the trap that has been set for you and as you say, the same trap that you see posters experience on this bboard in every day.
Posted by alan on April 19, 2002, at 22:23:38
In reply to The Controlled Substance Catch-22 - My Worst Fear » Elizabeth, posted by fachad on April 19, 2002, at 9:57:21
> Drug Seeking. Dose Escalation. Doctor Shopping.
>
> Those are some of the most pejorative words ever used in medicine and in behavioral health care. In so many ways both medicine and mental health has tried to get away from pejorative language and pejorative concepts, but when it comes to controlled substances, they sometimes become self-appointed judge, jury and executioner in a trial that is rigged with a built-in bulletproof Catch-22.
> But I have thought it thru, comprehended the vastness of the dilemma from a theoretical standpoint, and tried to work out rational solution scenarios.
>
> (BTW, this activity in itself would meet DSM IV Criteria 5 for Substance Dependence: "a great deal of time is spent in activities necessary to obtain the substance...” I had to interject that because I know how much you love DSM-IV. And it just further shows that this Catch-22 is all encompassing and bulletproof.)
>
> I think any rational person, and most pdocs are rational, intuitively understands a Catch-22 situation. Besides, if you are not hiding anything, there is no reason to doubt your sincerity.
>
> Please post some follow-ups for us, and let us know how it is going, and how it worked out, because the only thing standing between any one of us taking a CS and this awful situation is blind luck.
>
> -fachad
*****************************************
All superb points fachad! I know because I've LIVED them - you've just enunciated them so clearly and plainly.The beauty though is finding a doctor that understands and sees beyond the double bind in all of it's complexity. It took me years to find one that did and I'd now know how to go about doing it again if I had to: copying your post and taking it in to the doc as a theoretical case study to see if they GET it!
Alan
Posted by JohnX2 on April 20, 2002, at 2:07:19
In reply to Re: help! (rant; advice?), posted by JohnX2 on April 19, 2002, at 3:09:33
> > > A few months ago I moved and had to find a new pdoc. She seemed pretty good at first, but it turns out that she has a lot of attitudes and assumptions that I recognize because a lot of people on PB have reported similar behavior in their (your) doctors. So I'm hoping someone here has some idea how I might approach this problem.
> > >
> > > This new pdoc wrote a prescription for Xanax as-needed, but she only gave me 10 doses per month (keep in mind that Xanax is a short-acting drug -- I think it wears off in about 4-6 hours for a typical adult). This month I ran out early and had to ask her to call in a refill. When I saw her the other day, she asked me if I'd been "overusing" the Xanax. (She said this in a way that strongly implied that she felt that I'd "overused" it the month before. The way I see it, the amount she'd prescribed hadn't been adequate.) I tried to explain that I'd been having problems with insomnia and back pain that had contributed to my need for more Xanax than the amount prescribed. Then she got freaked out and accused me of abusing it -- it's "not indicated" for those problems, and so forth. I explained that insomnia and muscle tension can be symptoms of anxiety. She gave me the generic heard-it-a-thousand-times lecture about how I should find other ways to "manage" chronic pain. (I've tried all that stuff, and besides, I don't want to "manage" it, I want to treat it!) In the end, she wrote another 10-dose prescription for this month.
> > >
> > > I also told her that I'd been having problems with early-morning depression sometimes, which I speculated was caused by the last buprenorphine dose of the previous day "wearing off" overnight. I don't remember exactly how I phrased it, but I did think it should have been clear what I meant. She somehow managed to interpret it to mean that I was becoming tolerant. (She also claimed that if I was becoming tolerant, it must be because I was using it to get high. Tolerance to benzos occurs almost exclusively in the context of abuse, but this isn't necessarily true of opioids. I didn't bother telling her that, though.) I pointed out that I had said "wears off," not "stops working." She backed off a bit, but she didn't think that this problem was worth doing anything about. (I'd thought that a small bedtime dose of buprenorphine might be worth trying, but I was scared to make that request after she verbally jumped on me -- it made me feel like I didn't deserve it, you know?)
> > >
> > > After all this nonsense (all in a single appointment, mind you), I was faced with having to remind her (I had told her this before) that I need 20 mg/night of Ambien, that 10 isn't adequate (I asked for a prescription for Ambien because I haven't been sleeping very well -- she put up a little resistance to this, too, of course, but compared to the other stuff, she was being very rational and laid-back!). Some background: I first took Ambien in 1996 and it has always been clear that 10 mg isn't effective, but 20 mg is (it's not like Ambien just doesn't work for me or I grew tolerant from "overusing" it or something). She insisted I "try" 10, even though I told her that she could confirm what I was telling her by talking to the pdoc I'd seen while I was in Boston. This is a big problem for me because I don't have another appointment for two months; sleeping fitfully and inconsistently for that long is bound to have nasty effects. This pdoc talks about wanting to see functional improvement from the medication, but she doesn't seem to want to do what it will take to bring about that improvement.
> > >
> > > I don't abuse or misuse or overuse any drugs, including psychiatric medications; and I've always been responsible about my use of medications, in particular of those prescribed for as-needed use. So the way my new pdoc has been acting is naturally off-putting -- it's clear she's just assuming that I'm up to no good, for some reason. (What that reason might be is a mystery to me: I've *never* gotten this much crap about supposed "drug abuse" from any doctor I've seen.) How am I supposed to deal with this woman??? I want (and need) her to trust me, but she seems bent on mistrusting me. What can I do/say?
> > >
> > > Any ideas?
> > >
> > > -elizabeth
> >
> > Elizabeth,
> >
> > Anecdote: I was taking Klonopin to treat myofacial pain and needed to up the dose. It started to wear off over time (poop-out or maybe my neurological tick got worse? who knows) and I was getting frustrated that other medicinal routes weren't helping. So eventually I upped the dose behind my doctor's back and ran short on the refill. I called the stand-by doc and he was leary about refilling the med, he just wouldn't do it (I went without it for a day and my life really sucked). When I got a hold of my pdoc (who actually is really understanding), I just told him "look, this is the only medicine that works for me, you sent me to the best neurologist in town who said he could not help me any other way, I refuse at this point to go on with my life in anymore pain. I don't care if I have to raise the dose of my medication in the meanwhile." (I had been hinting at suicidal ideation over this chronic pain). Point being, if the medical system did not have anything to alleviate my pain and suffering better than Klonopin, then what else was I to do in the mean time? Unless they had a better option, who are they to deny comfort.
> > I guess I understand where you are coming from.
> > Fortunately I did find another med to treat my pain subsequent to this.
> >
> > I don't know what to say, but I understand the frustration. :-(
> >
> > Also, I found a few of my own cheats to manage my particular pain and rebound insomnia (non-standard approaches with unknown risk)..but gotta have some quality of life.
> >
> > Your bastard-of-late empathetic friend,
> > John (returning from planet mania)
>
> Can you comb thru the phone book (or whatever your health provider's directory is) and just get a couple appt with whomever are the 1st available pdoctors? I don't know what area it is (or what your finances or insurance situation is), but if it is well populated, then you should be able to find *someone* who can get you in shortly (a few days or week). Granted this is a baromoeter for a bad pdoc in general (crowded restaurant theory), but if you get in the door and start with a clean slate and "tell the right story <- this is the trick, ahem", you will walk out the door with what script you require. You can juggle multiple pdocs simultaneously until you get your situation more settled. (Sorry for the timid reader, this may sound ugly, don't try this at home). Maybe you'll get lucky and develop a better report with the new pdoc anyways.
>
> John
I want to clarify that I don't advocate obtaining prescription medications for the same controlled substances from various sources simultaneously. In this case I wondered how quickly Elizabeth could find another pdoc to help with the Xanax and Ambien, but who would also prescribe the buprenorphine (don't have much experience with this class of med or how open in general pdocs are to them..)John
Posted by Elizabeth on April 21, 2002, at 12:39:28
In reply to Re: help! (rant; advice?) » Elizabeth, posted by JohnX2 on April 19, 2002, at 2:48:29
Hi everyone. I was gratified to see such an overwhelmingly positive response from so many of you. Thanks guys! You have all been very supportive (as Dr. Bob might say ;-) ). I'm seriously thinking of printing out your posts and showing them to my pdoc so she can get an idea of how bad her behavior is. I'm too chicken to do that, of course. I'm often afraid to assert my rights with people who have some sort of power over me, for fear of being punished.
I've been so angry and anxious about this stuff that I just haven't wanted to think about it, and that's why I haven't posted a followup until now. But anyway....
Firing my pdoc really wouldn't be practical, mainly for reasons Shelli mentioned: getting somebody to prescribe Buprenex isn't trivial. I'm not in or near Boston, or New York, or L.A., or any large city. There is a med school here, but I've checked out the doctors there and they're *awful*: a private psychiatrist would be my best bet, but it could be months before I could see one, and even after that they might still refuse to prescribe the buprenorphine.
I have called some private pdocs to try to get a feel for their attitudes. It's hard enough even to get them to talk to me on the phone. Even if I can, I can't get a pdoc who doesn't know me to promise that they'll keep prescribing the stuff I'm already on, or even give me a general idea of their attitudes. Just making an appointment with somebody at random isn't likely to yield results, except for wasting a lot of money that I don't have. And I don't know anybody who I can trust to give me a referal to somebody who'll be sympathetic.
There are two private pdocs in town who know me. One of them is the guy I saw when I was in high school, over a period of two years. He was actually willing to talk to me on the phone for a couple minutes (this shouldn't be a marvel, but it is). He had space in his schedule when I talked to him. The other is someone I saw briefly during a few months last year. I couldn't get her secretary to ask her to call me, and her schedule is full anyway. In neither case is it certain that they'd prescribe buprenorphine, but there's a better chance than there is with someone I don't know. If the woman I'm seeing now actually refuses to prescribe things I need or something (to date, she's just been saying offensive things), I'll seriously think about talking to them. There is a money issue -- my current pdoc is seeing me at a reduced fee, but neither of the other two does does that -- and that that's why I'm hesitant to switch unless I really need to.
Some directed responses:
John:
What are the "non-standard approaches with unknown risk" that you take towards dealing with pain and insomnia? What is "the right story," in your experience? (I've always been able to get away with being honest.) And when were you a bastard? :-)Re finding another doc for the controlled drugs: buprenorphine is *hard* to get; few pdocs will agree to it without a great deal of convincing. I was actually amazed that this woman did. I think she just didn't want to make any changes. Also, the Ambien and Xanax doses are quite high. A lot of doctors seem to have trouble with the idea of prescribing 20 mg/night of Ambien, in particular. (A while back, the company that makes Ambien sent out a letter saying that, statistically, 20 mg didn't work significantly better than 10 mg but had more side effects. So I'm an outlying data point -- a concept that a lot of people, even educated people such as doctors and pharmacists, don't seem to get.)
Bekka:
I was "seeing" my previous (out-of-town) pdoc over the phone for quite a while. He's not comfortable doing it long-term. He didn't know me very long anyway (just a few months), but I did tell my current pdoc that she can call the guy I was seeing in Boston if she doesn't believe me (not the exact phrasing). Calling him myself and asking him to call her might be a good idea -- he's a really nice guy, and I saw him for several years, for talk therapy as well as meds (so it was a weekly-or-more thing, and he really got to know me). I've taken Klonopin in the past, and I'd prefer it if I were taking a benzo around-the-clock. For my purposes, Xanax is better because it starts working rapidly.fachad:
That was a particularly great post. But I beg you, don't believe that I "love" the DSM! (Sure, I cite it often, but that's just because there's no real alternative. There is the ICD, but that's not really much different.) I do think that, although DSM-IV gets the general idea of "addiction" right, it does include some criteria (like the one you mentioned) that just shouldn't be there. (The one about legal problems is also disturbing.)I think that a lot of the BS that we get from doctors regarding CSs is a result of the government's insistence on meddling in what ought to be strictly medical matters: is drug abuse a mental disorder, or a crime? And are doctors supposed to diagnose it, or find patients guilty of it? Can politicians (or their apointees) decree that certain behaviors indicate mental pathology? It's all very disturbing.
The idea about talking to my former pharmacist is an interesting one. I did go to one pharmacy pretty much all the time when I was in Boston (the only one there that took my insurance). There were only two pharmacists there, one of whom I chatted with often. I often got prescribed 20 mg/night of Ambien, and I would think the pharmacy still has the records. I don't think that a pharmacy is such a great way to prove "compliance," though, because one could always be using another pharmacy or something.
I'm not convinced that "most pdocs are rational."
Mitch (or is it Ritch?):
A lot of the problem is that she just didn't prescribe enough Xanax: she prescribed 1-2 mg p.r.n. but only gave me 20 mg each month. Most months that's okay; every now and then I need more. So as a result, one of those incidents that tend to fuel mistrust (in this case, my running out of Xanax) happened when I'd only been seeing her for a little while. I think part of it is she doesn't get that I really need to take 2 mg a lot of the time. I don't think she's going to try to force me to go off the controlled drugs, because she's started having me see her less often (next appt in 2 months instead of 1), which indicates to me that she doesn't expect me to need to make many changes in meds at this point.Kate:
I know what you mean about feeling "disgusted at myself for wimping out." I've been feeling a lot of that in the last few days! (BTW, 400 mg/day of Ativan might not be so very excessive if you're on an IV drip; I'm told that I was on 120 mg for a while when I was in the hospital in Feb 2001!) It really is weird having a pdoc question your responsibility after every pdoc you've seen before trusted you and didn't have a problem if you needed to tweak something a little on your own. Alas, I'm a terrible liar, and I don't think I could pretend to be afraid of benzo addiction and still keep a straight face.rainbowlight:
Yeah, Boston was full of psychiatrists too (there are 3 or 4 medical schools in the Boston area). What part of CA are you in? I saw a great pdoc when I was in Santa Barbara.Shelli:
I felt really validated after reading the first couple lines of your post. Thanks!You hit the nail on the head about why I can't just go find somebody else. Plus, as I mentioned, pdocs around here are such jerks about letting you interview them before making an appointment! (I think it's not really fair to demand a promise to prescribe something before they've examined you, but it'd be nice at least to get an idea of where they stand on the relevant issues.) I've actually known some very experienced pdocs who were still very petty, as well as very young pdocs who were very open-minded (is that enough verys for you?). I think it has a lot to do with the culture of the locale and of the place where they did their residency.
Seeing a pain specialist might work out. The problem, of course, is that I don't really have very severe pain! (The back pain is, well, a pain, but it's not like it prevents me from being able to function or anything. It does give me some trouble sleeping, but most docs don't take insomnia seriously enough.) I should ask my internist to prescribe something for the back pain. (He wanted me to try ketoprofen, even though I've already tried NSAIDs galore.)
BTW, trazodone and Atarax aren't controlled drugs; I wouldn't expect any pdoc (or even GP) to hassle you about those.
Bob:
I wish that anger over injustice helped relieve my anxiety! Instead, it just makes it worse. I think threatening to sue my pdoc would probably backfire. :-) But I do want to try and be upfront and assertive with her. This last time I just wasn't expecting any of this stuff -- I was speechless, as well as intimidated. Maybe I'll bring notes, like a list of points I want to make, to the next appt. (No, I'm not in the New York area; if I was, this wouldn't be happening!)Alan:
The pdoc who I saw in Boston is a psychoanalyst, and he's very concerned with confidentiality. So he took minimial notes and didn't keep a "treatment summary" or anything similar that I could hold in my hands. (Basically he makes a diagnosis and notes the times of therapy and what meds are being used. He only uses very broad diagnoses, too, and doesn't use DSM except for insurance purposes.) I'm going to call him and explain the problem, though. He's helped me a lot in the past with various things, and I think he might be able to do something here.I think one of the problems here is that this pdoc doesn't seem to believe that I know myself, how I feel, and what works for me, better than she does. :-P I'm going to try to figure out a way to convey that to her beyond all doubt. I've been looking inward and trying to understand what's wrong with me for more than ten years, and the assumptions and speculations she keeps making just seem infantile. I don't think my situation here is as extreme as the ones you described, though. She's got some dumb ideas, but she's still prescribing the stuff I need, which is the important thing; so I'm holding off on firing her for now. If she starts making real trouble, though, I'm outta there!
Posted by Elizabeth on April 26, 2002, at 19:47:13
In reply to help! (rant; advice?), posted by Elizabeth on April 19, 2002, at 1:52:57
I called my doctor in Boston. He agreed to speak with the new doc. Then I called her and she said okay, so I'm going to go to her office and fill out a release form. I think I will ask her to call me after they speak, since my next appointment with her isn't until June sometimeorother. I'm thinking of asking her if I can have a small amount of trazodone, since that does seem to work okay in the short term and doesn't cause withdrawal symptoms.
I'm still feeling nervous. I hope that things turn out okay.
-elizabeth
Posted by JohnX2 on May 3, 2002, at 3:28:40
In reply to Re: help! (rant; advice?) -- followup, posted by Elizabeth on April 26, 2002, at 19:47:13
Posted by mixedstates on May 4, 2002, at 12:41:07
In reply to help! (rant; advice?), posted by Elizabeth on April 19, 2002, at 1:52:57
> A few months ago I moved and had to find a new pdoc. She seemed pretty good at first, but it turns out that she has a lot of attitudes and assumptions that I recognize because a lot of people on PB have reported similar behavior in their (your) doctors. So I'm hoping someone here has some idea how I might approach this problem.
>
> This new pdoc wrote a prescription for Xanax as-needed, but she only gave me 10 doses per month (keep in mind that Xanax is a short-acting drug -- I think it wears off in about 4-6 hours for a typical adult). This month I ran out early and had to ask her to call in a refill. When I saw her the other day, she asked me if I'd been "overusing" the Xanax. (She said this in a way that strongly implied that she felt that I'd "overused" it the month before. The way I see it, the amount she'd prescribed hadn't been adequate.) I tried to explain that I'd been having problems with insomnia and back pain that had contributed to my need for more Xanax than the amount prescribed. Then she got freaked out and accused me of abusing it -- it's "not indicated" for those problems, and so forth. I explained that insomnia and muscle tension can be symptoms of anxiety. She gave me the generic heard-it-a-thousand-times lecture about how I should find other ways to "manage" chronic pain. (I've tried all that stuff, and besides, I don't want to "manage" it, I want to treat it!) In the end, she wrote another 10-dose prescription for this month.
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> I also told her that I'd been having problems with early-morning depression sometimes, which I speculated was caused by the last buprenorphine dose of the previous day "wearing off" overnight. I don't remember exactly how I phrased it, but I did think it should have been clear what I meant. She somehow managed to interpret it to mean that I was becoming tolerant. (She also claimed that if I was becoming tolerant, it must be because I was using it to get high. Tolerance to benzos occurs almost exclusively in the context of abuse, but this isn't necessarily true of opioids. I didn't bother telling her that, though.) I pointed out that I had said "wears off," not "stops working." She backed off a bit, but she didn't think that this problem was worth doing anything about. (I'd thought that a small bedtime dose of buprenorphine might be worth trying, but I was scared to make that request after she verbally jumped on me -- it made me feel like I didn't deserve it, you know?)
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> After all this nonsense (all in a single appointment, mind you), I was faced with having to remind her (I had told her this before) that I need 20 mg/night of Ambien, that 10 isn't adequate (I asked for a prescription for Ambien because I haven't been sleeping very well -- she put up a little resistance to this, too, of course, but compared to the other stuff, she was being very rational and laid-back!). Some background: I first took Ambien in 1996 and it has always been clear that 10 mg isn't effective, but 20 mg is (it's not like Ambien just doesn't work for me or I grew tolerant from "overusing" it or something). She insisted I "try" 10, even though I told her that she could confirm what I was telling her by talking to the pdoc I'd seen while I was in Boston. This is a big problem for me because I don't have another appointment for two months; sleeping fitfully and inconsistently for that long is bound to have nasty effects. This pdoc talks about wanting to see functional improvement from the medication, but she doesn't seem to want to do what it will take to bring about that improvement.
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> I don't abuse or misuse or overuse any drugs, including psychiatric medications; and I've always been responsible about my use of medications, in particular of those prescribed for as-needed use. So the way my new pdoc has been acting is naturally off-putting -- it's clear she's just assuming that I'm up to no good, for some reason. (What that reason might be is a mystery to me: I've *never* gotten this much crap about supposed "drug abuse" from any doctor I've seen.) How am I supposed to deal with this woman??? I want (and need) her to trust me, but she seems bent on mistrusting me. What can I do/say?
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> Any ideas?
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> -elizabethElizabeth, I am so sorry to hear about this awful situation. Also sorry for my tardiness in responding as I have been away. To begin, donot let your new pdoc make you feel bad. You are extremely bright and very articulate. Your eloqquently written posts are always a great help to me especially your maoi posts, as i am an maoi user. It is unfortunate that your pdoc is not allowing you to be a partner in your treatment plan. I find that totally unacceptable in the treatment of bipolar which can be so unique from patient to patient. I am very glad my doctor allws and encouurages my involvement. I also use ambien and my pdoc put me on 20mg right from the get go as he said the standard 10mg would not work. He also said that when I am cycling and with mixedstates that I may need 2.5 or 5mg of zyprexa and he let me decide the dose as only I would no how it worked best for me. I also take xanax as anxiety is a large issue for many bipolars(your doc should have been sensitive to this). my doc lets me take it prn but allowed me to give him my estimate of how much I need each month. I know you will "hold your new pdocs feet to the fire" and make her let you partner in your treatment. Again your words and info have meant much to me and I wish you the very best.
mixedstates@msn.com
Posted by Elizabeth on May 6, 2002, at 14:48:09
In reply to Re: help! (rant; advice?), posted by mixedstates on May 4, 2002, at 12:41:07
Hi mixedstates. Thank you for your kind words. I'm not bipolar -- did I say something that made you think that I was? -- but I often have episodes of various types of anxiety and/or psychomotor "jitters." Often I wake up in the morning feeling jittery, and if I don't do something about it, it can stay with me for the entire day. I don't think it should be necessary for me to take a benzo around the clock, since this doesn't happen every day or even every other day. Xanax starts working very soon after taking it (I notice some improvement within perhaps 15 minutes), so I can use it as-needed and not be impaired much by the anxiety episodes.
I'm just not used to doctors being very suspicious, closed-minded, etc., even though I realize that most doctors (most people in general, really) are like that. For several years I was seeing a guy in Boston who was very cool. He knows me very well because I saw him weekly for talk therapy, not just "medication management." I called him up the other day and explained my current difficulties, and he agreed to talk to the pdoc who I'm seeing now. Maybe he'll be able to reason with her. :-}
My former pdoc said that although the labelling says the recommended dose of Ambien is 10 mg/night, there are really a lot of people who need more. He knows that I needed 20 because he prescribed it for years.
I'm still weirded out that this new pdoc seems to be basically accusing me of abusing my medication (the way I see it, she just is too stingy), but hopefully with some help from my ex-pdoc I can straighten out the situation. Again thank you for your encouraging post.
-elizabeth
Posted by kj on November 15, 2002, at 0:41:18
In reply to Re: help! (rant; advice?), posted by JohnX2 on April 19, 2002, at 3:09:33
Ok, dumb question! I came online looking for information about Lexapro. It's my first experience with anti-depressant medication. I'm suffering severe depression and thoughts of suicide as a result of methamphetamine withdrawl. I just started the medication today, so I can't offer any opinion on it yet. But I was reading this thread, and can't figure out...what is a pdoc? Like I said...dumb question.
Posted by IsoM on November 15, 2002, at 1:20:05
In reply to Re: help! (rant; advice?), posted by kj on November 15, 2002, at 0:41:18
This is the end of the thread.
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