quincy
Board Addict
Reged: 11/07/02
Posts: 333
Loc: pacific northwest
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OK- Im finally going to a PM doc. The problem is I don't know how to act. I could be myself, a young woman who works in healthcare, knows alot about my disease and medicines and who generally is very direct. Or else I could act like a young ignorant woman who is in pain and really dosen't know what to do. You know what I mean, go through the whole ignorant patient act. The receptionist said on the phone that the visit would last over an hour, as the doctor would really find out a detailed history from me, myself as I saw it. I sent over some medical records, but she said the doc (an osteopath) likes to talk for a long time and get the whole picture. I think this sounds great, but I don't know how to act. Which usually works the best in order to get help? I guess it depends on the doctor. I know this sounds manipulative, but I have different working relationships and personalities with different doctors. My woman PCP is great, she appreciates my medical training, although I do act kind of ignorant when it comes to narcotics, like I don't have much experience with them. With my rheumatologist I acted like a lost little girl, sometimes crying even. I wasn't faking it, but I was in so much pain and frustrated that he didn't take me seriously. I just want this new doc to take me seriously. He will most likely be a big part of my life for awhile and I want to do this right. I need advice on how you all act with your PM docs.
Sarah 
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oldnavy170
Board Addict
Reged: 05/12/03
Posts: 357
Loc: New York
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The truth goes a long way! Just tell him how you feel and don't play the dumb girl act! Good Luck. 
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TLT
Board Addict
Reged: 10/21/02
Posts: 358
Loc: loc. usa
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I agree with oldnavy,
"Honesty is the best policy"!!
I will tell you that I struggled with this exact dilemma when I first went to see my PM DR.
I was previously going to a methadone clinic before seeing him. I did not want ot reveal this to him b/c I was afraid of what he might think of me. They made me sign an agreement with them, and doing so meant that I must be completly honest with the Dr at all times.
I decided to tell him, afterall it is illegal to lie to your Dr to get narcotics, so I told him everything, the reason I was going to meth clinic was b/c, ny GP, told me that I had no signs of injury to my back, this is after he kept me on vicodin for 2 years before kicking me to the curb.
I also told him that I debated whether or not to be honest with him about this, due to all the stigma associated with the clinics.
He really appreciated my being candid with him, and told me that he would had found out, since at the end of our session, he was going to submit me to urine test. Then when they found the methadone, I would had been dismissed from his care.
He also said that my previous dose of methadone was 100mg a day, and he had to give me something that would be eqaul to it, so had I lied to him, the normal dose he starts his pts out on, is 20mg morphine per day. That would had set me off in w/d,s, he did end up giving me 200mg morphine per day, and at the end of our session, he again shook my hand and thanked me for being honest!
I know that your situation is somewhat different than mine, but, I still believe that being honest always pays off in the long-run!!
I wish you all the best!!
Terri
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"RUDENESS IS THE WEAK MANS IMITATION OF STRENGTH"
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537
Threadhead
Reged: 12/08/01
Posts: 753
Loc: west coast CA
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I also have a question about my first PM doctor visit. Will I need to tell him about the extra hydrocodone I've been ordering online? My family doctor gives me a small script of 5 mg vicodin each month, but I've put myself on sometimes up to 15 mg at a time, 3 times a day because of the back pain. So, do you all think the PM doctor would find out through a drug test the extra hydro I've been taking?
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quincy
Board Addict
Reged: 11/07/02
Posts: 333
Loc: pacific northwest
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Yeah;
I was wondering about that too. I do have old scripts for hydro, which I keep around for exactly this reason, but what about the Valium? I guess I will have to stop taking it a few days before the appointment. I beter go look up the half life of it and figure out how long I need to abstain.
Sarah 
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pygmalion
Member
Reged: 08/23/02
Posts: 130
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First, PM docs have heard it all & seen it all. They've heard every story in the book and I'm sure when he spends that hour with you, he will try to determine what exactly you're there for. Playing "dumb" is generally not a good idea. Again, the doctor has probably heard that whole routine a million times. Just be honest and tell him how the pain affects your life, what level the pain is at and what you expect to get out of this treatment. You want relief, plain and simple and that is what the PM doc is for.
He will ask you what treatment you've tried in the past, all the doctors you've seen for this condition and medications you've tried. Depending on your situation, he might not prescribe anything right off the bat. He might order you to try some alternative treatments before resorting to opiate therapy. Again, this all depends on your ailments.
Don't tell the doc you buy pills off the internet! That will probably end the session right there. BUT, when you first sign up for treatment with a PM doc, you will have to sign a very strict agreement stating that you will not obtain narcotics from any other doctor, can only use one pharmacy to fill all your prescriptions, never take more than prescribed amount unless you first talk to the doctor, and in some cases, this agreement will state that you might have to come in with your medication to show them that you have not been taking more than precribed, e.g. count your pills. You really have to be disciplined, but more important, honest with the doctor and phone him immediately if the meds aren't working. Never take more than prescribed because they can and will terminate treatment.
PM treatment is a serious thing, but to get the results you want, you have to be honest and forthright, and also not use OPs anymore. From what I hear, if you get the right doctor, you will get exactly what you need to manage your pain. Good luck!
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toe
Pooh-Bah
Reged: 10/09/02
Posts: 1422
Loc: MidWest USA
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How often do you get to see a PM doc? I have a back specialist who is not a bad guy but I only get to see him every few months, he takes days to get back to me, etc. (Don't tell me to change docs, I'm in a PPO and lucky to seee him at all) So he cannotprescribe and titrate my meds. He had my completely ignorant (about C-IIs) doctor start me on the MS Contin and it is like NOTHING.
When I told my pain doc I wished I had someone I could see more often he said I could try PM but I swould have the same scheduling problems. The doc who was covering for my regular doc refuses to raise my script from 2x30 MS COntin a day and the regular won't be back until the 22nd!
Sorry, OT. Look, there. I stopped myself.
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"It's the end of the World as We Know it. . ."
-REM "and I'm seeking asylum in Canada"-toe
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quincy
Board Addict
Reged: 11/07/02
Posts: 333
Loc: pacific northwest
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Yeah, I guess there is no point in acting ignorant anymore. I have been dealing with this disease for almost a year, read every book, researched and tried tons of meds and have already and am currently on opiate therapy. Basically I need him to decide what med is right for me and at what dose. I have decided to make a list of what I have tried, start a pain log, and a medication log. I will also stop the meds I ordered from the OP earlier this month in case of a drug test. I work in healthcare and know a lot about all different kinds of meds, not just narcotics, I know a lot about different diseases and Im not going to play "stupid, helpless" female. Im going to tell him that I feel bad because I am in pain all day, I am barely holding onto my job, my life is a mess, etc. I don't think he will stop my narcotics if Im already on them from my PCP> When I made the appointment I told the receptionist what I am taking and that my PCP wants a aPM doc to take over. So I don't think I will have to worry about that. As for OP's - I will be glad I don't have to use them!! TOO Expensive for me!
Sarah
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Jeremiah
Agape GrandParent
Reged: 07/14/02
Posts: 705
Loc: U.S.A.
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Hi Quincy!
I understand your concern. Kinda dont want to say the wrong thing which may prevent your getting help. But you know what?
In the medical field,especially those who specialize,they have something like a sense about people called "the ring of truth".
I guess over all the years,they develop this and can tell fairly quickly if a patient is being dishonest or holding back vital information. Not good. My opinion,from seeing many professionals,is tell the truth. It may help you more than you realize right now.
Try not to worry,ok?
J.
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I can't see me lovin nobody but you,for all my life
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quincy
Board Addict
Reged: 11/07/02
Posts: 333
Loc: pacific northwest
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Thanks for all the advice guys. Im going into my PCP today for an emergency visit. I was in so much pain yersterday that I couldn't get out of bed. I have also been nauseaous and having severe headaches. I see the PM in 10 days, I hope she will give something stronger until then. I hate to ask her, but the meds IM on SIMPLY DO NOT WORK ANYMORE! I can't stay in bed all day, and keep calling in sick. I was told to resign yesterday by my boss when I called in sick AGAIN, so my job is in real jeopardy. I am going to tell her straight out that I can't take this level of pain and that I need more. I don't care if she thinks I am a drug seeker and Im going to say this to her up front. Well, Im off to see her right now. Wish me luck that she will help me.
Thanks All
love,
Sarah
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quincy
Board Addict
Reged: 11/07/02
Posts: 333
Loc: pacific northwest
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Ok, just got back from the doc. She is really great, but rather ignorant about the medications. She prescribed more Hydro, but just hydro with no APAP. 5mgs with no APAP. I can't find it in any pharmacy!! Now why didn't she just give me some norco or something?? Im waiting for her to call back, I want to say like: maybe one of the ones with 10/325? Thats what my mom takes for her fibro...or something like that. Its unbeleiveable how ignorant some docs actually are about medications!! I hope the PM realizes this and will correct the problem. I would have just rather increased the methadone. Its longer lasting and works better.
Sarah
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LumbarSpasm
Silent Chaos
Reged: 05/07/02
Posts: 1538
Loc: USA
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I bet she meant to rx oxycodone with no APAP.
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LumbarSpasm
Or just a pain in the butt?!
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quincy
Board Addict
Reged: 11/07/02
Posts: 333
Loc: pacific northwest
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No, I don't think so. I recently had a kidney stone and got some oxy, but she didn't want to prescribe that because she said it was more addicting??!! She dosen't know a whole lot about medicines, I know more but hesitate to speak up. I called her and told her that they didn't make that, but a pharmacist recommended Norco and she called it in. She is real hesitant to prescribe schedule II's. Thank God Friday is only 3 more days. I am already finished with the norco and am relying on my old stash of 5/500 of which I have to take like 5 at a time. I might try an extraction so my liver dosen't fall out. God I hope I can get something that works from this guy!!
Sarah
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Jordan530
WonderWoman
Reged: 11/20/02
Posts: 597
Loc: The Left Coast of Florida
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Quincy, I was thinking about you yesterday and wondering how it went on your first visit to your PM? I know you were so worried about it. Please keep us posted and I hope it went well.
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'A balanced diet is a cookie in each hand'
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Daycamp72
Enthusiast
Reged: 06/29/02
Posts: 283
Loc: Tara
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OK, guys. Answer me THIS one. I have an appointment set up Aug. 7 with a pain doc. My FIRST. I do agree with everyone about being honest. However, HOW do I explain my tolerance to hydro to this doctor and the amount I have to take to control my pain (since I order hydro from an OP?)
Pyg, my goal is to get on a system with this pain doc and NOT order from OPs any longer. I'll save a bunch of $$$.
If I told him exactly how much I took and what I took, the next logical question from him would be, WHERE DO YOU GET THE TABLETS?
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