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Help With Getting A Second Opinion


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Hi gang, I've been away from the site for a bit, but I'm back and I have a question I'd imagine someone here could help me with. (before i start, props to Jewy and Heisenberg for making this board everything that it is now.....when I left here a few months ago, this place was in dire need of people who could step out and lead the way. I suspect many of us are in their debt).

Ok, so I have DDD of L4, L5, and S1 from a car wreck. It can be quite painful, and I've gone to two spine specialists. To make a looooong story short, I ended up having kidney stones this past summer which required 2 surgical interventions and a month of recovery time to get over. During this period, the specialist I currently go to drug tested me, and even though I informed them that I had been prescribed opiate painkillers from some one other than them, they still essentially said I was a drug seeker and now will not prescribe me anything but suboxone.

I tried to manage my pain with the suboxone, but as of the last two weeks I've come to realize that, given the pain I frequently find myself in, suboxone just isn't a good option. Of course, given my status at my current doctor, any time I have brought this up recently is taken as a junky cry wolf sort of moment. It's supremely irritating to pay some one twice a month to essentially do nothing for you.

So, my question. I'd like to pursue other options, but I'm not sure how to do this. If I were to have my records taken from my current doctor and given to a new one, I'm fairly certain that they would read them and either refuse to see me or only prescribe me suboxone or trams. Neither of these drugs have ever helped my pain in the past...I wish they had DhC continuous here in the states, because I feel like that would by far be the most effective for my pain, but alas....

Anyway, back to the point: do I have to let any new doctor know that I have been previously in the care of another doctor and then subsequently hand over files from previous doctor? I have a copy of my MRI in my possession, so I can imagine that I don't have to give a new doctor anything but that. Nevertheless, I am extremely wary of the law, and do not want to be caught (or even seen as) doctor shopping. My profession is such that I would probably be fired upon arrest or even suspicion of this type of (possibly) shady dealing. That said, I also don't believe in having to live in pain, either...

So what's a guy to do? Any feedback, stories, experiences are welcome...I am a legitimate pain patient who is seriously trying to do the right thing whilst not living in pain.

(I'm sorry if any of this post doesn't adhere to forum rules...please let me know if it doesn't and I will adjust it accordingly).

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Hey Jsarus - I'm new but do have some experience with this. I also have a spinal injury and see an orthopedist quarterly for steroid injection and a prescription. I recently had to be transferred to a

Jsarus,    I am so sorry that your struggle is such a common one for people who really just want to live in something less and better than constant misery!   I will tell you I have avoided PM docs

You know how we do fam! It's how we roll here at DBG and Jewenberg's Beach Bar & Pharmacy!

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Aunt Pitty Pat

Hey Jsarus - I'm new but do have some experience with this. I also have a spinal injury and see an orthopedist quarterly for steroid injection and a prescription. I recently had to be transferred to a different doctor in the group. He's considered the pain management doc. I had to change because my doctor had his prescription priveleges questioned because he was not doing the proper record keeping for his patients.

A doctor shopping patient was caught filling too many prescriptions and my doctor was one of her prescribers. This prompted an investigation of all of his patients and they found several doing the same doctor shopping. All of the doctors visited by these patients lost or had prescribing priveleges limited. My doctor was in no way a pill mill vendor. He's one of the most highly regarded back surgeons in the region. He just was shitty at record keeping.

So to make a long story short it really depends on your state. You should google something like drug record keeping and your state and see what comes up. My new doc is great. As long as I let him know of any prescription I have besides his it's ok but every quarter now I have to pee in a cup and my prescriptions and records are backed up to a file in my state. My states laws are not all that conservative on this issue either.

If I were you I'd start looking for a new doc but tell them the absolute truth about everything. I know it's really hard but you just have to suck it up and do it. Remember it's their job to help you. You may have to see several before you find one. Also I wouldn't request my records from my current doc until I was sure that I had a new one. One of the worst things that could happen is that your current doc drops you because he/she thinks you are looking for another who will prescribe what you want.

Good luck. I hope it works out for you. It's totally terrifying thinking about not having access to meds you need, going through withdrawl and feeling intense pain.

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Thanks so much for the feedback..I'm still really on the fence about being totally honest, because in my experience once a doctor sees you as anything even resembling an addict they immediately not only refuse to write you a prescription, they also dont see your claims to be in pain as even remotely legitimate. But in principle I agree with you: Honesty should be the preferred policy when dealing with your doctor.

I guess I'm also wondering about legality, etc. What exactly constitutes doctor shopping? Or is it one of those lovely "I can't tell you what it is, but I know it when i see it" kind of laws that wreak such havoc on our judicial system in the USA?

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Aunt Pitty Pat

I hear ya but it sounds like you are kind of already in that position anyway right? Do you have records of the kidney stone stuff? No doctor in their right mind would call you a doctor shopper for having that taken care of. My husband gets them every now and then and I can't stand to watch him in that kind of pain. He usually ends up in the er with dilly in the IV. I think if you have your MRI and the kidney stone documentation you should be good.

I think what constitutes doctor shopping is getting and filling controlled scripts from multiple doctors for the same condition for the same type meds. I think if try to find another pm doc and don't tell them about the previous one and get caught you might have trouble finding another who will treat you. It's not fair. If you have legitimate health problems you shouldn't have to deal with this but I guess it's the nanny state we live in today.

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DorothyZbornak

I would have to agree with Aunt Pitty Pat - I would bring in any documentation that you have regarding the Kidney Stone situation. Even if you might not have any that the doctor gave you, should have some on your insurance website - as far as claims go and whatnot - that you could print out.  Also, they most likely would have had to have done an MRI or X-Ray to see that you had the stones, right?  Perhaps you could go back to where you had that done and get a copy to show the new PM doctor.  Documentation could be your best friend in this case. 

 

I also agree that kidney stones are no joke - I get them more often than I would like to admit - and have been doing so since I was 20.  My last go-round was 2 weekends ago.  Ugh.  I've had lithotripsy's and have had them surgically removed - I would almost prefer to have them removed of the lithotripsy - that procedure beat me up pretty bad - although I had 7 stones in each kidney, so there was a lot of breaking to do!

 

The new doctor should be able to look back at your past prescriptions (of opiates) that you had filled at that time to see that you were only getting filled what you said that you were getting filled.  Most (if not all) states have a database that they can check into regarding your Schedule Prescription History. 

 

Good luck and I hope that you are able to find someone that will work with you fairly.  That is what they are (supposed to be) there for, right?  Riiiiiiight.

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So if I try to go to a new doctor with just an MRI, pretending to have never seen another PM doc,I could conceivably be banned from all doctors in my area? (I'm pretty sure nothing I'm doing or will do will qualify as doctor shopping...I'm just afraid my new doc would be biased from what s/he sees from my current doc).

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Jewbacca

I'm sorry to hear about this quandary you find yourself in Jsarus. After reading over your account of the situation, as well as some other members' comments / suggestions, I'd have to concur with those who are advising you to take the fully transparent route when visiting a new PM doc. As has been pointed out, most states have a prescription database, and while I can't speak to every PM doc's policies and procedures, I do know several personally in my state, and both of them cross reference the state database for prior opiate prescription fills as part of their "on-boarding" process with new patients, so if I were a betting man, I'd put my money on the notion that they would discover your kidney stone related opiate prescriptions, as well as your prior prescriptive history with your former PM doc.

 

While I'm the last guy who you'll find defending PM docs, given my long and storied history with same, I just think that in this situation, the odds of you getting lucky enough to find a new PM doc who will not conduct due diligence and discover your prescriptive history (presuming, of course, that your state has such a database), and who will then prescribe opiates for your kidney stone situation (at least on an on-going basis) are just pretty long and a fairly poor gamble. Despite the propensity of PM docs to label people as drug seekers, I have to agree with several other members who have said that they have a hard time believing a PM doc would label you a doc shopper if you walk in the door with a fully documented medical history in hand, inclusive of the kidney stone nightmare. I absolutely, positively understand your reluctance and concern, as it's perfectly reasonable. However, at the end of the day, I think your chances of receiving the care you need and desire are much greater with full, well documented disclosure as opposed to an in-office interaction involving only selective factual disclosure. And as for being banned from other docs in your area, I believe the chances of that happening are very, very low, so long as you are 100% transparent and truthful with the doctor. Even if they aren't willing to provide the type of care you're looking for, I think you could thank them for their time and move on to another without them having any desire to ban you from local PM care and label you a doc shopper. On the other hand, should you only provide them with half of the story, only to have them find out the rest in the course of whatever due diligence they ultimately perform, then I believe the risk of such a "ban" would be far greater.

 

So, in summary, if it were me, I'd go the full-disclosure route, lay it all out on the table and see how it goes. Despite my personal disdain for the current state of chronic pain care in the US, I have known enough doctors in my time (including my own mother, who just retired as medical director at a detox clinic) to know that most will at least appreciate your honesty, even if they lack any semblance of a personality, aren't all sh*ts and giggles, and ultimately refuse to provide the care you desire. Of course, as always, that's just one Wookie's opinion, and your results may vary.

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Jsarus, 

 

I am so sorry that your struggle is such a common one for people who really just want to live in something less and better than constant misery!

 

I will tell you I have avoided PM docs for my own personal reasons; so I cannot say for certain what I would do if in your exact position.  My first and last referral to a PM clinic caused me to wait in pain (waiting for... what?  I did not know).  I just made the choice to not go there (physically and figuratively) 

 

I did find a personal referral (just a person in my community who was kind and wanted to share her good experience with others) for a specialist who I waited nearly 90 days to see.  He was willing to prescribe fairly useful scheduled items in the earlier stages of his inspection and review of me and my condition.  I came with most of my recent records from a specialist; new doc. was mostly interested in diagnosis and base line labs, as well as any maintenance meds that had/had not worked. Perhaps it was not a PM doc I had come from, he did not overly scrutinize ANYTHING except ME over the course of time.

 

I was honest with this doctor in my reason for being in his office as a new patient.  I was not receiving any willingness from my previous specialist to treat me as an individual; I was told my progressive treatment steps upon meeting the old specialists. Simply, "We are starting you on XYZ, if it does not work, we will put you on ABC as well as XYZ, I do not prescribe Narkotiks, I'm sorry you are telling me you are troubled by some of the side effects of ABC, you shouldn't be.  See you in 3 months. Did I answer all of your questions and provide you with the best possible care today?" 

In my mind: I pictured my bottom jaw banging the floor over and over again as I listened to this very obvious "one GIGANTIC poorly designed, UGLY, polyester size fits all MY PAITENTS" approach.

 

I spent a great deal of energy being anxious about my first meetings with this new doc and found that over a period of weeks/months if I put in the time and efforts to be patient with his best efforts (which really spread over months and months and some failed treatments) he saw that I was not in for a short haul, quick payout, but interested and willing to be patient with him.

 

After 8 months of half successful maintenance treatments and ongoing scheduled refills; he looked me in the eye and said he was worried; thought I should seriously receive a 2nd opinion and shared his mild concern about my scheduled use.  He asked me to TRY to not lean so heavily on these meds.  I left feeling really horrible and as if I had ruined a good relationship, but didn't know how else to describe that every attempt thrown my way WAS a "fail" at least for me.

 

I'll be frank, at that point, I made the decision to protect the relationship and the sometimes access to his scheduled script, over losing all the time and hopeful trust he had built up in me.  I stopped looking to him for any prescriptions that would flag further concern (and landed here).

 

When I returned to him recently for a non-maintenance check up (meaning I was in considerable pain), he inquired about my use of the scheduled meds he had been prescribing and I answered "none" as I was not taking that medication he had last shared concern over.  He said with surprise, "Good, because that has been shown to sometimes exacerbate long-term pain"  He continued through the examination and at the end; surprised me with, "I know I said that I was glad you weren't using any XXX, as it can lead to rebound pain in some people.  But, do you want some anyway?" My answer in that moment wanted to be a firm "YES, HELL YES", however, I went with a more docile "It's up to you, I will follow your lead."  His lead ended well in this instance.  I think I gave him the sense that I was willing to lose the opportunity in an attempt to follow his original direction and respect his concerns.  He also was human in that moment, unable to be only callus and concerned about my scheduled use to my visible pain.

I left with a larger qty. and mult. refills, more than any other time previous.  

 

It gave me a perspective that I did not think I wanted to have, but that may have value in some instances.

 

I believe the system we all voice disillusion with IS BAD in nearly every way; I don't enjoy or feel any personal empowerment going into an office feeling that I am a backseat passenger on a vehicle owned soley by ME.  

 

I may have developed an idea of what has worked best for my body and over the course of many failed treatments, but I am still patronizing a doctor for his/her expertise as well.  I have found (and it could be age, gender, ethnicity, geographical location, religious beliefs, fear of Dee-EE-A scrutiny) or ALL of the above, can play into why you receive certain treatment in a doc. office.  

 

I am saying that the angle I have taken here, seems to be a long winding path, but at this time it is a relationship that I have chosen to nurture in a way, where I communicate that I have and expect some mutual respect for this person who I have expectations of.

 

Also, I often think that a doc. having some base line (aka getting a chance to see their patient NOT in pain at each visit) can be a powerful memory.  If this memory is left in their minds the next time they see you,  whether in pain or not, it may give them some sense of having a shot at helping you in general. (this may upset some people as I realize how impossible this can be to do)

 

(I have faked being pain free/in little pain in his midst).  

I get the sense that some docs. become worried and frustrated that they cannot heal or manage someone's pain and also can't help to hear the whispers of the DEE.a threats)

 

I appreciate now my docs. mention of 2nd opinion; in the moment, it only added to my feelings of "getting caught" and made me feel that it was him wanting to pass me on for someone else to deal with (and it may have been exactly that in that moment) OR it may have been that he was questioning his ability to serve me as he was others and in a way that I deserved.

 

I suppose what I am describing (and only what is working for ME at this point in life) is a very simple, pick your battles whenever possible and make as many allies and as few enemies (even if it hurts ego or actual body parts) and ONLY if you think that you can live with yourself this way.

 

Telling or showing someone you consider them an ally DOES NOT necessarily mean that you support, agree or like a darn thing about them, but it may mean that you have found some value in their believing they are your ally (this can be powerful and to your benefit in some end results)

AGAIN, only my opinions and experience.

 

I do hope so much that you can find a way into a better situation even if and knowing that it will likely cost you a considerable amount of time and pain. (for this I am so sorry)

 

Take Care, 

Beranda

 

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This response is why I am back on DBG.....

I cannot thank you all enough for the helpful advice. I think that I will follow it to the letter and opt to fully disclose my medical history to my new doc (whoever that may be). My gut feeling is that it will more than likely be a struggle to find an ideal situation, but there is truly something to be said for coming to the table honestly and in good faith.

Thanks to everyone who took the time to consider my problem. I feel truly blessed to have this support.

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Jewbacca

This response is why I am back on DBG.....

I cannot thank you all enough for the helpful advice. I think that I will follow it to the letter and opt to fully disclose my medical history to my new doc (whoever that may be). My gut feeling is that it will more than likely be a struggle to find an ideal situation, but there is truly something to be said for coming to the table honestly and in good faith.

Thanks to everyone who took the time to consider my problem. I feel truly blessed to have this support.

 

You know how we do fam! It's how we roll here at DBG and Jewenberg's Beach Bar & Pharmacy!

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opiated999

In this day & age PM Doc's first thing they do is run your name through the data base. That's why You sign so many disclosure forms, releases etc. As Jewy said they fill find out everything, even if it's a few months down the road. God knows I've been through so many consults, for insurance related more then medication, The difference bettwen now & say 1996-2002 is 180 degree shift in the willingness of any M.D. to actually listen & try to just be fair, w/ out trying to add a bunch of what I call "toxic pain meds" or anti elipetics or anti depressants. I wish You well & good luck. Opiated-

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Aunt Pitty Pat

Also Beranda is 100% correct. I'm here because I don't want to ruin the regular inadequate prescription I get from my current doc. I won't ask for anything unless he prompts the conversation because at least I have what I have. If I got dropped I would be screwed. Also I would be worried less about the kidney stone and more about the PM doc. Above all do NOT ask for your records until you are ready to move. The last thing you need is to find yourself with no doc

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kittykat

 

Jsarus, 

 

I am so sorry that your struggle is such a common one for people who really just want to live in something less and better than constant misery!

 

I will tell you I have avoided PM docs for my own personal reasons; so I cannot say for certain what I would do if in your exact position.  My first and last referral to a PM clinic caused me to wait in pain (waiting for... what?  I did not know).  I just made the choice to not go there (physically and figuratively) 

 

I did find a personal referral (just a person in my community who was kind and wanted to share her good experience with others) for a specialist who I waited nearly 90 days to see.  He was willing to prescribe fairly useful scheduled items in the earlier stages of his inspection and review of me and my condition.  I came with most of my recent records from a specialist; new doc. was mostly interested in diagnosis and base line labs, as well as any maintenance meds that had/had not worked. Perhaps it was not a PM doc I had come from, he did not overly scrutinize ANYTHING except ME over the course of time.

 

I was honest with this doctor in my reason for being in his office as a new patient.  I was not receiving any willingness from my previous specialist to treat me as an individual; I was told my progressive treatment steps upon meeting the old specialists. Simply, "We are starting you on XYZ, if it does not work, we will put you on ABC as well as XYZ, I do not prescribe Narkotiks, I'm sorry you are telling me you are troubled by some of the side effects of ABC, you shouldn't be.  See you in 3 months. Did I answer all of your questions and provide you with the best possible care today?" 

In my mind: I pictured my bottom jaw banging the floor over and over again as I listened to this very obvious "one GIGANTIC poorly designed, UGLY, polyester size fits all MY PAITENTS" approach.

 

I spent a great deal of energy being anxious about my first meetings with this new doc and found that over a period of weeks/months if I put in the time and efforts to be patient with his best efforts (which really spread over months and months and some failed treatments) he saw that I was not in for a short haul, quick payout, but interested and willing to be patient with him.

 

After 8 months of half successful maintenance treatments and ongoing scheduled refills; he looked me in the eye and said he was worried; thought I should seriously receive a 2nd opinion and shared his mild concern about my scheduled use.  He asked me to TRY to not lean so heavily on these meds.  I left feeling really horrible and as if I had ruined a good relationship, but didn't know how else to describe that every attempt thrown my way WAS a "fail" at least for me.

 

I'll be frank, at that point, I made the decision to protect the relationship and the sometimes access to his scheduled script, over losing all the time and hopeful trust he had built up in me.  I stopped looking to him for any prescriptions that would flag further concern (and landed here).

 

When I returned to him recently for a non-maintenance check up (meaning I was in considerable pain), he inquired about my use of the scheduled meds he had been prescribing and I answered "none" as I was not taking that medication he had last shared concern over.  He said with surprise, "Good, because that has been shown to sometimes exacerbate long-term pain"  He continued through the examination and at the end; surprised me with, "I know I said that I was glad you weren't using any XXX, as it can lead to rebound pain in some people.  But, do you want some anyway?" My answer in that moment wanted to be a firm "YES, HELL YES", however, I went with a more docile "It's up to you, I will follow your lead."  His lead ended well in this instance.  I think I gave him the sense that I was willing to lose the opportunity in an attempt to follow his original direction and respect his concerns.  He also was human in that moment, unable to be only callus and concerned about my scheduled use to my visible pain.

I left with a larger qty. and mult. refills, more than any other time previous.  

 

It gave me a perspective that I did not think I wanted to have, but that may have value in some instances.

 

I believe the system we all voice disillusion with IS BAD in nearly every way; I don't enjoy or feel any personal empowerment going into an office feeling that I am a backseat passenger on a vehicle owned soley by ME.  

 

I may have developed an idea of what has worked best for my body and over the course of many failed treatments, but I am still patronizing a doctor for his/her expertise as well.  I have found (and it could be age, gender, ethnicity, geographical location, religious beliefs, fear of Dee-EE-A scrutiny) or ALL of the above, can play into why you receive certain treatment in a doc. office.  

 

I am saying that the angle I have taken here, seems to be a long winding path, but at this time it is a relationship that I have chosen to nurture in a way, where I communicate that I have and expect some mutual respect for this person who I have expectations of.

 

Also, I often think that a doc. having some base line (aka getting a chance to see their patient NOT in pain at each visit) can be a powerful memory.  If this memory is left in their minds the next time they see you,  whether in pain or not, it may give them some sense of having a shot at helping you in general. (this may upset some people as I realize how impossible this can be to do)

 

(I have faked being pain free/in little pain in his midst).  

I get the sense that some docs. become worried and frustrated that they cannot heal or manage someone's pain and also can't help to hear the whispers of the DEE.a threats)

 

I appreciate now my docs. mention of 2nd opinion; in the moment, it only added to my feelings of "getting caught" and made me feel that it was him wanting to pass me on for someone else to deal with (and it may have been exactly that in that moment) OR it may have been that he was questioning his ability to serve me as he was others and in a way that I deserved.

 

I suppose what I am describing (and only what is working for ME at this point in life) is a very simple, pick your battles whenever possible and make as many allies and as few enemies (even if it hurts ego or actual body parts) and ONLY if you think that you can live with yourself this way.

 

Telling or showing someone you consider them an ally DOES NOT necessarily mean that you support, agree or like a darn thing about them, but it may mean that you have found some value in their believing they are your ally (this can be powerful and to your benefit in some end results)

AGAIN, only my opinions and experience.

 

I do hope so much that you can find a way into a better situation even if and knowing that it will likely cost you a considerable amount of time and pain. (for this I am so sorry)

 

Take Care, 

Beranda

 

 

Very Very well said my friend :)

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Thanks KK!

Were you able to get through the whole saga without a trip to replenish your popcorn or go to the bathroom...

Some people just can't adhere to the K.I.S.S. method every time.  

I'll try not to make it a habit.

Take Care, 

Beranda

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Heisenberg / HNB

Also Beranda is 100% correct. I'm here because I don't want to ruin the regular inadequate prescription I get from my current doc.

QFT.  This is the exact reason I ever found this forum in the first place.  Well for anxiety meds in my case, but you hit the nail on the head here.

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