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Suggest Treatment For Diverticulitis And Spinal Degeneration
Question: How does a person get a doctor to listen to them within the 6 or 7 minutes of actual contact? The last two or three decades of office visits have been essentially that the MD walks in, looks at my age, gender, etc. considers the common problems of someone my age, gender, et al. After the MD tells me that the appointment time limit has been met they walk out and code a XXXXXXX to Medicare - often incorrect.
In the meantime, not one of my issues such as multiple levels of spinal degeneration, diverticulitis with complications, SVTs, et al is ever addressed. Nor, are all the errors electronically transferred to my medical record such as a broken arm - I have never had a broken arm, etc. I now find the only treatment possible is to wait for s/s to become extreme and hopefully pick a good and costly ER.
In the meantime, not one of my issues such as multiple levels of spinal degeneration, diverticulitis with complications, SVTs, et al is ever addressed. Nor, are all the errors electronically transferred to my medical record such as a broken arm - I have never had a broken arm, etc. I now find the only treatment possible is to wait for s/s to become extreme and hopefully pick a good and costly ER.
Brief Answer:
Not all doctors are the same as you describe but I hear what you say
Detailed Answer:
Good morning and thank you for choosing to ask your somewhat NON-medical questions but still relevant I believe on this network. I hear what you're saying and understand why you feel the way you do. For the most part I do believe that many patients are not "listened to" and that far too many "diseases are treated"...or THOUGHT to be treated by doctors without taking into account the important detail of treating the person as more than just their ailment or disease. The treatment process should ALWAYS include identifying not just the problem which the patient NOTICES and brings to the table but other things they may not notice or may have importance and must be treated concomitantly. The treatment process should always include a thorough examination and appropriate testing to get to a diagnosis...not more than needed, not less than needed but the right amount. The treatment process should then, involve the collaboration with the patient and preferably family (if possible) in listing options to take care of the problem which can range from NO ACTIVE INTERVENTION ("benign neglect" is what I sometimes like to call it) all the way to a multifaceted, multidisciplined, and phase approach to a complex issue that may have numerous smaller problems that need to be unraveled and teased out one at a time until the entire "extension cord is fully UNKNOTTED" so to speak and then, you can talk about rewrapping that cord so it doesn't get tangled....which in patient terms might be something akin to a good robust convalescent stage which may or may not include the proper medications, physical therapy, other types of interventions/therapies, and EDUCATION (vitally important) so that patients and families can understand HOW NOT to fall into the same trap or step of circumstances again....or how to recognize warning signs of impending problems and bring them up to the appropriate peoples' attention, etc. etc. And of course, the whole time there's 2 way communication going on with questions, answers, adjustments, alternative thoughts, how can we optimize the costs, the budgets, available community or pharmaceutical resources.....it's HUGE...as to what a COMPLETE TREATMENT protocol actually SHOULD BE.
But that process doesn't happen to a lot of people.....it doesn't happen to TOO MANY people. I don't even want to get into examples of a PERSONAL nature that have happened within my family of how shortcuts, misfires, and miscues to the above process resulted in a lot of unnecessary angst, unnecessary medication, possible physical harm, etc. etc. because the PROCESS above was not followed and how even COLLEAGUES OF MEDICINE didn't take or have the time to spend with their patients to do right the first time.....and mind you there are 3 generations of doctors in my family and our connections to the medical field span virtually every major teaching and community hospital in N.E. Ohio.....and we were still not treated as we SHOULD'VE been treated according to what I've mentioned as well as some of the points you've mentioned.
And that's the reality....solution? You have to find someone who believes in the process and not just that....someone who LIVES it and PRACTICES it.....If you go to a doctor who is going to treat you for smoking cessation for example, would you prefer to go to someone who themself DOESN'T smoke or would it be OK to see someone who smokes 2 packs a day, has tried quitting numerous times so they can understand the patient who tells them "it's so hard", etc. etc......which would you choose? Most people would likely choose the nonsmoking doctor in that example because they feel more confident that a doctor who lives the example is likely more dedicated to the goal and as a result going to be more diligent to obtain the desired outcome of SMOKING CESSATION in that patient....as opposed to just offering them another cigarette and patting them on the back for having given it another try....
So, would it XXXXXXX you if I told you that my initial appointments in my practice (I'm a neurologist) are no less than 60 min. in length and I've been known to spend up to 3 hrs. with a first time patient.....and I make housecalls as well just like the old fashioned docs do.....I've even picked up the milk bottles on the front stoops for some of my MEDICARE patients when I've visited.....never ridden in the horse drawn buggy that delivers the milk.....but picked it up...and sometimes the newspaper itself? Would it XXXXXXX you to know that I don't REMEMBER EVER giving a patient a 6-7 minute appointment....and I work also at the VA Hospital as the Director of the Headache Clinic.....I've never in my career seen a patient for 6-7 min. I give pharmaceutical reps at least 15 minutes when I have time to speak with them. My follow up appointments in my practice both private as well as hospital are a minimum of 30 min. and that's a short follow-up...most go out to 45 min.
On the other side of the fence, however, are insurance companies and Medicare is not a pretty agency to have to talk about....not because the concept is bad...because it's not....it's a very good concept...but the system by which it operates and the system that doctors especially have to use it by which is forever changing according to government regulations and regulators and legislators who think that doctors actually ENJOY doing nothing but reading quarterly bulletins from CMSS on the changes that don't even affect the entire country necessarily....just some states...so now we have to worry about MEDICARE coverages on patients seeing us who may be outside the state they're being treated.....it is an awful system and a quagmire that only the RED TAPE MINDED and agile minds can fathom and enjoy. Personally, I'd much rather spend my FREE hour a day in my office reading on the latest discoveries in headache therapy having to do with melatonin, or how treating PTSD appropriately can reduce headaches by as much as 50% in migraineurs, or how exercise therapy and other NONtraditional ways of stimulating the brain are much more effective in treating Alzheimer's patients than the crappy poisonous pills that pharmaceutical would love for us to prescribe and gleefully order down our patients' throats at $8 or $10 per pill sometimes up to twice daily FOR THE REST OF THEIR LIVES.....those vulturous pharmaceutical companies....
So as you can see Ms. xxxxxxxxxxxxxx there are sympathizers to at least some of what you say but in order to have a full bird's eye view of the scene you must be not only a provider of health care services with a critical eye toward quality of the product you're offering to patients....but have the experience of being not only a patient or family member of patients utilizing the system, as well as a provider who also depends upon the system of health care to remunerate fairly and honestly for all the time, training, and extra things that patients never see are done by doctors so their health is looked after....again, assuming that the provider remains true to the original PROCESS I outlined above.
As far as accurate documentation is concerned.....long ago, I stopped getting upset about the fact that these errors are constantly committed knowing that I've likely committed my fair share of misunderstanding patients at time, overinterpreted what they've said, or simply written down inaccuracies from their history or family history for whatever the insundry reason and what I now do at EVERY SINGLE visit is I REVIEW with the patient exactly what I wrote in my note from the time before to make sure they agree with what I THOUGHT they told me vs. what we agreed on would be the best course of treatment as well as what I finally prescribed, asked them to do, or concluded as a result of getting tests and studies done. I do that at every visit...takes about 5 minutes....and then, the NEW VISIT starts.....Now, you see why NONE of my visits can ever take 6-7 minutes...simply impossible for me.....
As far as your medical issues are concerned I am sorry you haven't really been treated for your problems to the fullest extent as you feel you should've been treated. But you should know after what I've written that NOT ALL PHYSICIANS are as you describe. It is truly a problem and a task for patients to locate that one physician or set of physicians who fit all the details one is looking for but it is possible....you simply need to keep looking and not be satisfied with someone just because "it's too hard or complicated to change." You'll never feel better, you'll never get better, and the doctor probably isn't going to get much out of the relationship either professionally speaking since they will have stopped long ago looking for anything new to do since the patient may appear content or happy to be traveling down the status quo pathway.....right? The way a doctor sees it...if a patient is willing to ALLOW the doctor to walk in out of the examining room in 6-7 minute and not be pushed or challenged to explain anything about the condition for which the patient is being treatment nor about the prescriptions that you hastily write out of the script pad in their lab coat, or the orders they're giving to get more blood work done even though the patient had the same work done 3x in the past year....well, then, great for the doctor.....you've just allowed him to INCORRECTLY CODE Medicare and continue using the same error filled chart for yet another successful visit and since you may need that refill of the script for a drug that you THINK you're supposed to have.....it's better to just take the dang script and go to the pharmacy so you can keep taking your pills rather than risk stopping the whole process and saying, "Wait a minute.......I need some answers....a lot of answers......I need your time and your expertise for MY CASE....." Now, if you were to have a session like that with your doctor either the doctor will comply because they want to keep you as a patient and make adjustments to his schedule so that the usual 6-7 minute visit turns into a 15-20 minute visit (still short for me)....or the doctor will ignore your request, give you the script, and tell you that he'd be happy to take this up with you at a future visit....but since you weren't scheduled for that extra time today....just see the girl up front for another appointment...And that should be your signal to start looking and make the commitment to change to someone who is different.....
You may have to kiss a lot more frogs along the way...in fact, I guarantee you will kiss a lot more frogs along the way.....BUT the search will bear fruit that is to your liking.
Who knows? You may even land up in XXXXXXX OH needing a neurologist who treats headaches. That could happen you know.
Now, even though I am ONLY a neurologist...and just a neurologist I may be able to point you in the right direction for getting help for at least one at least one of your ailments if you have more specific information and a question.
Cheers!
Not all doctors are the same as you describe but I hear what you say
Detailed Answer:
Good morning and thank you for choosing to ask your somewhat NON-medical questions but still relevant I believe on this network. I hear what you're saying and understand why you feel the way you do. For the most part I do believe that many patients are not "listened to" and that far too many "diseases are treated"...or THOUGHT to be treated by doctors without taking into account the important detail of treating the person as more than just their ailment or disease. The treatment process should ALWAYS include identifying not just the problem which the patient NOTICES and brings to the table but other things they may not notice or may have importance and must be treated concomitantly. The treatment process should always include a thorough examination and appropriate testing to get to a diagnosis...not more than needed, not less than needed but the right amount. The treatment process should then, involve the collaboration with the patient and preferably family (if possible) in listing options to take care of the problem which can range from NO ACTIVE INTERVENTION ("benign neglect" is what I sometimes like to call it) all the way to a multifaceted, multidisciplined, and phase approach to a complex issue that may have numerous smaller problems that need to be unraveled and teased out one at a time until the entire "extension cord is fully UNKNOTTED" so to speak and then, you can talk about rewrapping that cord so it doesn't get tangled....which in patient terms might be something akin to a good robust convalescent stage which may or may not include the proper medications, physical therapy, other types of interventions/therapies, and EDUCATION (vitally important) so that patients and families can understand HOW NOT to fall into the same trap or step of circumstances again....or how to recognize warning signs of impending problems and bring them up to the appropriate peoples' attention, etc. etc. And of course, the whole time there's 2 way communication going on with questions, answers, adjustments, alternative thoughts, how can we optimize the costs, the budgets, available community or pharmaceutical resources.....it's HUGE...as to what a COMPLETE TREATMENT protocol actually SHOULD BE.
But that process doesn't happen to a lot of people.....it doesn't happen to TOO MANY people. I don't even want to get into examples of a PERSONAL nature that have happened within my family of how shortcuts, misfires, and miscues to the above process resulted in a lot of unnecessary angst, unnecessary medication, possible physical harm, etc. etc. because the PROCESS above was not followed and how even COLLEAGUES OF MEDICINE didn't take or have the time to spend with their patients to do right the first time.....and mind you there are 3 generations of doctors in my family and our connections to the medical field span virtually every major teaching and community hospital in N.E. Ohio.....and we were still not treated as we SHOULD'VE been treated according to what I've mentioned as well as some of the points you've mentioned.
And that's the reality....solution? You have to find someone who believes in the process and not just that....someone who LIVES it and PRACTICES it.....If you go to a doctor who is going to treat you for smoking cessation for example, would you prefer to go to someone who themself DOESN'T smoke or would it be OK to see someone who smokes 2 packs a day, has tried quitting numerous times so they can understand the patient who tells them "it's so hard", etc. etc......which would you choose? Most people would likely choose the nonsmoking doctor in that example because they feel more confident that a doctor who lives the example is likely more dedicated to the goal and as a result going to be more diligent to obtain the desired outcome of SMOKING CESSATION in that patient....as opposed to just offering them another cigarette and patting them on the back for having given it another try....
So, would it XXXXXXX you if I told you that my initial appointments in my practice (I'm a neurologist) are no less than 60 min. in length and I've been known to spend up to 3 hrs. with a first time patient.....and I make housecalls as well just like the old fashioned docs do.....I've even picked up the milk bottles on the front stoops for some of my MEDICARE patients when I've visited.....never ridden in the horse drawn buggy that delivers the milk.....but picked it up...and sometimes the newspaper itself? Would it XXXXXXX you to know that I don't REMEMBER EVER giving a patient a 6-7 minute appointment....and I work also at the VA Hospital as the Director of the Headache Clinic.....I've never in my career seen a patient for 6-7 min. I give pharmaceutical reps at least 15 minutes when I have time to speak with them. My follow up appointments in my practice both private as well as hospital are a minimum of 30 min. and that's a short follow-up...most go out to 45 min.
On the other side of the fence, however, are insurance companies and Medicare is not a pretty agency to have to talk about....not because the concept is bad...because it's not....it's a very good concept...but the system by which it operates and the system that doctors especially have to use it by which is forever changing according to government regulations and regulators and legislators who think that doctors actually ENJOY doing nothing but reading quarterly bulletins from CMSS on the changes that don't even affect the entire country necessarily....just some states...so now we have to worry about MEDICARE coverages on patients seeing us who may be outside the state they're being treated.....it is an awful system and a quagmire that only the RED TAPE MINDED and agile minds can fathom and enjoy. Personally, I'd much rather spend my FREE hour a day in my office reading on the latest discoveries in headache therapy having to do with melatonin, or how treating PTSD appropriately can reduce headaches by as much as 50% in migraineurs, or how exercise therapy and other NONtraditional ways of stimulating the brain are much more effective in treating Alzheimer's patients than the crappy poisonous pills that pharmaceutical would love for us to prescribe and gleefully order down our patients' throats at $8 or $10 per pill sometimes up to twice daily FOR THE REST OF THEIR LIVES.....those vulturous pharmaceutical companies....
So as you can see Ms. xxxxxxxxxxxxxx there are sympathizers to at least some of what you say but in order to have a full bird's eye view of the scene you must be not only a provider of health care services with a critical eye toward quality of the product you're offering to patients....but have the experience of being not only a patient or family member of patients utilizing the system, as well as a provider who also depends upon the system of health care to remunerate fairly and honestly for all the time, training, and extra things that patients never see are done by doctors so their health is looked after....again, assuming that the provider remains true to the original PROCESS I outlined above.
As far as accurate documentation is concerned.....long ago, I stopped getting upset about the fact that these errors are constantly committed knowing that I've likely committed my fair share of misunderstanding patients at time, overinterpreted what they've said, or simply written down inaccuracies from their history or family history for whatever the insundry reason and what I now do at EVERY SINGLE visit is I REVIEW with the patient exactly what I wrote in my note from the time before to make sure they agree with what I THOUGHT they told me vs. what we agreed on would be the best course of treatment as well as what I finally prescribed, asked them to do, or concluded as a result of getting tests and studies done. I do that at every visit...takes about 5 minutes....and then, the NEW VISIT starts.....Now, you see why NONE of my visits can ever take 6-7 minutes...simply impossible for me.....
As far as your medical issues are concerned I am sorry you haven't really been treated for your problems to the fullest extent as you feel you should've been treated. But you should know after what I've written that NOT ALL PHYSICIANS are as you describe. It is truly a problem and a task for patients to locate that one physician or set of physicians who fit all the details one is looking for but it is possible....you simply need to keep looking and not be satisfied with someone just because "it's too hard or complicated to change." You'll never feel better, you'll never get better, and the doctor probably isn't going to get much out of the relationship either professionally speaking since they will have stopped long ago looking for anything new to do since the patient may appear content or happy to be traveling down the status quo pathway.....right? The way a doctor sees it...if a patient is willing to ALLOW the doctor to walk in out of the examining room in 6-7 minute and not be pushed or challenged to explain anything about the condition for which the patient is being treatment nor about the prescriptions that you hastily write out of the script pad in their lab coat, or the orders they're giving to get more blood work done even though the patient had the same work done 3x in the past year....well, then, great for the doctor.....you've just allowed him to INCORRECTLY CODE Medicare and continue using the same error filled chart for yet another successful visit and since you may need that refill of the script for a drug that you THINK you're supposed to have.....it's better to just take the dang script and go to the pharmacy so you can keep taking your pills rather than risk stopping the whole process and saying, "Wait a minute.......I need some answers....a lot of answers......I need your time and your expertise for MY CASE....." Now, if you were to have a session like that with your doctor either the doctor will comply because they want to keep you as a patient and make adjustments to his schedule so that the usual 6-7 minute visit turns into a 15-20 minute visit (still short for me)....or the doctor will ignore your request, give you the script, and tell you that he'd be happy to take this up with you at a future visit....but since you weren't scheduled for that extra time today....just see the girl up front for another appointment...And that should be your signal to start looking and make the commitment to change to someone who is different.....
You may have to kiss a lot more frogs along the way...in fact, I guarantee you will kiss a lot more frogs along the way.....BUT the search will bear fruit that is to your liking.
Who knows? You may even land up in XXXXXXX OH needing a neurologist who treats headaches. That could happen you know.
Now, even though I am ONLY a neurologist...and just a neurologist I may be able to point you in the right direction for getting help for at least one at least one of your ailments if you have more specific information and a question.
Cheers!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Saghafi,
Thank you for your thoughtful response.
My husband was a physician and I am a registered nurse.
Health plan doctors here see approximately 22 patients qd. One hour of the 8 hour day taken out for lunch.
It is serendipity that you are a neurologist. I have had three traumatic spinal injuries over the last 30 years with significant neuropathy and chronic pain. Have been prescribed demerol to extreme muscle relaxants. Since none of the meds relieve the nerve, muscle or bone pain, I don't take them. May eventually discover a neurologist able to improve my s/s.
Happy to be alive and I stay away from doctors as much as is humanely possible - more than a few are outright dangerous to a persons health. I have noted that there seems to be an increased illicit use of scheduled drugs amongst health care professions adding to the chaos of an already dysfunctional health care system.
It is most unlikely that I will ever be in Ohio. However, I know it would be my pleasure if we met.
Wishing you a happy and safe XXXXXXX Day.
Sincerely,
Thank you for your thoughtful response.
My husband was a physician and I am a registered nurse.
Health plan doctors here see approximately 22 patients qd. One hour of the 8 hour day taken out for lunch.
It is serendipity that you are a neurologist. I have had three traumatic spinal injuries over the last 30 years with significant neuropathy and chronic pain. Have been prescribed demerol to extreme muscle relaxants. Since none of the meds relieve the nerve, muscle or bone pain, I don't take them. May eventually discover a neurologist able to improve my s/s.
Happy to be alive and I stay away from doctors as much as is humanely possible - more than a few are outright dangerous to a persons health. I have noted that there seems to be an increased illicit use of scheduled drugs amongst health care professions adding to the chaos of an already dysfunctional health care system.
It is most unlikely that I will ever be in Ohio. However, I know it would be my pleasure if we met.
Wishing you a happy and safe XXXXXXX Day.
Sincerely,
Brief Answer:
Not only you but the DEA
Detailed Answer:
Thank you for your cordial return response. Believe me...it has gotten to the point that not only patients such as yourself have begun to sound the warning bells but now the DEA has decided to step in with its heavy hand....hey, in my opinion, doctors invited the beast to the table....nobody else. I'm not going to completely exonerate patients from the guilt equation because patients can be pushy (as you very well know), demanding, and relentless in their pursuit for prescriptions and many doctors simply don't want to lose the business, or offend patients who may end up writing letters to Medical Boards, etc.....so they cave....simple as that. So to those patients, some of the DEA should be parked on their doorsteps as well....and probably are!
It is unfortunate that doctors have resorted to the prescription of some of the most powerful and dangerous pain killers as first line drugs for clinical situations better handled by guiding and EDUCATING patients that the immediate and chronic use of addictive narcotics and muscle relaxants can have far reaching deleterious side effects which must be heeded even if this means less than 100% pain control in the moment. As I always tell patients, "A little pain doesn't kill people nearly as much as a LOT of worthless drugs."
Doctors should instead be advocating the use of more reasonable pain reduction methods which does guarantee the 100% eradication of pain but rather recruits patients themselves in looking for alternatives methods of becoming more active and strengthening their weakened or painful parts such that useless poisons can be avoided.
Acute pain relief plan can clearly include the use of powerful narcotics since there are NON-TERMINAL situations where this is appropriate but it should be done with a temporary time frame in mind and with a well defined END GAME beyond which patients will likely have some pain but can work to get rid or better control pain using alternative means. As I've said before I'm a neurologist and not a pain management or PM&R specialist but I'm afraid my perspective on some pain management specialists is that've really become NARCOTICS/CONTROLLED SUBSTANCE management specialists and have very little else to offer when it comes to creatively trying to look for solutions which take into account the science of pain together with the psychology of PAIN RELIEF to develop a better way and to teach patients how to avoid traps instead of setting them ourselves for them.
It would be a pleasure likewise to make your acquaintance. XXXXXXX really is quite a hustling and bustling town these days with all of the recent sporting activities, the Republican National Convention coming to town in less than 2 weeks and of course, XXXXXXX now using our Fair Town as their backdrop to blockbuster hits at least several times a year it seems! I'd be also very happy if you came to offer my expertise as possible to help you feel better though it certainly seems that is a difficult proposition given your aversion to seeing doctors anymore coupled with the fact that it sounds as if you've been put through the paces.
The armamentarium of REASONABLE drugs for pain relief without getting into the narcotic and controlled substances, since as you can see this is not what I typically prescribe my patients, is sadly limited by technology. Pain relief in the form of something that virtually takes all annoying pain is not available except for neuropathic agents such as the tricyclics (nortriptyline), combinations of nonsteroidals and muscle relaxants (diclofenac + tizanidine), and then, the antineuropathic agents (gabapentin, pregabalin, capsaicin). Otherwise, my mainstays for proactive treatments have always revolved around AQUATHERAPY, STRETCHING EXERCISES, BIOFEEDBACK, and then, the newest DEVICE called a THERMAZONE. This is something that I first became aware of while treating my headache patients but it is always useful for some chronic pain situations. You may look it up at www.thermazone.com but it is not covered to my knowledge under Medicare or most other insurance plans. It is not a cure but rather a modality for temporary relief. The nice thing about the THERMAZONE device is that there is no limit to how long or how many times you can use it over an area of your body but the downside is that it's not a portable unit. So you are parked next to it for as long as you like...but you ain't moving for than 1-2 feet around the machine in any direction until you decide to take it off at which point generally pain relief slowly dissipates. But it really does work for headache patients marvelously well since in migraine patients many they are debilitated anyways for the duration of their headache since it really doesn't matter that they'd be hooked up to the machine anyways and why not get faster and quicker relief to become more functional sooner than just letting the headache run its course? So for those types of patients it's a plus....but for chronic back pain I don't know that it would make a person feel all that much better....but take a look....you may find it novel enough to try it out AND maybe with some luck you can find a payor to pick up the tab.
I've got one more suggestion that some people have found helpful...the XXXXXXX Arthritis Foundation's website: http://www.arthritis.org/living-with-arthritis/pain-management/
Your condition is in fact a type of arthridite (you knew that). This website contains a wealth of information on diet, exercises, and alternatives to pain management which involve activity and more complementary styles and approaches. If you locate your LOCAL OFFICE where you live they may be able to direct you to AQUATHERAPY facilities that often times do not charge for classes or may charge minimal fees. There is more coming out now and ANTI-ARTHRITIC diets which is something that very few physicians will tell their patients about since we are all so directed toward Big Pharma Brother in thinking that therein lies the cure....well, see what you think.
If I've satisfactorily addressed your question could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback as to our transaction? Again, many thanks for posing your questions and comments, it was a pleasure chatting with you....I'll put in one more plug for a XXXXXXX visit to get to know us and if you were so moved to drop by and allow me an opportunity to give you perhaps some other ideas as to how to make your stay even more enjoyable....other than using the facilities and bedding of one of the newest 5 Star hotels that have been built recently...lots to choose from!
Do not forget to recontact me in the future at: www.bit.ly/dYYYYYYYYYYYYYYY for additional questions, comments, or concerns having to do with this topic or others.
I would absolutely love hearing from you if you end up trying any of the ideas I've listed or have any more questions in the event some things have not bee tried for you.
This query has utilized a total of 93 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.
Not only you but the DEA
Detailed Answer:
Thank you for your cordial return response. Believe me...it has gotten to the point that not only patients such as yourself have begun to sound the warning bells but now the DEA has decided to step in with its heavy hand....hey, in my opinion, doctors invited the beast to the table....nobody else. I'm not going to completely exonerate patients from the guilt equation because patients can be pushy (as you very well know), demanding, and relentless in their pursuit for prescriptions and many doctors simply don't want to lose the business, or offend patients who may end up writing letters to Medical Boards, etc.....so they cave....simple as that. So to those patients, some of the DEA should be parked on their doorsteps as well....and probably are!
It is unfortunate that doctors have resorted to the prescription of some of the most powerful and dangerous pain killers as first line drugs for clinical situations better handled by guiding and EDUCATING patients that the immediate and chronic use of addictive narcotics and muscle relaxants can have far reaching deleterious side effects which must be heeded even if this means less than 100% pain control in the moment. As I always tell patients, "A little pain doesn't kill people nearly as much as a LOT of worthless drugs."
Doctors should instead be advocating the use of more reasonable pain reduction methods which does guarantee the 100% eradication of pain but rather recruits patients themselves in looking for alternatives methods of becoming more active and strengthening their weakened or painful parts such that useless poisons can be avoided.
Acute pain relief plan can clearly include the use of powerful narcotics since there are NON-TERMINAL situations where this is appropriate but it should be done with a temporary time frame in mind and with a well defined END GAME beyond which patients will likely have some pain but can work to get rid or better control pain using alternative means. As I've said before I'm a neurologist and not a pain management or PM&R specialist but I'm afraid my perspective on some pain management specialists is that've really become NARCOTICS/CONTROLLED SUBSTANCE management specialists and have very little else to offer when it comes to creatively trying to look for solutions which take into account the science of pain together with the psychology of PAIN RELIEF to develop a better way and to teach patients how to avoid traps instead of setting them ourselves for them.
It would be a pleasure likewise to make your acquaintance. XXXXXXX really is quite a hustling and bustling town these days with all of the recent sporting activities, the Republican National Convention coming to town in less than 2 weeks and of course, XXXXXXX now using our Fair Town as their backdrop to blockbuster hits at least several times a year it seems! I'd be also very happy if you came to offer my expertise as possible to help you feel better though it certainly seems that is a difficult proposition given your aversion to seeing doctors anymore coupled with the fact that it sounds as if you've been put through the paces.
The armamentarium of REASONABLE drugs for pain relief without getting into the narcotic and controlled substances, since as you can see this is not what I typically prescribe my patients, is sadly limited by technology. Pain relief in the form of something that virtually takes all annoying pain is not available except for neuropathic agents such as the tricyclics (nortriptyline), combinations of nonsteroidals and muscle relaxants (diclofenac + tizanidine), and then, the antineuropathic agents (gabapentin, pregabalin, capsaicin). Otherwise, my mainstays for proactive treatments have always revolved around AQUATHERAPY, STRETCHING EXERCISES, BIOFEEDBACK, and then, the newest DEVICE called a THERMAZONE. This is something that I first became aware of while treating my headache patients but it is always useful for some chronic pain situations. You may look it up at www.thermazone.com but it is not covered to my knowledge under Medicare or most other insurance plans. It is not a cure but rather a modality for temporary relief. The nice thing about the THERMAZONE device is that there is no limit to how long or how many times you can use it over an area of your body but the downside is that it's not a portable unit. So you are parked next to it for as long as you like...but you ain't moving for than 1-2 feet around the machine in any direction until you decide to take it off at which point generally pain relief slowly dissipates. But it really does work for headache patients marvelously well since in migraine patients many they are debilitated anyways for the duration of their headache since it really doesn't matter that they'd be hooked up to the machine anyways and why not get faster and quicker relief to become more functional sooner than just letting the headache run its course? So for those types of patients it's a plus....but for chronic back pain I don't know that it would make a person feel all that much better....but take a look....you may find it novel enough to try it out AND maybe with some luck you can find a payor to pick up the tab.
I've got one more suggestion that some people have found helpful...the XXXXXXX Arthritis Foundation's website: http://www.arthritis.org/living-with-arthritis/pain-management/
Your condition is in fact a type of arthridite (you knew that). This website contains a wealth of information on diet, exercises, and alternatives to pain management which involve activity and more complementary styles and approaches. If you locate your LOCAL OFFICE where you live they may be able to direct you to AQUATHERAPY facilities that often times do not charge for classes or may charge minimal fees. There is more coming out now and ANTI-ARTHRITIC diets which is something that very few physicians will tell their patients about since we are all so directed toward Big Pharma Brother in thinking that therein lies the cure....well, see what you think.
If I've satisfactorily addressed your question could you do me the kindest of favors by CLOSING THIS QUERY and be sure to include some fine words of feedback as to our transaction? Again, many thanks for posing your questions and comments, it was a pleasure chatting with you....I'll put in one more plug for a XXXXXXX visit to get to know us and if you were so moved to drop by and allow me an opportunity to give you perhaps some other ideas as to how to make your stay even more enjoyable....other than using the facilities and bedding of one of the newest 5 Star hotels that have been built recently...lots to choose from!
Do not forget to recontact me in the future at: www.bit.ly/dYYYYYYYYYYYYYYY for additional questions, comments, or concerns having to do with this topic or others.
I would absolutely love hearing from you if you end up trying any of the ideas I've listed or have any more questions in the event some things have not bee tried for you.
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