I really need some advice ASAP

[Braley (OP)]

I have a question. I have severe lower back pain, chronic knee pain, and neck pain. I've only been diagnosed with Degenerative disc disease. My primary dr had me on 7.5 Lortab 3-4 times a day, but he wanted a pain management dr to take over my pain meds. So now My current pain management dr is currently treating my lower back pain by doing radiofrequency neurotomy, and prescribing me 7.5 Lortab only twice a day, which doesn't even take the pain away a little. The Radiofrequency Neurotomy hasn't worked either, and he said I won't feel a difference until my 3rd week. Well I'm in my 5th week, and I'm still hurting really bad. So I'm thinking of trying another pain management dr. The only problem with that is they don't accept my Medicaid so I will have to be a self pay, which is $300 for the first visit, and $175 each month after. My question is since I will be a cash only patient, what are the chances of them giving me a higher dosage pain medication? Cause in my experience, that is the only thing that helps me function and do my job.

[Chip]

That would be totally up to your primary pain doctor - cash money doesn't buy a stronger pain killer.

See your doctor or ring him if you need to climb that ladder.

[bignasty]

cash money doesn't buy a stronger pain killer.

Fortunately for the OP, cash does buy you better service with a lot of pain mgmt. dr's.....especially the sketchier kind. Do you know the ethnicity of the Dr. you're thinking about going to for $300? IME a lot of middle eastern dr's will write more liberally if you pay cash.

Cash money will also usually buy you anywhere from 80-200 mgs a day of methadone at your local methadone clinic...IF there's one near you. If not, there's always the streets where cash money definitely will buy you a stronger pain killer.....it'll just be in a bag instead of a bottle.

[Chip]

I understand now. I thought that he was going to offer money to have his dose put up by the same doctor.

My mistake, I hadn't slept for 4 nights when I read that.

It's no excuse really ... the Australian system does not work like that so that's where I'm coming from.

It IS all about the money and that's just wrong in my eyes.

[Dopeless Hopefiend]

I understand now. I thought that he was going to offer money to have his dose put up by the same doctor.

My mistake, I hadn't slept for 4 nights when I read that.

It's no excuse really ... the Australian system does not work like that so that's where I'm coming from.

It IS all about the money and that's just wrong in my eyes.

Yeah Chipper, the US is about the only "developed" country where it does work like that. It's pretty fucked up for the majority of people who don't have the resources to pay cash for medical care, but nice for those who can afford it. Even those folks who can often get fucked in the long run though. I know countless people who had a good thing going with a cash pay pain doctor, then for whatever reason the doctor leaves or something. Then you're stuck with a huge habit & no other doc will fill what you were getting. It's screwed all the way around really.

[Chip]

The US is such a wealthy country but when I hear that Trillions of folding goes into the war effort etc. I just can't fathom why they can't dovert much of that and give heavily subsidised Medical care (or free) like it is in Canada, the UK, here etc.

The no-money, no fix you up policy seems cruel and harsh -- here, free health care is a right but it is changing as there are many private hospitals and slowly we are seeing bits of the free system get privatised.

I also understand that your social welfare system is far more limited -- what is a poor and jobless person going to do ? Get sick and homeless ? Sell drugs or their body ? It opens the door to desperation, crime, incarceration and then even a job is very unlikely so then comes a life of poverty.

Your system scares me and those without money get my heartfelt sympathy. No wonder crime is growing.

No money, no honey.

Then the there's the mentally sick who are really let to slip between the cracks.

Don't get me wrong, I like the US but I imagine that living there is must be fraught with worry as life can change for the worse for many people, without notice.

We get free legal aid and I'm even entitled to free Dental care.

I get paid $550 each fortnight but we have HIGH housing, accommodation and food costs, and that doesn't even cover a fraction of what my cost of living is - it's not perfect here either.

I just wonder why the people don't demand more government assistance.

I just dont understand why Bill Gates and other pholanthropists won8t step in and try to help the sick, poor and homeless out if the Government won't.

So I really feel for you guys.

[Opi-ette]

Chipper I could go on a 45 page rant regarding your post and how fucked up our health care and other benefits are here but I don't have time but the one thing that you posted really strikes a nerve in me. Dental coverage. When I was just a lil' pup working part time jobs while going to school, there was boundless dental coverage. Now even full time jobs barely offer dental coverage, and even if they do, the co payments and monthly or weekly dues they take out of paychecks for it is ridiculously expensive.

Rotting teeth can cause heart disease and other health problems due to all of the bacteria being swallowed. A couple of years ago my mom went into congestive heart failure. She needed 3 heart operations and was near death but her surgeons wouldn't touch her until I had all of her teeth pulled as they were rotting and opening her up (especially her heart surgeries) would have been a death sentence and of course the worry of being sued for malpractice if anything happened to her due to being operated on with her teeth in the condition they were in trumped anything else.

So I had to take her after she was cleared from being in ICU for 2 weeks to have all of her teeth pulled. I could not find one dental surgeon that would do it without payment up front and the whole ordeal was 2K and change. She finally was cleared for her surgeries but spent her time in the hospital ( appx 6 months IIRC if not longer. Its still a blur) with no teeth in her mouth. It was so heartbreaking to see her like that and she was embarrassed to be seen with no teeth in her mouth.

After she came home and recovered, we then had to figure out how to get her dentures as of course that is considered "cosmetic". I would have loved to have gotten her implants but that costs nearly as much as a new car, so that was yet another hurdle and financial disaster.

PS: She recently lost them :/

[Chip]

I couldn't agree with you more.

One's dental health state is paramount to one's self image also.

I qualify for free dental care but it doesn't happen in a hury - you have to be unemployed and old for a while.

The surgeon took out half my teeth (hello "meth mouth" !

Opi-ette, it's the MOST essential of all services because WE ALL HAVE TO EAT, and we all smile.

The system doesn't have to be like this.

What impressed me was that the surgeon that i ended up with was the BEST one i had ever met - this guy could be working privately and earning a ton more money but he chose to help the poor and disadvantaged instead. That sort of person gets all my admiration and respect.

As junkies and users, PLEASE take the time to look after your teeth !

I just hope the US gets around to providing subsidised dental care to those of us that need it.

Opi-ette, thanks for giving me an insight to the harsh reality of your country's health case, that 2K would've meant a lot to you and it's such sad to hear.

BTW, implants here are NOT free anywhere - you're looking at 20K and upwards.

[Opi-ette]

Chipper, I'm glad you found a good hearted surgeon. Hard to come by these days.
Sorry to hear about your teeth. Were you able to get any sort of denture or are you
considering implants?

I went for a check up recently, thanks in part to a Groupon I found for a dentist in my area. He was sort of a jerk but I couldn't have afforded it without that Groupon.
I have some cavities (which before my start of opiates I had pristine teeth) and they are $88 each and he won't do a cleaning (which is covered under the groupon) until all of my cavities are filled. *sigh*

You are absolutely right. Teeth are essential to good physical and mental health. Since mom lost hers, she can't eat anything healthy like salads or raw vegetables. Even some proteins are difficult for her.

My holiday wish is for everyone to be able to have affordable health and dental care.

[Chip]

Opi,

i can't afford them until later in life BUT i can't have them anyway as the surgeon told me that my teeth got so bad that the underlying bone has been damaged by infection (that i didn't know about or feel).

I don't use dentures and still have half of all the front teeth and my smile doesn't show the tooth loss.

Dentures sound horrible so i eat like a chipmunk now

[Z]

Dental is an issue here as well.  The gov health insurance covers emergency treatments only, and even then it's heavily restricted.  Many dentists require payment up front, and some offer in house financing.  Its all about the Benjamin's I guess.  Or the bordens here.

One thing I have done is to go to the university for more rudimentary stuff.  Often the work is free or on an income based sliding scale.  The dentists have to perform certain numbers of each procedure to graduate.  Considering the cost it was a reasonable exchange to me!

Tooth pain sucks so badly.  Its important to take good care of them before they get to the point of no return.

[Chip]

For a while, MMT/BMT users at my clinic were offered up to $4500 per annum to fix their teeth - it was brought in by the conservative government at the time (which was so unlike them).

Then about a couple of years later, the labor party (like your democrats, i think) FUCKING abolished the scheme !

Most junkies and users have bad teeth - you're not going to spend those precious dollars on dental when you need dope OR you just forget that they're there. Tweakers fail to understand the benefit of saliva and the detriment of sweet drinks.

But we had it so good for a while and i was uber impressed with that policy which is now gone.

[Esoteric Anhydride]

Dental is an issue here as well.  The gov health insurance covers emergency treatments only, and even then it's heavily restricted.  Many dentists require payment up front, and some offer in house financing.  Its all about the Benjamin's I guess.  Or the bordens here.

One thing I have done is to go to the university for more rudimentary stuff.  Often the work is free or on an income based sliding scale.  The dentists have to perform certain numbers of each procedure to graduate.  Considering the cost it was a reasonable exchange to me!

Tooth pain sucks so badly.  Its important to take good care of them before they get to the point of no return.

+1 - dental schools can be a lifesaver, I've had a bunch of work done at UW Dentistry.

[dysmorphic]

IF you're looking just for more medication prescribed by a dr here is what I did.

After many years of self medicating I used my Medicare insurance to start shopping around. It was hard to find a dr who would help me out and give me what I wanted. I went through six or more doctors as one after another kind of fucked me around. I fired doctors before. Remember that you can too. Call him out on his arrogant dbag behavior and leave. Or better yet hold the room hostage until they get a doctor in there to actually help you. Having legitimate issues is something you need to take responsibility for and ensure you have the doctor helping you in the way that makes you feel better.

So shop around. I found a primary care doctor that helped me deal with my pain and it's management. No pain clinics or anything like that. I saw my doctor every single month and so should you. You need to be in constant contact with your doctor, you need to be a model patient. Acting like a junky or a crackhead will get you treated like one. I'm not judging, I'm just telling what worked for me. I have only two times in ten years lost my medication. I am accountable to my dr and that is what was making it work so well.

If you have a legitimate issue then act like it. As a matter of fact every monthly visit should be a pretty poor and shitty day, if asked say most days are like that. When called on the phone by the doctor or his office staff and they ask how you're doing? Say miserable. When offered treatment / medication you should at least try it how the doctor wants to treat it. The medication will come, give it time. You have to work the doctor so he comes to his own conclusions about your treatment. If the medication isn't working then be sure to tell your doctor that. Just don't try to scam or otherwise take advantage of your doctor because they deal with it all the time.

When the good medication starts being offered go easy. It's better to slowly up your dose over time while taking as little as you can. It is always better to stock pile it. My wife and I hade 10 bottles of morphine plus the three bottles we were prescribed so we could travel. Each bottle had 220 count 30mg ir. I was scared to fly with it all and I actually broke out in a sweat when we flew out of Vegas. What could they do though? It was all prescribed medication and legal. We still have an ass ton of it. Not just that either, bottles and bottles of other shit too.

In a nutshell here is what you do. Find a doctor who seems sympathetic to you and your health issues. Slowly over time ask for the medication that better eases your pain. Once you find one you like slowly over time ask to increase the dose. If you want something more then have a reason for it and again add stuff slowly over time. It can take years to get into a relationship with a doctor that allows for open and honest discussion of how you're feeling and what you feel can help you feel better. Once the trust is there don't fuck it away!!! Never use your entire prescription. Always have a stash and you'll never give yourself a reason to lose a doctor you have so much time and history with.

One final thing..... diminishing returns. Pain medication, benzos and sleeping meds all have them. More then that you'll eventually get to a point where you're taking soooo fucking much that you just don't get the effect that you used too. For me it took about 15 years. Now I'm at a place where I'm older, in worse shape and do not get the relief I used to get from the medication. Along with that is the realization that I'll need the pain medication when I'm older. If I could go back I would have used less potent opiates and worked into harder medication far slower then I did.

So now I'm slowly tapering my use with my ultimate goal of stopping completely. I do have legitimate issues and that means suffering through even an easy taper. I was on 400mg to 600mg of morphine a day. I'm down to 30mg to 45mg a day. I was cutting my dose in half every week but I wasn't getting stable on a lower dose. So now I'm down tocutting 25% of my dose instead 50% of it and I stay at that level for two weeks. There is still a ton of suffering involved when you get to the point of getting little relief from opiates and needing to get off of them. Clinical addiction is another harsh reality of prescribed opiate use.