About 2.5 weeks ago… my sciatic nerve decided to “march to a different drummer”. By now, I have went thru two weeks of high dose & decreasing Prednisone without much change in my dramatically elevated pain level. On the “second day”, I could not get in to see any of the seven prescribers in PCP practice that we have been going to for 20 yr+, so I went to the “Urgent Care” in the same bldg – owned by the same hospital – as the PCP group.
I already have a “iffy back” that is subjective to being “painful” because of activity – like yard work and because of that, I typically have a fair amount of opiates and muscle relaxers in the house. I had already started “treating” the pain at its onset.
After a few days, the intensity of the pain hadn’t lessened, I was concerned that the Prednisone that I had received from the Urgent care was “too low a dose “.. so I was able to get an appt with the PCP group and the prescriber that I saw agreed on the low Prednisone dose and TRIPLED the dose.
Another week had passed and no change in the intensity of my pain and our PCP decided that it was time to get a MRI.. Had the MRI on Wednesday and had the last appt of the day with our PCP on this past Friday. It would seem that the “spongy fibrocartilaginous material” between L4-L5 had bulged and had impinged on the sciatic nerve.
I am now waiting for a referral to a neural surgeon and hopefully will be seeing him this coming week.
Our PCP has always let me titrate my own opiate dose when I have had painful flares over the years. By this point, I was running low on opiates. I was using a rather low dose of a IR opiate and in it would now appear that I am a fast/ultra fast opiate metabolizer. Taking a dose, it would “kick-in” in about 30 -45 minutes and start to dramatically “peter-out” about 2.5 hrs after taking the dose. So a IR dose that should have been providing 4-6 hrs of some pain management… was providing only about TWO HRS.
Our PCP gave me a paper Rx to take to the pharmacy to get filled for enough to last me about 3 weeks. At the pharmacy, the pharmacist told me that SILVER SCRIPTS has a QUANTITY LIMIT of SIX DOSES IN 24 HRS… and I am taking TEN DOSES every 24 HOURS !
So I go home and call Silver Scripts and talk to the PA dept… I am first told that it would take at least 72 hrs… they would have to talk to the doctor… I did not have 72 hrs of medication left and I was the last appt for the weekend.
I pointed out to the PA dept customer service that running out of medication would cause my pain level to go to the upper end of the pain scale, and I could be dependent enough that I could be thrown into withdrawal if I ran out of medication.
I identified myself as a Pharmacist whose specialty was pain management and intentionally throwing me into withdrawal resulting in a torturous level of pain and withdrawal that could be considered pt/senior abuse and that torture in this country is still considered ILLEGAL.. I sensed that I was not getting very far with this person..
So… I stated that one of the basics of the practice of medicine is the starting, changing or stopping a pt’s medication and that Silver Scripts did not have a license to practice medicine and that their chief Medical Director Dr Brennan… only had a license to practice medicine in MASS as well as having a law degree.. so he should be well aware what is legal or illegal and being done under his name.
I also told the CS person that it is ILLEGAL – under the controlled substance act – for a prescriber to prescribe controlled substance for a person that he/she had not done a in person physical exam and that Dr Brennan does not have a license to practice medicine in the state of Indiana – where I live.
The CS person asked me if I wanted them to process the PA even if they couldn’t get a hold of the prescriber….. and that would be 24 hrs… and I repeated that I would be out of medication before the 72 hr time frame. This was about 6 PM on Friday and was assured that I would receive a determination by 6 PM on Saturday.
About 11 AM on Saturday, I got a voice mail…that the PA has been approved 🙂
In the interim, I went to the Silver Scripts formulary (2018) on the web.. and found the following:
Notice that their QL’s have nothing to do with mgs/day but tablets/caps/day. And if your necessary dose of Oxycodone is 10 mg/dose… they will only pay for Oxy/APAP 10/325 and allow enough APAP/day that could harm your LIVER. Of course, if this destroys your liver and you need a transplant… then it is Medicare that has to pick up the cost… since they only have to worry about the cost medications.
Filed under: General Problems
Ain’t it grand living in a place where a CSR cab make policy and prescribe meds!!
Thanks for your insight and example of dealing with rigid, uneducated bureaucrats.
I have recently started documenting all interactions. I live in a One Party Consent state so I MAY record convos without their consent. Sometimes it is better to tell them, sometimes not. I started after trying to fill husband’s RA opioid meds. His reg pharm, Rite Aid was out and not getting more for 2 weeks, Walgreens said no more pain pts, my little pharm said they’d fill if all his meds were trsnsferred to them. So we did that but 1 had no refills (Fri afternoon). “Nope, can’t fill it”….
I finally drove to a pharmacy behind big hospital 30mi away that I had used for years, explained to head pharmacist, who looked annoyed, said, “Yeah, and now you will be labelled as a “drug seeker”…..I wouldn’t be called that if it took 4 stores to fill my BP meds though.
5 minutes later, he had RX filled. My hero.
You tell them Steve! Being in pain is bad enough now we have to fight with everyone to get relief. Sorry your suffering with the pain in your back.Feel better soon.
Awesome Job! Lol I was going to say, Way to Go! But I see Dr Ibsen already said that one. 🙂
I hope you can feel better soon and it can be stopped.
In fact, sciatic does hurt Really BAD, one of my new pain conditions along with a new form of
polyarthrithis. Ugh.. the list keeps growing. I’ve got to see the rhumetologist again to try to find out what type this one is..
Doesnt seem to improve as I get older.
Way to go!