Legislators bang the gavel to sue drug companies

https://www.longislandadvance.net/2418/Legislators-bang-the-gavel-to-sue-drug-companies

Suffolk Legislators voted unanimously 18-0 to commence legal action against pharmaceutical companies who overzealously market prescription opiates, Tuesday night. 

The drug companies are not mentioned in the resolution. Legis. Rob Calarco (D-Patchogue), who introduced two bills with Legis. Kara Hahn as co-sponsor that pushed the decision forward, said the resolution would attempt two objectives. “Our county law department thinks we have a good case,” Calarco said. “The issue is that there are prescribed opiates that are inappropriately marketed and misrepresented as safe for long-term use and misrepresented as being not addictive. The law firm we’ve hired will be responsible for coming up with a dollar amount, which we believe the county has incurred to our health insurance plan for our employees and Medicaid costs for low-income individuals. They’ll determine how much we spent on those who have become addicted, whether on treatment programs or the fact we have to put NARCAN in our police cars as well as the societal costs that include people holding up convenience stores, etc. to fuel their addiction.”

Simmons Hanly Conroy, LLC, a Manhattan firm, has been retained on a contingency basis to represent the county. 

“They’ll frame the lawsuit and draft it up and will also be responsible for filing it with the court,” Calarco explained. “This won’t be an overnight thing.”

Calarco said there was some discussion on what the county was alleging. “In my opinion, what we’re dealing with is that these drug companies are not telling people the full risk involved in taking these opioids. We are one of the only nations in the world that prescribes such high potency products with such regularity.” 

The decision resulted in a thoughtful process after a resolution passed last November, directing the county attorney to study the feasibility of such an action. Two additional bills were passed in November; one that created a six-member committee to review the lawsuit’s viability, the other to provide a study of opioid addiction and abuse-related costs in Suffolk County. 

The county’s action follows a small but growing trend of legal action from municipalities concerned about the troubling rise in opioid addiction. In August, New York Attorney General A.G. Schneiderman announced a settlement with Purdue Pharma to insure responsible and transparent marketing of prescription opioid drugs by the manufacturer. The agreement strengthened and made permanent an internal Purdue program that would prevent its sales staff from promoting the powerful painkiller to health care providers who may be involved in abuse and illegal diversion of opioids. It also requires Purdue to disclose financial relationships with any individuals, including doctors and other health care professionals, who appear on the company’s “unbranded” websites that endorse the benefits of pain treatment.

According to an official from the Attorney General’s office, Purdue will provide annual information to the external auditor regarding this information for three years. The auditor will then evaluate Purdue’s compliance and present their findings in a written report with the first report due August 2016. The Attorney General’s office will also monitor the drug firm. 

Purdue was also required to pay $75,000 to the state.
Calarco began pushing for legal action, one that might seem unlikely, last fall. But the impetus he pointed to involved two California counties, Orange and Santa Clara, as well as the city of Chicago that filed two separate federal lawsuits last summer charging that certain opioid manufacturers knowingly and aggressively marketed opioids by misrepresenting their drugs. The drug companies targeted were Purdue Pharma, which makes OxyContin; Endo Health Solutions, Inc., which makes opioids such as Percocet; Teva Pharmaceutical Industries that makes Actiq; Janssen Pharmaceuticals that makes Duragesic; and Actavis that makes Kadian.

The county will seek to recover damages associated with the over-prescription of opiates.

Several statistics from the Suffolk County Health Assessment Report 2014-2017 have emerged chronicling a harrowing jump in opioid-related deaths, by 30 percent between 2007-2011. The incidence of oxycodone, which appears in 33 percent of opioid-related deaths nearly doubled between 2007 and 2011, it said. 

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Research shows marijuana lowers pain with minimal side effects

http://www.examiner.com/article/research-shows-marijuana-lowers-pain-with-minimal-side-effects

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My ONE DAY STAYCATION at our local hospital

All hospitals have routines, but.. unfortunately.. all pts don’t always safely fit within their routines. I had to go back to the local hospital for a scheduled procedure.   I had the same procedure done > 10 yrs ago with a different prescriber and a different hospital.

First the physician’s staff called me TWICE a few hours apart to tell me about the timing of the procedure.. as if the office staff was not communicating with one another.

I told them that I had the procedure before… I was informed that I had to be NPO after midnight and had to be at the hospital at 10:30 and make sure that I have a driver to take me home.

I get there and they ask ” have you have your blood labs done yet ?”… no one told me about having labs done… Had just been to my PCP a couple of weeks early and had my annual physical and had blood/urine labs done..  TOO OLD !! .. OK… I’m in a hospital.. how much of a push to get some blood work done….

Get into the pre-op room… IV cath put in arm… all of the usual procedures…  I knew that I would have to be laying flat for a couple of hours after the procedure..  no big deal…

So they start going over the particulars… it was now abt noon and procedure is to start at 12:30… and it will take abt 1.5 hrs… I am informed that this physician wants a me to be flat in bed for FIVE HOURS… and then WALK AROUND FOR ONE HOUR…

I start doing the MATH … procedure will be over at 2 PM… plus 5 hours flat on my back… it is now 7 PM and another hour walking would make it 8 PM.. if ALL GOES RIGHT !

Barb CANNOT drive after dark because of some of her medical issues that affects her eyes… so I told the nurse that we have a scheduling problem… a few back and forth with the nurse of  “CAN’TS”.. She told me that I couldn’t drive.. even though I would be at least 6 hours post procedure… well I am not letting Barb out on the road.. dangerous to other people on the road.. besides ourselves…  Nurse leaves the room.. seemingly the procedure is going to go forth… and I guess at 8 PM – 9PM… getting home is my problem…

I am sitting there on the bed… I could feel my BP rising… This was an elective procedure… there is no life-death issues here… unless Barb or I have to drive home after dark…

I push the “CALL BUTTON” on the handset… nurse comes back in … and I pull the FINAL CAN’T … This procedure CAN’T happen TODAY !  “I’ll have to talk to the doctor…”… I didn’t say it… but.. you can talk to the Mayor … the Governor… or whoever…   I know how to pull a angio-cath and get dressed.

Procedure is now rescheduled in 10 days for 9 AM… and be done by 4:30… giving a 2 -2.5 hr window of “wiggle room” to get out of town before the sun goes down.

On the good side.. when the hospital called concerning pre-admission information.. they confirmed my allergies to CARROTS AND PEAS … someone appeared to have listen on my previous stay and took notes in their system. 🙂

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State Change Could Help Patients Get Pain Medications

http://wlrn.org/post/state-change-could-help-patients-get-pain-medications

Read this article very carefully… the BOP has stated that they have done EVERYTHING WITHIN THEIR AUTHORITY to help chronic pain pts  get their medication… Of course, those registrants of the DEA (wholesaler, prescriber, pharmacy) the BOP has no authority over those entities in the regards of this issue… AND.. the DEA and AG Bondi are MIA in changing the path of this denial of care to chronic pain pts. Yes you can TRY and get the Pharmacist’s mindset to stop first start looking for a reason to “JUST SAY NO”. Walgreens has some 20 K Pharmacists and it is my understanding that all it takes is ONE PHARMACIST to “black ball” a pt from all of Walgreen’s 8500 pharmacies. I can almost guarantee that putting all those 20 K Pharmacists thru a re-education program.. will not change 100% of their mindset toward first looking for a reason to fill a controlled Rx. As long as the DEA is out there with tangible or intangible threats of fining corporate pharmacies or wholesalers…  the problems from that part of the medication distribution system will be in a holding pattern. Remember… THREE WHOLESALERS controls abt 90% of the market. Pharmacists cannot dispense medication that the wholesalers refuse to sell them because of rationing.

Reacting to pleas from desperate patients unable to get pain medications, the Florida Board of Pharmacy on Wednesday approved a rule change aimed at training pharmacists to change their mindset about prescriptions for controlled substances.

The change switches the rule from a focus on reasons to reject prescriptions for highly addictive narcotics to an emphasis on ensuring that legitimate patients get the medications doctors have ordered.

“Instead of starting out with trying to find a reason to doubt a prescription, you start off with an assumption that everything in the prescription is good, and you work towards achieving patient access,” Florida Pharmacy Association Executive Vice President Michael Jackson said after the unanimous vote Wednesday morning.

The board’s action came after a series of meetings on the issue earlier this year in which members of the Controlled Substance Standards Committee heard from patients, doctors and even pharmacists frustrated by the “pharmacy crawl,” where patients have traveled to up to a dozen drug stores in search of their medications. The problem has escalated statewide in the aftermath of state and federal crackdowns on “pill mills” that earned Florida a reputation as the epicenter of a prescription drug-abuse epidemic.

At least one doctor told the committee about patients with chronic pain who had committed suicide after they were unable to get prescriptions filled. Other patients complained that pharmacists had refused to fill prescriptions because they could not prove that doctors’ orders were “medically necessary.” Some pharmacists complained that distributors had cut back on their supplies of narcotics out of fear of scrutiny from the U.S. Drug Enforcement Administration, which has imposed heavy fines on pharmacy chains and suppliers in Florida.

“I know this is emotional,” Gavin Meshad, chairman of the committee and a member of the pharmacy board who represents consumers. “People are passionate about this. I think we’re doing everything in our power to try to address the problem.”

The rule begins with an affirmation that “it is important for the patients of the state of Florida to be able to fill valid prescriptions for controlled substances” and spells out for pharmacists the necessary steps to ensure that the prescriptions are legitimate and that patients should have them.

The rule also includes requiring pharmacists to take a two-hour, “Validation of Prescriptions for Controlled Substances” course to educate pharmacists about ensuring access to pain medications for “all patients with a valid prescription.” Pharmacists would have until 2017 to take the course.

While the regulatory change won’t have any impact on the amount of drugs pharmacies are able to order from suppliers, the education requirement should help alleviate the difficulty patients are now encountering, said Board of Pharmacy Chairwoman Michele Weizer.

“If (the prescription) is a legitimate purpose and we can get in touch with the prescriber if we need to, they should find it much easier than they have in the past,” she said.

The change, which still needs to go through what can be a time-consuming regulatory approval process, also won’t force chain pharmacies like Walgreens and CVS to revamp corporate policies that result in some patients being blacklisted or turned down even when prescriptions are valid.

But patients can take some steps to improve chances of getting their prescriptions filled, said Jackson, whose association represents independent pharmacies.

Jackson said patients should try to find pharmacies close to their residences or workplaces and establish relationships with pharmacists. Patients should also be “open about sharing their health information” with their pharmacists, Jackson said.

“If you establish a pharmacist-patient relationship, just like a physician-patient relationship, you’ll have a health care provider who’s more motivated to work to resolve your problems,” he said. “But screaming and yelling at pharmacists will only create doubt in the pharmacists’ mind that there’s something going on here that they’re not sure they understand.”

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Opioid Prescriber Monitoring May Increase Overdose Deaths

http://www.medscape.com/viewarticle/836489

AVENTURA, Florida ― Surveillance of opioid prescribers, designed to prevent opioid overdose deaths, may actually be having the opposite effect, new research suggests.

Sonia Mendoza

The qualitative study, aimed at assessing doctor-patient interactions after a prescription monitoring program (PMP) known as “I-STOP,” which was mandated by New York State in 2013, showed that Staten Island prescribers of opioids are refusing patient requests for the drugs, “are abruptly discontinuing long-term narcotic treatment, and are refusing to accept new patients who are at risk of nonmedical narcotic use,” report investigators.

In addition, clinicians predicted that effects of the program will lead to an increase in the use of heroin and illicit opioids by those dependent on prescription opioids, as well as an increase in state border crossings to obtain prescriptions.

Lead author Sonia Mendoza, research coordinator at New York University and the Nathan Kline Institute for Psychiatric Research, in New York City, told Medscape Medical News that although increased transparency from PMPs offers benefits, this particular program has also led to an increase in discharges upon discovery of diversion.

“We found that a lot of prescribers were afraid that patients would simply go to New Jersey because they had no access to New Jersey’s monitoring program,” said Mendoza.

“They thought it did increase honesty and transparency regarding patients’ behaviors. But at the same time, they didn’t have comprehensive care for the patients, which led to discharges without proper referrals,” she added.

The study was presented here at the American Academy of Addiction Psychiatry (AAAP) 25th Annual Meeting and Symposium.

Opioid Overdose Epidemic

The investigators report that Staten Island has four times the number of opioid overdose deaths of any other New York City borough. As a result, enhanced surveillance by law enforcement has been instituted for opioid prescribers.

Operational PMPs are now in place in 48 states. In New York, the PMP is known as the Internet System for Tracking Over-Prescribing (I-STOP) and is a registry for all prescriptions of Schedule II, III, and IV controlled substances.

For the study, the investigators recruited clinicians through the Substance Abuse and Mental Health Services Administration (SAMSHA), which lists all opioid maintenance–certified prescribers in Staten Island and the other boroughs of New York City. Community-based buprenorphine-certified prescribers and patients underwent semistructured interviews and “ethnographic observations.”

“We wanted to look at the impact especially in primary care physicians who don’t have a background in addiction psychiatry,” said Mendoza.

 Results showed that after I-STOP was put in place, providers have reported discharges, but sometimes without proper referral.

One prescriber noted during the study that 20% of these patients were discharged from his practice. “You find that they go to different doctors and are not honest. They’ve taken more medicine than they’re supposed to do. You have to sit down and talk to them for a long time [and] give them a chance to be honest,” he said.

“You’re reigning in the people who are making money on the side, and if I can fix [patients] rather then throw them back out there, I try. Sometimes it works, sometimes it doesn’t,” said another study interviewee. “The moment you find diversion, you let them go; I-STOP is to detect diversion.”

 Regarding whether patients might cross state borders to get prescriptions, one prescriber said, “they can go to Jersey and I-STOP won’t know,” and another said, “they cross the bridge and get a prescription; if they want to do something, they do it.”

Interestingly, both providers and patients reported ambivalence about I-STOP’s overall effect on patient behaviors.

The program “has caused a major heroin problem in Staten Island. They turned a pill problem into a heroin problem,” said one prescriber.

 

However, another countered that he felt that he was on the right track. “It’s validating and has improved the link and communication between patients and doctors.”

Fear-Driven?

Overall, the findings suggest that “drug policies that target prescribers for sanctions in an effort to maintain boundaries around ‘legitimate’ medical use of opioids may paradoxically be leading patients to use illicit drug markets and to higher risk narcotic use,” write the investigators.

 

Mendoza added that many of the interviewed prescribers said that “clamping down on opioid analgesics” was correlated with increased heroin use or their patients turning to the streets for illicit opioids.

“And that has been confirmed in the latest Department of Health data from New York State,” she said.

“They are also aware that the DEA is closely monitoring. So if a patient is deviant, they discharge them because they are just afraid of the consequences to themselves.”

Mendoza noted that specific protocols need to be created to better guide clinicians.

“Additional interventions to educate prescribers and provide support for substance abuse treatment, patient referrals, and harm reduction interventions such as naloxone kits…are needed to complement prescription monitoring programs,” write the investigators.

 

In addition, Mendoza reported that some of the most successful interviewees described having contracts with patients for periodic urine tests and random pill counts.

“Also, having better relationships with their patients and longer consultations were important.”

Need for Checks and Balances

Maria Sullivan, MD, PhD, associate professor of psychiatry at Columbia University Medical Center in New York City, told Medscape Medical News that the study authors called attention to the increased burden on prescribers, in terms of time and effort, to comply with the state’s 2013 mandate.

Dr Maria Sullivan

“I would agree that there is a higher burden on providers. However, the intention of this electronic monitoring program is to reduce the very substantial overdose death rates that have been occurring. And there is some preliminary evidence that it is beginning to have a positive impact,” she said.

 

Dr Sullivan, who was not involved with this research, is also chair of the AAAP research committee and chair of the clinical expert panel for the Providers’ Clinical Support System for Medication Assisted Treatment.

She noted that although there is some variability in the way different states have adopted these programs, “it’s really checking at the point of each prescribing that ensures that there is not multiple providers involved.”

“I think that the balance is clearly in favor of implementing electronic prescribing in terms of improved patient outcomes and reducing public health costs.”

 Dr Sullivan added that fear is “an unfortunate response” from some prescribers and noted that there are current initiatives sponsored by SAMHSA to train providers who have not previously felt comfortable prescribing buprenorphine or naltrexone for opioid dependence.

“Ultimately, these programs are protective for the physician as well, because you can have a higher confidence level that the opioids you’re prescribing are not being diverted or misused,” she said.

“I really think these are necessary checks and balances trying to stem the tide of the current opioid epidemic.”

 The study authors have reported no relevant financial relationships. Dr Sullivan reported having received medication study samples from Alkermes.

American Academy of Addiction Psychiatry (AAAP) 25th Annual Meeting and Symposium: Abstract 44, presented December 6, 2014.

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CVS/pharmacy Continues Commitment to Fight Drug Abuse, Now Sells No Prescription Necessary Opioid Drug Reversal Med in NJ

http://mercerme.com/cvspharmacy-continues-commitment-to-fight-drug-abuse-now-sells-no-prescription-necessary-opioid-drug-reversal-med-in-nj/

CVS/pharmacy, the retail division of CVS Health, is reinforcing its longstanding commitment in the fight against the nationwide epidemic of prescription drug abuse with a number of efforts launching this past month.

Most notably, CVS/pharmacy has expanded the availability of the opioid overdose reversal medicine, naloxone, in several states, including New Jersey. The medication was already available at CVS/pharmacy without a prescription in Rhode Island and Massachusetts. Naloxone is now available without a prescription at CVS/pharmacy locations in 12 additional states: Arkansas, California, Minnesota, Mississippi, Montana, New Jersey, North Dakota, Pennsylvania, South Carolina, Tennessee, Utah and Wisconsin.

How is 16K our of 44 K determined as MOST ?

“Over 44,000 people die from accidental drug overdoses every year in the United States and most of those deaths are from opioids, including controlled substance pain medication and illegal drugs such as heroin. Naloxone is a safe and effective antidote to opioid overdoses and by providing access to this medication in our pharmacies without a prescription in more states, we can help save lives,” said Tom Davis, RPh, Vice President of Pharmacy Professional Practices at CVS/pharmacy. “While all 7,800 CVS/pharmacy stores nationwide can continue to order and dispense naloxone when a prescription is presented, we support expanding naloxone availability without a prescription and are reviewing opportunities to do so in other states.”

In addition, CVS Health is currently participating in a research project with Boston Medical Center and Rhode Island Hospital to support a demonstration project of pharmacy-based naloxone rescue kits to help reduce opioid addiction and overdose deaths.

Since opiate addiction  is a mental health disease… and Naloxone is a “opiate neutralizer ” how can anyone believe that Naloxone will help reduce opiate addiction… If a addict is not ready to be clean and stay in recovery.. all the Naloxone is going to give them another chance to keep on abusing whatever substance they “like” and helps them deal with the monkeys on their back and/or demons in their head… or if their OD was an attempt at suicide.. they get to try it again. Even if they go thru an addiction recovery program.. and they return to their previous friends, environment or other triggers.. their chances of remaining in recovery quite disappears.

CVS/pharmacy has also renewed its Medication Disposal for Safer Communities Program, in which it has teamed up with the Partnership for Drug-Free Kids to donate drug collection units to police departments around the country to help their communities safely dispose of unwanted medications, including controlled substances.

“Our Safer Communities program has donated more than 400 drug collection units to local law enforcement around the country since last year, resulting in almost seven tons of unused medication being collected in our communities,” said Davis. “We are pleased to continue this program with the Partnership for Drug-Free Kids and provide a permanent drug disposal solution at local police departments.”

Police departments interested in receiving a drug collection unit can apply at www.cvs.com/safercommunities.

Also, the Drug Enforcement Administration (DEA) will hold National Prescription Drug Take-Back Day on Saturday, September 26. On that day, hundreds of CVS/pharmacy locations around the country will host local law enforcement collection events in store parking lots from 10:00 AM to 2:00 PM. To locate a participating collection site, visit http://www.deadiversion.usdoj.gov/drug_disposal/takeback/.

Other on-going initiatives at CVS/pharmacy to combat prescription drug abuse include:

• Availability of postage-paid Environmental Return System envelopes at all of its pharmacies with which customers can send their unwanted medications for secure and environmentally-safe disposal.
• Identification of physicians who exhibit extreme patterns of prescribing high risk drugs such as pain medications and suspension of dispensing their controlled substance prescriptions.
• Advocating at the federal and state levels to implement policy changes to curb prescription drug abuse, such as mandatory electronic prescribing of controlled substances and improved prescription drug monitoring programs.

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California governor signs hard-won right-to-die legislation

http://www.modernhealthcare.com/article/20151005/NEWS/310059996

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http://www.wftv.com/news/news/local/video-shows-judge-berating-sentencing-domestic-vio/nnwwh/

SEMINOLE COUNTY, Fla. —

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Letter to Normals from a Person with Chronic Pain

This is an adaptation of a piece written by Bek Oberin.
A Letter to Normals from a Person With Chronic Pain
Having chronic pain means many things change, and a lot of them are invisible. Unlike having cancer or being hurt in an accident, most people do not understand even a little about chronic pain and its effects, and of those that think they know, many are actually misinformed.
In the spirit of informing those who wish to understand: These are the things that I would like you to understand about me before you judge me.
Please understand that being sick doesn’t mean I’m not still a human being. I have to spend most of my day in considerable pain and exhaustion, and if you visit, sometimes I probably don’t seem like much fun to be with, but I’m still me, stuck inside this body. I still worry about work, my family, my friends, and most of the time, I’d still like to hear you talk about yours, too.
Please understand the difference between “happy” and “healthy”. When you’ve got the flu, you probably feel miserable with it, but I’ve been sick for years. I can’t be miserable all the time. In fact, I work hard at not being miserable. So, if you’re talking to me and I sound happy, it means I’m happy. that’s all. It doesn’t mean that I’m not in a lot of pain, or extremely tired, or that I’m getting better, or any of those things. Please don’t say, “Oh, you’re sounding better!” or “But you look so healthy!” I am merely coping. I am sounding happy and trying to look normal. If you want to comment on that, you’re welcome.
Please understand that being able to stand up for ten minutes doesn’t necessarily mean that I can stand up for twenty minutes, or an hour. Just because I managed to stand up for thirty minutes yesterday doesn’t mean that I can do the same today. With a lot of diseases you’re either paralyzed, or you can move. With this one, it gets more confusing everyday. It can be like a yo-yo. I never know from day to day, how I am going to feel when I wake up. In most cases, I never know from minute to minute. That is one of the hardest and most frustrating components of chronic pain.
Please repeat the above paragraph substituting “sitting”, “walking”, “thinking”, “concentrating”, “being sociable” and so on, it applies to everything. That’s what chronic pain does to you.
Please understand that chronic pain is variable. It’s quite possible (for many, it’s common) that one day I am able to walk to the park and back, while the next day I’ll have trouble getting to the next room. Please don’t attack me when I’m ill by saying, “But you did it before!” or “Oh, come on, I know you can do this!” If you want me to do something, then ask if I can. In a similar vein, I may need to cancel a previous commitment at the last minute. If this happens, please do not take it personally. If you are able, please try to always remember how very lucky you are, to be physically able to do all of the things that you can do.
Please understand that “getting out and doing things” does not make me feel better, and can often make me seriously worse. You don’t know what I go through or how I suffer in my own private time. Telling me that I need to exercise, or do some things to “get my mind off of it”, may frustrate me to tears, and is not correct. if I was capable of doing some things any or all of the time, don’t you know that I would? I am working with my doctors and I am doing what I am supposed to do. Another statement that hurts is, “You just need to push yourself more, try harder”. Obviously, chronic pain can deal with the whole body, or be localized to specific areas. Sometimes participating in a single activity for a short or a long period of time can cause more damage and physical pain than you could ever imagine. Not to mention the recovery time, which can be intense. You can’t always read it on my face or in my body language. Also, chronic pain may cause secondary depression (wouldn’t you get depressed and down if you were hurting constantly for months or years?), but it is not created by depression.
Please understand that if I say I have to sit down, lie down, stay in bed, or take these pills now, that probably means that I do have to do it right now, it can’t be put off or forgotten just because I’m somewhere, or I’m right in the middle of doing something. Chronic pain does not forgive, nor does it wait for anyone.
If you want to suggest a cure to me, please don’t. It’s not because I don’t appreciate the thought, and it’s not because I don’t want to get well. Lord knows that isn’t true. In all likelihood, if you’ve heard of it or tried it, so have I. In some cases, I have been made sicker, not better. This can involve side effects or allergic reactions, as is the case with herbal remedies. It also includes failure, which in and of itself can make me feel even lower. If there were something that cured, or even helped people with my form of chronic pain, then we’d know about it. There is worldwide networking (both on and off the Internet) between people with chronic pain. If something worked, we would KNOW. It’s definitely not for lack of trying. If, after reading this, you still feel the need to suggest a cure, then so be it. I may take what you said and discuss it with my doctor.
If I seem touchy, it’s probably because I am. It’s not how I try to be. As a matter of fact, I try very hard to be normal. I hope you will try to understand. I have been, and am still, going through a lot. Chronic pain is hard for you to understand unless you have had it. It wreaks havoc on the body and the mind. It is exhausting and exasperating. Almost all the time, I know that I am doing my best to cope with this, and live my life to the best of my ability. I ask you to bear with me, and accept me as I am. I know that you cannot literally understand my situation unless you have been in my shoes, but as much as is possible, I am asking you to try to be understanding in general.
In many ways I depend on you, people who are not sick. I need you to visit me when I am too sick to go out. Sometimes I need you help me with the shopping, the cooking or the cleaning. I may need you to take me to the doctor, or to the store. You are my link to the “normalcy” of life. You can help me to keep in touch with the parts of life that I miss and fully intend to undertake again, just as soon as I am able.
I know that I asked a lot from you, and I do thank you for listening. It really does mean a lot.

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