Thursday, June 22, 2006

Drug Seeking...? Maybe, maybe not!

When I found the world of medical blogging, I thought I had died and fallen into a big vat of dark chocolate. I love medicine. I have loved medicine since I was a child and for fun would sit around reading my moms nursing textbooks. My dream FOREVER was to be a surgeon.

Unfortunately, when adolescence hit my neighborhood, my hormones convinced me that other things were more important than school and now at 45, my children are grown and I don’t have the money for school.

So now I live my life vicariously through all the wonderful BLOGS out there belonging to folks in the medical field. I love it!! The one recurring theme through several of them I have felt the need to speak to though. I know it is a touchy subject, but there is more than one side and I want any docs (and others but it is the docs who can prescribe) to hear one more.

I met my “now husband” 7 years ago. I am 45 and he is 52. Dear Spouse lives with chronic pain. He has several chronic illness’ (most of which showed up within the past 4 years. I can only hope that is not a reflection on being around me so much.) Without violating his HIPPA rights, let’s just say a couple of them cause him unrelenting pain 24/7.

Now I cannot judge another person’s pain. Neither can you. I do know I have watched this big bear of a man (6’5) change before my very eyes. When we met, he was full of laughter and merriment. He was bright and seemed to light up a room when he entered it. (He sure lit my world but I’ll tell that story later.) He has worked since he was 15 years old and went to college while supporting his parents since his dad had his first heart attack at 44 and was gone by 56. He is a hard worker. A smart, intelligent man.

For four years, we went from our family doctor, whom we love and adore, to several others before we found someone willing to treat the pain. I know, I know... Doctors are afraid of prescribing the “good stuff” too much or too often. You all have governmental agencies breathing down your necks and big brother watching your every script. I do not pretend to know the answer to this dilemma. I do know, that when we finally found someone willing to “TREAT HIS PAIN”, I have watched some life come back into his world.

There are side effects. Sometimes he cannot keep his eyes open no matter how hard he tries. He was laid off from his job shortly before he was given this pain medication. Since he began this treatment we have noticed that it makes it very difficult for him to stay awake sometimes. Between the sedation and the other symptoms of his illness', I don’t know if he will ever be able to go back to work.

No job means no benefits. No benefits means no insurance. Again, I don’t know what the answer is. Do we let him hurt constantly non-stop 24/7 so that he can hold down (maybe) a full time job, or do we allow him some peace in his body and his mind by giving him the medication required even though it has this other negative impact on his life? He was barely able to work anyway. The 40 hours a week took everything he had. There was nothing left in his non-work hours. He was just totally wiped out. So what is quality of life?

On the medication (Fentanyl), he is more comfortable. He smiles more. He laughs more. He is not as depressed since the pain is lessened. It is not gone, it has just lessened. We accept that it may never be fully gone, but we are thrilled with the improvement he has now.

The future is scary to me. Right now I am able to (barely) pay the COBRA premiums for his insurance. Unfortunately COBRA is only good here in our state for 12 months. His medications come to $1900 a month. With the insurance we pay $200 out of pocket. We’re “making payments” on I don’t even remember how many medical bills each month. Without the COBRA...I do not know WHAT we will do. But I do know that to let him suffer is just wrong. Just plain, downright wrong.

One day, we can talk about how chronic illness changes (and challenges) a semi new marriage.



kt said...

i am so sorry that your husband has had this pain. i have had my share of taking care of people with chronic pain and it is very hard to watch - all you want to do is wave your magic wand to make it go away for them. i wish for you and him the magic wand and the correct medicine to help him.

Dr. Charles said...

a very controversial subject, such a dilemma when the only meds that help are addictive...

Sid Schwab said...

Excellent post. It's hard on all sides of the picture, because whereas there are people out there who use the system to get drugs -- and skeptical as I might be, I've fallen for it more than once -- most people who say they are in pain really are. And even drug-seekers can hurt. On the other hand, I've seen some incredibly stupid "officials" come down on doctors for over-prescribing when it was in fact justified. An example: chronic pancreatitis. The main manifestation is pain: severe, disabling. In fact, I was taught in residency that you shouldn't operate on someone for chronic pancreatitis (because the outcome of surgery, and the proper selection of the right patient for the right operation is hazy) unless that person was addicted. One of my first cases of it in private practice was a man in chronic pain from the disease, referred by his gastroenterologist. He was an excellent surgical candidate and, by golly, the operation I chose to do was a great success: off all med in about a week.

But about the time he sent me the patient, the GI doc was told he was being investigated by the state board for the amount of pain med he'd been prescribing to this patient. And when, before any major action, the proof of proper care was evident (ie, the surgical result), the board wrote back to the doc saying he was off the hook, but that in the future he ought to pay more attention to how it looks when he writes such prescriptions!! IDIOTS!!!!!

So yeah. Your sentiments ought to be at the beginning of the thought process. But it ain't always easy. But your dream is a good one: being a surgeon is pretty cool.

Sid Schwab said...

I should have added this: you and your husband have my sympathy for being caught up in one of the more disgraceful aspects of American healthcare, namely financing.

And as to your "dream" of being a surgeon: you are only a click away from finding an entertaining and enlightening book on what it's like to get there...

NeoNurseChic said...

Hugz to you and your husband for going through this. I am someone who does live in severe, constant pain....for over 5.5 years now, actually. It wasn't until about 4 months ago that I was allowed pain management for the first time ever. I took and tried over 100 other meds with terrifying side effects in the categories of anti-seizure meds, antidepressants, beta blockers, etc...all in the name of pain relief. In the eyes of my doctors, those meds were safer than things like morphine and other pain meds.

But from my eyes...the worn out tired eyes of a twenty-five year old who has seen the inside of the hospital walls far more than she would like to...the pain meds are far less risky than the antiseizures, etc. From the stance of all this pain, is it right that this pain goes untreated?


I don't care what fear and what laws. We are humans first. It is not right to let people live in constant, severe agonizing pain that disrupts their lives to the point of being unable to live...all in the fear of some government that doesn't give a damn or in the eyes of those that judge who have no right to do so.

I'm so sorry you are going through this - from someone who has been going through it for awhile now...