Looking in the rear view mirror

Posted on February 16, 2022 by Pharmaciststeve

I found this graphic on my computer with a date from 2014


Then there is this graphic that shows ALL OVERDOSES – starting about the time that the Decade of Pain Law expired and was not renewed.. Opiate Rxs peaked in 2011 – again near the start of this graphic and projects the OD deaths thru the end of the decade. So if that prediction is correct, Overdose deaths will have INCREASED TEN FOLD in 15 yrs. If you notice in the graphic, there is a substantial uptick after the 2016 CDC guidelines were released and in 2021 when our SW Southern border was opened up. Reportedly a “flood” of illegal Fentanyl analog and other illegal abused substances started happening about one year ago. What is also interesting is the number of deaths contributed to use/abuse of alcohol and nicotine have not increased anywhere near those of involving legal/illegal controlled substances.  According to this article https://www.nbcnews.com/politics/immigration/fentanyl-seizures-u-s-southern-border-rise-dramatically-n1272676 in the first 9 months of 2021 federal fiscal year the seizures of just illegal fentanyl analogs was over THREE TIMES MORE than all of the entire 2020 fiscal year.

There is another graphic where the various illegal/legal drugs caused OD’s. What is not shown, and it is not known if the CDC did not track or did not disclose.. is the number of OD’s from Pharma opiates was relatively flat for the entire decade, were they from people who had a legal Rx for the opiate showing in the toxicology – which would suggest a SUICIDE or some pharma opiates that have been diverted from legal sources.

What I find interesting is that both pharma opiate production limits and the number of Rx opiate filled have been CUT IN HALF, since 2011.

One just have to wonder how anyone can claim that pharma opiates have any connection to all the OD’s involving illegal Fentanyl. In 2021, that number is reported as being 75,000.

Filed under: General Problems | Leave a Comment »

Clinical Trial Finds BP Elevation With Regular Acetaminophen Use

Posted on February 16, 2022 by Pharmaciststeve

So …. they CUT YOUR PAIN MEDS, YOUR BLOOD PRESSURE GOES UP… and they tell you to take a non-opiate pain med for your pain.. This study suggests that Acetaminophen ( Tylenol ) could cause your blood pressure to GO HIGHER !   The GOOD NEWS  is… you won’t harm your liver taking Acetaminophen, the BAD NEWS is, high blood pressure could harm your kidneys and so will most NSAIDS (Aspirin, Motrin, etc) – depending on how much you take. So what is worse … the frying pan or the fire ?

Clinical Trial Finds BP Elevation With Regular Acetaminophen Use

https://www.uspharmacist.com/article/clinical-trial-finds-bp-elevation-with-regular-acetaminophen-use

Edinburgh, UK—Regular use of acetaminophen might not be appropriate for patients with hypertension because the painkiller significantly raises blood pressure, according to a new study.

The University of Edinburgh study suggests that goes against conventional belief, adding that the drug “is widely used as first-line therapy for chronic pain because of its perceived safety and the assumption that, unlike nonsteroidal anti-inflammatory drugs, it has little or no effect on blood pressure (BP).”

Their study, published in Circulation, notes that observational studies suggest that acetaminophen may increase BP, but few clinical trials have tackled the question. That is why they conducted a clinical trial to access the effect of regular acetaminophen dosing on BP in hypertension.

For the double-blind, placebo-controlled, crossover study, researchers randomized 110 participants to receive 1 g of acetaminophen 4X daily or matched placebo for 2 weeks followed by a 2-week washout period before moving over to the alternate treatment. They measured ambulatory BPs at the beginning and end of each treatment period.

Defined as the primary outcome was a comparison of the change in mean daytime systolic BP from baseline to end of treatment between the placebo and acetaminophen arms.

With 103 patients completing both arms of the study, researchers report that regular acetaminophen, compared with placebo, was found to result in a significant increase in mean daytime systolic BP (132.8±10.5 to 136.5±10.1 mmHg [acetaminophen] vs. 133.9±10.3 to 132.5±9.9 mmHg [placebo] ;P <.0001) with a placebo-corrected increase of 4.7 mmHg (95% CI, 2.9-6.6) and mean daytime diastolic BP (81.2±8.0 to 82.1±7.8 mmHg [acetaminophen] vs. 81.7±7.9 to 80.9±7.8 mmHg [placebo]; P = .005) with a placebo-corrected increase of 1.6 mmHg (95% CI, 0.5-2.7).

They add that similar findings were identified for 24-hour ambulatory and clinic-measured BP.

“Regular daily intake of 4 g acetaminophen increases systolic BP in individuals with hypertension by ≈5 mm Hg when compared with placebo; this increases cardiovascular risk and calls into question the safety of regular acetaminophen use in this situation,” the authors conclude.

In an accompanying commentary, Steven M. Smith, PharmD, MPH, and Rhonda M. Cooper-DeHoff, PharmD, MS, of the Department of Pharmacotherapy and Translational Research, College of Pharmacy at the University of Florida, in Gainesville, point out, “An important but often underappreciated contributor to stagnant BP control rates is drug-induced hypertension. At least 40 to 50 drugs currently in use have been implicated in raising BP, through activation of sympathetic (e.g., pseudoephedrine, venlafaxine) or renin-angiotensin systems (estrogen-based oral contraceptives) promotion of sodium/volume retention (corticosteroids, calcineurin inhibitors) or other mechanisms.”

Drs. Smith and Cooper-DeHoff also advise that nonsteroidal anti-inflammatory drugs, to which acetaminophen often is used as an alternative, blunt the effectiveness of many first-line antihypertensives.

Calling the new study an “important addition” to the research, the commentators write that the BP-raising effects of acetaminophen have been known for more than half a century, but that few clinical trials have provided evidence of that.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

Filed under: General Problems | 1 Comment »

SUCKERBERG: Texas AG Paxton rips Meta for stealing user biometrics to ‘make more money’

Posted on February 15, 2022 by Pharmaciststeve

Texas AG Paxton rips Meta for stealing user biometrics to ‘make more money’

https://www.foxbusiness.com/technology/texas-ag-paxton-rips-meta-for-stealing-user-biometrics-to-make-more-money

AG Paxton says Meta’s privacy violations are ‘damaging’ to personal identity

Texas Attorney General Ken Paxton has filed a lawsuit against Meta for stealing users’ personal information and causing irreparable damages, he told “Mornings with Maria” Tuesday.

Paxton: There’s specific statutory damages for a deceptive trade practice up to 10,000 per violation and then 25,000 for actually capturing someone’s biometric identifier, whether that’s face, fingerprints, or anything without their knowledge. Because this is all personal information and this is information you can’t change. 

I mean, it’s not like you can go get a new Social Security number or a new driver’s license. This is your personal information and once it’s out, once they’ve shared it, once they’ve disclosed it, the genie is out of the bottle. You can’t get it back. So that’s damaging to you as an individual when you have not known about it, you didn’t consent to it as required by law. And now it’s been used by Facebook to make more money as they share it with other people without your knowledge or your consent…

TEXAS SUES META OVER FACEBOOK’S FACIAL-RECOGNITION PRACTICES

They actually implied or told us that they weren’t using facial geometry or capturing your face. And the reality was they’ve been doing it for well over a decade without our knowledge and actually misleading consumers and the state of Texas that they were actually capturing this information…

We filed this in East Texas in a state district court. I wouldn’t be surprised if we are in trial within a year or so. And in front of a jury, explain to the fellow Texans exactly what happened with Facebook. 

Filed under: General Problems | 1 Comment »

Why Try to Kill the Physician

Posted on February 15, 2022 by Pharmaciststeve

Why Try to Kill the Physician

https://www.daily-remedy.com/why-try-to-kill-the-physician/

The king is dead, long live the king.

The reign of the physician is over, replaced by a system of nudges, consultants, and care gap analyses. The lone physician is now gone. In its wake resides a nexus of data and decision prompts, all interacting to standardize healthcare for patients.

Clinical decisions are made in rapid succession. Each correlating data with a decision until the process achieves peak efficiency. In such a system, physicians become an unnecessary expense and a rate-limiting step.

So physicians are replaced. Sometimes they are replaced with mid-level healthcare providers. Sometimes they are replaced with outsourced consultants. But in nearly all circumstances, clinical decisions transfer from an individual physician to a system of decision-making.

It is justified as a cost-cutting measure, as a way to eliminate extraneous costs from healthcare. But the underlying assumption is that the clinical decisions made by a system are equal to that of a physician. Sometimes that is true, but sometimes not.

And in emphasizing the cost of care alone, we overlook a more fundamental balance – between the cost of care and the quality of decision-making. We seem to believe the two are on the same side of the figurative healthcare scale, moving in unison. When in reality, they are weighed against one another, in determined opposition.

There comes a point, in the push for healthcare efficiency, where additional cost cutting measures compromise the quality of care. There is a limit to the number of physicians we can eliminate through a cost-effective system of patient care. It is defined by the nature of the individual clinical decision.

Some clinical decisions are considered simple, nearly reflexive. We do not need a physician to tell us to lose a few pounds to stave off the effects of obesity. Yet many decisions are considered complex. These are the decisions that require physician input. So it would appear that the balance between cost and quality of clinical decision-making is defined by the complexity of the underlying decision.

But, when evaluated in its full context, every decision in healthcare is in reality complex. We merely choose which decisions to simplify and which to keep complex. When a patient repeatedly presents with elevated blood pressure, many would naturally assume that the patient is hypertensive and prescribe a medication. This appears to be a simple decision. These are the Best weight loss pills for women.

But elevated blood pressure is a complex phenomenon, influenced by psychological, behavioral, and physiologic processes. An anxious person can have elevated blood pressure, just like someone who loves to eat processed foods with an extra dash of salt. When physicians diagnose someone with essential hypertension, they essentially acknowledge that they do not know the primary cause of the elevated blood pressure, but recognize that medications may help.

In healthcare, complexity abounds every decision. But to pursue every aspect of every clinical decision would render healthcare obsolete. It would collapse under the weight of its own impractically. Simplification becomes a necessary aspect of modern healthcare.

But the trend towards simplification became a pursuit for the oversimplified as we vied for efficiency as a proxy for cost savings. We can only go so far in this direction because healthcare is not simple – we just need to pretend it is in order to navigate through it.

Systems can only replace physicians when we find an optimal balance between decisions that can be simplified and those that must remain complex. But the more we learn about healthcare, and barriers to optimal patient outcomes, the more complex healthcare proves to be.

And the more complex healthcare becomes, the less we can rely on systems for clinical decisions – the balance tilts away from the simple. Eventually we must revert back to physicians as primary decision-makers, incurring additional costs accordingly. Otherwise, healthcare will not advance further.

So perhaps the presumed demise of the physician has been greatly exaggerated.

I have stated many times that our healthcare system is nothing more … nothing less… that a FOR PROFIT BUSINESS. This article refers to corporations replacing physicians with “mid-levels”..  mid-levels are ARNP, NP, PA… and to the best of my knowledge, when a mid-level provides a product/service to a pt the corporation that they work for get reimbursed at 85% of what a MD would get reimbursed.  I doubt if mid-levels, get a salary that is 85% of what MD’s get paid…  So the corporation has a “larger spread” between what the practitioner gets paid and what the corporation gets reimbursed from insurance for the service provided. the times they are a changing !

 

Filed under: General Problems | 1 Comment »

You need to get Quality Control into that store: CVS #10548 @ 2600 W Michigan Kalamazoo MI location

Posted on February 15, 2022 by Pharmaciststeve

You need to get Quality Control into that store: CVS #10548 @ 2600 W Michigan Kalamazoo MI location

The CVS #10548 @ 2600 W Michigan Kalamazoo MI location has severe issues while dealing with people’s Rx.
#1 They have my middle name listed as my last name.
#2 They filled ALL RX INSTEAD of the one I called in. Before I had to resort to CVS Mail order bc this store NEVER FILLED my Rx in a timely manner. Today my son picked up the Rx I called for yesterday #272043 cost $0.00. Yet this store refilled #283434 cost $47.00 WHEN I NEVER ORDERED IT. Plus, they filled a 3rd Rx I NEVER ordered bc I don’t take it anymore. You need to get Quality Control into that store or soon they’ll give someone the wrong Rx that doesn’t belong to them and you’ll have a lawsuit on your hands. They are much too incompetent to be open to the public. Do something.

Filed under: General Problems | Leave a Comment »

As pandemic pushes people to be healthier, pharmacy is ready to help

Posted on February 14, 2022 by Pharmaciststeve

As pandemic pushes people to be healthier, pharmacy is ready to help

https://www.tricitiesbusinessnews.com/2022/02/malleys-pharmacy/

Since the start of the pandemic, Malley’s Compounding Pharmacy has weathered a prescription-filling rush, a shutdown, a slowdown and then a shift to steady business with more customers focused on prioritizing health and wellness, including adding more supplements to their routine.

“We’ve seen an increase in business with people just wanting to be healthier,” said Anne Henriksen, pharmacist and owner of the Richland pharmacy at George Washington Way and McMurray Street. “People are more in a wellness mindset and interested in supplements to improve their overall health, and we are versed in the different supplements offered, including potential allergens.”

Like all small business owners, it’s been stressful to navigate pandemic challenges. Her team is often stretched nearly to the breaking point with the constant threat of Covid-19 exposures. Then there’s pre-planned vacations or unexpected work absences.

“When you only have six people there on any given day, and then you give lunch breaks, you might have just two people in the front while others are in the back doing other things,” she said. “It’s hard to be able to manage staff, and then do the things you need to do.”

In operation since the 1950s, Henriksen bought the Tri-City landmark with her husband in 2010 after owning another pharmacy location in town.

It wasn’t a dream she initially had while getting her pharmacy degree at Washington State University in Pullman.

Henriksen returned to the Tri-Cities where she had arrived as a teen and come to love the sense of community she found at Richland High.

“I’ve been able to make it what you want it to be,” she said about the drug store she operates with two other pharmacists and a handful of additional staff members, including her husband.

Malley’s stands out for its unique service offering compounding, which includes making medications from raw materials.

Malley’s Compounding Pharmacy at 1906 George Washington Way in Richland is a longtime Tri-City pharmacy, filling a wide variety of medications, including custom doses for children and pets. (Courtesy Malley’s Compounding Pharmacy)

“It’s always based on a prescription from a doctor,” Henriksen said. “Compounding is done for a variety of reasons – maybe it’s one particular dose, or a lower dose in a liquid versus a higher dose in a liquid. Often with heart medication for a baby, it’s not made commercially in a low dose a baby would need.” Henriksen said her team works closely with children’s hospitals in Seattle and Spokane to provide medications as prescribed.

Henriksen said typically pharmacies offering compounding services only accept payments in cash, but Malley’s is contracted with all the major insurance companies.

“We work with state Medicaid and all the plans that these children need. I understand how much these bills add up for children with special needs, and it’s important to be able to cover these on their insurance,” she said.

Henriken’s pharmacy recently created medication for a patient in hospice that could be absorbed through the skin instead of by swallowing.

“This helps with agitation that comes with end of life,” she said.

As one of the only compounding pharmacies in Eastern Washington, Malley’s helps with bioidentical hormones, often for menopausal symptoms, and also dispenses veterinary medications.

The onset of the pandemic brought an initial rush to Malley’s as people hurried to fill 90-day supplies of their prescriptions and then hunkered down. The pharmacy pace was temporarily slower than normal for several months in 2020 before rebounding.

Without a drive-thru, Malley’s offered curbside service before the pandemic and still provides the option to customers today.

It tries to offer a more personal relationship with customers. Henriksen described the chain pharmacies as “overwhelmed” and often the only option for patients.

“People often lack a choice in pharmacy,” she said. “We have been pushed out of insurance networks to where people can’t use us. When there’s a level playing field, smaller pharmacies are going to win.” Henriksen is active in state legislative efforts to avoid the squeeze on independently owned drug stores. She encourages people to let her staff check on coverage before allowing an insurance company to tell them a prescription isn’t covered unless filled by a chain pharmacy.

“It’s often said to be more expensive to come to us, and it’s either a negligible amount or not higher at all. Don’t pay a cash price without talking to an independent pharmacy first. We will never do that to you,” she said.

Like all pharmacies, Malley’s has struggled to keep at-home Covid-19 tests in stock. “Our ability to buy them has been extremely difficult,” she said.

Malley’s is open weekdays 9 a.m. to 6 p.m. and by appointment on Saturdays for urgent needs.

search Malley’s Compounding Pharmacy: 1906 George Washington Way, Richland; 509-943-9173; Malleyspharmacy.com; @malleyscompoundingpharmacy.

 

Filed under: General Problems | Leave a Comment »

Time to Kick the CDC Out of Washington

Posted on February 14, 2022 by Pharmaciststeve

Time to Kick the CDC Out of Washington

https://www.medpagetoday.com/opinion/fromtheeditors/97093

Return COVID briefings to where they began, with the career scientists at Atlanta headquarters

Although the CDC was included on the White House COVID Response Team to bolster the scientific credibility, it ended up being at the expense of its own.

CDC and its director, Rochelle Walensky, MD, need to reclaim their independence and return to Atlanta. Let the White House continue to tout its pandemic accomplishments, and return the COVID briefings to where they started, conducted by career scientists at CDC headquarters.

The agency’s presence in Washington has hindered, not helped, its reputation. Rather than effectively and expertly managing the crisis, the White House COVID Response Team’s uneasy marriage of politics and public health has instead fueled distrust of public health guidelines. And this unbalanced partnership has tainted the formerly apolitical health agency.

Leaving the White House COVID Response Team would disentangle the CDC from this politically charged arrangement, and empower it to manage this public health crisis as they’ve managed every prior public health crisis, from 2009’s H1N1 swine flu pandemic to 2014’s Ebola outbreak.

At the beginning of the COVID-19 pandemic, it looked like the CDC would once again be leading the country through another public health crisis, with regular briefings on the situation. However, these were discontinued after CDC’s former director of the National Center for Immunization and Respiratory Diseases, Nancy Messonnier, MD, told reporters at a press briefing on Feb. 25, 2020 that “disruption to everyday life may be severe” from this “novel coronavirus” in the U.S.

Shortly thereafter, the “White House COVID Task Force” was born under the Trump administration. COVID briefings were no longer handled by the federal public health agency, but by a handful of politicians and federal agency heads.

Including CDC in the White House COVID briefings has muddied its messaging with that of the White House, and led to some uncomfortable moments for Walensky, as well as a dramatic decline in public trust of the agency. Returning the COVID briefings to the CDC would help to rebuild some broken trust with the public.

Unmooring the CDC from the White House sends the message that the pandemic is not over, and the nation’s public health agency is focusing their attention on ending it, rather than endorsing whatever the White House says. Separate COVID briefings also might help Walensky to clarify and strengthen her messaging, rather than acting as window dressing in a politically charged venue.

If the CDC held its own briefings, it also might encourage a more active role for HHS Secretary Xavier Becerra, who has been practically invisible during the pandemic with the White House running the show. The Association of Health Care Journalists recently penned a letter to Becerra, asking him to hold a press conference open to all reporters for general questions, arguing it would reflect “the promise of government transparency” from this administration.

The White House COVID Response Team should retain some scientific voice in the form of Anthony Fauci, MD, the chief medical adviser to the president. Fauci should return to what he does best: explaining the science behind the latest COVID vaccines and treatments, while leaving the cable network and political show appearances to Walensky or other CDC officials so they can reiterate the public health messages without being so heavily entangled in White House messaging.

The CDC must return to Atlanta to resume the role it was always meant to play: an apolitical arbiter of public health decisions and an advisor to the White House, not its yes-man. Mixing the two together has left a political stench on the agency’s credibility. The time has come to dissolve this doomed marriage of convenience.

Rachel Warren, SVP, Editorial

Ian Ingram, Managing Editor

Molly Walker, Deputy Managing Editor

Kristina Fiore, Director, Enterprise & Investigative Reporting

Joyce Frieden, Washington Editor

Filed under: General Problems | 1 Comment »

Pain Patient Story

Posted on February 14, 2022 by Pharmaciststeve

Pain Patient Story

https://doctorsofcourage.org/pain-patient-story/

I received the following well-written letter from a patient 2 years ago. How many other patients are in this same situation?  It is for patients like her that everyone needs to learn that drugs are not the cause of addiction so we can get the Controlled Substance Act repealed.

 

I need help finding a doctor with the courage to prescribe my medications and increase the doses as needed when I move. I have severe intractable chronic pain, throughout my entire body, due to a 1986 motorcycle crash, where a drunk driver exceeding 80mph hit the motorcycle I was on the back of, literally tearing and breaking my body to pieces and almost ending my life. I obviously survived, however, 33 years later, being 52 years old now, I have a plethora of added conditions that cause a cruel and torturous constant state of pain. I moved to New Mexico in 2009, and it took me years of different doctors, all requiring new tests (i.e. x-ray to MRI, etc.), fighting my way through this completely messed up system with no doctors even close to being qualified to understand or care for my severe and unique condition. I finally have a doctor who, at minimum, feels terrible for me after viewing the few x-rays and MRIs that have been done, and although he won’t raise my medication to the dosage I need to have life quality, he will not lower my dosage because he realizes I’m suffering terribly. Now I’m just barely making it through each day, trying to stay strong. The medical board here is even backing my doctor up with what I do have, as they know my condition is very severe. Unfortunately, I do not have a condition that is technically considered end of life like cancer, and my conditions are mostly all physically impairing and have been dubbed “end of care” whatever that is supposed to mean. Basically, there’s nothing more that can be done to improve my conditions, and I’m one of the rare cases that truly just needs pain relief through the only thing that helps… opioid medications.

I cannot even take most types of opioids, because they just make me loopy in the doses I need, and don’t allow me to function. The only medication that truly works to ease my pain, and keep my brain faculties clear, is the demonized Oxycontin 80mg ER tablets, with breakthrough pain medication throughout the day. The doses I’m on are shy by two pills a day, as the Oxycontin doesn’t last 12 hours as they claim. I do not feel any kind of “high” or loopiness from this medication, only a slight relief from the completely debilitating pain I have. My doctor and nurse, along with myself of course, have been trying to get someone who specializes in pain and opioid prescribing to tell my doctor that it’s ok to raise my dose to 4-80mg ER tablets per 24 hours, because my doctor is just not a specialist in this field, and is afraid to increase my doses. I completely understand his concern, however, he’s sent me to many different so called pain specialists, and in this state as many others, they refuse to prescribe any opioid medications to any patients anymore, no matter how severe the condition. Therefore he’s just stuck in my care as it stands now, which he knows is still keeping me from life quality, but he tried. The state of affairs for a unique patient such as myself is just terrible, and I have fallen into the cracks of the medical system and the opioid crisis everyone is so invested into. They just forgot, or don’t even care, about the patients like myself, who legitimately require opioid medication therapy to survive my severe state of pain throughout my totally broken and increasingly degenerating body. We’ve been fighting to get someone educated and brave enough to tell my doctor it is ok to raise my dose to 4 pills a day, understanding that after 33 years taking opioids for my conditions, tolerance has built up, and what seems extremely high doses to an average person, is nothing to my tolerant state. But there isn’t 1 pain doctor or facility in the state of New Mexico that is qualified to understand this. And Medicare/ Medicaid here has completely cut out Palliative Pain Care in the state. It’s non-existent. So now, I’m completely terrified of my move to another state, as every doctor in the country it seems only has one plan of care for all patients taking opioid medication… lowering dosages and cutting patients off completely, no matter the condition. I’m 52 in May, tired of fighting for proper pain care, sick of being a Guinea Pig to all these “non-opioid” medications that have had scary consequences to my health (I’ve had really bad reactions to them), and invasive procedures that end up causing more harm and pain. I just want to live out the remainder of my life with adequate pain relief for quality of life. My first granddaughter is to be born in late August of this year, and I want to be able to enjoy being a grandmother, playing with and caring for her. But without proper pain relief I will continue to be homebound, unable to enjoy my older years, just as I’ve been unable to enjoy my years after being a victim to a drunk driver and my severe condition continuing to get more severe as I age. I feel I became a victim of a crime in 1986 at only age 18, and continue being victimized by the very medical system that is supposed to be making sure I’m safe and not suffering endlessly. I know other patients with as severe amounts of intractable pain (if anyone even exists with as much pain as me) turn to ending their life as the only way to stop the torture.

That’s very sad and I understand it, but that’s not who I am. I’m a fighter and was made clearly aware, by my orthopedic surgeons who saved my life 33 years ago, that I would end up in severe pain by age 40, and they thought I’d be forced to live in a nursing home. But I refuse to give up my life and independence, and push myself on a daily basis. And now, I want to move to my dream home so I can enjoy the things that improve life quality like nature, green grasses, trees, clear and clean natural water sources everywhere, and most important, my granddaughter! After all I’ve been through and all the suffering, I do not think these final years of happiness and life quality is too much to ask for. In fact, at this point I feel I’ve followed all the rules, cooperated with my doctor even though I still suffer, and I feel it’s owed to me to finally have some peace, decent care, and life quality. As I said, I’ve been strong and have fought for my independence and don’t plan in just “giving up” on quality of life and happiness. But I can’t do it completely alone. I must have a doctor who is willing to give me that life quality care, along with the other care for other conditions I suffer from, and prescribe medications, including high dose opioid medications, that have been proven to work for my biology (I cannot take some of the opioids such as morphine as they just make me loopy), and yet allow me to stay as independent as possible, for as long as possible. I know my doctor currently will do whatever he can for me, including writing a letter of recommendation for care, as he feels terribly for my suffering.   He would even increase my dose to 4-80mg ER per 24 hours if another doctor gave him the recommendation to do so.

The problem I fear so much, is the receptiveness of another doctor in another state to actually take over the prescribing and care. Too many doctors today fear the loss of their licenses so much, that they all have completely stopped any and all opioid prescribing regardless of a patient’s severe condition. It’s completely wrong, unconstitutionally and civilly wrong. We’re all supposed to have the right to life, liberty, and the pursuit of happiness, regardless of our disabilities and medical/ medication needs. I would even consider some part time work if my pain was controlled properly; in fact, that is one of my many desires for life quality, to work again and contribute to society, pay taxes, etc. In fact, I was working, and excelling at work to the highest and award worthy levels before moving to New Mexico, when I was being prescribed 4-80mg ER Oxycontin per day along with the breakthrough medications that I only took if the pain got severe enough. I was excelling above all my peers and truly enjoying my work. But when I got to New Mexico and changed doctors etc., she got my records and prescribed them once, but when a Prior Authorization was needed, she refused and lowered it to 2 per day, which at the time didn’t need the PA as it now does. I deteriorated quickly after that, pushed myself to continue working for as long as I could take it, until I had to be put onto the FMLA due to my inability to even get out of bed many days, and the company I worked for allowed me to continue working until all the FMLA allowed time was used up. I’ve been unable to work since and unfortunately my body has continued to deteriorate with added painful conditions too. But I sure would love to have my pain controlled with medication that works well with my body and be able to work again as well. My mind is still very much intact, and I’m intelligent and talented and can learn just about any task or job fairly quickly, and usually become top employee fast and qualify for promotions. How I would love to feel those accomplishments again, adding to my life quality, giving me purpose, validating my life and ability to succeed. But as I stated, that was taken from me back in 2009, even before “the opioid crisis in America” took such a horrible turn in medical care for so many patients. I need help Doctors of Courage. Help with finding a doctor willing to take over my care without taking my opioid pain medications away or trying to change them, and if possible, even getting a recommendation to my physician currently to raise my medication dose to 4-80mg ER Oxycontin per 24 hours and maybe even reduce the breakthrough medication.

I follow all the rules and laws, take urine tests every few months, have a contract with my doctor, and all the requirements for patients taking opioid medications, and have never had any problems. In fact, my doctor has it in my file as “Uncomplicated Opioid Dependence”. I have so many things wrong or going wrong with my body, they won’t even know what every one is until my autopsy is done at this rate. It’s a terrible system, the medical and medical insurance system. It’s broken worse than my broken body, which is extremely broken. And the really sad part is, in my particular case, my medical conditions that cause my severe chronic intractable pain, are things that are quite viable and undeniable with things like theIr x-rays and MRIs, unlike some of the other pain patients out there fighting for their medications and pain relief that have conditions that aren’t so easily viewable, but I still am being treated poorly, like the other pain patients. I’m a perfect patient subject to use to show how horribly out of control the opioid crisis solutions have affected pain patients. Because my conditions are multiple, complicated, severe conditions, and yet just like every other pain patient, most all doctors, so called “pain specialists” and so called “experts” still use the new “no opioid prescribing”, “opioid weaning” methodology, or what we pain patients call the “One Size Fits All” theory and solution they have come to the conclusion will stop the opioid epidemic. I am a clear case patient that, if used as an example, can verify to all those doctors, specialists, rule makers like HHS, CDC, DEA, Our Government, The White House, Senators, Governors, EVERYONE who has turned their backs on all patients who need pain medication, that it’s a horrible injustice, cruelty, unconditionally wrong to just take this “guideline” and this opioid crisis, and apply it to every and all, rather than using a case by case patient analysis to see if a patient truly requires opioid pain medications, even in high doses due to tolerance or severity and number of years taking opioid medications, just the same as a diabetic needs insulin, or a coma patient who needs a feeding tube. It’s a critical mistake to just stop prescribing opioid medications to everyone as a policy. And I’m the perfect patient to show them how much of a mistake it is. It’s cruelty, inhumane, and against everything true medical care providers are supposed to be doing (caring for patients). It’s torture and we treat our pets and animals better than pain patients at this point. I’m the perfect patient to get a thorough pain diagnostic profile on, and present to everyone who has turned their backs on severe intractable pain patients, forcing inhumane torture and suffering.

I cannot afford to “fly to Washington D.C.” to protest these actions taken, but I’m willing to help any way I can to show our side of this crisis, and how cruel, inhumane, and totally wrong they all are in this methodology they are using in this solution to the opioid crises epidemic, and how patients like me and so many others are being poorly treated, undertreated, and outright ignored and shut out, falling right through the cracks of the system. And how patients like us do not have the time to wait while suffering so badly in torturous pain, for them to “work out the issues”, as they say they are doing, while so many are in so much pain, that death becomes the best option to patients who would have never dreamt of suicide or had mental issues of depression prior to their medications being taken from them and being forced to suffer unimaginable pain.

We should never have to suffer like this, as disabled Americans with legitimate conditions. I’m hoping, when I move, that I can get the help I need to get to the dosage I need. Please let me know if I can help our fight for pain patients. I’m willing to allow full examination or whatever it’s needed, and the history of how I got here as a victim of crime in the first place. Talk about being dealt the worst hand ever! Since I was just barely 18 years old. I’m about to turn 52, and suffering. God Bless Doctors Of Courage!

Having just connected with her again after 2 years, she wrote the following update:

Hi Linda,

It truly has been a very rough time since I emailed you. I never have been able to move, which is truly depressing, and so much has changed, for the worse. My doctor has retired here in NM, and I am about to be completely out of my medications because the new doctor refuses to prescribe anything, and the horrible part, the pain doctor he sent me to literally said he would not continue to prescribe even what I’ve been taking for a decade+ because, and I quote, “my insurance will drop me” he said. Not because that’s the best patient care. As it is a fact that my condition is bad, getting worse, and there is no procedure that can help me, and it’s dangerous. So to answer your initial question I just read from the first email, yes, use my story, I want to be a part of this anyway I can. I’m not sure what’s going to happen to me, but I’m scared and they are putting me back on the Rollercoaster of hell. Tell me what you need from me.

And my response to all pain patients is that you need to learn the REAL cause of drug abuse so that you can teach it to everyone and we can get the Controlled Substance Act repealed. Chasing the CDC guidelines will get you nowhere.  I really don’t see much help even coming out of the Supreme Court decision on the Kahn/Ruan case, because the DOJ can still use the phrase in the CSA “legitimate medical practice” calling anything they want “illegitimate”. As long as the propaganda against opioids is in the minds of the jurors, doctors will be prosecuted and convicted, and opioids will become a thing of the past.

 

Filed under: General Problems | Leave a Comment »

Communicating What You Need in the Emergency Department

Posted on February 13, 2022 by Pharmaciststeve

Communicating What You Need in the Emergency Department

Tips for “speaking doctor” when you live with chronic pain

https://www.practicalpainmanagement.com/patient/resource-centers/chronic-pain-management-guide/communicating-what-you-need-emergency

Emergency department visits can be demoralizing. It’s bad enough to be scared and sick, but as a friend of mine once said, “Having to go to the hospital is admitting defeat. You can’t deny you have a disease that worsens your life.”

Even with a team of doctors, individuals living with chronic pain may find themselves requiring a trip to the emergency room from time to time.

As an emergency doctor, I know that not all of my colleagues understand chronic pain. To make matters worse, the healthcare environment in the US often pressures doctors to see a new patient every 15 minutes, leading their empathy to wear thin. In the spirit of making things better for both the patient and the doctor, below are a few ways to have a more successful experience in the emergency department (ED). While it’s still possible you’ll end up with a doctor that seems burned out, these tips should help you communicate what you need in a way that an ED doctor will respond to and respect.

Tips for “speaking doctor” when you find yourself visiting the emergency room. (Source: 123RF)

Fill The Doctors in on Your Condition

Although it may sound burdensome, it can be very helpful to provide your ED care team with a one-page summary of your condition. For example, you could write the summary and then ask your doctor’s office to put it on their letterhead with an additional list of diagnoses, allergies, recent lab tests, medications, and any treatments to avoid. Keep a few copies of the summary in a safe, easily accessible spot at home and maybe one in your car. You likely know more about your disease and how it impacts your body than anyone else, so this summary can speed things along in the case of emergency. At the same time, it’s important to remain humble about what you don’t know, and be respectful of your ED doctor’s training. For instance:

You could say: “I’ve had a complicated course, so my doctor helped me to put this summary together to explain my current condition and treatment plan.”

This preemptive approach lets the ED doctor learn about you from another doctor, thereby enabling him or her to “save face” for not knowing much about endometriosis, for example. If you go for regular lab work, adding those results as a request from your doctor could also save you a trip or phone call. “If bloodwork is necessary, please add a calcium, magnesium, and phosphorus panel if it has been more than 2 months since my patient’s last blood draw.”

Patients living with chronic pain have very different tolerances of, and responses to, stimuli than others. Therefore, it’s important to let the ED know why you came in now, since many patients may feel like they should be living in the emergency department.

You could say: “Normally I can do this/feel like this/handle this, but for the past [time period], I’ve noticed this…”

This information is particularly important if the issue is pain. In addition, anchor your baseline pain with a concrete description. For instance,

You could say: “I’ve handled my chronic migraine without needing extra medication for over a year, but now…” Or, “I have no cartilage in my knees, but I’m usually able to get around by using NSAIDS. For the past three days, however…”

If you’re asked to rank your pain on a scale, let your doctor know what the most painful experience is for you before deciding on a number. For instance,

You could say: “Before I started treatment, I was at an 8. With my meds, my pain ranking came down to a 6, and when I added acupuncture treatment, I believe it came down to a 4. Today, I’m back up to an 8 or 9 – this is pretty extreme for me.”

Be Proactive about Sensitive Areas and Treatments

After you’ve presented your chief complaint about why you came to the emergency room, let the team know if there are any areas of your body, or any types of treatments, that you are very sensitive about. For example, if a simple touch to your right shoulder may make you jump or scream, give them a fair warning. Or, if you had an unpleasant experience with a previous treatment or emergency visit, let them know in advance.

You could say: “I’m sorry to be a bother, but could you let your team know that I’m paranoid about what goes in my IVs? A nurse once gave me X by accident, and I had [side effect], so now I double check when people give me meds. I don’t want anyone to be offended.”

Avoid Certain Phrases

Below is a brief list of phrases that make many emergency team members cringe, why they do, and what you could say instead to get a better reaction.

“I know my body.” People often use this phrase as a way of disagreeing with their care plan, or as code for “I think you’re wrong.” Instead, try to be concrete about why you’re worried, and how abnormal your symptoms are at this particular time. Use your medical history, current context, and goals to frame what’s happening and what you need.

You could say: “I’ve had fibromyalgia for 6 years [history] and this feeling is new [context]. I’m most worried about this new flare-up, and because this pain is severe, I just want to make sure there’s not something else going on in this area that could cause it to hurt so abruptly [goal 1], and ultimately feel better [goal 2].”

“I have a high pain threshold.” This phrase is often used by patients seeking medications, wanting faster service, or who may feel embarrassed about seeking emergency care to try to justify their visit. While you likely DO have a high pain threshold, emergency staff see a wide range of patients over their careers – they’ve undoubtedly seen someone with a bone sticking out of their skin saying, “No, I’d prefer not to have pain medicine, I’m ok.” Instead, use the script above for more specific history, context, and goal phrasing. 

You could say: “I have sickle cell disease [history], so going through labor without medication was nothing for me [context], but today my pain feels different.” 

The phrase “feels different” always gets a doctor’s attention.

“I’m allergic to [x].” In many doctor’s minds, the word “allergy” exclusively refers to something that may cause hives or lead to a severe reaction, such as anaphylaxis. Medications that make you nauseous, anxious, or dizzy, on the other hand, are not allergies. So, it’s important to be more specific.

You could say: “Morphine gives me a huge rash, fentanyl makes my nose itch, and Toradol has done nothing for me.”

“I’m not leaving until you figure this out.” Emergency doctors are not the best trained to solve complex pain conditions; they do, however, want to figure out if what they prescribe, if anything, will be potentially helpful. Know what you really need or are worried about and relay that information to your doctor.

You could say: “I’ve been feeling like this for [x] days; I called my doctor and she can see me Tuesday. I just want to be sure this isn’t appendicitis, and it would be great if I could get something today to have a good night’s sleep.”

“I need a test.” A rule of thumb in the emergency room when it comes to laboratory tests, such as blood tests, is that a doctor will not order any test that is irrelevant to the problem at hand. However, if you are already getting blood drawn, your doctor may do you a favor and add a scheduled lab at your request. However, at the end of the day, it’s not their job to do so.

“The only thing that works for me is [a specific drug].” Doctors realize that patients know which medications have worked best for them in the past, but they also are keenly aware of drug-seeking behavior. Having your list of prescribed medications on your doctor-signed medical history summary (as noted above) can go a long way in the emergency department. For example, if you were traveling and a prescription was lost, or if there’s an extenuating circumstance that caused you to run out of a prescription unexpectedly, the doctor may be more responsive when you have your list in hand.

Overall, individuals living with chronic pain, and those trying to treat them, each face unique challenges. But the goal of relieving suffering always comes first. By being specific and knowing how to communicate your needs quickly, your emergency visits can be less frustrating.

Filed under: General Problems | Leave a Comment »

New CDC opiate dosing guidelines – Just kicking the can down the road – a bureaucratic specialty

Posted on February 13, 2022 by Pharmaciststeve

New CDC opiate dosing guidelines – Just kicking the can down the road – a bureaucratic specialty

Did anyone notice that Dr Chou is back again with these new CDC guidelines – wasn’t that the guy on the last “secret committee” that – at the time – stated that he had no conflicts of interest, but several years later changed his “no conflicts” to admitting that he had conflicts of interest when he help to develop the 2016 guidelines ?

There is some 20 pages of footnotes/references in this 211 pages of proposed guidelines and it look like it to me that a whole page of references. Guess who was listed as one of the authors of those references – CHOU

It will take another FOUR YEARS for things to come to the surface that these VOLUNTARY GUIDELINES are being misread, misinterpreted and wrongly used to create policies and procedures for many health care corporations and for many bureaucrats at all levels of state/fed government to implement new/revised regulations to align with what their interpretation of these guidelines are.

Has the community had enough of all of this bureaucratic BS ? OPEN YOUR EYES… they are using our legal system to deny you pain management and screwing with your quality of life and maybe even life itself.  How many of you know someone who has committed suicide and/or died prematurely ?  How many of you have had your blood pressure to increase to “stroke territory” and your prescriber now has you on up to four different BP meds and nothing is changed.  Is your prescriber is not BRIGHT ENOUGH to put two and two together to figure out that they have reduced or eliminated your pain meds and your BP goes up dramatically ?

Just look at what is going on with the TRUCKERS in CANADA … these good people have been working for the last two years – all during this pandemic – to get the products that everyone of us need everyday.  Now, all of sudden, they have to proved that they have been vaccinated to cross the USA/Canada border.  The truckers had a go fund me account set up and amassed around TEN MILLION and the go fund me company decided that the truckers were violent and confiscated that 10 million was going to give it to charities that go fund me approved of…  almost immediately the Gov of FL and the AG of TX started going after go fund me… go fund me caved and refunded all the donations to the people that had made the donations.

Then the truckers when to a new donation site GiveSendGo and raised abt NINE MILLION and then some bureaucrat from Canada decided to declare that the truckers were a PUBLIC NUISANCE and is trying to confiscate that money… does this sound familiar –  what J&J & TEVA pharma was found guilty of for selling FDA approved opiate meds ?

I have published over and over charts … now one that shows that it is expected by the end of the decade that the number of OD’s from illegal Fentanyl analogs and other illegal drugs will DOUBLE from the number in 2021. The DEA started in 1973 with the philosophy that prescribing Rx opiates caused addiction … which leaded to illegal drugs and OD’s.  The CDC & DEA has now had to admit that 75% of all drug OD’s have a illegal fentanyl analog – and according to Wikipedia.. there is some 400 different analogs and ONLY ONE IS FDA APPROVED FOR HUMAN USE and all those tablets they show of the news many nights … is all illegal Fentanyl analogs – because there is no FDA approved solid dosage form of the FDA approved Fentanyl .

The DEA can’t stand up now and admit that they have been wrong for 5 decades… we spend over 100 billion/yr fighting the war on drugs… that covers (partial or full) a lot of paychecks … starting with the cop on the street, county, state, private/public jails/prisons, courts, judges, defense attorneys… on and on..   If the DEA folded – our unemployment rate would at least DOUBLE !

Talking/communicating with members of Congress, signing petitions, having a few dozen people having a protest somewhere… what good has it done?  IMO, the only thing left is THE LAW. Those interested in advocating for themselves ,… go to this website  http://www.steveariens.com and on the front page click on BLOG link … that will take you to my blog that FAKE BOOK will not let me link to on a FAKE BOOK post.. Go to the RESOURCE TAB on the top of the first page… go to near the bottom of that page and look for a link label “call their bluff with a letter from attorney ?

IMO, the CDC has just KICKED THE CAN DOWN THE ROAD and if these proposed guidelines are adopted, may just lower the bar as to what is considered the standard of care and best practices for pain management and we have a pretty good idea what the DEA is going to start doing …  Warning/threatening prescribers if they don’t lower everyone’s dose to at or below the new standard… they are going to jail..  More and more in the community will be put into a torturous levels of pain, become bed/chair/house confined and either commit suicide or suffer a premature death from under/untreated pain.

 

 

 

Filed under: General Problems | Leave a Comment »

« Previous Page — Next Page »