https://mtrx2010.livejournal.com/492.html
The 90mg ceiling recently placed on my medications has created a health crisis for me.
I have written this as a testimony to my injuries, medical condition, and how the
90mg ceiling is affecting me.
–
On March 7 2018 I became a victim of the new 90MG ceiling placed on all opioid pain medicine instated by medicaid
and my own insurance Molina Healthcare. The new rule indicates insurances like molina and under the medicaid
umbrella of healthcare to not issue prescriptions exceeding 90MG’s of pain medicine based on a morphine
equivelency of a 1:1 ratio.
To further clarify the ratio, different opioid medications carry a subjective strength difference. The idea is
one in which a particular medicine can equate the strength of another based upon quantity/dosage size. For
example 10mg of oxycodone equals 15mg of morphine sulfate. There is little more than survey analysis to prove
these differences in strength. However some medications yield obvious differences in strength.
Prior to my reduction, I was receiving 60mg of morphine extended release twice daily every 12hours, and 10mg of
oxycodone IR 10mg four times daily. for a total 160mg’s flat of medicine every 24hours. in a world of morphine
equivelency these 160mg’s are rated at a non-tangible higher dosage. My 40mg’s of oxycodone per 24hrs equates to
40×1.5=60mg’s of morphine. Again the difference between 40mg and 60mg’s is intangible. It is a proposed
equivelency.
On March 7 2018 my pain medicine per 24hrs was reduced to 80mg’s flat. Both of my medications were
reduced by half, overnight, with no titration or weening program. The abrupt reduction in my medicine has
resulted in a sudden onset of severe pain and reduction sickness. As time progresses, my pain levels augment to
debilitating levels.
As of the first day of this writing on March 21 2018 my health has severely degraded due to intolerable and
debilitating pain. It has gotten to the point I can not push myself any further, because my own flesh will not
cooperate with my commands. I am growing weaker and weaker unable to sustain my own body weight.
When I met my pain doctor he told me I was grossly under medicated. I was in severe pain, and couldn’t walk
anymore. I had spent 84days in bed with very little medicine. lost 30lbs do to not eating and muscle atrophy. He
even offered anti-depressants to help me through what he described as a very traumatic experience I was withering
away and facing a slow, painful death. It had gotten so severe I took it upon myself to write my own will and
tack it to the wall next to my bed incase I didn’t wake up the next day.
My doctor immediately increased the prescription of morphine and oxycodone I was previously administered, and the
results were amazing. I was walking again, eating, cleaning my home, caring for my elderly mother, i learned
to ride a bike again, engaged in activities with my daughter like walks and bike rides, and even started taking
on work projects and community services to both further my recovery and give of myself.
His goal was not only to manage my pain, but to rehabilitate me and assist me in my integration back into
society. He wanted to see me working again, and return to my studies focused towards a PHD in computer science.
Before my injuries I was a scientist, a music teacher, and an athlete. His focus was to return me to my life to
the best of his abilities. However this 90mg ceiling on medication has not only impeded that goal, but taken
back all the progress I made over the passed year, reinstating my life long sentence to a bed and wheelchair.
In order to understand the severity of my medical crisis there needs to be an understanding of my injuries. On
February 15 2011 I fell off a 60FT cliff and landed onto a bed of solid rock in the form of a dry river bed. The
free fall from 60FEET destroyed my entire body.
The destruction began at my feet where by both feet were shattered and destroyed. my ankles shattered and my
heels snapped off as the shock traveled up my legs, shattering them as well. The shock continued up my body
shattering my spine beginning at the lumbar region. My left arm broke, and left hand was detached from my body
internally leaving an apendage connected to my frame by only the skin. Both feet, heels, ankles, legs, arms,
and spine suffered severe damage from the impact alone, but that is not the full extent of my injuries, nor the
only cause of my life long pain. After impact I spent 3MONTHS in brackenridge hospital austin texas, 6MONTHS in
a body cast, and over a year bed ridden with only a wheel chair to move about. I had been declared immobile.
In the initial 3MONTHS of my injuries my entire body had to be surgically reconstructed. Many of the surgeries
went wrong, and some were just performed poorly causing extensive nerve and tissue damage. Perhaps one of the
most painful examples of this was my right leg, and left arm.
my right heel became necrotic and began to rot from not beeing rolled over during the initial 2weeks of having my
heel reattached to my skeleton via a bracket and 12 screws. They made an attempt to clean off the necrotic
tissue, but the doctor made a mistake and took way too much tissue from the side of my heel resulting in a wound
so deep my bones were exposed to the air along with my hardware and metal brackets.
I spent several weeks with a wound vac in place over the gaping hole in my foot, but it proved of little use.
The pain was so extreme they had to insert nerve blockers into my legs to stop me from screaming all night and
passing out as I had done several nights in a row prior to having received nerve blockers. I endured the wound
vac and set a record at the hospital for how long a person could wear a nerve blocker in their leg, but it did no
good. It was then decided the only way to save my foot and leg was to reconstruct it yet again using muscle and
skin grafts.
In Order to seal the hole in my foot they decided to do the muscle graft. They came up with several graft plans,
but ultimately settled on the fastest, cheapest one. Supposedly because i didn’t have insurance. The doctor cut
my right leg open all the way up the back from my ankle to the back of my knee. Then proceeded to remove a large
piece of muscle tissue from my calve muscle, and inserted it into the hole in my foot. Then they cut off and
inverted a large piece of skin and vascular tissue off the ankle above the heel, inverted it, and use it to
cover the hole they plugged up with calve muscle. After which they removed a large slab of skin off my thigh to
patch up the skin they took from my ankle.
The entire process destroyed my entire right leg resulting in permanent injuries and pain. To make matters worse
the hardware wasn’t done well enough to bind my broken ankle bones together, so those bones never fused. To this
day I walk on broken feet with bones which won’t fuse, and no doctor will touch or attempt to repair them due to
the fear of cutting through the damaged tissue and muscle grafts causing even more severe permanent pain, and
possibly endangering my appendage.
In order to reattach my left hand back to my skeleton they cut open the top of my hand and inserted several
horizontal and vertical rods in order to reconstruct the hand and numerous broken bones. On top of all the metal
inserted into my hand, they attached it wrong and placed the hand too low on the wrist making it to where my
wrist can no longer bend, and remains in constant pain and swelling. They said they almost couldn’t save my
hand, but in doing a poor job they created a permanent injury.
My left leg was also broken and reconstructed with large metal rods and screws. while some was removed they did
not remove the large rod in my shin, and i suffered a lot of nerve damage. My left ankle is always swollen and
burning like my right ankle, and with the persistant pain of my right leg, I can not walk without proper
medication. Nor can I function in any capacity in order to care for myself or loved ones.
My spine was shattered along L1 and L2. the impact was so intense it traveled up my body and split the 2
vertebrae clean in half horiztontally and cracked the bones above and below the fractured bones. I was told I
could receive a metal rod to make the bones heal faster, but everyone i met who has had metallic reconstruction
of the spine has reported worse or persistent pain after the surgery. My only other option was a body cast to
compliment my 2 broken legs and arms. i accepted the body cast which lasted 6MONTHS.
The lower back of my body cast was malformed with a large ridge in it. They were attempting to follow the contour
of my lower back, but it didn’t go as expected and formed a large ridge instead. I layed on that ridge for
6MONTHS which ground a hole into my spine. Upon removal of my body cast the entire backside was full of blood,
and there was a black necrotic hole in my lower lumbar region. The wound healed after a few years and lost it’s
black appearance but it left a perminant scar as testimony to my malformed body cast.
The act of laying on that ridge for 6MONTHS with broken bones lead to an improper healing of my spine which has
only compounded with the back problems inherent to having a shattered spine. While not the worst of my painful
regions it effectuates my entire mobility. There are days which hurt more than others, and days which hurt much
much worse than others.
All in all I had both legs casted and reconstructed; left arm and hand casted and reconstructed; body and spine
casted; and right arm slinged. My entire body was destroyed and reconstructed. The damage from the poor
reconstruction was as severe as the damage of the initial impact off the 60FT cliff, and in the opinon of some,
much worse. Either way the damage is painful and perminant.
—-
My life has been a constant struggle ever since. Without medicine I do not believe I would have survived. without
sufficent medicine I can not function as a human being. Without medicine I can not walk, because every step is
taken on broken bone suspended by metal. The tissue/nerve damage is so severe it impedes my every movement. I can
not eat, prepare meals, ambulate by myself, lift objects, work, bathe, maintain my househould, care of my
elderly mother, care for my animals, tend my garden, engage in any form of community service, complete my
studies, or do anything besides lay in bed and wither.
The introduction of the 90mg morphine equivelency has destroyed my life in only a matter of DAYS. I have been bed
ridden for two weeks straight, and my medicine could not be rescheduled correctly, because the cuts were not
made at my doctor’s office-they were made at the pharmacy. I am on the wrong combination of extended release and
break through medication. Break through medicine is vital to the control of pain, and mine was cut in half over
night at the pharmacy instead of rescheduled by a doctor do to the fact nobody properly warned me or my doctor of
these cuts coming from medicaid and molina health care.
With that portion of my diagnosis shared I think it would easier for anyone reading this document to understand at
least understand some of what i’m going through. The diagnosis is permanent. -And without doctors who are
willing to help and give of themselves, I would not survive. I would simply lay in bed unable to fullfill basic
human needs until I withered away, and met my brothers in pain on the other side.
On march 7 i recieved the first of my medication reductions. My doctor said they were lowering my morphine,
because Molina Health Care would no longer pay for my 60mg morphine. I accepted it as there was nothing either of
us could do about it if that statement were true. When I went to pick up my oxycodone at the pharmacy they said
the order for 4 oxycodone daily would not go through, and required an authorization. However I was never able to
get that authorization. The doctor’s office said no authorizations would go through. Even though the insurance
said all I needed was an authorization.
For several days we tried back and forth until I was able to contact someone directly at my clinc, and I was told
authorizations hadn’t been going through for anyone. I finally told my doctor’s assistant if that were the case,
then to simply send whatever she could and I would hold out until the next appointment-it was at any rate, better
than receiving nothing. They had to cut my oxycodone in half to make it go through, and that is the moment the
totality of my medicine was divided in half.
It is now march 23 2018. I fear the worst. It is so hard to fathom anyone would put on arbitrary 90mg limit on
anyone’s medicine. I am after all american-since when do we deny people of medicine who are in legitamate need??
However that obviously caries no bearing on the situation, and is in fact the reason I was denied proper
medicine. It is because I am american, and I live in america during an opioid hysteria which has swept my nation
coast to coast. It has given politicians a fear to prey upon. It has given the media a fear to sell to the
public. Fear is big business in our country, and the opioid hysteria has been marketed to americans in the form
of an “opioid crisis”.
I have been bed ridden each and every single day with worsening pain for over 2weeks now. I’ve lost weight. my
skin looks discolored. my hair has grown into knots, and i cannot stand long enough to care for myself. I have
been subsisting on one or two hotpockets a day, and sometimes fruit if i’m lucky. I can’t really go grocery
shopping in this condition, and neither can my 76yr old elderly mother for who I am responsible. I can’t care
for her in this condition, and we have no caregivers. Nobody is willing to commute, and those who are, are not
willing to deal with the mess my household has become since my collapse. My living conditions have become
squalid, i am weak, I am hungry, my mother is getting sick and sicker from diabetes and various health
problems, and my pain grows stronger and stronger as I grow weaker and weaker.
I can’t even work on music because my reconstructed hand hurts so bad I can’t lift the instrument or use my
fingers to play. I can’t play video games to pass the time. I can’t even work on intricate circuits do to the
tendonitis, arthritis, carpel tunnel syndrome in both hands, and metallic inserts which have caused my hands to
swell to the point of impediment. I can no longer perform any good deeds for anyone. The pain feeds the
inflamation and the inflamation feeds the pain to the point it has taken me days to type up this document. Tasks
which only required an hour of my time, now require days.
Everything I have worked for is being taken away. The pain i suffered learning how to walk against all odds on
broken ankles. The job I was creating by helping a family build a medical website and dental tourism company.
The plants and gardens I gave life to using only a spoon and a pair of knees. The cats I adore who adore me in
return. The time I spend caring for my aquascape aquariums where a 100 different aquatic creatures are
experiencing famin, because I can not get up to feed them, or tend to their ecosystems. The time I spend with
my teenage daughter who was missing for a decade, before I was able to find her and regain my rights as a
father-and now has to watch me die slowly alongside my mother who are both helpless in helping me. My hopes of
returning to college to one day complete a PHD in computer science and a minor in astronomy. All the sacrifice,
effort, and drudging through the mire of a pain ridden life are all being made void by one simple action set
forth by people without medical PHD’s and without empathy. All of this is being taken away from me, And yet I
have done no wrong. I have committed no crimes. I have broken no rules. Neither the rules of the system, my
clinic, or of any authority. The only thing I am guilty of is trying to rebuild a broken life which shattered at
the bottom of a 60FT cliff. I life rebuilt by the compassion of the doctors I’ve met on my painful journey, and
rebuilt by the friends, family, and loved ones who put in everything they could to see me walk again. The
efforts of so many are being destroyed by the efforts of a hysterical few.
I, my family, my friends, and all my loved ones who must watch me go to waste and slide into the oblivion, have
all been hurt and traumatized by the passed two weeks of my life. I pay the price of pain and agony. They pay
the price of loss, and watching me tortured to death slowly, painfully, and helpless.
The whole point of going to pain management was to rehabilitate me and re-integrate me into society. My doctor
and I had goals set forth to make that happen. I have worked harder than a majority of the non chronic pain
communit can possibly fathom. I had to learn to walk again on permantly broken limbs, and function with
permiment severe pain. Only my medication regimen made that possible.
With the proper medication my life is a miracle. I stand as a man who survived a 60FT drop off a cliff and lived
to tell about it, and walk again against all odds. Without proper medication my life is curse-An eternal bed
sentence where I lay writhing in agony, crying day in and day out, and stands as a testament to things worse
than death. My flesh becomes a torture prison with no release and no pause in pain. it is persistant 24 hour pain
existing 7 days a week. Laying still and not moving provides no relief. Over the counter NSAIDS, cremes,
lotions, bandages, and medications provide no relief. -And what’s worse cannibis is not legal in my state as an
alternative to opioid pain medicine due to another hysteria long since engrained in the people’s mind.
Here I have no alternatives, and no solutions. The cut to 90mg mme is arbitrary, inhumane, and catastrophic.
I can not believe something like this would happen in America. It blows my mind. I simply can not imagine the
kind of person who would put their signature on such an inhumane, sadistic, and evil law.
Every person around me is shedding tears for me, because they see what i’ve become under the 90mg ceiling-And my
pain has become theirs. I try to empathize with the kind of person or people who would have passed a law like
this, and I just can not do it. Either my life has become so pain ridden I can not see anything else-or the act
itself is so evil my mind can not create an understanding for their point of view. A point of view which is
torturing and murdering 1000’s of americans including myself. Those responsible have created a slow, and painful
death undeserving of a human being. I can not help but to wonder if I will still be alive by the time this
document falls in sight of public eyes.
What have they done? How could any person lack the empathy and guilt so much so as to unleash such a broad
suffering upon their own people? This isn’t just wrong and immoral. it’s macabre, draconian, and morbid.
The realization of the nature of this castrophe is upon me where I can clearly see there is no opioid crisis.
There is only opioid hysteria. That is why I can not see their point of view. It is because I am not diluted in
the hysterical madness force fead to the public by media and politicians-none of which are medically qualified to
make their statements, laws, or judgements as to what kind of medical care I need or deserve.
If any single one of the people instating this 90mg rule had fallen off a 60FT cliff; and had their entire body,
flesh, and bone mutilated; shattered and reconstructed with metal; and subsequently sentenced to a life of
eternal pain and torture; they would beg for one of two things-more medicine….or death. Those are the only two
solutions for people like me. Medicine or Death. -The hysterical beurocrats have arbitrarily chosen death for
us. Ask anyone who has been severely tortured how long it took them to start praying for death.
Pain is not empathic. It does not convey from one person to another in the same way as emotions and
circumstances. Perhaps one day we will have a device that permits doctors and people to feel and interpret the
pain and suffering of others, so they can empathize with pain in order to provide the best treatment possible-but
science has not lead us there yet. The day of any such technology is far away, and any such technology would
never capture the real pain of chronic pain patients. -And even if it could-who would be brave enough to use it?
-But atleast it would force doctors and insurance companies to experience the pain of their patients before
letting them go on untreated.
Pain is not empathic, so we as a people must train ourselves to make it empathic. It is up to the public and law
makers to understand the pain of their patients. It is up to them to put forth the effort to see and understand
the consequences of their actions. It is up to them to make an effort to feel our pain as chronic pain patients.
If at all, they must take the most painful thing they have experienced; or something painful enough to require
pain medicine; or painful enough to make them cry. -And imagine each and every single moment of each and every
single day with that pain till the end of days. Once more people can do that-This country will never ever see a
90mg ceiling on pain medicine again.
-Marty
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FROM: Jeffrey W. Grolig, M.D.J.D.