Hi guys,

My general practitioner and I really don't mesh! I've been going to her for maybe 11 years, I haven't really seen her many times but every time I have RECENTLY, she seems agitated. She yelled at me for filling medication from the ER, even tho I called and asked the staff BEFORE I filled it the next day, I was prescribed Loratab 5 mg, Flexeril 10 mg and Voltaren. When I went into my next appt. I told her I went to the ER and that I had called and the staff told me that if you had a problem with them you would've called. She looked through the report and the medications, asked me what I had filled, I told her the Flexeril and Loratab, I didn't fill the Voltaren because it was 45 dollars. She said "They didn't have a generic?" I said "that was the generic"she said "there is no way" and she wrote in my file "Didn't try this medication", and she asked "So, you filled the loratab?" I said yes and she was obviously angry, I told her that did help more than the Ultram and she yelled "Well you don't want to be on those the rest of your life!" I went ahead and filled the Voltaren when I had the funds just to see how it helped, it made me puke so I never took it again.

She was once caring, once she couldn't diagnose me, she thought I was full of it. She refused to refill my ativan and once she referred me to the Neuro, she refused to refill ANY of my medicines. She waited until I ran out of medication to tell me she would no longer be filling my prescriptions. I DID take Lisinopril for high blood pressure, I called and said I need a refill of that and she had the Nurse ask me "The doctor wants to know if you really still need the Lisinopril?" I said "Well why wouldn't I? I've been taking it for months, I would assume that if I didn't my blood pressure would go up again, right?" and she said "Well check your pharmacy by 5" which it was never called in.

So how do I go about switching doctors? I want to switch before I have to go back to her, how do I switch a doctor without a reason to see a doctor? (i.e. visiting the doctor because of a sickness) What do I do? I have NO experience with this, I just refuse to go back to her, I would rather be horribly sick for weeks than to deal with someone that is really rude to me and doesn't believe me. (BTW, my neuro had diagnosed me with Small and Large fiber sensory neuropathy, with obvious proof)

I have a good doctor in mind, where do I go from here?

Thanks guys

call the new doctors office, see if they are taking new patients, if they take your insurance, then make an initial appointment also known as a meet and greet. You could also go in person to the office to find out info instead of over the phone, and talk to the staff about what your medical problems are and see what feeling you get from the office staff before you make the first appointment.

I had a good pcp who moved to colorado. I have been through a few pcp's since. IM still not really happy with who i have now but im having trouble finding anyone who is any good where i now live. I have specialists who i travel to and am happy with but a pcp should be close.

It sounds to me like your doctor doesn't want to see you anymore. Some doctors get touchy when you ask for controls all the time. They will totally clam up and shut down if they sense any drug seeking behavior. It might be a personal thing with them, or they may have been burned by some situation in the past.
Some just have very little compassion and always want to control the patient, etc.

Get copies of your Neuro work to take to the new doctor you find. Your old one does not have to do anything but provide you with your records should you ask for them. (be prepared that there may be upsetting comments in them if you get them directly!). You could ask your Neuro who he recommends for general medical care, that is if you trust him.
Make sure you find a doctor within your insurance umbrella.

Ask around to see who of your friends or co-workers has a good PCP. People who have good docs just love to talk about how good they are. Get recommendations from them (verbally) as to how they feel about the docs they have.
Ask at the ER if any docs have a private practice outside of the hospital. Ask nurses how they feel about the docs they work for. If they work them too hard, if the docs are short tempered with them, if the patient load is very heavy.
Would they use these docs personally.
Who would they recommend?
Sometimes docs are afraid to give referrals, cause if it turns out bad - they don't want to be held responsible. But nurses like to brag about the good ones they work for.

Finding a good doc can be difficult.
I fired 4 docs in 5 years before I landed a good one on the 6th try.

My son has had a malaise for 6 years and has had as many docs in that amount of time. His last one, 4 months ago, placed him in the hospital for testing (the only one to do so) and they kept him for 9 days trying to get to the bottom of his weakness, sweats, chills, nausea, diarrhea, fever, etc.
They think they may have found out - Lymes.
His wife remembers a tick, 6 years ago when he was riding his bike, on a trail in the woods. Some of his tests came out negative, one or two... positive.
He finally found a doc willing to bother to do some detective work.

They're out there, ya just gotta dig to find 'em!

I agree with MrsD that this is how docs act when they don't want to prescribe controlled substances. Docs are always suspicious of patients who come in wanting disabilty forms filled out or wanting benzos or opiates. To get the best care, you have to come in requesting nothing. Unless you have a very serious chronic disease, they won't give out those kinds of meds for the long run. To get good diagnostics, they want patients to be clean and wanting only to find out what is wrong so it can be fixed.

Also being on controlled substances before you have had solid diagnosis impedes it, because the docs won't do anything for you if you are on those controlled substances, no matter how bad you hurt or how sick you are.

I am not saying what she did was right, but it is very, very common. You are likely to find a new doctor who wants to take you off controlled substances on the first visit with him/her. You will bounce from doc to doc.

Also, if you plan on finishing nursing school, it is just better not to be on those drugs. Ativan is a huge issue, but both Ativan and Vicodin (lortab) together is a red flag, especially in some one so young. You could lose your license by getting drugs from one doc or dentist when another has already prescribed to you. I would not want a drug impaired nurse working on me, and therefore, I would not use drugs if I was working in the profession. In fact, in the hope of going back per diem, I stopped using all pain meds. Ironically, now I am not functioning well enough to work (but at least I know that and accept it versus being on pills and not knowing you are impaired)....I am hoping in time the meds they use to TREAT the condition will kick in. If not, I have to accept that I can't do this line of work anymore.

Let's see if all of us together can assist you to get a solid, good diagnosis. You are awfully young for neuropathy unless it is hereditary.

Whether you see it or not, the doctor feels you are engaging in drug seeking behavior. That may not be true, but this is what they look for, going to multiple providers, especially ERs and urgent care, not in your system.

Josh, I would love to see you get fully worked up, while not on neuroactive substances.

If you are going into nursing, and have issues like this with meds, I fear that you are in for some employment difficulty. Nursing is hideously stressful and you can't pop an Ativan every time you get stressed, which is 20 times per shift. If meds are ever missing....who do you think they will look at? It only gets worse as you age. I am sorry to be so frank, but this is the reality of employment in nursing.

I have worked at many places where people have been let go over drugs, and you can't compromise patient care. If you are in this much pain, you are in the wrong field. Consider changing your major to a non-patient care job. They are going to know you are on these meds due to drug tests, and just because the docs prescribed them doesn't mean your employer has to tolerate it.

Also, consider what I said about tolerance withdrawal and interdose withdrawal of Ativan (lorazepam). Ativan is meant to be short term.

I am not saying that you don't have pain or disease. I am saying it has to be thoroughly worked up, and managed in a way that you can be a safe nursing care provider. I say this because I care. As some one at the end of their career after 30 years, you need to be in full control as a nurse. No drugs, no nonsense.

Josh,

What did the neurosurgeon say?

I would encourage you to have biopsies. They can find many things in just the skin biopsy, such as amyloidosis. Also, for hereditary neuropathies, they can find out which one it is, if I am correct. The other thing is a muscle biopsy, for things such as myotonic dystrophy or other myopathies.

At one point they told me I had hereditary neuropathy, and I certainly was not thrilled to hear that. Turns out the autoimmune stuff is very stubborn as well, and I am just stuck with this. It isn't going away.

I went back and read that you have abnormal EMGs. I would check out the hereditary neuropathies and myopathies. Some ethnicities have an increased incidence of them. I think if you research this and bring studies to your doc, you may have better luck getting this diagnosis down.

Kitt knows a lot about hereditary neuropathies. There are also some really obscure ones. Check the neurowustl web site.

If you are having spasms, baclofen is a better drug than lorazepam, however, that too has issues, and you can't mix that with the opiates or you will get some degree of respiratory depression.

You have not been fully diagnosed, and need to get to a teaching hospital. You have neuropathy, but why? It is the why, that will bring about validation.

That said, no matter what you have short of terminal cancer, a lot of docs will not want to prescribe opiates, and really, they do cause a lot of autonomic issues. I have AN and opiates just about killed me, even tho I needed something for pain and asked for them and always used the responsibly. Also consider what happens if you have a car accident or any accident on these drugs.

Your primary may care more about you than you think. She doesn't want to see you dependent on meds.

When we don't want to hear something, we kill the messenger.

My primary care doc is the one who started giving me Ativan, she thought that I should take it until I have a diagnosis because of the anxiety I had from the pain and the frustration of this illness.

Also, I'm not leaving her practice because of the drugs, to this day I take no controlled substances and while I'm in loads of pain, I am content with my neuro. I'm leaving her practice because of the way she treats me, I never asked for medications. She was the one to tell me to go to the ER if ever needed to because of the pain which the ER I go to is in the same network as her office, they're across the street from eachother. The only reason I took the medications was because I called and asked her *her staff* if it was okay, I called the next day just to tell them I went to the ER. I had a prescription for 15 and took maybe 3. She offered me opiates before that point and I refused them. I've never been to any doctor she hasn't referred me to in the past 11 years. In my entire life I've been to 3 doctors.

I can't afford to drive all over the country for a risky diagnosis, the Mayo clinic says 1/3 of SFN's are idiopathic and a lot of other medical centers say the idiopathic rate is even higher. My Neuro follows the testing standards of the Mayo clinic for 1/20th of the cost. I believe I'm in good hands as he's tested me for some pretty particular stuff (most of Liz Jane's spreadsheets.) We're still trying to find the cause, he's not giving up. I have no muscle involvement, yet anyways. I'm not finding a new GP for medication, I need a general practitioner that is friendly and polite, that cares for my feelings considering I pay them an arm and a leg.

I've talked to the ANA *American Nursing Association* concerning medication and ability to work. It's considered discrimination, I actually have a very good friend that is a RN, she's on fentanyl for neuropathy following Guilliam Barre Syndrome. We all need different treatments, none of us are the same. I would rather an RN take care of me that isn't in horrible pain because of medications than do sloppy work because she is in so much pain she can't think straight! I would never hide the fact that I took ANY medications from an employer. I don't think that me taking medication that I can tolerate would stop me from taking quality care of anyone. I'm not letting this condition change what I want out of my life, what if this isn't permanent?

I no longer take ativan, since I've gotten some of my pain under control I no longer need it and I've quit taking it myself. I never took it regularly, maybe twice a week.
Thanks for the help

I can't blame you for changing doctors. That was the only way I got diagnosed. It is also frustrating to be treated poorly. Since you are not taking the meds, it is not an issue. I would make sure she did not document her 'impressions'. Stuff written in medical records comes around to bite us in the backside at times.

ADA is worthless. I pursued a termination that occured when I informed my employer I needed IVIG. I had not ever had one blemish on my record. I got nowhere, as in our state, employers can do as they will. That employer was self insured, and IVIG is currently $7800 per month. I was perceived as a worker's comp risk, a potential ligation risk, some one who may need long term disability payments, etc. Now a days, employers look at what kind of risk their employees present to them. My friend with Sarc was just terminated too.

I would not count on ADA.

Given your young age, 21, you stated, I would be inclined to really, really push for diagnosis. I don't think you need to travel to Mayo. I made a trip from the midwest out east and it was not really helpful. I got a plane ride, hotel stay and some chauferred rides, and no blood was even drawn.

I am seen at a teaching hospital tho, and highly recommend that any one with idiopathic get a full work up. I was initially told mine was idiopathic. If I was not treated for the autoimmune issue, it could damage my internal organs. It may anyway, who knows? But with the IVIG I have half a chance, altho to be honest, I wonder if the docs will add yet a more aggressive option. I am on the cusp of an autoimmune disaster, and am not real optimistic, probably because walking and getting out of bed is such an effort.

I am concerned that your pain level and fatigue will be really tough on you as a nurse. 12 hour days, forced double shifts etc. Ugh. But you are young, and hopefully the strength of youth will allow you to achieve your dream.

I suggest before you leave your current doc, get your records and make sure they do not need 'correcting'. You can have any inaccuracies corrected. I have done it myself. Once you leave the practice, they are not motivated to do that.

I pray your condition is not permanent.

I wish you the best.

This website is really useful

http://neuromuscular.wustl.edu/

I know Glenn and I push for folks to read it, and it isn't exactly exciting reading but it has all the high points and it mentions some very odd entities worth exploring. Many docs don't research stuff, since their time is so limited. Mine does and he gets a kick out of my conclusions at times, so it is worth looking at and discussing with your doc, if you see yourself in any of these odd things.

At one point, I did an immense genealogy, (back to the Black Plague) only to find I did not have an obscure hereditary neuropathy of Swedes.

I am going back to playing with my new touch phone....what a riot....surfing the net on a phone...what will they think of next?

I have one of those new Android touch screen phones, I love it!

Thank you so much for all of your concern, you've spent a lot of time replying to my threads, I really appreciate it. I will for sure read that, ANY education I can get on the issue is amazing. I'm very interested in the medical journals and writings.

I've started searching my family background, I did find a great grandfather that had neuropathy since a young age, he battled it his entire life. I haven't found much else, my family must be pretty healthy! Like I said, thank you again, I really appreciate the time you've spent to help me out!