[PurpleFoot721]

Hi All,

Well, it has been a month of being on the low dose of methadone and a month since my last visit to see my PM. Over the past week, I saw both my PCP and my PM and now I am extremely upset, but it comes with a bit of a funny story to start off with.

A few weeks ago, I received a call from my PCP reminding me that both my husband and I still needed to have our annual physical before the end of the year. We decided to wet up our appointments together for last Thursday. Well, a week ago, I received another call from their office again reminding me that I still need to have my pap smear as well, but if I wanted they could do it there. I figured that instead of making a separate appointment and having to go across town to have yet another appointment with yet another doctor that I would have to explain things to, I would have it done there along with my physical, all in one day. Then another call came in saying that they won't have time to do a physical on both my husband and I and do a pap at the same time, so they canceled me having a physical done until next month.

On Thursday, we went to our appointments and they took us to our exam room. The nurse looked into the charts and there was quite a mix up. I was listed as being scheduled and approved for a physical, and my husband was scheduled and approved for a pap smear. She had no idea what to do since these were pre-approved by our insurance, so she left that for our doctor to decide what was to be done about not only the office error, but also the insurance approval error. Needless to say, I had a physical, and my husband had a flu shot, tetanus shot and trigger point injection for an issue with his arm and shoulder.

Then the bad news came. I found out that Thursday was the last day for our PCP in that office. He was going to leave being a general practitioner and go back to being an anesthesiologist. The doctor that owns the practice was to take over our medical care from that point on, since he is the only other doctor in that office. I have never liked this doctor. He has made more than one mistake with me and I do not need a doctor that constantly makes mistakes with my healthcare. He is a great business man, but a horrible doctor. He does have a PA that works for him that is rather good and if he ever finishes med school, I would gladly be one of his patients. As a PA, he rarely treats me.

Yesterday, I had my appointment with my PM. My first appointment with him was wonderful. This appointment was with a PA that knows absolutely nothing about CRPS and only follows a treatment plan that deals with generalized pain that was set up by the pain management doctor. I found out that he only visits with new patients and those that are extreme cases once a week. I figured that I would try her out and went through the appointment. I told her how this past month was while on the low dose of methadone. She didn't like what I had to say, so she told me to stop to try something else. No tapering off, just stop. It was a low dose so no tapering should be necessary. I asked a few basic questions, questions about the possibility of using some sort of topical, maybe even clonidine. I was told that none of them are effective for severe pain and clonidine is only used for treating withdrawal symptoms, not nerve pain. I asked about possibly a compounded ketamine cream. Her response was that ketamine can not be compounded into a cream that would be effective, it is an iv anesthetic only. She wrote me a prescription for fentanyl and said this will work if you want some sort of topical that works. It's the only transdermal prescription that she would write. She refilled my gabapentin and amitriptyline wrote a script for fentanyl and percocet and sent me on my way. all prescriptions were post dated for next week, 11/2 so that I could finish with my prescription of methadone before having these filled. I was not happy with yesterday's appointment.

I want to ask, should I be concerned about withdrawal symptoms of the methadone? I was told to take them as directed until they are gone and then start with the fentanyl and percocets. I have a weeks worth left. Should I try to start tapering off over the next couple of weeks even though I was told to just stop?

I have had two disappointing appointments in the past week, one with my PCP who is leaving General Practice and the other with what I thought was going to be a continuing appointment with my PM who turned out to be a PA that knows nothing about CRPS. I feel like I need to start searching for a new doctor for both primary care and pain management.

Thanks for listening to my long rant of the what has been going on over the last couple of days.

[-Spike-]

Originally Posted by PurpleFoot721

Hi All,

Well, it has been a month of being on the low dose of methadone and a month since my last visit to see my PM. Over the past week, I saw both my PCP and my PM and now I am extremely upset, but it comes with a bit of a funny story to start off with.

A few weeks ago, I received a call from my PCP reminding me that both my husband and I still needed to have our annual physical before the end of the year. We decided to wet up our appointments together for last Thursday. Well, a week ago, I received another call from their office again reminding me that I still need to have my pap smear as well, but if I wanted they could do it there. I figured that instead of making a separate appointment and having to go across town to have yet another appointment with yet another doctor that I would have to explain things to, I would have it done there along with my physical, all in one day. Then another call came in saying that they won't have time to do a physical on both my husband and I and do a pap at the same time, so they canceled me having a physical done until next month.

On Thursday, we went to our appointments and they took us to our exam room. The nurse looked into the charts and there was quite a mix up. I was listed as being scheduled and approved for a physical, and my husband was scheduled and approved for a pap smear. She had no idea what to do since these were pre-approved by our insurance, so she left that for our doctor to decide what was to be done about not only the office error, but also the insurance approval error. Needless to say, I had a physical, and my husband had a flu shot, tetanus shot and trigger point injection for an issue with his arm and shoulder.

Then the bad news came. I found out that Thursday was the last day for our PCP in that office. He was going to leave being a general practitioner and go back to being an anesthesiologist. The doctor that owns the practice was to take over our medical care from that point on, since he is the only other doctor in that office. I have never liked this doctor. He has made more than one mistake with me and I do not need a doctor that constantly makes mistakes with my healthcare. He is a great business man, but a horrible doctor. He does have a PA that works for him that is rather good and if he ever finishes med school, I would gladly be one of his patients. As a PA, he rarely treats me.

Yesterday, I had my appointment with my PM. My first appointment with him was wonderful. This appointment was with a PA that knows absolutely nothing about CRPS and only follows a treatment plan that deals with generalized pain that was set up by the pain management doctor. I found out that he only visits with new patients and those that are extreme cases once a week. I figured that I would try her out and went through the appointment. I told her how this past month was while on the low dose of methadone. She didn't like what I had to say, so she told me to stop to try something else. No tapering off, just stop. It was a low dose so no tapering should be necessary. I asked a few basic questions, questions about the possibility of using some sort of topical, maybe even clonidine. I was told that none of them are effective for severe pain and clonidine is only used for treating withdrawal symptoms, not nerve pain. I asked about possibly a compounded ketamine cream. Her response was that ketamine can not be compounded into a cream that would be effective, it is an iv anesthetic only. She wrote me a prescription for fentanyl and said this will work if you want some sort of topical that works. It's the only transdermal prescription that she would write. She refilled my gabapentin and amitriptyline wrote a script for fentanyl and percocet and sent me on my way. all prescriptions were post dated for next week, 11/2 so that I could finish with my prescription of methadone before having these filled. I was not happy with yesterday's appointment.

I want to ask, should I be concerned about withdrawal symptoms of the methadone? I was told to take them as directed until they are gone and then start with the fentanyl and percocets. I have a weeks worth left. Should I try to start tapering off over the next couple of weeks even though I was told to just stop?

I have had two disappointing appointments in the past week, one with my PCP who is leaving General Practice and the other with what I thought was going to be a continuing appointment with my PM who turned out to be a PA that knows nothing about CRPS. I feel like I need to start searching for a new doctor for both primary care and pain management.

Thanks for listening to my long rant of the what has been going on over the last couple of days.

Aaaahhhhum,

I ah, I have had Ketamine Cream. *Scratches head* GULP.... It was effective! hmmm

I hate having to switch Doctors. It is really a crap shoot. If it were me though, that is exactly what I'd be doing, especially with that PA knowing nothing about CRPS, which is very obvious. (I'd be so frustrated)

[Dhall748]

RANT ON Purple foot! Sounds frustrating!
Dont give up!

[EnglishDave]

Hi Alaina,

Sorry you are going through such turmoil and having to deal with Drs and bureaucracy like this.

Regarding Ketamine, not only does it come in cream (with amitryptiline often) and gel form, but I take oral liquid. There are also oral anaesthetic tablets which require no other equipment for surgery. Ketamine is on the WHO Essential Medicines List and anyone in the Pain field should be fully versed as to it's applications and uses.

Hope things settle without too much upheaval.

Dave.

[DejaVu]

Hi Alaina,

I, too, am very sorry you have had this experience.

One of my doctors knows more about topical medications because she uses them more and wants to know about the options available. My primary care doctor is in favor of them and is just learning about the potentially helpful combinations. He is very open to writing a prescription once he understands what to write. (I often talk with the compounding pharmacist -- and look up topical medications online --to learn the latest and greatest and then show the options I prefer to my doctors.)

I have not had good luck with PAs for the most part. Some of them eventually gain a lot of experience and are highly specialized. Many PAs have minimal training and just aren't ready to handle more complex challenges. M.D.s have more extensive training and experience.

(We are seeing more and more PAs in the ER -- aka A&E -- and many find this fact a bit disturbing. My PCP and specialists are very upset with the fact that the local teaching hospital, also a Level I trauma center, is heavily staffed with PAs. I, personally, have had some very unhelpful experiences with PAs and have had to make sure I see practitioners with more experience/training. I do have a very experienced Orthopedic PA, however. )

I hope you will quickly find a practitioner better able to serve your needs, pronto.


DejaVu

[PurpleFoot721]

Thank you everybody so far for your comments.

DejaVu, I have had both good and bad experiences with PAs so far. I prefer the PA at my PCP's office to the doctor who owns the practice, but prefer the other doctor that was there up until this past Thursday. The PA that is there is very knowledgeable about general health and he is currently in med school to get his MD. I do like working with him when I have that option but rarely do have that option. If the PA is in a specialized practice, such as pain management or orthopedics, they don't seem to know much other than some basics of the practice they are working for. I think that anyone that is willing to learn can do as much as they can.

I am really trying to look into topicals more now after I checked the results of my blood test that I had the other day. My AST (SGOT) levels have shot up quite a bit since my last test, which was done in June, going from 30 up to 50 now, which tells me my liver is having a little bit of a difficult time processing all of these pills I have to take now. It is not horrible but it is something that needs to be watched. At least the fetyanyl patch gets rid of having to take methadone 3x a day.

As for finding a new doctor, both PCP and PM, I have a few that are supposedly good doctors. I want to wait till the end of the year before I make any changes. I have never liked the hospital network I am in now, but my husband likes the doctor we were seeing. I want to switch out of this hospital network. The only problem is that I can't stand the idea of loosing my ortho by switching PCPs. I think it was his surgery that caused me to end up having CRPS, but he still does everything he can to help me

[vintagewine]

Hi Alaina,

I'm sorry that you were misinformed because Ketamine most certainly can be compounded in a cream and it is helpful for certain types of pain.

My cream had ketamine, marcaine and capsaisin compounded into it.

Good luck

[DejaVu]

Hi Alaina,

You have been on my mind.
Maybe your PA has an open mind and might appreciate some information on topical approaches? Some practitioners simply don't know and will support/treat their clients once they do know.


DejaVu