Comments for DrPullen.com - Medical and Health Blog

Comment on Can’t find a doctor to prescribe pain meds? by Joan

Joan — Mon, 21 May 2012 09:26:23 +0000

Dr. Cynic,
I think maybe I wasn’t clear enuff. I did say that I get some relief but I don’t remember saying it was only for a short time. On most meds, the relief only lasts a short time. I don’t know of any that last an entire day.
Also, what U have to realize is that my pain comes from Diabetic Peripheral Neuropathy, which most doctors cannot get a lot of success at treating this pain at all. So when I get some relief, to me it is a success !!
I would rather get partial relief or part time relief, than to get nothing at all. Living with this type of pain for 24 hrs. a day, every day is no fun. If a narcotic/Opioid gives me a couple of hours of getting my pain down from a #10 to a #5 or #6, then at least this helps me function, rather than being stuck in a bed all day.
It is not a failure on your part to treat my pain. I realize it isn’t easy and I will probably never have full relief in my life. If U were able to give me full relief, U would go down in all the history books !!
As for other patients, with other types of pain, I really can’t say. I just know my own and what I have to deal with. And when I see a doctor like U tell everybody that U don’t want to accept patients who must take meds for their pain, it upsets me a great deal.
I am currently struggling to find a new pain management doctor AGAIN !! Not by my own choice…but because once again, another doctor decides they no longer want to treat patients who have to use medications only to relieve their pain.
All the pain doctors want to do these days is give shots or treatments of some kind that are useless to me.
Where does this leave me ? Or others like me ? It leaves us in PAIN !! And this isn’t fair.
Where do we go ? Must we be forced to consider going to the streets ? I Sure hope not.
If I don’t find a new doctor to continue my current medication within 2 more weeks, I will be without any and lost in the process of looking for a new doctor. I have no idea what to do. I dread the constant, excruciating pain I’ll get again.
I’m satisfied with a few hours a day relief. I know it’s the best I’m gonna get. IF I can get it.
Thanks for answering and I hope U understand me better now.
What U need to realize when some of your patients don’t praise U for relieving their pain all the time….is that we are so sick of being in pain, that we have days when we feel like nothing will ever give us full relief.Or any relief sometimes. We don’t mean to make U feel inadequate. We’re just cranky !!
U would be too if U were in our “shoes”. That is…IF I could wear shoes.
U know…..When my last doctor increased my dose by a mere 5mgs. It really increased the relief I was getting from her & I told her she helped me & thanked her. Then she hit me with this bomb about 2 months later & I feel very let down. She told me I didn’t do anything wrong, and I knew that. But that wasn’t going to get her to keep me on as a patient anymore.
I’m just praying that I can find a new doctor soon. I have 2 appts., but they are at a sports rehab place, so I don’t know if they’ll be able to treat me with any meds in addition to any other treatments they offer. I sure hope so or I am deep trouble. I got a letter from my old doctor the other day…saying ai could go in to see her for one more month of meds if I needed it, but it had to be before a certain date.
I’ll likely try to go so I can at least have one more month to try finding this new doctor.
Don’t know if it will help me or not. But at least it’s something.(for one month)

Comment on Can’t find a doctor to prescribe pain meds? by Joan

Joan — Mon, 21 May 2012 05:19:12 +0000

Jessica, I respect some of your feelings about this problem, yet others I can’t.
I agree that there are a lot of people who claim they have severe back pain & go in to get an exorbitant amt. of pain meds. Doctors are stuck because back pain is hard to prove.
Being a pain patient for awhile now, I can tell U that I’ve seen some in that waiting room that I could physically see they were taking too much pain meds. Their eyes were all red & bleary & their speech was impaired. Nobody on pain meds for pain should be showing those symptoms. Those people were getting a buzz off of it. It was obvious.
A patient who is in true pain will never get a “Buzz” from their pain meds. The only thing the meds do, is relieve some pain for them. That is their purpose. And here is where I totally disagree with U. Pain medication is not only meant for cancer patients. People have different types of pain from different causes. When pain is “Acute”, your need for pain meds/narcotics/Opioids should not be permanent. It should be very short lived. But when your pain is chronic, and U cannot find any relief from any other type of medication or therapy, there aren’t many things U can turn to.
If I could have a decent, normal life without taking meds, I would be fine without them. But this I can’t do. Believe me, I tried. I tried for at least 10 of the 18 yrs. I have had my problem. After this, my doctor recommended some pain management and meds. Strong meds. I’ve seen people taking much more in volume than I take, so I don’t feel that I’m using it as a dependency thing. I take only as much as I can find some relief from.
It doesn’t matter which type U take. What matters is which type works for your pain. If Tylenol works for U, then great, U take that. If regular aspirin works better for U, then take that. Everyone is different as well as their pain is different. We all have different tolerances for pain also. Unfortunately, once your in pain for a lot of years, U also develop a lower tolerance for it. I used to have a very high tolerance, but I find I’m not as strong against it anymore. I’m tired of being brave. I’m in pain !! Help me !!
If I should develop cancer in my future, I truly pray that I can be brave & not take too much medication for my pain. But I promise U that if I do need it, I want it !!
To refuse to treat a patient in pain with the correct medication is cruel & unethical. And if it happens to be an Opioid, then it must be.
I’m happy that U don’t have chronic intractable pain in your life. If U ever should get it, I hope U can find a compassionate doctor who will not prejudge U. And I’m sure at this moment U will say to me that U will not take strong meds. You’ll make do on Tylenol or something other than Opioids/narcotics. But just wait n’ see. Wait n’ see what your trying to deal with & if U have the strength to avoid strong meds. Honey….when U take every type of over the counter help that’s there & nothing helps at all…where will U turn ? Will U just suffer for the rest of your life ? Will U be willing to not get out of bed each day & not be able to get yourself dressed & washed & fed or take care of your kids ?
Are U willing to do that, just to be able to tell everybody that U don’t take strong medications ? That’s insane & ridiculous. If U wish to be a martyr, U may do that. But don’t expect everybody else to be one with U.
I’m sorry for the loss of your relative. But U still cannot judge their pain with another’s pain. They are all different.
One person can take a 5mg. pill & get totally knocked out from it, while another could take 50 mg. pill & not feel anything. I can’t explain to U why. I just know it is.
It’s my guess that your relative did have either a high pain tolerance, or was taking other treatment to help in addition what U knew of.
Can U say that U can compare the pain of falling down & cutting your knee, to the pain U may have from a bad toothache ? I don’t know if all cancer pain is the same, depending on which type U may have. From what I’ve seen or been told, different cancers bring different levels of pain for each person. Knowing this…I would say U don’t have the right to criticize anyone for taking pain medication that is stronger than your relative took. Some people need 3 sugars to make their coffee sweet enuff to drink. Others only use one. Which one is right ? Do U get my point ?

Comment on Can’t find a doctor to prescribe pain meds? by dr cynic

dr cynic — Mon, 21 May 2012 03:56:02 +0000

Joan, you completely missed the point. I’m not sick of my patients; I love my patients. I’m saying that opioids don’t work all that well. If you say that they take the edge off for a short time only, then you agree. I have been very generous with narcotics with patients, but they still suffer. Really folks, doctors do the best they can to get rid of pain. but there are no magic treatments.

Comment on Prednisone Taper by Dr. Pullen

Dr. Pullen — Sun, 20 May 2012 19:19:02 +0000

William B: Safe yes. As effective- maybe. The taper is probably to prevent recurrence of the HA. DrP.

Comment on Prednisone Taper by William Bristol

William Bristol — Sun, 20 May 2012 17:57:42 +0000

Dr. Pullen, I usually taper the prednisone treatment for 8 days for migraine headaches when nothing else works. After the first 60 mg dose, the migraine will usually go away. Is it safe to stop after the first or second 60 mg dose? Thank You!

Comment on Can’t find a doctor to prescribe pain meds? by Jessica

Jessica — Sun, 20 May 2012 15:36:12 +0000

I know that there really is people out there who are in pain, and who are we to say that they aren’t. But I feel like some people that are in real pain play up there symptoms to get more pain medication then they need. I recently had a family member who died of cancer and at the end was in terrible pain and all she was on was hydro 7.5′s. I know that all people aren’t like this and everyone’s pain perception is different but I feel like doctors should not rx medications such as oxy or roxy for things such as back pain, etc . Those medications are for terminally ill paitents.

Comment on Prednisone Taper by Dr. Pullen

Dr. Pullen — Sat, 19 May 2012 17:18:56 +0000

Randy: The 3 week course you describe is reasonable. I do not think the prior cytomel will have any impact. DrP.

Comment on Prednisone Taper by randy bradford

randy bradford — Sat, 19 May 2012 13:53:00 +0000

Thanks Dr Pullen for your information. I am 72 very active runner recently diagnosed with microscopic colitis. My GI put me on a 3 week course of prednisone 30mg to 20mg to 10mg weekly.

This looks close but not identical to your burst treatment. How does that weekly tapering sound to you? After finishing the second week of 20mg and going to the 10 mg dosage I did start to feel sore and fatigued. But it only lasted about three to four days at 10mg and now that I’m at the end of the course I feel fine. Don’t know yet if the colitis issue is really solved.

Meanwhile during this period and for the last two months I was taking 5mcg of cytomel because my endo thought my T3 was low. I wonder if that had any impact on my course of prednisone?

In general, what do you think of the tapering 3 week treatment of prednisone? Not exactly the same as you were describing but close.

Thanks for any comments. Randy

Comment on Can’t find a doctor to prescribe pain meds? by Joan

Joan — Fri, 18 May 2012 08:31:37 +0000

Dr. Cynic,
You sound like a very judgmental person & maybe should not be a doctor at all. Just because U are sick of certain patients, it doesn’t give U the right to say that all of us are the same.
U should be more careful of which patients U accept to treat, but not deny those who actually need the Opioids for some relief. Peripheral Neuropathy is a very painful condition and I wish I did not have it. It is daily torture. There is no way to have a normal life if U have this disease. Yet most doctors won’t treat it with Opioids, which have been proven to be the only effective treatment for it out there. They certainly are not the cure !! There is NO cure. Your classifying ALL pain patients into one category…ie “Addicts”!!
That isn’t fair to people like me. I’m left with intractable pain, 24/7 & there’s no willing doctors to be found.

Returning to work with a painful condition may not be possible in all cases. It depends on what type of job they’re used to doing. In my case, I can barely get out of bed w/o treatment, so how could I work anywhere ? I’m not looking for handouts either. I do not collect S.S. Disability & can’t. But I will agree with U on one point. And that is that a lot of people who take the Opioids for pain, just get lazy about returning to work. But they do this even if they’re not on Opioids too. So how can U say it’s only for that reason ?

Also, the reason your patients are not telling U they are getting any relief is probably because you are under treating their pain. Most doctors do. If they would take more time to listen to their patients, then give them the correct dosages of meds, maybe they would be getting enough relief ? It’s a well-known fact that pain is definitely under treated. Doctors hand out anti-depressants like they are candy. They are terrible answers to pain relief. Most don’t work.Not for Peripheral Neuropathy anyway. Maybe they might for Fibro or the like, but not nerve disease !! And neither do the anti-epileptics work for us either. Tried those also. Several times, with no relief. Only got brain dead from them.
I am perfectly normal in the brain dept. I just have excruciating pain all the time. Live with this, Doc. See how it feels. Try to get some sleep. Then get your butt out of bed after maybe 2 to 3 hours sleep & put in a full day of work.
I’m lucky if I can get myself into the shower for 10 minutes. The water actually hurts when it hits my skin !! Now that’s painful !! Would U enjoy seeing your wife suffering like this ? Or your child ?
Am I Angry about your comment ? U betcha I am !! Have a heart Doc. Don’t judge us all so easily.
Sometimes I wish the “real” pain patients would get a badge of some sort, so the doctors would know who to treat & who not to.
And the DEA should get real also. Don’t they have anything better to do with their time ? Maybe all of them should suffer in pain every day too ? Or try to get a shoe on their foot. Or struggle just to stay upright when they attempt to walk outside for the mail…and not have to feel like they are stepping on rocks the whole way. I can’t even walk thru my own home without some protection on my feet, so it doesn’t feel like I have sharp pebbles under my feet with every step I take.

U know Doc…when my doctor asks me what # my pain is….I don’t know what to tell them. That’s because my pain varies so often, that it’s impossible to say truthfully. I’m afraid that if I tell them my pain has come down to a 5 sometimes, that they will think I don’t need anything for relief anymore. But also…my pain varies thru out the day and can be anywhere from a 5 to a 12 !! So what do U want me to tell U ? Do U want my pain # at that moment ? Or what it was 5 minutes ago ? Or maybe what it will be in half an hour when my meds start wearing off ?

I only ask that U be fair to those who really have true pain. Stop turning us away and leaving us to suffer. That really makes a good person start to think if they could take the chance on a street seller. If their own doctor won’t help them, who do we have to turn to ?
Since this pain started about 18 years ago for me, I have tried several different approaches to find relief. Nothing at all has given me any relief except Opioid use. Even this doesn’t take the pain away. It merely takes the edge off of it for short period of time. Heck, Doc….I’ll take that !!! It’s lots better than nothing.
I’ve recently heard about a new treatment, which again I’m willing to try. If I can find anything that gives me relief, or that may end my need to use Opioids, or at least cut it down, I will do it. I just hope this works, and I can get it under my coverage terms. Sometimes, they just won’t pay anything to help me get it. This is all not to mention also, that I’m made to travel all over the state to find a doctor willing to help. And this is because most of U are not willing to live up to your Oath.
I’m sorry that some patients have taken U for a ride. But don’t include all of us in that category, please.

Comment on Prednisone Taper by Dr. Pullen

Dr. Pullen — Fri, 18 May 2012 05:26:00 +0000

Darius: The higher the dose the more likely side effects like high blood sugar, psychosis etc, but as long as a course is brief adrenal insufficiency on stopping is not expected. The dose you mention is well withing a typical dosing range. DrP.

Comment on Can’t find a doctor to prescribe pain meds? by dr Cynic

dr Cynic — Fri, 18 May 2012 03:37:34 +0000

I, also have grown weary of Rx’ing opioids. after 20 years of primary care, I have seen hundreds of people who, because of chronic pain, can’t work, can’t function, and have 10/10 pain. After starting opioids, patients don’t return to work, or function at a higher level, or even say that they are more comfortable. In short, narcotics rarely improve quality of life. Also, no doctor keeps a person in pain because we are cruel or greedy. If we could cure people’s pain, we would do it.

Comment on Prednisone Taper by darius sohei

darius sohei — Thu, 17 May 2012 05:04:31 +0000

yeah that makes sense, best to err on the side of caution.
would the amount of prednisone taken during the burst effect its duration? i see so many varying dosage amounts on the web that it’s more than a little confusing, (i’m more interested in using it to reduce inflammation after an IBD type “flare”)
is there a daily top end range, and can that same amount be continued for the duration of the burst? example, 20mg 3x/day for ten days

Comment on Prednisone Taper by Dr. Pullen

Dr. Pullen — Thu, 17 May 2012 03:49:42 +0000

Darius: Good question. I consider a burst less than 2 weeks really. There is no data that I have seen to tell how long between burst courses of prednisone is needed to avoid adrenal suppression. My opinion is that it is best to avoid more than a few, maybe 6-8 burst a year. DrP.

Comment on Prednisone Taper by darius sohei

darius sohei — Thu, 17 May 2012 00:29:06 +0000

thanks for the earlier reply – 1 more question: if “bursts” are 7 days or less, and keeping it in this time frame negates the need for tapering, how much time between bursts is necessary to offset any potentially negative sides?

Comment on Oxycontin vs Oxycodone by Dr. Pullen

Dr. Pullen — Wed, 16 May 2012 02:11:08 +0000

Joan: There are many opioids. Codeine is one of the natural opiates from the poppy resin Synthetic opioids are derived from the opiates, and are in the same family, work on the same receptor in the brain and elsewhere. Oxycodone is the opioid that is the active component in many drug formulations including Percocet, Tylox, Roxicet, Oxycodone, Oxycodone and others. Oxycontin is a brand name sustained release formulation with the active ingredient oxycodone. Hope this helps. DrP.

Comment on Oxycontin vs Oxycodone by Joan

Joan — Tue, 15 May 2012 18:47:59 +0000

I still don’t understand which drug is which. I don’t think I’ve been on either one, but now I’m not sure. I am sure I’ve never been on Oxycontin.I just don’t know if it’s the same thing as Oxycodone.
I think my breakthru meds are Oxycodone ? But normally, I take methadone for pain.
People are telling me that neither one is codeine. Is it ?
They’ll say they can’t take codeine, but then they say they are on Oxy. So what are they doing ?

Comment on How to spot a drug seeking patient by Eileen

Eileen — Tue, 15 May 2012 06:21:55 +0000

See that is exactly what I was saying. the patients that really need the meds are treated like they are just druggies that just want to use excess pain meds and they are really not able to function without it. It actually raises their quality of life and without it they would not be able to get through each day. My husbands back has gotten much worse from when he was first diagnosed. He had an MRI and it was pretty bad then and that was almost 10 years ago. He refuses to have surgery because it is such a high risk surgery. There are days when he simply cannot get out of bed. Even days when he uses his meds and he is just in to much pain. I know what it is like to watch someone suffer a great deal from pain that he cannot do anything about. It is really unfair to lump everyone in together and treat people with a genuine condition as though they are just drug seekers. He hates the way the pain medication makes him feel most of the time. He is nocked out by it and he doesn’t like the way it makes him non functional. SO there are many people who hate the way the meds make them feel but they are forced into using something that will allow them to continue on in daily life and keep going. Pain medication actually does work for its intended purpose believe it or not!! For those of you out there that just want to put it down and make it all out to be just about ppl getting high, you couldn’t be more wrong for people who have been using these meds long term. The high is something that ends up long gone if you are on it for long enough and that is how people who have been on it for so long function on it well. They are not affected by it in that way anymore. If my husband avoids using it for a while just to take a break from it he will of course go through periods where he becomes somewhat more sensitive to it again but eventually that wears back off. That is just part of the cycle. That is when he hates feeling drowsy from his meds. He doesn’t like the way pain meds make him feel either so it is just people jumping to automatic assumptions when they really do not know how someone who has to use the meds to work everyday feels. Ignorance is not the way to judge is what I keep saying. I know hat people think that they know but unless you are someone who is experienced at long time pain mgt, then you cannot understand what these people go through. A never ending cycle of pain and discomfort. And even for those people that may experience a certain amount of a “high” from their meds, for the ones that are in agonizing pain, who are we to say that this is a bad thing for them???? They are really the ones that are suffering here, not you or I. So………….why should we concern ourselves with people and their pain mgt unless they prove otherwise, really…………..just leave these poor people alone. They suffer enough everyday without helping or adding to their pain/discomfort!!

Comment on Can’t find a doctor to prescribe pain meds? by Joan

Joan — Tue, 15 May 2012 05:08:36 +0000

Sorry Maria. I know well how U feel. Just finding a caring pain management doctor is almost impossible. Then when U have one, they feel they can do anything they want, with no regard to what the results do to U.
Once again…thru no fault of my own, I am without a doctor to go to to help relieve my pain. And why ? Because the DEA has scared them all into dumping all the patients they have who need medication to relieve their pain. Can’t even get a new doctor to take over because all of them are afraid to take U in as a patient if U need meds. Unfortunately, my pain is not caused by something that can be relieved by any type of injection, and because those injections bring in a lot of money for these doctors and med only patients don’t, I am out of options.
At least U can still find a doctor who will treat U out there. I have nobody. So I guess I will have to remain in intractable pain the rest of my life, because there is no doctor I can rely on to be there for me. Yeah right…What life ???

The last one I had just plain decided out of the blue that she would not be writing any scripts for any of her patients unless they were also taking injections from her. M-O-N-E-Y !!! in her pocket. With me…all she gets is the 80% of her regular office charge. Not enuff for her part time Saturday morning job to supplement her doctor husband’s income for her.
All she has to do is keep her injection patients on a Saturday. Work for a few hours, once a week, and she has it made. Let’s not mention that her husband is also the same type of doctor. He does not do medication patients either.
Well…there are a small few doctors who still treat patients like me, but they are not local to me at all & I can’t drive there. I’m half blind. How would I get to them every 30 days ? Impossible !!
It’s a tough situation for anyone in pain these days. The DEA is making it harder and harder for us all. Especially doctors like Dr. Pullen, here. PHhhhfffffftttttt !!!

Just hang in there Maria….you will find a doctor who will both give U injections and meds to fill in when the injection wears off and U will feel better soon. At least U have a chance. I don’t.

Comment on How to spot a drug seeking patient by Rather not say

Rather not say — Tue, 15 May 2012 03:06:54 +0000

Dr. You are the problem. All you morons are scared to death of the DEA and they should not even be screwing with doctors. As if we don’t have enough problems with illegal narcotics in this country, we have so called cops with no medical training screwing with doctors and what they do and the ones with the control have no medical license. I’ve never seen a DEA agent with a medical license. I had a bad accident in 05 and went off a single track cliff while mountain biking in the Rocky Mountains on a $6,000 downhill mountain bike. One false move and my life has been forever changed. I’ve been through every treatment there is and they have not worked or have made the pain worse. I am fortunate to have a good Dr. But I have a genetic disorder that does not allow my body to allow opiates to attach to the receptors normally which means I require high doses of the medication. Between long and short acting morphine and oxycodone/oxycontin I take about 2,000mg of narcotics daily with muscle relaxants and benzo’s to help the muscles relax. The injury has spread over time and will not stop. I have numberous bad discs, degenerative disc disease, degenerative facet disease, vertical and horizontal herniations and many are in the thoracic reigon from (-2 down to the sacrum. I’ve seen over 20 surgeons and all have said not to have surgery because all thoracic surgeries must go through the chest from the front and is very risky and will put tremendous strain on discs above and below and I have been told be all that if I have surgery to expect to have to fuse above and below about every 1-2 years until I’m totally fused. The alternative treatments I’ve tried have caused so many other health issues I can’t begin to count. So not all injuries are self healing. The spine, discs, vertabre, etc don’t just heal. I’m lucy to be able to walk and have fallen from my back and not only injured my head in the original accident but several times since in falls and now have seizures, and between the pinched nreves in the spinal cord and the seizures I lose bladder control several times a week, awake or asleep and I get treated like crap by other Dr’s. I had a bad car accident, stopped breathing and heart stopped and I was dead and brought back and wish they had known I was a DNR but I was in critical ICU and 12 hours later discharges and told they could not help me and my pain and I needed to go home and treat myself. What a load of crap these Dr’s are.

Comment on Can’t find a doctor to prescribe pain meds? by Maria

Maria — Mon, 14 May 2012 23:44:56 +0000

I don’t know what to do. I just cry. I feel like I’m a bad person for asking for pain relief. I did the costly injections and they work for a few days… not totally out of pain but a bit better. I give up and I just want to die. Someone just kill me. It hurts. Death is better than pain.