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Sunday, June 16, 2013

And Now I am a Criminal!

So we went to see the Pain Management doctor last week. Well, not the doctor--we never see the doctor--we pay $35.00 which is the co-pay for a doctor/specialist, but we always see the Physician's Assistant instead. I tell you, Pain Management is a racket.

Anyway, we are waiting for the PA to come in and it seems to be taking longer than usual for her to show up. Finally, she comes in and I can tell something is wrong. Because usually she is a pretty cheerful gal. That day, she has this look on her face which was anything but pleasant.

Then she says, "We have a problem with Robert's urine screen. And the doctor is VERY UPSET!"

OK, about then, I am just pretty shocked.

And she goes on, "There is no Fentanyl in his urine screen." Then she sort of glares at me....

And I'm thinking, huh? And then, I think, oh Ha ha! because I'm thinking she said "Phenergan" which is another drug Bob was taking at one time, but I took him off it. The reason I took him off of it is because I had read somewhere that Phenergan can cause/contribute to cervical dystonia. And I thought maybe being off that drug would help his neck. It didn't, but, by the same token, I didn't see any difference between Bob on Phenergan than Bob off Phenergan, so I figured why take a drug that's not doing anything?

So, I start to tell her this, I say, "That's because I took him off--" and she interrupts me.


And now, I am totally confused. Because Phenergan was prescribed for nausea and why do I need her permission? It's not that big of a deal, as far as drugs go.

And I can't think of what to say, but it occurs to me suddenly we may be talking about two different drugs, so I say, "We are talking about Phenergan?"

She says, "No! I am talking about FENTANYL. THERE IS NO FENTANYL IN HIS URINE! And, not only that, the screen shows TRAMADOL!  And we HAVE NOT prescribed TRAMADOL!"

Now the way she said TRAMADOL, she might as well had said CRACK COCAINE. Because that's the way she made it sound.

I say, "Tramadol was prescribed by his primary care doctor for lung pleurisy."

She says, "What about the Fentanyl? Why isn't there Fentanyl in his urine? What are you doing with his patches?"

I just stare stupidly at her, I don't even know what to say, because this is really weird. I mean, Bob has two Fentanyl patches and I change them out every 72 hours. I do this religiously. I even have "patch" marked on my calendar for the days I need to change them. Because without his Fentanyl patches, Bob would be screaming in pain. And this woman is treating me as if she thinks I am some kind of freaking drug dealer, stealing Bob's patches and selling them on the street! GA!

I finally mumble something about putting them on him every 72 hours. Then I say, "You can check him! He has them on! I'll show them to you!" Because now I am really scared that Bob is not going to get his monthly prescriptions for pain. So I pull Bob's shirt up and show her the pain patches.

Then she gives me the third degree. Asking how/when/where I put them on. Asking if any had fallen off or not stuck properly. Asking is I accidently missed a dose. And I tell you, I felt like a criminal by the time we left that office. But we got his prescriptions. We were warned there would be another drug screening in the near future.

As I rolled Bob out of that office, he looked at me and said, "Weird."

It was weird. I have no clue why the stuff didn't show up in the drug screen. Of course, the first thing I did when we got home was google "Fentanyl drug screen" and the first things I found were some forums with junkies asking if Fentanyl would show up on their parole drug screen. To which, some people answered that Fentanyl requires a special type of drug screen test. Then I found some other forums for pain management patients and, you know, a couple of people wrote that the same darn thing happened to them. i.e. Fentanyl did not show up on the drug screenings....

So then I called the company which makes the drug and asked if they knew why it wouldn't show up on a drug screen or if there was a special drug screen for it. They couldn't answer my question. They had no clue.

Then I thought long and hard about it, and realized that that drug screen was the first one we had done using urine from Bob's condom cath bag and I wonder if that made a difference. That, and the fact, that the PA had told me to "bring some urine" with us, i.e. not empty the cath bag before we left the house. And I did that. In fact, I brought in urine that was over a day old and I had stored it in the fridge over night. And I wonder if that made a difference....

So I am armed with questions for the next Pain Management appointment. Such as, did the lab run the right test? Did the condom/cath bag i.e. latex/silicone skew the results? And does Fentanyl have a shelf life?


DebbieL said...

Wow! What in the world is wrong with these people? Well, you know how I feel about this kind of stuff. Hang in there, girl! From the other "criminal" -- Debbie

J.L. Murphey said...

First of all, You are not a criminal!

Pain management doctors are under such state and federal scrutiny as of the first of the year and a long laundry list of new verification procedures.

The PA in this case was a piss ant qualification.Confusion with drug names is common specialist versus layman. The refrigeration probably kept his urine fresher. I know when we do a 24-hr urine screen for Mr. T, we always refrigerate it.

The lab is probably at fault. You are within your rights to have another lab screen for results.

Is there a lubricant on Bob's condom? That could have an effect. I don't know about latex and silicone. Next time ask for an in and out cath to get the freshest possible urine. That's what they sometimes have to do with Mr. T because of ongoing prostrate problems.

Fentanyl does have a shelf life. Check the box. I hate patches that's why I opted for injectable drugs. Patches are notorious for not making good contact with the skin and an iffy absorption rate depending on the skin condition.

I remember once I lost Mr. T's morphine RX. I searched the house top to bottom and couldn't find it. That is a highly controlled substance. I called the doctor in a panic because Mr. T only had two injections left in the vial. While they were writing out a new RX, I found the original under the couch when it had fallen out of my purse with the grandkids rousing about. I ran to the pharmacy to get it filled because I was down to one dose. I went through the same rigamarole that you did with the doctor's office.

But hey, stuff happens.

Anonymous said...

Please don't beat yourself over the head and flog yourself for a possible bad test and a lousy attitude from the PA. You KNOW you were doing everything properly, and Bob hasn't been in any severe pain, so the patches are working as prescribed. They should be asking questions, but in a civil manner and questions that would conclude why the test results were what they were. It always seems the medical profession is first to jump on the patient rather than the lab or other "professionals" (used lightly).

You're doing a great job in caring for Bob, so don't let some baboons indicate otherwise.

Lots of hugs and prayers for both of you. Dan

Barb Polan said...

That the PA is still alive shows how gracious you are when under attack. Nice job!