Musical Prescriptions

WARNING - Today's entry may contain TMI. If you don't want to read TMI, then skip this entry and wait for the next update.

The last few days have been more of the same, pain seems mostly under control, bowels as regular as can be expected, and no appetite to speak of. The pain that I do have mostly comes in the morning or otherwise after awaking from sleep.

The hip pain has returned briefly, but I think that I've found a positive correlation between that pain and the need to defecate. The three times that I've felt it this week have each been when I've woken up in the middle of the night with an urgent need to go to the bathroom. Once my bowels have cleared, the pain goes away pretty quickly. Somehow when my bowels are full, they swell just enough to push on something which causes this pain. Don't know whether they push directly on the nerve, or if they push on something else that pushes on the nerve, but it's been the same each time I've experienced that specific pain.

On a somewhat related note, I've woken up the last two nights with pain lower down in my legs. I know that this pain is tied to the whole sciatic thing, but for some reason is only being felt down around my knee. It's not in the knee itself, but is in the lower thigh, just above the knee and in the shin just below it. This pain does not, however, seemed to correlate to my bowels in any way that I can tell. It feels ike it's down in the bones which would make sense given my condition, but I've learned that these pains don't necessarily originate from the point where they are felt, all that I can do is just describe them as best I can and rely on the doctors to do the math. In both instances, I've woken up for one reason or another, not really noticing the pain until I get up, but once I'm vertical, it is there with a vengence. The pain level has been up there, perhaps as high as a 7, though when you get above 5 or 6, it's hard for me to really say what the number is. I've always had a fairly high pain tolerance. The first night, it took two Vicodin to make it go away. Tonight it took only one, but it took a full hour for it to take effect. I hope this is something transient like all of the others and won't be around much, if any, longer.

Being that today was Thursday, I called the pain management doctor to discuss my progress since our last changes. I told him about all of the above, the appetite concerns, and also mentioned to him that since we went to the regimen on the laxative of a single dose in the morning and a double at night, that I've had to wake up to use the toilet in the middle of every night. I informed him that I've since reversed the dosage and he agreed with that course. I also mentioned to him that I needed a refill of the Methadone. Since he now has me taking two 5mg pills at each dosage, they're going pretty quick, especially since he had originally prescribed them for one per dosage, and I only have a couple of days' worth left. He said that he'd go ahead and write me a prescription for 10mg pills so that I wouldn't have to take two pills each time and he did the same with my Neurontin. Even though I have refills remaining on the original Neurontin prescription, he also has me taking two of those at each dosage, so he again decided to save me the hassle and give me a new prescription for a double sized pill. Last, he was giving me a prescription for something to help with the appetite problem. The prescriptions would be left with the front desk at his office and I could come pick them up anytime. Thus began our irritating adventure for the day.

My wife had some errands to run, so she agreed to stop and pick up the prescriptions for me and drop them off at the pharmacy. When she arrived at the pharmacy, they informed her that they were out of the Methadone and that it was on "backorder". So she called me to see what I wanted to do. I asked if it was just the 10mg dosage that they were out of and they responded that no, they were out of all dosages of it. I told her not worry about it, to just bring it home with her and I'd call around to find out who could fill it. As I started to do so, I found that every pharmacy that I called was out of it and had it on backorder, except for Wegmans. The woman at the Wegmans pharmacy told me that they are not allowed to say over the phone whether they can fill it or not, since it's a narcotic, and that I would have to drive over there and hand it to them in order for them to say whether they have it in stock or not. I was a little perturbed by this and explained to her that the previous two pharmacies I had called had told me that they didn't have any in stock. She then sarcastically said, "fine, let me ask the pharmacist if we can tell you if we don't have any in stock". She briefly put me on hold and then came back to confirm that they were indeed out of it. In all, I called 7 pharmacies and got the same response from all of them. I was starting to smell a script and from the anecdotal comments that I got, am fairly certain that this is some FDA or other government bureaucracy "war on drugs" BS.

The prize for most far fetched(or perhaps most creative) goes to the one woman that I spoke with who told me that this medicine "is not used much any more" as the reason that they didn't have any. So apparently my real problem is just that my doctor is prescribing archaic medicine. Perhaps I should ask him about upgrading to leeches?

The story that I pieced together is that they're not supposed to tell anyone over the phone whether they have any particular narcotic in stock and that supplies to the pharmacy are rationed. Each pharmacy gets a certain allotment on a periodic basis, the frequency and day of delivery also cannot be conveyed, and when they have sold out of what they have, then there's nothing that they can do until the next allotment arrives. This sounds a lot like the nonsense that Nanny Bloomberg recently imposed on the NY city hospitals. I also suspect that it had to do with the quantity of my prescription, because each asked for the quantity before they would divulge that they were out of it.

Out of luck, I called my doctor back. I was getting a little worried because I had exactly two days worth of the Methadone left and it was an hour before his office closed on a Friday. I wasn't sure what I was going to do come Monday. The person that I spoke to verified that they aren't supposed to say whether or not they have it in stock and does limit the supply that pharmacies have on hand, so yes, the government expects patients to drive all over town presenting their prescription to each pharmacy in person until they find one that is able to fill the prescription. All in the name of stopping a handful of addicts from gaming the system or planning a robbery or something. Never mind the enormous inconvenience that it places on legitimate patients who are either in too much pain to be driving all over town, or are affected by the medication in such a way that they are unable to drive, or that have to rely on someone else to drive around town and deal with this on their behalf. Yes, let's inconvenience the many legitimate patients in the name of foiling the few miscreants out there who may cause trouble.

Anyway, she offered to call one of the pharmacies, that they work with, on my behalf and call me back. After a little back and forth, it was determined that this pharmacy would only be able to partially fill the prescription, but didn't want to do that out of concern that the insurance may not allow for it to be split up. The did, however, have sufficient quantity of the 5mg dosage that they could fill it for me, so I had to drive up to the doctor's office and exchange my 10mg prescription for a new one with 5mg pills. I had to sign for the exchange and everything. I promptly trotted over to the pharmacy to drop it off. Since they were closing in 40 minutes, I expected to just drop it off and have to come back on Saturday to pick it up, however they weren't overly busy and were able to fill it while I waited. Mission accomplished. On the way home, I stopped at the original pharmacy and picked up the other two that my wife had dropped off earlier in the day.

Lesson learned. If you have a prescription for any medication that requires you to hand deliver the prescription to the pharmacy, when the doctor is not allowed to fax it over, make sure you start the process of getting a refill at least a week before you run out in case some bureaucratic nonsense requires your pharmacy to wait for an undisclosed new shipment to arrive.

Upon returning home and examining my new medicine that is supposed to help with my appetite, I realized that what he gave me is an anti-depressant. After reading the information sheet that accompanied it, I realized that increased appetite is a side effect of the drug, and not its primary purpose. I'm not too keen on taking a drug for it's unintended purpose and I'm not thrilled with the idea of taking an anti-depressant especially since I'm not depressed and I've heard all kinds of horror stories about what they can do to people. I've decided to hold off on taking it until the doc and I have a chat on Monday to address these concerns. He's done right by me so far with the pain meds, but I'm really going to have to weigh the concern over weight loss against the concerns of taking an anti-depressant. I may also call my Oncologist and see what he has to say about it.