I would be lost without my GP (or primary care doctor). He is the guy that prescribes my pain relief. My rheumatologist does not. That seems to be a pretty normal state of affairs.
Yesterday I was desperate, and couldn’t get in to see my usual GP. But I saw a different one, whom I have seen a few times before. He’s got a special interest in muscular skeletal issues and sports medicine, so he is a good choice, and has been very attentive and interested on previous visits.
But I was worried. He has also expressed concerns about the dosages of Endone and Targin (oxycodone) I have been taking. So I was afraid he would not want to fill my script for Endone.
He was wonderful though. He asked where I was at ‘with everything’. The last time I saw him I was begging him for cortisone injections into my SI joint and lumbar spine. He sent me for those and wanted to know if they helped. They did indeed! He offered to send me again, but the truth is I can’t afford any more cortisone shots right now. I would love to get my SI joint injected again, because it also causes a lot of referred hip pain. But I can manage it right now. If I get to the point where I can’t walk again, I will find the money then.
I explained it to him this way. Cortisone shot = out of pocket expenses at $70 per joint. I need at least 8 injected. Total $560.
Box of 120 endone tablets = out of pocket expenses $6.
Yes the cortisone injection is treating the problem and the oxycodone is just masking it. But you can’t argue with the math when you live on a Disability Support Pension and have two kids.
So he agreed to fill my script. I asked him for a higher dose. I know that Oxynorm is 10mg of oxycodone, and I always take two 5mg tablets, because one doesn’t touch the pain. So why not prescribe the 10mg tablets.
He refused. He gave me my one month’s supply. Six boxes of endone. Twenty tablets per box. That’s 120 tablets. He told me I could take up to 8 tablets per day. So let’s do the math again.
Assume a 30 day month. 8 tablets per day. That would mean I need two hundred and forty 5mg tablets to make it through the month. Or one hundred and twenty 10mg tablets. Lucky math was my best subject, because this doesn’t add up.
He is telling me I can take 8 tablets per day, but my prescription authority is only for enough to take 4 per day.
Clearly he doesn’t believe I should need 8 tablets per day, every day.
He asked me to only take them when I really need to. I told him I do. He told me I was addicted now.
I paused. I was going to correct him, and say ‘No, I have developed a tolerance and so need a higher dose now.’ But that’s semantics, really. Instead I said, yes, so some extent I am, and I do understand that’s why I need higher doses. Then I asked him if he had a solution to that.
He actually looked very sad and said ‘No. I’m sorry.’
I told him I didn’t really expect any treatment to work (because that’s exactly how I felt at that moment), and that oxycodone at least gave me some quality of life.
He asked me how long I had been suffering from rheumatoid. I said 8 years.
He quietly agreed, and handed me the script.
I gratefully accepted the script and thanked him. But that conversation finalised my decision on prednisone. I asked for a script for prednisone as well, because I am going to need something to control the inflammation, not just pain relief, just for a little while. Because I need a break. Otherwise I will be back in two weeks asking for more Endone.
And then he stopped. He asked me if I knew why my disease had gotten worse lately. Had anything changed. Was I under too much stress? Was I depressed?
He was being caring, trying to help.
I told him my disease hasn’t gotten worse. This is normal for me.
He said I looked considerably worse today than the last time I’d seen him.
I told him this was because I have just spent nearly 4 days without Endone. Without proper pain relief. That every other time he has seen me I have had enough Endone in my body to allow me to function and to even smile. I have a habit of smiling. It’s a good habit. Except when you are trying to explain to people that you are in pain. People seem to think you can’t do both.
Yesterday I couldn’t smile. Three nights with no sleep because of severe pain will dampen a smile. Plus I was still in severe pain. No smile meant he took me more seriously.
But I still smiled when he handed me the script for Endone.