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   WE need a patient ADVOCATE do you agree ? (Pain Management board)

29th October 2007
Hello Everyone,

Many of you remember that I (Conductor) was recently in the hospital due to a fall that occurred on June 1, 2007. I endured a right basilary skull fracture. We don't know if I had a bleed that caused me to fall and crack my skull or if I fell and landed on my head, which caused the bleed.

Part of the medical difficulty was that I was taking Coumadin due to my Lupus Anticoagulant diagnosis.

THE PAIN PROBLEMS?? If I did not have my Mom there to help me, I cannot imagine the withdrawal types of problems I would have gone through. Normally, I use the Duragesic (Sandoz generic) Patch 75 mcg that I change every two days. As well, I use Actiq 800 mcg (2-3 per day) and Dilaudid 8 mg (up to 5 per day). My Mom came very, very close (and I'm not joking on this one) to grabbing the physician by his lapels to make sure I had some form of fentanyl going into my system! So, I was so graciously allowed (back to sarcasm) 1 (one) 25 mcg fentanyl patch every 3 days. I was not allowed any Actiq or any Dilaudid. For BT pain, I was allowed 1 (one) Percocet every 4 - 6 hours. Certainly, I was in the hospital for serious reasons, but just telling my parents that the hospital staff needs to "make sure he's alive" didn't particularly cut it in my opinion. They didn't want to render me unconscious--that was their comment. The other physicians with whom I've since followed-up did not understand that complete lack of adequate care for the Pain problems.

Some people might disagree with me, but severe pain being caused by lack of appropriate medication (that I've been on for almost 10 years) doesn't seem right. Going from the fentanyl patch 75 mcg every 2 days, Actiq 800 mcg (2 - 3 per day), and Dilaudid 8 mg (up to 5 per day) for Pain Management down to the fentanyl patch 25 mcg (from 75 mcg) every 2 days and 1 Percocet every 4 - 6 hours for BT pain does not help the situation!

I don't know what kind of things would have happened if I had not had my Mom available. (My Father was in Michigan at the time of my fall. As soon as he was informed, he drove back home!) My Mom was my advocate--and she could only do a little bit! The most unfortunate aspect was that I was transferred to a hospital in another county--a place where my Internal Medicine doctor does not have privileges. She didn't have a voice there!

While it does me little good, I still get furious about this situation. I believe we need advocates, but I don't know how effective they could be for us in these types of situations. Maybe others will have better ideas than I do!

Sincerely,
Jon (Conductor)

P.S. Steve, I get seriously IRKED when nurses--or anyone else who doesn't know your situation--make comments about you dosage levels. Because I have taken these medications for such a long period of time...I need higher doses of most opiates. I underand why you would be irritated with that nurse who made the comment about your "profane" fentanyl dose!
29th October 2007
Hi All,

I know all too well about this. I've had over 65+ surgeries for my kidneys, including the removal of my left kidney almost 2 yrs. ago. My kidneys, or should I say kidney, is the reason I'm in PM. It's soooo horrible when I go in for surgery, although I will not be having anymore surgeries because my remaining kidney is dysfunctional/failing and I will not go on dialysis.

Anyway, Boxerluver already knows this story from the kidney board, but when I had this one surgery done 5 yrs. ago, it was a nightmare!! I was on Oxycontin 40mg bid & Actiq 800mcg 6/day prn (averaging 5/day). Anyway, the SOB surgeon assurred me I would be taken care of by the PM team at the hospital. WRONG!! I wake up in recovery screaming my head off!! The nurse had already given me 50mg of Demerol IV and said "she should be out already". Are you kidding me???

Well, I'm screaming in pain, my mother and husband are yelling at the docs and nurses and the nurses are yelling at the docs. My b/p was 250/130 and climbing. The ahole nurse comes over and says "why are you still in pain?? I don't understand"? I told her to look at my med chart and she did and came back and said "ohhh, you poor thing, you are an addict"! WHAAATTTT!!!

This is something you should never say to a post-op patient screaming in pain with stroke level b/p and rising! She shouldn't have said it period! It took 30 minutes before the PM team came in and hooked up my PCA pump (seemed like an eternity). It took 15mg of Dilaudid spread out in 5mg doses over 30 minutes just to take the edge off. I was still miserable! Eventually, the Dilaudid was changed to Fentanyl.

It was a week in the hospital I will never forgot! I was still in severe pain, but they would not increase the Fentanyl anymore due to "my possible breathing stopping". Give me a break!! Someone who is wide awake with still very high b/p, 100% oxygen saturation, and a pulse of 130 is not going to stop breathing on you!

Well, needless to say, this is one mistake I've never made again. Believing the surgeon has set up my post-op PM. I make it a point to have already a plan in writing!! This horrid experience was partly my fault, but, it will never happen again! Take care and bye for now!! :angel:
 
 

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