Chronic Illness

[tonyb]

I'm on five prescription medications -- all generic, thank the god of your choice -- and I'd rather be on none at all.

I was recently prescribed codeine to treat pain following a dental procedure. I took one of the 20 pills in the prescription and determined that I really didn't need any more. But I'm reeeaaallly glad opiates exist. There's no good reason for people to live in pain such as I've had the good fortune of not experiencing myself in quite some time. And it annoys me no end that unscrupulous pharmaceutical distributors and retailers knowingly divert opioids to the illicit market and put honest prescribers and pharmacists and patients under a spotlight for doing with those drugs precisely what they should be doing.

 

[scottyrocks]

Yeah, I don't take pain killers unless absolutely necessary, as in after periodontal or open heart surgery. But those Rx oxys, percs and vics really did the trick on the rare occasions I really needed them.

Of course it helps that I don't have an addictive personality.

 

[Fading Fast]

Like most things, balance is needed. I have no issue with a company advertising its product even if it is a drug company. But as we learned what is harmful and helpful in that advertising, we need to adjust our regulations to control for harmful outcomes.

Not everyone would be prudent enough / has enough time to do their own research from books, so there is a place for informative advertising at least until doctors know everything and take all the time you need with them.

A shingles vaccine, a device for easing dental work and treatment for a skin condition - all of which have helped - have all been "discovered" by friends or relatives from ads and not from their doctors. Oh, and an easier and less-expensive procedure we saw in an on-line ad helped my girlfriend's dad avoid a painful and expensive day in the hospital.

 

[AmateisGal]

The opioid epidemic and the subsequent crack down has made it very difficult for some patients with chronic illnesses and chronic pain to get meds that *literally* keep them going. I'm on a pain prescription, but in my state, it's not classified as an opioid where I have to go to the doctor, get a written prescription, and then take it to my pharmacist, and I'm only allowed 30 pills. But many are. And that gets costly. A doctor visit for me, before my deductible kicks in, is $130.

Don't mistake me - I totally get why we need to crack down on opioid prescriptions. Doctors were far too lax in giving pain med prescriptions to people who in turn often abused them. I've heard stories of people who went to various doctors just so they could get several prescriptions because they desperately needed to get their fix and their regular doc wouldn't give them anymore; many of them have turned to heroin now. It's incredibly sad.

HOWEVER, I believe that those of us who live with chronic pain on a daily basis need to be able to have access to pain prescriptions without constantly justifying "why" we need them, and also without being judged as a "druggie" or a "doper" by not only society, but even our own doctors. One of my rheumatologists refused to prescribe me any pain meds and said I should control my pain through meditation and yoga. While there is definitely a place for those things within your pain management kit, sometimes yoga and meditation DO NOT WORK and you need to take something for the pain. There are countless times I've gone to bed or woken up in so much pain that I've been in tears. Do I hate that I have to take a pill to help manage my pain? Yep. But that's the way it is. I've accepted that there's no cure for what I've got and I've got to deal with it the best way I can.

As with so, so many things in life, it's about balance.

 

[LizzieMaine]

On the other hand, we survived reasonably healthy until the 1980s without prescription drug advertising, and the entire civilized world save us and New Zealand seems to be doing just fine without it. I think the worst side effect of it, even aside from the opioid epidemic -- which is out of control in New England, and just about every single person involved in it started out with a prescription from a doctor -- is the general "Something's wrong with me, give me a pill for it" mentality that has sprung up in the last thirty years. The world pre-1980s was not like this, and we have to ask ourselves if the situation as it is today really and wholly is an improvement? Or have we, along with the Medical Establishment itself, been sold a bill of goods?

Full disclosure: I have taken opioids twice in my life. I have had morphine for post-surgical pain and for a kidney stone. It worked, under strictly controlled circumstances, but I didn't take it home with me -- and I was a bit disturbed by how the doctor assumed I wanted to take home an opioid prescription. I told him I didn't need one, and he tried his best to convince me that I should take it anyway. Even if he wasn't getting spiff money from the manufacturer, that whole interaction had a very bad smell to it, like I was dealing with a pusher out behind the high school.

 

[Fading Fast]

There are a lot, lot, lot more treatments, procedures and drugs than back in the '80s but our doctors have less time to spend with us than they did in those days. Hence, IMHO, one has to be much more personally engaged and informed about their healthcare than they did back then.

If one is diligent in doing their homework on which doctors, medicines and facilities they use and - as always - has some luck, then I would argue medical care (owing to advancements) is dramatically superior than what we had in the pre-'80s. Is that due to drug advertising - no, but as noted in my prior post, drug advertising has helped friends and relatives of mine. In our current system, I believe the advertising is necessary (owing to the limited knowledge / time of some doctors) but that it should be tightly regulated by a smart and dedicated gov't.

I, too, was given morphine last year in the ER for my first ever kidney stone. The morphine made me so nauseous that I threw up (second time in my life that I had morphine, second time I threw up - I'm done with morphine). The doctors and nurses in the hospital both pushed for me to take the prescription "just in case," when I said I didn't want it.

IMHO, this was driven not by a drug pushing mentality, but by a "you shouldn't suffer" mentality coming from a good place. The ER experience was mixed to say the least, but the nurses and doctors all seemed to be reading form the same "we don't want you to be in any pain if we can prevent it" script. I think they've clean up a lot of the kick-back so I hope I'm not being naive, but it seemed to be a philosophy of addressing any suffering versus pill pushing that drove the, well, pill pushing.

Is that the drug companies at work or just our modern cultural meme? My guess, the latter.

 

[LizzieMaine]

Drug-company spiffs are still very much a thing. They have to be reported, but they still occur.

I don't think I've really ever gotten the "we want to help you" thing from any doctor, really. I have, however, many times gotten the "we just want to get rid of you" thing from a doctor. "Here, take a couple of Vicodin, and get some sleep. And here's your ER bill for $1450." I think all too often the quickie prescription is basically a fast brush. That's the main reason I gave up on trying to seek any meaningful medical treatment for my migraines.

As for the cultural meme, there's definitely something to that. Experts on such things believe one family in particular is responsible for it.

 

[AmateisGal]

Drug-company spiffs are still very much a thing. They have to be reported, but they still occur.

I don't think I've really ever gotten the "we want to help you" thing from any doctor, really. I have, however, many times gotten the "we just want to get rid of you" thing from a doctor. "Here, take a couple of Vicodin, and get some sleep. And here's your ER bill for $1450." I think all too often the quickie prescription is basically a fast brush. That's the main reason I gave up on trying to seek any meaningful medical treatment for my migraines.

That stinks, Lizzie! I've been very fortunate to have two very, very caring doctors - one is my primary physician and the other is my gynecologist. After I found out about my now-ex's affair, I went to my primary care physician for testing and broke down. She sat with me for 45 minutes and talked to me. She does that all the time.

I wish you could find better medical treatment.

 

[LizzieMaine]

I have a good endocrinologist, but he's the one good apple in a pretty moldy barrel. And he's 75 miles away.

 

[AmateisGal]

I have a good endocrinologist, but he's the one good apple in a pretty moldy barrel. And he's 75 miles away.

That's something, anyway. I've had to travel 50 miles to another city to find a good neurologist.

 

[LizzieMaine]

It could be worse. There used to be a doctor in my home town that a friend went to -- he was all kindly-smalltown-nicey-nice to her face, and then turned around and wrote a mawkish autobiography about his life as a kindly small town doctor in which he basically dismissed her as an overweight "but not unattractive" hypochondriac who wasted his valuable time. She considered suing, but didn't imagine she'd get anywhere. She did, however, write him a heartfelt letter telling him what a hypocritical self-righteous fraud he was.

 

[Zombie_61]

What makes me laugh (sort of) are all the TV commercials now for Rx meds, most often for relief from chronic illnesses. The lists of possible side effects, often including death, make me wonder why anyone would take them, never mind how they got approved by the FDA.

Sometimes when I see these commercials I just have to laugh because the potential negative side effects are almost always horrendously worse than whichever condition you're taking them for in the first place.

Such marketing to the end consumer makes no sense, but people must be showing up at their appointments saying, "I need some of that Exmoral I saw on the teevee that's supposed to cure what I've decided I have."...

Oh, that absolutely happens. I've had at least three different doctors tell me about how much time they've had to waste by explaining to some self-diagnosed nitwit that they couldn't possibly have whichever extremely rare condition they stumbled across on the 'Net while looking up instructions for how to properly sautée a mountain pygmy possum.

...Such advertising also drives up prescription costs, escalating an already out of control health care cost problem (USA) (along with random drug testing in the workplace).

If I ever found myself in a position to do so (yeah, that'll happen), I would not only ban any and all pharmaceutical advertising but also make it a Federal law that any company that produces any type of medical supplies (medications, equipment, tongue depressors, you name it) must be non-profit and that any business that's even remotely considered to be a health care provider (hospitals, doctors'/dentists' offices, that guy down by the river who will remove your inflamed appendix with a rusty can opener) must lower their rates accordingly. Sure, most of those businesses would probably close and their overpaid C.E.O.'s would pursue other careers, but it seems to be the only way we'll ever get reasonably priced healthcare in this country.

 

[scotrace]

It's not the side effects fine print that bothers me -- it's the fact that prescription drugs are advertised to the lay public at all. They were not, until the 1980s, and they should not be at all. This "ask your doctor if such and such is right for you" mentality has led to to a flood of overmedication, marketing-driven doctor-hopping, and greed-fed corruption of doctors themselves, which in turn has contributed to any number of social crises, not the least of which is the opioid epidemic which has cut a broad swath of addiction and death thru my own corner of the world.

The US is one of only two countries in the world that allows consumer advertising of prescription drugs, and even the AMA -- hardly an organization free of the stink of corruption -- condemns the practice. The Boys don't just deserve to be condemned for their role in this, they deserve to be lined up against a wall and shot.

This is a much better expression of what I was trying to say, Lizzie.
Ohio has the highest overdose death rate in the United States, and my county is one of the worst in Ohio. A single county in Ohio has the highest death rate from opioid overdose in the United States. It's all anyone talks about here.
I went to the funeral of a very dear 26 year old friend a few years ago. She had been an addict, but had been clean for some time. She died, not due to an overdose, but from a heart valve bacterial infection that the doctors missed because they dismissed her as a dope addict and never checked her out. She died suddenly at her home, after a long period of increasing weakness, in her mother's arms, with her toddler daughter nearby. Completely treatable and unnecessary. I will never forget Jenna, and her torment due to drug addiction, or the idiotic interference of law enforcement in a process that needed actual solutions.
The addiction epidemic has so many far reaching implications, it's hard to know where to start. But banning direct marketing of all prescription drugs, outlawing kickbacks to healthcare workers, stopping the mass imprisonment of addicts, and eliminating practices that require frequent and expensive visits to a provider for routine care, are at least a start. And add ending government efforts to prohibit use of natural remedies already in use for centuries without resulting in addiction.

 

[LizzieMaine]

The hand of the AMA has been all over every point mentioned above. It's very interesting to look back at the life and career of Morris Fishbein, M.D. -- the head of that Association during the Era, and the man who set the tone for it right down to the present day. Fishbein held a medical degree, but he never practiced as a physician a day in his life -- he was a promoter, an advertising man, and a marketer, plain and simple. He sold the AMA's "Seal of Approval" to drug manufacturers for money, making himself and the AMA very very rich -- it was he who encouraged and greately profited from the filthy relationship between the AMA and Big Tobacco during the Era -- and he called anyone who dared to oppose him a "quack." This included not just alternative-medicine providers and methods, but any allopathic doctor who questioned his methods or the political line of the Association.

Antitrust and racketeering charges were brought against the Association on more than one occasion under Fishbein's reign, and every now and then fines would be paid. But even after a doctor he'd falsely labeled a quack sued him and won, and Fishbein was forced out of office, the AMA has continued in the tradition he established. And yet, even this organization has publicly denounced modern direct-to-consumer advertising of prescription meds. For an organization with such dirty hands to have turned against the Boys is a sign of just how extremely corrupt the whole situation has become.

 

[Bugguy]

All the above makes for a great long read - this is why I enjoy the Lounge so much.

Allow me to go against the flow and say something positive about the VA... I've been in a 5-year NIH-spnsored study of dual therapy for a common chronic condition. I was enrolled at the Cincinnati (OH) VA and last year transferred to the Nashville (TN) VA at Vanderbilt. For all the criticism the VA takes, I have never been as well managed as I have been the past two years. As part of routine follow-up, I was spotted as Vitamin D deficient - now fixed, and last week I tested low for B 12 - fixing. I can't say enough positive about my care.

Full disclosure - I have been a hospital administrator for 45 years. I make a living now working with troubled physicians. I spent several years developing a program on behalf of an adult academic hospital to transition adolescents with chronic childhood diseases from a Top 3 children's hospital to an adult care setting. Interestingly, I spent half my effort transitioning the parents into a setting where their dependent child is emancipated. This topic is near and dear to me as a provider.

 

[AmateisGal]

All the above makes for a great long read - this is why I enjoy the Lounge so much.

Allow me to go against the flow and say something positive about the VA... I've been in a 5-year NIH-spnsored study of dual therapy for a common chronic condition. I was enrolled at the Cincinnati (OH) VA and last year transferred to the Nashville (TN) VA at Vanderbilt. For all the criticism the VA takes, I have never been as well managed as I have been the past two years. As part of routine follow-up, I was spotted as Vitamin D deficient - now fixed, and last week I tested low for B 12 - fixing. I can't say enough positive about my care.

Full disclosure - I have been a hospital administrator for 45 years. I make a living now working with troubled physicians. I spent several years developing a program on behalf of an adult academic hospital to transition adolescents with chronic childhood diseases from a Top 3 children's hospital to an adult care setting. Interestingly, I spent half my effort transitioning the parents into a setting where their dependent child is emancipated. This topic is near and dear to me as a provider.

I think it really depends on where you live in the country as to how well the VA is run. My father did not have a good experience at the VA in Denver (he lives in western Nebraska, but had a stroke and they flew him to Denver). But he often goes to Hot Springs, SD, and had good treatment there.

 

[tonyb]

Yeah, I don't take pain killers unless absolutely necessary, as in after periodontal or open heart surgery. But those Rx oxys, percs and vics really did the trick on the rare occasions I really needed them.

Of course it helps that I don't have an addictive personality.

I found the physical pain of open heart surgery far from the worst of it. It didn't hurt all that much, really -- surprisingly less painful than I expected.

But psychically? Man, it kicks your ass! Did mine, anyway. I was like a wounded animal, and snarly as one, as my lovely missus can attest.

 

[tonyb]

All the above makes for a great long read - this is why I enjoy the Lounge so much.

Allow me to go against the flow and say something positive about the VA... I've been in a 5-year NIH-spnsored study of dual therapy for a common chronic condition. I was enrolled at the Cincinnati (OH) VA and last year transferred to the Nashville (TN) VA at Vanderbilt. For all the criticism the VA takes, I have never been as well managed as I have been the past two years. As part of routine follow-up, I was spotted as Vitamin D deficient - now fixed, and last week I tested low for B 12 - fixing. I can't say enough positive about my care.

Full disclosure - I have been a hospital administrator for 45 years. I make a living now working with troubled physicians. I spent several years developing a program on behalf of an adult academic hospital to transition adolescents with chronic childhood diseases from a Top 3 children's hospital to an adult care setting. Interestingly, I spent half my effort transitioning the parents into a setting where their dependent child is emancipated. This topic is near and dear to me as a provider.

I've heard many a VA benificiary express similar sentiments. That's wholly anecdotal, of course. Still, it has me wondering what's behind all the trash talk about the VA.

 

[Bugguy]

I think it really depends on where you live in the country as to how well the VA is run. My father did not have a good experience at the VA in Denver (he lives in western Nebraska, but had a stroke and they flew him to Denver). But he often goes to Hot Springs, SD, and had good treatment there.

You're right, as in most things in life, location matters. This was my experience. I guess I'm fortunate that my role may offer better access. Perceptions do make and burn reputations. Thanks for the comment.

 

[EngProf]

This is an outsider's opinion, but a nearby outsider: I suspect that the proximity and collaboration of Vanderbilt Hospital, which is literally right next door to the Nashville VA, helps with keeping the VA's treatment-quality up.
Vanderbilt is rated in the Top-10 and at least used to share people (doctors and nurses) with the VA. Vanderbilt University and Vanderbilt Hospital just went through a corporate split so I don't know if things are done differently now.

Bugguy (insider) - opinion??

(By "nearby" I mean that my office is about 200 yards from the VA Hospital. By "outsider" I mean that I don't have direct dealings either with the Vanderbilt or VA Hospitals.)