I found your name twice while I was Googleing trying to find out any kind of advice on my situation. First of all I will, I don't know if you can give me advice- I'm just hoping...I pretty much feel abandoned by the Va.

Ok here goes...

I am 90% with 10% unemployability for ptsd/ asthma/ migraines..(sexual trauma while I was in) I was diagnosed with fibromyalgia about a year ago and also have compression fractures in my back t 11 and t 12. Also have severe pain in hips which they are saying is my sacro-illiac joint out of whack. I was put on methadone by a civilian Dr about 6 years ago because my old Dr wasn't doing anything for me- except writing things in my record like " overwight, well fed, not moving like she's in pain"... stuff like that when I was in severe agony!

I came back with a presciption from the civilion doc, requested a transfer to a NEW va doc and was given a wonderful doctor who listened, ran tests and put me on a narcotics contract for 10 mg methadone 3x day...I have NEVER EVER broken that contract, abused my meds or anything...for like six years!!!

Well here's where my dilemma is- at the begginning of July of this year, I went to my Dr and said that I was thinking about getting off methadone because I felt it might not be working as well as it should be because SOMEDAYS...some days, I would forget to take my noon dose.(I was being prescribed hydromorphone 2mgs for breakthrough pain to cover that)

Dr. agreed and wrote out a taper schedule and sent me home with the hydromorphone and I was excited to get off the methadone for good.. I was down to a crumb of a 10mg pill and was sick as a dog.I compensated by doubling up on the hydromorphone. I also googled methadone detox and did lots of gatorade, vitamins and green tea. Finally I called my Dr. They sent me clonadine because I still wanted to tough it out.

I ended up not being able do do it because of the severe pain and the restless arms and legs. My Dr called me on July 25 and we talked... I told her I was sorry I let her down but I couldn't go thru the withdrawals at this time- and I needed more methadone! She asked what dose I was down to and said not to be sorry. I told her how I had taken more of the hydromorphone to compensate.

The next day I got methadone and.more hydro HERE'S WHERE I GUESS I SCREWED UP- I did NOT read the methadone bottle until it was about the 5th of Aug, when it seemed like there weren't enough in there to last 3 more weeks..I've been on it for 6 years for crying out loud. It was a mistake. I was supposed to break them in half..they were 5mg tablets. And to top it off, she assumed from our conversation that I wanted to still try to keep trying to ween off because the bottle says " this is your last methadone refill"

I called the contract meds line on the 5th BEFORE I read the writing that said break them in half...and basically said that they didn't send me enough. Then when I realized that this was MY FAULT- I called it back and explained. Well. No one. No one is returning my calls. I have spread the pills out and have a half for today and one for tomorrow. I'm sick. I got yelled at by the head pharmacist who told me I'm going to have to suffer. I bet I've called 15 times. The red team, the pharmacy ( who I know cannot refill, I just was checking on it) called my phyc. Dr ended up getting the va line in Ohio. The nurse there said she would have my Dr call. I got so pissed off at the pharmacist I took the hydromorphine and flushed it, thinking that I might as well get.it all over with at the same time...

I don't know what to.do. I feel like they are accusing me of something by ignoring me or punishing me. I have always been responsible this was just an honest mistake on my part and now I don't know how to fix it. A VA centralized scheduler even started questioning me to the point I was going to walk into traffic. I expressed that to.the nurse. Yet no one calls.

Please tell me if there is anything I can do...I feel cut off and abandoned. And this was my idea in the first place...thanks for reading,


Reply;

The meds that are strictly controlled are a problem across America. This isn't a VA problem, it's an American political health care issue.

Our country's "war on drugs" has affected tens of thousands of people just like you every day. Doctors can't freely prescribe pain medicines other than NSAIDS because of DEA regulations. Every prescription they write is monitored and if they write too many they come under fire from bureaucrats who have no degree in medicine.

Many civilian docs won't write anything stronger than ibuprofen...not ever. They will refer you to someone who may, like a surgeon or pain specialist.

You also can't purchase marijuana in most states even if you have a prescription. The war on drugs people have determined it's bad for you although any science available tells us that there has never been a death from pot and the biggest problem with the drug is the risk of imprisonment.

You don't have a problem with VA, you have a problem with the laws of this country that don't allow your doctors to treat you as they believe they should.

There are 2 things to do. The second step is to find a civilian as a secondary caregiver. I don't know where you live but in states like Florida, pain clinics are popping up everywhere. Some docs are fighting back and although they may be a bit expensive, that's the price you'll pay for needing that medicine in America today. If you are 100% and you have Medicare, you'll find that the doctor visits are actually quite reasonable and often enough, prescriptions are also cheap enough at Walmart, Sam's Club and similar discounters. I use Sam's Club as an alternative to VA quite often and if I'm careful, it's affordable.

The very first thing to do right now is to stop calling people and get in front of them. I always advise that a face to face meeting, when it can be arranged, is worth 1000 phone calls. My VA doc is a pretty good guy. He calls me every now and then about my blood pressure or what have you and he'll tell me that he's going to send me a new medicine or a pill dispenser or whatever. Then it doesn't come. As soon as we hang up, his phone rings and rings again and he forgets. If I'm there in front of him, he deals with that moment and I watch him enter orders into his computer. A phone call never really happened...it disappears the moment the phone is hung up.

If your doctor is at a local clinic or hospital, don't call and ask for anything. Walk in one morning and tell the clerical people you want to see your doctor. Be very nice as they try to stop you. Smile a lot and look sick. As they ask why, tell them you are very ill and have been throwing up and having explosive diarrhea. Ask where the closest restroom is and appear to be needing it soon.

NEVER get angry or show impatience. Once you are in a battle of wills, you lose. Just be very patient and tell them that you have a problem on top of the barfing that you can only discuss with your doctor. If it's a male clerk, say "It's a woman thing."

Don't discuss this with anyone but your physician!

You'll wait as they triage you. You'll see a nurse for blood pressure and so on. Do the same with that person. Just be so nice that it really makes you want to barf and be firm that your underlying problem can only be discussed with your doctor.

Once you have face time with the doc, you will likely have your problem worked out quickly.

This works well in most places. Once you are physically in front of them, they can't turn you away. It annoys them but that's why they get paid. The secret is to be so nice that you elicit sympathy and they will want to help you. They will try to schedule you for the next available appointment but be firm and be very polite..."I'll wait all day if necessary but I must see Dr. _____. Thank you." Be just sick enough to worry them but not sick enough that someone panics and calls 911.

The final part of the secret...once you are successful with this, thank them by bringing cookies. Wait 3 days or so and come back with a big box of home made cookies. Don't try it the day of your visit, the bribe is too obvious. You want to reward them for good behavior afterwards.

If this sounds trite, so be it. My wife makes the best oatmeal cookies in the universe. I'll talk her into making 6 or 8 dozen of them and I take them into my clinic in baggies with 3- 6 each in of them. My doctor gets 2 dozen. I walk around to individuals and hand them cookies and thanks for taking such good care of me and other veterans.

There isn't a single person in the clinic who doesn't know me. If I walk in, it's all smiles and hands out for cookies. As soon as I am seen, a nurse will come out and usher me right into the treatment areas where I get hugs and we gossip a little. My doctor tries to find me whether I have an appointment or not. The times he calls me at home he always ends with, "Tell your wife we haven't seen her and her oatmeal cookies in a long time. Y'all stop by soon." He could care less about seeing me but my wife and those cookies are really a hot item.

For your future planning...I write letters to the hospital director to tell how pleased I am with the services of my clinic...even when I think they could do better. I do not ever complain, even if I could. Those little letters get passed around and people get congratulations from the bosses and they remember me.

I know how all this works because I spent 35 years as a health care worker. I started as a medic in the Army and went on to civilian hospitals and eventually became an administrator and health care consultant. Getting the most out of the system requires that you become a person, not just another patient. I've helped treat thousands and thousands of people over the years. I remember the ones who appreciated me to this day.

There you have it. I hope this helps. I'm here for any questions or comments you may have and I'd enjoy hearing how things are working out for you.

The Formulary

A formulary is a listing of medicines allowed by a health insurer for use by its beneficiaries. Like most modern health care provider entities, the VHA uses a national formulary to accomplish cost controls while allowing providers and patients a choice of quality medications for the treatment of various conditions. Detailed information about the way this works and what drugs are on the VHA  formulary may be found here.

Almost all providers and payers of health care in America use a formulary. Formulary committees are usually made up of pharmacists, physicians and administrators and they spend a great deal of time ensuring that affordable medicines are available to their patients.

The concept of the formulary seems simple. To develop and administer a formulary is a complex task. Each organization will develop its own reasoning for what is allowed, what is prohibited, an appeals process and any associated fees or co-pays. An example of just how complex this can be may be found at The Fingertip Formulary.

The VA often approves medicines that aren't on the VHA  formulary. The rationale for approving prescriber requests for non-formulary medications may be found here.







Generic Drugs

A generic drug is a less expensive version of a brand name medication.

Pharmaceutical manufacturers spend a lot of money to develop a drug. If the drug is approved and if it becomes popular, the manufacturer may reap a large reward in terms of profits. Eventually the patent on the drug runs out and generic manufacturers are then allowed to duplicate the medication and sell it for far less cost.

The popularity of generic drugs continues to grow as our health care systems search for ways to control costs. The FDA maintains an Office of Generic Drugs with a specific focus on maintaining the quality of generics.

The Food and Drug Administration requires that a generic medicine is "therapeutically equivilant" to the original drug. packaging, the delivery (pill, capsule, etc.) and some inert ingredients may change but the basic part of the medication is required to be exactly the same as the original. A letter to prescribers that explains how FDA views therapeutic equivilance may be found here.

Copays and Pharmacy Charges

Many veterans will find that they are required to pay a "copay" amount for their prescribed medications. This usually depends on the Priority Group that the veteran is assigned to.