Hi Kathy! My Sis is in Physical Rehab. in L.V. She was a personal trainer. 2:20 "Chronic pain patients wondering how the hell do we get care when it seems like doctors are now abandoning us as the pendulum shifts?" Exactly. Too bad there's no test to show the amount of pain one is in, to distinguish need from abuse (I think that's what I'm saying). I'm in chronic pain and have never been addicted to or abused Rx drugs, yet I feel my access to appropriate meds is being unfairly regulated, and (except perhaps for med marijuana), getting tighter. I don't want to be addicted to anything, and I don't want to O.D., but living in chronic pain is not living - it can be just as bad as the other extremes. Thanks dr.s!!!
We must stop paying doctors based on "patient satisfaction". In order for them to treat us properly and thoroughly we have to give them *MORE TIME* to get to know us, and our medical history, and our needs.
Wow as a chronic pain Pt. This was so helpful. I have M.S. and as much as I've studied this illness, I had no idea how painful it was going to become. I worked in the hospital for years and naively, I had no concept of how debilitating chronic pain was. Great show, very informative, sympathetic, as well as encouraging. Well done
I've had CRPS since March of 2010-. You should be ashamed the way you addressed pain as well as how you conducted yourselves. As far as your guest there is no way as a person with one of the worse chronic pain disorders I would never see her. Wow guys is that the best you can do. Meghan how are you doing?
@@RussEastburn Did you hear them talk specifically about CRPS at around the 50 minute mark? PS - Sorry to hear you live with the beast. I was diagnosed in March 2008 with CRPS.
It is so frustrating when people think im drug seeking, i have been in pain since i was a small child, i would cry and cry over how much pain i was in and adults said it was growing pains. Well almost 30 now pretty sure its not growing pains, just has progressively worsened, by the time i was a legal adult i started having mobility issues (was 6 feet tall 120 pounds for all those who will blame it on being fat) and was just locking up in pain and eventually my world got smaller and smaller until i couldn't keep up with work or friends. I have full body pain constantly and have spent the past 10 years researching everything, trying every natural thing and supplement, i've repeatedly done cognitive behavioral therapy, mindfulness and meditation, nutrition courses, gentle exercise class, breathing exercises to calm nervous system, every attempt at neuroplasticity, completely changed my diet, removed anything inflammatory, i have tried countless non-narcotic drugs, including the antidepressants drs seem to think will help pain, nerve blockers, etc.. tried chiropractor, acupuncture, trigger point injections, massage, EVERYTHING! Now tell me, would a drug addict spend 10 years taking courses to prove they are in pain or would they just buy drugs on the street? Honestly if it weren't for the whole fentanyl crisis i would just buy opiates on the street for legitimate use. but finally after a full decade of jumping through hoops my doctor gives me one T3 a week. I understand the potential for addiction and physical dependance and how opiates are problematic with chronic conditions but i think it's fair to at least have the option of pain relief 2 or 3 days a week. Hoping to work towards that trust. They are the only thing i have found to help! and no i don't expect to be pain free i expect to go from pain that is excruciating to pain that is simply extremely uncomfortable. I think for the amount of work i have put in i have pretty reasonable expectations. Really wish doctors would stop looking at me and deciding because i am young and i don't have broken bones sticking out of my skin that they can't comprehend how much i suffer every day and night of my life. Pain relief makes the difference between whether or not life is worth living. I would never abuse opiates because even when i'm in pain i don't want to "waste" them because eventually i know i will be in even worse pain and wish i saved up my one pill.. This is probably to long for anyone to bother reading, but real pain patients are suffering because doctors won't prescribe opiates.
I agree I pray that that doctor puts him or herself in your shoes and asks would they themselves want to suffer as they have made you to do so. God bless you, as a chronic pain patient myself for the past 14 years I understand, but thankfully I was turned over to a pain management clinic and they showed me "MERCY" and are true angels. They are not perfect but they know their job and I am truly grateful to my doctors and hospital doctors and specialists. I pray things get a whole lot better for you! God bless and keep you.
having worked as an moa in a pain clinic prior to getting my CNA and then LPN I really appreciate seeing this done from this perspective. Both of you were radiating compassion and caring with a wealth of knowledge and that great gallows humor I have come to expect from zdogg and Tom.
so ive been "helped" off opioids for my pain for five years now... i dont feel better, i feel worse, without the meds i cant move, the less i move the more i hurt the more i hurt the less i move, and when i try to push through it the pain is so bad i rock and cry. Good job pain management people.
My "doctor"s idea of a taper was "you took a tramadol after you told me you were in unrelieved pain, GOODBYE" from 100mcg/hour fentanyl that HE PUT ME ON without even knowing what was wrong with me (poly arthritis, carpal tunnel and chronic migraines thank you very much, all but the migraines easily medically proven) to NOTHING instantly.
Yes, there are actually people with severe chronic pain (me for one). I've had 7 surgeries (3 were back surgeries), and I'm in chronic pain. Without some type of pain medication, I can't even move. I've quit all pain killers several times for an extended period (weeks to months), and I was in horrible pain. For some people, they need some type of help with their pain so they can exercise (or just stand and walk). It's a shame that everyone that takes pain medication is lumped in the same pile.
You bring up a legitimate issue, Summer. Have you tried seeing a doctor for Buprenorphine as pain treatment, or receiving joint injections? That might be an alternative. Best wishes to you.
I feel the same..fucking sux others make it hard for others😠 And the thing is anyone In healthcare should know the things your body goes through when you're in pain..smh
My mother had intense surgeries that actually made her pain worse in the long run. Opiates were a godsend for her and our family’s wellbeing. She literally might have killed herself if she had to live in the pain she was in. She never said anything like this but I know that she was in so much pain that life was miserable without treatment.
I'm a phlebotomist in a hospital, and often drawing patients in the ED. We had a poor lady one day, she was older, but had chronic pain issues. (I don't know her condition) but her provider was prescribing her a minimal amount of pain meds. Since it really wasn't enough to get her in a comfortable place where she could get through her day, she was self medicating with extremely high doses of Advil. When she came to the ER, she was so extremely sick, was suffering kidney failure and liver failure. Would she have been better off with an appropriate daily dose of an opioid? And perhaps an anti inflammatory? I felt so sorry for her, all because her doctor wouldn't recognize her pain and treat her appropriately, or was he scared to treat her appropriately? I'm not a dr, but I too have pain issues (Osteo and rheumatoid arthritis) and my dr has been treating me for 15+ years with said meds. I can't run a marathon, but I am functional and my organs are fine. This is a great discussion, by the way-I'm so happy a nurse friend posted you on FB🙂
Doctors do not seem to be educated about the death rates caused by long term use of NSAIDS and Tylenol, or maybe they simply don't care. Chronic pain patients are "complicated" (many docs will say) and really just do not want the extra burdens, and there are many extra burdens involved to take on a chronic pain patient. ruclips.net/p/PLYuXoJ1HRCth87Q-p2rOUVCp5GxLOkUYz
Really good point! My sister who has chronic back and neck pain was continually prescribed strong NSAIDs even with GERD, gastritis and stomach upsets . Just take it with food and water just keep taking it!!! All different ones . I guess no one cares about her stomach or kidneys
Had a family member dependent on opioids, years through several docs that never communicated. Not entirely her fault. Her care giver couldn’t go to every appointment. It wasn’t until she was admitted to the hospital that she got 1 team that communicated and made decisions together that they were able to take her meds way down. She was on so many medications, none of the docs would take responsibility despite prescribing meds that counteracted each other and were just making her more addicted. Thank you for having this conversation. It made me so leery of docs and the prescribing of any pain meds, I don’t even like ibuprofen
I wish all of your videos were Captioned. Even just the auto captioning. Your viewers with hearing loss and various learning disabilities and other reasons to require captions would certainly appreciate the access they provide to your content!
Hi I'm a chronic pain patient have been for a long time. I have lupus, degenerative disc disease, rheumatoid arthritis, osteoporosis, mild scoliosis, fibromyalgia, osteoarthritis, PTSD, anxiety, and really bad migraines, muscle spasms, a tumor that has been growing out of my spinal canal for quite some time that has now grown longer down my back that started above the area where your bra strap would be and has wrapped around muscles and ligaments. I also have neuropathy. I've been in several car wrecks as a passenger, I also fell 8ft from a swing from in the air and landed face-first into wood chips. I've had two different concussions, one that lasted for 9 months and one that lasted for a total of 6 months. I go to a pain management clinic and I've done steroid injections, cauterization of nerves, epidural injections, and migraine injections. I have been on Dilaudid for the past 5 years because my pain is so great, but because the people that do not get prescribed these pain medications that use them to get high have now cause the ones that need these to be able to get through the day and I have some type of ease from the pain now are being taken away. I have asked my family doctor what he thought about medical marijuana and I've asked my Pain Clinic Doctor what he thought about medical marijuana and they both have said they do not condone in it. I have researched everything into all of this I have family that are in the medical field and said that being an opioid user would be in my best interest to use medical marijuana. I had back surgery in 2013. I had three discs taken out, the fluid sacs between the vertebrae I have lost my spine is basically rotting and my vertebrae are breaking and they say it's a failed back surgery I have a rod screws and bolts and had my back fused together I even had donor bone graph done as well. My tumor that is growing rather largely is inoperable and that was said by my neurosurgeon. My pain clinic doctor says it would be in my best interest to have the stimulator put in and if they cannot remove my tumor because it's inoperable why would I have them open me up to put something foreign in my body? All I'm trying to do is find something that can help my pain because the pain medications are being taken away. Us people as chronic pain patients it's not our fault that the people that want to get high off the medications for us to be turned away. So what do we do?
Cathy sounds like a great doc!! We need more docs like her! We need to reward doctors that take their time and do right by the patients and educate them! Education on health is so important!
Ever had the feeling of something blocking your airway? The next time you feel it, count how long you can go NOT clearing your throat. She’s clearing her throat bcuz she either really has to OR her BRAIN is telling her she has to- & there’s no difference in the sensation you feel in that moment. During the live, all of the ppl who joined the “anti throat clearing committee,” really only made it worse. She’s a Dr., not a Robot, so she’s not immune to feeling some jitters. Even good stress can cause hypersensitivity &/or nervous ticks. Some Ppl start tapping their foot, saying “umm,” or humming, others start to itch in a certain spot, blink repeatedly or they clear their throat. I think she did an amazing job. This isn’t a documentary or produced tv special, it’s live and unedited and she’s a Dr. not an actress or YT personality. I just feel bad that anyone, let alone ppl throughout the live AND in the comments would feel the need to complain or even point out what they perceive as a “flaw.” I don’t think everyone realizes that she likely has no control over it.
Chris Manzi P.s what do you mean “excusing THE ISSUE!” What is your “issue?” Are you “outraged” by a woman clearing her throat? If so, click away. You ASSume that I invested a great deal of time & effort, I did not. Please remember, your perspective is ALWAYS going to be limited to your own experience and ability; never will your perspective accurately reflect the character, quality or needs of another person- especially a stranger. 🦶 👄
By the time she gets done finding stuff wrong with ppl so she can disqualify everyone from getting the help and relief they need their will only be a hand full of ppl left and Everyone else will be left suffering . Never mind the lil oath she took .
As a food scientist, I've never heard or seen anyone operate on a "bliss point". Maybe in more abstract terms, we search for a way to make it most appealing to the 5 senses and then sometimes conduct preference testing. I've never seen a formula of trying to hit x amount of fat and x amount of salt to make a consumer addicted to our product. It's more of a free flow between culinary excellence vs functionality. If anything it's much easier to make a high fat, high sodium, high sugar product because everything is living up to its basic culinary functions. It's when we make things like low-fat sour cream where consumers want the same flavour, mouthfeel, consistency, acidity etc. that we have to get creative with gels and starches. We also have to make sour cream do things, it's original recipe didn't, like have the perfect cutable texture between gel and cream, proper smell, prevent excess whey syneresis, perfect off-white colouration etc. all while making sure every batch comes out the same despite the fact we're working with live cultures with their own degree of variance.
Great show. I believe we are living in the dark ages in regards to pain and it’s many mechanisms. The main issue is the effects of the food, water, heavy metals and air lead to inflammation. The inflammation progress over time. Now we have an issue of mast cell activation and substance p. After speaking with many physicians, none of them were able to give me any info on this. The bigger issue is : NO ONE WAS HONEST WITH THE PATIENTS WHEN PAIN MEDS WERE STARTED. The oxy movement created victims who have later become criminals in the eyes of Practioners. If the patient pain has been turned up as a result of the meds, WHY IS THE PATIENT TREATED LIKE THEY GOT THEMSELVES INTO THIS POSITION? Who really responsible for this opioid crisis? Because the patients are caught in the crossfire being labeled as malingerers because the amount of pain isn’t believed! Hyperalgesia, Neuropathic Pain, central sensitization and inflammation along side of damage to the sheath of the nerves are all a result of the dishonesty in the big pharma community. Yet we are treated like the ONLY ISSUE IS WETHER OR NOT WERE ADDICTED. The bigger issue is the blind eye turned to those who knew the results of these meds long term, yet didn’t adequately warn patients. The next bigger issue the governments control over physicians and patients as if they have medical knowledge to avoid mistakes. Then most insurance will Not pay for alternative treatments. So what are chronic pain patients supposed to do? This issue is a labyrinth. I have 50 pages of research and questions which no one has adequately explained !
25:00 we can prescribe Marinol which is THC in pill form and FDA approved. Used in cancer and Aids most commonly not in chronic non-cancerous pain in my area.
The opioid crisis has me educating my hospice pts that short-term, APPROPRIATE use of MSIR is not only necessary, but certainly not ADDICTIVE at end of life. The education is definitely working in much of the geriatric population. Education is key, for those willing to learn. 91 people a day are dying in the U.S. r/t the opioid crisis; more than the crack epidemic!
As someone who has taken methadone for 3 years straight (and for a 9 month period 6 months prior) pain management and opiod related topics are a topic i feel very strongly about. I consider my pain doctors some of the best. When I started seeing them 4 years ago (June 2013) we started with identifying what type of pain I had so we could choose what type of medications to start with. We were hoping it was neuropathic and inflammatory pain so we started with a super-motrin per say (meloxicam) and gabapentin,lyrica, cymbalta etc and notbing was working and by about 3 months (August/September 2013)in we realized I was having nocioceptive pain from the increasing number of dislocations per day due to my genetic condition and muscular spasms from my joints trying to keep everything somewhat what together or spasming after I dislocated something. So we started methadone and titrates up to 8mls twice a day and I felt it wasn't helping a ton and by March 2014 my pain doctor was getting scared by having me on it so long at my young age (14/15 at the time) and I felt it wasn't beneficial enough so we staryed titrating off and it was so bad. I didn't realize how much it was helping until it was gone and at my young I was expecting all my pain to be gone all the time. So I was in a fast decline and by October 2014 I was admitted to the hospital and hooked up to a diluadid pain pump which helped so much get my body over that hump. The thing they noticed was my body was in a pain crisis from the no joke over 150+ dislocations a day I experience and the chronically dislocated joints I have so at first I was pushing the button like crazy but once my pain was controlled I was pushing the button regularly but not too much. It translated to 2.5 mls of methadone (I do liquid for absorption purpose and so I can play with these odd doses) and in February 2015 I was still having elevated leg pain so we upped my base methadone to 3 mls twice a day, added in a mucle relaxant twice daily, and my pain doctor instead of adding another medication for breakthrough pain he trusts me so much he gives me a range of 3-5 mls twice a day and I give more when I need more and my base when my body was my baseline. I have never had to up my medication since this time even though I have been on it so long but when I miss a dose I feel it really bad. Methadone really needs to be used more in chronic pain management in which all other options have been exhausted. Methadone traditionally is used in drug addicts to wean them off heroin but it is used because it doesn't cause the same high symptoms that the short acting opiates like vicodin, percocet, loratab, oxcodne etc. In addition, methadone is long acting meaning it can be taken twice a day and work great all day. Versuses these short term acting opiates that need to be taken every 4-6 hours. Even though I have to take methadone twice a day every and I have for 3 years straight now. I have a life with a very low level of pain and I am living because I take methadone. My case though is very clear cut because 150+ times a day of dislocations and chronic dislocations it is very clear what needs to be done once the pain type is identified. My care though could be considered palliative or hospice like because my disease is progressive in nature and it could limit my life and definitely effects my daily life. I have never increased my medication by myself and every month I have methadone left over because because I am not maxing out my dose of medication every day or even more then maybe 3 days or so a month. I think this range has kept me from getting resistant to opiates because my body is getting a similar but slightly different dose every few days or sometimes daily (since I use liquid methadone I can alter my medication intake by .05 ml increments so if I am just little more pain I can take slightly more but not a ton in retrospect). I have never had any addictive tendencies and my doctors even though they don't absolutely love me being on methadone long term (neither do I) they and I love I have a life now outside my pain and my pain is now not keeping me in bed or crying from how bad my body hurts. I wish doctors would more effectively utilize opiates when they need to because doctors have become so scared of opiates and rightly so but they have their place in some cases for breakthrough meds or in my case overall control. I wish this culture around opiates would change if methadone was used more often the opiod addiction in terms of the high would drop because methaldne doesn't produce that high. Yes methadone is used for drug addicts but it is also a great opiates that can be really maximized in the pain world.
I wish I could find a doctor that would prescribe methadone for my chronic pain, I got a spinal infection ate the discs in my cervical spine had to get daily antibiotic infusions through a PIC line for 4 months and then had multi-level anterior and posterior instrumentation and fusion surgery of the cervical spine and because of all the nerve damage and all of the hardware in my neck I have chronic pain I was on Dilaudid when the infection started until my incisions healed and because I am an opiate addict they took me off of it and put me on buprenorphine which does absolutely nothing for pain but keeps my withdrawals at bay, The only way I can get methadone is to go to a methadone clinic and do daily dosing which is ridiculous because I do have a job and I've been trying to find a doctor that prescribes methadone for chronic pain in my area but in the 9 months I've been looking I have not succeeded in finding one.
@@angelabartlett5784 so now 5 years down the line for me I had to switch to another drug. I couldn’t find an adult doctor willing to prescribe either. I have a great pain clinic (the stigma and rules around methadone just make it impossible for them to prescribe) though and we have a regime that works phenomenal for me. I was never an opioid addict though so my situation is a bit different. I will also say the amount of methadone I was on was 3-5 mgs (I was prescribed the high end and took more when I needed more but always at least 3mgs or 3mls) 2x a day. A literally baby dose. They said they have babies in the NICU withdrawing more then I Got
Thank you for the couple minutes about CRPS! I reminded myself throughout this video when you were talking about opioids that you were talking about back pain, etc, and that it wasn't directed at the CRPS community, and then at the end you touched on CRPS and I was so thankful that you did so!
Magnesium is a natural stool softener and muscle relaxant. Stress depletes magnesium. Specifically, magnesium malate supports symptoms of fatique as it fuels the mitochondria of your cells. Any chronic condition benefits from supporting mitochondria (ie CoQ10 and magnesium and B vitamins). And magnesium helps sleep. Where's the discussion on sleep? Quality sleep is when our body repairs to help our entire system to repair - in the end- helping chronic pain.
A lot of the time I think people automatically not liking certain doctors even if they do everything right like Kathy, is really because past experiences with other doctors. I have had very negative experiences with doctors before, and if I see a new doc who's personality or something reminds me of a past doctor I do get hesitant but I think it's all about building trust on both ends.
Ok look it, I’m not on opiates, however, I’m a little offended because I am SINCERELY allergic to gabapentin, aspirin, NSAIDS, vicodine, ibuprophine, and unless im givens benzo along with it, morphine sends me into a severe panic attack. Not everyone lies about allergies
So grateful for you Dr. Kathy! It's truly a necessity to get chronic pain patients to adapt to the multimodal practice of pain management objectively. It's transformative. Learning to listen to your body far surpasses the limits of opioid medications. I think the best practice is to be able to have access to opiates as needed for flares/high pain days, but to also incorporate aspects from the mind/body complex: guided meditation, biofeedback, walking, yoga, tai chi, clean eating, herbal supplementation to address vitamin deficiencies, water hydration, swimming, aquatics for extreme joint pain/mobility issues, medical marijuana even, if it benefits the patient and can aid in tapering/replacing benzos/opioid doses. It's definitely a whole being process. 💞
My 16 year old presented in ER for abdominal pain. They ruled out emergent issues, said maybe a slow evolving appendix issue or possibly just constipated. Discharged her with a RX for, I SWEAR norco 7.5 and told her come back if her pain got worse. I was like, hell no. I had her drink the old nurses trick of warm prune juice with a patient of butter. She pooped for a full evening and never had the pain again.
wow learned so much about chronic pain and how to deal with! never knew why my brain feels on fire on my worst pain days when I'm barely conscious and have to go to the ER and the doc has to give me 8x the normal dose of dilaudid just to get the pain under control! thankfully that only happens every now and then.
Parker Stephan yep. nothing else worked and the doc had to get my pain under control cause my bp was so dangerously high also. hate those pain meds though.
Jen Saw no I haven't taken opiodes for several years and avoid them if at all possible. I believe it was give all at one time after the morphine didn't work. don't remember much from that night w. couldn't walk straight for 3 days after that.lol I have a neural stimulator in my head which blocks 70% of my normal pain which hovers around 3-6 on the pain scale depending on the day. without it my pain is around 9 or 10. just to give some context for that night.
What about pain patients who DON'T dr shop, don’t increase their meds and pass all the random pee tests ? Do you try to take them off pain meds and why ? Edit: my pain dr saved my life. I was going to end it all because of my untreated pain. Her generosity with increasing my meds (I was opiate naïve) until the pain meds worked, saved my life
Dilaudid, I remember, I received post-op for pain from brain surgery, and it is an effective pain medication, but, even though I didn’t continue to take opioids after I was discharged, I found myself craving them, and feeling just terrible while I was on them. The side effects are terrible, so, I switched to the more natural option of MEDICINAL marijuana, and the side effects from the opiates went away.
I used to take 5-7.5 mg oxycodone unprescribed recreationally. I first took it for a terrible flu. And whenever I couldn’t handle knee pain. But I enjoyed it so I took it for pleasure too. Looking back, I had a blast.. I would take 7.5-15 mg Ir oxycodone and go on a mountain bike ride for 20-40 miles and not feel tired! It was a tool that helped me get into great shape and stamina all while enjoying it a ton! No other medication works the same where I can be so active, let alone compelling me to excercise and enjoy life. To prescribers, oxycodone should be used before hydrocodone morphine etc of the patient has to work, take care of household/family, etc. It seems to provide better analgesia without the sedation that’s commonly seen with other medications.
Doctors and nurses seriously need to be able to have more time with their patients, surely I'd imagine the doctors and nurses would like that better because it's less stress on them and they can really be able to do a great job. What's causing this problem, is it a shortage of doctors and nurses?
Hospitals are chronically understaffed. It is about saving money. Insurance doesn’t want to pay for medical professionals to spend time with patients. It is pretty common for insurance companies to only pay for a doctor for a 15 minute visit. If the only problem is lack of trained professionals, government could offer free or low cost tuition or loan forgiveness to encourage people to go into the profession.
The tappering did not work for me. I have lupus and CRPS and my surgeon told me he could see through my spinal cord before the mrsa was found in my spinal fluid. I am crippled and suffering. I black out when I try to do anything and have moments when I lose my vision and hearing. I am starting to have a hard time walking. I taught myself to walk after being told I wouldn't be able to. I have been thrown in a mental hospital twice this year trying to get help. The last time was at Stanford.
I would LOVE to find a good pain doctor. Having pain is exhausting, having none treated pain is worse, being treated like a drug seeker heartbreaking. I have trigeminal neuralgia and the pain is, HOLY cow! (I have had babes with no drugs, and that was cake).
It's concerning to have a goal to decrease the opioids ahead of really understanding where your patients are. I have seen this drive patients to surgical interventions. That resulted in significantly poor outcomes. This individual in particular was a stable productive not altered. when the state's cracks down she was unable to get the medication she needed ended up with an interthecal pain management device got infected etc. Poor lady should have just got her meds she'd still be functioning. I've also seen residents blow out people's kidneys giving them tordol because they're afraid to write for opioids. It's concerning she doesn't come off as very experienced further a lot of times increasing pain medications which required to actually get active. It's clear that she really cares. So that's a good start but it's also clear that she has a lot to learn
My dentist wouldn’t give me any pain pills after having major dental work, lots of pain. Gave me Tylenol 3. It didn’t touch the pain. He said he didn’t want me to become addicted. It took me 2 hours to find oxycodone, dilaudid injections and pretty much anything else, from friends. I do not have a prescription history. Just dental work the past couple years. So just remember that, doctors. If you don’t help us alleviate our pain, we will find it elsewhere.
I have to protest about the mother who refused to give her daughter pain pills after oral surgery. First of all, any time the bone has to be removed or reshaped, the pain is very real. The Exodontist knows exactly what s/he did to get that tooth out of there. The mother did not. Second, there is a complication of tooth extractions called 'dry socket' where the clot at the base of the extraction site is lost, leaving the bone exposed. It is excruciatingly painful. It happened to me when I had my third molars surgically removed. It is how I learned that pain above 8.5 will make you break out in a sweat and that it takes up to thirty minutes for pain medication to take effect. Doctors know that pain is best controlled if you keep out ahead of it. There is honestly no virtue in gritting your teeth against agony if you can help it. Any time I have had left over pain pills I saved them for occasions when I actually felt pain. I have eked a generous Rx out for several years.
That’s because she’s a doctor already. They aren’t going to ask doctors about possible addiction when they are patients. I feel the opiates screening should apply to everyone
I wonder how many are like me - they need a Vicodin or Percocet once in a while, maybe once per week, but not all day every day. I also will break a Vicodin in half on occasion. I get a pretty big prescription, I think 90, but it last for a really long time, at least a year. So does a doctor take it away? Or does the doctor give more? I had an emergent pain issue, from a worsening orthopedic condition, and I told them, I don't need anything, I got all I need. The key thing is that I had to rest! And that's not available in a pill. FWIW, I cannot take oral NSAID's due to severe ulcers, esophageal, stomach, and duodenal. I have tried topical NSAIDs with mixed results, but it's only on label for the knee. I have had success with wearable ultrasound, but it takes commitment to use it. Also, I can't exercise due to neuromuscular disease - I get really bad DOMS. As for legalized weed, I'm all for it IF and ONLY IF smoked forms of weed are illegal. Edibles, fine, eat all you want. But people like myself with pulmonary issues should not be exposed to people who smoke pot. Really, anyone with many plant allergies should not be subject to it. I am actually allergic to pot smoke and tobacco smoke, and am very happy about banning smoking. Let's not even get into that if medical marijuana is allowed, is the FDA regulating it as any other prescription drug? If not, WHY NOT! Steroid injections - one worked fine, one sent me on the floor writhing. Oral steroids work some, but doctors are WAY more afraid of steroids long-term than opioids long-term (go figure). Opioids are the #1 reason that I can work and pay taxes. Without them, I would be bedridden and on permanent disability.
I'm an ER nurse. I'll get people in who say they can only take the D medicine. I'll suggest docusate. 1g IV acetaminophen has the same analgesic effect as morphine.
You are wrong. Acetaminophen can be dangerous too. I have CRPS and when I meet people who feel this way I don't understand why they don't choose to do something else for a living.
heidi foss there are dozens throughout the US and canada but the lack of education for most doctors, even in states with mmj, is severely lacking. Cannabis can be used for legitimate medical purposes, most people using it are using it for a reason and its NOT to get high. Same as chronic pain patients who use opiods or other pain meds.
Pentiuman...your message is exactly what they need to " hear AND UNDERSTAND" I've been telling Doctors this for 30yrs. I'm chronic pain person too. Here we are in 2024 and same thing now..they use the "heroin" logic to treat us. So they start out treating a junkie...not a PM person.
I had 22 aporations on my leg almost loos it had doctor save it ,however have conic pain where cant even sleep. i am seeing a pain management, have had different med now he has prescribe this med hydromorphone hcl 2 mg dont know what to do any more...
I was always taught pain is a vital sign, it's what the patient says, treat it as they say it and to remember that I'm not a rehabilitation nurse. I'm really torn with this. ( baby nurse)
Stacey W ER Nurse here. You're right with the pain being the 5th vital sign... and in practice you'll see under medicating... over medicating... and "I want to be medicated" scenarios. My advice...as a nurse.. is to always be the patient advocate. If I have a patient stating they have severe pain... and they might not "look" like they are in pain... Ill still notify my provider... medicate them as appropriate or prescribed... because as much as someone would like to believe they have a great bullsh*t meter... Ive been surprised many times with there being an acute diagnosis which can be painful. I can honestly say...in my expierence... the patients who are genuinely ill and have pain outnumber the seekers. Some people manage thier pain better than others... sometimes the yelling writhing patient gets all the attention (squeaky wheel gets the grease)... and the silent sufferer won't tell you thier pain level unless you ask them. Advocate. Keep your patients safe. And good luck to your career.
Deanna L yea, thank you! It's just disheartening when patient refuses the alternative complains pain is 6 and caused by inflammation I get them tylenol and the practically through it in my face because "they want the good stuff" I don't go to the nuclear option immediately esp with my renal pts.
What's better for severe pain Oral Demerol or Oral Dilaudid. I have been on Norco 10mg Q 4-6hrs for years and now with the new laws My doctor can't write enough medication in a month so I need something stronger and last longer.
Enduring activity will be available April 11 or 12 at www.physiciansweekly.com/cme-corner/. It'll be available for a year and provides 1 credit to MDs, PAs, NPs, RNs, and LPNs
CRPS can happen from nerve injury from a bug bite from surgery from a broken bone or start on own. It also can be fullbody and spread. So what do you do for someone like me who is treated like shit by doctors cause I’m 32 and tattooed and I have 40 diagnoses including 7 very rare ones and 4 of those rare ones in brain. I have CRPS, fibro, bilateral trigeminal neuralgia, neuropathy, pseudo tumor cerebri, myelopathy, Chiari malformation and addisons just to name some. Yet cause I’m young and tattooed I’m treated like shit and not helped or I’m on opioids and other meds 20 meds I’m on and they don’t help. I’ve had hundreds of painful procedures and dozen surgeries. I’ve been on same dose opioids for over a year and in the year I’ve gotten worse. I’m also bedridden 24/7 for 3yrs AND I HAVE NO LIFE can’t bathe. Can’t sit up. Need a bedpan and commode. All day I cry in bed in dark cause lights and sounds make things worse. But cause I’m young nope won’t do anything to change your medscause your young. So someone who is young and should have functionality can’t get help cause they r young. But if I’m 80 and lived a full life than getmeds to help ya be functional makes no sense. I’ve lost 6yrs total of life and missing my sons life who is a teen. I have a total of 20 conditions thT cause severe pain. CRPS alone on McGill Pain index is more painful than natural childbirth and cancer pains that may not be end stage. Chronic and rare diseases affect more than cancer and aids combined yet we are ignored and judged and treated like shit I’ve seen about 100 doctors at 3 major universities in Illinois. So what does someone like me do and others like me?! I even get scared to use my meds due to being treated like shit my medical community even to point I’d rather die than go to ER.
Great show I enjoyed it. I am a chronic pain suffer that went cold turkey off 100 mg fental patches I feel better but now I am in pain daily an I can’t walk now so I don’t know what to do next? Help me
As a methadone patient SWIM wants to let you doctors know that A) methadone has zero euphoria, sedation, or high. Unless you’re not tolerant Maybe. B) methadone is way better than being unstable and addicted to street drugs or unprescribed medication. C) that a methadone patient who gets injured actually requires more pain medication than average. At the methadone clinic SWIM do used to go to, The doctor said that if you ever end up in the hospital and get them at the needed pain medication, if the nurses don’t give you enough or act like methadone is already sufficient for pain, you call though Clinic and the doctor will personally come write you a sufficient medication, because he knows that a methadone patient will be highly tolerant. Like a “Vicodin is like a jollyrancher” to SWIM, the doctor once said.
I've tried weed, I know it had more THC than CBD, but weed in some people (especially those who already have anxiety) it causes anxiety and I know that was true for me and I've heard other people say that it was true for them as well. I will never try weed again for any reason, it feels like I'm dying when I'm taking it, it's not fun, I may not be in any real danger but it's terrifying.
Man I wish canada was like America. We r suffering a huge moral ban on opioids. People with actual Chronic pain are struggling to be taken seriously at all. I'm not one of them but it's been in the news a lot.
ZDOGG should put my PAIN MANAGMENT Doctor. He is out of LONG BEACH,.CA and he would SCHOOL EVERYONE IN THIS MATTER!!!! I MEAN SCHOOL!!! UUUGGGHHHMMMM! UGGHHHMMMM!
AWESOME presentation!! What a breath of Fresh Air! Please tell me at least one of you have a practice in WI? I have worked in Pain management/ Internal Med., etc. I want to work with you!!
Unless youre paralyzed from birth, how could you go your whole life without exercising? I mean what are we defining as exercise? Does playing sports count? Does walking for 30+ minutes count? Or is it only structured exercise in a gym that's counted? But that makes no sense because exercise is exercise regardless of how structured it is and where its done.
Opiates suck for me. I get horrible side effects but the pain doesn't respond so I'm still in pain but with all the nausea and balance issues. Plus my spo2 goes into the low 80s..... NSAIDs are much better. If naproxen doesn't work call an anesthesiologist.....
Good lord, I was in for stone stuck in my bile duct, I’m allergic to morphine so they gave me dilaudid, worked for the severe abdominal pain a bit but makes you throw up your shoes. NO THANK YOU JUST HIT ME WITH A 2x4 and knock me out.
The problem is prescribers only know how to prescribe. They write meds but once a patient has gotten to the point of getting off there is no help. Doctors don’t even bother using the cdc guidelines for lowering at least than 10% in any given week rather than cutting them off cold turkey. This is when people turn to street drugs because not only is the physical sickness being awful the mental side of it makes you almost suicidal between the lack of sleep and the sweating/freezing , heart racing , diarrhea, vomiting, hallucinations and possible heat attack. There has to be a program put in place for people who get freak injuries. Chronic pain is a whole new bag of worms. If you are going to have the ability to prescribe opiates then I think the doctors should have to take a dosage increasing every week and then have to stop cold turkey so that understand what it’s like for chronic pain patient’s.
I remember my uncle went in for surgery to fix his shoulder (he overuses it due to his job and his ligaments had become very weak and snapped due to overuse and they gave him pain medication for the after the surgery and he also took none, he actually said he wasn't even in any pain, which I found surprising.
My “pain doc” (doesn’t) think it’s adorable when the pharmacy wants to play “doctor” He will literally call them out !! But yes, all of it is a bit aggravating.,
Just because someone smokes doesn’t mean they will be addicted to pain meds. My husband has never been addicted in fact he takes as little as he can. Try to exercise when your in extreme pain. Most chronic pain patients know what works for them. I feel that it is best if pain clinics had a group of drs, counseling, chiropractic, counseling and PT then patients could be lower on meds if all of these worked together! The only way I can live is taking opioids. She is very knowledgeable unlike some of the bs that you said in the last video!
Another interesting thing pain management doctors could use in their arsenal to manage chronic severe pain is the pain blocking effects of adrenaline. Like during A basketball game, of player hurts their ankle but has a strong drive and motivation to finish causing them to not notice pain in the foot until the game is over and their adrenaline comes down, and all the pain hits them like a train. This can be seen with stimulant drugs like caffeine, cocaine, and amphetamines that release dopamine and norepinephrine (adrenaline). While they don’t block pain, they distract the person from pain. From an evolutionary standpoint this makes perfect sense. If I am in the grass plains of Africa, And I sprained my ankle it will hurt. Until you have a tiger coming toward you, where you will have The fight or flight response allows you to run away distracting from pain inhibiting you. So it could be very successful if doctors used a traditional opiate , in conjunction with acetaminophen, NSAIDs, and some Stimulant-like medication (cymbalta). Prescribing something like amphetamines or methylphenidate could possibly help certain patients but stigma likely hinders their use.
Chronic pain people r being forgotten, neglected and tortured. PCPs are refusing to write any scrips for pain meds which include ultram. Recently I saw a patient that had surgery on his upper thigh. He had a very large abscess which was removed.He was discharged from the hospital with an orange size open wound in his upper thigh. He was discharged from hospital with absolutely no pain medicine. Gentlemen, does not have a drug or alcohol issue.. Myself I’m a cancer 2 x Different cancers. Breast cancer and advanced stage III cervical cancer.This happened to me when I was in my 20s where I had modified radical surgery and radiation. I recently took a fall and broke my hip and have a nice Dramatic spiral fraction of my femur. My femur was almost fx in half in length . No pain management. I had to stop my PT therapies it was too painful. We now have a person that was very active, working which is now An invalid, confined to the house. Has a very poor quality of life. Which will continue to go downhill . Yes that’s right I cannot take nacids has Severe gerd at night time I aspirate on stomach contends. Barrett’s esophagus, and a host of G.I. issues which is not my fault. Don’t tell me that my pain is in my head. We will see the suicide/murder rate to raise. The sale of street drugs like heroin laced with fentanyl . Will increase. the fentanyl comes from China isn’t that a scary thought. I well die in pain all because of this so-called opioid epidemic.
Hi Kathy! My Sis is in Physical Rehab. in L.V. She was a personal trainer.
2:20 "Chronic pain patients wondering how the hell do we get care when it seems like doctors are now abandoning us as the pendulum shifts?" Exactly. Too bad there's no test to show the amount of pain one is in, to distinguish need from abuse (I think that's what I'm saying). I'm in chronic pain and have never been addicted to or abused Rx drugs, yet I feel my access to appropriate meds is being unfairly regulated, and (except perhaps for med marijuana), getting tighter. I don't want to be addicted to anything, and I don't want to O.D., but living in chronic pain is not living - it can be just as bad as the other extremes. Thanks dr.s!!!
💯
Amen!
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Dr. Travnicek was articulate, informative, and funny. Please bring her back! I'd also love to see that episode discussing medical marijuana.
We must stop paying doctors based on "patient satisfaction". In order for them to treat us properly and thoroughly we have to give them *MORE TIME* to get to know us, and our medical history, and our needs.
Wow as a chronic pain Pt. This was so helpful. I have M.S. and as much as I've studied this illness, I had no idea how painful it was going to become. I worked in the hospital for years and naively, I had no concept of how debilitating chronic pain was. Great show, very informative, sympathetic, as well as encouraging. Well done
I've had CRPS since March of 2010-. You should be ashamed the way you addressed pain as well as how you conducted yourselves. As far as your guest there is no way as a person with one of the worse chronic pain disorders I would never see her. Wow guys is that the best you can do. Meghan how are you doing?
@@RussEastburn Did you hear them talk specifically about CRPS at around the 50 minute mark? PS - Sorry to hear you live with the beast. I was diagnosed in March 2008 with CRPS.
Here's some woo woo: look up Terry Wahls
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It is so frustrating when people think im drug seeking, i have been in pain since i was a small child, i would cry and cry over how much pain i was in and adults said it was growing pains. Well almost 30 now pretty sure its not growing pains, just has progressively worsened, by the time i was a legal adult i started having mobility issues (was 6 feet tall 120 pounds for all those who will blame it on being fat) and was just locking up in pain and eventually my world got smaller and smaller until i couldn't keep up with work or friends. I have full body pain constantly and have spent the past 10 years researching everything, trying every natural thing and supplement, i've repeatedly done cognitive behavioral therapy, mindfulness and meditation, nutrition courses, gentle exercise class, breathing exercises to calm nervous system, every attempt at neuroplasticity, completely changed my diet, removed anything inflammatory, i have tried countless non-narcotic drugs, including the antidepressants drs seem to think will help pain, nerve blockers, etc.. tried chiropractor, acupuncture, trigger point injections, massage, EVERYTHING! Now tell me, would a drug addict spend 10 years taking courses to prove they are in pain or would they just buy drugs on the street? Honestly if it weren't for the whole fentanyl crisis i would just buy opiates on the street for legitimate use. but finally after a full decade of jumping through hoops my doctor gives me one T3 a week. I understand the potential for addiction and physical dependance and how opiates are problematic with chronic conditions but i think it's fair to at least have the option of pain relief 2 or 3 days a week. Hoping to work towards that trust. They are the only thing i have found to help! and no i don't expect to be pain free i expect to go from pain that is excruciating to pain that is simply extremely uncomfortable. I think for the amount of work i have put in i have pretty reasonable expectations. Really wish doctors would stop looking at me and deciding because i am young and i don't have broken bones sticking out of my skin that they can't comprehend how much i suffer every day and night of my life. Pain relief makes the difference between whether or not life is worth living. I would never abuse opiates because even when i'm in pain i don't want to "waste" them because eventually i know i will be in even worse pain and wish i saved up my one pill.. This is probably to long for anyone to bother reading, but real pain patients are suffering because doctors won't prescribe opiates.
I agree 100%
I agree
I pray that that doctor puts him or herself in your shoes and asks would they themselves want to suffer as they have made you to do so. God bless you, as a chronic pain patient myself for the past 14 years I understand, but thankfully I was turned over to a pain management clinic and they showed me "MERCY" and are true angels. They are not perfect but they know their job and I am truly grateful to my doctors and hospital doctors and specialists. I pray things get a whole lot better for you! God bless and keep you.
having worked as an moa in a pain clinic prior to getting my CNA and then LPN I really appreciate seeing this done from this perspective. Both of you were radiating compassion and caring with a wealth of knowledge and that great gallows humor I have come to expect from zdogg and Tom.
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I was told there would be dilaudid.
That’s it I’m out!
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The Dilaudid was a lie.
so ive been "helped" off opioids for my pain for five years now... i dont feel better, i feel worse, without the meds i cant move, the less i move the more i hurt the more i hurt the less i move, and when i try to push through it the pain is so bad i rock and cry. Good job pain management people.
My "doctor"s idea of a taper was "you took a tramadol after you told me you were in unrelieved pain, GOODBYE" from 100mcg/hour fentanyl that HE PUT ME ON without even knowing what was wrong with me (poly arthritis, carpal tunnel and chronic migraines thank you very much, all but the migraines easily medically proven) to NOTHING instantly.
Yes, there are actually people with severe chronic pain (me for one). I've had 7 surgeries (3 were back surgeries), and I'm in chronic pain. Without some type of pain medication, I can't even move. I've quit all pain killers several times for an extended period (weeks to months), and I was in horrible pain. For some people, they need some type of help with their pain so they can exercise (or just stand and walk). It's a shame that everyone that takes pain medication is lumped in the same pile.
You bring up a legitimate issue, Summer. Have you tried seeing a doctor for Buprenorphine as pain treatment, or receiving joint injections? That might be an alternative. Best wishes to you.
I feel the same..fucking sux others make it hard for others😠
And the thing is anyone In healthcare should know the things your body goes through when you're in pain..smh
I'm an OB RN and I loved Kathy. And Z, you're super smart. My hospital isn't dialing back pain meds at all. They're all about satisfaction.
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My mother had intense surgeries that actually made her pain worse in the long run. Opiates were a godsend for her and our family’s wellbeing. She literally might have killed herself if she had to live in the pain she was in. She never said anything like this but I know that she was in so much pain that life was miserable without treatment.
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Student Nurse here, love your vids man. It's good to learn about health and medicine in a funny, approachable way
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I'm a phlebotomist in a hospital, and often drawing patients in the ED. We had a poor lady one day, she was older, but had chronic pain issues. (I don't know her condition) but her provider was prescribing her a minimal amount of pain meds. Since it really wasn't enough to get her in a comfortable place where she could get through her day, she was self medicating with extremely high doses of Advil. When she came to the ER, she was so extremely sick, was suffering kidney failure and liver failure. Would she have been better off with an appropriate daily dose of an opioid? And perhaps an anti inflammatory? I felt so sorry for her, all because her doctor wouldn't recognize her pain and treat her appropriately, or was he scared to treat her appropriately? I'm not a dr, but I too have pain issues (Osteo and rheumatoid arthritis) and my dr has been treating me for 15+ years with said meds. I can't run a marathon, but I am functional and my organs are fine. This is a great discussion, by the way-I'm so happy a nurse friend posted you on FB🙂
Sue Chesley I
Doctors do not seem to be educated about the death rates caused by long term use of NSAIDS and Tylenol, or maybe they simply don't care. Chronic pain patients are "complicated" (many docs will say) and really just do not want the extra burdens, and there are many extra burdens involved to take on a chronic pain patient.
ruclips.net/p/PLYuXoJ1HRCth87Q-p2rOUVCp5GxLOkUYz
The elderly are highly disproportionately either under or overmedicated. It's really sad.
Really good point! My sister who has chronic back and neck pain was continually prescribed strong NSAIDs even with GERD, gastritis and stomach upsets . Just take it with food and water just keep taking it!!! All different ones . I guess no one cares about her stomach or kidneys
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Had a family member dependent on opioids, years through several docs that never communicated. Not entirely her fault. Her care giver couldn’t go to every appointment. It wasn’t until she was admitted to the hospital that she got 1 team that communicated and made decisions together that they were able to take her meds way down. She was on so many medications, none of the docs would take responsibility despite prescribing meds that counteracted each other and were just making her more addicted. Thank you for having this conversation. It made me so leery of docs and the prescribing of any pain meds, I don’t even like ibuprofen
She exercises motivational interviewing and SMART goals. I love her.
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I wish all of your videos were Captioned. Even just the auto captioning. Your viewers with hearing loss and various learning disabilities and other reasons to require captions would certainly appreciate the access they provide to your content!
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Hi I'm a chronic pain patient have been for a long time. I have lupus, degenerative disc disease, rheumatoid arthritis, osteoporosis, mild scoliosis, fibromyalgia, osteoarthritis, PTSD, anxiety, and really bad migraines, muscle spasms, a tumor that has been growing out of my spinal canal for quite some time that has now grown longer down my back that started above the area where your bra strap would be and has wrapped around muscles and ligaments. I also have neuropathy. I've been in several car wrecks as a passenger, I also fell 8ft from a swing from in the air and landed face-first into wood chips. I've had two different concussions, one that lasted for 9 months and one that lasted for a total of 6 months. I go to a pain management clinic and I've done steroid injections, cauterization of nerves, epidural injections, and migraine injections. I have been on Dilaudid for the past 5 years because my pain is so great, but because the people that do not get prescribed these pain medications that use them to get high have now cause the ones that need these to be able to get through the day and I have some type of ease from the pain now are being taken away. I have asked my family doctor what he thought about medical marijuana and I've asked my Pain Clinic Doctor what he thought about medical marijuana and they both have said they do not condone in it. I have researched everything into all of this I have family that are in the medical field and said that being an opioid user would be in my best interest to use medical marijuana. I had back surgery in 2013. I had three discs taken out, the fluid sacs between the vertebrae I have lost my spine is basically rotting and my vertebrae are breaking and they say it's a failed back surgery I have a rod screws and bolts and had my back fused together I even had donor bone graph done as well. My tumor that is growing rather largely is inoperable and that was said by my neurosurgeon. My pain clinic doctor says it would be in my best interest to have the stimulator put in and if they cannot remove my tumor because it's inoperable why would I have them open me up to put something foreign in my body? All I'm trying to do is find something that can help my pain because the pain medications are being taken away. Us people as chronic pain patients it's not our fault that the people that want to get high off the medications for us to be turned away. So what do we do?
Poppy tea.
Dr. Travnicek is an EXCELLENT co-host! Bring her back!
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Cathy sounds like a great doc!! We need more docs like her! We need to reward doctors that take their time and do right by the patients and educate them! Education on health is so important!
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She always clears her throat. Did it in most recent interview too.
Ever had the feeling of something blocking your airway? The next time you feel it, count how long you can go NOT clearing your throat.
She’s clearing her throat bcuz she either really has to OR her BRAIN is telling her she has to- & there’s no difference in the sensation you feel in that moment. During the live, all of the ppl who joined the “anti throat clearing committee,” really only made it worse.
She’s a Dr., not a Robot, so she’s not immune to feeling some jitters. Even good stress can cause hypersensitivity &/or nervous ticks. Some Ppl start tapping their foot, saying “umm,” or humming, others start to itch in a certain spot, blink repeatedly or they clear their throat.
I think she did an amazing job. This isn’t a documentary or produced tv special, it’s live and unedited and she’s a Dr. not an actress or YT personality.
I just feel bad that anyone, let alone ppl throughout the live AND in the comments would feel the need to complain or even point out what they perceive as a “flaw.” I don’t think everyone realizes that she likely has no control over it.
Chris Manzi Lol, I’m a writer.
Chris Manzi P.s what do you mean “excusing THE ISSUE!”
What is your “issue?”
Are you “outraged” by a woman clearing her throat? If so, click away. You ASSume that I invested a great deal of time & effort, I did not.
Please remember, your perspective is ALWAYS going to be limited to your own experience and ability; never will your perspective accurately reflect the character, quality or needs of another person- especially a stranger.
🦶 👄
I only recently came across this, but I wanted to say it was a great episode and I really appreciate Kathy!
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By the time she gets done finding stuff wrong with ppl so she can disqualify everyone from getting the help and relief they need their will only be a hand full of ppl left and Everyone else will be left suffering . Never mind the lil oath she took .
As a food scientist, I've never heard or seen anyone operate on a "bliss point". Maybe in more abstract terms, we search for a way to make it most appealing to the 5 senses and then sometimes conduct preference testing. I've never seen a formula of trying to hit x amount of fat and x amount of salt to make a consumer addicted to our product. It's more of a free flow between culinary excellence vs functionality. If anything it's much easier to make a high fat, high sodium, high sugar product because everything is living up to its basic culinary functions.
It's when we make things like low-fat sour cream where consumers want the same flavour, mouthfeel, consistency, acidity etc. that we have to get creative with gels and starches. We also have to make sour cream do things, it's original recipe didn't, like have the perfect cutable texture between gel and cream, proper smell, prevent excess whey syneresis, perfect off-white colouration etc. all while making sure every batch comes out the same despite the fact we're working with live cultures with their own degree of variance.
High fat is more satiating, but high sugar and starch is less
Great show. I believe we are living in the dark ages in regards to pain and it’s many mechanisms. The main issue is the effects of the food, water, heavy metals and air lead to inflammation. The inflammation progress over time. Now we have an issue of mast cell activation and substance p. After speaking with many physicians, none of them were able to give me any info on this. The bigger issue is : NO ONE WAS HONEST WITH THE PATIENTS WHEN PAIN MEDS WERE STARTED. The oxy movement created victims who have later become criminals in the eyes of Practioners. If the patient pain has been turned up as a result of the meds, WHY IS THE PATIENT TREATED LIKE THEY GOT THEMSELVES INTO THIS POSITION? Who really responsible for this opioid crisis? Because the patients are caught in the crossfire being labeled as malingerers because the amount of pain isn’t believed! Hyperalgesia, Neuropathic Pain, central sensitization and inflammation along side of damage to the sheath of the nerves are all a result of the dishonesty in the big pharma community. Yet we are treated like the ONLY ISSUE IS WETHER OR NOT WERE ADDICTED. The bigger issue is the blind eye turned to those who knew the results of these meds long term, yet didn’t adequately warn patients. The next bigger issue the governments control over physicians and patients as if they have medical knowledge to avoid mistakes. Then most insurance will Not pay for alternative treatments. So what are chronic pain patients supposed to do? This issue is a labyrinth. I have 50 pages of research and questions which no one has adequately explained !
ruclips.net/p/PLYuXoJ1HRCth87Q-p2rOUVCp5GxLOkUYz
Hyperalgesia is a genetic disorder called p450 disorder zdog
Let me correct that. P450 variant disorder which is a genetic disorder
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Knowledge that will assist me at work from cool, down-to-Earth doctors? What could be better?!
25:00 we can prescribe Marinol which is THC in pill form and FDA approved. Used in cancer and Aids most commonly not in chronic non-cancerous pain in my area.
I have seen Marinol ordered more for increasing appetite than for pain relief.
The opioid crisis has me educating my hospice pts that short-term, APPROPRIATE use of MSIR is not only necessary, but certainly not ADDICTIVE at end of life. The education is definitely working in much of the geriatric population. Education is key, for those willing to learn. 91 people a day are dying in the U.S. r/t the opioid crisis; more than the crack epidemic!
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I'm not a doctor but I still learn so much from watching these videos.
As someone who has taken methadone for 3 years straight (and for a 9 month period 6 months prior) pain management and opiod related topics are a topic i feel very strongly about. I consider my pain doctors some of the best. When I started seeing them 4 years ago (June 2013) we started with identifying what type of pain I had so we could choose what type of medications to start with. We were hoping it was neuropathic and inflammatory pain so we started with a super-motrin per say (meloxicam) and gabapentin,lyrica, cymbalta etc and notbing was working and by about 3 months (August/September 2013)in we realized I was having nocioceptive pain from the increasing number of dislocations per day due to my genetic condition and muscular spasms from my joints trying to keep everything somewhat what together or spasming after I dislocated something. So we started methadone and titrates up to 8mls twice a day and I felt it wasn't helping a ton and by March 2014 my pain doctor was getting scared by having me on it so long at my young age (14/15 at the time) and I felt it wasn't beneficial enough so we staryed titrating off and it was so bad. I didn't realize how much it was helping until it was gone and at my young I was expecting all my pain to be gone all the time. So I was in a fast decline and by October 2014 I was admitted to the hospital and hooked up to a diluadid pain pump which helped so much get my body over that hump. The thing they noticed was my body was in a pain crisis from the no joke over 150+ dislocations a day I experience and the chronically dislocated joints I have so at first I was pushing the button like crazy but once my pain was controlled I was pushing the button regularly but not too much. It translated to 2.5 mls of methadone (I do liquid for absorption purpose and so I can play with these odd doses) and in February 2015 I was still having elevated leg pain so we upped my base methadone to 3 mls twice a day, added in a mucle relaxant twice daily, and my pain doctor instead of adding another medication for breakthrough pain he trusts me so much he gives me a range of 3-5 mls twice a day and I give more when I need more and my base when my body was my baseline. I have never had to up my medication since this time even though I have been on it so long but when I miss a dose I feel it really bad. Methadone really needs to be used more in chronic pain management in which all other options have been exhausted. Methadone traditionally is used in drug addicts to wean them off heroin but it is used because it doesn't cause the same high symptoms that the short acting opiates like vicodin, percocet, loratab, oxcodne etc. In addition, methadone is long acting meaning it can be taken twice a day and work great all day. Versuses these short term acting opiates that need to be taken every 4-6 hours. Even though I have to take methadone twice a day every and I have for 3 years straight now. I have a life with a very low level of pain and I am living because I take methadone. My case though is very clear cut because 150+ times a day of dislocations and chronic dislocations it is very clear what needs to be done once the pain type is identified. My care though could be considered palliative or hospice like because my disease is progressive in nature and it could limit my life and definitely effects my daily life. I have never increased my medication by myself and every month I have methadone left over because because I am not maxing out my dose of medication every day or even more then maybe 3 days or so a month. I think this range has kept me from getting resistant to opiates because my body is getting a similar but slightly different dose every few days or sometimes daily (since I use liquid methadone I can alter my medication intake by .05 ml increments so if I am just little more pain I can take slightly more but not a ton in retrospect). I have never had any addictive tendencies and my doctors even though they don't absolutely love me being on methadone long term (neither do I) they and I love I have a life now outside my pain and my pain is now not keeping me in bed or crying from how bad my body hurts. I wish doctors would more effectively utilize opiates when they need to because doctors have become so scared of opiates and rightly so but they have their place in some cases for breakthrough meds or in my case overall control. I wish this culture around opiates would change if methadone was used more often the opiod addiction in terms of the high would drop because methaldne doesn't produce that high. Yes methadone is used for drug addicts but it is also a great opiates that can be really maximized in the pain world.
I hope you never have to come off of methadone. It's no joke. Even if you wean down.
I wish I could find a doctor that would prescribe methadone for my chronic pain, I got a spinal infection ate the discs in my cervical spine had to get daily antibiotic infusions through a PIC line for 4 months and then had multi-level anterior and posterior instrumentation and fusion surgery of the cervical spine and because of all the nerve damage and all of the hardware in my neck I have chronic pain I was on Dilaudid when the infection started until my incisions healed and because I am an opiate addict they took me off of it and put me on buprenorphine which does absolutely nothing for pain but keeps my withdrawals at bay, The only way I can get methadone is to go to a methadone clinic and do daily dosing which is ridiculous because I do have a job and I've been trying to find a doctor that prescribes methadone for chronic pain in my area but in the 9 months I've been looking I have not succeeded in finding one.
@@angelabartlett5784 so now 5 years down the line for me I had to switch to another drug. I couldn’t find an adult doctor willing to prescribe either. I have a great pain clinic (the stigma and rules around methadone just make it impossible for them to prescribe) though and we have a regime that works phenomenal for me. I was never an opioid addict though so my situation is a bit different. I will also say the amount of methadone I was on was 3-5 mgs (I was prescribed the high end and took more when I needed more but always at least 3mgs or 3mls) 2x a day. A literally baby dose. They said they have babies in the NICU withdrawing more then I Got
Thank you for the couple minutes about CRPS! I reminded myself throughout this video when you were talking about opioids that you were talking about back pain, etc, and that it wasn't directed at the CRPS community, and then at the end you touched on CRPS and I was so thankful that you did so!
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Magnesium is a natural stool softener and muscle relaxant. Stress depletes magnesium. Specifically, magnesium malate supports symptoms of fatique as it fuels the mitochondria of your cells. Any chronic condition benefits from supporting mitochondria (ie CoQ10 and magnesium and B vitamins). And magnesium helps sleep. Where's the discussion on sleep? Quality sleep is when our body repairs to help our entire system to repair - in the end- helping chronic pain.
A lot of the time I think people automatically not liking certain doctors even if they do everything right like Kathy, is really because past experiences with other doctors. I have had very negative experiences with doctors before, and if I see a new doc who's personality or something reminds me of a past doctor I do get hesitant but I think it's all about building trust on both ends.
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Ok look it, I’m not on opiates, however, I’m a little offended because I am SINCERELY allergic to gabapentin, aspirin, NSAIDS, vicodine, ibuprophine, and unless im givens benzo along with it, morphine sends me into a severe panic attack. Not everyone lies about allergies
So grateful for you Dr. Kathy! It's truly a necessity to get chronic pain patients to adapt to the multimodal practice of pain management objectively. It's transformative. Learning to listen to your body far surpasses the limits of opioid medications. I think the best practice is to be able to have access to opiates as needed for flares/high pain days, but to also incorporate aspects from the mind/body complex: guided meditation, biofeedback, walking, yoga, tai chi, clean eating, herbal supplementation to address vitamin deficiencies, water hydration, swimming, aquatics for extreme joint pain/mobility issues, medical marijuana even, if it benefits the patient and can aid in tapering/replacing benzos/opioid doses. It's definitely a whole being process. 💞
"Pain Week" in Las Vegas... there's an S&M joke in there somewhere, lol!
My 16 year old presented in ER for abdominal pain. They ruled out emergent issues, said maybe a slow evolving appendix issue or possibly just constipated. Discharged her with a RX for, I SWEAR norco 7.5 and told her come back if her pain got worse. I was like, hell no. I had her drink the old nurses trick of warm prune juice with a patient of butter. She pooped for a full evening and never had the pain again.
wow learned so much about chronic pain and how to deal with! never knew why my brain feels on fire on my worst pain days when I'm barely conscious and have to go to the ER and the doc has to give me 8x the normal dose of dilaudid just to get the pain under control! thankfully that only happens every now and then.
an er Dr gave you 16mg of dilaudid?
Parker Stephan yep. nothing else worked and the doc had to get my pain under control cause my bp was so dangerously high also. hate those pain meds though.
Jen Saw no I haven't taken opiodes for several years and avoid them if at all possible. I believe it was give all at one time after the morphine didn't work. don't remember much from that night w. couldn't walk straight for 3 days after that.lol I have a neural stimulator in my head which blocks 70% of my normal pain which hovers around 3-6 on the pain scale depending on the day. without it my pain is around 9 or 10. just to give some context for that night.
i don’t know of a single doctor that would give 16mg of dilaudid all at once.
Hyper...algia....
What about pain patients who DON'T dr shop, don’t increase their meds and pass all the random pee tests ? Do you try to take them off pain meds and why ? Edit: my pain dr saved my life. I was going to end it all because of my untreated pain. Her generosity with increasing my meds (I was opiate naïve) until the pain meds worked, saved my life
Dilaudid, I remember, I received post-op for pain from brain surgery, and it is an effective pain medication, but, even though I didn’t continue to take opioids after I was discharged, I found myself craving them, and feeling just terrible while I was on them. The side effects are terrible, so, I switched to the more natural option of MEDICINAL marijuana, and the side effects from the opiates went away.
I had colon cancer and get dilaudid when i go to the er but they will not give me anything to go home with a mung other operations
I used long term opiates and I am happy to say that I am medication free now. I was only ever using my meds when absolutely necessary.
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I used to take 5-7.5 mg oxycodone unprescribed recreationally. I first took it for a terrible flu. And whenever I couldn’t handle knee pain. But I enjoyed it so I took it for pleasure too. Looking back, I had a blast.. I would take 7.5-15 mg Ir oxycodone and go on a mountain bike ride for 20-40 miles and not feel tired! It was a tool that helped me get into great shape and stamina all while enjoying it a ton! No other medication works the same where I can be so active, let alone compelling me to excercise and enjoy life. To prescribers, oxycodone should be used before hydrocodone morphine etc of the patient has to work, take care of household/family, etc. It seems to provide better analgesia without the sedation that’s commonly seen with other medications.
Doctors and nurses seriously need to be able to have more time with their patients, surely I'd imagine the doctors and nurses would like that better because it's less stress on them and they can really be able to do a great job. What's causing this problem, is it a shortage of doctors and nurses?
Ashley ASHLEYM hundred percent a shortage of nurses and doctors have way too many patients with too little time
Hospitals are chronically understaffed. It is about saving money. Insurance doesn’t want to pay for medical professionals to spend time with patients. It is pretty common for insurance companies to only pay for a doctor for a 15 minute visit.
If the only problem is lack of trained professionals, government could offer free or low cost tuition or loan forgiveness to encourage people to go into the profession.
I just came across this video and then went to the CME page and it has been taken down. Dang it. Good info, just wish i could have gotten the CMEs
The tappering did not work for me. I have lupus and CRPS and my surgeon told me he could see through my spinal cord before the mrsa was found in my spinal fluid. I am crippled and suffering. I black out when I try to do anything and have moments when I lose my vision and hearing. I am starting to have a hard time walking. I taught myself to walk after being told I wouldn't be able to. I have been thrown in a mental hospital twice this year trying to get help. The last time was at Stanford.
Oh come on! Because of my caffeine addiction I’m labeled as an addict!? That’s just splitting hairs!!!
Chris Manzi true very true.
I would LOVE to find a good pain doctor. Having pain is exhausting, having none treated pain is worse, being treated like a drug seeker heartbreaking.
I have trigeminal neuralgia and the pain is, HOLY cow! (I have had babes with no drugs, and that was cake).
Sarah Veuleman : long acting Tegretol is fantastic for TGN.
I hope you are able to find a good pain Doctor that will help you 🙏
Try lyrica if you haven't
Yes, we need the CME links. How do we get the CME?
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Please have more shows with this physician.
If there's any place for you to get Dilaudid without prescription it at www.discreetblackmarket.com
It's concerning to have a goal to decrease the opioids ahead of really understanding where your patients are. I have seen this drive patients to surgical interventions. That resulted in significantly poor outcomes. This individual in particular was a stable productive not altered. when the state's cracks down she was unable to get the medication she needed ended up with an interthecal pain management device got infected etc. Poor lady should have just got her meds she'd still be functioning. I've also seen residents blow out people's kidneys giving them tordol because they're afraid to write for opioids. It's concerning she doesn't come off as very experienced further a lot of times increasing pain medications which required to actually get active. It's clear that she really cares. So that's a good start but it's also clear that she has a lot to learn
My dentist wouldn’t give me any pain pills after having major dental work, lots of pain. Gave me Tylenol 3. It didn’t touch the pain. He said he didn’t want me to become addicted. It took me 2 hours to find oxycodone, dilaudid injections and pretty much anything else, from friends. I do not have a prescription history. Just dental work the past couple years.
So just remember that, doctors. If you don’t help us alleviate our pain, we will find it elsewhere.
I have to protest about the mother who refused to give her daughter pain pills after oral surgery. First of all, any time the bone has to be removed or reshaped, the pain is very real. The Exodontist knows exactly what s/he did to get that tooth out of there. The mother did not. Second, there is a complication of tooth extractions called 'dry socket' where the clot at the base of the extraction site is lost, leaving the bone exposed. It is excruciatingly painful. It happened to me when I had my third molars surgically removed. It is how I learned that pain above 8.5 will make you break out in a sweat and that it takes up to thirty minutes for pain medication to take effect. Doctors know that pain is best controlled if you keep out ahead of it. There is honestly no virtue in gritting your teeth against agony if you can help it.
Any time I have had left over pain pills I saved them for occasions when I actually felt pain. I have eked a generous Rx out for several years.
That’s because she’s a doctor already. They aren’t going to ask doctors about possible addiction when they are patients. I feel the opiates screening should apply to everyone
Dr. Kathy is my hero!
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love that Mr. Tom looks like the world of sports reporter from my childhood!
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I wonder how many are like me - they need a Vicodin or Percocet once in a while, maybe once per week, but not all day every day. I also will break a Vicodin in half on occasion. I get a pretty big prescription, I think 90, but it last for a really long time, at least a year.
So does a doctor take it away? Or does the doctor give more? I had an emergent pain issue, from a worsening orthopedic condition, and I told them, I don't need anything, I got all I need. The key thing is that I had to rest! And that's not available in a pill.
FWIW, I cannot take oral NSAID's due to severe ulcers, esophageal, stomach, and duodenal. I have tried topical NSAIDs with mixed results, but it's only on label for the knee. I have had success with wearable ultrasound, but it takes commitment to use it. Also, I can't exercise due to neuromuscular disease - I get really bad DOMS.
As for legalized weed, I'm all for it IF and ONLY IF smoked forms of weed are illegal. Edibles, fine, eat all you want. But people like myself with pulmonary issues should not be exposed to people who smoke pot. Really, anyone with many plant allergies should not be subject to it. I am actually allergic to pot smoke and tobacco smoke, and am very happy about banning smoking. Let's not even get into that if medical marijuana is allowed, is the FDA regulating it as any other prescription drug? If not, WHY NOT!
Steroid injections - one worked fine, one sent me on the floor writhing. Oral steroids work some, but doctors are WAY more afraid of steroids long-term than opioids long-term (go figure).
Opioids are the #1 reason that I can work and pay taxes. Without them, I would be bedridden and on permanent disability.
Correct me if I'm wrong but isn't processed sugar more addictive and abused than nicotine and alcohol? Is sugar a drug?
I'm an ER nurse. I'll get people in who say they can only take the D medicine. I'll suggest docusate.
1g IV acetaminophen has the same analgesic effect as morphine.
You are wrong. Acetaminophen can be dangerous too. I have CRPS and when I meet people who feel this way I don't understand why they don't choose to do something else for a living.
I would love to see an expert on medical marijuana due to my extreme prejudice against drugs.
heidi foss there are dozens throughout the US and canada but the lack of education for most doctors, even in states with mmj, is severely lacking. Cannabis can be used for legitimate medical purposes, most people using it are using it for a reason and its NOT to get high. Same as chronic pain patients who use opiods or other pain meds.
Why are you extremely prejudiced against drugs?
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Pentiuman...your message is exactly what they need to " hear AND UNDERSTAND" I've been telling Doctors this for 30yrs. I'm chronic pain person too. Here we are in 2024 and same thing now..they use the "heroin" logic to treat us. So they start out treating a junkie...not a PM person.
Great guest Dr. T!!!
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I had 22 aporations on my leg almost loos it had doctor save it ,however have conic pain where cant even sleep. i am seeing a pain management, have had different med now he has prescribe this med hydromorphone hcl 2 mg dont know what to do any more...
I was always taught pain is a vital sign, it's what the patient says, treat it as they say it and to remember that I'm not a rehabilitation nurse. I'm really torn with this. ( baby nurse)
Stacey W ER Nurse here. You're right with the pain being the 5th vital sign... and in practice you'll see under medicating... over medicating... and "I want to be medicated" scenarios.
My advice...as a nurse.. is to always be the patient advocate. If I have a patient stating they have severe pain... and they might not "look" like they are in pain... Ill still notify my provider... medicate them as appropriate or prescribed... because as much as someone would like to believe they have a great bullsh*t meter... Ive been surprised many times with there being an acute diagnosis which can be painful.
I can honestly say...in my expierence... the patients who are genuinely ill and have pain outnumber the seekers.
Some people manage thier pain better than others... sometimes the yelling writhing patient gets all the attention (squeaky wheel gets the grease)... and the silent sufferer won't tell you thier pain level unless you ask them.
Advocate.
Keep your patients safe.
And good luck to your career.
Stacey W I forgot to mention... treating pain doesn't always have to be with a narcotic.
Deanna L yea, thank you! It's just disheartening when patient refuses the alternative complains pain is 6 and caused by inflammation I get them tylenol and the practically through it in my face because "they want the good stuff"
I don't go to the nuclear option immediately esp with my renal pts.
Pain is not a sign! (Signs are objective)...It is a symptom (subjective)... Tell those who meed to learn this please.
Dr. Del
Good talk... More coming ? Both docs care !!
What's better for severe pain Oral Demerol or Oral Dilaudid. I have been on Norco 10mg Q 4-6hrs for years and now with the new laws My doctor can't write enough medication in a month so I need something stronger and last longer.
Dilaudid for sure ,no competition
we need those CE links Z!
Enduring activity will be available April 11 or 12 at www.physiciansweekly.com/cme-corner/. It'll be available for a year and provides 1 credit to MDs, PAs, NPs, RNs, and LPNs
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Great talk today in Chicago!!
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CRPS can happen from nerve injury from a bug bite from surgery from a broken bone or start on own. It also can be fullbody and spread. So what do you do for someone like me who is treated like shit by doctors cause I’m 32 and tattooed and I have 40 diagnoses including 7 very rare ones and 4 of those rare ones in brain. I have CRPS, fibro, bilateral trigeminal neuralgia, neuropathy, pseudo tumor cerebri, myelopathy, Chiari malformation and addisons just to name some. Yet cause I’m young and tattooed I’m treated like shit and not helped or I’m on opioids and other meds 20 meds I’m on and they don’t help. I’ve had hundreds of painful procedures and dozen surgeries. I’ve been on same dose opioids for over a year and in the year I’ve gotten worse. I’m also bedridden 24/7 for 3yrs AND I HAVE NO LIFE can’t bathe. Can’t sit up. Need a bedpan and commode. All day I cry in bed in dark cause lights and sounds make things worse. But cause I’m young nope won’t do anything to change your medscause your young. So someone who is young and should have functionality can’t get help cause they r young. But if I’m 80 and lived a full life than getmeds to help ya be functional makes no sense. I’ve lost 6yrs total of life and missing my sons life who is a teen. I have a total of 20 conditions thT cause severe pain. CRPS alone on McGill Pain index is more painful than natural childbirth and cancer pains that may not be end stage. Chronic and rare diseases affect more than cancer and aids combined yet we are ignored and judged and treated like shit I’ve seen about 100 doctors at 3 major universities in Illinois. So what does someone like me do and others like me?! I even get scared to use my meds due to being treated like shit my medical community even to point I’d rather die than go to ER.
Great to see this video long before we were all talking about COVID CHAOS!!
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Great show I enjoyed it. I am a chronic pain suffer that went cold turkey off 100 mg fental patches I feel better but now I am in pain daily an I can’t walk now so I don’t know what to do next? Help me
I hear CBD works very well for some folks either oral or topical.
As a methadone patient SWIM wants to let you doctors know that A) methadone has zero euphoria, sedation, or high. Unless you’re not tolerant Maybe. B) methadone is way better than being unstable and addicted to street drugs or unprescribed medication. C) that a methadone patient who gets injured actually requires more pain medication than average. At the methadone clinic SWIM do used to go to, The doctor said that if you ever end up in the hospital and get them at the needed pain medication, if the nurses don’t give you enough or act like methadone is already sufficient for pain, you call though Clinic and the doctor will personally come write you a sufficient medication, because he knows that a methadone patient will be highly tolerant. Like a “Vicodin is like a jollyrancher” to SWIM, the doctor once said.
That's one thing I don't understand. Why are we counting tramadol?
Dr. T was awesome.
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I've tried weed, I know it had more THC than CBD, but weed in some people (especially those who already have anxiety) it causes anxiety and I know that was true for me and I've heard other people say that it was true for them as well. I will never try weed again for any reason, it feels like I'm dying when I'm taking it, it's not fun, I may not be in any real danger but it's terrifying.
Man I wish canada was like America. We r suffering a huge moral ban on opioids. People with actual Chronic pain are struggling to be taken seriously at all. I'm not one of them but it's been in the news a lot.
ZDOGG should put my PAIN MANAGMENT Doctor. He is out of LONG BEACH,.CA and he would SCHOOL EVERYONE IN THIS MATTER!!!! I MEAN SCHOOL!!! UUUGGGHHHMMMM! UGGHHHMMMM!
Chris DeBie that’s great to know some ppl are getting the help they actually need!
AWESOME presentation!! What a breath of Fresh Air! Please tell me at least one of you have a practice in WI? I have worked in Pain management/ Internal Med., etc. I want to work with you!!
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I love Dillaudid it fucks you up pretty good in the first 5 mins! Dr Dogg is Kathy single?
My new favorite channel! This was a very interesting video.
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Where is my damn Dilaudid
Unless youre paralyzed from birth, how could you go your whole life without exercising? I mean what are we defining as exercise? Does playing sports count? Does walking for 30+ minutes count? Or is it only structured exercise in a gym that's counted? But that makes no sense because exercise is exercise regardless of how structured it is and where its done.
Lol I just felt guilty having to take my Dilaudid for my burn but fantastic video
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Could we get a link for the CME info please.
Found it...Thanks!!!!!
Opiates suck for me. I get horrible side effects but the pain doesn't respond so I'm still in pain but with all the nausea and balance issues. Plus my spo2 goes into the low 80s.....
NSAIDs are much better. If naproxen doesn't work call an anesthesiologist.....
Good lord, I was in for stone stuck in my bile duct, I’m allergic to morphine so they gave me dilaudid, worked for the severe abdominal pain a bit but makes you throw up your shoes. NO THANK YOU JUST HIT ME WITH A 2x4 and knock me out.
The problem is prescribers only know how to prescribe. They write meds but once a patient has gotten to the point of getting off there is no help. Doctors don’t even bother using the cdc guidelines for lowering at least than 10% in any given week rather than cutting them off cold turkey. This is when people turn to street drugs because not only is the physical sickness being awful the mental side of it makes you almost suicidal between the lack of sleep and the sweating/freezing , heart racing , diarrhea, vomiting, hallucinations and possible heat attack. There has to be a program put in place for people who get freak injuries. Chronic pain is a whole new bag of worms. If you are going to have the ability to prescribe opiates then I think the doctors should have to take a dosage increasing every week and then have to stop cold turkey so that understand what it’s like for chronic pain patient’s.
Good discussions - thanks! (from a fellow hospitalist)
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What do you think of the testing of Cytochrome P450 in regards to the metabolism of pain meds?
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How to apply this to CME? Tune in every Sun?
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I remember my uncle went in for surgery to fix his shoulder (he overuses it due to his job and his ligaments had become very weak and snapped due to overuse and they gave him pain medication for the after the surgery and he also took none, he actually said he wasn't even in any pain, which I found surprising.
would paramedics be able to gets credit for it
You would have to check with your Physician Adviser for approval.
I think it's adorable when pain docs think they're in control of how much opiates a patient takes.
My “pain doc” (doesn’t) think it’s adorable when the pharmacy wants to play “doctor”
He will literally call them out !!
But yes, all of it is a bit aggravating.,
Loved the explanation of tapering down
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Just because someone smokes doesn’t mean they will be addicted to pain meds. My husband has never been addicted in fact he takes as little as he can. Try to exercise when your in extreme pain. Most chronic pain patients know what works for them. I feel that it is best if pain clinics had a group of drs, counseling, chiropractic, counseling and PT then patients could be lower on meds if all of these worked together! The only way I can live is taking opioids. She is very knowledgeable unlike some of the bs that you said in the last video!
Dr. Z, thanks!
Excellent show!
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Another interesting thing pain management doctors could use in their arsenal to manage chronic severe pain is the pain blocking effects of adrenaline. Like during A basketball game, of player hurts their ankle but has a strong drive and motivation to finish causing them to not notice pain in the foot until the game is over and their adrenaline comes down, and all the pain hits them like a train. This can be seen with stimulant drugs like caffeine, cocaine, and amphetamines that release dopamine and norepinephrine (adrenaline). While they don’t block pain, they distract the person from pain. From an evolutionary standpoint this makes perfect sense. If I am in the grass plains of Africa, And I sprained my ankle it will hurt. Until you have a tiger coming toward you, where you will have The fight or flight response allows you to run away distracting from pain inhibiting you. So it could be very successful if doctors used a traditional opiate , in conjunction with acetaminophen, NSAIDs, and some Stimulant-like medication (cymbalta). Prescribing something like amphetamines or methylphenidate could possibly help certain patients but stigma likely hinders their use.
+ZDoggMD take the pain " vital sign " and replace it with BGM. it will be the next vital sign in my opinion.
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thank you for this!
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Chronic pain people r being forgotten, neglected and tortured. PCPs are refusing to write any scrips for pain meds which include ultram. Recently I saw a patient that had surgery on his upper thigh. He had a very large abscess which was removed.He was discharged from the hospital with an orange size open wound in his upper thigh. He was discharged from hospital with absolutely no pain medicine. Gentlemen, does not have a drug or alcohol issue.. Myself I’m a cancer 2 x Different cancers. Breast cancer and advanced stage III cervical cancer.This happened to me when I was in my 20s where I had modified radical surgery and radiation. I recently took a fall and broke my hip and have a nice Dramatic spiral fraction of my femur. My femur was almost fx in half in length . No pain management. I had to stop my PT therapies it was too painful. We now have a person that was very active, working which is now An invalid, confined to the house. Has a very poor quality of life. Which will continue to go downhill . Yes that’s right I cannot take nacids has Severe gerd at night time I aspirate on stomach contends. Barrett’s esophagus, and a host of G.I. issues which is not my fault. Don’t tell me that my pain is in my head. We will see the suicide/murder rate to raise. The sale of street drugs like heroin laced with fentanyl . Will increase. the fentanyl comes from China isn’t that a scary thought. I well die in pain all because of this so-called opioid epidemic.
Bring Dr.Travnicek back as a co-host and let her wear her Pj's!!!
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yay! for cme's!!