Vets: The VA doesn’t feel your pain.

I am being involuntarily removed from my methadone prescription for chronic pain. I was taking 5 mg three times a day. The doctor says she is “weaning” me off of methadone. She didn’t say why.

Some months ago I went to the so-called “Pain Evaluation Clinic” at the Michael E. DeBakey Veterans Medical Center in Houston. I saw a psychologist for about an hour and spent about the same with a physician assistant who proceeded to make clear that I would be taken off methadone. I have taken the drug for more than 11 years. I had a couple of medical tests on the horizon that concerned me so I was spared from the weaning for the time being.

I never really received an explanation why I was being taken off methadone. The PA told me that my prescription for 15 mg was equivalent to 60 mg morphine equivalence. In extensive reading this afternoon, I found nothing to indicate whether this equivalence is accurate due to the medication itself.

The PA, I suppose, tried to scare me out of my methadone prescription. She gave me the impression that I could all of a sudden overdose while taking just a normal dose. I found nothing to support such claims.

It is true that methadone overdose deaths represent about 1-of-4 total fatal ODs. I found this on one government medical site:

“Methadone is a very strong painkiller. It is also used to treat heroin addiction. Methadone overdose occurs when someone accidentally or intentionally takes more than the normal or recommended amount of this medicine. This can be by accident or on purpose.

 “Methadone overdose can also occur if a person takes methadone with certain painkillers. These painkillers include oxycontin, hydrocodone (Vicodin), or morphine.”

Look Ma, no spontaneous overdose from normal dosage for years.

Don’t bother going to the VA for severe pain. They want you to hurt. I guess service to the country wasn’t enough.

Here is some additional illumination about methadone overdose from CRC Health Group, a West Coast addiction and behavioral treatment group based in California:

“Between 1999 and 2004, deaths attributed to methadone increased by 390%, an effect primarily related to increased utilization in pain clinics , as well as diversion.

 “Methadone accumulation can lead to sedation, respiratory depression, respiratory arrest and even death. Lethal respiratory depressive effects can occur in doses as low as 30 mg in non-tolerant persons

  “Initial efforts to characterize risk factors derive largely from Australia, where deaths related to methadone tablets prescribed for chronic pain increased markedly between 1984 and 1994. Diversion of methadone tablets accounted for about half the deaths, whereas deaths from prescribed methadone declined over this period. “

As CRC quite succinctly pointed out:

  “You must take methadone responsibly and with respect for its power, but the careful and considered use of methadone has proven quite safe, even for long-term consumption. Methadone has been proven not to harm the lungs, heart, brain, liver, kidneys, or any other organ.n 4,000 deaths. However, many of these deaths did not involve methadone treatment for opiate addiction — instead, they involved individuals who were using methadone without medical supervision for pain treatment, or who were otherwise abusing methadone.

 “Methadone use saves far more lives than it endangers. According to the National Alliance of Methadone Advocates (NAMA), opiate addicts who are not on methadone are more than three times more likely to die than are individuals who are using methadone as part of a supervised addiction recovery program.

 “Methadone, much like any strong opiate analgesic, has a respiratory depressive effect. If you take too much methadone, you can stop breathing and die.”

Simple enough!

A registered nurse friend of mine said recently:

 “You’re right that it’s the fentanyl and oxy and it’s the serious main-liners fucking it up for all of us. This entire thing is blown up by big pharma – I’m sure we could follow the $ and figure it all out, but the guy in pain is paying the real cost of trying to make it without his pain meds. It’s a mess,” she said. “It’s horrible and I can’t believe the medical system is letting them interfere with medical practice like this. It’s illegal and malpractice not to treat a patient with the correct medication when it’s available. Period.”

My weaning is in a rapid fashion. It makes me wonder if VA practitioners receive a bonus for cutting off opioids for some old vets with severe pain.

I started with being prescribed 10.5 mg three times per day. This month I received a prescription for 5 mg twice a day. Next  month it will be 5 mg once a day and 2.5 mg once a day.

I was never given a firm reason why I should quit taking methadone. I don’t have to though. It seems most VA top leaders want to look good for their boss in the White House. I doubt he could tell an opioid from a hemorrhoid.

Even worse than how I will fare without methadone from a withdrawal standpoint — almost 12 years is a long time on an opioid — is the pain.

I have not been offered a firm solution to the often severe chronic pain from spinal stenosis in my cervical spine, this despite having two surgeries. I also suffer from excruciating lower back pain that doctors at the VA have never seemed to agree on the reason. It limits my walking and the problem has never been substantially addressed, with the exception of a diagnosis of arachnoiditis. The condition is a pain disorder caused by the inflammation of the arachnoid, one of the membranes that surround and protect the nerves of the spinal cord.  The diagnosis seems dubious after seeing a number of different doctors.

Most disturbing are the VA pain strategies involving high doses of over-the-counter analgesics such as Tylenol or Ibuprofen. For real? Do they seriously believe such OTC drugs will help after taking methadone for almost 12 years?

Other VA “pain control” suggestions include physical therapy, chiropractic, acupuncture and group therapy. I just know sitting with a group singing “Kumbaya” will kill the pain.

I don’t know what will happen in the future. Most certainly, I am scared. I was put on methadone by a VA pain doctor in Dallas who suggested methadone after he told me there was nothing he could do to help. I have tried all the VA has had to offer since 2006 and those strategies that do not work for me have only grown 12 years later.

I can certainly understand why many VA patients may go elsewhere for help with pain. I don’t plan to seek black market opioids. Beyond that, I will do what I need to do to survive severe pain on a daily basis.

Just another day in America. Right?

This has been one of those extraordinary days in America.

Two presidents — one white and former president and one black who is the president — spoke on the same page praising work of the five Dallas police officers killed in an ambush following a protest march on July 7.

A former Democratic party presidential candidate and the presumptive Democratic candidate embraced in a showing of party unity.

Hey there, take a look at my neck it's a lot like your's. That is if your neck looks anything like mine.  (It actually is my MRI neck picture) MRI image. Copyright 2016. Dick at EFD
Old man take a look at my neck it’s a lot like your’s. That is if your neck looks anything like mine. (It actually is my MRI neck picture) MRI image. Copyright 2016. Dick at EFD. Oh, and Fair Use paraphrasing Neil Young’s “Old Man” which is a hell of a good song.

The U.S. attorney general was grilled by Republicans who demanded to know why she didn’t refer charges against the presumptive Democratic candidate in a politically-charged scandal over e-mails.

One of eight Supreme Court justices said she could not imagine a presidency under the presumptive Republican candidate.

All of this took place today as I sat in the Parkinson’s Disease clinic at the Houston VA waiting to see my neurologist. Oh, I don’t have Parkinson’s, at least I don’t think so.

I began reading an interesting article on one major problem I do have, that is maintaining balance. The article was in “Neurology Now,” a title I previously didn’t know. But this magazine had an attractive cover layout that pictured the former California first lady, who also was once an NBC television news correspondent, and a member of the famous Camelot clan from which came a murdered, young U.S. president. That lady shouldn’t be former anything and proves she isn’t by speaking out on Alzheimer’s Disease.

The article, which I have yet to finish, suggests Tai Chi and other methods can help older folks to maintain balance. You, the reader reading this blog, may read this article  before I do. I have had concerns over the last couple of years, since my balance had gone awry, that I might get stopped by police and asked me to perform a field sobriety test. I don’t drink and drive, anymore at least. Buy my balance is way out of whack and that would be the first thing I would tell police. Well, I would tell them right after saying: “No,” I would not perform any tests.

Before I finished the article my neurologist, a very nice lady who came from India to help veterans, gave me about 10 shots of Botox. The Botox shots — I have received about four or five sets — have been in my head, neck and face to attempt helping the great pain I suffer from my cervical spine and the osteoarthritis that has savaged my neck over the years.

The shots today were in the back of my neck in a peripheral area of my spine.

My neck felt better, for the first time since I have received the shots, although after the drive back from Houston the neck is back to its painful ways. My lower back has, in the interim, become much more painful among standing and walking. That has been attributed to the diagnosis I was given of a rare disease called “Arachnoiditis.” And as I must always point out, the disorder has nothing to do with spiders.

I will be checking in my self-examination mirror to determine if the Botox has made the back of my neck appear any younger. In the meantime, my doctor said she will say what, if anything, she will do about my lower back.

This was what happened in my day, another day in America.

Physical therapy, damn it!

Just Monday I started physical therapy. I didn”t plan it. I suppose one never plans it. The VA is paying for my therapy through its Veterans Choice program which allows veterans, in certain cases, to receive non-Veterans Affairs providers. In most instances the program might allow vets to be seen where VA facilities are too great a distance. In my case, the therapy was set up here because it would cause too much of challenge physically and professionally to attend physical therapy several times a week some 85 miles away in Houston.

I think this is maybe the fifth time I have had physical therapy. I’ve had it mostly for my cervical disc problems. Last year I had therapy for a month after arthroscopic surgery to repair a meniscus tear in my knee.

I have to say that I have never had successful physical therapy. It may make me feel better as I walk out the door or maybe for an hour or so. In my case over the first two visits so far, I have felt much worse than I originally felt. I am receiving treatment for my neck pain after two neck surgeries over the past 20 years. I also am getting treatment for a back pain that may or may not be caused by an inflammation of a spinal membrane called arachnoiditis. And as I have to repeatedly say, “No, it isn’t something caused by a spider bite.”

A physical therapist who, did something or other to me yesterday, said a muscle in my back is causing my problem. That may be but that is now three diagnoses for my lower back pain and the first by a non-doctor who is forbidden by law to diagnose medical conditions.

I had a visit with my podiatrist today at the Houston VA, some four months after I had hammertoe surgery. All is well there at least. I told Doc that I was a reluctant patient in physical therapy. He told me to give it a shot. That is what I am doing.

But as I told my DPM, I have to weigh the pain I have from physical therapy with the pain I have been having in my neck and back. Right now, the pain increase I have from physical therapy is outweighing the original pain. That cannot go on for too long, no matter how generously I am being treated by the VA.

Oh, if you don’t see my writing here very much in the next few weeks, it will be due to someone deciding to “improve” my health and well-being.

You want to know what’s bothering me? Well, here it is …

This morning I woke early to catch a ride to the VA hospital in Houston. It was one of those 5 o’clock rising-type morns but luckily I made it back home after a five-hour round trip. That is really amazing considering how long it usually takes. This morning’s trip was for a test called an “EMG.” A definition of that term from the Mayo (Hold the mustard) Clinic:

 “Electromyography (EMG) is a diagnostic procedure to assess the health of muscles and the nerve cells that control them (motor neurons). Motor neurons transmit electrical signals that cause muscles to contract. An EMG translates these signals into graphs, sounds or numerical values that a specialist interprets.”

It wasn’t really a pass/fail type test so no No. 2 pencils were involved. I have had these tests before, one of which revealed I had a moderate case of carpal tunnel syndrome in my hands. This morning the EMG was taken on my legs and were conducted by the neurologist I have been seeing for more than a year for my lower back pain.

I had finally decided to once and for all have the VA determine what could be done with regard to my excruciating lower back pain that I developed several years ago. The diagnoses had jumped back and forth from a problem involving disc and bone spurs in my lumbar and sacral spinal regions. I underwent some three MRIs in as many years, all had noted no change in my discs. An early diagnoses had shown what was originally described as a rare condition called arachnoiditis. Subsequent examinations by doctors said not so much. But again, it seems as if we are back at that diagnosis. This time, according to my neurologist after my EMG tests this morning, it seems that my pain is likely compounded from what she, my neurologist, referred to as advanced neuropathy in my legs.

Arachnoiditis is when the arachnoid, a membrane that surrounds and protects nerves of the spinal cord, becomes inflamed and leads to scars that “stick together.” The condition can cause tingling, numbness and burning pain in the lower back and legs. Also:

 “Some people with arachnoiditis will have debilitating muscle cramps, twitches, or spasms.  It may also affect bladder, bowel, and sexual function.  In severe cases, arachnoiditis may cause paralysis of the lower limbs.”

Sounds lovely doesn’t it?

As for cures? Well, there aren’t any. Sounds even better, right? Actually, the medical world treats the symptoms mostly with pain management.

Neuropathy is, according to Mayo:

 ” … a result of nerve damage, often causes numbness and pain in your hands and feet. People typically describe the pain of peripheral neuropathy as tingling or burning, while they may compare the loss of sensation to the feeling of wearing a thin stocking or glove.

 “Peripheral neuropathy (as it is commonly called) can result from problems such as traumatic injuries, infections, metabolic problems and exposure to toxins. One of the most common causes is diabetes.”

Yes, I have diabetes, type II, and yes I am trying to keep it in check. But my neurologist says even if I keep my diabetes in check it doesn’t mean my neuropathy will go away. This condition, too, is mostly just treated for symptoms which is probably most annoying beyond pain in my condition is mostly numbness in my feet. I shouldn’t wear flip flops in order to prevent feet injury which can turn into something serious due to diabetes, but I do. Often I can’t feel if the flip flops are on my feet. The same goes for socks.

There are a lot of treatments for neuropathy. I am taking a couple of drugs for its treatment. One is neurontin a.k.a. Gabapentin and the other is Lyrica. The pain in my feet is pretty well controlled most of the time. My doctor is adding a lidocaine cream for my feet. But for either malady, there is nothing that can really fix me up.

Surgery is not usually indicated for arachnoiditis and may do more harm than good. My neurologist explained this morning that, most often, the attempts to remove the nerve endings that become stuck will cause surrounding nerves to become stuck.

The no-surgery option comes after also having a “drive-by” diagnosis yesterday by a VA neurosurgeon by telephone who clearly sounded as if he had something else better to do. I mean, every neurosurgeon I have ever seen was live and in-person and who usually gave me a thorough examination. Oh, but not this one, he was so good he could stick a copy of the radiology report up to his temple like the Johnny Carson psychic character “Carnac the Magnificent.”

Oh, and I can’t forget the bulging disc and other problems which have had me taking methadone for severe neck pain over the past seven or so years.

All of which brings up a quiz. Which is the correct question?

–Are I f***ed?

–Am I f***ed?

Well, either answer seems pretty appropriate. It is just of matter whether you want good language or a proper prognosis.

What’s for the future? Well, pretty much the same, for now. I will soon take a look at just how I can live financially with a disability retirement. That is pretty much what I have to figure out right now.

So that is what’s up with me right now. That, and rummaging around the pantry to see what is for supper.