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My Predicament

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#1 nursemanda

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Posted 08 July 2013 - 05:53 PM

Wellll... here's the whole story (not that it will help my situation to tell anyone but it makes me feel better to vent)

 

In college I took my medication as needed - meaning I took more than I should, more frequently than I should've. I was honest with my doctor and she warned me not to do that because it's unhealthy for numerous reasons. I was in school studying to become a nurse and I had to do .. whatever it took to become an RN. Meaning i disobeyed. After nursing school I began taking my medication as directed but I hated how 10 mg of ritalin would give me heart palpitations so I took half a pill (they are scored) at a time and found this worked much better. For unrelated reasons, my doctor left her practice and I was stuck with some greenhorn nurse practitioner who barely knew the definition of narcolepsy let alone anything about medication management related to narcolepsy. I was honest with her as well about how I took my medication... but she was angry. She made my medication scheduled instead of prn and made it every 6 hours. . . even an idiot knows you don't take medication to wake up every 6 hours ... BECAUSE EVENTUALLY WE HAVE TO SLEEP. erm... anyway, I told her that. She sarcastically offered to change the order and I told her not to bother because I was going to just take it as I needed it anyway. So. She made me sign a controlled substance abuse contract in which I agreed not to adjust my dose independently and would take it as prescribed. I signed the paper. I realized I had been taking my medication incorrectly and I needed to regulate my dose better so i wouldn't run out of medicine too soon.

 

Two months go by. I'm prescribed 40mg per day, 10mg every 6 hours but I still didn't want the heart palpitations from a 10 mg dose and I still wasn't about to take medication to stay awake when I was trying to sleep. So. Instead of taking 10mg q6h, I took 5mg q3h and I don't take it when I'm going to bed. My doctor brought me in for a pill count and hooray, I'm right on. My pill count is perfect. But when the nurse comes in to the room, she asks why I have half tabs in my bottle. I, stupidly, tell her the truth about taking a half tab q3h instead of a whole tab q6h. That's all I tell her. She considers me in violation of the contract and instead of telling me when I call half a dozen times throughout the week, she mails it to me and I have 2 weeks left of medication. They tell me I have to go see my sleep specialist to have medication prescribed from now on. I call the specialist but due to the july 4th holiday, they wait a week to call me back and tell me he won't see me anymore because I've missed too many appointments. I'm a nurse. I'm busy. I understand it's not ok to miss appointments but when i have to work double shifts while having narcolepsy ... I tend to forget what day of the week it is, let alone some long ago forgotten date of an appointment I sheduled. Those appointments weren't important to me. They were just check ups. Now, I NEED them or I won't be able to function ... and I have already ruined my only hope.

 

So. you see. I'm ... *sigh* almost out of options due to my own ... irresponsibility, hard-headedness... I know what I need. I know more about my medication than my doctor did (not the specialist - he's brilliant). I understand her reasons but if she had actually tried to help me instead of just giving me rules to restrict me, I wouldn't have violated the contract in the first place.

 



#2 Ferret

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Posted 08 July 2013 - 10:44 PM

Did you tell the nurse about the heart palpitations when you take 10 mg. all at once?

The reality is that you did take a total of 10 mg every six hours...or is the nurse's ability to do math impaired as well as her capacity for empathy? Sounds like she's on a power trip. On the other hand, you need to eat a little humble pie too because you've been irresponsible. Write her and/or your Doctor a letter of explanation and apology and see where that goes. Good luck.



#3 doinmdirndest

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Posted 09 July 2013 - 12:38 AM

I must respectfully disagree w/this advice. when it comes to the palpitations, I don't know enough to offer a perspective. I have a general idea this is a contraindication that = , sadly, -0- amphetamines 4u.

what is far more significant is the urgent need you have to 'fire' this nurse practicioner.


it is so obvious she is on a power trip. in her view, controlling you w/unorthodox 'contract' and so on eclipses all else, including your wellness. and the half life of the med is but 3 1/2 hrs, I'm pretty sure the stuff cant work for 6 on 1 dose. (thoughts, anyone?)

if I were in your shoes I would terminate all dealing w/her. even if it means risking untreated eds.

get authentic advice from a DOCTOR about palpitations. I suspect desoxyn or Adderall may be a better choice. this is from my own experience--Ritalin was a 'rough ride' for me. hopefully my 'hunch' above is incorrect.

#4 Ferret

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Posted 09 July 2013 - 07:33 AM

I sure understand what you're saying Doin' and the need to fire her BUT, it's kinda like quitting your job...it's a whole lot more satisfying when you have another job already lined up.

"Rough Ride"??? She's going to crash and burn if she goes off Ritalin cold turkey. However, that was my personal experience and may not be hers.

Suck up...get a prescription to carry over and immediately get going to find another Sleep Doc. or talk to your Specialist about your problem.

Working as a nurse, surely she has contacts that can pull strings under the circumstances?



#5 DeathRabbit

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Posted 09 July 2013 - 10:10 AM

I think that she's being an idiot; nothing you did seems irresponsible. In fact, her moronic treatment plan is irresponsible, and I would say next time you see her, you need to bring back up. Preferably, someone who is particularly intimidating. If that doesn't work, threatening a malpractice law suit right back at her might get her more in step. The only culpability I see on your part here is missing the appointments with the specialist. Is there another one in town you can see??? Alternatively, you could also try a nootropic, which is much less maligned. They don't always work, but for the people that do have success, they work miracles.



#6 ApparentlyNarcoleptic

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Posted 09 July 2013 - 10:01 PM

Since when do doctor's create CONTRACTS with patients regarding treatment?!?  Treatment of any illness, let alone a chronic condition, requires constant re-evaluation and "tinkering" as needed.  I've never heard of something so disgraceful out of a medical professional - and I have very very many of my own.  I don't understand (and maybe I'm just misreading or misunderstanding) but it seems that the DOCTOR said your pill count was perfect and everything was fine - but then the NURSE said it was wrong?  Since when did she get the authority to overrule the doctor and dismiss you as a patient?!?  If I did get that correct, I would try to find a way to get in touch with the doctor and explain to him what has happened.  It would be important for him to know.  Additionally, I'd look more into this contract business if I were you.  I can't imagine it being ok for dr's to pull such crap.  It sounds unethical to me.  Otherwise, you'll just need to find yourself a new doctor.  Best of luck!  I hope your meds last long enough for everything to get fixed



#7 nursemanda

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Posted 10 July 2013 - 01:50 AM

Well I may be a prideful person but I know when I need to bow my head and suck up. so I bit my tongue today and called the office to ask for advice or maybe enough medicine to make it to my next earliest specialist appointment. they told me that it was out of the question and the entire office would not prescribe anything. I'm glad you guys feel this way too, I just wish there was something more I could do. I feel so helpless. I'm so thankful to have people like you guys. I'd be lost without this board :-)

#8 Ferret

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Posted 10 July 2013 - 08:28 AM

Too bad you didn't record that phone call...or get them to put it in writing. It would provide perfect evidence of a power trip on their part to the detriment of the patient.

A bad comparison would be holding back on an operation because you caused the health problem. I'd love to knock the pedestal out from under some of these a$$holes.







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