Author Topic: Doctor, Pharmacist, Ortho-Important ?  (Read 1171 times)

soccerluvof4

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Doctor, Pharmacist, Ortho-Important ?
« on: November 19, 2021, 05:09:20 AM »
 Morning,

I am only looking for some idea I can bring to my Doctor is some one has one. I would not expect any Doctor to tell me this is what you should do...just maybe "ask your Doctor if this is a option.

So yester 11/18 I had a total knee replacement. I got home about 6-7 hours later all went well. I have a ball with medicine being distributed to my knee which should last about 72 hours and can take 1k mg of Tylenol as they prescribed me-

Hydrocodone and my insurance will not cover it and the pharmacist says it dangerous to take because I have been taking 3mg a day of Clonazepam for 30 years never has been increased. Supposedly the combination can cause me to have difficult or stop breathing and or lessen the effect of the Clonazepam which can lead to another host of problems. So then they tried a lower dose Opiod began with a T like guessing it was Tramadol and again I cant get it approved. Doctors office says one option to try and pay cash But if it has that risks I am not sure I am willing to do it anyhow. So for now they have me taking 1000MG of Tylenol 3xs a day. Being only 24 hours in so far not an issue and they have a call into the board of insurance company which will have and answer of approval or not. I did a little research to verify if this is the case with Benzos and Opiods and everything says do not take together.

This obviously is seperate of my bloodthinner etc..

So the question is, is there anything that some one might suggest I can go back to my Doctor and say I did some research and what about this?

I figure I have till midday Sunday to get this figured out.

Thanks in advance 

sonofsven

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Re: Doctor, Pharmacist, Ortho-Important ?
« Reply #1 on: November 19, 2021, 06:16:33 AM »
Are you wanting to get the tramadol? Try adopting a dog, lol.
Or are you looking for alternatives? I take cbd tincture for chronic pain and ibuprofen for acute pain.

Morning Glory

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Re: Doctor, Pharmacist, Ortho-Important ?
« Reply #2 on: November 19, 2021, 06:35:41 AM »
I'm sorry that happened to you.  There should be a follow up phone number on your discharge paperwork.  Call them and explain everything you have said here. Do it before that local anesthetic wears off. Yikes.

The US healthcare system is ridiculous and scary.


BikeFanatic

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Re: Doctor, Pharmacist, Ortho-Important ?
« Reply #3 on: November 19, 2021, 06:40:59 AM »
This is surgical pain and I can see where Tylenol will not cut it. Really they wonít approve Tramadol?
If your MD surgeon prescribed a narcotic, I would pay myself and take it. Benzodiazepines and narcotic have synergy effects where they make each other stronger. So maybe start with a lower narcotic dose than prescribed. Do not drink alcohol at all with these drugs.
I think  or guess, you have a nerve block that anesthesia set up for you that may last 24 hours or so but once that wears off you likely will have pain. So I am not an expert but have cared for family after surgery and the fear of pain is real. I would pay myself and take what the MD prescribed and if you are too sedated then go to plan B.
Toradol is a ibuprofen type drug, is that what you are talking about also known as ketorolac?

soccerluvof4

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Re: Doctor, Pharmacist, Ortho-Important ?
« Reply #4 on: November 19, 2021, 06:44:59 AM »
I'm sorry that happened to you.  There should be a follow up phone number on your discharge paperwork.  Call them and explain everything you have said here. Do it before that local anesthetic wears off. Yikes.

The US healthcare system is ridiculous and scary.


Are you wanting to get the tramadol? Try adopting a dog, lol.
Or are you looking for alternatives? I take cbd tincture for chronic pain and ibuprofen for acute pain.




Looking for alternatives for the Opioid because no way I can stop taking my Benzo and I researched this morning and even went to Mayo and John Hopkins websites as others and all say the same to not take together. I have had several conversations with my Doctors PA yesterday and so far everything that they have put through because being an Opioid is being denied. At this point I guess I am hoping the 3k mg of Tylenol a day works or the pain isnt going to be as bad as everyone has warned me its going to be if we dont find another solution. Doing pretty good so far but wont be 24 hours till noon. I just turned my local down from an 8 to a 6 to see if I can make that solution longer.

jim555

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Re: Doctor, Pharmacist, Ortho-Important ?
« Reply #5 on: November 19, 2021, 06:46:30 AM »
My experience with pain meds, Tylenol didn't do anything for me.  Neither did Tramadol.  Naproxen 500mg (Aleve) was probably the best, then Ibuprofen. 

soccerluvof4

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Re: Doctor, Pharmacist, Ortho-Important ?
« Reply #6 on: November 19, 2021, 06:51:13 AM »
This is surgical pain and I can see where Tylenol will not cut it. Really they wonít approve Tramadol?
If your MD surgeon prescribed a narcotic, I would pay myself and take it. Benzodiazepines and narcotic have synergy effects where they make each other stronger. So maybe start with a lower narcotic dose than prescribed. Do not drink alcohol at all with these drugs.
I think  or guess, you have a nerve block that anesthesia set up for you that may last 24 hours or so but once that wears off you likely will have pain. So I am not an expert but have cared for family after surgery and the fear of pain is real. I would pay myself and take what the MD prescribed and if you are too sedated then go to plan B.
Toradol is a ibuprofen type drug, is that what you are talking about also known as ketorolac?



Thats is good info and you are correct they would not approve the Tramadol because still a Opioid even though a lower dosage but at the time they called in Toradol as an anti- inflammatory so my DW is getting that this morning which yes is under the name Ketorolac.

Thanks

JJ-

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Re: Doctor, Pharmacist, Ortho-Important ?
« Reply #7 on: November 19, 2021, 07:05:26 AM »
Sorry for your anxiety on this. Pain can be scary.

The situation is a bit weird. What medicine is in your ball? I wonder if that is causing insurance complications.

Is it that you're currently in pain or scared of being in pain?

Stop trying to Google solutions and schedule an appointment with your doctor. They are the pros here and can talk to you about risks.

Morning Glory

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Re: Doctor, Pharmacist, Ortho-Important ?
« Reply #8 on: November 19, 2021, 07:06:57 AM »
I'm sorry that happened to you.  There should be a follow up phone number on your discharge paperwork.  Call them and explain everything you have said here. Do it before that local anesthetic wears off. Yikes.

The US healthcare system is ridiculous and scary.


Are you wanting to get the tramadol? Try adopting a dog, lol.
Or are you looking for alternatives? I take cbd tincture for chronic pain and ibuprofen for acute pain.




Looking for alternatives for the Opioid because no way I can stop taking my Benzo and I researched this morning and even went to Mayo and John Hopkins websites as others and all say the same to not take together. I have had several conversations with my Doctors PA yesterday and so far everything that they have put through because being an Opioid is being denied. At this point I guess I am hoping the 3k mg of Tylenol a day works or the pain isnt going to be as bad as everyone has warned me its going to be if we dont find another solution. Doing pretty good so far but wont be 24 hours till noon. I just turned my local down from an 8 to a 6 to see if I can make that solution longer.

They really should have had this conversation with you before surgery, instead of putting you in this position now. I can tell you that the bighospital website information is very general,
and the conversation about risks and benefits should be between you and your medical team.  You should call them again because you'll most likely be in pain after that local wears off.

Will other posters please refrain from recommending specific drugs/interventions? Even some otc things can be dangerous if you have underlying health conditions.  He needs to talk with someone who knows his history.

soccerluvof4

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Re: Doctor, Pharmacist, Ortho-Important ?
« Reply #9 on: November 19, 2021, 09:05:34 AM »


I am not researching like WebMD or things like everything you google your going to die. I am not really feeling anxiety but actually pleased as how things are going so far and just being pro-active.

As far as what is in the ball I honestly dont know but I am told that is more a nerve block so has no barring on the opioid benzo issue.

I was just on another phone call right before I logged in to check posts and the PA is really working hard on a solution so that is good as well. I have not had to call them once, when they were called about the rejections they have done nothing but called me and always apologize so I am in good spirits. Just trying to think outside of the box because I wil be going through this on my other knee and I am sure with the commonality of Benzos this has to come up.

Thanks to all so far!

JJ-

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Re: Doctor, Pharmacist, Ortho-Important ?
« Reply #10 on: November 19, 2021, 09:16:08 AM »


I am not researching like WebMD or things like everything you google your going to die. I am not really feeling anxiety but actually pleased as how things are going so far and just being pro-active.

As far as what is in the ball I honestly dont know but I am told that is more a nerve block so has no barring on the opioid benzo issue.

I was just on another phone call right before I logged in to check posts and the PA is really working hard on a solution so that is good as well. I have not had to call them once, when they were called about the rejections they have done nothing but called me and always apologize so I am in good spirits. Just trying to think outside of the box because I wil be going through this on my other knee and I am sure with the commonality of Benzos this has to come up.

Thanks to all so far!

I still don't know what solution you're after as you are not clearly communicating the issue. If you can specify what the problem is you can talk with your care team on whether it is a short or long term issue and what the risks are with managing those issues. You seem to be chasing a mix of meds but for what purpose? Short term pain relief following a surgery? Is the current plan insufficient?

The doctor can still order things for you that are blanket not advised depending on the risks, and you can still do it even if insurance does not cover it.
« Last Edit: November 19, 2021, 09:29:00 AM by JJ- »

geekette

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Re: Doctor, Pharmacist, Ortho-Important ?
« Reply #11 on: November 19, 2021, 09:32:37 AM »
Are they having you apply ice packs?  That usually helps with inflammation.

Morning Glory

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Re: Doctor, Pharmacist, Ortho-Important ?
« Reply #12 on: November 19, 2021, 09:38:38 AM »
Two years ago I would have been completely shocked that they didn't keep you in the hospital for 3-4 days following this surgery. I know that with covid they are discharging people extremely early but this should involve some home care or intensive outpatient follow-up. I've heard it called "hospital at home".

I'm glad that your PA seems to be on top of things, and is going to get you some safe pain relief soon. Do you have a support person who can maybe deal with this for you, so that you can get some rest?

Extramedium

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Re: Doctor, Pharmacist, Ortho-Important ?
« Reply #13 on: November 19, 2021, 09:42:32 AM »
As an ortho PA, I would second the notion of tons of communication with your surgeon's team, including the PA.  I would also recommend against solutions here in this forum, when you have experts already caring for you who know you in particular and have a formal caring professional relationship established.  If you feel you're not getting enough answers, keep calling, and if that doesn't do it, show up in clinic.  They will want to help you.

Some times all the discussion about postoperative care that happens while planning the surgery can get mixed up.  There's a lot of information that gets thrown at patients all at once, and it would be very unusual for all of it to be retained in memory.  Needing to hear the plan again (and again) is normal, as a stressful event can make planning and understanding a few steps ahead very difficult.  So, check in regularly.

I always tell patients that their coming by for an extra appointment is not getting in the way of me doing my job; it IS me doing my job.

soccerluvof4

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Re: Doctor, Pharmacist, Ortho-Important ?
« Reply #14 on: November 19, 2021, 09:43:53 AM »


I am not researching like WebMD or things like everything you google your going to die. I am not really feeling anxiety but actually pleased as how things are going so far and just being pro-active.

As far as what is in the ball I honestly dont know but I am told that is more a nerve block so has no barring on the opioid benzo issue.

I was just on another phone call right before I logged in to check posts and the PA is really working hard on a solution so that is good as well. I have not had to call them once, when they were called about the rejections they have done nothing but called me and always apologize so I am in good spirits. Just trying to think outside of the box because I wil be going through this on my other knee and I am sure with the commonality of Benzos this has to come up.

Thanks to all so far!

I still don't know what solution you're after as you are not clearly communicating the issue. If you can specify what the problem is you can talk with your care team on whether it is a short or long term issue and what the risks are with managing those issues. You seem to be chasing a mix of meds but for what purpose? Short term pain relief following a surgery? Is the current plan insufficient?

The doctor can still order things for you that are blanket not advised depending on the risks, and you can still do it even if insurance does not cover it.


Dont know how much clearer I can be. Had a knee replacement and the Pharmasists and Insurance company will not fill the Opioid prescription because of a Benzo I take and can not be taken off of. The risks are to high that the Pharmacy does not want to fill it and the Insurance Company does not want to be at risk for the combination. As I have state I have been In constant contact with my team and actually they have been calling me apoligizing for the error so I am just trying to be proactive and reach out to see if anyone knows or has heard of a solution. I cant say if it will be long term or short term because everyones recovery is different but I know my local nerve block will run out midday Sunday and that is when if it is gonna be bad I need to have something to get me through. My pain tolerance is high so I am willing to just try the 3k grams of tylenol a day but the keep saying that if the pain gets to high its a lot harder to back it down. So again this is to be pro-active because of all the reasons I have stated.

soccerluvof4

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Re: Doctor, Pharmacist, Ortho-Important ?
« Reply #15 on: November 19, 2021, 09:48:11 AM »
As an ortho PA, I would second the notion of tons of communication with your surgeon's team, including the PA.  I would also recommend against solutions here in this forum, when you have experts already caring for you who know you in particular and have a formal caring professional relationship established.  If you feel you're not getting enough answers, keep calling, and if that doesn't do it, show up in clinic.  They will want to help you.

Some times all the discussion about postoperative care that happens while planning the surgery can get mixed up.  There's a lot of information that gets thrown at patients all at once, and it would be very unusual for all of it to be retained in memory.  Needing to hear the plan again (and again) is normal, as a stressful event can make planning and understanding a few steps ahead very difficult.  So, check in regularly.

I always tell patients that their coming by for an extra appointment is not getting in the way of me doing my job; it IS me doing my job.


Thank you! and they have been very good to me as I mentioned and want to find a solution I can tell. I feel comfortable with that but i was just hoping someone might of ran into a similar situation because I know I am not there only patient and I am going to have the other knee done so something to think about as well. Good to hear your like that with your patients and I feel they are trying and doing there best but not everyone as you know knows everything so just trying to be helpful i guess

soccerluvof4

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Re: Doctor, Pharmacist, Ortho-Important ?
« Reply #16 on: November 19, 2021, 09:50:25 AM »
Two years ago I would have been completely shocked that they didn't keep you in the hospital for 3-4 days following this surgery. I know that with covid they are discharging people extremely early but this should involve some home care or intensive outpatient follow-up. I've heard it called "hospital at home".

I'm glad that your PA seems to be on top of things, and is going to get you some safe pain relief soon. Do you have a support person who can maybe deal with this for you, so that you can get some rest?


Thanks for asking I am doing pretty good on all the home stuff. Fortunately I have good upper body strength so getting around already has been pretty good so no issues there. Actually so far better than I was expecting. My DW is helping out obviously as well.

soccerluvof4

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Re: Doctor, Pharmacist, Ortho-Important ?
« Reply #17 on: November 19, 2021, 09:53:36 AM »
Are they having you apply ice packs?  That usually helps with inflammation.


Yea i am apply ice packs about every two hours, Keeping it elevated and my neighbor borrowed me an Ice machine which produces cold air for this very surgery. When they called me this morning I mentioned my concern about the swelling and the one thing they suggested was to really try to get me knee a foot above my heart and keep doing what I am doing. I also have a very strong anti-inflammatory they want me to start Sunday that you can only take for 5 days.

JJ-

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Re: Doctor, Pharmacist, Ortho-Important ?
« Reply #18 on: November 19, 2021, 09:56:13 AM »


I am not researching like WebMD or things like everything you google your going to die. I am not really feeling anxiety but actually pleased as how things are going so far and just being pro-active.

As far as what is in the ball I honestly dont know but I am told that is more a nerve block so has no barring on the opioid benzo issue.

I was just on another phone call right before I logged in to check posts and the PA is really working hard on a solution so that is good as well. I have not had to call them once, when they were called about the rejections they have done nothing but called me and always apologize so I am in good spirits. Just trying to think outside of the box because I wil be going through this on my other knee and I am sure with the commonality of Benzos this has to come up.

Thanks to all so far!

I still don't know what solution you're after as you are not clearly communicating the issue. If you can specify what the problem is you can talk with your care team on whether it is a short or long term issue and what the risks are with managing those issues. You seem to be chasing a mix of meds but for what purpose? Short term pain relief following a surgery? Is the current plan insufficient?

The doctor can still order things for you that are blanket not advised depending on the risks, and you can still do it even if insurance does not cover it.


Dont know how much clearer I can be. Had a knee replacement and the Pharmasists and Insurance company will not fill the Opioid prescription because of a Benzo I take and can not be taken off of. The risks are to high that the Pharmacy does not want to fill it and the Insurance Company does not want to be at risk for the combination. As I have state I have been In constant contact with my team and actually they have been calling me apoligizing for the error so I am just trying to be proactive and reach out to see if anyone knows or has heard of a solution. I cant say if it will be long term or short term because everyones recovery is different but I know my local nerve block will run out midday Sunday and that is when if it is gonna be bad I need to have something to get me through. My pain tolerance is high so I am willing to just try the 3k grams of tylenol a day but the keep saying that if the pain gets to high its a lot harder to back it down. So again this is to be pro-active because of all the reasons I have stated.

I would rephrase all of this is "my concern is that when the post op pain management solution runs out, my pain might be too high and prevent me from XYZ. Can we discuss potential solutions and plans for this scenario?"

You may need to fill in the blank whether the current solution is adequate for pain tolerance preferences. You may not know this until it runs out.

Per @Extramedium , just go give a visit. Let them help you.

Cranky

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Re: Doctor, Pharmacist, Ortho-Important ?
« Reply #19 on: November 19, 2021, 10:03:24 AM »
If this is any reassurance I did not find the opioids tone more helpful than ibuprofen. Good luck!
« Last Edit: November 19, 2021, 01:21:13 PM by Cranky »

Dollar Slice

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Re: Doctor, Pharmacist, Ortho-Important ?
« Reply #20 on: November 19, 2021, 10:03:47 AM »
I'm not sure if they offered you one of those ice machines that pumps cold water into a cuff around your knee, but my mom just had her knee done and she loves that thing. She said it really helps with the pain (and swelling). If you don't have one you can order them off Amazon for a couple hundred bucks, I think. I can get the name of it from her if you want, LMK.

They also gave her magnesium supplements that were supposed to do something for pain, but she didn't seem to think they did much of anything. (She was taking oxy, though, so they might have been helpful if she wasn't taking those!)

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Re: Doctor, Pharmacist, Ortho-Important ?
« Reply #21 on: November 19, 2021, 10:14:33 AM »
I had minor surgery a month ago and was prescribed hydromorphone.  It gave me GERD.  I phoned the ambulatory patient number they had given me and the nurse suggested Advil, since both relieve inflammation.  The Advil worked just as well as the hydromorphine.

I'm not suggesting you take Advil instead, since I'm not on the meds you are on, I'm pointing out that there should be someplace to call that can help.  Call them. 

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Re: Doctor, Pharmacist, Ortho-Important ?
« Reply #22 on: November 19, 2021, 10:33:15 AM »
If it's the same in the US as it is where I live, those who, by virtue of their specialization, usually know the most about pain management are anesthesiologists, some of which even have a subspecialization in it (also pain management outside of the hospital, acute or chronic).
So that's who I would turn to if my case was more complicated. Good luck!

Cranky

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Re: Doctor, Pharmacist, Ortho-Important ?
« Reply #23 on: November 19, 2021, 01:27:54 PM »
Okay, now I’m home and not bouncing around on the bus.

The worst day is typically the day that nerve block wears off. The first week is kinda crummy, but it really does get better pretty quickly after that, so you will only have a few days to get through, and I think it helps to keep in mind that the worst discomfort is pretty limited. I seriously only took the oxy for a couple of days because it made me so dizzy.

You will have quite a lot of swelling for a while. Keep your legs elevated. There are wedge pillows for this on Amazon. Use the ice machine. Wear those compression socks. Get up and walk a little every hour.

There’s a knee replacement support group on Facebook that I found a lot more helpful than the giant folder of stuff my doctor handed out.
« Last Edit: November 19, 2021, 02:44:50 PM by Cranky »

soccerluvof4

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Re: Doctor, Pharmacist, Ortho-Important ?
« Reply #24 on: November 19, 2021, 01:28:44 PM »
Thanks everyone for your support and responses. So I called the pharmacist about if I could pay cash for the Tramadel and they said yes. I went and Called my PA and they asked if it was still denied by the Insurance company after sending them my case. I said no. Said they would call me back. About an hour later they Approved the Hydrocodone which is the stronger one and its costing me 4$ and change which as I mentioned wasnt my biggest concern it was the combinations with a Benzo. Anyhow I guess in the situation of combining the too the Doctor has to present the case to the insurance company and the review the case. In cases of Like Cancer and Surgeries with history of "Your going to need this for Pain" in combination with a Benzo they will allow it because there is no alternative. So its resolved and to minimize risk they are giving me tips to do since again that was my biggest  concern.

@Dollar Slice My neighbor just had a total knee replacement and gave me theirs to use. I think because I am just 24 hours out and I have a wrap on it didnt work as well as the ice packs are BUT i plan on transitioning to it once I get this ace off because will be alot more convenient and my neighbor claimed just left it on all day and said feels that is why their recover went so well.


Anyhow thanks everyone. What a circus but all is resolved.

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Re: Doctor, Pharmacist, Ortho-Important ?
« Reply #25 on: November 19, 2021, 01:33:36 PM »
Okay, now Iím home and not bouncing around on the bus.

The worst day is typically the day that nerve block wears off. The first week is kinda crummy, but it really does get better pretty quickly after that, so you will only have a few days to get through, and I think it helps to keep in mind that the worst discomfort is pretty limited. I seriously only took the icy for a couple of days because it made me so dizzy.

You will have quite a lot of swelling for a while. Keep your legs elevated. There are wedge pillows for this on Amazon. Use the ice machine. Wear those compression socks. Get up and walk a little every hour.

Thereís a knee replacement support group on Facebook that I found a lot more helpful than the giant folder of stuff my doctor handed out.


Oh good stuff @Cranky, I will for sure look out that face book page and thanks for the other info.