Dear Amber:
I wanted to clarify a couple of things:
1. With the MS Contin you may find that you do NOT need to increase to three times daily after 5d - let me know if you do
2. Please contact me after taking your first dose if this medication is too strong
3. Please DO NOT use any percocet for breakthrough pain if you do not need it.
4. As we discussed - discontinue methadone
Please check in with me tomorrow.
``````````````````````````````````````````````````````````````````````````````````````````````````````````````Dr. C,
My pharmacy has been unable to fill the Oxy.&Perc.. I was told by the pharmacy staff that Medi-Cal requests further info from you, but they have been unable to reach you. You can contact them at 707-446-2400. My last name in their system is "Reeder-Bedford." Also, if these meds are unable to be filled by Friday, I will be completely out of Meth.. I have only enough tabs to last me til Friday night's dose. In that case, what would you suggest I do if I run out and am not able to get Oxy. & Perc. filled? . . .
You seemed to suggest that the dose of Oxycontin 15mg 2xper day might be too strong of a dose. Do I need a smaller dose, eg. 10mg 2x or 3xperday? Or is the 30mgOxy. equivalent to 35mg Meth. I'm currently on? . . .
Also with the Perc., I had the understanding that I only need to take that for breakthrough pain; if the Oxycontin was unable to cover my episodes of major pain. I don't need to take it otherwise since the Oxycontin should be enough to cover the pain.
-Amber
```````````````````````````````````````````````````````````````````````````````````````````````````````````````````Hi Amber,
I contacted them yesterday and they needed prior authorization requested which I had them fax to me, I filled them out and and sent them, I also notified our authorization person. Our office had no records of receiving phone calls or any notification from the pharmacy or Medi-Cal, nonetheless it is completed now. There is no specific dose conversion for MS Contin, but this should be fine (I don't think there is a smaller dose), so just start with 2 tabs a day and go to 3 if needed.
````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````````Dr. C,
I googled Oxycontin and the lowest dose they have is 10mg tabs. Is there any risk of the 2- 15mg doses per day being too large of a dose? I would much rather take too small of a dose an need to take the Percoset than have the initial dosage be too high. I will start with the two tabs of 15mg if you think that is the correct dose for me.
When I went to the pharmacy today they said that I will be able to pick up the prescription tomorrow, Thursday, and that I have 3 to pick up: Oxycontin, Percoset, and Morphine. I only had dropped off a prescription for the first two. Where did the Morphine come from and would that not be waaaay too many medications for me to be taking?
-Amber
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Amber,
Per the pharmacy formulary the lowest dispensible dose of MS Contin (which is the long acting Morphine Sulfate is 15 mg); For Oxycontin there is a 10 mg dose but the medication I ordered is the MS Contin formulation. Taking it twice a day should not be too high. You can hold off on the third dose if you do not need it. I have no idea where the additional prescription Oxycontin came from came from. The prescriptions I wrote were for:
1. Morphine (MS CONTIN) 15 mg SR 12hr Tablet
2. Percoset 10/325
I have copies of the Rx I wrote. I have no idea about oxycontin
``````````````````````````````````````````````````````````````````````````````````````````````````````Dr. C,
Okay, so MS Contin is NOT the same as OxyContin. I was thinking it was the same medication. So for clarification, I'll be taking the MS Contin (which is also called Morphine Sulphate) 15mg and the Percoset 10/325. And the random OxyContin is the prescription I will NOT pick up from the pharmacy.
Thank you for clarifying. Now I get to talk to pharmacy and get it straightened on their end!
If I'm able to start the Morphine Sulphate today, I'll message you tomorrow letting you know how things are going.
-Amber
`````````````````````````````````Dr. C
Just so you know my plan, if my meds aren't filled by tomorrow at 2pm I will be headed to L&D to get help there. I don't know where this medication problem is coming from but there is nothing that I can do to make things better and I can't be missing doses due to the risk to baby and my pain level has been steady at level 8+ since yesterday evening. I've been up all night in pain and these issues with the pharmacy are only making my pain issue and baby's potential issue even worse.
It shouldn't have to take 5 days to fill a prescription especially when the prescriptions are being written for specific days and I can't fill early at all. Taking this to the very end of my week's worth of pills is so not cool.
-Amber
``````````````````````````````````````````````````````````````````````````````````````````````````````````````I am sorry Amber there is nothing I could have done to speed the process up. As soon as I received your message I placed the authorizations. I just contacted the number on the claim form and there is nothing I can do to speed the process. I agree you will need to be seen urgently if your meds are not filled
I actually did not date your prescriptions to be filled at the very end of this of this week. I dated the day they were written specifically to allow additional time. The pharmacy should have copies of the prescriptions, they were not written to be filled late they were dated 5/28/15. Given that at this point I have not been able to find an adequate regimen for you, if this does not work and you do not receive your medication, you will have to be evaluated urgently and I will place an order to pain management clinic specifically for transfer of care for your pain management so that you have a specialist specifically in pain management managing your care. I am sorry we have not been able to control your pain adequately, but we can get you to an appropriate provider.
Thanks, Dr.C
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Really? Wow.. It's taken MONTHS and all this hassle and she finally wants to/gives the option of me being managed by someone who knows what they're doing? She should have done this MONTHS ago when I complained of my pain not being controlled.
She wrote the prescription for 5/28 and I dropped it off the same day. But it's taken her until today to get all the paperwork into the pharmacy... That's so not allowing for enough time to fil the prescription.
Asking questions about why pharmacy needs extra paperwork/information and giving authorization for one prescription at a time over a 3 day span... nope. that's not doing it.
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