posted
Hello everyone. I'm writing today with news that will hopefully be able to help a few patients in the DC Metro area (or who are able to travel there).
---Preface---
Both in my personal and semi-professional experience with many LLMDs, I've found that many are lacking in the field of pain management. Pain is a very frequent symptom in tick-borne infections, and the medications we take can put even worse stress on our bodies - some of which even inactivate or limit many pain-management therapies (ie. Rifampin inhibits many oral opiates' uptake by more then 80% in some cases).
While many LLMDs feel their practice is "holistic", I personally find it hard to justify that claim if pain is not alleviated to make the treatment process easier for the patient. I've found some physicians who solely direct patients to either OTC remedies or certain natural supplements and compounds, which for some provide substandard relief compared to other therapies available.
However, many of these other options are controlled substances, office procedures (trigger point injections), and other option that require more time, management, and oversight. I get the impression from many of the LLMDs I've spoken with or been treated by, that they just don't see these as part of their view on the therapy. The most legitimate reason I can postulate is that they either do not feel they have the expertise and time to implement these sorts of treatments in addition to the normal Lyme complex treatments, or they fear the additional oversight that it would bring specifically in the prescribing of controlled substances. Unfortunately, I also have met those that seem to either be biased against these therapies or feel it somehow undermines or insults the complimentary pain relief treatments, which I don't feel is appropriate and sets back acceptance in the medical community as a whole.
No matter what, I believe that all physicians treating chronic, painful conditions should feel an imperative to help their patient find /sufficient/ relief. Thus, if many primary practitioners don't feel comfortable or capable, the correct method of action is to provide a referral to a specialist the LLMD maintains in their "referral base" (Typically, most physicians have colleagues who they refer to when their specialty is needed, and vise-versa)
Those that treat protracted and severe pain as a specialty are called "Pain Management Specialists" These physicians are typically practicing Anesthesiologists (The doctors that handle everything associated with all forms of sedation, from general anesthesia and monitoring for major surgery, to nerve blocks to relieve pain while setting a fracture to right) who undergo additional training after their residency - a "Fellowship" in Pain Management. There, they are given a comprehensive education in treatment options for chronic or especially severe pain that extends beyond the expertise of other physicians. After the completion of their Fellowship, many join or open Pain Management Practices that cater to patients in their area. There, they provide advanced therapies to help give patients more functionality and a better quality of life.
I just wanted to give some background prior to my announcement information, so I hope that light overview answered any questions. If you have any further questions, don't hesitate to ask. Now, onto the important stuff.
---End Preface---
-----ANNOUNCEMENT----
Today I spoke with a physician at an excellently-staffed pain-management center in the DC Metro area, with whom I have a good rapport personally and professionally. I've also received treatment there myself and can attest to their compassion and professionalism
They currently treat a very small amount of Lyme patient's pain, besides my own. Learning this, I inquired about their patient load and if they'd be willing to see additional patients with Lyme complex and associated issues(Fibromyalgia, Chronic Fatigue, MS, Co-infection pathogens etc...), explaining that between the attitudes of some LLMDs and the unfortunate pain specialists who believe the IDSA party line as it applies to Lyme (I've met none personally, but I've spoken with those patients who have), that many chronic Lyme patients are under-treated with regard to pain management.
The doctor replied to the affirmative and permitted me to refer interested patients in need to their office for evaluation. What follows is some basic information and the process that I think will make it the safest and quickest for all of you, me, and the practice.
First, I'll give as much information as I can publicly, about the practice. Those interested are welcome to ask any other questions and I'll try to help.
1. Location - They operate a few offices in the DC Area. There are those in Montgomery County, approximately mid-county in a suburban area with an excellent nearby hospital and many biotech companies. There are also others in the southern part of Frederick Country.
2. Insurance and Payment - I know for a fact they take BlueCross plans and I believe they handle most major insurance, including Medicare. Medicaid however, or Medicaid HMO is likely not participatory. If you have a particular plan that you'd like me to check, or wish to speak to the office directly, I'm sure we can figure something out. Please remember if you have an HMO, you need an actual referral from your primary care doctor and to check if this practice is covered in network. Those with PPO and indemnity can just make an appointment and go, if their insurance is accepted. For those without insurance or with a type that isn't accepted, don't be afraid to mention it. The staff will be more than happy to work with you to provide a payment plan to your needs and ability.
3. Documentation - For the purposes of documentation and evaluation, patients will require notes/reports and diagnoses from their primary physician. Note, this is not the same as a referral. Ask your LLMD for some of your records and feel free to bring in any lab or scan reports that help to illustrate your illness. Be sure to ensure contact information for one or more physicians treating you is available, should the office wish to call to discuss your health.
4. Scheduling - If you decide you are interested and after we talk via PM, I'll provide contact info so you can schedule with the office. Your initial visit will probably at least be 45 minutes and if both you and the physician you see agree that there is benefit for you in a treatment plan, you will likely need to return with at least some frequency, especially if your treatment plan includes certain controlled substances. Every case is different, but an office visit (insurance covered) once a month is the "norm". If you can't make it that frequently or are a self-pay and the expense would be very stressful, again mention that to the physician and/or staff so that they can work with you to find a plan that fits. Also, please note there are a number of doctors in the practice, as well as nurse practitioners.
5. Evaluation - Please understand that I am not promising anyone or everyone acceptance of treatment. If you choose to make an appointment and one is granted, it will be up to you and the doctor evaluating if it will be in your best interests to undertake the treatment protocols they provide. If for any reason either you or the physician don't feel that the practice is a good "fit" for your particular health needs, that's quite alright. What I can assure you though, is that I can't imagine anyone at that practice turning away a Lyme patient or discarding their pain.
5.5 - Drug Tests. You will likely have to give a urine sample if any controlled substances are a part of your plan, and then again at certain intervals or randomly. This is a VERY "high-end" urinalysis which makes it 1) Unfortunately expensive, if paying out of pocket. $300 or so and 2) Extremely accurate and practically unable to fool. The best thing I can say is to offer total and complete honesty with regard to any medications you take - even those that may not be legal in all states or that you have "left over", may not be your prescription (ie. Sometimes use a relative's valium to help get to sleep etc..). With honesty your individual case will be evaluated and there's a chance the office will work with you, but should you ever try to hold back or lie regarding anything abusable you take, you will not be able to continue treatment - its too much of a liability to have a patient proven untrustworthy.
Finally, Safety - Some may wonder why I don't simply provide the practice's information outright, but I don't feel that is an ethical choice. Let me assure you that I am not trying to act as a control-freak gatekeeper, but simply doing my due diligence to find those who are seeking to visit for the right reasons.
Every pain management clinic (and truthfully, every physician who prescribes controlled substances), has to worry about those that abuse these medications. Unfortunately, laws (especially in Maryland recently) are so strict and politicians beef up their campaigns by being "tough on prescription drug abuse" and passed a law that really does nothing to deter actual abuser but makes it more stressful for compassionate pain specialists and their patients alike. This is one reason that documentation of diagnosis and treatment is so important, as is confirmation with the drug screening (and the honesty as I mention above).
On a personal note, the Physician I speak with has granted me a great deal of personal and professional respect by allowing me to refer new patients to his office. Thus, it would be remiss of me to repay his faith in me by just listing the information on a forum and being done with it. I owe it to him to do my due diligence in attempting to ensure those interested have at least been lightly vetted. I also feel a responsibility to the Lyme community as a whole to ensure that legitimate patients are presented. The last thing the community needs is to have our very real need for pain management blighted because of a few abusers use our ailment in their drug-seeking behavior.
I'm certain that the vast majority of Lymenet, and all Lyme patients as a whole are highly unlikely to be abusers and dealers, but just in case anyone is reading this with the intention to abuse or sell please consider the following:
Please don't make life harder for patients who have already suffered under a poorly understood group of illnesses, by casting dispersions on their authentic pain relief. I won't lecture on life choices, but find another vector that doesn't harm the ability of patients with a legitimate need. For those that lack any compassion for the ill and need a more pragmatic reason: You'll likely fail. Reputable clinics have people far, far more adroit than I over the internet, in vetting abusers. For those faking, Lyme and associated illnesses will NOT get you what you're looking for for a number of reasons.
To all the patients here who are simply looking for help, I'm sorry I had to take so much time writing such unpleasantness. Neither I nor the practice takes a suspicious stance by default regarding patient inquiries, its just a sad necessity these days.
So in summation, for those interested or who have more questions, please send me a PM! Please note that I may not be able to respond the same day, but I'll make every attempt to do so promptly. If you've not heard back within a week, message me again.
Thank you, and I hope I can set some patients on a path that, for myself, provided a great asset in my continued fight against illness.
Posts: 690 | From East coast, USA | Registered: Jun 2006
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