I’m Not a Junkie
As a person who has never even experimented with hard drugs, it seems strange that I should find myself feeling defensive about my “drug habits,” yet recent interactions with my rheumatologist have left me feeling like I need to scream to him, his nurse, and to the world, “I am not a junkie!”
Diagnosed with rheumatoid arthritis 14 years ago, I’ve been prescribed somewhere between one and two dozen different medications to treat the disease and its symptoms. For ten of those years I was treated by a rheumatologist I loved. She couldn’t have been more compassionate, understanding, informative, and perceptive. Unfortunately, her office is 70 miles away and her office staff was so persistently disorganized that it was very difficult to get a human to answer the phone, let alone have the nurse return a call. Because I loved my doctor so much, for years I put up with having to repeatedly call the office for an hour straight before getting an answer, placing the same request 5-6 times before getting an adequate response, and waiting in the office for two-three hours before each exam. However, now that I have two small children who use up what little sick leave I’m ever able to accumulate with their tummy bugs and fevers, I just couldn’t make it work to stay with my beloved doctor, seeing as how every check up with her required six hours for the commute, wait time, and actual visit.
My former doctor never had any issues prescribing medications to increase my comfort. She suggested Lortab and Tramadol for pain, Flexeril for muscle spasms, and Trazadone for sleep. I have used these medications sparingly, and I frequently flush expired medications down the toilet and have refills available that go unfilled. If I can get by without them, I prefer not taking those medications. The side effects of painkillers and muscle relaxers reduce my productivity, leave me in a fog, and don’t allow me to be fully present while parenting. Therefore, I only take them if I’m in a lot of pain and my husband or a sitter is home to watch the kids (or at bedtime). All that being said, when I am in a flare, a painkiller or muscle relaxer can make the difference between agony and a bearable level of pain. Even if I’m not in a flare, RA aches often make it difficult to get comfortable enough to sleep, so about three times a week I take Trazadone to help ease me into slumber. These drugs are not an everyday regimen, but they can be very important during the times when I need them.
Unfortunately, my new rheumatologist doesn’t seem to understand that. I switched to him about a year ago, and in many ways I’ve been happy. He is knowledgeable about the newest RA research, is very attentive, his office is located 10 minutes from my house, and his office staff is exceptional and incredibly responsive. Yet, I don’t always find that he is as responsive. When I switched to his practice, I brought my entire medical records from my former rheumatologist (I didn’t trust her office staff to send them over, so I couriered them myself). My new doctor keeps medical records in an online format as well that I have access to, so for over a year I’ve seen Flexeril, Tramadol, and Trazadone listed as inactive prescriptions (because I don’t use these medications frequently, I had months of refills remaining, and had not had to request a prescription from him). However, once I needed these medications, it seemed like my medical history went out the window.
My new rheumatologist was willing to continue the Trazadone without complaint. Yet, when I requested Flexeril, he said that he couldn’t prescribe both the Flexeril and the Trazadone; I would have to choose one or the other, and should consider requesting one from my general practitioner. At the time, my sleep needs overshadowed my muscle spasms, so I continued with the Trazadone. However, a few weeks ago my shoulder and neck became so tight I could barely turn my head. This quickly led to pain in my shoulder and jaw joints on that side of my body. I alternated heat and ice, stretched, and went to the chiropractor, but my muscles just wouldn’t release. I called his office and said that my need for the Flexeril now exceeded the need for Trazadone, and asked if he could discontinue the latter in order to prescribe the muscle relaxer. He told me that he could not, and said I should go to my general practitioner for both of these medications. I was surprised that there was a problem prescribing meds that I have taken off and on for many years, and having to make an appointment with my GP added two days to my wait time before I got some relief. Fortunately, my GP was more responsive than he was and had no issues prescribing both meds, the Flexeril did indeed prevail in finally allowing my muscles to release and stop tugging on my joints, and I started to regain range of motion and comfort.
There was another occasion when I was in a lot of pain, and I was in need of Tramadol. Fortunately, for several months I was able to cope with pain with only high doses of ibuprofen, and I hadn’t realized I had let my prescription for Tramadol lapse. When I called my pharmacy for a refill on my empty bottle, I was informed that it had been longer than six months since my last refill, so I needed a new prescription. I called my rheumatologist’s office and requested the medication, but was told that he couldn’t prescribe it without coming in for an exam (even though I had just been in two weeks prior), and the earliest available was the following week. I was in intense pain that day, and couldn’t wait a week, so I dug through my medicine cabinet and found a bottle of Lortab and took one of those. I experience much more significant side effects from Lortab than from Tramadol, so I only take it when the pain is excruciating. However, without an option available, I opted for the loathsome Lortab side effects.
My next appointment with my rheumatologist is in a few weeks, and I’m preparing myself for a conversation about the legitimacy of my need for the prescriptions I’ve requested. I want to understand his rationale, and I fear that his reluctance to prescribe palliative medications is due to my relatively young age. While I understand it is a doctor’s responsibility to factor in the potential reliance and abuse some patients develop with prescription drugs, and I am indeed still in my thirties, I think my disease activity and my history with these drugs has to be taken into consideration as well. When taking into account how rarely I take these medications, I feel like my current defensiveness about my need for them has nothing to do with potential abuse on my part, but rather about a lack of compassion on my doctor’s part.
Right now, what RA tips would most be helpful for you?