Blatant discrimination and faulty science

http://www.pressherald.com/2016/03/27/maine-health-officials-working-to-prevent-unintended-consequences-from-opioid-prescribing-bill/

Dr. Christopher Pezzullo, Maine’s chief health officer, said the dosage maximum is important because the science does not support such high doses. The dosage cap of 100 morphine milligram equivalents proposed in the bill closely coincides with U.S. Centers for Disease Control and Prevention guidelines on prescribing opioids that were released last week…

Pezzullo pointed to recent research that shows over-the-counter pain medications are more effective than opioids at controlling pain…

As far as I can tell, this doctor is referring to a paper by this man at the National Safety Council, an alleged “nonprofit, nongovernmental public service organization.”

Donald Teater is responsible for advising National Safety Council advocacy initiatives to reduce deaths and injuries associated with prescription drug overdoses. Teater is a patient advocate who specializes in psychiatric services and opioid dependence treatment. Prior to joining NSC, Teater held positions at Blue Ridge Family Practice as a physician, and at the Mountaintop Healthcare and Good Samaritan Clinic of Haywood County as a physician and medical director. At present, along with his role at NSC, Teater treats opioid dependence at Meridian Behavioral Health Services and Mountain Area Recovery Center, along with volunteer work in the field.

Looks like Kolodny from PFROP has been cloned. From the National Safety Council Wikipedia page:  “The Board of Delegates develops the mission agenda, creates public policies, and tracks safety, health and environmental trends.” It seems everybody’s on board for the opioid war.

Click to access Evidence-Efficacy-Pain-Medications.pdf

For example, when testing pain medications, the intervention is the dose of pain medication and the effect is usually 50 percent pain relief. Fifty percent relief of pain is considered effective treatment, allowing people increased functional abilities and an improved quality of life (Cochrane. org, 2014). So the question becomes, how many people must be treated with a certain dose of a medication for one person to receive 50 percent pain relief (effective relief)?

The whole white paper is based on this notion that pain medication can be 50% effective, and that it’s only effective if the patient experiences 50% relief. How many patients experience 50% relief with drugs? It can’t be that big of a percentage, because 50% relief seems almost miraculous to me. Most chronic pain patients, including me, estimate relief derived from drugs at 25% to 30%.

Dental pain:  A recent review article in the Journal of the American Dental Association addressing the treatment of dental pain following wisdom tooth extraction concluded that 325 mg of acetaminophen (APAP) taken with 200 mg of ibuprofen provides better pain relief than oral opioids. Moore et al. concluded, “The results of the quantitative systematic reviews indicated that the ibuprofen-APAP combination may be a more effective analgesic, with fewer untoward effects, than are many of the currently available opioid-containing formulations.” (Moore, 2013, p. 898)

For one thing, there’s usually an end to dental pain, especially wisdom tooth extraction (although some patients experience phantom tooth and nerve pain afterwards). And the key words here are “with fewer untoward effects, than are many of the currently available opioid-containing formulations.”

Sure, for acute pain, the effects of taking over-the-counter drugs is mostly positive. That is, if they work. If a dentist told me to take Tylenol after a wisdom tooth extraction, I’d tell him to fuck off. No, before the procedure, I’d find out what the pain management program was going to be, and if I didn’t agree, the wisdom teeth would stay in.

The problem is the long-term effects of taking these drugs (along with their efficacy), although doctors don’t seem to care about that. Or else, they care more about the “epidemic” of addiction than the damaging results of long-term use of OTC drugs.

http://www.nsc.org/learn/about/Pages/Over-the-counter-pain-medications.aspx

(10/6/2014) National Safety Council: Over-the-counter pain medications are more effective for acute pain than prescribed painkillers

In certain circumstances, opioid painkillers are an appropriate treatment option. NSC Medical Advisor Dr. Donald Teater points to research showing short-term opioid painkiller use can be helpful when treating patients recovering from surgery. These medications also can be effective in treating chronic pain associated with terminal cancer because opioids have positive psychotherapeutic effects that help offset depression and anxiety.

So, cancer and terminal patients deserve these psychotherapeutic effects, but chronic pain patients don’t? This is what you call discrimination against the disabled.

The new standards would allow for exceptions for end-of-life care, palliative care, cancer pain and potentially other diagnoses. Also, those currently on higher doses – the 16,000 taking more than 100 morphine milligram equivalents per days – would be given until July 2017 to taper to lower doses.

This reminds me of medical cannabis programs, all of which have a list of qualifying conditions. Is there a list of qualifying conditions for other drugs? Yes, now for opioids, thanks so much to all who have contributed to this blatant discrimination.

Nobody Puts Baby In A Corner

(Photos taken 3/28/2016.)

Find The Bee

(Photos taken 3/24/2016.)

What Do I See? Take a walk with me…

Yes, I’ve been bribing the squirrels. Hopefully, carrots are good for squirrels, too.

Just doing my part to further human-animal relations. 🙂

I see that the Tumbleweed Invasion of 2016 is alive and well.

And I’m thinking maybe I should become a Bandido.

I see a bumper sticker that makes me smile. 🙂

Ah, yellow.

Same leaves, different background. Just because.

Oh, look! A new weed to explore!

I hear the dog before I see the dog.

Since I don’t understand dog language, I can’t interpret his barks. But he doesn’t appear to enjoy my company.

Ah, a protective bark. Poor babies, your home looks crowded.

In New Mexico, jets in the sky are pretty much a daily occurrence.

I’m sure we’re all tired of seeing these photos. Perhaps things will be different in my new place.

Just a portrait of American Misery, I suppose.

Plastic, plastic everywhere.

Seems like nobody cares.

But there’s beauty to be found, if one dares.

Among the rubble and sadness.

There’s always yellow.

Sadly, I see that my starfish is beginning to look like Donald Drumpf. (And there’s always laughter.)

And life goes on. 🙂

(Photos taken this week.)

#WWJD?

http://america.aljazeera.com/opinions/2016/2/trump-might-be-fine-with-torture-but-most-americans-arent.html

Support for torture is particularly strong among Republicans: In the 2015 poll, for example, a hefty 73 percent came out in favor, compared with 46 percent of Democrats. Moreover, after the terror attacks in Paris and San Bernardino late last year, Americans are particularly concerned about national security…

But there is more to these polls than meets the eye. Those who do back torture tend to support its use in exceptional circumstances, such as the “ticking time-bomb” scenario, when a bomb is about to go off and torture is required to find it. When politicians say they will reauthorize the rough stuff, it is usually for such restricted situations. While this might amount to occasional support for harsh methods, it is hardly the same as unqualified enthusiasm. So, a CBS poll from 2014 found that 49 percent of Americans thought enhanced interrogation techniques were “sometimes justified,” versus 36 percent who did not…

I don’t know why so many Americans still believe that torture works. I know what torture feels like, even if I’ve never been waterboarded.

Keep in mind, when you support torture — in any circumstance — our enemies then have the right to do the same. And eye for an eye, right? Anyway, we don’t need to understand our enemies when we can bomb the shit out of them from the sky. Or when we can lock them away in prison.

At the New Hampshire debate, for example, Cruz said he wouldn’t bring back enhanced interrogation in any sort of “widespread use” because “bad things happen” when it spreads…

Too late, dude.

So, torture supporters, I’m just wondering:  What would Jesus do?

John Void
I wouldn’t have tortured him, but if Trump insists on volunteering to be tortured, I won’t stand in the way. I mean, if that’s what he really wants. As long as he’s not hurting anybody else, I’ll try to be open-minded about his lifestyle.

Words to live by

Come and get me

Wed, Mar 30, 2016 1:17 pm
From: painkills2@aol.com
Re: Illegal eviction
To: vistasmanager@crhmi.com, vmanager@corerealtyholdings.com
Cc: customercare@crhmi.com, egoodman@crhmi.com, dmorehead@crhmi.com, dougmorehead@crhmi.com, info@corerealtyholdings.com

Ms. Buchman,

I am in receipt of your letter dated today, which was taped to my door, again requesting a doctor’s certification of my disabled state. As I mentioned in a previous email, if you’re willing to pay for a doctor’s visit, then I can satisfy this unreasonable request.

Contrary to your assertion that I did not respond to your letter of 2/25/2016, please see my email of 2/25/2016, posted here:

https://painkills2.wordpress.com/2016/02/25/go-ahead-screw-me-over/

The move-in date for my forced relocation is April 3rd. If you’re unwilling to accommodate this schedule, I suggest you start eviction proceedings. See you in court. (Looking forward to it.)

Johnna Stahl

Also posted at painkills2.wordpress.com

PPP :)

Featured photo taken yesterday.

Pay day seems so far away…

Crop Til You Drop

(Photos taken yesterday.)

Take out your heating pad

http://well.blogs.nytimes.com/2016/03/25/seeking-painkillers-in-the-emergency-room/

(3/25/2016) Seeking Painkillers in the Emergency Room, by Helen Ouyang, M.D.

Helen Ouyang is an emergency physician at NewYork-Presbyterian Hospital and an assistant professor of medicine at Columbia University.

Physicians need to know that if they don’t prescribe a narcotic because it’s not clinically indicated, or worse yet, because the patient already has an addiction problem, that they have the backing of administrators at every level, from their own department to the head of the hospital all the way up to state officials. If patients are seeking narcotics and have a documented history of doing so — and become combative or refuse to leave after discharge — they may need to be escorted out of the emergency room by security and their treatment terminated to avoid interrupting the care of other patients…

I’m guessing that every patient who has been diagnosed with — and given the label of –“chronic pain,” has a “documented history” of “seeking narcotics.” When someone is in enough pain to seek medical attention, what do you think they’re looking for? A heating pad?

Will this include any patient who asks for painkillers any time in their lives? If you ask your dentist for some Vicodin after you have a cavity filled, will he write that in your electronic health record? “Patient was seeking narcotics.”

This is what I want pain patients to know: If you go to the emergency room for any reason, keep in mind that you will no longer be able to complain about doctors refusing to treat your pain. No one in the administration of the hospital will help you (unless you have connections).

For those patients who don’t suffer from chronic pain, you will face the same problems. A doctor refuses to treat your pain? Too bad. A doctor refuses to treat your pain for hours and hours, so that she can determine your addiction potential before giving you an opiate? Well, the pain didn’t kill you, did it? Shall we depend on our legal system to put a price on your suffering?

Under comments:

Joe Snyder, Houston
Cartilage in both knees are gone from jogging in early ’70s. Synvisc (hyaluronic acid) injections had limited effectiveness in quelling pain, and less so, as time went by. I have high pain tolerance (I.e., hobbled about with ruptured Achilles’ tendon for several weeks before diagnosis). I was able to tolerate knee pain during the day at work, but at bedtime I became more conscious of the pain and had trouble sleeping. All I required was a small, occasional dose (1-2 times a week….maybe) to allow a semblance of proper sleep time. The two “pain management” docs I saw were glade to take my personal info and charge Medicare (>$600) for a single office visit; and, then deny further “treatment”. Frustrated and sensing few options I had Total Knee Replacement a year ago. Not much improvement. I feel that if I was prescribed a small quantity of (in my case hydrocodone/ acetaminophen) I could have avoided a very risky surgery. I am a 75 years old semi-retired pharmacist.

Mary DeForest, New Mexico
I guess this is a Prebyterian problem. I can’t get anything for pain for obvious trauma, like being attacked by dogs. I had part of my nose-including bone-removed, a section of my lip, and tissue between those 2 places removed. I was in agony, and I had nothing for the pain. Presbyterian is cruel. I’m told that it is because I’m a senior citizen and they don’t want me addicted at this age. I don’t even take NSAIDs because of stomach problems and gastroentology keeps telling other doctors to tell 60+ patients to take NSAIDs, because of internal bleeding.

rebecca
Sometimes those of us in chronic pain end up in the ER because our pain spikes and the meds we *have* are no longer sufficient to keep it under control. Chronic pain isn’t a steady state, it has peaks and valleys. Sometimes my migraines are worse than others. Sometimes I can get rid of them with the meds I have, sometimes it gets bad enough that I need stronger medication, and the only place for that is the ER. I do get meds from my pain specialist, but he tells me to go to the ER when those stop working, so what should I do?

Your doctor tells you to go to the ER because he doesn’t want you calling him when you’re in a flare. Because he won’t help you, just like the ER will no longer help you. You asked what you should do, when the answer is obvious to me:  All these “experts” are telling you to suffer. And to stop asking for help, because they refuse to give it.

Samer, Illinois
Government agencies played a huge role in creating the problem during my medical school years and residency “pain is the fifth vital” was pounded in…

Many doctors blame the fifth-vital-sign procedure for drug abuse and addiction, as if that makes any sense at all. And, pray tell, what’s the alternative? Doctors should stop asking patients to rate their pain? Just like Medicare should stop asking patients to rate their doctors, right?

Health Nut, Minnesota
Working in the medical field, I disagree that the fault of opioid abuse falls into the hands of physicians. I remember our hospital being “written up” by the insurance companies for not providing total pain care of our patients as our ER physicians said this was going to happen if we complied with federal government in management of pain. We offered non narcotic pain relief and counseling instead. But the government forced our hand on this issue. We are, once again, acknowledged for our low patient satisfaction scores for our decreased opioid use in our ER. Its been a lose-lose situation for us, and I can imagine, most hospitals!

An insurance company writing up a hospital for not following federal guidelines for the management of pain? Huh? I’m too tired to look up the specifics of these guidelines, but as far as I know, it’s mostly about doctors rating patients’ pain as the fifth vital sign. But that’s not only a requirement of the federal government, it’s also followed by international organizations, too.

I’m sure there are a small percentage of ER patients who are just looking for drugs to treat an addiction, but the majority of people who are forced to go to the ER are not drug addicts. People use everything they can to manage pain, including over-the-counter drugs, ice, heat, etc., before they even get to the ER. So, an ER offering only “non-narcotic pain relief and counseling” is the stupidest thing I’ve ever heard.

And then, when you place blame on low patient satisfaction scores, you’re basically just blaming the patients for not agreeing with your anti-drug ideology. You mean patients in pain are not satisfied with anti-inflammatories and counseling? Gee, who would have thunk it?

Briam, usa
The heroin dealer around the corner won’t say no

Honeybee, Dallas
Then let them go to the heroin dealer.
But remember that 9 out of 10 won’t to a heroin dealer.
Instead, they will go through withdrawal and get their lives back.

Yes, it’s probably true that 9 out of 10 patients denied treatment for pain won’t go to a heroin dealer — it’s not like they’re easy to find. But suggesting that most patients who go through withdrawal will then get their lives back is utter nonsense. In fact, when it comes to the treatment of addiction, the opposite is usually true — those who experience the torture of withdrawal are usually even more motivated to relapse.

Let’s see what else Honeybee has to say, shall we?

Honeybee, Dallas
To be fair, it doesn’t sound like any legitimate user is going to be denied any drug.
I don’t see the problem. Yes, there will be a few more hoops, but nothing ridiculously unreasonable. Huge mistakes were made with alcohol and tobacco; I’m glad the govt and the doctors are trying to prevent a similar disaster with opioids/opiates.

I suppose there will be a lot of people who refuse to see the problem — that is, until they experience the problem for themselves. And it’s unreasonable to compare alcohol and tobacco to opioids, just like it’s unreasonable to compare opioids to cannabis, especially when we’re specifically talking about the potential for addiction. This is a person who obviously believes the drug war has been a success.

Honeybee, Dallas
Note how many of the chronic-pain claimants have a host of other health issues and constant problems abiding by the simple 30-day refill policies (“I got sick” or “I went out of town” or “The pharmacy charged too much”). This is textbook addict behavior and addicts want their drugs on demand with no questions asked, no hoops presented.

So should the doctors enable the addict or cause them to suffer withdrawal? Objective observers will say to step the addicts down gently but firmly. Yes, they will suffer. Yes, their pain will feel worse. But they will survive. Cutting them off is necessary, but we also need to help them withdraw.

Hillary Clinton, is that you?

familydoc, brooklyn, NY
I reach for narcotics rarely now and haven’t found my patients to be in more pain. It may sound lame to hear doctors recommend therapy, heat and a variety of complementary approaches to pain but I’ve found it returns patients to functionality faster than masking the pain with narcotics…

Perhaps your patients stopped complaining to you about their pain, or maybe they see a different doctor when they’re in pain. Perhaps your patients have learned to find their pain relief elsewhere, instead of from their doctor.

What sounds lame is to pay a doctor to tell you to plug in your heating pad. Too bad you can’t take a heating pad wherever you go, right? You went to medical school for that? I’m paying you to refer me to a heating pad and a therapist?

(It’s like these doctors have never heard of the internet, where advice is plentiful and free.)

I think it’s hilarious that doctors have created their own downfall, making themselves obsolete. Just freaking hilarious. 🙂

“I am of the light and the air”

Kate’s words. My photos. 🙂

https://katemcclelland01.wordpress.com/2016/03/26/today-i-realized/

As always, thanks for viewing.

A Visit From The Easter Bunny

Saturday’s Sunrise.

Can you see the Easter Bunny?

Can you see her now?

(Photos taken 3/25/2016.)

http://mic.com/articles/138973/why-do-people-paint-eggs-for-easter-the-tradition-is-more-multicultural-than-you-d-think#.8TJu7eGAt

According to the History Channel’s website, painting hard-boiled eggs was originally a Pagan tradition: “The egg, an ancient symbol of new life, has been associated with pagan festivals celebrating spring.”

http://www.bloomberg.com/news/articles/2016-03-25/cage-free-eggs-may-be-golden-goose-for-retail-profits

Consumers usually pay more than twice as much on average for cage-free eggs, $3.42 a dozen, versus conventional eggs, which cost an average $1.31 to $1.45 per dozen, according to the U.S. Department of Agriculture. But cage-free eggs only cost about 15 cents more to produce than conventional eggs for farmers…

Again, Men

http://distractify.com/humor/2016/03/26/absurd-headlines-40

N.J. doc has elaborate excuse for how his semen got on patient, report says

A doctor from Montclair accused of ejaculating on one of his patients claims that his semen may have gotten onto the 22-year-old woman because he forgot to wash his hands after masturbating, the NY Post reports.

Dr. David Newman, 45, told cops that he masturbated in the lounge before treating the woman for shoulder pain at Mt. Sinai Hospital in Manhattan on Jan. 11, according to The Daily News…

On a lighter note:

This Charity Bookstore Is Begging People To Stop Donating Their Copies Of ‘Fifty Shades Of Grey’

Men

Wife ‘ripped off husband’s testicles after he refused to do housework’

His wife, Marinela Benea, said she was fed-up with being ignored by her husband. She said: ‘Ionel had been given a bottle of wine for a day’s work instead of getting paid, and had arrived home drunk. When he gets drunk, he changes. All night he made me keep the fire on because he was cold and I did it to avoid having an argument.

‘In the morning I opened the curtains and told him to go out and do some work, or at least to help with the household chores but he shouted that I’m not entitled to give him orders. ‘I told him he was not any kind of man and I grabbed his balls. It was not my fault that he pulled away, and that’s when it happened…

Afterwards she remained unrepentant, saying that she obviously did not know her own strength and that he deserved what had happened to him…

I would never do something like this. Really, I wouldn’t…

Still, having to deal with my mover dude this weekend (who dumped me) has been very stressful. At first, I thought it was my fault — you know, me and my problem with honesty. But after thinking about it, I’ve decided that this dude has a problem with women who are smarter than him. 🙂

When he referred to women as ho’s, I didn’t say anything. (When he talked about his stable of women, he sounded like a pimp. Or a gigolo, I don’t know which.) When he referred to these women as being part of the Special Olympics, I didn’t say anything. I suppose I got tired of keeping my mouth shut, another problem of mine.

Men. Seriously, life is not all about sex. You guys need to learn to join all of us women, here, in 2016.

Taking Out The Trash

On Saturday, when I left to take my trash to the bin, I was greeted by some great clouds.

This one’s an airplane taking off.

I don’t know about you, but I see an eagle taking flight.

I took a moment to take a selfie in the sunset.

And then another…

And now I’m beginning to think I take too many selfies. 🙂

News Flash:  If you’re unable to find the trash can, you shouldn’t be taking care of a dog.

The apartment complex hasn’t turned on the sprinklers yet this season, so my yellow flowers are looking a little forlorn.

But they look great in black and white.

It’s been a really long weekend. (Heck, it’s been a really long month.) On Friday, the dude who promised to help me move decided to be an asshole and backed out. Thankfully, I just found a replacement, so let’s hope this one works out. (C’mon, don’t be lazy, cross your fingers and toes for me, won’t you?)

(Photos taken 3/26/2016.)