chalice-divine

Death and taxes I can handle.

My HMO plan through Kaiser Permanente?

The jury is waaaay out at the moment.

On October 17th around approximately 10 pm in the evening my arm began to hurt as I was working on my computer. It began as an ache in the underside of my right arm and within a few minutes it spread to my forearm and into the back of my hand and the outer edges of my index finger and my pinkie.

The aching rapidly grew worse, until it was alarmingly painful and impossible to ignore. I first tried some massage with lotion but the muscles continued to ache and I felt tingling, pins and needles, and some brief numbing feelings come and go in my middle, index finger and thumb as I attempted to rub out the pain. I took a muscle relaxer and tried an ice pack for about 40 minutes.

I was unable to find a position that would afford me some relief from the pain, but no matter what position I put my arm in, it just continued to ache. I then tried applying a hot pack for another 20 minutes or so, but still failed to get relief. At midnight I took a Vicodin and tried a hot shower, and the pain receded just enough for me to be able to doze, but I was not able to get any real sleep, and the pain in my arm repeatedly woke me. I continued to apply ice packs through the rest of that early morning and struggled the next four days to get it under control.

I waited that long because I am accustomed to pain due to Fibromyalgia, and I thought it would lessen if I simply rested the limb and treated it with ice and gentle massage. I am actually one of those people who rarely bother health practitioners over things that I feel certain will heal on their own, or pass, such as viral illness and such. I don't want to waste the states money, or the practitioners time with petty ailments.

On the 21st of October I called Kaiser and spoke with a nurse, who advised me to come in for assistance, and so I was seen by Dr. Vidush, who evaluated me that same day.

I felt encouraged by Dr. Vidush's concern for me and so I requested that he become my primary physician, since I did not feel comfortable with my first physician's response to me on my initial visit. I was struggling with tears as I related to him what was happening to my arm, and told him I was feeling desperate about my inability to rest, and I requested that he give me an injection of some kind of painkiller more effective than Vicodin, since my prescription for that medication was not relieving my new arm pain effectively.

I had advised him that I had a severe allergic reaction to organic codeine as a child, at which point he informed me that I was not able then to take a whole spectrum of pain medication due to that single allergy. I replied that I had been given several different pain medications in my lifetime, and that the codeine was the only drug that I didn't want to try since it triggered an episode of anaphylaxis in me as a little girl. I suffered from that episode after having been given a dose of codeine cough syrup, so it seemed prudent for me to avoid that particular medication.

He said I would receive an injection of pain medication, but after he left the room, a nurse came after a bit and said I was only going to be given an injection of the anti-inflammatory medication Tramadol. Her explanation for denying me an injection of pain medication was that they didn't have any of the medication Dr. Vidush wanted to give me on hand. Difficult to believe in a facility of that size, but I was too tired at that point to keep on trying to get help. All I wanted to do was go home and lie down.

So after all that effort and the extra pain involved with travel and sitting and waiting, I was given something that did absolutely nothing to help me. The  Tramadol did not seem to make any difference at all in the level of pain I was experiencing, and I did in fact voice my concern to the nurse who administered the injection at the time she gave it to me, but she was very confident that it would help me.  

I have never liked having something put into my body that is unnecessary, both because it is a waste of resources, it puts money into the pockets of the health care organization despite not being relevant or necessary, and with all the suffering and illness in the world and in other countries that never receives any intervention or medication so badly needed, to waste it seems almost criminal to me.

So despite the reason I requested the initial appointment, which was to seek effective pain relief, after the increased discomfort of traveling and the waiting involved, I was not given a medication that would address my pain level in the office. Instead I was given a prescription for Darvocet, which I was unfamiliar with. I waited for it to be filled in the pharmacy and then once I was given the medication, I returned home and the took it as prescribed.

I already had a previous prescription of Vicodin that I have to help me manage my pain due to arthritis in my neck and moderate to severe lower back pain which plagues me most days and can be severe enough without some kind of medication that it interferes with my ability to walk. After taking three doses as prescribed of the Darvocet, I found that in addition to the severe pain I was experiencing in my arm, my neck and back both began to hurt much worse then they would normally when I have my dose of Vicodin, so I stopped the Darvocet and returned to my Vicodin prescription. It turns out that Darvocet is in fact less effective then Vicodin, so despite my report that Vicodin wasn't helping me manage the pain in my arm, I was given something weaker then Vicodin and sent home.

I  had requested a refill for the Vicodin through the mail as usual nearly 7 days earlier, and I ran out of the Vicodin I had on hand the next day, yet no more arrived by mail. After two days of waiting, with my pain level reaching an appalling level, I phoned the pharmacy after trying to check on the prescription online and receiving an instruction to call the pharmacy about it. I then discovered that Dr. Vidush has discontinued the Vicodin, apparently without notification and I had to reach him by phone to receive an explanation.

I ran out of my Lyrica prescription as well, which is very important for me, as it reduces the pain I normally experience due to my ongoing battle with the disease Fibromyalgia. Instead of receiving the Lyrica I need to maintain a manageable level of pain caused by Fibromyalgia,  the pharmacy issued instead the medication Nortriptyline,  which I discovered in the past is ineffective for my Fibromyalgia .

So in addition to the new and frightening pain I had in my arm, I began to experience a flare up of additional pain in my neck, lower back, jaws, hands, and right leg.

Sleep became impossible at this point.

Tired and disoriented by the pain, and deeply disturbed and worried that my new physician had discontinued the medications without warning or prior explanation after one visit, I put in a call to his office, and then I called the Patient Advocates for Kaiser and related my experience to them.

I received a call from Dr. Vidush later that afternoon, and he explained that he discontinued the Vicodin out of a concern over my allergy to organic codeine, though I have been taking it for months without any ill effects, and he also said that the pharmacy changed his order for Lyrica to Nortriptyline without notifying him, which I thought alarming. I didn't know that pharmacies could change a medication ordered by a doctor.

I apologized to Dr. Vidush for not checking with him first before calling Patient Advocacy about the Lyrica, since he said it wasn't his error or doing that I was left without medication for my Fibromyalgia symptoms. He ordered the Vicodin and Lyrica for me, and I went down to the pharmacy and picked the medications up, and once I arrived home I took them as prescribed. After a couple days, my neck, lower back, hands and right leg pain lessened again, but the arm pain seems to remain unmanageable despite the Vicodin.

I called him yesterday ( on November 4th) to request permission to try taking two at a time until I see him on Friday the 7th, so I can sleep, and then I emailed him that evening concerning what seemed to be a worsening of my arm pain, due to  painful cramps periodically in the back of my arm, my forearm, under my right shoulder blade, and up into my neck on the right side, to just behind my right ear.

They are excruciating,  and last up to several minutes. Rubbing the knotted muscles or stretching my arm and neck muscles do not relieve them. I don't think I have had more then two hours sleeps at once since this ordeal has started, the best I can seem to manage is a broken doze, and I often have to get up and pace, or try showering in order to keep the pain from causing me to have some kind of hysterical episode.

There is also a tingling and numbness that comes and goes in my right hand and forearm, and yesterday the fingers in my left hand actually went numb for a brief period of time, from the middle finger to the thumb and the base of my thumb as well, which I reported in my email to him last night. There is no pain in my left hand or arm, but to have my fingers go numb on that side is really worrisome.

He responded with an email that said he was sorry I was in pain, and again told me to go to pain management, which is bewildering. I don't think they diagnose, and they don't do emergent care. I made an appointment with them for the 28th which is the soonest they will see me.

He said if not pain management then go to urgent care or the emergency room. He did not send me an answer through email about whether I can increase my Vicodin dose.

I called again this afternoon and I am still waiting for a return call, since I a, hoping for an answer to that request. I do know that the therapeutic dosage for Vicodin can go as high as 8 tablets a day, and I am only requesting permission to take 6 until I see him on Friday in order to try and lower my pain level enough to have a little break from this experience, and maybe even a few hours of unbroken rest.

As anyone knows, the waiting time when you seek urgent care or emergency services is long, and the people who work in the field are cold for the most part, and the overall feeling when one does seek those places is of being a cow in a cattle yard, funneled through the chutes with zero empathy, concern, or evidence that anyone even really cares at all that you are suffering.

As long as you are not dying, its okay that you sit and ache, burn, and swim with nausea from so much pain as you wait for someone to help. Even more disturbing is you generally wait all that time and they turn you away without anything that makes a significant difference in your distress, so it’s a real gamble on whether or not all that waiting and suffering you do in uncomfortable chairs under glaring lights will even be worth the effort and the pain it cost you to try.

I have never experienced anything like what's happening to me now, and I am frightened, anxious, and pain wracked, as well as exhausted. My bewilderment and anxiety are growing as he keeps recommending the same actions rather then anything proactive or immediate to intervene on my behalf as I am undergoing this horrid experience.

Is it my poverty, or some kind of regulations that bar him from  expediting this process with a call giving me permission to increase the Vicodin?

Have I angered him by seeking the support of patient advocacy when it seemed he had taken away the medications I need to be okay?

Is it the dreaded HMO bottom line that kept him from taking x-rays or ordering an MRI or any other kind of attempt to diagnose what was happening to me when I first sought him for assistance with this terrible pain?

I am in a bewildering and furious darkness, confused, hurting, frightened, and feeling that helpless feeling I have had so many times in the past when I have been suffering and exhausted by it,  and the human beings around me did little or nothing to help me cope, or give me an empathetic explanation of why they were doing whatever it is people do in the face of suffering, when they limit their involvement or withhold help. I am so tired that everything I perceive in my daily rounds of life seems unreal at this point. I can barely think in a linear fashion.

I wish I could understand. It might help me deal with the emotional distress the pain and my bewilderment are causing me a little better. I am accustomed to hard realities in life, but I have never managed to find a way to handle the idea that people can be so detached and clinical in the face of the tremendous suffering that  flesh can transmit to us as we walk the path of physical beings. I can grasp it on an intellectual level, of course, but the ethics of it all are stunningly sour considering the emotional needs of all human beings to be nurtured, and privy to swift aid in a time of crisis or intense suffering.