when “yes” means “no”

When a toddler asks, “Can I have another vitamin?” your options are limited.  “No. More than one per day would be  bad for you,” results in tears.  Sometimes kids just aren’t mature enough to understand.  Changing the response to, “Yes.  You can have another one tomorrow,” leads to a happy, healthy child.

Sure, kids need to learn to accept “no” as an answer, but when they’re young, it’s possible to get the point across more effectively by saying “yes” followed by a little teaching.  There’s nothing wrong with dealing with things in an age-appropriate manner.  As the child matures, understanding develops and the question is no longer asked.  Eventually they learn to accept “no” gracefully.

Recently Edwin Leap wrote a column titled Attention Doctors! People May Not Like You!  and if you wonder about the reason for the dislike, Doctor D‘s post about Pills and Suspicions deals with the same topic.

I wondered, having no first-hand experience with the situation, if treating drug-seekers like immature toddlers would be effective.  Sure, I’d be happy to write a prescription if that’s what you need.  Let’s talk some more about your symptoms and see what would be the most effective way of treating the problem…  mmmhmm…  It sounds like this would work better for you…

Of course I’m not so naive as to think that would really work on planet earth.  I can’t imagine how doctors can stay nice and helpful when it’s necessary to always be on guard.

Anyone want to move to planet WarmSocks?  On my small planet, there’s only one source for prescriptions.  Anyone caught filling too many prescriptions get shipped back to earth.  Because I’m mighty tired of drug seekers.  I want to be able to discuss pain management options with my doctor without there being any question as to whether I’m looking for narcotics.  It’s not just that I won’t take more pills.  I don’t want the suspicion.



12 thoughts on “when “yes” means “no”

  1. Gee, what a timely topic! Yes, I don’t want the suspicion either and am considering asking my rheumy for a script for muscle relaxer for neck/shoulder pain and headache. I don’t know how these compare to narcotic pain meds or how doctors view them. She had rx’d some tramadol once – I wasn’t thrilled with it and think it made my other pain worse, so tapered it down with alternating arthritis tylenol, which alternated with my Nsaid, does fairly well, though not perfect. But this shoulder/neck/headach pain was gawd awful the other day and despite my usual pain meds, an extra few doses of prednisone and an old tramadol, nothing touched the pain of this which was just short of puking/migraine (I’ve only had three migraines over several years, so I don’t take meds for that.) I guess this was/is a tension headache, but I suspect some underlying RA pathology may be coming to the forefront due to some new onset crepitus in my neck prior to all this starting, and perhaps strained shoulder/neck after that carrying groceries, and it may have caused the tension in the muscles. Anyway the worst of that headache went away with sleep finally, but less severe though constant and persistent pain, getting worse as the day wears on, this whole past week still. And yes, Ashley, the “hair hurt” is in there too, so part must be scalp vascular sensitivity.

    So I’m hoping my rheumy won’t be suspicious if I ask for something though I’m trying to hold off doing that for now – you know, tincture of time, but it sucks! Sorry for the poor wording everyone. Hope you get the gist.

    • Tramadol and I didn’t get along too well, so I understand your being less than thrilled with it.

      How’s the head/neck? I sure hope you’re feeling better now. Did you ask your doctor for a prescription? I’m a lot more comfortable describing the problem and asking, “What can I do? without suggesting a specific treatment plan. Although I don’t think I’d have any difficulty asking for another cortisone shot, so maybe when the problem has been established and we’ve previously figured out a treatment that works, I’d be okay with it. I’d be interested to know how your appointment went.

  2. It’s still there, although not the excruciating headache, just enough tension to keep me really uncomfortable all day and gets worse as the day wears on. It’s being continually aggravated by other factors that I can’t get out of right now unfortunately. I also may have a gum abscess and possibly some sinus problem trying to form on that side which is contributing to some of the uncomfortableness and so am skipping my methotrexate. Sleep and laying a particular way on the affected side a certain way (go figure) are the only things that seem to help.

    I don’t have coverage for anything that they could possibly relate to my RA right now as it’s pre-existing, so I haven’t set up an appointment yet – that’s another reason I’m holding off calling, although will if I have to. Hoping the tincture of time will make it go away.

    I sure hope you will be able to get the Enbrel. I agree that health reform needs to address this kind of situation, but I’m sure it would add somehow to the administrative nightmare regardless. I am thinking it’s time for me to finally try a biological, however, when I do finally get some coverage, I don’t know which ones would be covered under my plan, but do know I won’t be able to afford the co-pay for any of them.

    • You can afford the co-pay for Enbrel. I think this one has two different patient assist programs. I’m on one that’s only available to people who have insurance. It covers up to $4000 of co-pay during the first six months. After that, they’ll pay part of your co-pay (half or $10, whichever is best for your particular situation), up to a total of $1000.

      Real world application: my insurance company says that my co-pay for this drug is $25. For six months, Enbrel will pay my $25 co-pay. After that, I will pay $10 and Enbrel will cover the other $15 for me. By the time the first six months are up, you’ll know if the med is working. If it is, you can come up with $10 per month if it means having a life again.

      Good luck with the headache. Hot bath? Chamomile tea?

        • That’s expensive!

          My understanding of the EnbrelSupport program is that first your prescription insurance would be charged; it would pay the bulk of the cost, and leave you with the $125 co-pay. Then the $125 claim would be submitted to EnbrelSupport. For the first six months, EnbrelSupport would pay the entire $125 and you would owe nothing. Zero. $0. The maximum that would be paid for your co-pays during this time is $4000, and you would be well within that amount.

          After that initial six months, EnbrelSupport would cover $115 and leave you with a co-pay of $10.

          When you’ve been on the plan for a full year, it expires. You can then ask them to extend it for another year. And another…

          Unless you live in Massachusetts. Massachusetts has some different rules about what pharmaceutical companies can do, so people who live there can’t participate in EnbrelSupport. I think I might be tempted to move to a different state!

          There is another plan for people who don’t have insurance coverage, but then you’d be paying for x-rays and b/w out of pocket before you could even begin treatment.

          This is exactly the type of thing that needs to be addressed if the goal is to make healthcare affordable.

          I hope you’re able to get coverage soon!

          • Not until later this year. Any drug that costs over 50, I would have to pay the difference up to 125…I have other meds I’m not on right now that I should be on. And I don’t make much over minimum wage. In addition they raised the copays to see specialists and some other things, and of course deductibles have to be met. In addition to the cost of rent, groceries, gas and everything else going up a lot. So we’ll see what happens.

    • Well, after switching back to my 12-hour combo antihistamine/decongestant, I think this whole thing is coming down to a sinus infection (and not some acute flare in a “new” area of the neck)that was communicating with my ear, tooth/jaw and somehow with my neck and shoulder. I read some dental blogs that indicated this scenario could occur. I had tried the 24 hour version around the time this whole mess started and when I switched it back, boy did I feel a heck of a lot betterm – but not if I miss or am late on a dose yet. Who knew that one version would be so different from the other? So I’ve skipped my MTX for the last two weeks hoping this along with the sinus med will help keep any infection at bay. Will try to skip it next week too, just in case, and because I finally got an H1N1 shot last week and want to let antibodies build with less interference so to speak. Also because I did have an abscess in that spot several months ago (no cavity or anything) and wondering if I’ve got some low grade lingering infection in nose or gums.

      But do still need to get neck xrayed to see what’s going on with the crepitus, though it’s less now, and b/c I’ve not had it xrayed in the 14 years I’ve had RA and should see what the status is.

      Having what I am assuming is a lingering infection of some sort, it’s now making me a bit more apprehensive again about moving towards the biologicals because of infection risk. And it’s hard to tell with me because my white counts tend to run a bit high as a rule, apparently due to the prednisone. That sucks because although I’ve held off on biologicals for some time, I do so wonder how much more “normal” I could potentially feel on one of them! How much more energy could I have. I also wonder if they will slow damage more than MTX, but because I’m a long timer, they may not have much advantage in that regard – unless you look at it from the perspective that they may help retard it more in joints that haven’t been attacked much yet. I’d be hard pressed to afford them unless one of those programs will help, but I really cannot afford to lose time from work for bad infections. What a quandry!

      • (((Chelsea)))
        When I get a sinus infection, my teeth, ears, and eyeballs ache. It’s miserable. 😦 There’s a huge difference between antihistimines, and I have found the 24-hour ones to be useless. I’m glad you got that sorted out.

        I think the biologics are reputed to work even when other DMARDs haven’t worked. Different types of these meds target different causes of inflamation, so the hope is that if one doesn’t work, another one might. As to infection, I was concerned about that. I talked to my PCP, and he answered my questions; he also told me to make sure I talked to my rheumy about those concerns. She didn’t seem overly concerned about the possibility of infection – more like it’s a managable twist, and the benefits outweigh the risk.

        I’ll look into some of the assistance programs and see what’s out there. I sure hope you’re able to get treatment that is effective for you!

        • The antihist/decongest was the same brand, just a 12-hr formulation vs the 24-hr formulation.

          I guess my concern over infection is that I’m getting an infection just taking an increased dose of MTX – much less what a biologic might predispose me to if you get my drift. One year I did add Kineret on top of my MTX and got a terrible sinus infection that lead to the absolute worst migraine I’ve ever had. And then got the flu pretty bad a couple of months after that, despite having had the vaccine. Not a for sure causation, but enough to make me hesitant. And then to have this problem just on increased MTX this year…know what I’m sayin’?

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