Doctor Supports Pain Relief

Pitching Relief
A Physician With Firsthand Knowledge About Pain Advocates Opium-Based Drugs Despite Fears of Abuse

By Marc Kaufman
Washington Post Staff Writer
Sunday, April 23, 2006


Howard Heit knows pain.

He lives it, he studies it, he works to reduce it. His own pain used to get so bad that he wore patches of hair off the back of his head by rubbing it hard against walls in a desperate effort to get some relief.

"What I was feeling was like a cramp in my leg, but multiply that by 100 times and make it continuous," he now says. He no longer hurts like that, but he still wears a brace with a head attachment he can push against for acupressure when a pain spasm hits.

Heit is a doctor. Today he's a pain and addiction specialist in Fairfax, but once he was an up-and-coming gastroenterologist, a football player, a jock. That was before his auto accident, the one that changed his life and taught him about pain problems the very hard way -- as a patient who often didn't get the help he so badly needed.

The doctor still spends a lot of time in his wheelchair, but that hasn't stopped him from becoming a prominent practitioner and lecturer over the past decade. More recently, his profession and personal history have propelled him to the center of a contentious national dispute that he virtually personifies.

On one side, the Drug Enforcement Administration and Justice Department -- alarmed by the seemingly widespread diversion of opium-based prescription drugs such as OxyContin and Dilaudid to addicts and abusers -- have investigated, arrested and prosecuted as "drug dealers" scores of pain doctors who allegedly misused their authority to write prescriptions for narcotic painkillers. On the other side, many pain doctors and patients have protested the DEA's approach as overly aggressive and punitive, saying that it's unfairly penalizing pain patients.

Heit, 61, doesn't use prescription opioids for his own pain now, but he does prescribe them in high doses to many of his patients, and he's seen the drugs (in conjunction with proper monitoring) provide remarkable relief -- the kind he still wishes he had had available back when he really needed it. As the showdown between pain doctors and prosecutors stiffened several years ago, he felt obliged to get more actively involved in defense of opioid treatment despite the potential risk to his practice.

So he joined a team of 18 pain and addiction specialists, hospice and cancer-care workers and DEA officials to write and review guidelines for the proper prescribing of narcotics. He was delighted when, after more than two years of work, their Frequently Asked Questions presentation was posted on the DEA Web site in the summer of 2004. But several weeks later the FAQs disappeared from the site and was soon essentially repudiated by the agency, leading 30 state attorneys general to write to the agency in protest. The chill in the world of pain management has grown worse ever since.

"It now is apparent to me that the spirit of cooperation that existed between the DEA and the pain community to achieve the goal of balance has broken down," Heit wrote in a much-discussed commentary in the journal Pain Medicine last month. "The DEA seems to have ignored the input and needs of the healthcare professionals and pain patients who actually prescribe, dispense, and use [prescription opioids]."

Tough words from a man who shares some of the DEA's concern over drug diversion, but who clearly cares most passionately about making sure that pain sufferers get the relief they need.

"Our government is letting the misbehavior of a relatively small number of people too often trump the needs of many, many good people with complex medical problems and lots of pain," he said recently, seating behind his office desk where a chart of pain levels is prominently displayed. (1-2 is mild pain, 5-6 is distressing pain, 9-10 is excruciating pain.) "Many doctors won't prescribe for pain now. And believe me, that's not where we as a society want to be."

A New Era Reversed

Pain is the most common symptom that brings patients to a doctor's office, but it remains one of the least understood. There's no CAT scan, no blood test to objectively measure the level of a person's pain, and years of research have determined that different people experience pain very differently. So pain patients are an inherently challenging group for doctors, their ailments difficult to assess and their suffering often difficult to treat.

The strongest and most effective pain relievers are opioids, derived from the opium poppy or synthetic versions of its active compounds. In the popular imagination, and traditionally in law enforcement, opioids have been associated with addiction, moral weakness and crime. That the same compounds are a godsend to millions of suffering but otherwise unexceptional and law-abiding people is far less widely understood.

The nation's qualms about narcotic pain relief seemed to lessen in the 1990s, when many researchers concluded that the drugs were less likely to cause addiction in pain sufferers than earlier believed. While many patients will become physically dependent on opioids -- just as other patients become dependent on insulin, calcium channel blockers or anti-depression medicine -- the overwhelming majority can and will be weaned off if their pain subsides. The advent of OxyContin, a time-released, partly synthetic opioid that provides unique pain relief, added to the sense that a new day had arrived in the nation's thinking about opium-based pain relief.

But that was before OxyContin abuse and overdoses became a widespread problem in places like Appalachia and rural New England, and before local leaders and politicians began calling for stronger action to keep these prescription products from turning into a street drug of choice. It has proved very difficult to stop the criminal diversion of prescription narcotics from the nation's drug supply chain, but relatively easy to identify doctors who write large numbers of Percocet or Vicodin or OxyContin prescriptions that -- through carelessness, bad luck or, as prosecutors charge, criminal intent -- sometimes fall into the wrong hands.

Using sometimes novel legal theories, prosecutors have charged many pain doctors with prescribing opioids "outside the normal practice of medicine," and dozens are now in, or facing, jail. One of the most prominent is William Hurwitz, a nationally known pain doctor also based in Fairfax. After a trial last year, Hurwitz was convicted of 50 counts of drug trafficking, and was found responsible for the overdose death of a patient and serious injuries of two other patients. He was sentenced to 25 years in federal prison.

At the time of his sentencing, DEA Administrator Karen Tandy held up a plastic bag with 1,600 pills and said they were prescribed by Hurwitz to one patient on one day. "Dr. Hurwitz was no different from a cocaine or heroin dealer peddling poison on the street corner," she said. "Indeed he was worse, because unlike the street dealer, he had and abused the trust and authority to treat people in pain. He hid behind his white lab coat and Stanford medical degree to try to conceal the fact that he had become a common drug trafficker."

(Regarding the prescription for 1,600 pills, Hurwitz said it was a clerical error that was corrected by a pharmacist before it was filled.)

That case is now on appeal and has become -- along with several other prosecutions -- a cause celebre for advocates including those in the Pain Relief Network, who are helping Hurwitz and a number of other arrested and convicted doctors to fight the charges against them. While acknowledging that Hurwitz could have been more careful in some of his prescribing, his supporters cast him as a dedicated and courageous professional who has been railroaded by the government.

The new era in pain relief anticipated and promoted by pain doctors and drug manufacturers seems increasingly far off.

Lives Transformed

Wendy Shugol is a nationally recognized special-education teacher at Falls Church High School, a French horn player in the Fairfax City Band, a horseback rider and avid woodcarver. She also has cerebral palsy and a host of other serious conditions, and doubts she could even get out of bed were it not for the massive doses of opioids she takes daily. She says her referral to Howard Heit in 1998 marked a fundamental transformation in her life. "I'm a different person now," she says. "My life was miserable, and I was basically miserable to be around."

Shugol, 54, wheeled herself into Heit's Arlington Boulevard office two weeks ago for a monthly appointment, smiling broadly and filled with an energy seldom seen in people who don't carry her many physical burdens. The first order of business was, as always, to hand Heit her vials of drugs, so he could see exactly how many pills she had used since the last visit. Heit took out a pill counter and went to work, first on the OxyContin, and then the Dilaudid. He was puzzled to find more than 100 extra pills.

"Have you been taking everything you need?" he asked.

"Yep, but I think you made a mistake last time," she replied. Rather than writing a prescription for 230 pills, Heit had written one for 330 pills, and that's what the pharmacist filled. (a note from Zen Angel: I have never gotten an RX for more than 60 pills...and those 60 are not nearly adequete for my needs).

As Shugol continued to talk of the active life she can now have because of the opioids and her care by Heit, the doctor went through the detailed paperwork he keeps on all patients. He found a photocopy of his last prescription for her and, to his chagrin, he had indeed overprescribed by 100 pills.

"What you're seeing here is that we're all human and make mistakes," Heit said, somewhat sheepishly. "But Wendy returned them, as she should, and I can see from my records exactly what happened. These are powerful and valuable drugs, and so we should take great care."

Without intending to, Heit had demonstrated an issue at the heart of the doctor-DEA debate: What constitutes a medical error in prescribing, and what constitutes criminal behavior? Many doctors who have been prosecuted argue that they were aggressively treating pain as the literature now recommends, and that sometimes they made mistakes by trusting a patient who said he or she was in great pain and needed opioid painkillers. In response, the DEA says doctors who are prosecuted show a pattern of misprescribing that has more to do with a desire for money, easy-to-please return patients or even sexual favors than with the proper treatment of pain.

Shugol had followed Kathryn Brock of Reston -- another woman in a wheelchair with an easy smile and a strong desire to remain active -- into Heit's office. Brock sufferers from rheumatoid arthritis in virtually every joint in her body, and she, too, is subject to constant pain. She says that her regimen of six OxyContin and eight Dilaudid pills a day has kept her marriage going, and gives her the ability to continue painting, which she does regularly.

Like Shugol and most other chronic pain sufferers, she says the opioids don't make her feel euphoric or "high" at all. (Researchers believe that the pain essentially soaks up the drugs' active ingredients for most legitimate users.) Another Heit patient the same afternoon was an administrator in a healthcare business, a man in his mid-forties who developed a condition 10 years ago that caused him to pass frequent kidney stones. The pain was so excruciating he would collapse on the floor. He was going to a nearby emergency room regularly.

The man, who requested anonymity because of the continuing stigma associated with opioid use, began pain treatment with Heit three years ago. He hasn't been to the emergency room since.

Coming to Terms

Heit began learning about pain in earnest at 41, two decades ago, after a speeding car smashed into his in McLean. He didn't immediately feel his injuries, but in the following weeks he began to have increasingly intense spasms of pain around his neck and head. A lifelong athlete, he tried to ignore the pain but it grew, and his neck began to rotate uncontrollably with a condition later diagnosed as axial spastic torticollis.

Heit says it took a long time for him to come to terms with his changed life, after going through the classic steps of denial, bargaining, anger, depression and late acceptance. His anger phase featured an obsession with people who park their cars illegally in handicap spots. He would glue a sticker that read "Stupidity is NOT a physical handicap" on their windshields and ultimately got into 18 fistfights with motorists who weren't happy with what he'd done. (He says he left the field undefeated.) His depression emerged after it became clear that he couldn't practice medicine as he had known it.

But at the end of a conference about the brain that he attended, an epiphany: He could still be useful, he had something to contribute, and he would rededicate his professional energies to pain management and addiction. Over several years he retrained in this underappreciated specialty, and in 1992 opened his practice.

While caring for 250 to 300 patients in his practice, he also teaches at Georgetown University School of Medicine, speaks regularly at pain and addiction conferences, writes and co-writes dozens of journal articles and does consulting work for some major manufacturers of prescription opioids. One of his ambitions is to persuade medical schools to give more attention to training students in pain management and what he always calls "the disease of addiction."

While Heit isn't shy about prescribing high-dose opioids when he thinks they're necessary, he's also a great believer in the maxim that satisfying activity is one of the greatest analgesics. This is an approach he often shares with his patients and says his own history and condition -- he can walk only short distances before needing his wheelchair -- appears to give him credibility.

"A patient will tell me of a problem they're having, a feeling, and I'll be able to quickly know exactly what they mean," he said. "I've been there, and they know it."

Heit's personal story also appears to give him some added credibility with federal authorities. He worked closely with DEA liaison and policy chief Patricia Good on the ill-fated Frequently Asked Questions, and the two remain friends. Good says she was impressed by Heit's dedication to patients, his determination to run a tight ship in terms of narcotics he prescribes, and his willingness to engage with -- and even take on -- the DEA. She found Heit to be open to the DEA's conclusion that some pain doctors were careless or worse with their narcotic prescriptions, and he was eager to put together professional guidelines that could help the DEA while protecting doctors and their patients.

The FAQ document was widely applauded as a successful collaboration, and was welcomed by the Journal of the American Medical Association. But soon after, lawyers at the DEA concluded that there were errors in the statement, and so it was withdrawn. Good says the agency plans to present its own policy guidance soon, but many pain doctors are skeptical that anything positive will come of it. (Heit is not one of those. Despite his broadside against the DEA, he hopes that the agency will resume its discussion and even collaboration with pain and addiction doctors.)

Good, who retired last year, says she supports her former agency's narcotics-control mission, but remains disappointed that the FAQs were deemed flawed. And so, when the agency was planning her retirement party, she asked that a number of pain doctors be invited to recognize their collaboration. Howard Heit was the only one who made it.

The Gift of a Baby

A fourth patient seeing Heit earlier this month was a young woman who had fallen down a flight of stairs at a nightclub and ruptured two disks in her neck. Another jock accustomed to playing with pain, she tried to gut her way through it. Doctors recommended surgery, but she resisted.

Her boyfriend recommended Heit, and she began treatment. She improved markedly, married the boyfriend and, while still on OxyContin, got pregnant. She knew she could never get through the pregnancy without the medication, but she was concerned that the child could be in withdrawal at birth.

When the baby was born in 2004, Heit was at the hospital to examine the newborn for signs of opioid trouble, and was relieved to find none. Heit is the kind of person who likes to connect quickly and deeply to others, and so it wasn't entirely unexpected that he would be in the hospital. But there was another reason for his presence.

The new mother, whom Heit had received permission from Virginia medical authorities to treat, was Jamie Heit -- his son David's wife. And the healthy child, born to a woman who wasn't sure she could ever carry a baby after her fall, was his first granddaughter, Lilly.

Sleepytime

I have been up pretty much all night, every night, for about two weeks now. The pain is so bad, so relentless, I cannot sleep. By the time it lets up enough for me to try, I'm left with maybe, MAYBE three hours to sleep.

I am not a happy camper about this.

I like to sleep. Love it, in fact. I get this from my mother's side of the family. My grandmother so hated to be woken up for any reason that the family would draw straws to determine who had the "honors" on any given day. The procedure for this? Opening the door slowly, extending a broom stick into the room, poking my grandmother softly with said broom stick, and then slamming the door and running like hell. You see, Granny would pick up whatever was handy and throw it at the offender. Her cane, books, water carafe, you name it, it's been chucked at the door. She was legally blind, so you'd think her aim would be bad....but no. She'd had years to perfect the art of flinging miscenellania at the bedroom door. If it had been an Olympic sport, she'd have brought home the gold, every time.

My mother was much like Granny. Trying to wake her up would usually only result in an earful of language that would have made a sailor flinch. After which, she'd fall back asleep almost instantly. And a nap was to NEVER be interupted, unless someone was bleeding or the house was on fire. My mother was an old hippie and not a stickler for rules by anyone's measure, but the "mom is asleep, leave her alone" rule was one on which she would not waver in the slightest.

This is not to say that my dad's side of the family did not have their annoying sleeping rituals. My father and former stepmonster snored so loudly you'd have thought the foundation of the house would shake apart from it. And for some reason, they absolutely would not sleep without the tv on. They would wake up from a deep sleep if it was even turned down a tad, or if the channel was changed. And though they slept with the noise of the television and the noise of one another's chainsaw snoring....my father absolutely insisted on QUIET in the house when he was asleep, and was easily roused from sleep (and roused to anger) from too much noise. I remember being on a vacation with my father, all of staying in this quaint log cabin in the woods in Tennessee. My father actually went outside and yelled at the crickets to shut up so he could sleep....and amazingly, they did. For a short while, anyway. My younger sister was nicnamed "Butt-Butt" for years, thanks to her penchant for sleeping on her stomach and knees with her posterior sticking straight up in the air. But perhaps the weirdest of all was my brother, who insisted on sleeping with a fan on his face all night, every night...even in the dead of winter.

Probably the strangest sleep ritual I've ever personally witnessed was that of an ex-boyfriend, whom I will refer to as "Craig." Craig and I had an unusual relationship, and it started out in a bizarre way. I was living temporarily (for the summer) at a punk house occupied by my best female friend at the time, "Kasey" and her boyfriend, "Quinton." I had a job babysitting for my older brother's kids during the day, and many times it left me absolutely exhausted. One night, I had crashed out on the sofa and was literally sleeping through a party Kasey and Quinton was holding for some reason or other. I was sleeping blissfully when a strange guy poked me in the ribs until I woke up. "What do you want?" I growled out (shades of my mom & grandmom at work there). "Do you have a boyfriend?" he asked me. I replied that no, I did not. "Now you do!" he said happily, and wandered off. I assumed he was drunk and went back to sleep without another thought for the stranger. In all likelyhood, I assumed, he'd forget all about me tomorrow.

I was wrong. Not only did he remember me, but he took his offer--and my silence as acceptance of said offer--in all seriousness. I woke up to find out that although I'd gone to sleep boyfriendless, I woke up with not only a boyfriend but a date with said boyfriend for that evening! I didn't know whether or not this guy was a desperate loony, a hopeless romantic or a flake. In any event, I had nothing better to do, so I went on the date. From that day til the end of summer, Craig and I were an item.

Now, Craig and I dated at a time when I was not sexually active. He knew this, and was fine to wait. He had a reputation at the time of being something of a relentless horndog, but my experience with him was that he was a total gentleman. And he had plenty of chances to be relentless had he chosen to be so: you see, Craig and I used to sleep together.

And when I say "sleep together," I do actually mean "sleep." We often slept in the same bed, both at my place and at his. And believe it or not, sleeping was all that we did. Well, we might have fooled around a bit...but there was no sex. Honest.

It was from this arrangement that I was able to witness his excessive sleeping ritual. Every night, no matter where he happened to be at the time, he would take an hour or so to completely blacken the room. Not a single shred of light could be permitted to shine where he intended to have his fourty winks. He would safety-pin curtains together, roll up towels and stick them under the doorstops, tape dark paper onto the digital displays of alarm clocks and put heavy blankets up over the tops of windows where a small streak of moonlight might somehow penetrate the curtains and interfere with Craig's precious slumber. He would even lie down on the bed and check the room from every angle to be certain that a careless midnight rolling-over would not subject him to anything other than total darkness. It was like sleeping next to the vampire Lestat.

Now that I am married, I often hear stories from people I know or via places like "Dear Abby" about couples with incompatible sleeping rituals or habits: one snores, or hogs the blankets, or has bad nightmares nearly every evening. One insists it remain very warm while the other would prefer a chillier atmosphere. One wants to cuddle during sleep, and the other wants to left alone.

In that, I suppose my husband and I are normal: we have some sleep issues, but none drastic enough to want to send the other to sleep in the guest room permanently. We both snore, and I prefer the room to be cold while he'd like it to be warm, and we both would rather not cuddle all night long. He is a notorious comforter hog, and I am a notorious pillow hog. He likes to hit the snooze button a dozen times or so every morning, and it drives me nuts. But like I said, we don't seem to be much different than most other couples.

The only real difference is my sleep problems, which I work to make as inconvienant on my husband as humanly possible.

Let me describe what sleeping is like for a person like me, with MS and trigmenial neuralgia.

First, sleep doesn't always come. Insomnia is common, almost routine. The fact that the fatigue is awful all day and I'm exhausted beyond words doesn't seem to have any effect on the insomnia. Not to mention the fact that there are actually two kinds of insomnia I suffer through: lack of sleep due to the pain, and lack of sleep due to MS. Of the two, I prefer the latter. I tend to get stuff done when it's the MS to blame: I do a little laundry, some dishes, work on some homeschooling stuff for the kids, work on my book. When it's the pain, I can do little to nothing. I can play solitaire on the computer. I can read a little. I can blog.

Even when insomnia isn't an issue, sleep does not come easy. Every night, when I lay down to sleep, what we in the MS community refer to as the "pins and needles sensation" starts up. It literally feels like someone is jabbing me with little needles, up and down my legs. Sort of like having them "fall asleep," but different somehow. I also get the restless leg syndrome, which is hard to describe. It's basically what it sounds like: your legs are restless. Which leaves you restless, too.

These symptoms usually last anywhere from 20 mintues to an hour before I can finally fall asleep. After that, three big symptoms keep me from staying asleep: neurogenic bladder, muscle spasms and unexpected neuralgia pain.

The neurogenic bladder means I have to go to the bathroom...a lot, and with great urgency. I haven't responded well (or at all) to the medications currently on the market for it. I basically get up to go to the bathroom, on the average, every hour to hour and a half. Then I crawl back into bed, and the pins and needles/restless leg starts up all over again, and I have to go through the whole rigamorale until I can finally, once again, fall asleep....until the next time I have to go to the bathroom.

The next thing that wakes me up is, thankfully, much more rare: the muscle spasms. Imagine having 100 charley horses in your leg, all at the same time, waking you up from a deep sleep. That's what it's like. On a bad night, I might wake up from spasms two or three times. And then (you guessed it) I have to sit through the rigamorale yet again before I can finally fall asleep.

The unexpected neuralgia pain is pretty much what it sounds like. It means I go to bed in little or no pain, but something happens in the night which brings on a bad attack of it. This can be something as little as simply rolling over too hard on my side and having my face hit the pillow just a smidgen too forcefully. Or it can have no cause that I can determine. In any event, once this happens, I can't fall back to sleep until the pain is over. I must either wait it out (if it happens to be my lucky night and the pain is short-lived) or take medications and wait for them to kick in. Either way, you're looking at anywhere from 20 mintues to an hour or more. And even then....you guessed it! The rigamorale must be suffered through before sleep can commence.

So as you can imagine, I don't get a lot of sleep...and what sleep I do get, is rarely very restful. It is usually sleep that will send me to the ER for a shot: if I've gone too long without any appreciable sleep, I can't fight the pain. I get a shot, the pain comes down to a tolerable level (it never really goes any entirely anymore) and I can get enough sleep to combat the pain when it returns. It's really the best I can hope for these days.

For now, it's almost four in the morning, and I'm no closer to sleep than I was at midnight. Que sera, sera.

A Sad Good-Bye

I read several blogs on a pretty regular basis (and when I mean several, I do mean SEVERAL...the list is quite long). I don't always comment as often as I should, but I do read them and enjoy them. Many I have read for years now.

Absolutely Zero: Confessions of a Queer Neurotic is one of them. The blogger, Dennis, is a witty, clever, compassionate and thoughtful blogger who never fails to make me think (even when I don't agree with him). Sadly, Dennis has decided to bid adieu to his blog. And as I am uncertain whether or not he will read or approve his comments, I wanted to write my good-bye to him here. I hope he sees it someday.

Dennis, yours was one of my favorite blogs. Always insightful, always thought-provoking, always worth the read. I will miss it, and you. If you ever decide to come back to blogdom, please, let me know. I will consider myself honored to have the chance to read your writings and musings once more.

Take care of yourself, Dennis. You will be missed, and the loss to the blogging world your exit represents will not easily be displaced.



And on the blogging note, and aside to Dark Angel: I'm getting an error message from Blogger every time I try to comment on your site. It's not happening on any other blog, just yours. I thought I'd give you a heads-up....

Checking In....

...to let everyone know I'm still here.

It's been a weird month or so for me. My mother-in-law and sister-in-law were here for ten days, and the house was pretty crowded. We're now looking into buying a home. Personally, for me, it's got to have a master bathroom. I'm sick of schlepping up and down the stairs five or six times a night.

I used a scooter for the first time while my in-laws were here, at Jonathan's insistance. We went to the Oregon Zoo, and usually when we do the Zoo, I am exhausted by the end and sick for a week. Well, I took the scooter...and it was surprisingly easy and effective. I am now seriously considering buying one for occassional use.

A few days ago, I met a friend from the message boards. We met at Powell's, and I had a great time. She has the lightest blue eyes...very striking. And her son was just adorable.

I'm getting a little worried about the upcoming summer, because I am already having trouble with the heat and it's only April. It may be time to invest in cooling paraphenalia. I don't want to be stuck in the house all summer long this year. I'm tired of living that way.

On the plus side, I've been able to stay out of the ER for some time now. On the negative side, the last time I went was probably the most frustrating visit ever.

I had terrible pain in my side and other symptoms that pointed to either a bad UTI or a kidney stone. I called the doctor on call, who told me to go in. Now unfortunately, this coincided with a bad bout of the facial pain. I was handling the neuralgia, but dealing with both pains was more than I could tolerate. I kept trying to explain this to the nurse and then the doctor, but they couldn't understand me. They thought I was there for pain meds again. I kept trying to explain that yes, my face hurt, but I was more concerned with the kidney issue. It finally got (sort of) straightened out, and I got some antibiotics: my reason for going in the first place. Then the doctor gives me this long, drawn-out lecture about not coming into the ER for pain meds. Excuse me? I hadn't gotten any, didn't want any. I tried to explain this, but once again, the facial pain made it difficult to talk and nearly impossible for the doctor to understand me. I tried to ask for paper and pen, but was pretty much ignored or misunderstood. I gave up trying to explain myself and resigned myself to listening to the lecture.

And then came the kicker...remember that last time I was in the ER, when the doctor on call supposedly told the ER to refuse treatment? This doctor told me that apparently this was a PERMANENT order. They weren't to treat me for pain again, ever. Period. I showed her my pain management contract, which does give me clearance to come to the ER so long as I call the doctor on call first. The ER doc told me that it didn't matter. "My" doctor (meaning the on-call doc) had ordered the ER to withhold pain treatment from me. I told the doctor that there had been a mix-up, that my regular doctor was aware of the problem and that the contract was the final word, not this on-call doctor's (or the PA, whichever the case may be). She flat-out did not believe me. TOLD me she didn't believe me. She then accused me of lying to her about the last time I'd been into the ER! At first, I had no idea what she was talking about. Then I remembered her asking me, earlier on, about the last time I'd had my pain treated there. I had told her it was back in January. Now this ER doctor was livid with me because she'd looked up the record and seen that visit to the ER when I had NOT been treated a few weeks ago. I tried to explain myself, that I thought she wanted to know when the last time I had been treated here was and that during the visit in question I had not been examined nor treated. The ER doctor continued to insist I had lied for some ulterior purpose, although what that is, I have no idea. I didn't want to argue, really couldn't argue with my face the way it was. I just sat, dumbfounded, and listened to her rant at me.

Again and again, she kept telling me that she "wasn't comfortable" giving me pain meds. I would try to tell her I didn't WANT any, but she would tell me to not interrupt her. She droned on and on about how "important" it was for me not to "use the ER to treat chronic pain." I'll admit, my patience was running thin at that point, as there seemed to be no end to her lecture. I finally said to her, "My doctor has given me a contract. I call in, and they tell me to come to the ER. What am I supposed to do, NOT follow my doctor's orders?" The doctor didn't understand me, and it took a few times before she finally got the jist of what I was saying. And her response? Basically, that I have to "learn to live with it" and that I have a bad doctor! "I'd look into finding another doctor, if I were you." WTH?

She was finally done with her nearly ceaseless ranting and left the room. I didn't know whether to laugh, cry or sigh. I sighed.

I'm still not sure WHAT is going on. I don't know if there is a permanent order, or if this particular ER is just sick of the sight of me, or what have you. But I do know this: I no longer feel comfortable getting care there. ESPECIALLY if there is this misconception that I am NEVER to be treated! And who, exactly, made THAT order, anyway? I still don't know who lied to me: the on-call doctor, or the PA. I'm starting to think the PA is the source of the trouble, and the hospital wants me gone.

You know, you hear about the shithole our nation's health system has become, but you don't really KNOW until you end up smashed in the cogwheels of the demon machine....

Easter 2006

I want to wish everyone who celebrates a Happy Easter!



It's not been too happy here at the Zen Angel house. I was up all night in pain, and I'm not the most pleasant person to be around right now. We had a hectic week, and were planning on dying eggs today...only to find out that my husband bought the wrong kits. The kind he bought were Easter decorating kits, not coloring kits. You know, the kind that require plastic gloves and sponges? Now tell me...how am I supposed to get a 2-year-old to do THAT? Not to mention the fact that the 9-year-old hates plastic gloves and won't wear them. So the kits are basically useless. The kicker? I can't take them back or even give them away, because while I was trying to catch a catnap on the sofa, my son opened all three boxes for reasons unknown and scattered their innards here, there and everywhere. Sigh.

To make matters worse, there was a mishap at work and my husband had to go in. We had planned to go out to eat for the holiday, as I am in no condition to cook a big meal. Well, it's dinnertime, and my husband is still coping with the work situation. I have little in the house and no way to get to a store, so we have A) no way to dye eggs, and B) only TV dinners to eat to celebrate the most holy day on the Christian calendar. At this point, I wonder if anything will even be open by the time he gets back. Sigh again.


It's still (sort of) early, so hopefully things will start to turn around soon. I'm holding on to that. Why were holidays so much fun as kids and so much work as adults?


Happy Easter to everyone!

Another Shout-Out For Portland

We made Real Estate News' list for Best Places to Live and Work for Those Under 35. Whoo-Hoo!


The entire list:


Best Cities for The Under 35 Crowd

City Rent for 2-bedroom Apartment * Known For...

Atlanta, Ga. $930
Peaches; Varsity, the world's largest drive-in; southern barbecue
Boston, Mass. $1655
Atlantic seafood; Boston cream pie; pub culture
Chicago, Ill. $1050
Deep-dish pizza; the classic Chicago dog; German and Polish foods
Denver, Colo. $900
Meats of all kind, including beef, elk, deer, buffalo
Minneapolis, Minn. $899
Irish pubs; wild rice; salmon; Scandinavian and German foods
New York, NY $2257
Thin-crust pizza; world-class cuisines of all ethnicities
Portland, Ore. $695
Microbrews; Pacific seafood; wines; fresh produce
San Francisco, Calif. $1672
Sourdough bread; Dungeness crab; Chinese and Italian cuisines
Seattle, Wash. $1015
Coffee culture; Pacific seafood; brewpubs; apples
Washington, D.C. $1440
Maryland blue crabs; pub fare; power dining

Arachnids with the Munchies

Now I really HAVE seen it all......




View more funny pictures at FunnyJunk.com

Walgreen's: The Pharmacy America Trusts?

I'd first like to thank my friends and readers, Carol and Teal for sending these articles my way. This is lengthy, so please bear with me....




Palm Beach woman sues Walgreens over insulting comments on prescription


For years, Janey Karp has battled depression and anxiety with the help of prescription drugs. Though millions of Americans do the same, Karp admits she is intensely private and can't help but feel stigmatized for needing medication to feel normal.

So when the 53-year-old Palm Beach resident read the Walgreens printout attached to her prescription last week for the sleep aid Ambien, she couldn't believe her eyes. Typed in a field reserved for patient information and dated March 17, 2005, was "CrAzY!!" In another field, dated Sept. 30, 2004, it read: "She's really a psycho!!! Do not say her name too loud, never mention her meds by names & try to talk to her when ... " The information continued onto another page but was not attached.

"I was devastated, humiliated and embarrassed," Karp said. "I honestly couldn't speak. I was trembling."

Karp filed suit Tuesday against Illinois-based Walgreen Co., accusing the nationwide retail chain of defamation, negligent supervision and intentional infliction of emotional distress.

Since the notes have been in the computer since at least September 2004, the date of the first entry, it's anyone's guess how many Walgreens employees may have read them, Lively said.

The company Web site says there are 5,122 stores nationwide, with 673 in Florida. The site boasts that Walgreens new computer system for filling prescriptions links all stores into a single network.

Lively said the notes would not be an issue if the entry contained something helpful, such as the patient requests not to call out her name.

"But to put the demeaning terms crazy and psycho is not a patient preference and is not going to help a staff person provide a service," she said.

**************

More Walgreens customers sue over insults on their prescription printouts

Less than a month after a Palm Beach woman sued Walgreens for labeling her "CrAzY!!" and "psycho" in its nationwide computer system, two more Floridians have come forward with similar allegations.

A Palm Beach Gardens grandmother, 64, filed suit Wednesday, accusing the retail chain of negligent supervision and intentional infliction of emotional distress for typing in its system in May 2003: "WATCH CONTROLS SHE SEEMS SHADY."

For nearly 20 years, Elizabeth Noah has patronized the Fairway Drive Walgreens near her home in PGA National, she said. So when the retired United Technologies financial analyst picked up a prescription for anxiety medication the evening of Feb. 6, she began to cry when she read the notation on the Drug Utilization Review -- or DUR -- stapled to the bag.

The other Walgreens pharmacy customer, Erin Cutler, 30, and a married mother of three who lives outside Ocala, was shocked when she saw that her Walgreens DUR labeled her a "b----." Also alleging negligence and intentional infliction of emotional distress, Cutler is filing suit today in Marion County against pharmacist Bruce D. Adams and Walgreens. The initials B.D.A. are typed next to the Oct. 20 entry. Adams on Wednesday referred questions to the Walgreen Co.'s Deerfield, Ill. corporate office.

The DUR is an internal program, accessible to pharmacists and pharmacy technicians, according to Walgreens spokeswoman Carol Hively. The nationwide chain's 5,122 stores -- 677 in Florida -- are connected via satellite and each location has access to the information stored in the system, the lawsuits state.

Palm Beach resident Janey Karp, who takes medication for depression and anxiety, filed suit against Walgreens on March 7, after being labeled crazy and psycho.

"The purpose of the notes field [in the DUR] is to help our patients by entering information related to customer service preferences or insurance," Hively said. "Personal or uncomplimentary comments about a patient is a totally inappropriate use of the notes field. This should never have occurred. We take patient concerns very seriously and have apologized to Ms. Karp. We are reiterating our policies with pharmacy staff and have launched an investigation into this matter."

Walgreens has never apologized to Karp, according to Lake Worth attorney Cathy Lively, who represents all three plaintiffs. Noah and Cutler contacted Lively after reading about Karp's case.

Since Karp's case made national news, Lively said she has been flooded with calls and e-mails from Walgreens customers reporting similar experiences across the country.

"It's certainly not an anomaly. It cannot be, there are way too many," she said.

[said Cutler], who now uses another pharmacy chain. "This is the pharmacy that America trusts, that's their slogan. The trust is gone."

***************

And just when you think it couldn't get any worse.....

Girl Sues Over Birth Control Pill Embarrassment

CHICAGO A 14-year-old girl was subjected to ridicule and emotional distress from other students at her school when a classmate spread the word that she was taking birth control pills, according to a lawsuit filed in Cook County Circuit Court on Tuesday.

Britney Oliver found out that the girl was taking birth control from her mother, Susan Oliver, a Walgreen pharmacist, the suit says.

Susan Oliver was employed as a pharmacy technician at a Walgreen store in Posen when the unnamed 14-year-old picked up a prescription for Ortho Tri-Cyclen, birth control pills, at the store on Feb. 13, the suit said. Oliver told her daughter Britney that the girl, a classmate of hers, had a prescription for and picked up the pills, the suit says.

Britney shared that confidential information with many students at the school, and as a result, the 14-year-old, “Jane Doe,” suffered mental anguish, severe emotional distress and was the target of ridicule among peers, the suit says.

Susan Oliver, her daughter Britney, and Walgreen Co. are named as defendants in the suit. In addition to public disclosure of private information, breach of fiduciary duty and intentional infliction of emotional distress by the Olivers and Walgreen, the suit also says Walgreens is guilty of fraud and deceit, since in much of its advertising, the company calls itself "The Pharmacy America Trusts." The suit alleges that is false advertising.

Because, Apparently, Some People Need a Law to Tell Them They Shouldn't Copulate with Animals....

My comments are in red:




Lawmakers hope to outlaw bestiality
By Howard Fischer



Spurred into action by a spate of recent incidents, lawmakers hope to take the

first steps today to once again make it illegal to sexually abuse animals in Arizona. Once again? You mean, it was actually illegal once and someone took that OFF the books? WHY? So he could fuck the cat without fear of prosecution?

Rep. John Nelson, R-Litchfield Park, said the lack of any laws took some

people by surprise when a Mesa deputy fire chief was arrested earlier this

month after witnesses said he had been trying to have sex with a neighbor's

sheep. It turned out that Maricopa County sheriff's deputies could charge

Leroy D. Johnson only with disorderly conduct and trespassing. Let me

see if I have this right: the FIRE CHEIF was screwing a

neighbor's sheep? Oh, sorry...he was ATTEMPTING to

screw the neighbor's sheep. Ewwww. Or, ewe?

Nelson wants to persuade the House Committee on Counties,

Municipalities and Military Affairs to make it a felony to have sexual

contact with any nonhuman vertebrate. Violators could face up to a

year in state prison. So it's bad to knock boots with

vertebrates, but fish are fair game? Anyone else picturing

the Troy McClure character from The Simpsons right now?

Nelson's bill would also impose a 2 1/2-year prison term on anyone who

forced someone else to have sex with an animal.

Sheriff Joe Arpaio, saying he was alarmed about the lack of any statutes, demanded that lawmakers fix the problem or he would take the issue

directly to voters. I've got to say, I'm alarmed by the lack of

laws on this as well...but more so by two things: 1) there was apparently a law and someone decided, hey, it's okay to fuck sheep. Take the law off the books! 2) People really, honestly, sadly, pathetically do need a law in place to tell them not to

have intercourse with livestock. It's a sad world

we live in, truly.

Besides the sheep incident, police report two dogs have been

victimized recently.

A missing 8-pound poodle was found this past weekend after it had been sodomized, Phoenix police said. And police in Southern Arizona

seized a greyhound mix near Three Points, saying it had been both

physically and sexually abused. Holy cow. What kind of sick, screwed up, poor excuse for a multi-celled organism rapes a POODLE?!?!?!? Can you imagine the response of other inmates, should this guy get caught and sent to prison?

"Yeah, boys, this one's the Poodle Pounder!"


[Nelson] said Arizona appears to be in the minority of states that

does not make sex with animals a crime.

"That doesn't necessarily mean we're wrong," Nelson said. "But why

shouldn't we be in line with everybody else if the rest of the nation thinks it's a problem?" I don't think this is a question of "what the rest

of the nation thinks." I think this is a question of, hmmm,

how should I put this....you should never have sex with any

living being incapable of giving consent. And just

because the dog licks your face or humps your leg does

NOT mean he's giving consent, you sick weirdos.

Blech....

All Apologies

Sorry for being MIA the last few weeks. I've had a hard time, health-wise, due to the neuralgia....and then I had my mother-in-law and sister-in-law over to visit for ten days. In the interim, I got very little blogging done. I haven't forgotten it by a long shot....


Two bits of celebrity news I've come across lately: George Michael was busted for pot and Yanni was busted for domestic violence. I'm not shocked by the former (it's the only way to explain the constant 5 O'Clock shadow), but the latter? Who would've taken Yanni for an abuser? Now not only does his music suck...but he's a pathetic jerk personally, too.


I've got an inbox full of stuff to share, and I'll be blogging more now, health permitting....