Falling out during session.

[ladee]

Then possibly, you are going to have to have this very uncomfortable conversation with him.... trying to guess what is going on, even tho it seems apparent to you, you still need validation of your feelings... and if he is wanting to end the relationship, he needs to tell you so... and sometimes, regardless what a T thinks, we can stand our ground about certain things we KNOW will help us.... if you have been on this drug off and on for 20 years, addiction would have presented long before now...and I would also ask him to agree to disagree until after your hospitalization... then he can let you go... to do this now is very unprofessional regardless of the fact of disagreement.. I don't know when you see him again... but you do have a responsibility to yourself, not to him, to get some straight answers....

I am sorry you are feeling threatened... and if you can't say it to him, write it down and hand it to him.... you need to know where things stand and not add to your stress by guessing.... prayers for courage and strength to do what you have to do to maintain self care.

 

[FauxLiz]

@ladee and @EveHarrington Thank you for the encouragement to stand up for myself and supporting me in knowing that this medication for me is important enough to stand my ground. I see my t next Tuesday but I reached out to him earlier today and asked if we could meet before then. He got back to me this evening and offered a call this weekend if I wanted which I said that I did but now hours later I haven't heard anything more. I have been working on a letter to email him which is about done and then the ball will be in his court.

 

[ladee]

Checking in to see how things are with you today. Hope you have some answers and some cooperation from him.... in my thoughts.

 

[Butterflies2023]

Coming into this late.... ona medical team you should have your primary care MD, psychiatrist for medications related to psyche, and either or both a psychologist and social worker for weekly counseling. Daily or whatever frequency is determined for counseling

I don’t know the name of the medication so it’s hard to discuss anything more.

Shop for a counselor you feel comfortable with - remember it’s a two way street and if you feel this T is not receptive then look for someone else

 

[FauxLiz]

@ladee I heard back from him this morning and he offered a phone session tomorrow or a session on Monday. I am not against phone sessions but in this case I prefer face to face because honestly I can tell more by seeing him in person. He offered me a time and before I agreed I wanted to know if this would take the place of our normal session on Tuesday, I don't want it to because I think we will have significantly more to discuss than can be completed in an hour.

@SherlocktoWatson my medical team actually consists of a Primary Care, neurologist, neurosurgeon, headache/pain specialist, cardiologist, psychiatrist and psychologist. I see my psychiatrist for meds related to depression, anxiety and ptsd, My psychologist and I have therapy twice a week, my primary care takes care of basic health needs but the panel of specialists manage and prescribe everything else. Until just the last few months I have felt comfortable with my therapist and if things don't get better I will find someone else but I am hoping to work things out.

 

[anonymous]

I'm wondering why you feel that the inpatient facility would change or more importantly, deny you a script that a whole team of specialists are ok with you taking?

Nerve and cardiac illnesses are long lasting and do have a detrimental impact on mental health. I have to admit, I find it a little surprising that you would choose to deliberately keep the facility in the dark regarding your treatment regimen.

If you want to change your medications, no one can force you to do so, short of convincing the rest of your care providers to change their minds. Though if this mystery drug is the only thing that is effective for you after extensive trial and error, why would they do so?
Especially when the recommendation is coming from a facility which is new to your specific case as well as temporary.

Your evasiveness about this drug is raising red flags for me.
Here's how this looks from my perspective:

• You don't want your psychologist communicating with your care team, because of a abuse potential drug.
• You don't want an inpatient facility communicating with your care team because of said drug.
• You have been prescribed a drug with abuse potential, for 20 years.
• You use the drug to cope with sudden spikes in your mental health symptoms.
• You refuse to let it go, despite admission to an inpatient facility.
• You don't want to say what drug it is, either because it's embarrassing, or you think we will freak out if we knew what it is.
• Your psychologist of 3 and a half years, is convinced this drug is holding you back from your recovery, so you have taken elaborate steps to ensure he can't take it away from you. Even to the point of contemplating firing him, over this issue.

Obviously I don't know all the answers and am drawing some conclusions based on very little information, so I'm not saying this must be what's happening. But from what you've written here, that's how it looks to me.

 

[FauxLiz]

@anonymous the medication is a nasal spray called Stadol (butorphanol tartrate). It is a schedule IV narcotic used for the treatment of migraine headaches. However, it is rarely used today due to the development of other headache treatments and it’s classification as a narcotic. Why do I believe the inpatient facility will take me off of it - because it is a narcotic. I have no intention of keeping the facility in the dark about my treatment regime in fact I have to bring a 30 day supply of all meds with me and I will. But as I said previously I have enough experience dealing with well intentioned but new to me doctor’s telling me that this medication just isn’t prescribed anymore and that I need to stop taking it.

I would willing stop taking this medication ever again if any other treatment option besides hospitalization for if pain meds worked.

You mentioned that I use the medication for spikes in my mental health condition that is in correct. I have two neurological conditions in addition to ptsd. The first is called Arnold Chiari Malformation in a snap shot it is a genetic birth defect causing a part of the brain to be pushed down into the spinal column obstructing the flow of csf. The other is a condition called chronic daily migraine easy enough for most people to understand but the reality is that I suffer with a debilitating migraine 20-25 each month. This is considered to be a disabling condition as several times a month the pain is so bad I throw up for hours, must have absolute quiet, cold/cool and darkness it is when I am at this point that I take my “rescue medication”. I do this as like most in its classification it completely knocks me out.

Why would I worry that my treatment team would take me off this medication if they were informed by a third party short term treatment facility because it is a narcotic and in this country the number of pain patients being removed from pain medication due to the opiate crisis is scary and little to nothing is being done to actually help them they are just left without the medication that has allowed them any quality of life because others abuse meds. I am not one of them and I won’t have anyone in my medical team long or short term say otherwise to protect themselves and not me.

Yes I have taken steps to prevent my t from taking it away from me because as most mental health professionals in this day and age he believes that any use of pain medication or alcohol is a crutch and a form of self sabotaging. This is not.

Also if they feel the need/desire to terminate my use of this medication while I am inpatient I will defer to the professionals there, I will inform them that they will need to be prepared when I have a migraine that reaches that pain level with something else or I will be unable to participate for possibly days. I have never lied about what the medication is, what it is used for or failed to turn it over when I have been hospitalized for physical health reasons.

 

[anonymous]

Obviously I don't know all the answers and am drawing some conclusions based on very little information, so I'm not saying this must be what's happening.

I put this in so you would (Hopefully) know I wasn't trying to attack you or anything. I try to never use the anonymous thing as a easy way to throw a cheap shot.

Thank you for clarifying, that's gotten rid of the red flags I mentioned earlier. What you're saying makes alot more sense now.

Sorry if I upset you at all.

 

[joeylittle]

@FauxLiz - I just wanted to ask some follow-up questions. Thanks for your post clarifying things in re: the Stadol and why you are using it.

the number of pain patients being removed from pain medication due to the opiate crisis is scary and little to nothing is being done to actually help them

I will inform them that they will need to be prepared when I have a migraine that reaches that pain level with something else or I will be unable to participate for possibly days. I have never lied about what the medication is, what it is used for or failed to turn it over when I have been hospitalized for physical health reasons.

All of this makes a lot of sense. Pain management in US health care is a real mess, and I suspect there are many, many individuals who are struggling with exactly what you describe - losing access to the meds that give them a decent quality of life, simply because of over-correcting on having flooded the market with opiates for any and all pain, back before it was understood what a problem that could turn into. It is a real problem that patients are often not treated like individuals in this regard, and are instead lumped into the statistics.

One way to look at it - there could be an opportunity to try a different migraine med in a controlled setting. That's something that obviously you'd want co-ordination of care on, between your neurologist(s) and the psychiatrist(s).

But my real question is this:

You mentioned that I use the medication for spikes in my mental health condition that is in correct.

I'm curious - it sounds like you are mixing the chiari and the migraines in with mental health. So, it's hard to tell - are you also using the Stadol for things that are purely PTSD-related? I know that there can be physical pain that comes along with PTSD symptoms - but what I'm asking is, whether you are able to separate out what is a PTSD spike vs what is a migraine or something chiari-related. And if so, what would you be using the stadol for, in re: your mental health (mood, anxiety, dysregulation, sleep disturbances, those sorts of things).

Yes I have taken steps to prevent my t from taking it away from me because as most mental health professionals in this day and age he believes that any use of pain medication or alcohol is a crutch and a form of self sabotaging. This is not.

I would agree, that it's not the same as self-sabotage if you are only using it for migraine pain and chiari pain. I think if you were able to express that clearly to your T, and to any psych professional, they would likely probe to make sure you were telling the truth - but it's not hard to see how sometimes a narcotic for pain relief is the best option.

If you are also using it to dull psychological issues, then yeah - I'd say your T is actually right, it's not a good habit to get into. Using narcotics to manage psychological issues may be effective, but it will never be a reliable long-term solution. I know that you'd not be prescribed benzos on top of the narcotic, so I can see where you'd be between a rock and a hard place with needing the migraine med and not being able to give it up for an anxiety med, say. Is that the situation?

 

[FauxLiz]

One way to look at it - there could be an opportunity to try a different migraine med in a controlled setting. That's something that obviously you'd want co-ordination of care on, between your neurologist(s) and the psychiatrist(s).

@joeylittle if there were another migraine medication to try and do so in a controlled setting I would try it. I see a headache specialist because in my lifetime I have exhausted every medication on the market for migraine both on and off-label. I have tried every medical procedure and alternatives that the specialists can come up with from injections, procedures, surgery, acupuncture, biofeedback, and. meditation to name a few. There is a new class of meds that will be released for migraines in 2018 and my headache doctor and his team have already discussed with me that I will be trying these to see if they are helpful. I have been inpatient for my migraines enough times in the past for controlled settings to have been proven ineffective thus far.

I'm curious - it sounds like you are mixing the chiari and the migraines in with mental health. So, it's hard to tell - are you also using the Stadol for things that are purely PTSD-related? I know that there can be physical pain that comes along with PTSD symptoms - but what I'm asking is, whether you are able to separate out what is a PTSD spike vs what is a migraine or something chiari-related. And if so, what would you be using the stadol for, in re: your mental health (mood, anxiety, dysregulation, sleep disturbances, those sorts of things).

I am not mixing the Chiari and migraines with my mental health. I take this medication maybe a total of 5 days a month give or take the number of doses because honestly the bottle that I am prescribed has a maximum of 15 doses in it but must be primed if it has been more than 12 hours since the last dose so some doses are lost through that each month. A ptsd spike does not encompass a stabbing pain in my eye that makes we wish I could gouge it out to relieve the pressure. A ptsd spike does not include a sharp tight throbbing pain that has me clutching the back of my skull in hopes that I can tear it out, because I am crying and throwing up from the pain. My ptsd yes causes anxiety, joint pain, heart palpitations, hypervigilence and insomnia to name a few. I take anti-depressants sleep meds and benzo's in a very small dose for my ptsd symptoms so those are completely separate from my Chiari and migraines. I understand the good intent that he has regarding working through my ptsd without this medication but I am also aware that the pain from the Chiari and migraines can also hurt my ability to work on my ptsd as it can be so intense that suicide becomes an option and that doesn't help either.

 

[EveHarrington]

This is more serious than I thought.

I’m leaning toward saying kick your idiot therapist to the curb.

He’s in waaaaay over his head and trying to exert influence in a world where he knows nothing.

You need a T who supports you, not one who is a threat to your very precarious functioning and well being.

 

[joeylittle]

I take anti-depressants sleep meds and benzo's in a very small dose for my ptsd symptoms so those are completely separate from my Chiari and migraines.

So, you do not use the Stadol for mental health, then?