It is my opinion that Dr. Upham will one day make a great all-around G.P. As for now, she lacks experience with patients that need to take opiate-based pain medications for extended periods of time. I was one such patient of hers. To be fair, she inherited me when I had already been on strong around the clock opioids for some years. I met her at a residency clinic and was impressed with her. The managing Doctor and I had an agreement as to the doing of the medication I was on and that as I got certain pain-causing problems fixed I would reduce my dose. He also said that my dose was always to be weight dependent, as in mg./kg. So if I lost weight, I would go down, if I had less pain, I would go down. Robin was in Med school and residency at the first peak of the national opiate crisis, dso I can see where her educators might have gone a bit far in the teaching of the importance of opiate reduction. I was seeing her in an office different from the residency clinic for several months… before she became my official "Doctor of Record"(D.O.R.) and her former mentor was no longer the D.O.R. After an incident that I will explain in a bit, I did some research, finding some of the information such a the date she became my D.O.R.) Well, I fell at my Dad's 80th B-day party and landed on my hip and that broke off some arthritic calcification, grinding up an already-compromised hip. I was going to have my knee replaced first, but this was so painful the Surgeon said to have the hip done first. Two weeks after this had happened I asked if I could go up a little on my pain med until they fixed my hip, not knowing that she had become my D.O.R. just days earlier. I was at a dose far lower than my maximum, even less than half. Her response was, "I am taking you off of Methadone completely. I was a bit shocked and asked what she planned on giving me and she said maybe nothing because studies showed that after a while the Opiates were no longer effective. This is after over 15 years on pain meds with no problems, no bad urines, no early refills, etc. When I called the residency clinic I was told that she was now my D.O.R. and that there was not only nothing they could do, but that they couldn't discuss it with me. I did want to get either off of or way down on my pain meds, but after I had had my hip and knee replaced. She was unconcerned and sent me to the pain clinic and they gave me injections to the tune of nearly $1,000 apiece. I had three before my operation. My thought was I could have just taken a few more of the least expensive pain meds on the market and gotten more relief. Well, I suffered through and got my hip fixed and after a month she finished the taper off of morphine to just methadone and we went on with the slow Methadone taper. She did have me on a nice slow taper for a year or so and when I started having some withdrawals, she would slow it. Everything was OK. Then I had my knee replaced. The anesthesiologist I requested, the one from mu hip replacement, somehow didn't get assigned to the surgery. the one I got had no clue. I had needle tracks all down my back where he tried to get the epidural in until another doctor had to do it, then after the surgery he didn't prescribe adequate pain meds by a long shot. I have too much of an enzyme and metabolize opiates quickly, it was in my chart but ignored. I lay on the hospital in agony for almost 2 days until I saw Dr. Previt walk by, my hip Anesthesiologist and I yelled out and he came in and remembered me very well and asked how things were going and when I told him he told the nurse not to give me anything until he returned. He went and did his best to straighten things out and helped immensely. (Never have a major surgery right before a weekend) For some reason Palliative care had gotten involved, they prescribe meds for people who are dying basically and have not one clue about post-surgery pain that someone who has been on pain meds for 15+ years has. There answer was to reduce my pain meds because of something that almost NEVER actually happens, a patient with chronic pain can start to have more pain with increasing doses of meds. That had already been checked out years ago and I didn't have that. This was all most likely a result of the "Opiate Crisis" and the CDC had Drs. scared about losing their licenses. In defense of Dr. Robin Upham, when I got out of the hospital, she managed my morphine/post-surgical pain and did a good job, realizing they had undermedicated me in the hospital.
Fast forward then rewind a bit, and I am down to 60 mg/day of Methadone from an all-time high of 270mg/.day and then 150mg/day for over ten years because I asked to have my dose reduced from 270mg/day as I was not feeling like I was engaging in life. That's when the managing Dr., Dr. Harp, and I made up the dosage contract, and we got down to 160mg./day then made the agreement.
So I am at 60 mg/day, and I asked if we could just hold there, instead of going off entirely or at least go down 5 mg every 2 or 3 months. After having been on Methadone or any Opiate that long, your receptors are downregulated, and you feel pain more intensely taking 60mg/day of Methadone than someone who had never taken pain meds in their life. Dr. Upham, grudgingly agreed as I recall. I was given a Narcan kit many years before when I was at a high dose, just in case. I only had the liquid in a glass vial, and I had a couple of insulin syringes in my toolbox for oiling small things, etc. Well, my roommate goes and gets a bag of heroin and decides he wants to snort it. I warned him that it isn't like cocaine and not to do more than a tiny amount. He ignores me and a few minutes later goes silent in the next room, I come in, with my bad hip and knee and back, etc. and find him slumped over a coffee table looking blue and not breathing. I tried desperately to pick him up, injuring m
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