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TKR The long and winding road - round 2

OP
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Rather

Rather

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One rant before I turn in for the night.

The craziness of the opioid problem and insurance companies is enough to turn me into an activist. My OS prescribed 42 hydrocodone for the 1st week after surgery with instructions for 1-2 every 4-6 hours. At the end of that week, I requested a refill which he promptly submitted to my local pharmacy through an integrated e-prescription system that allows him to do this without having to use the special paper scripts - this is especially handy since we live an hour away for his office.

But when I called the pharmacy to see if the script had been filled, I was told they hadn't received it. After multiple calls, I discovered that the system was connected to insurance so the insurance company could put a hold on it before it reached the pharmacy. It seems that my insurance company (employer-provided PPO premier plan) was doing that with all opioid refills. The doc could override the system, but then the pharmacy was told that the script was held for review by the insurance company and that it would be at least a week to review it before making a decision. So I asked my pharmacist if I had any other options besides going without pain management for a week. He said that he could fill the script if I was willing to forego the insurance and pay cash - which is what I did.

So in an effort now to appear responsible and accountable with opioids, the insurance company decides to delay prescribed pain meds when they can easily see that the patient just had a knee replacement. And in the end, I got the meds, which had I been part of the abusing community would not help address that problem. But the insurance company folks can pat themselves on the back and show with numbers how they are contributing to reducing the epidemic. Nevermind that some of those numbers come from denying pain meds prescribed by doctors to people who need them.

In the middle of recovering from this surgery, this is not a battle patients should need to fight. Rant off...goodnight.
 

Macknit

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Oh @Rather I completely feel your rant pain!!! I even posted something on my thread about a very similar issue! To address the opioid crisis, the Dr office would only prescribe 7 days at a time and after the first week of 50 pills it immediately dropped to 40 pills (in essence going from 10 mg Oxycodone every 4 hours to 5 mg every 6 hours) and this was happening at a time when I still needed the 10 mg. I did the exact same thing and paid for the prescription, to fill the interim time slot!

It seems rather nefarious to have the insurance company delay filling the Rx just to manipulate their numbers! And you are right....this is not a battle that the patient should have to deal with! I dissolved into tears when I first realized the quantity they gave me for that 2nd week!!

I'm glad you had a different solution. Unfortunately, you were forced to find a work around...eventually it just may be that throughout our nation the Drs will be in the position to sell the pain meds on the side! :sad:

Ultimately, medical clinics or the insurance companies are responding with just a knee jerk reaction (pun intended!) to our nation's opioid crisis and this can't be a true long term solution.
 

luvcats

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I am so right there with you. On my first knee, my surgeon did not address my existing tolerance when he proscribed my pain meds. I was horribly undermedicated the whole time. To make it much worse, I came home from the hospital taking 2 every 3 hours, only to discover that the bottle said 2 every 4-6 and I was running out. When I tried to address this with my surgeons office, they said I couldn't have any more until the 2 weeks the original prescription should have covered was through. So I had to stretch it out and did some not-recommended things to help me get through an awful period.

My second round was managed by my pain specialist, and it was a completely different, and much less horrible, experience.

The law makers are absolutely punishing those of us with a real need because others are abusing the system. But there are ALWAYS people who will abuse various substances. Maybe we should address why that is instead of making life miserable for people with serious problems.
 

luvcats

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Just popped by to see how things are going for you. Is the pain improving?
 
OP
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Rather

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@luvcats Sorry to have been so quiet for so long. One reason is that I didn't want to acknowledge what was happening in case I might jinx it. And I confess to some guilt feelings. My healing seems to be happening at a pace I was not at all expecting. Despite much more pain early on, the pain has significantly decreased so that I only need 1 hydrocodone at night and Tylenol during the day. My ROM and flexion are reasonable - at least for me. With yesterday's PT visit I was at 100 and -4 and I was 17 days out from surgery.

Since I'm not drugged all of the time, I was able to work from home this week (another reason for not having much time) and I will be returning to campus next week, working a few hours there each day and the rest at home. I started driving yesterday. This is TOTALLY different from what I experienced with the first knee as I was unable to drastically reduce the hydrocodone for several weeks and was not able to return to work until 5 weeks out from the surgery.

What are the differences? With the first knee I had terrible times with restless leg and an increasingly inflamed IT band. I couldn't sleep more than 1.5-2 hours at a time and was always exhausted. The IT band pain was so difficult that I stopped even realizing that my knee hurt. The swelling spread from my knee to my entire lower leg, lasted for months, and I only got relief from a therapist using kinesiology tape and lymphatic massage weekly for many weeks. None of those things have happened with this knee.

I have been able to sleep for hours at a time. Yes, I sleep like I'm in a coffin - on my back with my legs elevated and ice on my knee - unmoving for hours. But I think my ability to sleep has made such a huge difference in both my healing and my attitude.

I'm not pain-free. I am using a cane to walk. And getting up from sitting is done slowly, especially when a chair doesn't have sturdy arms and I can't use my upper body to help me up. Even after a good night's sleep, I need a nap during the day. And if I push things too much, I get that tight band feeling all around my knee that is only relieved by elevation and my trusty ice machine. But overall, I am beyond amazed so far at the difference this time and crossing my fingers that things will keep moving in this same direction.
 

luvcats

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I confess to some guilt feelings. My healing seems to be happening at a pace I was not at all expecting.
I know exactly where you're coming from. After a fairly horrible first knee, my second knee was almost a breeze. Much less pain, faster improvements. And you come and see so many others posting the usual horror stories, you feel guilty that you're having an easy time.

Don't feel guilty! We are all delighted for you that things are going well and quickly! Take your blessing and run! :running:

I started driving yesterday.
The joys of the left knee over right!

I sleep like I'm in a coffin - on my back with my legs elevated and ice on my knee - unmoving for hours.
:loll::rotfl:
This is exactly me. Just cross my arms over my chest and add a lily. lol

I'm so glad this is going easier. I hope it continues.
 

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