August 9, 2024
David had a video visit with Dr. J, Palliative Care (Supportive Medicine) physician this afternoon. Dr. B referred us to him after we asked if such a visit would be beneficial. Dr. J is based in Atlanta and is open to video visits as often as possible. He was already familiar with David’s history, so he jumped right in with questions about his pain. Where it seemed to originate, where he felt it, how it felt, how often he felt it, how often he needed to take pain medication. He determined from speaking with David that he possibly has two sites of pain. One type in the abdomen that could be coming from the peritoneum involvement with the bladder and the other in his rectum which is the site of the mothership tumor. He explained some of the pain he was experiencing is indicative of referred pain and could be attributed to the bladder issues. He said with any pain medication, the goal is to reduce the pain by 50%. Damn. And here we were thinking 125% reduction was our objective. He wanted to try an extended release of the same type he has been taking in hopes of giving him more relief. He also discussed a couple of options for a nerve block that could reduce the pain he was feeling and thereby reduce the reliance on the opioids. He is still on a low dose but not having to increase before it is absolutely necessary is our goal. Dealing with opioid prescriptions for chronic pain is not an easy task. You usually can’t get them until you are out and then sometimes pharmacies are in short supply due to the overuse and also increased need. Dr. B’s office prefers you pick up the prescription in person and that means a two-hour drive just to get the piece of paper. We have managed to get them to call it in once before but, going through the three lines of defense before you can get to the doctor is exhausting. I did ask about this in an earlier visit, and he told me to just let them know a few days before it is needed because it is difficult for them to just stop him during clinicals to key it into the system electronically. He said he doesn’t mind doing it if we give him a few days. With this new prescription, Dr. J explained he would not be able to prescribe it until he sees David in person, but he would reach out to Dr. B and ask him to prescribe it until we can see Dr. J in the office. Because it was already after 5 on Friday, he would need to make contact on Monday. David made an appointment with Dr. J on 8/26. He said that would give David two weeks to see how the ER formula was working for him. David wanted to think about the nerve block and has some questions and apprehension about it. The block could work anywhere to 1 week to 3 years and that is a pretty big range where it could work or not work. His main concern is what if he NEEDS to feel some pain to know something is wrong and then doesn’t.