Maine Drug Law PL488: A Multitude of Problems…Part 3

Maine Drug Law PL488: A Multitude of Problems…Part 3

HIPAA is a privacy law enacted, passed by Congress and signed by President Clinton in 1996. A state (Maine) cannot implement the law at will to supersede federal because federal laws take priority over state laws due to the supremacy clause of our Constitution.

Under the Privacy Law there are Covered Entities and Business Entities; however, neither list includes veterinarians. The American Medical Association’s web page has this description of HIPAA on it today. Note, this description is on the website of the American Medical Association, which represents human medicine,  not the American Veterinarian Association (AVMA) which represents that of animals. Plus neither veterinarians nor their designated staff is bound by HIPAA regulations. How can pet owners who agree to have their personal prescriptions reviewed by someone from a veterinary practice be assured that whatever is seen will remain confidential? They can’t. Whereas in human medicine any HIPAA violations are dealt with appropriately. I think this places an extra burden on a practice, especially a small one. Plus I believe they are as uncomfortable viewing a humans prescriptions as we are knowing the law requires them to.

That gives rise to the question, how can Maine residents be sure their personal data is safe? On March 22, 2017, it was announced that a hacker had breached the Maine Department of Labor’s Job Link, a job matching service. While the service was outsourced to a Kansas company in July 2016, it was reported that the Maine DOL’s computer system is antiquated therefore indirectly played a part in the breach. Officials say the hacker was able to view names, social security numbers, and birth dates of site users. Since July, over 12,000 Maine residents have utilized the site and to date the number of users affected is unknown. So how do we know if the Maine PMP is secure? It’s disturbing alone that a veterinary practice staff member is required to look at consenting humans drug records and that a 5-year window of prescription activity is accessible on the PMP. Now we must also wonder about the security of the electronic system.

 

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Email sent by Maine DOL on March 24

 

Secondly, the state is mandating that veterinarians operate outside their scope of practice since pharmacology is often vastly different between the species. They are expected to make a judgment call when reviewing the owner’s (or anyone picking up the animal) prescription drugs on the PMP database and determining if prescribing a controlled drug for the animal would enable the owner to “potentially” exceed the mandated daily limit of 100 MME. This alone is requiring a doctor trained in animal physiology to understand human physiology. Would you expect your dentist to prescribe medications for your cat’s seizures? Or expect your veterinarian to know how much Vicodin you need following major orthopedic surgery? What if a veterinarian makes the wrong judgment call simply based on the numbers? A pet could be denied much-needed medication. Do legislators really have the power to make such laws where one’s medical privacy is violated and their pet possibly left in pain or distress?The inclusion of veterinarians in this hasty bill is not the answer to the opiate epidemic. Perhaps stricter sentencing should be considered. Recently in my Maine community, during the same court session, a drug trafficker was given a suspended sentence and allowed to freely exit the building whereas someone who embezzled money was sentenced to jail hence escorted out by deputies. The drug he trafficked was Suboxone which is both addictive and has the potential to be fatal  if combined with certain other drugs. While I’m certainly not defending someone who embezzled money, as a nurse who worked in a large city teaching hospital, I’ve never heard of someone dying because of it. The stark contrast in sentencing was disturbing and reinforced my belief that including veterinarians in PL 488 is not going to stem the opiate epidemic; appropriate sentencing is.

As a Maine resident who refuses to allow my HIPAA rights to be violated, and as an animal owner who does not want my pet to suffer, I  reached out to my elected officials and Augusta, the state capital, multiple times since February 2017 in an attempt to express my concern. My communications have been completely ignored with the exception of Senator Thomas Saviello who was initially helpful but once I began asking more focused questions regarding PL 488, he no longer responds. This is certainly not the reaction I expected from my elected officials nor is it one I’ve experienced while living in other states.

Next ~ Who else is adversely affected by Maine’s PL488?

Maine’s New Drug Law: Veterinary Visits Get Complicated….Part 2

Maine’s New Drug Law: Veterinary Visits Get Complicated….Part 2

Why are the legislators in Maine including veterinarians in a bill that is geared towards stemming the opiate epidemic?

The nation has an opioid abuse problem and it’s naive to think some animals owners have never diverted their pet’s medication or sought drugs for the animal when it’s really for them. To vet shop, however, requires more than doctor shopping. When doctor shopping one much be a very good actor. If you have a history of chronic pain even better. Veterinarian shopping requires a prop; your animal. It means establishing a profile for your pet at numerous veterinary practices. It means paying multiple veterinary bills to get drugs which A. aren’t really the type an addict wants and B. could be obtained cheaper on the street or through friends.

It’s not uncommon for veterinarians to prescribe painkillers to animals that suffer from chronic pain or that have undergone surgery. In some cases, these painkillers can be opioid-based. But what our legislators fail to take into consideration is the dosing difference between humans and animals; the dosing difference between felines and canines. And unlike a human who can “act” the part of a person in pain and verbalize their symptoms, animals can’t. Because they cannot communicate, non-verbal cues are the best way to determine the severity of a pet’s pain regardless of what the owner says. The veterinarian listens to the owner describe what Pup or Kitty are doing but then does a physical assessment of the animal. The last two decades have seen a huge change in the way veterinary medicine addresses pain in an animal. Whereas the previous line of thinking was Animals don’t feel pain” or “Keep them quiet and it will speed their healing because they won’t move around much”. Thankfully the veterinary profession has embraced the idea of pain management for both large and small animals and several pain scales are currently in use. Colorado State University Veterinary Medical Center uses this scale to evaluate acute pain in kittens and this one to evaluate acute canine pain.

A November 2015  publication from JAMA  gives an excellent overview of how pain is assessed and evaluated in animals whether it’s acute as in surgical or chronic like osteoarthritis. And if one is fortunate to live in a progressive area, there are even pain management clinics for animals like the one at Cummings Hospital which is part of The Veterinary School of Medicine at Tufts University in Massachusetts. More than ever, veterinarians are aware of the pain in animals whether it be a broken leg, advanced arthritis or cancer. This excellent article, The Hurt Unlocker, by Genevieve Rajewski, Editor for Tufts Veterinary School, gives a great overview of pain in animals and how it’s best managed.

PL 488 requires the following parameters for veterinarians:

  • All veterinarians who prescribe opiates or benzodiazepines must register as data requesters with the PMP
  • All veterinarians must check the records of the individual seeking care for the animal, and if appropriate the owner, prior to prescribing opiates or benzodiazepines. A valid state or federal photo ID should be checked, and a birthdate and the full name must be acquired in order to check the PMP of an individual. This would also apply to anyone you had to drop off or pick up Fido.
  • All written prescriptions must include a DEA number.
  • All prescriptions intended for use by an animal must indicate such use on the prescription.
  • Diagnosis and exemption codes are not required for veterinary prescriptions.
  • As of July 1, 2017, veterinarians with the capability to prescribe electronically will be required to do so. In April 2017 a waiver is expected to be released that will allow veterinarians without the capability to apply to be exempt.
  • The Aggregate Morphine Milligram Equivalent for the person who either owns the animal or is transporting.  The 100 MME/daily limit would include the anticipated new prescription.
  • The number of prescribers currently prescribing controlled substances to the individual.
  • The number of pharmacies currently filling prescriptions for controlled substances for the individual.
  • Veterinarians will be required to complete three hours of CE (continuing education) related to the prescription of opioids by December 31, 2017, and subsequently every two years. **

The Maine Veterinary Medical Association has even “helped” veterinarians by preparing a presentation  plus consent form for the humans to sign which gives the veterinarian or his designate permission to access the person’s drug records. What exactly does that mean? If narcotics are being prescribed, the human bringing the animal in or picking the animal up must consent to have their drug records accessed by someone in the veterinary practice. Let’s think about this for a minute. Your dog has surgery and because of the postoperative pain, the veterinarian wants to prescribe tramadol, a Schedule III narcotic as of 2014. Because of work hours, you ask your neighbor to pick Fido up. Imagine their shock when they have to fill out the consent form, show their driver’s license or another form of photo ID and wait while their drug profile is accessed and evaluated by a veterinarian, highly trained and skilled in animal medicine. And if the veterinarian calculating the human dosage determines your neighbor is at the top of the 100 MMEs daily allotment and the tramadol for your dog would exceed that amount, legally they can’t prescribe it. Also, a veterinarian had no way of knowing why a person is on the controlled drugs; only that they are. Based on numbers found in a database, a highly skilled veterinarian is being ordered by the State of Maine to practice veterinary medicine but use human protocols. In short, they are being mandated to practice outside their scope which is a violation. To ask a veterinarian who as I outlined in my previous post has extensive knowledge of animal physiology to prescribe pain medication for an animal based on how much of the daily allotment a human already has prescribed for them by a medical doctor is absolutely ludicrous.

Then there is palliative care for an animal with an end-stage disease that is painful. The State has not set any exemptions for veterinarians but has for human doctors.

Prescribers are exempt from the limits on opioid medication prescribing established in this rule if:

  1. Pain associated with active and aftercare cancer treatment. Providers must document in the medical record that the pain experienced by the individual is directly related to the individual’s cancer or cancer treatment. An exemption for aftercare cancer treatment may be claimed up to six months post remission

  2. Palliative care in conjunction with a serious illness;

As someone who had a beloved dog diagnosed with canine lymphoma in October 2015, I would have been beyond furious if her oncologist couldn’t prescribe opiates for her as she neared the end ~ simply because my daughter or I were at the top of the daily allotment. 

Addiction is an epidemic that can no longer be ignored. However the welfare of innocent animals should not be impacted, veterinarians mandated to operate at best, on the fringe of their scope of practice, nor our guarantee of privacy under HIPAA violated because neither veterinarians nor their staff is bound by HIPPA regulations.

Yet the State of Maine is doing all of these things.

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Maine: Passed A Law That Could Harm Animals And Their Veterinarians…Part 1

Maine: Passed A Law That Could Harm Animals And Their Veterinarians…Part 1

Like nearly every state, Maine is dealing with an opiate and heroin epidemic. In 2015, Maine experienced 272 overdose related fatalities.

In an effort to combat the opiate epidemic, the Maine Legislature enacted   P.L. 2015, ch. 488 (An Act to Prevent Opiate Abuse by Strengthening the Controlled Substances Prescription Monitoring Program) which became effective January 1, 2017. PL 488 affects nearly all facets of healthcare by establishing specific rules for prescribing and dispensing controlled medications. It defines the protocols that must be followed and sets prescription limits on how much opiate a patient may legally be prescribed to take per day. This is called the Aggregate Morphine Milligram Equivalent and the total daily amount allowed is 100 Morphine Milligram Equivalents (100 MMEs).

PL 488 mandates that whenever a medical provider prescribes a controlled substance, they first check the PMP (Prescription Monitoring Program) to review the MME for the patient, what controlled drugs the patient is currently taking, who prescribed them and the pharmacy that filled the prescription. They must calculate if the drug they want to prescribe will, when added to the patient’s current daily MMEs, increase the allowed 100 MMEs and if so, not prescribe it. They must note if there are multiple prescriptions, providers or pharmacies. If the provider notices anything in the patients PMP profile that raises a red flag, they are required by law to report it to the PMP Coordinator. There are of course many other components to PL 488 but I only want to touch on the highlights and how it impacts Maine residents who are pet owners in addition to veterinarians. Yes, that’s correct ~ veterinarians because Maine’s Legislatures have determined that the inclusion of veterinarians in PL 488 will help reduce the opiate epidemic. I disagree because including veterinarians in PL 488 creates two major violations. First, however, I’d like to walk you through a veterinarian’s education.

If a young person thinks they want to become a veterinarian, they should begin preparing in high school by paying attention to their performance in science courses, such as chemistry, biology, and physics. This same attention applies to math courses; trigonometry, geometry, and algebra. After high school graduation the student attends a 4 year college to earn their bachelor’s degree where they take the prerequisite courses for admittance into veterinary college.These consist of many advanced science courses, such as biochemistry, organic and inorganic chemistry, and physics. They are necessary to prepare the student for the vigorous coursework in veterinary college. Prospective veterinarians must complete a doctor of veterinary medicine degree. Typically, a doctorate in veterinary medicine takes four years to complete. Of these four years, three are spent on classroom training where students take courses in animal anatomy and physiology. They also take courses on disease diagnosis, prevention and treatment. After completing three years of classroom training, students take another year left to complete their degree in veterinary medicine. The fourth year is typically spent getting practical, hands-on training. This takes the form of a one-year clinical rotation in a veterinary medical center or veterinary hospital to gain experience in a variety of areas of veterinary medicine. After graduating with a doctorate in veterinary medicine, veterinarians are not yet able to open a practice. Before practicing veterinary medicine, graduates must pass the North American Veterinary Licensing Examination and any applicable state exams. Their path is definitely not a short one but throughout it is focused primarily on one thing ~ animal anatomy, physiology and wellness. 

Maines’s new PL 488 and its impact on veterinarians is such. If an owner takes their pet to be seen and the veterinarian feels it necessary to prescribe a narcotic or benzodiazepine for your pet, they must first do a check on the owner with DHHS to determine if the owner is taking a controlled substance. As I previously mentioned I still need to clarify the parameters but the fact that a veterinarian or perhaps his staff has the power to access a person’s prescriptions is a huge HIPAA violation. But I digress. Let’s use a hypothetical situation. The owner has an anxiety disorder for which he takes Valium on a daily basis. He also has a severe back issue (long-term) so is on hydrocodone for pain control. His cat is hit by a car and taken to the vet where she undergoes successful emergency surgery but because her injuries are severe, the vet prescribes a pain medication; hydrocodone. Would the fact that the owner is on hydrocodone prohibit the vet from prescribing it for the cat’s postoperative pain? If so, would he be allowed to prescribe a different pain medication such as tramadol which also falls in the opiate category? Is he is prohibited from prescribing any narcotic because the owner is on two (2)?  Or is it only if the owner is on the same drug? If his prescriptive powers are limited because the owner is taking a controlled substance, what criteria is used to determine if the animal can or cannot get a prescription?

Whilst I understand the opiate epidemic our country is tackling, how can a veterinarian or anyone for that matter be absolutely certain that a person who is taking several controlled drugs is abusing or trafficking? Plus the thought that an innocent animal might have to suffer needlessly because his owner is on a controlled substance is not only abhorrent but inhumane.  I want to know if it’s possible for the check to be done during non-business hours when DHHS is closed. Does the veterinarian’s office have to speak directly to a DHHS employee or is the information accessible online? And if it is accessible online, how can we, the human patient, be assured it’s secure? If the drug check on the owner can’t be done when DHHS is closed, then what happens to the animal who is in pain?  Any pet owner knows that many accidents happen at night, weekends or holidays when government agencies like DHHS are closed; what then?  Going back to HIPAA, who has authority within the veterinary practice to request the DHHS information? Can a receptionist do it? A vet tech? Or only the veterinarian? Finally, I do not understand how PL 488, a state law, can override HIPAA, a federal law enacted in 1996 by Congress and signed into effect by then President Bill Clinton. Under HIPAA an individual’s medical and other health information including prescriptions is private and protected. The Privacy Law sets limits on who can look at and receive our health information such as covered entities and their business associates. As a nurse and former Union representative, I am extremely familiar with HIPAA. In light of PL 488, however, I reviewed it once again and nowhere did I find where veterinarians, veterinary technicians, or veterinary employees of any type are entitled to our records in any form. Additionally, PL 488 is, in essence, requiring veterinarians to understand human medication dosages compared to animals which often differ greatly.

I chose a veterinary team for my German Shepherd based on their reputations and expertise in animal physiology, not human. I value all members of her team despite being in different practices because of their knowledge. Having said that, I expect they keep current with the newest modalities of treatment for my dog. They work long hours yet now the State of Maine expects them to undertake additional training in order to understand and monitor the Prescription Monitoring Program (PMP)?  A program historically used only for humans?

This is ludicrous. There has to be a middle ground, a way the government, human healthcare providers, and law enforcement can work together in an effort to reduce the rampant drug abuse without violating a person’s rights or including veterinarians where there is potential for an animal to suffer because “something” raises a red flag when in reality it could be legitimate.

Veterinary Visits In Maine Just Got Complicated…

Veterinary Visits In Maine Just Got Complicated…

Like nearly every state, Maine is dealing with an opiate and heroin epidemic. In 2015, Maine experienced 272 overdose related fatalities. In January 2017 one of Maine’s media outlets, WMTW, did an outstanding feature entitled Goodnight moon, goodnight mum,’ ‘Chronicle’ investigates Maine’s heroin epidemic. Anchor David Charns did a phenomenal job detailing the pain and heartache of addiction through a series of interviews and videos including one with Oxford County Sheriff’s Office Sgt. Matthew Baker Sergeant who, moments after arriving home from work in February 2015, discovered his 23-year-old daughter Ronni near death in the upstairs bathroom. Despite CPR from her father and several doses of Narcan by paramedics, she died, leaving behind an 11-month-old daughter Claire. Ronni’s daughter, now 2, lives with her grandparents and is the source of the name of the WMTW article:

When Claire asks for her mother, she and her grandfather look up, past that second-floor bathroom, to the sky. “I’ve always told her that that full moon is mum,” Baker said. “We go outside, and she says, ‘Goodnight moon and goodnight mum.'”

In an effort to combat the Maine opiate epidemic, the Maine Legislature enacted Public Law 488 which became effective January 1, 2017. PL488 affects nearly all facets of healthcare except in this law, veterinarians are included. I didn’t have all the exact data on PL488 so reached out to my State Senator, Thomas Saviello. I must tell you, he is the only government official to respond during the two weeks I called and emailed various agencies, elected officials including the State House. A sad indictment against them but a huge kudos for Senator Saviello. 

What I do know about PL488 and its impacts on veterinarians is such. If an owner takes their pet to be seen and the veterinarian feels it necessary to prescribe a narcotic or benzodiazepine for your pet, they must first do a check on the owner with DHHS to determine if the owner is taking a controlled substance. As I previously mentioned I still need to clarify the parameters but the fact that a veterinarian or perhaps his staff has the power to access a person’s prescriptions is a huge HIPAA violation. But I digress. Let’s use a hypothetical situation. The owner has an anxiety disorder for which he takes Valium on a daily
basis. He also has a severe back issue (long-term) so is on hydrocodone for pain control. His cat is hit by a car and taken to the vet where she undergoes successful emergency surgery but because her injuries are severe, the vet prescribes a pain medication; hydrocodone. Would the fact that the owner is on hydrocodone prohibit the vet from prescribing it for the cat’s postoperative pain? If so, would he be allowed to prescribe a different pain medication such as tramadol which also falls in the opiate category? Is
he is prohibited from prescribing any narcotic because the owner is on two (2)?  Or is it only if the owner is on the same drug? If his prescriptive powers are limited
because the owner is taking a controlled substance, what criteria is used to determine if the animal can or cannot get a prescription?

Whilst I understand the opiate epidemic our country is tackling, how can a veterinarian or anyone for that matter be absolutely certain that a person who is taking several controlled drugs is abusing or trafficking? Plus the thought that an innocent animal might have to suffer needlessly because his owner is prescribed a controlled substance is not only abhorrent but inhumane.  I want to know if it’s possible for the check to be done during non-business hours when DHHS is closed. Does the veterinarian’s office have to speak directly to a DHHS employee or is the information accessible online? And if it is accessible online, how can we, the human patient, be assured it’s secure? If the drug check on the owner can’t be done when DHHS is closed, then what happens to the animal who is in pain?  Any pet owner knows that many accidents happen at night, weekends or holidays when government agencies like DHHS are closed; what then?  Going back to HIPAA, who has authority within the veterinary practice to request the DHHS information? Can a receptionist do it? A vet tech? Or only the veterinarian? Finally, I do not understand how PL488, a state law, can override HIPAA, a federal law enacted in 1996 by Congress and signed into effect by then-President Bill Clinton. Under HIPAA an individual’s medical and other health information including prescriptions is private and protected. The Privacy Law sets limits on who can look at and receive our health information such as covered entities and their business associates. As a nurse and former Union representative, I am extremely familiar with HIPAA. In light of PL488, however, I reviewed it once again and nowhere did I find where veterinarians, veterinary technicians, or veterinary employees of any type are entitled to our records in any form. Additionally, PL488 is, in essence, requiring veterinarians to understand human medication dosages compared to animals which often differ greatly.hipaa_violations_by_type_-_pie_chart

I chose a veterinary team for my German Shepherd based on their reputations and expertise in animal physiology, not human. I value all members of her team despite being in different practices because of their knowledge. Having said that, I expect they keep current with the newest modalities of treatment for my dog. They work long hours yet now the State of Maine expects them to undertake additional training in order to understand and monitor the Prescription Monitoring Program (PMP)?  A program historically used only for humans?

This is ludicrous. There has to be a middle ground, a way the government, human healthcare providers, and law enforcement can work together in an effort to reduce the rampant drug abuse without violating a person’s rights or including veterinarians where there is potential for an animal to suffer because “something” raises a red flag when in reality it could be legitimate.

Once I have all the specifics, I’ll revisit this in a future post.

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Discrimination Against Chronic Pain Sufferers…

Discrimination Against Chronic Pain Sufferers…

In September 2016 I posted about Chronic Pain & Pills… and the difficulty a family member was having. He is 73 and retired after 47 years of steady and often physically challenging employment. He was a tractor-trailer driver for 40 of his 47 years in the workforce so essentially sat in the cab of the truck for over 10 hours a day. He began feeling ill in 1991 but typical for him wouldn’t take off work to see a doctor until I finally insisted. His PCP at the time diagnosed him with fatigue. Hmmmm. As a nurse,  the diagnosis of fatigue didn’t sit well with me so once again I insisted he seeks a second opinion. This doctor ordered basic blood work and when it came back within normal limits, he also diagnosed him with fatigue. Again my professional experience kicked in and I instinctively felt they were both wrong; it was more than fatigue but I didn’t know what or whom to turn to.

One night while working at the hospital I saw a pamphlet about Lyme Disease which was still somewhat new in 1992. I remember looking at it and with each paragraph, my mouth fell open a bit more. It specifically described the symptoms and the discomfort he’d been experiencing since the previous summer. More telling, however, was the photograph of the classic red rash; a red ring surrounding a clear area and a red center. I remembered he’d been bitten by a tick the summer of 1991 and developed an identical rash. Small at first, it enlarged in size over days/weeks until it was approximately 6” in diameter. It lasted for at least a month and always felt warm. I realized that I might have found the answer to his lingering illness so made an appointment with an ID (infectious disease) specialist in  Philadelphia. After a comprehensive examination and specific blood tests, she diagnosed him with Stage 3 ( late disseminated) Lyme disease. He was hospitalized in ICU and after several days transferred to a medical floor for nearly a week. He had a port implanted in his chest prior to discharge and once home, received IV antibiotics for several weeks through it.  Finally, after what seemed like an eternity he began to feel better. Unfortunately, Stage 3 Lyme Disease can cause long-term joint inflammation (Lyme arthritis) usually in the knees along with a host of other complications, many which continue to resurface years later. He developed severe arthritis in his knees which the ID specialist thought was probably made worse by his profession ~ driving for long hours all week. He also developed arthritis in his hands, specifically in his fingers. It hurt his hands to try to grip things and he often dropped them. As a  driver, he often had to unload freight. I  remember he developed callouses on his inner wrists. When I asked what caused them, he said he was unable to unload the freight by hand so picked the boxes up using his wrists. Yet not once did he complain.  His dedication and strong work ethic were beyond reproach.

Shortly after moving to Maine he started seeing a rheumatologist for his arthritis. He began receiving injections to his knees which initially worked very well but as the years passed the effect of the injections didn’t last as long. He was still working so his knees were bent every day and he was frequently unloading freight by his wrists. His rheumatologist prescribed Vicodin which he only took on the weekend and even then, only if he couldn’t stand the pain. When he retired at age 66, he was finally able to live the kind of life most of us take for granted. He had the freedom to watch the news on television, walk the dog, drive to the store, sleep in a regular bed, make toast and a cup of tea in the kitchen. All those little everyday things that he wasn’t able to do for 40 years while living in a truck. Yet even with these lifestyle changes, his knees and hands continued to hurt and were steadily worsening. He had the Vicodin prescriptions filled every month even if he had leftovers from the previous month because he didn’t want the doctor to think he didn’t need them. They were prescribed four times daily as needed but rarely did he take more than one or two a day and some days none at all. 

He went to the rheumatologist for his routine appointment in March 2016 and upon arrival was told they needed a urine sample.  When leaving he was given a paper saying that in the future he had to bring his Vicodin bottle with him. That was new but given all drug-related issues in society not surprising. In the beginning of April,  the doctor’s office called to say the test didn’t indicate enough Vicodin in his system so it would no longer be prescribed for him. Dumbfounded doesn’t even come close to describing my reaction. He was glad he had leftover pills because when the Vicodin was stopped nothing else was prescribed. He didn’t see the rheumatologist until August so he would have been in horrible pain for five months. During the August visit, the doctor said that he wasn’t allowed to prescribe Vicodin based on the urine test, that it wasn’t his policy but rather that of the hospital whose umbrella he was under. He added that the hospital was working with the state to decrease narcotic prescriptions. He prescribed a different medication which is completely ineffective against the severity of his pain.

It pains me to watch him struggle to get up from a chair or limp when he walks. My heart aches as I see him wince in pain when trying to open a jar. Now is the time he should be enjoying his life but because of chronic pain, he is doing anything but. He wants very much to go to Tennessee this summer to visit his family but is worried that his arthritis will affect him; that he won’t be able to participate in simple activities with his grandchildren due to his pain level. Every week I read of more drug-related arrests and indictments in our small rural community. Many are for trafficking which simply amazes me. Where do they get the drugs? If a 73-year-old man with arthritis so severe and painful that it’s adversely affecting his life can’t get a prescription, where are these people getting them? I asked his PCP about it but he said he doesn’t prescribe for a patient who’s been “cut off” by another provider.

As to the medical center’s across the board policy, I have to wonder if it ever crossed their minds that not every person with chronic pain is a potential trafficker? That not every senior citizen is supplementing their income by selling some of their pain pills? Why do doctors automatically assume that everyone who complains of severe, chronic pain has nefarious motives? What gives them the right to play God with a person’s health and welfare? A person who has been their patient for 15 years? Yet because of a prejudicial policy, he suffers each and every day, his quality of life so impaired that he is often unable to enjoy his days.

The same thing applies to the state. In April 2016 over two-thirds of the Maine legislature voted to override two harm reduction bills vetoed by Governor Paul LePage ~ LD1552, a bill that would provide public funding for syringe exchange and expand syringe access, and LD 1547, legislation to allow access to the life-saving overdose antidote Narcan (naloxone) without a prescription, something Governor  LePage vehemently objected to. During a town meeting in Damariscotta last year LePage said:

“There comes a point in time where who is responsible for who. You know a shot of Narcan is $70 and the person who gets it doesn’t have to pay it back.”

So a state whose governor publicly implies that a human life is not worth $70 is the same state establishing narcotic prescribing guidelines?

With no doctor to help and pain that is severely impacting his life, my family member has decided to try medical marijuana  because it’s legal in Maine. As I researched cannabis I was surprised because it’s definitely a profitable business. You make an initial appointment with a doctor who is certified by the state to prescribe medical marijuana. Upon completion of the appointment, providing your medical condition is one that qualifies,  you will be issued a Medical Marijuana Card (usually tamper-proof). The first visit ranges from $150 to $300 and the annual recertification is about $50 less. Then there is the cost of the actual cannabis which can be approximately $300 a month.  My family member doesn’t want to smoke so will try a concentrate that he can add to a cup of tea. And of course, insurance doesn’t cover any of the costs whereas a prescription for Vicodin is $10.

So let’s recap. A senior citizen with a long, well-documented history of Lyme Disease and arthritis. Retired after 47 years in the workforce, 40 of them as a tractor-trailer driver. No history of drug or alcohol abuse. He didn’t take Vicodin four times daily because he didn’t want to develop a dependency plus the prescription said: “as needed”. Yet for not taking them when he didn’t need them or was driving, the hospital’s inane and unjust policy is forcing him to turn to an alternative source in an attempt to obtain some degree of pain relief. In doing so, he’ll be spending several hundred dollars a month of his limited retirement income; money that he could spend on enjoying his life instead.

Maine, like every other state, is seeing the tragedy of the nation’s prescription opioid and heroin epidemic but it is also seeing an increase in people with chronic pain, especially as baby boomers age. Chronic pain now affects more than a third of Americans yet as I have discovered, getting help from your physician, no matter how many years you’ve been a patient, is often impossible.

I will never go to that hospital for a procedure because of his experience. And should I develop a condition which causes me chronic pain, I’ll definitely seek help elsewhere because no one should be made to arbitrarily suffer like my family member; to have his treatment altered based on not taking as many pain pills as they think he should but rather, as prescribed. To be judged on the results of a single urine test as opposed to a long documented medical history and 15 years.

What a sad indictment against the medical profession. When did it lose humanity and compassion?

Halfway To The Light…

Halfway To The Light…

Finally! I had my right eye corrected last week with a laser procedure called a YAG.  Because my eye was blurry from the various solutions and gels, I couldn’t really tell if my vision was improved during the ride home. Plus I had a late afternoon appointment so it was dark during the drive. When I woke up the next morning, however, I could see the floor in my house for the first time since the spring of 2016! Who would think seeing a floor would bring such joy? Now mind you, I’m not talking about everyday happiness here but the real deal, yell-out-loud unbridled bliss! And it got even better because as I was taking my daily vitamins that morning one dropped on the floor and of all the ones to drop it was  Turkey Tail  , which is a capsule containing freeze-dried, brown, turkey tail mushroom. A brownish capsule on a hardwood floor? See where I’m going with this?

I was going to post that day but wanted to give it some time to make sure the improvement lasted and it has. I go on Tuesday, February 13 for the left eye and they’ll probably also book my appointment for the optometrist so that I can finally get glasses and hopefully contact lenses for near vision. The timing is perfect because I’m at the strongest strength in the cheater glasses. Sometimes I alternate between two different strengths if I have an especially long paper to do. I’ve also started to slowly catch up on blog reading which I wasn’t able to do very well before.

On the way down we stopped at a sporting goods store where I had an unused gift card from my AT hike. Since I haven’t been able to hike, walk the dogs or snowshoe, I’ve gained some weight. Plus my legs aren’t nearly as strong as they’ve always been. So I bought a new pair of snowshoes since mine are ancient. I was going to buy my second choice, Tubbs Wilderness because they were less expensive even though I really wanted my first choice, Tubbs Mountaineer. When in shape I do backcountry snowshoeing so having really good crampons are important to me and the Mountaineer’s are very aggressive. Lady luck was with me because they were having an in-store sale and I wound up getting the Mountaineer for less than $200 (the amount of my gift card). The Wilderness wasn’t on sale so it was a no-brainer. Of course, I’ve started out just walking to rebuild leg strength and then will snowshoeing on trails and a rolling field near me before I even attempt to ascend. Currently, my legs are a step above the straw man from the Wizard of Oz so one step at a time.

It’s been a heck of a year but soon it’ll be over.

winter

Blue, aka mainebluedog, Needs Help…

I’ve written about a pit bull puppy named Blue, aka mainebluedog, several times. He was found with his muzzle taped in the mountainous and heavily wooded terrain of Maine at Sunday River Ski Resort on October 2, 2015. Miraculously he was discovered by resort security who called animal control. She in turn immediately took the puppy to Bethel Animal Hospital which is owned by Dr. Gary Stuer, one of Sasha’s veterinarians. He and his staff went to work trying to save as much of the puppy’s lips, mouth and facial tissue as possible.  They estimated he was only between 5-6 months old!  The authorities were notified and the HSUS announced a $5,000 reward however over a year later the monster that did this to an innocent and defenseless puppy has yet to be found. The investigation and reward both remain open.

This is very similar to what the area would have looked like the first week in October.

 

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After staying at Bethel Animal Hospital for nearly one month, the puppy now named “Blue” was adopted by a wonderful family from Maine. Because of the open investigation, they have remained anonymous to protect Blue. Everyone has respected their request for anonymity and continues to do so. Because of the widespread media coverage, many people were interested in Blue so his new family set up an Instagram account hence the name “mainebluedog”. Just looking at the photos and video clips show how very loved he is. I don’t know their names; I reached out to them via his Instagram asking permission to write more about Blue and use some of their photos to which they kindly agreed.

Follow Blue on Instagram

Blue is a very active (you will see for yourself on his Instagram video clips) and well-traveled fellow.  His family noticed that he was limping and took him to their veterinarian. It was discovered that Blue has Medial Compartment Disease in his elbows. The preceding link provides a good overview of the disease as it’s actually composed of several different conditions. Blue is under the care of a veterinary specialist and in mid-December had his elbows scoped. He currently has some restrictions on his level of activity thus the Boo Mobile.

 

Blue had his follow-up appointment on December 29 and his Mom reports that the appointment went well but he’ll remain on exercise restriction for several months at which time they will discuss his progress with the specialist and see what the next steps are.

As you can imagine, the type of special treatment Blue needs is expensive. Whether or not surgery will be needed remains to be seen. A friend of Blue’s family has kindly set up a fundraising page to help with expenses,  Help Blue Get Back On His Feet.  His story is also featured on The Dodo!

 

Blue has such an indomitable spirit and supportive, loving family that I’m confident he’ll meet any challenges head-on. However, everyone needs a bit of help at times and I can’t think of a more worthy cause than Blue’s health. This poor boy hasn’t even reached two and has already endured such trauma. When I think of him as a mere puppy, alone in the woods with his muzzle taped shut my emotions are polarized; I’m thankful that he was found because I’m sure he would have died. At the same time, I’m disgusted by the sadistic and cruel person who committed such a barbaric act against a living, sentient being.

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When my GSD Sasha developed her unique medical issues, there were times I wouldn’t have been able to fully provide what she needed if others hadn’t helped me. It would give me immense pleasure If I can help pay it forward for Blue.

Please consider making a donation to Blue’s fundraiser  Help Blue Get Back On His Feet.; I assure you any amount will be appreciated. Also, if you would kindly share his Go Fund Me link within your social media and email circles it would go far in helping reach the goal. **Goal met!

 

I last wrote about Blue on October 17, 2016, in a post called A Little Joy After My Bleak Posts Of Late…  At the bottom of that are three links to my initial posts which were part of a blog challenge. All four posts have additional links and photographs.

Blue’s a pretty funny boy don’t you agree?

 

In closing, I’d like to explain how I chose the cover photo because I found it significant. Blue is relaxed in the snow looking towards the mountains. Although they aren’t the mountains where he was found, had things turned out differently he wouldn’t have this wonderful life.

“Saving one dog will not change the world, but surely for that one dog, the world will change forever.”
 ~Karen Davison (The Perfect Companion)