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crazyjaneThat's me. I'm the aforementioned fat bitch. And I am sick and fucking tired.
A bit of background first: I'm in my mid-forties, with two extremely active nine year old girls. I'm studying, working part-time, trying to set up a business and (when I get time to breathe) kick-starting a writing career. I have intermittent episodes of major depression, and I suffer from osteoarthritis in my knees. About ten days ago I woke up with sciatica, something I've had three times in the last ten years. I have chronic pain which fluctuates from about a 5 to an 8 out of 10 on bad days. With the sciatica, I'm hovering about 8 pretty much constantly - and have hit 9 a few times.
And I'm fat. Really fat. What the media and the medicos like to call 'morbidly obese', as though I were some kind of blubber-laden zombie shambling around looking for brains.
Yes, my weight probably contributes to the degeneration of my knees. I know that. I'm trying to drop a bit of weight to help with that. But here's the thing.
Today I broke down and went to a doctor to get some pain relief for the sciatica. I'd been trying to manage it with Nurofen Plus, but it's not helping - so I thought that, rather than take handfuls of an ineffective drug, I'd seek a better solution. If I could get some relief, it would mean that I could actually sleep at night, do stretching and flexing of my back without crying and, you know, function.
Now, you may not be aware that the Federal Government, in its dubious wisdom, has now declared codeine a Class 2 drug. This means that you can buy, at most, 5 days' supply without a prescription - and even then, you can only obtain that if a pharmacist is satisfied that you really need it. Yes, that's right. You have to convince a pharmacist that your suffering is bad enough to obtain a packet of Panadeine or Nurofen Plus - and if they don't agree, your only option is to go find another pharmacist who might be disposed to let you buy some. If you're in pain bad enough to need codeine, the last thing you want to be doing is driving around the place.
If you're in chronic pain, you're going to be paying a hell of a lot more now. Either you're paying doctor's fees (which means you're out an average of $15 after the Medicare rebate) on top of the prescription ($10+), or you're buying every five days (an average of $6 on top of petrol in your quest to find a damn sympathetic pharmacist). Previously, you could buy a packet of 48 Nurofen Plus for $10 or under, which would last a hell of a lot longer.
Why is the Government doing this? Because, according to the pharmacist I spoke to today, 'People are using too much codeine and addicts are using it to substitute for heroin'. Right. So the best solution they could come up with is to punish everyone indiscriminately - including those who might need the stuff for legitimate reasons. There is no funding for more and better pain management clinics, no funding for rehab or drug education, and heaven forbid they might actually try to target their strategy where it's needed. Oh, no.
So, with all this in mind, I asked the doctor today for two forms of pain relief - Nurofen Plus, which is what I use to control the arthritis pain and inflammation, and Tramadol. Now, Tramadol is a non-addictive, non-tolerating opioid drug. You don't find yourself needing more of it to have an effect, and you don't get physically addicted to it. Psychological addiction is offset by the side-effects - most people suffer horrible nausea, not to mention drowsiness. All in all, it's a fantastic drug for people in severe pain. I've used Tramadol in the past when my arthritis pain has been really bad.
The doctor I saw commented that I appeared to be in a lot of pain and was having difficulty walking. I asked her for the drugs. That's when she shut down the chatty, friendly personality and started to lecture me.
She didn't want to write me the prescriptions at all. Her reasoning? I was fat. I needed to lose weight. If she gave me the drugs I would just take more and more of them. What I really needed was a dietician.
I explained that I had had Tramadol before, and that I didn't use it unless pain was more than I could bear, and then a maximum of one in any given day (the prescribed amount is 2 for the strength I buy). I told her I knew how to take non-steroidal anti-inflammatory drugs like Nurofen Plus, that I never took more than the recommended limit in any given day. She dismissed this.
I told her that I was in the process of dropping some weight. I explained to her in detail how I was doing this - portion control, and cutting down on fat and sugar. I pointed out that it was easier to stay active, even just a little bit, when I could walk without crying in pain.
Her response to all that? I still needed to be under the care of a dietician, because I would 'slip'. I wouldn't be able to stay on a diet.
Note the language here. There was no attempt to engage with me at all. She somehow just 'knew' that I would become a tolerant, addicted woman who was completely unable to lose weight if I wasn't being controlled by another person.
I managed to hang on to my emotions, though I know my face was burning red with humiliation. You see, if I'd broken down and shown her how much pain and distress I was really in by crying (which is what I really wanted to do), she would likely have been even less sympathetic (if that was even possible). I made promises. I reassured her over and over. I pretty much begged for help.
In the end, she grudgingly wrote me a prescription for the smallest possible amount of the drugs. In the case of the Nurofen Plus, the prescription was for the same amount I could have gotten over the counter from a pharmacist. She kept telling me I needed a dietician, even after I told her firmly several times I would not see one. When I asked her to refer me for an X-ray and ultrasound to diagnose the cause of the sciatica (which could be anything from a herniated disk to bone spurs to spinal tumours), she at first refused. Again, I practically had to beg.
Explain that one to me. She refused to find out what was causing this terrible pain I've been suffering, and maybe indicate some therapeutic treatment. She would rather have put me on a diet than catch a potentially severe problem early.
Her parting shot to me was that she thought I was doing the wrong thing, and there was still time for me to let her send me to a dietician. I didn't bother answering. At that point I was so upset that I needed to leave before I started screaming. I managed to hold myself together until I'd gotten my prescriptions from the pharmacy next door - then I sat in my car crying and shaking, utterly humiliated and furiously angry.
Just as a contrast? In the last three months, several friends of mine have needed strong pain relief. One was loaded up with several different drugs, including a morphine derivative, without having to request anything. Another was given a prescription for 100 Panadeine Forte (each tablet containing 30 mg of codeine, as opposed to the 12 found in Nurofen Plus). Yet another was given both Panadeine Forte and Tramadol. Not one was subjected to the kind of treatment I received today.
The difference? None of them were 'morbidly obese'. One was perhaps 10 kg heavier than the stats told her she 'should' be. One was severely underweight by those same standards (and would have been considerably more affected by the drugs she was given).
So right now, this where I stand. If I need to manage my pain, I need to prove my case every time to a pharmacist, or try to get a doctor's appointment. If I do have to see a doctor, I need to beg for pain relief while being subjected to insulting condemnations of my personality - and then I am still entirely at their mercy. There was nothing stopping that doctor from refusing to write me any prescriptions whatsoever. She could have blackmailed me into going under a dietician's care by holding out the possibility of pain relief. In other words, she could have coerced compliant behaviour out of someone in pain so severe that it interferes with sleep, normal living and general quality of life.
How is this even remotely excusable?
The Government assumes I'm an addict. The doctor assumes I'm weak, have no willpower at all and will become both addicted and a 'failure' at losing weight. The pharmacist shrugs her shoulders and says, 'Well, it's the law now'.
This is NOT good enough.
I am not a junkie. I am not morally weak. I have not abrogated my right to medical aid. I am a fat woman in chronic pain, trying to better my situation and requesting a little help.
I have the right not to be humiliated. I have the right to obtain relief from pain. I have the right to be treated like any other human being - with decency, compassion and courtesy. I didn't lose that right when I started buying my clothes in plus sizes or walking with a stick.
It'll be a long time before I can face going back to a doctor. In that time I just have to hope that my sciatica will die down and that I can learn to cope with the pain.
Thank you for nothing, Mr. Rudd and Ms. Roxon.
A bit of background first: I'm in my mid-forties, with two extremely active nine year old girls. I'm studying, working part-time, trying to set up a business and (when I get time to breathe) kick-starting a writing career. I have intermittent episodes of major depression, and I suffer from osteoarthritis in my knees. About ten days ago I woke up with sciatica, something I've had three times in the last ten years. I have chronic pain which fluctuates from about a 5 to an 8 out of 10 on bad days. With the sciatica, I'm hovering about 8 pretty much constantly - and have hit 9 a few times.
And I'm fat. Really fat. What the media and the medicos like to call 'morbidly obese', as though I were some kind of blubber-laden zombie shambling around looking for brains.
Yes, my weight probably contributes to the degeneration of my knees. I know that. I'm trying to drop a bit of weight to help with that. But here's the thing.
Today I broke down and went to a doctor to get some pain relief for the sciatica. I'd been trying to manage it with Nurofen Plus, but it's not helping - so I thought that, rather than take handfuls of an ineffective drug, I'd seek a better solution. If I could get some relief, it would mean that I could actually sleep at night, do stretching and flexing of my back without crying and, you know, function.
Now, you may not be aware that the Federal Government, in its dubious wisdom, has now declared codeine a Class 2 drug. This means that you can buy, at most, 5 days' supply without a prescription - and even then, you can only obtain that if a pharmacist is satisfied that you really need it. Yes, that's right. You have to convince a pharmacist that your suffering is bad enough to obtain a packet of Panadeine or Nurofen Plus - and if they don't agree, your only option is to go find another pharmacist who might be disposed to let you buy some. If you're in pain bad enough to need codeine, the last thing you want to be doing is driving around the place.
If you're in chronic pain, you're going to be paying a hell of a lot more now. Either you're paying doctor's fees (which means you're out an average of $15 after the Medicare rebate) on top of the prescription ($10+), or you're buying every five days (an average of $6 on top of petrol in your quest to find a damn sympathetic pharmacist). Previously, you could buy a packet of 48 Nurofen Plus for $10 or under, which would last a hell of a lot longer.
Why is the Government doing this? Because, according to the pharmacist I spoke to today, 'People are using too much codeine and addicts are using it to substitute for heroin'. Right. So the best solution they could come up with is to punish everyone indiscriminately - including those who might need the stuff for legitimate reasons. There is no funding for more and better pain management clinics, no funding for rehab or drug education, and heaven forbid they might actually try to target their strategy where it's needed. Oh, no.
So, with all this in mind, I asked the doctor today for two forms of pain relief - Nurofen Plus, which is what I use to control the arthritis pain and inflammation, and Tramadol. Now, Tramadol is a non-addictive, non-tolerating opioid drug. You don't find yourself needing more of it to have an effect, and you don't get physically addicted to it. Psychological addiction is offset by the side-effects - most people suffer horrible nausea, not to mention drowsiness. All in all, it's a fantastic drug for people in severe pain. I've used Tramadol in the past when my arthritis pain has been really bad.
The doctor I saw commented that I appeared to be in a lot of pain and was having difficulty walking. I asked her for the drugs. That's when she shut down the chatty, friendly personality and started to lecture me.
She didn't want to write me the prescriptions at all. Her reasoning? I was fat. I needed to lose weight. If she gave me the drugs I would just take more and more of them. What I really needed was a dietician.
I explained that I had had Tramadol before, and that I didn't use it unless pain was more than I could bear, and then a maximum of one in any given day (the prescribed amount is 2 for the strength I buy). I told her I knew how to take non-steroidal anti-inflammatory drugs like Nurofen Plus, that I never took more than the recommended limit in any given day. She dismissed this.
I told her that I was in the process of dropping some weight. I explained to her in detail how I was doing this - portion control, and cutting down on fat and sugar. I pointed out that it was easier to stay active, even just a little bit, when I could walk without crying in pain.
Her response to all that? I still needed to be under the care of a dietician, because I would 'slip'. I wouldn't be able to stay on a diet.
Note the language here. There was no attempt to engage with me at all. She somehow just 'knew' that I would become a tolerant, addicted woman who was completely unable to lose weight if I wasn't being controlled by another person.
I managed to hang on to my emotions, though I know my face was burning red with humiliation. You see, if I'd broken down and shown her how much pain and distress I was really in by crying (which is what I really wanted to do), she would likely have been even less sympathetic (if that was even possible). I made promises. I reassured her over and over. I pretty much begged for help.
In the end, she grudgingly wrote me a prescription for the smallest possible amount of the drugs. In the case of the Nurofen Plus, the prescription was for the same amount I could have gotten over the counter from a pharmacist. She kept telling me I needed a dietician, even after I told her firmly several times I would not see one. When I asked her to refer me for an X-ray and ultrasound to diagnose the cause of the sciatica (which could be anything from a herniated disk to bone spurs to spinal tumours), she at first refused. Again, I practically had to beg.
Explain that one to me. She refused to find out what was causing this terrible pain I've been suffering, and maybe indicate some therapeutic treatment. She would rather have put me on a diet than catch a potentially severe problem early.
Her parting shot to me was that she thought I was doing the wrong thing, and there was still time for me to let her send me to a dietician. I didn't bother answering. At that point I was so upset that I needed to leave before I started screaming. I managed to hold myself together until I'd gotten my prescriptions from the pharmacy next door - then I sat in my car crying and shaking, utterly humiliated and furiously angry.
Just as a contrast? In the last three months, several friends of mine have needed strong pain relief. One was loaded up with several different drugs, including a morphine derivative, without having to request anything. Another was given a prescription for 100 Panadeine Forte (each tablet containing 30 mg of codeine, as opposed to the 12 found in Nurofen Plus). Yet another was given both Panadeine Forte and Tramadol. Not one was subjected to the kind of treatment I received today.
The difference? None of them were 'morbidly obese'. One was perhaps 10 kg heavier than the stats told her she 'should' be. One was severely underweight by those same standards (and would have been considerably more affected by the drugs she was given).
So right now, this where I stand. If I need to manage my pain, I need to prove my case every time to a pharmacist, or try to get a doctor's appointment. If I do have to see a doctor, I need to beg for pain relief while being subjected to insulting condemnations of my personality - and then I am still entirely at their mercy. There was nothing stopping that doctor from refusing to write me any prescriptions whatsoever. She could have blackmailed me into going under a dietician's care by holding out the possibility of pain relief. In other words, she could have coerced compliant behaviour out of someone in pain so severe that it interferes with sleep, normal living and general quality of life.
How is this even remotely excusable?
The Government assumes I'm an addict. The doctor assumes I'm weak, have no willpower at all and will become both addicted and a 'failure' at losing weight. The pharmacist shrugs her shoulders and says, 'Well, it's the law now'.
This is NOT good enough.
I am not a junkie. I am not morally weak. I have not abrogated my right to medical aid. I am a fat woman in chronic pain, trying to better my situation and requesting a little help.
I have the right not to be humiliated. I have the right to obtain relief from pain. I have the right to be treated like any other human being - with decency, compassion and courtesy. I didn't lose that right when I started buying my clothes in plus sizes or walking with a stick.
It'll be a long time before I can face going back to a doctor. In that time I just have to hope that my sciatica will die down and that I can learn to cope with the pain.
Thank you for nothing, Mr. Rudd and Ms. Roxon.
Ignore the fcukwits!
Date: 2010-05-06 01:57 am (UTC)I once had a beanpole anaesthetist give me a 5 minute lecture about my weight (96kg at the time) and possibility of future diabetes while he WHEELED ME INTO SURGERY! It was a conscious procedure, where I had been mildly sedated, and I needed to keep very still for the entire procedure. Think I could stop myself from crying? No.
Find a new doctor if you can, and complain to health authority.
Re: Ignore the fcukwits!
Date: 2010-05-06 01:57 am (UTC)(no subject)
Date: 2010-05-06 02:08 am (UTC)Incidentally, law or no law, my local pharmacy has both neurofen plus and panadeine forte available off the the shelf without even needing to consult the pharmacist (surprised me actually, because I thought anything with codeine was controlled.) I know because I got some just a few days ago.
(no subject)
Date: 2010-05-06 03:31 am (UTC)Any doctor that automatically assumes that you are in the wrong doesn't deserve to be called a human being. My brain is currently not responding to pings, so I can't recommend to you the clinic that's been recommended to me, but I will once I remember what it is. It's a gay/bi/whatever friendly clinic where a friend of mine works as a receptionist, and all the staff are supposed to be friendly and will listen.
*hugs*
(no subject)
Date: 2010-05-07 02:43 am (UTC)http://www.northsideclinic.net.au/
Supposed to be really good, very friendly, and listens.
Defending the codeine decision
Date: 2010-05-30 03:25 am (UTC)The 'substitute for heroin' statement is, at best, a half-truth from somebody who doesn't seem to understand the issues. Codeine is addictive, and being able to get it over the counter means that people can meet their addiction. And, its the other ingredient, the ibuprofen, that has been causing concern.
People have been using so much codeine (a packet plus of nurofen plus a day) that the ibuprofen in there has caused renal failure, stomach ulcers, perforated guts - you name it.
Pharmacists are supposed to regulate its sale. Unfortunately due to either lack of will, a desire to grab money and/or the fact that a person can visit multiple pharmacies this hasn't worked. The drug is causing too many problems to be available over the counter. It is too dangerous. It needs to be regulated. Codeine is also not a particularly good painkiller for chronic pain (there are better options).
As such, the decision taken to reduce its sale to 5 days supply over the counter, and only on consultation is, in my mind, a sensible one. It has taken a very long time to reach this decision, and people like the Pharmacy Guild (sensing, I suspect, a drop in income) were very unhappy about the restriction.
There are people out there who can safely use Codeine over the counter for chronic (more than 5 days) pain. But there are lots of people for whom having this available is causing significant concerns. I don't think it indiscriminately punishes the population - it is appropriate over the counter for short term relief of pain that does not respond to ibuprofen alone - and it is still available for that. For other indications, it is more appropriate not to have it available.
Re: Defending the codeine decision
Date: 2010-05-30 04:56 am (UTC)Thanks for such a detailed reply. It's good to get the perspective of someone who's involved on the other side of the counter (as it were).
I do understand the rationale for restricting supply, but I think it's very much a one-sided approach. I honestly can't see it stopping someone who is determined to get hold of codeine - I have already seen someone walk into a chemist and be issued a 5 day supply of ibuprofen and codeine for 'a friend'. It wouldn't be hard for that to be done over and over again.
My real concern here is that what may be intended to be protective is going to be, in practice, punitive. Without meaning any disrespect to any pharmacist, this puts the onus on them to make what amounts to a diagnosis. They are in a position where they either must trust what they are being told by the person wanting the medication, or defer a decision to a doctor. I would not blame any pharmacist for wanting to err on the side of caution - but then, where does that leave the person in chronic pain?
Add to that the situation where most doctors do not understand chronic pain, or the various treatments that are available, and their patients end up either begging for prescriptions (as they themselves are often uneducated as to pain management alternatives) or forced into a fall-back position of trying to self-medicate, often breaking the law to do so.
It worries me that a whole new group of offenders can be created here, as well as the stigmatisation that already is a problem for people in chronic pain.
I'm aware of the dangers of ibuprofen abuse - many people aren't. They are simply not told. With the focus of these new laws being on codeine, what is to stop people buying large amounts of ibuprofen from supermarkets, and potentialy harming themselves?
If supply is to be restricted, people have to be thoroughly educated - and pain management therapies have to become available for those without private health insurance.
There is a culture out there where people are being told that these laws are to stop them getting addicted to codeine - I only have anecdotal evidence, but this is from pharmacies right across Melbourne. People aren't being told about ibuprofen abuse, or alternatives, or anything like that. They're being told that this is purely about addiction - and often, the implication is that they are potential addicts who need to be protected from themselves, not people in chronic pain who should be supported and aided in pain management.
Again, thanks for providing that info. I think it is important that information flows freely - and I wonder how much trouble could be avoided if it happened more often.
Re: Defending the codeine decision
Date: 2010-05-30 09:20 am (UTC)1. The problem is codeine abuse. There is NO problem with ibuprofen abuse. Its just that the tablets contain both codeine and ibuprofen, so in order to satisfy a codeine
addiction VERY large amounts of ibuprofen must be concurrently consumed.
2. Codeine is a morphine derivative. In fact, it is converted to morphine in your body. This is how it works.
3. It is somewhat of an accident of history that codeine is available over the counter. Heroin and Morphine, two other addictive opioids were too - but they were pulled. Codeine is really just next in line.
4. Pharmacists should be able to pick appropriate simple analgesia and supply safely. In the case of codeine with ibuprofen, you would do it when it is short term analgesia where ibuprofen alone is insufficient. It is highly inappropriate for a pharmacist to supply opioid analgesia for chronic pain.
5. Combination products (such as nurofen plus - ibuprofen with codeine) should be avoided for chronic pain as one cannot adjust the dose of one medicine without adjusting the dose of the other. Further, codeine has no advantage over any other opioid for chronic pain but has several disadvantages. It should not be used for chronic pain, especially in a combo product.