Find us on Google+ Gastroparesis: Gastroparesis Patients vs Drug Seekers

Friday, July 12, 2013

Gastroparesis Patients vs Drug Seekers

A few nights ago, my roommate had a friend over who works as a nurse in an emergency room. She asked me about my gastroparesis (GP) and why I've gone to the emergency room for it. I tried to explain the basic symptoms of gastroparesis and how much pain it causes, especially when you haven't eaten in over a week on top of dehydration. The first thing she said to me was,


"Most patients with Gastroparesis I encounter are drug seekers."


I want to explain why we are not drug seekers for those who may know little to nothing about GP and why that comment bothered me so much.


No two GPers are a like - we are all different in some way, but that doesn't make us any less ill.

According to the Mayo Clinic (http://www.mayoclinic.com/health/gastroparesis/DS00612)

"Gastroparesis is a condition in which the muscles in your stomach don't function normally.

Ordinarily, strong muscular contractions propel food through your digestive tract. But in gastroparesis, the muscles in the wall of your stomach work poorly or not at all. This prevents your stomach from emptying properly. Gastroparesis can interfere with digestion, cause nausea and vomiting, and cause problems with blood sugar levels and nutrition.

There is no cure for gastroparesis. Making changes to your diet may help you cope with gastroparesis signs and symptoms, but that's not always enough. Gastroparesis medications may offer some relief, but some can cause serious side effects. Signs and symptoms of gastroparesis include:

Vomiting
Nausea
A feeling of fullness after eating just a few bites
Abdominal bloating
Heartburn or gastroesophageal reflux
Changes in blood sugar levels
Lack of appetite
Weight loss and malnutrition"


I am also going to add pain to the symptoms. Because, I know that if I try to eat with Gastroparesis, my stomach starts spasming and doesn't stop until I vomit everything up. That's not even mentioning the pain my esophagus feels after vomiting up so much food/liquids.






Just like you, probably, I *hate* going to the Emergency Room. But I must go if I want nausea relief because I can't keep down pills, or fluids. I ask for pain medicine after the doctor presses on my stomach because I cry. I've been crying for a week now because of the pain. I read something on Physician's Weekly that I would like to quote that sums up how I feel,

"When a person goes to the ER it’s because their pain has become too much for them to handle on their own. You then need to take into account the fact that anybody who is in pain wants not to be in pain and the faster the better. Please don’t judge us too harshly because people like myself who live with chronic pain want our pain to go away as soon as humanly possible. Chronic pain is a hideous disease. It never gives you a moment’s peace. When we with chronic pain go to an ER then you can be certain that we’re at a level of desperation for the pain to stop that we are willing to endure the terrible irritation of waiting in an ER. Waiting in an ER when they are in pain makes people anxious. It’s a well-establish fact that anxiety magnifies the perception of the pain that someone is experiencing."

Now, there's a difference in being legitimately sick and just seeking drugs.

According to Physician's Weekly about drug seeking behavior(http://www.physiciansweekly.com/drug-seeking-behaviors-emergency-department/),

"Studies have been conducted on screening tools to identify drug-seeking behaviors in chronic pain patients, but few have provided quantitative data on such behaviors in the ED (Emergency Department). With this in mind, Dr. Grover and colleagues performed a case-control study examining the relative frequency of various drug-seeking behaviors in drug-seeking patients as compared with all ED patients. The study was published in the January 2012 Journal of Emergency Medicine. “Our goal was to provide emergency physicians with information as to which drug-seeking behaviors are most commonly used by drug-seeking patients,” says Dr. Grover. “Identifying behaviors that are most commonly used by drug-seeking patients may help evaluations of patients suspected of drug-seeking behavior.”

A retrospective chart review of 152 drug-seeking patients and of age- and gender-matched controls was conducted, with the authors noting several drug-seeking behaviors that were exhibited over 1 year. Drug-seeking patients accounted for 2,203 visits to the ED, averaging about 14.5 visits per patient per year. For the control group, patients accounted for 315 visits to the ED, which is an average of 2.1 visits per patient per year. Patients in the drug-seeking arm reported their pain level as 10 out of 10 more often than control group patients (Table 1). Additionally, drug-seeking patients occasionally complained of pain levels greater than 10 out of 10, while the control group had no instances of these events. Drug-seeking patients were also significantly more likely to request medications parenterally.

The odds ratios for both requesting parenteral medication and reporting pain levels greater than 10 out of 10 were significantly higher than all others observed in the study (Table 2). These were the most predictive of drug-seeking behavior, while a non-narcotic allergy was less predictive. However, the odds ratio for a non-narcotic allergy was greater than 1, and was still a behavior that was more commonly used by drug-seeking patients than the control group. For other studied behaviors, the confidence intervals were too wide to allow the authors of the study to meaningfully interpret the data."

Here are some common schemes of drug seeking behavior according to Acpinternist.com(http://www.acpinternist.org/archives/2002/04/drug_abuse.htm),

"Most scammers try to get the doctor to write a prescription or gain access to a prescription pad so they can write a script themselves.

Patients will sometimes say they're from out of state and the pharmacy won't fill their prescription. They try to evoke the practitioner's compassion to continue the medication.

Other times, a patient you've never seen before will present with a prescription, ask you to refill it and promise to schedule an appointment next week. If you fill that prescription, you've been had.

Some patients will misrepresent their medical condition to induce you to write a prescription. Others will use the old standby excuses: "I lost my prescription," or "I didn't have enough money to fill the prescription and it expired."

Drug abuse is a developing phenomenon. It starts with patients losing prescriptions, not being able to track the amount of prescriptions or claiming that the doctor wrote the wrong prescription.

A concatenation of events often indicates abuse rather than serendipity or accident. A single transaction by itself does not mean abuse. But if your record shows repeated violations, you are not only denying what's going on, but also making yourself vulnerable to DEA or even patient litigation."




In conclusion, there are several differences between chronically ill patients who may need medication to survive or even try to function while others just want to get high. At my most recent ER visit, the nurse told me I was the true emergency (dehydration and pain) and that he had gotten things like tooth aches all day. I know Gastroparesis is an invisible illness and most people think it's in our heads until they see our labs. That's another key difference.

Keep fighting to educate those out there who may still be skeptical of the illness. We shouldn't be punished because of lack of education.



2 comments:

Kelley Murphy said...

I feel your pain Emily! I have been dealing with ER visits for 8 years..drugs like Reglan and Zofran do not work anymore and only Dilauid works for the pain. Its a challenge everytime I go, because every doctor and nurse approach GP differently. All I can do is be confident and informed in what I express to the staff and hope that I get a compassionate and competent professional! The unfortunate part about getting pain medicine is that it has adverse effects on your GP. My prayers are with you and all of us that are affected by this horrible condition. But the good news is more and more health professionals are becoming aware of it. Keep spreading the word!

jamespaplu paplutinda said...

This is an awesome post. I like this topic.This site has bunches of preferred standpoint.
addictions canada A.R.T.I.