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Friday, July 20, 2018

Collecting Stories of Hope, Emergency Room Experiences, and The Slack Application

One of my best friends inspired me to do something a bit outside of the box and different - so I did some thinking. I found a website called, "Slack." You can create different "channels" so that people can communicate (almost like a chat room) about that subject.

If you would like to check the website out for yourself, the link is: http://slack.com/features

I made an account and then created a message board completely about Gastroparesis (GP) and/or chronic, invisible illnesses.

It has several thread subjects already, like the ER & Stories of Hope projects that I'm working on. It has a place to recommend doctors, ask questions about diagnoses, and is a great way to help and connect with others. There is nothing else about GP on this site, so please help me change that.



To join my channels:

https://join.slack.com/t/emilysstomach/shared_invite/enQtNDAyMDExOTgyMDY0LTMwNGU4NzhjNTExYzJmNWFlMzdlZGU5ZWUyZWQxZTUwOWRkNGMwYTczMjVjNjc4NGI0ODE4M2IzYzUxZTk3NzE



Think of it like email and email threads without the email part. That way, if I'm working on a project I can keep it to that subject on this site. If someone else is working on there project then we can all comment on that thread as well. It's just a way to keep all the subjects together and discussions together so that you don't have to search constantly for the subject that was discussed.


There is also a phone application for it! I found the application, "Slack" on my Android phone.



https://emilysstomach.slack.com


So, let's work together on this thread to not only have a good time, but to help those who are struggling. I mean, not everyone is on Facebook or, if they're like me, they're too tired to be on Facebook most of the time.

This is also for people who want to learn about gastroparesis and loved ones.




Source: Imgur





I am writing an article and I'm calling it, "Stories of Hope." Since a lot of people have been recently diagnosed and are struggling, I wanted to give them hope by posting different people's stories that they might relate to, and realize they can fight Gastroparesis, and they can still have some sort of life, though they might not ever have the same one they had before GP.

I started collecting "Stories of Hope" years ago, and I have them on my website if you want to take a look at a sample and see if that helps you: http://emily-scherer.squarespace.com/gp-stories/.

If you would like to include a picture, you are more than welcomed to!

My blog reaches thousands of people, and if anyone can relate and it helps them to keep fighting, I think that would be a positive thing and most importantly, you can help someone else. You never know who you might touch or help! I would really appreciate it.

I could use your first name and last initial, or I can make up a name for you, for privacy reasons. If you are interested in participating, please email your story to me at: emilysstomach@gmail.com.

You can also message my page, Gastroparesis - Emily's Stomach.

I feel like the people sharing their Stories of Hope are really Gastroparesis heroes and should be known and encouraged, because they help so many.

To those of you who have sent stories already, thank you for being brave and selfless.




Source: Imgur.




I am also collecting Emergency Room (ER) stories from people who have Gastroparesis (and/or any other invisible, chronic illness) because I want people to be aware of how we are treated when we go to the Emergency Room.

I feel like these stories will bring more awareness to what we go through as people who are battling chronic, invisible illnesses. I feel like the way we are treated is unfair and not right.

Doctors took an oath to help others and so what if the people coming in are drug addicts? Drug addicts can't have medical emergencies? They shouldn't judge but help instead of dismissing us. If you would like to share your ER story/stories, please email them to me: emilysstomach@gmail.com.

One of my friends went to the Emergency Room last week, they dismissed her as a drug addict, and so she went home and committed suicide because she was tired of the medical system failing her.




Source: Flickr.


This stigma has got to stop.

My neighbor is a nurse at an Emergency Room, by where I live. She told me that Gastroparesis was not real, and the people who came into the ER where she worked who claimed had Gastroparesis, only wanted pain medicine. I wanted to tell her that it would have been a lot easier for me to buy drugs off of the street than to spend thousands at an Emergency Room, and then being poked and prodded one hundred times! Additionally, when you are THAT sick to go to the Emergency Room, you should NOT have to fight for basic healthcare.

I have three different tests that prove I have Gastroparesis, and I cannot make those results up. I am not sure if doctors or nurses do continuing education, but more and more people are being diagnosed with Gastroparesis and other invisible illnesses.





Source: On Image.



The image below is what this project of Emergency Room experiences and stories are trying to debunk. Hopefully, these stories and experiences you share with me for my blog will help educate people about Gastroparesis and other invisible, chronic illnesses, so that we can get the medical attention we need without judgments or cruelty.



Thursday, July 19, 2018

Invisible Emergencies Series, Part Three - The Danger of Treating ER Patients as Drug Addicts (Research Portion)

In the Gastroparesis Community, we have lost people who went to the Emergency Room for REAL emergencies and were dismissed as drug seekers. One of my friends went home and died because her lungs filled up with fluid, drowned, and passed away. Another Gastroparesis Warrior went to the Emergency room last week, and was treated as a drug seeker who was then harshly judged, and went home and committed suicide because she was tired of the medical community failing her. She felt like there was no other recourse because the doctors would not listen to her or help her in any way, instead, all they did was judge her and accuse her of being a drug seeker.

I understand there is an "opioid crisis" in America right now, but does that give doctors and health care professionals the right to make judgments on patients?

I did address the difference between Gastroparesis Patients vs Drug Seekers in a previous blog article, which can be found here: http://www.emilysstomach.com/2013/07/gastroparesis-patients-vs-drug-seekers.html

Doctors have taken an oath to help others and they are NOT supposed to judge anyone - so what happened to the oath that they took? Furthermore, what if the patients were drug addicts? Drug addicts cannot have legit medical emergencies? Instead, doctors cannot seem to get past what they perceive to be "drug seeking behavior" to even evaluate if there is a medical emergency going on with the patient.

This has got to end.

Most people with chronic, invisible illnesses, will NOT go to the Emergency Room unless others drag them to the Emergency Room because of how they are treated. That is NOT OK. I have asked people to share their Emergency Room experiences to shed light and awareness on how people with chronic, invisible illnesses are treated. People who are dehydrated, which is an actual medical emergency, are scared to go to the Emergency Room because of how EMTs treat us, doctors treat us, and we are SO sick when we are in the Emergency Room, and we should NOT have to fight for basic medical treatments.

I have asked people in the Gastroparesis Community to share their experiences with the Emergency Room because I do not want to lose anyone else I care about. I know Doctors are busy and they deal with a lot of different, horrible things in the Emergency Room, but that is no excuse to treat patients who desperately need help, which is why they went to the Emergency Room to start with. Usually, anyone with an invisible chronic illness, will avoid the Emergency Room at all costs, until they have to go because they cannot control their vomiting, they are in immense pain, or their Gastroparesis has caused secondary infections and issues. I will be in collaboration with Kristine Bishop and Debbie Popp on the next installment of this series, sharing stories of those who are chronically ill with Gastroparesis, invisible illnesses, and how they were treated in the Emergency Room.


The Hippocratic Oath is as follows,

"I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say 'I know not,' nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help."







The following is research I have put together about drug seekers vs those who seriously need medical help.




Source: http://www.idealmedicalcare.org/patient-profiling-are-you-a-victim/





According to Pain News Network,

"The Danger of Treating ER Patients as Drug Seekers
January 13, 2016
By Emily Ullrich, Columnist

Recently the news has been covering the story of Barbara Dawson, a Florida woman who was arrested after she refused to leave a hospital that would not treat her for abdominal pain. While being escorted from the hospital in handcuffs, she collapsed in the parking lot and later died.

For many of us who are chronic pain patients, this kind of treatment is all too familiar. More often than not, when doctors see that we are on pain medications, they automatically assume that we are drug addicts and that we are 'drug-seeking' just by going to the hospital.

Personally, I have so many of these experiences, that I couldn't possibly list them all. Last year, I was hospitalized for upper abdominal pain. I had been to the emergency room earlier that week for the same issue, so the doctor told me he was admitting me, 'Because otherwise you'll just keep coming back.'

On my first day after being admitted, I was given no pain control and was taken off of my muscle relaxers. I got no sleep. I was told there was absolutely nothing wrong, and they couldn't find any reason to keep me. I overheard my nurse speaking to another nurse, saying that my liver enzymes were in the thousands.


I questioned the doctor, who was in the process of discharging me, about my liver enzymes. He asked how I knew about this. I claimed that I had asked the nurse, because I could tell he was angry and I didn't want to get her in trouble, although I had every right to know this potentially life threatening information. At that point, he felt pressured to keep me and try to figure out what was wrong.

Because they weren't treating my pain, my blood pressure was high and I was at risk of heart attack or stroke. Instead of treating my pain, they put me on two different blood pressure medications.

At one point, I was taken to another floor for an abdominal scan. I was in so much pain I was trembling. A nurse said, 'So, you're an addict. When's the last time you used?'

I was dumbfounded. I replied that I was absolutely not an addict and asked why she said this.

'Oh, maybe I used the wrong terminology,' the nurse said. 'You've been on pain meds for a long time, right?'

I said yes and she said, 'Well, okay. You can't deny that, then. I just used the wrong word, sorry.'

I was suddenly acutely aware of the frequent misuse of the term 'LTDU' (long term drug user), which is applied to many of us who take pain medications.

Upon transfer from my room to the exam room, I was given my medical records to hold. I opened and read them. Not surprisingly, I saw multiple remarks about 'drug seeking behavior.' The nurse told me I was not allowed to read my own records. I said, 'I'm allowed to hold them, but not read them? They're mine!'

'Yes. Well, it's hospital policy,' she replied.

I was hospitalized a second time last year, for the same issue, plus bradycardia. The admitting doctor was nasty to me, saying, 'I am admitting you, but you will not be given one drop of pain medication other than Tylenol.'

Eventually, I was given a small dose of pain medication, but I was still trembling and vomiting the pain was so bad; yet the doctors refused to raise my dosage. I called the nurse, who got me a patient controlled pain pump. This was slightly more helpful, but when I let them know that the dosage was not controlling my pain, they took it away entirely. The gastrointestinal team came in and talked to me, but never came back.

I was discharged within three days, with no answers. Over those three days, I was told by one nurse, 'If you call me every time it's time for your medication, you are called a ‘clock watcher,’ which we consider a form of drug-seeking.'

I was again gobsmacked. Later, another doctor came in and said, 'We have no reason to believe you're in pain.'

I said, 'Why would I go through all of this just to get a mediocre amount of pain medicine?! I'm not drug-seeking, I'm relief-seeking!'

The doctor said, 'Well, there's not much difference.'

During this second stay, I had to call the charge nurse and often the patient advocate, just to get minimal pain control. Every time, I pointed out their sign, which said 'If your pain is not relieved within 30 minutes, please tell your nurse. Our goal is to treat patients with respect and dignity.'

I pointed this out so many times that instead of heading their own policies, they literally changed the sign! They came in and screwed a new sign to the wall, which mentioned nothing about pain care or patient rights.

In August of 2014, before the two events described above, I had my gallbladder removed. I was already on pain medications for chronic pain and I expressed concern to the doctor that my pain after surgery would not be adequately controlled. He said, 'Don't worry. You'll get your precious Percocet. One prescription, that's it!'

I was hurt and offended that he was treating me this way, as though I would have an organ removed just to get pain medicine! But, it got worse. As I was waking up from surgery, my eyes were not yet open, and I heard one nurse say to another, 'The doctor said she's going to claim she's in pain, but just get her out of here.'

I opened my eyes and declared, 'I heard you!' They both grew silent, and pretended that never happened.

This past August, on my 40th birthday, I landed in the ER again. Again, I had severe upper abdominal pain and was told that, 'Nothing is wrong, and you will not be given narcotic medication.'

I asked the doctor to look at my liver enzymes. He saw that they were extremely elevated, and gave me a dose of pain medicine. The next thing I knew, the admitting doctor was in the room, telling me that I was 'getting what I wanted' and I was going to be admitted. She introduced herself, and then proceeded to verbally steam roll me, telling me that I would not receive pain medications while I was in 'her hospital.' She told me that I was already 'unnecessarily on pain medicines.'

I questioned her, but she curtly cut me off. 'I see that you have a bunch of 'garbage pail diagnoses,'' she said.

I was furious. I asked if she even knew what some of them where, and if she knew better than the doctors from 'her' hospital who had made those diagnoses. She rolled her eyes, and continued with her speech on the lack of treatment I would receive while admitted.

I said, 'So, I'm being admitted for pain control and further testing, but I won't receive pain control beyond the medications I currently take?'

'That is correct,' she said, her snide attitude seething. I told her that it was my 40th birthday and the last place I wanted to be was in the hospital, but I really wanted some answers. She just stared at me. I decided that I would take my chances, and go home. If this was any indication of the abusive treatment I was in for if I stayed, I wanted no part of it.

I was discharged with a diagnosis of intractable abdominal pain. Three weeks later, I looked at my online medical records, and noticed that my diagnosis had been changed to 'narcotic withdrawal.'

Four years ago, I developed a severe kidney infection. I was deemed a drug-seeker by numerous ER's, without any testing for my symptoms. Eventually, a doctor took me seriously, but by then, I was developing sepsis, and my life was in danger [due to sepsis].

Even during this horrible incident, I was taken off my regular pain medication and was given a tiny dose of IV pain medicine, equivalent to about half of my home medications. The nurses watched me writhe and cry in pain all day and night, until I spent two days in and out of consciousness. They argued with the doctor on my behalf and I argued with him, but nothing changed. I was still supposedly 'drug seeking.'

I could go on and on, but I think by now you get the point. Our lives are in danger, on the off chance that doctors may accidentally give medicine to someone who is trying to get high. This is absolutely unacceptable.

Also, I'm not sure how much validity is behind their theory. It seems to me that if someone wanted to get high, buying drugs off the street would be much easier and cheaper. Like most of us who take pain medication to treat our pain, I do not feel any euphoria, just a little relief.

How is this kind of behavior in line with a doctor's Hippocratic oath to 'First, do no harm?' It seems the oath is now 'First, judge and abuse.'

Emily Ullrich suffers from Complex Regional Pain Syndrome (CRPS/RSD), Sphincter of Oddi Dysfunction, Carpal Tunnel Syndrome, Endometriosis, chronic gastritis, Interstitial Cystitis, Migraines, Fibromyalgia, Osteoarthritis, Periodic Limb Movement Disorder, Restless Leg Syndrome, Myoclonic episodes, generalized anxiety disorder, insomnia, bursitis, depression, multiple chemical sensitivity, and Irritable Bowel Syndrome.

Emily is a writer, artist, filmmaker, and has even been an occasional stand-up comedian. She now focuses on patient advocacy for the Power of Pain Foundation, as she is able.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network."




Source: Pain News Network






According to ABC News, in 2016,

"Lawyers for the family of a Florida woman who died after police forced her out of a hospital in handcuffs released police dash-cam video today from her arrest last month, capturing some of her last moments alive.

Barbara Dawson, 57, died at Calhoun Liberty Hospital in Blountstown, Florida, early Dec. 21 after she collapsed while being taken out in handcuffs by a Blountstown police officer, according to officials.

Dawson had gone to the hospital seeking treatment for abdominal pain the night before, but an officer was called to the hospital after she had been discharged by medical staff who alleged she had become unruly and refused to leave, officials said. The officer then arrested Dawson and removed her from the hospital for 'disorderly conduct and trespassing.'

Martha Smith-Dixon, Dawson's aunt, said at a news conference today that Dawson's family hopes the public release of the police dash-cam video will help bring "justice for Barbara" and prevent similar incidents in the future.

'Police are supposed to protect and serve,' Smith-Dixon said. 'The hospital is supposed to save lives. When Barbara, our family member, went to the hospital, she was denied all of those rights.'


Woman Dies After Being Hauled out of Florida Hospital in Handcuffs

Though Dawson is not visible in most of the police interior dash-cam video, she can be heard repeatedly shouting 'oh my God,' and saying she 'can't breathe' multiple times as Dawson is told that she's OK, 'there's nothing wrong with you' and to 'please stand up.'

The officer can be heard on the tape telling Dawson at one point, 'We surely don’t want to hurt you ... but you are going go to jail one way or the other, OK? So you can help us ... or we can do it the hard way.' An officer and hospital staff can be seen trying to lift her, now silent, into a police car as the dash-cam continues to roll inside.

Calhoun Liberty CEO Ruth Attaway said in a statement today that hospital officials are reviewing the police video, adding, 'First, we continue to grieve the loss of a patient and a member of the community. Our thoughts and prayers are with the family and friends of Ms. Dawson as well as with our community.'

'Our primary objective in this situation is to remain transparent and to welcome investigation from authorities. We have already welcomed reviews and investigations from the Agency for Health Care Administration and the Florida Department of Law Enforcement as well as the Department of Health. To the fullest extent permitted by state and federal law, we will continue to be transparent and forthcoming with our community and the public.'

Daryl Parks, an attorney for Dawson's family, said today in a news conference that the audio from the recording revealed Dawson was 'in a panic, telling [the officer] that she cannot breathe.'

At one point in the video, a police officer radios in, saying, 'Let them know I have a 270-pound black female that has been non-compliant, lying on the ground, and it has been physically impossible for us to get her in the back of this car.'

There is a long gap of audio in the recording -- about 20 minutes -- from when Dawson could no longer be heard to when medical assistance arrived.

'We believe from a medical standpoint, and from a policeman's stand point, that [gap] is significant in the delay that you have there,' Parks said. 'There was not deliberate speed to assist her.'

A police report of the incident sent by the Blountstown Police Department to ABC affiliate WTXL-TV said the responding officer who was arresting Dawson believed 'Dawson was just being noncompliant and making herself dead weight in an effort to avoid going to jail.'

Parks said that the officer's assumption 'cost Barbara Dawson her life.'

The police report also noted that Dawson repeatedly asked for her oxygen tank before she collapsed and that she was brought back inside the hospital.

Dawson later died because of a blood clot in her lung, according to an autopsy report from the medical examiner's office in Panama City.

Blountstown Police Chief Mark Mallory told ABC News in a statement today that law enforcement were first responders and 'not medically trained professionals.' He explained that while police officers are CPR-trained, CPR 'would not be utilized on a person that is breathing and that has a heartbeat, as was the case with Ms. Dawson.'

He added that though 'the officer may have suspected that Ms. Dawson was intentionally noncompliant, he nonetheless fully executed his duty and responsibility, requesting that medical professionals continue to verify Ms. Dawson’s health status, even after the medical professionals initially assessed and evaluated Ms. Dawson following her collapse.'

'In Ms. Dawson's case, the responding officer acted appropriately, by audio recording of the events as they transpired on December 21, 2015, the officer sought medical professionals that responded to Ms. Dawson in the Calhoun-Liberty Hospital parking lot included the following: registered nurses, a paramedic, and a doctor,' Mallory added. 'Upon the arrival of the various medical professionals, the officer deferred to the professional training and expertise of the summoned medical professionals to evaluate and [assess] Ms. Dawson's need for medical intervention.'

'Regardless, Ms. Dawson's passing is a loss felt by our community, and our thoughts and prayers remain with her family and friends during this time,' Mallory said.

Lawyers for Dawson's family said today it was 'suspicious' that the hospital's surveillance camera 'wasn't working.'

Hospital spokeswoman Sandi Poreda told the Associated Press last month that there is no hospital video of the incident because a server was down for upgrades. Poreda said hospital staff determined on Dec. 22 that the server had not stored video since Nov. 28. She added that the server has been fixed, footage is now being recorded and the hospital is also in the process of installing new cameras.

Benjamin Crump, one of the attorneys for Dawson's family, said it 'is very important that we remember the larger implication in the tragic death of Barbara Dawson,' adding that police and hospital personnel treated her 'like she was not worthy of consideration.'

Lawyers at Parks and Crump Attorneys at Law, the firm representing Dawson's family, told ABC News today that the firm has not filed any lawsuits, as of today.

The BPD and the Florida Department of Law Enforcement have launched independent investigations into Dawson's arrest and death. The Florida Agency for Health Care Administration has also started its own investigation 'to determine if the hospital violated any state or federal requirements surrounding last week’s incident at the hospital.'"





Source: Located on the image




According to NewsWeek,

"
THE DRUG WAR IS WRECKING OUR ER DEPARTMENTS
BY GEOFFREY HOSTA ON 1/18/16 AT 2:42 PM

Every day I see people during the worst moments of their lives. As an emergency room doctor, I see the victims of violence, disease and age at their most vulnerable.

During one of my more depressing shifts, a nine-year-old girl (let’s call her Nancy) came into the emergency room with an arm broken at a 90 degree angle. On that same night, a drug-seeking patient (let’s call him Richard) came into the hospital for the fifth time that month with the same concocted excuse.

While I worked on Richard’s fake ailments, I was unable to alleviate Nancy’s excruciating pain. She suffered with little more than a stuffed animal to comfort her because Richard needed his fix.

In an environment of drug prohibition, patients like Richard are not rare. But it is not the sheer number of drug seekers that exacerbates what is already a problem of ER overcrowding. It is also the ailments that drug seekers like Richard create. They tend to invent symptoms indicative of serious illnesses that offer a quick ticket to the back and the best chance for intravenous drugs.

Unfortunately, those complaints require hefty ER resources, which would have otherwise helped people like Nancy. Worse still, addicts repeat the trick. One of my drug-seeking patients made 183 visits to my emergency department in a year and visited at least two other emergency rooms. Based on my experience, I estimate that drug seeking accounts for 20 to 30 percent of all ER visits.

Scholars corroborate my estimate. One researcher claims that drug seeking comprises as much as 20 percent of all ER visits. Meanwhile, ER visits for narcotic medications rose at least 75 percent for all age groups between 2004 and 2009.

ER doctors prescribed 49 percent more painkillers in 2010 than in 2001. Painkiller prescriptions (drug seekers’ favorite fix in the heroin-opioid epidemic) for ER dental complaints alone rose 26 percent between 1997 and 2007.

One study found that a group of patients at risk for drug seeking averaged over twelve ER visits per year. Participants also visited multiple hospitals — over four, on average — using multiple aliases. Another study found the situation to be worse, with drug seekers visiting the emergency room an average of 14.5 times per year (versus non-drug seekers visiting about two times a year).

ER drug seeking is so rampant that it has become a favorite online topic among healthcare providers. They discuss it in forums, dedicate numerous blog posts to the subject, and even write parodies with titles including, 'ER Places Bowl Full of Percocet in Waiting Room, Lowers Visits.'

Healthcare providers (such as ER doctors and nurses) have even reported violent addicts who had been denied drugs waiting to exact revenge in parking lots.

Many providers have become so frustrated that they prefer to risk under-treating pain in non-drug seekers than be burned again. (This is a shame, considering that identifying drug seekers is difficult , leading to widespread — and racially uneven — under treatment of pain.)

Some healthcare providers now sadly believe that ER patients with honest pain complaints are the minority. Presumably in an effort to relieve the side effects of drug seeking, one ER doctor won a 'Best of Craigslist' designation for anonymously telling drug seekers how to obtain drugs quickly and without annoying the staff.

Healthcare administrators have taken action to combat ER drug seeking. They have created 'habitual patient' files in order to track suspected drug seekers. Some hospitals have also adopted computer systems to identify and track suspect patients.

For example, patients are enrolled in one such program if they visit the ER more than four times in one month, whenever a staff member is concerned, or if the state has convicted the patient of prescription fraud. Other hospitals have increased physician education to help identify drug seekers. Administrators have also considered adopting screening tools utilized by pain clinics.

The prevalence of ER drug seeking has also caught the attention of legislators. Nearly every state has a prescription drug monitoring program, intended to help providers determine whether a patient is lying or over-prescribed.

Some states have linked these databases in order to limit out-of-state 'painkiller tourism.' Several states prohibit 'doctor shopping,' by which drug seekers obtain prescriptions from multiple providers.

New York City limited ER opioid prescriptions to a three-day supply and imposed other rules. The FDA , DEA and other federal bodies have guidelines affecting ER prescriptions. Perhaps the most telling sign of an important social problem is the contradictory policy requirements intended to solve it. While the DEA threatens loss of licensure for excessive ER prescriptions, other publicly-recognized bodies threaten hospital staff with retribution if they inadequately prescribe.

This preoccupation with ER drug seeking is the result of the sizable problems that it creates. For example, drug seeking almost certainly increases wait times and sucks up ER resources. That damages the healthcare of anyone who needs hospital care — so essentially, everyone at one time or another.

Considering that drug seekers are rarely well to do enough to afford health insurance, ER drug seeking probably drives up healthcare costs, too. And because prohibition encourages addicts to game the healthcare system, instead of patronizing legal businesses offering safe and inexpensive drugs, the law victimizes addicts as well.

I don’t blame Richard. Under drug prohibition, he has two places to get his fix: medical outlets like emergency rooms, or the streets. Some are surprised that people like Richard favor hospitals with their bureaucratic hurdles, gatekeepers and other annoyances. But on the streets, he faces violence, incarceration, job loss and impure, expensive drugs.

If there were a third option — to buy drugs legally — drug seekers would face a new equation. Under these new incentives, at least some (and probably most) ER drug seekers will prefer legal highs from salons and shops over clinical and bureaucratic emergency rooms and dangerous corner dealers.

And as ER drug seekers disappear, so do all of their associated problems. So support an end to the Drug War, if not to right its other innumerable wrongs, then for anyone who will ever urgently need ER care — like Nancy, your family, or yourself.

Geoffrey Hosta is a board-certified emergency room doctor with over thirty years of experience in emergency medicine."



Source: www.Flickr.com



According to Pro Talk,

"How To Get Labeled a 'Pill Seeker' – Even When You’re Not One
Posted August 9, 2016 in by Anne Fletcher


Recent personal experiences have opened my eyes to how similar the behavior of individuals in severe, chronic pain can be to that of people in the throes of severe substance use disorders (SUD) when they can’t get their drug of choice.

In other words, severe pain and substance use disorders can make you feel desperate and driven to get what you need for relief.


Is it “Doctor Shopping” or Chronic Pain?

Certainly, there’s concern when a SUD is so consuming that an individual 'doctor shops,' trying to get one or more prescription medications to get high. But it’s not uncommon for someone in acute or chronic pain to be put in the same position and to act the same way to get alleviation of pain.

However, if you have a history of a substance use disorder, even if it’s in remission and/or even if painkillers were not your drug of choice, it’s likely that you’ll have difficulty finding a physician to prescribe opioids. One of my relatives has a chronic medical condition caused by an alcohol use disorder that’s been in remission for nearly 9 months. The pain caused by the condition has been likened to that of childbirth, and the relative has been bedridden with it much of the past several months. The national society representing this person’s condition recommends opioids for acute and chronic pain when less strong pain relievers don’t work, which has been the case with my relative. The person has never enjoyed opioid painkillers in large part because they cause unpleasant allergic-type reactions (severe itching, nausea, and vomiting) but a few can be tolerated with lesser side effects in order to get pain relief.

Several local physicians have given the relative short-term prescriptions for the pain, but then cut them off although the pain has not been resolved and despite having an appointment in several weeks at a world-renowned clinic for the disorder in several weeks. (A specialist at a nearby pain clinic who hadn’t even seen the person said that opioids would not be an option, and another doctor said even the mildest of opioids 'could be a slippery slope.') Thus, the suffering continues.


8 Ways to Get Labeled a “Pain Pill Seeker” When You Aren’t One

While watching a loved one go through this and through my work, I’ve learned the following lessons about how people become labeled 'painkiller seekers,' even when they’re not:


Ask for painkillers when you have a history of any type of substance use disorder.

When the doctor says 'no' because of your addiction history, argue that painkillers have never been a problem for you. The truth is, according to renowned addiction physician, Mark Willenbring, M.D., director of Alltyr Clinic in St. Paul, MN and formerly with the National Institutes of Health, 'The neuroadaptations in the brain that result from the combination of genetic vulnerability and environmental triggers are substance-specific. That is, the dysregulation of consumption of the intoxicant only applies to the specific drug consumed. It does not apply to other drugs. In my practice, I find that opioid addicts seldom like alcohol, and vice versa.'


Look like you’re sick and tired when you go to the doctor’s office or emergency room.

My relative was told by a nurse in family practice, 'I can tell you right now that if you go to the E.R. the way you’re looking, you’re not going to get any help. My relative said, 'You mean, looking sick? Should I go home and put on makeup and then go to the ER?' Jeffery Junig, MD, PhD, an addiction psychiatrist in solo private practice in Fond Du Lac, Wisconsin and Assistant Clinical Professor of Psychiatry, Medical College of Wisconsin, said, 'People face ‘opioid discrimination’ not only for their medical histories, but also for tattoos, haircuts, or muscle-shirts. [I’ll add piercings to the list.] Over the years I’ve met many severe opioid addicts who looked like businesspersons or professionals, who were given 60 oxycodone tablets for a backache. Yet I’ve had patients who were stable in their recovery from opioid use disorders who received only ibuprofen for kidney stones.'


Act like you’re not sick enough – and don’t even think about cracking a joke.

That same nurse told my loved one that she didn’t seem like she was in enough pain to get emergency help. People who live with chronic pain can tolerate more pain than normal people and can often come across as being more composed than they feel.
Lose your temper – especially when you’ve been treated with disrespect. That obviously means you’re a 'druggie.'


Act like you’re very much in need of painkillers.

One health care professional outright told us that if you seem too desperate, it’s a red flag that you might have an addiction problem (even if you don’t.)


Go to more than one health care provider at the same medical facility and ask for help.

But what’s a person to do when one doctor doesn’t believe in giving out painkillers or another cuts you off for no apparent reason and you’re still in pain?


Have a mental health disorder that causes you to be emotionally dysregulated, especially when you’ve been experiencing chronic pain.

Medical professionals might say it’s all or partly in your head. Of course a vicious cycle becomes created as the dysregulation becomes worse and the pain worsens – or vomiting from your pain or illness makes it hard to keep your psych meds down.


Be very specific about the painkiller you want, especially if you’ve been offered one or more that you know you can’t tolerate or won’t work for you. That suggests you’re looking for your 'drug of choice.'


How Opioid Hysteria is Hurting People
Willenbring said:

'So many people are suffering needlessly because of the hysteria about opioids – we’ve gone too far the other way in making it so difficult for those who need pain relief to get opioid painkillers. The suicide rate is likely to be high in individuals with chronic pain.'

Junig agreed that, although we clearly had a problem in this country with the over-prescription of opioids, things have swung so far in the other direction that doctors are routinely cutting people off pain medications, throwing patients into withdrawal, which leads many of them to illicit opioids and even heroin. He added:

'Opioids and their actions are some of medicine’s greatest discoveries, and they can be used safely with appropriate precautions. And people with history of opioid dependence have the same right to pain relief as any other patient.'

His main issue is this:

'Many of the anti-opioid doctors try to distinguish between ‘acute pain’ and ‘chronic pain’. You’ll often hear comments that opioids are appropriate for ACUTE pain – for instance, after surgery or broken bones – but should not be used for CHRONIC pain, as if the suffering is somehow less severe or less-worthy of treating for those with chronic pain. But what if the pain is actually JUST AS BAD in the chronic patient as it is in the acute pain patient? What if the severity is the same?'

Junig said that he has a patient whose chronic pain is so intense that tears roll down his face every few minutes, when he is struck by paroxysms of phantom-limb pain. He even had an implant in his brain to try to control it, but the implant only causes him to have seizures and doesn’t reduce the pain.

'Many docs would call him a ‘chronic pain patient,’ Junig said, 'even though his pain is at least as severe as a person coming out of major surgery.'


Choosing Your Health Care Professional(s) Wisely

I asked Dr. Willenbring if I was wrong to be disinclined to advise people in recovery to be very careful and selective about giving out information about a past history of addiction to medical providers. He replied:

'I tend to agree with you. However, it’s getting more difficult over time, with the electronic medical record, to not have information about an addiction history revealed. Few people understand that when they sign an informed consent to establish care, there’s usually a provision in there to allow access to a patient’s full prescription history, whether it was provided by someone else or not. (That provision in the informed consent document can be struck if the patient crosses it out and initials it, but I believe that some systems still can tap into outside prescription history.)'

Willenbring added:

'Also, pharmacists already have access to that. So if someone has ever been prescribed Naltrexone, for example, or Suboxone, then that would make it clear that they have an addiction history. Another way that your history can come out is if a spouse or other relative, such as an adult child, sibling, or parent, interact with the provider. The risk is that if the addiction history is somehow found out after the fact, then the health professionals might regard that as deception and an attempt to manipulate for controlled medications. Obviously, this is a double bind, so one would have to weigh how likely it is that a provider will learn about an addiction history in some way other than directly from the patient.'

Jim Carter, Ph.D., a San Diego clinical psychologist who specializes in behavioral health, said:

‘Pill seeker’ is a ridiculous label. All patients seeking treatments from MDs are either ‘pill seekers’ or ‘surgery seekers.’ What else would the patient seek? I would encourage any patient (with or without a history of SUD) seeking opioid medication treatment to proceed with caution and carefully select a provider whom the patient can trust enough to openly discuss the potential risks and benefits.'"




Source: Imgur




According to Pamela Windell, M.D.,

"Patient Profiling: Are You a Victim?
Posted on January 21, 2014 by Pamela Wible MD


Ever felt misjudged by a doctor? Or treated unfairly by a clinic or hospital? You may be a victim of patient profiling.

Patient profiling is the practice of regarding particular patients as more likely to have certain behaviors or illnesses based on their appearance, race, gender, financial status, or other observable characteristics. Profiling disproportionately impacts patients with chronic pain, mental illness, the uninsured, and patients of color. Like racial profiling by police, patient profiling by physicians is more common than you think.

We rely on doctors to first do no harm–to safeguard our health–but profiling patients often leads to improper medical care, and distrust of physicians and the health care system, with potential lifelong consequences. For the first time, people share their stories:

'I was once denied pain meds after a fall off a 10-foot porch by the same doc who gave my pretty female friend pain meds after getting two stitches in her finger. I felt like my appearance had something to do with it.' ~ Jay Snider




'In 1986 I was in a motorcycle accident. I tore up my face on the road. I was taken to the ER and treated like crap because I had no insurance. They cauterized my facial wounds rather than stitch me up, and then dumped me on the sidewalk with amnesia. I still have distinct black scars; people think they’re tattoos. I went into collections and it took years to pay that one off. Six weeks ago, I fell while trimming a tree. When the ER found the insurance card in my wallet, I was treated like gold.' ~ James Cummings





'I was pressured by our doctor from my son’s birth all the way through grade school. I kept telling him no vaccines whatsoever, zero, nada. I was hassled, shamed, talked down to, and more. Not a fun experience, whatsoever. I was profiled as a bad mother.' ~ Sheri Ricker






'As a teen, I fractured my nose. Many sinus issues later, I consulted an ENT specialist. He insisted that I damaged my sinus passages by using cocaine. His assumptions caused me pain, humiliation, confusion, and anger. I repeatedly assured him that I wasn’t a user. Two surgeries later, my septum was removed. Afterwards, he was so cruel as to continue his tirade about my cocaine use. As the gauze was being removed from my nose, I fainted. When I was roused, he insisted that I leave immediately showing no concern about whether I could even make it home safely.' ~ Lonnie Stoner






'It was 1975. I was 23 and I’d been on the pill for 4 years, but I became concerned about potential negative side effects of long-term hormonal manipulation. So I researched other contraceptives and felt the diaphragm was the simplest and safest option for me. When I went to the county clinic to get fitted, I explained what I’d researched to the doctor. He scoffed at my concerns, urged me to stay on the pill, and disputed any potential negative consequences. He reminded me that taking a pill each day was SO much easier than having to be responsible for using the diaphragm properly. It was clear he thought I was too young and clueless to make this decision about my own reproductive health care. Although he tried to dissuade me from switching to a diaphragm, I insisted that’s what I wanted, and he finally fitted me for it. After he left the room, the nurse said, ‘Don’t worry, dear; it’s quite easy to use. I’ve been using one for years with no problems. It’s a good choice for you to make!’ It was clear she didn’t approve of his patronizing attitude either.' ~ Patsy Raney






'I injured my back at work. I couldn’t get time off, so my family doc prescribed pain meds so I could get through the day and Xanax for sleep. I returned every six months for two years and he always accused me of taking more than I was prescribed. He got progressively more rude and angry. I brought my wife with me to see if I was imagining it. She witnessed it too, so we searched for another doctor. I asked my new doctor to taper me off of the pain meds and Xanax so I could try medical marijuana instead. He was skeptical. He told me to go to the pain clinic. I’d gone there once before and was treated like a criminal. I didn’t want to go there! So he wrote up a contract that said I would agree to take pain meds and Xanax and I’d be drug tested monthly to make sure that I wasn’t using medical marijuana. When I told him I wouldn’t sign the contract, he told me to find another doctor. This was at a critical time when I needed real help and was worried about taking the meds for over two years.' ~ Carl Williams


I’ve been a doctor for 20 years. I thought I’d seen it all. Drug addicts have altered my prescriptions, even forged my name. Patients have lied to me. Many haven’t followed my treatment plans. Some have died as a result. Still, I try to treat everyone fairly and with respect. But now I’m wondering, 'Have I ever profiled a patient?' I bet I have. So on behalf of my colleagues and myself, I’ve got a message for any patient who has ever been misjudged or mistreated:


"




According to Healthe Careers,

"Is It Chronic Pain or Drug-Seeking Behavior?
By Stephanie Stephens On Jul 27, 2017


Current healthcare headlines frequently contain two words: opioid epidemic. As VOX recently reported, the number of opioid use disorder diagnoses has grown by nearly eight times the rate of the most effective treatment. A person can get opioids with a prescription from a healthcare provider — or on the streets.

An internet forum post from a student doctor doesn't mince words. It's directed at a 'drug seeker' who visits the emergency department in need of a script. It's also important to note that use of the term has fallen out of favor in recent years, as healthcare professionals focus more on 'the disease' and its treatment.

The post says: 'I hate you because you think you can march in to any E.R. in the country and demand narcotics your way like it is Burger King. I hate you because your fake symptoms force me to throw away millions of dollars of our national treasure on tests that don't need to be done…I hate you because in wasting the time of our E.R. staff, a harmless grandmother in the room next door must be tied to her bed because there is no sitter.'

But there are two sides to every story, right? There's the other side, as former EMT Christina Phillips documents in her March Kevin MD blog entitled, 'My mother isn’t a drug-seeking patient. She’s in pain.'

She writes: 'I still haven’t forgotten how easy it is, as a clinician, to see the symptoms first and the patient second, and to reach quick conclusions based on previous experience. How can I forget, when just months ago I had to help my mother contend with a doctor who, despite the chart in his hand and the eleven-inch scar across her abdomen, refused to believe that she’d had her pancreas removed?'

Distinguishing and dealing with drug-seeking behavior can be a challenge for any healthcare professional — even those with experience. Meet your fellow physicians on the front lines and learn how they approach the patient who comes seeking drugs. Yes, some really need them, and some do not, but it's how these patients are managed that makes all the difference to you, them and the healthcare system.



Patients Behaving Badly

Not so fast with judgments, suggests R. Corey Waller, M.D., M.S., FACEP, DFASAM and chair of the legislative advocacy committee of the American Society of Addiction Medicine. An addiction, pain and emergency medicine specialist, he's also senior medical director for the Camden Coalition of Healthcare Partners in New Jersey.

'Drug-seeking behaviors are predictable and identifiable, and should be looked at as symptoms of chronic brain disease — addiction — not defined by lab results,' Dr. Waller says.

'Neurobiological changes support a drive that asks, 'How do I survive?' Chronically-addicted, drug-seeking patients are scared of withdrawal, horrible pain and of not being able to control themselves or handle job or family responsibilities,' he says. 'If they're yelling or 'want to see your boss,' that's a sign of a higher degree of illness.'

He 'gets when physicians eventually abandon E.R. work because 'those patients drove them insane,' he says. Dr. Waller knows that even though he has specialty training in addiction medicine that helps him understand, not everyone does.

'As doctors, we like to fix things,' he says. 'We’re all Type As, and it's frustrating when we can't change the outcome for a person. And for some reason we as humans often shy away from this subset of the patient population.'

He thinks it's because we've all had personal experiences with addiction — with family or friends — and it raises an 'emotional context' that hypertension, for example, does not. 'Couple that with stigma, and it certainly deserves some soul-searching,' he says.



Raising Red Flags

One of his habitual drug-seeking patients made 183 visits to his emergency department in a year, said emergency-room physician Geoffrey Hosta, M.D., in Newsweek last year.

'This kind of behavior can sometimes even interject a level of aggression with the potential for violence in this setting,' says Rade Vukmir, M.D., J.D., FACEP of Pittsburgh, Pennsylvania. He is a professor adjunct of emergency medicine at Temple University and a spokesperson for the American College of Emergency Physicians.

'In the E.D., we're America's safety net, and our goal is to treat people appropriately, do a medical screening exam on every patient, and determine the appropriate diagnosis and treatment for the patient's best benefit,' he says. 'This process shouldn't be adversarial, but sometimes it can be in circumstances such as this.'

Drug-seeking behavioral signs can be telling, he says. Most people describe symptoms and experiences, but a patient's inappropriate focus on a particular medicine, specifying specific formulation, dose and route of administration, often stands out.



'I Want It That Way'

'This is what my doctor prescribes for me in this dose,' they might say. A patient who repetitively presents at off hours to a hospital when their primary care physician is closed, or a cross-covering physician is involved, may raise a red flag,' he says.

Additionally, patients may request refills early because medication was 'lost' or 'stolen,' they may say they're allergic to non-opiate pain relievers, and they may want shorter-acting narcotics versus recommended longer-acting meds, according to an analysis in Physicians Practice.

A 2013 study in the Annals of Emergency Medicine also lists such telltale behaviors as multiple visits for the same complaint, suspicious history and symptoms out of proportion to examination.

'We do try and help the patient through the process,' says Dr. Vukmir. Remember, we're not here to make moral judgments, and we're treating the condition, not the complaint.'

Doctors do have help with complexities of drug-seeking behavior from pharmaceutical databases in some states, he says. The U.S. Department of Justice and Drug Enforcement Administration operate the Diversion Control Diversion State Prescription Drug Monitoring Programs. However, a clever and motivated individual might fill a prescription in one state, and drive to another city in an adjoining state, leaving what doctors describe as wide gaps in the database trail.



Contracts Keep It Clean

In a town of approximately 4,000 people, John Cullen, M.D., owns the only doctor's office in Valdez, Alaska. It's very isolated, he says, and when a new patient comes to see him and requests a narcotic prescription, that patient is probably really hurting without it.

'Many people really don't want to go through withdrawal, and, yes, it's tragic when someone gets behind that eight ball,' he says. 'We have to determine if they're really having chronic pain or they have an opioid use disorder, and that takes time. Sometimes we have to use opioids because of a patient's other health issues. Some patients can do very well long term.'

Gut instinct rules here, he says, for 'a lot has to do with how you feel about a patient. You develop a sense when people aren't giving you the full truth. Some are really good at this.'

When he does judiciously dispense them, patients sign his practice's pain contract. It stipulates they won't get narcotics from another source, and will obtain them from the specified pharmacy. They'll be tracked in a database and see the doctor on a regular basis without missing any appointments. They'll come in when requested for urine screenings and a pill count.

'The same rules apply to everybody,' says Dr. Cullen, a spokesperson for the American Academy of Family Physicians. Anyone whose behavior attracts the attention of local law enforcement will be duly noted at the medical practice. It's not a punitive thing, and we don't become emotionally invested as a prescriber one way or the other. We can simply say, 'You didn't follow up so we can't prescribe these anymore.''



Encouraging Opioid Avoidance

If they do stop prescribing, and all medical risks are assessed, the medical team treats the patient appropriately for withdrawal and prescribes long-term follow-up care.

'As family practitioners, we see ourselves as part of the solution,' Cullen says. 'Many patients on chronic pain medications come in on a lot more meds than they should. If they need to stay on them, our job is to get them down to a safe level. We all try very hard not to prescribe them — unless there is no other option.'

He utilizes alternative therapies such as acupuncture, physical therapy, exercise, massage therapy and more. 'Plus we have found non-narcotic gabapentin, pregabalin and anti-inflammatories to be very effective,' says Dr. Cullen. 'We also try to utilize the opioid buprenorphine more frequently, which is safer than oxycodone and morphine.'

Acceptance is a mighty force, Dr. Vukmir says. 'When a patient says, 'I know you’re concerned about me, and yes, I have an issue and am trying to get some help,' we are ecstatic. We will go to whatever reasonable lengths to get a patient into a supervised treatment program.'

'I talk to the patients about their individual risk for addiction and dependence versus the benefit of an opiate prescription,' says Aimee Moulin, M.D., FACEP at the University of California at Davis Medical Center. She says she encounters multiple drug-seeking patients every shift, 'especially in the lower acuity areas.'

'I try to keep the conversation focused on the best treatment options for the patient,' says Dr. Moulin. 'I’m open about my concerns for addiction and dependence, and hope to engage the patient in that discussion. I also refer patients to an addiction specialist and treatment if necessary. With every patient, I think about the risks of addiction and overdose.'"



Not all chronically ill patients are drug seekers. I can speak to my own personal experience that I have been treated as a drug seeker multiple times in the Emergency Room, and I always go to the same one so it's not like I "shop around." The last time I went to the Emergency Room, my husband forced me to go. I fell off of my bed and hit my head really hard on the corner of my nightstand. I had a huge lump on the back of my head. I do not remember any of this - I was completely blacked out. My husband said that I was trying to explain to the doctor what happened but I was slurring my words very badly. The doctor just automatically assumed I was a drug addict seeking drugs from the Emergency Room. My husband had to step in and had to explain what happened. After that, my husband said that the doctor took me seriously. I had a really bad concussion and they were about to write me off as a drug seeker. What if I had a brain bleed? Thank goodness, I did not, but the doctor was judging before he even ran any tests. The doctor should have kept me overnight for observation since I blacked out and do not remember any of this, but instead, sent me home with pain medicine for my head. This stigma of judging people to be drug seekers and/or drug addicts before tests are even conducted is ridiculous. It needs to stop.


Source: https://paincommunity.org/blog/wp-content/uploads/stop-stigma-284x300.png



I wanted to share this from University Health's Website because most people do not realize they have patient rights. According to their site,


"Purpose:

To assure that the basic rights of human beings for independence of expression, decision and action, concern for personal dignity and human relationships are preserved for all patients, and to define the responsibilities of patients.

A. Access to Care

Individuals shall be afforded impartial access to treatment that is available and medically indicated, regardless of race, creed, sex, national origin, religion, sexual orientation, disability or source of payment. Free translation services are available.


B. Respect and Dignity

The patient has the right to considerate, respectful care at all times, under all circumstances, with recognition of his personal dignity and worth.


C. Privacy and Confidentiality

The patient has the right, within the law, to personal privacy and information privacy, as manifested by the right to:

Refuse to talk with or see anyone not officially connected with the hospital, including visitors, persons officially connected with the hospital but who are not directly involved in his care.

Wear appropriate personal clothing and religious or other symbolic items, as long as they do not jeopardize safety or interfere with diagnostic procedures or treatment.

To be interviewed and examined in surroundings designed to assure reasonable audiovisual privacy. This includes the right to have a person of one's own gender present during certain parts of a physical examination, treatment, or procedure performed by a health professional of the opposite sex; and the right not to remain disrobed any longer than is required for accomplishing the medical purpose for which the patient was asked to disrobe.

Expect that any discussion or consultation involving his/her case will be conducted discreetly and that individuals, not involved in direct care, will not be present without permission of the patient.

Have his/her medical record read only by individuals directly involved in treatment or monitoring of quality, and by other individuals only on written authorization by the patient or that of his/her legally authorized representative.

Expect that all communications and other records pertaining to his care, including the source of payment for treatment, be treated as confidential.

Expect that information given to concerned family members or significant other legally qualified person, be delivered in privacy and with due consideration of confidentiality.

Request transfer to another available room if another patient or visitors in that room are unreasonably disturbing to said patient.

Be placed in protective privacy and/or be assigned an alias name when considered necessary for personal safety.



D. Personal Safety and Security

The patient has the right to expect reasonable safety in so far as the hospital practices and environment are concerned. To address the needs of patient, visitor and staff regarding safety and security, the University Police patrol 24 hours per day and are present in the Emergency Room around the clock. Other safety and security measures include limited access to the facility through the use of electronic access cards and readers on exterior entrances, video monitoring in numerous areas of the campus, and the use of employee identification badges that are to be conspicuously displayed.


E. Identity

The patient has the right to know the identity and professional status of individuals providing service and which physician or other practitioner is primarily responsible for his care. This includes the patient's right to know of the existence of any professional relationship among individuals who are treating him, as well as the relationship to any healthcare or educational institutions involved in his care. Participation by patients in research programs, or in the gathering of data for research purposes, shall be voluntary with a signed informed consent.



F. Information

The patient has the right to obtain from the practitioner responsible for coordinating his care, complete and current information concerning his diagnosis (to the degree known), treatment, pain management, and any known prognosis. This information should be communicated in terms the patient can reasonably be expected to understand. When it is not medically advisable to give such information to the patient, the information shall be made available to a legally authorized individual.

The patient has the right to formally access his medical records. The patient shall complete the Authorization to Disclose Protected Health Information (form #1148) which is then sent to Health Information Management for processing. The Manager/Charge Nurse is to be notified when such requests are made.

The patient may access, request an amendment to, and/or receive an accounting of disclosures of their own protected health information as permitted under applicable law.


G. Communication

The patient has the right of access to people outside the hospital by means of visitors, and by oral and written communication. The patient may request not to be included in the patient directory. Inclusion in the patient directory means that the patient's name; room number and a general condition report may be given to people who ask about the patient by name.
The prisoner patient has the right to visitors only as approved by the warden of the prison or jail where the prisoner patient is incarcerated.

When the patient does not speak or understand the predominant language of the community, or is hearing impaired, he/she shall have access to an interpreter if at all possible. This is particularly true where language barriers are a continuing problem.



H. Consent

The patient has the right to reasonably informed participation in decisions involving his/her health care. To the degree possible, this shall be based on a clear, concise explanation of his/her condition and of all proposed technical procedures, including the possibilities of any risk of mortality or serious side effects, problems related to recuperation, and probability of success. The patient shall not be subjected to any procedure without his/her voluntary, competent, and informed consent, or that of his/her legally authorized representative. Where medically significant alternatives for care or treatment exist, the patient shall be so informed.

The patient has the right to know who is responsible for authorizing and performing the procedures or treatment.

The patient shall be informed if the clinician proposes to engage in or perform human experimentation or other research/educational projects affecting his/her care or treatment, and the patient shall sign an informed consent if participation is desired and maintains the right to refuse to participate or withdraw from any such activity at any time.

The patient may refuse treatment to the extent permitted by law. When refusal of treatment by the patient or his/her legally authorized representative prevents the provision of appropriate care in accordance with ethical and professional standards, the relationship with the patient may be terminated upon reasonable notice.

If a patient is unconscious or is determined to be mentally incompetent and no consent can be obtained from an appropriate family member, legal action may be taken to obtain a court order for diagnostic and therapeutic procedures. In life-threatening emergencies, where the patient is incompetent or unconscious, appropriate treatment may be administered without consent.


I. Consultation

The patient, at his/her own request and expense, has the right to consult with a specialist.


J. Transfer and Continuity of Care

A patient may not be transferred to another facility unless he/she has received a complete explanation of the need for the transfer and the alternatives to such a transfer, and unless the transfer is acceptable to the other facility. The patient has the right to be informed by the responsible practitioner or his/her delegate of any continuing healthcare requirements following discharge from the hospital.

Regardless of the source of payment for his/her care, the patient has the right to request and receive an itemized and detailed explanation of his/her total finalized bill for services rendered in the hospital. The patient shall be informed of eligibility for reimbursement by any third-party coverage during the admission or pre-admission financial investigation.


K. Hospital Rules and Regulations

The patient shall be informed of the hospital rules and regulations applicable to his/her conduct as a patient. The hospital's Notice of Privacy Practices is available from the Admitting Department or can be found on the hospital website.


L. Complaint Process

The patient has the right to file a complaint regarding services and is entitled to information regarding the hospitals mechanism for the initiation, review and resolution of such complaints.


M. Patient Responsibilities

Patients have the responsibility for:

Providing accurate and complete information about medical complaints, past illnesses, hospitalizations, medications, pain, and other matters relating to their health.

Following the treatment plan recommended by those responsible for their care.

Their actions if they refuse treatment or do not follow the healthcare team's instructions.

Seeing that their bills are paid as promptly as possible; following hospital rules and regulations.

Being considerate of the rights of other patients and hospital personnel.

Seeking information, and in the event they have questions, asking them."

















Velusetrag and Investigational Medicine Trials for Gastrointestinal Motility Disorders

One of my Gastroparesis friends brought this medication to my attention this morning. A special thanks to Robin for kping me informed about these trials.

Some of these trials were done a year ago, while some of these are up to date. I wanted to include them all so that the progression of these clinical trials can be seen. It gives me hope that there are clinical trials being conducted to help find a less invasive way to help motility in those who have Gastroparesis.


According to Theravance Biopharma,

"Velusetrag is an oral, investigational medicine developed for gastrointestinal motility disorders. It is a highly selective agonist with high intrinsic activity at the human 5-HT4 receptor and is being developed in collaboration with Alfa Wassermann in a Phase 2 program to test its efficacy, safety and tolerability in the treatment of patients with gastroparesis. A Phase 2b study is currently underway following positive top-line results from a Phase 2 proof-of-concept trial.


Axelopran (TD-1211) is a once-daily, oral peripherally active mu opioid receptor antagonist being developed for the treatment of opiod induced constipation (OIC). Axelopran, which has completed long term toxicology studies, is intended to normalize bowel function without impacting analgesia. As a stand-alone treatment, axelopran has been successfully advanced through Phase 2 studies, demonstrating a rapid restoration of normal bowel function followed by maintenance in OIC patients compared to placebo. Phase 2 study data also shows statistically significant improvements in a range of gastrointestinal symptoms in OIC patients for axelopran as compared to placebo. We are refining the development and commercial strategy for both single agent and a fixed-dose combination of axelopran, as well as speaking with potential collaborators.



Axelopran (TD-1211) is an investigational, once-daily, oral peripherally active mu opioid receptor antagonist for opioid-induced constipation (OIC). We believe that pairing axelopran and an opioid in a fixed-dose combination (FDC) could present an important market opportunity, as it has the potential to provide pain relief without constipation in a single abuse-deterrent pill for patients using opioids on a chronic basis. To this end, we have developed a proprietary spray-coating technology and applied it to the creation of a FDC of axelopran and controlled-release oxycodone.

To date, we have successfully conducted a Phase 1 study of our novel axelopran FDC , showing that our proprietary spray-coating formulation allowed oxycodone to be coated with axelopran in a single pill without any modification of oxycodone, its activity or abuse-deterrent characteristics. Based on our work to date, we believe our spray-coating technology is applicable to a broad range of opioids, allowing for a potential FDC platform. We are refining the development and commercial strategy for both single agent and a FDC of axelopran, as well as speaking with potential collaborators.



TD-8954 is a selective 5-HT4 receptor agonist being investigated for potential use in the treatment of gastrointestinal motility disorders, including enteral feeding intolerance ("EFI"). Millennium Pharmaceuticals, Inc., a wholly-owned subsidiary of Takeda Pharmaceutical Company Limited has a global license, development and commercialization agreement for TD-8954 for potential use in the treatment of gastrointestinal motility disorders, including short-term intravenous use for EFI to achieve early nutritional adequacy in critically ill patients at high nutritional risk, for which TD-8954 received U.S. Food and Drug Administration (FDA) Fast Track Designation.



TD-1473 is an intestinally restricted pan-janus kinase (JAK) inhibitor that has demonstrated a high affinity for each of the JAK family of enzymes (JAK1, JAK2, JAK3 and TYK2). Through the inhibition of these enzymes, TD-1473 interferes with the JAK/STAT signaling pathway and, in turn, modulates the activity of a wide range of pro-inflammatory cytokines. Importantly, as an intestinally restricted treatment, TD-1473 is specifically designed to distribute adequately and exclusively to the tissues of the intestinal tract and to minimize systemic exposure. As such, we believe that this novel approach to JAK inhibition has the potential to treat inflammation in the tissues of the intestinal tract while minimizing the risk of systemic side effects. We are conducting a Phase 1 clinical study of TD-1473."




Image Source: Located on the image.





According to Government Clinical Trials,

"Brief Summary:

This is a multicenter, randomized, double-blind, incomplete block, three period fixed sequence crossover, multicenter, placebo-controlled study. The study will assess three oral doses of velusetrag (5 mg, 15 mg, and/or 30 mg) or placebo, administered once daily in three periods of 1-week duration each, with a 1-week washout period between treatment periods, in subjects with diabetic or idiopathic gastroparesis.

Study 0093 will evaluate the effect of Velusetrag in subjects with diabetic or idiopathic gastroparesis by assessing changes in gastric emptying.

Velusetrag (INN,[1] USAN; previously known as TD-5108) is an experimental drug candidate for the treatment of gastric neuromuscular disorders including gastroparesis, and lower gastrointestinal motility disorders including chronic idiopathic constipation and irritable bowel syndrome.[2] It is a potent, selective, high efficacy 5-HT4 receptor serotonin agonist [3] being developed by Theravance Biopharma[4] and Alfa Wassermann.[5] Velusetrag demonstrates less selectivity for other serotonin receptors, such as 5-HT2 and 5-HT3, to earlier generation 5-HT agonists like cisapride[6] and tegaserod.[7]

In a large clinical trial in patients with chronic idiopathic constipation (n=401), velusetrag statistically and clinically improved the frequency and consistency of complete spontaneous bowel movements (CSBMs) compared to placebo. Doses of 15 and 30 mg were well tolerated compared to placebo.[8]

Velusetrag showed accelerated intestinal and colonic transit after single dosing and accelerated gastric emptying after multiple dosing in healthy volunteer subjects.[9] In addition, velusetrag showed accelerated gastric emptying in patients with diabetic or idiopathic gastroparesis. The proportion of patients who experienced at least a 20% improvement is gastric emptying ranged from 20% to 52% for velusetrag dosed patients and 5% for placebo patients.[10][11]

On December 6, 2016, Theravance Biopharma announced that the U.S. Food and Drug Administration (FDA) has granted Fast Track designation to velusetrag for the treatment of symptoms associated with diabetic and idiopathic Gastroparesis.[12]

As of May 10, 2017, Velusetrag is being studied, at doses of 5, 15 and 30 mg over a 12 week treatment period, for symptomatic improvement in patients with diabetic or idiopathic gastroparesis in the DIGEST study.[13]"

References
"WHO Drug Information, Vol. 24, No. 1, 2010. International Nonproprietary Names for Pharmaceutical Substances (INN). Recommended International Nonproprietary Names: List 63" (PDF). World Health Organization. p. 79. Retrieved 26 April 2016.
M. Vazquez-Roque, and M. Camilleri (2011). "Velusetrag". Drugs of the Future. 36 (6): 447–454. doi:10.1358/dof.2011.036.06.1594078.
Smith, JA; Beattie, DT; Marquess, D; Shaw, JP; Vickery, RG; Humphrey, PP (2008). "The in vitro pharmacological profile of TD-5108, a selective 5-HT(4) receptor agonist with high intrinsic activity". Naunyn-Schmiedeberg's archives of pharmacology. 378 (1): 125–37. doi:10.1007/s00210-008-0282-y. PMID 18415081.
"Theravance Biopharma: Programs". Theravance Biopharma. Retrieved 2017-05-10.
"Theravance and Alfa Wassermann Enter Into Agreement to Develop and Commercialize Velusetrag for Gastroparesis". www.sec.gov. Retrieved 2017-05-10.
"Cisapride". Wikipedia. 2017-02-17.
"Tegaserod". Wikipedia. 2017-02-17.
Goldberg, M; Li, YP; Johanson, JF; Mangel, AW; Kitt, M; Beattie, DT; Kersey, K; Daniels, O (2010). "Clinical trial: The efficacy and tolerability of velusetrag, a selective 5-HT4 agonist with high intrinsic activity, in chronic idiopathic constipation - a 4-week, randomized, double-blind, placebo-controlled, dose-response study". Alimentary pharmacology & therapeutics. 32 (9): 1102–12. doi:10.1111/j.1365-2036.2010.04456.x. PMID 21039672.
Manini, ML; Camilleri, M; Goldberg, M; Sweetser, S; McKinzie, S; Burton, D; Wong, S; Kitt, MM; et al. (2010). "Effects of Velusetrag (TD-5108) on gastrointestinal transit and bowel function in health and pharmacokinetics in health and constipation". Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society. 22 (1): 42–9, e7–8. doi:10.1111/j.1365-2982.2009.01378.x. PMC 2905526 Freely accessible. PMID 19691492.
"Theravance Biopharma Presents Positive Phase 2 Study Data on Velusetrag (TD-5108) for Treatment of Gastroparesis in "Poster of Distinction" at Digestive Disease Week (DDW) 2015 (NASDAQ:TBPH)". investor.theravance.com. Retrieved 2017-05-10.
House, SA Editor Douglas W. (2015-05-18). "Theravance's velusetrag performs well in gastroparesis study". Seeking Alpha. Retrieved 2017-05-10.
Morales, Sysy (2016-12-18). "FDA Gives Fast Track Designation for Gastroparesis Treatment". Diabetes Daily. Retrieved 2017-05-10.
"The Diabetic and Idiopathic Gastroparesis Efficacy, Safety, and Tolerability (DIGEST) Study". ClinicalTrials.gov. Retrieved 26 April 2016.





As of right now, these are the only options available to people battling Gastroparesis:



Source: Located on image.




According to the U.S. Library of National Medicine,

"Velusetrag has been used in trials studying the treatment of Gastroparesis and Alzheimer's Disease. It is a highly selective serotonin receptor agonist effective in patients with chronic constipation. It is being developed by Theravance. Velusetrag was discovered by Theravance through the application of its multivalent drug design in a research program dedicated to finding new treatments for GI motility disorders."



Source: unknown.



As of August of 2017, According to Theravance Biopharma,

"Theravance Biopharma Announces Positive Top-Line Results from Phase 2b Study of Velusetrag (TD-5108) in Patients with Gastroparesis: Improvements in Symptoms and Normalized Gastric Emptying Demonstrated in both Diabetic and Idiopathic Gastroparesis Patients



Theravance Biopharma, Inc.
Aug 02, 2017, 07:00 ET


DUBLIN, Ireland, Aug. 2, 2017 /PRNewswire/ -- Theravance Biopharma, Inc. (NASDAQ: TBPH) ('Theravance Biopharma' or the 'Company') today announced positive results from a 12-week, Phase 2b study of velusetrag (TD-5108), an oral investigational drug in development for the treatment of patients with diabetic and idiopathic gastroparesis. Top-line results from the study demonstrated statistically significant improvements in gastroparesis symptoms and gastric emptying in patients receiving 5 mg of velusetrag as compared to placebo. Additionally, velusetrag was shown to be generally well-tolerated, with 5 mg and placebo having comparable rates of adverse events (AEs) and serious adverse events (SAEs).

The study was conducted in 232 patients with either diabetic or idiopathic gastroparesis who received either velusetrag (5, 15 or 30 mg) or placebo, administered orally as a once daily dose. After four weeks of dosing, when the primary assessments were made, patients in the 5 mg velusetrag treatment arm demonstrated statistically significant improvements in symptom scores compared to placebo in two separate patient reported outcome (PRO) tools: the Gastroparesis Cardinal Symptom Index (GCSI) (nominal p = 0.0327) and the Gastroparesis Rating Scale (GRS) (nominal p = 0.0159). Improvements in GRS total score were maintained at 12 weeks of treatment (nominal p = 0.0427). Compared to placebo, patients in the 5 mg treatment arm also demonstrated statistically significant improvements in gastric emptying time (nominal p < 0.001) and in individual disease-specific symptom scores including post-prandial fullness/early satiety, bloating and upper abdominal pain (all nominal p < 0.05). Importantly, the symptom improvements seen with 5 mg of velusetrag were observed in both diabetic and idiopathic gastroparesis patients. The primary endpoint analysis included a pre-specified analysis of each dose against placebo to report nominal p-values. The analysis also included multiplicity adjustments of p-values to account for three dose comparisons to placebo. Patients in the 15 and 30 mg velusetrag study arms did not demonstrate nominally statistically significant improvements in gastroparesis symptoms versus placebo, possibly due to an increased frequency in gastrointestinal side effects at these doses that may have been caused by rapid emptying of the stomach. The lack of dose response resulted in a lack of statistical significance across the three doses when adjusted for multiplicity. As a result, the statistical comparisons for the 5 mg dose are not adjusted for multiple comparisons, and all are quoted as nominal. Of note, the 15 mg and 30 mg doses remained highly statistically significant compared to placebo in gastric emptying time (nominal p < 0.001), as measured by scintigraphy. "We are very encouraged by the results of this study as they demonstrate not only consistent evidence of improved gastric emptying but also meaningful improvement in gastroparesis symptoms following treatment with 5 mg of velusetrag. The findings from this study demonstrate that a 5 mg dose was sufficient to ameliorate the symptoms of gastroparesis. We believe that these findings provide clear evidence of the potential benefit of velusetrag in patients with gastroparesis, a debilitating disease in significant need of therapeutic innovation," said Brett Haumann, MD, Chief Medical Officer of Theravance Biopharma. "We are now preparing to meet with regulators to discuss the next phase in our development plan." Velusetrag was shown to be generally well-tolerated, with rates of AEs and SAEs comparable between the 5 mg dose and placebo. The most commonly reported AEs across all groups (active treatment and placebo) were diarrhea, nausea and headache. Consistent with velusetrag's mechanism of action, patients receiving treatment demonstrated higher rates of diarrhea and nausea/vomiting than those receiving placebo, and these rates were numerically highest in the 15 and 30 mg arms of the study. Diabetic subjects treated with velusetrag generally maintained adequate glucose control throughout the study, and there were no episodes of hyperglycemia reported. There was no difference in the number of cardiac adverse events, with four events reported in placebo subjects and four events reported in all velusetrag treated subjects. There were no deaths reported in the study. Theravance Biopharma intends to present additional results from the study at upcoming medical conferences, as well as in appropriate scientific journals. Theravance Biopharma will hold a conference call and webcast presentation today at 8:00 am ET to discuss the results of the Phase 2b study of velusetrag. To participate in the live call by telephone, please dial (855) 296-9648 from the U.S., or (920) 663-6266 for international callers, using the confirmation code 61886684. To listen to the conference call live via the internet please visit Theravance Biopharma's website at www.theravance.com, under the Investor Relations section, Presentations and Events. To listen to the live call please go to Theravance Biopharma's website 15 minutes prior to its start to register, download, and install any necessary audio software. A replay of the conference call will be available on Theravance Biopharma's website through September 2, 2017. An audio replay will also be available through 8:00 am ET on August 9, 2017 by dialing (855) 859-2056 from the U.S., or (404) 537-3406 for international callers, using the confirmation code 61886684. [**Blogger's NOTE: Call has already been done as of today] About the Phase 2b Study

The study was a multicenter, double-blind, placebo-controlled, parallel group Phase 2b characterizing the impact on symptoms and gastric emptying of multiple doses of velusetrag administered once daily over 12 weeks of therapy. The study enrolled 232 subjects with diabetic or idiopathic gastroparesis with documented gastric delay, by either gastric emptying scintigraphy (GES) or gastric emptying breath test (GEBT), and documented symptoms prior to and throughout the baseline period. Two daily patient reported outcomes (PRO) tools were used to characterize symptom change: the Gastroparesis Cardinal Symptom Index (GCSI), which assessed the severity of three cardinal symptom domains; and the Gastroparesis Rating Scale (GRS), which assessed severity, frequency and timing of seven symptom domains, including the three symptom domains in the GCSI. GRS is a proprietary PRO tool being developed by the Company with academic collaboration. The primary endpoint in the study was mean GCSI score at the end of week 4 of the treatment period.


About Gastroparesis

Gastroparesis is a disorder characterized by delayed gastric emptying and symptoms of gastric retention in the absence of mechanical obstruction. In the United States, it is estimated to affect approximately six million individuals, or 1.8% of the population, and includes two major sub-classes: those with diabetic gastroparesis (29% of the overall gastroparesis population) and those with idiopathic gastroparesis (36%).1 Symptoms of gastroparesis are variable but typically include nausea, vomiting, early satiety, postprandial bloating/fullness or upper abdominal discomfort. Severe cases may also suffer from dehydration, electrolyte disturbances, weight loss and malnutrition. There is also a correlation between severity of symptoms and impairment of quality of life.2


About Velusetrag

Velusetrag is an oral, once-daily investigational medicine discovered internally and developed for gastrointestinal motility disorders. The compound has been granted Fast Track designation by the U.S Food and Drug Administration (FDA) for the treatment of symptoms associated with idiopathic and diabetic gastroparesis.

Velusetrag is a highly selective agonist with high intrinsic activity at the human 5-HT4 receptor. 5-hydroxytryptamine receptor 4 (5-HT4) agonists are established as gastrointestinal (GI) prokinetic agents for the treatment of GI tract dysfunction, such as chronic constipation. Velusetrag (or TD-5108) is a 5-HT4 receptor agonist that demonstrates high in vitro intrinsic activity and selectivity for the 5-HT4 receptor and has no significant affinity for all other receptor types, ion channels, or enzymes tested.

A previous Phase 2 trial of velusetrag showed that all three doses of velusetrag (5, 15 and 30 mg) reduced gastric emptying time (GE t1/2) compared to placebo in patients with either diabetic or idiopathic gastroparesis. The completed Phase 2 trial was the first study to evaluate gastric emptying, a diagnostic criterion for gastroparesis, in a patient population including both diabetic and idiopathic gastroparesis patients, as opposed to diabetic gastroparesis patients only. In addition, velusetrag has completed a 400-patient Phase 2 proof-of-concept study in chronic idiopathic constipation, demonstrating statistically significant prokinetic activity at all three doses tested in that study.

Velusetrag is being developed by Theravance Biopharma in collaboration with Alfasigma (S.p.A.) ("Alfasigma"). Under the terms of the agreement, Alfasigma has an exclusive option to develop and commercialize velusetrag in the European Union, Russia, China, Mexico and certain other countries, while Theravance Biopharma retains full rights to velusetrag in the United States, Canada, Japan and certain other countries.


About Theravance Biopharma

Theravance Biopharma is a diversified biopharmaceutical company with the core purpose of creating medicines that make a difference in the lives of patients suffering from serious illness.

Our pipeline of internally discovered product candidates includes potential best-in-class medicines to address the unmet needs of patients being treated for serious conditions primarily in the acute care setting. VIBATIV® (telavancin), our first commercial product, is a once-daily dual-mechanism antibiotic approved in the U.S., Europe and certain other countries for certain difficult-to-treat infections. Revefenacin (TD-4208) is a long-acting muscarinic antagonist (LAMA) being developed as a potential once-daily, nebulized treatment for chronic obstructive pulmonary disease (COPD). Our neprilysin (NEP) inhibitor program is designed to develop selective NEP inhibitors for the treatment of a range of major cardiovascular and renal diseases, including acute and chronic heart failure, hypertension and chronic kidney diseases, such as diabetic nephropathy. Our research efforts are focused in the areas of inflammation and immunology, with the goal of designing medicines that provide targeted drug delivery to tissues in the lung and intestinal tract in order to maximize patient benefit and minimize risk. The first program to emerge from this research is designed to develop intestinally restricted pan-Janus kinase (JAK) inhibitors for the treatment of a range of inflammatory intestinal diseases.

In addition, we have an economic interest in future payments that may be made by Glaxo Group Limited or one of its affiliates (GSK) pursuant to its agreements with Innoviva, Inc. relating to certain drug development programs, including the Closed Triple (the combination of fluticasone furoate, umeclidinium, and vilanterol), currently in development for the treatment of COPD and asthma.

For more information, please visit www.theravance.com.


THERAVANCE®, the Cross/Star logo, and VIBATIV® are registered trademarks of the Theravance Biopharma group of companies. Trademarks, trade names or service marks of other companies appearing on this press release are the property of their respective owners.

This press release and the conference call will contain contains certain 'forward-looking' statements as that term is defined in the Private Securities Litigation Reform Act of 1995 regarding, among other things, statements relating to goals, plans, objectives, expectations and future events. Theravance Biopharma intends such forward-looking statements to be covered by the safe harbor provisions for forward-looking statements contained in Section 21E of the Securities Exchange Act of 1934 and the Private Securities Litigation Reform Act of 1995. Examples of such statements include statements relating to: the company's strategies, plans and objectives, the company's regulatory strategies and timing of clinical studies, the potential benefits and mechanisms of action of the company's product and product candidates, the company's expectations for product candidates through development, potential regulatory approval and commercialization (including their potential as components of combination therapies) and the company's expectations for product sales. These statements are based on the current estimates and assumptions of the management of Theravance Biopharma as of the date of the press release and are subject to risks, uncertainties, changes in circumstances, assumptions and other factors that may cause the actual results of Theravance Biopharma to be materially different from those reflected in the forward-looking statements. Important factors that could cause actual results to differ materially from those indicated by such forward-looking statements include, among others, risks related to: delays or difficulties in commencing or completing clinical studies, the potential that results from clinical or non-clinical studies indicate the company's product candidates are unsafe or ineffective (including when our product candidates are studied in combination with other compounds),the feasibility of undertaking future clinical trials for our product candidates based on FDA policies and feedback, dependence on third parties to conduct clinical studies, delays or failure to achieve and maintain regulatory approvals for product candidates, risks of collaborating with or relying on third parties to discover, develop and commercialize product and product candidates, and risks associated with establishing and maintaining sales, marketing and distribution capabilities with appropriate technical expertise and supporting infrastructure. Other risks affecting Theravance Biopharma are described under the heading 'Risk Factors' contained in Theravance Biopharma's Form 10-Q filed with the Securities and Exchange Commission (SEC) on May 9, 2017 and Theravance Biopharma's other filings with the SEC. In addition to the risks described above and in Theravance Biopharma's filings with the SEC, other unknown or unpredictable factors also could affect Theravance Biopharma's results. No forward-looking statements can be guaranteed and actual results may differ materially from such statements. Given these uncertainties, you should not place undue reliance on these forward-looking statements. Theravance Biopharma assumes no obligation to update its forward-looking statements on account of new information, future events or otherwise, except as required by law.

References:

1 American Gastroenterological Association. "Technical Review on the Diagnosis and Treatment of Gastroparesis." http://www.gastrojournal.org/article/S0016-5085(04)01634-8/fulltext. Published online July 27, 2005.

2 Journal of Neurogastroenterology and Motility. "Prevalence of Hidden Gastroparesis in the Community: The Gastroparesis 'Iceberg'." http://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2012.18.1.34. Published online January 16, 2012."



In conclusion, these trials look promising. Hopefully, soon, we will have more treatments for Gastroparesis. There are several clinical trials being conducted that show promising results. I have more clinical trials in another blog article I wrote, which you can find here: http://www.emilysstomach.com/2018/06/fda-accepts-cardiac-safety-trial-for.html. I really hope that these trials continue to show promise, because as of right now, there are medications that can cause permanent neurological side effects, or very extreme measures like stomach surgery or the gastric pacemaker to help with Gastroparesis. We need something less invasive that will help to increase our motility.