Comments on Payne Hertz: Macho, Macho Man!

This is from an ER nurse and a chronic pain suffer...

2009-10-07T02:40:42.819-04:00

This is from an ER nurse and a chronic pain sufferer. Yea, we do judge patients. There are people who really have pain. I'm one of them. But you have to understand how many drug seekers we see, that we know for a fact whether from law personnell, family members or sometimes even the patients themselves that they abuse the drugs or often sell them for a profit. It bothers me that we have to weed thru these people to get to the real pain sufferers but we do. I have told many patients with pain to do a pain clinic but after my experience with one I won't recommend that. I have never been to the ER for pain meds but did go to a pain clinic thinking that was the place to go for proper treatment and non judgemental MDs, nurses, etc. Boy was I wrong! They treated me more like a drug seeker than I ever saw a nurse or doc in the ER treat anyone. Right up to and including saying crap and laughing in front of me that I could hear. Theres no good place that I know of for pain managaement unless you find a doctor who is willing to treat you with what you need and with docs being charged with crimes for prescribing the doses needed, I would be afraid to prescribe it also...

PROFOUND IGNORANCE IN-ACTION The blowhard who is ...

2009-08-01T02:22:56.310-04:00

PROFOUND IGNORANCE IN-ACTION

The blowhard who is afraid to reveal his name (but has little qualms about revealing the names of others) seems to have good reason to remain anonymous - he is demonstrably quite ignorant, indeed.

The issue of the P450 liver enzymes affecting analgesic potency of known active metabolites of opiates/opioids mentioned by "Sara Robinson" (on Aug 27, 2007) applies exclusively and ONLY to the de-methylization of the methyl group portion existing within the 3-methyl ether that is present ONLY in codeines and codeinones, and does NOT EXIST in morphine or the morphinones - such as hydromorphone (Dilaudid). "Sara Robinson" happened not to mention that in her post.

Enter the obtuse "Scalpel", who posts and boasts about his "fantasy" conversation with a patient requesting hydromorphone for pain (on Aug 28, 2007):

"Nah, my tooth got fixed, but good luck with that "mystery pain" of yours. NSAIDS "don't work" eh, and you need REALLY BIG doses of narcotics, but oddly you are allergic to all of them except Dilaudid. Bummer." ...

Scalpel continues his "fantasy" conversation/thoughts by stating:

... "Funny how those P450 deficiencies missed that one, huh?"

Wow, "Scalpel", your hot-headed ignorance is showing big-time ... We assumed - because you seem to know how to write - that you also know how to read. Yet (if you did read) you would have quickly learned that:

(1) Morphine and hydromorphone (Dilaudid) are NOT "pro-drugs" (as is the case with codeine, where the 3-methyl ether group must be de-methylated to the become the active metabolite morphine by the P450 2D6 isozyme); as well as

(2) NONE of the various subtypes of the P450 enzymes are an issue at all in the metabolization (and, thus, the resultant analgesic potency) of either morphine or the morphinones (i.e., Dilaudid). This is verified by the Indiana University School of Medicine, Department of Pharmacology P450 drug interactions table published in 2006 (stored on my hard-disk drive), as well as by the more recently (Jan 12, 2009) updated version at:

http://medicine.iupui.edu/clinpharm/ddis/table.asp

I'm not sure if they provide that table in braille for the blind, but - since you are clearly in some way "informationally challenged", and they are a public institution, you should be able to request a disability accommodation so that you, will have an opportunity to participate in your "continuing education" ...

It might be a good idea to "bone-up" on common pharmacological knowledge well established (at least) a year prior to your post (if not earlier) before you go shooting your mouth off ...

Or are you a charlatan by trade, instead (and not a degreed physician)? In the world of science (as opposed to the world of your mind) facts do matter - and tend to lend an air of credibility to your statements ...

Good luck to you, "Bozo" ... ;)

-DR

Here's helpful information for all fibromyalgia su...

2008-06-02T17:38:00.000-04:00

Here's helpful information for all fibromyalgia sufferers.

Fibromyalgia is a condition where you feel chronic pain in certain parts of your body; it is a muscular pain especially around the joints. There can also be centralized pain felt in the spinal chord, brain, neck shoulders etc. People with fibromyalgia generally complain of pain in the joints, but it actually is the muscles and the tendons around it that cause the pain, it can be excruciating sometimes and can be a continuous throbbing pain. People suffering from Fibromyalgia also show symptoms of depression, sleeplessness, irritable bowel syndrome, stress and many others, which are caused due to the pain.

Rid Fibromyalgia provides a simple process to helps you eliminate all your symptoms of fibromyalgia and enjoy living your life again. This will provides us the best and most effective solutions on how to rid ourselves from pain.

The Rid Fibromyalgia provides an eBook entitled “Heal the Body” that will teach you the best diet that will allow you to eat your way to wellness, it will also document which vitamins and supplements will target and reverse the illness, how to achieve pain relief through acupuncture, what exercises are safe and will work, and what type of medications may make you sicker, and what will work. This eBook takes a step by step approach in showing you how to rid yourself of the pain naturally so that you can take back your life.

We must know the symptoms of this illness. For us to know what would be the approach we will going to apply. Here's Signs and Symptoms of Fibromyalgia and steps to treat it naturally.

We must also be responsible and aware to the things to gain and cope up with this kind of illness. Eating nutritious food with regular exercise would be result to a better life. Here's Basic Tips in Coping Fibromyalgia.

If we say Fibromyalgia Diet, there is no specific recommended diet for fibromyalgia. But a healthy diet rich in vitamins and minerals can certainly help in coping with the illness. Magnesium rich vegetables are recommended for patient's suffering from fibromyalgia. Here's some information for you to help in Fibromyalgia Diet.

We must also think that vitamins are important for Fibromyalgia sufferers. This will give us additional energy and strength to kept a healthy living. But of course, you must be aware that not all vitamins are effective or directly gives you a good result. Find the best vitamins that would easily give a good response if your taking it. The best thing is your healed and keep your body healthy as possible. Here's The Benefit of Vitamins for us to know why vitamins are important for fibromyalgia sufferers.

Also feel free to view this video Fibromyalgia Help. It really gives good information for those who have Fibromyalgia and encourage not to give up because in every pain your getting through has a good solution in the end.

Here's Rid Fibromyalgia, For free info and helpful articles on fighting fibromyalgia.

Thanks, Alex. You've touched on what motivated me ...

2007-11-13T15:30:00.000-05:00

Thanks, Alex. You've touched on what motivated me to start this blog in the first place, and that was my experience of reading a lot of the medblogs and doctor/nurse forums and seeing just how prevalent this kind of thinking really is. That and of course seeing the flip side of thousands of "paranoid" patients in their own forums complaining about being on the receiving end of this abusive mentality and behavior. I don't know whether it's a case of people being corrupted by power or that some doctors share the same ruthless, authoritarian mindset so prevalent in our culture nowadays that says that anybody who is poor, or sick, or has made mistakes with their lives deserves their fate and should be treated with contempt.I do know we need to speak out against it or things will never change.

I don't even want to go to this jerk's site - I've...

2007-11-11T23:07:00.000-05:00

I don't even want to go to this jerk's site - I've met him a million times already. Probably young (younger than me :-) 52), interestingly defensive and aggressive and angry, deeply arrogant M.D.'s.

No thanks; I'll pass. I've paid my dues; life is way to short to spend with ugly people like this "doctor" (if he/she/it is actually a doctor).

What is depressing, and why I think it is very worthwhile, Paine, that you wrote this all out, is how common this sort of physician blog-site is these days.

An observation: it is the ER docs that are the angriest, craziest, and entitled-presumptuous - especially as regards pain patients.

..alex...

Thanks, Dr. DeLuca. It is always good to see there...

2007-11-11T22:29:00.000-05:00

Thanks, Dr. DeLuca. It is always good to see there are doctors like yourself out there who are the polar opposite of what I am describing here. I greatly appreciate the work you do both on your blog and website and with PRN as well as the critical thinking you bring to bear on issues of pain control, drug policy and access to pain relief.

Very excellent post, Paine. You really explore the...

2007-11-10T21:54:00.000-05:00

Very excellent post, Paine. You really explore these issues. I know how much work it is to produce a post like this, how much time it takes. It's difficult, takes skill and talent; it is real work.

Thanks for doing the work.

..alex...
Alex DeLuca, M.D., MPH
doctordeluca@painreliefnetwork.org
War on Doctors/Pain Crisis blog

That doesn't surprise me. Like a lot of malignant ...

2007-10-29T23:25:00.000-04:00

That doesn't surprise me. Like a lot of malignant narcissists he is only interested in his hallelujah chorus of doctor worshipers and fellow narcissistic bigots. He blogs anonymously, which is understandable enough, but he openly admits to blacklisting patients in violation of HIPAA and he revealed my real name on another blog when I posted something he didn't like--namely, something that he had written in the comments section here. It shows just how low his standards and ethics really are that he has no respect for the rights of others to confidentiality or to blog anonymously, but he thinks his opinions and obvious lack or morals and character should be exempt from criticism .

But on the bright side, I suppose I can now fool myself into believing that the near total absence of comments from the medical profession criticizing all these patient-bashing blogs out there is due to the fact that such comments are being deleted.

The doc didn't like me posting anything regarding ...

2007-10-29T09:53:00.000-04:00

The doc didn't like me posting anything regarding the recent Texas pain Summit, which was held to find out why Texas was receiving poor grades despite passing acts like the ACS Texas Pain Initiative. The reason is obvoius, because of morons like him. So no longer can you post anonymously on his site. So I set up an account & now he has an account block on which he has to approve all comments first. He can dish it out but he can't take it.

Oh my, another doctor here with chronic assmosis o...

2007-10-25T10:24:00.000-04:00

Oh my, another doctor here with chronic assmosis of the brain. I thought the doctor at our website was bad. He also seems to have chronic diarrhea of the mouth.

excellent blog, payne hertz....we've linked it on our site.
sorry scalpel, I have no interest in your site at all. I get my fill of your type in the real world. I suggest you start learning something.
tc
power over pain

Thanks so much for this post Sara.This is entirely...

2007-09-16T06:14:00.000-04:00

Thanks so much for this post Sara.
This is entirely new information to me, and I suspect it would be to every physician within 500 miles. Having said that,I think everyone who has suffered long term pain senses the differences in meds and doses, but had no scientific evidence to fall back upon, so this truly is fascinating! Besides, we're busy handing over UA cups and filling in questionaires no one reads.I just had no idea that actual genetic testing was being done, and as part of treatment. Where I live, it's a major leap to find a doctor who "believes" in various long term conditions, much less treating them with opiates. I'm somehow certain the genetic testing information has not made its way this far west. I look forward to more of your posts.
Thanks again,
codeee

"Isn't that a rather broad generalization of women...

2007-08-31T03:29:00.000-04:00

"Isn't that a rather broad generalization of women? That sounds like a pretty "macho" attitude to me. There are a whole lot of women out there in chronic pain as well. Maybe I'm not understanding what you're trying to say, cause it sounds to me like you're putting women down the same way that doctor does."

That's not my intention at all. You might want to read that part again in context. What I am saying in that section, is that there is a particular attitude that is harmful to patients, and that male doctors, nurses and other health professionals are not the only ones who have this attitude. I am not trying to say this attitude is typical of women, or even of most men, but I do feel this hostile attitude towards suffering people is all too common in our society, and unfortunately is well represented in the medical profession among both male and female doctors.I have simply ventured an opinion as to the roots causes of this problem, which really has nothing to do with gender and everything to do with a particular mindset.

You might note that I mentioned a female friend as an example of someone who can take pain pretty well, so I am well aware women have pain and are also subject to abuse in their search to get it treated. It is not my intent, either in this article or this blog, to perpetuate that abuse but quite the opposite, which is to expose it and confront it openly.

This bit here: "Women are clearly prone to this sh...

2007-08-31T00:12:00.000-04:00

This bit here: "Women are clearly prone to this shortcoming as well. They see people coping with horrible, constant pain, and deep down inside they know they would never be able to endure pain like that and still function, so they need to convince themselves that the person is just a weakling and a faker and couldn't possibly be in that much pain."

Isn't that a rather broad generalization of women? That sounds like a pretty "macho" attitude to me. There are a whole lot of women out there in chronic pain as well. Maybe I'm not understanding what you're trying to say, cause it sounds to me like you're putting women down the same way that doctor does.

Your hateful, arrogant, and ignorant remarks say m...

2007-08-29T16:18:00.000-04:00

Your hateful, arrogant, and ignorant remarks say more about what people with chronic pain have to deal with than anything I could possibly write.

If you were upset about something I said, you should have attacked me. Instead, you chose the low road of attacking everyone with chronic pain: people whose only crime is they're in Hell and want out. I bet you do that a lot.

But thanks anyway for the case study of bigotry in action.

Nah, my tooth got fixed, but good luck with that "...

2007-08-28T04:11:00.000-04:00

Nah, my tooth got fixed, but good luck with that "mystery pain" of yours. NSAIDS "don't work" eh, and you need REALLY BIG doses of narcotics, but oddly you are allergic to all of them except Dilaudid. Bummer.

Funny how those P450 deficiencies missed that one, huh? Keep dreaming that some day your true deficiency might be revealed to be something other than drug addiction and generalized pussiness.

Fucking losers. Get off your ass, go back to work and quit your whining.

Wow, I can talk dirty too. I really must be macho. Hey, your hit counter is up to 511 already. Time to sign up for Google ads!

Thanks a lot for your comment, Sara. It really got...

2007-08-27T22:50:00.000-04:00

Thanks a lot for your comment, Sara. It really got me thinking about the implications of what you wrote. I know absolutely nothing about genetics, but I do know a lot of people who have food and drug intolerances and also need large doses of narcotics. I have read where some people are deficient in cytochrome P450 2D6 and thus cannot properly metabolize many narcotics, leading to the necessity of higher dosages to achieve the same pain control, and there are many common meds that can suppress this enzyme, making the problem worse.

Glad you found a doctor who is interested in science rather than speculation.

It would be nice for many people to be able to document this and other deficiencies if this is the case.It could sure save people a lot of grief having to discover their drug intolerances the hard way. Could you post the name of the lab you got that test from? I wasn't aware those DNA tests were that comprehensive.

"None of us mean old ER docs would begrudge a pati...

2007-08-27T22:23:00.000-04:00

"None of us mean old ER docs would begrudge a patient a visit or two for an acutely painful condition like a toothache or back injury."

Wow, how big of you. I hope the next time you go charging into the ER with a toothache some doctor like you tells you you've used up your allotment of "a visit or two" and into the drug-seeker bin with you.

"It's the repeat visitors that are the problem."

No, it's doctors like you that are the problem. Sometimes people go to the ER repetitively because they have to and lack any other alternative.

"What an angry pathetic person you are. But thanks for the links, anyway. I'm sure your 473 visitors will enjoy my site."

You're right I'm angry. Goddamned angry in fact at this whole mindless, barbaric system people in pain are forced to endure. I'm also pretty pathetic right now compared to what I used to be capable of, you'll be happy to know. But my anger is based on 15 years in Hell dealing with the likes of you and seeing the lives of thousands of people destroyed by untreated pain. What's your excuse? Some alleged "drug addict" lied to you and bruised your little ego? Cry me a river and then go drown yourself in it.

I do hope my 473 visitors enjoy your site, though, as it's an education in the sort of medieval attitudes this blog was started to expose.

Oh, and thanks for showing up to confirm my hypothesis.

None of us mean old ER docs would begrudge a patie...

2007-08-27T08:14:00.000-04:00

None of us mean old ER docs would begrudge a patient a visit or two for an acutely painful condition like a toothache or back injury.

It's the repeat visitors that are the problem.

What an angry pathetic person you are. But thanks for the links, anyway. I'm sure your 473 visitors will enjoy my site.

Thanks for the link. It's a great post, and an exc...

2007-08-26T17:31:00.000-04:00

Thanks for the link. It's a great post, and an excellent point.

The only thing I can add to it regards that ridiculous crack about patients with lots of different drug sensitivities being more likely to have psychgenic pain. Genetic medicine is about to put the big fat lie to that conceit.

Most drugs are metabolized by the half-dozen P450 enzymes produced by cells in the liver. We're discovering, via genetic testing, that a goodly number of people are missing one or more of these (I personally am lacking two); and that if you don't have them, you don't metabolize a great many drugs properly.

This leads to overdosing, as a succession of "normal" doses fails to clear the system in the expected time. In a short while (just a day or two if you're dosing 3x/day), this can add up to serious toxicity, with attendant symptoms.

When I got my gene test back and saw the list of drugs associated with the missing enzymes, I was stunned at how accurate it was. This list is now in my medical file, and my doctor refers to it before writing any Rx. If it's on the list, we start with a dose that's 25% of normal. I've had no problems with reactions since.

The jerk who wrote that arrogant comment is about to get bitch-slapped by science. Wish I could be there to watch.