Doctor Suspended After IC Patient Dies From Pain Medication Overdose

[icnmgrjill]

This is very sad. An IC patient Tammy Dawn Daniels (age 35) died in 2009 from "toxic amounts of the drugs" (pain medications) in her system. The prescribing doctor, Dr. Mickey Ray Tyrell, was suspended for 30 days and sentenced to 200 hours of community service.

In just three months, the patient was given 990 demerol pills and 120 of oxycontin. It's clear that she was in severe pain but that is shockingly excessive IMHO. That's roughly 330 demerol pills per month, at more than ten a day.. and a whopping 4 oxycontins per day. Folks.. if you're using that amount of medication, it's absolutely time to see an IC specialist AND get yourself into a supervised pain program.

What a tragedy this is. - Jill

Read the full story at: http://www.tulsaworld.com/news/artic...7_VNTiia557925

[bubbe1]

That is a very sad story. Those 30 days just don't seem enough somehow.

[playethic]

One of the things that worries me about this story is the likely outcome. In my opinion the likely outcome is that someone new is going to be in torture-level agony and doctors will be too nervous to prescribe opiates to help her (/him).

Where I live, waits to get in to a pain speciality program are over a year - maybe 8 months for the expedited, triaged appointment.

And an IC specialist has only 4-ish options they can offer patients (Elmiron, heparin/lidocaine/baking soda instills, Uracyst instills, Ranitidene, or a waiting list spot for bladder dilation/fulguration). What if said patient has tried all of those and is still in torture-land?

More patients will have to suffer torture-level pain because doctors will be too afraid to help.

Trying various narcotics is par for the course. My guess is it's likely her doctor wasn't prescribing these to be taken at the same time - perhaps she tried demerol and found it didn't work for the pain so the dr. tried oxycontin and she switched over - perhaps that's why she had both.

There are already so so so many judgements IC patients have to deal with by medical professionals that they are on 'excessive' narcotics. The IC patients know that. They don't even want to be on them. But if she's got that level of pain, she won't survive. Not possible to live with ongoing pain that is literally like a blowtorch. We don't know that she was suicidal. It's quite possible that she desperately desperately needed the pain to stop.

I don't think criminalizing doctors so patients find it harder to get pain control is the answer.

[melanie626]

FYI....Demoral is no longer a good oral agent for chronic pain and is hardly if ever used and it is unclear the dose of oxycontin a day---But I do think it unfair to say that 4 tabs is "whopping" though and it is languege like that that gives oxycontin a bad name

I whole heartidly agree with Jill, the best way to manage long term chronic pain is through the evaluation and supervision of a pain clinic or a primary physician who will work with your on your chronic pain and Urologist to treat your IC. Sadly many Uro's will not treat the pain because they don't want to be bothered with the chronicity of the pain medication refills, so I cannot stress enough the vital importance of getting a TEAM of providers and then designate the one to be the point of contact. Advocating is scary and hard and when opiods are involved it can feel extra vulnerable. When in doubt, bring a spouse, friend or contact patient relations if your feeling like your team isn't working for you.

Melanie

[playethic]

One mistake in my earlier post --- clarification in caps:

And the IC specialist [WHERE I LIVE] has only 4-ish options he currently offers patients (Elmiron, heparin/lidocaine/baking soda instills, Uracyst instills, Ranitidene, or a waiting list spot for bladder dilation/fulguration). What if said patient has tried all of those and is still in torture-land?

[playethic]

I agree. Pre-diagnosis and on oxycontin I was on higher levels than 120 - beyond the levels Jill determines to be 'whopping' and 'exceedingly high'. I agree with Melanie's comment on use of language.

Judgements for being on unnecessarily high painkillers makes things more difficult. I'm on less now. If I had been denied that level of painkiller then because someone else said it was too 'whopping', I'd be dead. The pain was not possible to bear. Access to that medication got me through the agony. I got through it and the dose came down. Someone else now may not be given access to enough to manage their pain, and they might not make it.

[ICNDonna]

I have to agree that he was "underpunished" --- and I have to wonder if he should be practicing medicine?

Donna

[kadi]

Maybe I'm reading Jill's comments differently, but it seems to me that it's the amounts of two different strong painkilling drugs prescribed simultaneously that she was noting as high.

[suzannes]

No one knows what else she was taking, ambien, ativan, ect. Could be the combination of all the drugs. As a nurse practitioner I think there really does need to be a balance but I am here to tell you that it is hard for to find that balance.

Suzanne

[dg2901]

That amount of meds seems way out of proportion. Holy smokes! I've been one of the patients suffering from the horrendous pain of this disgusting disease and I've never been given any type of pain meds by my treating physicians. I have however been referred to a pain management Dr though never made the appt. I cant imagine a urologist or primary care physician attempting to manage the pain that IC brings.
It seems strange too that this patient was a nursing instructor who, one would assume, would know better than to take so many meds at such high doses. Something is fishy with this story.

[playethic]

You're right Kadi ... the whole access-to-pain-prescriptions topic hits a nerve for me and I reacted and hit 'post' too quickly. I also noticed that the info about # of pills didn't specify the mg's of pills -- so hers and mine may have been different. At the ER, nurses eyebrows would go up at 'excessive' amounts I was on, so I know it was a lot. I know I didn't want to be on that high, but I know that it was the only way I could survive the pain.

Anyway I realized those things after 'post' and went back to change it but couldn't seem to find an option to edit what I wrote! [that'l teach me... ]

[zyphia]

I have had them all.......Oxycontin, MS Contin, Dilaudid, Duragesic patches, you name it, had them all..ONCE...because of severe pain from spinal injuries in addition to IC and other problems with pain....but because of my bummed out liver from a bout with infectious hepatitis and jaundice as a child I cannot metabolize a lot of medications and pain medications are at the top of the list. As a former nurse and an ER nurse for a time, I saw a lot of people on Rx's of Oxy as maintenance for pain and a normal Rx was 10 milligrams twice a day so the Rx the doctor wrote for the young lady for the Oxy was acceptable in some circles for maintenance if she was taking 2 per day @ 10 milligrams a day and had 120 pills (from June 2 to Sept 2), but I don't know about the 990 Demerol. Some Rx's for Oxy are written for up to 60 milligrams per day. I don't understand tho, a nursing instructor taking that combination of drugs. Seems to me she would have known better. I do agree tho, that he was wrong. I would think a red flag should have popped up somewhere along the way with either the pharmacist or the people in the ER. I know it would have if she had been a patient in the ER where I worked. I may have made an enemy for sticking my nose into her business but maybe I would have saved her life. I do know in my case my Rx's for controlled substances are only filled for a period of 30 days so I wonder why there were no questions asked about someone given 990 Demerol tablets in such a short period of time. Of course there are always a lot of "what ifs" when something like this happens. It is so sad and senseless. My pain regimen is a lot different from so many of you on the board because I have to stay away from narcotics but I manage. It isn't fun at times and I do try to live as normal a life as I can. Lately I have become more homebound because the Parkinson's is getting to be more of a bother. It is not so much the typical Michael J. Fox Parkinkson's....I don't skake or tremble..mine is freezing and I am having a hard time getting around so am becoming more housebound which irritates me to no end..grrrrrrrrr. I am living thru my PC these days and am enjoying more and more reading the posts on the board so keep them coming. I am planning a trip to England later this summer....hopefully we will stay at a friends house in Oxfordshire...I won't get to do much, just plod up and down the village lane with my walker...hahaha..but it keeps me busy planning. This will be my last trip to Europe. I have gone every year since 99and it is time to hang up the old traveling shoes. My body is worn out. Oops sorry for the ramble.....

[bob04951]

This is horrible. It is a step backwards. A doc cannot monitor you every minute of the day, they put their faith in you as you do in them. Gives pain meds yet another bum rap. That is way a lot of pills to be prescribing at one time for ANY patient. Bob only gets an 18 day supply of oxycodone and one month of fentanyl patches, and he cannot renew earlier than 2 days ahead. And doc knows I watch him pretty closely. That doc should maybe not be allowed to even prescribe narcotics for a while. That was a whole lot of medication. What was he thinking??? Woulld be uncomfortable even accepting that many pills and surprised the pharmacy filled the order.

It is a real shame, and who knows where her head was. If she was showing signs of depression a huge red flag would have been flying over her head. Does anyone know if she was on antidepressants as well? If so, he needs a good lashing, and needs to take a few classses on pain meds/interactions, etc.

This is just so discouraging, most of us have a hard time just getting what we need to get through the day, one story like this makes docs paranoid, but on the other hand maybe a bad doc has been weeded out. Feel bad for her family, they were probably against the pain meds to begin with. It's just always a setback, but if we took everything away from a "maybe" depressed patient with which they could do themselves harm, they'd all be living in padded cells. Supervision is the key, and perhaps that is a question docs should ask before they prescribe huge amount of any med to a patient who has a history/signs of depression. That is why I am a firm advocate of always having someone with you for all appts. Depressed patients can hide stuff from loved ones, and they would never know.

Hope we never hear a story like this again, but find it interesting that they actually mentioned she was an IC patient. Where does that put us? That IC patients are drug seeking? If she were a cancer patient everyone would say Ahhh, poor thing, she must have been in a lot of pain. Just an interesting analogy, which lead us to educating our friends and loved ones about how painful this thing can be. Distressing, really, and so very sad.

[zyphia]

Did you read any of the comments made by the readers of the story that were posted at the bottom of the URL that Jill posted? I found them interesting, especially the last one.

[bob04951]

Thank you Zyph, I had not read that, typically do not open up any attachments but did that. Well, you saw her name Tao something which is eastern religion, pretty much organic. Just shows the ignorance some have, if what she said was true, 3/4 of the country would have IC, man, woman and child. Half tempted to respond, but it's just not worth it. You can't educate someone with that mindset. SIGH. Jill, wife of Bob