I almost ran out of Mirapex two weeks before I could refill (I doubled my dose morning and evening instead of just the evening. Strangely, I did not receive much co-operation from the sleep doctor's office. Just to recall:
I am getting a small amount of Lorazepam from Dr. C
I am getting Mirapex (and could get more Neurontin) from Dr. Johnson, the pulmonologist.
I am getting Ultram from my pain doctor, Dr. R........
who does not really want me as a patient, (I think he sees me enough as his patient's father.)
I finally sent a FAX to Dr. J's office when I knew he was there. This was adressed to the nurse. where I explained why I need an increase in dose.
Finally I received a call from James, the physician's assistant, with whom I had a nice chat once free of charge.
Now he was not very amiable but still respectful, and clearly he did not want to increase the Mirapex dosage. Finally when I cornered him (I can do that better in person) he admitted that he was reading Dr. J's notes (I do not believe that, I think Dr. J was in the room but he does not like confrontation.) And what Dr. J wanted me to take Mirapex at a low dose and if does not work I should ALSO take Neurontin!
Well, that was the first time I heard that, but perhaps I had not been listening very well. If you remember I had terrible withdrawal symptoms (vertigo) when I switched from Neurontin to Mirapex. I should have done it gradually but how do you slice a capsule in half?
Then he said why do you need another dose in the morning when RLS is at night? (I just explained to him I have to take it because of augmentation, he probably did not exactly know what the word meant).
To make a long story short, he finally phoned in the increase in Mirapex but only one
refill this time. He also said Dr. J. wants me to go to a neurologist and was already to make the appointment (they can be so accomodating at time especially when they want to pass you on to another doctor) when I stopped him with the news that the pain doctor already had this idea and I already have an appointment with the female partner of the neurologist he wanted to make the appointment with.
He apparently did not believe me and demanded to know the name of the doctor which I could not recall immediately but eventually let him know. He talks too much and indicated that they want her to handle all my medications from that appointment on. And judging from the tone of of all the paperwork she sent over she will be a hard taskmaster.
Now everything depends on how open-minded this lady is. I looked her up on a website. You cannot tell much by a blurry photo, but I will be surprised if she will turn out to be open minded. (This same web site also offered to send me all the dirt on this doctor (any doctor) for $7.75, - but I do not want to go that far - yet).
My present medication is MIRAPEX 0.5mg twice a day
....................................... ULTRAM 50 mg twice a day
on occasions a 0.5 mg Klonopin in the evening.
Interestingly and revealingly at that point I asked James, what is the fuss? What I am requesting is not unreasonable! He admitted that it is not, but said Dr. J. disagrees with it. Then I said, he saw me for 15 minutes at the end of which he was edging toward the door, who do you think knows what is best for me, Dr. J or me? Then he levelled me with their giant killer: Yes but he is the one with the authority to write prescriptions!
So they won this round - almost. I did get two more months of reprieve on both medications. Dr. G, the neurologist will probably want to change those to an antidepressant
But I will be watching her like a hawk.