Test Results

[Brynmr]

I've been diagnosed with severe RLS by my neurologist (which I've only seen once). Last month my GP informed me that he was going to reduce my oxy prescription because oxy showed up negative in my blood tests. I looked into that and sometimes oxy doesn't show up in blood tests. My cousin had that happen to her on 2 occasions when she was taking oxycodone for her back troubles. What bothered me a lot was my GP never asked me if I was taking oxy as prescribed. He just assumed I wasn't. Well, I most certainly am taking the 40 mg daily as prescribed. I am not hoarding it to sell for profit. Also he had his PA do all the talking through MyChart. Cutting back on the dosage will simply cause me to suffer more. I finally had to beg him not to reduce the dosage at which the PA said there was still 3 months on file at the pharmacy and the doctor is retiring next year. I guess that means he'll either reduce the dosage or send me to pain management - which I don't want - more cost to me and I'm thinking pain management will likely want to tell me what I need because they know better. I really hate the medical profession and not just for this (I got issues with my Pulmonologist). My Neurologist doesn't prescribe drugs so he's pretty useless. I don't even know why I'll be seeing him this September. He'll go something like: "Yes, you have severe RLS. Drop the co-pay on the way out, thank you". I need to find another GP - hopefully one who can prescribe the drugs I need but I have no idea how to go about that. I'm pretty stressed out about this. I told my doctor this too. Crickets.

[Rustsmith]

There are several things that may be contributing to the missing oxy in your test results.

1. The half life of oxycodone is three to five hours. That means that half of the dose that you take has been processed by your body after 3-5 hrs. This is important because it means that if you took you last dose six hrs ago, there is probably very little left for the test to detect.
2. There are several types of tests used to detect the opioids other than methadone. Some of the tests are not highly specific to your med and so they can miss what is really there. These are called false negatives in the analytical world.
3. Not all analytical procedures are created equal. The test machines that most labs use for this type of test today are supposed to be calibrated on a regular basis. If the test was being done for a criminal proceeding, the last calibration would be a matter of record. In your instance, it probably isn't and the machine might be so far of whack that even dropping an oxy tablet into a blood sample would fail to detect anything.
4. The doses of opioids used to treat RLS are very low when compared to what is used for almost all other conditions.The test procedure and machine calibration are not intended for RLS level doses, which can be 10% of what is given to treat chronic pain or cancer pain.

Unfortunately, doctors in clinical settings (as opposed to research) have a long reputation of not understanding lab testing and its limitations. They tend to take whatever the lab report says as gospel truth and do not understand enough to question results, even when they are obviously wrong.

Ten years ago, I had a doctor that insisted that I sign an opioid contract that had very blunt statements about how the doctor would dump any patient who failed a test. I pointed out that the test being used was not highly sensitive for the opioid that I was taking and usually required a second, more sensitive test to detect my dose. The doctor accused me of lying, so I dumped the doctor before she could dump me.

[Brynmr]

Saving this in my RLS folder. Thanks Steve. I'll be passing these points onto my GP - soon to be my ex GP. imo patient/doctor relationships should be based on mutual trust. Obviously I don't have this kind of relationship with my doctor.

[Rustsmith]

Saving this in my RLS folder.

I corrected a couple of typos, so you might want to re-save it.

I also should have stated that I am an adjunct professor of Chemical Engineering and have worked in a chemical research setting ever since I was a junior in high school. Therefore, I have a little bit better understanding of lab testing and the strengths and limitations of equipment than most clinical physicians. A few do understand (for instance, my neurologist was a Chemical Engineering undergrad), but I am continually amazed at the outright ignorance of some doctors when it comes to reading test results. For example, a very high hematocrit reading and a very low hemoglobin result are completely opposite, yet if the doctor doesn't think about the contradiction and just reads the numbers in the report, the patient could have something very wrong and the doctor wouldn't know. Or maybe a known diabetic who is in a diabetic coma and whose glucose test numbers are erroneously high could delay treatment and cause brain or organ damage result from very low blood sugar (this actually happened to a close friend's wife. She lived, but is now partially paralyzed and only has regained about 1/3 of her cognitive abilities).