Grinding Inside the Cogs of the “New and Improved” Veterans Affairs

I didn’t get that wrong, formerly the Veterans Administration is now the Veterans Affairs department or whatever.

Let me say up front that the vast majority of the worker bees I’ve encountered at the VA are nothing short of awesome !!!. They actually care about people and go above and beyond to help you out. They have my deepest appreciation for these last few months of my care.

Now the negative side of the equation. The dust-up at the top is settling down somewhat, but the VA has what I call an institutional inertia and real change happens slowly. The rotten apples I’ve encountered were all physicians or PAs. I’ll divulge some personal medical information to illustrate what has happened. The big picture with the hospitals and clinics is that the DEA and some other federal agencies hammered them for more than just waiting lists. As a result, it is nearly impossible to get anyone to prescribe controlled substances. They demand a ‘contract’ for pain medication with your primary care physician and then strictly control the dosage and frequency of refills. Not that this is a bad thing as many vets they see have drug issues and are seeking opiates or benzodiazepines for ‘mysterious’ ailments. In the past the VA was infamous for prescribing large quantities of these meds that of course, in some case ended up on the street. They weren’t monitoring it adequately and ended up with a lot of dependency issues as well as the diversions. I get it, but what has happened is a knee-jerk reaction in the other direction so nobody gets anything in spite of medical evidence that confirms the conditions.

We’ll start with the first of my health issues. About 30 years ago I got a severe blow to the left temple when an unrestrained garage door spring bullwhipped the attachment pulley and plate against my noggin on it’s edge, it knocked my ass cold for about 3 minutes. I suffered a slightly depressed skull fracture and had vicious problems with headaches and sleep-disturbances afterwards. I saw a neurologist and had endless testing to determine the diagnosis. A sleep study finally nailed it down. The head injury damaged the area of my brain that controls my REM sleep. Based on that study, I was only getting about 50% of the minimum REM sleep to be properly rested. In other words, Chronic Sleep Deprivation. If any of you have experienced that it’s nasty to say the least. I had another sleep-study a few years ago and it clearly confirmed that the condition was active and now at about 40% of the necessary REM sleep period.

So the neurologist referred me to a psychiatrist as they are the best specialty for neuro-pharmacology issues and playing with different meds. We spent nearly a year trying alternatives to benzos for sleep to no avail whatsoever. My squash just doesn’t get sleepy with medications that put most people out. Once we exhausted that avenue we went with Ambien, Ativan, Xanax, Valium etc. They worked initially but after a few months they would get less effective. Once we reached the maximum dosage with no change we moved on to something else. I found a great psychiatrist in Austin, that got me on Clonezepam (Klonopin). We tinkered with the dosage and voila…I slept and didn’t need an ever increasing dosage. As most docs require, I had to go in monthly for med checks. When I moved out of Austin my PCP prescribed them for me and he had a program of urinalysis biannually to ensure you had the correct serum level of the med on-board, proving that your were taking it as prescribed.

Enter the VA, and what’s the first thing they want to do with me? Yep…take me off of the Klonopin. I got the song and dance about it being addicting and they could use alternatives for sleep…Bullshit !! I firmly told them that I had already spent a long time trying their alternatives and they just didn’t work. I finally got a reasonable Doctor in Maine to call my Doc back in Texas to get the scoop. Of course, I agreed to sign a release for my records as well as permitting him to speak with Dr. Ramirez. He looked me up a half-hour later and said that he spoke with Ramirez and I had been a model patient and complied completely with the medication dosing. So he immediately got me back on my correct dosage of Klonopin as well as writing a long note in my file about the conversation he had and clearly stating that it was clinically appropriate to prescribe the med due to the brain injury. I was elated and hoped that the road would be clear for treating my sleep disorder going forward…….riggghhhhttt !!!

I get transferred from the Maine facility to Worcester, Massachusetts. I went to the clinic there and guess what the PA wanted to do first? Take me off the fuckin’ Klonopin. Speaking with other Vets, I learned that this particular clinic had a house cleaning by the DEA and was one of the major violators of controlled medication scripts. A number of providers were fired and now they were gun shy about prescribing anything at all from the schedule drugs. I never got to make the appointment there with the real doc to lay out my case and ended up being transferred to the Northampton (MA) VA Medical Center…there I ran into another pshrink that wouldn’t even consider continuing me on the medication. Once again, I had to firmly advocate for myself and pointed out the note in my records from Maine that had “settled” the issue. The douchebag told me he disagreed with the other M.D.’s clinical judgement and starting tapering me down on the only medication that works..fuck me with a nail-studded 2×4. The very last thing I need right now is 2 hours or less of sleep every freakin’ night which is what happens without the benzos.

I’m seeing another Doctor today (6/5) and hopefully I can get him to pay attention and correct this fiasco. If not, I have MassHealth and will just go to a private Doctor that’s more interested in me as a patient than covering his ass. Fuck ’em. [Update-the new doc fixed me back up again on the sleep stuff and the correct dosage.]. The run-around is enough to make one loony-tunes.

Issue #2: I developed a bilateral peripheral neuropathy in my feet a few years ago. My mom has Sjogren’s Syndrome which is a risk factor for it as well as hereditary causes. I saw an awesome neurologist that specialized in peripheral neuropathy and he ruled out all the other factors such as diabetes. There is no cure for the condition and it can only be treated symptomatically. He put me on Gabapentin (Neurontin) and slowly brought me up to the maximum safe dosage. I was also prescribed Norco (Hydrocodone/Acetaminophen) as needed for the bad days. The neurologist made the diagnosis with EMG testing that he likes to perform and evaluate himself, confirming the condition beyond any medical doubt. It’s a miserable and painful condition. Imagine walking with hot marbles in your shoes with shooting pain up to the mid-calf. Nothing relieves the pain except the opiates, not shoe inserts, not soaking the feet, nuttin’ at’all. It has gotten much worse over the last few months and it’s to the point now that I can’t even stand the covers on my dogs in bed. I sleep with the damned things sticking out.

I get into the cogs of the VA and you first have to see your primary care provider that takes about a month for an appointment, THEN he/she has to send in a request for a consultation with the specialist and then you get to wait once again for an appointment. Of course, just the same as the benzos, they’re absolutely committed to coming up with a reason NOT to give you any opiates. You get the impression that they believe everyone is drug seeking and barely listen, in my case that I would gladly have all my medical files released for their perusal. I’ve had a horrid few weeks with it and ended up going to the local hospital that had me fixed up and out the door, script in hand in less than an hour. I had previously gone to urgent care here, but the female doctor was the rudest physician I ever dealt with. She found out I was staying in the Veterans Transitional Housing Center here on base, got up and walked out of room saying “I can’t do anything for you”. I couldn’t believe an alleged medical professional could act like this with a patient. I pay that bitch’s salary and she hasn’t heard the end of that one. We have a Hell On Wheels Patient Advocate here that loves to ‘write-up’ this kind of bullshit. I still have some dignity and should at least get a little respect from them. She needs to go back to playing bit parts in Bollywood instead of practicing medicine.

Still waiting for an appointment with my PCP so I’m going to do the end run and just go off-base to a neurologist in town.

You’ll eventually get care, but the process to arrive there is ridiculous. It’s a bureaucratic jungle.

I would love to hear from anyone that has experienced care from the VA and your take on it.

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I deal with dysfunction of the VA as a provider not as a patient, yet. There are a couple of things one may want to consider when dealing with the VA providers. You don’t have to have a license to practice in the state in which you are working as a VA doctor, PA/NP, nurse etc… You have to have… Read more »

LC Getalis, Imperial Czar of Pharmacology
LC Getalis, Imperial Czar of Pharmacology

I’d very much like 5 minutes alone with the cockstraddling DEA dipshits who moved Norco™ to the Schedule-II list last year.

readerjp
readerjp

Just a note – June 5th is the anniversary of the 6-Day War, and June 6th is the anniversary of D-Day. And we can count on Ogabe not being there AGAIN, the only president who has never attended.

redc1c4
redc1c4

i am not a veteran, and thus not eligible for care from the VA. my 20 + years in the CA ARNG/USAR? my 20 year letter describing my eligibility for retirement, should i live that long? the scar on my ankle where i had surgery at Long Beach Navy Hospital, back when there was such a thing? piffle… you didn’t… Read more »

LC Aggie Sith, a goddess, only different, G.G.O.R.
LC Aggie Sith, a goddess, only different, G.G.O.R.

Completely off-topic, but I have been absent from here for a while, and thus missed LC Brendan’s grief and sorrow. I am so sorry for your loss, my friend, and pray that you find comfort in the memories that shroud you in a blanket of love <3

LC Roguetek
LC Roguetek

I used to have a vicodin scrip for the bad days. The VA went to a ‘pain contract’, followed by piss tests every 60 days.

The problem? The VA’s urology lab couldn’t keep up. So… no narcotics for me.

I manage.

Random side note, has anyone else noticed that Red Bull seems to have minor pain relieving properties?