Patients who do not live nearby may come for a two or three week stay. You will first need to discuss with your doctor if he or she will be willing to continue medications that we begin. These may or may not include the following:
naltrexone low dose or ultra low dose
dextromethorphan (long acting)
memantine high dose – research in France has shown it may work for pain, exceeds the FDA approved 20 mg/day dose
They are not magic bullets, not cures. Experience comes in how and when to time the use of these medications to minimize risk of side effects and “clamp” pain and/or major depression. Thankfully, I do have patients whose “intractable” pain is in remission. Intractable means there has been no response to opioids or other medications or combinations tried so far. Where is the research on rational polypharmacy?
Medications that I use are based on my focus on neuropharmacology, not on injections and spinal cord stimulators which often have already been tried and failed to help.
Bear in mind, doctors who do not use these medications may be unwilling to continue them. Some specialists limit their practice to procedures, others do not specialize in neuropharmacology. If that is the case, you may need to return every month until your condition goes into remission or stabilizes. Most of my patients are complex and have usually been tried on a long list of medications and interventions that failed to help.
You can use the search function on my website to read about some of the medications I prescribe or case studies, particularly note the articles posted May 26, 2009, for some of these medications and the science of glia and inflammation that is present in chronic pain or in major depression.
There is not a doctor on the planet who can predict what anyone’s response to treatment will be. If they do, you should avoid them for dishonest practices.
I cannot speculate what percentage of patients would be helped by my approach. To do that, you would need to compare one person’s pain with another – no such standardized comparison exists.
Treatment and outcomes are individualized for every person with pain. Each person has a different pain threshold. Some lack a chromosome and have difficulty metabolizing medications.
I am generally available to my patients Pacific Standard Time afternoons, evenings, weekends and holidays. I am not in the office on Tuesdays though I may otherwise be in meetings or in the hospital.
I do not recommend spinal cord stimulators because:
1. Most important, there are no long term studies showing lasting benefit;
2. they may cause complications, example infection, paralysis, migration of the device or the leads, or new pain and scarring at the site of the external box, tethering to the cord itself – this prevents removal;
3. for the rest of your life, you will never be able to have an MRI scan once the leads are in place, regardless of whether you have cancer or stroke;
4. there may be other ways to relieve intractable pain. Consider trying them first.
Recomended stay: Long distance patients should plan on staying nearby for at least two weeks, in some cases three weeks, and bring a friend or family member for at least the first week, preferably longer. We cover a vast amount of information and it is difficult for anyone to grasp all at once, especially those in pain or those who may be experiencing side effects.
Bring a blood pressure cuff. It may be needed the first few days, depending on which medication we try.
I will need pertinent past medical records that your doctors will need to fax to my office. The past records I require are outlined in the Release for Medical Records. That is in the FORMS section at the top of this website.
You will need to bring with you — do NOT fax – the completed forms for new patients as detailed in the FORMS section, at top of this website.
Do bring me copies of the Release for Medical Records that you sent to your doctor. We may need to urgently fax them again once you arrive. I cannot see you without records.
Cost depends upon how much time is needed at each visit and how many visits are made during the first two weeks. Insurers do not reimburse for record reviews, reports and extended telephonic conversations that are billed separately. Brief conversations are always available to my patients at no fee.
My patients tend to be complex. I need to know those complexities in order to avoid repeating problems or failures of treatment that arose for you in the past.
It is essential to enlist the help of your doctor before you plan to see me. After returning home, you may need to return to my office every 4 weeks for a few months until your local doctors and/or pain specialists can continue your care. I do not have a license to practice medicine outside California. Some doctors are unfamiliar with these medications and would not be willing to use them which is why patients have come from long distance for care.
I work in a team approach that includes a Psychologist, Physical Therapist, and, when indicated, a Psychiatrist, Addictionologist, Anesthesiologist and/or Rheumatologist. We are all independenet solo practitioners with no financial ties to each other. I have chosen each person based upon their expertise.
I may obtain some chemistry studies and a drug screen. Those studies are done by outside labs. I have no ownership in them and I do not sell products.
Patients who have had issues with substance abuse including alcoholism must let me know well in advance.
Payment is required in full at the time of visit. I do not accept credit card payments or PPO insurance such as Blue Cross, Blue Shield, Aetna. As a courtesy, visits are electronically billed and all PPO insurers can reimburse you directly though I am not on their panel.
I accept Medicare but Medicare does not reimburse for prolonged office visits that are often required for complex histories and complex medical regimens that we will begin. Experience with long distance patients has shown they require extended time. Medicare does not allow for that time, thus you would be required to remain nearby as long as needed to provide you with information and medication you may require.
Some HMO’s may be willing to refer you for care but are unlikely to allow for prolonged evaluations. Your primary care provider would need to write to them on your behalf for special arrangements.
Mercy Medical Airlift is a charitable medical airlift system that may be able to offer transportation.
National Patient Travel Center provides information about all forms of charitable, long-distance medical air transportation.
American Airlines offers programs for kids with medical needs and may have miles for adults that fliers have donated.
Find and book cheap flights, hotels, vacations and rental cars with Kayak.com. Using Kayak, one of my patients was able to find expensive hotel rooms for less than $100 per night.
The first three below have fully-equipped kitchenettes and complimentary high-speed Internet. Ask if they offer discounts for Scripps Memorial Hospital and free shuttle.
Hyatt Summerfield/Sorrento Mesa, 10044 Pacific Mesa Blvd, San Diego CA, 92121, 858-597-0500. Large suites are single story, pets allowed.
The Marriott’s Residence Inn San Diego/La Jolla on Gilman Avenue, telephone 858-587-1770, 800-331-3131. Large suites are two story. Walking distance to 25 restaurants and movie theaters.
The Marriott’s Residence Inn/Sorrento Mesa, 5995 Pacific Mesa Ct, San Diego CA 92121, 858-552-9100. Large suites are single story, pets allowed.
Hyatt Regency La Jolla room rates compare to Marriott’s, restaurants just outside the lobby. Walking distance to 25 restaurants and movie theaters. Telephone 800-233-1234 or 858-552-1234.
I wish you a peaceful and happy stay and warm regards. If there is any way I can be of help, please let me know.
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