Closing Practice Due to Illness- Information For Doctors & Patients


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I’ve been awesomely tired at the way medicine is practiced. And with two new autoimmune illnesses, I’ve been feeling near death too much of the time the last 6 months. I am closing my practice this month due to illness. Too much fatigue and not enough enthusiasm to re-enter the monster world that practice in pain management has been increasingly limited to.

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It has been a privilege to work with so many great souls who carry such dignity with so much pain. Bright, motivated, willing to do anything to test a treatment that may work, working hard to be free from pain. Exploring a new paradigm together.  Privileged to be invited to meet the foremost glial scientists in the world and leaders in medicine, to feel at one on pharma boards with medical leaders legendary in pain management. Fun to offer the clinical experience I’ve seen. You have all been my inspiration. Medicine has been  a powerful experience, life death, taking every ounce of physical energy and interest for decades. My only interest. So much to be done discovering the way to help, awesome, unimaginably neat science. Best wishes to all! There is nothing more exciting than medicine.  Pain is the number one reason people seek medical help.

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To my current patients, you know how to contact me if you need records – just ask.  If I have not gotten you established in next months care with copy of records sent, let me know ASAP.

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To patients I have seen in recent past but not monthly, if you need records, let me catch up with you in January, I’m overwhelmed this month.Please do this:

  1. Notify me by email in subject line, SEND ME MY RECORDS IN JANUARY or by text, preferably email
  2. email this to me today and email again mid January – hopefully I’ve recovered from this busy month by then.
  3. Helps if you email both today and the, as in early January.
    I will try to notify a few others I’ve seen in last couple years. Inshallah.
    Illness, old age, death lurk. Dangerous flu season.
  4. Sadly, be aware that doctors do not know or take kindly to the simplest of these medications and may be unwilling or unable to help. Let me know by mid January if you would.

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These few instructions below are to give a start to doctors. Please accept my apologies for illness, lack of time, I’m exhausted.

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To doctors who have asked instructions on a few medications I prescribe, see below with apologies for length and lack of organization. Time consuming! 

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Never forget that tramadol (Ultram), Nucynta and buprenorphine (Suboxone) are opioids. Do not give naltrexone until off all opioids at least two full weeks.

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I never use one drug alone, not LDN, not ketamine (if indicated),  never alone because intractable pain means  they’ve failed all. After 3 months, any new pain is now centralized pain. Stop pain at all costs, safely.  I tell pts taper off all opioid before I see you. Opioids cause inflammation that increases pain.

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NEW PARADIGM

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The innate immune system in the CNS has a balance of pro- and anti-inflammatory cytokines. Opioids cause release of those inflammatory cytokines creating inflammation that increases pain. Opioids = the old paradigm. It doesn’t work for chronic pain. A few months ago, an Insurer denied a low dose opioid on exactly that ground: no publication exists that shows opioids work for chronic pain. Old paradigm. Now current government stressed teachings have returned American pain medicine back to the 1970’s, pre-opioid era.

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A better paradigm IMO is reduce the pro-inflammatory cytokines that are being overproduced and causing pain.

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Read all active links page one, that leads to innate immune system, microglia

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Read 3 posts on METFORMIN done on or about March or April 2017,

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Read long list of meds and things I check on 10/6/16.

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Use the small rectangular search function top left above small picture.

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Donate to relieve nerve pain – see link at banner to RSDSA.org. Contact James Broatch, Executive Director. This one organization has done more than any in the world, for nerve pain. Support the finest research and care and education.

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I’ve been blessed by seeing and following patients in depth, seeing the experience of frankly unbelievable results in many, some with CRPS 20 years, now pain free for 5 years after sciatic N nicked age 27, after 3 suicide attempts before seeing me. Such was daughter of 2 amazing loving brilliant MDs East coast who looked into every treatment, failed everything.

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This paradigm. It’s not just ketamine. Not one drug. All pain must be taken seriously. Always remove the opioid causing pain. Treatment will not work otherwise, so don’t waste your time, not physical therapy, nothing, stop the opioid first to see how productive the cleaner system can be.

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I must close office this month —- two autoimmune conditions got me. I feel great, but body and brain are duking it out. Hoping to die. Glee at the thought and joy and love but I surrender that also. Surrender it all. Nothing to hold back, finding no need to be nagged by the dazzling world every second of the day. Done with it all. The world holds no interest. It failed.

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I’ve done the work assigned to me trying to find a better way. I’ve left this blog until annual payment expires or I do, whichever is sooner. Heh

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Medicine will change. It’s becoming priced for the 1%, I am aghast. Sickened by costs. My body can do without that delusion. Why surrender to worship of the dying body at my age. I have no attachments. I’m feeling the air of freedom coming.

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Medicine needs a to grow citizen change and powerful interests to fund important research and clinical work using the addition of this paradigm with other new treatments and strong investment in glial research. Who knows? Surrender. It’s all in the right timing. The right moment, the right spark igniting an embalmed long-dead interest in pain relief using more than the old 1960’s methods now being taught—–well my dears, don’t take too much Xanax with your Tylenol you guys, you workers, disabled, seniors, millions of chronic pain pts, infants, surfer dudes, triathletes with joint arthritis decades too young for total knees. We don’t have solutions for many with intractable nerve pain. Not everything works for everyone or every condition.

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But one thing for sure:

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Opioids cause pain. I know people with severe chronic pain live in fear of pain of taper most of all, and I too would be terrified of coming off of opioids that I feel I have demonstrated to myself relieves pain.

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But I can’t quite explain the science to patients with such fear. I’d love Professor Linda Watkins slide- it’s so clear if you could see the graph, while morphine is temporarily giving you a few points of little relief, maybe bringing your pain down from 9 to7 for a few hours, yet at the same time the opioid is triggering far more pro inflammatory cytokines in the brain and those opioids are causing pain.

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Taper advice recently given, going very well, easy, no flares:

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In recent weeks I’m tapering a man who has been forced by nerve pain into disability for years in his 50s, with a young family. For years, he can barely sleep at night, work, travel, or let alone play with his new darling infant grandson as baby ages because there is this fearful, horrific nerve pain, day and night. It’s been impossible to treat.

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How to Taper

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No one knows what is best for everyone. One way:

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Slowly stop one pill every one to two weeks.

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My fellow is having no side effects other than a little looser stool, as he slowly tapers a vast numbers of opioid pills and sublingual films he’s used daily, strictly on prescriptions every month for seven long years.

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He plans to continue taper and I encourage go at a rate that is comfortable. Listen to the body. It’s his choice.

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His pain is the same as it was for months prior to these weeks of taper. He notices possibly a little more loose stools. No discomfort no flare of pain. Numbers of pills are down, nice slow, painless process, pain is the same. We are seeing the science demonstrated in him, taper does not always mean suffering or more pain.  He’s on the move. We’ll see how far he wishes to go on taper. We each have a choice. He’s a very special person and many in his shoes may wish to prove to themselves their pain is no worse, and maybe even better when they’re off this monster opioid demon that put so many people into living hell.

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Just go slow. He’s doing great.

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First slowly taper off the opioids, and remain off at least two weeks, and then I will begin to treat with this paradigm.

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Yes, fear of change but it’s been years of no change. Who would not be afraid to stop opioids with so much pain. Not all will trust the science. But realize that the tiny relief from dose of opioid maybe only because opioids are also relieveing anxiety not due to its analgesic effect. Feelings drive severity of pain and suffering. That’s not the analgesic effect. Opioids help anxiety, that relives pain.

This wonderful man in his 50s, I feel so bad, but years ago the practice was to test whether higher and higher doses helped. Now we know, no help. We must taper, and if patients are willing — it is their choice but stress their best interest – stop the opioid and try something else. A different paradigm.

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This blog represents 7 1/2 years of a small number of things documented, that I’ve seen and loved. Thankfully was able to squeeze an intense focus 3 to 7 days each post, teaching myself and distilling it to a reader, intense focus, loved the patient come back to life. Socks blown off. Documented a few case reports. There were so many more, demonstrating this approach works for many. Sadly it does not work for all. Nothing does. I have been the last of the line of almost every therapy for CRPS. You need large numbers to know how much the investment is worth for a disabled person with so little money, children, young, desperate to get back to life. I mostly have seen the failures, and gave me so many lessons they brought from the best centers in the world, that failed. We need a lot more research. This paradigm can give lives back. Not always. But at times 100% relief, unheard of, stable. holding despite repeat ankle sprain running on treadmill with the permanent foot drop after sciatic injury.

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IC is tough! Treat constipation and muscle relaxants for pelvic awfulness.

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Cannabis

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See grand rounds on cannabis SMHLJ yesterday—- pdf. Cannabis helps muscle spasm, nausea, depression, energy, OA pain, migraine, sleep, anorexia/munchies beware munchies and cardiovascular heart attack, arrhythmia, stroke. I dunno if it helps nerve pain – it fails to help my Polymyalgia Rheumatica but it alters brain interests so the sedentary body that can sit for 12 hours and read without moving, now spontaneously gets up, now for the first time in weeks may listen to music, may feel like taking effort to cook and do things, finds the mood is lifted, energy is almost livable.

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Most beautifully, it has awakened or deepened the focus and Increased the interest in my well studied but inadequate spiritual work.

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Jnana yoga, the Absolute.

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Of course when you are deathly ill unable even to set up for weeks at a time the last six months, the issue of consciousness, bliss and being in the moment is absolutely wonderful. Unfortunately it often takes a killer illness to slow us down. Thank the Lord!

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Closing practice this month

I need to close my practice this month and give away all of my office furniture, instruments but a few, and 43+4-year-old Medical books. All will be picked up by Habitat for Humanity. Makes me sad I will never again see my gorgeous Birch desk with a return, and inlaid wood around edges. But chairs, cabinets, useful **underline useful exam table with great storage cabinets and drawers below and comfortable 4 inch pad**

If you know any local doc who needs an old fashioned wooden exam table doubly useful for cavernous storage, please let me know because I’m not sure habitat will take the exam table. There is no space in modern, tiny but expensive exam rooms, with all those shiny toys.

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Sorry, rambling, so many details important to me through fog of exhaustion.

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Verbal transcription can make serous word changes. Scary. If so, It’s not me. I am truly ill, no energy to reread to perfection — so WARNING words may be misleading or weird or does not make sense, a word change.

So much illness, so blessed that all I could do for so many months was surrender to the spiritual journey and let go of the crazy of the world. Ramakrsna taught, “You cannot uncurl the curly tail of the pig.” Spiritual life is all I want.

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BUT! The fucking mess up in the medical world. The details the burn down energy all day because you must take care of them, all.

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It drains energy more than I can spare what with autoimmune body/brain duking it out. My goal: spiritual life. I’ve done my job. It’s all on you, readers.

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Reread my front page about training your doctor. Take action. Make change happen.

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I am retired. Sorry but do not call me. I am retired with the exception of training doctors interested in learning from my experience for 3 intensive telephonic hours. Not sure any exist. That would be a miracle, a start. Costly. Next I’d love to see teaching videoconferencing with satellite conferencing of clinical chronic pain research clinics set up to work on CRPS pain treatment with addition of this paradigm, comparing to other treatment choices that patients prefer, long term, longitudinal, CRPS study. But make it clear, data to be sorted selecting those choosing opioids vs no opioid groups. We does well on opioids? surely some types of pain?

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Why CRPS? Netherlands can answer why they invested 25 billions Euros to study CRPS. Cost of treating nerve pain is devastating to our economy, to the lives of family and patient. Nerve pain treatment breakthroughs are the toughest nut to crack in research. Read the work of Dinstinguished Prof. Linda Watkins and IL-10 injected spinally, can relieve nerve pain for 3 months in animals, and relive severely disabling OA joint pain in elderly dogs whose arthritis renders them unable to even move, now painlessly running, jumping, chasing a ball and walking stairs after joint injection.

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C’mon. Where is the $10 million to finish the human studies needed on that?

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Go forward with energy, change the way, and enjoy the work while doing it! Gosh the attacks have been brutal. Fear of doing something no one else has done. Is it legal? Training too long, no income or bare survival 20 years, trying the untried.

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Let’s get this dead field moving! It’s gotta need the likes of Bill and Linda Gates foundation. Time, money. Specialists. So much fun to give, test and learn from patients who have so many rare intractable pain syndromes during this time — they had failed everything, in London, Germany, Scandinavia, Taiwan, failed at the foremost pain centers for CRPS and other pain syndromes, and I got to see life return in the eyes and limbs after so much desperate disability and suffering. It’s been such satisfaction and joy. So sweet.

Thank you all.

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It has been such a blessing. And an endurance test, to learn as much as I could, and test the science that was published. Follow the best science. 20 to 22 hours per day for 43 years, reading all night til 5 or 7 AM, getting up after two hours sleep. Seemed so hard at the time, the body feels pain with sleep deprivation, unpaid for almost 20 years, what stupid doctor turns down other work, and with no income and support continues to get 29 years of formal education?

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Dukha. We learn from suffering, finally, to let go. Surrender. Enjoy the freedom.

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Enough. Body exhaustion. Illness determines if and when energy exists. It is out of my hands. Thank goodness. I surrender to the process. We do our very best, then surrender because there is nothing more we can do.

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Enjoy the journey.

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Love the Self.

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Fill the hearts with gratitude and love the Self. You the infinite Self, witnessing the people in their family Biblical plays and Greek dramas. Surrender and witness. You have done your job and now let go. Be.

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You are the Witness. There is always pain on the planet, always someone who has it worse. Suffering seems to be part of our body’s destiny, according to so many ancient sages I have read. They say our destiny is already mapped out before we are born. One avatar said you can modify its severity by purity, spiritual work. The only way to find freedom, bliss, is to ask, “Who am I?” Realize who that is. The Infinite Self.

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Lord Buddha called this life dukha. Google the meaning.

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Suffering is part of the lengthy meaning for which there is no simple translation. Of course we all spiritually suffer. Sages teach: we are not the mind, not the body. We are infinite. We always have been. You are conscious right now, always have been, always will be. No big deal. Ordinary. Nothing different. Just focus on “I am.” Ask yourself who is this “I AM.” Find the silence without words where everything vanishes but that consciousness, bliss. Just enjoy being. We have all had those moments, nothing else.

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The body and mind will have its own devolutions with age and disease, but you are always conscious sages say. There is no God, there is no other. You the Self are the infinite and always will be.

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Surrender, illness, energy, ego, every like and dislike

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Sadly I need to stress, I must retire due to illness, exhaustion. Surrender office work in medicine. Hopefully I can teach if there is any interest learning what took me intense reading, trialing for years.

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My patients can always obtain their records.

They ask, but I know no one who does what I do and your doctors may have fear of some weird doctor (me) doing something different!  or patient of weird doctor who was presribed nasal ketamine for pain or depression and it works on stable dose for years. FEAR. Doctor will not accept patient taking stable dose for intractable pain for years and opioids are not adequate for these extreme pains. That is sad. Not sure if refusal is politics or personal issues or fear.

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There are real consequences practicing in pain management; who knows them as policies are whispered not publicly in political corridors instead of research and treatment? Fear has been a growing undercurrent in our field.

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Two pain specialists in San Diego recently reported losing license due to opioid prescribing, not seeing patient was abusing or diverting. Arresting doctors. Why the extreme of taking away the license from someone who is crazy enough to work in this entombed system. Arresting doctors, studiously not treating addicts — unless you can afford $60,000 a month and many repeat visits, for years.

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Opioid coverage will be cut off by insurers. Feds don’t need to step in. This has been happening. Simply surrender, do what you can, surrender.

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Bring peace while they kill it, do something to change it. Costs are unimaginably exploding with insurance fees forced to massive premiums and deductibles, outpricing working patients I see as far back as 8 years ago. Medicare payment of highly technical expertise is only 10% of what PPO insurer is stuck marked up paying.

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There is destruction by sex and greed in every field. Surrender. Always has been.

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Our healthcare system is stuck treating chronic pain with 1960’s pain management. God bless the medical establishment and the profit motive that drives so much of my field. The proceduralists, who do high volume 30 epidurals in 30 minutes high volume, high income, and wowie cost of those spinal cord implants. How many hundreds of thousands, please give us research with 5 year results.

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The cost of American medicine is killing the middle class, what to speak of the disabled and poor. Surrender. It will bring joy and focus to your work taking the field to the next level. Do best, surrender results knowing you’ve done all the work. Surrender, care nothing about outcome one way or another. Don’t get dazzled by results. Perfect peace. Every moment is a test of peace.

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All other readers, please do not contact me unless you are a physician interested in me teaching for 3 hours. Scheduling would be a few months from now, if any survive the serious flu season coming up.

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For myself, for all of us, I am trying to learn: to do all due diligence, then surrender, find the joy in the moment and just “BE” even in the most tedius moments of the day. This will be hard work this month, more energy and time than I have.

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I may not have the energy to post on these pages for awhile. I’ve got a stash of publications I’m dying to talk about.

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This may be a rant. My tongue may loosen, and become more disinhibited in comments — blame it on age. On truth telling. Rage. I finally hope to have time to myself however difficult it is to struggle.

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Sages say to you are not feelings, so convert fear/anger/body/ego into surrender, wanting no outcome either way, realizing there is nothing I can do more than I already have.Breathe.  It is out of my hands. Surrender all. Surrender the ego, means having no like and no dislike for any outcome. Total complete surrender. Imagine it. Practice it. Just “BE” it. Pure consciousness. No words. Surrender. Infinite. There is no other, no ideas. Pure Consciousness, bliss.

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I look forward to my remaining hours, no doubt being irritated about “ALWAYS SOMETHING” to fix that takes hours on the phone each day. All of us have this torture. Surrender. That’s the teaching. Just “BE.” Enjoy the moment.  Kibbitz talking and making wisecracks while tech support is working with you on hold for 2 hours. Enjoy the grievance. The world will go on —- be with the love in the heart and the silence. No words.

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That’s the practice. And my practice would love more time to enjoy the silence.

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Otherwise, would gladly teach only if physicians call discussing an interest allowing time and cost 3 hours, otherwise solitude is my sweetest goal and my focus and my work.

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Joy to you all! You are that infinite. There is no other.

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The material on this site is for informational purposes only.

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It is not legal for me to provide medical advice without an examination.

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It is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider.

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Comments are welcome.

This site is not for email, not for medical questions, and not for appointments.

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For My Home Page, click here:  Welcome to my Weblog on Pain Management!

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Please IGNORE THE ADS BELOW. They are not from me.

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7 Responses to “Closing Practice Due to Illness- Information For Doctors & Patients”

  1. jackie Williams Says:

    Dear Dr. Saben. I have lived with chronic pain and I cannot tell you how much I have admired your enthusiasm and search for pain relief. You have mattered a great deal in the lives of so many. No one can ask more of this life than that in my opinion. I am terribly sorry for your illness, May you be blessed with peace and no pain. You are an awesome person. My heart is with you. Jackie Williams

    • Nancy Sajben MD Says:

      Sweet words. That is all I can hope for, to educate those who dig deeper into good solid science —- that is being ignored by pharma because opioids are worth billions, guaranteed every 30 days for decades. Not addicted, boy does it make pain worse.

      May we live in truth and peace, not fear in an overpriced pharma market paid for with taxpayer money.

      If we supported more research in pain relief, we’d save billions, get rid of so many disabilities, and the opioid choice would not be the only honcho in town we have left after flunking gabapentin etc.

      Taxpayer dollars are paying pharma’s unaffordable prices.

      Get fired up, everyone. The funnels of money need to be directed in a sane way. Congress will never do it.

  2. Nancy Sajben MD Says:

    I am embarrassed and so sorry for the many words misdirecting, diverting you from my inability to receive your kindness. Thank you so much for writing.

    It’s so nice to feel the love and confidence and life return in lives when people have been freed from the limitations of pain. Such absolute joy.

  3. Vitalitus LLC Says:

    Nancy,

    I’m so sorry to hear this. I hope you come out of this soon and stronger than ever.

    Please let me know if there is anything at all I can do.

    Regards,

    Eddy Cardentey

    On Dec 7, 2017 1:27 AM, “Pain Management Specialist in San Diego & La Jolla” wrote:

    > Nancy Sajben MD posted: “. . . I’ve been awesomely tired at the way > medicine is practiced. And with two new autoimmune illnesses, I’ve been > feeling near death too much of the time the last 6 months. I am closing my > practice this month due to illness. Too much fatigue and not enou” >

    • Nancy Sajben MD Says:

      Thank you.

      Truly, it has been a gift to see pain get better, at times resolved, when all else has failed.

      PEA has been amazing for so many with CRPS and who knows how many others with nerve pain if only they would try something other than opioids that fail.

  4. Sara Says:

    So Sorry to hear of your closing your office due to health. But taking care of oneself is very important and thank you for your great help in the work of CRPS, with intra-nasal ketamine, LDN, dextromethorphan, oxytocin, PEA, and so much more as well!
    I am happy to hear you will keep the website up for a while maybe donate the information to RSDSA?
    I am further as health allows willing to teach other new Dr’s willing to learn what you have via phone or other video etc!

    AS we all age, sadly, we must let go…but still pass or knowledge on to others willing to listen!

    Again THANK YOU for your help to all with intractable pain!


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