Patient: L.H.

I have been a patient of Dr. William R. Work since September of 2002. An established patient recommended him very highly to me.

I suffer from transformed migraine as well as fibromyalgia and have a deteriorated hip socket. All of which are quite painful. I have been in treatment for migraines since 1996 and have been through several doctors as well as the best Kaiser Permanente has to offer.

I was treated with Imitrex in pill form, which never worked for me, and then I was put on the injections, which worked for a year and then actually started making the migraines worse. I have an extensive list of medications that have been tried on me and failed. I am so sensitive to smells, lights, stress, and heat that by the year 2000 I became totally disabled. My medical records and history were extensive and sufficient enough that I easily qualified for Social Security Disability based on my migraines alone.

Before I was forced to quit working I was in the ER sometimes 4 times a week for severe migraine. I have a migraine every single day of my life.

From 1999 to 2002 I was treated with Stadol nasal spray, weekly injections of Demerol (usually in the ER) as well as clonidine. I felt like my life was out of control and that there was no hope for me. One neurologist actually told me that he was sorry but there was no treatment he could give me that would work. There was nothing he could do for me. I was being told I was an addict; I was treated with rudeness and lack of compassion in the ER. All in all I realized that no one was WILLING to find a way to help me have some semblance of a normal life.

When I first went to Dr. Work I told him that I was taking Stadol NS and Demerol injections were needed and still there was no sense of controlling my pain and I was barely able to function. I was unable to participate in my family at all.

Since I only have Medicare with no prescription coverage Dr. Work started me on Methadone 60 mg twice a day, with Soma 350 mg 3x's a day. Neither my family nor I could believe the change. I still had daily pain but the new medication offered me greater relief and the ability to participate in life. Even with the limitations my condition place on me the new medications allowed me for the first time to feel like a vital part of my family not just a dead weight.

When I qualified for the Patient Assistance Program at Purdue Pharma, Dr. Work changed my medication to OxyContin, 120 mg 2x's daily, Soma, 350 mg 3x's daily, clonidine 0.2 mg 2x's daily. I also have OxyFast 3 ml every 4 hours as needed for breakthrough pain as well as Demerol 150 mg IM when all else fails. With this regime I am finally able to go out for lunch with a friend, cook dinner for my family, and attend family reunions. I feel human.

Where I once was bedridden everyday I now have about 4 days of each week where I can function as a normal person. I must still avoid my triggers of which smells (perfumes & food) as well as flickering lights (I can detect the flicker in fluorescent lighting as if it were a strobe light) are still a very real challenge to me.

The side effects of the medications do not really affect me except the constipation, but I follow Dr. Work's plan to take care of that problem. I do get the OxyContin sweats real bad but the increase in the clonidine has helped.

I am still unemployable but I can participate in my family more than I ever thought possible.

I am not an addict. I know I am dependent on the opiate medication but have no problems with taking my medication exactly as it is prescribed.

I realize that there has been a lot of news coverage of the people abusing medications like Vicodin. These cases have made it extremely hard for those of us with chronic debilitating pain to get adequate treatment. We are treated like addicts. It is a humiliating experience.

Sincerely,

L.H.

Patient: C.M.

I am a 40-year-old male. When I was 20, I was in an automobile accident (in 1983). My injuries were very extensive and never quite healed entirely. I had my right ankle and left foot broken, my jaw was broken in 2 places; I injured my spine and had numerous other injuries. I worked hard in physical therapy and surgery was performed more than 7 times on my right ankle and my jaw. There were also a number of additional minor surgeries.

In approximately 1993, the strategy was changed to a long-term pain management strategy. Many tests were performed including nerve blocks. Low doses of Lortab (initially 5/500 QID and then increased to 7.5/500 QID) were the only thing that made any impact at all on the pain. I also needed either Valium or Soma off and on throughout the years as my spine continued to be hurt by my poor posture (my right ankle never regained full function).

There were several episodes of terrible pain, which left me bedridden several times throughout 2002. I again attempted to see pain management specialists but most did not seem to know what to do. I did explain the many times in the past I was able to function on pain medicines and non weight-bearing exercise. I worked very hard. The pain was very intense. My doctor at that time was hesitant to increase my medicine doses.

Over the winter of December 2002 and January 2003, the pain got even worse. I was put on the fentanyl patch combined with OxyContin, but the physician at the time did not know how to correctly calculate the doses for breakthrough pain medicines. Over that period, I gained approximately 30 pounds for the first time in my life. I have had never weighed more that 180 prior to that.

When I went to see Dr. Work, he prescribed OxyFast for breakthrough pain and titrated my baseline pain medicine (calculating the correct does to OxyContin only from the mixture of the patch and OxyContin). I went in every 2 weeks until my dose was effective enough for me to walk again. My pain levels went down dramatically. I was able to exercise again initially on an exercise bike, and eventually I was able to ride a bike many times when my pain was not flaring as badly. There was still some difficulty caused by my insurance limiting the quantity of tablets that meant I was limited to 480 mg per day of OxyContin and 80 mg doses of breakthrough pain medicine. Still, after I worked through some pain I was able to control it enough to do enough physical therapy to get much function back.

During the early phases of my pain evaluations, Dr. Work decided that I might have a problem with my testosterone levels. The test indicated that he was absolutely correct and I was shocked to find out that my test indicated that my testicles were not producing any! The only testosterone was likely produced in another gland (that I do not recall) [adrenals].

Dr. Work got me on a cream based Hormone Replacement Therapy (HRT) program using testosterone and progesterone to increase my levels to the normal range. I believe this has been also an important part of my recovery.

Unfortunately as my health was getting better, I lost my insurance. I switched to methadone 80 mg TID and 3 tablets of Norco 10/325 QID PRN. The methadone has worked excellent, but the Norco is not nearly as effective as the OxyFast and I will be applying for the Purdue Patient Assistance Program.

Still, the regimen has been amazingly helpful. My mother has told me she can see that I am "coming back to life". I feel a lot more hopeful even though there are some days when the pain is still too bad to function; this is so much rarer now. It scares me to think what would have happened to me is I had not been treated by Dr. Work. Not only has the improvement been profound, but also it was clear to me at the time I first went in that it would keep getting worse if something was not done. There were all sorts of radical surgeries I was trying to find information on and I was also trying to figure out how to pay for a wheel chair.

As things are going now, I have a good chance at returning to work in another few months (or years at the most). I sleep normal most nights, for the first time since my accident! Things were looking very grim, but now I know that my pain can be managed and I can return to a normal life. I am also convinced that if I had met Dr. Work perhaps a year earlier, I never would have become disabled (unable to work)!

C.M.
Rocklin, California

Patient: J.L.C.

Dr. Work,

This letter is to tell you a little about me and where I was and where I am now. I'll try to keep it short. Since I became hurt and after my first surgery then developing my blood clots I went down hill fast. I ended up being in a position where I was unable to move my body. I was seeing doctors who didn't care. They were giving me codeine, Darvocet and anything they could give me to shut me up. No one listened that I couldn't walk anymore. I was in such pain I was crying all the time. No one understood the pain I was describing. This went on for 1 and 1/2 years. I was begging for help from anyone. I just kept getting passed around. I was ready to end my life. [emphasis mine] I became a burden on my family and I could not deal with that. My life that I had was taken from me because of the accident. No one cared, in my opinion. My wife had to hold me up and literally I had to hold on to her while she dragged me around to my medical appointments. I was finally diagnosed with RSD [CRPS, Type II] by Dr. S.S. Then I went to Dr. R.S. From there I was sent to you, Dr. Work.

From the day I had my first appointment with you and explained everything to you, you gave me hope. And slowly you have brought me back to some type of life now. I am not ashamed to be in public anymore. I have help with my pain. I really believed that I would have that intensity of pain all my life. I still have pain, don't misunderstand me. But I'm not at a 10+ anymore. I hover around a 6 on my scale of 1 through 10. With the breakthrough medicine (Actiq) and the Duragesic.

To summarize: I was ready to give up, no one was helping, and no one would. With your treatments and care, I realized that I can still feel like I am human. If I hadn't ended up in your care, I can honestly say I would not be here today to write this to you, because most assuredly I would have given up by now.

Thank You,
J.L.C.

Diagnoses: CRPS, Type II of the left lower leg, HTN, DM Type II, Dysmetabolic Syndrome, male hypogonadism (severe), ED, Restless Legs Syndrome, and depression.

Patient: Elaine L., Esq.
California

October 1, 2003

To whom it may concern:

I am writing to tell you about the terrible emotional, psychological, and financial costs of my lifelong struggle with lower lumbar back pain, and the extent to which 400 mgs a day of OxyContin and breakthrough Oxydose have improved my life condition.

I am an otherwise-healthy 38-year-old attorney, employed during the mid-1990s and again since 2000 by government agencies. I came to this job with one disk bulge in my lower spine, arthritis, and the beginnings of "facet hypertrophy"--growths in and around my facet joints. What had begun as scoliosis at age 13 had matured into a painful spinal condition, exacerbated by years of sitting down as a classical musician and years of college and graduate school. Many days were lost, as I lay bedridden and unmedicated, waiting for one of my "back pain spells" to pass. Sometimes I medicated them with alcohol, and sometimes I just suffered.

When I had the good fortune to meet William R. Work, M.D., late in 2001, doctors had been diagnosing and misdiagnosing my pain for over 20 years. Some suggested surgery, which terrified me; many had no answer for me at all. I was told I could expect my degenerative disk disease to worsen, and given conflicting advice: exercise to stay in shape, immobilize to avoid further damage.

My answer was to stay as physically fit as possible. I had a sympathetic doctor prescribing 120 Vicodin ES a month for me. That barely touched the pain. He was located in a different state where I had worked for the federal government, and though I had moved on I clung to him as my only hope. Occasionally a HMO GP, seeing that I limped badly when I walked, would grudgingly give me arthritis meds, physical therapy, and a cane to walk with. Many doctors tested and poked and prodded but none had any answers but surgery and injections.

The event that brought me to Dr. William R. Work was a delay in my monthly shipment of meds during the summer of 2001. Suddenly without Vicodin, I found myself unable to sit in my chair at work long enough to do 8 hours of work. I had long been a silent reader of articles on pain management websites. I had previously been opposed to "graduating" to what I viewed as "serious narcotics": derivatives of Percodan or worse! However, it was clear that I stood to lose my job and everything I had worked for if I did not seek stronger medication. My pain, I believed, could even lead to being crippled or dying an early death. I could not even drive long distances, let alone work 8 hours a day in a chair!

I am a teetotaler and consider myself a sober person. I quit drinking alcohol many years ago, even socially, as I saw in the criminal justice system the damage it does to people. I found in myself that it was a bad habit for my health and my temperament. This attitude of mind created an even stronger bias in me against pain medications. My Vicodin was the exception; I allowed myself to view it as extra-strength "aspirin" for my back.

I was beaten into a state of reasonableness by my pain. Shortly after seeing Dr. Work for the first time and having my fears about OxyContin put to rest somewhat, I started adding Oxy to my Vicodin regimen. Slowly I titrated up to about 320 mgs a day. My boyfriend at the time commented on the lift in my mood and the improvement in my emotional and physical state. At the office, the volume of my work increased. I started doing more: dancing, jogging, even traveling to Europe to study dance. My whole life was enriched.

In January of 2002 my condition worsened suddenly. I was at work talking to my paralegal, standing in her office, when I "folded up" like a cheap patio chair. My legs had gone out from under me and I was shot through with radiating pain from my lower back! Two co-workers had to help me into my car, an old automatic Oldsmobile, and I carefully drove home and got into bed. For the next 21 days I could not get up. As soon as I could be moved, my boyfriend drove me 3 hours to Dr. Work in extreme agony. He immediately ordered my dose increase drastically, and he battled on my behalf with my insurance company to justify the change in my medications.

That was when I truly graduated from large amounts of hydrocodone and small amounts of Oxy to the 800 mgs of OxyContin per day required to render me functional again. At first, I admit, the drugs had the terrible side effect of nausea. However, once that passed I returned to work, once again a productive member of society. I could not believe how well they worked! This medication that I had feared and fought off saved me from being handicapped!

I am a litigator and my job requires sharp mental focus and concentration, persuasive writing and speech, and active listening. I have never found that my use of OxyContin has in any way impaired those functions. Indeed, the worse distraction I have ever had to cope with was pain.

Since 2002 I have tapered to my current dose of 400 mgs of Oxy and roughly 400 mg of liquid Oxydose per day. I am currently dieting to take pressure off of my disks: Dr. Work is also supervising my weight loss. He really does treat the whole patient!
As the damage has traveled up my spine, I now have bulges, spurs, and nerve problems from S1 up to L3. Without the OxyContin, there is no way I could sit in this chair, draft pleadings, and argue cases. The taxpayers would lose an efficient prosecutor, and I would lose my professional and personal life and become an invalid.

Without medication, I could not play with my nieces and nephews; I could not practice tai chi; and I could not practice law. Dr. Work has saved my life, qualitatively, and I am so very thankful to have met him.

My personal attorney and best friend, Kelly C., Esq., comments about my condition in January, 2002: "When I saw you lying there in your sickbed, screaming at the slightest movement in your body, I never thought I would see you walk again. I have seen you dance since then. I have seen you win trials, jog, and work long hours. Without your pain doctor, I have no idea how you would have survived."

I think Kelly said it best. My current regimen of 400 mg of OxyContin and 400 to 600 of Oxydose is my "lifeline." Because of it, I do not need a handicapped placard; I do not need charity; and I am a taxpaying, self-supporting member of my community, active in my church, work, and family.

Thank you for your attention.

Elaine L, Esq.

Patient: D.M.

My chronic pain began in after suffering through 3 back operations, which were suggested as a "last options" after every type of physical therapy known, every anti inflammatory produced, and approximately 15 trials of epidurals, trigger point injections, acupuncture and all suggested therapies from surgeons, "pain specialists" and my family practice doctor. I was mostly on muscle relaxants and 800mg of Ibuprofen 4 times a day, anti-depressants, with some Vicodin when my doctor could see I could not "go on" any longer without some type of pain medication. However, none of this helped me. I was mostly trying hold onto my job, which meant working part-time, coming home to the couch and medicating until I could withstand the pain. That meant I had to pick which hours I would take my meds and might feel a little better and suffer through the rest of the day. I was close to losing my job and going onto disability because I could not be counted on to show up for work or even stay here if I could make it in. All these medications did not help me. The muscle relaxants made me feel "drugged" and act drugged, nodding off in the middle of sentences, stumbling, falling into a nod and then "waking" to more pain. Pain was my constant companion.

I came to Dr. Work three years ago. He immediately saw the daze I was in, suggested I wean off all the other medications, the Ibuprofen (my stomach was a mess), the Elavil (300mg a day), the Neurontin, the muscle relaxants, the Vicodin, and begin on OxyContin with breakthrough meds as a backup. When I returned in two weeks, we adjusted the Oxy and breakthrough. When I returned in a month, he did not recognize me as the same patient. He actually thought I was a new patient. In addition, I was, I was a different person. As the months continued, my OxyContin had to be increased at times, we experimented with different breakthrough medications, and after about 3 months (seeing him twice a month), I was cured! I was working full time; returned to hobbies that I could not even begin to participate in for years, I returned to my family as the person they had known and loved. As an example, one day after being on Oxy and breakthrough only, for about 2 months, my husband turned to me and said, "Welcome back." I knew exactly what he meant. I was no longer feeling drugged, pained, grumpy, withdrawn, or groggy, I just felt normal!

Since starting on long acting opioids, I've earned a promotion at work; returned to my hobbies of painting; I can actually hike to the locations I wish to portray and then stand for two or three hours to paint them. I fish and camp as I used to when I was 25 years old! It seems now there are days without enough hours to do the things I LIKE to do. And I CAN do them because I'm not sitting grinding my teeth with pain (oh yes, the teeth suffered too because of the pain and ensuing bruxism)
Additionally, I have a mentally disabled brother who lives with my husband and I and I care for him 24/7. Before Dr. Work, this task fell to my husband only. Now I volunteer two days a month to drive their mental health group to "outings." Although I work on a computer all day long, (and I work 9 hours a day, 5 days a week), I come home and can sit at the computer for another hour for fun, I can read again instead of nodding off when trying to get through one page. I used to be a gourmet cook and decorated wedding cakes for side income; I do this again now. I care for my 3 pets daily with all that entails. Before, shopping was a chore, a task, and I couldn't walk around a mall if my life depended on it, now I wander through the stores and shop whenever I care to. Best of all, my granddaughter who is 9 years old and lives with us for 2 to 3 months every summer has found out I can keep up with her! I can't express here how much this means to me.
My life has changed, and although I am not pain free, and don't have expectations that I ever will be, I live a normal life, much like any other's. The only difference is that I must take medication twice a day and my breakthrough to be "normal." There is not a way to convey on paper what this means to a chronic pain patient. I am forever indebted to Dr. Work for having the courage to prescribe what he saw I needed at my evaluation. He saw what I had been through and that I was sinking, and sinking fast! I don't want to think about where my life would be if I hadn't found the doctor who truly gave it back to me.

As an aside, I talked with a surgeon about a minor procedure I was having scheduled. I talked with her for over 2 hours. At the end of our appointment, of course I informed her of my medication regimen. She was "bowled over". She could not believe I was walking/talking and coherent. However, I asked her, "If I hadn't told you, would you have ever suspected or even guessed that I am a chronic pain patient and take the amounts of medication I do?" She admitted she would not have suspected it in a million years. This is true of any I choose to let know that I am an opioid-dependant patient, which are not many! The stigma remains. But if you were to stand next to me in the bank line, or in the grocery store, or if I met you at a social gathering, you would not guess that what maintains my happiness in life is long acting opioids.

The only side effect I have had through the 3 years has been some anxiety. I suspect because of my "born with" tolerance to pain med's and the tolerance I have developed over the years, I take a higher than average amount and this is part of the territory. However, tranquilizers take care of that. Constipation is easily taken care of, for me, with over the counter products. These have been my only side effects.

I wanted to make this short but there is just no way to express all that I've been through with horrible debilitating pain day after day, year after year, and to find a doctor that believes me when I say "I'm in pain" has been a miracle. Not to be perceived as just a "drug seeker" is wonderment in itself. I hope this is helpful to you.

Thank You.
D.M.

Diagnoses over 10 years: Severe Osteoarthritis, Degenerative Disk Disease (9 herniations confirmed by MRI and other tests), Degenerative Joint Disease, Failed Back Surgery X 3.


RE: D.M. (This is the previous patient's husband)

Prior to coming to you she had seen several doctors and surgeons. After she refused any more surgery, each one would start her on the same routine (physical therapy, pool therapy, therapeutic massage, trigger point, epidurals, etc., etc.) no matter how hard D. tried to explain her history and the fact that none of these worked they insisted these were the cure. One "pain specialist" told her that in six months he could take anyone off pain medication and they would only be taking Ibuprofen, and she still wanted pain medication, she should seek counseling to deal with her pain. I can't tell you how miserable she was and how poor her quality of life. She was taking anti-depressants, pain pills, muscle relaxants and anti-inflammatories. She would come home from work, take her medication then fall into a stupor and fall asleep. She couldn't take medication at work because she wouldn't be able to function, so consequently by the time she was able to take medication she was in severe pain. Our sex life and social life was nearly non-existent. She spent weekends lying on the couch for years.

A month after her seeing you and being put on OxyContin and you taking her off the other medications, she returned to the person that I thought that I had lost and almost forgotten. She is mostly pain free or at least close to. She is alert, active and a joy to be around. You would never know she was taking medication. Our life is normal again and maybe even better than before.

Thank you again from the bottom of my heart.

Sincerely,
R.M.


Patient: D.M. (This is the previous patient's work supervisor)

Dr. Work:

Regarding D.M.:

I have been D's Supervisor and a close friend for the past 12 years. I have seen her go through the surgeries, physical therapy, different medications, etc. over the years. From 1995 to 1999, she missed great periods of time at work, months at times after some surgeries. She was not improving from any of these "treatments" and was steadily going downhill.

I know she was questioning whether she should seek permanent disability at one point. Obviously, her work suffered and her pain was evident. She was not what anyone would call "active."

Since becoming your patient and starting her present medications she has changed back to the friend and employee she used to be. I can and do depend on her for her help here and she does not miss much work due to "pain days," if anything, maybe too many vacation days! But I know these are days she truly enjoys and she is not using her time off spent on the couch suffering. She is active and alert, and no one here at our department would ever guess she is taking the medications she has told me she is, and we both work in the midst of police officers, sheriff's deputies, probation officers, etc., and I know they do not and have not ever suspected D is "medicated". She is an asset to our department. [Patient works as a paralegal in a probation department and was just promoted.]

I hope this helps explain how D has benefited from her present medication regimen.

C.J.
Legal Offices Services Supervisor
___________ County Probation Department