Question: Are there medications or health issues that would cause a drug screen to show up neg? I take Oxycodone 30mg's 4x's daily, and Methadone 2x's daily. I had a full hip replacement 10 months ago and still have allot of pain, and my other hip needs replacement as well due to a subcondrol cyst. I use to take 9 Roxicodones a day and Fent Duresgic path 100mcmg's x48 hours which I chose to get off of 6 months ago. I go to see a reg doc for pain meds. I have OA.severe RA, Lupus, EPV, Fibromyalgia. I had an uptake 3 years ago for Hyperthyroidism, and am extremely Hypo, also Graves.. I take several meds a day and drink allot of water because of Polycethemia Vera. I had a routine drug screen and it's not showing enough Roxi's in my system and she is going to drop me as a patient. I do not know what to do? I do not abuse, I take my meds as told. I do not understand why it doesn't show up? I even took 1 before the screen. I am a 56 year old female, I do not drink alcohol. Last visit she was concerned she would have to drop me due to the fact my pain level is too high, but I have no hips left and also other medical conditions. Can Synthroid, Hypothyroidis, TSH levels at 12.6, can't get level. I have extreme pain all the time and choose to go off Fent and down on pain meds which is why I nolonger go to a Pain Management Specialist. I read that certain meds and conditions can cause the body not to store certain meds for long, yet I am hypo and would think it would stay in my system. I was told today there is not enough of the roxicodone in my system, and after taking 9 a day for years and now 4 a day the past 7 months, this doesn't give me much relief. Please advise, I am at my wits end with pain and this new doctor. I can't have the other hip replaced until my right hip is healed enough to walk. Add 5 herniated disks in my back, the bone on bone pain, my thyroid out of whack, and the daily pain is just getting too much for me to bear with no relief or end in sight. If she drops me what should I do? Is it possible for my system even though I am hypo to metabolize the roxi's that quickly? She is treating me like a criminal, like I am lying. I worked hard and had great success for 40 years. I was able to retire on disability and feel blessed that I am ok financially, but I don't like the way she treats me. My internist got in trouble for writing pain meds for those with no documentation and she took over his patients, which is fine. Could the lab be wrong? please advise. Thank you, XXXX

Thank you for your reply Dr. XXXXXXX fyi, this is long. Please read when you have time, this is just my history. I don't want to take you away from family. I was a sales rep, so talking allot made me allot of commissions. I am seeing my surgeon on Friday my left hip in the groin area is starting to hurt like the right hip when I developed the subcondrol cyst. For years I complained of lower back pain after walking or standing long hours, and went to a pain management specialist who put me on the fent patch and oxycotin and many trigger point injections. When the Oxycotin scare came out i threw them down the toilet and ask for something else, my internist had prescribed it as the miracle drug, but living in this area of VA, word traveled very fast how it was killing people. The pain management doc I was seeing was over an hour drive away , took me all day to just go there and back, and my internist said he could write them, so that's what i did since he is close, and the pms is the one who put me on the patch and roxicodone. I left there in 2006. No one ever checked my hips. I thought it was menopause when I found I had Graves and 7 tumors on my thyroid. One day in XXXXXXX of 09, I had stomach pains. My boss said I shouldn't be sweating it was 30 degree's outside and insisted I go to the ER. I knew it was my gallbladder it sometimes bothers me, no stones but to allow me back to work I had to go. The ER did a Cat Scan, I was in tachycardia 157, and body temp of 103, but no feeling of a fever. The Cat Scan showed a left adrenal tumor 3.4cm x 1.6cm x2.4 cm. I have had a Cat Scan yearly for it, it's never changed in size. I have had the 24 hour urine, and it's fine, so we leave it alone. The ER Doc ran a thyroid panel and told me to see an Endocrinologist which I did, found I had 7 small tumors on my thyroid and Graves I had 15 needle biopsies without any pain meds or anesthesia. I didn't want to wait. I have a high pain threshold I am told. I was always thin, hyper, I gaffed telephone poles for Verizon and Comcast for 22 years, carrying 40lbs of tools, dropping and locking my hips over and over again, That helped destroy my hips, and then an outside business sales rep for 17 years, wearing high heels walking blocks, climbing stairs and going door to door. I was very very successful, in a very stressful job selling business services, and I was the top national sales rep, I did it for my kids, but again, always in great physical shape, and very active. I hate alcohol, hate the taste, never did illegal drugs, but I smoke and drink caffeine. I had 1 cold nodule and the Endocrinologist never gave me another choice, just said I needed a 131 uptake. Had I known what would happen to me, that it would cause that snowball effect and trigger the auto immune disorders, if i had known I could have had surgery to have a small part of my thyroid removed, i would have done that. Afterwards he told me since I was 50 and no more children that the uptake was easier, it ruined my life and health. i would have rather stayed hyperthyroid. Since that time I have had a mild heart attack, chf twice, 3 thyroid storms, and still show having Graves? how?? and my TSH levels have always been wacky, the lowed i have gotten to is 9, I am over 12 now, and can not get relief, but as a single mom, mortgage, college I pushed myself to continue and always feeling ill. The xrays on my back show the herniated disks and spinal stenosis, bone spurs, and Anglosing spondylitis (sure I spelled it wrong) I am grateful I don't have neck pain or headaches. XXXXXXX Chiari seems to run in my family. My older sister has it, and both of my older sisters have a right frontal lobe tumor, benign. I have neither. My sister in Florida gets better care then i do. I just woke up one day in April 2012 and had severe groin pain. Within 24 hours I couldn't walk. I thought it was a hernia. I went to ER, and the report said severe OA both hips, subcondrol cyst and torn labrum in my right hip, my left did not bother me. I interviewed 5 doctors and it got to the point I couldn't take it, the pain, i could feel the bone on bone, and wanted surgery would do and it did not freak me out. i was at my wits end on pain and said just do it. $50,000, i paid $2000.This was XXXXXXX of 2013, I had the surgery Feb 28th 2013. I've had the same OBGYN for almost 40 years, and he gave me a doctors name. He said if he had to get hip replacement, that this is the surgeon he would use. He called him, and was able to get me seen right away. I went out of area for surgery, and he is a terrific doctor and he did a traditional metal on metal full hip replacement.. He said due to my age and condition, this should hold at least 20 years, so if I make it to then I will fell blessed, but if I can't get this pain controlled and have a quality of life/ I won't make it, but i am fighting hard not to get depressed or give up. And if I end up in a wheelchair, i am ok with that i have come to be a peace with it. I may never have to get it redone if it heals, we don't know yet. if I had been younger and in better condition he would have done ceramic. No one in my immediate family has lived past 68, maybe i can break that record, but i still have groin pain and difficulty walking without assistance, but i know it can take up to 2 years, it's uncemented. But, the pain is still less then before surgery which is why if the right never gets better then this? I can live with it, the pain. I found out XXXXXXX 2012 about the RA and other auto immune disorders. in 43 years of working the only sick time i took off was when I had two children, never took off work. If you see me on LinkedIn.com, you can see the awards, the success I achieved, and I look younger then my age. Unfortunately, Comcast held my job as long as they could over a year, but I can not balance, fall, and pain, so I get full LTD and will get XXXXXXX disability, no choice. But I just heard from HR that if I do recover they want me back as a sales consultant, so I keep hoping this is just a break for a couple years. The surgeon and Rheumatoid doctor also said if i ever want to get better I have to rest, so i took this option to get healthy. After surgery, and my surgeon said for what I had done that 9 30mgs a day, and the 2 100 Fent patches every 48 hours was not absurd due to my other spinal conditions (womens lib, had I known gaffing phone poles carrying 40lbs of weight on my hips for years would do this? women are NOT made to do this kind of work, I am paying for it now) But...even with 2 100mcmg's of Fent for 7 years in my system? a drug screen showed very little, so the same thing happened with the patch on, not showing built up, only methadone seems to show staying in my system. Methadone does nothing, I just know that I would have some type of withdrawals if I didn't take it, again by choice, and it's a small amount. When pain hits bad, I take 1mg of Xanax to take the stress of pain off. I do not have panic disorder. The surgeon one of the best in the DC area said from looks of the Xrays that it took 10 to 15 years for my hips to get this bad, and always shows as low back pain and is what caused the disks to herniate it's always been my hips he said and that I would have to get the left done as well. I am assuming using the left more this past 10 months has caused it to start to hurt. I have every faith that the pain is not due to his skill, and with recalls, i am just waiting to hear if mine is one of them, I would never blame him. In May, I decided I wanted to wean down on pain meds and went back to the pain management specialist i had seen years before. He was kind to take me back and did so because my records showed no abuse, he explained how the rules and laws have changed, and agreed to wean me down to a manageable amount. But, dummy me, 2 months later, my internist once again said he would treat me and save me from seeing 2 doctors so far from my house. My internist is 10 minutes away. So I wrote the pain management specialist a letter, thanked him, and never picked up the last scripts. Which I could have and then wrote the letter, but I would never do this to a doctor, I had an appointment the next day with the internist, so I have never had two scripts from 2 different doctors at the same time they are spaced exactly to the refill due date. I've only have 1 doctor write me any meds. even non pain meds. But,over the past several months, the DEA came into XXXXXXX XXXXXXX County and 50 doctors lost their licenses, turned them over, or were fined for over writing pain meds for people who have no documentation. One doctor was taking cash only and busted, bringing in over $400,000 a week, a hundred patients a day, they lined up, walked in and out, i can not believe this happened, what are doctors doing? is it just for the money? I have tons of documentation. I get a copy of every visit,have my xrays and reports all the way to 2009. I paid allot of money to get these, it's a very large folder. I can not go back to see that pain management specialist, he thought my internist was a quack, said if I left again, he couldn't take me back, he told me after the letter. I feel like I was duped by my internist. I don't blame the specialist at all. Instead of an all day, painful affair, i figured an hour and home I could handle. I will never make this mistake again. This lady, she is not a doctor but can write pain meds? joined my internist practice, and changed the name, instead of fighting the charges, he surrendered his license. A patient he was writing for apparently had an accident and they found allot of meds in her system. She said it was the internist fault he never had an MRI or Cat Scan done,and got her addicted, so she plea bargained. I have learned to look at the medical websites about a Dr and his history, getting informed so I don't mess up again. The FBI came in and checked all records, The FBI and DEA cleared mine due to years of MRI"s and the surgeons tests and reports. I've never been worried because I have never doctor shopped, always the same pharmacy and never lied. But this new lady, she first says my pain level is too high and she is afraid if audited that I am suppose to be at a 2 or 3, I am at a 5 or 6 with meds I am on currently at all times. I don't complain, I can manage with the dose I am on and not asking for more, so why is she worried? and then the urine screen said I don't have enough of the Roxicodone built up in my system. i took one that morning, and 3 the day before. Yet the bottle says take as needed? so if I hadn't needed it for a couple of days and took a drug screen, why would it matter? I don't get it. I have a low hanging bladder and urinate every 30 minutes, and have come to drink tons of water to avoid having to have phlebotomies and/or blood thinners. Plus with no inner thermastate to regulate body temp, I stay hydrated so my hair doesn't fall out and my skin doesn't flake. The Lupus on my back is the worst the doctor has ever seen. I could send you a picture, and you would probably freak. I look like someone beat me from top to bottom, it's black/brown/red and blue, it's horribly ugly, but at least not on my face. I've seen what Graves does to the face, that would be awful. FYI, this same lab showed on a drug screen I had 5 months ago a drug I've never taken or heard of,, and not a pain med, a med a man uses for mens cancer? there have been complaints that this lab makes mistakes, when that happened I insisted on another test with another lab and it came back fine. So now my internist said she may drop me anyway. She has not told me, my internist called and warned me that I may want to find another pain doc. I have an appointment with her on the 20th. Can she drop me that day without refilling my pain meds first? or leave me high and dry, is this legal? I am hoping having less then 3 weeks to find a doctor. Even taking 9 Roxicodone a day a year ago it never showed up as having allot in my system, it's always been that way, but my internist has known me for 20 years, I do not abuse, do not like a buzz, which is why I do not drink.Even the pain specialist, a Wash Top Doctor said mine never showed up retaining allot but not unusual with being hypo and wasn't concerned, he said everyone is different, but my internist is worried telling me she was mad. Now seriously if I wasn't taking them as suppose to, would I have taken a test that day? I had the option of then or next month, so makes no sense I am floored at this practice. I want to be around for my children and one day grandchildren. My former husband is a police detective, former DEA and he said that this nurse writing the scripts needs to know that not everyone metabolizes the same way. My brother in law is a retired 6th Circuit Court Judge, and a former State Attorney and running for state Gov next term, said ridiculous and my nephew is a State Prosecutors office, who handles these types of cases said as long as some of the prescribed meds are in my system it should be fine, it's if I had too much built up that they should worry and my son just turned down a field agent offer with the FBI, wants to be a Federal XXXXXXX So the very last thing I would do is abuse the system with all eyes on my sister and brother in law, you know how the media is, and you will see my name on the news next term, I am already being investigated because they have to do a background on everyone, mine is fine so far, I have a clean background. But this lady, she talks down to me, tries to degrade me, and treats me like a common criminal. I do not want more meds, and I will not subject myself to her anymore, I want to find another doctor. I think she is going to get in trouble because she seems to pick and choose her patients. I can handle a level of 5 or 6, if it gets worse, i will have no choice but to have a revision, and my left done, but sawing the bone off, the pain was more then I expected. I don't want to do it just yet, the pain is too fresh in my mind and months of physical therapy again? that would be 3 years straight with just the hips, I need at least a years break from it. I just want a good doc that will treat me, and also help me with my auto immune issues. I saw Dr Verige, he was former Pres Bush Sr's doc when he was in the White House. He treated Pres Bush for a thyroid storm. He told me that it's the most misunderstood, miss diagnosed, under diagnosed and debilitating disease there is. That's worse then hip pain, it causes all over swelling and pain. Both the Endocrinologist and Rheumatoid Dr said the same thing, my auto immune disorders also cause pain especially my RA level of 69 high, but he doesn't feel comfortable putting me on RA meds due to the risk and complicating other health issues until things get under control and in remission, that they are XXXXXXX and can cause heart attacks and even death. He feels at this time, my body is not healthy enough to take RA meds and since it's not bothering me in the upper spine and neck, just the knees and ankles, that he wants to wait until my hip pain is under control. Just too many things at once. I also had a pulmonary embolism years ago and thyroid cancer. I have developed that disorder of the tailbone, constant pain sitting on a hard surface and scoliosis at the tail end, this is recent, but I cannot believe it hurts so bad to sit on my rear end? I would like to know how was all this missed for so many years with all the tests, all the xrays, MRI's, Cat Scans, biopsies when you look back at them it clearly shows the destruction of my hips? The surgeon was amazed, but said that doctors look at the are of complaint, and if it's the lower back, they are not looking at the hips. He said it's deferred pain,and once it hits the groin, it's too late for resurfacing or synovial replacement and he thinks my internist is a quack too,that it should not have been missed and this could have been avoided. Especially since I complained to the same doctor all these years. I am just angry right now. I am not a XXXXXXX person, not going to blame a doctor, what's done is done, I just want some kind of a life. I struggle not to get depressed. I am 56 but my boys are only just 23 and 24, not involved with their dad and no other relatives, no grand parents. They live with me, take care of me and the house, do the shopping, cooking, cleaning, help me dress, dry my hair, tie my shoes. I have been out of my house in 15 months only for doctors and tests and have no life at all, and no parent wants their children to care for them, we want them to move on and be on their own. They will not leave me, they even pay the mortgage, I am so blessed having good children in this day and age. So I fight depression, I fight for them, I fight, I want a life. The surgeon said and the RA doc said that some people have to stay on pain meds forever to have a quality of life and I have none. My surgeon said since the patch worked the best for me it wouldn't kill me to stay on it since it's transdermal and I am not addicted, but chemically dependent and it's not a sin, he said I am not an addict, but my body is depended on the pain meds for relief, again not a sin, but this nurse makes me out to be a bad person, The surgeon said that it's no different then people with bone cancer, I will always have pain. My mistake was listening to my internist to come back to him again, and I now know it was all about money. He must have been doing allot of bad scripts to have to give up his license, so folks that need medications are now suffering due to doctors like him. I would have no problem being checked weekly. But she doesn't like me, I have heard her in another room giving more meds to someone with back pain,no surgeries or documentation,but they cry and whine. My mother was German and she taught me to never let anyone see your pain or if you are having a bad day at work or home life, to keep it to myself. I tell her, but i am not going to walk in and carry on and cry. My father lived during the depression, shot times during the wars, and also said never let it show, so am I suppose to go in and be a whinny woman looking for sympathy?, I don't do that. I'm sorry this is so long, I am just happy to have someone to listen.to talk to. I do not talk to my friends or children much about my pain. I don't want sympathy or burden them, and no one wants to hear it over and over again. I do not mind if I have to drive to Fairfax, or another county since I found out that I should only see a doctor every month. My internist was having me come in every 10 days and charging my insurance for 3 or 4 visits a month. I thought I had to do this, the pain management doctor said it's just once a month, so I've been taken to the cleaners I guess, and when he lost his license I should have switched then since they only take cash, no insurance and $100 a visit. But again, close, easy drive to and from, easy with my walker. My son wants me away from those doctors and said he will arrange his schedule to take off the days I need to go and take me. He is 6'6 and can lift me if I fall. My co pay is $10 so why would I want to pay $100? My home address is as follows: XXXX XXXX XXXX home:XXXX cell: XXXX YYYY@YYYY i will be eternally grateful if you can help me find a doctor that can help me. My surgeon can not write me pain meds unless I had surgery, which he did for 4 months after surgery, the same amount I was on before surgery. He is concerned I get a new doctor. I talked with him on Monday when I found out. He said waste no time, it will take a week or more and if he needs to write a letter he will. i am seeing him Friday for xrays and to check my right hip, and left him. he wouldn't do a double last year because he feared with my other health issues it may be too much on me. What should have been a 2 hour recovery took 11 hours. I had a spinal, but he told me I woke up during surgery so they had to give me a general as well. I have no memory of waking up. It spooked him, he said I am someone they run across sometimes, hard to knock out. When I had a Colonoscopy 10 years ago, the doc said I was the first patient wide awake and was going to give me more anesthesia to put me to sleep. I ask if I could watch the screen it doesn't bother me. I find it fascinating and should have been a doctor. i am looking at getting a scooter. if I have to, i don't look my age, not overweight. and luckily live in a large one level home. i am surprised she gave me a hard time about my cholesterol, that it's so high, thinks i don't take my crestor.. Hypothyroidism contributes to that as well, so I feel she isn't educated enough about my other issues to determine this or how my body metabolizes food, or drugs. My kidneys and liver functions are perfect and i take allot of over the counter pain meds daily. i also read that generic Syntroid and Vit D, the 50,000 units I take water soluble can contribute to how much of a short acting pain med or any other med will stay in my system. Thank you again for your trouble, this site is helping me. If you have access to my previous post when i fell and was knocked out, knowing i had a concussion and nothing was broken I was happy I took her advice. My internist wanted me to go to the ER, $150 co pay and then come in and see him the next day, another $100, that would have been $250 in 24 hours for something that just caused a mishap and bruises. i was fine. Have a good evening, and Happy New Year to you and yours. Sorry again bother you, and Sorry about this Obamacare, it's going to be the ruin of the medical field ( I sold Comcast Business Class Services, high speed internet, fiber, phone to doctors, practices, hospitals, and was educated in EMR and EHR) so I know what this is doing to doctors in private practice as well. Maybe we will get lucky and Congress will over turn it, I pray, and now he wants a bail out for insurance companies? and doesn't care what doctors have to pay for malpractice and overhead. Things have sure changed the past 30 years. Best XXXX

Thank you so much Dr. XXXXXXX Sorry it was long. You do not need to reply to this, I am going to close out the discussion and do the review, you are awesome. I had a flu shot 6 weeks ago and woke up sick, have 104.1 temp almost all day, feels like pneumonia which I've had before. I have antibiotics. I text doctor, no reply, couldn't have gotten in anyway, had to cancel x rays, we got 3 inches of wet snow and ice last night and everything was closed down all day. Best XXXX