tempeture strip on a urinalysis test

[abbeyjustcuz2924]

I just took a urine test this morning (I have taken many in the past 5 years). I never have a problem with them as I have no reason to have a problem as I take my meds as my doc says to. Problem is I have noticed lately that in this clinic where my doc works, pain patients are starting to get treated very badly as I think many people in this group have encountered. Anyway, I took my blood and urine test this morning and now this afternoon I saw that I had a result already on my online chart. The result was for urine temperature. The result stated "could not be read, it appears that patient scratched it"!!!!! I did nothing different than I always do. How did the temp strip get scratched and is this going to lead to some sort of problem? I already called the office and the secretary told me (as I offered to come immediately and do another test right now) that I have to wait for the rest of the results as the doctor can't reorder the urinalysis as it has already been submitted. Now, if they will really test the urine, I have no worries as I know it will come back exactly as it should. All I can think of is the felt tip pen the lab tech had me write on the bottle with scratched the temp strip as that was the only thing I/she did different from any other test day. I saw on the internet today that you should only use ball point pens to write on these cups with and NOT a felt tip pen which is exactly what she gave me to write my initials on the cup. So, I guess my question is how can a temp strip be scratched as I know I did nothing different but what the tech had me do with the felt tip pen and is this going to lead to some type of problem (the rest of the results are not in yet but even though I am confident that the results will be fine as I know what I do with my medications, I can't help but feel panicked as I have noticed a significant difference on how patients on pain meds are treated in this clinic and it is not good treatment). Could this result create a problem in any way even if everything else comes back perfect.....and do they really have to still test the specimen they took? One last question, if you would, please....how are patients supposed to be given a proper test anyway? Are the cups supposed to be in a sealed bag before they give them to me? At this office, the tech simply gets a cup from their stock of them (they have no tamper resistant sticker on the cap), places it and a biohazard bag on a metal shelf in the bathroom and tells me to fill it, place it in the bag and bring it back to her (she does turn off the water and put blue dye in the toilet before she leaves the room for me to give the sample) Any help would be greatly appreciated!!

[Tuckamore]

Hello My Friend in Pain. Sorry it took me a bit to see your question.

Without going into a lot of medical jargon (you've read it) yes the metabolites are correct. I don't think you'll have an issue with these results.

We have to protect ourselves to the best of our abilities - Chronic Pain Patients have little to no "rights". We are at the mercy of our PMP. When drug screens are done or pill counts we have to do our best to assure they are done correctly.

Drug screens today are very accurate - until you factor in the human error component. Many of our PMP are not going to factor in human error - taking the action you suggested is in your best interest.

Thanks for the update. I'll be interested in hearing more.

My Best,
~Tuck

[abbeyjustcuz2924]

Dear Tuck,

I truly hope u are having a better day today. I am experiencing literal blinding pain today thanks to my left leg today. So, I may have typos too! :)

My tests all came back now. I have one question. All came back negative but my meds but i have a question. I take Morphine 100mg ER and oxycodone 30 mg for breakthrough pain. I noticed that this time the "value" test came back with greater than 3000 for the morphine (which it always comes back as), greater than 100 for the oxycodone (which it always comes back as) but this time it also came back with greater than 100 oxymorphone? I have checked my past tests and have seen that in the last year 2 other tests came back with the same result for oxymorphone but just 1 test came back with negative for oxymorphone. So this test now too has come back with the oxymorphone result along with my morphine and oxycodone. Is this ok in your opinion? I have read about it online and know that oxycodone will sometimes metabolize as oxymorphone and be picked up in urine even though it is considered a "minor metabolite". I think this is fine as other tests have come back with it while other tests dates have not. Is is just how my body is metabolizing before that particular test?

As I said, I think all is fine and I have heard nothing from the clinic. I did notice that this test took over 2 days to come back while all other tests have taken no more than 9 hours to come back as this clinic does all of its own lab work as they have a state of the art lab right there.

No matter what, I have decided that I will request that the tech stay with me in the restroom from now on and ask them to look at the temp strip as soon as I hand it back to the tech. (from what I read online the temp strip is supposed to be read within 4 minutes and ideally with patient still there so a retest can be done right then if the strip shows anything than what it should, I've read between 90-100 degrees F. I saw on my chart that this temp was not read for 18 minutes from the time i gave it to the tech and i even asked her if all was ok and she said "oh yes, you can go now"!)

Just thought I'd ask your opinion. I think I'm correct in saying the oxymorphone is an exact result match to the oxycodone as my body metabolized the oxycodone as oxymorphone as well this time like other tests in the past have come back. I guess i just want to hear someone I have come to respect (through reading your many informed oh so intelligent posts here as well as I know what we both deal with each and every day just to live a semi-normal life) tell me that I am correct in my thinking on this subject.

Thank you for any/all info u can get to me about making another chronic pain patient's voice heard. Is there a way to tell you my email address? I also completely agree with you about the time someone(docs,etc) should have to deal with what we do. I had only ever said 24-48 hours as I just can not wish that on anyone, but what u said made me look at it in a whole new way...they would never truly know without going through it for at least a few months as yes, they must live with all the scrutiny along with all of the pain to TRULY understand us and what we go through 24/7. Yes, pain meds are a wonderful tool for us to use to help, but nothing takes it all away and we are never truly ourselves again whether it be the pain that never goes away or the flare ups or how we sometimes feel (mentally) due to taking that type of med and knowing that you must find a way to accept it cuz all else has failed that the professionals know about, at least to this point. I remain hopeful that someday they will truly come up with a solution, but until then I very much fear the atmosphere I have been seeing/hearing with my own eyes/ears for the last 3 years (at least here in PA how pain patients are treated seems to have tremendously changed within the last 2-3 years....ever since huge medical giants have gobbled up  the small practices and put "pain clinics" in place...just as you said).

I will let u go for now...and again, I hope u are feeling better today. Hope to "talk" to u soon.

All My Best,
Abbey

[Tuckamore]

I'm sorry there were so many error in my last post. As I said I'm having a horrid pain flare - and didn't proof read it.

I meant to say the small physician owned clinics are being gobbled up - not goggled up. Gosh! Those small clinics seemed to take the time to build good relationships with their patients - then the giants came because the small clinics couldn't compete.

I feel bad for the medical providers that want to do better - want to spend time listening to their patients - want to do get that CT done right away and not wait a month. They really don't have that time or independence anymore. We don't want to wait more than 10 minutes to see the doc but when all we get is a rushed ten minutes with him/her we're disappointed and sometimes angry. I'll wait 45 minutes IF my provider takes the time to listen - and has to time to explain what's going on with me in detail. But everyone's in a hurry and providers are timed. They actually get "warnings" from corporate when they spend too much time with patients or their wait time is too long - or they don't see their quota.

I agree that some of these providers should have our pain long enough to understand where we are coming from - though like you I wouldn't wish this pain on anyone. However we've debated here how long that should be. It has to be more than a few days - they have to go through the drug screens and pill counts. They have to feel the scrutiny we do - get the "looks" when we fill our scripts - get turned down by a pharmacy for no apparent reason - be treated like second class citizens - give up the activities we've had to give up - have some sleepless nites - etc.  I'm guessing it would have to be several months. I don't want anyone to have my pain for that length of time - unless in the end it helps all of us chronic pain patients.

But that's off the subject of your concern. I really think you'll be okay. As long as they do "both" drug screens there shouldn't be a problem.

I'm sure you'll let us know. I'm glad to see that you are active in our community.

~Tuck

[Tuckamore]

Yes, many of these PMP or PCP initially work for a great smaller clinic that takes time with their patients and seem to truly  -  it's a conducive atmosphere to build  good doctor - patient relationships.

Sadly with the costs and demands if instant medical results smaller physician owned clinics are being goggled up by large corporate giants in order to compete. This corporations truly are a business. for one they tell the physician how many patients they must see a day and how much time each patient is allowed. They dictate what tests can and cannot be done unless certain criteria is met. Even if it's very obvious a patient needs an MRI or a CT - these corporate giants or HMO's insist an x-ray be done first.- they have a protocol to follow.  Eventually the MRI or CT may be done - but it's weeks maybe more before it's actually ordered.

Yes there are places to make your voice heard. There are advocacy groups fighting for chronic pain patients - they have been for years but they don't seem to be making progress.  Unfortunately I can't provide links here. I'll try to get you a message with that information before the end of the week.

Having a nasty pain flare so I have to stop for now.  Keep in touch.

~Tuck

[abbeyjustcuz2924]

Dear Tuck,
thank you so much for your comment, it is greatly appreciated! Some of the results have come back and as I was sure, all is negative except the 2 meds that should be in my system. I am just waiting now for the test that gives a specific range such as greater than 300ng/ml. I'm not sure why that one is taking so long as it has come back any other time in 24 hours or less but this time it is different so I can't help but still be a bit worried. I think that they use both tests u spoke of as 2 results come back...one says if u are positive or negative and the other, as I said tells you a greater than or less than number for a value.
My PMP is my PCP and has been for the last 9 years. We did have a great and very trusting relationship but I can just feel the difference when I see him anymore (do u know what I mean....he seems to be his normal great self but something is amiss). I do believe it is the clinic and not him....he works for a huge statewide health giant and I do believe it is the corporate heads running the doctors and not really him but he must go along is he values his very excellent job for this rural area. I guess I understand in a way, but I wish he would stand up for us more as well...especially the ones who never come in early, not even if our schedule is horrendous, never complain and never complain about taking urine tests and never, ever get results that should not be there. We can't fake MRI's and failed surgeries....as I'm sure you know all too well.

But so far, so good as I said. The clinic has not contacted me in any way and no news is usually good news from them...and I'm positive in only what I should be positive in......like I said, just still waiting for the result that gives the range of the number, but it is weird that result is taking so long. Another thing I noticed is that the temp was not even resulted until 18 minutes after I handed it in and according to what I read on the internet (which I know is not always credible), that should be done within 4 minutes of the patient turning in the sample. Also, the lab tech carried the sample cup outside of the bag, against her labcoat and placed it on a metal shelf in the restroom for me. Also, when I brought it back to her, she put the cup in a green bag and put a label on it...then she turned it over (yes the cup full of the sample), handed me a felt tip pen and told me to write my name on the sticker on the bag so I had to press against the sample cup to write my name on the sticker. I also read on the internet that one must use ballpoint pens to write on the stickers and not felt tip pens as felt tip pens can smear the ink and/or scratch the sample cup. So there is much I have had to think about since yesterday....and a lot to wonder about as to why they seem to be trying so hard to discredit good people.

I've always said...not that I would wish our pain on my worst enemy, but I wish they could just feel what we feel for just 24-48 hours and they would truly know how vital this medication is to our lives. I don't like how they just seem to feel lately that they can treat us any way they wish, especially such a statewide health giant. Tuck, I even asked her if all was ok before I left and she said yes, you can go now. She should've seen immediately that something was wrong with the temp strip....not 18 minutes later, don't u agree? I would have gladly given another sample as I never shy away from them. If they truly read my record, they would see that I have been on these meds since 1999! If I was doing wrong, I would have been doing it long before yesterday, haha!!

Again, thanks so much, Tuck. I'm just still waiting for the range number results and then we will see what, if anything, is said after that. I also sent a message to my PCP through my online chart alerting him to the result in case he hadn't seen it yet. He has not responded. Ahhh, well....another day living in the pain cycle that society has felt the need to place upon us. If only they truly knew what they are doing to people that truly have the need for this relief and the records to back it up.....I wonder how long it would take them to reach for that capsule and thank God for the relief it does bring to someone who can't even walk without it.

Talk to u soon as I will let u know what happens from here. I hope I am just being overly concerned....but from what I have seen with my own eyes and heard with my own ears lately towards pain patients, I am not optimistic. Is there anything in place yet with Senate, etc that we can join to try and fight some of this craziness? Thanks for any further input you may have! Hope u are having a good day in sunny Florida!!

[Tuckamore]

Hi Abbey,

I'm not an authority of Drug Screening. I sorry to hear that the climate in your pain management clinic has changed - for the worse. Unfortunately that is not so uncommon these days - the whole climate has changed - every where, not just your clinic.

Do you know what type of testing your clinic utilizes? Any credible drug screening program will involve a two-step process. Initial (immunoassay) and confirmatory (gas chromatography-mass spectrometry [GC-MS]) testing are the methods most commonly utilized to test for drugs. Using a combination of both tests allows a high level of sensitivity and specificity, meaning there is an extremely low chance for false positives or false negatives. It's not 100% - nothing is 100%.

Do you have a good, trusting relationship with your PMP? I use to think that mattered and I'd like to believe that in most instances it still does - but I hear some pretty frightening stories here. Ppl that have been with their PMP for years have an abnormal drug screen and they are dismissed.

It's a sad situation that something that is not 100% can forever ban you from Pain Management. Some PMP are not well trained in analyzing the results of these drug screens - which makes it even sadder.

All that said - I think you may be overly concerned. The results are not back yet. If they use the two-step process you should be just fine.  

One of our members has more medical information in drug testing than I. He should see your thread and comment. Although I have been in PM for years and have a medical background I am very new to drug testing - it wasn't done with my long time PCP who was also my PMP.

Please let us know how this resolves. I'll look forward to your additional comments and updates.

Best of Luck,
~Tuck