Is there a doctor in the house?

DESkins · Post by **DESkins** » Fri May 30, 2008 7:35 am

I need some suggestions. What, if any, pain medications are out there that fill the void between morphine and dilaudid? Strictly prescription stuff, mind you.

SkinsFreak · Post by **SkinsFreak** » Fri May 30, 2008 8:58 am

I've personally used several prescription pain meds. I've had back and neck surgeries and suffer from psoriatic arthritis.

I am currently taking a combination of meds; a type of morphine commonly known as MS Contin 30 mg, which is a time-release pill, and Ultam 50 mg (tramadol). After trying various kinds of pain meds, this combination works best for me.

Vicodin, Percoset and Darvocet are very common. I didn't care for these as they effect moods and have sexual side effects. All are very addictive, but if managed by a physician and taken sparingly, for those that suffer from chronic pain, they can be extremely beneficial.

After my surgeries, they gave me dilaudid while in the hospital. Man, that was the good stuff, but very strong and not practical on an everyday basis, at least for me.

By the way, from what I understand, all narcotic pain meds are derivatives of morphine, it's just what strength you want to take.

Edit: I'm not a doctor.

BnGhog · Post by **BnGhog** » Fri May 30, 2008 9:26 am

To all the kids out there, Drugs are bad ummmkaaay.

DESkins · Post by **DESkins** » Fri May 30, 2008 1:27 pm

Yes, drugs are bad... but I've got to take a bunch of them, and one of the kinds that I am on is dilaudid, which is pretty potent, but also leaves me feeling pretty crappy after the pain comes back and I can't take more for another few hours. In this case, if I can come up with some other form of pain management, I can maybe go home, and I want to be able to offer suggestions, rather than just wait for the doctor to say "well, what do you think about...", and have to say "I dunno, 'cause I'm not like, oh, a doctor."

Besides, considering that doctors are why I'm in the hospital in the first place, I'd rather get information from other sources as well.

Cappster · Post by **Cappster** » Fri May 30, 2008 2:03 pm

Oxycontin or Oxycodone works pretty good but I don't think it is up there with morphine.

SkinsFreak · Post by **SkinsFreak** » Fri May 30, 2008 5:10 pm

Cappster wrote:Oxycontin or Oxycodone works pretty good but I don't think it is up there with morphine.

Actually, both of those are brand names for morphine. I use MS Contin, which is the same as Oxycontin, except it's in a time release pill. The generic name on my script bottle is morphine. It just comes in different strengths.

***

Yes, illegal drugs are bad. Legal drugs can be bad as well, but only if misused and abused. But for folks that suffer from chronic pain, these drugs are manufactured and prescribed for a reason, and are very helpful.

***

DESkins, as I previously said, I am also familiar with dilaudid, and you're right, it's pretty potent. I know they give that to patients in the hospital, but due to its potency, I'm not sure if it's prescribed for out-patients. The time release pills can work pretty well. These pills can give you a base and then you can take something on top of that more frequently.

For example, I take the MS Contin 30mg (time release) once every twelve hours. On top of that, I take a 50mg tramadol four times a day. Again, this works well for me, in that the time release pills gives a good base that lasts throughout the day. Some combination like this might work for you as well.

Dude, it sucks to be stuck in the hospital, I can attest to that. But I hope and pray you will soon regain your health and strength and make it home to be with your family, where you're supposed to be. There are medications that can help you, so don't get too down. Keep us posted and let us know how things are going.

DESkins · Post by **DESkins** » Fri May 30, 2008 8:02 pm

Well, it's the stupidest thing, really. About 4 years ago, I was diagnosed with CLL, Chronic Lymphocytic Leukemia, and went through chemotherapy, using a new regimen of rituxan, fludarbine and cytoxane. In late February, I was told to go to the hospital because they suspected internal bleeding, but when I got there and they did the initial blood work, they just about had a kitten, made me sit down, wouldn't let me do anything, etc. Turns out that my hemoglobin, which should have been 13, was 5, my platelets, which should have been 110-150K were 400, and my white blood count, which should have been 4K, was 0. Turns out that the chemo actually caused the leukemia to mutate into myelodysplasia (sp?), a form of bone marrow cancer. I spent 38 days in the hospital after that, and almost died three times in the first two weeks, but I pulled through, and got out in April. This past Saturday I woke up with intense chest pains that caused vomitting, and once I could concentrate on anything else, I noticed that I was experiencing pain going up the neck and down the left arm, classic signs of a heart that is up to no good, so I told my wife that I thought we'd be going to the hospital ASAP. Not a heart attack, fluid around the heart, but they also managed to totally mess up with a few PICC lines, and the pain meds right now consist of 4 mg of dilaudid every 4 hours, having found that tylenol, tramidol and morphine just don't cut it against that kind of pain. And of course they just now found that they left a piece of one of the three PICC lines that they put in my right arm, in the subclavial vein under my right clavicle, so they get to go "fishing" for their piece of rubber tubing. Still, I expect to be out of here on Monday, since I've now spent almost as much time in the hospital since the beginning of the year as I have at home.

Countertrey · Post by **Countertrey** » Fri May 30, 2008 9:11 pm

Dude, you are dealing with serious health issues, serious pain, and with serious pain medications.

You need to consult with a pain specialist ASAP. If your doc can't manage your pain, DEMAND it of your doc. Be as much of a pain in his or her butt as you need to be.

Best wishes, man. I'll be thinking of you.

welch · Post by **welch** » Fri May 30, 2008 10:44 pm

As CT says.

My wife just had double knee replacement, so she read a series of articles by Jane Brody on pain management. Roughly, there are long-term release meds and short-term "burst" meds. Each has a different use.

You need a pain management doc, and if "they" brush you off, then let us know and we'll all come down and remind them that pain management is an important part of medicine. Brody has a reference to a whopper of a journal article.

Good luck.

DESkins · Post by **DESkins** » Sat May 31, 2008 4:47 am

Actually, they are doing a pretty fair job, considering what they have to work with. The normal course of treatment for a clot would be heparin, or some other clot buster/blood thinner, but due too the reduced platelet count, they can't do that, or I won't be able to stop bleeding when I cut myself on my razor-dull wit. But, the doctors understand that I have them right where I want them. See, I get the nurses, the housekeeping staff, the food service staff, the escort staff, and I tell them "I want you to take this chocolate, as a favor from me. Now, one day, and that day may never come, but one day, I may need a service from you, and I will come to you, and I will remind you of the favor that I have done for you this day." So the doctors know that if they screw with me, I can throw (at least theoretically) a monkey wrench in their own plans for getting out of here early on any given evening.

Seriously, the biggest problem that I have with pain management is that I can't use the PICC line, and an IV line has been lasting less than 24 hours before it has been getting pulled out because the stupid plastic needle gets kinked up, and causes me pain, which is kind of counter-productive. And the stuff that they were giving me, the dilaudid, worked beautifully, for about 30 minutes before the pain overcame the drug. But those 30 minutes frightened my wife, because of some of the hallucinations that I was having. She told me about one, I was very excited that I was going to be able to shower the next morning, but first I had to prove that I could cut my meat at dinner, because if you couldn't cut your meat, there were shark attacks in the shower. Now, I don't know about anybody else, but I studied sharks for years, and I can tell you that I was completely safe from shark attack. Sharks can't go any higher than the 5th floor of a hospital, and I was on the 6th, so I was completely safe.

And on a serious note, if they try to brush me off, I'll remind them that I pretty much own them right now, because of a little piece of rubber tubing that was left in me.

GSPODS · Post by **GSPODS** » Sat May 31, 2008 6:08 am

If you have time for a little reading ...

http://www.usdoj.gov/dea/pubs/csa/812.htm#c

Narcotics, which are most often derivatives of Opium, not Morphine, which is itself an Opium derivative, are listed on Schedules, based upon their medical usage and their risk of dependency and side effects.

Schedule 1 chemicals have no medical use. You will want to discuss the benefits versus the dependency risks and side effects of Schedules 2 and 3 with your physician.

I'm not a doctor, but I did once, in a former life, consider going into chemical engineering. I hope this info helps.

SkinsFreak · Post by **SkinsFreak** » Sat May 31, 2008 9:58 am

DESkins wrote: And the stuff that they were giving me, the dilaudid, worked beautifully, for about 30 minutes before the pain overcame the drug. But those 30 minutes frightened my wife, because of some of the hallucinations that I was having.

On a lighter note, that's kinda funny, in that, I had a similar experience. They were giving me 3mg of dilauded every 3 hours. My wife would bring my daughters to the hospital for a visit. A few times, it was immediately after a dose of dilauded. My wife said she could tell they just dosed me. I guess I was acting a bit goofy, I don't know, I thought I was acting perfectly normal. :lol:

On a more serious note... that really sucks, I'll be praying for you, brother. As others have said, stay on them about managing your pain. And you do have the edge, since they made a mistake. Along with the dilaudid they giving my through the IV, they would also give me a time release Oxycontin, which helped significantly between the doses of dilauded. You're right, the dilauded was great, but only for about a half an hour. I remember I used to just lay there staring at the clock on the wall, waiting for my next dose.

Anyway, good luck, man. I sure all of us here at THN are pulling for you.

SkinsFreak · Post by **SkinsFreak** » Sat May 31, 2008 10:05 am

GSPODS wrote:Narcotics, which are most often derivatives of Opium, not Morphine, which is itself an Opium derivative, are listed on Schedules, based upon their medical usage and their risk of dependency and side effects.

Actually, you're right about that. But I'm quite sure the side effects and risks of dependency are the furthest thing from his mind at this point. All narcotic pain meds are addictive, but with proper management, you can ween yourself off these drugs fairly easily. It's when people abuse these drugs for recreational purposes, they get hooked and don't want to stop, then it becomes a problem. That isn't the case here.

GSPODS · Post by **GSPODS** » Sat May 31, 2008 10:20 am

SkinsFreak wrote:
GSPODS wrote:Narcotics, which are most often derivatives of Opium, not Morphine, which is itself an Opium derivative, are listed on Schedules, based upon their medical usage and their risk of dependency and side effects.

Actually, you're right about that. But I'm quite sure the side effects and risks of dependency are the furthest thing from his mind at this point. All narcotic pain meds are addictive, but with proper management, you can ween yourself off these drugs fairly easily. It's when people abuse these drugs for recreational purposes, they get hooked and don't want to stop, then it becomes a problem. That isn't the case here.

The hopeful purpose of the information was so that DESkins could discuss with his doctor which Schedule II and Schedule III medications can be taken in combination, the schedule II for chronic pain, and the Schedule III for acute pain.

I recognize the information may or may not be useful, and being that I am not a doctor, it's the only advice I could give. You were correct in your previous post. We are all pulling for a full recovery.

DESkins · Post by **DESkins** » Sat May 31, 2008 12:01 pm

Thanks for the wishes for a full recovery. I'm actually pretty fortunate, they've already identified 6 potential bone marrow donors, almost all of whom are matches on 99 out of 100 areas, so I am told that I could have a transplant as early as this summer. That would rock, because a transplant is my only actual hope of a cure. This would also mean that I will be out of work for about a year following the transplant, not something that I am looking forward to, but it is what it is.

I did speak with the doctor this morning, he started me on oxycotin 2x day, 8 a.m. and 8 p.m., on top of the dilaudid, I'm hoping that it helps, and it's starting to kick in just a bit, so I'm feeling kind of fuzzy, and I think I might just lay down for a bit. Thank you for your input and your concern, I ordinarily would not post something like this, but I'd run into a mental wall after a week of being in serious pain, and couldn't think straight for myself.

DESkins · Post by **DESkins** » Wed Jun 04, 2008 7:24 pm

Latest development, I am going home tomorrow afternoon, after one more round of blood tests and transfusions, and the removal of the IV line in my left arm. We've decided against leaving in a PICC line, and I will be taking care of the pain medication, same as I am doing with the insulin and the blood clot managment. We've reached a stage now where I can keep the pain under control, it just took a few days of using a combination of things in order to get the pain managed in such a way that I can now control it on my own with only oral meds. We'll see how it goes, and maybe I can avoid this place until it's time for the marrow transplant.

SkinsFreak · Post by **SkinsFreak** » Wed Jun 04, 2008 7:48 pm

DE, hey, that's great you're going home, I wish you the best. I'm sure your family will be happy to have you back at home. Keep us posted. You shall remain in our prayers and we wish you well.

By the way, just out of curiosity, what combination of pain meds did you and your doctors come up with?

DESkins · Post by **DESkins** » Fri Jun 06, 2008 7:08 am

Well, after a minor setback involving communication from my doctor's office with his patient, I'm still at the hospital, and am now scheduled to have another ultrasound on my arm today, preparing me to go home sometime this afternoon, hopefully. Idiots let another blood clot form and knew about it, but becuase one of the meds is supposed to prevent anymore from forming, they didn't feel it necessary to advise me that I have another one that has formed in the interim. Needless to say, the doc and I had a little heart to heart about my desires to be aware of what was going on in my own body, and he is very much aware of how disappointed I am in the performance to date ("I'll take my disease and go somwhere else with it, thank you VERY much, if you can't start talking to me about it!).

Pain control (as it stands, and always subject to change) is currently 30 mg oxcontin 2 x day, and 20 mg of prednisone 4 x day, with dilaudid being phased in orally at a rate to replace 10 mg of prednisone each time, so that the prednisone does not interphere with my oral chemo. The higher the dose of steroids, the better my chances of pulmonary embolism, something I definitely do not have any enthusiasm for these days. And of course, all of this is subject to change, as I said, depending on my pain tolerance (usually pretty high) and my doctor's ability to tolerate my pain (also, fortunately pretty high, it seems!). But the biggest thing is how quickly the pain seems to disappear once I get home.