Some New Ideas

I met with Dr. Larry today (my G.P.) to talk about pain issues. My experience with Dr. Bonzo (my palliative care doc that I was seeing for awhile) led me away from working with her and towards my experienced regular, head-to-toe doc. I haven't been keeping him in the loop enough recently, anyhow.

At the appointment my blood pressure was fairly high (146/90) which is way high for me -- or for anyone else, for that matter. Human normal is (last I checked) about 120/80. Possibly this high number was because I'd really only had coffee to drink that day, or possibly it could be that I have been in a lot of pain and irritable as a side-effect. Or maybe it was that I'd just taken a walk. Or some combination of all of the above. This is only a footnote to this account, anyhow.

At the appointment I asked Dr. Larry if one could be come accustomed to opiates and therefore experience a decreased effect, and he said yes: one could develop a tolerance to the drug over time. Another question I asked was whether or not I could take this 12-hour pill every 8 hours, and apparently that is totally fine. I also mentioned that when I take my 12-hour pill, it only really seems to last for about 6-9 hours. (It used to work great, and either the pain is increasing or the effectiveness is decreasing or some combination thereof).

I got some new prescriptions and was left with a few decisions to make.

Essentially, I am faced with the necessity of upping the dosage. I'm at the point where I can't really comfortably live with the pain on the current dosage. This will take some further monkeying to get them all right, but there are a bunch of options:

10mg 3x daily (30 mg total)

(Current schedule)

Downside: isn't really cutting it, pain-wise.

Upside: Less drugs in my system than all the other options.

20 mg 2x daily (40 mg total)

Downside: 12-hour pills may not be lasting long enough for me. So this could still leave me stranded here and there during the day. 

Upside: the 20mg tablets do seem to work.

10 mg 24x daily (40 mg total)

Downside: individual pills may not be strong enough to ever really cover the pain, though coverage should be fairly even. Also, will have to set an alarm for every 6 hours, day and night.

Upside: could cover all the gaps, if the pills aren't lasting as long.

20 mg 3x daily (60mg total)

Downside: Lots and lots of chemicals, and (potentially) doubled side effects over my current dosage.

Upside: Totally ought to work. It may be like hunting goldfish with a hand grenade -- in terms of precision and effectiveness -- but it should definitely eliminate all the pain. I may drop a lot of things and be a really dangerous driver, but I should be feeling great.

15 mg 3x daily (45 mg total)

Downside: this would be a totally new pill for me, I haven't ever taken a 15mg before, so I'm not quite sure how it would feel. But it might be the baby-bear-bed magical middle ground between the too-weak 10mg and the too-strong 20mg. Oh, another downside is that it is TWO HUNDRED AND THIRTY EIGHT FRIGGING DOLLARS for a month's supply. I was in a poor mood anyhow, but this news pushed me over the edge and I rejected the prescription bottle and walked out of Walgreens in a huff. So now this 15mg is currently *not* an option until I find out if there is a generic or something. Or actually pay the $238. Whichever comes first. 

Upside: May very well work, and is a good middle ground option.

Another alternative to shelling out $238 is to wait for about 3 weeks until the prescriptions will be completely covered by insurance. But really, it's just a shell game I'm playing by myself, here. My medical insurance, MCHA, has a $2,000 annual out of pocket deductible. Because it is still early in 2012, I haven't hit that deductible yet (I'll hit it just a few weeks). So: I can spend it now or spend it later -- but either way I'm still going to end up paying the first $2,000 that my health care costs this year. After that point, all doctor visits and prescriptions cost $0.00. Maybe its that I would personally rather give my money to Mayo Clinic than to Walgreens, but I know it really doesn't matter: each will get paid, whether by me or by insurance is immaterial.

For revised drug plans, I've all but decided on the 10 mg 4x/day currently, but I would also like to try the 15mg 3x/day. And now I really wish I hadn't rejected the prescription when they handed me the bill at Walgreens. Now I'll need to se if they can still fill it, or I'll need to get a new prescription.

I'm essentially balancing pill strength versus length of time that the pill is active, while trying to keep the daily mg. total to a minimum.

I feel like there's a way to write this all out in a mathematical formula. Basically I'm just making stuff up now, but I feel like it could be written out all sciencey, like:

Dmg = Pr - Lt

Where Pr is Pain Reduction, Lt is Length of Time and Mg is Daily milligrams. 

Or another example that just occurred to me (that looks similarly sciencey):

someone losing an eye ≠ everything being fun

Which is completely unrelated, but true.

Earlier tonight I took a single 5mg oxy(codone). Oxy(codone) is the fast-acting "normal" version of the sustained-release Oxy(Contin) that I usually take. I almost never take the Oxy'done at all, but this was a a "scientific" experiment to see if I felt any effect from it. The effect was only very slight, and my guess is that taking a total of 2 (10mg) would have probably fixed the pain for a few hours. I won't mess with taking more of those unless I really need them, but I was just curious. I'm sure there's some science to pill effectiveness and it seems like a 20mg tablet would be twice as strong as a 10mg, but it really seems to be more like 3 times as strong.  Also, the 12-hour 20mg Oxy'Tin is for some reason more effective than taking a 5mg Oxy'Done every 3 hours, and easier on the system also. Don't ask me why.

So now you know the sorts of things I spend my days thinking about.