Thursday, January 05, 2012

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.


Emily said...

What if you took a 20mg sustained release, then 8 hours later take 10mg immediate release, then 4 hours later repeat the pattern?

20contin -- 8 hrs
10codone -- 4 hrs
20contin -- 8 hrs
10codone -- 4 hrs

Downside: It'd be a pain in the ass, as it were.
Upside: You can save the last of your deductible for Mayo, and three weeks from now start on the 15mg sustained release, which would then be free.

The reason the larger SR pills work better than the same amount in regular pills is because it's easier to prevent pain than to treat it when it comes up. The SR does a better job keeping a steady amount of the drug in your system than repeated doses of regular pills.

I can't remember: have you been on fentanyl at some point in the past? That's the ultimate in sustained release, and it sure is convenient.

I'm sorry you're having to up the dosage. It's just a part of the picture with opiates. Luckily, people generally develop a tolerance with regard to the side effects, too, so you'll feel dopier for a while but hopefully you'll settle back to your currently level of dopiness. Bleah. Cold comfort, I know.

I'm just glad you're alive. And loved and supported and cared for and covered by insurance. And blogging. Thanks for blogging!

M said...

These are good ideas and would indeed save some $$. Though I was told that the sustained-release pills area easier on the system and don't quite last the same amount of time or something like that, so I'm guessing my docs would steer me away from mixing them like this. But a clever use of available resources!

The Fenta-nyl was a nonstarter with me: though I was told the same: that it is the preferred pain relief option. The side effects greatly outweighed the pain relief, even in the higher doses. I heard of someone overdosing on it a while back. Which is actually kind of ridiculous for someone to accidentally do. Its like a nicotine patch, and it takes 12 hours to start working. You'd think the person would wake up and notice that they accidentally put on 5 fenta(nyl)s, and just tear 4 of them off. How many accidental ODs have a 12-hour window to correct your mistakes? Not many, I'm guessing!

I think you're right regarding the side effects, and it does seem to be true. Thanks -- I appreciate it very much, and I'm happy to be here, too.

Wendy said...

What I'm learning in nursing school is to always, always, stay ahead of the pain. I'm glad you're experimenting (and sorry you have to). Each one will be metabolized differently by you - your body, but I have faith you'll figure it out.

Much love!

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