The 20mg Solution

***Note: as I'm using the names of a bunch of drugs that are addictive and have street value, I'm starting to be consistent about mis-spelling and mis-punctuating them. I really don't want my blog to end up in some junkie's Google search. ***

Today, as I mentioned previously, I just feel beat-up. I know that after a seizure (and I don't think I was having a seizure, but I feel that the aftereffects of intense tremors could be similar) people feel sore and wiped out, spent. That's me today. I've been napping virtually all day and I'm surprised that I can continue to climb back into bed and keep sleeping. Usually if I go down for a nap (which isn't every day, even when its a possibility) I'm only good to sleep for an hour max. Today, since 11 am, I've managed about 5 hours of sleeping.

I really think that the 20mg Oxy-tin is the way to go, now. That's what I'm on as of last night, and there is a subtle difference. Its more than the dosage, its like a subtly different drug. I remember taking vico-din as a kid after some dental work. That's the famed hydro-codone 5/325 tablet, according to Uncle Mike's Virtually Bottomless Store of Pharmaceutical Knowledge. 5mg of Oxy-done, and 325 of Tylenol/acetaminophen. Put simply, I really liked it. It made me feel like I was sitting under a warm blanket, inside on a chilly fall day, all safe and comfy. The world was quiet, I was kind, things were simple, and there wasn't that much to be concerned about. This is exactly why I've been leery of it: I clearly liked the stuff.

When they prescribed the Hydro-done 5/325 to me, they eventually stopped refilling the prescription because I was taking too many of them -- not out of some high-seeking behavior, but because it wasn't really doing enough for the pain at the recommended 1 pill every 4-6 hours. I was taking 2 of them every 2 hours at one point, or, put another way: dumping 650 mg of Tylenol into my system every 2 hours. That's way too much. The prescription didn't call for me taking it that often, but it was the only way to nuke the pain.

The maximum allowable daily dose of Tylenol/Acetaminophen *had been* 4,000 mg a day. Johnson and Johnson (the makers of the drug) announced in July 0f 2011 that they were reducing the maximum allowable daily dose to 3,000 milligrams. According to an article in the Huffington post, taking too much Tylenol can cause bad things, including liver damage. "In the U.S., it's blamed for about 200 fatal overdoses and sends 56,000 people to the emergency room each year." (http://preview.tinyurl.com/7h8fp79)

Perhaps Tylenol should adopt the use of Jace Everett's "True Blood" soundtrack song, "Bad Things" in their commercials. Of course the talkie bit would have to be replaced with a 3,000 mg a day warning. It would be entertaining, but sales would plummet.
http://www.youtube.com/watch?v=MDY42pFwq7c

And so, back to our story.

The 5/325 was too much because I was (though without knowing it) exceeding the recommended daily dose by over 4,000 milligrams daily under the old schedule, and by more than 5,000 mg daily under the new recommended limit that Johnson and Johnson proposed. This only went on for a few days, but still.

So, then they took away (or allowed the prescription to run out, anyhow) my vico-din 5/325 and gave me just straight oxy-done 5mg -- no Tylenol. This is a drug that I was allowed to bump up to 2 pills every 2 hours, but they still weren't comfortable with that long-term. Which is what led to the Oxy-tin long-acting.

But, to get back to my 20mg vs 10mg comparison, the 10mg just didn't seem to be cutting it recently. Taking a 20mg oxy-tin last night and this afternoon seems to have changed my world view for the better. Yes, I am definitely more clumsy. I dropped a dish in to the sink yesterday, shattering both the dish and the pint glass that was already in the sink. I felt that warm-fuzzy-blanket feeling, and I'm sure that why I'm able to sleep more, also. I feel much less tense and irritable than I did yesterday.

Apparently being Tense and Irritable runs in the family, occasionally.

Tense and Irritable is the name of a book that my dad did in 1964, that I remember us having boxes of in the attic when I was growing up. I always liked it. I found a copy for sale on Amazon.com, of all places. They have everything. Even books! But I digress.

My main point being that I feel much better on the 20mg. Oddly, the pain is still there sometimes (though not as bad) but I just don't care about it as much. Which is guess is all that really matters. The calm and inner quiet that I feel can be linked to the wondrous absence of pain that I feel more of the time, today. Or it could just be that I'm doped up on prescription opiates. Same difference. I resisted as long as I could, but I think upping the dosage is the best for me and for everyone around me. 

I'm able to focus enough to write, anyhow. Though I drove my truck briefly this morning and probably shouldn't have been behind the wheel. I think that was still the Taze-O-Done working its way out of my system, more than the 20mg 'tin.

Anyhow, I continue to breathe better and have almost no difficulty swallowing. I guess I did have a big allergic reaction to the Taze-O-Done. Lesson learned, for me: don't take Trazodone. Put another way: Don't Traz me, bro.

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.