Medication Buggeration, Part 672…

Finally sorted.

Doc won’t give me Tramadol and morphine. Period. Says it’s too dangerous ( database confirms the danger, flagged as Major, but I’d still be willing to take the risk – it’s a case of possible problems weighed against certain pain).

So we settled on morphine with a free rein for me to find my optimum dose (which I’d have done anyway but with permission he can hardly complain I’m taking too much!), and he’s going to send DHC round later today after I pointed out that I still lacked a fast-acting analgesic.

Should be fun when his colleague finds out. I took DHC for several years – it’s a good drug (it’s also the basis of my suicide kit as it’ll take me off fast and beyond the reach of rescusitation) – until Dr. Numbnuts stopped it because it might cause pleural oedema. Big deal – I might get killed by a meteorite, or a number 190 bus. I care about certainties not maybes and, as with Tramadol, I’m perfectly happy to take DHC if he prescribes it.

I accept I might develop pleural oedema, but balanced against the cast-iron certainty of intolerable pain if I don’t take it, it’s a no-brainer. Anyway, pleural oedema is easily spotted and is treatable. A patient would have to be seriously stupid to neglect it until it became life-threatening (first sign of coughing pink froth, get help, don’t wait).

I was also saddled with the job of tracking down Gabapentin supplies as the local pharmacy can’t get any and, seemingly, doesn’t give a toss about all the customers dependent on it as they don’t have the initiative to get off their arses and find some.

I did – first phone call and Boots, a mile away, have ample supplies in all strengths. And why the surgery reception staff aren’t doing that is beyond me – it’s their bloody job, surely.

Anyway, I’ve done it so I phoned the surgery to get someone to pass on the message to the GP – and the bloody woman gave me an argument because a script had already been issued (to the pharmacy with no stock). I said “Look, I don’t care – all you have to do is pass my message on to Dr. Bates. Please do that. OK?”  I felt like saying why the hell aren’t you phoning round, instead of arguing with me?

Has he got the message? I don’t know. The woman wasn’t exactly on the ball, as I’d asked to speak to the young woman I’d spoken to earlier, because she knew the situation and it would save explaining – she’s not working this afternoon. Which was odd as I’d already had a conversation with her this afternoon.  So anyway, I passed on the message with no great hope that it would be relayed in time to get me some Gaba today, which was the intention. If it’s not I shall do my utmost to make her life a living hell – just as mine is going to be without Gaba. I gave her the message at twenty to three. It’s now ten past four – I’m putting my money on not getting it!

But my DHC has arrived, so between that, the morphine (supposed to be every 12 hours but sod that if I need it more often in the absence of Gaba. I’ll increase it to every six hours, interspersed with DHC, also every 6 hours so that I’ll have a dose of one or the other every 3 hours – and I stress that this is only in the absence of Gabapentin.

And if you think that’s drug abuse then you have never been in severe enough pain to understand.

One thing I discovered while poking around the morphine section of is that I really shouldn’t be drinking – the consequences, if it all goes tits up are pretty grim. But then, they are if I can’t get the hell out of here now and again, and unwind.

28 thoughts on “Medication Buggeration, Part 672…

  1. sorry about all the above Ron, and i know you dont get out much so probably rarely drink at all.and i am assuming by drinking you mean beer.cider or shorts etc etc. but as someone who rarely drinks these days at all, (used to do but hell, i even toasted my ex husband after his funeral on Wednesday with soda water.) do you HAVE to have alcohol to help you unwind?i can relax just as much as i used to do while out with drinking friends. and only drink, lemonade, diet coke or soda water …mostly the latter. not only is it refreshing, but its cheap or zilch in some it doesn’t set my IBS off either. just a thought is all.

    • I don’t have to have beer – I like beer! Of course, I’ve already been drinking with morphine in my system, and come to no harm, so maybe I’m worrying needlessly. Beer, by the way, is actually good for IBS – nature’s stool softener!

      • MAYBE YOU ARE (oops). i just know it doesnt mix with some drugs, as a young woman i used to know didn’t survive taking paracetamol after a couple of beers.. but a lot depends on who you are, what stature, what you take with what and a host of other things, as to what results ensue.
        i hate beer and dont particularly like the taste or smell of alcohol so its easy for me yo keep off it.
        as for beer being good for IBS it may well be but i find mine is controlled at the moment with 1 sachet of fibogel after breakfast (another natural source of roughage) to counteract my having to take 2 co-codamol 2-3 times a day ..last dose at night to help me sleep cos of the itchy prickly skin on my feet at night. due to overstretching causing tightening over the upper feet and ankles.

          • i meant maybe you ARE worrying needlessly (your words in your previous message were……..QUOTE:”.I’ve already been drinking with morphine in my system, and come to no harm, so maybe I’m worrying needlessly”. UNQUOTE

            again..caps. sorry. didn’t mean to shout at yer.

              • I don’t habitually use the caps key Ron. i have poor eyesight, a black keyboard and the lamp ive got gives off so much heat i cant bear it on. for more than a few minutes. i dont put caps lock on deliberately. i hit it without realising ive done so, particularly at night when the light is behind me.i often answer these things while practically dropping asleep just before bedtime but if i were to leave it till the next day there would be no comments at all from me. i have not had the time to keep going back to correct all that i have done in caps lately due to having a funeral to organise. . when i do i do do just that so you dont realise i did it. but there are times when i just dont have the time. or energy.
                i dont have to comment so if you would rather i didnt .fine. i am not a typist. never was.never will be.

                • What on earth brought that on? You seem to have taken a fairly innocent question far more seriously than intended. And to be fair, habitually isn’t the same at all as deliberately.

                  More in daylight – it’s late and I’m tired.

                  • sorry. things still a bit fraught here……. all i was saying ,in brief, is it is accidental. i dont intend doing it. it just happens, as it does with 100s of other people i know.

                    why? i dont know other than what i said above. bad eyesight, black keyboard (as most are these days. i only buy cheap ones.cant afford dearer.) they work. and its usually evening when there’s no daylight that i accidentally hit caps lock.

                  • ok . decided to go for it (the illuminated one) after your recommendation plus reading reviews etc… its not that much in cost and looks like could well be the answer. thanks again.

  2. I really hope that they came through with the Gaba! I’ve a feeling they didn’t?
    I’m really lucky with my doctor and am really grateful for that, I couldn’t imagine what I’d be like if I had a doctor like yours! My GP gives me 2 months supply of Gaba at a time, so that I never run out. I’m on 900mg three times a day. If I lived near to you I could send some around to you. Sorry that I can’t Ron 😦 Even if I posted them this evening you wouldn’t get them ’till Monday!

    • Nope – they screwed up. FFS, I even found that the local Boots has a cart-load, in all strengths, and they still fucked it up. The only way I’m going to survive the weekend – and that might sound melodramatic but, trust me, it’s not – is to not take the overnight doses tonight and tomorrow and load upon DHC or Tramadol instead, so I have at least a couple of daytime doses for Sunday, and even then I’ll be reduced to half a dose, 300mg.

      And come Monday morning I’m going to do my best to get a dozy, witless, reception bimbo fired. I gave her the information for the doc at twenty to three, well before the start of surgery, so there’s no excuse for not passing it on.

      I think she held it back because I snarled at her when she tried to give me an argument, as I said in the post.

  3. gaba 300mg are short across our nation ! gaba 600mg are in plentiful supply !
    24 is good on a quiet day, 30 on occasional struggle day, any activity day requires 36. The effect seems to build up and if you predict a burst of extreme pain (which we all seem to understand better than our medical masters) the peak can be almost adequately softened.
    Keep on fighting, glass is always more than half full.

  4. Ron, I’ve got spare Gaba and Tramadol I’ll send to you. You should hopefully get it tomorrow if Ian can post it tonight 1st class.
    Take care my friend. xx

      • Definitely spare. The Gaba is 600mg and Tramadol 50mg. If you don’t get them tomorrow, at least you’ll have some spares if there’s another emergency.

        • As I lay in bed wide awake at 3am, I realised that in my haste (or due to Fibro Fog) to post the meds to you, I totally forgot to put a note in with them. So when you receive an anonymous brown envelope full of Gaba and Tramadol, it’s from me!

          I have a feeling that I may have done this before, when I sent you the mugs. If this is the case, I apologise for my bad manners, and can only blame Fibro Fog.

  5. Hi Ron! 🙂 I’ve been in too much pain and going to so many appts. so I behind on everything again! Sorry about that. You know something else that I think is weird? Correct me if I’m wrong, but wouldn’t people who weigh more, require higher doses of medications to get the relief they’re supposed to get? Maybe I’m wrong but I think about that sometimes for myself and others.

    Also, so much has gotten worse with my health. UGH!!!

    AND…I do have a question for you. Pain became extreme for me after a simple hemmorhoid (sp?)(sorry about that, LOL) surgery in spring, 2012. It was then that I could barely walk anymore due to extreme pain in feet, legs, hips, etc. THEN, I had oral surgery almost 2 weeks ago and I’m STILL in terrible pain, with NO infection!!! There have been similar issues as well. I have also had EMG nerve tests that show severe nerve damage in my back, legs, feet, etc.

    I just can’t help but think that after that surgery in spring, 2012 it threw me into RSD. Thoughts?

    • Correct me if I’m wrong, but wouldn’t people who weigh more, require higher doses of medications to get the relief they’re supposed to get? Maybe I’m wrong but I think about that sometimes for myself and others.

      Sorry, that one slipped by me.

      There’s no simple yes or no answer. For example, Phyllocontin dosage isn’t based on weight, but when I lost so much weight – 31kg – my levels became toxic when tested in March. I have no trouble understanding that, with such a huge loss, but my GP did and, last month, tried to cut my dose in half based on that test. I told him I wanted a fresh blood test and, guess what, now my weight’s normal, I don’t have a problem! Idiot!

      Other drugs have the dose directly linked to body weight, but this tends to apply to kids more than adults. For adults this is mainly a problem when, as with me, there is cataclysmic weight loss. Fat people don’t normally need a higher dose.

      A question I can’t get an answer to, do diuretics cause me to excrete drugs too rapidly? I cannot see any circumstances, for drugs excreted via the kidneys, where the answer is not Yes.

  6. Ron, are you on MST Continus? I take a 60mg dose every 12 hours, along with Oramorph, Gabapentin and Paracetamol for the pain. I can increase the Oramorph to hourly if needed but find that I can cope with the morning, afternoon and evening most days. I find the combination to be quite good and that’s why I’m wondering if you have the MST.
    Another drug that has helped John with his pain is Duloxetine 60mg gastro-resistant tablets. He has depression and was on Paroxitine each morning to help his moods each day, but he was then changed onto the Duloxetine and he’s seen a big difference in the pain in his legs and back. I’m not saying that it doesn’t stop him having terrible pain but it does seem to have help dull it a little and at times he is getting some hours without feeling pain 🙂 He takes this every morning, and believe me, even I have seen the difference. John is also on MST 60mg and can increase to 100mg if required and is being started on Gaba next month.
    I know that Anytriptilne (sp?) is also a prescribed drug that helps with pain and could be taken at night?
    John and I are also on Diazepam 2mg, not for depression but to relax muscles and any spasms – I take mine at teatime and then bedtime, whilst John has his morning, afternoon and night. We can also increase the dose to 4 or 6mg if required.
    I know I’m speaking to an expert 🙂 , but I thought that other options could be explored if you haven’t already. John and I can vouch for the Duloxitine, him for taking it and me for seeing a difference in him.
    Jay x

    • I’m taking Zomorph – effectively the same as MST – sustained-release morphine. Also 60mg b.d. for now – might well go up.

      Oramorph, so far, has proven utterly useless, which I just don’t understand. I can only assume that the solution is too weak or the dose too low – or both.

      Amitriptyline, in a low dose, 10 to 30mg about an hour before bedtime, is very effective. I took it for years until it was stopped when taking Tramadol (dangerous combo) – I want it back now! Just on general principles, really – I don’t think I actually need it now as I’m sleeping very well. However, I don’t want my GP to think I can get by without it as, if I ever do really need it again, it’ll be difficult to get. It shouldn’t be that way, but it is.

      Duloxetine is a major antidepressant, which also has a role in pain control, and John is clearly benefiting from both. His medication seems to be developing painfully slowly though – his GP seems needlessly cautious when it comes to adding drugs. On the other hand, mine throws everything in at once, then later decides I can’t have half of it! I know what makes me more angry!

      Gaba needs treating with caution, when he gets it, as you have to build up slowly to the optimum dose. I didn’t, I was in too much pain to be patient, and went from zero to 900mg twice a day in a week. Can’t say I came to much harm, though it wasn’t fun; others might not be so lucky! Very effective drug though, if he can cope with it (makes me incredibly tired, even on the tiny dose I’m left with this weekend). Like most analgesics that are actually useful, it’s also addictive. Only a problem if it’s stopped suddenly, though. Same with morphine.

      I have to treat antidepressants and similar drugs with caution, as most don’t like me. Ami, an old-school tricyclic, is about all I can tolerate on a regular basis. SSRIs not at all.

      Once I get Gaba back – hopefully on Monday – I’ll be fine. Even if my idiot GP is slow a friend’s sent me some in the post.

  7. Well that friend is a good friend for doing that for you 🙂 Bloody disgrace though when your GP’s receptionist, and your GP as well, don’t get the drugs to you on time! Doctors receptionists are soooo up themselves. They are supposed to be the first port of call, and the first face you see on entering the GP’s practice. They are supposed to be like hotel receptionists and have a pleasant and pleasing manner, however, they see themselves as the gatekeepers and protectors of the GP’s! Every one of them seem to want to keep the doctor away from the patient and then try to piss about with prescriptions, appointments, etc. I was a medical secretary for years and was forever having to tell receptionists off! No matter where I worked, be it a practice or a hospital, I was forever giving the receptionists down the banks!
    The biggest insult to me was to be called a receptionist!!!!! 🙂 Next time any of the receptionists try it on with you then remind them that they are supposed to be the face and voice of the surgery, not the GP’s themselves!

  8. Re: the oramorph… a couple of things I’ve found help with me (I have no evidence for my approach, it’s mostly just been seredipity!)

    — It can lose some potency if it gets too hot – mine’s been in the fridge during the recent heatwave, which also seems to dull the god-awful taste of the stuff.
    — I’m pretty sure you know this, but once opened, use within 3 months, and my pharacist says he’s seen plenty of anecdotal evidence that suggests it starts to decline after just a month.
    — Works more quickly on an empty stomach
    — Acid-reducing and stomach-coating meds slow it down and reduce its effectiveness.
    — Again, fairly sure you’ll know this, but take it the instant you suspect you’re in for a pain flare (small dose). Wait ten-fifteen mins. If pain is still building, take a big dose & extra paracetamol if you can.
    — Paracetamol potentiates the action of morphine, both in suspension and in sustained-release capsules. I use both forms of morphine for pain control, tho not at the dose or with most of the others you do, and find paracetamol five mins before an Oramorph dose, and an hour before Zomorph, has the best effect for me (altho it can be difficult to take something five mins before you take your PRNs as soon as you realise it’s needed, the logistics are a bit mindboggling!)

    Apologies if I’m repeating things you already know, or that aren’t helpful. I had a trial getting adequate pain relief myself – I’m mildly allergic to codeine in seemingly any form, which was a shame as DHC worked so well! I can’t take Tramadol with my SSNRIs, and the one time I did anyway I lost two entire days to one low dose – stoned completely off my face. It still hurt, I just didn’t care at all. Buprenorphine doesn’t work well, and the adhesive patches ruined my skin. Additionally, with my condition (Ehlers-Danlos Syndrome Type 3) I get all sorts of crazy reactions and topical analgesia or local anaesthetics are just ignored by my body… now on 10mg Zomorph BD, 50mg amitriptyline nocte, 200mg sertraline QD and 2.5-5ml (5-10mg) Oramorph PRN, and the morphine will prob go up when I see consultant in a couple of weeks..

    Anyway, I hope some of that stuff might be worth trying for you. Also, check your dose – syringes give better accuracy than spoons/cups, I was missing about 1/3 of a dose due to parallax error with a measuring cup. Best of luck.

    • Thanks for the info, but as you say, I do know all this.

      My Oramorph lives in the fridge, but the only dose that has actually provided any benefit was the one I took as soon as I got it. Chilled, it does nothing, even when left to come up to room temp overnight.

      If it hadn’t been for that first dose, I’d suspect I’d been fobbed off with a bottle of sugar water laced with bitters.

      I don’t mind the taste, by the way – in my time I’ve had far worse.

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