Medication Buggeration, Part 978…

A couple of days ago I got a meds delivery, accompanied by – these days – a not unusual terse note from the prescribing GP (who is becoming a total pain in the butt, frankly). I’d love to go down there and dish out the bollocking he deserves, and I’m sure that’s what he’s hoping for, as he can then dump an expensive patient for “verbal violence”.

Among the meds I’d asked for was codeine linctus, and it was the one which generated the snotty note which said:-

“I’m not happy to give MORE strong opiates alongside high-dose morphine AND Tramadol.”

This struck me as perverse, not least because Tramadol had been discontinued some weeks previously as it’s not a happy combination with morphine. It also pisses me off when people don’t have the basic courtesy to put their name on stuff like this. So I replied:-

“I don’t know who wrote the note, directly above, to which I’m responding, but please be advised that the only opiate analgesic I am currently taking is morphine, as Zomorph, 60mg b.d., and Oramorph, 10ml, every 6  to 8 hours.

The reference to Tramadol mystifies me, it having been discontinued some weeks ago. To eliminate any further confusion, Gabapentin and DHC were also withdrawn, but more recently, as Dr. Xxxxx can confirm.

While the BNF has a reference for the use of morphine in terminal care cough suppression, it seems like overkill in my case, unless there is information to which I am not privy? I rather doubt it but APH communication skills are not the best…”

And sat back to wait for a shirty phone call. Nothing yesterday, and today – a bottle of codeine linctus arrived!

Chalk another one up to the good guys!

Which is all very well but I’m getting tired of this bugger making my life difficult – the more so when it’s based on his error or, as last time, an out-of-date blood test from APH, which should have been picked up on, not left for me to challenge, and how many patients are having their health compromised because they can’t – or won’t – stand up to their GPs?

There was, to be fair, a possibility that this originated in APH, and that it wasn’t, in fact, an error, but that seems not to have been the case or, if it is…

Aaaargh!!! No! That way madness lies…

Let’s just call it a win for common sense and hope this marks the passing of his urge to interfere with my meds (which has been going on for far too long and is why I threw Gaba and DHC into the mix – get them out of the way now!).

My morphine, by the way, is mid-range, not high (the range runs from 10mg caps to 200mg – I’m taking  60mg, which is right in the middle. Even factoring in Oramorph, which appears to be stabilising at one 10ml dose a day – two if I spend much time on my feet – doesn’t change it much. Seems reasonable as I wanted it for breakthrough pain  (I could, in fairness, use more, but no point in getting used to it until I see how reliable supplies are going to be).

It doesn’t kick in as fast as I’d like – takes a good hour, sometimes longer. The nurses say it should take only a fraction of that time – anyone out there have personal experience?

Now if I can just stay on morphine long enough to stabilise properly before some other bugger gets the urge to mess with my pain meds, I’ll be happy.

PS: I accept that GPs are under a lot of pressure right now but, whoever is responsible – and GPs themselves have to accept some responsibility for not standing up to the government – it should NEVER become the patients’ problem. That is entirely inexcusable.

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8 thoughts on “Medication Buggeration, Part 978…

  1. am wondering where all this for you is going to end. its shocking when your GP makes mistakes. too much emphasis on pc notes ,(not always read properly) and pc diagnosing. Bring back the old caring family doc we all knew and loved.
    i too am wondering when my leg will return to normal. having had, like 50% of the people in my area (and no doubt other areas too) fluid filled legs thanks to the beautiful summer we have had from around march to now with very little respite which so many people have enjoyed, but others,like me, couldn’t, thanks to grossly swollen legs ,ankles and feet, barely able to get a pair of shoes on most days. now the left one has returned to almost normal and been so a few days now but the right one??? feet and ankles are back to usual size,. calf area is down on a morning, but gradually builds up to twice its size and i can barely walk on it for pain in that area front sides and back until painkillers kick in. doc says, no infection and no clots.so why the swelling in that area only (and not much fluid there either but it is around a 3/4 inch 3 cornered scar from a 6r old injury ,and so much pain im taking co codamol 2 caps 4 times a day. which i never reached with my spinal spondyosis so far? all i get from my doc is its just due to tissue displacement due to the excess fluid ive been carrying for so long. almost 6 months now..he did up my frusemide from 20 to 40mg.and thats when my left leg and right ankle/foot reduced and stayed at near normal.
    i keep asking others i know who have water retention problems if this is normal. but so far had nothing back of any consequence. but most are at same stage as you with leaky legs etc.
    anyway at least you got cough syrup.so hopefully that will help you to calm your cough down.
    all the best to you. hope you manage to tame your wild GP one day.

    • Best thing you can do is ask for a referral to the Vascular Clinic – find out exactly what the problem is. If there’s no lumpiness of the skin (i.e., it’s simply swollen), then odds are it’s basic oedema and possibly age-related. That doesn’t mean it can’t be painful, though, and Co-codamol – depending on the strength (8/500 pretty useless, 30/500 much better), might be inadequate. Hell, I never thought, three months ago, that I’d be barely holding my own stuffed to the ears with morphine (60mg of Zomorph [capsule] at five this morning, plus 10ml of Oramorph [liquid] at 09.30). With luck that will hold me until the next Zomorph at 17.00 – if not, then more Oramorph.

      Oedema, even the plain vanilla version, can be very painful as, essentially, you have enough fluid to fill two legs crammed into one leg (it’s a simplification, but pretty accurate). Unlike blood, which is confined to veins and arteries, lymphatic fluid simply fills up all the available spaces between your cells – when you have more fluid than you have room for, then you have oedema.

      And yes, you can have very different symptoms in each leg. My left leg is almost back to normal now, while my right still leaks prodigiously and is very swollen (though I have to say that the nurses’ idea of “normal” isn’t mine!

      • Thanks Ron. knew i would get a straight answer from you. now i need to know if i am better walking on it and getting exercise as much as i can or sit with the leg up as much as i can or both? old age is a bummer. isnt it?
        i hate hospitals almost as much as you do. especially attending outpatients clinics. they always want you there like yesterday. or as early as they can make the appointment for. like you, i have reasons for needing at earliest late morning appointments or preferably afternoons.
        i have to phone dietician at the hospital to make appointment or at least tell them i want an appointment. why they think my darned doc sent a request to them if there was any possibility of me NOT wanting to see them, is beyond me. yet another sign of red tape gone wrong or simple idiocy. and whats the betting they only work mornings???
        hope you get to your appointment on time but not too early on Tuesday.

        • I’ve been told that the leg is better elevated – i.e. higher than your heart, ideally, if not the best you can manage.

          This is fine if you don’t take diuretics – for the first half of the day I’m peeing every 15-20 minutes so elevating my leg is utterly impossible. I also find that the pain I get when getting out of bed in the morning comes rampaging back every time I lower my leg.

          I’ve also been told that exercise is better. Since I was told both these things by the same staff nurse it’s not helpful!

          Based on experience, a little exercise is beneficial, but too much is seriously bad news on the pain front, and the only thing I appear to get from elevating my leg is more pain when I lower it again. Telling this to the nurses is a total waste of time, and I’m hoping I can get some sense out of the doc next week.

          I’ve also tried bed rest, but all that happens is that I fall asleep, miss most of my meds and feel terrible as a result!

          It’s all very well for the nurses to say “keep your leg(s) elevated” but for most people attempting to live normal lives, it’s impossible – too many things get in the way. And when my legs were at their worst, I’d get some relief from my new bed, overnight, but not any longer.

          I’m convinced that the “one size fits all” remedy of elevating swollen legs needs to be re-evaluated, because I don’t think it does work for everybody, and I’m not about to give up what little life I have left for something which, for me at least, is unproven. And if you want to try either elevation or exercise, you WILL need better pain meds and – again based on my experience – simpler is better, and morphine works well for me, with the benefit that I can increase the dose without the worry I’m going to poison myself as it’s the only pain drug I have. It seems to be reasonably free of side-effects, unlike Gabapentin, which causes convulsions. Oramorph is somewhat bitter, but I’ve taken worse – it certainly doesn’t justify all the whining you’ll find online about the taste, but that’s the problem with online reviews – you rarely hear from satisfied customers!

          Might be worth talking to your GP about morphine. Yes, it’s addictive, but so are codeine and DHC. I felt a bit fluey for few days when I stopped DHC, but that’s all. Some GPs are scared of morphine from what I’ve been told, and will go for doses that are too low to be effective, but 10ml seems about right for me for Oramorph, or 50-60mg for Zomorph, which is what the current guy suggested. And that’s part of my problem – I seem to have walked into the middle of a feud between him and the other guy, who keeps trying to cut back on everything I’m taking and would be happy if I took 2.5ml of Oramorph – which does nothing!

          So I’m keeping records of all the morphine I take, so he can’t claim I’m taking too much. So far I’m winning the arguments – but I’m hoping he gives up soon – I don’t need the hassle.

          Unlike most users, though, I don’t get any of the fun from morphine – seems a bit unfair!

          • OMG Ron, i hope i haven’t reached the stage of needing morphine already. this is the first time i have had fluid filled legs which resulted in, (didn’t have it while swollen) pain. one leg is completely down and ok. the other one (right leg) is only swollen around the calf. as i said before and its that one i get the pain in mostly.only get just an occasional twinge in the left one….
            have had oedema before but nothing like this years. have now had it from march till now as have half of my town due to the hot weather.according to my doc. am hearing from people on the net as is my daughter and son, of countless others in other areas with the same problems this year. its robbed us all of being able to enjoy our summer. best one we’ve had in years.
            as for elevating legs……….. i do try to lay on bed with feet on 3 pillows (as high as my old body will allow) while i talk to friends on the phone. or,if i am tired ill have a nap. either way, the swelling appears to go down by time i get off the bed and doesnt come up quite as much the rest of that day. my doc suggested 2 hours in an afternoon. all fine while im at home but as my family are all busy in mornings, afternoons are usually the time i talk to them on here or want to do things with them. or i get appointments for afternoons so my daughter can go with me….as for exercise. starting walking to gate or over to a neighbours about 50 yards away, 2-3 times a day. as my daughter suggested i do. have turned down a trip to Derbyshire today by car as i dont think that would help at all. too long sitting in a car. although the small amount of walking i would do, would probably help. i aren’t finding the bit of walking i do makes the pain worse. not so far anyway. but to be fair, i dont think this swelling is completely fluid related. its possible i have an infection. so i am off to docs again on Monday. i do have some flucloxicillin in but as it doesnt seem to be my skin that’s the problem other than needing cream on night n morning to stop the tightness, i haven’t taken the antibiotics, anyway., at this moment in time, the co codamol i took at 11am seem to be working. half an hour and i can take more if i need to.
            thanks for all your very helpful advice. if not needed right now im sure it will be sooner or later. so i keep your emails with specific advice like this.

            • Nothing to be afraid of with morphine – it’s good stuff. But if Co-codamol is getting the job done for now, at least you know there’s a fall-back position for when it doesn’t.

              And one thing I noticed – when the swelling in my left leg went down, the pain in the right went off the scale. I can’t get a straight answer from the nurses (because I really don’t think they have the in-depth knowledge I was expecting), but my theory is that as one leg gets smaller, the fluid that previously went into it has nowhere to go but the other leg – which is already full. Hence the pain.

              Incidentally, you might find it easier to raise the foot of the bed, rather than use pillows, using these

              http://www.completecareshop.co.uk/disability-elderly-aid/8697/elephant_feet.html or these

              http://www.completecareshop.co.uk/disability-elderly-aid/8698/elephant_feet_tall.html These are the lowest prices I can find.

              Or ask for a district nurse or OT referral – loads of stuff, even my bed, can be had free if you can push the right buttons.

    • Hospital appointment on Tuesday. Booked the ambulance and told I need to be ready two hours early. Bloody good luck with that. If they arrive at 08.45 they can sod off!

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