Bardda1
11-06-2004, 04:53 PM
Hi, I just found this site and from reading everything I'm sure you all will have some good advice.
My husband has had several back surgeries over the past three years including a fusion and a spinal nerve stimulator implant. He is still in tremendous pain and has been diagnosed with "failed back surgery symdrome". He has been taking Vicodin for a long time and about 18 months ago was referred to a PM who tried him on Methadone that didn't help much and then switched him to Oxycontin. For the first few months the Oxycontin helped a alot, now not so much.
Our problem now is that since the spinal nerve stim was implanted last March, he has not been able to keep much food down and has lost over 40 lbs on an already slender body. He is 6'1 and has gone from 185 to 144. Not only does he not have any desire to eat, but when he tries he usually throws it up. Our GP has been looking for other reasons for the weight loss and his upper GI showed just inflamation which he said was caused by the pain meds. He takes Compazine and Protonix for nausea and stomach pain, but it really doesn't help much. He feels weak and sick much of the time. When I asked our GP's nurse what do we do now, she said "talk to the PM, he's the one giving him all this stuff". The PM's only thought is to increase the amount of pain meds which just makes his stomach problems worse.
Any advice here? He is literally wasting away. Is there a patch or something that might be helpful and not irriitate the stomach?
My husband has had several back surgeries over the past three years including a fusion and a spinal nerve stimulator implant. He is still in tremendous pain and has been diagnosed with "failed back surgery symdrome". He has been taking Vicodin for a long time and about 18 months ago was referred to a PM who tried him on Methadone that didn't help much and then switched him to Oxycontin. For the first few months the Oxycontin helped a alot, now not so much.
Our problem now is that since the spinal nerve stim was implanted last March, he has not been able to keep much food down and has lost over 40 lbs on an already slender body. He is 6'1 and has gone from 185 to 144. Not only does he not have any desire to eat, but when he tries he usually throws it up. Our GP has been looking for other reasons for the weight loss and his upper GI showed just inflamation which he said was caused by the pain meds. He takes Compazine and Protonix for nausea and stomach pain, but it really doesn't help much. He feels weak and sick much of the time. When I asked our GP's nurse what do we do now, she said "talk to the PM, he's the one giving him all this stuff". The PM's only thought is to increase the amount of pain meds which just makes his stomach problems worse.
Any advice here? He is literally wasting away. Is there a patch or something that might be helpful and not irriitate the stomach?
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jbot
11-06-2004, 09:07 PM
Hi Bar and welcome. I have almost the same problem but don`t throw up. I just stay sick to my stomach all the time.When the dr ran the tube to look he said the same thing they told your hubby.He put me on librax (sp) and OTC medicine for gas. There is a pain patch but it caused me to be sicker and didn`t help with the pain.Alot of people on this board use it with great results. It does by pass the tummy so it looks like it would be better. Codeine is very bad on my stomach so I take OTC Prilosec and that does help but has to be taken every day for months to keep working. It sounds like the GP don`t want to deal with your hubby because he thinks the PM dr did it. But no matter who gave the meds the bottom line is your hubby needs help. My friend has been having chemo and the dr gave her something that keeps her from being sick.I sure hope you find help and maybe some one else on the board will have better information then I have. Maybe look for another GP. Good luck dear.............
vamp36
11-07-2004, 04:18 PM
I also had this problem. I now have anti nausea meds that my doctor prescribes for me. I take them when I start to feel nausea and then it goes away. Stops me from vomiting. they are Reglan, phenergan and Zofran. The Zofran is VERY expensive so I only use it when I am really bad. I also am on Nexium for my stomach. The protonix didn't do much to help me. The Reglan I take an hour before breakfast and supper and I can eat then without throwing everything up. Good luck to you and your husband. Tina
Streetcar
11-08-2004, 08:05 PM
Hi Bardda,
Welcome to the PM board, I don't know anything about the spinal nerve stim, but from the symptoms and the the time line you've placed events on it sounds to me like its the stim implant that is causing the nausea. Is that something that is easily reversible? If it was, I'd see about doing that and resuming the PM where it was pre-implant until he got stable and then begin exploring other means of treating his pain.
I'd definately be looking for another PCP. It may very well be that your PM dr got your hubby into this mess; but, your PCP is supposed to be your ADVOCATE in all things pertaining to your health, not a finger pointer or "I told you so" person. It sounds to me like your PCP is very anti-opiate to come out and say the the inflammation is caused by the pain meds based sloely on an upper GI. There could be any number of causes for that inflammation and the PCP should be doing more test to pin-point the cause rather than basically saying "you got yourself into this mess, now get yourself out". How rude and non-compassionate for any dr, let alone your PCP. PCP should at least, the very least advise you to see a different PM dr. Here I am assuming that the PM dr did the implant, you didn't say.
I don't know if the state that you live in is one that has legalized marijuana for medical purposes but if it is, at this point I would probablly look into that as part of the overall treatment plan. From what I understand, it has proven be somewhat affective where there has been an on-going weight/nuesea problem. I'm not a pot head or anything close to it but at this point I'd do just about anything if I were in your hubbies shoes.
Sorry to rant, but I can feel the despair that your going thru and it makes me mad that chronic pain sufferers (or anybody else for that matter) get this kind of treatment from a medical proffessional.
I'll be praying for your husband that he gets the proper treatment.
Welcome to the PM board, I don't know anything about the spinal nerve stim, but from the symptoms and the the time line you've placed events on it sounds to me like its the stim implant that is causing the nausea. Is that something that is easily reversible? If it was, I'd see about doing that and resuming the PM where it was pre-implant until he got stable and then begin exploring other means of treating his pain.
I'd definately be looking for another PCP. It may very well be that your PM dr got your hubby into this mess; but, your PCP is supposed to be your ADVOCATE in all things pertaining to your health, not a finger pointer or "I told you so" person. It sounds to me like your PCP is very anti-opiate to come out and say the the inflammation is caused by the pain meds based sloely on an upper GI. There could be any number of causes for that inflammation and the PCP should be doing more test to pin-point the cause rather than basically saying "you got yourself into this mess, now get yourself out". How rude and non-compassionate for any dr, let alone your PCP. PCP should at least, the very least advise you to see a different PM dr. Here I am assuming that the PM dr did the implant, you didn't say.
I don't know if the state that you live in is one that has legalized marijuana for medical purposes but if it is, at this point I would probablly look into that as part of the overall treatment plan. From what I understand, it has proven be somewhat affective where there has been an on-going weight/nuesea problem. I'm not a pot head or anything close to it but at this point I'd do just about anything if I were in your hubbies shoes.
Sorry to rant, but I can feel the despair that your going thru and it makes me mad that chronic pain sufferers (or anybody else for that matter) get this kind of treatment from a medical proffessional.
I'll be praying for your husband that he gets the proper treatment.
Bardda1
11-10-2004, 02:52 PM
Thanks very much for the replies. My husband saw the GP again yesterday. He's lost 15 lbs in the past month since he saw him last. He got a referral to a gastroenterologist and he will see him on Tuesday. Maybe he'll have an answer. He also prescribed Reglan (thank you to the person who told me about that. The doc thinks that might be a good idea). I am waiting for a call back from the neurosurgeon who put in the nerve stimulator. I want to ask him if he's every seen this as a side effect of the implant. Everyone we've talked to so far says no, but I still want to ask.
I have another question...my husband is so fearful of being dependent on pain meds, although he knows he already is. His PM doc wants him to take 20 mg of Oxycontin 3 times a day, but he usually only takes it once a day, maybe twice if the pain is especially bad. And sometimes he'll take 10 mg instead of 20, especially if his stomach is having problems. He worries that if he takes 60 mg a day, it won't be long before he'll require twice that amount to relieve his pain. I'm thinking that maybe his body is withdrawing on a daily basis because he has 8 or 16 hours of pain meds in his body and 8 hours of no meds? Everyone keeps saying the stomach problems are caused by the pain meds, but maybe it's caused by not enough pain meds??
Thanks very much for replies. :)
I have another question...my husband is so fearful of being dependent on pain meds, although he knows he already is. His PM doc wants him to take 20 mg of Oxycontin 3 times a day, but he usually only takes it once a day, maybe twice if the pain is especially bad. And sometimes he'll take 10 mg instead of 20, especially if his stomach is having problems. He worries that if he takes 60 mg a day, it won't be long before he'll require twice that amount to relieve his pain. I'm thinking that maybe his body is withdrawing on a daily basis because he has 8 or 16 hours of pain meds in his body and 8 hours of no meds? Everyone keeps saying the stomach problems are caused by the pain meds, but maybe it's caused by not enough pain meds??
Thanks very much for replies. :)
Streetcar
11-10-2004, 08:07 PM
Hi Bardda,
The last thing your husband wants to do is cut an Oxycontin in half. They are made to releas half of the med at about one hour and the other half about hour 7 (approx). By cutting it in half there is no way of telling exactly how much med he will be getting in that dose. They way they're made it's 10mgs per half like you would think. None of us want to be dependent on narcotics, but if he has been taking them for more than a couple of days he is already depedent on them. I think all of us confuse dependence with addiction until we learn the difference. Addiction is a psychological problem that involves drug seeking behavior along with always looking for the HIGH that accompanies a new dosage (the high is the first thing that is lost with a new med or higher dose even though the analgesic effect is still there) and dependence is when the body requires any given med to function. A diabetic and their insulin is a good example of dependence and we certainly wouldn't think of them as an addict. It's the same with pain med dependence. Since your husband is already dependent on opiods he is only making himself miserable by not trying the Rx'd dosing. I know that there is some concern about the Oxy causing the stomach problems but he might find that taking the full dosages makes no difference to his stomach problems. You didn't say how long he has been on the Oxy but there are side effects to all pain meds and unless you give each one a couple of weeks at least you'll never know if those are going to go away or not.
As to needing an increase in dosage frequently, he will become tolerant to any given dose given enough time but that could be years once an adequate dose is established. He and his PM dr need to establish what an exceptable level pain is and make that their goal. For most of us CP sufferers pain free is NOT a reality but finding a level that we can live with is. Once that optimal level has been acheived, he might stay on the same meds at the same doses for quite some time unless of course things change.
Be Comfortable!
The last thing your husband wants to do is cut an Oxycontin in half. They are made to releas half of the med at about one hour and the other half about hour 7 (approx). By cutting it in half there is no way of telling exactly how much med he will be getting in that dose. They way they're made it's 10mgs per half like you would think. None of us want to be dependent on narcotics, but if he has been taking them for more than a couple of days he is already depedent on them. I think all of us confuse dependence with addiction until we learn the difference. Addiction is a psychological problem that involves drug seeking behavior along with always looking for the HIGH that accompanies a new dosage (the high is the first thing that is lost with a new med or higher dose even though the analgesic effect is still there) and dependence is when the body requires any given med to function. A diabetic and their insulin is a good example of dependence and we certainly wouldn't think of them as an addict. It's the same with pain med dependence. Since your husband is already dependent on opiods he is only making himself miserable by not trying the Rx'd dosing. I know that there is some concern about the Oxy causing the stomach problems but he might find that taking the full dosages makes no difference to his stomach problems. You didn't say how long he has been on the Oxy but there are side effects to all pain meds and unless you give each one a couple of weeks at least you'll never know if those are going to go away or not.
As to needing an increase in dosage frequently, he will become tolerant to any given dose given enough time but that could be years once an adequate dose is established. He and his PM dr need to establish what an exceptable level pain is and make that their goal. For most of us CP sufferers pain free is NOT a reality but finding a level that we can live with is. Once that optimal level has been acheived, he might stay on the same meds at the same doses for quite some time unless of course things change.
Be Comfortable!
twisten
11-15-2004, 12:54 AM
The way I see it is if the pain meds were causing it the problem should have started sooner. He was on them for quite awhile before the vomitting and such showed up wasn't he? To answer your question about withdrawal, yes it could be withdrawal that is happening BUT if he has never taken the 60 mg dose he is supposed to then it wouldn't be. You usually have other symptoms with withdrawal as well though such as diarrhea, hot/cold flashes, restless leg syndrome just to name a few. I think it is a good thing that he will be seeing a GI doc. Hopefully this doc will find the problem. Good luck and let us know how he makes out.
Izzybella
11-15-2004, 02:25 AM
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Director
11-15-2004, 01:55 PM
Maybe I just missed it when reading through the posts here about what to do for your husband. You mentioned you'll be seeing a GI doctor. I would ask him or your PM doctor about going on the Duragesic patch. It's the strongest pain med available and the patches come in 25-100 micrograms. That way he wouldn't have to swallow any pills except possibly a pill for BT pain if he needed it. Give it some thought and maybe run it by the doctors.
Bardda1
01-01-2005, 05:13 PM
Thanks everyone for the replies.
Since my first post my husband has had an endoscopy and a lower GI. After the endoscopy the Gastroenterologist told me that he found some minor inflamation in his stomach and a hiatal hernia (which the upper GI had previously showed he DEFINITELY did not have?) but he told me that this would not be causing his nausea/vomiting problem. The next day he had the lower GI and the report was sent to our family doctor as well as the gastro doc and the family doc called us to say it was completely normal. So the following week we went back to the gastro doc and he said that the inflamation IS the cause of the nausea/vomiting (contrary to what he told me a week before) and that if the could just "tough it out" and get off the pain meds he "guarantees" that all his problems would be solved. He told him to take Protonix (which he already tried and it didn't work) and to see him again in two months. So now I guess my husband is supposed to chose between being flat on his back with severe pain or being able to eat?
I specifically asked this guy before my husband had the tests done what we would do if the tests didn't show the cause of the problem. He said that he would keep looking for the cause. So he didn't find the cause and he is not looking for any other reason?
I just don't understand how you can take a pain medication for a year with no problem and then suddenly it starts causing problems?
I am concerned that all this medications he's been on could have caused liver damage and his tests do show dense calcification on his liver. But since his blood tests are normal, they won't let him get an ultrasound to rule that out. I know from internet research that liver diseases don't always show up in blood tests until it is far advanced...but I also know that some doctors HATE IT when you do your own research.
Sorry to rant. The pain management doctor just seems to shrug all this off and write him another prescription. The vomiting has slowed down some, but I guess you can't vomit if you didn't eat anything in the first place. He is just getting so weak, and I don't know where to go from here.
Since my first post my husband has had an endoscopy and a lower GI. After the endoscopy the Gastroenterologist told me that he found some minor inflamation in his stomach and a hiatal hernia (which the upper GI had previously showed he DEFINITELY did not have?) but he told me that this would not be causing his nausea/vomiting problem. The next day he had the lower GI and the report was sent to our family doctor as well as the gastro doc and the family doc called us to say it was completely normal. So the following week we went back to the gastro doc and he said that the inflamation IS the cause of the nausea/vomiting (contrary to what he told me a week before) and that if the could just "tough it out" and get off the pain meds he "guarantees" that all his problems would be solved. He told him to take Protonix (which he already tried and it didn't work) and to see him again in two months. So now I guess my husband is supposed to chose between being flat on his back with severe pain or being able to eat?
I specifically asked this guy before my husband had the tests done what we would do if the tests didn't show the cause of the problem. He said that he would keep looking for the cause. So he didn't find the cause and he is not looking for any other reason?
I just don't understand how you can take a pain medication for a year with no problem and then suddenly it starts causing problems?
I am concerned that all this medications he's been on could have caused liver damage and his tests do show dense calcification on his liver. But since his blood tests are normal, they won't let him get an ultrasound to rule that out. I know from internet research that liver diseases don't always show up in blood tests until it is far advanced...but I also know that some doctors HATE IT when you do your own research.
Sorry to rant. The pain management doctor just seems to shrug all this off and write him another prescription. The vomiting has slowed down some, but I guess you can't vomit if you didn't eat anything in the first place. He is just getting so weak, and I don't know where to go from here.
twisten
01-04-2005, 04:39 PM
Have you mentioned trying the duragesic patch to his pm doc? I didn't read anywhere in your posts that this had been tried. At this point I would try to get him into a different GI, keeping in mind GI's are notorious for not wanting there patients on any narcotic. I go through stages also where I can't eat anything without it coming back up. On those days I try to take things like soup, supplements such as boost or ensure, ice cream, fudgesicles are one of my favorites. Good luck and I hope you find help for your husband soon.