klh121560
01-20-2005, 09:53 AM
I still don't get it. I will use Dilaudid/Palladone as my example.
If someone is Rx'd dilaudid 8mg every 6hr, that means 32mg daily total. Now we switch to palladone 32mg once a day.
Let us say for argument sake that the 8mg every 6 hrs was working fine for the patient. Now comes palladone, Rx'd at 32mg once a day, the total amount used on the dilaudid. (Isn't that how you told me docs figure the amount from short to long).
Well the 32mg of palladone is over a 24hr period or really 1.3mg/hr. So the patient is getting 1.3mg hr which is really very little.
I never get this. It is just like percocet and oxycontin. Two 10mg/325 percocets do not equal one 20mg oxycontin in pain relief. At least in my humble opinion.
It should be rather, that if a 10/325 percocet helped a patient get relief, then we would want to have that 10/325 percocet working all day long at that level, not a small division of that level all day.
Does this question make sense? I hope so. This is why I think many docs get scared at higher RX dosages. They see the number, but don't realize it is spread often over a 12/24 hour period.
The LA meds don't have the stregth as the SA ones, but supposedly the steady serum blood level argument is used to suffice. Meanwhile patients only get a fraction of real pain relief.
Are my calculations and conclusions wrong? What are your thoughts? and anyone else who cares to answer ?
Peace,
Ken
If someone is Rx'd dilaudid 8mg every 6hr, that means 32mg daily total. Now we switch to palladone 32mg once a day.
Let us say for argument sake that the 8mg every 6 hrs was working fine for the patient. Now comes palladone, Rx'd at 32mg once a day, the total amount used on the dilaudid. (Isn't that how you told me docs figure the amount from short to long).
Well the 32mg of palladone is over a 24hr period or really 1.3mg/hr. So the patient is getting 1.3mg hr which is really very little.
I never get this. It is just like percocet and oxycontin. Two 10mg/325 percocets do not equal one 20mg oxycontin in pain relief. At least in my humble opinion.
It should be rather, that if a 10/325 percocet helped a patient get relief, then we would want to have that 10/325 percocet working all day long at that level, not a small division of that level all day.
Does this question make sense? I hope so. This is why I think many docs get scared at higher RX dosages. They see the number, but don't realize it is spread often over a 12/24 hour period.
The LA meds don't have the stregth as the SA ones, but supposedly the steady serum blood level argument is used to suffice. Meanwhile patients only get a fraction of real pain relief.
Are my calculations and conclusions wrong? What are your thoughts? and anyone else who cares to answer ?
Peace,
Ken
Sponsor
mommy2scl
01-20-2005, 10:03 AM
Now mind you I am no expert at this by any means, but 8mg of dilaudid every six hours is not actually having 8 mg in your system at a steady level for 6 hours either. It is 1.333 per hour. If you divide 32mg by 24 hours you come up with the same amount 1.333 in your system. So what is the difference?? I don't see what the issue is?? Should a doctor be dosing you to keep 8mg times 24 hours - 192mg???? Every knows that 8 mgs of dilaudid every 6 hours does not keep a serum level of 8 mgs the whole 6 hours. You would actually be better off with the long acting one especially with dilaudid which has a rather short half life and never lasts 6 hours. Now if you were to push 8 mg of dilaudid in an IV it would probably kill you as it would deliver the entire 8 mg at once. Even a short acting med does not dump it all in your system at once - at least I don't think it does, like I said I am no expert at this. But with your example, I don't understand your confusion.
8mg every 6 hours equals 1.3333 per hour
32mg every 24 hours equals 1.333 per hour
mommy
8mg every 6 hours equals 1.3333 per hour
32mg every 24 hours equals 1.333 per hour
mommy
klh121560
01-20-2005, 07:56 PM
Yes this is what I thought. I try to explain this to docs, but they just don't seem to get it or they do and just don't want to Rx what is really needed which is a higher dosage.
Just making sure I ain't crazy! (yet!)
- Ken
Just making sure I ain't crazy! (yet!)
- Ken
wirry1422
01-21-2005, 02:29 AM
Ken, the problem is you don't understand the release mechanics of the la meds. They do not evenly split the total dose over each hour, but rather deliver a "bolus" of medication immediatly, and another bolus in several hours. For example, oxycontin 20 mg (12 hour dosing) delivers 10 mg within the first 90 minutes, much like percocet 10/325, and then it releases another 10 mg at the six hour mark, much like taking a second percocet 10/325. The oxycontin 20 mg does not release 1&2/3 mg's every hour as you have eroneously indicated. Rather it releases the meds in the same increment as taking 1 percocet 10/325 every six hours. The 24 hour meds (avinza, palladone) release their meds in a very similar fashion as the 12 hour meds, only over a 24 hour period. And no, the serum level created by an oxycontin is not level, but simply more level than the serum level created by an ir med. However, if you read the full prescribing info for oxycontin, you will notice a serum chart showing two distinct peaks in the serum level, only the dips are less then on the chart for the equivalent ir meds, thus showing the superiority of oxycontin in achieving higher average serum levels than ir meds. That is why la meds are a better choice than ir meds, for chronic pain patients and anyone on high doses of opiates/opioids, not to mention the conveniece of la dosing, ken.
klh121560
01-21-2005, 09:58 AM
Thank you for the clear up. I always believed in LA meds. I actually should be going to methadone soon and staying with it. I will use oxycodone as a BT med. Thanks for everyones input !
Ken
Ken
Shoreline
01-21-2005, 10:13 AM
Verry good guys, You have explained it perfectly. It's all about the release mechanism ken doesn't seem to understand. Wirry and mommy explained it perfectly.
If you continue too fight for continued use of SA meds to treat chronic pain which should mean you have been dealing with this for a while and will be dealing with it for even longer, What's a few weeks or months of titration to get the dose adjusted compared to a lifetime of pain.
The SA dilaudid has a very shoprt half life, barely over 2 hours, so by the sixth hour you have 1/2 or 1/2 of 1/2 of the original dose, and virtually nill in your system by the time for your next dose. The doc's assumption and most folks familiar with PM and the meds you want are aware that SA dilaudid hits fast and hard and barely offers 3 hours of relief. If you associate that feeling 40 minutes after taking a pill, "the warm fuzzies" with pain reief, you will never be satisfied with any pain med regardless of the dose and regardless of the med.
The LA's are designed to have a smooth slow onset and maintain a constant serum level. There is no way you can possibly maintain a constant serum level with QID dosing of oral dialaudid.
You seem to be quite worked up over the fear of your doc taking away your SA dilaudid or not making the proper conversion. Have you not been in pain a while, do you not expect to have to deal with this for some time, You may very well want your doc to start you on the highest strenght dose of a med with a release ssytem you or nobody else has ever tried outsideof clinical trials where narcan is kept on hand.
So what if he starts you at less than your SA mg dose, do you not think he will be willing to adjust your dosage to suite your individual needs. A few weeks or months of titrastion is nothing comapred to facing a life tme of living in pain.
The highest strength dose will come with the same warning about use in opiate tolerant patients and caution in prescribing the 32mg capsules. Although you may want it, it doesn't mean your family won't sue the doc if you OD. That's the big catch, The patient wants it, but the surviving families are quick to sue when the family member who claimed they couldn't live with suicidal levels of pain any longer OD's on a med the very fisrt day it makes it to market.
The full presccibing info may very well be just Like Kadians' FPI. Calcualte the dose and start at half. By not following the prescribing directions the doc leaves himself open to lawsuits from the demanding patients families who are angry that the doc OD the patient.
This med hasn't even hit the market, you have never taken it, How do you know you will not be satisfied with whatever dose he prescibes. It's a brand new med, Expect him to start on the cautious side and titrate you acordingly. I would assume you have lived with pain for a while and expect to for a while, making the use of these meds neccesarry. What's a few weeks of titration and adjusting doses compared to the big picture.
Can you remeber a time when your pain wasn't treated at all or have the most potent meds always been available to you and you have never tried to learn to live with it using non opiate modalities.
The dissatisfaction with what he may prescribe sounds more like a patient that prefers SA meds because they do have a fast onset and you do feel it. SA dilaudid barely lasts 3 hours due to a half life of barely 2 hours, you are on the downside after the 2 hour with SA Dialaudid, Why would a patient argue to continue on with a med that doesn't last the way it's prescribed now.
Dilaudid is highly abused and easily abused IV. Instead of feeling lucky to have a doc treating you, you are bashing your doc and aking how to make him understand .
La meds will not have that onset and "wack" that SA meds have. If you associate that feeling when SA meds are at their peak with actual pain relief, you will never be satisfied with any long acting med, which will eventually become clear to the doc and then you will get a chance to learn to deal with the pain without any meds.
I think you may be the first person to complain about his docs prescribing of a med before it even hits the market. Titration is part of using long acting meds. Initial trial of a brand new release system isn't going to be based entirely on your wants. It will be based on the pescribing instructions and common sense that says you don't start a patient on the most potent dose of any new med untill you know their response.
SO it takes a few weeks or months to get it right. What's that compared to years before and years ahead of having to deal with the same problem you need the meds for.They started my pump at 2 mgs per day, They increased it from 10 to 12 mgs a few days ago, It took 6 months just to get back where I was and Now I'm actaully gainng ground.My first dozen increases were .4mgs a day to .6 mgs a day, But when it comes to deaing with this for life, 6 months isn't a long time. I also have to look forward to switching from IT morphine to IT diluaid. Will he hit the nail on the head, on the first shot, NO. My doc even acknowledges that. It will take a couple tweaks to get it correct, But I can deal with it because I have no other choice and I know there is light at the end of the tunnel.
If Palladone has the same prescribing instructions for initial use as Kadian, you will start at half of your present dose to be safe and titrate upwards. IF a doc disregards the prescribing instructions based on clinical trials of a brand new med, when you OD because you know better than the doc about a med that's not even available, your family will sue and win because the doc listened to the patient more than the PDR and the manufacturers full prescribing info.
So what is it that you actually want. The same number of mgs of the SA meds or to just stick with th SA meds alltogether? Pick a % increase over the SA meds out of the sky? This version has an 18 hour half life so basically it's a brand new medication to you, and all he knows for certain is your not alergic to dilaudid.
He doesn't know if you will be back wanting BID dosing, or a 50 increase or a 20 decrease to avoid barfing. So they play it safe, start on the low side and work with you and the med. If you don't understand the need to be safe with these meds you really have no understanding of the potency and ability to do more harm then good these meds have for some people.
If your unwilling to work with your doc, and kick and scream about your starting dose he may suggest you find another doc that's willing to work with a patient that has complaints about a med before it even hits the market, which may be hard to find .
Good luck, Dave
If you continue too fight for continued use of SA meds to treat chronic pain which should mean you have been dealing with this for a while and will be dealing with it for even longer, What's a few weeks or months of titration to get the dose adjusted compared to a lifetime of pain.
The SA dilaudid has a very shoprt half life, barely over 2 hours, so by the sixth hour you have 1/2 or 1/2 of 1/2 of the original dose, and virtually nill in your system by the time for your next dose. The doc's assumption and most folks familiar with PM and the meds you want are aware that SA dilaudid hits fast and hard and barely offers 3 hours of relief. If you associate that feeling 40 minutes after taking a pill, "the warm fuzzies" with pain reief, you will never be satisfied with any pain med regardless of the dose and regardless of the med.
The LA's are designed to have a smooth slow onset and maintain a constant serum level. There is no way you can possibly maintain a constant serum level with QID dosing of oral dialaudid.
You seem to be quite worked up over the fear of your doc taking away your SA dilaudid or not making the proper conversion. Have you not been in pain a while, do you not expect to have to deal with this for some time, You may very well want your doc to start you on the highest strenght dose of a med with a release ssytem you or nobody else has ever tried outsideof clinical trials where narcan is kept on hand.
So what if he starts you at less than your SA mg dose, do you not think he will be willing to adjust your dosage to suite your individual needs. A few weeks or months of titrastion is nothing comapred to facing a life tme of living in pain.
The highest strength dose will come with the same warning about use in opiate tolerant patients and caution in prescribing the 32mg capsules. Although you may want it, it doesn't mean your family won't sue the doc if you OD. That's the big catch, The patient wants it, but the surviving families are quick to sue when the family member who claimed they couldn't live with suicidal levels of pain any longer OD's on a med the very fisrt day it makes it to market.
The full presccibing info may very well be just Like Kadians' FPI. Calcualte the dose and start at half. By not following the prescribing directions the doc leaves himself open to lawsuits from the demanding patients families who are angry that the doc OD the patient.
This med hasn't even hit the market, you have never taken it, How do you know you will not be satisfied with whatever dose he prescibes. It's a brand new med, Expect him to start on the cautious side and titrate you acordingly. I would assume you have lived with pain for a while and expect to for a while, making the use of these meds neccesarry. What's a few weeks of titration and adjusting doses compared to the big picture.
Can you remeber a time when your pain wasn't treated at all or have the most potent meds always been available to you and you have never tried to learn to live with it using non opiate modalities.
The dissatisfaction with what he may prescribe sounds more like a patient that prefers SA meds because they do have a fast onset and you do feel it. SA dilaudid barely lasts 3 hours due to a half life of barely 2 hours, you are on the downside after the 2 hour with SA Dialaudid, Why would a patient argue to continue on with a med that doesn't last the way it's prescribed now.
Dilaudid is highly abused and easily abused IV. Instead of feeling lucky to have a doc treating you, you are bashing your doc and aking how to make him understand .
La meds will not have that onset and "wack" that SA meds have. If you associate that feeling when SA meds are at their peak with actual pain relief, you will never be satisfied with any long acting med, which will eventually become clear to the doc and then you will get a chance to learn to deal with the pain without any meds.
I think you may be the first person to complain about his docs prescribing of a med before it even hits the market. Titration is part of using long acting meds. Initial trial of a brand new release system isn't going to be based entirely on your wants. It will be based on the pescribing instructions and common sense that says you don't start a patient on the most potent dose of any new med untill you know their response.
SO it takes a few weeks or months to get it right. What's that compared to years before and years ahead of having to deal with the same problem you need the meds for.They started my pump at 2 mgs per day, They increased it from 10 to 12 mgs a few days ago, It took 6 months just to get back where I was and Now I'm actaully gainng ground.My first dozen increases were .4mgs a day to .6 mgs a day, But when it comes to deaing with this for life, 6 months isn't a long time. I also have to look forward to switching from IT morphine to IT diluaid. Will he hit the nail on the head, on the first shot, NO. My doc even acknowledges that. It will take a couple tweaks to get it correct, But I can deal with it because I have no other choice and I know there is light at the end of the tunnel.
If Palladone has the same prescribing instructions for initial use as Kadian, you will start at half of your present dose to be safe and titrate upwards. IF a doc disregards the prescribing instructions based on clinical trials of a brand new med, when you OD because you know better than the doc about a med that's not even available, your family will sue and win because the doc listened to the patient more than the PDR and the manufacturers full prescribing info.
So what is it that you actually want. The same number of mgs of the SA meds or to just stick with th SA meds alltogether? Pick a % increase over the SA meds out of the sky? This version has an 18 hour half life so basically it's a brand new medication to you, and all he knows for certain is your not alergic to dilaudid.
He doesn't know if you will be back wanting BID dosing, or a 50 increase or a 20 decrease to avoid barfing. So they play it safe, start on the low side and work with you and the med. If you don't understand the need to be safe with these meds you really have no understanding of the potency and ability to do more harm then good these meds have for some people.
If your unwilling to work with your doc, and kick and scream about your starting dose he may suggest you find another doc that's willing to work with a patient that has complaints about a med before it even hits the market, which may be hard to find .
Good luck, Dave
Shoreline
01-21-2005, 10:30 AM
Here is an example of a Ortho surgeon in my town that hasn't had hospital privlidges, mal practice ins and excepts no insurances, just a cash biz for prescriptions since 94, He "listens" and lets his patients pick and choose their meds and dose.
Chesapeake doctor charged with prescription scheme in which 4 died
© January 20, 2005 NORFOLK -- Dr. Sidney S. Loxley, a Chesapeake orthopedic surgeon long in trouble with the state medical board and local police, now faces a 91-count federal indictment charging him with operating a prescription drug service "that exceeded the bounds of legitimate medical practice."
Loxley's prescriptions, the indictment says, led directly to the deaths of at least four patients, a charge that could land him in prison for life if convicted. Loxley's wife also was charged in the indictment with 40 counts of fraud and money laundering.
Loxley was picked up late Wednesday near his home where Chesapeake police, assisting in serving the federal warrant, arrested him for a drunken driving charge as he pulled into his driveway intoxicated, where federal officers were waiting- the least of Loxley's problems.
He is accused in the indictment of prescribing Demerol, Dilaudid, Methadone, Oxycontin and other highly addictive drugs by the hundreds to patients, some already suffering from addiction.
A federal magistrate ordered Loxley and wife jailed without bond pending a hearing next week.
Loxley's attorney, Andrew Sacks, said the doctor was only trying to help patients suffering from chronic pain.
........................................ ........................................ ........................
This was back in september and he continued to practice up until yesterday.
September 9, 2004
CHESAPEAKE — An orthopedic surgeon who has been accused of being drunk while treating patients has been charged with driving while intoxicated and domestic assault.
Dr. Sidney Loxley was arrested last week by police who had received radio calls about a domestic disturbance at Loxley’s home on Shillelagh Road.
Loxley’s wife, Carol, called 911 about 10 a.m. Sept. 1 to report a domestic assault, said Christina Golden, police spokeswoman. Loxley also said that her husband had been drinking and had left their home.
Shortly after the call, a police officer spotted Sidney Loxley driving a green Hyundai and swerving on Shillelagh. When the officer pulled Loxley over at Dominion Boulevard and Cedar Road, Loxley’s speech was slurred and his eyes were bloodshot and watery, according to court documents.
Officer Charles Adams also wrote in court papers that Loxley had trouble walking a line during a sobriety test and fell at least once.
He also had difficulty touching his nose and reciting the alphabet.
Loxley was released later that day on $2,500 bail and is scheduled to appear in General District Court on Oct. 4.
Police records show that officers have been to Loxley’s home five other times since last summer on reports of domestic problems.
In June, federal authorities filed suit against Loxley in U.S. District Court, accusing him of treating patients while drunk, which they believe to be a factor in several deaths.
The suit seeks the forfeiture of Loxley’s office at Battlefield Boulevard and Kempsville Road and his home on Shillelagh Road. It also accuses the doctor of improperly prescribing narcotics and of conducting financial transactions with proceeds gained from illegal activity. Federal drug investigators searched Loxley’s home and office and seized thousands of patient records and other documentation.
The suit is a civil action, and Loxley has not been criminally charged by federal authorities.
The government sometimes files forfeiture actions as a precursor to criminal charges.
According to the suit, the Drug Enforcement Administration sent an undercover agent into Loxley’s office on several occasions.
The DEA agent, posing as a salesman with a shoulder injury, visited Loxley’s office several times. Loxley didn’t fully examine the agent’s shoulder, according to the suit, and gave him prescriptions for hundreds of pills, including Vicodin, Percocet, Bextra and Vistaril.
The suit also states that the agent smelled alcohol during at least one visit and investigators who took trash from Loxley’s home and office, they usually found empty liquor bottles. In October, Loxley was put on three years of probation by the state Board of Medicine for improperly prescribing drugs for his wife before they were married.
Carol Loxley was charged with two counts of illegally possessing Demerol. She pleaded guilty last year and received a three-year suspended sentence on each charge.
The October action was the second time in 10 years that Sidney Loxley had been disciplined by the medical board for misconduct.
........................................ ................................
This guy wasn't a PM doc, He was an Ortho surgeon that lost his licence, insurance and hospital privlidges for having an affair with an 17 year old patient and then marrying her the day after his divoivorce was final.
There are docs that will "listen" and give you whatever you want, you just have to worry about showng up and finding yellow tape across the doors of his office.
This won't effect local PM docs because he was not a PM doc. He was a well known soft touch with no ethics or morals and needs to be in jail where he can't harm anyone else or turn a patient with simple painful complaints into dependent repeat customers that pay cash.
Dave
Chesapeake doctor charged with prescription scheme in which 4 died
© January 20, 2005 NORFOLK -- Dr. Sidney S. Loxley, a Chesapeake orthopedic surgeon long in trouble with the state medical board and local police, now faces a 91-count federal indictment charging him with operating a prescription drug service "that exceeded the bounds of legitimate medical practice."
Loxley's prescriptions, the indictment says, led directly to the deaths of at least four patients, a charge that could land him in prison for life if convicted. Loxley's wife also was charged in the indictment with 40 counts of fraud and money laundering.
Loxley was picked up late Wednesday near his home where Chesapeake police, assisting in serving the federal warrant, arrested him for a drunken driving charge as he pulled into his driveway intoxicated, where federal officers were waiting- the least of Loxley's problems.
He is accused in the indictment of prescribing Demerol, Dilaudid, Methadone, Oxycontin and other highly addictive drugs by the hundreds to patients, some already suffering from addiction.
A federal magistrate ordered Loxley and wife jailed without bond pending a hearing next week.
Loxley's attorney, Andrew Sacks, said the doctor was only trying to help patients suffering from chronic pain.
........................................ ........................................ ........................
This was back in september and he continued to practice up until yesterday.
September 9, 2004
CHESAPEAKE — An orthopedic surgeon who has been accused of being drunk while treating patients has been charged with driving while intoxicated and domestic assault.
Dr. Sidney Loxley was arrested last week by police who had received radio calls about a domestic disturbance at Loxley’s home on Shillelagh Road.
Loxley’s wife, Carol, called 911 about 10 a.m. Sept. 1 to report a domestic assault, said Christina Golden, police spokeswoman. Loxley also said that her husband had been drinking and had left their home.
Shortly after the call, a police officer spotted Sidney Loxley driving a green Hyundai and swerving on Shillelagh. When the officer pulled Loxley over at Dominion Boulevard and Cedar Road, Loxley’s speech was slurred and his eyes were bloodshot and watery, according to court documents.
Officer Charles Adams also wrote in court papers that Loxley had trouble walking a line during a sobriety test and fell at least once.
He also had difficulty touching his nose and reciting the alphabet.
Loxley was released later that day on $2,500 bail and is scheduled to appear in General District Court on Oct. 4.
Police records show that officers have been to Loxley’s home five other times since last summer on reports of domestic problems.
In June, federal authorities filed suit against Loxley in U.S. District Court, accusing him of treating patients while drunk, which they believe to be a factor in several deaths.
The suit seeks the forfeiture of Loxley’s office at Battlefield Boulevard and Kempsville Road and his home on Shillelagh Road. It also accuses the doctor of improperly prescribing narcotics and of conducting financial transactions with proceeds gained from illegal activity. Federal drug investigators searched Loxley’s home and office and seized thousands of patient records and other documentation.
The suit is a civil action, and Loxley has not been criminally charged by federal authorities.
The government sometimes files forfeiture actions as a precursor to criminal charges.
According to the suit, the Drug Enforcement Administration sent an undercover agent into Loxley’s office on several occasions.
The DEA agent, posing as a salesman with a shoulder injury, visited Loxley’s office several times. Loxley didn’t fully examine the agent’s shoulder, according to the suit, and gave him prescriptions for hundreds of pills, including Vicodin, Percocet, Bextra and Vistaril.
The suit also states that the agent smelled alcohol during at least one visit and investigators who took trash from Loxley’s home and office, they usually found empty liquor bottles. In October, Loxley was put on three years of probation by the state Board of Medicine for improperly prescribing drugs for his wife before they were married.
Carol Loxley was charged with two counts of illegally possessing Demerol. She pleaded guilty last year and received a three-year suspended sentence on each charge.
The October action was the second time in 10 years that Sidney Loxley had been disciplined by the medical board for misconduct.
........................................ ................................
This guy wasn't a PM doc, He was an Ortho surgeon that lost his licence, insurance and hospital privlidges for having an affair with an 17 year old patient and then marrying her the day after his divoivorce was final.
There are docs that will "listen" and give you whatever you want, you just have to worry about showng up and finding yellow tape across the doors of his office.
This won't effect local PM docs because he was not a PM doc. He was a well known soft touch with no ethics or morals and needs to be in jail where he can't harm anyone else or turn a patient with simple painful complaints into dependent repeat customers that pay cash.
Dave
klh121560
01-21-2005, 07:07 PM
Dave (and all) -
I think you may have misunderstood my question/concern, or I just did not communicate it properly. First off, never have I, nor will I bash my doctor. I know how lucky I am too have him and I think he is great. My only concern was with his unwillingness to titrate to higher dosages of a pain medicine because of a fear I believe doctors to have about higher dosages and numbers. If a doctor Rx's say dilaudid at 4mg every say 6 hrs, but it is not working though the patient has tried it for weeks, the doctor should be willing to go higher, assuming the patient is good and not abusing or misdirecting his meds. It is either that, or keep changing meds. My point is thata doctor who then goes to LA meds, feels that the dosage equivalent to the SA dosage taken in one day is enough and often it is not. Many times doctors do not see that a long acting med has to be divided by the hours it is Rx'd. 24mg of anything that is taken once a day, is divided by 24. No ? Is this not 1mg an hr. If the LA release mechanism is different, then yes I agree this does not hold true.
I am in favor of LA meds for long term chronic pain. I have tried most LA meds for CP without luck which is why I will stay with methadone next time and use oxy (Percocet) as a short term BT.
The SA drug you mentioned (dilaudid( was actually Rx'd to me to see if it works so when palladone comes out I can be switched to it. Now having tried dilaudid, the 8mg/6hrs did not work. Nor did the 16mg. So I treid 24mg as a short term drug to see if it works at all and around 24mg to 28mg it does. So now I know that Palladone is not a true option for me since my PM doc will not go that high in Rx'ing Palladone at what would be an equivalent dosage.
Don't anyone get the idea I am looking or wanting SA meds. Nor don't think I am looking for the "warm fuzzies" as that is wrong. I hate the "warm fuzzies" becuase it clouds my thinking, and when I go back to work, I need to think clearly. Even now as I study, I need to think clearly. never did I mention this so assumption of what I think or want are not warrented.
Do I worry about LA meds not working fast enough? No! I feel I give any med I try long enough for it to work. That usually means at least one month (since my visits are 1/month) or two months. After that, if it is not working, I ask for a higher dosage. My doc goes to a point where he says his mental limit is. This is my disagreement. So I either live with it or find another doc. Unfortunately there is little to choose from.
Having barely enough to get by day to day, means living to get by day to day. I do not agree with it and will continue to fight for what I believe are my medical rights as I think we ALL are entitled too.
If I seem ticked, I am. I will say I am wrong for my communication. But please don't anyone put words in my mouth !
Peace,
Ken
I think you may have misunderstood my question/concern, or I just did not communicate it properly. First off, never have I, nor will I bash my doctor. I know how lucky I am too have him and I think he is great. My only concern was with his unwillingness to titrate to higher dosages of a pain medicine because of a fear I believe doctors to have about higher dosages and numbers. If a doctor Rx's say dilaudid at 4mg every say 6 hrs, but it is not working though the patient has tried it for weeks, the doctor should be willing to go higher, assuming the patient is good and not abusing or misdirecting his meds. It is either that, or keep changing meds. My point is thata doctor who then goes to LA meds, feels that the dosage equivalent to the SA dosage taken in one day is enough and often it is not. Many times doctors do not see that a long acting med has to be divided by the hours it is Rx'd. 24mg of anything that is taken once a day, is divided by 24. No ? Is this not 1mg an hr. If the LA release mechanism is different, then yes I agree this does not hold true.
I am in favor of LA meds for long term chronic pain. I have tried most LA meds for CP without luck which is why I will stay with methadone next time and use oxy (Percocet) as a short term BT.
The SA drug you mentioned (dilaudid( was actually Rx'd to me to see if it works so when palladone comes out I can be switched to it. Now having tried dilaudid, the 8mg/6hrs did not work. Nor did the 16mg. So I treid 24mg as a short term drug to see if it works at all and around 24mg to 28mg it does. So now I know that Palladone is not a true option for me since my PM doc will not go that high in Rx'ing Palladone at what would be an equivalent dosage.
Don't anyone get the idea I am looking or wanting SA meds. Nor don't think I am looking for the "warm fuzzies" as that is wrong. I hate the "warm fuzzies" becuase it clouds my thinking, and when I go back to work, I need to think clearly. Even now as I study, I need to think clearly. never did I mention this so assumption of what I think or want are not warrented.
Do I worry about LA meds not working fast enough? No! I feel I give any med I try long enough for it to work. That usually means at least one month (since my visits are 1/month) or two months. After that, if it is not working, I ask for a higher dosage. My doc goes to a point where he says his mental limit is. This is my disagreement. So I either live with it or find another doc. Unfortunately there is little to choose from.
Having barely enough to get by day to day, means living to get by day to day. I do not agree with it and will continue to fight for what I believe are my medical rights as I think we ALL are entitled too.
If I seem ticked, I am. I will say I am wrong for my communication. But please don't anyone put words in my mouth !
Peace,
Ken