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Old 05-19-2008, 04:56 PM   #1
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Need Advice About Changing Meds~

Hi everyone~
Im home, and exhausted. Thank you for all of the well wishes, and I did well, but not my best, at all.
For those of you who know me, Im on the patch 12's, 15 mg. LA hydro 4x daily, 10 mg hydro 4-6 Xdaily, and its just NOT working any more.
Im going to call my doc and ask if I can try oxycodone compound instead of the patch or one of the hydros.
What are your thoughts? Also, Im afraid to ask for a specific med, b/c Im afraid to look like Im demanding or wanting just that med. but after all of my thinking, and Ive tried oxy before, I think its my best bet.
This combo isnt working for me, even if Id doulble the hydro doses OR the patch. I think having the two hydros and the low patch dose isnt doing anything for me any more.
BUT, IM afraid he will tell me I need a pain holiday. God, Im so sick of worrying about that all of the time.
Thanks for everyone, support...sorry I havent replied sooner, Im really tired and hurting after all of the wet weather in Jersey, and having to start over because of the rain was really a bummer~
xoxoxox,
IZZY'SMOM

Last edited by IZZY'SMOM; 05-19-2008 at 05:36 PM.

 
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Old 05-19-2008, 05:03 PM   #2
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Re: Need Advice About Changing Meds~

Izzy,

pain Holidays are not necessary if your doc is willing to employ opioid rotation. As I understand it, opioid rotation works just as well at addressing tolerance and finding relief. Research says that we don't become fully tolerant to all opioids just because we develop tolerance to one of them. It's called incomplete cross tolerance. One of the best meds to use in opioid rotation is methadone. One can go from 600mg daily morphine to 80mg daily methadone very successfully. After being on the methadone for awhile, then rotate to something else, or back to the original med.

Gotta go - if you have questions just ask - my carpool ride is here.

steve

 
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Old 05-19-2008, 05:34 PM   #3
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Re: Need Advice About Changing Meds~

I tried methadone once, amd it was horrid for me...Ill never touch it again. Thanks Steve~
I need to go, my son is waiting for me to golf with him, but Ill check back later on. God, I just want to crawl into bed...this was the worst ever.
xoxoxox,
IZZY'SMOM

Last edited by IZZY'SMOM; 05-19-2008 at 05:34 PM.

 
Old 05-19-2008, 05:48 PM   #4
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Re: Need Advice About Changing Meds~

Why the insistance on a compounded med, any reason you couldnt use OxyContin, MS Contin, Kapanol or Paladrone as a LA med?

Could you add Celebrex 200mg twice a day to your regime, it can add significantly to th releif without adding to the side effects.

Last edited by aussiejono; 05-19-2008 at 05:50 PM.

 
Old 05-19-2008, 06:19 PM   #5
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Re: Need Advice About Changing Meds~

Hey Izz.....Here are my thoughts:

(1) Compounded Oxycodone won't have the true long acting mechanism. While the gel they use in the capsule will slow absorption, it won't be long acting. Thus, if you are set on Oxy, I would go with OC. The absence of a true LA med may only compound your problem(s).

(2) The patch may not be working properly because you may be too active for it. I dare say that you work up a lot of natural body heat, and the patch is probably releasing med way too fast. Also, the 12 patch isn't very strong, and given your level of pain, you're probably under medicated from a LA med standpoint. The whole purpose of a LA med is to elevate your BPL. The 12 has only recently been added to the patch line up and is mainly used for tapering and moderate dose increases. Very few use it as a stand alone LA med.

(3) You say that doubling up on the patch isn't working. The patch isn't designed to be a quick fix....The literature says it takes several consecutive application changes to properly elevate your BPL. Additionally, if you have periodically put an extra one on, it may actually make things worse because your levels go up & down which puts your body under stress.

(4) Unless I'm missing something, you basically have four LA choices....The patch, OC, Methadone, and Opana. Given your activity level, I'm thinking OC or Opana would be best. If OC, you would probably need 3 X or maybe even 4 X day. I've heard great things about Opana and am thinking of trying it myself. Those I've talked to who use it all say it works much better than OC and lasts much longer.

(5) I'm with Steve in that I probably wouldn't ask for a specific med. Instead, I would tell your Doc the patch isn't working due to your activity level and would like to try something in a pill form. If he suggests Methadone, then you could object given your previous history. Then, that only leaves OC or Opana. Once he offers up one or the other, I would tell him that your concerned that the standard 2 X day doesn't work for many, and given your activity level, your body would burn through meds even faster. So, could you try 3 X? Asking for 4 X wouldn't be prudent @ this point, so I'd wait until you try 3 X first.

Hope all this helps.

Ex

 
Old 05-19-2008, 06:27 PM   #6
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Re: Need Advice About Changing Meds~

Dont you guys have MS Contin or Kapanol in the US (SA Morphine)

 
Old 05-19-2008, 06:36 PM   #7
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Re: Need Advice About Changing Meds~

Quote:
Originally Posted by aussiejono View Post
Dont you guys have MS Contin or Kapanol in the US (SA Morphine)
Yes, I forgot about MS Contin....So, you have 5 choices.

Ex

 
Old 05-19-2008, 06:40 PM   #8
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Re: Need Advice About Changing Meds~

One that has just hit the market in Australia is a patch called Norspan containing buprenorphine (aka Temgesic)

 
Old 05-19-2008, 07:32 PM   #9
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Re: Need Advice About Changing Meds~

Thx....
Ex you are always right on...Ill ask about what you have said.
As far as the "insistance" of compounded meds...they work better and thats what I choose. I can pay for 240 vicoprofen at 560.00 per month or I can get 10mg of hydro compounded 240 at 96.00 per month. you do the math~ Pluse the LA hydro...same thing. Thats one reason I use the compounded meds. Steve, thx too....Thank you, I know you guys are looking out for me~
xoxoxo,
IZZY'SMOM

Last edited by IZZY'SMOM; 05-19-2008 at 07:54 PM.

 
Old 05-19-2008, 07:46 PM   #10
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Re: Need Advice About Changing Meds~

Hey Izz, would I ever see you on TV? b/c I do look for you, but i am not sure if your a famous golfer? LOL.

I think your way under medicated too. I think you might want to try Oxycontin, it works so well for me and I take (3) 40 mgs a day plus B/T meds of oxycodone 5 mgs. My pain is at a 6-7, not great but better than a 10. I don't know how your Dr feels about presribing OXY as I know he a GP Doc vs a PM Doc so you will have to see what he thinks.

I have heard Kadian works well and ms contin, so maybe you could try those.

to bad methadone doesn't work for you as I have heard its a really good medication. What happened to you when you took it??

take care and welcome home. It will be so nice to sleep in your own bed tonnight with your hubby.

 
Old 05-19-2008, 10:46 PM   #11
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Re: Need Advice About Changing Meds~

Hey Izz, I have had a lot of success with Oxycontin. I can definitely attest to the fact that 2x/day is far less effective than 3x/day. I also take hydro for BT and from what many have said here, this can be a good combo. (meaning, having oxycodone as an LA med and hydro as a BT med) From what I've read and what Steve and Ex, among others, have said, they adhere to different pain receptors, giving better overall coverage.

I hope you can get everything straightened out. It has to be so hard to find something that works for someone who is as active as your job requires. I hope the decision that was made, due to the rain, didn't affect you too negatively.

Rest up, you deserve it. Hugs, CMP/MM

 
Old 05-20-2008, 04:19 AM   #12
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Re: Need Advice About Changing Meds~

Izzy,

The methadone is just one of a handful of choices. My concern was to point out that your doc's seeming preference for Drug Holiday isn't the only option. That opioid rotation works too.

Given your preference for compounded meds you have many options. Shoot, practically everything's on the table. You could go with morphine, oxycodone, hydromorphone (brand dilaudid), or oxymorphone (brand Opana).

The natural progression from your LA hydro would be either morphine or oxycodone. I'd go with oxy in that case. Next up would be hydromorphone, then oxymorphone. I'd still probably stick with your compounded SA hydro for BT pain, but at 15mg or 20mg.

I think the compounding gives you more options than most folks and it seems to suit you fine for relief and financially.

steve

 
Old 05-20-2008, 07:57 AM   #13
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Re: Need Advice About Changing Meds~

Hey Izz....Something else you may consider....Is a rotation based on your "season." For example, use a pill form during the golf season along with whatever BT meds you decide upon. Then, during the "off season", employ the patch and some combination of BT meds. I've heard of many that do this due to the heat issues & etc.

Your Doc may be more receptive to an idea such as this and leave on the table the option of coming back to the patch @ some point. I would just explain your activity level (after all, he has to know) and how you think you're just not getting what the patch is designed to do.

Also, one final thought...Your LA med is really low compared to your BT meds....I think one of the main reasons you don't feel well is because you are getting a lot of short acting meds in & out all day long. Lots of ups & downs.

Just a thought.

Ex

 
Old 05-20-2008, 11:38 AM   #14
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Re: Need Advice About Changing Meds~

Thanks everyone!
Yes, I was thinking along the lines of the conpound oxycodone. I used it before and it worked great, but I couldnt handle the tylenol.
Ill call him tomorrow. I feel like hell, and Im going to lie low today. Dont worry if I dont post up a storm, Ill still check in~
You guys are the best~
xoxoxoxox,
IZZY'SMOM


p.s. Ex, you hit the nail right on the head about season rotation. Thats exactly what I need to do, and Ill ask him first thing~

 
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