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  • lurker posting for the 1st time -- fentanyl patch and percocet questions (LONG)

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    Old 01-14-2010, 11:28 AM   #1
    lilsparkle825
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    lurker posting for the 1st time -- fentanyl patch and percocet questions (LONG)

    (For those who don't want to read all of this, where do you wear your patches if you wear two...and if you went from a lower dose patch to a higher dose, how did you make the switch without going through OD side effects? Should I even be worried about that?)

    Hi,

    Apologies in advance for being so long-winded, but I wanna answer any questions you may have upfront.

    First of all, I just want to say what a godsend this site and all of you are for contributing. I don't know what I would do without this board, and I have only known of its existence for about 2 weeks. I found it on Google when I was in inpatient rehab and they informed me they would be putting me on a "duragesic patch" -- I had no idea what this was and wanted to get some idea of what I was consenting to before I got it, and I have been here reading ever since.

    Background on me...I was a regular, active, fun loving 22 year old college grad until the 5th of December, when I was in a single-vehicle MVA leaving my former apartment in my old college town. I had been visiting some old roomies and friends, and I decided to make the 2-hour drive home that morning to avoid most of the snow, which was supposed to get pretty bad that evening. In the part of the state where I live, snow is rare, and I wanted to get to work on Monday...long story short, I was told I hit an ice patch on the highway, lost control and hit a tree, breaking my left humerus, fracturing my pelvis in 3 places (including my sacrum) and breaking my left femur. On top of this, I suffered a brain injury which led to 5 hemorrhages and them almost having to perform brain surgery....I think it was only the strength of all the prayers surrounding me that led to me healing from that trauma and avoiding that kind of surgery. The only thing that seems to be affected brain-wise is my mood...I had a bit of anxiety and literally lost my ability to be patient for a few weeks, but that is all in the past.

    Now onto the reason I am here...the pain. I was told that during my hospital stay I was on IV fentanyl and/or morphine (I have no idea of the dosage), but then after a few days they removed me from the IV and put me on 5/325 Percocet every few hours...I want to say 2 every 4 hours or so. Once I was discharged and got to rehab, they switched me to the 25 mcg duragesic patch with the Percocets only for b/t. The first few days I was in HEAVEN...or so I thought. I was still taking about 4 Percs a day, but only one at a time. As time went on, I gradually moved up to taking 2 at a time again, and by the time I was discharged and got home I was taking the Percocets pretty much as the label directed. The pain eventually got so bad that I was taking 2 every 3 hours!! (Yes, I was still able to function!)

    Then came the nerve pain about 10 days ago on the 5th of January...boy, I thought I was in pain before! It began in my left foot and shot up through my ankle into my calf, and seemed to bring along some numbness. Besides the fact that it HURTS like nothing I have ever experienced, I feared it would interfere with my rehab, since every little thing hurts (putting on a sock, lifting it, setting it down, standing on it, putting it on a blanket or pillow, elevation...you get the picture). I returned to my rehab doc, who upped my Neurontin from 300 mg only at bedtime to 300 mg three times a day and prescribed the Medrol dosepak. This helped a little, as I felt relief from the dosepak around the end of day 2. Day 3 was much better (no pain), but by day 4 it was back. Granted, it is more in my toes/heel and the sides of my foot instead of all over, but it is still excruciating. During the past week I was able to reduce my Percocet intake from 12 a day (which I know is bad for my liver) to 7 or 8 at one or two every 6 hours, but mind you I am still on the patch on top of that. I could tell the Neurontin was helping, but night time is HORRIBLE -- I have literally woken up every night this past week, including last night, although I went back to the dr yesterday and he upped my Neurontin to 300 mg in the morning and afternoon and 600 at night and gave me another dosepak. One more thing he did (finally): I told him I read somewhere (actually here) that many people get more relief from changing their patch every 48 hrs vs every 72, and I had changed my patch early (instead of yesterday at noon, I changed it before bed on Tuesday night). He said that this is true, and since my patch doesn't even seem to be on after day 2, that would be fine. He also upped my patch from 25 mcg to 50, with much hesitation despite the high # of percs I must take.

    I have a few questions here...I have no health insurance, but am on charity at the hospital where I was taken following my accident. I had a followup appt with my ortho surgeon 2 days after my appt with the rehab doc, and when I showed him my script for the 25 mcg duragesic patches, he wrote me another so I could get them for a much reduced price at the hospital pharmacy (they will give you meds for free/almost free if one of their docs or clinics writes it, and my original script came from outside of their network). This gave me 3 boxes of the Sandoz 25mcg patches, although yesterday my rehab doc told me to move up to 50. When I told him about the 3 boxes I have at home, he told me I can either keep them for when I eventually (hopefully) taper down or I can just use two of the 25s now. I will use them now, since I don't see the ortho doc for another 4 weeks and I would rather not drive 2 hours away and wait another 3 in the pharmacy this week. I usually wear them on my upper back or arm covered with a Tegaderm, so how do I wear two? Side by side? On opposite sides of the back? One on the back and one on the arm? Also, my 48 hours with this patch will be up at 11pm tonight. How do I go about upgrading the strength without going through overdose side effects, which I am really afraid of? I read that 17 hours after removing a patch, up to 50% of the meds can still be in your system, so does that mean tomorrow morning when the two new patches kick in, I will also have about 12 mcg from the old patch floating around in my system? I am really scared, but also sick of the pain and await your answers/advice. Thank you all soooo much.

     
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