Discussions that mention cialis

Pain Management board


Hey Dlfo, I happened to pick up the Kadian conversion book the manufacturer sends toPM docs. Just as an example, They were converting dilaudid to morphine, The conversion rate is anywhere from 1.3 to 7. That's a pretty wide range and everyone is different. The route of delivery makes a difference. Dilaudid is far more efficient when given IV than when given orally.

Like kissa said you not on a high dose and 80 relief is where docs should be considering cutting back if your not taking adantage of it and excercising, and doing something other than swalling pills to improve your condition.

If your concerned about respirtory surpression, you take the same risk of respirtory supresssion with Intrathecal meds delivered by pumps. Opiates are opiates regardless of how they are delivered. Eventually side efects will prevent you from further increasing wehter it's oral or pump. If you start out trying to obtain better than the 80% relief your getting with avinza, how much higher to you think you can go before you impaired by side effects, or can't pee without being cathed or can't have BM without being unimpacted weekly.

You seem to think it's strange that it took 5 months to finally talk about the pump as if it was somehow being withheld. I talked to my docs who do the implants and management themselves for 3 years before I did an actual trial. The first trial failed due to spinal fluid leak and I waited 6 more months before doing another trial.

The main question the pump doc is going too ask is why do you want a pump. If your answer is to get better than 80% relief when your already their with orals, A doc with any credibility would tell you to come back when you can no longer obtain pain relief with oral meds or just laugh you ourt of the office. Then again, he may be willing to make 30K for 2 hours work and straighten you out as far as what to expect. Once you have a pump, if the doc sauys I don't go above 2 mgs a day,which is equal too 600 mgs of oral morphine on some charts and youmay actually take a giant step back if he's not willing to shoot for the same absurd goal you want.

My dose was more than 3 times what yours is before I even considered a pump because it is the last resort. I was experiencing intolerable side effects and couldn't get better than 50% relief from orals. The benefit of the pump is it doesn't circulate through your body systemeically. If you take LA orals on top of a pump, you defeat every advantage of usig a pump. If your able to work now, and aren't satisfied with 80% relief, By the time a pump is relieving 100% of your pain and you have to adjust it at every visit to maintain that level, the drugs themselves will impair you to the point of disability. Is that exceptable in your mind. To trade yourbrain and other working parts of your body for 100% relief. Your not planning on having kids are you. I guess they do make Viagra and why shouldn't you have some of that, but cialis lasts longer so that's the one your entitled too because it's the better drug.

Just because they make a stronger med, doesn't mean you are entitled to a stronger med, better delivery system or even should consider a pump.

My doc said that when you can no lopnger obatin relief from orals or the side effects become to imapiring then we should talk about a pump. That made sense to me because I had resonable expectations. There is no amount of medication that would relieve 100% of my pain and leave me fiunctional.

As far as bolus doses, delivered with an at home telemetry device, THose don't change your settings or concentration, They simply alow a slight increase for a limited period of time. The reason they use higher concentrations like 25mgs per ml or 30 mgs per ml is because a patients dose is so high they have to come in so often it becomes a hassle.

I hopped between 120 mgs of meth and 600 of oral morphine "Kadian and generic MSC." But morphine is morphine. The initial conversion the doc uses will be between 100:1 and 300 1.

At 100:1 your morphine pump dose would 1.8 mgs a day devided by 24 hours.
That equates to a delivery rate of 0.075 mgs per hour. Although the home bolus telechnology is available, it doesn't mean you will get it, or the doc may remove all orals in place of a bolus device. The home telemetry uinit does not have the ability to increase the mix ratio/ concentration of the meds that are in your pump. When your meds are ordered for refill the doc chooses the concentration, whether it's 15mghs per ml or 30 per ml.

The only thing the home telemetry unit can do is increase the flow rate for a 1 or 2 hour period. If .075 was you constant flow rate a bolus would mean the pump would speed up and deliver at a rate of say .080 per hour for a couple hours, The telemetry device may be set to allow you to do this once a day or twice a day but parameters are set by the doc. Other wise they couldn't predict your refill date and these preservative free meds at whatever concentration with whatever adjunct med, have to be mixed by a compounding pharmacy. I live in VA and my group uses a pharamcy in Fla, so they need 2 weeks advance notice to order the meds.

Going from .075 to .080 doesn't sound like a lot but it's a %5 increae in what you were fealing and intrathecal meds don't require the large 10, 15% or 20% increases to make a diference. 5% can be the difference between tolerable and intolerable side effects.

If the doc goes on the conservative side, he would use 300:1 as your starting dose and your starting dose would be .6 mgs a day or .0025mgs per hour. . If you have a 40 ml resevoir, and the doc started on the wild side "wreckless" and used 50:1 conversion to start. 180 mgs of oral morphine would equate too O.2 mgs per day or .oo83 mgs per hour (.0083 X 24 hours =0.2 per day). Usingg 50:1 and a daily dose of .2 mgs a 40 ml pump will last 200 days with a 1mg per ml concentration. :rolleyes: I just don't see how a pump could not deliver enough meds to manage your pain. :dizzy:

How your doc that doesn't do pumps can predict you will need to continue long acting Avinza and BT meds even with a pump because the pump can't deliever an equivelant dose is absolutely wrong. The pump can deliver more meds than you ever considered possible. 5 months or 10 years from the time you began LA opiates isn't the time to think about the pump if your getting 80% relief. What unwanted side effects are you experiencing that won't allow you to increase the oral dose of avinza, not that should need an increase at 80% relief. You need counseling to learn to cope with the remaining 20%. .

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