my chronic pain history

Hi --
I am taking the following meds:
Aspirin – 324 mg at noon each day
Diazepam – 2.5 mg daily
Toprol XL – 100 mg 2x daily
Flomax – 0.4 mg 2x daily
Synthroid – 0.1 mg daily
Prednisone – 50 mg daily
Avapro – 0, 100, 150, or 300 mg daily as needed
Imitrex – as needed
Oxycontin ER
Codeine Sulphate - 60 mg 3x daily
Detrol LA – 4 mg daily
Tramadol – 50 mg tabs
5 mg Zolpidem tartrate - 1-2 per day
Lomotil – 2x daily
Loratidine – 10 mg daily
Metoclopramide – 5 mg daily
Prochlorperazine – 10mg tablets - 2.5 mg as needed
Testim 1% – 1 tube every day
Imuram – 50 mg per day
Fentanyl patches (25 ug / hr -> ?)
Red Yeast Rice – 2x 600 mg per day

The Imuram is for myasthenia gravis, the Testim and narcotics are for back injury, surgery & rehab.

My rehab schedule is:
* gluteus max & abdominal tension, 2 knee to chest, alternating single knee to chest, seated * lower back stretch - every other day 15 minutes
* angry cat, mid-back stretch, lower trunk rotation (9/23/2008: no more than 50% rotation)
* forward lean in half kneel - every other day 15 minutes
* 65 cm ball: anterior pelvic tilt, posterior pelvic tilt, pelvic circles, figure eight pelvic rotation, shoulder shrugs, ROM shoulder, arm, & neck - daily - 60 minutes
* bridge, ball-based flexion and extension, sitting forward bend with no flexion or extension, ball-based "swim" - every other day - 10 minutes
* 1/2 push-ups against table, knees on floor, feet crossed and up 15 min. every other day
* NMES PPR7 at 13/13 every 2-3 days - 5x30 minutes
* 15# rt. Arm, 8# lt. arm: press, curl, reverse curl - every other day 50 reps
* 4# / ankle: curl, reverse curl - every other day 50 reps
* 4 minutes @ 2 mph on treadmill - every other day 20 minutes

On the ten point pain system I monitor about 15 pain points and average them. I am between 5.3 and 5.6 on normal days. Some days I work out a bit harder and end up around 6.2 to 6.5.

What side effects or interactions do I need to watch out for? I have the following allergies: rifampin, tylenol, dust, dog hair, pollen

I have had the following surgeries:
* Oral, facial (numerous)
* Heel, thumb, hernia reductions
* Ulnar reduction, great toe-nail removals (lt. & rt.)
* Oral repair, partial laminectomy (C1-C2)
* Partial laminectomy (C2-C3)
* Full laminectomy (L5-S1), partial (L4-L5)
* Partial diskectomy (L3-L4)
* Sinus repair
* Diskectomy, fusion (C5-C6)
* Abdominal repair
* Left ulnar nerve re-location
* Partial diskectomy (L3-L4)
* Diskectomy, fusion (L2-S1)

I have had the following injuries:
* Shot (.22 rifle), upper lip, palate, sinus
* Simple fracture, left, right ulnae
* Achilles bruise; compound right thumb fracture; right inguinal hernia
* Compound fracture left elbow, ulna
* Non-displaced fractured patella, "turf toe" (lt. & rt.)
* Non-displaced fractured fibula
* Shot (.25 pistol, multiple shot-gun): mouth, cranium, thorax, abdomen, left elbow
* Aggravated ulnar injury
* Aggravated lumbar area

Willy,

With all you've been through, we are lucky to have you here!

You sound like you're working very hard to make your situation better.
What brought about the change?

Not many people with CP could be so dedicated. Lots of times I just
collapse in my chair and think ... Who cares. My husband walks in,
ruffles my hair and then I KNOW.

If you have no one to ruffle your hair, we'll all get busy with our cyber
fingers. : - D.

Work hard. Come back.

Pamela

Hi Willy,
Welcome from me as well. I am also a bit concerned with some of the medications that you are on....and the what appears as doubling of some of them for what might be a single condition. I see for example that you are on two different urinary problems, and as far as I know, they aren't usually prescribed that way. And the pain meds as well.
It might be prudent to discuss all of your meds with your doctors and make sure that they all know that you are on all of these meds.
I'm sorry that you found yourself needing to join us, but glad that you did and that you found us.
Sandi

Hi --
First, thanks to all of you for your posts. Quick update on what I take and why.
1) I am on the Fentanyl patches to give 24x7 relief. I use 50 ug/hr patches.
2) I am on the 12 hr. Oxycontin ER for the evening only, taking a 15 mg pill at midnight.
3) I am on tramadol when aspirin is inadequate.
4) I am on codeine sulfate when tramadol is inadequate.
5) I am on Testim as my testosterone level are about 50% of the minimum. After three
months it is up to about 75% of the minimum. My intent is to increase Testim until I
am 75% of the way between minimum and maximum, meaning the normal range for a
younger person. I am approaching 61.
6) I am on Toprol as my heart-rate without it tends to run up towards 110-125 bpm without
using it. At the rate I take it I maintain a pretty reliable 64 bpm.
7) I am on Imuram as myasthenia gravis is affecting my vision and the other meds have
proven ineffective. I also have swallowing issues, but I can manage that through patience
while eating, vision not so easy to manage.
8) I am on prednisone both for myasthenia as well as osteo-arthritis in my right hip. Besides
the gun-shot injuries I was pretty active in sports prior to being shot the second time.
9) I am on lomotol, Imetrix and Metoclopramide to manage the side-effects of Imuram. I
started Imuram in the latter third of March so I am a few months away from being able to
decide if it is actually helping preserve my vision.
10) I am on Detrol, Synthroid, and Flomax because I am 61 and have the normal issues of
anyone of my age and gender.
11) I am on zolpidem as that seems to be the only way to turn things of enough to get to
sleep. If 5mg works, fine, if not after an hour I take another.
12) I am on prochlorperazine if the Metoclopramide doesn't work, if I actually do throw up
the Imuram.
13) Only two doctors prescribe for me, a neurologist for myasthenia and pain issues, a GP
for the rest. Both communicate regularly and I provide a list of meds for them at each
appointment.
14) My PT schedule will increase in intensity as that is the only way I can see working out
of the hole I am in at present. My intent is to be off of disability within a year, pro-
viding the myasthenia is under control. That is my biggest concern as I see no way to
manage that without medication.

So, that is the rationale for my initial post. I cannot express how much I appreciate all of
your responses and am willing to try any suggestions that clear my physicians' approval. I
did not mention it but I take my BP and pulse twice a day and do use Avapro on the rare
occasions that my BP (low end) is above 90. I pretty much ignore the high number.

Thanks --
-- WillyJ (this site enforces anonymity - sorry!)

kttn251977 --
First shooting occurred as I am of mixed race and the old rules had it that
one drop of "black" blood made you "non-white", i.e., fair-game for lynchings,
shootings, etc. The shot was fired from my cousin, no less. Second shooting
occurred while blocking a hold-up of the company I worked for. The crooks
had hostages so it was no possible to simply disengage, so I actively got
involved in rescue work. Developed a good piece of advice: don't get in a gun-
fight unless you have a gun on you.

I handle the side-effect you describe by taking lots of Senokot. drinking lots of
water, and eating whatever else has lots of fiber in it. Also, the main side-
effect of the myasthenia meds is diarrhea.

I was on Cymbalta which put me in the hospital with high (106F) fevers so I
intend to stay away from that. It may have been an interaction with tramadol,
but since it stopped when the Cymbalta stopped the course of action seemed
pretty easy to call.

Sorry to hear about your fight with depression. If it helps, go to PT then look
around. You'll probably find a lot of people with similar issues so it makes you
realize that God didn't pick you to be Her / His personal outhouse. No matter how
bad things get, there is always somebody in worse condition, so you can make
it back to where-ever you want to get to. It might not be fast and certainly
won't be fun, but the bigger the challenge the better the reward feels when
you get there, and you will.

Take care --
-- WillyJ

Hi Willy,

I looked at your list of meds again and might have a tip or two for you. The condition you are taking Imuran for I have no clue what it is. I think you said that you started the Imuran in March. I have crohn's disease and have been on 225mg of Imuran for nearly 7 yrs. Usually people are started on 50mg. My gi dr has his patients take the Imuran at bedtime to avoid the nausea that can be associated with the drug. Most people do have lots of nausea if they take it during the day. It should also help with some of your joint pain. Do you have regular blood draws to check your liver, if not you should.  Some drs do it every 3 months, my rheumy orders labs every 30 days. The down side to Imuran is it takes about 3 months to get in your system before you can notice any difference. So, don't throw the towel in yet, its too soon.

I don't know how long you have been on Prednison, but taken long term it can cause necrosis of the hip joint. Its an old standard crohns medication and the people that became steroid dependent, many had to have hip replacement surgery. A good drug with nasty side effects.

Lomotil I see you take I think 2 a day, I am assuming  for diarhea. If the two does not help, you can have up to 8 a day, not to exceed 8 in 24 hrs. My 1st gi tried the 2 a day crap, of course it did nothing for my chronic diarhea, gi number 3 is the one that changed my doseage for the max doseage. He could not belive what that other one did on the Lomotil.  Made a huge difference.

Wow thats alot of aspirin. Watch out for stomach issues, including a stomach bleed. Why such a high dose may I ask?  

Susie                                                                                                                                                                                                                                                                                                                      

Willy,
It is possible that the Cymbalta reaction was from combining with the narcotics, the Ambien or the Imitrex. Not sure whether it was actually
Serotonin Syndrome or not, but regardless of an actual dx, the combination of those drugs is likely to really mess with your serotonin levels
which can cause spikes in temperature, high BP and high HR, among other problems. Serotonin Syndrome is very rare, but still there are less
dangerous complications that can result from combining so many meds that alter serotonin & other chemicals in the brain. Just something to
consider in the future as too much serotonin can be fatal.

It sounds like you are pretty happy with your neurologist, but having a trained pain medicine specialist (often certified in anesthesia) does
have its advantages -- chief of which is that they can choose medications to safely & effectively treat symptoms. In addition, from my experience
at least, my neurologists would only see me every couple of months, even when I was really in bad shape. They did get me in right away when I
developed the SS, but other than that I was on my own between appointments. My PM's have much more proactive about seeing me as
often as needed -- sometimes a couple times a week when I would be in especially bad shape or when I would have a lot of problems with
my meds. good luck with everything!

blessings,
frances